Respiratory arrest
Respiratory arrest is the cessation of normal breathing due to failure of the lungs to function effectively.
Apnea is the cessation of breathing. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than 5 minutes may damage vital organs, especially the brain, possibly permanently. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if left untreated for more than five minutes. Damage may be reversible of treated early enough. Respiratory arrest is life-threatening situation that requires immediate medical attention and management. To save a patient suffering from respiratory arrest, the game plan is to restore adequate ventilation and prevent further damage. Management interventions include supplying oxygen, opening the airway, and means of artificial ventilation. In some instances, an impending respiratory arrest could be predetermined by signs the patient is showing, such as the increased work of breathing. Respiratory arrest will ensue once the patient depletes their oxygen reserves and loses the effort to breathe. Respiratory arrest is different from respiratory failure. Respiratory arrest refers to the complete cessation of breathing. Respiratory failure is the inability to provide adequate ventilation for the body’s requirements. Respiratory arrest is also different from cardiac arrest, the failure of heart muscle contraction. If untreated, one may lead to the other. [1]
Causes
- Muscular dystrophy, amyotrophic lateral sclerosis (ALS), spinal cord injuries, and strokes may cause a change in breathing resulting in respiratory arrest.
- Chest injury or acute lung injury.
- Scoliosis or other spinal problems affecting breathing muscles.
- Lung diseases and conditions.[2]
- Severe hypovolemic or hemorrhagic shock.
- Airway obstruction: Obstruction may occur in the upper and lower airway. Upper airway obstruction is common in infants less than 3 months old, because they are nose breathers. Nasal blockage may easily lead the upper airway obstruction in infants. For other ages, upper airway obstruction may occur from edema of the vocal chords, foreign bodies, or pharyngolaryngeal tracheal inflammation. Lower airway obstruction may occur from bronchospasm, drowning, or airspace filling disorders (e.g. pneumonia, pulmonary edema, pulmonary hemorrhage).
- Decreased respiratory effort: Central nervous system impairment leads to decreased respiratory effort. Central nervous systems disorders may cause hypoventilation, such as stroke and tumors. Drugs may decrease respiratory effort as well, such as opioids, sedative-hypnotics, and alcohol. An overdose of any of these drugs may lead to a decreased respiratory effort. Metabolic disorders could also decrease respiratory effort. Hypoglycemia and hypotension depress the central nervous system and compromise the respiratory system.
- Respiratory muscle weakness: Neuromuscular disorders may lead to respiratory muscle weakness, such as spinal cord injury, neuromuscular diseases, and neuromuscular blocking drugs. Respiratory muscle fatigue can also lead to respiratory muscle weakness if patients breathe over 70& of their maximum voluntary ventilation. Breathing over an extended period of time near maximum capacity can cause metabolic acidosis or hypoxemia, ultimately leading to respiratory muscle weakness. [3]
See also
References
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| Medical examination and history taking | | | Auscultation | |
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| | Breathing | |
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| | Other | |
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