🫁 Respiratory arrest is defined as the complete cessation of breathing, leading to absent or inadequate gas exchange. It is a medical emergency that rapidly causes hypoxaemia, hypercapnia, and death unless immediate intervention occurs. Pathophysiology involves either airflow obstruction, central drive suppression, neuromuscular failure, or lung/circulatory compromise. 💡 Rapid recognition and management using an ABCDE approach is critical.

🧾 Approach to Diagnosis

👀 Recognition: Unresponsive patient, apnoea, absent chest rise, cyanosis.
🫀 Circulation check: Always assess for concurrent cardiac arrest → pulse, ECG.
🎧 Airway & Breathing: Look for obstruction, listen for breath sounds, feel for chest movement, measure SpO₂ and end-tidal CO₂ if available.
🧪 Investigations: Tailored once airway and ventilation are secured (ABG, CXR, ECG, metabolic bloods, cultures).

📊 Causes, Diagnosis and Management of Respiratory Arrest

Category	Causes	Diagnosis	Management
🛑 Airway Obstruction	Foreign body (choking) Swelling (anaphylaxis, angioedema) Airway trauma (tracheal injury)	Visual inspection of airway Stridor, choking, absent breath sounds History of sudden collapse	Heimlich manoeuvre or suction Early intubation or surgical airway if severe IM adrenaline in anaphylaxis
🧠 CNS Depression	Drug overdose (opioids, sedatives) Traumatic brain injury Brainstem stroke	GCS assessment, history of overdose/trauma No spontaneous breathing Pupillary and neurological exam	Naloxone for opioid toxicity Bag–mask ventilation & intubation Neuroimaging for trauma/stroke
🌬️ Lung Disease	Severe asthma attack COPD exacerbation Pneumonia, ARDS	ABG: hypoxaemia, hypercapnia Auscultation: wheeze, crackles, silent chest CXR for consolidation/hyperinflation	Oxygen ± non-invasive ventilation Bronchodilators, IV steroids (asthma/COPD) Antibiotics for pneumonia Intubation if refractory
❤️ Cardiac Causes	Cardiac arrest Severe arrhythmias Massive MI	Pulse check, ECG History of chest pain, collapse	CPR + ACLS protocols Defibrillation for VF/VT Treat reversible causes (4 Hs & 4 Ts)
⚖️ Metabolic/Endocrine	Hyperkalaemia Hypoglycaemia Thyroid storm, adrenal crisis	Blood glucose, U&E History of endocrine disease Weakness, altered mental state	Correct abnormalities (e.g. insulin/calcium for hyperkalaemia, IV dextrose for hypoglycaemia) Supportive oxygen & ventilation
🦠 Other	Sepsis Tension pneumothorax Hypo/hyperthermia	Blood cultures, lactate (sepsis) Clinical exam + chest percussion (pneumothorax) Core temperature	IV antibiotics + fluids (sepsis) Immediate needle decompression + chest drain (pneumothorax) Active warming/cooling

💡 Commentary & Teaching Pearls

🔑 Always check for cardiac arrest alongside respiratory arrest - they often coexist.
⚡ The first priority is airway + ventilation: bag–mask ventilation while preparing for intubation.
🧪 ABG helps distinguish type 1 vs type 2 respiratory failure and guides management.
❌ Do not delay resuscitation for investigations - stabilise first, investigate later.
🧠 Think of reversible causes: foreign body, opioid overdose, tension pneumothorax, hypoglycaemia - treat them immediately if suspected.
🏥 In the UK, follow Resus Council ALS guidelines for combined cardiac–respiratory arrest.

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Respiratory Arrest

🧾 Approach to Diagnosis

📊 Causes, Diagnosis and Management of Respiratory Arrest

💡 Commentary & Teaching Pearls

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