Hypoxia

Recognition

All patients who experience a cardiopulmonary arrest will have suffered some degree of hypoxia. Understanding the events leading up to the time of arrest will enable the team to discover whether it was the result of a primary cardiac event, such as a myocardial infarction, or whether it occurred at the end of a long period of physiological compensation. For example, the patient who experienced respiratory failure as a result of a severe exacerbation of asthma will present with the following signs and symptoms.

• Tachypnoea (respiratory rate of greater than 30 breaths per minute or a respiratory rate of 10 breaths or less a minute).

• Tachycardia or bradycardia.

• Reduced conscious level.

• Falling PaO^ despite oxygen therapy.

• Rising PaCO^ despite therapy (Advanced Life Support Group 2001).

Response

In order to prevent further hypoxia and to try to reverse the damaging effects of hypoxia on the myocardium, the patient needs to be oxygenated as effectively as possible. This may be achieved by ventilating the patient. This initially might involve a bag-valve-mask connected to high-flow oxygen (12-15 litres per minute) and ensuring adequate rise and fall of the chest.

• The gold standard is to secure the patient's airway with an endotracheal (ET) tube. However, expertise in this area is required and the hypoxia may be compounded while the ET tube is being passed. An alternative which may be considered in this situation is the insertion of a laryngeal mask airway (LMA).

• If the patient is intubated it is essential that regular checks are carried out during the resuscitation to ensure the ET tube does not become misplaced into a bronchus or oesophagus.

• Misplacement of the ET tube will compound the hypoxia suffered by the patient.

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