When a person has a pulse but is not breathing, they are experiencing respiratory arrest. This is a life-threatening emergency where oxygen is no longer reaching the lungs. This situation often results from underlying issues like drug overdose, near-drowning, or a severe allergic reaction. Brain damage can begin within minutes without intervention, so immediate action is required to supply oxygen and prevent the heart from stopping.
Immediate Assessment and Emergency Activation
The first step in any emergency is to confirm the scene is safe for both you and the victim. Once the environment is secure, check the victim for responsiveness by gently tapping them and shouting, “Are you okay?”. If there is no response, the person is unconscious and requires immediate emergency activation.
Next, look for signs of breathing and simultaneously check for a pulse for no more than 10 seconds. To check for a pulse, feel for the carotid artery in the groove on the side of the neck closest to you. If you detect a pulse but the person is not breathing or is only gasping, immediately call 911 or your local emergency number, or designate someone else to call. Inform the emergency dispatcher of the person’s condition and precise location.
Performing Rescue Breathing
The most immediate intervention is opening the airway, which is often blocked by the tongue falling backward. Use the head-tilt/chin-lift maneuver to open the airway. Place one hand on the victim’s forehead and two fingers of the other hand under the bony part of the chin. Gently tilt the head backward while simultaneously lifting the chin upward to move the tongue away from the back of the throat and align the air passage.
With the airway open, deliver rescue breaths to an adult using the mouth-to-mouth technique. Pinch the victim’s nose shut using the hand on the forehead, and make a complete seal over their mouth with your own. Give one breath lasting about one second, watching to ensure the chest rises visibly, which confirms the air is entering the lungs. If the chest does not rise, reposition the head using the head-tilt/chin-lift maneuver and attempt the second breath.
The recommended rate for rescue breathing in an adult is one breath every five to six seconds, equating to about 10 to 12 breaths per minute. Avoid breathing too forcefully or giving too many breaths, as this can cause air to enter the stomach and lead to complications. Continue this consistent rhythm until the victim begins breathing on their own, or until trained medical help arrives.
Monitoring and Transitioning Care
While performing rescue breathing, continuously monitor the victim’s condition, particularly the pulse, to ensure the heart continues to beat. Reassess the pulse approximately every two minutes, checking for no more than 10 seconds. This regular check is necessary because respiratory arrest frequently precedes cardiac arrest, meaning the heart may stop soon after breathing ceases.
If you cannot detect a pulse during reassessment, the situation has escalated to cardiac arrest. You must immediately transition to full cardiopulmonary resuscitation (CPR). Full CPR involves alternating between chest compressions and rescue breaths at a ratio of 30 compressions to two breaths for a single rescuer. Chest compressions must be delivered hard and fast in the center of the chest at a rate of 100 to 120 compressions per minute.
If the victim begins to breathe normally but remains unconscious, place them in the recovery position. This position helps maintain an open airway and prevents aspiration. Roll the person onto their side, support their head, and bend the top knee forward to stabilize the body. This lateral position allows fluids, such as vomit or saliva, to drain out of the mouth by gravity, preventing airway blockage.
Special Considerations for Respiratory Arrest
When providing care to infants and children, the rate and volume of rescue breaths require adjustment. For children and infants, the recommended rate is one breath every three to five seconds, equating to 12 to 20 breaths per minute. The volume of air delivered should be gentler and shallower than for an adult, just enough to see the child’s chest visibly rise.
If respiratory arrest is caused by a foreign body airway obstruction (choking), rescue breaths will likely not be effective. The obstruction must be cleared using appropriate abdominal thrusts or back blows. If a breath does not go in, reposition the head and attempt the breath again. If the breath still fails, assume an obstruction is present.
Using a barrier device, such as a pocket mask or face shield, is recommended, especially when providing rescue breathing to a stranger. These devices help reduce the risk of disease transmission. While a barrier device is helpful, its absence should not delay the immediate intervention of providing life-saving breaths.