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ACLS Algorithms (aclsalg.htm) /  ACLS Secondary Survey for a Patient in Respiratory Arrest

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Patient in Respiratory Arrest

Apr 27, 2018

Version control: This document is current with respect to 2015 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are
replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net (mailto:support@acls.net?
subject=ACLS%20Secondary%20Survey%20for%20a%20Patient%20in%20Respiratory%20Arrest%20Algorithm&body=Hi%2C%20I%20had%20questions%20about%20the%20AC
for an updated document.

Using the ACLS Primary Survey for a Patient in

Respiratory Arrest PDF version
The ACLS Secondary Survey takes you through the advanced assessment and action you need to accomplish for a
patient in respiratory arrest (see Table 1). Your assessment guides you in finding the answers and taking appropriate
next steps.

The assessments follow the CAB format of the primary survey:

Circulation
Airway
Breathing

If a cervical spine injury is suspected and you are familiar with the technique, you should utilize a jaw thrust to open the
airway while maintaining cervical stabilization  Print PDF (images/algo-arrest.pdf)

Table 1. Advanced Cardiac Life Support Secondary Survey

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Is the To open the airway for unconscious patients, use the head-tilt, chin
patient's lift. Insert an oropharyngeal airway (OPA) or a nasopharyngeal airway
airway (NPA) if needed to keep the airway open. The oral airway is ONLY
obstructed? indicated in patients who are deeply unconscious as they stimulate
the gag reflex and thus cause risk of aspiration.

Does the If yes, use the airway that is appropriate to your skill level. King Airway
patient need System™, LMA, Combitube™, and or endotracheal intubation.
an advanced
airway?

Is the patient Give bag valve mask ventilations every 6 seconds or 10 breaths per
breathing? minute.

If bag-mask ventilation is adequate, defer the insertion of an

advanced airway until it becomes essential (patient fails to respond
to initial CPR or until spontaneous circulation returns).

Is the Confirm correct placement of advanced airway device by observing

advanced the patient, confirming the presence of lung sounds in at least 4 lung
airway device fields and using waveform capnography.
placed
properly?
 Is the Secure the advanced airway device so it does not dislodge, especially
advanced in patients who are at risk for movement. Secure the ET tube with
airway device tape or a commercial device. Do not use devices to secure the airway
secured device that are circumferential.
correctly?

What was the Attach ECG leads. Identify patient's rhythm.

patient's
initial cardiac
rhythm?

What is the Monitor patient for arrhythmias or cardiac arrest rhythms (ventricular
patient's fibrillation, pulseless ventricular tachycardia, asystole, and PEA).
current
cardiac
rhythm?

Does the Establish IV or IO access.

patient need
an IV?

Does the Start IV/IO fluids, if needed, using a crystalloid.

patient need
fluid?

Does the Give appropriate medications to manage rhythm (e.g., amiodarone,

patient need lidocaine, atropine) and blood pressure (eg, dopamine or epinephrine
medications (used with caution as it increases myocardial oxygen demand).
for rhythm or
blood
pressure
control?

Is a reversible Search for reversible causes of the arrest. Find and treat reversible
cause causes of the arrest.
responsible
for the arrest?

The appropriate airway will depend not only on the patient’s condition, but the experience level of the provider as well.

If the patient is in cardiac arrest, placing an advanced airway is a significant interruption to chest compressions. You must weigh the need for an advanced airway against the
need for continued chest compressions. If bag-mask ventilation is working and seems adequate, you may want to put off inserting an advanced airway until the patient fails to
respond to initial CPR and defibrillation, or until spontaneous circulation returns.

(https://www.acls.net/judy-bio.html) Written by Judy Haluka (https://www.acls.net/judy-bio.html) and last updated Mar 30, 2017

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