Respiratory Arrest With a Pulse
Objective: Tell respiratory arrest from cardiac arrest, bag at the right rate, and start CPR the moment the pulse is gone.
Why This Is Hard
Opioid OD, drowning, and peds can look dead and still have a pulse. Crews start compressions because the sat is 40%. AHA 2025 adult BLS: if they are not breathing normally but have a pulse, ventilate about 10/min. Compressions on a beating heart steal coronary filling and can cause injury.
- Feel a pulse for up to 10 seconds while you look for breathing. If unsure and no signs of life, start CPR.
- Adults with a pulse: 1 breath every 6 seconds (10/min), visible chest rise.
- Children/infants with a pulse: 20–30 breaths/min (every 2–3 seconds). See pediatric airway.
Field Rules (Education)
- AHA 2025 Part 7: unresponsive, not breathing normally, no pulse → CPR. Unresponsive, not breathing normally, pulse present → rescue breaths only.
- Opioid picture: bag first, naloxone per protocol without interrupting ventilation. AHA 2025 Part 10: antagonist for respiratory arrest; during cardiac arrest only if it does not stop CPR.
- Recheck the pulse about every 2 minutes. Respiratory arrest becomes cardiac arrest.
- Advanced airway: same adult rate ~10/min with a pulse; if they lose the pulse, continuous compressions plus that rate.
Field Pitfalls
- Compressions on a patient with a carotid pulse because the sat is terrible.
- Bagging an adult at 30/min “because they look dead.”
- Giving naloxone and walking away from an apneic patient.
Practice
60-second drill
Partner: pinpoint pupils, RR 0, strong carotid. First 20 seconds including whether you start CPR.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- AHA 2025 Part 7: Adult BLS — pulse but not breathing: 1 breath every 6 seconds (10/min)
- AHA/AAP 2025 Pediatric BLS — pulse but inadequate breathing: 20–30 breaths/min
- AHA 2025 Part 10 — naloxone for opioid respiratory arrest; do not interrupt CPR in arrest
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.