Code 3 Workshop

Paramedic Education
Home/All lessons/Airway & Breathing/Respiratory Arrest With a Pulse
Lesson

Respiratory Arrest With a Pulse

10 min Airway & Breathing Skip to quiz

Objective: If they have a pulse and are not breathing, bag them. An adult gets about 1 breath every 6 seconds. Do not start compressions on a beating heart. Start cardiopulmonary resuscitation (CPR) the moment the pulse is gone.

Why this matters

Opioid overdose, drowning, and children can look dead and still have a pulse. Crews start compressions because the sat is 40%. If they are not breathing normally but have a pulse, bag them. Do not start compressions on a beating heart. Compressions on a beating heart reduce blood flow to the heart muscle and can cause injury.

Verbalize
  • I feel for a pulse for up to 10 seconds while I look for breathing. If I am not sure and there are no signs of life, I start cardiopulmonary resuscitation (CPR).
  • Adult with a pulse: about 1 breath every 6 seconds, which is 10 per minute, with chest rise. I do not bag them at 30 because they look dead.
  • Child or infant with a pulse: about 20 to 30 breaths per minute, about 1 breath every 2 to 3 seconds. I do not copy the adult rate onto a child.

Clinical sequence

  1. If a pulse is present and they are not breathing, this is bagging, not CPR. Open the airway, place an adjunct, and use a two-person bag. A two-handed jaw-thrust seal beats a one-handed E-C clamp.
  2. Give the adult about 1 breath every 6 seconds, with chest rise. Give a child or infant about 20 to 30 breaths per minute. Follow your protocol card, and see the pediatric airway lesson.
  3. Watch the belly. If it rises, slow down and fix the seal. If you have an advanced airway, watch the waveform. With a pulse, adults still get about 10 breaths per minute.
  4. Check the pulse again about every 2 minutes. Respiratory arrest becomes cardiac arrest. If the pulse disappears, start CPR. Do not keep only bagging a patient with no pulse. If an adult loses the pulse after an advanced airway, continue compressions and keep about 10 breaths per minute. Do not change a child to that adult rate.

Teaching points

  • Unresponsive, not breathing normally, and no pulse means start CPR. Unresponsive, not breathing normally, and a pulse is present means rescue breaths only.
  • In an opioid picture, bag first. Give naloxone per protocol without stopping the bag. The reversal drug is for respiratory arrest. During cardiac arrest, give it only if it does not stop CPR. Do not give naloxone and walk away from a patient who is not breathing.

Common errors

  • Starting compressions on a patient with a carotid pulse because the sat is very low.
  • Bagging an adult at 30 breaths per minute because they look dead.
  • Giving naloxone and walking away from a patient who is not breathing.

Practice

One-minute check

Partner: pinpoint pupils, not breathing, and a strong carotid pulse. Say what you do in the first 20 seconds. Include whether you start CPR, the adult bag rate, and when naloxone fits.

Related: Naloxone, CPR.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Adult, unresponsive, no breathing, strong pulse. Current teaching is:
2. A child with a pulse and no effective breathing needs:
3. An apneic suspected opioid overdose with a pulse needs:
4. If you are not sure there is a pulse and there are no signs of life:
← Delayed Sequence Intubation Framing Mainstem Intubation Recognition →