A 65 year old man collapsed while climbing stairs. You found the patient. You checked the pulse and found that pulse is felt simultaneously, you scanned the chest and found that the chest is not moving. What problem would you suspect and what would be your action?

Appeared in: RML 2023

Explanation

The patient's assessment reveals a palpable pulse but an absence of breathing (chest not moving).
This combination of findings defines respiratory arrest, where the heart is still functioning but ventilation has ceased.
According to Basic Life Support (BLS) guidelines, the correct immediate intervention for respiratory arrest is to provide rescue breaths.
This action delivers oxygen to the lungs, which is then circulated by the still-beating heart, preventing hypoxia and progression to full cardiac arrest.

Option A: This is incorrect because cardiac arrest is defined by the absence of both pulse and breathing. Since a pulse is present, starting chest compressions (CPR) is unnecessary and potentially harmful.
Option C: Cardio-respiratory arrest is another term for cardiac arrest, meaning both the heart and lungs have stopped working. This is incorrect as the patient still has a pulse.
Option D: A heart attack (myocardial infarction) is a cause of cardiac or respiratory arrest, but it is not the arrest itself. The immediate life-threatening problem is the lack of breathing, which requires immediate intervention (rescue breaths), not just transport to an outpatient department.

Clinical Relevance

Nursing practice connection: Knowing Assessment and immediate management of respiratory arrest helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Accurate assessment of pulse and breathing is a fundamental nursing skill that dictates the correct life-saving algorithm. Misidentifying respiratory arrest as cardiac arrest can lead to inappropriate chest compressions on a beating heart.
In any unresponsive patient, the sequence of 'Check-Call-Care' is vital. After checking for responsiveness, breathing, and pulse, the nurse must immediately call for help before initiating care.
What if? If during the 2-minute pulse check, the patient's pulse is now absent, the diagnosis changes from respiratory arrest to cardiac arrest. The nurse must immediately stop rescue breaths and begin high-quality CPR, starting with chest compressions.

How to Approach the Question

First, analyze the patient's status presented in the clinical scenario. The key findings are: collapsed (unresponsive), 'pulse is felt', and 'chest is not moving'.
Correlate these findings with the definitions of life-threatening emergencies. The presence of a pulse rules out cardiac arrest.
The absence of breathing (chest not moving) combined with a present pulse points directly to a diagnosis of respiratory arrest.
Evaluate each option, which contains both a diagnosis and an action.
Select the option that correctly identifies the condition as respiratory arrest and pairs it with the appropriate first-line intervention according to BLS guidelines, which is to provide rescue breaths.

Concept Tested & Keywords

Concept Tested: Assessment and immediate management of respiratory arrest.
Stem keywords: collapsed, pulse is felt, chest is not moving
Lead-in keywords: What problem would you suspect, what would be your action
Clinical cues: The presence of a pulse is the key finding that rules out cardiac arrest.
Clinical cues: The absence of chest movement is the key finding that indicates apnea or respiratory arrest.

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 7-9

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 45-47

Practise the full RML 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.