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?

1. A

   It is cardiac arrest, start CPR

2. B

   It is respiratory arrest, give rescue breath

3. C

   It is cardio respiratory arrest, give chest compression and breath

4. D

   It is heart attack, take him in cardiology OPD

Appeared in: RML Lucknow - 2021

Explanation

• The patient has a palpable pulse, indicating the heart is still circulating blood.
• The patient's chest is not moving, which signifies apnea or the absence of breathing.
• This clinical state is defined as respiratory arrest.
• The correct intervention per BLS guidelines is to support oxygenation by providing rescue breaths.
• This action is critical to prevent the patient's condition from deteriorating into cardiac arrest due to hypoxia.

Why Other Options Were Wrong

• Option A: This is incorrect because cardiac arrest is defined by the absence of a pulse. This patient has a palpable pulse. Starting chest compressions (CPR) is not indicated and can cause harm.
• Option C: This is incorrect because a pulse is present. Cardio-respiratory arrest implies the failure of both cardiac and respiratory functions, meaning no pulse and no breathing.
• Option D: This is incorrect as an immediate action. While a heart attack could be the underlying cause, the life-threatening emergency is respiratory arrest. An outpatient department (OPD) is not equipped for resuscitation.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Differentiation between respiratory arrest and cardiac arrest and the appropriate Basic Life Support (BLS) intervention helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Rapidly and accurately assessing for both pulse and breathing simultaneously (in less than 10 seconds) is a critical nursing skill in an emergency.
• Initiating rescue breathing promptly in a patient with respiratory arrest can prevent the condition from deteriorating into cardiac arrest, significantly improving the patient's chance of survival.
• What if? If the patient was found with no pulse and no breathing, the diagnosis would be cardiac arrest. The immediate action would be to call for help and immediately start high-quality chest compressions at a rate of 100-120 per minute, with a compression-to-ventilation ratio of 30:2.

How to Approach the Question

• First, analyze the key clinical findings presented in the scenario: the patient has collapsed, a pulse is felt, but the chest is not moving.
• Break down the findings: 'Pulse is felt' confirms that the heart is still functioning (circulation is present). 'Chest is not moving' confirms the absence of breathing (respiratory function has ceased).
• Synthesize these two findings to arrive at the correct diagnosis: The presence of a pulse with the absence of breathing is the definition of respiratory arrest.
• Recall the standard Basic Life Support (BLS) protocol for this specific condition. For an adult in respiratory arrest, the correct intervention is to provide rescue breaths.
• Evaluate each option against this conclusion. Option A and C are for cardiac arrest (no pulse). Option D is an inappropriate disposition for an emergency. Option B correctly identifies both the problem and the immediate, life-saving action.

Concept Tested & Keywords

• Concept Tested: Differentiation between respiratory arrest and cardiac arrest and the appropriate Basic Life Support (BLS) intervention.
• 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 combination of a present pulse with absent breathing is the classic sign of respiratory arrest.
• Negative lead-in flag: false

Question ID

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Copy ID

Reference Book

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

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

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart B (pp 276-535 of 550) p. 181-183