From the Guidelines
For an unresponsive patient who is breathing, first check for a pulse, as this will determine the next course of action. According to the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, if the patient is unresponsive and breathing abnormally, it is crucial to assess their pulse to determine if they require CPR. The guidelines emphasize the importance of assuming a patient is in cardiac arrest if they are unresponsive with absent or abnormal breathing, and to promptly initiate CPR.
In this scenario, since the patient is breathing but not responsive, it is essential to check for a pulse to determine the best course of action. If the patient has a pulse, monitoring their breathing and pulse until emergency responders arrive is recommended, as stated in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1. However, if the patient does not have a pulse, CPR should be initiated immediately.
Key considerations include:
- Checking for a pulse to determine the next course of action
- Monitoring the patient's breathing and pulse if they have a pulse
- Initiating CPR if the patient does not have a pulse
- Calling for emergency services or having someone else call while monitoring the patient
- Protecting the patient from environmental hazards and loosening any tight clothing that might restrict breathing.
It is crucial to prioritize the patient's airway, breathing, and circulation (ABCs) and to follow the most recent guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
From the Research
Initial Assessment and Response
- The patient is unresponsive but breathing, indicating the need for immediate assessment and potential intervention.
- According to standard first aid and medical protocols, the first step for an unresponsive patient who is breathing is to check for a pulse [ 2 ] and ensure the airway is clear.
Oxygen Therapy Considerations
- Oxygen therapy may be necessary, but it should be provided judiciously. Studies suggest that while oxygen is crucial for maintaining aerobic metabolism, its indiscriminate administration may increase morbidity and mortality [ 3 ].
- The optimal oxygenation strategy should aim for normoxia, avoiding both hypoxemia and hyperoxia [ 3 ].
CPR and Ventilation
- If the patient is not breathing or does not have a pulse, CPR should be commenced immediately. However, for a patient who is breathing but unresponsive, the priority is to ensure the airway is protected and to provide oxygen if necessary [ 4 ].
- The role of oxygen during CPR and the optimal oxygen concentration are areas of ongoing research. Some studies suggest that ventilation with high oxygen concentration after CPR may be associated with worse neurologic outcomes [ 4 ].
Next Steps
- Call for help to ensure professional medical assistance is on the way.
- Check for a pulse and assess the patient's airway, breathing, and circulation (ABCs) [ 2 ].
- Consider providing oxygen if the patient shows signs of hypoxia, but avoid hyperoxia [ 3 ].
- If the patient's condition worsens or they stop breathing, be prepared to start CPR [ 4 ].