Agonal breathing

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I'm a new nurse and had a question about agonal breathing. We had a patient in her early 20s who had a bad reaction to Xanax and suffered severe respiratory depression, so severe that she went into agonal breathing. Her VS remained stable and her O2 sat. remained at 100%. ABG's showed alkalosis. Is it normal for the pulsox to show 100% oxygenation with agonal breathing?:confused: My only other experience with this was with an older woman before she died, and she was de-satting; but I also know that that is the process with death. I'm curious to know what's the "norm" as far as VS during agonal breathing. Does the body just compensated better in young people? Thank you!

Specializes in LTC, home health, critical care, pulmonary nursing.
NO!!!!!!!!!!!!!!

LOOK at you're BLS... if not breathing or it is agonal.. but sats are good.. you have time for narcan or romazicon while you breathe for the patient or supply O2.

FTLOG ,,, you only do CPR when there is NO PULSE... you can have a minimal breather with a solid pulse so NEVER EVER do CPR without checking the pulse, cripes sakes.!!!!!!!!!

In this case you had time to provide O2, put on a continious sat monitor and ambu or bag until it worked. Next, check pulse... don't just jump on a chest and do cpr for crying out loud.

reverse your drugs if given the chance and give O2 or breathe for them. Many times you'll get them back or have to intubate them but NEVER EVER do CPR on a respiratory arrest... geeze I need a valium myself now:uhoh3:

not being nasty to OP, but to the crap you've been told to do by others whom will not be named, zeeze!:down:

Perhaps before you get so irate, you should actually READ what people have posted. No one told anybody to do CPR.

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Specializes in ER.

I'm replying to the OP, before I read other posts, which I normally do....

Why are you assuming it's a bad reaction (read: allergy)? What about overdose?

did you give her supplemental oxygen?? Was Flumezanil used to reverse? I'd worry about her breathing by what I SAW, rather than relying on sats. Always trust what you see (and how they look: cap refill, skin color, rate of breathing, etc) over what's on a monitor. Think of asystole on the monitor, then you see the patient talking to you... same concept.

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Specializes in LTC, home health, critical care, pulmonary nursing.

In which no mention of CPR was made...

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Specializes in ER.
no!!!!!!!!!!!!!!

look at you're bls... if not breathing or it is agonal.. but sats are good.. you have time for narcan or romazicon while you breathe for the patient or supply o2.

ftlog ,,, you only do cpr when there is no pulse... you can have a minimal breather with a solid pulse so never ever do cpr without checking the pulse, cripes sakes.!!!!!!!!!

in this case you had time to provide o2, put on a continious sat monitor and ambu or bag until it worked. next, check pulse... don't just jump on a chest and do cpr for crying out loud.

reverse your drugs if given the chance and give o2 or breathe for them. many times you'll get them back or have to intubate them but never ever do cpr on a respiratory arrest... geeze i need a valium myself now:uhoh3:

not being nasty to op, but to the crap you've been told to do by others whom will not be named, zeeze!:down:

:)

just to clarify, zookeeper, they were discussing another thread about respiratory arrest and it led to a comment about cpr and chest compressions. not any reference to the op's post. side tracked a bit. :twocents:

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Yes, Romazicon was given, and there was minimal response after the first dose. A second dose was given and the pt. responded a bit better, but was still doing poorly and was then transferred to ICU. There she was arousable only by deep sternum rub, shake, and shout. Even then she was very obtunded.

I say it was a "bad reaction" and not an "allergy" b/c this was the first exposure to ANY benzodiazepine ever. Allergic reactions, as I understand, don't occur until the 2nd time a pt. receives a med; and if it does, it is on rare occasion. As far as overdose, the med was well within the "safe dose" limits for Xanax. Only 0.5 mg. was given, and we have a computer charting system which shows the med's dosage, as scanned by the RN administering the med. The patient was placed on 4L O2 via nasal cannula. Apparently she was pale, cool and clammy (blood sugar was 96), and had the agonal breathing.

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Specializes in NICU.
Ventilation and oxygenation are two different concepts. Hold your breath, you are not ventilating, but you are oxygenating just fine. I just left a thread where we are talking about this very subject. In fact, with good preoxygenation, a "normal" patient can go up to 8 minutes without breathing before their saturation falls below 90%. However, I would expect their CO2 to indicate a lack of ventilation. Also, an alkalotic ABG tells us little. Was the alkalosis of metabolic or respiratory etiology?

This was why someone mentioned doing "just CPR" in an emergency. There is oxygen in the blood stream. In an emergency... as in cardiac arrest.... compressions will circulate the oxygen that is in the blood stream.

No one said the patient the OP was referring to needed CPR.

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This was why someone mentioned doing "just CPR" in an emergency. There is oxygen in the blood stream. In an emergency... as in cardiac arrest.... compressions will circulate the oxygen that is in the blood stream.

No one said the patient the OP was referring to needed CPR.

Attention to detail? Perhaps you need to reread my posts, I'm not the one making a big deal about the CPR response. It was an innocent enough question unrelated to the OP that ruffled somebodies feathers, just not my feathers.

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Specializes in NICU.
Attention to detail? Perhaps you need to reread my posts, I'm not the one making a big deal about the CPR response. It was an innocent enough question unrelated to the OP that ruffled somebodies feathers, just not my feathers.

GilaRN,

I quoted you because your post made perfect sense. And it allowed someone else to realize why the new BLS regulations have changed. I agree with your posts 100%. I just quoted you to help the angry poster realize where the confusion began.

Sorry about the misunderstanding

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GilaRN,

I quoted you because your post made perfect sense. And it allowed someone else to realize why the new BLS regulations have changed. I agree with your posts 100%. I just quoted you to help the angry poster realize where the confusion began.

Sorry about the misunderstanding

No problem, I thought you may have been replying to somebody else. That makes sense.

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Specializes in ICU, ER, EP,.

no,no no,.... it was me! trying to reply to happybunnynurse that said something like in case of emergency just to do CPR.

I'm a bit poor at computers and I quoted the wrong post. I didn't want the OP to think they should have done CPR in this instance simply because the blood stream held O2 and try to circulate it.

Sry, my computer skills stink and I was trying hard to refocus on breathing and airway and the OP situation, not on the CPR bit.

Does that make sense? Did not mean to cause confusion, my attempts to refocus only caused more confusion... my bad:o That CPR post was quoted from somewhere else, someone agreed with it and I was worried that the new OP would think it applied to the origional situation that was breathing.

I think I muddied the water instead of helping. NOT my intention at all... sry! I really did mean to help, not be nasty.

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For the record this is what I said:

Isn't this why in an emergency you can do cpr with just chest compressions?

I don't see how that can be taken as "just do cpr". However, I'm sorry if it was taken that way. Maybe I should have said in a pre-hospital, on the street, by yourself emergency.

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For the record this is what I said:

Isn't this why in an emergency you can do cpr with just chest compressions?

I don't see how that can be taken as "just do cpr". However, I'm sorry if it was taken that way. Maybe I should have said in a pre-hospital, on the street, by yourself emergency.

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