Agonal breathing

TigerGalLE, BSN, RN · Nov 12, 2010

Group hug everyone!!!! :redbeathe

MassED, BSN, RN · Nov 12, 2010

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.

perhaps a drug screen to scan for other causative agents?? Sounds like something was up....

Esme12, ASN, BSN, RN · Nov 12, 2010

Oh my! I should have stayed online.

My comment in response was in respone to a statement about CPR not necessarily in reference to the agonal breathing patient. My interpretation was the comment by honeybunny that ....this is why the AHA guidelines have changed to straight CPR not stopping and giving ventilations as has been previously mandated. The new AHA guidelings have been changed to reflect the focus of circulating what O2 is in the blood stream already and getting the O2 to vitals organs before focusing on ventilation. I was not saying CPR was the response to the OP situation.

NO CPR should be given to an adult, I repeat ADULT, when there is a pulse present. It would be an extremely extraordinary situation that would change that.........the OP in reference to the "agonal" pattern of breating does not mean the patient has dying resperations......just a pattern of breathing consistant with agonal resps. The patient can maintain an O2 sat of 100% in a healthy young individual for an extended peroid of time because they have a healthy heart. That is why on children......a low O2 sat is an ominous sign! The patient obviously has a sensitivity to sedation, or , took something on the sly, or someone gave a wrong dose. The response is to notify the MD give reversal agents as ordered by MD supplemental O2 and prepare the patient for transfer pending further work-up.

Sometime I think we need to be a bit more polite and not jump to conclusions. Be kinder to one another!

LindsayJ · Oct 30, 2012

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!

I'm about two years late to this convo, but Zookeeper3, it should be noted that in neonates, compressions SHOULD be performed if the HR is less than 60, even though there is technically a pulse. It is important to clarify between adult and neonatal/pediatric protocols.