Respiratory Arrest (Apnea): Symptoms, Complaints, Signs

The following symptoms and complaints may occur together with apnea (cessation of breathing):

Leading symptoms

  • Apnea (= no breathing movements visible, no breathing audible, no air movements perceptible via mouth/nose).
  • Pale skin/cyanotic (purple to bluish discoloration) skin.

The following symptoms usually precede respiratory arrest:

  • Bradypnea – pathologically slowed breathing (< 10 breaths per minute).
  • Dyspnea (shortness of breath)
  • Shallow breathing
  • Strained breathing
  • Anxiety
  • Disturbance of consciousness

Respiratory emergency

According to the European Resuscitation Council ABC guidelines, the following should be assessed in a respiratory emergency:

  • A (= airway): can the upper airway be kept open independently (esp. if consciousness is impaired)? or is the airway compromised?
  • B (= (Be)Breathing):
    • Respiratory rate: is there tachypnea (increased respiratory rate; adults: > 20/min; children: > 25/min)? This is often the first sign of respiratory failure (respiratory weakness) in children?
    • Work of breathing: signs of increased work of breathing include intercostal (“between the ribs“), subcostal (“below a rib”), and sternal (sternum-related) retractions, nostrils, and use of auxiliary respiratory muscles.
    • Breath volume: lateral differences indicate unilateral processes (e.g., attenuated breath sound and hypersonoric knocking sound in pneumothorax).
    • Oxygenation (supply of oxygen): measurement by pulse oximetry (measurement of oxygen saturation (SpO2) of arterial blood and pulse rate; target range: 94-98%); if this is not achieved by means of a reservoir mask that allows an oxygen concentration of 95-98%, there is a threatening oxygenation disorder.
  • C (= Circulation/Circulation): tachycardia (heartbeat too fast: > 100 beats per minute) occurs compensatory almost always with a respiratory disturbance; this is often aggravated by fever and volume deficiency.
  • D (= disability/neurological condition): occurrence of a clouding of consciousness due to progressive hypoxia (oxygen deficiency) or hypercapnia (increased carbon dioxide content in the blood); as a critical sign occurrence of confusion, agitation or even drowsiness.

Sure signs of death

Notice:

  • Neither lack of pulse nor lack of respiration is a sure sign of death. This also applies to the zero line in the ECG (= uncertain sign of death).

Sure signs of death are:

  • Early changes
    • Death spots (livor mortis) – The first death spots appear about 20-30 minutes after circulatory arrest.
    • Rigor mortis (Rigor mortis; rigor mortis) – Rigor mortis occurs sequentially according to the Nysten rule:
      • After about 1-2 hours on the eyelids,
      • After 1-2 hours on jaw / chewing muscles small joints.
      • Neck/neck
      • Upper extremity
      • Lower extremity
      • At room temperature, rigor mortis is fully developed after about 6-12 hours (faster in heat, slower in cold).
    • Injuries incompatible with life (eg, separation of head and torso).
  • Late changes
    • Putrefaction (synonyms: putrescence, putrefaction) onset of decay: discoloration, odor change and liquefaction) and putrefaction.
    • Colonization of most of the body by fly and beetle maggots, ants, etc.
    • Adipocire (= corpse or fat wax formation in the absence of air).
    • Mummification of the body (eg, dry environment).

To narrow down the time of death, it is necessary to determine the core body temperature and the ambient temperature.

Note: If there are no definite signs of death, immediate resuscitation must be started!