5.2 Emergency Procedures & Resuscitation

CRT/RRT Respiratory Therapist Exam Exam

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1 Introduction: NBRC TMC Exam Overview

NBRC TMC Exam Overview Credential Pathway: CRT to RRT Study Strategies for the TMC Exam Content Domains & Weight Distribution

2 Chapter 1: Patient Data Evaluation

1.1 Patient History & Physical Assessment 1.2 Diagnostic Procedures & ABG Interpretation 1.3 Hemodynamic Monitoring & Waveform Analysis 1.4 Laboratory Values & Diagnostic Data

3 Chapter 2: Airway Management & Oxygen Therapy

2.1 Airway Anatomy & Assessment 2.2 Airway Management Devices & Procedures 2.3 Oxygen Therapy Devices & Delivery 2.4 Humidification & Aerosol Therapy

4 Chapter 3: Mechanical Ventilation

3.1 Ventilation Fundamentals 3.2 Initial Ventilator Settings 3.3 Ventilator Monitoring & Waveform Analysis 3.4 Weaning & Liberation from Mechanical Ventilation

5 Chapter 4: Pharmacology & Equipment

4.1 Respiratory Pharmacology 4.2 Equipment & Troubleshooting 4.3 Specialty Procedures

6 Chapter 5: Infection Control, Ethics & Professional Practice

5.1 Infection Control & Prevention 5.2 Emergency Procedures & Resuscitation 5.3 Professional Practice & Ethics

5.2 Emergency Procedures & Resuscitation

Key Takeaways Explain This Topic AI

Adult CPR: push at 100-120/min and at least 2 inches (5 cm, avoid >6 cm) deep, allow full recoil, keep chest-compression fraction above 80%

Compression-to-ventilation ratio is 30:2 without an advanced airway; with an advanced airway use continuous compressions and 1 breath every 6 seconds

Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; non-shockable are pulseless electrical activity and asystole

Epinephrine 1 mg IV/IO every 3-5 minutes for ALL arrest rhythms; give it early in non-shockable arrest

Amiodarone 300 mg IV/IO (then 150 mg) for refractory VF/pulseless VT; lidocaine is an alternative

Rapid Response Teams are called for deterioration BEFORE arrest; staff worry alone is a valid trigger

NRP: warm-dry-stimulate; PPV at 40-60/min if HR <100 or apneic; chest compressions (3:1, 120 events/min) if HR <60 after 30 s of effective PPV

Cricothyrotomy through the cricothyroid membrane is the rescue airway when you cannot intubate and cannot oxygenate

Last updated: June 2026

Emergency Procedures & Resuscitation

Respiratory therapists own the airway and ventilation during a code and frequently push medications. The TMC tests Basic Life Support (BLS) , Advanced Cardiac Life Support (ACLS) , Rapid Response activation, Neonatal Resuscitation Program (NRP) steps, and emergency surgical airway, all against current American Heart Association (AHA) guidance.

Adult BLS / High-Quality CPR

Parameter Target
Compression rate 100-120 per minute
Compression depth At least 2 inches (5 cm); avoid exceeding 6 cm
Recoil Full recoil each cycle; do not lean on the chest
Ratio (no advanced airway) 30:2
With advanced airway Continuous compressions; 1 breath every 6 seconds (10/min)
Chest-compression fraction Above 80% -- minimize interruptions
Compressor switch Every 2 minutes (about 5 cycles of 30:2)
Tidal volume Just enough for visible chest rise; avoid over-ventilation

Over-ventilation is a classic RT pitfall: it raises intrathoracic pressure, lowers venous return, and reduces coronary perfusion. Capnography is the gold standard for confirming endotracheal tube placement and gauging CPR quality -- a sudden end-tidal CO2 (EtCO2) rise above ~10 mmHg, and especially toward 35-40 mmHg, often signals return of spontaneous circulation (ROSC) . Persistent EtCO2 under 10 mmHg after 20 minutes suggests poor odds.

Defibrillation -- Shockable vs Non-Shockable

Shockable: ventricular fibrillation (chaotic, no organized complexes) and pulseless ventricular tachycardia (rapid, regular, wide-complex, no pulse). Non-shockable: pulseless electrical activity (organized rhythm on the monitor, no pulse) and asystole (flat line).

AED / manual defibrillation steps:

Power on the device.

Apply pads (right upper sternal border and left mid-axillary line).

Clear the patient; analyze the rhythm.

If a shock is advised, clear and deliver it.

Resume compressions immediately -- do not pause to check a pulse until 2 minutes of CPR are complete.

ACLS Arrest Medications

Drug Dose Indication Frequency
Epinephrine 1 mg IV/IO ALL arrest rhythms (give early in PEA/asystole) Every 3-5 min
Amiodarone 300 mg, then 150 mg IV/IO Refractory VF/pulseless VT After the 3rd shock
Lidocaine 1-1.5 mg/kg, then 0.5-0.75 mg/kg Alternative to amiodarone for VF/pVT Every 5-10 min
Atropine 1 mg IV (max 3 mg) Symptomatic bradycardia -- NOT arrest Every 3-5 min
Magnesium 1-2 g IV Torsades de pointes specifically As needed

Reversible causes -- H's and T's:

H's T's
Hypovolemia Tension pneumothorax
Hypoxia Tamponade (cardiac)
Hydrogen ion (acidosis) Toxins
Hypo/hyperkalemia Thrombosis -- pulmonary (PE)
Hypothermia Thrombosis -- coronary (MI)

As the RT, you directly address Hypoxia (oxygenate, confirm tube placement) and Tension pneumothorax (recognize absent breath sounds and tracheal shift, prompt needle decompression).

Rapid Response Teams (RRT)

A Rapid Response Team intervenes before arrest. Typical activation criteria: heart rate <40 or >130, systolic BP <90 mmHg, respiratory rate <8 or >28, SpO2 <90% despite oxygen , acute mental-status change, urine output <50 mL over 4 hours, or simply a staff member's gut concern. The TMC rewards recognizing early deterioration -- a tachypneic, hypoxemic patient on oxygen warrants a call, not watchful waiting.

Neonatal Resuscitation (NRP)

Step Action Trigger
1. Rapid assessment Term? Tone? Breathing/crying? At birth
2. Initial steps Warm, dry, stimulate, position, clear airway if needed Any "no" above
3. PPV at 40-60/min Start with 21% O2 (term) / 21-30% (preterm) HR <100 or apneic/gasping
4. Chest compressions, 3:1 90 compressions + 30 breaths = 120 events/min HR <60 after 30 s of effective PPV
5. Epinephrine 0.01-0.03 mg/kg IV/IO Repeat every 3-5 min HR <60 despite compressions + PPV

The single highest-yield NRP fact: the most important and effective action in a depressed newborn is establishing effective ventilation -- the MR. SOPA steps (Mask reposition, Reposition airway, Suction, Open mouth, increase Pressure, Alternative airway) correct most failed PPV before compressions are ever needed.

Emergency Surgical Airway

When you cannot intubate and cannot oxygenate despite a supraglottic rescue device, perform a cricothyrotomy through the cricothyroid membrane (between the thyroid and cricoid cartilages). It is a temporizing measure until a formal tracheostomy can be placed.

Choking and Foreign-Body Airway Obstruction

A conscious adult or child with a complete obstruction (clutching the throat, no air movement, cannot speak) receives abdominal thrusts (Heimlich maneuver) until the object clears or the victim becomes unresponsive. If the victim goes unresponsive , lower them to the floor and begin CPR, checking the mouth for a visible object before each set of breaths -- never perform a blind finger sweep. For infants under 1 year , alternate 5 back blows and 5 chest thrusts. A patient with a partial obstruction who can still cough forcefully should be encouraged to keep coughing rather than interrupted.

Post-Resuscitation (ROSC) Care

The code does not end at a pulse. Immediate priorities the TMC tests include: titrating oxygen to an SpO2 of 92-98% (avoid hyperoxia), maintaining EtCO2 35-45 mmHg with ventilation, treating hypotension, obtaining a 12-lead ECG to identify ST-elevation MI, and considering targeted temperature management (32-36 degrees C) for comatose survivors.

Post-ROSC target Value
SpO2 92-98% (avoid hyperoxia)
PaCO2 / EtCO2 Normocapnia (about 35-45 mmHg)
Systolic BP Above 90 mmHg (MAP above 65)
Temperature Targeted 32-36 degrees C if comatose

Throughout, the RT secures and confirms the airway with waveform capnography , prevents the over-ventilation that drops cardiac output, and prepares for transport to definitive care such as the cardiac catheterization lab.