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Asthmatic arrest — DipIMC MCQ

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HardResuscitationAsthmatic arrestDipIMC

During CPR for status-asthmaticus arrest, ventilation becomes progressively difficult, the chest remains hyperexpanded and venous return appears impaired. Tension pneumothorax is not found. What manoeuvre should be considered for the likely dynamic hyperinflation?

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Correct answer: A — Disconnect the ventilator briefly and allow manual chest decompression

The best answer is “Disconnect the ventilator briefly and allow manual chest decompression”. Severe airflow obstruction can cause gas trapping, high intrathoracic pressure and impaired venous return during asthmatic arrest. RCUK advises considering ventilator disconnection and manual chest decompression while continuing ALS and checking for pneumothorax. Faster ventilation, larger tidal volumes and shortened expiration worsen dynamic hyperinflation rather than relieving it.

Reference: Resuscitation Council UK 2025, Special circumstances: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines