Q: What are agonal respirations?
Agonal respirations are an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular
inspirations followed by irregular pauses. They may also be characterized as gasping, laboured breathing, perhaps
accompanied by strange vocalizations and myoclonus (a brief, involuntary twitching of a muscle ). In some cases,
agonal respirations can mirror normal breathing however become less frequest with time. The cause is due to cerebral
ischemia, due to extreme hypoxia or even anoxia which accompanies sudden cardiac arrest. Agonal breathing is an
extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to
complete apnea and heralds death.
Agonal respirations are commonly seen in cases of cardiac arrest , and may persist for several minutes after cessation of
heartbeat. The presence of agonal respirations in these cases indicates a more favourable prognosis than in cases of
cardiac arrest without agonal respirations.


Q: What is the difference between vomit and regurgitation?
When performing CPR, especially in an aquatic related incident, it is to be expected that fluid will begin to accumulate in
the mouth and upper airway. This is considered a REGURGITATION (ie. a passive mechanism causing a backward
motion of gastric content to travel up the airway). This is caused by a rescuer's actions such as rescue breathing or chest
compressions. There is a common misconception from many lifeguards (and first aiders) that regurgitation and vomiting
are the same thing. VOMITING is an active mechanism caused by the muscular action of the stomach to "throw up" it's
contents. A patient actively vomiting may indicate something about this patient has changed and we need to be aware of
this change.
If the victim vomits while performing CPR:
• Roll the patient, and sweep to clear the airway
• Reassess ABC's
if there is a change in victim status, the victim's vital signs should re-assessed. If a victim takes a breath or actively begins
vomiting suddenly when CPR or ventilation of a victim is being performed, then the rescuer should stop and re-assess the
pulse (and breathing, if breaths are recurrent). THIS IS A CHANGE IN VICTIM STATUS suggesting revival.
If the victim regurgitates while performing CPR:
• Finish the 30 compressions
• Roll the patient, and sweep to clear the airway
• Give 2 breaths
• Position and Resume CPR
Regurgitation is not a change in victim status . Pausing to re-assess vital signs only delays critical circulation which, at
best, during CPR provides only one-fourth to one-third of the body's normal circulation. This more acceptable
management of regurgitation is confirmed in BCLS literature and has been supported by emergency physicians who have
queried why re-assessment was ever taught for regurgitation.
One of the underlying principles of the 2010 CPR Guidelines is to “Minimize interruptions in chest compressions.”
Reassessing every time you notice some fluid causes excessive interruptions and simply diminishes the patient's
prognosis.