Chapter Four

Breathing Emergencies

Background

A breathing emergency is any respiratory problem that can threaten a person’s life.

The pathway from the mouth and nose to the lungs is called the airway.

Why time is critical…

0 minutes Breathing stops. Heart will

soon stop beating. 4 – 6 minutes

Brain damage possible. 6 – 10 minutes

Brain damage likely. Over 10 minutes

Irreversible brain damage certain.

Distress vs. Arrest

Respiratory distress – a condition in which breathing becomes difficult

Respiratory arrest – occurs when breathing stops

Normal breathing is regular, quiet and effortless. A person does not appear to be working hard or struggling.

Normal Breathing in Children and Infants Normal breathing rates in children and infants

are faster than normal breathing rates in adults.

Infants have periodic breathing, changes in breathing patterns are normal for infants.

Breathing emergencies can be caused by - Choking Illness Chronic conditions, such as asthma Electrocution Heart attack or irregular heartbeat Injury to the head, chest, or lungs Allergic reactions Drug overdose Drowning Emotional distress

Asthma Inflammation of the air passages that results

in temporary narrowing of the airways. Asthma attacks are often recognized by the

wheezing or whistling sound that is made when exhaling.

Chronic Obstructive Pulmonary Disease COPD is a long term lung disease

encompassing both chronic bronchitis and emphysema.

Airways become partly blocked and the air sacs in the lungs lose their ability to fill with air.

There is no cure and it worsens over time. The most common cause of COPD is

smoking.

Emphysema & Bronchitis

Emphysema is a disease that involves damage to the air sacs. Exhaling is extremely difficult.

Bronchitis is an inflammation of the main air passages. To be diagnosed with chronic bronchitis, a person must have a cough with mucus on most days of the month for at least 3 months.

Hyperventilation

Occurs when a person’s breathing is faster and more shallow than normal.

Often results from fear or anxiety and usually occurs in people who are tense and nervous.

Also caused by- Head injuries Severe bleeding Asthma Exercise

Allergic Reactions An allergic reaction is the response of the

immune system to a foreign substance that enters the body.

A severe allergic reaction can cause a condition called anaphylactic shock.

Signals include – Rash Tightness of chest and throat Swelling of face, neck and tongue Person may feel dizzy or confused

Croup A harsh, repetitive cough that most commonly

affects children younger than 5 years. Cough can range from high pitched wheeze

to a barking cough. Croup mostly occurs during the evening or

nighttime.

Epiglottitis Infection causing severe swelling of the

epiglottis. When it swells it can block the airway. Most common in children between 2 and 6 years

of age. Hib vaccine has helped decrease the number of

cases.

Signals of breathing emergencies - Trouble breathing or no breathing

Slow or rapid breathing

Unusually deep or shallow breathing

Gasping

Wheezing, gurgling, high pitched noises

Skin is moist or cool, flushed, pale, ashen, or bluish

Victim feels dizzy or lightheaded

Victim feels apprehensive or fearful

If a person is having trouble breathing - Help the person rest in a comfortable position. If they are conscious, check for other

conditions. If the person is having a hard time talking have

them nod or shake their head to answer questions.

If a bystander is present and can answer questions about the victim, ask the bystander instead.

Try to calm the victim.

Care for an unconscious adult that is not breathing - The cause is most likely a cardiac

emergency. Begin CPR immediately.

If you suspect the person is having a respiratory emergency, such as drowning, give 2 rescue breaths after checking for breathing.

Choking

Choking is a common breathing emergency. It occurs when the person’s airway is partially or completely blocked.

Causes of Choking in Adults

Trying to swallow large pieces of poorly chewed food

Drinking alcohol before or during meals Wearing dentures Eating while talking excitedly or laughing Eating too fast Walking, playing or running with food or

objects in the mouth

Choking in Children & Infants

Common cause of injury and death in children younger than 5 years.

Children should not be given hard, smooth foods such as raw vegetables until they are 4 years old. No peanuts until 7 years or older.

Food should be chopped into pieces no larger than ½ inch.

Signals of choking -

Coughing, either forcefully or weakly Clutching the throat Can’t cough, speak, cry or breathe High pitched noises Panic Bluish skin color Loss of consciousness

When to call 9-1-1 If the person continues to cough without

coughing up the object, have someone call 9-1-1 A partially blocked airway can quickly become

blocked A person who has choked and has been given

back blows and abdominal thrusts or chest thrusts to clear the airway requires a medical evaluation.

Internal injuries and damage to the airway may not be obvious immediately.

Care for a conscious choking adult orchild who is coughing- If a person is coughing forcefully, let him or

her try to cough up the object.

A person who is getting enough air to cough or speak is getting enough air to breathe.

Stay with the person and encourage him or her to continue coughing.

Care for a Conscious Choking Adult or Child Give five back blows and five abdominal

thrusts until the object is dislodged and the person can breathe or becomes unconscious.

Hand Position for Abdominal Thrusts

Special Considerations

A large or pregnant person Give chest thrusts instead of abdominal thrusts

Being alone and choking Bend over and press your abdomen against a firm

object A person in a wheelchair

Give abdominal thrusts

Care for a Conscious Choking Infant Give five back blows

and five chest thrusts until the object is forced out, the infant begins to breathe on his or her own or the infant becomes unconscious.