Chapter Four
Breathing Emergencies
Background
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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…
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0 minutes
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4 – 6 minutes
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Brain damage possible.
6 – 10 minutes
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Breathing stops. Heart will
soon stop beating.
Brain damage likely.
Over 10 minutes

Irreversible brain damage
certain.
Distress vs. Arrest
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Respiratory distress – a condition in which
breathing becomes difficult
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Respiratory arrest – occurs when breathing
stops
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Normal breathing is regular, quiet and
effortless. A person does not appear to be
working hard or struggling.
Normal Breathing in
Children and Infants
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Normal breathing rates in children and infants
are faster than normal breathing rates in
adults.
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Infants have periodic breathing, changes in
breathing patterns are normal for infants.
Breathing emergencies can be caused by 
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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
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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
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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
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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
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Head injuries
Severe bleeding
Asthma
Exercise
Allergic Reactions
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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 –
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Rash
Tightness of chest and throat
Swelling of face, neck and tongue
Person may feel dizzy or confused
Croup
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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
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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
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Slow or rapid breathing
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Unusually deep or shallow breathing
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Gasping
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Wheezing, gurgling, high pitched noises
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Skin is moist or cool, flushed, pale, ashen, or bluish
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Victim feels dizzy or lightheaded
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Victim feels apprehensive or fearful
If a person is having trouble breathing 
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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
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Choking is a common breathing emergency.
It occurs when the person’s airway is partially
or completely blocked.
Causes of Choking in Adults
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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
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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 
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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
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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 or
child who is coughing
If a person is coughing forcefully, let him or
her try to cough up the object.
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A person who is getting enough air to cough
or speak is getting enough air to breathe.
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Stay with the person and encourage him or
her to continue coughing.
Care for a Conscious Choking Adult or Child
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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
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A large or pregnant person
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Being alone and choking
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Give chest thrusts instead of abdominal thrusts
Bend over and press your abdomen against a firm
object
A person in a wheelchair
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Give abdominal thrusts
Care for a Conscious Choking Infant
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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.