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 4 – 6 minutes Brain damage possible. 6 – 10 minutes Breathing stops. Heart will soon stop beating. 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 or child 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 Being alone and choking Give chest thrusts instead of abdominal thrusts 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.