Chapter 8 - Breathing Emergencies
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Breathing emergencies should be detected during the initial assessment.
It occurs when someone's breathing is so impaired that life is threatened.
Occur in two ways:
 breathing is difficult (respiratory distress)
 breathing has stopped (respiratory arrest)
When breathing stops:
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
Breathing emergencies can be caused by:
- Obstructed airway (choking)
- Illness (ex-pneumonia)
- Certain respiratory conditions (asthma, emphysema)
- Electrocution
- Shock
- Drowning
More causes of breathing emergencies:
- Heart attack or heart disease
- Injury to the chest or lungs
- Drugs
- Poisoning, such as inhaling or ingesting toxic substances
- Allergic reactions to food, insect stings, or other allergens
- Hyperventilation
SIGNALS OF RESPIRATORY DISTRESS
Abnormal breathing:
 breathing is slow or rapid (slow respirations are less than 8 per minute for adults and
less than 10 per minute for children/infants
 breaths are unusually deep or shallow
 gasping for breath
 wheezing, gurgling or making high pitched noises
Abnormal skin appearance:
 at first, skin is unusually moist skin & appear flushed
 later skin may be pale, ashen, or bluish appearance
 when victim’s skin, or nail beds appear blue = cyanosis
Victim feels:
- short of breath
- dizzy or light headed
- pain in chest or tingling in hands and feet
- apprehensive or fearful
Common conditions causing respiratory distress:
1)
Asthma
Facts – narrows air passages
Triggered by – Allergic reaction to pollen/food/a drug/ insect stings
Emotional stress/physical activity
Signs & symptoms – Struggle to breathe
Wheezing when exhaling
2)
Emphysema
Facts – lungs lose ability to exchange carbon dioxide and oxygen effectively.
Caused by – smoking; usually develops over many years.
Signs & symptoms – Shortness of breath
Possible coughing, cyanosis, or high fever
Advanced cases: restlessness, confusion, weakness
3)
Hyperventilation
Facts – Rapid breathing upsets body’s balance of oxygen and carbon dioxide
Triggered by - Fear/anxiety
- Injury to head/severe bleeding/illness
- Asthma
- Exercise
Signs & symptoms – Shallow, rapid breathing
Dizziness
Numbness in fingers/toes
4)
Anaphylaxis (Severe Allergic Reaction)
Facts – Swelling of air passages restricts breathing.
Triggered by – Food/insect stings/a drug
Signs & Symptoms - Skin Rash
Tightness in chest/throat
Swelling of face/neck/tongue
Care for Respiratory Distress:
- Have the victim rest in comfortable position.
- Keep victim from getting chilled or overheated.
- Reduce heat; add moisture.
- If authorized, help victim take any medications.
- Summon more advanced medical personnel.
- Monitor vital signs.
Key Points of Respiratory Arrest:
- Life threatening
- Commonly caused by illness, injury, or choking
- Often preceded by respiratory distress
- Body systems will progressively fail
RESCUE BREATHING
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Given to victims who are not breathing but still have signs of circulation
Works because you inhale 21% oxygen and exhale 16% oxygen
Make sure you follow BSI (body substance isolation) precautions
Steps for Adults:
1Airway - tilt head & check breathing (use head-tilt/chin-lift)
2Check breathing 3-5 sec.
3Give 2 slow breaths that last 2 seconds for adults (use a breathing barrier)
4Check for signs of circulation no more than 10 sec. and look for severe bleeding
5Summon advanced help if you have not already done so
6Begin rescue breathing
 Give 1 breath every 5 sec. for adults
 Breaths should last approximately 2 seconds
7- After a minute, recheck for signs of circulation and breathing
Do Not Stop Rescue Breathing Unless:
Victim begins to breathe on his/her own
Victim has no signs of circulation (begin CPR)
Another trained person takes over
EMS personnel arrive on the scene & take over
You are too exhausted to continue
The scene becomes unsafe
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Special Considerations
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Air in stomach
 Gastric distension
Vomiting
Mouth-to-nose breathing
Mouth-to-stoma breathing
Victim with dentures
Suspected head, neck, or back injuries
Try to minimize movement of the head and neck when opening the airway.
Try to open the victim’s airway by lifting the chin without tilting the head back.
Perform a jaw thrust – works better using BOTH hands. Place hands under the angles
of the jaw and lifting
Place your mouth over the victim’s (use your cheek to close the nose) and breathe
Rescue Breathing for Children & Infants
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Uncorrected breathing emergencies in children and infants are the primary cause of
cardiac arrest.
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Rescue breathing is the same as for adults, EXCEPT:
 1 breath every 3 seconds
 use less air for each breath – breathe only until you see the chest rise
 you do not tilt a child’s or infant’s head as far back as an adult. Tilt it JUST
enough so that air will go through
 breaths last only 1 ½ seconds
 for infants, cover both the mouth and nose
 after 1 minute of rescue breathing (about 20 breaths in a child or infant) recheck
the pulse.
Airway obstruction
– most common cause of respiratory emergencies
Common causes of choking include:
 trying to swallow large pieces of poorly chewed food
 drinking alcohol before or during meals -alcohol dulls the nerves that aid swallowing,
making choking on food more likely)
 wearing dentures – harder to sense whether food is fully chewed
 eating while talking excitedly or laughing or eating too fast
 walking, playing, or running with food or objects in the mouth
First Aid - Airway Obstruction - Conscious victim
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Conscious choking victim
- abdominal thrusts
Yourself
Obese or pregnant victim
Child
Care for an Unconscious Choking Adult:
 When you attempt 2 rescue breaths they do not go in:
1. Reposition the head
2. Give 2 slow breaths again. If they still don’t go in, assume the airway is blocked
3. Straddle one of the victim’s thighs and give up to 5 abdominal thrusts
4. Do a finger sweep
5. Open the airway
6. Give 2 slow breaths – if they still don’t go in, repeat steps 1-6
Once air goes through, check for signs of circulation.
Care for a Conscious Choking Adult Who Becomes Unconscious
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Open the airway by grasping the lower jaw and lifting the jaw up.
Perform a finger sweep; make sure to use a hooking action.
Try to open the victim’s airway using the head-tilt/chin-lift.
Give two slow breaths – often the throat muscles relax.
If air does not go in, reposition the head
Give 2 slow breaths.
If air still does not go in, assume the airway is still obstructed.
Straddle one of the victim’s thighs and perform up to 5 abdominal thrusts.
Perform a finger sweep.
Give 2 slow breaths – if they do not go in, reposition the head and repeat the 2
breaths. Then repeat steps 6-9.
11. If they do go in, complete the initial assessment by checking for signs of circulation
and severe bleeding.
- Make sure you take the person to emergency department even when object is
dislodged – may have internal damage due to thrusts and/or some of the material may
still be in lungs.
- For an unconscious choking victim who is pregnant or obese – perform up to 5 chest
thrusts on the center of the victim’s sternum.
Care for an Unconscious Choking Child
1 - Give two slow breaths (1 ½ seconds for children)
2 - If breaths do not go in, reposition the head
3 - Give 2 more breaths. If they still don’t go in, assume the child is choking:
4 – Give up to 5 abdominal thrusts
5 - Open victim’s mouth and do a finger sweep (use little finger) IF object is visible.
6 – Open the airway
7 - 2 slow breath (about 1 ½ seconds)
8 - Repeat 1-7
 If breaths do go in or victim begins to cough on his/her own, check for circulation
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Care for Conscious Choking Infant
Give 5 back blows and 5 chest thrusts
Care for an Unconscious Choking Infant
 Check for consciousness, and breathing
 If no breathing, attempt 2 slow breaths
1- If they do not go in, reposition the head and give 2 more breaths. If they still don’t go
in, assume the airway is blocked
2- Give 5 back blows
3- Give 5 chest thrusts
4- Look for the object
5- IF you see it, try to remove with your little finger
6 – Open the airway and give two slow breaths
7-Keep repeating steps 1-6 until breaths go in, then check for signs of circulation.