Chapter 3 – CPR-PR
Taking Action and Caring for Breathing Emergencies
Epinephrine Administration
2 million people in the US are at risk for anaphylaxis and each year 400 to 800 people die
Symptoms:
 Swelling of the face, neck, hands, throat, tongue, or other body part
 Itching of tongue, armpits, groin or any body part
 Dizziness
 Redness or welts on the skin
 Red watery eyes
 Nausea, abdominal pain or vomiting
 Rapid heart rate
 Difficulty breathing or swallowing
 Feeling of construction in the throat or chest
Epinephrine is a medication prescribed to treat the signs and symptoms of these reactions.
Call EMS if anyone has ANY of the above symptoms
Use an epinephrine auto-injector when a victim:
 Relates a history of allergies or allergic reactions
 Is having an allergic reaction
 Requests assistance to administer epinephrine
 Provides the epinephrine or auto-injector
 Has a family member who relates a victim’s history of allergies or allergic
reactions and provides the victim’s auto-injector.
Before assisting or administering epinephrine:
 Summon more advanced medical personnel
 Check the label to ensure that the prescription is for the victim
 See if they have already taken a dose – if so, do NOT give another unless
instructed by medical personnel
 Ensure that the prescription has not expired
 Ensure that the medication is clear and NOT cloudy or discolored
 Read and follow instructions provided
To administer:
1. locate the middle of outer thigh or upper arm to use as injection sight
2. grasp the auto-injector firmly and remove the safety cap
3. hold the auto-injector at a 90 degree angle
4. firmly jab the tip into the thigh. You will hear a click – hold in place 10
seconds.
5. Remove from the thigh and massage the injection site for several minutes
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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:
- Summon advanced medical personnel
- 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 1 second 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 1 second
7Do this for two minutes, remove the mask and recheck for signs of circulation and
breathing for no more than 10 seconds.
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
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 second
 for infants, cover both the mouth and nose
 after 2 minutes of rescue breathing recheck breathing and pulse for no more
than 10 seconds.
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
Get permission, identify yourself
If coughing, encourage him to keep coughing
Give 5 back blows with the heel of your hand
Give 5 abdominal thrusts
Yourself
Obese or pregnant victim – chest thrusts
Child
Infant
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. Give 5 chest thrusts – adult about 1 ½ to 2 inches; child 1 to 1 ½ inches
4. Look inside victim’s mouth
5. Grasp tongue and lower jaw – if you see an object, take it out
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.
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.
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.