There are two types of breathing emergencies:
1. Respiratory distress is a condition in which breathing becomes difficult.
2. Respiratory arrest occurs when breathing stops.
Both conditions are life threatening. By recognizing respiratory distress and taking immediate action, you may prevent respiratory arrest.
Signals of Respiratory Distress
1.
Gasping for air
2.
Breathe faster or slower than normal
3.
May make high pitched noises such as wheezing, gurgling, or high pitched sounds
4.
Skin may be unusually moist
5.
Skin could be pale, ashen or cyanotic (bluish coloration of the skin around mouth or fingertips)
6.
May feel dizzy or light-headed
7.
Tingling in the hands, feet or lips
Conditions That Cause Respiratory Distress
1. Asthma is a condition that narrows the air passages and makes breathing more difficult. The characteristic sign of asthma is wheezing when exhaling.
2. Emphysema is a disease in which the lungs lose their ability to exchange carbon dioxide and oxygen effectively. Signals include— a. Shortness of breath. b. Restlessness. c. Confusion. d. Weakness.
3. Bronchitis is a condition resulting in inflammation of the lining of the trachea, bronchi and bronchioles. The inflammation causes a buildup of mucus that obstructs air passages. Signals include— a. Persistent cough. b. Tightness in the chest. c. Trouble breathing.
As with emphysema, the victim may also feel restless, confused and weak.

4. Anaphylactic shock , also known as anaphylaxis , is a severe allergic reaction.
Signals include— a. Skin rash. b. Tightness in the chest and throat. c. Swelling of the face, neck and tongue. d. Dizziness or confusion.
5. Hyperventilation is a condition that occurs when someone breathes faster than normal. Signals include— a. Deep, rapid breathing. b. Fear, apprehension, confusion or dizziness. c. Fingers, toes or lips feel numb or tingly.
Care for Respiratory Distress
CHECK the scene. Check the victim. CALL 9-1-1 or the local emergency number.
CARE for conditions you find.
Loosen any tight clothing.
Provide fresh air.
Make sure someone has called 9-1-1 or the local emergency number.
Check for other life-threatening conditions.
Interview the victim and any bystanders.
Children and Respiratory Distress
Infections of the respiratory system are more common in children and infants than adults.
Signals of respiratory distress in children include— a. Agitation. b. Unusually fast or slow breathing. c. Drowsiness. d. Noisy breathing. e. Pale, ashen, flushed or bluish skin color. f. Increased breathing trouble. g. Altered level of consciousness. h. Increased heart rate.
Common childhood illnesses that cause respiratory distress include croup and epiglotitis.
Croup is an infection that causes swelling of the throat around the vocal cords, resulting in a cough that sounds like the bark of a seal.
Epiglotitis is a bacterial infection that causes severe inflammation of the epiglottis, which can swell and completely block the airway. Signals of epiglotitis include—
1. Rapid onset of a high fever.
2. Sore throat and drooling from the mouth.
3. Swelling of the epiglottis that prevents the child from swallowing.

Care for a child in respiratory distress includes—
1. Allowing him or her to remain in the most comfortable position for breathing.
2. Calling 9-1-1 or the local emergency number if the child’s breathing does not appear to improve or at the first signal that the child’s condition is worsening.
3. Not attempting to place any object in the child’s mouth.
4. A child with a blocked airway has a life-threatening emergency.
Airway Obstruction – Conscious Victim
Airway obstruction is the most common respiratory emergency.
There are two types of airway obstruction:
1. An anatomical airway obstruction occurs if the airway is blocked by the tongue or swollen tissues of the mouth or throat.
2. A mechanical airway obstruction occurs if the airway is blocked by a foreign object.
Common causes of choking include—
1. Trying to swallow large pieces of poorly chewed food.
2. Drinking alcohol before or during meals.
3. Wearing dentures.
4. Eating while talking or laughing, or eating too fast.
5. Walking, playing or running with food or objects in the mouth.
Partial Airway Obstruction
A victim with a partial airway obstruction can still move air to and from the lungs.
This air allows the victim to cough in an attempt to dislodge the object. If the victim is coughing forcefully or wheezing, do not interfere with attempts to cough up the object.
Stay with the victim and encourage him or her to continue coughing to clear the obstruction.
Complete Airway Obstruction
A person with a completely blocked airway is choking and is unable to speak, breathe or cough. Sometimes the victim may cough weakly and ineffectively or make high-pitched noises. Act immediately!
Care for an Airway Obstruction
If a person cannot cough, breathe or speak, assume the airway is obstructed.
Position yourself behind the victim and deliver back blows and abdominal thrusts until the object is removed, the victim can breathe or the victim becomes unconscious.
Conscious Adult or Child
A combination of 5 back blows followed by 5 abdominal thrusts is an effective way to clear an airway obstruction. To give back blows –
1.
Position yourself slightly behind the person.
2.
Provide support by placing one arm diagonally across the chest and lean the person forward.

3.
Firmly strike the person between the shoulder blades with the heel of your other hand.
If the back blows do not clear the obstruction, give abdominal thrusts.
To give abdominal thrusts –
1.
Stand or kneel behind the victim and wrap your arms around his or her waist.
2.
Make a fist with one hand and place the thumb side against the middle of the victim’s abdomen, just above the navel.
3.
Grab your fist with your other hand and give quick, upward thrusts into the abdomen.
4. Repeat sequence of 5 back blows and 5 abdominal thrusts until the object is dislodged or the victim becomes unconscious.
5. Help a conscious choking adult or child who becomes unconscious to the floor.
If a victim is pregnant or too large for you to give abdominal thrusts, give chest thrusts.
If you are alone you may have to give abdominal thrusts to yourself. This can be done by—
1. Leaning over a firm object and pressing your abdomen into it.
2. Making a fist and giving yourself quick, upward thrusts.
Conscious Infant
Choking is a common cause of death and injury in infants. An infant can easily swallow small objects or small pieces of food which can then block an infant’s airway.
Additional reasons for choking include—
1. The infant’s airway has not fully developed.
2. Infants are still developing eating skills.
If an infant cannot breathe, cough or cry, assume the airway is obstructed and perform 5 back blows followed by 5 chest thrusts.
To give back blows –
1.
Sandwich the infant between your forearms supporting the head and neck by holding the jaw between your thumb and forefinger
2.
Turn the infant over so that he or she is facedown on your forearm.
3.
Give 5 firm back blows with the heel of your hand while supporting the arm that is holding the infant on your thigh.
To give chest thrusts –
1.
Sandwich the infant between your forearms continuing to support the infant’s head.
2.
Turn the infant onto his or her back and support your arm on your thigh. (The infant’s head should be lower than the chest).
3.
Give 5 chest thrusts.

When a conscious choking infant becomes unconscious— mouth.
1. Lower the infant to a table or floor.
2. Call 9-1-1 or the local emergency number. Then check for an object in the
3. If the object is visible, remove it with your little finger.
4. Attempt 2 slow rescue breaths. If the breaths do not go in, reposition the airway and give breaths again.
5. Continue the sequence of giving 5 chest compressions, removing an object if you see it, providing 1 rescue breath, until you are able to get air in or EMS personnel arrive and take over.
Respiratory Arrest
Respiratory arrest is a life-threatening condition in which breathing stops. It is commonly caused by injury, illness or choking. If uncared for, respiratory arrest can lead to cardiac arrest. Body systems will progressively fail during respiratory arrest. You can keep the person’s respiratory system functioning artificially by giving rescue breathing.
Rescue breathing is a way of breathing air into a victim’s lungs to supply the oxygen he or she needs to survive. Rescue breathing is given to victims who are not breathing but still have signs of circulation. The air you take in with every breath contains about 21% oxygen but your body uses only 5% of that oxygen. The air you breathe out of your lungs and into the victim’s lungs contains about 16% oxygen, enough to keep the victim alive.
A resuscitation mask or face shield (also known as a breathing barrier) may reduce the risk of disease transmission between the responder and the victim.
Adult Rescue Breathing
1.
Check scene, then check person
2.
Tap shoulder and shout, “Are you OK?”
3.
No response, send someone to call 9-1-1
4.
Open airway (tilt head, lift chin), check for signs of life (movement and breathing) for no more than 10 seconds
5.
If no signs of life, give 2 rescue breaths
6.
Check pulse
7.
If there is a pulse, give 1 rescue breath every 5 seconds for about 2 minutes.
8.
Recheck pulse and breathing.

Child Rescue Breathing
1. Check scene, then check person
2. Tap shoulder and shout, “Are you OK?”
3. No response, send someone to call 9-1-1
4. Open airway (tilt head, lift chin), check for signs of life (movement and breathing) for no more than 10 seconds
5. If no signs of life, give 2 rescue breaths
6. Check pulse
7. If there is a pulse, give 1 rescue breath every 3 seconds for about 2 minutes.
8. Recheck for signs of life and a pulse about every 2 minutes.
Infant Rescue Breathing
1.
Check scene, then check infant
2.
Obtain consent from parent or guardian, if present
3.
Flick foot or tap shoulder and shout, “Are you OK?”
4.
No response, call 9-1-1. If alone – give about 2 minutes of care. Then call 9-1-
1.
5.
Open airway (tilt head, lift chin), check for signs of life (movement and breathing) for no more than 10 seconds.
6.
If no breathing, give 2 rescue breaths
7.
If breaths go in, check for pulse (and severe bleeding).
8.
If the infant has a pulse and is still not breathing, give 1 rescue breath every 3 seconds for about 2 minutes.
9.
Recheck for signs of life and a pulse about every 2 minutes.
Special Considerations
Rescue breathing is a simple skill to perform; however, several situations exist that may require special attention:
Air in the stomach causes gastric distention, which may lead to the victim vomiting
Vomiting may cause the victim to aspirate (inhalation of vomit, blood, etc. into the lungs)
- If the victim vomits, roll person onto his or her side and wipe the mouth clean before repositioning victim and continuing rescue breathing.
*Mouth-to-nose breathing
*Mouth-to-stoma breathing
*Victims with dentures
*Victims with a suspected head, neck or back injury