Chapter 7 Breathing Emergencies

Breathing Process By breathing, oxygen is transferred to the blood Blood transports oxygen to brain, other organs, muscles and other parts of body Without oxygen, brain cells can begin to die in 4 to 6 minutes (possible brain damage) 6-10 minutes – brain damage likely Over 10 minutes – irreversible brain damage certain

Breathing Emergencies 2 types 1. Respiratory distress- most common; breathing becomes difficult 2. Respiratory arrest- breathing stops Both of these emergencies are considered life threatening

Respiratory Distress Causes: Partially obstruction*illness Chronic conditions*electrocution asthma, emphysema*heart attack Injury to head, neck*allergic reactions chest, lungs, abdomen*drugs Poisoning*emotional distress Respiratory distress can lead to respiratory arrest

Signals of Respiratory Distress Trouble breathing- gasping, slow or rapid, usual noises as wheezing, gurgling Skin unusually cool or moist Flushed, pale, ashen, or bluish skin Shortness of breath Dizzy or light headed Pain in chest or tingling in hands, feet or lips Feels apprehensive or fearful

Conditions that Cause Respiratory Distress Asthma – narrows air passages and makes breathing difficult (wheezing); 3 rd ranking cause of hospitalization among those under 15 Emphysema – lungs and alveoli lose their ability to exchange carbon dioxide and oxygen effectively (worsens over time) Bronchitis – inflammation of lining of trachea, bronchi, and bronchioles; caused by buildup of mucus that obstructs passage of air and air exchange in lungs

Conditions that Cause Respiratory Distress Anaphylactic Shock – severe allergic reaction; air passages may swell and restrict person’s breathing; caused by insect stings, food, other allergens or certain medications; signals- rash, tightness in chest and throat, swelling of face, neck, tongue Hyperventilation- breathing is faster than normal; rapid breathing can upset body’s balance of oxygen and carbon dioxide

Care for Respiratory Distress Check scene to ensure your safety before you approach victim Check victim for consciousness Call Care for the conditions you find: Help victim rest comfortably Loosen clothing- open doors/windows for fresh air Make sure someone called If conscious- check for other life threatening conditions (bleeding) Interview victim and bystanders Continue to monitor ABC’s Calm and reassure victim Assist with any medications

Children and Respiratory Distress Signals Agitation Unusually fast or slow breathing Drowsiness Noisy breathing (wheezing) or high pitched sound Pale, ashen, flushed or bluish skin color Breathing trouble increases Altered level of consciousness Increased heart rate Causes Croup – viral infection causes swelling of tissues around vocal cords Epiglottitis –bacterial infection causes a severe inflammation of epiglottis

Choking Conscious Victim Most common cause of respiratory emergencies 2 types 1. Anatomical - airway blocked by tongue or swollen tissues of the mouth and throat; result from injury to neck or a medical emergency (anaphylaxis) 2. Mechanical – airway is partially or completely blocked by a foreign object such as a piece of food, small toy, or by fluids such as blood or vomit

Choking Causes Poorly chewed food Drinking alcohol Wearing dentures Eating while talking/laughing Walking, playing, or running w/food or objects in the mouth Signals Partial obstruction- can still move air to and from lungs; may cough or speak; clutch at throat w/one or both hands Complete obstruction- unable to speak, breathe, or cough

Conscious Choking Care Adult and Child Adult and Child (5 back blows, 5 abdominal thrust) Check scene and victim Introduce self and get consent – call If coughing forcefully or can speak – encourage them to continue If can’t talk or gasping, position self slightly behind victim Place one arm diagonally across chest and lean victim forward, one leg in front of victim Firmly strike victim between shoulder blades w/heel of other hand 5 times Stand behind victim, make fist w/one hand and place thumb side against middle of victim’s abdomen, just above navel Grab fist with other hand and give 5 quick upward thrusts Repeat if object is not dislodged

Conscious Choking Care Adult and Child Continue 5 back blows and 5 chest thrust until Object is forced out Adult or child can breathe or cough forcefully Adult or child becomes unconscious

Conscious Choking Care Infant Can easily swallow small objects such as pebbles, coins, beads, parts of toys, nuts, hotdogs, grapes, popcorn eating skills develop slowly Obtain consent Call if can not cough, cry or breathe Give 5 back blows followed by 5 chest thrusts Carefully position infant face down on your forearm, support head, neck w/hand, lower infant onto your thigh, keeping infant’s head lower than its chest

Conscious Choking Care Infant (cont.) Give 5 firm back blows between shoulder blades w/heel of hand Carefully position infant face up on your forearm; support infant’s head, neck w/hand; lower infant onto your thigh, keeping infant’s head lower than its chest Give 5 chest thrust Place 2 fingers on center of breastbone, about 1 finger width below imaginary line between nipples Compress chest ½ to 1 inch, 5 times

Conscious Choking Care Infant (cont.) Repeat cycles of 5 back blows and 5 chest thrusts until: Object is expelled Infant starts to breathe, cry, or cough forcefully Infant becomes unconscious EMS personnel arrive or another trained responder takes over

Special Considerations Abdominal thrusts may not be appropriate for some adults or children If you can not reach far enough around victim or victim is in late stages of pregnancy – use chest thrust – same as abdominal thrust except you place fist in middle of breastbone If you are alone and choking – give yourself abdominal thrust (same way) or lean forward and press your abdomen over any firm object (back of chair, railing, or sink)

Conscious to Unconscious Choking If choking victim (adult, child, or infant) goes unconscious – Carefully lower victim to floor Call if someone has not already called Tilt head back and open mouth grasping lower jaw and tongue between thumb and finger and lifting the jaw Look into mouth for an object, try to remove object only if it is visible with fore finger (little finger for infant) Open airway w/ head tilt/chin lift technique and attempt 2 rescue breaths If breaths do not go in, begin chest compressions

Respiratory Arrest Breathing stops W/out oxygen, heart stops functioning causing the circulatory system to fail Can keep person’s respiratory system functioning artificially by giving rescue breathing Signals: Absence of breathing Skin color ashen or cyanotic

Respiratory Arrest Care Rescue Breathing Rescue breaths are a way of breathing air into victim’s lungs to supply that person w/oxygen he/she needs to survive Rescue breaths given to victims who are not breathing but still have signs of life Air you take in w/every breath contains about 21% oxygen, but body uses only 5% of that oxygen Air you breathe out of your lungs and into victim’s lungs contains about 16% oxygen, enough to keep someone alive

Respiratory Arrest Care Rescue Breathing If you discover a child or infant is unconscious and no one is available to call 9-1-1; give 2 minutes of care and then call yourself Child and Infant: (check scene/victim, obtain consent) Open airway, no breathing, 2 breaths, circulation (pulse); Tilt head, pinch nose, give 1 breath every 3 sec. – each breath about 1 second (1 and 2 and breathe; 2 and 2 and breathe; 3 and 2 and breathe….. 40 and 2 and breathe) 40 breaths in 2 minutes Check for pulse Child – carotid artery in neck Infant – brachial artery in upper arm Continue rescue breathing as long as a pulse or other sign of life are present and child is not breathing

Respiratory Arrest Care Breathing Barriers (resuscitation masks and face shields) – create a barrier between your mouth and nose and the victim’s When to Stop Care: Scene becomes unsafe Victim begins to breathe on his/her own Another trained person takes over for you EMS personnel arrive on scene and take over You are too exhausted to continue

Special Considerations Air in the stomach – gastric distention; can make victim vomit Caused by breathing too much force or breathing too quickly Vomiting- roll onto side, bend top leg and move it forward, wipe mouth, roll back, continue Mouth to Nose breathing – close victim’s mouth and breathe into nose Mouth to Stoma – in front of neck, breathe into stoma Victims with Dentures – do not remove unless block airway Suspected head, neck, back injury – do not move them