FIRST AID 3 - Breathing Emergencies

FIRST AID 3 -Breathing Emergencies March 2010 CANADIAN COAST GUARD AUXILIARY - PACIFIC

ABCs • ABC stands for: Airway Breathing Circulation • This is the Primary Survey

Breathing Emergencies

Breathing Emergencies • Breathing emergencies include respiratory distress and respiratory arrest.

Causes of Respiratory Distress 1. Asthma - the air passages become narrowed - may be triggered by stress, physical activity or an allergic reaction to food, pollen, a drug, or an insect sting. 2. Medical illnesses - heart failure, pneumonia, emphysema, bronchitis or high fever can cause distress. Rapid breathing or hyperventilation can be caused by fear, anxiety, or great excitement and occurs more often in tense or nervous people.

Causes of Respiratory Distress 3. Chest trauma or injuries - these are major cause of death - Chest injuries caused by collisions, falls, sport mishaps and other penetrating or crushing forces. Chest injuries can cause a breathing emergency if the lungs are crushed by the ribs or punctured by a penetrating wound.

Causes of Respiratory Distress A wound penetrating the rib cage may allow air to enter the chest, through the wound and result in serious internal bleeding. 4. Anaphylactic reaction Anaphylaxis is a severe allergic reaction, possibly causing air passages to swell, making breathing difficult.

Causes of Respiratory Arrest 1. An obstructed airway (choking) 2. Illness (such as pneumonia) 3. Respiratory conditions (such as emphysema or asthma 4. Electrocution 5. Shock 6. Drowning 7. Heart attack or heart disease

Causes of Respiratory Arrest 8. Injury to the head, chest or lungs 9. Severe allergic reaction to food, or insect bite 10. Drugs and alcohol 11. Poisoning, such as inhaling or ingesting toxic substances

Signs and Symptoms of Respiratory Distress • The casualty may seem unable to catch their breath or may be gasping for air. • Breathing may be faster or slower than normal. • Breathing may be unusually deep or shallow. • The casualty may make unusual noises such as wheezing or gurgling, or high pitched sounds.

Signs and Symptoms of Respiratory Distress • The casualty’s skin may be unusually moist and flushed, later appearing pale or bluish as the oxygen level in the blood falls. • The casualty may feel dizzy or light headed. • The casualty may feel pain in the chest or tingling in the hands or feet. • The casualty may appear apprehensive, fearful, or very anxious.

Signs and Symptoms of Asthma • Wheezing when exhaling

Signs and Symptoms of Hyperventilation Caused by Anxiety • Shallow rapid breathing. • Casualty says they cannot get enough air or is suffocating. • Casualty is fearful and apprehensive or confused. • Dizziness and numbness or tingling of fingers and toes.

Signs and Symptoms of Allergic Reaction • Previous allergic episodes • Rash, hives, itching • A feeling of tightness in the chest and throat. • Swelling of the lips, face, ears, neck, and/or tongue. • Wheezing when exhaling, or high pitched noises when inhaling. • Weakness, dizziness or confusion. • Nausea, vomiting

Signs and Symptoms of Penetrating Chest Injury • Difficulty breathing • Bleeding from an open chest wound. • A sucking sound coming from the wound with each breath. • Severe pain at the site of the injury. • Obvious deformity, such as that caused by a fracture. • Coughing up blood.

Signs and Symptoms of Respiratory Arrest • Unconsciousness. • Bluish appearance of the face. • Absence of chest and abdominal movement other than the occasional attempt to breath. • Absence of breath sounds other than the occasional gasp or gurgle.

Diagnosis of Respiratory Arrest • Open the airway and place your ear close to the persons mouth, looking at their chest. • Look listen and feel for signs of breathing: 1. Look at the chest and abdomen for movement 2. Listen for breathing sounds. 3. Feel for exhaled breath on your cheek. If none of these signs is present, the person is not breathing and is in respiratory arrest.

Initial Actions for Breathing Emergencies • In all case start with the emergency action principles. 1. Survey the scene 2. Check the person unresponsiveness, and call EHS 3. Do a primary survey and care for life threatening problems.

First Aid for Respiratory Distress • Immediate first aid is often crucial in preventing a life threatening emergency. • Respiratory distress can lead to respiratory arrest which if not immediately cared for will result in death.

First Aid for Respiratory Distress • In addition to the emergency action principles: 1. Help the casualty take an prescribed medication for their condition. This may be oxygen, an inhaler for asthma, or medication for an allergy. 2. If the casualty is conscious but unable to speak, ask yes or no questions the casualty can answer by nodding.

First Aid for Respiratory Distress Try to reduce any anxiety that may add to the casualty’s breathing difficulties. 3. Provide enough air. 4. Help the person maintain normal body temperature.

Anaphylaxis • Severe attacks are rare, but when they do so, they are a truly life threatening medical emergency. • They are caused by caused by an insect bite or sting, by contact with drugs, medications, foods, or chemicals to which the individual is allergic.

Signs and Symptoms of Anaphylaxis • An allergic reaction often occurs suddenly after contact with the substance. • Mild reactions include: 1. Swelling and redness of the skin localised near the area of contact. 2. Hives, itching, rash. • These may develop into severe reactions

Signs and Symptoms of Anaphylaxis • These severe reactions may include: 1. Swelling of the lips, ears, hands and or feet. 2. Redness of the skin generalized all over the body, such as raised, itchy, blotchy rash (hives) 3. Weakness, dizziness 4. Nausea, vomiting

Signs and Symptoms of Anaphylaxis 5. Breathing difficulty, coughing, and wheezing that can cause an obstructed airway as the throat and tongue swell. • Death can occur from a severe reaction if the casualty’s breathing is severely impaired

First Aid for Anaphylactic Shock • In all case start with the emergency action principles. 1. Survey the scene 2. Check the person unresponsiveness, and call EHS 3. Do a primary survey and care for life threatening problems.

First Aid for Anaphylactic Shock • Watch the person carefully as any allergic reaction can become life threatening. • Assess airway and breathing. • If the casualty has difficulty breathing or their throat is closing, call EHS. • Get them into the most comfortable position for breathing. • Monitor ABCs and offer reassurance.

First Aid for Anaphylactic Shock • Where the casualty has a known allergy, assist them with their Epipen kit as necessary.

First Aid for Hyperventilation • If the casualty’s breathing is rapid and there are signs and symptoms of an injury or an underlying illness or condition, get them to EHS as soon as possible.

First Aid for Hyperventilation • If the casualty’s breathing is rapid and you are certain that it is caused by emotion, such as excitement: 1. Tell them to relax and breathe slowly, which may be enough to correct hyperventilation. 2. Do NOT get them to breath into a bag. 3. If the condition does not correct itself within minutes or if the casualty becomes unconscious from hyperventilation, get to EHS.

First Aid for a Penetrating Chest Wound • This needs first aid and medical attention promptly because the conditions will worsen. • The affected lung will not work properly, breathing will become difficult, and internal bleeding will worsen. • If the wound is sucking air: 1. Cover the wound with a dressing that does not let through, such as a piece of plastic wrap or bag. Otherwise a folded cloth or clothing.

First Aid for a Penetrating Chest Wound 2. Tape the dressing in place, except for one side that remains open. This method keeps air from entering the chest cavity through the wound during inhalation, but allows it to escape during exhalation.

First Aid for Flail Chest • Flail chest is when the chest wall becomes unstable due to fractures of the breast bone, cartilage connecting ribs to the breast bone, and or the ribs. • To stabilise the chest wall and enable the casualty to breath more easily, apply a bulky dressing such as a towel to the affected area.

First Aid for Flail Chest • Secure the dressing with tape of triangular bandages. • This will allow the rib cage to move as one unit again. • Remember the fractured bone ends may puncture the lungs and cause further respiratory distress. • Continue monitoring ABCs until delivery to EHS.

Rescue Breathing for Respiratory Arrest in an Adult • Rescue breathing is breathing air into a casualty to give them oxygen so that they can survive. • In the primary survey, after you have opened up the airway if you cannot see, hear or feel any signs of effective breathing, give 2 full breaths immediately to get air into the casualty’s lungs.

Rescue Breathing for Respiratory Arrest in an Adult 1 1. To give breaths, keep the airway open with the head tilt/ chin lift. 2. Place the air mask over the casualty’s nose and mouth, and make a tight seal. 3. Next take a deep breath, and with your lips around the mouthpiece, breathe slowly into the casualty until you see their chest rise. Each breath should last 2 seconds.

Rescue Breathing for Respiratory Arrest in an Adult 2 4. Pause between each breath to take a breath yourself, and to let the air flow out of the casualty’s chest. 5. If you do not see the casualty’s chest rise and fall, as you breathe into their lungs, recheck that the head tilt/ chin lift is correct. 6. If air still does not go in, the airway is obstructed.

Rescue Breathing for Respiratory Arrest in an Adult 3 7. When you successfully delivered two rescue breaths, check for signs of circulation. If the casualty has circulation but is not breathing, continue by giving 1 breath every 5 seconds. 8. After 1 minute’s breathing (12 breaths) recheck signs of circulation to make sure the heart is still beating.

Rescue Breathing for Respiratory Arrest in an Adult 4 9. If the casualty still has circulation but is not breathing, continue rescue breathing. 10. Check for signs of circulation every few minutes.

Rescue Breathing for Respiratory Arrest in an Adult 5 DO NOT stop rescue breathing unless one of the following occurs: 1. Your personal safety is threatened. 2. The casualty begins to breathe on their own. 3. The casualty has no signs of circulation - begin CPR. 4. Another trained rescuer arrives on scene and takes over. 5. You are too exhausted to continue.

Rescue Breathing for Respiratory Arrest in a Child or Infant • Use the head tilt/ chin lift gently. • Fit the air mask over the child’s mouth and nose. (for an infant or small child the face mask may have to be upside down to best fit the infant’s face) • Use smaller breaths, and in an infant use “puffs” of air. • Breathe in only enough to make the chest rise.

Rescue Breathing for Respiratory Arrest in a Child or Infant 2 • Give 1.5 second rescue breaths at the rate of one breath every 3 seconds for a child, or one puff every 3 seconds for an infant.

Special Considerations for Rescue Breathing 1 • Avoid air getting into the stomach, by having the head tilted back far enough, by not over-inflating the lungs, and by giving long slow breaths. • Air in the stomach can cause vomiting, and in an unconscious that vomit may get into their lungs (this is called aspiration) - it hampers rescue breathing and can be fatal

Special Considerations for Rescue Breathing 2 • Vomiting may well occur even if air does not get into the stomach. • If this happen turn the casualty’s head and body together onto one side. This prevent vomit entering the lungs. • Quickly wipe the casualty’s mouth clean, turn them onto their back and continue with rescue breathing.

Special Considerations for Rescue Breathing 3 • Mouth to nose breathing is sometimes necessary where you cannot seal your mouth over the casualty’s mouth due to injuries to their mouth or jaw.

Special Considerations for Rescue Breathing 4 • Casualties with dentures should not necessarily have their dentures removed, as they can help support the casualties mouth and cheeks during rescue breaths. • If the dentures are loose, the head tilt/ chin lift may help keep them in place. • Only remove them if they become loose and block the airway or make it difficult to give breaths.

Suspected Head, Neck or Back Injuries • Suspect such injuries in any casualties who have experienced violent force. • In such cases minimise movement of the head and neck when opening the airway. • Use the jaw thrust method instead of the head tilt/ chin lift.

FIRST AID 3 - Breathing Emergencies