Chapter 3.docx

Airway and Breathing Emergencies Chapter 3 Airway and breathing emergencies When a person's breathing is affected through injury or illness, their life can be in immediate danger. As a first aider, you have to be able to recognize a breathing emergency very quickly and know what first aid to give-th...

Airway and Breathing Emergencies Chapter 3 Airway and breathing emergencies When a person's breathing is affected through injury or illness, their life can be in immediate danger. As a first aider, you have to be able to recognize a breathing emergency very quickly and know what first aid to give-the casualty's life may depend on it. Hypoxia Choking and breathing emergencies cause a lack of oxygen in the blood, a condition called hypoxia. This can damage vital tissues and eventually cause death. The causes of hypoxia are grouped under three headings: Lack of oxygen -for example: The oxygen level is low, such as at a high altitude The oxygen is displaced by other gases, such as a build-up of silo gas in a grain silo The oxygen in a small space is used up-for instance in a confined space Blocked airway-for example: A casualty chokes on a foreign object, such as food An unconscious casualty's airway is blocked by their tongue A casualty's airway becomes swollen due to an allergic reaction Abnormal heart and lung function-where the heart and lungs are not working properly due to: An illness such as pneumonia or congestive heart failure An injury preventing effective breathing A drug overdose or poisoning Effective and ineffective breathing The normal breathing rate varies for infants, children and adults. A breathing rate that is too slow or too fast is a sign of a breathing emergency. Breathing rhythm refers to the interval between breaths. In normal breathing, the intervals are even and breathing is effortless-this is regular breathing. Breathing depth refers to the amount of air moved in and out of the lungs with each breath. Signs of effective breathing include: Breathing that is quiet Equal expansion of both sides of the chest when the person inhales The person is alert and relaxed Skin colour is normal Speaking without taking a breath every few words When a person is not getting enough oxygen, the body responds by breathing faster and deeper. Signs of ineffective breathing include: The casualty is struggling for breath or gasping for air Breathing rate is too fast or too slow Breathing rhythm is irregular Breathing depth is too shallow or too deep Breathing is noisy or raspy The person is "getting tired" from trying to breathe The person is sweating Decreased level of consciousness The lips, ears and fingernail beds turn blue-called cyanosis Chest movement may be abnormal First aid for ineffective breathing Always send or go for medical help at the first sign of a breathing emergency. The first aid for ineffective breathing has two parts: Give first aid for the injury or condition and position the responsive casualty in the semi-sitting position if possible If breathing stops the casualty will become unresponsive, get medical help immediately and begin CPR This table lists some of the causes of breathing emergencies. To give first aid, first determine the cause of the breathing emergency, and then decide on the best first aid actions. Causes of airway and breathing emergencies Injuries Medical conditions Poisoning Broken ribs Asthma Inhaled poison - e.g. carbon monoxide or hydrogen sulfide Near drowning Stroke Swallowed poison - E.g. household cleaners or medication overdose Knife or gunshot wound Allergic reaction Injected poison - e.g. bee sting Burns to the face or airway Pneumonia Head injury Congestive heart failure Compression of the chest preventing chest expansion Emphysema/bronchitis Inhalation injuries Inhalation injuries happen when the casualty inhales hot steam or hot (superheated) air, smoke or poisonous chemicals. Signs and symptoms of inhalation injuries include signs of shock: Dizziness, restlessness, confusion Pallor or cyanosis Abnormal breathing rate or depth Together with a history of fire and: Noisy breathing Pain during breathing Burns on the face, especially the mouth and nose Singed hair on the face or head Sooty or smoky smell on breath Sore throat, hoarseness, barking cough, difficulty swallowing First aid for an inhalation injury Perform a scene survey and do a primary survey. Give first aid for the ABCs. Place a conscious casualty in the semi-sitting position and loosen tight clothing at the neck, chest and waist. If breathing stops, begin CPR starting with compressions. Give ongoing casualty care until handover to medical help. Breathing emergencies caused by illness Illnesses that can lead to severe breathing difficulties include asthma, allergies, chronic obstructive pulmonary disease (e.g. emphysema), congestive heart failure, stroke and pneumonia. Chronic Obstructive Pulmonary Disease {COPD) Chronic Obstructive Pulmonary Disease is a term used to describe a group of respiratory conditions such as chronic bronchitis and emphysema. Casualties present with on-going shortness of breath and appear to be struggling to breathe. Some people may use supplemental oxygen delivered by nasal prongs from a small canister they carry when they have a more serious case of COPD. Asthma Asthma is a reactive airway illness in which the person has repeated shortness of breath, characterized by wheezing and coughing. A mild asthma attack is not a health emergency and can be managed by the casualty. A severe asthma attack can be fatal and requires immediate first aid. In response to a 'trigger' the person's airway can spasm, swell and secrete thick mucus, which narrows the airway passage. Some common triggers that can cause asthma are: Colds, upper airway infections Pet dander Insect bites, stings Foods Pollen, paint and smoke Signs and symptoms of a severe asthmatic attack: Shortness of breath with obvious trouble breathing Coughing or wheezing Fast, shallow breathing Casualty sitting upright trying to breathe Bluish colour in the face (cyanosis) Anxiety, tightness in the chest Fast pulse rate, shock Restlessness at first, and then fatigue First aid for a severe asthma attack Perform a scene survey and a primary survey; send for medical help. Place the casualty in the most comfortable position for breathing. This is usually sitting upright with arms resting on a table. Help the casualty take prescribed medication. Give ongoing casualty care. If the unconscious casualty stops breathing, begin CPR. A person with asthma may carry medication in the form of a: Metered-dose inhaler (MDI) Turbuhaler Diskus® Usually the person can give themselves this medication without help. If the person needs help, a first aider can assist. An inhaler delivers a pre-measured amount of medication. Always read and follow the manufacturer's instructions. Check the prescription label to confirm the casualty's name and expiry date. To assist with a Metered Dose Inhaler The metered dose inhaler (or "puffer") is the more common method of delivering medication for asthma. Shake the container, then remove the cap. Tell the casualty to breathe out completely, Check your applicable workplace legislation/ regulations Tell the casualty to breathe in slowly and deeply-as the casualty does, the MDI will be pressed to release the medication. The MDI can be in the mouth, or just in front of the mouth. Tell the casualty to hold their breath for 10 seconds so the medication can spread out in the lungs. Then tell them to breathe normally, so the medication won't be expelled. If more doses are needed, wait at least 30-60 seconds before repeating these steps. Spacers {Aerochamber®) When the medication comes out of the inhaler, it may be deposited on the back of the throat and not reach the lungs or the casualty may be gasping for air and unable to hold their breath. To deal with this, use a spacer if available. It traps the particles of the spray, allowing the casualty to inhale more effectively over several breaths. Spacers make it simple to inhale the medication, and should always be used when available. Small children and other casualties who have difficulties coordinating proper inhalation with the release of the medication will often have spacers with them. It allows them to inhale two or three times before the medication is completely dispelled. A mask can be attached to the device to make taking the medication easier. If the casualty complains of throat irritation after using the inhaler, have them gargle or rinse the mouth with water. Severe allergic reaction An allergic reaction occurs when the immune system reacts to a substance the body encounters. Most allergies are annoying but not dangerous. Anaphylaxis is a severe allergic reaction which usually happens when a substance to which the casualty is very sensitive enters the body, although it can also be caused by exercise or have no known cause. Anaphylaxis can happen within seconds, minutes or hours of a substance entering the body. As a rule, the sooner the casualty's body reacts, the worse the reaction will be. Anaphylaxis is a serious medical emergency that needs urgent medical attention. Common early signs and symptoms of an allergy may include itchy flushed skin with hives; sneezing and a runny nose; coughing. If it's a severe reaction there may be swelling of the face and neck, especially the lips and tongue. Breathing may become difficult if the swelling is internal too. There may be nausea and vomiting and the casualty may be anxious and feeling sense of impending doom as their blood pressure drops and they go into shock. This is a true medical emergency and requires immediate first aid. First aid for a severe allergic reaction Perform a scene survey and a primary survey. Send for medical help. Place the casualty in the most comfortable position for breathing-usually sitting upright. Assist the casualty with their medication, usually this is an epinephrine auto-injector. Give ongoing casualty care. It is important to be familiar with, and follow the manufacturer's instructions, which is located on the side of the auto-injector. Check the expiry date. If the only auto-injector is an expired product, it may still save a life and should be administered anyway, if the indicated liquid remains clear. Check your applicable workplace legislation/ regulations To use the auto-injector: Remove the EpiPen® from the storage tube. Hold it firmly with the orange tip downward. Remove the blue safety release. Use the auto-injector on only the fleshy part of the mid-outer thigh. Auto-injectors can be given through lightweight clothing. Press the orange tip of the EpiPen® firmly into the mid­ outer thigh until the unit activates. Hold the auto-injector in place for several seconds, then pull it straight out. After the injection, keep the casualty warm and avoid any exertion. Call 9-1-1 as soon as you have given the first dose. If the casualty shows no improvement within 5 minutes or if their condition deteriorates before help arrives a second dose may be given if it is available. This will require a second EpiPen®. Individuals who are feeling faint or dizzy because of impending shock should be placed flat on their back unless they are vomiting or experiencing respiratory distress. It is important that the casualty does not sit or stand immediately as this could cause a drop in blood pressure. The medication will begin to wear off within 10 to 20 minutes-get medical help right away. If you or anyone else is injected by mistake, get medical help. Follow manufacturer's directions for proper care of the used device. Put the used unit back in the storage container and take it to the hospital with the casualty. Choking A person chokes when the airway is partly or completely blocked and airflow to the lungs is reduced or cut off. The choking casualty either has trouble breathing or cannot breathe at all. Open and clear airway Partly blocked airway Completely blocked airway With good air exchange, the obstruction is mild and person can still cough forcefully, breathe and speak. With poor air exchange, the obstruction is severe and the person cannot cough forcefully, has trouble breathing, or cannot speak. With a completely blocked airway, there is no air exchange-coughing, breathing and speaking are impossible. When the air supply to the lungs is cut off, the person's face immediately becomes red or "flushed". Shortly after, as the oxygen in the body is used up, the face becomes grey and the lips and ear lobes become blue. The person then becomes unconscious and eventually the heart stops beating. Signs of choking Mild obstruction Able to speak Signs of distress-eyes show fear Forceful coughing Wheezing and gagging between coughs Red or "flushed" face First aid for choking Severe obstruction Not able to speak Signs of distress-eyes show fear Weak or no coughing High-pitched noise or no noise when trying to breathe Grey face and blue lips and ears First aid for a choking adult or child Perform a scene survey. If the casualty can cough forcefully, speak or breathe, tell them to try to cough up the object. If a mild obstruction lasts for a few minutes, get medical help. If you think there might be a severe obstruction, check by asking, "Are you choking?" If the casualty cannot cough forcefully, speak or breathe, use back blows followed by abdominal thrusts to remove the blockage. Give back blows and abdominal thrusts: Support the casualty and give up to five blows between the shoulder blades using the heel of your hand. If the obstruction is not cleared, step behind the casualty ready to support them if they become unconscious. Make a fist, place it on the casualty's abdomen at the belly button, in line with the hip bones. Grasp the fist with the other hand and give five forceful inward and upward abdominal thrusts. If the object is not removed, repeat back blows and abdominal thrusts. If the casualty becomes unconscious Lower them to the ground. Call for medical help and get an AED if available. Begin chest compressions immediately. After the first 30 compressions, check the mouth. Remove any foreign object you can see. Try to give 2 breaths. If air does not go in, continue to give chest compressions and inspecting the mouth before ventilations. First aid for a choking casualty much larger than the rescuer If a choking casualty is very large or is in the late stages of pregnancy, give back blows as normal, followed by chest thrusts. While supporting the casualty, give up to five back blows between the shoulder blades, using the heel of your hand. If the obstruction is not cleared, stand behind the casualty. Keep your arms horizontal and snug up under their armpits. Place your fist against the lower half of the breastbone, thumb-side in. Hold your fist with your other hand. Pull inward forcefully. Continue giving back blows and chest thrusts until either the object is removed or the casualty becomes unconscious. Choking adult - self-help If you begin to choke on an object you may have to clear your own airway. If there are people around, get their attention, do not isolate yourself from others. Try to cough up the object. Give yourself abdominal thrusts until you can cough forcefully, breathe or speak. A second method is to use a solid object like the back of a chair, a table or the edge of a counter. Position yourself so the object is just above your hips. Press forcefully to produce an abdominal thrust. How abdominal thrusts work When you choke on something, your body tries to unblock your airway by coughing. Abdominal thrusts try to do the same thing with an artificial cough. The illustration below shows how an abdominal thrust creates a cough. An abdominal thrust pushes the diaphragm up towards the lungs very quickly. This forces the air from the lungs up the airway and hopefully blows the obstruction out. For the best effect, the fist has to be in the correct place. Keep your forearms off the abdomen and make each thrust a strong and sudden movement. First aid for a choking casualty in a wheelchair If you can reach around from behind the wheelchair, give back blows as normal, and abdominal or chest thrusts. If you cannot reach around the wheelchair: Position the wheelchair against a wall. Put the wheelchair brake on. If possible, carefully lean the casualty forward and support the shoulders. Perform five back blows between the shoulder blades, using the heel of your hand. Put the heel of one hand, with the other on top, in the middle of the abdomen and give up to five sudden, inward/ upward thrusts. Alternatively, place the heel of one hand on the center of the breastbone and give firm chest thrusts. Repeat back blows and abdominal or chest thrusts until the object is removed or the casualty becomes unconscious. If a doctor, physiotherapist or other health professional has shown you a different way of giving abdominal thrusts to a person in your care, use the recommended method. If the casualty becomes unconscious, take them out of the wheelchair. Call for medical help and get an AED. Pull the casualty forward supporting them as best as you can and lower them to the ground. Roll the casualty to the floor to a face-up position. Begin chest compressions immediately. After the first 30 compressions, check the mouth. Remove any foreign object you can see. Try to give 2 breaths and continue to give chest compressions and inspecting the mouth before ventilations. First aid for a choking infant An infant is choking when they suddenly have trouble breathing, coughing, gagging, with high-pitched, noisy breathing. Perform a scene survey and primary survey. If the baby can cough forcefully or breathe let the baby try to cough up the object. If a mild obstruction lasts for more than a few minutes, send for medical help. If the baby cannot cough forcefully, cannot breathe, makes a high-pitched noise when trying to breathe or starts to turn blue, begin back blows and chest thrusts. Secure the baby between your forearms and turn them face down. With the baby's head lower than the body, use the heel of your hand to give five forceful back blows between the shoulder blades. Turn the baby face-up and give five chest thrusts. Keep giving back blows and chest thrusts until either the airway is cleared or the baby becomes unconscious. If the baby becomes unconscious, send for medical help. Begin chest compressions immediately. After the first 30 compressions, check the mouth. Remove any foreign object you can see. Try to give 2 breaths and continue to give chest compressions and inspecting the mouth before ventilations