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Breathing Emergencies Chapter 7 Breathing Emergencies A lifeguard can be called upon at any time to ● Giving back blows and chest thrusts to a respond to a breathing emergency. Therefore, conscious infant who is choking. it is important for lifeguards to know how to ● Giving chest thrusts, doing a foreign object recognize and care for a breathing emergency. check/removal and giving rescue breaths to Caring for breathing emergencies includes— an unconscious adult, child or infant who ● Performing rescue breathing for a victim has an airway obstruction. who is not breathing. ● Administering emergency oxygen, if avail- ● Giving back blows and abdominal thrusts for able and trained to do so. a conscious adult or child who is choking. 102 Lifeguarding BREATHING EMERGENCIES the air passages become constricted by a spasm of the muscles lining the bronchi or by swelling of the bronchi A lifeguard may detect a breathing emergency during the themselves. Asthma may be triggered by an allergic reac- initial assessment. A breathing emergency occurs if a tion, emotional stress or physical activity. A characteris- victim has difficulty breathing (respiratory distress) or tic sign of asthma is wheezing when exhaling. stops breathing (respiratory arrest/failure). Without ade- Emphysema is a disease in which the lungs lose their quate oxygen, hypoxia will result. Hypoxia is a condition ability to exchange carbon dioxide and oxygen efficiently, in which insufficient oxygen reaches the cells. Signs and causing a shortness of breath. symptoms of hypoxia include increased breathing and Anaphylactic shock, also known as anaphylaxis, is a heart rates, cyanosis (a condition that develops when tis- severe allergic reaction. The air passages may swell and sues do not get enough oxygen and turn blue, particularly restrict breathing. Anaphylaxis may be caused by insect the lips and nailbeds), changes in the level of conscious- bites or stings, foods, chemicals, medications or latex ness, restlessness and chest pain. Breathing emergen- allergies. Anaphylactic shock is a life-threatening cies can be caused by— condition. ● Obstructed airway (choking). ● Injury to the head, chest, lungs or abdomen. Caring for Respiratory Distress ● Illness, such as pneumonia. Lifeguards do not need to know the cause of respiratory ● Respiratory conditions, such as emphysema or distress to provide care. Whenever a victim is experienc- asthma. ing difficulty breathing— ● Heart attack. ● Summon emergency medical services (EMS) person- ● Coronary heart disease, such as angina. nel by calling 9-1-1 or the local emergency number. ● Allergic reactions (food or insect stings). ● Help the victim rest in a comfortable position that ● Electrocution. makes breathing easier. ● Shock. ● Reassure and comfort the victim. ● Drowning. ● Assist the victim with any of his or her prescribed ● Nonfatal submersion injury. medication. ● Poisoning. ● Keep the victim from getting chilled or overheated. ● Drugs. ● Administer emergency oxygen, if it is available and ● Emotional distress. trained to do so. Respiratory Distress Someone with asthma or emphysema who is in respi- A victim who is having difficulty breathing is in respira- ratory distress may try to do pursed lip breathing. Have tory distress. Signs and symptoms of respiratory distress the person assume a position of comfort. After he or she include— inhales, have the person slowly exhale out through the ● Slow or rapid breathing. lips, pursed as though blowing out candles. This creates ● Unusually deep or shallow breathing. back pressure, which can help open airways slightly until ● Shortness of breath or noisy breathing. EMS personnel arrive. ● Dizziness, drowsiness or light-headedness. ● Changes in the level of consciousness. Respiratory Arrest ● Increased heart rate. A victim who has stopped breathing is in respiratory ar- ● Chest pain or discomfort. rest, or respiratory failure. Respiratory arrest may de- ● Skin that is flushed, pale, ashen or bluish. velop from respiratory distress or may occur suddenly ● Unusually moist or cool skin. as a result of an obstructed airway, heart attack or ● Gasping for breath. other cause. If an unconscious victim is not moving or ● Wheezing, gurgling or making high-pitched noises. breathing normally but has a pulse, he or she needs ● Inability to speak in full sentences. rescue breathing. When checking an unconscious vic- ● Tingling in the hands or feet. tim, lifeguards may detect an irregular, gasping or shallow breath. This is known as an agonal breath. Injuries and other conditions, such as asthma, emphy- Do not confuse this with normal breathing. Look for sema and anaphylactic shock, can cause respiratory movement and check for breathing and a pulse during distress. the initial assessment. If the person is not moving or Asthma is a condition that narrows the air passages breathing normally but has a pulse, begin rescue and makes breathing difficult. During an asthma attack, breathing. Breathing Emergencies 103 Epinephrine Administration Approximately 2 million people in the United States Before assisting or administering epinephrine are at risk for anaphylaxis, and each year 400 to 800 to the victim— people die from anaphylactic reactions. Insect ● Summon EMS personnel. stings; penicillin; aspirin; food additives, such as sul- ● Check the label to ensure that the prescription fites; and certain foods, such as shellfish, fish and is for the victim. nuts, can trigger anaphylaxis in susceptible people. ● Ensure that the person has not already taken These reactions may be life threatening and require epinephrine or antihistamine. If so, do not ad- immediate care. A medical ID bracelet should be minister another dose unless directed by EMS worn by anyone at risk. Some possible signs and personnel. symptoms in anaphylactic victims include— ● Ensure that the prescription has not expired. ● Swelling of the face, neck, hands, throat, ● Ensure that the medication is clear and not tongue or other body part. cloudy or discolored. ● Itching of the tongue, armpits, groin or any ● Read and follow instructions provided with the body part. auto-injector. ● Dizziness. ● Redness or welts on the skin. An epinephrine auto-injector is simple and easy ● Red, watery eyes. to use. However, it needs to be accessed quickly. ● Nausea, abdominal pain or vomiting. Assisting the victim with the medication can in- ● Rapid heart rate. clude getting the pen from a purse, car, home or ● Difficulty breathing or swallowing. out of a specially designed carrier on a belt. It may ● Feelings of constriction in the throat or chest. also include taking it out of the plastic tube or as- sisting the victim with the injection into the thigh. Epinephrine is a medication prescribed to treat The standard epinephrine dose is 0.3 mg for an the signs and symptoms of these reactions. If adult or 0.15 mg for a child weighing less than someone shows any of these signs or symptoms, 45 pounds. To administer an intramuscular summon EMS personnel. injection— 1. Locate the middle of the outer thigh or the up- LIFEGUARDING TIP: Lifeguards should per arm to use as the injection site. follow local protocols or medical directives when applicable. 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. 104 Lifeguarding Epinephrine Administration (continued) 2. Grasp the auto-injector firmly and remove the safety cap. 3. Hold the auto-injector at a 90-degree angle to the victim’s outer thigh. 4. Firmly jab the tip straight into the thigh. A click will be heard. Hold the auto-injector firmly in place for 10 seconds. Continue to check the victim’s airway, breathing and circulation (ABCs). Give the used auto-injector to EMS personnel. In all cases of epinephrine administration, follow-up care and transport to a medical facility is needed. The beneficial effect of epinephrine is relatively short in duration. Someone having a severe allergic reaction may require additional 5. Remove it from the thigh and massage the in- medications that can be administered only in a jection site for several seconds. hospital. RESCUE BREATHING Rescue Breathing—Adult If an unconscious adult is not moving or breathing but Rescue breathing is a technique for breathing air into a has a pulse, begin rescue breathing. victim to give him or her oxygen needed to survive. Ex- 1. Conduct an initial assessment. haled air contains enough oxygen to keep a person alive. 2. Use a resuscitation mask and give 1 rescue breath When giving rescue breaths, take a normal breath and about every 5 seconds. breathe into the mask. Each breath should last about 1 Ⅲ Position the resuscitation mask. second and make the chest clearly rise. Give 1 rescue Ⅲ Tilt the head back and lift the chin to open the airway. breath about every 5 seconds for an adult. Give 1 rescue Ⅲ Breathe into the mask (Fig. 7-1). breath about every 3 seconds for a child or infant. Ⅲ Each rescue breath should last about 1 second and Continue rescue breathing until— make the chest clearly rise. ● The victim begins to breathe on his or her own. Ⅲ Watch the chest clearly rise when giving each res- ● Another trained rescuer takes over. cue breath. ● Too exhausted to continue. Ⅲ Do this for about 2 minutes. ● The victim has no pulse, in which case cardiopul- 3. Remove the resuscitation mask, look for movement monary resuscitation (CPR) should be initiated or an and recheck for breathing and a pulse for no more automated external defibrillator (AED) used if one be- than 10 seconds (Fig. 7-2). comes immediately available. Ⅲ If there is a pulse, but still no movement or ● The scene becomes unsafe. breathing— Breathing Emergencies 105 Fig. 7-1 Fig. 7-2 Fig. 7-3 Fig. 7-4 ● Replace the mask and continue rescue breathing.
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