Breathing Problems

Victims with breathing problems may have a mild or severe blockage of their air passages, may be having a heart attack, stroke or may have experienced a serious injury leading to breathing problems.  Other breathing problems may be caused by medical conditions.  

Signs of breathing problems
  • Breathing becoming more difficult
    • Very fast or very slow
  • Weak and ineffective cough
  • Breathing is noisy
    • Makes a sound or whistle as air enters or leaves lungs
  • Inability to speak or breathe
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

Asthma

  • Most victims with asthma usually know about their condition and carry an inhaler.  
  • Sometimes they may have so much trouble breathing, they may need help with their inhaler
  • Assess the scene for safety
  • Ask if you can help – retrieve inhaler
    • Shake the medicine canister
    • Remove the cap
    • Attach a spacer, if available and you know how
    • Tilt the victim’s head back slightly and instruct to breath out slowly
    • Put the inhaler or spacer in the victim’s mouth
    • Push down on the medicine canister
    • Instruct the victim to breath in slowly and deeply as you push down
    • Instruct the victim to hold his breath for 10 seconds and then breathe out slowly
  • If no inhaler is available or victim does not get better after using the inhaler
    • Call or direct bystander to call EMS
    • Stay with the victim until EMS arrives and takes over
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Choking

When an object becomes lodged in the airway it can be considered a mild to severe airway obstruction, depending on the victim’s inability to breathe.  Good air exchange and the ability to make forceful coughing efforts, is usually present in a mild airway obstruction. If a victim experiences a mild airway obstruction, the victim should be encouraged to continue coughing until the obstruction has been removed.  

Victims with a severe airway obstruction will have poor air exchange and may need immediate care. Victims with a complete airway obstruction will have little to no air exchange and will need immediate care.

The universal sign for choking is grasping the throat.  Not all victims know or use the sign.  It is important to recognize the signs of choking and to take immediate action when a severe airway obstruction occurs. 

Signs of a severe airway obstruction include all or one the following:

  • Breathing becoming more difficult
  • Weak and ineffective cough
  • Inability to speak or breathe
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)
  • Caring for Choking victim
    Check victim for choking. Elicit response to question, “Are you choking?”  Observe signs of obstruction (speaking and breathing). 

    Responsive Adult or Child - begin Heimlich Maneuver

  • Assess the scene for safety
  • Ask if you can help
  • Call or direct bystander to call EMS
  • Move behind the victim
  • Reach around the victim’s waist with both arms just above the navel 
  • Place a fist with the thumb side against the victim’s abdomen
  • Grasp the fist with other hand
  • Press into the abdomen with quick inward and upward thrusts
  • Continue administering thrusts until the object is removed or the victim becomes unresponsive
  • If unable to move behind the victim, have victim lay on the ground and administer abdominal thrusts using both hands in the same location as if they were standing
  • If victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call EMS - begin CPR
    • Continue CPR cycle until a second rescuer or EMS takes over, you are too tired to continue, or victim begins breathing
    • If victim begins breathing, place in recovery position until EMS arrives

Pregnant women should NOT be given the Heimlich Maneuver from behind, but rather given abdominal thrusts to victim while she is lying on the ground.   

    Non-responsive Adult or Child – begin CPR

  • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
  • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

     Infant choking - observe signs of obstruction (speaking and breathing) 

  • Assess the scene for safety
  • Call or direct bystander to call EMS
  • Support the infant’s head, neck, and back with hand and forearm
  • Use thigh to support your arm
  • Give five strong back blows
  • Turn the infant over, supporting the head and neck, using your leg or nearby object
  • Check mouth and throat for obstruction
  • Give five chest compressions, using two fingers and check airway again
  • Repeat these steps until the object is removed
  • If victim begins breathing, place in recovery position until EMS arrives
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

Allergic Reactions

People have allergic reactions to many things, including foods, insect stings and bites.  Although many allergic reactions are mild, some can become severe within minutes. People who have severe allergies may carry an epinephrine pen.  Some states and organizations permit first aid rescuers to help people use their epinephrine pens.  First aid rescuers can help administer an epinephrine injection, if permitted to do so by their state regulations and/or company. 

    ***Anaphylaxis is the most severe form of allergic reaction.  It has a rapid onset and may cause death.  

Signs and Symptoms of Allergic Reaction

  • Difficulty breathing
    • very fast or very slow
    • noisy and/or wheezing
  • Inability to speak or breathe
  • Swelling and itching skin
  • Facial and/or tongue swelling
  • Low blood pressure
  • Vomiting 
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

    Caring for Victim of Allergic Reaction

    • Asses the scene for safety
    • Call or direct a bystander to call EMS
    • Ask the victim if you can help
    • Determine if victim has epinephrine pen

    With Epinephrine Pen

    • Can help someone with a severe allergic reaction breathe more easily
    • Contains a small amount of medicine which can be injected through clothing
    • Takes several minutes to take effect
    • Given on the side of the thigh
      • Retrieve epinephrine pen
      • Hold the pen in your fist without touching either end (needle comes out of one end)
      • Push the end with the needle hard against the side of the victim’s thigh (about halfway between the hip and knee)
      • Give the injection through clothes or on bare skin
      • Hold the pen in place for approximately 10 seconds
      • Remove the needle by pulling the pen straight out  
      • Dispose of the pen properly
      • Note the time of the injection
      • Stay with victim until EMS arrives
    • If victim does not respond to first dose, and EMS does not arrive within 5-10 minutes a repeat dose may be administered
    • Remain with victim and record any changes in victim
    • Report findings to EMS when they arrive
    • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
      • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
      • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

    Without Epinephrine Pen

    • Remain with victim until EMS arrives and takes over
    • Record any changes in victim
    • Report findings to EMS when they arrive
    • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Heart Attack

A heart attack is the death or damage to the heart muscle and may lead to a victim’s death. A heart attack usually develops within the first 4 hours of after the onset of symptoms. A heart attack increases the chance of cardiac arrest in victims and unlike with a cardiac arrest, the heart usually does not stop beating. Early recognition of signs and symptoms can improve a victim’s chance of survival. 

Signs and Symptoms of a Heart Attack

  • Pain, fullness, and/or squeezing sensation of the chest
  • Jaw pain, toothache, headache
  • Shortness of breath
  • Nausea, vomiting and/or general upper abdominal discomfort
  • Heartburn and/or indigestion
  • Arm pain (commonly in the left arm, but may be both)
  • Overall fatigue
  • Sweating
  • Some victims (about ¼ of all heart attacks) are silent, without chest pain or symptoms

***Women, the elderly and people with diabetes are more likely to have atypical signs of a heart attack – ache in the chest, heartburn or indigestion, or an overall uncomfortable feeling in the back, jaw, neck or shoulder.

Caring for a Heart Attack Victim
   
 
If victim is NOT breathing:

  • Assess the scene for safety
  • Call or direct a bystander to call EMS
  • Retrieve AED, if available
  • Check breathing
  • Begin CPR
    • Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

    If victim is breathing:

  • Assess the scene for safety
  • Call or direct bystander to call EMS
  • Ask if you can help
  • Encourage victim to remain calm and in a comfortable position (recovery position if possible)
  • Offer 1 adult dose or 2 low dose aspirin, if certain the victim is experiencing a heart attack and has no known allergy
  • Stay with victim until EMS arrives and takes over 
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all - begin CPR
    • Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 minute