Respiratory distress can take many forms beyond choking and asthma. From chronic lung diseases to acute illnesses, various conditions can make breathing difficult. Understanding these issues is crucial for providing effective first aid in respiratory emergencies.
Recognizing abnormal breathing patterns and using tools like pulse oximetry are key skills. Interventions range from oxygen therapy to medication administration and teaching breathing techniques. Quick action in severe allergic reactions can be life-saving.
Respiratory Conditions
Chronic Lung Diseases
- Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that makes it hard to breathe due to airway inflammation and damage to lung tissue
- Includes emphysema which is damage to the air sacs in the lungs (alveoli) and chronic bronchitis which is inflammation of the airways
- Caused by long-term exposure to irritants like cigarette smoke, air pollution, and chemical fumes
- Cystic fibrosis is an inherited disorder that causes thick, sticky mucus to build up in the lungs and digestive tract
- Leads to frequent lung infections and difficulty breathing over time as mucus clogs airways
- Also affects pancreas function leading to digestive issues and poor growth
Acute Respiratory Illnesses
- Pneumonia is an infection that inflames the air sacs in one or both lungs, which may fill with fluid or pus
- Caused by bacteria, viruses or fungi and leads to cough with phlegm, fever, chills and difficulty breathing
- Can be life-threatening especially in infants, older adults and those with chronic illnesses
- Bronchitis is inflammation of the lining of the bronchial tubes which carry air to and from the lungs
- Acute bronchitis is usually caused by viral infections and improves within a few weeks
- Chronic bronchitis is a type of COPD with long-term inflammation and mucus production
Pulmonary Embolism
- A pulmonary embolism occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow
- Most often, the clot travels up from deep veins in the legs (deep vein thrombosis)
- Causes sudden shortness of breath, chest pain, and cough that may include blood
- Risk factors include prolonged immobility (long trips, bedrest), certain medications, smoking, cancer, and pregnancy
Respiratory Symptoms and Assessment
Abnormal Breathing Patterns
- Dyspnea, or shortness of breath, is difficulty breathing or uncomfortable breathing
- Can occur with exertion or at rest depending on severity and underlying cause
- Important to assess onset, duration, aggravating/alleviating factors, and associated symptoms
- Hyperventilation is very fast, deep breathing that can cause dizziness, numbness and tingling
- Often related to anxiety or panic attacks but can have medical causes like asthma, heart failure, or pulmonary embolism
- Assess respiratory rate and depth, mental status changes, chest pain, and ability to speak in full sentences
Pulse Oximetry
- Pulse oximetry is a noninvasive method of measuring the oxygen saturation of a patient's blood
- Uses a sensor placed on a thin part of the body, usually a fingertip or earlobe
- Normal pulse ox readings are 95-100%; below 90% indicates hypoxemia and need for supplemental oxygen
- Provides critical information about a patient's oxygenation status and response to respiratory interventions
- Factors that can affect accuracy include poor circulation, skin pigmentation, and nail polish
Respiratory Interventions
Oxygen Therapy
- Oxygen therapy provides supplemental oxygen to patients with low blood oxygen levels (hypoxemia)
- Can be delivered via nasal cannula, simple face mask, non-rebreather mask or other devices
- Flow rate and delivery method depend on patient's oxygen saturation, respiratory status and underlying condition
- Concerns with oxygen therapy include fire hazard, drying of nasal passages, and suppressed respiratory drive in some COPD patients
Bronchodilator Medications
- Nebulizer treatments deliver liquid bronchodilator medication in mist form using compressed air or oxygen
- Helps open narrowed airways to make breathing easier; common in asthma, COPD and other lung diseases
- Takes 10-15 minutes to administer medication; patient breathes normally with occasional deep breaths
- Rescue inhalers (albuterol) provide quick relief of asthma symptoms and bronchospasm
- Administered by metered dose inhaler (MDI) using a spacer device
- Patient takes 1-2 puffs as needed for cough, wheeze, chest tightness or shortness of breath
Breathing Techniques
- Pursed-lip breathing helps control shortness of breath by slowing down breathing rate and relieving tension
- Inhale slowly through nose for 2 counts with mouth closed
- Exhale slowly through pursed lips (like blowing out a candle) for 4 counts
- Especially useful during exertion and stress; promotes relaxation and more efficient breathing
- Positioning for comfort relieves breathing difficulty by optimizing lung expansion
- Sit upright in bed or chair with arms resting on pillows or overbed table
- Lean forward with elbows resting on knees while sitting (tripod position)
- Lie on side with head elevated and pillow between legs to ease breathing and reduce pressure on chest
Severe Allergic Reaction
Anaphylaxis
- Anaphylaxis is a potentially life-threatening allergic reaction that can occur within seconds or minutes of exposure to an allergen
- Triggers include foods (peanuts, shellfish), medications, latex and insect stings
- Causes the immune system to release a flood of chemicals that can lead to shock and respiratory failure
- Signs and symptoms include hives, swelling of throat and tongue, difficulty breathing, dizziness, and loss of consciousness
- Epinephrine (adrenaline) is the first-line treatment given by intramuscular injection to reduce airway swelling and improve blood pressure
- Antihistamines, steroids, and bronchodilators are also used to control symptoms
- Patients with known allergies should carry an epinephrine auto-injector (EpiPen) at all times for emergency use