Breathing difficulties - first aid

Definition

Breathing difficulties can be described in several different ways. You may be short of breath, unable to take a deep breath, gasping for air, or feel like you are not getting enough air.

See also: Choking

Alternative Names

Difficulty breathing - first aid; Dyspnea - first aid; Shortness of breath - first aid

Considerations

If you are having difficulty breathing, it is almost always a medical emergency (other than feeling slightly winded from normal activity like exercise or climbing a hill).

Causes

Difficulty breathing has many potential causes. Some of the most common are:

• Collapsed lung, which can happen if you have emphysema or asthma, but may also happen spontaneously in young, healthy people
• Heart attack
• Heart disease, asthma, emphysema, chronic bronchitis, or heart failure
• High altitudes, which can be a problem even in young people
• Injury to the neck, chest wall, or lungs
• Life-threatening allergic reaction
• Pulmonary embolism, or a blood clot in the lung, which can cause very abrupt and severe difficulty breathing
• Sudden illness or infections like pneumonia, acute bronchitis, whooping cough, croup, or epiglottitis

Symptoms

The following symptoms are often associated with difficulty breathing:

• Bluish lips, fingers, and fingernails
• Chest moving in an unusual way as the person breathes (may indicate an airway or chest injury)
• Chest pain (could be a heart attack or injury; sharp chest pain could be pulmonary embolism or collapsed lung)
• Confusion, light-headedness, weakness, or sleepiness
• Cough (if the person also has phlegm/sputum, this may be pneumonia; a barking cough in a child is croup)
• Fever
• Gurgling, wheezing, or whistling sounds
• Using chest and neck muscles to breathe

First Aid

1. Call 911 immediately.
2. Check the person's airway, breathing, and circulation. If necessary, begin CPR and first aid for bleeding.
3. Loosen any tight clothing.
4. Help the person use any prescribed medication (such as an asthma inhaler or home oxygen).
5. Continue to monitor the person's breathing and circulation until medical help arrives. DO NOT assume that the person's condition is improving if you can no longer hear wheezing.
6. If there are open wounds in the neck or chest, they must be closed immediately, especially if air bubbles appear in the wound. Bandage such wounds at once.
7. A "sucking" chest wound allows air to enter the person's chest cavity with each breath. This can cause a collapsed lung. Bandage the wound with plastic wrap, a plastic bag, or gauze pads covered with petroleum jelly, sealing it except for one corner. This allows trapped air to escape from the chest, but prevents air from entering the chest through the wound.

Do Not

• DO NOT give the person any foods or drinks.
• DO NOT move the person if there has been a chest or airway injury, unless it is absolutely necessary.
• DO NOT place a pillow under the person's head if he or she is lying down. This can close the airway.
• DO NOT wait to see if the person's condition improves before getting medical help. Get help immediately.

Call immediately for emergency medical assistance if

Call 911 if you or someone else has labored breathing, especially if accompanied by:

• Blue lips, fingers, or fingernails
• Chest pain
• Coughing up large amounts of blood
• Dizziness or light-headedness
• Excessive drooling
• Facial, tongue, or throat swelling
• High-pitched or wheezing sounds
• Hives
• Inability to speak
• Nausea or vomiting
• Rapid or irregular heartbeat
• Sweating

Call your doctor right away if:

• Your shortness of breath is brought on by coughing, especially productive coughing.
• Your child's cough has a barking sound.
• You have a fever, green or yellow phlegm, night sweats, weight loss, loss of appetite, or swelling in your legs.
• You are coughing up small amounts of blood.

Prevention

• Wear a medical alert tag if you have a pre-existing breathing condition, such as asthma.
• If you have a history of severe allergic reactions, carry an epinephrine pen and wear a medical alert tag. Your doctor will teach you how to use the epi pen.
• If you have asthma or allergies, eliminate household allergy triggers like dust mites and mold.
• Don't smoke and keep away from secondhand smoke. Don't allow smoking in your home.
• If you have asthma, see the article on asthma to learn ways to manage it.
• Make sure your child obtains the whooping cough (pertussis) vaccine.
• When traveling by airplane, get up and walk around once in awhile to avoid forming blood clots in your legs. Clots can break off and lodge in your lungs. If traveling by car, stop and walk around regularly.
• Lose weight. You are more likely to feel winded if you are overweight. You are also at greater risk for heart disease and heart attack.

References

Manno M. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 166.

Thomas SH, Brown DFM. Foreign bodies. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 57.