Breathing Difficulties

In a first aid situation you are likely to encounter a casualty who has breathing difficulties. Psychological stress may trigger breathing problems that affect the blood's chemical composition, causing a range of symptoms that make the casualty feel unwell. Accidents that include a heavy impact to the chest can cause injuries that result in severe breathing difficulties.

Hyperventilation

This is a breathing difficulty that may be triggered by the stress of an accident or some other form of emotional shock. The person over-breathes, causing the level of carbon dioxide in the blood to drop. This leads to a combination of the signs and symptoms listed below:

• Fast, shallow breathing
• Feeling of pins and needles in the limbs
• Dizziness
• Cramps
• Panic attacks

Treatment

1. If the casualty is otherwise uninjured, remove her from the scene of the accident to a quiet place where there is no audience. People who are hyperventilating often subconsciously react to onlookers, making themselves worse.
2. Reassure the casualty but remain calm and speak firmly. Encourage the casualty to regain control of her breathing.
3. If the situation persists, and you are certain that there is no other underlying condition such as asthma or chest injury, let the casualty inhale her own breathed-out air from a paper bag. This air contains more carbon dioxide and this will help restore the balance of oxygen and carbon dioxide in the blood.
4. Call a doctor or ambulance if symptoms do not disappear. Do not slap the casualty - she may become violent and attack you, and you run the risk of being charged with assault.

Chestinjuries

Serious injuries following an accident, or the aftermath of any illnesses causing problems with breathing, can lead to the lung collapsing. Air enters the space between the lung and the chest wall, making breathing very difficult. In severe cases, the pressure affects the uninjured lung and the heart, causing a tension pneumothorax, a condition requiring urgent medical attention if the casualty is to survive.

Chest injuries with more than one broken rib will often result in the casualty having difficulty in breathing as the chest wall is unable to move effectively. There may also be an open break on the chest wall where ribs have sprung out. Remember that the ribs extend around the back and there may be injuries here as well as on the front.

Chest injuries may be accompanied by a sucking wound to the chest. Here there is a direct passage between the outside and the lungs, often caused by a puncture injury from a sharp object pushing through the chest wall.

Signs and symptoms of collapsed lung and other chest injuries

• History of chest impact or recent illness affecting breathing
• Chest rises as the person breathes out(paradoxical breathing)
• Swelling or indentation along the line of the ribs
• Open fractures
• Difficulty in breathing
• Pain on breathing
• Shock, as there is likely to be some degree of internal bleeding
• Bright red, frothy blood coming from the mouth and/or nose. (This is an indication of a punctured lung as oxygenated blood is escaping from the respiratory system. There may or may not be an associated sucking wound to the chest.)
• Sucking wound to the chest

Treatment

Ensure that an early call for emergency medical help has been made. If the casualty is conscious, she will often find it easier to breathe if sitting up. Help the casualty into a sitting-up position if possible and provide support to remain in this position comfortably. If you can determine the side of the injury, lean the casualty to the injured side. This helps relieve pressure on the good lung, allowing the casualty to breathe a little easier.

If there is an open sucking wound to the chest, cover this up as soon as possible. The best cover comes from using plastic sealed on three sides over the wound area. Help the casualty remove blood from her mouth. If the person becomes unconscious, place into the recovery position on the injured side and monitor breathing carefully. Treat any open wound once the person is in the recovery position. Treat any broken ribs.