# Breathing Incident



## cfman (Dec 27, 2008)

I would like to run this issue by you folks.  Please advise the steps a* lay rescuer *should take.

A female is complaining of being unable to breath, but is able to speak and it's clear she is wheezing and getting oxygen in.  She is also complaining of bad pains on the side of her abdomen and back as well as dizziness/faintness.  She has asthma but no inhaler on her person.

Aside from activating EMS immediately, how would you handle the situation as a lay rescuer?

Thanks for any advice.


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## ffemt8978 (Dec 27, 2008)

As a lay rescuer, that's about all you can do until EMS arrives.  Keep the patient calm, stay with them, and closely monitor them for any changes.


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## cfman (Dec 27, 2008)

Do you raise their legs since they complain of dizziness/faintness?  Do you put a cold ice pack or ice on their head?


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## ffemt8978 (Dec 27, 2008)

There's some contention in the current studies about elevating the legs, but consider this.  If a person is having difficulty breathing, they're going to want to go to a tripod position for comfort and you'll have a very difficult time getting them to lay down without causing an increase in anxiety and therefore an increase in respiratory rate and effort.

Why would you apply a cold pack?  The patient isn't hyperthermic, and applying cold packs to the head will do nothing to treat the root cause of their breathing problems.


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## cfman (Dec 27, 2008)

Makes sense.


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## KEVD18 (Dec 27, 2008)

if this person is a random stranger and you have no medical training:

call 911
wish them luck
carry on.

there is nothing you can do for them medically and, at least in my personal opinion, nothing you can do to comfort them. i personally derive no comfort from untrained total strangers. when im having a medical emergency, i dont get much comfort from anybody not wearing a white coat.

now, if its a friend/family obviously you're in for the long haul but thats a given.

if you can get someone having difficulty breathing to lie flat and raise their legs, then more power too you. as ff said, it doesnt quite work like that. they usually prefer to sit bolt upright or tripod.

an ice pack? might as well size and apply a traction splint.


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## traumateam1 (Dec 28, 2008)

How are they recieving oxygen? Home oxygen?

Call 9-11, thats really all you can do.


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## mycrofft (Dec 28, 2008)

*Get EMS, make sure the victim is not alone.*

You don't have to be super reassuring, just be there and if they seem to need some encouragement, give it. If they lose consciousness, follow your first aid instructions. If you have not taken first aid, do it!
Many things could cause what you describe and we don't diagnose with our heads in a sack (can't see the pt; note that to a pro they are "patients" and to laypersons they are "victims"?). Big thing is not to do something outlandish like administer medicines or do a cricothyrotomy with a steak knife etx.


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## BossyCow (Dec 29, 2008)

My initial response to this call is that its an anxiety attack. the dizziness and stomach pain tells me that its more likely hyperventilation. Based on other posts by the OP I'm not going to assume that he can tell the difference between wheezing and a noisy hyperventilation. His comment that the pt appears to be 'getting oxygen' confirms my initial assessment. 

If someone is having difficulty breathing, a layperson needs to call 911. Especially if they have a history of asthma or other respiratory issues. Loosen their clothing, keep them calm and try to keep them focusing on you. Reassure them and wait for EMS to assess them.


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## csykes (Jan 26, 2009)

To add to what has already been stated, get the person into an environment more conducive for calming, if possible; if they are suffering from anxiety, stay right there where the stressor is does nothing but makes matters worse.  With moderate to severe asthmatics, they need meds, so 911 will be the first thing done in any case because a lay responder cannot determine the cause, also, you cannot rule out a cardiac event here.


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## VentMedic (Jan 26, 2009)

BossyCow said:


> My initial response to this call is that its an anxiety attack. the dizziness and stomach pain tells me that its more likely hyperventilation. Based on other posts by the OP I'm not going to assume that he can tell the difference between wheezing and a noisy hyperventilation. His comment that the pt appears to be 'getting oxygen' confirms my initial assessment.


 
"Getting oxygen" as in ventilating or actual exchange at the cellular level?

Dizziness, faintness and stomach pains can also be signs of hypoxemia. That also makes a person very anxious. 

I would rather err on the side of caution that it is not just an anxiety attack or if it is the cause might just be something more serious. One can appear to be "hyperventilating" but without clinical lab results, tachypnea would be a more appropriate assessment term rather than the *diagnosis *of hyperventilation. 

A patient can be breathing rapid and soundling like a freight train but the PaCO2 might also be very elevated and/or a pH could be rapidly dropping from a metabolic problem such as a new onset of diabetes or something originating from the stomach.

Remember hypoxia usually precedes cyanosis. Severe respiratory failure generally occurs when arterial saturation of hemoglobin falls to 85-90 and cyanosis may appear later after that. Air trapping may keep the SpO2 slightly higher until failure occurs. Then the SpO2 may drop like a rock and so will the patient. 

But, for the layperson: call 911, position of comfort out of the way of noxious stimuli and supportive care.


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## BossyCow (Jan 26, 2009)

VentMedic said:


> "Getting oxygen" as in ventilating or actual exchange at the cellular level?
> 
> Dizziness, faintness and stomach pains can also be signs of hypoxemia. That also makes a person very anxious.
> 
> ...



I have found in most cases, you can generally assess how much is anxiety and how much is organic by addressing the one that is best handled in the field... the anxiety. By reassuring the pt, coaching them on slowing down the breathing, getting the whiney, annoying bystanders out of the room, with a true anxiety pt, you can start to see some major improvement fairly quickly. 

My post was not to dismiss the possibility of more serious underlying conditions rather to express a lack of confidence in the OP's primary assessment based on the information as presented. As an Asthmatic myself I'm well aware of the link between not being able to breathe and feeling anxious. As one doc chastized a new EMT-P who flippantly described my frequent flier COPD pt as 'he's just anxious'... "Why don't I duct tape your mouth and nose shut and we'll see how long it takes you to get anxious? Not breathing is a good time to get anxious"


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