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The Respiratory System and Problems
Hypoxia
Hypoxia arises when there is insufficient oxygen in the body tissues. If not treated quickly, hypoxia is potentially fatal. There are a number of causes of hypoxia, ranging from suffocation, choking or poisoning to impaired lungs or brain functions.
Recognitions:
In moderate and severe hypoxia, there will be:
Rapid breathing
Breathing that is distressed
Difficulty speaking
Grey blue skin (cyanosis) – at first, more obvious in the extremities (lips, nails, earlobes) and later, affects the rest of the body
Anxiety
Restlessness
Headache
Nausea and possibility of vomiting
Breathing may stop if hypoxia is not quickly reversed

INJURIES OR CONDITIONS CAUSING LOW BLOOD OXYGEN (HYPOXIA)
Injury or condition
Causes
Insufficient oxygen in inspired air
■Suffocation by smoke or gas ■ Changes in atmospheric pressure
Airway obstruction
■Blocking or swelling of the airway ■ Hanging or strangulation ■Something covering the mouth/nose ■Asthma ■ Choking ■Anaphylaxis
Conditions affecting the chest walls
■ crushing (by a fall of earth/sand) ■ chest wall injury with multiple rib fractures
Impaired lung functions
■ lung injury ■ lungs infections such as pneumonia
Damage to the brain or nerves that control respiration
■ head injury that damages breathing centre in the brain
Impaired oxygen uptake
■ Carbon monoxide/ cyanide poisoning

Chocking
Choking: Chocking can be defined as the condition where a foreign object is stuck in the throat, block it and cause muscular spasm.

Recognitions:
Universal sign, casualty pointing his chest / throat
Red face
Swollen face
Appearance of blood vessels
Casualty may cough, speak in mild choking
In severe condition, casualty may stop coughing, speaking

First Aid Protocol – Chocking in Adult and Child
• Encourage the casualty to cough.
• If casualty unable to cough, give up to five back blows.
• Check mouth at each step if obstruction cleared.
• If obstruction not cleared give up to five abdominal thrust.
• Dial 114 SAMU if obstruction not cleared after three cycles of 5 back blows and 5 abdominal thrust.
• Continue with 5 back blows and 5 abdominal thrust until:
(i) Obstruction cleared.
(ii) Ambulance arrives and takes over.
(iii) Casualty becomes unconscious.

First Aid Protocol – Chocking in Infant
• Give up to five back blows.
• Check mouth at each step.
• If obstruction not cleared, give up to five chest thrust.
• Dial 114 SAMU if obstruction not cleared after three cycles of 5 back blows and 5 chest thrust.
• Continue with 5 back blow and 5 chest thrust until
(i) Obstruction cleared
(ii) Ambulance arrives and takes over
(iii) Casualty becomes unconscious

N.B: Always advise a casualty who suffered from chocking to seek medical attention as the foreign object may has caused some internal injuries.

Drowning
Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.

First Aid protocol – Drowning Unconscious Casualty Who Is Breathing

Check response
No response, open airway and check breathing
Breathing present
Breathing present – perform secondary survey and treat any injury found
Replace wet clothes
Place casualty in recovery position over a blanket
Cover the casualty (to prevent hypothermia)
Dial 114 SAMU
Monitor and record vital signs until help arrives

N.B: Keep the casualty’s head lower than the rest of the body as far as practicable

First Aid Protocol – Drowning Unconscious Casualty who is NOT Breathing

• Check response.
• No response, open airway and check breathing.
• If there is no breathing, ask someone to dial 114 SAMU
• Give 5 initial rescue breaths
• Give 30 chest compressions followed by 2 rescue breaths.
Continue with 30 chest compressions followed by 2 rescue breaths until:
(i) Casualty shows signs of survival
(ii) Ambulance arrives and takes over
(iii) You are relieved by another first aider
(iv) You are too exhausted to continue

N.B: If you are alone with the casualty, perform 1 MINUTE resuscitation before calling SAMU.

Asthma
Asthma is a disease affecting the airways that carry air to and from your lungs. People who suffer from this chronic condition (long-lasting or recurrent) are said to be asthmatic.
The inside walls of an asthmatic's airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases susceptibility to an allergic reaction. (Reaction to dust, pollen, cigarette smoke)
(A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects – longer than a 3 month period)

Asthma Triggers
Airway and chest infections
Upper respiratory infections, which affect the upper airways, are often caused by cold and flu viruses and are a common trigger of asthma.
Allergens
Pollen, dust mites, animal fur or feathers, for example, can trigger asthma.
Airborne irritants
Cigarette smoke, chemical fumes and atmospheric pollution may trigger asthma.
Medicines
The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma for some people.
Emotional factors
Asthma can be triggered by emotional factors, such as stress or laughing.
Foods containing sulphites

Sulphites are naturally occurring substances found in some food and drink. They are also sometimes used as a food preservative. Food and drinks high in sulphites include concentrated fruit juice, jam, prawns and many processed or pre-cooked meals. Most people with asthma do not have this trigger, but some may. Certain wines can also trigger asthma in susceptible people.
Weather conditions
A sudden change in temperature, cold air, windy days, poor air quality and hot, humid days are all known triggers for asthma.
Indoor Conditions
Mould or damp, house dust mites and chemicals in carpets and flooring materials may trigger asthma.
Exercise – Sometimes, people with asthma find their symptoms are worse when they exercise.
Exercise
Sometimes, people with asthma find their symptoms are worse when they exercise.
Food allergies
Although uncommon, some people may have allergies to nuts or other food items, known as an anaphylactic reaction. If so, these can trigger severe asthma attacks.

What happens during an asthma attack?

During an asthma attack: the bands of muscles around the airways tighten there is increased inflammation in the linings of the airways, which swell the airways produce sticky mucus or phlegm, which can cause them to narrow further

The passages of the airways narrow, making it more difficult for the air to pass through and therefore more difficult to breathe. This can cause the characteristic wheezy noise, although not everyone with asthma will wheeze. In a life-threatening attack, there may not be a wheezy sound.
An asthma attack can happen at any time. However there are usually warning signs for a couple of days before. These include symptoms getting worse, especially during the night, and needing to use the reliever inhaler more and more.

Recognitions
Difficulty breathing
Wheezing
Difficulty speaking, leading to short sentences or whispering
Coughing
Distress and anxiety

First Aid Protocol – Asthma

• Reassure the casualty.
• Place casualty in sitting position. (Leaning forward)
• Advise to have slow and deep breathing.
• Help the casualty to take his inhaler if necessary
• If the attack persists, the casualty may take another puff at 15 minutes interval.
• If after 4 puffs, if attack did not ease, dial 114 SAMU.
• Monitor and record vital signs until reach hospital or ambulance arrives.

Penetrating Chest Wound

A sharp object penetrating the chest can cause severe damage to the orangs in the chest and the upper abdomen and this will lead to shock. The lungs are particularly susceptible to injury, either by being damaged themselves or from wounds that perforate the pleura that surround each lung. If this happens, air can enter between the membranes and exert pressure on the lung, and the lung may collapse, a condition called pneumothorax.
Pressure around the lung may build up to such an extent that it affects the uninjured lung. As a result, the casualty becomes increasingly breathless. This build-up of pressure may prevent the heart from refilling with blood properly, impairing circulation and causing shock - a condition called tension pnuemothorax. Sometimes, blood collects in the plueral cavity and puts pressure on the lungs.

Recognition:
Difficult and painful breathing, possibly rapid, shallow and uneven
Casualty feels an acute sense of alarm
Signs of cyanosis

There may also be:
Coughed-up frothy, red blood
A crackling feeling of the skin around the site of the wound, caused by air collecting in the tissues
Blood bubbling out of the wound
Sound of air being sucked into the chest, as the casualty breathes in
Veins in the neck becoming prominent

First Aid Protocol – Penetrating Chest Wound

• Assess the injury.
• Place casualty in half sitting position, leaning on the injured side.
• If no foreign object, ask casualty to cover the wound with his palm.
• Cover the wound with a dressing.(diagonal)
• Cover the dressing with a plastic bag.
• Secure firmly with adhesive tape on three edges only.
• Cover with a blanket.
• Dial 114 SAMU.
• Monitor and record vital signs until ambulance arrives.

N.B: If casualty becomes unconscious, place in recovery position with injured side facing down.

INHALATION OF FUMES (CASUALTY TRAP IN A ROOM FILLED WITH FUMES)

The inhalation of smoke, or gases such as carbon monoxide

A casualty who has inhaled fumes is likely to have low oxygen levels in his body tissues and therefore needs urgent medical attention. Remember, fumes that have built up in a confined space will quickly and will overcome anyone who is not wearing protective gear.
Smoke inhalation - any person in a confined space during a fire should be assumed to have inhaled smoke. Smoke from burning plastics, foam padding and synthetic wall coverings is likely to contain poisonous fumes.
Carbon monoxide inhalation - CO is a poisonous gas produced by burning, it has no taste or smell. It acts directly on red blood cells to prevent them from carrying oxygen. In large quantities, they can be fatal.

Sources of fumes include:
Carbon monoxide: car exhaust, fires, blocked chimney flues, emissions
Smoke: fires (smoke is low oxygen)
Carbon Dioxide: Coal pits, wells, underground tanks
Solvents/fuels: Glues, cleaning fluids, lighter fluids, camping gas and propane stoves

Recognition:
Carbon Monoxide
Headache
Confusion
Aggression
Nausea and vomiting
Incontinence
High levels:
Cyanosis
Rapid, difficult breathing
Impaired consciousness

Smoke:
Rapid, noisy and difficult breathing
Coughing and wheezing
Burning in airway
Soot in airway
Unconsciousness

Carbon dioxide:
Breathlessness
Headache
Confusion
Unconsciousness

Solvents/fuels:
Headache and vomiting
Impaired consciousness
Solvent abuse is a potential cause for cardiac arrest

First Aid Protocol – Casualty trapped in a room filled with fumes

Assess the situation
• Call for help
• Advise casualty to remain at floor level
• If it is safe, open windows, and doors
• When casualty is out the building, place him in sitting position in a safe place
• Ensure plenty of fresh air
• Cover with a blanket
• Dial 114 SAMU
• Monitor and record vital signs until ambulance arrives

N.B: Not to enter the room if not proper equipped and trained for that task.