Respiration

Air is essential to life as is the action of breathing. We breathe air in and out of the lungs and expel a by-product of air. Air is taken in at the mouth or nose. The nose warms, filters and humidifies the inspired air. In the mouth and upper throat (pharynx), air shares the same passage as food. As it divides, a flap of skin (epiglottis) protects the windpipe (trachea) when we swallow to prevent the inhalation of food or drink. The voicebox (larynx) lies below the epiglottis. The trachea is surrounded by rings of cartilage and muscle which keeps it open. At its base divides into two pipes, known as bronchi. The bronchi branch and divide to form other air passages.

How We Breathe

When we breathe in, several muscles are activated. The diaphragm, a wide swathe of muscle between the chest cavity and the abdomen, and the muscles between the ribs (intercostal) contract pulling the ribs up and out, thereby expanding the lungs volume and drawing air in. When breathing out, the diaphragm and intercostal muscles relax causing the ribcage to fall and expelling air in the process.
An adult normally breathes about sixteen times per minute and children around twenty to thirty times a minute. The rate can be altered in response to stress, exercise, injury or illness. The average man can hold around twelve and a half pints of air, the average woman around eight and a half pints.

Disorders of Respiration

Any disturbance of the respiratory system can be fatal as it leads to asphyxia. Asphyxia is the medical term for suffocation, caused not only by smothering, but by any condition that can prevent air being supplied to the body. Patients may experience any of the following: (1) rapid, distressed breathing, (2) confusion, irritability and aggression which lead to unconsciousness, (3) blueness of the skin (cyanosis), and (4) respiratory and cardiac arrest.

Airway Obstruction

The airway may be obstructed by food, vomit, or other foreign material, by swelling of the throat after injury, or, in the case of an unconscious casualty, by the tongue. Generally there will be noisy, labored breathing and a reversed movement of the chest and abdomen—the chest will suck in and the abdomen will push out. There may also be some cyanosis and flaring of the nostrils.

Suffocation

This conditions occurs when air is prevented from reaching the lungs, either because there is a physical barrier that prevents air entering the nose or mouth, or because the air the casualty breathes is bad or is filled with smoke. In these cases, you must remove any obstruction to the breathing or move the casualty to fresh air. If unconscious be prepared to resuscitate. Conscious patients should be reassured and watched carefully. Usually there is no residual damage to these casualties.

Compression

In some cases, there may be compression on the chest wall which inhibits the normal breathing response. Carefully remove any objects to allow the natural responses to take over. It should be noted, however, that some patients whose chest walls are compressed seem to recover and then relapse. This is thought to be due to 'bad blood'.

Choking

A foreign object sticking at the back of the throat may either block the throat, or induce muscular spasms. Signs are difficulty of breathing and in speaking. There may also be cyanosis and signs from the casualty, for example pointing to the throat. Generally when you reach the scene the patient has already tried coughing up the offending article.
Your next step is therefore to calm the casualty by reassurance, getting them to sit and bend forward so that their head is lower than their chest. Encourage them to cough. If that does not work, then administer five sharp blows to the back with the flat of your hand between the shoulderblades. Failing this, you should try abdominal thrusts; the sudden pull up against the diaphragm compresses the chest and may expel the obstruction. Stand behind the casualty, interlock your hands below their ribcage and pull sharply inwards and upwards. If this also fails to expel the object, then try again four times, then alternate five back slaps blows with five thrusts, stopping only if the casualty begins to cough and expels the object, or becomes unconscious.

Loss of consciousness may relieve muscle spasms and the casualty may now begin to breathe. For casualties who do not, lie them down and turn them over on their sides, giving four to five blows between their shoulderblades. If the back blows fail, then kneel astride the casualty and perform abdominal thrusts. Do this by placing the heel of one hand below the ribcage and covering it with the other hand, pressing sharply inwards and upwards. Upon the return of breathing, turn the patient into the recovery position and monitor carefully. If they remain in respiratory arrest, you may have to start resuscitation.

Drowning

Death by drowning usually occurs not because the lungs are full of water, but because throat spasms prevent breathing. Only a small amount of water normally enters the lungs. The water that comes gushing out of a rescued casualty's mouth generally comes from the stomach, rather than the lungs, and should be allowed to drain naturally. Attempts to force water from the stomach may result in stomach contents being inhaled. As well as asphyxia, a drowned casualty may be suffering from the effects of cold and should also be treated for hypothermia. Water entering the lungs causes irritation and even if the casualty appears to recover quickly there is always the chance of secondary drowning, where the air passages swell some hours later.

If carrying the casualty, keep their head lower than the body to reduce risk of inhaling water. Lay them down and cover with a blanket. Open the airway, check breathing and pulse and be prepared to resuscitate if necessary. Water in the lungs may increase the resistance to resuscitation and you may have to perform this at a slower rate. Monitor them for a least a day to check for secondary drowning, which should be treated as for normal drowning.

Hanging, Strangling and Throttling

Pressure on the outside of the neck squeezes the airway and blocks the flow of air to the lungs. There may be constricting articles around the neck, marks on the neck, rapid distressed breathing and possibly congestion of the face. Remove any constricting articles from around the patient's neck, supporting the body if necessary. If the casualty is unconscious, check breathing and pulse and be prepared to resuscitate if appropriate. If not, lay them into the recovery position. If conscious, talk to them and reassure them, monitoring them for some time.

Inhalation of Fumes

The inhalation of smoke or bad air can be fatal. Rescue attempts should only be made if you aren't put at risk yourself. There may be irritation of the air passages causing spasms, swelling and resulting in rapid, distressed, noisy breathing. Headaches, confusion, aggression, nausea and vomiting are signs of bad air which may be observed in miners working in deep shafts. You should remove the casualty to fresh air, resuscitating them if necessary. The patient should then be monitored for some days after.

Breathing Difficulties

Breathing difficulties may be caused by chronic illness (such as emphysema found in miners), infections in the respiratory tracts (such as bronchitis) and by allergic reactions (such as hay fever). Sudden attacks may be the result of psychological stress (hyperventilation), chest injury or the condition known as asthma. Prompt help can do much to help breathing and ease distress.

Collapsed Lung

If air enters the space occupied by a lung, it will interfere with breathing and this may cause the lung to collapse (pneumothorax). This can occur as a result of a wound that penetrates the chest wall or can happen spontaneously because of a weakness of the lung itself. The pressure of air may also affect the action of the unaffected lung and heart. Your first task is to help the casualty into a position in which they can breathe. In less serious cases no special treatment, apart from rest, is necessary as the air is absorbed into the tissues over a period of a sevenday or more. In more severe cases of pneumothorax, surgical aspiration through a puncture wound in the chest may be immediately necessary. Full recovery is usual.

Illness

There are several illnesses of the lungs known. Some are more serious than others. All are a result of infection, whether primary or secondary. Patients should be kept separate from others to prevent the spread of the infection through the infirmary.

Bronchitis

This condition is due to the inflammation of the air passages (bronchi) and may be classified as either acute or chronic. Acute bronchitis often follows a cold or cough. Initially there is a hard and unproductive cough with a mild fever, general malaise, aching muscles and depression. After a few days the patient will begin to cough up sputum and the cough becomes less painful. Treatment includes bed rest, warmth, steam inhalation and hot drinks. Chronic bronchitis is a different disease and is the result of constant irritation of the air passages by smoke, dust and fumes. Men are more commonly affected than women. The patient is said to have chronic bronchitis if they cough up sputum for at least three months in two years. Symptoms include chronic productive cough, increasing breathlessness, wheezing and sometimes depression. The patient should stop anything that will irritate them and get plenty of fresh, clean air. Breathing exercises may help, as may areca, borage and grindelia.

Emphysema

This condition may result as a consequence of bronchitis and is common in those individuals working in a dusty environment. There is breathlessness, edema and the chest may become barrel-shaped. Wheezy breathing is common. Treatment is basically to protect the patient from infection and preserve their health as much as possible.

Pneumonia

This condition results from the inflammation of the lungs. The outflow of the fluid and cells from the inflamed lung tissue fills the airspaces, causing difficulty in breathing. In severe cases the disease may be fatal. There are two types of pneumonia—lobar and bronchopneumonia. Lobar pneumonia causes a high fever, often with delirium and if extensive the patient may become short of breath, cyanosed and lose consciousness. The sputum coughed up may be bloodstained. It is often fatal, especially when it affects both lungs. Bronchopneumonia is usually less dramatic than lobar pneumonia, but there will be a cough, difficulty in breathing and a fever. It can be fatal in elderly patients and in those already weakened by disease. Areca is the only herb known to help. On Pern, pneumonia is by and large fatal in most cases; medicine here is mostly symptomatic in treatment. There is little in the way of preventative medication, and there are no antibiotics such as penicillin.

Pleurisy

The inflammation of the lining of the lungs is known as pleurisy. It may be dry or with effusion (fluid gathering on the lungs). A number of conditions may cause it, including pneumonia, chest injury, chronic kidney failure and infections. The main symptoms are sharp, stabbing pains which are made worse by coughing or deep breathing. The patient often takes only short grunting breaths and usually exhibits fever and a painful cough. You should be able to hear a 'plural rub' when you listen to the lungs. Bed rest is the most effective treatment.

Hyperventilation

The condition of over-breathing (hyperventilation) is a common manifestation of acute anxiety and may accompany hysteria or a panic attack. It is sometimes seen in individuals who have had a fright or shock. There will be fast, deep breathing and there may be attention-seeking behaviour, with dizziness, faintness, trembling or marked tingling in the hands. Cramps may also be present in the hands and feet. Speak firmly but kindly to the casualty, leading them away to a quiet place. Breathe with them, talking them through each breath until breathing returns to its normal rate. Have someone sit with them for a few hours.

Asthma

This is a condition where the muscles of the air passages go into spasm and constrict, making breathing (especially breathing out) very difficult. Asthma attacks can be triggered by allergy or nervous tension and there may be wheezing as the casualty breaths out, distress and anxiety. There may also be cyanosis. Reassure and calm the casualty, getting them to sit down and lean slightly forward, resting on a support. Ensure a good supply of fresh air. Elecampane and grindelia have been shown to have some effect in treatment.

Others

Other breathing difficulties may be a result of a stroke, paralysis, head injuries and poisoning. Even high pressure from flying can affect the normal breathing mechanism, with *between* affecting some individuals seriously.

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