Breathing Difficulties (BLS)

Question 1

Explain an assessment of the respiratory system

Answer 1

An assessment of the respiratory system is carried out to ascertain the rate, depth and effectiveness of the casualties breathing. It is also used to look into the history of a patient. The assessment of airway and breathing can occur more or less simultaneously in a conscious casualty. In the less responsive casualty, look, listen and feel for no longer than 10seconds.

• LOOK - at the rise and fall of the chest
• LISTEN - for any air leaving the nose/mouth
• FEEL - for any air leaving the nose/mouth

Question 2

Explain the normal breathing rates?

Answer 2

Age	Rate (breaths per min)
Adult	     12-20
5-12yrs	     20-25
2-5yrs	     25-30
1-2yrs	     25-35
0-12mnths    30-40

Assisted ventilations (via BVM) should be considered when:

• RR<10bpm
• RR>30bpm (when clinically appropriate, I.e. unconscious patient who’s DKA, septic, respiratory failure)

Question 3

Describe respiratory arrest

Answer 3

Respiratory compromise is a broad term covering and including the stoppage of breathing. This can happen whilst the patient still has a pulse and can also be knows as respiratory arrest.

With respiratory arrest:

• The casualty has stopped breathing
• They still have a pulse
• It may be sudden or follow a slow deterioration
• If this cannot be confirmed with a pulse check then commence CPR/BLS immediately
• Although no officially recognised by the UK Resuscitation Council the recognition of respiratory arrest relies on the ability to obtain a pulse

Question 4

Explain the management of respiratory arrest

Answer 4

A casualty with respiratory arrest will usually be collapsed, unconscious and cyanosed. You will not be able to see, hear or feel breathing. Check for up to 10seconds(60 seconds in case of hypothermia).

• If the casualty is not breathing but has a pulse:
Check for breathing(if absent, seek help ASAP)
• Maintain a patients airway
• On return, give two rescue breaths and check the pulse
• Ventilate the patient with 10 breaths over 1 minute, so 1 breath every 6 seconds
• This can be achieved by mouth-to-mouth ventilation, however a face shield, a pocket mask or bag valve mask is preferred

Call for help immediately and continue with ventilation. Check the pulse after every 10 breaths and commence CPR if the pulse disappears.

Question 5

Chest examination RISENFALL

Answer 5

R - respiratory Rate
I - injuries: search for all penetrating trauma
S - symmetry of chest wall movement
E - effort of breathing

N - neck signs (TWELVE)

F - Feel: bone crepitus and surgical emphysema
A - Assess resonance
L - Listen to both sides of the chest
L - Look at the patients back

Question 6

Neck signs (TWELVE)

Answer 6

• Trachea - is it central?
• Wounds - Any wounds or haematoma?
• Emphysema - Any surgical emphysema?
• Larynx - is it intact? Is there any crepitus?
• Veins - Distended neck veins?
• Every time - Before applying a collar

Question 7

When is it not necessary to perform CPR (ROLE)?

Answer 7

• In the battlefield environment, when correct triage drills and first aid categorises patient as dead(ref-CGO’s)
• Massive cranial and cereal disruption(incompatible with life)
• Hemicorporectomy (or similar massive injury)
• Incineration(>95% full thickness burns with charing)
• Decomposition/putrefaction
• Riga mortis and hypostasis

Question 8

Describe how to use a pocket mask

Answer 8

The moulded face-mask is applied firmly over the casualties mouth and nose, so as to ensure a good seal. The rescuer ventilates the casualty through the one way valve. The design allows expired air to be directed away from the rescuer. Some pocket masks also incorporate an oxygen inlet.

Question 9

Explain how to use a bag valve mask (BVM)

Answer 9

• Use the correct size mask(one that fits comfortably and creates a tight seal around the face)and connect the bag
• Maintain patent airway(e.g. jaw thrust, OPA or NPA)
• Connect oxygen tubing and adjust flow of oxygen to 10-15l/pm
• Place the mask over the casualties nose and mouth, and apply pressure to make a seal
• If the seal is poor, the casualty will be inadequately ventilated
• Squeeze the bag firmly to ensure adequate chest movement and allow it to refill. Do not over-inflate as this may lead to air collecting into the stomach(gastric distention) and problems of regurgitation
• Aim for 10-12 breaths every minute( one squeeze every six seconds)

Question 10

Explain the one person technique for using a BVM

Answer 10

• Ensure a good seal over the mouth and nose to allow positive pressure ventilation
• Hold in place with your left thumb and index finger
• Perform a jaw thrust with your left middle and little finger behind the angle of the mandible. This means a bit of a stretch and requires practice