Respiratory Emergencies 101 - When to Act Fast and What to Do

Today's topic could literally be a breath saver. We're covering respiratory emergencies – how to recognize them, when to act fast, and what to do while waiting for professional help. Because sometimes, knowing the difference between "wait and see" and "call 911 now" makes all the difference.

The Respiratory Red Flags

Respiratory emergencies don't always announce themselves with drama. Sometimes the subtlest signs spell trouble. Here are the warning signs that should trigger immediate action:

In Adults:

• Respiratory rate >30 breaths per minute

• Inability to speak in full sentences

• Obvious distress or anxiety

• Using accessory muscles (neck, shoulders) to breathe

• Blue discoloration (cyanosis) of lips or fingernails

• Altered mental status

• Unequal chest movement

• Sudden onset of symptoms

In Children:

• Respiratory rate >60 breaths per minute

• Retractions (skin pulling in between ribs, below ribs, or above clavicles)

• Nasal flaring

• Grunting with breathing

• Head bobbing with breaths

• "Seesaw" breathing (chest goes in when abdomen goes out)

• Decreased activity or alertness

• Poor feeding

Did You Know? Children can compensate for respiratory distress longer than adults, but when they finally decompensate, they crash much more quickly. This is why respiratory rate and work of breathing are critical vital signs in pediatric assessment!

Common Respiratory Emergencies

1. Severe Asthma Attack

What happens: Airways narrow dramatically due to bronchospasm, inflammation, and mucus production. Key signs:Wheezing, inability to speak in full sentences, anxiety, using accessory muscles to breathe. Immediate action:

• Help the person use their rescue inhaler (typically albuterol)

• Have them sit upright, slightly leaning forward

• Keep them calm - anxiety increases oxygen demand

• If no improvement after rescue inhaler or symptoms are severe, call 911

• Continue rescue inhaler every 20 minutes until help arrives if needed

"I tell my patients: If you're too breathless to walk or talk, or your rescue inhaler isn't helping within 15-20 minutes, that's not a 'wait and see' situation – that's a '911 now' moment." - Dr. Rivera, Pulmonologist

2. Choking/Foreign Body Airway Obstruction

What happens: An object partially or completely blocks the airway. Key signs: Universal choking sign (hands at throat), inability to speak or cough effectively, blue lips. Immediate action for conscious adult or child >1 year:

• Perform abdominal thrusts (Heimlich maneuver): Stand behind the person, wrap your arms around their waist, make a fist with one hand, place it just above their navel, grasp your fist with your other hand, and pull inward and upward with quick thrusts

• Continue until the object is expelled or the person becomes unconscious

• If they become unconscious, call 911 and begin CPR

For infants under 1 year:

• Hold infant face down on your forearm, supporting their jaw

• Deliver five back blows between shoulder blades

• Turn infant face up and deliver five chest thrusts

• Repeat until object is expelled or help arrives

3. Anaphylaxis

What happens: Severe allergic reaction causing swelling of airways and potentially cardiovascular collapse. Key signs:Difficulty breathing, swelling of face/lips/tongue, hives, nausea/vomiting, dizziness, rapid heartbeat. Immediate action:

• Use epinephrine auto-injector (EpiPen) if available

• Call 911 immediately

• Keep person lying flat with legs elevated unless breathing is difficult

• If breathing is difficult, allow them to sit up

• If they have a second epinephrine auto-injector, be prepared to administer it after 5-15 minutes if symptoms persist and emergency responders haven't arrived

Warning: Anaphylaxis can initially respond to treatment but then return hours later. Medical observation is essential even if symptoms improve.

4. Pulmonary Embolism

What happens: A blood clot blocks blood flow in the lungs. Key signs: Sudden shortness of breath, chest pain (often sharp) that worsens with breathing, rapid breathing and heart rate, sometimes coughing up blood. Risk factors: Recent surgery, pregnancy, birth control pills, long periods of immobility, cancer. Immediate action:

• Call 911 immediately

• Help the person rest in a position that's comfortable for breathing

• Don't give anything to eat or drink (in case emergency medications or procedures are needed)

5. Tension Pneumothorax

What happens: Air gets trapped in the pleural space under pressure, collapsing the lung and potentially shifting the heart and great vessels. Key signs: Sudden chest pain, extreme shortness of breath, decreased or absent breath sounds on affected side, potentially distended neck veins and shifted trachea (in severe cases). Common causes: Trauma, mechanical ventilation, lung disease, spontaneous in tall, thin individuals. Immediate action:

• Call 911 immediately

• Keep person calm and still

• Monitor breathing and consciousness while awaiting help

"Tension pneumothorax is one of those 'minutes matter' emergencies. I've seen patients go from talking to unconscious in less than five minutes. Recognition and rapid intervention are critical." - Emergency Medicine Physician

6. Acute Pulmonary Edema

What happens: Fluid fills the air spaces in the lungs, often due to heart failure. Key signs: Severe shortness of breath, especially when lying down, frothy pink-tinged sputum, anxiety, sweating, using accessory muscles to breathe.Immediate action:

• Call 911

• Help the person sit upright with legs dangling (reduces fluid return to the heart)

• Provide reassurance while awaiting emergency services

7. Epiglottitis

What happens: Inflammation and swelling of the epiglottis that can rapidly obstruct the airway. Key signs: Difficulty swallowing, drooling, muffled voice, sitting forward with jaw thrust out and tongue protruding, high fever. Immediate action:

• Call 911 immediately

• Keep the person calm and in position of comfort

• Do NOT attempt to examine the throat or lay the person down

• Do NOT give food or water

Medical note: While less common since Hib vaccination, epiglottitis still occurs and remains a true emergency.

When Someone Is In Respiratory Distress

While waiting for emergency services:

DO:

• Keep the person calm – anxiety increases oxygen demand

• Maintain an open airway

• Allow them to find their position of comfort (usually sitting upright, leaning forward)

• Loosen tight clothing

• Monitor breathing and consciousness

• If the person has prescribed emergency medications (like an inhaler or EpiPen), help them use them

DON'T:

• Give food or drinks

• Place a pillow under the head of someone struggling to breathe (can flex the neck and narrow the airway)

• Leave the person alone

• Assume symptoms will improve on their own

• Delay calling for help if you're unsure

For Special Populations

For Those with COPD:

• Use prescribed oxygen at their prescribed flow rate – not higher

• Help them use pursed-lip breathing

• Position with arms supported on pillows to optimize accessory muscle use

For Those with Known Asthma:

• Follow their Asthma Action Plan if available

• Note how much rescue medication they've already used

• Monitor response to treatment

For Children:

• Keep them in a position of comfort, often in parent's arms

• Never force a child to lie down if they're struggling to breathe

• Watch for "head bobbing" – a sign of severe distress

• Monitor for decreased activity level or decreased interest in surroundings

The Importance of Basic Life Support Training

Reading about emergency techniques is helpful, but nothing replaces proper training. Consider taking a Basic Life Support or First Aid course, which typically covers:

• CPR techniques

• Choking management

• How to use an AED (automated external defibrillator)

• Recognition of common emergencies

Did You Know? Current CPR guidelines emphasize the importance of chest compressions over rescue breathing for untrained responders. It's now often called "Hands-Only CPR" – push hard and fast in the center of the chest at a rate of 100-120 compressions per minute.

Wrap-Up Challenge

1. Check your home or workplace for emergency supplies – do you have what you need for respiratory emergencies?

2. Make sure everyone in your household knows when and how to call for emergency help.

3. Consider putting emergency information (including medical conditions and medications) on your phone's lock screen or in your wallet.

Coming up tomorrow in our respiratory series: "Pediatric Respiratory Care" - special considerations for tiny lungs and the little humans they belong to!

*Disclaimer: This blog post provides general information about respiratory emergencies but is not a substitute for proper emergency medical training. In a real emergency, always call your local emergency number (like 911 in the US) and follow the dispatcher's instructions.