A few months ago, me and my family were on a train traveling to Bangalore. It was a dusty windy evening and the cabins around were all quiet except for the regular sound of the billowing engine. Few hours into the journey, we heard a great commotion along the corridor. Curiosity made me walk over to the place, where I found a huge crowd of people around someone in the next coupe. It was quite impossible to get to the exact scene so I couldn’t know what was happening. Just as I decided to return back to my seat & check this out later, I heard someone calling out for any doctor or medic on-board.
Wondering if I could be of any help I answered their call. The crowd made a small way for me to hardly squeeze through & once in the coupe, I saw amongst the huge crowd, a teenager gasping for breath. He was almost pale with the effort of breathing and on the verge of losing consciousness. I immediately urged the crowd to back off as they were cutting out his limited oxygen supply. Luckily the TTR was around and came to my aid in controlling the crowd. As the crowd was clearing, I got a small plastic bag and asked the boy if he had any inhalers for asthma with him, luckily he pointed out to his bag. On finding the inhaler, I added 10 puffs into the bag and made him take slow deep breaths with it. In a matter of minutes he seemed to have attained significant relief and it was heartening to see the kid smile in peace.
This form of asthma exacerbation isn’t any isolated or extra-ordinary situation, but if left uncared of could be potentially life-threatening! You may live days without food but not even minutes without breath! Breathlessness is a symptom that is heard very often, but seldom understood. Firstly lets see what encompasses the term breathlessness or dyspnea – it is simply a word to explain any difficulty or shortness of breath. It may occur all of a sudden (acute) or progress gradually over time (chronic). The simple way of understanding the cause of breathlessness is that it happens when the body needs more oxygen than what it is getting now and thus you compensate for this increased demand by breathing faster and harder, thus straining yourself.
Causes
Respiratory causes like asthma, chronic obstructive pulmonary disease, pneumonia (lung infection), pulmonary embolism (clot in pulmonary artery cutting of blood & oxygen supply to lungs), tuberculosis, tumor etc
Cardiac causes like pulmonary edema (fluid in lungs due to failure of pumping mechanism of heart), MI (heart attack) etc
Traumatic causes like open or closed injury to lung tissue or ribs, pneumo/hemothorax (air or blood within the protective layers of lung), foreign body aspiration (choking on any item), etc
Firts aid pointers to keep in mind in various occasions
First and foremost do not panic or make the patient panic
Keep the patient in high fowler’s/propped up (siting in 90 degrees) position & avoid over crowding
In case of known asthmatic, ask for any inhaler available, add 10 puffs into a plastic bag and ask the patient to take slow deep breaths from the same
In case of choking on foreign object encourage the patient to cough continuously until the object is out & if he can’t cough perform Heimlich maneuver if trained.
In case of suspected pneumonia or chest infection never use over the counter medicine, visit doctor immediately.
In case of nasal congestion causing breathlessness try steam inhalation through each nostril for 10 mins each along with saline nasal drops.
In case of severe allergic reaction, remove the irritant whether food, medicine, etc,
if you carry an Epipen (pre-filled injections with adrenaline) use it or consult doctor immediately.
In case of suspected heart attack, keep the patient away from exertion and use the emergency tablet (isosorbide dinitrate) under the tongue- only if earlier prescribed by doctor for the patient & consult doctor immediately.
Always carry all allergic food & medicine list with you to where ever you go
Prevention is always better than cure
If you are aware you have a condition causing breathlessness or impending breathlessness, carry your medications with you
Wear a medic alert tag which has a small slip mentioning your disease and the emergency contact numbers
Ensure you have your inhalers with you if you are an asthmatic
Take the preventive vaccines available like pneumococcal vaccine to prevent infections for susceptible patients
Get adequate exercise & avoid obesity
Get regular health check ups to keep any risks under control
Avoid or quit active & passive smoking, as this is the sole culprit for exacerbating almost all causes of shortness of breath.
Wear face mask whenever there is lot of dust
Any unconscious vomiting patient has to be put on left lateral position/ recovery position to avoid aspiration to lungs
A patient who is prone to develop allergic asthma have to know their triggering factors by doing a skin/blood allergic test & try to stay away from these allergens.
Anti-pneumonia vaccination:
When asked about anti-pneumonia vaccination, Dr Danish Salim said that it is advised only for people who are more than 55 years, orfor immuno-compromised persons. "Immuno-compromised people are those with diseases like HIV, the ones who are on steroids for a long time. Apart from these two categories, vaccination is also given to people who are travelling to countries where there is a greater incidence of pneumonia.
“The others have enough immunity, and do not need to use the anti-pneumonia vaccine. One might still contract pneumonia, but it won't be fatal, if vaccinated. It is possible to treat pneumonia better unless the patient is very young, say under 10 years, or very old, say above 80 years,” he said.
Fowler's Position:
In Fowler’s position, the patient would be upright at 90 degrees.
Heimlich Manoeuvre:
Heimlich manoeuvre or Abdominal thrusts is a first aid procedure used to treat choking. In it, the rescuer needs to stand behind a patient and use his or her hands to exert pressure on the bottom of the diaphragm. If any foreign object is lodged in the trachea, the manoeuvre helps expel it.
(The writer is Head and Academic Director, Accident and Emergency Department, PRS Hospital).
