Breathing problems can arise from underlying lung diseases such as asthma or emphysema, as well as from illnesses such as pneumonia. Be aware that the other body system problems such as heart attack, stroke, seizure, or anxiety can all result in breathing issues as well.

Signs of a breathing problem include fast or shallow breathing, noisy breathing, producing unusual sounds, or the inability to talk due to breathlessness. Persons with asthma often make a musical sound when breathing, which can be heard as wheezing. Severe allergic reactions can also cause wheezing. High-pitched sounds during inhalation may suggest a partial blockage of the upper airway.

Persons who have asthma or chronic lung disease are generally familiar on how to use their breathing medications. Common medications include albuterol and atrovent inhalers. The use of a spacer (a tube attached to the inhaler that holds the medication until the person breathes it in) can improve the effect of these medications. A person in severe distress may be unable to properly use their inhaler. Call 911 if the person appears in significant distress.

Technique for using an inhaler:

Figure 4

1. Shake the inhaler canister.
2. Place the opening of the inhaler into the spacer if available.
3. Instruct the person to fully exhale.
4. Place the spacer or inhaler into their mouth.
5. Simultaneously have the person inhale slowly and deeply while pressing down on the top of the inhaler canister.
6. Instruct the person to hold their breath for up to 10 seconds if possible.
7. Be prepared to repeat if respiratory problems persist.
8. Stay with the person until the symptoms improve or until emergency response arrives.

1. Form a fist around the pen and remove the safety release cap (Figure 5a & 5b).
2. Place the orange end of the pen against the outer mid-thigh (with or without clothing) (Figure 5c).
3. Push down hard until a click is heard or felt, and hold the pen in place for 10 seconds>(Figure 5d).
4. Remove the pen and massage the injection site for 10 seconds.
5. Properly dispose of the used device in a sharps container (Figure 5e).
6. Note the time of the injection.
7. Seek medical care.

Antihistamines, such as diphenhydramine (Benadryl®), are also important in the treatment of severe allergic reactions. Be aware that epinephrine will wear off, and the persons receiving an injection should be evaluated at an appropriate medical facility.

Heart disease remains the leading cause of death in the United States. Your prompt actions can mean the difference between life and death during a heart attack. If the person is experiencing a heart attack, blocked blood flow to the heart tissue results in muscle death. (Keep in mind the mantra: Time Is Muscle.) Prompt response and medical attention is critical in limiting damage to the heart muscle.

Chest discomfort can be described as ache, pressure, squeezing, or crushing. Certain persons such as women and diabetics are less likely to have classic signs of a heart attack. These individuals may simply experience nausea or unexplained fatigue. Shortness of breath could be the only sign of an impending heart attack for some individuals.

Denial often adds a significant delay in seeking care. Many persons argue that they are too young or too healthy to have a heart attack. Even those with minimal risk factors can suffer a heart attack.

Aspirin keeps blood clots from growing larger and may reduce the severity of a heart attack. If there is no true allergy to aspirin, no serious bleeding, and no signs that suggest a stroke, give aspirin to the person.

1. Keep the person and yourself calm.
2. Have the person sit or lie down.
3. Activate the emergency medical system by calling 911.
4. Give 2 to 4 baby aspirins or half to a full adult aspirin tablet. Make sure the aspirin is not enteric coated.
5. Be prepared to administer CPR. Heart attacks can become fatal quickly.

1. Ensure safety of the scene.
2. Help the person lie down.
3. Elevate their legs if possible.
4. If there is no rapid improvement or the person becomes unresponsive, call 911.

Low blood sugar can cause altered states of consciousness such as agitation, confusion, and loss of consciousness. Very low blood sugar can result in excessive tiredness, weakness, and even seizure-like activity.

1. Give them a sugar-containing beverage, such as fruit juice, milk, or a soft drink.
2. Encourage them to sit or lie down.
3. Call 911.
4. If their symptoms improve, encourage them to eat.

A stroke, sometimes called a brain attack, is a medical emergency caused by a blocked blood vessel or bleeding in the brain.

• Slurred or unintelligible speech
• Facial droop
• Numbness
• Weakness on one side of the body
• Difficulty walking or maintaining balance
• Loss of vision
• Severe headache
• Loss of consciousness

Stroke is a neurological emergency, so time is critical.

1. Immediately call 911.
2. Help the person sit or lie down.
3. Retrieve an AED and first aid kit.
4. Record the time that neurologic symptoms were noted and the last time the person was free of symptoms.
5. Be prepared to perform CPR if needed.

Causes of seizures or seizure-like activity include epilepsy, low blood sugar, head injury or trauma, heart disease, ingestion of a toxin, or heat-related illness.

1. Help them to the ground if needed.
2. Clear the area around them to prevent injury.
3. Place a small pillow or towel under their head.
4. Call 911.

1. Feel the person’s pulse. (Keep in mind that heart problems can cause seizure-like activity.)
2. Position the person on their side to reduce the chance of choking on vomit. (Persons may throw up after a seizure.)
3. Stay with them until help arrives.

Shock can be caused by overwhelming infection, blood loss, severe allergic reaction, severe dehydration, or heart problems. When blood flow is significantly reduced, the body does not receive an adequate supply of oxygen, and shock occurs. Victims experiencing shock may lose consciousness or fail to respond.

• Poor skin color that is pale, gray, or bluish
• Dizziness and lightheadedness
• Nausea or vomiting
• Behavior change such as agitation, confusion, or unresponsiveness
• Clammy skin

1. Activate the emergency response system by calling 911.

2. Help the person lie down and elevate their legs.

3. Cover the person with blankets to keep warm.

4. Be prepared to perform CPR.

5. Stay with the person until help arrives.