Difficulty In Breathing

(DIB)
When you can not breath, nothing else matte
Slogan of the American Lung Association

Breathing difficulty may involve:

Difficult breathing
Uncomfortable breathing
Feeling like you are not getting enough air
trouble breathing
working hard to breath
 Definition of difficult breathing
 Difficult breathing: is An increase in the effort of breathing Often use of
accessory muscles . In another way: Breathing at less than 12 or more than
20 breaths per minute with poor or irregular quality and rhythm.

 Accessory muscles: Additional muscles used to draw air into the chest
Includes the muscles of the neck, abdomen, and chest

 Retractions: The chest sinks in just below the neck or under the breastbone
with each breath . This is one way of trying to bring more air into the lungs,
and can also be seen under the rib cage or even in the muscles between the
ribs.
 Signs and symptoms
Accessory muscles include:
Neck muscles
Chest muscles
Intercostal muscles
Abdominal muscles

Retractions include:
supraclavicular
Sternal
Intercostal
Substernal

Nose flaring. The openings of the nose spreading open may

mean that a person is having to work harder to breathe.
 Other Signs and symptoms
o Breathing rate. An increase in the
number of breaths per minute
o Fever
o Nasal and chest congestion
o Chest and neck pain
o Mood change
o low oxygen levels(Hypoxia)
o Shortness of breath
o Abnormal heart rhythms
o Low body temperature
o Color changes. A bluish color seen
around the mouth, on the inside of the
lips, or on the nails
o noisy breathing (Wheezing)
o altered mental status
o Coughing
o Hoarse voice
o Nasal and chest congestion
o Heart attack
 Causes of difficulty in breathing

 Most cases of difficult breathing are due to airway, heart or lung

conditions. Your heart and lungs are involved in transporting oxygen
to your tissues and removing carbon dioxide, and problems with
either of these processes affect your breathing.

•AIRWAY causes of DIB

o Foreign body obstruction

o Severe allergic reaction
o Airway swelling (inflammation or infection)
o Airway burns
 LUNG causes of DIB

 Asthma
 Chronic obstructive pulmonary disease (COPD)
 Pulmonary hypertension is high blood pressure that affects the
arteries in the lungs.
 Pneumonia is a lung infection that can cause inflammation and a
buildup of fluid in the lung.
 pulmonary embolism (PE): is a blockage of an artery in the lungs by
a substance that has moved from elsewhere in the body through the
bloodstream
 CARDIAC causes Other causes
of DIB
 Anemia
 Cardiomyopathy (problem
 Broken ribs
with the heart muscle)
 Foreign object inhaled
 Heart failure
 Guillain-Barre syndrome
 Pericarditis (inflammation of
the tissue around the heart)  A chest wall deformity
 investigation
 allergy tests
 chest X-rays
 lung tests
 CT scans
 spirometry and methacholine challenge
tests
 arterial blood gas analysis
 Management of Difficulty in Breathing

• If suspected airway inflammation or burns:

• Keep patient calm
• Give OXYGEN if it does not upset the patient
• If patient is alert without other injuries, seated upright may
make the patient more comfortable

• If suspected choking:
• Use age-appropriate chest thrusts/abdominal thrusts/back blows
 Management of Difficulty in Breathing

• If suspected choking in infants:

• In infants, alternate between 5 back blows and 5 chest thrusts
• If suspected allergic reaction:• Remove allergen• Give
intramuscular ADRENALINE without delay • Give OXYGEN
 Management of Difficulty in Breathing

• If suspected asthma/COPD
• Give SALBUTAMOL
• Give OXYGEN if indicated
• If suspected DIB from fever
• Give ANTIBIOTICS as soon as possible
• If signs of poor perfusion, give IV FLUIDS
 Management of Difficulty in Breathing

• If suspected trauma:
• Give OXYGEN
• If tension pneumothorax or cardiac
tamponade give IV FLUIDS
• If suspected acute chest syndrome:
• Give OXYGEN
• Give IV FLUIDS
 Remember

1. • Perform ABCDEs first

2. • Treat life-threatening conditions
3. • Take a SAMPLE history
4. • Do a physical examination
5. • Think about causes
6. • Think about considerations in children
7. • Think about disposition and transport
8. • Prepare for rapid transfer for chest tube insertion
 Some references
 The World Health Report 2001:World Health Organization. (2001).
. World Health Organization.Mental health: new understanding, new hope
 Or link of pdf: https://www.who.int/emergencycare
/publications/BEC_Difficulty_in_Breathing_2018a.pdf?ua=1
 Van Slooten, E., Friedman, D. B., & Tanner, A. (2013). Are we getting the
health information we need from the mass media? An assessment of
Journal of Consumerconsumers' perceptions of health and medical news.
(1), 35-53.17, Health on the Internet
 Medical News Today : https://www.medicalnewstoday.com
/articles/324429
Thanks