Breathing management

Dial 2222

Remember! An unresponsive patient or patient with grossly abnormal breathing or no breathing or no palpable pulse = CARDIAC ARREST

Consider the following:

Not all will be needed or appropriate for every patient. Further management will depend on the diagnosis i.e. pneumonia may need antibiotics.

  • If the patient is hypoxic it is safer to start high concentration oxygen (15L non re-breathe mask) and then wean.

    Consider humidified oxygen to aide secretion clearance.

    Please refer to Skills – Oxygen Delivery for details on different oxygen therapies.

  • Consider oral and/or nasopharyngeal suctioning if evidence of secretions and the patient is unable to cough and clear effectively.

    Please refer to Skills - Basic Airway Management.

  • In patients with reduced or absent breaths you may need to assist ventilation while waiting for help to arrive. The video will demonstrate this technique.

Bag mask ventilation technique

  • Naloxone is an opiate antagonist which rapidly reverses the effect of opiates.

  • Patient position has a significant effect on ventilation. Optimal position will vary between patients depending on restrictions, pain and ability. But aim to position in an upright position such as high semi-Fowlers.

    Frequent changes of position will aide secretion clearance and improve lung recruitment.

  • Give a Bronchodilator (salbutamol) if bronchoconstriction present.

    Saline or mucolytic to aide secretion clearance.

    If the patient requires oxygen then put the nebuliser through oxygen.

  • Refer patients for chest physiotherapy, available out of hours via switch.

  • Ensure pain free to aide deep breathing and coughing.

  • Appropriate for patients with collapse/ atelectasis.

Stop and think

  • Is the patient better or worse?

  • Do we need any more help?