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Are they breathing?

When someone collapses, it can be really scary. Your first thought might be whether they're still breathing or even alive. Read on to find out how to check that someone is still breathing and how to look after them while they're unconscious.




What is meant by 'unconscious'?



Consciousness is not a digital state - people are not either conscious or unconscious.


In fact, consciousness is a sliding scale that goes from fully alert to completely unresponsive.


Someone who's steadily getting drunk is a good example of this.





Why do people become unconscious?


There are lots of reasons for someone to become unconscious. The most common causes include:

  • Low blood pressure

  • Fainting

  • Seizure

  • Low blood sugar

  • Alcohol or drug use

  • Heart problems

  • Hyperventilating

  • Trauma

It's useful to know why someone has become unconscious, but it's not essential as the way you manage the person initially is the same.



The Problem with Being Unconscious


Being unconscious is not a problem in itself. However, as someone's level of consciousness drops, they'll lose control of their tongue muscle, as well as their cough and gag reflexes.


This means that if they're lying on their back, or a similar orientation, then their tongue, blood or vomit might block, or partially block their airway. This leads to reduced levels of oxygen in the blood which can be rapidly fatal if not corrected.



Having a reduced level of consciousness is in fact an airway management problem. We manage it using a 'stepwise approach', which simply means we need to do a series of actions, starting with the most basic and moving to the next step if necessary.


Don't forget to ensure safety and call for help before you dive in...


Step 1: Check for breathing


To check for breathing, we 'look, listen and feel'. We'll then know whether the person is breathing on their own, not breathing at all, or has problems with their breathing. As a result, we can then take appropriate next steps.


Look


Look for their abdomen and/or chest moving. It doesn't matter what position the person is in, something should be moving if their breathing muscles are working.


Listen


Place your ear as close to their mouth as possible and listen for any sounds. Normal breathing is quiet, so sounds indicate that there's a problem. Common sounds include:


  • Snoring - caused by their tongue being 'flapped' as they breathe

  • Bubbling or gurgling - caused by breathing through fluid such as blood, vomit and saliva

  • Stridor - a high pitched note caused by narrowing of the upper airway

  • Wheezing - caused by narrowing of the lower airways in conditions such as asthma and anaphylaxis

Feel


Use your 'feel' sense to help your other senses.


Breathing is notoriously subtle so you might need to put your hand on their abdomen and/or chest to feel for movement. You might also need to feel for their breath against your cheek while you're listening.



If the person is breathing normally (ie. quietly), go straight to Step 4. If not, move on to step 2...



Step 2: Clear their mouth


It's important to check that there's nothing in the mouth that's obstructing their airway, or that might get breathed in to their lungs. If there were any sounds, there might be something in their mouth.


Open their mouth and have a look. You might find:


A solid object


Such as dentures, food or a toy.


If this is the case, you need to remove it if you can. Either get hold of it using a pincer grip, or turn the person so that they're on their side and sweep your finger behind it.


Be careful though. There's a risk that if you can't easily get it you might push something further down their throat, making the situation worse. There's also a risk of infection, particularly if you have any open wounds on your fingers, or if you cut yourself on something in their mouth. Wear clinical gloves if you have them to hand but you don't have time to go and get them, the patient needs you.


There's also a very small risk that the patient might 'bite down' due to low oxygen levels in the blood. If you think this is happening, get your fingers out quick!


Liquids


Such as blood, vomit and saliva.


This needs to be cleared straight away. Turn the person on their side so that it drains out under gravity. If necessary, get your fingers in to help remove any solid bits, but be careful as above.



Once their mouth is clear, 'look, listen and feel' again to see if you've solved the problem.


If the person is breathing normally (ie. quietly), go straight to Step 4. If not, move on to step 3...



Step 3: Open their airway


If there are still noises, particularly snoring, or they are still not breathing, the next thing to do is 'open' their airway. This means that we are going to mechanically pull their tongue out of the back of their throat.


There are two manoeuvres that will do this:


Head-Tilt, Chin Lift


For casualties who are not suspected of having a spinal neck injury, the 'head-tilt, chin lift' manoeuvre works really well.

In practice, most airways will open just with the 'head-tilt' manoeuvre.


Demonstrate this on yourself by trying to snore with your head tipped right back, then push your lower jaw forward as well!


Jaw Thrust


For casualties who are suspected of having a spinal neck injury, the 'Jaw Thrust' manoeuvre should be used.

This is essentially just the 'chin lift' part of the previous manoeuvre, meaning that the cervical (neck) spine isn't moved.


Demonstrate this on yourself by trying to snore with your head in a neutral position and with your lower jaw pushed forward!



Once their airway is open, 'look, listen and feel' again to see if you've solved the problem.


The person should now be breathing normally (ie. quietly). If so, move on to Step 4.


However, if they're still not breathing, then they're in Cardiac Arrest. Read this post to find out more about what to do next.



Step 4: Maintain - recovery position, NHS vid


Once the person is breathing with a clear and open airway, you need to maintain it until help arrives. Keep monitoring it, and if anything changes, go back through the steps to sort the problem out.


You may also need to deal with other problems such as bleeding while you're waiting. Remember that the airway is the most important thing to manage aside from the extremely rare event of catastrophic bleeding.


If you're worried that the person may have a spinal injury, or if you can't move them fr some reason, you could just keep the person where they are and continue to manage their airway.


However, if moving the person isn't a problem, you could put them in to the 'recovery' or 'safe airway' position.


How you get someone in to this position is irrelevant. What is important is that:

  • The person is stable - bring their knee up to achieve this

  • Their head is back - keeping the tongue out of their throat

  • Their lips are lower than their throat - so that liquid drains out

Once you've moved someone in to this position, check their breathing again to make sure that it's good and then continue to monitor it until help arrives.



Summary


If someone has a lowered level of consciousness, it can be a scary situation.


However, following these simple steps will ensure that their oxygen levels are maintained, minimising any permanent damage.

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