Difficulty breathing, how to give first aid correctly? Experts explain four situations

Author: Mi Yuhong, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Reviewer: Chen Qiling, Chief Physician, Peking University People's Hospital

Dyspnea is a common emergency condition that can be caused by a variety of diseases, from simple colds to serious lung diseases such as severe pneumonia, advanced lung cancer, pneumothorax, poisoning, etc. Understanding the characteristics of dyspnea in different situations and the correct first aid methods are crucial to improving the patient's survival rate.

Sudden dyspnea in patients with severe pneumonia is often a signal that the disease has progressed to a serious stage. Pneumonia is an inflammation of the lungs caused by bacterial or viral infection. When the infection further invades the alveoli and causes exudation of lung tissue, pneumonia can be diagnosed. The difference between severe pneumonia and ordinary pneumonia is that the former is manifested in that the gas exchange function of the lungs is severely affected, mostly manifested as stubborn and difficult-to-correct hypoxemia, and carbon dioxide retention may also occur. The development of severe pneumonia usually has triggers such as cold or a history of upper respiratory tract infection in the early stage, which can be influenza virus infection, bacterial infection, or a mixed infection of both. Once symptoms such as dyspnea occur, patients should immediately stop daily activities to avoid aggravating the condition, and go to the hospital as soon as possible to seek professional treatment. In the hospital, in addition to ensuring that patients get enough rest and giving necessary oxygen therapy, doctors will also take targeted anti-pathogen (such as antiviral or antibacterial) treatments according to different pathogens, and ensure that other organs are protected from further hypoxia during the period to prevent multiple organ failure.

For patients with advanced lung cancer, dyspnea may be one of the direct consequences of disease progression. Lung cancer is a malignant tumor that originates from lung tissue. As the tumor grows, it may directly block the airway or compress the surrounding lung tissue, causing air to be unable to smoothly enter and exit the lungs or enter the blood, thereby causing dyspnea. In addition, lung cancer may also cause pleural metastasis, resulting in a large amount of pleural effusion, further limiting the expansion capacity of the lungs. Patients with advanced lung cancer may also lose their gas exchange function due to tumor tissue replacing normal alveoli, causing severe hypoxemia. For the above situations, emergency measures are mainly to take action against specific causes, such as extracting effusions through thoracentesis to relieve pressure, or using stents to support narrow airways to solve external obstruction problems. However, long-term solutions still need to rely on the treatment of the tumor itself, including surgery, radiotherapy, and chemotherapy. It is worth noting that patients with lung cancer are often in a hypercoagulable state and are prone to pulmonary embolism. Therefore, during the treatment process, doctors need to carry out necessary anticoagulant therapy according to the specific situation to prevent new thrombus formation.

Figure 1 Original copyright image, no permission to reprint

Pneumothorax is another condition that may cause acute dyspnea. It refers to the abnormal entry of air into the pleural cavity, which should maintain negative pressure, after the alveoli rupture, causing partial or complete collapse of lung tissue. According to the development process of pneumothorax, it can be divided into three types: closed, communicating and tension. Closed pneumothorax refers to a pneumothorax formed after a one-time rupture of the alveoli, which no longer continues to expand; communicating pneumothorax is caused by the presence of a large rupture or adhesion and traction between the two layers of pleura, resulting in a continuous open rupture, allowing air to freely enter and exit the pleural cavity during inhalation and exhalation; while tension pneumothorax is continuous, that is, air continues to enter the chest cavity with each breath and cannot be discharged, eventually leading to increased chest pressure, affecting the function of the heart and other important organs. Tension pneumothorax is very dangerous and can rapidly deteriorate in a short period of time, even endangering life. During first aid, medical staff need to quickly identify the type of pneumothorax and take appropriate measures, such as one-time suction of closed pneumothorax, and for tension pneumothorax, continuous chest drainage is required to restore the normal shape and function of the lungs.

Figure 2 Original copyright image, no permission to reprint

Poisoning is also a common cause of dyspnea, especially poisoning by chemicals. For example, when carbon monoxide poisoning occurs, carbon monoxide binds to one of the hemoglobin molecules. This process increases the affinity of the remaining three hemoglobins for oxygen molecules, resulting in the inability to effectively release oxygen into the tissues, thereby causing tissue hypoxia. In addition, certain drugs such as morphine can cause respiratory depression by inhibiting the respiratory control center in the central nervous system. In the face of dyspnea caused by poisoning, the first priority is to immediately remove the patient from the toxic environment and take vomiting or other detoxification measures according to the specific circumstances. For known specific poison poisoning, such as carbon monoxide poisoning, hyperbaric oxygen therapy should be given in time to accelerate the removal of carbon monoxide from the body; for other types of poisoning, specific antidotes may need to be used. In any case, it is crucial to seek medical attention in a timely manner and obtain professional medical guidance.