What to do until medical arrives: Difficulty breathing

A number of medical emergencies can arise in a jail or prison, and it may take time for a medical staff to arrive


A number of medical emergencies can arise in a jail or prison. That is why it is handy to have health care staff available to respond and treat life threatening conditions. Depending on the location of the man-down, however, it may take a while for medical staff to arrive. 

So, it is important to know what to do in the early stages of any medical emergency. This is part of a series to help corrections officers manage medical emergencies until health staff arrive to provide definitive care. I made a list of the common emergencies officers may encounter in the course of a shift. In this post we’ll tackle breathing difficulties.

Consider this emergency situation: During a fairly uneventful shift in the new admit holding area, one of the inmates point to a corner and tells you a guy is turning blue. Following the direction of his gaze, you see that one of a group recently brought in a drug bust is gasping for air and definitely looking distressed. After quickly securing the area and calling a man-down, you get a closer look and see that he has a ripped jumpsuit in the area of his left chest.

What is Going On
This person is not getting the air needed to supply necessary oxygen to his blood. This is causing the blueish cast to his skin. Oxygenated blood is bright red, giving the skin a pink tint. Blood low in oxygen is a deep blue-red and can leave skin and mucous membranes with a blue tone, called cyanosis. 

Cyanosis can come on suddenly as in this event, or can creep in slowly, as in an individual with a chronic lung condition. For dark-skinned individuals, cyanosis is best seen in the lips, gums, around the eyes and the nailbeds.

What to Be Concerned About
Oxygen powers all the body’s cells so low oxygen that comes on suddenly is an emergency situation. The ripped jumpsuit is an indication of a possible chest wound and the respiratory distress indicates a wound that has reached the lungs. The open passage from the chest cavity to the outside air causes a change in pressures that collapses the lung and draws air into the chest with each breath. This increases chest pressure and decreases lung capacity, causing the loss of oxygen.

Other causes of breathing difficulty can include choking, asthma, blood clots in the lungs, a heart attack, face or neck injury with swelling, narcotics overdose or respiratory infections such as pneumonia. Determining a likely cause of the breathing difficulty will guide your immediate actions.

Actions Until Medical Arrives
Once the cause of the respiratory difficulty is located, measures can be taken to reduce the downward spiral. An open chest wound needs to be closed immediately to stop the entry of air into the chest cavity. Medical personnel will create a three-sided sealing bandage over the wound until a chest tube can be placed. This 3-sided seal keeps air out during inhalation but allows air to escape during exhalation; relieving some of the internal chest pressure.

In the meantime, any clean cloth held over the wound will help; even a part of the torn jumpsuit will suffice. Though the best option might simply be your gloved hand placed over the wound. 

For other respiratory emergencies base actions on the cause of the distress, if known. Here are some general actions to take in any respiratory emergency.

•    Monitor airway, breathing, and pulse. If the patient has no signs of life or gasping, irregular breathing, which are agonal respirations, begin CPR.
•    If the breathing is absent or only happening a couple of times a minute, but the patient has a pulse deliver rescue breaths with a pocket mask or bag-valve mask. 
•    If you suspect narcotics overdose as a cause of absent or inadequate breathing follow local protocols for naloxone (Narcan) administration. 
•    Use the Heimlich maneuver if the circumstances of the breathing difficulty make choking a possible cause.
•    Loosen any tight clothing and help the patient find a position of comfort for best breathing.
•    Help the person use any prescribed medication (such as an asthma inhaler if KOP at your facility).

Proper treatment of medical emergencies is as much what you don’t do as what you do. Here are a few things to avoid when dealing with difficulty breathing.

•    Don’t wait to see if the patients improve before you summon medical help. Minutes are precious when the body is without oxygen.
•    Don’t offer a drink or any food. This will not help the situation.
•    Don’t force the patient to lay flat. This might make it more difficult for them to breath. 
•    If there is any chance of chest or airway trauma minimize patient movement, like the patient with the open chest wound, while waiting for help.

What to Do Before This Happens to You
Respiratory difficulty can be a life-threatening situation. It is common enough to happen sometime during your correctional career. Take these steps to be ready to manage a respiratory emergency.

•    Know the process for summoning immediate emergency assistance
•    Take a Basic Life Support class
•    Practice emergency response in your facility
•    Know were emergency equipment can be quickly located near your shift location

Finally, recognize that an inmate is struggling against restraint and complaining of difficulty breathing may indeed be having a medical emergency. An inmate that suddenly goes limp needs immediate basic life support medical assessment and likely needs advanced life support assessment and care. 

Have you had to deal with a respiratory emergency while on duty? Share your experience in the comments section below. 

About the author

Dr. Schoenly has been a nurse for 30 years and is currently specializing in correctional healthcare. She is an author and educator seeking to improve patient safety and professional nursing practice behind bars. Her web-presence, Correctional Nurse, provides information and support to those working in correctional health care. Her books, Essentials of Correctional Nursing and The Correctional Health Care Patient Safety Handbook are available in print and digital on amazon.

Follow on Twitter: www.twitter.com/lorryschoenly

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Blogging @ www.correctionalnurse.net

Professional Details @ www.linkedin.com/in/lorryschoenly

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