by Leonard Marks, MD
At least two or three times a year in my meandering as a coach, referee, or fan I am called to help a child who is absolutely petrified that she (since this occurs more commonly in females than males, I will use the female pronoun) cannot breathe. This athlete is often panicking, frantic, flailing or moving her hands and arms about. sometimes clutching her upper chest or throat, breathing very rapidly, and crying If this patient is an asthmatic (as, in my experience, they commonly are) they are grabbing for their inhaler and using several puffs.
As an observer, I first look to see if, indeed, the patient cannot breathe.
- Is her chest moving freely in an out?
- If I put my hand close to her mouth as she is exhaling, can I feel air with a reasonable force?
- Although she feels she cannot get air, can I hear it move in with breathing?
- If the chest is moving and I hear air going in and out then she is breathing?
It is important to listen to her. Very commonly the athlete is making vocalizations or upper airway sounds as she is breathing. Try to talk to the athlete, asking her to relax and quiet down so you can hear.
- Do you hear obvious wheezes? Commonly with the asthmatic attack you will hear wheezing when the athlete exhales and there will be some coughing.
- Does she appear to have something caught in the throat? Ask, “Do you have something caught in your throat?” Is her voice hoarse?
If there is no wheezing or coughing and she is moving air, you are probably dealing with HYPERVENTILLATION. This is a condition in which the athlete feels she cannot get enough air and breathes too hard to compensate. Usually this will occur after a heavy run or prolonged exertion at an emotional point to the athlete during the practice or game. Sometimes it is prompted by trying to hard to condition or a game error.
Hyperventilation is scary for both the athlete and coach. For all concerned the athlete cannot get enough air and is panicked. In time she can become light headed and develop tingling of the hands and feet. This can increase the panic and cause her to breathe even harder. At time she might even pass out. This is due to a change in the acidity of the blood caused by “blowing off” all of the Carbon Dioxide. As the blood becomes less acidic (more basic), the respiratory drive increases. In other words we have a “vicious circle” in which the hard breathing causes acid base shifts which cause hard breathing.
Treatment is simple and rapidly successful.
First, try to calm the child down. I find that the parents are often very anxious and make the situation worse. Find someone on the sideline to calm the parents down. Do not let the scared parent make the child even more upset.
The definitive treatment is the old paper bag technique. Have the child breathe in and out into a paper bag, using slow, steady, deep breaths. In an emergency I have use a stocking hat, sock, my cupped hands, and even a plastic bag which I do not recommend due to its inherent dangers. This permits rebreathing of the carbon dioxide which will straighten out the blood acidity, permitting the breathing to return to normal.
Overall, the key is recognition of fast breathing in which the athlete can move air well, calming her down, and proper use of the bag. The treatment is simple and rapid with a complete return to normalcy within a couple of minutes.
