Req 5 — Choking, Asthma & Altitude

The airway is a short, narrow tube between the outside world and the lungs. It doesn’t take much to block it — a piece of food, a swollen airway, smoke inhalation, or altitude-induced fluid in the lungs can all cause the same terrifying result: the victim can’t breathe. This requirement covers five breathing emergencies:

• 5a — Choking
• 5b — Asthmatic attack
• 5c — Anaphylaxis
• 5d — Inhalation injuries
• 5e — Altitude sickness

Requirement 5a: Choking

What it is: Choking occurs when a foreign object (usually food) partially or completely blocks the upper airway, preventing adequate airflow.

Recognizing a Choking Victim

Mild choking (partial obstruction): The person can cough forcefully, speak, or cry. The airway is not completely blocked. Encourage them to keep coughing — this is the body’s best clearing mechanism. Do NOT interfere.

Severe choking (complete obstruction): The person cannot cough effectively, cannot speak, or can only produce a weak cough. May be grabbing their throat (the universal choking sign), turning blue around the lips (cyanosis), and showing panic. Cannot breathe.

First Aid for a Conscious Adult or Child (Over 1 Year)

1. Ask: “Are you choking?” If they cannot answer, act.
2. Give 5 firm back blows: Stand to the side, support the chest with one hand, and deliver 5 firm blows between the shoulder blades with the heel of your other hand.
3. Give 5 abdominal thrusts (Heimlich maneuver): Stand behind the person, make a fist, place it above the navel and below the breastbone. Grab your fist with the other hand. Give 5 quick, inward-and-upward thrusts.
4. Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the person becomes unconscious.

If the person becomes unconscious, lower them to the ground, call 911, and begin CPR. Look in the mouth before each breath — if you see the object, remove it.

Special Situations

• Pregnant or obese individual: Use chest thrusts instead of abdominal thrusts.
• Infant (under 1 year): Do NOT use abdominal thrusts. Use 5 back blows and 5 chest thrusts (two fingers on the center of the chest).
• Self-treatment: Thrust your own abdomen against the back of a chair or use your own hands for abdominal thrusts.

Requirement 5b: Asthmatic Attack

What it is: Asthma is a chronic condition in which the airways become inflamed and hypersensitive. During an attack, the airways narrow (bronchoconstriction) and produce excess mucus, making breathing difficult. Triggers include allergens, cold air, exercise, respiratory infections, and smoke.

Signs and symptoms:

• Wheezing (high-pitched whistling sound when breathing, especially on exhale)
• Shortness of breath
• Chest tightness
• Coughing — often worse at night or with exertion
• In severe attacks: inability to complete sentences, blue lips or fingertips, labored breathing using neck and chest muscles

First aid:

1. Help the person use their prescribed rescue inhaler (bronchodilator) — usually albuterol (blue inhaler). This is a fast-acting medication that relaxes the airway muscles.
2. Have them sit upright and lean forward slightly — this position opens the airways.
3. Stay calm and reassuring — anxiety worsens bronchospasm.
4. Remove the trigger if identifiable (move away from smoke, cold air, the allergen).
5. If symptoms don’t improve within 15 minutes of using the inhaler, or if this is a severe attack from the start, call 911.

When to call 911: Blue lips or fingertips (cyanosis), no relief after rescue inhaler, too breathless to speak, silent chest (no wheeze — means no airflow at all).

Prevention for Scouts with asthma: Carry a rescue inhaler at all times; know your personal triggers; warm up gradually before exercise; keep an asthma action plan accessible to adults in the troop.

Requirement 5c: Anaphylaxis

What it is: Anaphylaxis is a severe, whole-body allergic reaction that can kill within minutes. It occurs when the immune system overreacts catastrophically to an allergen — most commonly bee stings, peanuts, tree nuts, shellfish, fish, milk, eggs, or certain medications. The airway swells, blood pressure drops, and multiple body systems fail simultaneously.

Signs and symptoms (which may develop within seconds to minutes of exposure):

• Skin: Hives, flushing, itching — often appearing first
• Airway: Throat tightening, difficulty swallowing, hoarse voice, stridor
• Breathing: Wheezing, shortness of breath
• Circulation: Dizziness, rapid or weak pulse, pale or clammy skin, fainting
• GI: Nausea, vomiting, abdominal cramps
• Mental status: Anxiety, confusion, loss of consciousness

First Aid: Epinephrine First

Epinephrine (EpiPen) is the only effective treatment for anaphylaxis. Antihistamines, inhalers, and other medications are not fast enough — they do not reverse the life-threatening effects.

1. Administer epinephrine auto-injector (EpiPen) into the outer thigh (can be given through clothing). This is the FIRST action, not a last resort.
2. Call 911 immediately.
3. Lay the person flat with legs elevated (unless breathing is easier sitting up).
4. If a second dose is available and symptoms return or persist after 5–15 minutes, administer it.
5. Do NOT give epinephrine and then consider the emergency over — anaphylaxis can have a biphasic reaction where symptoms return hours later. Hospital monitoring is essential.

If no epinephrine is available: Call 911 immediately. You can give an oral antihistamine as a bridging measure, but it will not stop anaphylaxis — it only may slow the progression slightly. Prioritize getting to emergency services.

Requirement 5d: Inhalation Injuries

What it is: Inhalation injuries occur when the lungs and airway are damaged by inhaling hot gases, smoke, or toxic chemicals. They are a leading cause of death in structure fires — not the flames themselves, but what’s in the smoke.

Smoke Inhalation

Signs and symptoms: Soot around the nose or mouth; hoarse voice; stridor; coughing; eye irritation; singed nose hairs; confusion; blue lips.

First aid:

• Move the victim to fresh air immediately.
• Call 911 — even mild smoke inhalation can cause delayed pulmonary edema (fluid in the lungs) that isn’t apparent initially.
• If the victim is unresponsive, begin CPR if needed.
• Do NOT go back into a burning building to rescue someone.

Airway Burns

Breathing superheated air can burn the larynx, vocal cords, and upper airway. This is a true airway emergency — the airway can swell shut within minutes.

Signs: stridor (a harsh crowing sound), hoarseness, and difficulty breathing after being in a fire.

This is a 911 emergency. The airway may need to be secured by advanced medical providers.

Carbon Monoxide Poisoning

Carbon monoxide (CO) is an odorless, colorless gas produced by incomplete combustion — faulty heaters, generators used indoors, exhaust from vehicles in enclosed spaces. It binds to hemoglobin more effectively than oxygen, starving tissues of oxygen without any outward sign.

Signs and symptoms: Headache, dizziness, nausea, confusion, cherry-red skin (a late and unreliable sign); unconsciousness. The insidious danger: victims are often unaware they’re being poisoned.

First aid: Move to fresh air immediately. Call 911. Begin CPR if unconscious and not breathing. CO poisoning requires hyperbaric oxygen treatment in severe cases.

Prevention: Carbon monoxide detectors in sleeping areas; never run generators, grills, or camp stoves inside a tent or enclosed space.

Requirement 5e: Altitude Sickness

What it is: At higher altitudes, the air has less oxygen per breath. Most people begin to feel effects above 8,000 feet (2,400 m) — especially if they ascend rapidly. Altitude sickness is the body struggling to adjust to less available oxygen.

Forms of Altitude Illness

Acute Mountain Sickness (AMS): The mildest and most common form. Symptoms begin 6–12 hours after arrival at altitude.

• Headache (the cardinal symptom)
• Fatigue and weakness
• Loss of appetite, nausea, dizziness
• Difficulty sleeping

High Altitude Pulmonary Edema (HAPE): Fluid in the lungs. A potentially fatal escalation of AMS.

• Shortness of breath at rest
• Dry cough that may become productive (pink, frothy sputum)
• Blue lips or fingertips
• Crackling sounds in the lungs

High Altitude Cerebral Edema (HACE): Fluid on the brain. The most severe form; can be rapidly fatal.

• Severe headache unresponsive to medication
• Loss of coordination (ataxia) — test by walking heel-to-toe in a straight line
• Confusion, altered mental status
• Loss of consciousness

First Aid

• Immediate descent is the definitive treatment for HAPE and HACE — descend 1,000–2,000 feet minimum.
• For mild AMS: Stop ascending and rest at the same altitude until symptoms resolve; hydrate; ibuprofen for headache.
• Portable hyperbaric chambers (Gamow bags) can simulate descent if available.
• Supplemental oxygen helps.
• Do not ascend further with any symptoms of altitude illness.

Prevention: “Climb high, sleep low” — the golden rule of altitude acclimatization. Ascend no more than 1,000 feet per day above 8,000 feet. Allow rest days. Avoid alcohol and sedatives at altitude.

You’ve covered the major threats to the airway. Next, you’ll learn what to do when someone loses consciousness entirely.