Respiratory paralysis

A Respiratory paralysis is a halt in breathing. This state always comes about without any external influence or impairment.

What is respiratory paralysis?

The respiratory paralysis is not caused by external influences such as strangulation or inhaled foreign bodies. It arises from internal factors.
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With respiratory paralysis, breathing comes to a standstill. In common parlance, breathing is the activity of the lungs. Gas exchange takes place in the lungs. When inhaling, oxygen is inhaled, while exhaling carbon dioxide is exhaled. When breathing is paralyzed, this process no longer works.

In respiratory paralysis, the volume of gas in the lungs initially remains unaffected. The gas exchange within the lungs also remains unaffected for the time being. Within a short time, however, a life-threatening lack of oxygen develops in the blood. This leads to hypoxemia, which can lead to the failure of various vital functions. Respiratory paralysis also leads to an insufficient supply of oxygen to the brain.

The respiratory paralysis is not caused by external influences such as strangulation or inhaled foreign bodies. It arises from internal factors. In respiratory paralysis, a distinction is made between central and peripheral respiratory paralysis. While central respiratory paralysis is a damage to the respiratory center, peripheral respiratory paralysis is caused by a disruption of the respiratory muscles.

causes

The respiratory center is located in the posterior brain in the medulla oblongata. It is an area of ​​the brain that unconsciously and unconsciously regulates inhalation and exhalation. Respiratory paralysis can accordingly be caused by damage to the respiratory center in the medulla oblongata. One possible cause of such central respiratory paralysis is a thrombosis of the basilar artery.

In basilar thrombosis, a blood clot forms in the basilar artery, i.e. in one of the arteries that supplies the brain with oxygen-rich blood. This closes the vessel and leads to a reduced blood flow (ischemia) in the area of ​​the brain stem. The respiratory center can also be affected by this reduced blood flow. Bleeding into the brain stem can also cause central respiratory paralysis.

Very rarely, central respiratory paralysis occurs when multiple sclerosis attacks. Inflammatory demyelinating foci in the respiratory center are only found in one to two percent of all those affected. In peripheral respiratory paralysis, the cause of the paralysis is a failure of the respiratory muscles. For example, after the administration of muscle relaxants, respiratory paralysis can occur. The most common occurrences of this kind are during anesthesia.

Another cause of peripheral respiratory paralysis is myasthenia gravis pseudoparalytica. It is a neurological disease in which the transmission of signals between muscles and nerves is impaired. Poliomyelitis, an infectious disease known as polio, can also cause peripheral respiratory paralysis in individual cases. Polyneuropathies are diseases that affect the peripheral nervous system.

Common causes of polyneuropathies are diabetes mellitus, Guillan-Barré syndrome or infectious diseases such as Lyme disease or diphtheria. The polyneuropathies can also affect the nerves that supply the respiratory muscles, so that paralysis can also occur here. In addition, respiratory paralysis can result from paraplegia above the back segment C4.

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Diseases with this symptom

• thrombosis
• poliomyelitis
• Diabetes mellitus

• Ischemia
• Myasthenia gravis pseudoparalytica
• Lyme disease

• Cerebral hemorrhage
• multiple sclerosis
• Paraplegia

Diagnosis & course

Respiratory paralysis can develop suddenly or slowly. It is accompanied by symptoms such as shortness of breath, blue lips, blue fingers, insomnia, anxiety, or fatigue. Often the respiratory paralysis is also heralded by shortness of breath. One consequence of respiratory paralysis is so-called asphyxia. The term asphyxia is understood to mean the threatened state of suffocation caused by a drop in the oxygen content in the arterial blood system with a simultaneous increase in the carbon dioxide content.

The increase in carbon dioxide levels is also known as hypercapnia. This hypercapnia is registered in the brain stem. As a result, those affected suffer from a considerable fear of suffocation. Asphyxia manifests itself as central cyanosis. Cyanosis is a bluish discoloration of the skin and mucous membranes. If the asphyxia persists and the cause of the respiratory paralysis cannot be corrected, consciousness becomes cloudy or even coma occurs.

With sudden respiratory paralysis, there is often not enough time for a detailed diagnosis. Respiratory paralysis is an emergency that needs to be treated immediately. Otherwise, complete respiratory paralysis threatens to reduce the supply of oxygen to the brain. This can result in death within a few minutes.

Complications

With respiratory paralysis, breathing comes to a standstill without any external influence. The paralysis, which can already be seen in the name, occurs either in the area of ​​the respiratory muscles or in the area of ​​the respiratory center in the brain. It is initially difficult to name complications in the context of respiratory paralysis. This is because respiratory paralysis is an acute condition that only lasts for a very short time. If the respiratory paralysis is not treated immediately by intensive care medicine, it leads to death by suffocation within a few minutes.

However, this death by suffocation is in the narrowest sense not a "complication" of respiratory paralysis, but the logical consequence. Untreated respiratory paralysis always leads to death from suffocation. Death is preceded by an insufficient supply of oxygen to the brain and organs. Since breathing does not occur in the presence of respiratory paralysis, no more oxygen is absorbed, which could be distributed in the body. The organs, including the brain, cannot be adequately supplied with oxygen. Immediate medical intervention is necessary to prevent these compelling consequences of respiratory paralysis.

Death by suffocation can only be avoided if ventilation or a resuscitation is performed immediately as the first measure. In summary, it can be said that the respiratory paralysis means that oxygen can no longer be absorbed and that the brain and other organs are not supplied with oxygen. Death by suffocation then occurs within a few minutes unless medically counteracted.

When should you go to the doctor?

Respiratory paralysis must be distinguished between acute and insidious respiratory paralysis. If emergency care is necessary due to the cessation of breathing, first aid techniques are used. If there is a sudden development, an ambulance service must be contacted immediately. At the same time, it is advisable to initiate a breath donation for the person concerned.

Since there is a risk of death by suffocation, mouth-to-mouth resuscitation should be initiated immediately until the emergency doctor arrives. In the event of a gradual progression, a doctor should be consulted as soon as the shortness of breath persists for several hours. If the person concerned already has blue lips and blue fingers, it is important to hurry. A doctor should also be consulted if there are signs such as persistent insomnia or permanent fatigue.

Inexperienced people usually do not associate these symptoms with respiratory paralysis. Nevertheless, these are the first signs of respiratory paralysis with a creeping course. Many sufferers report a feeling of permanent fear of suffocation. They too should be examined intensively by a doctor. Symptoms such as discoloration of the skin or clouding of consciousness are further indications that make a doctor's visit necessary. Since creeping respiratory paralysis can develop into acute respiratory arrest at any time, the lack of oxygen supply threatens a life-threatening condition.

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Treatment & Therapy

A respiratory donation as part of first aid is suitable as an immediate therapeutic measure. Breathing donation is one of the life-saving emergency measures. With respiratory donation, a person with respiratory paralysis is supplied with the missing oxygen through the ventilation of the helper. According to the guidelines of the European Resuscitation Council, mouth-to-mouth resuscitation is the standard for resuscitation. The breath is donated with the patient's head overstretched.

The nose is closed and air is supplied through the mouth. Alternatively, ventilation can also be provided through the nose. This variant is known as mouth-to-nose ventilation. The resuscitation is carried out until the patient breathes independently again, until a helper from the rescue service arrives, until the helper is exhausted or until another helper can relieve.

Ventilation is then carried out as part of emergency medicine. Positive and negative pressure ventilation, bag ventilation or ventilators can be used. The aim is to supply the patient's body with oxygen to prevent permanent damage. When patients are stable, the cause of the respiratory paralysis needs to be found and, if possible, corrected.

Outlook & forecast

If respiratory paralysis is not treated directly by an emergency doctor, it usually leads to death. Therefore, in the event of respiratory paralysis, a doctor must be called immediately or the hospital visited. The patient must be given emergency ventilation. This is done through mouth-to-mouth resuscitation, during which the nose is held shut so that the air cannot escape from the lungs.

The longer the respiratory paralysis lasts, the more the organs are damaged by the reduced oxygen supply. The brain can also be damaged here, which can later lead to disabilities or limitations in thinking or coordination. Death from asphyxiation occurs approximately 15 minutes after respiratory paralysis.

The doctor must also provide emergency ventilation for the patient. Whether the patient can be resuscitated or not depends heavily on the cause of the respiratory paralysis and cannot be universally predicted. In some cases, resuscitation is necessary to wake up the patient. The emergency doctor has to arrive very quickly, especially after an accident, so that the patient does not die.

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prevention

In most cases, respiratory paralysis is an unpredictable event for which no preventive measures exist.

You can do that yourself

Self-help is not possible with respiratory paralysis. A doctor or an emergency doctor must be consulted immediately to treat the respiratory paralysis. If the respiratory paralysis persists, it leads to death. Respiratory paralysis always occurs when the breathing has stopped even without any external impact on the chest. In this case, it is a serious health problem that can only be properly treated in a hospital.

In the event of respiratory paralysis, first aid must always be provided immediately. Mouth-to-mouth resuscitation is required here to provide the affected person with oxygen. This ventilation should continue until the emergency doctor arrives. As a rule, the emergency doctor can carry out resuscitation in the event of respiratory paralysis and thus revive the patient. However, this is only possible in cases in which no fatal or serious accident has occurred. If respiratory paralysis occurs briefly and temporarily, a doctor should still be consulted.

Other first aid measures include laying the person on their back. The chin is raised to clear the airway. With mouth-to-mouth resuscitation, the patient's nose must always remain closed so that the air does not escape again. This ventilation should be continued until the patient is breathing again or the emergency doctor has arrived.