CHAPTER 51 BASIC EMERGENCY CARE

EMERGENCY CARE FIRST AID IS EMERGENCY CARE GIVEN TO AN ILL OR INJURED PERSON BEFORE MEDICAL HELP ARRIVES. ITS GOALS ARE TO PREVENT: DEATH INJURIES FROM BECOMING WORSE IN AN EMERGENCY, THE EMERGENCY MEDICAL SERVICES (EMS) SYSTEM IS ACTIVATED. TO ACTIVATE THE EMS SYSTEM, DO ONE OF THE FOLLOWING: DIAL 911 CALL THE LOCAL FIRE OR POLICE DEPARTMENT CALL THE PHONE OPERATOR

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS THE AMERICAN HEART ASSOCIATION’S (AHA) BLS (HEARTCODE) PROCEDURES SUPPORT CIRCULATION, AIRWAY AND BREATHING (CAB). THE AHA’S BASIC LIFE SUPPORT COURSES TEACH THE ADULT CHAIN OF SURVIVAL. THESE ACTIONS ARE TAKEN FOR: HEART ATTACK SUDDEN CARDIAC ARREST RESPIRATORY ARREST STROKE CHOKING OTHER LIFE-THREATENING PROBLEMS

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) CHAIN OF SURVIVAL ACTIONS ARE DONE AS SOON AS POSSIBLE. CHAIN OF SURVIVAL ACTIONS FOR THE ADULT ARE: 1. RECOGNIZING CARDIAC ARREST AND ACTIVATING THE EMS SYSTEM AT ONCE 2. EARLY CARDIOPULMONARY RESUSCITATION (CPR) 3. EARLY DEFIBRILLATION 4. EARLY ADVANCED CARE THIS IS GIVEN BY EMS STAFF, DOCTORS, AND NURSES. 5. ORGANIZED POST-CARDIAC ARREST CARE THIS IS CARE GIVEN TO IMPROVE SURVIVAL FOLLOWING CARDIAC ARREST. HYPOTHERMIA PROTOCOL WITH ROSC (RETURN OF SPONTANEOUS CIRCULATION)

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) SUDDEN CARDIAC ARREST (SCA) OR CARDIAC ARREST IS WHEN THE HEART STOPS SUDDENLY AND WITHOUT WARNING. THERE ARE 3 MAJOR SIGNS OF SCA. NO RESPONSE NO BREATHING OR NO NORMAL BREATHING AGONAL GASPS ARE NOT NORMAL BREATHING. NO PULSE THE PERSON’S SKIN IS COOL, PALE, AND GRAY. THE PERSON IS NOT COUGHING OR MOVING.

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) RESPIRATORY ARREST IS WHEN BREATHING STOPS BUT HEART ACTION CONTINUES FOR SEVERAL MINUTES. IF BREATHING IS NOT RESTORED, CARDIAC ARREST OCCURS. RESCUE BREATHS ARE GIVEN WHEN THERE IS A PULSE BUT NO BREATHING OR ONLY GASPING. TO GIVE RESCUE BREATHS: OPEN THE AIRWAY. GIVE 1 BREATH EVERY 5 TO 6 SECONDS FOR ADULTS GIVE 1 BREATH EVERY 3 TO 5 SECONDS FOR INFANTS AND CHILDREN. GIVE EACH BREATH OVER 1 SECOND. THE CHEST SHOULD RISE WHEN BREATHS ARE GIVEN. CHECK THE PULSE EVERY 2 MINUTES. IF THERE IS NO PULSE, BEGIN CPR. IF THE PULSE IS LOWER THAN 60 IN AN INFANT OR CHILD, BEGIN CPR.

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) WHEN THE HEART AND BREATHING STOP, BLOOD AND OXYGEN ARE NOT SUPPLIED TO THE BODY. CARDIOPULMONARY RESUSCITATION (CPR) MUST BE STARTED AT ONCE WHEN A PERSON HAS SCA. CPR SUPPORTS CIRCULATION AND BREATHING. CPR INVOLVES FOUR PARTS. 1. CHEST COMPRESSIONS 2. AIRWAY 3. BREATHING 4. DEFIBRILLATION CPR PROCEDURES REQUIRE SKILL, EFFICIENCY, AND SPEED. CHEST COMPRESSIONS AND AIRWAY AND BREATHING PROCEDURES ARE DONE UNTIL A DEFIBRILLATOR ARRIVES.

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) CHEST COMPRESSIONS CHEST COMPRESSIONS FORCE BLOOD THROUGH THE CIRCULATORY SYSTEM. BEFORE STARTING CHEST COMPRESSIONS, USE THE CAROTID ARTERY ON THE SIDE NEAR YOU TO CHECK FOR A PULSE. FOR EFFECTIVE CHEST COMPRESSIONS, THE PERSON MUST BE SUPINE ON A HARD, FLAT SURFACE. HAND POSITION IS IMPORTANT FOR EFFECTIVE CHEST COMPRESSIONS. AIRWAY THE RESPIRATORY PASSAGES (AIRWAY) MUST BE OPEN TO RESTORE BREATHING. THE HEAD TILT-CHIN LIFT METHOD OPENS THE AIRWAY. JAW THRUST OPENS THE AIRWAY IN PERSONS WITH SUSPECTED HEAD TRAUMA

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) BREATHING IF THE PERSON DOES NOT GET OXYGEN, PERMANENT HEART, BRAIN, AND OTHER ORGAN DAMAGE OCCURS. A RESCUER INFLATES THE PERSON’S LUNGS. MOUTH-TO-MOUTH BREATHING IS ONE WAY TO GIVE BREATHS. BARRIER DEVICE BREATHING IS USED WHENEVER POSSIBLE. MOUTH-TO-NOSE BREATHING IS USED WHEN YOU CANNOT BREATHE THROUGH THE PERSON’S MOUTH. MOUTH-TO-STOMA BREATHING IS USED FOR PEOPLE WHO BREATHE THROUGH STOMAS IN THEIR NECKS. BEFORE GIVING MOUTH-TO-MOUTH OR MOUTH-TO- NOSE BREATHING, ALWAYS CHECK TO SEE IF THE PERSON HAS A STOMA.

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) DEFIBRILLATION VENTRICULAR FIBRILLATION (VF, V-FIB) CAUSES SUDDEN CARDIAC ARREST. A DEFIBRILLATOR IS USED TO DELIVER A SHOCK TO THE HEART. THE SHOCK STOPS THE VF (V-FIB) AND ALLOWS THE RETURN OF A REGULAR HEART RHYTHM. DEFIBRILLATION AS SOON AS POSSIBLE AFTER THE ONSET OF VF (V-FIB) INCREASES THE PERSON’S CHANCE OF SURVIVAL.

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

BASIC LIFE SUPPORT (BLS) FOR HEALTH CARE PROVIDERS (CONT’D) CPR IS DONE ONLY FOR CARDIAC ARREST. IT IS DONE IF THE PERSON DOES NOT RESPOND, IS NOT BREATHING (OR HAS NO NORMAL BREATHING), AND HAS NO PULSE. CPR IS DONE ALONE OR WITH ANOTHER PERSON. THE RECOVERY POSITION IS USED WHEN THE PERSON IS BREATHING AND HAS A PULSE BUT IS NOT RESPONDING. IT HELPS KEEP THE AIRWAY OPEN AND PREVENTS ASPIRATION. LOGROLL THE PERSON INTO THE RECOVERY POSITION. KEEP THE HEAD, NECK, AND SPINE STRAIGHT. DO NOT USE THIS POSITION IF THE PERSON MIGHT HAVE NECK INJURIES OR OTHER TRAUMA.

BASIC LIFE SUPPORT FOR CHILDREN AND INFANTS SUDDEN INFANT DEATH SYNDROME (SIDS) IS THE SUDDEN, UNEXPLAINED DEATH OF AN INFANT YOUNGER THAN 1 YEAR OLD. IT IS THE LEADING CAUSE OF DEATH IN CHILDREN BETWEEN 1 MONTH AND 1 YEAR OF AGE. IT USUALLY OCCURS DURING SLEEP. CARDIAC ARREST CAUSED BY HEART DISEASE IS RARE IN CHILDREN. MORE COMMON CAUSES INVOLVE: RESPIRATORY DISEASES INJURIES THAT LEAD TO RESPIRATORY ARREST OR CIRCULATORY FAILURE

BASIC LIFE SUPPORT FOR CHILDREN AND INFANTS (CONT’D) THE AHA’S PEDIATRIC CHAIN OF SURVIVAL INVOLVES THE FOLLOWING STEPS: 1. PREVENTING CARDIAC ARREST 2. EARLY AND EFFECTIVE CPR 3. RAPID ACTIVATION OF THE EMS SYSTEM OR THE AGENCY’S RAPID RESPONSE TEAM (RRT) 4. EARLY AND EFFECTIVE ADVANCED LIFE SUPPORT 5. ORGANIZED POST-CARDIAC ARREST CARE

HYPOTHERMIA PROTOCOL (WITH ROSC) To save brain

CHOKING FOREIGN BODIES CAN OBSTRUCT THE AIRWAY. THIS IS CALLED CHOKING OR FOREIGN-BODY AIRWAY OBSTRUCTION (FBAO). AIR CANNOT PASS THROUGH THE AIRWAYS INTO THE LUNGS. THE BODY DOES NOT GET ENOUGH OXYGEN. IT CAN LEAD TO CARDIAC ARREST. SEVERE AIRWAY OBSTRUCTION AIR DOES NOT MOVE IN AND OUT OF THE LUNGS. IF NOT REMOVED, THE PERSON WILL DIE. ABDOMINAL THRUSTS ARE USED TO RELIEVE THE OBSTRUCTION.

HEMORRHAGE HEMORRHAGE IS THE EXCESSIVE LOSS OF BLOOD IN A SHORT TIME. IF BLEEDING IS NOT STOPPED, THE PERSON WILL DIE. YOU CANNOT SEE INTERNAL HEMORRHAGE. THE BLEEDING IS INSIDE BODY TISSUES AND BODY CAVITIES. SIGNS AND SYMPTOMS INCLUDE PAIN, SHOCK, VOMITING BLOOD, COUGHING UP BLOOD, AND LOSS OF CONSCIOUSNESS. EXTERNAL BLEEDING IF NOT HIDDEN BY CLOTHING, EXTERNAL BLEEDING IS USUALLY SEEN. BLEEDING FROM AN ARTERY OCCURS IN SPURTS. THERE IS A STEADY FLOW OF BLOOD FROM A VEIN.

FAINTING (SYNCOPE) FAINTING IS THE SUDDEN LOSS OF CONSCIOUSNESS FROM AN INADEQUATE BLOOD SUPPLY TO THE BRAIN. COMMON CAUSES INCLUDE HUNGER, FATIGUE, FEAR, AND PAIN. DIZZINESS, PERSPIRATION (SWEATING), AND BLACKNESS BEFORE THE EYES ARE WARNING SIGNALS. THE PERSON: LOOKS PALE HAS A WEAK PULSE HAS SHALLOW RESPIRATIONS IF CONSCIOUSNESS IS LOST

SHOCK  SHOCK RESULTS WHEN ORGANS AND TISSUES DO NOT GET ENOUGH BLOOD.  CAUSES INCLUDE BLOOD LOSS, HEART ATTACK (MYOCARDIAL INFARCTION), BURNS, AND SEVERE INFECTION.  SIGNS AND SYMPTOMS INCLUDE:  LOW OR FALLING BLOOD PRESSURE  RAPID AND WEAK PULSE  RAPID RESPIRATIONS  COOL, MOIST, AND PALE SKIN  THIRST  RESTLESSNESS  CONFUSION  LOSS OF CONSCIOUSNESS.  SHOCK IS POSSIBLE IN ANY PERSON WHO IS ACUTELY ILL OR SEVERELY INJURED.

SHOCK (CONT’D) ANAPHYLACTIC SHOCK ANAPHYLAXIS IS A LIFE-THREATENING SENSITIVITY TO AN ANTIGEN. AN ANTIGEN IS A SUBSTANCE THAT THE BODY REACTS TO. ANAPHYLAXIS CAN OCCUR WITHIN SECONDS. ANAPHYLACTIC SHOCK IS AN EMERGENCY. THE EMS SYSTEM MUST BE ACTIVATED. THE PERSON NEEDS SPECIAL DRUGS TO REVERSE THE ALLERGIC REACTION. KEEP THE PERSON LYING DOWN AND THE AIRWAY OPEN. START CPR IF CARDIAC ARREST OCCURS.

STROKE STROKE (CEREBROVASCULAR ACCIDENT) OCCURS WHEN THE BRAIN IS SUDDENLY DEPRIVED OF ITS BLOOD SUPPLY. USUALLY ONLY PART OF THE BRAIN IS AFFECTED. A STROKE MAY BE CAUSED BY: A THROMBUS – COLLECTION OF PLTS, FIBRIN, & RBCS ATTACHED TO INNER WALL OF ARTERY AN EMBOLUS – FOREIGN OBJECT, AIR/GAS, TISSUE/TUMOR, PIECE OF THROMBUS HEMORRHAGE IF A BLOOD VESSEL IN THE BRAIN RUPTURES SIGNS OF STROKE VARY, DEPENDING ON THE SIZE AND LOCATION OF BRAIN INJURY.

FAST

SEIZURES SEIZURES (CONVULSIONS) ARE VIOLENT AND SUDDEN CONTRACTIONS OR TREMORS OF MUSCLE GROUPS. MOVEMENTS ARE UNCONTROLLED. THE PERSON MAY LOSE CONSCIOUSNESS. SEIZURES ARE CAUSED BY AN ABNORMALITY IN THE BRAIN. COMMON CAUSES INCLUDE HEAD INJURY, HIGH FEVER, BRAIN TUMOR, POISONING, NERVOUS SYSTEM DISORDERS OR INFECTIONS, LACK OF BLOOD FLOW TO THE BRAIN, SEIZURE DISORDER, AND EPILEPSY.

SEIZURES (CONT’D) EPILEPSY IS A BRAIN DISORDER IN WHICH CLUSTERS OF NERVE CELLS SOMETIMES SIGNAL ABNORMALLY. IN EPILEPSY, SEIZURES RECUR. THE PERSON HAS A PERMANENT BRAIN INJURY OR DEFECT. CHILDREN AND YOUNG ADULTS ARE COMMONLY AFFECTED. EPILEPSY CAN DEVELOP AT ANY TIME IN A PERSON’S LIFE. THERE IS NO CURE AT THIS TIME. DOCTORS ORDER DRUGS TO PREVENT SEIZURES. DRUG THERAPY DOES NOT WORK FOR SOME PEOPLE. WHEN CONTROLLED, EPILEPSY USUALLY DOES NOT AFFECT LEARNING AND ACTIVITIES OF DAILY LIVING.

SEIZURES (CONT’D) THE MAJOR TYPES OF SEIZURES ARE: PARTIAL SEIZURE GENERALIZED TONIC-CLONIC SEIZURE (GRAND MAL SEIZURE), WHICH HAS TWO PHASES  IN THE TONIC PHASE, THE PERSON LOSES CONSCIOUSNESS.  THE CLONIC PHASE FOLLOWS. MUSCLE GROUPS CONTRACT AND RELAX. GENERALIZED ABSENCE (PETIT MAL) SEIZURE, WHICH USUALLY LASTS A FEW SECONDS THERE IS LOSS OF CONSCIOUSNESS, TWITCHING OF THE EYELIDS, AND STARING. NO FIRST AID IS NECESSARY. YOU CANNOT STOP A SEIZURE. YOU CAN PROTECT THE PERSON FROM INJURY.

BURNS  BURNS CAN SEVERELY DISABLE A PERSON.  BURNS CAN CAUSE DEATH.  MOST BURNS OCCUR IN THE HOME.  INFANTS, CHILDREN, AND OLDER PERSONS ARE AT RISK.

BURNS (CONT’D) SUPERFICIAL BURNS (FIRST DEGREE) INVOLVE THE EPIDERMIS ONLY. THEY ARE PAINFUL, BUT THE BURN IS NOT SEVERE. PARTIAL-THICKNESS BURNS (SECOND DEGREE) INVOLVE THE EPIDERMIS AND PART OF THE DERMIS. THEY ARE VERY PAINFUL. NERVE ENDINGS ARE EXPOSED. FULL-THICKNESS BURNS (THIRD DEGREE) INVOLVE THE ENTIRE EPIDERMIS AND DERMIS. FAT, MUSCLE, AND BONE MAY BE INJURED OR DESTROYED. NERVE ENDINGS ARE DESTROYED.

BURNS (CONT’D) SEVERITY DEPENDS ON: BURN SIZE AND DEPTH THE BODY PART INVOLVED THE PERSON’S AGE BURNS TO THE FACE, EYES, EARS, HANDS, AND FEET ARE MORE SERIOUS THAN BURNS TO AN ARM OR LEG. INFANTS, YOUNG CHILDREN, AND OLDER PERSONS ARE AT HIGH RISK FOR DEATH.