Chapter 49 Basic Emergency Care Emergencies can occur anywhere. You are encouraged to take a first aid course and a basic life support (BLS) course. These courses prepare you to give 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 and prevent injuries from becoming worse. For emergencies in out-of-hospital settings, 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 When the EMS system is activated, emergency personnel rush to the scene. They treat, stabilize, and transport persons with life-threatening problems. They communicate with doctors in hospital emergency departments. The rules in Box 49-1 on p. 748 in the textbook apply to any emergency. Review the Focus on Long-Term Care and Home Care: Emergency Care Box on p. 748 in the textbook. Review the Teamwork and Time Management: Emergency Care Box on p. 748 in the textbook. Review the Promoting Safety and Comfort: Emergency Care Box on p. 748 in the textbook.

BASIC LIFE SUPPORT (BLS) FOR ADULTS The American Heart Association (AHA) BLS procedures support breathing and circulation. 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 When the heart and breathing stop, the person is clinically dead. Damage to the heart, brain, and other organs occurs within minutes. Any delay reduces the person’s chance of surviving.

Chain of Survival actions are done as soon as possible. Chain of Survival actions for the adult are: Early access to emergency cardiovascular care This means activating the EMS system or rapid response team (RRT). Early CPR Early defibrillation Early advanced care This is given by EMS staff or the RRT, doctors, and nurses. Hospitals and nursing centers call special codes for life-threatening emergencies.

Sudden cardiac arrest (SCA) or cardiac arrest is when the heart and breathing stop suddenly and without warning. There are three major signs of SCA: No response No breathing (Consider agonal gasps to mean “no breathing.”) No pulse The person’s skin is cool, pale, and gray. The person is not coughing or moving. Respiratory arrest Respiratory arrest is when breathing stops but heart action continues for several minutes. If breathing is not restored, cardiac arrest occurs. Permanent brain and other organ damage occur unless circulation and breathing are restored. Agonal gasps do not bring enough oxygen into the lungs. SCA can occur anywhere and at any time. Common causes of SCA include heart disease, drowning, electric shock, severe injury, choking, and drug overdose. These causes lead to an abnormal heart rhythm called ventricular fibrillation. If a normal rhythm is not restored, the person will die. Common causes of respiratory arrest include drowning, stroke, electric shock (including lightning strikes), choking, drug overdose, smoke inhalation, suffocation, heart attack, coma, and other injuries.

When the heart and breathing stop, the person is clinically dead. Cardiopulmonary resuscitation (CPR) must be started at once. CPR supports breathing and circulation CPR involves four parts (the ABCDs of CPR): Airway Breathing Circulation Defibrillation CPR procedures require speed, skill, and efficiency. Airway, breathing, and circulation procedures are done until a defibrillator is available. Damage to the brain and other organs occurs within minutes. Review the Promoting Safety and Comfort: Cardiopulmonary Resuscitation for Adults Box on p. 749 in the textbook.

Airway Breathing The airway must be open to restore breathing. The head tilt-chin lift method opens the airway. 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. Mouth-to-barrier device breathing is used whenever possible. Mouth-to-nose breathing is used for drowning victims and when the mouth cannot be used. 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. During SCA, the person’s tongue often falls toward the back of the throat and blocks the airway. Refer to Figure 49-1 on p. 749 in the textbook. Before giving breaths, check for adequate breathing. Agonal gasping is not adequate breathing. After opening the airway, take 5 to 10 seconds (but no more than 10 seconds) to check for adequate breathing. When you start CPR, give 2 breaths first. Each breath should take 1 second. You should see the chest rise with each breath. Then two breaths are given after every 30 chest compressions.

Circulation Defibrillation 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. For effective chest compressions, hand position is important. Defibrillation Ventricular fibrillation (VF) causes sudden cardiac arrest. A defibrillator is used to deliver a shock to the heart. The shock stops the VF and allows the return of a regular heart rhythm. Defibrillation as soon as possible after the onset of VF increases the person’s chance of survival. In cardiac arrest, the heart has stopped beating. Blood must be pumped through the body in some other way. Refer to Figure 49-8 on p. 751 in the textbook. While checking for a pulse, look for signs of circulation. See if the person has started breathing or is coughing or moving. Give compressions at a rate of 100 per minute. Interrupt chest compressions only when necessary. Automated external defibrillators (AEDs) are found in many health care agencies, public places, and homes. Review the Focus on Children and Older Persons: Defibrillation Box on p. 753 in the textbook.

CPR is done only for cardiac arrest. It is done if the person does not respond, is not 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. You must determine if cardiac arrest or fainting has occurred. Review the Promoting Safety and Comfort: Performing Adult CPR Box on p. 754 in the textbook. Review the contents of Box 49-1 on p. 748 in the textbook. Refer to Figure 49-15 on p. 756 in the textbook. A hand supports the person’s head.

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 occurs during sleep. The American Heart Association (AHA) defines a child as a person between 1 year of age and puberty. An infant is a person from birth (outside of the delivery room) until 1 year (12 months) of age.

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 The AHA’s pediatric Chain of Survival involves these steps: Preventing cardiac arrest Early and effective CPR Rapid activation of the EMS system or the agency’s rapid response team (RRT). Early and effective advanced life support The BLS sequence for infants does not involve defibrillation. Review with students the contents of Box 49-2 on pp. 757-758 in the textbook. CPR procedures differ for children and infants. Refer to pp. 760-763 in the textbook. Remember to use barrier devices for breathing whenever possible.

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. Vomiting blood, coughing up blood, and loss of consciousness signal internal hemorrhage. 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. If a blood vessel is cut or torn, bleeding occurs. The larger the blood vessel, the greater the bleeding and blood loss. Signs and symptoms of internal bleeding include pain and shock. Follow the rules in Box 49-1 on p. 748 in the textbook. Keep the person warm, flat, and quiet until help arrives. Do not give fluids. To control external bleeding, follow the rules in Box 49-1 on p. 748 in the textbook. Follow the guidelines on p. 763 in the textbook. Review the Promoting Safety and Comfort: Hemorrhage Box on p. 763 in the textbook.

SHOCK Shock results when organs and tissues do not get enough blood. Causes include: Blood loss Heart attack (myocardial infarction) Burns Severe infection Shock is possible in any person who is acutely ill or severely injured. Follow the rules in Box 49-1 on p. 748 in the textbook. Maintain an open airway and control bleeding.

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.

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. Some common causes include: Head injury during birth or from trauma High fever Brain tumor Poisoning Nervous system disorder Lack of blood flow to the brain Seizure disorder Epilepsy

Epilepsy 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. There are brief changes in the brain’s electrical function. The person can have strange sensations, emotions, and behaviors. Sometimes there are seizures, muscle spasms, and loss of consciousness. A single seizure does not mean epilepsy. Activity and job limits occur in severe cases.

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. You cannot stop a seizure. You can protect the person from injury. To protect the person from injury during a seizure, follow the guidelines on pp. 764-765 in the textbook. Also, follow the rules in Box 49-1 on p. 748 in the textbook.

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.

Partial thickness burns involve the epidermis and part of the dermis. They are very painful. Nerve endings are exposed. Full thickness burns involve the entire epidermis and dermis. Fat, muscle, and bone may be injured or destroyed. Nerve endings are destroyed. Severity depends on: Burn size and depth The body part involved The person’s age Full-thickness burns are not painful. Emergency care of burns includes following the rules in Box 49-1 on p. 748 in the textbook. Follow the guidelines on pp. 765-766 in the textbook. Review the Focus on Children and Older Persons: Burns Box on p. 766 in the textbook.

FAINTING Fainting is the sudden loss of consciousness from an inadequate blood supply to the brain. Dizziness, perspiration, and blackness before the eyes are warning signals. The person: Looks pale Has a weak pulse Has shallow respirations if consciousness is lost Emergency care for fainting includes the following: Have the person sit or lie down before fainting occurs. If sitting, the person bends forward and places the head between the knees. If the person is lying down, raise the legs. Loosen tight clothing. Keep the person lying down if fainting has occurred. Raise the legs. Do not let the person get up until symptoms have subsided for about 5 minutes. Help the person to a sitting position after recovery from fainting. Observe for fainting.

STROKE (CEREBROVASCULAR ACCIDENT) Stroke 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 An embolus Hemorrhage if a blood vessel in the brain ruptures Signs of stroke vary, depending on the size and location of brain injury. Emergency care for stroke includes following the rules in Box 49-1 on p. 748 in the textbook and following the guidelines on p. 766 in the textbook.

QUALITY OF LIFE Protect quality of life during emergencies. Treat the person with dignity and respect. Protect the right to privacy and confidentiality. Protect the person from onlookers. Information about the person’s care, treatment, and condition is confidential. Protect the right to personal choice. Protect personal items from loss and damage. Protect the person from further injury. Reassurance, explanations about care, and a calm approach are helpful. Do not expose the person unnecessarily. Review the Teamwork and Time Management: Emergency Care Box on p. 748 in the textbook. Choices are few in emergencies. They are given when possible. The person needs to feel safe and secure.