1. Chapter 51 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.
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2. 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
When the EMS is activated, emergency personnel (paramedics, emergency medical technicians) rush to the scene. They treat, stabilize, and transport persons with life-threatening problems. They have guidelines for care and communicate with doctors in hospital emergency departments.
Each emergency is different. The rules in Box 51-1 on p. 800 in the Textbook apply to any emergency.
Review the Focus on Communication: Emergency Care Box on p. 800 in the Textbook.
Review the Promoting Safety and Comfort: Emergency Care Box on p. 801 in the Textbook.
Review the Focus on Long-Term Care and Home Care: Emergency Care Box on p. 801 in the Textbook.
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3. Basic Life Support (BLS) for Adults
The American Heart Association’s (AHA) BLS procedures support circulation and breathing.
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. Heart, brain, and other organ damage occurs within minutes.
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4. Basic Life Support (BLS) for Adults (cont’d)
Chain of Survival actions are done as soon as possible.
Chain of Survival actions for the adult are:
Recognizing cardiac arrest and activating the EMS system at once
Early cardiopulmonary resuscitation (CPR)
Early defibrillation
Early advanced care
This is given by EMS staff, doctors, and nurses.
Organized post-cardiac arrest care
This is care given to improve survival following cardiac arrest.
Any delay reduces the person’s chance of surviving.
Review Focus on Communication: Chain of Survival for Adults Box on p. 801 in the Textbook.
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5. Basic Life Support (BLS) for Adults (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.
Permanent brain and other organ damage occurs unless circulation and breathing are restored.
Agonal gasps do not bring enough oxygen into the lungs.
SCA is a sudden, unexpected, and dramatic event. It can occur anywhere and at any time.
Common causes of SCA include heart disease, drowning, electric shock, severe injury, choking, and drug over-dose. These causes lead to an abnormal heart rhythm called ventricular fibrillation. If a normal rhythm is not restored, the person will die.
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6. Basic Life Support (BLS) for Adults (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.
Common causes of respiratory arrest include drowning, stroke, choking, drug over-dose, electric shock (including lightning strikes), smoke inhalation, suffocation, heart attack, coma, and other injuries.
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7. Basic Life Support (BLS) for Adults (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.
Chest compressions
Airway
Breathing
Defibrillation
CPR procedures require speed, skill, and efficiency.
Chest compressions and airway and breathing procedures are done until a defibrillator arrives.
Brain and other organ damage occurs within minutes.
The defibrillator is used as soon as possible.
Review the Promoting Safety and Comfort: Cardiopulmonary Resuscitation for Adults Box on p. 802 in the Textbook.
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8. Basic Life Support (BLS) for Adults (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.
In cardiac arrest, the heart has stopped beating. Blood must be pumped through the body in some other way.
Refer to Figure 51-1 on p. 802 in the Textbook for locating the carotid pulse.
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 at least 100 per minute. Interrupt chest compressions only when necessary.
During SCA, the person’s tongue falls toward the back of the throat and blocks the airway.
Refer to Figure 51-5 on p. 804 in the Textbook for the head tilt-chin lift method.
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9. Basic Life Support (BLS) for Adults (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.
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, 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.
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10. Basic Life Support (BLS) for Adults (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 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. 807 in the Textbook.
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11. Basic Life Support (BLS) for Adults (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.
You must determine if cardiac arrest or fainting has occurred.
Review the Promoting Safety and Comfort: Performing Adult CPR Box on p. 807 in the Textbook.
Review the Focus on Communication: Performing Adult CPR Box on p. 807 in the Textbook.
Review the contents of Box 51-1 on p. 800 in the Textbook.
Refer to Figure on p. 809 in the Textbook. In the recovery position, a hand supports the person’s head.
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12. 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
The American Heart Association (AHA) defines a child as a person from 1 year of age to puberty. An infant is a person from birth (outside of the delivery room) until 1 year (12 months) of age.
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13. Basic Life Support for Children and Infants (cont’d)
The AHA’s pediatric Chain of Survival involves the following 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
Organized post-cardiac arrest care
Review with students the contents of Box 51-2 on pp in the Textbook.
The AHA’s CPR guidelines for children and infants differ from adult guidelines. The procedures also differ. Refer to pp in the Textbook.
Remember to use barrier devices for breathing whenever possible.
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14. 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.
Airway obstruction can be mild or severe.
See Chapter 12 for emergency care of the choking person.
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15. 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.
If a blood vessel is cut or torn, bleeding occurs. The larger the blood vessel, the greater the bleeding and blood loss.
Follow the rules in Box 51-1 on p. 800 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 51-1 on p. 800 in the Textbook. Follow the guidelines on p. 816 in the Textbook.
Review the Promoting Safety and Comfort: Hemorrhage Box on p. 816 in the Textbook.
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16. Fainting
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
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.
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17. 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; and loss of consciousness.
Shock is possible in any person who is acutely ill or severely injured.
Follow the rules in Box 51-1 on p. 800 in the Textbook.
Keep the person lying down, maintain an open airway, and control bleeding.
Begin CPR if cardiac arrest occurs.
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18. 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.
Some people are allergic or sensitive to foods, insects, chemicals, and drugs.
The body releases chemicals to fight or attack the antigen.
The person may react with an area of redness, swelling, or itching, or the reaction can involve the entire body.
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19. 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
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 is needed. Activate the EMS system.
Follow the rules in Box 51-1 on p. 800 in the Textbook and the guidelines on p. 818 in the Textbook.
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20. 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
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21. Seizures (cont’d)
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.
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22. 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.
There are brief changes in the brain’s electrical function. The person can have strange sensations, emotions, and behavior. 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.
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23. Seizures (cont’d) You cannot stop a seizure.
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.
To protect the person from injury during a seizure, follow the guidelines on pp in the Textbook. Also, follow the rules in Box 51-1 on p. 800 in the Textbook.
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24. 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.
Common causes of burns and fires include: scalds from hot liquids; playing with matches and lighters; electrical injuries; cooking accidents (barbecues, microwave ovens, stoves, ovens); falling asleep while smoking; fireplaces; space heaters; no smoke detectors or non-functioning smoke detectors; sunburn; chemicals.
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25. 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.
Full-thickness burns are not painful.
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26. 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.
Some burns are minor; others are severe.
For emergency care of severe burns, follow the rules in Box 51-1 on p. 800 in the Textbook.
Follow the guidelines on p. 820 in the Textbook.
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