Chapter 49 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 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
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
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.
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.
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.
Airway • 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.
Circulation • 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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
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.
