Wednesday, October 26, 2016

Week 8 - Medical Emergencies


Breathing Problems

Victims with breathing problems may have a mild or severe blockage of their air passages, may be having a heart attack, stroke or may have experienced a serious injury leading to breathing problems.  Other breathing problems may be caused by medical conditions.  

Signs of breathing problems
  • Breathing becoming more difficult
    • Very fast or very slow
  • Weak and ineffective cough
  • Breathing is noisy
    • Makes a sound or whistle as air enters or leaves lungs
  • Inability to speak or breathe
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

Asthma

  • Most victims with asthma usually know about their condition and carry an inhaler.  
  • Sometimes they may have so much trouble breathing, they may need help with their inhaler
  • Assess the scene for safety
  • Ask if you can help – retrieve inhaler
    • Shake the medicine canister
    • Remove the cap
    • Attach a spacer, if available and you know how
    • Tilt the victim’s head back slightly and instruct to breath out slowly
    • Put the inhaler or spacer in the victim’s mouth
    • Push down on the medicine canister
    • Instruct the victim to breath in slowly and deeply as you push down
    • Instruct the victim to hold his breath for 10 seconds and then breathe out slowly
  • If no inhaler is available or victim does not get better after using the inhaler
    • Call or direct bystander to call EMS
    • Stay with the victim until EMS arrives and takes over
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Choking

When an object becomes lodged in the airway it can be considered a mild to severe airway obstruction, depending on the victim’s inability to breathe.  Good air exchange and the ability to make forceful coughing efforts, is usually present in a mild airway obstruction. If a victim experiences a mild airway obstruction, the victim should be encouraged to continue coughing until the obstruction has been removed.  

Victims with a severe airway obstruction will have poor air exchange and may need immediate care. Victims with a complete airway obstruction will have little to no air exchange and will need immediate care.

The universal sign for choking is grasping the throat.  Not all victims know or use the sign.  It is important to recognize the signs of choking and to take immediate action when a severe airway obstruction occurs. 

Signs of a severe airway obstruction include all or one the following:

  • Breathing becoming more difficult
  • Weak and ineffective cough
  • Inability to speak or breathe
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)
  • Caring for Choking victim
    Check victim for choking. Elicit response to question, “Are you choking?”  Observe signs of obstruction (speaking and breathing). 

    Responsive Adult or Child - begin Heimlich Maneuver

  • Assess the scene for safety
  • Ask if you can help
  • Call or direct bystander to call EMS
  • Move behind the victim
  • Reach around the victim’s waist with both arms just above the navel 
  • Place a fist with the thumb side against the victim’s abdomen
  • Grasp the fist with other hand
  • Press into the abdomen with quick inward and upward thrusts
  • Continue administering thrusts until the object is removed or the victim becomes unresponsive
  • If unable to move behind the victim, have victim lay on the ground and administer abdominal thrusts using both hands in the same location as if they were standing
  • If victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call EMS - begin CPR
    • Continue CPR cycle until a second rescuer or EMS takes over, you are too tired to continue, or victim begins breathing
    • If victim begins breathing, place in recovery position until EMS arrives

Pregnant women should NOT be given the Heimlich Maneuver from behind, but rather given abdominal thrusts to victim while she is lying on the ground.   

    Non-responsive Adult or Child – begin CPR

  • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
  • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

     Infant choking - observe signs of obstruction (speaking and breathing) 

  • Assess the scene for safety
  • Call or direct bystander to call EMS
  • Support the infant’s head, neck, and back with hand and forearm
  • Use thigh to support your arm
  • Give five strong back blows
  • Turn the infant over, supporting the head and neck, using your leg or nearby object
  • Check mouth and throat for obstruction
  • Give five chest compressions, using two fingers and check airway again
  • Repeat these steps until the object is removed
  • If victim begins breathing, place in recovery position until EMS arrives
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

Allergic Reactions

People have allergic reactions to many things, including foods, insect stings and bites.  Although many allergic reactions are mild, some can become severe within minutes. People who have severe allergies may carry an epinephrine pen.  Some states and organizations permit first aid rescuers to help people use their epinephrine pens.  First aid rescuers can help administer an epinephrine injection, if permitted to do so by their state regulations and/or company. 

    ***Anaphylaxis is the most severe form of allergic reaction.  It has a rapid onset and may cause death.  

Signs and Symptoms of Allergic Reaction

  • Difficulty breathing
    • very fast or very slow
    • noisy and/or wheezing
  • Inability to speak or breathe
  • Swelling and itching skin
  • Facial and/or tongue swelling
  • Low blood pressure
  • Vomiting 
  • Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)

    Caring for Victim of Allergic Reaction

    • Asses the scene for safety
    • Call or direct a bystander to call EMS
    • Ask the victim if you can help
    • Determine if victim has epinephrine pen

    With Epinephrine Pen

    • Can help someone with a severe allergic reaction breathe more easily
    • Contains a small amount of medicine which can be injected through clothing
    • Takes several minutes to take effect
    • Given on the side of the thigh
      • Retrieve epinephrine pen
      • Hold the pen in your fist without touching either end (needle comes out of one end)
      • Push the end with the needle hard against the side of the victim’s thigh (about halfway between the hip and knee)
      • Give the injection through clothes or on bare skin
      • Hold the pen in place for approximately 10 seconds
      • Remove the needle by pulling the pen straight out  
      • Dispose of the pen properly
      • Note the time of the injection
      • Stay with victim until EMS arrives
    • If victim does not respond to first dose, and EMS does not arrive within 5-10 minutes a repeat dose may be administered
    • Remain with victim and record any changes in victim
    • Report findings to EMS when they arrive
    • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
      • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
      • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

    Without Epinephrine Pen

    • Remain with victim until EMS arrives and takes over
    • Record any changes in victim
    • Report findings to EMS when they arrive
    • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute

Heart Attack

A heart attack is the death or damage to the heart muscle and may lead to a victim’s death. A heart attack usually develops within the first 4 hours of after the onset of symptoms. A heart attack increases the chance of cardiac arrest in victims and unlike with a cardiac arrest, the heart usually does not stop beating. Early recognition of signs and symptoms can improve a victim’s chance of survival. 

Signs and Symptoms of a Heart Attack

  • Pain, fullness, and/or squeezing sensation of the chest
  • Jaw pain, toothache, headache
  • Shortness of breath
  • Nausea, vomiting and/or general upper abdominal discomfort
  • Heartburn and/or indigestion
  • Arm pain (commonly in the left arm, but may be both)
  • Overall fatigue
  • Sweating
  • Some victims (about ¼ of all heart attacks) are silent, without chest pain or symptoms

***Women, the elderly and people with diabetes are more likely to have atypical signs of a heart attack – ache in the chest, heartburn or indigestion, or an overall uncomfortable feeling in the back, jaw, neck or shoulder.

Caring for a Heart Attack Victim
   
 
If victim is NOT breathing:

  • Assess the scene for safety
  • Call or direct a bystander to call EMS
  • Retrieve AED, if available
  • Check breathing
  • Begin CPR
    • Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute 

    If victim is breathing:

  • Assess the scene for safety
  • Call or direct bystander to call EMS
  • Ask if you can help
  • Encourage victim to remain calm and in a comfortable position (recovery position if possible)
  • Offer 1 adult dose or 2 low dose aspirin, if certain the victim is experiencing a heart attack and has no known allergy
  • Stay with victim until EMS arrives and takes over 
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all - begin CPR
    • Continue CPR cycle until EMS or second rescuer takes over, AED becomes available or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 minute 

Tuesday, October 18, 2016

Week 7: First Aid Basics

First aid is the immediate care given to someone in an emergency situation, due to an illness or injury before EMS(Emergency Medical Services) arrives and takes over. Most of the time first aid is provided by a bystander (or by the victim) with minimal or no medical equipment. First aid is usually provided for minor illnesses and injuries. However, first aid may also be provided to someone who has a more serious illness or injury, such as a heart attack or severe bleeding.

Important Terms

Fear of being sued has caused reluctance for bystanders to become rescuers in emergency situations. However, initial rescuers are rarely sued and in most emergencies you are not legally required to provide first aid.

Good Samaritan Law – provides protection against lawsuits for persons who are acting in good faith, while providing reasonable first aid. These laws are not a substitute for competent first aid or for staying within the scope of rescuer training. Laws vary from state to state, and it is important to become aware of your state’s guidelines.

Although laws vary, Good Samaritan protection generally applies when the rescuer is:

  • Acting in an emergency situation
  • Acting in good faith, indicating that he or she has good intentions
  • Acting without compensation
  • Not guilty of malicious misconduct or gross negligence toward the victim (intentionally NOT following established medical guidelines)

Duty to Act – requires an individual to provide first aid when they have a legal duty. If a rescuer does not have a legal duty to provide care he or she is not required to provide first aid.

Duty to act may imply in the following situations:

  • When it is a requirement of employment. If you are designated as responsible for providing first aid to meet Occupational Safety and Health Administration (OSHA) requirements and you are called to emergency, you are required to provide first aid. (some examples of occupations that may require a duty to act include, but are not limited to: park rangers, athletic trainers, law enforcement officers, life guards, teachers)
  • When a pre-existing responsibility to a person exists. If you have a pre-existing relationship and are responsible for a person, for example a parent, you must give first aid if they need it (some examples of pre-existing relationships are parent/child, driver/passenger).
Consent
  • Permission from a responsive (alert) person allowing you to provide care.
Implied Consent
  • When a victim is unconscious, it is understood that if the person were responsive (alert), he or she would request and allow you to provide care.
Abandonment
  • When a rescuer initiates care and fails to continue to provide care until EMS or a second rescuer takes over.
Negligence
  • When you have a duty to respond to an emergency situation and you fail to provide care or give inappropriate care which causes injury or harm.
Universal Precautions
  • Wearing gloves, gowns, masks, and other protective devices every time you provide care in situations where you may come into contact with bodily fluids.
Clinical Death
  • When a victim’s breathing and heartbeat stops. There is a high likelihood that victims who are clinically dead for less than 6 minutes can be revived with little to no cellular damage.
Biological Death
  • When a victim’s breathing and heartbeat stops. Persons who are clinically dead for 10 minutes or more may have irreversible damage to brain cells and tissues. Reviving a victim is not likely, however it is not impossible.

Rescuer Concerns

Safety
  • Rescuers should never enter unsafe situations. If your safety or that of the victim’s is at risk, do not attempt to provide care. Instead call EMS and wait for EMS support to arrive.
Infectious Disease
  • Using personal protective devices, such as gloves, masks, gowns, etc… can reduce your exposure to infectious diseases.
Lawsuits
  • States have Good Samaritan laws in place to provide protection for rescuers who are acting in good faith, in situations where the rescuer does not have a legal duty to provide care.
Hurting a Victim
  • Victims who are clinically dead are helped when provided care and not often made worse with rescue efforts.
Inability to Save Victim
  • Rescuers should focus on providing care to the best of their ability. Basic life support efforts can improve a victim’s chance of survival. Rescuers who have provided care in traumatic situations may feel overwhelming emotions. If a rescuer continues to experience depressed like symptoms it is important to seek support from an outside resource.

Personal Protective Equipment (PPE)

Personal protective equipment should be used when available, prior to providing care. This equipment is designed to minimize exposure to infectious diseases and bodily fluids.

Gloves
  • Always use medical exam gloves when providing care
  • Check for rips, tears or damage before providing care
  • Remove any jewelry that may damage or cause tears
  • If you have a latex allergy use alternative vinyl or nitrile gloves
  • Remove gloves using skin to skin and glove to glove method
    • Using gloved hand, pinch the wrist of the other gloved hand
    • Pull the glove off while turning inside out, place in palm of gloved hand
    • Using bare hand place fingers inside wrist of gloved hand and remove inside out, collecting the gloves inside each other
    • Dispose of gloves in an appropriate container
Rescue mask/Face shield
  • Always use when providing rescue ventilations
  • Mask or shield should have a one way valve to prevent exposure to bodily fluids
  • Dispose of mask/shield in an appropriate container

Chain of Survival

 photo Chain of Survival_zpsa4tozpgt.png

The Chain of Survival is a common way of describing the order in which rescuers should provide care for a victim of cardiac arrest. Early action can improve the chance of a victim’s survival.

Link One: Early Access
  • Rescuer recognizes early warning signs and immediately calls EMS to activate EMS (emergency medical services) to provide early access to care.
Link Two: Early CPR
  • Rescuer immediately begins CPR cycle to continue minimal supply of blood to the victim’s heart and brain until defibrillator and EMS personnel take over.
Link Three: Early Defibrillation
  • Rescuer utilizes AED (automated external defibrillator) to administer a shock to the victim which may restore the heartbeat in some instances.
Link Four: Early Advanced Care
  • EMS arrives and provides advanced cardiac life support care to victim of sudden cardiac arrest. In addition, EMS may provide IV fluids, medications, and use advanced airway devices.

Action at an Emergency

In an emergency situation, the bystander is a vital link between the victim and Emergency Medical Services (EMS). When entering the scene of an emergency situation, it is important to recognize the severity of the emergency before deciding how to respond.

Assess the Scene

Always remember to check the scene for safety hazards BEFORE providing care, it is important to ensure if you and the victim(s) are in a safe location, free of imminent danger or hazards.

  • Determine
    • if it is safe to help
    • number of victims
    • if you will need additional assistance from EMS
    • what personal protective devices are readily available to you
  • Safety
    • If the area is unsafe for the victim or rescuer, move the victim to a safe location, if can be done safely
    • Do not put you or the victim’s safety at risk
    • If you cannot safely provide care, do not become another victim, call EMS and wait for EMS to arrive
Activate EMS
  • For serious situations, always call EMS
  • Provide vital information to EMS dispatcher
    • Your name and number
    • Location of emergency
    • Information about the type of emergency
    • Number of victims
    • Victim(s) condition
    • What care is being provided at the scene
Assess the Victim
  • Check the victim for responsiveness
  • Tap on the shoulder and shout, “Are you okay?”
  • Ask the victim if you he or she would like you to provide care
  • If the victim is facedown and unresponsive, turn the victim over
  • Check the victim for breathing
    • If victim is not breathing – begin CPR
    • If victim is breathing – check the victim and provide care
  • Check the victim for obvious signs of injury, such as bleeding, broken bones, burns, or bites
  • Look for medical information jewelry to determine if the victim has a serious medical condition
  • Place the victim in recovery position (on side)
    • If the victim has difficulty breathing because of vomiting, or other secretions
    • you have to leave an unresponsive victim to get help
  • If the victim shows signs of shock, have the victim lie flat on back
  • If the victim does not show signs of trauma or injury, raise the feet about 6-12 inches.
    • Do not raise the feet if it causes the victim any pain
Provide Care
  • Decide to provide care
  • Determine what type of care is needed
  • Begin care immediately – early care is critical for a victim’s survival

Victim Assessment

When providing care to a victim it is important to identify and correct any condition that may not be immediately life threatening, but may have the potential to become life threatening should they not be corrected.

SAMPLE

Gather information about victim using the SAMPLE history method. Ask victim about the following information

  • Signs and symptoms
  • Allergies
  • Medications
  • Past medical history
  • Last meal eaten
  • Events leading to the injury or illness

Medical information tags may identify allergies, medication, or medical condition

DOTS

Use the DOTS method to check the victim head to toe for the following conditions

  • Deformity
  • Open wounds
  • Tenderness
  • Swelling
Head to Toe exam
  • Head – look for blood, check eyes, check mouth for loose teeth or blood, check the nose and ears for fluid or blood, look for bruising of the eyes or behind the ears
  • Neck – look for bleeding, distention of the jugular vein, open wounds, or tracheal deviation
  • Chest –look for blood, broken ribs, open wounds, accessory muscle breathing
  • Abdomen –look for bleeding, abdominal wounds, tenderness, bruising
  • Legs –look for bleeding, bruising, open wounds, broken bones, deformities
  • Pelvis –look for bleeding and instability
  • Arms –look for bleeding, bruising, open wounds, broken bones, deformities
While you are waiting for EMS to arrive
  • Recheck the victim’s condition using ABC assessment:
    • Airway – use head tilt-chin lift method
    • Breathing – look, listen and feel for breathing
    • Circulation – check for severe bleeding
  • Treat for shock
    • Help victim lie on back
    • Keep covered and warm
    • Do not give anything to eat or drink
  • Remain with victim and record any changes in the victim’s condition
  • Report your findings and care to EMS when they arrive
  • If victim becomes unresponsive or has agonal breathing (irregular, shallow or gasping) or is not breathing at all – begin CPR
    • Continue CPR cycle until EMS arrives, a second rescuer takes over or you are too tired to continue
    • If you do not know CPR begin “Hands Only” compressions at a rate of 100-120 per minute