Chapter 43 Basic Emergency Care All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Emergency Care   First aid is the 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.   In an emergency, the Emergency Medical Services (EMS) system is activated. 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Emergency Medical Services   To activate the Emergency Medical Services (EMS) system, do one of the following:   Dial 911.   Call the local fire or police department.   Call the phone operator.   In nursing centers, a nurse decides when to activate the EMS system.   Know your center’s policy about cardiopulmonary resuscitation (CPR).   The nurse tells you how to help. If a person has stopped breathing or is in sudden cardiac arrest, the nurse may start CPR. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Basic Life Support   BLS procedures support breathing and circulation.   The American Heart Association’s (AHA) Basic Life Support courses teach the adult Chain of Survival.   Chain of Survival actions are:   Early access to emergency cardiovascular care This means activating the EMS.   Early CPR   Early defibrillation   Early advanced care 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Cardiac Arrest   Sudden cardiac arrest (SCA) or cardiac arrest occurs when the heart and breathing stop suddenly and without warning.   There are three major signs of SCA: No response No breathing No pulse   Respiratory arrest   Respiratory arrest occurs when breathing stops but heart action continues for several minutes.   If breathing is not restored, cardiac arrest occurs. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Cardiopulmonary Resuscitation   Cardiopulmonary resuscitation (CPR)   When the heart and breathing stop, the person is clinically dead.   CPR must be started at once when a person is in sudden cardiac arrest. CPR supports breathing and circulation.   The CABDs of CPR Chest compressions Airway Breathing Defibrillation   Chest compressions and airway breathing procedures are done until a defibrillator arrives. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Chest Compressions   Circulation   Chest compressions force blood through the circulatory system.   Before starting chest compressions, check for a pulse. Use the carotid artery on the side near you.   Also look for signs of circulation and see if the person has started breathing or is coughing or moving.   For effective chest compressions, the person must be supine on a hard, flat surface.   The AHA recommends that you: Give compressions at a rate of 100 per minute. Push hard, and push fast. Push deeply into the chest. Interrupt chest compressions only when necessary. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Airway and Breathing   Airway   The respiratory passages (airway) must be open to restore breathing.   The head tilt-chin lift method opens the airway.   Breathing   The person is given breaths.   Before giving breaths, check for adequate breathing.   When you start CPR, give two breaths first. Then two breaths are given after every 30 chest compressions.   Mouth-to-mouth breathing is one way to give breaths.   Mouth-to-barrier device breathing is used for giving breaths whenever possible. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Cardiopulmonary Resuscitation (Cont’d)   Defibrillation   Ventricular fibrillation (VF, V-fib) is an abnormal heart rhythm that causes SCA.   Defibrillation as soon as possible after the onset of VF increases the person’s chance of survival.   CPR is done only for cardiac arrest.   CPR is done if the person: Does not respond Is not breathing Has no pulse   CPR is done alone or with another person.   Hands-only CPR is used to educate persons not trained in Basic Life Support. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

The Recovery Position   The recovery position is used when the person is breathing and has a pulse but is not responding.   The position helps keep the airway open and prevents aspiration.   Logroll the person into the recovery position. Keep the head, neck, and spine straight. A hand supports the head.   Do not use this position if the person might have neck injuries or other trauma. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Hemorrhage   Hemorrhage is the excessive loss of blood in a short time.   If bleeding is not stopped, the person will die.   Internal hemorrhage   The bleeding is inside body tissues and body cavities.   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. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Fainting   Fainting is the sudden loss of consciousness from an inadequate blood supply to the brain.   The person:   Looks pale   Has a weak pulse   Has shallow respirations if consciousness is lost 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

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   Cold, moist, and pale skin   Thirst   Restlessness   Confusion and loss of consciousness as shock worsens 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Anaphylaxis   Anaphylactic shock   Some people are allergic or sensitive to foods, insects, chemicals, and medications. An antigen is a substance that the body reacts to.   Anaphylaxis is a life-threatening sensitivity to an antigen. It can occur within seconds.   Anaphylactic shock is an emergency.   The EMS must be activated.   The person needs special medications to reverse the allergic reaction. 14 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Stroke (Cerebrovascular Accident)   Stroke occurs when the brain is suddenly deprived of its blood supply.   A stroke may be caused by:   A thrombus   An embolus   Hemorrhage if a blood vessel in the brain ruptures   Signs of stroke depend on the size and location of brain injury. 15 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Seizures   Seizures (convulsions) are violent and sudden contractions or tremors of muscle groups.   Seizures are caused by an abnormality in the brain.   A single seizure does not mean epilepsy.   Epilepsy is a brain disorder in which clusters of nerve cells sometimes signal abnormally. There are brief changes in the brain’s electrical function. In epilepsy, seizures recur. There is no cure for epilepsy at this time. 16 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Types of Seizures   The major types of seizures   Partial seizure (only part of the brain is involved)   Generalized tonic-clonic seizure (grand mal seizure) has two phases (the tonic phase and the clonic phase).   Generalized absence (petit mal) seizure   You cannot stop a seizure.   You can protect the person from injury. 17 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Burns   Burns can severely disable a person and they can cause death.   Most burns occur in the home.   Infants, children, and older persons are at risk.   Burns are described as superficial, partial thickness, and full thickness:   Superficial burns involve the epidermis only   Partial-thickness burns involve the epidermis and part of the dermis.   Full-thickness burns involve the entire epidermis and the dermis. Nerve endings are destroyed. 18 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Burns (Cont’d)   Severity depends on:   Burn size and depth   The body part involved   The person’s age   Do not touch the person if he or she is in contact with an electrical source.   Have the power source turned off or remove the electrical source.   Use an object that does not conduct electricity (rope or wood) to remove the electrical source. 19 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Quality of Life   Protect quality of life during emergencies.   Protect the right to privacy and confidentiality.   Protect the person from onlookers.   Protect the right to personal choice.   Protect personal items from loss and damage.   Promote the person’s physical and psychological safety.   Choices are few in emergencies. They are given when possible.   The person has the right to choose a hospital.   Sometimes the person may choose to refuse care. 20 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.