Chapter 49

Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 49Chapter 49

Basic Emergency CareBasic Emergency Care

Slide 2 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

EMERGENCY CAREEMERGENCY CARE First aid is emergency care given to an ill or First aid is emergency care given to an ill or

injured person before medical help arrives.injured person before medical help arrives.• Its goals are to prevent death and prevent injuries Its goals are to prevent death and prevent injuries

from becoming worse.from becoming worse.

For emergencies in out-of-hospital settings, the For emergencies in out-of-hospital settings, the Emergency Medical Services (EMS) system is Emergency Medical Services (EMS) system is activated.activated.

• To activate the EMS system, do one of the following:To activate the EMS system, do one of the following: Dial 911Dial 911 Call the local fire or police departmentCall the local fire or police department Call the phone operatorCall the phone operator


BASIC LIFE SUPPORT (BLS) FOR BASIC LIFE SUPPORT (BLS) FOR ADULTSADULTS

The American Heart Association (AHA) BLS The American Heart Association (AHA) BLS procedures support breathing and circulation.procedures support breathing and circulation.

The AHA’s basic life support courses teach the The AHA’s basic life support courses teach the adult Chain of Survival.adult Chain of Survival.

• These actions are taken for:These actions are taken for: Heart attack Heart attack Sudden cardiac arrestSudden cardiac arrest Respiratory arrestRespiratory arrest Stroke Stroke Choking Choking Other life-threatening problemsOther life-threatening problems


• Chain of Survival actions are done as soon as Chain of Survival actions are done as soon as possible.possible.

• Chain of Survival actions for the adult are:Chain of Survival actions for the adult are: Early access to emergency cardiovascular careEarly access to emergency cardiovascular care

– This means activating the EMS system or rapid response This means activating the EMS system or rapid response team (RRT).

Early CPREarly CPR Early defibrillationEarly defibrillation Early advanced careEarly advanced care

– This is given by EMS staff or the RRT, doctors, and nurses.This is given by EMS staff or the RRT, doctors, and nurses.


Sudden cardiac arrest (SCA) or cardiac arrest is Sudden cardiac arrest (SCA) or cardiac arrest is when the heart and breathing stop suddenly and when the heart and breathing stop suddenly and without warning.without warning.

• There are three major signs of SCA:There are three major signs of SCA: No responseNo response No breathing (Consider agonal gasps to mean “no No breathing (Consider agonal gasps to mean “no

breathing.”)breathing.”) No pulseNo pulse

• The person’s skin is cool, pale, and gray.The person’s skin is cool, pale, and gray.• The person is not coughing or moving.The person is not coughing or moving.

Respiratory arrestRespiratory arrest• Respiratory arrest is when breathing stops but heart Respiratory arrest is when breathing stops but heart

action continues for several minutes.action continues for several minutes. If breathing is not restored, cardiac arrest occurs.If breathing is not restored, cardiac arrest occurs.


When the heart and breathing stop, the person When the heart and breathing stop, the person is clinically dead.is clinically dead.

• Cardiopulmonary resuscitation (CPR) must be started Cardiopulmonary resuscitation (CPR) must be started at once.at once. CPR supports breathing and circulationCPR supports breathing and circulation

• CPR involves four parts (the ABCDs of CPR):CPR involves four parts (the ABCDs of CPR): Airway Airway BreathingBreathing CirculationCirculation Defibrillation Defibrillation

• CPR procedures require speed, skill, and efficiency.CPR procedures require speed, skill, and efficiency.• Airway, breathing, and circulation procedures are done Airway, breathing, and circulation procedures are done

until a defibrillator is available.until a defibrillator is available.


• AirwayAirway The airway must be open to restore breathing.The airway must be open to restore breathing. The head tilt-chin lift method opens the airway.The head tilt-chin lift method opens the airway.

• BreathingBreathing If the person does not get oxygen, permanent heart, If the person does not get oxygen, permanent heart,

brain, and other organ damage occurs.brain, and other organ damage occurs. A rescuer inflates the person’s lungs.A rescuer inflates the person’s lungs. Mouth-to-mouth breathing is one way to give breaths. Mouth-to-mouth breathing is one way to give breaths. Mouth-to-barrier device breathing is used whenever Mouth-to-barrier device breathing is used whenever

possible.possible. Mouth-to-nose breathing is used for drowning victims and Mouth-to-nose breathing is used for drowning victims and

when the mouth cannot be used.when the mouth cannot be used. Mouth-to-stoma breathing is used for people who breathe Mouth-to-stoma breathing is used for people who breathe

through stomas in their necks.through stomas in their necks. Before giving mouth-to-mouth or mouth-to-nose Before giving mouth-to-mouth or mouth-to-nose

breathing, always check to see if the person has a stoma.breathing, always check to see if the person has a stoma.


• CirculationCirculation Chest compressions force blood through the circulatory Chest compressions force blood through the circulatory

system.system. Before starting chest compressions, use the carotid artery Before starting chest compressions, use the carotid artery

on the side near you to check for a pulse.on the side near you to check for a pulse. For effective chest compressions, the person must be For effective chest compressions, the person must be

supine on a hard, flat surface.supine on a hard, flat surface. For effective chest compressions, hand position is For effective chest compressions, hand position is

important.important.

• DefibrillationDefibrillation Ventricular fibrillation (VF) causes sudden cardiac arrest. Ventricular fibrillation (VF) causes sudden cardiac arrest. A defibrillator is used to deliver a shock to the heart.A defibrillator is used to deliver a shock to the heart. The shock stops the VF and allows the return of a regular The shock stops the VF and allows the return of a regular

heart rhythm.heart rhythm. Defibrillation as soon as possible after the onset of VF Defibrillation as soon as possible after the onset of VF

increases the person’s chance of survival.increases the person’s chance of survival.


CPR is done only for cardiac arrest.CPR is done only for cardiac arrest.• It is done if the person does not respond, is not It is done if the person does not respond, is not

breathing, and has no pulse.breathing, and has no pulse.

• CPR is done alone or with another person.CPR is done alone or with another person.

The recovery position is used when the person The recovery position is used when the person is breathing and has a pulse but is not is breathing and has a pulse but is not responding.responding.

• It helps keep the airway open and prevents aspiration.It helps keep the airway open and prevents aspiration.

• Logroll the person into the recovery position.Logroll the person into the recovery position.

• Keep the head, neck, and spine straight.Keep the head, neck, and spine straight.

• Do not use this position if the person might have neck Do not use this position if the person might have neck injuries or other trauma.injuries or other trauma.


BASIC LIFE SUPPORT FOR CHILDREN BASIC LIFE SUPPORT FOR CHILDREN AND INFANTSAND INFANTS

Sudden infant death syndrome (SIDS) is the Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant sudden, unexplained death of an infant younger than 1 year old.younger than 1 year old.

• It is the leading cause of death in children between 1 It is the leading cause of death in children between 1 month and 1 year of age.month and 1 year of age.

• It occurs during sleep.It occurs during sleep.


Cardiac arrest caused by heart disease is rare in Cardiac arrest caused by heart disease is rare in children.children.

• More common causes involve:More common causes involve: Respiratory diseasesRespiratory diseases Injuries that lead to respiratory arrest or circulatory failureInjuries that lead to respiratory arrest or circulatory failure

The AHA’s pediatric Chain of Survival involves The AHA’s pediatric Chain of Survival involves these steps:these steps:

• Preventing cardiac arrestPreventing cardiac arrest• Early and effective CPREarly and effective CPR• Rapid activation of the EMS system or the agency’s Rapid activation of the EMS system or the agency’s

rapid response team (RRT).rapid response team (RRT).• Early and effective advanced life supportEarly and effective advanced life support

The BLS sequence for infants does not involve The BLS sequence for infants does not involve defibrillation.defibrillation.


HEMORRHAGEHEMORRHAGE Hemorrhage is the excessive loss of blood in a Hemorrhage is the excessive loss of blood in a

short time.short time.• If bleeding is not stopped, the person will die.If bleeding is not stopped, the person will die.

• You cannot see internal hemorrhage.You cannot see internal hemorrhage. The bleeding is inside body tissues and body cavities.The bleeding is inside body tissues and body cavities. Vomiting blood, coughing up blood, and loss of Vomiting blood, coughing up blood, and loss of

consciousness signal internal hemorrhage.consciousness signal internal hemorrhage.

• External bleeding:External bleeding: If not hidden by clothing, external bleeding is usually If not hidden by clothing, external bleeding is usually

seen.seen. Bleeding from an artery occurs in spurts.Bleeding from an artery occurs in spurts. There is a steady flow of blood from a vein.There is a steady flow of blood from a vein.


SHOCKSHOCK Shock results when organs and tissues do not Shock results when organs and tissues do not

get enough blood.get enough blood. Causes include:Causes include:

• Blood lossBlood loss

• Heart attack (myocardial infarction)Heart attack (myocardial infarction)

• BurnsBurns

• Severe infectionSevere infection

Shock is possible in any person who is acutely Shock is possible in any person who is acutely ill or severely injured.ill or severely injured.


Anaphylactic shockAnaphylactic shock• Anaphylaxis is a life-threatening sensitivity to an Anaphylaxis is a life-threatening sensitivity to an

antigen.antigen. An antigen is a substance that the body reacts to.An antigen is a substance that the body reacts to.

• Anaphylaxis can occur within seconds.Anaphylaxis can occur within seconds.

• Anaphylactic shock is an emergency.Anaphylactic shock is an emergency. The EMS system must be activated.The EMS system must be activated. The person needs special drugs to reverse the allergic The person needs special drugs to reverse the allergic

reaction.reaction. Keep the person lying down and the airway open.Keep the person lying down and the airway open. Start CPR if cardiac arrest occurs.Start CPR if cardiac arrest occurs.


SEIZURESSEIZURES Seizures (convulsions) are violent and sudden Seizures (convulsions) are violent and sudden

contractions or tremors of muscle groups.contractions or tremors of muscle groups.• Movements are uncontrolled.Movements are uncontrolled.

• The person may lose consciousness.The person may lose consciousness.

Seizures are caused by an abnormality in the Seizures are caused by an abnormality in the brain.brain.


EpilepsyEpilepsy• Epilepsy is a brain disorder in which clusters of nerve Epilepsy is a brain disorder in which clusters of nerve

cells sometimes signal abnormally.cells sometimes signal abnormally.

• In epilepsy, seizures recur.In epilepsy, seizures recur.

• The person has a permanent brain injury or defect.The person has a permanent brain injury or defect.

• Children and young adults are commonly affected.Children and young adults are commonly affected. Epilepsy can develop at any time in a person’s life.Epilepsy can develop at any time in a person’s life.

• There is no cure at this time.There is no cure at this time. Doctors order drugs to prevent seizures.Doctors order drugs to prevent seizures. Drug therapy does not work for some people.Drug therapy does not work for some people.

• When controlled, epilepsy usually does not affect When controlled, epilepsy usually does not affect learning and activities of daily living.learning and activities of daily living.


The major types of seizures are:The major types of seizures are:• Partial seizurePartial seizure

• Generalized tonic-clonic seizure (grand mal seizure), Generalized tonic-clonic seizure (grand mal seizure), which has two phaseswhich has two phases In the tonic phase, the person loses consciousness.In the tonic phase, the person loses consciousness. The clonic phase follows.The clonic phase follows.

– Muscle groups contract and relax.Muscle groups contract and relax.

• Generalized absence (petit mal) seizure, which usually Generalized absence (petit mal) seizure, which usually lasts a few secondslasts a few seconds There is loss of consciousness, twitching of the eyelids, There is loss of consciousness, twitching of the eyelids,

and staring.and staring.

You cannot stop a seizure.You cannot stop a seizure.• You can protect the person from injury.You can protect the person from injury.


BURNSBURNS Burns can severely disable a person.Burns can severely disable a person. Burns can cause death.Burns can cause death. Most burns occur in the home.Most burns occur in the home. Infants, children, and older persons are at risk.Infants, children, and older persons are at risk.


Partial thickness burns involve the epidermis Partial thickness burns involve the epidermis and part of the dermis.and part of the dermis.

• They are very painful.They are very painful.

• Nerve endings are exposed.Nerve endings are exposed.

Full thickness burns involve the entire epidermis Full thickness burns involve the entire epidermis and dermis.and dermis.

• Fat, muscle, and bone may be injured or destroyed.Fat, muscle, and bone may be injured or destroyed.

• Nerve endings are destroyed.Nerve endings are destroyed.

Severity depends on:Severity depends on:• Burn size and depthBurn size and depth

• The body part involvedThe body part involved

• The person’s ageThe person’s age


FAINTINGFAINTING Fainting is the sudden loss of consciousness Fainting is the sudden loss of consciousness

from an inadequate blood supply to the brain.from an inadequate blood supply to the brain. Dizziness, perspiration, and blackness before Dizziness, perspiration, and blackness before

the eyes are warning signals.the eyes are warning signals. The person:The person:

• Looks paleLooks pale

• Has a weak pulseHas a weak pulse

• Has shallow respirations if consciousness is lostHas shallow respirations if consciousness is lost


STROKE (CEREBROVASCULAR STROKE (CEREBROVASCULAR ACCIDENT)ACCIDENT)

Stroke occurs when the brain is suddenly Stroke occurs when the brain is suddenly deprived of its blood supply.deprived of its blood supply.

• Usually only part of the brain is affected.Usually only part of the brain is affected.

A stroke may be caused by:A stroke may be caused by:• A thrombusA thrombus

• An embolus An embolus

• Hemorrhage if a blood vessel in the brain rupturesHemorrhage if a blood vessel in the brain ruptures

Signs of stroke vary, depending on the size and Signs of stroke vary, depending on the size and location of brain injury.location of brain injury.


QUALITY OF LIFEQUALITY OF LIFE Protect quality of life during emergencies.Protect quality of life during emergencies.

• Treat the person with dignity and respect.Treat the person with dignity and respect. Protect the right to privacy and confidentiality.Protect the right to privacy and confidentiality. Protect the person from onlookers.Protect the person from onlookers.

• Information about the person’s care, treatment, and Information about the person’s care, treatment, and condition is confidential.condition is confidential.

Protect the right to personal choice.Protect the right to personal choice. Protect personal items from loss and damage.Protect personal items from loss and damage. Protect the person from further injury.Protect the person from further injury. Reassurance, explanations about care, and a Reassurance, explanations about care, and a

calm approach are helpful.calm approach are helpful.

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Chapter 49