It’s 7pm, and you’re enjoying
dinner at your favorite restaurant.
Suddenly, you notice an older gentleman at the table next to you has
collapsed and doesn’t seem to be breathing. Now you’re at a baseball field on a very hot summer day
watching your kid pitch, when you notice that a player on the other team seems
disoriented and uncomfortable. Or
how about you are at a family barbeque and your niece is stung by a bee, and
now she can’t breathe. What are
you going to do?
These
are all real-life situations that are bound to come up at one time or
another. Hopefully a medical
professional will be with you, but what if you are the only one there to help? What would you do? In this edition of “Stethoscopes to the
Streets,” let’s talk about some common emergency situations and what every layperson
could do to help until medical personnel arrive. Come on, I know you could save someone’s life!
Firstly,
let me preface by saying the first thing to do in any emergency situation is to
call 911. Right away, before you
do anything. Even doctors who
happen upon an emergency in public will call 911 before doing anything, because
an ambulance has lots of equipment and people to help, not to mention a direct
connection to a hospital! So
lesson 1: call for help, or send someone to call for help. Secondly, I think it’s very important
for everyone to take a course in Basic Life Support, or BLS. This 4-hour course is available at
virtually any town, usually at a college, hospital, or through the American Red
Cross, and covers topics like cardiopulmonary resuscitation (CPR), the Heimlich
maneuver for choking people, and how to resuscitate an infant. It also demonstrates the use of a
defibrillator, an integral part of resuscitation of someone who is suffering
from ventricular fibrillation of the heart. It’s only four hours of your time, and you’d be able to help
employees, family members, friends, and strangers. Go find a course.
Now
that the formalities are taken care of, let’s talk about a sudden collapse! This
could be due to many things, but in an older individual, a sudden heart
arrhythmia or severe myocardial infarct would be the most likely causes. Again, please take a BLS course because
they will spend a few hours on this topic and I’m only going to give it a
paragraph, but here’s where to start.
After you call for help (911, or send someone to call), check to see if
the person is breathing. If they
are not breathing, give two rescue breaths by pinching their nose shut. Check for a pulse. No pulse? Start compressions by placing one hand on top of the other
in the middle of the person’s chest and forcefully pump downwards. The American Heart Association now says
that it’s OK for lay rescuers to administer JUST chest compressions (no rescue
breaths) in a pulseless patient.
The idea is to keep up the blood flow to the brain, and every time you
stop compressions, the brain is without oxygen. Otherwise, you can give 30 compressions then 2 breaths. How fast do you compress? Sing the song “Stayin’ Alive” by the
BeeGees in your head (I’ve actually hummed it aloud in the ER when I was giving
compressions; it really works!!)
The pace of that song is about 100 beats per minute, perfect for trying
to pump a heart. Another thing
you’d learn if you took a BLS course is that if you can find a defibrillator
(an AED, or automated external defibrillator), use it right away. This is a special device that
administers a shock if it senses that the patient is in a “shockable rhythm”
(never mind what this means; that’s in the weeds of cardiac
pathophysiology). Basically, turn
the device on and put the pads on the patient’s chest like the diagram on the
AED shows. Then it will talk you
through the whole thing. Hopefully,
help has arrived by now.
Do
you know how to identify that someone might be having a stroke? Being able to
figure that out is the most important thing for helping a stroke victim. By the
way, stroke is the leading cause of disability in this country, and the third
leading cause of death, so an idea of what to do could really help someone. A
stroke is the result when the blood supply is cut off from a certain part of
the brain. The brain does a lot of
things, and each anatomical part of the brain has a different role. This is why there are so many
manifestations of a stroke. A few
things you can look out for are the following: clumsy hands or feet, drooped
face (one side), slurred speech, speech makes no sense, sudden loss of vision
in one eye, and an unsteady gait.
Again, this is a small sampling of symptoms but it’s a start. The first thing to do if you’re even
suspecting a stroke is to get the person to the hospital NOW. Time is brain. Every second that ticks by without
blood supply to that certain part of the brain means there is less chance that
the person will be able to regain full function. Until help arrives, keep the person from harm’s way. Also, if they are able to swallow (they
do not have any problems with speech or moving their tongue) and they are
conscious, give them 325 mg aspirin (the equivalent of 4 “baby”or 81 mg aspirin
tablets). Although 15% of strokes
are caused by a hemorrhage within the brain instead of a blood clot, one of the
leading neurologists in Chicago told me on my neurology rotation that if you
are alone and waiting for help to come, aspirin is still the best thing you can
give to try to help.
On
hot summer days, heat illness is an
urgent medical situation you might happen upon. Heat illness is a spectrum of overheating disorders,
commonly when the elderly or babies are exposed to prolonged heat, or when
young, healthy individuals overexert themselves in hot conditions. Symptoms of heat illness or impending
heat stroke (a more serious condition where the body can’t regulate temperature
anymore) are profuse sweating or worse yet, someone who stops sweating,
increased thirst, but with little to no urination, confusion, dizziness,
fainting, muscle cramps, and a fast, weak pulse. If you see someone with these symptoms, get them to a cool
place, preferably an air-conditioned area. If they are conscious and able to drink, help them take
fluids such as Gatorade or other sugary, electrolyte-filled liquids. Strip off as much clothing as you can,
because clothes will trap in heat.
Find some fans and get them blowing on the person. If you have ice, ice packs, or other
cool objects, place them in the armpits, neck and groin areas (this helps cool
down the body core faster). If the
patient is unconscious or starts seizing, call 911 right away but try to get
them out of the heat as best as you can.
This
one is a bit obscure, but it might happen! What if you’re at work and a co-worker operating a piece of
heavy machinery like a power saw and manages to amputate a finger or hand?
A similar scenario could be an accident with a knife. Very dramatic, indeed, but your actions
could enable the surgeons to successfully reattach the lost body part. If possible, first get the person to
safety (and shut off any machines that may cause more damage), and call
911. The thing we really need to
do is stop the bleeding right away. Apply plenty of pressure or apply a
tourniquet (as I mention in the next paragraph). Ensuring proper hemostasis, or stopping blood flow, often
involves two people, one of which might be the injured if they can help. After we have stopped the bleeding, our
next priority is to try to save the severed body part. This involves keeping both ends of the
amputation clean and moist, and we’ll do this with saline and sterile gauze if
possible, found in a first aid kit.
I’ll describe the proper method using these items, but clean bottled
water and thin towels could do the trick in a pinch. Gently rinse the two ends with saline. Loosely bandage the injured end
attached to the person with gauze or towels, applying pressure to stop any further
bleeding. Then, soak some sterile
gauze in saline and wrap the unattached part (the finger, etc) gently. Place the gauze-wrapped item in a
plastic bag if one is available, then put the plastic bag on a bed of ice. Do not put the body part directly on
ice: this will damage the fragile vessels and nerves that will later be needed
during reattachment. Ta da! You just saved an appendage, and more
importantly, saved a life!
Speaking
of bleeding, do you know how to
effectively make it stop? I think
many people have at least some level of understanding about this, but let’s
review just to be on the same page.
There are obviously lots of reasons and ways that a person could start
bleeding, but one thing to keep in mind is that many people (especially the
elderly) are on “blood thinning” medications like coumadin, which could cause
them to bleed excessively, disproportionate to the injury they sustained. Of course, arrange for transportation
to the hospital if bleeding is excessive.
Then, find a first aid kit and/or clean towels. You’ll want to have the patient sit or
lie down, then apply constant, firm pressure over the site. If multiple sites are bleeding, do a
little “triaging” and do your best to stop the major bleeds first. If pressure alone doesn’t fully stop
the bleeding, there are a few tricks to try. First, raise the bleeding part as far above the heart as
possible. The heart is obviously
pumping blood, and if the injured area is dependent (or hanging downward with
gravity), that pumped blood is just going straight for the injury, and
subsequently onto the floor. If
the bleeding is VERY brisk from an arm or leg, you can use a belt, a shoelace,
or scarf to tightly tie as close as you can to the trunk. This means tying the scarf at the
armpit or groin. It’s not safe to
use tourniquets like this for very long, but the limb would be OK until you get
the victim to the hospital.
Finally,
what would happen if someone around you had a severe reaction to peanuts or a
bee sting in your presence? My mom
has pretty severe reactions to bee stings, and I’ve made sure my whole family
has had this tutorial. I’ll review
for everyone. People who have
severe allergic reactions can have swelling of their airways that can
compromise breathing as well as dilate all of their blood vessels, leading to
shock. If the patient is carrying
an EpiPen, or you could find one in short order, use it. The EpiPen has a dose of epinephrine, a
drug/neurotransmitter that will cause the airways to dilate and the blood
vessels to constrict, simultaneously helping the patient get air into their
lungs as well as keeping their blood pressure up, thus preventing shock. Simply place the pen on the patient’s
exposed thigh and push the plunger (directions are on the container). The needle will be safely hidden after
giving the medication so you won’t injure yourself. Anytime an EpiPen is used, the patient should go to the
emergency room, even if they feel better.
The dose of epinephrine may wear off, or they may have some side effects
from the epi itself. If the
reaction is not so severe that they have passed out or are having trouble
breathing, they may have a bad rash or localized swelling (especially after
stings). Give the patient a dose
of Benadryl (diphenhydramine), which is an antihistamine that will counteract
the products released during the allergic reaction. Sometimes patients are prescribed prednisone, a steroid, to
be used in high doses if they come in contact with a substance. If you have these handy, give the
patient the dose described on the bottle.
Emergency
situations are scary, even for medical students and doctors. However, a little knowledge and a lot
of staying calm can go a long way to helping save a life. Go get BLS certified, always call for
help first, then do everything you can to stabilize until the people with
drugs, equipment, and wheels to the hospital arrive. It’s important to remember to always keep yourself out of danger
first (you’re no help if you’re hurt, too!), and remain calm no matter
what. Anyone can help save a life,
especially you!
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