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Medical Emergencies

Asthma
Asthma is a respiratory condition in which the casualty suffers the onset of constricted passages in the lower airway and it becomes progressively more difficult to breathe.  Trigger factors for asthma may include:

Viral respiratory infections
Exposure to known allergens, eg: dust mites, pollens, animal dander, moulds
Exposure to chemicals or other occupational sensitisers
Exposure to irritants, eg: cigarette smoke, perfume
Reflux
Drugs, eg: aspirin and beta-blockers
Foods, eg: nuts, seafood
Food additives - colourings, metabisulphite, monosodium glutamate (msg)
Changes in weather, exposure to cool air
Exercise
Emotion

Asthma can be a life-threatening condition that may develop suddenly, or over several days.  Asthma is usually considered in three classifications of severity:

As a first aid provider you should be aware that both mild and moderate asthmatics are subject to unexpected severe attacks, and that minor respiratory infections such as colds and flu, as well as seasonal changes, may cause an asthmatic condition to worsen. Treat the condition with care, as the effects are sudden and serious.

OTHER SIGNS AND SYMPTOMS

pale, cool, clammy skin
coughing, especially at night
pale, cool, clammy skin
shortness of breath - using all the chest and diaphragm muscles to breathe
wheezing - a high pitched raspy sound on breathing
anxiety
exhaustion
rapid, weak pulse
cyanosis
severe asthma attack: collapse - leading to eventual respiratory arrest

CARE AND TREATMENT

Conscious casualty:
sit the person comfortably upright.  Be calm and reassuring
give 4 puffs of a blue reliever inhaler (puffer) - Ventolin, Respolin, Bricanyl, Respax or Asmol.  Use the person's own inhaler if possible.  If not, use the First Aid kit inhaler or borrow one from someone else.
Relievers are best given through a spacer, if available.

With spacer:
shake inhaler and insert mouthpiece into spacer
place spacer mouthpiece in person's mouth and fire 1 puff into the spacer
ask the person to breath in and out normally for about 4 breaths
wait 4 minutes.  If there is little or no improvement, repeat the above sequence.
repeat until 4 puffs have been given

Without spacer:
shake inhaler
place mouthpiece in person's mouth.  Fire 1 puff as the person inhales slowly and steadily
ask the person to hold that breath for 4 seconds, then take 4 normal breaths
repeat until 4 puffs have been given

Collapsed casualty:
call 000 for an ambulance
if possible, assist with 6-8 puffs of a reliever
if little or no immediate improvement - repeat reliever medication every 4 minutes
reassurance
if in respiratory arrest — expired air resuscitation (EAR)

Fainting or syncope, is a sudden brief loss of conscious that may only last a few seconds and is followed by full recovery within two minutes. Fainting is usually caused by a relatively minor event such as the sight of blood or just prior to receiving an injection. The casualty usually makes a full recovery once he or she is laid flat.

There are many causes of fainting, including:

standing for long periods
the sight of needles
the sight of blood
pain
emotional events
heat

SIGNS AND SYMPTOMS

dizziness or feeling light headed
nausea
pale, cool and clammy skin
anxious
collapse
loss of conscious
rapid recovery after being laid flat

CARE AND TREATMENT
Syncope

if unconscious - stable side position
raise the legs if possible
if conscious - lie the casualty flat and raise the legs if possible
call 000 for an ambulance if not fully recovered in a few minutes

Heat Syncope

stable side position
cool casualty by fanning
loosen and remove excessive clothing

CHOKING is due to the lodgement of a foreign object in the casualty's airway (trachea). In some instances, the object lodges at the epiglottis - the entry to the airway - but does not actually enter the trachea. Both cases cause initial coughing, the body's reflex action to dislodge the object.

If an object is firmly lodged in the airway, coughing at least keeps it high in the trachea, though may not expel it. Coughing with an object at the entrance to the airway, however, will generally cause it to be expelled.

Should you encounter a person with an apparent obstruction who is COUGHING EFFECTIVELY, DO NOT SLAP him or her on the back. If the obstruction is at the entrance to the trachea, then reactions to the slaps may cause the person to inhale the object and cause complete obstruction.

If a casualty initially coughs to no effect, and appears to be in increasing distress, then the object may be totally obstructing the airway.

SIGNS AND SYMPTOMS

difficulty or absence of breathing
inability to speak or cough
agitation and distress - grabbing the throat
cyanosis
eventual collapse

CARE AND TREATMENT

position the casualty - adults laterally, children head down
deliver four firm slaps between the shoulder blades
check mouth and clear any obstructions that may have come loose
reassess the casualty's attempts to breathe
repeat four firm slaps between the shoulder blades 4 if blockage has not been cleared call 000 for an ambulance
  
If this fails to free the object and the casualty has collapsed, quickly roll the casualty onto his or her side, place your hands over the ribs, and deliver quick, firm thrusts. This may expel the object through the forcing of residual air from the lungs.

alternate slaps and lateral chest thrusts
if ineffective, and the casualty is in respiratory arrest begin expired air resuscitation (EAR) immediately.
EAR may be effective, as the object lodged in the airway causes muscular deformity of the trachea. Complete collapse of the casualty causes relaxation of the muscles, this allows some space around the object through which EAR can provide essential oxygen.

Hyperventilation
Hyperventilation can be stress-related or deliberate over-breathing.  By deliberately over-breathing, the casualty causes the blood's carbon dioxide level to fall, resulting in distressing symptoms.

Hyperventilation may be precipitated by a number of causes, most of them related to anxiety, fear or irrational emotional outbursts. Reassurance of the casualty and a calm approach often lead to the condition being relieved spontaneously.

SIGNS AND SYMPTOMS

rapid respirations
rapid pulse
a feeling of shortness of breath
pressure, tightness or pain across the chest
anxiety
blurred vision
In extreme cases which have continued for some time

‘tingling’ in fingers and toes
hand and finger spasms and pain
fainting

CARE AND TREATMENT

reassurance
remove the cause of anxiety if possible
if fainted, lay casualty supine with legs elevated
if no improvement, call 000 for an ambulance
Not every casualty who is breathing rapidly is suffering from hyperventilation due to anxiety. In some cases the rapid respirations may be a sign of another, more serious, medical condition. It is important to eliminate more serious causes such as asthma.

NEAR DROWNING may be classified as either:

'wet' - where the casualty has inhaled water and the lungs' function has been affected; or
'dry' - a less common condition, but one that involves the closing of the airway due to spasms induced by water.
The most important consideration to be made by the first aid provider is to avoid DANGER. Do not attempt a rescue beyond your capabilities, and have the casualty brought to you. Meet the rescuer in the water and begin resuscitation immediately.

SIGNS AND SYMPTOMS

pale, cool skin
absent or laboured respirations
decreased level of consciousness
cyanosis
may have weak or absent pulse

CARE AND TREATMENT

DRABC
commence immediate EAR or CPR as required
on recovery, stable side position
treat hypothermia if present
suspect and treat spinal injuries
call 000 for an ambulance
It should be remembered that near drowning has a detrimental effect on the respiratory system, and on recovery, the nearly drowned casualty may experience a build up of fluid in the lungs. This fluid can lead to, at best, pneumonia, at worst, a fatal condition called 'late drowning'.

All casualties who have experienced near drowning MUST SEE A DOCTOR.

Poisoning
Poisons are substances that if inhaled, ingested, absorbed or injected, harm the structures or functions of the body. Some types of poisons may act immediately on the body, others may act more slowly. Some poisons, such as cyanide, are so toxic they only require a minute amount to be harmful, while others, such as garden sprays, are cumulative and require exposure over a long period to achieve the same level of toxicity. Some may be carcinogenic, and cause fatal cancers some years after exposure.

Whatever the substance, remember that PREVENTION IS BETTER THAN CURE!

always ensure that poisonous substances are kept only if really necessary
pills and medications should always be locked away in a childproof cupboard
Substances are never decanted into attractive containers such as soft drink bottles
all substances are labelled and understood before use
prescription medications are used only by the person prescribed them
all poisons and medications are disposed of correctly.
The wide varieties of poisonous substances present with a similarly wide variety of signs and symptoms. The list below is not exhaustive, but casualties may present with all, or at least some, of them.

Obtain a history, look for empty bottles, containers, and sometimes suicide notes.

SIGNS AND SYMPTOMS

May include the following:

pale, cool, clammy skin
rapid, weak (sometimes erratic) pulse
nausea and/or vomiting
cyanosis
headache
burns around the mouth
burning pain in the mouth or throat
blurred vision
ringing in the ears
smell of fumes or odours
stomach pains or cramps
drowsiness, which may lead to unconsciousness
seizures
breathing difficulties

CARE AND TREATMENT

call  for an ambulance
EAR & CPR as required
monitor the casualty at all times
keep samples of poison, medication or containers
keep samples of vomitus
be careful not to contaminate yourself during contact
If possible, ascertain what poison or medicine has been taken, including how much and when.

Shock
Shock is a life-threatening condition, and should not be confused with the flood of adrenaline that accompanies dangerous or fearful situations. This reaction to danger or fear is called the 'fight-or-flight' reaction, and is often confused with, and referred to as, 'shock'.

CAUSES OF SHOCK

Loss of blood and body fluids — may be due to haemorrhage, burns, dehydration and severe vomiting and diarrhoea
Heart attack — this is a very serious condition
Sepsis or toxicity — such as severe blood poisoning
Spinal injuries — due to the injury and the reaction of the nervous system
Shock is a deteriorating condition, and one that does not allow a casualty to recover without active medical intervention. As a first aid provider attending a casualty, you should ask yourself the following:

Does the injury appear serious?
If I don't do anything to help, is the casualty likely to become worse?
If the casualty's condition worsens, is death a possibility?
If the answer to these questions is 'YES!', then you should treat for shock.

SIGNS AND SYMPTOMS

pale, cool, clammy skin
thirst
rapid, shallow breathing
rapid, weak pulse
nausea and/or vomiting
evidence of loss of body fluids, or high temperature if sepsis present
collapse and unconsciousness
progressive 'shut-down' of body's vital functions

CARE AND TREATMENT

DRABC
control any bleeding
call 000 for an ambulance
if conscious, position supine, with legs elevated
if unconscious, stable side position with support under the legs to elevate them
reassurance
maintain body temperature, but do not overheat
treat any other injuries