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SE C T I O N E L E V E N - B ASI CS O F E M E R G E N C Y C A R E

In this section, Home Care Assistants will learn the basics of some common medical emergencies. The section does not go into first aid procedures such as minor wounds and fractures. Instead, its focus is to emphasize those situations which can be life threatening. The section is not a substitute for formal First Aid and CPR courses. Instead, its purpose is to give Home Care Assistants a theoretical overview of the basics of care for some of the most common medical emergencies. This will enable them to recognize emergency situations and initiate prompt action to ensure that victims receive the care they require. It will also serve as a guide in knowing what to do and what not to do. Home Care Assistants should know the basics of providing emergency care and first aid. Therefore, it is strongly recommended that Home Care Assistants who want to work as Home Care Assistants, either as self employed workers or as employees of an agency, take formal First Aid and Cardiopulmonary (CPR) courses . They are available from organizations such as St.  John’s Ambulance and the American Red Cross. Most Home Care Agencies make it a condition of employment that applicants successfully complete certified First Aid and CPR courses. Home Care Assistants must not consider themselves to be first aid attendants on the basis of this Senior Home Care Assistant Guide, as that designation would require broader theoretical knowledge, practical training and subsequent certification. Objectives of Emergency Care Emergency care is assistance given to people who have developed severe life threatening conditions, which require immediate attention. It provides temporary assistance or treatment until medical help is available. The basics of first aid are to:

keep the injured/ill individual alive; prevent the injury or condition from worsening; and, promote recovery.

There are three main goals in giving first aid. They are to:

maintain breathing; stop bleeding; and, prevent shock.

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General Rules of Emergency Care While each case is individual and unique, there are some general rules which Home Care Assistants can apply to any emergency situation. They are:

Know the limits of your knowledge and abilities. Remain calm and focused. Don:t move the victim or change hisGher Body position until you can get a better understanding on

what the problem(s) is. (He/she may need to be moved immediately if they are in a life threatening situation. (e.g. Their heads and/or body are underwater or fire breaks out.)

Check breathing, bleeding and pulse. Perform emergency procedures as indicated. Call for assistance or if another person is on hand, direct them to call for assistance. The following

information should be provided: o location of where you are (e.g. address, landmarks); o telephone number you are calling from; o what has happened (e.g. fall, accident); o what condition the victim is in (e.g. breathing, not breathing, conscious, unconscious, bleeding,

fractures); and, o life threatening situations.

Stay on the phone until the person on the other end of the line hangs up or until emergency services arrive.

If signs and symptoms indicate a specific problem, follow the guidelines for that condition. e.g.: o If it appears the victim may aspirate (inhale blood, vomit or water being into the lungs) then

position him/her on his/her side or back with their head turned to one side and placed lower than their feet. It the substance gets into the lungs, he/she may choke to death.

o If the victim is having trouble breathing or has an obvious injury to his/her chest, then position him/her on their back with their head slightly lower than the feet.

o Don:t remove clothing unless necessary -- if it is then tear the clothing along the seams. When clothing is removed, protect the victim from the cold. By cutting shoes off, instead of pulling them off, you can reduce the chances of additional pain and injury.

o If the victim has an injury, try not to let him/her see the injury. o Do not touch open wounds or burns without sterile bandages unless it is necessary to stop severe

bleeding. o Protect from shock by covering the victim with something warm such as a blanket or coat O

whatever is handy. o Keep the victim warm enough to maintain normal body temperature. o Reassure the victim that help is on the way. o Do not give the victim water or food. o Keep onlookers away from the victim. o When transporting a victim, be sure his/her feet point forwards, as this will enable the attendant in

the rear to watch for signs of distress.

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T4e ):Cs of )ssessing a 5erson0s Condi$ion When an emergency situation develops, the first thing that should be done is a quick assessment of the person:s condition. This involves checking the status of certain Body functions in a specific order:

“)J is for airway. Determine if the individual can breathe or breathe effectively by: o If conscious, ask if he can breathe and evaluate how well he responds. o If unconscious, tilt the head by pushing forehead backwards and lifting up the chin. o Note: Do not tilt the head if a spinal cord injury is suspected O instead, support it by placing

your hands on each side of the jaw and keeping it pulled in a straight alignment. o If there is anything in the mouth, which may be obstructing breathing, remove it.

I:J is for breathing. Once the airway is opened, check for breathing by placing your ear close to the individual:s nose and mouth and listen for a few seconds. o If there is no breathing, give two slow breaths and check for a carotid pulse. (The carotid is the

artery on both sides of the neck, which deliver blood to the brain. o If there is not a pulse, give cardio-pulmonary resuscitation (CPR)

ICJ is for circulation. Ensure that there is effective circulation: o If there is profound bleeding (i.e. blood is spurting out or gushes out), give first aid to control it. o Check for shock by:

- looking to see if the skin is pale or has a bluish tinge; - checking the Body:s temperature By feeling the forehead, cheek or neckC and, - looking for signs of sweating.

o Check the entire body by feeling the head, neck, shoulder, arms, hands, chest, abdomen, pelvis, buttocks legs and feet. Be alert for signs of pain or bleeding.

B reathing Emergencies There are three primary reasons why breathing can be affected:

lack of oxygen; blocked airway; impairment in heart and lung function.

Home Care Assistants should be alert for signs of breathing distress. They need to be able to determine if there is no breathing at all or if the breathing function is affected:

If breathing is present, but is not effective: o breaths may be slow and shallow or they may be fast and shallow; o the individual is gasping for air; o the skin has a bluish tinge; o the individual becomes more tired; o the individual is sweating; and, o the individual may lose consciousness.

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If breathing has stopped altogether then: o the chest does not rise and fall; and, o the breath cannot be heard or felt.

A rtificial Respiration Artificial Respiration is the process of supplying air to the lungs of an individual who is not breathing effectively, or is not breathing at all. When he/she is not breathing, then he/she needs to be resuscitated. The methods of resuscitation are:

M ethod When to Use Procedure

Mouth to Mouth

This is the commonest form of resuscitation and is the method used most frequently.

Pinch the individual:s nose shut with thumb & forefinger.

Take a deep breath and place your mouth tightly over the individual:s mouth.

Slowly blow the air from your into the individual:s mouth.

As the individual exhales, the air can be heard & felt escaping.

Remove your mouth from the individual:s mouth. Take another deep breath and repeat the process.

Nose to Mouth

Mouth to nose is used when the mouth does not allow blowing into it because: o the mouth is injured; o it is hard to make a difficult seal between mouths; and, o the mouth cannot be opened

Close individual:s mouth, if open. Tilt head back and lift chin. Hold individual:s mouth shut By pressing on the

chin. Take a deep breath Place your mouth over the individual:s nose. Slowly blow air from your lungs into the

individual:s nose. Remove your mouth from the individual:s nose. Listen & feel for air escaping. Take another deep breath & repeat the process.

Note: When giving mouth to mouth or mouth to nose resuscitation, if possible use a shield, facemask or barrier device between your mouth and the individual to protect both of you from germ transmission.

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Cardiopulmonary Resuscitation (CPR) Cardiopulmonary resuscitation is a combination of artificial respiration and artificial circulation.

Artificial Respiration delivers oxygen to the lungs.

Artificial Circulation pumps blood throughout the body. The goal of emergency CPR is to keep oxygenated blood circulating to the brain and other parts of the body until the pulse returns or until medical help can take over. Home Care Assistants (HCA) need to be familiar with CPR so that they know what to do and the order in which to do it, as often they will be alone with the client. When a client appears to be in distress the HCA should:

Determine if the client is responsive by:

o asking him/her if they are okay; and/or, o tapping him/her on the shoulder.

If there is no response the HCA should:

o call 9-1-1 or other emergency service for medical help; and, o check for breathing and pulse.

If the pulse and breathing are absent, commence CPR, if trained to do so.

Only perform CPR if the individual is unconscious and is not breathing and there is no pulse.

Notations:

The importance for Home Care Assistants to take a CPR course cannot be stressed enough.

The information provided in this section is theoretical information only. Practical training is also

required to obtain certification. The information provided here is intended as an introduction to CPR and not a formal training tool.

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Emergency Care for Cardiopulmonary Resuscitation

Tilt the head backwards to open the airway. Blow two Breaths of air into the lungs By following the steps outlined in “Artificial Respiration” Watch to ensure that the chest rises when the air is blown in. If it does not rise, reopen the airway and blow again. If it still doesn:t rise, give first aid for choking. Check for a pulse using one of the carotid arteries in the neck If there is a pulse, start artificial respiration. If there is not a pulse, start CPR. Ensure the individual is lying on a flat & hard surface. Kneel beside the individual. Slide your fingers to the notch where the ribs meet. Interlock fingers and keep the underside fingers straight. Position your shoulders directly over your hands & keep elbows locked. Press the heels of the hand, right down on the breastbone. Exert firm, downward pressure to depress the sternum (breastbone) about 1 ½ - 2 inches). Release pressure without removing hands from the chest. Continue with compressions using a regular rhythm which has about 4 cycles per minute. Each cycle

consists of: o 15 chest compressions o 2 breaths of air into lungs

Count compressions out loud to keep track of numbers and to maintain rhythm. Count as follows: o 1 & 2 & 3 & 4 & 5 and o 1 & 2 & 3 & 4 & 10 and o 1 & 2 & 3 & 4 & 15.

After the first minute (4 cycles) stop to determine if the heart has started beating by feeling for a pulse and by listening/feeling/hearing for breathing sounds.

If the pulse is still absent, continue with compressions and reassess every few minutes. Keep providing CPR until: o individual starts breathing; o another attendant takes over; o medical help arrives; or, o you are too exhausted to continue.

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Choking Choking occurs when there is an obstruction in the airway and air cannot get to the lungs. This causes the body to be deprived of oxygen, which can lead to cardiac arrest. Obstructions can be partial of full:

In Partial obstruction, some air is able to be inhaled and exhaled. Usually, forceful coughing will

dislodge the item.

Note: Do not hit the choking individual on his/her back .

In complete obstruction, air cannot be inhaled or exhaled. The individual with the obstruction will normally:

o clutch at his/her throat; o be unable to cough, speak or breathe. o appear pale with a slightly bluish tinge to the skin.

This is an urgent situation and the obstruction must be removed immediately!

Eating is the most common cause of airway obstructions because:

food (especially meat) is not chewed sufficiently; and, people are laughing and talking.

Older people are particularly prone to choking because:

Their dentures don:t fit properly. They have poor swallowing reflexes. They have chronic illnesses. They are weak.

Emergency Care for Choking Home Care Assistants may have a client who chokes. Therefore, it is important for them to know what to do as action has to be taken immediately. The following procedures explain how they might help their choking clients.

Ask the individual if he/she is choking. Determine if he/she can talk or speak. Perform the Heimlich Manoeuvre, which is a procedure using thrusts to the abdomen to dislodge

items from the airway.

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The Steps to take when applying the Heimlich Manoeuvre are:

If the choking individual is standing or sitting:

o Stand behind the choking individual. o Hrap your arms around the individual:s waist. o Make a fist with one hand and place the thumb against the abdomen. o Grasp the fist with the other hand. o Press fist and other hand into the abdomen. o Thrust upward with a swift and forceful thrust. o Repeat the procedure until:

-- the item is expelled; -- the choking individual becomes unconscious; or, -- medical help arrives.

If the choking individual is lying down, follow the same procedures listed above with some modifications to the Heimlich Manoeuvre:

o position him/her on his/her back. o kneel next to his/her thigh with your head facing forward. o place the heel of one hand against the abdomen at a spot which is above the navel and below

the breastbone. o place one hand on top of the other. o press your fist and hand into the abdomen and give a swift, upward thrust.

If the choking individual is unconscious:

o Call/send for medical assistance o Position individual on floor with back against the floor. o Open the mouth and look for the object. o If an object is spotted, hook your finger & remove it. o Open the airway by tilting the head and lifting the chin. o Blow twice into the individual:s mouth. o If air does not go in: -- Position heel of one hand on the lower half of the breastbone in the center of the chest -- Place heel of other hand on top of the first hand -- Press straight down to compress the chest 1 ½ - 2 inches -- Press at a rate of 15 compressions in 9 seconds. -- Keep repeating the process until: --- the object is expelled; or, --- medical help arrives.

Note: If the choking individual is obese or pregnant, the thrusting is done on the chest instead of on the abdomen.

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H emorrhage Hemorrhage is an excessive loss of blood in a short time, which generally occurs as a result of deep cuts and injured or severed/torn blood vessels. The severity of it depends on the size of the blood vessel(s) that has been damaged. If bleeding is not stopped, the individual will die. The signs and symptoms of hemorrhaging are:

pale, cold and clammy skin; rapid pulse which becomes progressively weaker; feeling lightheaded, dizzy, thirsty and/or nauseous; and, shallow breathing and difficulty getting air

Hemorrhaging can be internal or external: Internal hemorrhaging takes place inside the tissues and body cavities. Its signs are:

vomiting blood; coughing up blood; bleeding from the ear or nose; eyes appearing black or bloodshot; loss of consciousness; bloody or black stools; red or smoky urine; and/or, loss of consciousness.

Note: If internal bleeding is severe, the individual will show progressive signs of shock. Emergency Care for H emorrhaging With Internal H emorrhaging, there is little that can be done except summon medical help and treat for shock. In External Hemorrhaging, bleeding can be seen outside the body O be aware that clothing may hide it. Hemorrhaging must be stopped so emergency procedures need to be started immediately:

Have/assist the individual to sit or lie down. Remove clothing to see how serious the wound is. Cover with a clean cloth or sterile dressing. Apply direct pressure over the cloth/dressing. If the wound is large and gaping, bring the edges

together first.

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If dressings are not available, have the individual use his/her own hand to apply pressure. If direct pressure does not stop the bleeding, apply pressure to the artery above the bleeding site using

your first three fingers. When the bleeding is controlled, maintain pressure with dressings and bandages. If blood soaks through the cloth/dressing, do not remove it but apply others on top of it. Raise the injured wound above the level of the heart, unless the limb is broken. Place the individual in a restful position to slow the heart rate down.

H eart A ttack A heart attack (Myocardial Infarction or MI) occurs when the blood supply to the heart is cut off or impaired and heart tissue dies. The main cause is hardening of the arteries. The warning signs of a heart attack may include:

feeling heavy pressure or squeezing pain in the chest; pain radiating down the arms or into the jaw; shortness of breath; pale skin; sweating; weakness; nausea and vomiting; abdominal discomfort with indigestion and belching; fear; denying anything is wrong; shock; unconsciousness; and, cardiac arrest. (Cardiac arrest is when the heart stops beating.)

Emergency Care for H eart A ttacks

Phone 9-1-1 or other emergency service to get prompt medical attention. Provide rest by helping the individual assume a semi-sitting position -- or whatever position is most

comfortable. He/she may find it easier to sit or lie down. Hand an individual his/her medication only if he/she asks you to and the medication has been

prescribed for him/her. Reassure the individual and let him/her know that help is on the way. Loosen collar, belt and tight clothing. Keep individual quiet but do not restrain him/her while waiting for medical help.

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Stroke

A stroke (Cerebrovascular Accident or CVS) occurs when:

o a blood clot blocks a narrowed artery in the Brain and the part of the Brain past the clot doesn:t get enough oxygen; or,

o an artery ruptures and blood bleeds into the brain.

The main cause of strokes is hardening of the arteries.

A severe stroke can cause death while less severe strokes can cause brain damage. Some signs and symptoms that may indicate a stroke are:

paralysis of the face muscles; difficulty speaking; dizziness; sudden fall; numbness or weakness in the arm and leg on one side of the body; decreased level of consciousness; double vision or loss of vision; mental confusion; loss of bladder and bowel control; unequal size of eye pupils; and, severe headache.

Emergency Care for Strokes

Call 9-1-1 or other emergency service. Position the individual at rest O usually in a semi-sitting position. Do not give anything by mouth. Protect him/her from injuries. Reassure him/her and keep him/her warm. If the individual goes unconscious, place him in the recovery position.

Note: Place the paralyzed side of the body down when placing him/her in the recovery position. (The paralyzed side of the body can usually be determined by which side of the face is crooked or drooping.)

If breathing stops, start Artificial Respiration (AR). If there is no pulse, start Cardiopulmonary Respirations (CPR).

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The Recovery Position The recovery position is a lying-on-the-side position. It is used for a semi-conscious or unconscious individual who is breathing and has a pulse. This position will keep the airway open and prevent substances from being inhaled into the lungs. Note: Do not use the recovery position if the individual has a neck injury or other trauma. To place a individual in the recovery position:

Log-roll him/her onto his/her side, keeping the head neck and spine straight. Place the hand of the upper arm under the individual:s face and eLtend the lower arm along hisGher

other side. Bend the knee on the side the individual is not lying on (i.e. the leg on top).

Burns Burns are injuries to the skin and other tissues as a result of heat, radiation and chemicals. Burns that are caused by steam or hot liquid are called scalds. Burns are the leading cause of injury in the home. Because the elderly are particularly at risk, Home Care Assistants need to know the basics of what to do if their client is burned. Emergency Care for Burns

Cool the Burn immediately By immersing it in cold water. If this can:t Be done, pour cold water onto the area or cover it with a clean cloth. Cool it until the pain has lessened.

Loosen or remove anything on the burned area that is tight (e.g. jewelry, clothing) before the area starts to swell. Don:t remove anything that is stuck.

Loosely cover the burn, with a sterile, lint-free dressing (or a clean, lint-free cloth if a dressing is not available). If the area is large, use a sheet. Secure the dressing in place with tape but avoid taping the burned area.

Arrange for medical attention. Give first aid for shock

Things Not To Do When Providing Care For Burns

Don:t Breathe on, cough over or touch the burn. Don:t Break Blisters. Don:t remove clothing that is stuck to the Burn. Don:t use Butter, ointments, lotions or oily Bandages on the Burn.

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Don:t cover the Burn with fluffy material Ie.g. wool, flannel materialN. Don:t cool the individual too much -- once the burn has been cooled, keep individual warm.

Electrocution Electrocution occurs when a low frequency electric current passes through the body, which usually results in death. Some of its causes are:

touching a faulty or wet electrical outlet; coming in contact with a live power line; touching a metal object that is in contact with a live power line; faulty appliances; faulty electrical cords; and, lightning.

Emergency Care for E lectrocution

Look at the electrocuted individual but don0$ $o<c4 4imK4er, as he/she may still be in contact with the electrical source. (If you touch the individual, the current may pass through you.). Call 9-1-1 or other emergency service.

Turn off the source of electricity, if possible. If not, move the source away from you and the affected individual using a non conducting object made of cardboard, plastic or wood.

Once the individual is free from the electrical source, check for breathing and pulse. If either has stopped begin cardiopulmonary resuscitation (CPR) immediately.

If the individual is faint or pale or shows other signs of shock, lay him/her down with his/her head slightly lower than the body trunk. Elevate the legs.

F ainting Fainting occurs when there is a sudden loss of blood supply to the brain, which results in unconsciousness. Some of its common causes are:

injury; standing in one spot too long; hunger; fatigue; fear; and, pain.

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The warning signs of fainting include:

dizziness; perspiration; blackness before the eyes; pale appearance to skin; and, weak pulse.

Emergency Care for Fainting

If the individual is looking or feeling faint: o Have him/her sit down. o If sitting, have the individual lean forward with his/her head between the knees. o If the individual is lying down, elevate the feet and legs. o Loosen tight clothing.

If the individual has already fainted and is lying down: o Keep them in a lying position. o Elevate the feet and legs. o Ensure he/she remains lying down until the symptoms have subsided. o Wait at least 5 minutes after symptoms have subsided before getting up. o Ensure he/she gets up in stages. i.e. Goes from a lying position to a sitting position instead of

from a lying position directly to a standing position. Ensure there is a fresh supply of air. Watch for signs and symptoms of fainting.

Shock Shock is a circulation problem where the body organs and tissues do not get enough blood. It can be caused by injury or illness. It can be life threatening because the brain and organs cannot function properly. Shock can lead to unconsciousness. While an injury or condition may have caused it, shock can become a medical emergency of its own. Causes of shock are:

severe blood loss; major fractures; severe burns; crushing injuries; heart attack; severe allergic reactions; spinal cord or nerve injuries. medical emergencies (e.g. diabetes, epilepsy, infection, poisoning and drug overdose).

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Some signs and symptoms of shock are:

pale skin, which turns to bluish grey; bluish-purpose lips, tongue, ear lobes and fingernails; cold and clammy skin; shallow and irregular bleeding, which can be fast and labored; changing in levels of consciousness; weak, rapid pulse, may not be able to feel it near the wrist (if not, check carotid artery -- on neck); the individual may be: o restless; o anxious; o disoriented; o confused; o dizzy; and/or, o thirsty.

Emergency Care for Shock Minimize shock by:

giving first aid for the injury or condition that caused the shock; reassuring the individual; minimizing pain by handling the individual gently; loosen tight clothing; keep individual warm, without overheating; don:t give himGher anything to eat or drink But lips can Be moistenedC and, place the individual in the most appropriate position:

o If individual is fully conscious and there are no suspected spine or head injuries:

- place him/her on his/her back with feet raised. o If the individual is not fully conscious and there are no suspected spine or head injuries:

- place him/her in the recovery position o If the individual has a suspected head or spinal injury:

- steady and support him/her in the position they are already in. o If the individual has a fractured pelvis:

- keep him/her lying flat on his/her back. Where possible, place them on a hard surface such as a backboard and elevate the foot of the backboard.

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Diabetic Emergencies There are two kinds of diabetic emergencies:

Insulin Shock , wherein there is too much insulin and not enough sugar in the blood (hypoglycemia); and,

Diabetic Coma, wherein there is too much sugar and not enough insulin in the blood (hyperglycemia)

The following table summarizes the basics of each condition:

Insulin Shock Diabetic Coma

Onset Speed onset is sudden onset is slow, often occurring over a period of days

Possible Cause

took much insulin was taken exercised more than usual has not eaten enough has vomited

did not take enough insulin exercised less than normal ate too much food illness exists which requires more

insulin

Skin Condition sweaty, pale & cold flushed, dry & warm

Pulse/ Breathing

strong & rapid strong & shallow

weak & rapid

State of Consciousness

faintness to unconscious drowsy, becoming unconscious

Additional Signs & Symptoms

headache confused irritable aggressive trembling staggering difficulty walking

thirsty nausea & vomiting frequent urination breath smells like acetone (e.g. smell of

nail polish remover)

Note: It is not so important for Home Care Assistants to know the types of diabetic emergencies but it is

important that they recogniPe that the individual:s condition is an emergency and to obtain medical assistance immediately.

Emergency Care for Diabetic Conditions

The goal of emergency care for diaBetic conditions is to keep the individual:s condition from worsening while medical assistance is obtained.

If the individual is unconscious:

o place him/her in the recovery position and monitor the ABCs until medical help arrives.

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If the individual is conscious, ask

o Have you eaten today? A individual who has eaten but has not taken their medication may be in a diabetic coma.

-- Action Required: Remind him/her to take his/her medication. o Have you taken your medication today? A individual, who has not eaten but did take their

medication, may be having an insulin reaction. -- Action Required: Give them something sweet to eat or drink.

Note: When in doubt as to what type of reaction the individual is experiencing, give sugar in any form, since it can Be life saving for a individual in insulin shock and it won:t make himGher worse.

Send for medical help.

7on0$ ass<me $4a$ $4e indi;id<a2 is in a s$a$e of dr<n6enness w4en 4eKs4e co<2d Le in a diabetic emergency. Check to see if he/she is wearing a medic alert tag and observe him/her for signs & symptoms of diabetic emergencies.

Seizures Seizure, also known as convulsions, are sudden and violent contractions or tremors of the muscles. They are caused by abnormal electrical activity in the brain. Some causes of seizures are:

brain abnormalities; head injury; trauma; high fever; tumor; poisoning; central nervous infection; and, lack of blood flow to the brain.

The types of major seizures are:

Partial, wherein only a part of the brain is involved and a body part may jerk. The individual may also experience seeing, hearing and stomach discomfort.

Generalized, wherein the whole part of the brain is involved and the individual loses consciousness.

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Some of the signs and symptoms of a major seizure are:

a sudden cry; stiffening of the body; loss of consciousness; falling down; noisy breathing; frothing saliva at the mouth; jerking of the body; breathing may stop or be irregular O the individual may turn blue; and, loss of bowel and bladder control

M inor seizures, known as petite mal seizures may also occur. These seizures usually last for only a few seconds. There is loss of consciousness, twitching of the eyelids and staring. When the individual comes out of it, he/she is often confused, may have a headache and may fall into a deep sleep. Usually, no emergency measures are needed for petite mal seizures. Emergency Care for Major Seizures The primary goal for emergency care during a major seizure is to protect the individual from injury while the seizure is occurring and to ensure the airway remains open while he/she is unconscious.

During Convulsions o Don:t restrict the individual:s movement. Instead guide them away from harm. o Loosen tight clothing, especially around the neck. o Place something soft under his/her head.

Do not try to put anything in the mouth between the teeth or try to hold the tongue.

After Convulsions

Assess responsiveness. Place unconscious individual in the recovery position. Wipe away fluids from the nose and mouth. Determine if there are any injuries and provide appropriate care, if there are injuries. Keep individual warm and allow him/her to rest. And, Monitor breathing.

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Obtain Medical H elp if :

the individual is unconscious for more than five minutes; has a second major seizure within a few minutes; this is the individual:s first seiPureC and, the cause of the seizure is unknown (ask him/her when they regain consciousness)

H eat Exposure Heat exposure or hyperthermia refers to a high body temperature due to overexertion or high temperatures. Home Care Assistants need to know what to do for heat exposure especially if they and their clients live in the high temperature areas of the country. Hot weather can be very dangerous for elderly people. Heat exposure can cause:

H eat C ramps are painful muscle cramps in the legs and abdomen, which are caused by losing too much water and salt through sweating. They are not serious and can be reversed by giving the individual a glass of slightly salted water (1/10 teaspoon per quart). If after 10 minutes the cramps have not subsided, give him/her a second glass of lightly salted water. (If salted water is not availaBle, give regular water.N If cramps don:t go away, oBtain medical help. Do not give more than 2 glasses of the slightly salted water, as it will worsen the condition.

H eat Exhaustion is more serious than heat cramps because the individual has lost a lot of fluid

through sweating. Circulation is affected because the blood leaves the vital organs and pools in the vessels, just below the skin.

Some of the signs and symptoms of heat exhaustion are:

o excessive sweating; o dilated pupils; o dizziness; o blurred vision; o cramps; and, o signs of shock.

Emergency Care for H eat Exhaustion

If individual is conscious:

lie him/her down in a cool place and elevate the feet and legs; remove excessive clothing and loosen tight clothing at the neck and waist; and, give slightly salted water to drink.

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If individual is unconscious:

place him/her in the recovery position; get medical help immediately; and, monitor ABCs and give aid as required.

H eat stroke, also known as sunstroke, is the most serious heat illness and can be life threatening. It

is caused by prolonged exposure to a hot, humid and possibly poorly ventilated environment. Heat stroke can cause death or permanent disability if emergency care is not given.

Some of the signs and symptoms of heat stroke are:

o red, hot, and dry skin (no sweating). _ote: If individual:s temperature has risen due to heavy physical eLertion, the skin will appear

flushed, hot and sweaty; o body temperature may rise above 103 degrees Fahrenheit; o rapid, strong pulse at first and weakens in the later stages; o throbbing headache; o breathing is noisy; o dizziness; o nausea and/or vomiting; o confusion; o convulsions; and, o unconsciousness.

Emergency Care for H eat Stroke

Move individual to a cool and shaded location. Remove outer clothing. Cool the individual rapidly by: o immersing him/her in cool water (e.g. bath or shower); or, o spraying or sponging him/her with cool water; or, o wrapping him/her in a cool, wet sheet and fan him/her vigorously (or use an electric fan).

Monitor body temperature and continue cooling efforts until the body temperature drops to 101-102 degrees Fahrenheit.

When his/her body feels cool to the touch, cover with a dry sheet. If he/she is conscious, put him/her in the shock position; if unconscious, put him/her in the

recovery position. If emergency medical personnel do not arrive quickly, call the hospital emergency room for

further instructions.

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Cold Exposure Exposure to cold or hypothermia is a state of generalized body cooling, in which the body temperature drops more than 2 degrees from its normal 98.6 degrees. Elderly people are susceptible to hypothermia because they:

have poor circulation; have less ability to sense the cold; and, may be on medications that promotes heat loss.

Signs and symptoms of hypothermia vary according to the stage of hypothermia i.e. mild, moderate or severe:

Sign M ild Hypothermia Moderate Hypothermia Severe Hypothermia

Pulse normal slow & weak weak, irregular or

absent

Breathing normal slow & shallow slow or absent

Appearance

shivering slurred speech

shivering has ceased or is violent

clumsiness stumbling dilated pupils bluish skin

shivering has stopped

Mental State

conscious but withdrawn or disinterested

confused sleepy irrational

unconscious

Emergency Care for Cold Exposure

Prevent further heat loss by: o covering exposed skin; o adjusting clothing to keep wind out; o move the out of the cold, if possible; o loosen or remove tight clothing; o if individual has been moved indoors, replace wet clothing with dry clothing; o if individual is outside, place dry clothing over wet clothing; o do not let individual sit or lie on cold surface O have him/her sit/le on a rolled up jacket or

blanket. Give him/her something hot and sweet to drink, only if the hypothermia is in the mild state. Get medical help.

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If the individual has frost bite: o immerse the frost bitten part in a container of warm water about 104 degrees Fahrenheit. Keep

replacing the water to maintain that constant temperature until the area turns pink or does not improve anymore. (Note: This warming may be painful and could take up to 40 minutes.)

o do not rub the frost bitten area; o do not rub snow on the frost bitten area; and, o do not apply direct heat to the frost bitten area. o Dry the affected area. o Keep the affected area warm and elevated. o Get medical care.

Asthma Asthma is a respiratory illness wherein an individual has repeated attacks of shortness of breath, which is often accompanied by wheezing and coughing. Hhen the individual isn:t having an attack, heGshe can breathe normally. The signs and symptoms of an asthma attack are:

shortness of breath with breathing difficulties; individual must sit in an upright position to breathe; wheezing may or may not be present; the skin is a bluish color; fast pulse rate; anxiety; and, restlessness, which progresses to fatigue

Emergency Care for Severe Asthma Attack

Place the individual in the most comfortable position, which is usually sitting upright with arms on a table.

Hand him/her his/her prescribed medications, which usually comes in a canister-like inhaler. Reassure him/her as anxiety will increase the breathing and make the attack worse. Stay with the individual until medical help arrives.

Common Psychological Conditions Psychological emergencies can arise when a individual:s state of mind makes it difficult to cope with the situation at hand. The role of Home Care Assistants in psychological emergencies is to help him/her to cope and protect him/her (and others) until medical help arrives.

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Some psychological emergencies Home Care Assistants could face are:

suicide gestures, wherein an individual threatens to kill himself/herself.

anxiety/panic attacks, wherein an individual acts as if he/she is faced with a life threatening situation, when none exists.

hyster ia, wherein an individual has violent fits of laughing and/or crying, imagined illnesses and a

general lack of control.

emotional reaction to assault, wherein an individual, as a result of physical or sexual attack, goes into severe emotional shock during or after the attack.

alcohol and drug induced behavior, wherein an individual:s Behavior can range from quietness to

disorientation to aggressiveness. Emergency Care for Common Psychological Conditions

_ote the individual:s pulse and respirations, if possiBle. Try to find out what has caused the situation either from the individual or other people. Call for medical assistance. Provide quiet, supportive and reassuring care while waiting for medical assistance. If the individual shows signs of aggression or a crime has taken place, contact the police. Be warm, sensitive and compassionate. Control your own emotions. Only become involved to a level you are comfortable with O don:t put yourself at risk. Only make promises you can keep O don:t lie to the individual in any way. Include the individual:s family and friends in the care, as they may Be aBle to reassure and help

him/her. Be careful whenever there is aggressive behavior O don:t restrain the individual, unless the protection

of others is needed.

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Summary Emergency care involves providing assistance to an injured or suddenly ill individual using whatever materials are available until medical help can be obtained. Its purpose is to preserve life, to prevent the condition or injury from becoming worse and to promote recovery. This is accomplished primarily by maintaining breathing; stopping bleeding and preventing shock. Emergency care involves both knowledge and skills, which are attained by taking a formal first aid course from an established organization such as the American Red Cross and St. John’s Ambulance. This training requires regular upgrading to keep certification current. It is strongly recommended that Home Care Assistants take first aid and cardiopulmonary (CPR) courses, as they are working with a clientele, which is likely to need emergency care. Home Care Agencies and most clients will want Home Care Assistants who have a knowledge of First Aid and CPR.