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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
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First aid is the emergency care given to an ill
or injured person before medical help arrives.
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Its goals are to prevent death and prevent injuries
from becoming worse.
In an emergency, the Emergency Medical
Services (EMS) system is activated.
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Emergency Medical Services

To activate the Emergency Medical Services (EMS)
system, do one of the following:
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In nursing centers, a nurse decides when to activate
the EMS system.
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Dial 911.
Call the local fire or police department.
Call the phone operator.
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.
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Basic Life Support
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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
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Cardiac Arrest
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Sudden cardiac arrest (SCA) or cardiac
arrest occurs when the heart and breathing
stop suddenly and without warning.
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There are three major signs of SCA:
• No response
• No breathing
• No pulse
Respiratory arrest
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Respiratory arrest occurs when breathing stops
but heart action continues for several minutes.
If breathing is not restored, cardiac arrest occurs.
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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.
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Chest Compressions
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Circulation
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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.
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Airway and Breathing
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Airway
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The respiratory passages (airway) must be open to restore
breathing.
The head tilt-chin lift method opens the airway.
Breathing
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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.
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Cardiopulmonary Resuscitation
(Cont’d)
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Defibrillation
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CPR is done only for cardiac arrest.
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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 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.
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The Recovery Position
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The recovery position is used when the
person is breathing and has a pulse but is not
responding.
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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.
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Hemorrhage
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Hemorrhage is the excessive loss of blood in
a short time.
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Internal hemorrhage
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If bleeding is not stopped, the person will die.
The bleeding is inside body tissues and body
cavities.
External bleeding
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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.
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Fainting
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Fainting is the sudden loss of consciousness
from an inadequate blood supply to the brain.
The person:
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Looks pale
Has a weak pulse
Has shallow respirations if consciousness is lost
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Shock
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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:
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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
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Anaphylaxis
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Anaphylactic shock
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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.
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Stroke (Cerebrovascular
Accident)
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Stroke occurs when the brain is suddenly
deprived of its blood supply.
A stroke may be caused by:
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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.
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Seizures
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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.
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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.
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Types of Seizures
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The major types of seizures
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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.
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Burns
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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:
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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.
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Burns (Cont’d)
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Severity depends on:
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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.
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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.
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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.
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