Shock, sudden illness and unconsciousness

CHAPTER SIX-
 Common acute illness
1. Heart attack
2. Stroke
3. Seizures (fits)
4. Shock
5. Fainting
6. Allergic reactions
7. Asthma attack

“Knowing basic first aid and what to do in an

emergency can be the difference between life
and death”
 Objectives
At the end of this chapter the students will be able to
►Define common acute illness
►Identify symptoms of common acute illness,

►Provide first aid for someone who is having of common

acute illness including allergic reactions, shock, fainting,
and seizure
 6.1. Chest Discomfort (Heart attack)….
Call EMS immediately for anyone with chest
discomfort.
Do not delay and do not try to transport the patient to
a healthcare facility yourself.
While waiting for EMS to arrive encourage the victim
to chew 1 adult (not enteric coated) or 2 low-dose
“baby” aspirin if the patient has no allergy to aspirin
or other contraindication to aspirin, such as evidence
of a stroke or recent bleeding
 6.2 Stroke
 Stroke or “brain attack” is defined as any disease
process that interrupts blood flow to the brain.
 The disruption in flow is either from an occlusion
(ischemic) or rupture (hemorrhagic) of the blood vessel.

 Stroke Type: classified as resulting from two major

mechanisms: ischemia and hemorrhage.
►Ischemic strokes - thrombotic, embolic, or hypoperfusion
related) accounts for 87% of all strokes

►Hemorrhagic strokes - intracerebral and nontraumatic

subarachnoid hemorrhage
 Pre-hospital Considerations
The early detection of stroke must begin with the
general public.

Much work has been done in the prehospital setting

to improve rapid neurologic screening for stroke
Time is a critical component in the care of stroke
patients.

First aider should quickly ascertain the time of onset

of the patient's symptoms, giving particular attention
to bystander accounts to clarify details, because
stroke patients may be poor historians.
 Stroke pre-hospital …
 Detection –of STROKE symptoms
 Dispatch– of EMS Team
 Delivery – to a facility prepared to manage STROKE

 Door to treatment– rapid diagnosis and decision

making
►Time at the scene should be limited: rapidly stabilize
patient and transport to a facility capable of optimally
managing acute stroke, notify the receiving facility
patient's condition and estimated time of arrival.

►In some cases, it may be necessary to bypass closer, but

less capable, facilities in order to increase the chances of
the patient receiving the best possible care.
 Two major tools in widespread use are
Modified Cincinnati Stroke
Scale
1. Facial droop (one side of face
does not move as well as other
side)
2. Arm drift (one arm does not
move or one arm drifts down)
3. Speech (slurred, inappropriate
words or mute)
4. Time of onset
If any of the three items is abnormal
Los Angeles Stroke Screen
1. Age >45 y
2. No history of seizure disorder
3. New onset of neurologic symptoms in
last 24 h
4. Patient ambulatory at baseline (prior
to event)
5. Blood glucose level of 60–400
milligrams/dL
6. Obvious asymmetry in any of the
following examinations: facial
smile/grimace, grip, arm strength
If answers to all items 1–6 are "Yes" or
"Unknown,"
 TIME OF ONSET
The window of opportunity to effectively treat
STROKE is 3hrs (180 min)
►May be extended to 4 ½ hours in some cases

Need to know “ last known well”.

Difficult when
►Patient lives alone
►Woke up with symptoms
 NSA stroke Prevention Guidelines
 1. Know your blood
pressure.
 2. Find out if you have
atrial fibrillation
 3. If you smoke, stop.
 4. If you drink alcohol, do
so only in moderation
 5. Manage cholesterol level
 6. If you are diabetic,
control blood glucose level
►7. Include exercise in
the activities
►8. Ask your doctor if
you have circulation
problems which
increase your risk for
stroke
 9. Enjoy a lower sodium
(salt), lower fat diet.
 10. If you have any
stroke symptoms, seek
immediate medical
attention.
 Prevention…
Myth Reality
Stroke is not preventable Almost 80% of strokes are
preventable
Stroke cannot be treated Stroke requires emergency
treatment
Strokes only strike the Strokes can happen to anyone of
elderly any age
Stroke happens to the Stroke occurs in the brain
heart
Stroke recovery happens Stroke recovery can continue
for a few months post throughout life
stroke
Stroke
• First Aid Measures
– Provide moderate covering
– Do not apply heating pads or hot water bottles
– Maintain an open air way
– Give artificial respiration if indicated
– Position the victim on his side to drain secretion
– Do not give fluids unless the victim is fully
conscious
– Transport the patient to hospital immediately

9/23/2019 Compiled by Birhanu A 12

 6.3. seizure
Seizure is an abnormal electrical activity in the brain.

It can be caused by something interrupting the

electrical activity in the brain.
►This leads the muscles in the body to contract
uncontrollably and usually causes the person to lose
responsiveness.
In adults, seizure is the most common symptom of
epilepsy,
►but can be caused by other causes including a head injury,
alcohol poisoning or hypoglycemia (too low blood glucose)
 … seizure
Epilepsy
►A disease characterized by spontaneous recurrence of
unprovoked seizures (at least 2)
►is a condition which affects the brain and causes repeated
seizures, which are often sudden and dramatic.

Epilepsy = “seizure disorder”

Seizures are symptoms, while epilepsy is a

disease, so should not be used interchangeably
Convulsion or fit: the motor act of seizure
 Sign and symptoms of seizure
there are six key signs to look for;
1. Sudden loss of responsiveness
2. Rigid body with an arching back
3. Noisy difficult breathing
4. Convulsions (jerky uncontrolled movements)
5. Loss of bladder and bowel control
6. Afterwards they may be confused, tired and fall into
a deep sleep
 What to look for - seizures
the main objective of first aid is
►to ensure adequate brain oxygenation & cardio respiratory
function, and to protect them from injury.

With any kind of seizure it is really important to keep

checking:
►their level of response and pulse
►and that the person is breathing.

It is also important to protect them from harming

themselves during the fit
 First aid for seizures
Don’t restrain or move them.
Protect them from hurting themselves.

Clear away any potentially dangerous objects, like

hot drinks or sharp objects.

Make a note of the time when the seizure started

and how long it lasts.

Protect their head by placing something soft

underneath it, like a towel, and loosen any clothing
around their neck.
 First aid for seizures
Once the seizure has stopped, they may fall into a
deep sleep if they do, open their airway and check
their breathing.

If they’re breathing, put them in the recovery

position.

If they stop breathing at any point, prepare to treat

someone who is unresponsive and not breathing
(start CPR).

Keep checking their breathing, pulse and level of

response.
 First aid for seizures
Call EMS/939for medical help if:
►it’s the casualty's first seizure, or the cause is unknown
►they’re having repeated seizures
►the seizure lasts more than five minutes
►they’re unresponsive for more than ten minutes.
 6.4. Shock
Shock is a condition of inadequate circulation to
the body tissues and insufficient oxygen reaches
the tissues.

it can deprive the brain and other vital organs of

oxygen and can lead to organ failure,
unconsciousness and ultimately death if untreated.
High mortality - 20-90%

Shock is made worse by fear and pain.

Early intervention reduces mortality
What are the causes of the shock state?
 Hypovolemic VS Nonhemorrhagic

►Blood loss ►Tension

►Fluid loss pneumothorax
►Cardiac tamponade
►Cardiogenic
►Septic
►Neurogenic
 Causes of shock:
Common causes of shock includes
►severe external or internal bleeding
► burns
► crush injuries
► cardiac and respiratory emergencies
► spinal cord or nerve injuries
► severe allergic reaction
► infection

Based on causes shock can be divided into 4 types:

Hypovolemic, Cardiogenic, Distributive and
Obstructive shcok
 Types of shock
Shock types Causes

1. Hypovolemic caused by the loss of blood volume (such

as through bleeding) or profound
dehydration
2. Cardiogenic a result of a weakened heart that is
(includes septic, unable to pump blood as efficiently as it
anaphylactic, once did. Commonly occurs after a
neurogenic)
massive heart attack
3. Distributive a result of the inappropriately distributed
blood volume & flow to the organs
4. Obstructive results from an obstruction to blood flow
either into or out of heart
 Signs and symptoms of shock
 Breathing: Increased breathing rate & work of breathing
►Shallow and rapid breathing and, in later stages, gasping for air
►Pallor or bluish skin color (on lips, earlobes, and fingernail due
 O2)
 Circulation: Increased heart rate
►Reduced pulse volume (Weak pulse)
►Mottled skin (Cold and clammy skin)
►Thirst, Nausea/vomiting
 Disability: Restlessness and nervousness
►Reduced conscious level
►Coma
 First aid
What can I do about it?

Direct pressure / Positioning

tourniquet
STOP
the
bleeding!
pelvic Splint
wrap fractures

Prevent
 First aid for shock
 Treat the obvious causes of shock such as severe
bleeding, fractures and burns
First aid - “P.E.L.C.R.N.” (Pronounced Pell-Crin)
► P- Position the casualty on their back
► E- Elevate the Legs
► L- Loosen clothing at neck waist or wherever it is binding
► C- Climatize (prevent too hot or too cold)
► R- Reassure (keep the casualty calm)
► N- Notify medical personnel (Get Help)

 Prevent loss of body heat (cover with a

blanket, but avoid overheating)
 Give nothing by mouth if shock is severe
Positioning

Positioning if
spinal cord injury
suspected…
 6.5. Fainting
Fainting is a brief loss of consciousness that is
caused by a temporary reduction of blood flow to the
brain.

Fainting can occur when blood pools in the legs,

reducing the blood flow to the brain.
►Thus people may faint when they are standing for a long
time in the heat.

►Fainting can also be brought on by stress.

 Fainting
CAUSES:
►Taking in too little food and fluids (dehydration)
►Low blood pressure
►Lack of sleep
►Over exhaustion

SYMPTOMS:
►A brief loss of consciousness causing the casualty to fall
to the floor
►A slow pulse
►Pale, cold skin and sweating
 First Aid for Fainting
 Check for breathing
 CPR if necessary
 Call EMS if more than
a few minutes
 If conscious, lay the victim
down with feet elevated
 Loosen any tight clothing.
 Then allow the person to
rest for 10 or 15 minutes
 Look for and treat any injury
that has been sustained
through falling
Make sure s/he has plenty of fresh
air
 6.6. Allergic reactions
 It is the body’s unexpected reaction to something it has
come into contact with.
 Allergen– any thing that triggers an allergic reaction
►Commonest allergens is plant pollen, causes hay fever.
►Other include: animal hair, insect stings, specific drugs, and
foods (fruit, shellfish and nuts).

 It occurs because body’s immune system mistakes the

allergen for a threat, and tries to fight it off.
 A severe allergic reaction can develop within just a few
seconds of coming into contact with the allergen.
►It can affect the whole body and, if not treated quickly enough,
can potentially lead to death.
 Symptoms of Allergic reactions
These are the six key signs to look for:
1. Difficulty breathing (e.g. tight chest and wheezing)
2. Swelling of the tongue and throat
3. Itchy or puffy eyes
4. An outbreak of blotchy skin (mottled & spotty )
5. Anxiety
6. Signs of shock
 What you need to do – first aid
If you notice the symptoms
►get emergency help by transporting them to hospital as
fast as you can (even if the symptoms are mild or have
stopped).
Call EMS straight away.
►and give any information you have on what may have
triggered it (e.g. an insect sting, or certain food, like
peanuts).
 first aid ….
If they have medication with them,
►like an auto-injector, for example Epipen®, JEXT® or
Emerade® (are pre-filled injection device, containing
adrenaline/ epinephrine),
►help the victims to use it or do it yourself following the
instructions.

Help them into a comfortable sitting position, leaning

forward slightly, to help their breathing.

If they become unresponsive, open their airway and

check breathing. Follow the instructions for treating
someone who is unresponsive
 END.. always
• Know your limitations
• Provide care and reassure victims
• Keep bystanders away from victims
 THE END!
.
Reading assignment
►First aid for severe asthma
attack