AED	Automated external defibrillator
AHA	American Heart Association
BLS	Basic Life Support
CPR	Cardiopulmonary resuscitation
EMS	Emergency Medical Services
SCA	Sudden cardiac arrest
VF	Ventricular fibrillation
V-fib	Ventricular fibrillation

Emergencies can occur anywhere. Sometimes you can save a life if you know what to do. You are encouraged to take a first aid course and a Basic Life Support (BLS) course. These courses prepare you to give emergency care.

The BLS procedures in this chapter are given as basic information. They do not replace certification training. You need a BLS course for health care providers.

Emergency care

First aid is the emergency care given to an ill or injured person before medical help arrives. The goals of first aid are to:

• Prevent death

• Prevent injuries from becoming worse

In an emergency, the Emergency Medical Services (EMS) system is activated. Emergency personnel (paramedics, emergency medical technicians) rush to the scene. They treat, stabilize, and transport persons with life-threatening problems. Their ambulances have emergency medications, equipment, and supplies. They have guidelines for care and communicate with doctors in hospital emergency departments. The doctors can tell them what to do. To activate the EMS system, do one of the following:

• Dial 911.

• Call the local fire or police department.

• Call the phone operator.

In nursing centers, a nurse decides when to activate the EMS system. The nurse tells you how to help. If a person has stopped breathing or is in sudden cardiac arrest, the nurse may start cardiopulmonary resuscitation (CPR) (p. 694). Some centers allow nursing assistants to start CPR. Others do not. Know your center’s policy about CPR.

Death is expected in persons with terminal illnesses. Usually these persons are not resuscitated (Chapter 48). This information is on the care plan.

Each emergency is different. The rules in Box 47-1 apply to any emergency.

Box 47-1

Rules of Emergency Care

• Know your limits. Do not do more than you are able. Do not perform an unfamiliar procedure. Do what you can under the circumstances.

• Stay calm. This helps the person feel more secure.

• Know where to find emergency supplies.

• Follow Standard Precautions and the Bloodborne Pathogen Standard to the extent possible.

• Check for life-threatening problems. Check for breathing, a pulse, and bleeding.

• Keep the person lying down or as you found him or her. Moving the person could make an injury worse.

• Move the person only if the setting is unsafe. Examples include:

• A burning building or car

• A building that might collapse

• Stormy conditions with lightning

• In water

• Near electrical wires

• Wait for help to arrive if the scene is not safe enough for you to approach.

• Perform necessary emergency measures.

• Call for help. Or have someone activate the EMS system. Do not hang up until the operator has hung up. Give the operator the following information:

• Your location: street address and city, cross streets or roads, and landmarks.

• Phone number you are calling from.

• What seems to have happened (for example: heart attack, crash, fire)—police, fire equipment, and ambulances may be needed.

• How many people need help.

• Conditions of victims, obvious injuries, and life-threatening situations.

• What aid is being given.

• Do not remove the person’s clothes unless you have to. If you must remove clothing, tear or cut garments along the seams.

• Keep the person warm. Cover the person with a blanket, coats, or sweaters.

• Reassure the person. Explain what is happening and that help was called.

• Do not give the person food or fluids.

• Keep onlookers away. They invade privacy and tend to stare, give advice, and comment about the person’s condition. The person may think the situation is worse than it really is.

See Focus on Communication: Emergency Care.

FOCUS ON COMMUNICATION

Emergency Care

Some illnesses and injuries are life-threatening. To find out what happened and the person’s condition, you can say:

• “Tell me what happened.”

• “Where does it hurt?”

• “If you can, please point to where it hurts.”

• “Is the pain constant or does it come and go?”

• “Tell me what’s wrong.”

• “Can you move your arms and legs?”

See Promoting Safety and Comfort: Emergency Care.

PROMOTING SAFETY AND COMFORT

Emergency Care

Safety

During emergencies, contact with blood, body fluids, secretions, and excretions is likely. Follow Standard Precautions and the Bloodborne Pathogen Standard to the extent possible.

When an emergency occurs in a long-term care center, call for the nurse at once. You may need to activate the EMS system or take the person’s vital signs (Chapter 31). Assist as instructed by the nurse.

Comfort

Mental comfort is important during emergencies. Help the person feel safe and secure. Provide reassurance and explanations about care. Use a calm approach.

See Teamwork and Time Management: Emergency Care.

TEAMWORK AND TIME MANAGEMENT

Emergency Care

Onlookers can threaten privacy and confidentiality. During an emergency, your main concern is the person’s illness or injuries. You cannot give care and manage onlookers at the same time. Ask someone to deal with onlookers. If someone else is giving care, keep onlookers away from the person.

Basic life support for adults

When the heart and breathing stop, the person is clinically dead. Blood is not circulated through the body. Heart, brain, and other organ damage occurs within minutes. The American Heart Association’s (AHA) Basic Life Support (BLS) procedures support circulation and breathing.

AHA guidelines are updated every 5 years. Any changes to the material presented here are available on Evolve at http://evolve.elsevier.com/Sorrentino/longterm.

Chain of survival for adults

The AHA’s BLS courses teach the adult Chain of Survival. These actions are taken for heart attack (Chapter 40), sudden cardiac arrest, respiratory arrest (p. 694), stroke (Chapter 39 and p. 705), and choking (Chapter 12). They also apply to other life-threatening problems. They are done as soon as possible. Any delay reduces the person’s chance of surviving.

Chain of Survival actions for the adult are:

• Recognizing cardiac arrest and activating the EMS system at once.

• Early cardiopulmonary resuscitation (CPR).

• Early defibrillation. See p. 698.

• Early advanced care. This is given by EMS staff, doctors, and nurses. They give drugs and perform life-saving measures.

• Organized post-cardiac arrest care. This care is given to improve survival following cardiac arrest.

You will learn the Chain of Survival for children in the AHA’s BLS for Healthcare Providers course.

See Focus on Communication: Chain of Survival for Adults.

FOCUS ON COMMUNICATION

Chain of Survival for Adults

Calling for help is a critical step in the Chain of Survival. If others are around, tell a certain person to activate the EMS system. You may not know the person’s name. Point at the person. Make eye contact. You can say: “Call 911 and get an AED.” Begin care. Follow up soon. Make sure the person was able to contact help.

Sudden cardiac arrest

Sudden cardiac arrest (SCA) or cardiac arrest is when the heart stops suddenly and without warning. Within moments, breathing stops as well. Permanent brain and other organ damage occurs unless circulation and breathing are restored. There are three major signs of SCA:

• No response.

• No breathing or no normal breathing. The person may have agonal gasps or agonal respirations early during SCA. (Agonal comes from the Greek word that means to struggle. Agonal is used in relation to death and dying.) Agonal gasps do not bring enough oxygen into the lungs. Gasps are not normal breathing.

• No pulse.

The person’s skin is cool, pale, and gray. The person is not coughing or moving.

SCA is a sudden, unexpected, and dramatic event. It can occur anywhere and at any time—while driving, shoveling snow, playing golf or tennis, watching TV, eating, or sleeping. Common causes include heart disease, drowning, electric shock, severe injury, choking (Chapter 12), and drug over-dose. These causes lead to an abnormal heart rhythm called ventricular fibrillation (p. 698). The heart cannot pump blood. A normal rhythm must be restored. Otherwise the person will die.

Respiratory arrest

Respiratory arrest is when breathing stops but heart action continues for several minutes. If breathing is not restored, cardiac arrest occurs. Causes of respiratory arrest include:

• Electric shock (including lightning strikes)

Rescue breathing

Rescue breaths are given when there is a pulse but no breathing or only gasping. To give rescue breaths:

• Open the airway (p. 695).

• Give 1 breath every 5 to 6 seconds for adults.

• Give each breath over 1 second. The chest should rise when breaths are given.

• Check the pulse every 2 minutes. If there is no pulse, begin CPR.

Cardiopulmonary resuscitation for adults

When the heart and breathing stop, blood and oxygen are not supplied to the body. Brain and other organ damage occurs within minutes.

Cardiopulmonary resuscitation (CPR) must be started at once when a person has SCA. CPR supports circulation and breathing. It provides blood and oxygen to the heart, brain, and other organs until advanced emergency care is given. CPR involves:

CPR procedures require speed, skill, and efficiency. Chest compressions and airway and breathing procedures are done until a defibrillator arrives. The defibrillator is used as soon as possible.

See Promoting Safety and Comfort: Cardiopulmonary Resuscitation for Adults.

PROMOTING SAFETY AND COMFORT

Cardiopulmonary Resuscitation for Adults

Safety

The discussion and procedures that follow assume that the person does not have injuries from trauma (Chapter 35). If injuries are present, special measures are needed to position the person and open the airway. Such measures are learned during a BLS certification course.

You will learn CPR for infants and children in the AHA’s BLS for Healthcare Providers course.

Chest compressions

The heart, brain, and other organs must receive blood. Otherwise, permanent damage results. In cardiac arrest, the heart has stopped beating. Blood must be pumped through the body in some other way. 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. To find the carotid pulse, place 2 or 3 fingertips on the trachea (windpipe). Then slide your fingertips down to the groove of the neck (Fig. 47-1). While checking for a pulse, look for signs of circulation. See if the person has started breathing or is coughing or moving.

Fig. 47-1 Locating the carotid pulse. A, Two fingers are placed on the trachea. B, The fingertips are moved down into the groove of the neck to the carotid artery.

The heart lies between the sternum (breastbone) and the spinal column. When pressure is applied to the sternum, the sternum is depressed. This compresses the heart between the sternum and spinal column (Fig. 47-2). For effective chest compressions, the person must be supine on a hard, flat surface—floor or back-board. You are positioned at the person’s side.

Fig. 47-2 The heart lies between the sternum and the spinal column. The heart is compressed when pressure is applied to the sternum.

Hand position is important for effective chest compressions (Fig. 47-3). You use the heels of your hands—one on top of the other—for chest compressions. For proper placement:

• Expose the person’s chest. Remove clothing or move it out of the way. You need to be able to see the person’s bare skin for proper hand position.

• Place the heel of one hand (usually your dominant hand) in the center of the bare chest. The heel of this hand is placed on the sternum between the nipples.

• Place the heel of your other hand on top of the heel of the first hand.

To give chest compressions, your arms are straight. Your shoulders are directly over your hands. And your fingers are interlocked (Fig. 47-4). Exert firm downward pressure to depress the adult sternum at least 2 inches. Then release pressure without removing your hands from the chest. Releasing pressure allows the chest to recoil—to return to its normal position. Recoil lets the heart fill with blood.

Fig. 47-4 Giving chest compressions. The arms are straight. The shoulders are over the hands. The fingers are interlocked.

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. Interruptions should be less than 10 seconds. When there are no chest compressions, blood does not flow to the heart, brain, and other organs.

Airway

The respiratory passages (airway) must be open to restore breathing. The airway is often obstructed (blocked) during SCA. The person’s tongue falls toward the back of the throat and blocks the airway. The head tilt-chin lift method opens the airway (Fig. 47-5):

• Place the palm of one hand on the forehead.

• Tilt the head back by pushing down on the forehead with your palm.

• Place the fingers of your other hand under the lower jaw. Use your index and middle fingers. Do not use your thumb.

• Lift the jaw. This brings the chin forward.

• Do not close the person’s mouth. The mouth should be slightly open unless you need to do mouth-to-nose breathing (p. 697).

Fig. 47-5 The head tilt-chin lift method opens the airway. One hand is on the person’s forehead. Pressure is applied to tilt the head back. The chin is lifted with the fingers of the other hand.

Breathing

Air is not inhaled when breathing stops. The person must get oxygen. If not, permanent heart, brain, and other organ damage occurs. The person is given breaths. That is, a rescuer inflates the person’s lungs.

Each breath should take 1 second. You should see the chest rise with each breath. Then two breaths are given after every 30 chest compressions.

Mouth-to-mouth breathing.

Mouth-to-mouth breathing (Fig. 47-6) is one way to give breaths. You place your mouth over the person’s mouth. Contact with the person’s blood, body fluids, secretions, or excretions is likely. To give mouth-to-mouth breathing: