Medical Emergencies
- Choking
- Unconsciousness
- Heart Attack
- Resuscitation and CPR
- Poisoning
- Spilled Body Fluid
- SHARPS
- Overdose
Choking
Adult
If the person can speak or cough, encourage coughing, but do not strike the person on the back. Call 911, then proceed with;
• If the person cannot speak or cough but is conscious
o Wrap your arms around the person’s waist while standing behind them
o Make a fist with one hand, grasp that hand with the other hand, and place both hands above the navel to avoid the lower tip of the breastbone
o Give one quick upward thrust
o Repeat upward thrusts until the airway is clear, or until the person becomes unconscious
• If the person is unconscious, use resuscitation measures
Infant
A baby who is coughing is still able to breathe, do not hinder the efforts to expel the object. Stay with the baby and watch closely.
In case of choking:
CALL
• Shout for help and try to get the attention of a bystander or a family member to assist you
• If the baby is making high-pitched noises, is wheezing, can no longer make a sound, or becomes too weak to cough, have someone call 911. Ask someone to get the AED while you care for the baby.
• If you are alone, immediately begin to care for complete choking. Call 911, put the cell phone on speaker and place it beside you
CARE
• Sit or kneel while holding the baby
• Position the baby face down along your forearm, holding their jaw in your hand
• Rest your forearm on your leg so that the baby’s head is lower than their body
• Sit or kneel while holding the baby
• Deliver 5 firm back blows between the shoulder blades with the heel of your free hand
• Place 2 fingers on the middle of the chest just below the nipple line and quickly deliver 5 firm chest compressions, pushing 1/3 of the chest’s depth
• Repeat 5 firm back blows and 5 chest compressions until the object is coughed up, the baby starts to cry, breathe, or cough, of the baby becomes unresponsive
Child
If the child cannot speak, cough, breathe, or is making high-pitched noises, call 911, then immediately begin care for choking. Alternate between any two of the following methods until the object is coughed up.
Back Blows
• Place your arm across the child’s chest
• Bend the child forward and deliver 5 firm blows to the back between the shoulder blades
Abdominal Thrusts
• Place your fist just above the belly button
• Give up to 5 quick, inward and upward thrusts
Chest Thrusts
• Place your fists in the middle of the child’s chest with your thumb facing upward, and place other hand over your fist
• Give up to 5 chest thrusts by pulling straight back
If the child becomes unresponsive, begin CPR, starting with chest compressions.
Unconsciousness
To determine whether the person is unconscious, shout or gently pinch their shoulder
• If there is no response, check for breathing, look for chest movement, listen for breathing, lean in and feel for breath on your cheek
• Call 911
• If the person is unconscious but still breathing, place them in the recovery position and monitor the airway, breathing and circulation until the ambulance arrives
• If the person is breathing but injuries and apparent, do not more the person, address first aid needs to the best of your ability and wait for an ambulance or first aid attendant
• If the person is not breathing, begin CPR
Heart Attack
Warning Signs of a Heart Attack
• Feeling of heavy pressure or squeezing pain in chest, arms or jaw
• Shortness of breath, pale skin, sweating and weakness
• Nausea and vomiting
• Abdominal discomfort with indigestion and belching
• Apprehension or fright
• Denial of impending heart attack
Actions When You Suspect a Heart Attack
• Ensure prompt medical attention by calling 911. Reassure the person that help is on the way
• Assist the person to take ONLY THE DOES OF MEDICATION PRESCRIBED FOR THE CONDITION
• Help the person to rest, sitting or lying in the most comfortable position
• Loosen the person’s collar, belt and other light clothing
• Assist the person to remain calm
Resuscitation and CPR
ABC – Airway, Breathing, Circulation
“A” – Airway
• If you suspect neck injury, do not move the person onto their back
• Place hand on the person’s forehead to tilt head back and fingers of other hand under chin to lift the jaw
“B” – Breathing (Artificial Respiration)
• Look for chest movement, listen for breathing
• Feel for breath on your cheek
• If not breathing, start artificial respiration immediately using a one-way valve mask found in the first aid kits:
o Keep head well back,
o Pinch nostrils,
o Place your mouth over the person’s mouth,
o Give two full breaths, continue with one breath every 5 seconds until the person breathes normally or help arrives (ventilation)
• If air does not enter to person’s chest during artificial respiration:
o Reposition the head and attempt artificial respiration again
o If successful, got to section “C”
o To clear airway, place heel of one hand on top of heel of other hand just above the navel but well below the tip of the breastbone. Press upper abdomen with 6-10 quick thrusts. If this fails, open patient’s mouth by grasping tongue and lower jaw between thumb and fingers and lift chin. Insert index finger of other hand deep into mouth and use finger sweep to dislodge and remove foreign body.
o Attempt to ventilate, if unsuccessful, repeat sequence (abdominal thrusts, finger sweeps and attempts to ventilate) until obstruction is cleared.
“C” – Circulation – (Cardiopulmonary Resuscitation – CPR)
• Call 911 or ask someone else to do so
• Try to get the person to respond; if they are unable, roll the person onto their back
• Start chest compression. Place the heel of your hand on the center of the person’s chest. Put your other hand on top of the first with your fingers interlaced
• Press down so you can compress the chest at least 2 inches in adults and children and allow the chest to completely recoil before next compression
• Compress the chest one hundred times a minute (That is about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive”. Perform 30 compressions at this rate. Continue to do chest compressions until help arrives
• If you have been trained in CPR, you can now open the airway with a head tilt and chin lift
• Pinch closed the nose of the person. Take a normal breath, cover the person’s mouth with yours to create an airtight seal, and then give two, one second breaths as you watch for the chest to rise
• Continue compressions and breaths – 30 compressions, two breaths – until help arrives
Resuscitation of Infants and Small Children
• Cover baby’s mouth and nose with your mouth and use small breaths
• In an infant (younger than 1 year) place 2 fingers on the sternum below the nipples, compress the chest ½” to 1 ½”. After every 5 compressions, give 1 ventilation
• Continue until help arrives.
Poisoning
Procedure in all cases:
• Ensure there is no further danger
• If possible, identify the poison and container. Most containers provide information on dealing with swallowed contents. Read the label and follow directions
• Call the local Poison Control Centre (604-682-5050)
• If required, call 911. Send container and contents with the person to the hospital
For Inhaled Poisons
• Be sure you don’t also become affected: remove the source of the fumes if possible
• Move the person to fresh air
For Poisons in Contact with Skin or Eyes
• Using the eyewash area or sink, flood area with cold running water for at least 15 minutes (flush eyes gently)
• Eyewash stations are located in Clubhouse and ECE Kitchen eye flush bottle are located in Alisa’s Wish and the staff room kitchen and Foundry Kitchen
• Remove contaminated clothing and ensure person is comfortable
• Do not use chemical antidotes
For Swallowed Household Chemical Poisons
For conscious person:
o Call the Poison Control Centre (604-682-5050)
o Only induce vomiting on advice from the Poison Control Centre or Physician
o If advised by poison control, give milk or water. For adult 1-2 cups; for child ½-1 cup
o To avoid inhalation of vomit, place the person’s head lower than the body
o If poison is corrosive, DO NOT induce vomiting, but give milk or water
For unconscious person:
o Call 911
o Place the person in recovery position
o Monitor breathing. Begin CPR is necessary
o If victim is unconscious, DO NOT induce vomiting
Spilled Body Fluid
Universal precautions are steps we should take to protect ourselves when we come into contact with blood or body fluids of other people. The purpose of universal precautions is to stop the spread of germs to others.
Since we often can’t tell if a person is infected with communicable disease, it’s best to treat the blood and body fluids of every person as potentially infectious. Potential infectious body fluids include blood, semen, saliva, and vaginal secretions.
For larger spills that go beyond your ability to clean with the supplies at hand, contact a Senior Leadership Team Member for assistance and/or third-party biohazard cleaning service.
Chlorine releasing agents should not be used on urine spills due to the risk of high levels of chlorine gas release.
The Basics of Universal Precautions
Hand washing:
Hand washing is the single best way to prevent the spread of infectious diseases in a workplace. Wash hands frequently and thoroughly, especially after contact with anybody fluid or contaminated surface. Wash hands with soap. And lather hands for at least 10 seconds. Rinse hands thoroughly and dry.
Always wash hands:
• Before preparing food
• Before eating
• After coughing or sneezing
• Before breastfeeding
• After using the washroom or changing diapers
• Before and after providing first aid
• After handling blood or bodily fluids
Gloves:
Wear latex, vinyl or rubber disposable gloves when handling blood, body fluids or when cleaning cuts, scrapes and wounds. Gloves are also necessary when disinfecting contaminated surfaces. Wash hands after removing gloves and dispose of the gloves in a plastic bag. Add gloves to your first aid kit so that they are always ready.
Needle-stick injuries:
Go to the nearest Health Unit or Hospital Emergency Department for treatment or assessment.
Personal Articles:
Never share toothbrushes, razors or any other personal articles that can transmit even small amounts of blood or body fluid from one user to the next. Dispose of such items carefully.
Clean up of spilled blood and bodily fluids
If a client, personnel, volunteer, or visitor is exposed to blood or infectious body fluids through a break in the skin, an open wound or across mucous membranes of the eyes, nose, or mouth, they must IMMEDIATELY report to the nearest Hospital Emergency Department. Contact Program Supervisor and complete required agency documentation.
• Wear disposable latex gloves at all times when dealing with blood or body fluids
• Avoid getting another person’s body fluids in your eyes, mouth, open sores or wounds
When clean up is required:
• Refer to Universal Precaution BC Ministry of Health
• Wipe up blood or bodily fluids with absorbent paper towels
• Clean and rinse with usual disinfectant
• Clean up spilled fluids with freshly made solution of one part bleach to nine parts water (1:10)
• Place contained fluids and clean up materials in a plastic bag, seal the bag and place it in a plastic lined garbage
• Wash soiled clothing separately in hot soapy water and dry in a hot dryer or have clothes dry-cleaned
• Wash hands after gloves are removed with soap and water using an alcohol-based hand rub
• Ventilate the room well when using bleach solution
Exposure to Blood and Body Fluids:
If exposed to blood or infectious body fluid through a break in your skin or an open wound:
• Gently encourage bleeding
• Wash well with soap and water
• If you can safely pickup/transport the contaminated object, take it with you
• Report to the nearest Hospital Emergency Department
• Report to your Program Supervisor. The Program Supervisor will support the client, personnel, volunteer, or visitor to ensure they receive immediate assistance. The Program Supervisor will complete an incident report form and forward the information to the Executive Director and the Risk Management Committee
Spill Kit Locations
COMMUNITY SERVICES – Downstairs main reception
FOUNDRY – Janitor’s Closet
SHARPS
Any sharp object which might be contaminated with blood or body fluids should not be handled with bare hands. They should always be picked up using latex gloves, a pair of tongs and disposed of in a SHARPS container. Once the sharp item is placed in the container using appropriate safety measures. Once the container is full, take to the pharmacy and a new one must be purchased.
SHARPS Container Locations
SHARPS containers are located in all agency washrooms, as well as, at every first aid kit location.
Overdose
Follow the SAVE ME steps below to respond.
If the person is unconscious and must be left unattended at any time, put them in the recovery position.
Stimulate, Airway, Ventilate, Evaluate, Medication, and Evaluate.
*Ensure the area is safe for yourself
Call 9-1-1.
If you are alone, you can put the phone on a speaker. Remember, you will not get in trouble if you call 9-1-1 for a suspected overdose.
Stimulate:
If you suspect someone might be having an drug overdose, start by stimulating them to confirm that they are unresponsive. Shout at them – use their name if you know it. Next, do a trapezius squeeze (squeeze the nailbed of the finger) or pinch the webbing between their thumb and fingers to see if they respond to pain. Always tell someone what you are going to do before you touch them.
If the person does not respond to sound or pain, then it is a medical emergency.
The call-taker will ask for:
• Your location – address, cross streets, name of business, and town or city;
• Your phone number, in case you get disconnected; and
• What you think the problem is
*Ensure that you have gloves from the first aid kit before continuing.
Airway:
Check the person’s mouth for any obstructions. Items like gum, dentures, or a syringe cap would be preventing them from breathing properly. Remove any obstructions. Once you’ve confirmed the mouth is clear, tilt their head back – this opens the airway.
Ventilate:
The next step is to breathe for the person.
Breaths are crucial to the overdose response. They keep the brain alive. Ventilation is the best way to reduce the risk of irreversible brain injury.
9-1-1 dispatch provide step-by-step instructions on how to give rescue breaths followed by naloxone administration in a respiratory arrest or drug overdose.
A mask is available in the Take Home Naloxone Kit to provide a barrier. You can use a piece of clothing if you do not have a mask.
Keep the person’s head tilted back, pinch their nose, and give them two breaths. You should be able to see their chest rise with each breath. Continue to give one breath every five seconds until the person is breathing on their own or first responders arrive.
If you are responding by yourself and do not have naloxone, or do not feel confident about administering naloxone, breaths are more important. Some people may not be comfortable giving rescue breaths. In that case, call-takers can also coach 9-1-1 callers through providing chest compressions.
Evaluate:
Has the person responded to your breaths?
If they are unresponsive, continue the rescue breathing (one breath every five seconds). Now it is time to give naloxone, if you have it. If there is someone with you, have them prepare the naloxone kit.
If you do not have naloxone, or if you are alone and can’t prepare the kit, keep providing breaths until first responders arrive.
Muscular injections: the BC Take Home Naloxone kits contain:
• SAVE ME instructions on the lid
• Alcohol swabs
• Gloves and a breathing mask to protect the responder
• Three vanish point syringes
• Pill bottle containing three ampoules of Naloxone
• An overdose response information form to be completed after the Naloxone has been used
Naloxone comes in glass ampoules that need to be opened
1. Hold the ampoule by the top and swirl to bring the medication to the bottom. Gently but firmly snap the ampoule top off, away from your body. The plastic amp snapper is there to protect your fingers
2. Pull the plunger to draw up the liquid
3. Inject the Naloxone into a muscle. Press the plunger all the way down to trigger the safety retraction.
Evaluate:
Monitor the person to see if they respond to the naloxone. Do they start breathing again? Do they regain consciousness?
Step back when monitoring at the person may awake aggressively.
If not, keep giving one breath every five seconds.
If they have not regained consciousness after three to five minutes (approximately 40 breaths), you can give a second dose of naloxone.
Monitor the person after each dose is given for three to five minutes (approximately 40 breaths) before giving additional doses.
Naloxone is a safe medication, but people who are dependent on drugs may experience unpleasant withdrawal symptoms like pain, sweating, agitation and irritability. Naloxone can take three to five minutes to work, so waiting five minutes between dose is important.
For more information visit: www.towardtheheart.com
