Stopped Heart/Breathing (Cardiac/Respiratory Arrest)
Cardiac arrest and respiratory arrest are immanently life-threatening situations. Immediate action must be taken to keep the victim alive until emergency personnel arrive. Often, when breathing stops, so does the heart, and vice-versa. Consequently, cardiopulmonary resuscitation (CPR), which revives the heart, is typically administered simultaneously with artificial respiration.
If CPR must be administered, one must know how to perform it correctly to avoid breaking ribs and causing internal damage. Administering CPR without a certification can lead to legal action in many states, though the states have their own individual "Good Samaritan" laws designed to protect those who've administered rescue procedures. Regardless, a call to 911 should be among the first actions taken, as CPR usually works only well enough to keep someone alive until professional emergency personnel arrive -- seldom does it totally revive someone.
First, shake the victim and shout. If there is a chance of a spinal injury, tap the victim's shoulder instead of shouting. If the victim does not respond, place the victim on his or her back. Place one hand under the chin and pull up while putting the other hand on the forehead to push down, which will tilt the head back and open the airway. Check for breathing by placing a cheek close to the victim's nose while looking at the chest for movement. Look, listen and feel very closely for 5 to 10 seconds to identify any signs of breathing from the nose, mouth and chest. Be absolutely sure the victim is not breathing, for it is dangerous to blow forceful breaths into a healthy person.
If no breathing is detected, pinch the victim's nose closed with the hand that is on the forehead and pull the mouth open with the hand that is on the chin. Then give two full breaths into the victim's mouth while watching out of the corner of your eye for a rise in the chest.
If no air passes into the victim's lungs, re-tilt the head and try again. If it still doesn't work, the airway may be blocked. You will need to perform abdominal thrusts to dislodge any foreign objects that might be in the airway. To do this, place one hand on top of the other at the belly button and thrust five times toward the victim's head. Then check inside the mouth for obstructions. If you see nothing, turn the victim's head to one side and use the index and middle finger together in a hooking motion to clear any foreign objects that may be blocking the airway.
Tilt the head, give two more breaths and see if the chest rises. If this does not work, repeat the process of performing abdominal thrusts and finger sweeps, etc., until you are able to blow air into the lungs.
Check the victim's pulse by placing the index and middle finger on the neck straight below the corner of the mouth and aside the windpipe. If no pulse is detected you will have to aid the heart in pumping by starting chest compressions, as well as helping the victim breathe.
Locate the lower tip of the sternum and put two fingers there, parallel to the waistline. Next, place your other hand next to your two fingers, between the victim's nipples. This method determines the most effective spot – directly above the heart – to place the heel of the hand. If the hand is too low, you could break the victim's ribs while pushing down on the chest, as well as not successfully aid in pumping the heart.
When the heel of the other hand is in the proper place, put the free hand on top of the other and interlock the fingers. Making sure your shoulders are directly above the chest of the victim, lock your elbows and compress the chest 1.5 to 2 inches repeatedly 15 times and then stop. Reopen the airway as described above and give two breaths, then check for a pulse.
If there is still no pulse present, continue chest compressions and breathing at a ratio of 15 chest compressions to two breaths. About every minute, which is approximately four cycles of 15 chest compressions and two breaths, check for breathing and a pulse. If neither is present, do not stop this cycle until victim is revived or qualified medical personnel arrive.
As with any emergency, 911 should be called the moment that a drowning victim is found.
The victim's feet should be elevated to allow water to drain to the back of the throat to induce vomiting. This may assist in removing the water in the victim's respiratory system, as well as any unknown object that may be lodged in the victim's throat.
The victim should be checked for a pulse, breathing, airway blockages, and injuries causing excessive bleeding. If there is excessive bleeding, treat this wound first before beginning CPR. The victim may also vomit during CPR; when this happens, the victim should be turned on their side so they do not choke on the vomit.
If the victim is successfully revived, they should always be hospitalized even if they appear healthy. This is because damage may have occurred to the lungs or other organs that will require further medical attention.
The Heimlich maneuver should always be performed if a victim is choking. Determine if the victim is choking and needs assistance. A good indicator is the victim clutching his or her throat with one or both hands. If the victim is choking and is not breathing, the rescuer should begin the Heimlich maneuver.
The rescuer should be positioned behind the victim, with his or her arms wrapped around to the front of the victim. Make a fist with one hand and place it with the thumb facing inward just above the navel. Place the other hand over the fist and pull inward and upward with quick thrusts in rapid succession until the object is expelled and the victim is able to breathe.
Chest Pains / Heart Attack
A heart attack is damage to an area of heart muscle due to inadequate supply of oxygen to that area. Generally this is due to a clot or spasm in an artery, preventing blood flow to the heart. A heart attack may cause immediate cardiac arrest or progress to cardiac arrest.
Symptoms of a heart attack include an uncomfortable pressure, squeezing, or pain in center of chest that lasts a few minutes or comes & goes; pain spreading to the shoulders, neck or arms; and light-headedness, fainting, sweating, nausea and shortness of breath.
If the victim is conscious, help them get comfortable. Be calm and reassuring. Sit them upright with back support and padding under the knees. Loosen any tight clothing.
Administer nitroglycerin if the victim has a prescription. If the victim is undergoing cardiac arrest, administer CPR. Even if the heart attack seems mild, call an ambulance or transport the victim to the nearest medical facility as soon as possible.
Shock is a condition where the circulatory system cannot provide adequate blood flow to the major organs of the body. Shock is a very dangerous condition that progresses rapidly and can be fatal if not treated.
There are many types of shock, with different causes. Hypovolemic shock results from blood or fluid loss that decreases blood volume by 20%. Anaphylactic shock results from an allergic reaction that decreases blood pressure and causes fluid to leak from the bloodstream. Septic shock results from bacterial toxins that interfere with blood circulation. Cardiogenic shock can result from circulatory disorders that prevent the heart from adequately pumping blood throughout the body. Diabetic shock involves decreased consciousness, extreme dehydration and extremely high blood-glucose levels. Insulin shock is the opposite of diabetic shock and involves extremely low blood-glucose levels. Neurogenic shock involves damage to the nervous system. Emotional shock can result in a decreased flow of blood to the brain, causing fainting.
The different types of shock share similar symptoms. Look for:
Reassure the victim
If you suspect the victim is experiencing insulin shock, give the victim fruit juice to restore blood-glucose levels. If the victim is experiencing anaphylactic shock, signaled by rapid, pronounced allergic reactions like hives, itching, skin inflammation, coughing and nasal congestion, administer an epinephrine injection if available.
There are three types of altitude sickness: acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). All of these can be life-threatening conditions and require immediate attention.
AMS results from the body getting too little oxygen, and is caused by ascending to too high an altitude too quickly, so that the body cannot acclimate to the thinner air. Symptoms include headache, a feeling of uneasiness, nausea, appetite loss, distressed sleep, a bluish appearance around the nose, mouth and fingernails, and fluid retention in the face and hands. The only cure is either descent or acclimation. Acclimation can be aided by resting, limiting activity and drinking plenty of fluids. Severe cases are life threatening and require immediate descent.
HAPE results from fluid buildup in the lungs due to poor acclimation. This decreases the level of oxygen in the blood, resulting in decreased brain function and eventually death. Symptoms include those of AMS plus shortness of breath at rest, fatigue, tightness in the chest, coughing up fluid, and increased heart and respiratory rate. Oxygen should be administered if it is available, but the only cure is immediate descent, as HAPE is very life threatening.
HACE is swelling in the brain due to inadequate oxygen, which causes fluid leakage. Look for symptoms of AMS plus headache, fatigue, nausea, decreased consciousness, disorientation, memory loss, hallucinations, psychotic behavior, seizures and paralysis. The only cure is immediate descent; otherwise, death is imminent.