Are you prepared?
Your day has been going well. Things are running smoothly… when you hear a loud crash! You round the corner to find your client, Mary, on the floor. She is not moving or making any sound.
Her body is in an unnatural position and you notice a pool of blood on the floor where her left cheek is resting.
You call out for help and you hear someone say, “I’m calling 911!”
You shout your client’s name, “Mary!” But, she doesn’t respond.
You listen for breathing and look for the rise and fall of her chest. You check for a pulse.
“No breathing, no pulse!” You yell to the person on the phone with with 911. “I’m starting chest compressions.”
You straighten Mary’s body and begin chest compressions at about 100 per minute.
While doing chest compressions, you look over the body and notice the blood is coming from a minor cut on her hip. You are relieved about that.
Then, you notice her left leg seems shorter and is turned outward. You know this means she must have broken her hip in the fall.
Paramedics arrive to take over. You report what you have done, and mention your suspicion about the hip.
A defibrillator is used to shock Mary’s heart back into rhythm and a sling is placed to stabilize her hip. Then, she is transported to the hospital.
You learn later that Mary had a heart attack and that you were right about the broken hip.
Your quick action and assessment made a difference. She makes a full recovery!
So, when will you ever need to use your first aid skills? Who knows? Hopefully, never!
But, every year, millions of people are treated in emergency rooms for injuries and accidents like the one described here.
Keep reading to learn how you can provide basic first aid for everything from minor cuts and scrapes to major life threatening situations like this one!
Six basic steps for any emergency
- Use caution!
- Take a quick look around for any hazards. Be sure you don’t put yourself in any danger. You won’t be of any help to the victim if you get hurt also. For example, if a client has fallen on a wet, slippery floor, you might fall too if you rush to help without thinking.
- Check the victim
- Ask the victim what happened and if he or she is injured. Usually, conscious victims will be able to respond to you. If they don’t respond, they may be unconscious.
- Look for obvious signs of injury such as bleeding or unconsciousness. If the person is unconscious, check for breathing and a pulse. If there are no signs of breathing or pulse, call for help right away.
- Take note of the time when the emergency occurred. (You may be asked later.) This is especially important if the client loses consciousness.
- Get help
- Most emergencies will require you to call for help from other staff or emergency medical service (EMS). Follow your workplace policy on how to handle emergencies.
- Perform first aid
- While you’re waiting for help, keep the victim as comfortable as possible – without moving the person or causing further injury.
- Never perform life-saving procedures such as CPR unless you’re sure they are necessary. Unnecessary procedures can cause injury. And, only perform procedures for which you’ve been trained.
- Follow basic first aid procedures as needed.
- Provide emotional support
- The injured person will often be fearful or angry due to the stress of the situation. You can reassure the person by keeping yourself calm. To help decrease victim anxiety, listen carefully to what they tell you and let them know what you are doing to help them.
- Report the incident
- You may have to file an incident report. Be sure to learn your workplace guidelines for reporting emergencies. Remember: any information you have may be of great value to the treatment of the victim.
Infection control for first aid
It’s important to follow infection control guidelines during an emergency to protect yourself and the client from infection.
- Wash your hands, if possible… to help stop the spread of infection.
- Wear gloves to protect yourself and the victim.
- Tip: Always keep a clean pair of gloves in your pocket for emergencies!
- Avoid direct contact with blood or other body fluids such as saliva or vomit.
- Use a mask with a one-way-valve or face shield when doing rescue breathing to prevent the spread of infection.
Basic first aid for common emergencies
FOCUS ON FALLS
Falls are common accidents for people who are ill and elderly. A fall can result in serious injury, including cuts, head injuries, broken bones, and damage to internal organs.
Check out the situation…
- Did the client fall because the floor was slippery or cluttered? (If so, be careful that you don’t fall.)
- Did the client fall because he was weak when he got up?
- Did the client fall because she passed out?
Check out the client
- If the person is conscious, try to find out what happened.
- Check for life-threatening problems first, such as:
- Respiratory arrest (not breathing)
- Cardiac arrest (no pulse)
- Severe bleeding
- Look for any signs of broken bones (sharp pain, discoloration, deformity, or swelling).
- Follow your workplace policy on whom to call for an emergency
- Report the fall to your supervisor
FOCUS ON THE UNCONSCIOUS CLIENT
If you find a victim lying on the floor, you need to determine if the person is unconscious. Shake his or her shoulders and shout, “Are you okay?” If there is no response, the person is probably unconscious.
Here are some tips to help an unconscious victim:
- Always check for Airway, Breathing, and Circulation (the ABC’s of CPR) for the unconscious victim. This will help you know if the person is unconscious because the lungs aren’t working (respiratory arrest) or because the heart has stopped beating (cardiac arrest).
- Without breathing and/or a pulse, death will follow quickly unless cardiopulmonary resuscitation (CPR) or other life-saving efforts are performed.
- Anyone can do CPR, but it is best if you are trained. If you’re not trained, you should take a class as soon as possible! Most employers will require you to be CPR certified.
What’s new in CPR Science?
The latest research in CPR finds that chest compressions alone, without rescue breathing, can be just as effective or more effective in saving the life of a victim in cardiac arrest.
Here are some tips for doing CPR, with or without training:
- If you’re not trained in CPR, then just do chest compressions… about 100 a minute until paramedics arrive.
- TIP: Sing the song “Stayin’ Alive” in your head. Do chest compressions to the beat of the song to achieve about 100 per minute!
- If you’re well trained, and confident in your ability, then you can either alternate between 30 chest compressions and two rescue breaths or just do chest compressions.
- If you are trained, but rusty, then just do chest compressions at about 100 per minute.
FOCUS ON BROKEN BONES
When a bone is broken, it is said to be fractured. There are different types of fractures:
- Complete fracture: This is when the break goes completely through the bone.
- Incomplete fracture: This is when the break only goes part way through the bone.
- Compound fracture: This occurs when a sharp piece of broken bone pokes through the skin. Serious bleeding can happen with a compound fracture.
- Simple fracture: This kind of fracture doesn’t go through the skin. However, without proper treatment, this can become a compound fracture.
- Stress fracture: This type of fracture occurs from using a bone over and over causing a small crack. Some illnesses – like osteoporosis and cancer – cause bones to weaken and break very easily.
The symptoms of a broken bone or fracture are:
- Obvious deformity
- Pain and tenderness
Check out the situation:
- Check to see if the person fell down. If so, did the fracture come from the fall?
- Did the client move a certain way causing a fracture?
Check out the client:
- Check to see if the person is conscious.
- Look for signs of bleeding or obvious signs of a broken bone (such as a limb bent the wrong way or a bone poking through the skin).
How you can help:
- Call for assistance.
- Cover the part that’s injured with a sterile towel, sheet, or pad.
- Put on a splint to prevent the bone from causing further damage or injury.
- Keep from moving the person. However, remember to keep him comfortable, and reassure that you are there to help.
There are two ways to apply a splint:
- Find anything that is stiff such as a stick, cane, or rolled up newspaper. Tie the stiff object to the injured area with a belt, or rope. Make sure the client can’t bend the injured extremity.
- If the fracture is a finger or toe, “buddy” tape the broken toe or finger to the next toe or finger.
A few hot hip tips
The hip is the most commonly broken bone in the United States!
- There are more than 352 thousand hip fractures in the United States each year. The majority occur in women aged 65 and older and are generally the result of a fall.
Nearly one half of women who reach age 90 will suffer a hip fracture.
- The cost to treat a hip fracture is around 27 thousand dollars.
Signs and symptoms of a hip fracture include:
- Inability to bear weight on the affected side
- Severe pain in the hip or groin
- Bruising and swelling around the hip area
- Leg on the affected side is shorter and turns outward.
If you suspect your client has a hip fracture, call for help right away! Do not attempt to move the client yourself. This will be extremely painful. Just make the client as comfortable as possible until help arrives.
FOCUS ON CUTS
Cuts are commonly caused by sharp objects as well as blows from blunt objects that split the skin. The edges may be jagged or smooth.
A little bit of bleeding can be a good thing – it helps remove dirt from the cut. But, too much bleeding is a problem.
Heres what you can do:
- Use Standard Precautions to prevent spreading infection between you and the victim.
- Follow your workplace policy on whom to call. It may be the doctor, nurse, or 911.
How you can help:
- Clean the cut thoroughly and carefully with warm water. Soap is not necessary and may irritate the skin. Rubbing alcohol, iodine, and mercurochrome can also harm the skin and slow healing.
- Apply direct pressure until bleeding stops.
- Apply a small amount of topical antibiotic, like Neosporin.
- Put on a sterile adhesive bandage to continue pressure.
FOCUS ON SCRAPES
Scrapes are caused by the scraping or rubbing away of the top layer of skin, which exposes the underlying nerve ending. This is why scrapes are so painful! As an added bonus, dirt and other matter often enter the wound and make it a target for infection.
To treat a scrape and prevent infection:
- Wash thoroughly with soap and warm water.
- If the scrape oozes or bleeds, bandage it to protect from infection.
- Keep the scrape dry and clean.
- Report the scrape, including what caused it.
SIGNS OF INFECTION
Infection – not blood loss – is the biggest risk with cuts and scrapes. Even a small cut can allow millions of germs to enter the body.
Signs of infection that need immediate medical attention include: Redness, warmth, streaking (stripes of red leading away from the site), and any white or greenish drainage.
A SMALL CUT THAT BLEEDS, AND BLEEDS… AND BLEEDS!
Some medications, called blood thinners, keep the blood from forming a clot. This makes a small cut bleed forever!
Check the chart or ask the nurse if your client is on a blood thinner:
- What can you do differently to protect these clients and avoid bleeding situations?
- What will you do if there is a cut or scrape?
HOW DO I KNOW IF A CUT NEEDS STITCHES?
Generally, minor cuts and scrapes will not need further medical attention. However, there are some cuts that may need stitches, staples, or steri-strips.
Here is how you can tell the difference:
- A cut that is longer than 1/2 inch, or is gaping open, and more than 1/4 inch deep probably needs to be closed.
- A cut that is gaping open with dark red muscle showing should be closed, even if it is small.
- Any cut that will not stop bleeding, even if it is small, may need to be closed with steri-strips.
- Any cut on the face should be assessed, by a doctor or plastic surgeon because of the possibility of scarring.
FOCUS ON HEMORRHAGE (BLEEDING)
A hemmorrage means there is a lot of bleeding. It can be from an external wound (such as a stab wound or a compound fracture) or from an internal injury (such as a bleeding ulcer or trauma to the chest or stomach).
Internal hemorrhage may show up as skin discoloration or blood in the urine, stool, or vomit. The person will probably feel pain and tenderness in the affected area.
A person who is hemorrhaging may go into shock, lose consciousness, and die – if the bleeding isn’t stopped.
Your main goal is to… control the bleeding and get help fast!
- Always use Standard Precautions anytime you come into contact with blood. Remember to keep an extra pair of latex gloves with you at all times – just in case.
- Check for consciousness, respiratory arrest (not breathing) or cardiac arrest (heart stops beating). Stopping the bleeding won’t help if the person isn’t breathing!
- Follow your workplace policy on whom to call. When in doubt, call 911.
- While you are waiting for help, have the person lie down.
- Apply direct pressure.
- Cover the wound with a sterile gauze or pad. This will help the blood to clot and stop the bleeding.
- If blood soaks through the gauze, don’t remove it. Instead, place another gauze on top and continue to apply pressure on the wound for 5 minutes.
- Elevate the injury. Position the wounded part of the body above the level of the heart if possible while you apply direct pressure.
- After five minutes, if direct pressure and elevation hasn’t worked, you’ll need to do more to try to stop the bleeding. Large arteries that are found close to the skin’s surface supply blood to the head, arms, and legs. The bleeding may stop if you apply pressure to the major artery supplying blood to that wound. You do this by pressing your middle three fingers over the artery’s pressure point. If using the pressure point on a leg, you may need to use the heel of your hand instead of your fingers. Be sure not to cut off circulation completely.
Provide emotional support:
- The victim may be confused and scared. It will be reassuring if you remain calm and supportive.
Report the incident:
- Following your workplace policy, be sure to report and document what took place and what you did.
MORE ABOUT PRESSURE POINTS
Pressure points are where the pulse can be felt by placing a finger against an artery.
The most common pressure points used during first aid are located in the upper arms and in the creases above the upper legs.
To apply pressure, use 3 fingers (index and 2 middle) over the pressure point.
MORE ABOUT SHOCK
When too much blood is lost, a client may go into shock.
Signs of shock include:
- Pale, cool, clammy skin
- Rapid, shallow breathing
- Weak, thready pulse
- Agitation and confusion, followed by loss of consciousness
Shock is a medical emergency!
FOCUS ON CHOKING
If a person is choking, you shouldn’t get in the way as long as they’re coughing.
If coughing doesn’t remove the object and the person is breathing with extreme difficulty, turning a bluish color, and is unable to cough or speak, quickly ask, “Are you choking?”
A choking victim can nod their head yes, but will be unable to talk.
Here’s what you’ll do:
- Stand behind the person with your arms at the waist.
- Place one fist, with the knuckle of the thumb against the person’s midsection, slightly above the navel but well below the breastbone.
- Hold your fist firmly with the other hand and pull both hands sharply toward with an upward and inward jab (like the letter J). This is called the Heimlich Maneuver.
- This procedure should be done until the object is forced out or the victim becomes unconscious.
If the victim becomes unconscious, help them to the ground and get help right away!
FOCUS ON SEIZURES
Seizures or convulsions are uncontrollable temporary disorders that can be cause by epilepsy or sudden illness. Sometimes, seizures are barely noticeable. At other times, they cause severe muscle spasms. They aren’t likely to cause death unless the victims stop breathing. However, seizures may require immediate medical attention.
Assess the victim…
- Is the person having a major seizure?
- Has the person injured their head in a fall?
- Are they diabetic or epileptic?
How you can help:
- Gently lower the person to the floor.
- Clear all objects away from the victim and place a pillow or rolled towel under the head. Turn the head to the side.
- Never place anything between the teeth or in the mouth.
- Keep the person from getting hurt on nearby objects such as sharp edges of furniture by cushioning the victim.
- Never try to restrain the victim. After the seizures are finished, position the victim on his side.
- Make sure the person is breathing. If not, check to see that the airway is open, and, if you are trained, begin rescue breathing.
- Stay calm and keep the person comfortable until help arrives.
Conquer the myth
A commonly believed myth about seizures is that you are supposed to put something in the person’s mouth to keep the tongue from being swallowed.
This is a dangerous myth! Here are the facts:
It is impossible to swallow your tongue. Look in the mirror and open your mouth. Lift your tongue, and you will see the tongue is attached to the mouth by a tough piece of skin known as the lingual frenulum.
This keeps you from swallowing your tongue! Everyone, including people with seizures, have a frenulum to keep them from swallowing their tongue!
Sticking an object in a person’s mouth during a seizure can cause choking and damage the teeth.
Having a seizure may cause a person to bite the tongue, and it may even bleed. But, don’t worry, tongues usually heal very quickly!
FOCUS ON POISONING
People can be poisoned by taking too much medication, ingesting household chemicals, or eating spoiled foods.
They can also be poisoned by breathing poisonous gases, touching poisonous plants, or from insect bites.
Accidental poisoning happens over one million times every year!
If you come across someone who you think may be poisoned, you should try to determine the source of the poison. Then, get help quickly.
For a poison victim, the most important time is the first hour or two. So, get help quickly!
Here’s what else you can do:
- See if there’s any obvious source of poison. Do you notice any unusual odor? (Remember that carbon monoxide coming from faulty heating equipment has no odor.) If necessary, get the victim away from the poison.
- Are there empty medicine bottles near the victim? Can you see solid pills in the victim’s mouth? You can try to remove them using a clean cloth wrapped around your finger.
- Is the client breathing or conscious? If so, ask the person to tell you their symptoms. If not, inspect the mouth and smell the breath for signs of poison.
- If you suspect gas poisoning, open the windows immediately. If the problem is gas from an oven, turn it off. Get the victim (and yourself!) away from the gas so that you can breathe fresh air.
- If you suspect chemical poisoning – from a household cleaner, for example – do not induce vomiting. Call the Poison Control Center hotline. You may be instructed to give the victim water or milk to dilute the poison.
- If you think the victim has gotten poison on their skin (such as the toxins from a poisonous plant), wash the affected area with soap and cool water. Be sure the water and/or washcloth used to wash the poisoned area doesn’t touch healthy skin.
Calling poison control
Don’t know the number for poison control? Visit the American Association of Poison Control Centers at: aapcc.org and click on “Find Your Poison Center”.
It’s best to keep the number for Poison Control near all phones in the facility and the home.
If you can’t find your local number, you can always call the national hotline. It is staffed around the clock.
Here’s the phone number: 1-800-222-1222
You are caring for a 73 year old man who has several medical problems, including mild dementia. He lives alone, but his condition is worsening, so a home health team is brought in to help with his care.
- On your first visit, you notice he has 18 pill bottles on the counter, some are expired. You find cleaning supplies under the sink in old juice containers, and the refrigerator is packed with moldy food.
- What do you need to do to keep this client safe?
- Share your ideas with your co-workers and supervisor.
FOCUS ON BURNS
Burns from cooking, hot beverages, and hot bath water are common accidents. Burns can be painful, but small burns on adults are rarely serious. Large and/or severe burns can be very serious – even life threatening.
Before giving first aid for burns, ask yourself:
- Is the person in danger of more burns? For example, if clothing is on fire, help the victim stop, drop, and roll.
- Is the skin red, swollen, blistered, or broken?
- What is the person’s age and medical condition? The elderly and children are at risk for complication from burns.
- How deep or severe is the burn?
First degree burns involve only the outer layer of skin. The skin is dry, painful, and tender to touch. This type of burn can come from a hot water bottle, a heating pad, or a mild sunburn.
- Immediately put the affected part under running cold water, or wrap wet clothes on the burn until the pain decreases.
- Cover with a clean, dry gauze dressing for protection.
Second degree burns involve several layers of skin. You may see blisters, swelling, and red skin. The victim will be in a lot of pain. Immerse in cold water immediately. Do this before you call for help!
- Gently blot the area dry. Don’t rub as this may break the blister, opening it to infection.
- If the burn is on an arm or leg, keep it elevated as much as possible.
- Keep in mind that second degree burns usually heal within a few weeks.
Third degree burns involve all layers of the skin and any underlying tissue or organs. They are less painful than second degree because the nerves are destroyed.
- Do not remove any clothing near the burn.
- Don’t apply cold water or medication.
- If burns are on arms or legs, keep elevated above the heart. If burns are on the face, check to make sure the person isn’t having trouble breathing.
- Get help right away!
The do’s and don’ts of burn care
- DON’T apply ice to a burn. This may damage the skin.
- DON’T touch the burn with anything other than a dressing. This increases the risk of infection.
- DON’T break or pop any blisters.
- DON’T apply butter, oil, or lard to a burn.
- DON’T remove pieces of cloth that stick to a burned area.
- DO remove any jewelry and shoes. Swelling may make them difficult to remove later.
- DO remember that cold water is the best immediate treatment for minor burns. It lowers the skin’s temperature and lessens the severity of the burn.
- DO make sure the source of the burn has been extinguished. (Don’t put yourself in danger!)
- DO have the person lie down to prevent shock.
- DO elevate burned arms or legs to help keep the swelling down.
Caring for burns in the kitchen
Your client wants to cook her favorite Split Pea Soup from scratch. You know she is occasionally unsteady and often gets dizzy. But, she insists on cooking this soup, so you agree to help.
As she stirs the soup… the spoon slips. When she grabs it, her hand grazes the hot burner. You run her hand under cold water, and notice a blister beginning to form.
What degree burn do you suspect? What else do you need to do to care for this injury?