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Respiratory emergencies. Asthma drowning

Respiratory emergencies , CPR, Asthma

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RESPIRATORY EMERGENCIES Asphyxia Condition in which body is deprived of oxygen and leads to unconsciousness or death. In asphyxia, lungs do not meet the need of enough supply of air for breathing. If this condition continues, heart and lungs stop functioning and leads to death. So, it requires emergency care quickly. Causes  Drowning (fluid in the air passage)  Choking (any foreign body in air passage)  Inhalation of harmful gases, e.g., coal tar gas, motor vehicle gas/fumes, ammonia, etc  Narrowing of air passage due to hanging  Strangulation  Any kind of obstruction (most commonly in unconscious patient by falling of tongue)  Damage to chest or lungs  Swelling in the windpipe tissue due to burn or stings Electric shock  Due to poisoning (morphine or prussic acid)  Due to diseases, e.g., epilepsy, rabies, tetanus, etc Signs and Symptoms  Shortness of breathing, sometimes breathing may stop  Cyanosis (lips, nose, ear, fingers and toes)  Noisy breathing  Increased pulse rate  Appearance of froth in mouth and nose  Loss of consciousness  Sometimes fits may also occur First Aid Treatment  Eliminate the cause if possible.
 Make sure that airway is patent.  Vitals of the victim should be checked and maintained.  Provide artificial breathing (mouth to mouth respiration) immediately, must be continued till the normal breathing is maintained.  Place the victim in recovery position.  Arrange for transportation to send the victim to hospital. Airway Obstruction Airway obstruction is a condition, when difficulty in breathing is due to any obstruction in the air passage. Causes  Windpipe tissue swelling  Tongue falling back in case of epilepsy  Obstruction of air passage due to food particles or  Any foreign body  Unconsciousness Signs and Symptoms  Breathing is labored and noisy  Cyanosis  Nasal flaring  Chest wall drawing between ribs First Aid Treatment  Do not allow crowd to gather around the victim, so that person can get one fresh air.  Then, check vital signs of victim.  Reassure the victim, if he/she conscious.  Keep the victim under observation.  Arrange for transportation, to send to the hospital.
If the victim/patient is unconscious, then airway is opened and assessed for the patency using following methods: Head Tilt Chin Lift  Tilt the patient’s head back by pushing down on the forehead.  Unit 14 First Aid and Emergencies  Place the tips of index and middle fingers under the chin.  Pull up on the mandible (not on the soft tissues). This lifts the tongue away from the posterior pharynx and improves airway patency.  Be sure to pull up only on the bony parts of the mandible. Pressure to the soft tissues of the neck may obstruct the airway. Jaw Thrust  Stand at the head end side.  Place palms on the patient’s temples and fingers under the mandibular rami (Jaw line).  In patients with possible cervical spine injury, avoid extending the neck.  Lift the mandible upward with your fingers, at least until the lower incisors(lower jaw) are higher than the upper incisors (upper jaw). This maneuver lifts the tongue along with the mandible, thus relieving upper airway obstruction.  Be sure to pull or push only on the bony parts of the mandible.  Pressure to the soft tissues of the neck may obstruct the airway.  If any foreign object visible remove it, but if embedded in throat do not try to remove it. Suffocation Suffocation is a condition when air is prevented from entering to the lungs. It occurs due to external obstruction such as plastic bag or soft pillow. A child may be suffocated due to lying down of face on a pillow/cushion. Causes
 Any kind of physical obstruction, which stops the Air to enter into nose or mouth  Due to irritant gases  Motor exhaust fumes, smokes Signs and Symptoms  Breathing difficulty  Noisy respiration  Prominent neck veins  Confusion  Cyanosis  Loss of consciousness First Aid Management  Remove the cause.  Provide fresh air supply to the victim.  Stabilize the victim and arrange for transportation and send to hospital as soon as possible. Choking Choking is a condition in which foreign particles obstruct the back side of the throat and that produces muscular spasm. It occurs during swallowing, when food particles go into the wind pipe. Most of adults choke due to inappropriate chewing of food and children choke due of putting any object into the mouth. Causes  Eating food in hurry  Inappropriate chewing of food  Speaking while eating Signs and Symptoms  Cyanosis  Inability to take breath  Congestion in face and neck  Inability to speak
 Nasal flaring  Loss of consciousness First Aid Management In first aid management, first priority is to remove the obstruction as soon as possible First Aid Management of Choking in Children
 Place infant in lap upside down, provide 4-5 slaps between the shoulder blades.  If this method fails, then rotate the patient face up on lap.  Provide at least 4-5 thrust on the lower breast bone  With the help of one hand only.  Inspect the infant’s mouth.  If anything found, try to take it out.  Continue the efforts till medical help arrives. Drowning Drowning is a type of suffocation induced by the submersion or immersion of the mouth and nose in a liquid or water. It happens due to accidental fall in river, pond, well and if the person is unable to swim In drowning mouth and nose are completely submerged into water and small quantity of water enters into the lungs. Emergency Focus of Nursing Care for Patient with Drowning  Main aim is to drain out the water.  Place casualty in prone position.  Ensure that airway should not be obstructed.  Loose casualty cloth from the collar and around chest.  Early transportation. Causes  Accidental fall in water  Children left unattended near water body (pool/bath tub etc.)  Suicide attempt  Seizure and heart attack, while in water Signs and Symptoms
 All general signs and symptoms of asphyxia  Obstructed airway  Congestion in the lungs  Froth come outside and it is around the lips, mouth and nose First Aid Management  Reach to the victim immediately.  Drag the victim with the help of rope, towel, shirt Stick out of the water.  Place the victim in prone position to drain out water From the lungs.  Make the victim stable.  If any obstruction in airway, eliminate immediately.  Start manual breathing if victim is not breathing  Arrange for transportation and send the victim to the nearby hospital. HANGING, STRANGULATION AND THROTTLING Hanging: Hanging means suspension of the body by rope around neck from the noose, in which pressure on the outside of the neck leads to cutting off air supply to body. Strangulation: Strangulation means tight constriction around the neck which leads to cutting off air supply. Throttling: It happens when someone intentionally squeezes the person’s throat, which cuts the supply of air. Hanging and strangulation might occur due to accidents. Aims  To restore breathing.  To save life of the victim. Signs and Symptoms  All general signs and symptoms of asphyxia (refer asphyxia explained earlier)  Congestion around the face and neck  Prominent veins of neck and face may be visible
 Visible mark around the neck First Aid Management Remove the constriction around the neck immediately. Put victim in comfortable position. Do not bend the neck while positioning Check breathing pattern, if not breathing or difficult breathing, start CPR. Make arrangements for transportation and shift victim to nearest hospital as soon as possible. INHALATION OF FUMES Inhalation of toxic fumes, gases and smoke have lethal effects on lungs. These may irritate the throat, and due to throat spasm, airway closes. Burning of foams, packing material and plastic bag may result in toxic gases, which is fatal for our body. Carbon monoxide is produced by burning, it is a poisonous gas. Causes  Due to burning of building (fire)  Exhaust fumes of motor vehicle  Blocked chimney (produce CO)  Burning of stoves  Pits, wells and underground tanks produce CO, Aims  To restore breathing.  To make a call for emergency.  To make an arrangement of transport. Signs and Symptoms  All general signs and symptoms of asphyxia
 Breathing difficulty  Victim coughs vigorously  Suffocation, choking  Sometimes symptoms of shock may also occur First Aid Treatment  Call for emergency help/ambulance service.  Move victim away from danger.  Do not allow crowd to gather.  Ensure the supply of fresh air to victim.  Check vital signs in every 10 minutes.  Check vital signs in every 10 minutes.  Give oxygen to victim, if available.  Transport the victim to the nearest hospital as soon as possible. ASTHMA Asthma is a condition, in which airway is constricted and narrowed due to spasm of the muscles of air passage (bronchospasm), which results in difficulty in breathing. It is a distressing condition. Major Causes of Asthma  Exact cause is unknown possibly due to allergens.  Risk factors are allergy (due to environment, drugs, fumes, odor, deodorant, pollen grain, etc.)  Due to tension in nervous system. Signs and Symptoms  Breathing difficulty  Victim looks distressed and anxious  Wheezing sound  Nasal flaring and cyanosis
 Sudden loss of consciousness and stoppage of breathing occur together First Aid Treatment Reassure the victim. Give comfortable position to the victim. Make the victim to sit down and help to lean slightly forward, rest with support. Make an arrangement for transportation. Send victim to the hospital for medical help without delay. CARDIOPULMONARY RESUSCITATION (CPR) Cardiopulmonary resuscitation (CPR) is a lifesaving procedure, which is given to those persons who are in cardiac arrest. CPR helps to pump blood in the Person’s body, while performing CPR first aider chest compressions to the victim, along with sequence of rescue breaths, which help to save their life when victims are in cardiac arrest. CPR consists the following steps, that has to be performed in sequence:  Chest compressions  Airway  Breathing Indications for CPR The main indication to perform CPR immediately on any person/victim who is found unconscious, pulse and breathing is found to be absent or gasping. Contraindications for CPR The only contraindication is DNR order (do not resuscitate).
There are Six Major CPR Steps to be Followed Assess scene safety before initiating CPR. Step 1: Call for Help Step 2: Shake and Shout  If the victim is unconscious, tap or shake the shoulders of the victim.  Ask loudly to the victim, are you ok?  If the victim does not respond, call for help. Step 3: Check Victim for Circulation  Call the victim and check for a response.  If unresponsive, tap shoulder and call the victim.  Simultaneously, observe for pulse (carotid pulse) and rise and fall of the chest with respiration.  If the pulse is absent and no respiration is observed. Position the patient on a flat surface.  Start chest compression. Step 4: Give 30 Chest Compressions  Locate the centre of the chest slightly below the nipples (on breast bone/Sternum).  Place one of your hands on top of the other and interlock your fingers  With the heel of the hands and straight elbows, nah hard and fast in the center of the chest at fate 100-120/minute  Push at least 2 inches (5-6 cm) deep  Allow the chest to rise fully between compressions  Deliver 30 chest compressions. Step 5: Provide Two Rescue Breaths  Open the airway of the victim.
 Open the airway using head tilt chin lift method or Jaw thrust (explained earlier in the unit).  Assess for tongue fall or foreign body in the airway.  If no respiration is observed/heard even after open-ing the airway, clear the airway (as discussed earlier in the unit).  Hyper extend the neck to bring the wind pipe (trachea) in a straight line.  The first aider takes a deep breath and pinches the nose while making a seal on the mouth of the victim (respirator mask can also be used for prevention of infection).  Deliver the breath into the mouth of the victim.  Look for the rise of the chest with a blow of breath.  Repeat the breath.  After delivering two breaths continue chest compression Step 6: Repeat this Whole Process till the Ambulance Arrives Repeat 30 compressions and two rescue breaths. Complications of CPR  Fracture of ribs or the sternum due to chest compression.  Gastric insufflations from excessive artificial respiration. UNCONSCIOUSNESS Unconsciousness is a condition in which a person loses his/her consciousness due to disturbance in the normal functioning of the brain. Unconsciousness not only occurs due to diseases but also due to certain serious injuries. There are two major stages of unconsciousness, 1. Partial (stupor) 2. Complete (coma) Major Causes
 Fainting  Epilepsy, diabetes  Excessive bleeding  In case of poisoning  Shock  Head injury or trauma  Fever  Due to excessively hot weather or heat  Asphyxia  Hysteria First Aid Management  Remove the victim from danger.  Open window and door for fresh air supply.  Loosen all cloth around the victim’s chest and neck.  Do not allow gathering around the victim.  Check the vitals of the victim  Start manual breathing if the victim is not breathing.  Never give anything by mouth.  Never leave the victim alone.  Make an arrangement for transportation.  Send victim to a nearby hospital as soon as possible for medical help. FOREIGN BODIES-SKIN, EYE, EAR, NOSE. THROAT AND STOMACH It is a condition when any particle, material, or object enters the body through the skin or other natural opening the body. Most commonly it happens in children. Foreign Body in Skin
Foreign bodies under the skin usually occur accidentally speck of wood/glass/metal etc. Signs and Symptoms  Pain  Bleeding  Discomfort  Swelling First Aid Management  Reassure the victim.  Provide a comfortable position.  Wash the area with soap and water.  With help of sterile thumb forceps/tweezers hold The object nearer to the skin surface.  If the object is embedded deep, do not try to pull it out  Bandage the area and transfer to a medical facility.  If The wound is major, transfer the victim to the hospital for help. Foreign Body in Eye The foreign body in the eye may be dust, eyelashes, and, coal, metal particles, stone, glass, an insect. These the objects, which are commonly found in the eyes. Sometimes a piece of wood and glass (penetrating Particles) get lodged in the eye and danger the eye itself. Signs and Symptoms  Pain (burning sensation)  Swelling  Watery eye  Redness in the eye
 Discomfort  Blurred vision First Aid Management Reassure the victim. Instruct the victim, not to rub the eye. Provide a comfortable position toward the light. Inspect the eye by pulling the lower lid. Clean the eye with water, inner to the outer side. Use clean or boiled water and cool at room temperature. If the foreign particle does not come out with rinsing of the eye, use a clean swab or corner of a handkerchief to remove the particle. If the foreign particle is invisible, instruct the victim to hold the upper eyelid and put it over the lower eyelid. This shall dislodge the particle. If this method fails, then instruct the victim to blink his/her eye under the running water. If the particle is embedded in the eye, don’t try to remove it. Cover the eye with an eye pad. Arrange for transport. Send the victim to a nearby hospital for medical help as soon as possible. Never try to remove the adhered and embedded particle from the eye. Foreign Body in Ear
The foreign particles that are mostly found in ear inclu flies, insect, peas, beans, button, pieces of corn, we and chalk. It is very common in children, because t often put object into ear out of curiosity. Signs and Symptoms  Pain in ear  Ringing sensation in ear  Itching  Discomfort  Rupture of ear drum may cause bleeding, tingling. Sensation  Hearing loss First Aid Management  Reassure the victim.  Provide a comfortable position.  Use warm oil, put it into the ear so that the insect can float and come outside.  If the method fails, try to remove the foreign particle because it may cause damage to the tympanic membrane.  Make arrangements to send the victim to the hospital for medical aid in an ambulance. Foreign Body in Nose Foreign objects like beads, button, food particles, pencil pieces, etc. when inserted in the nose or nasal cavity requires are immediate medical attention. Signs and Symptoms The victim is unable to breathe Pain Discomfort Feeling of restlessness
First Aid Management  Reassure the victim.  Provide a comfortable position.  Instruct to take deep breaths by mouth.  Encourage the victim to sneeze.  If this fails, don’t try to remove the foreign particle.  Make arrangements to send the victim to the hospital for a medical facility as soon as possible. Foreign Body in Throat Foreign body in the throat needs immediate medical attention. A foreign body in the throat may cause choking. Children are prone to such accidents because they put something in their mouth like a coin, button, or any irregular object, which gets stuck into the throat. So it is very important to handle or care for the child. Signs and Symptoms  Difficulty in breathing  Difficulty in swallowing  Pain in throat  Pricking sensation in the throat.  Coughing, wheezing  Cyanosis around the lips  Sometimes the child becomes unconscious First Aid Management  Provide a comfortable position, facing toward light Instruct the victim to wide open his/her mouth  If an object is visible, then remove it with finger possible.  Do not try to remove the foreign particle if it is not visible or embedded deeply.
 Make arrangements for the victim’s transport transfer him to the nearest hospital. Foreign Bodies in the Stomach  The incidents of foreign objects in the stomach are commonly found in children. They put objects into the mouth while playing and it gets slipped into the stomach.  The things which can enter into the stomach ar buttons, coins, seeds of a fruit, safety pins, etc.  These foreign objects get eliminated with the passage of stool. No need for immediate care or to give laxatives. However, if any sharp object or chemical is ingested, transport the victim immediately to the nearest hospital.