Shock:

Description:

The most important distinction to make between the different forms of shock is that one is PSYCHOLOGICAL (mental. And the other is PHYSIOLOGICAL (circulatory.

PSYCHOLOGICAL SHOCK:

Can occur after a physical or emotional traumatic experience. It effects your state of mind and although this can give you symptoms such as palpitations and feeling faint it doesn't usually lead to serious physical collapse. However its effects can persist for years.

PHYSIOLOGICAL SHOCK:

This can be life threatening , common causes are:

• Hypovolaemic shock (Low blood volume)
• Cardiogenic shock (Heart fails to pump)
• Anaphylactic shock (Severe reaction)
• Septic shock (an overwhelming bacterial infections causes blood pressure to drop) fatal in more the 50% of cases

Signs & Symptoms:

• Pale, cold, clammy skin
• Rapid weak pulse
• Fast, shallow breathing
• Nausea or vomiting
• Dizziness
• Sweating
• Blue lips
• Feeling faint

Treatment:

• Treat the cause of the shock.
• Lay the patient down flat and raise their legs.
• Dial 999 for an ambulance (Dial 999.
• Keep patient warm.
• Do not allow the patient to eat, drink or smoke.
• Loosen tight clothing.

As the brains oxygen supple decreases:

• The patient will become restless and aggressive.
• Yawning and gasping for air.
• Unconscious.

CAUTION:

• If patient becomes unconscious , place into recovery position.
  

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.

You might also be interested in our blog. One of our more popular articles is about recognising a siezure.

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Primary & Secondary Survey:

PRIMARY SURVEY

The Primary Survey, or initial assessment, is designed to help the emergency responder detect immediate threats to life. Immediate life threats typically involve the patient's ABCs, and each is correct as it is found.

Life threatening problems MUST be identified first. This is to be completed in an order of priority to ensure the most important steps are undertaken in a logical order ensuring nothing is missed. This systematic approach uses the acronym DRABC.

D: Danger:

• Ensure safety for yourself and any others. Do not put yourself at risk.
• Remove danger or move the patient.
• Information: Find out what has happened from witnesses if possible.

R: Response:

• Assess the patient’s level of consciousness using the AVPU score (see levels of response AVPU).

Note: The presence of dementia in the elderly patient can make it hard to accurately assess the mental status and the responder should utilise family/carers to obtain baseline information.

A: Airway:

• Look into their mouth, if any liquid is found place the patient on their side and drain the liquid (postural drainage).
• Place patient back onto their back and open the airway using a head tilt/chin lift techniques.

B: Breathing:

• Place your ear over the patient mouth and look, listen and feel for 10 seconds.
• Ask yourself is the patient breathing normally, and not taking occasional gasps of air.
• If patient is breathing normally carry out a secondary survey.
• If in any doubt patient is breathing normally dial 999.
• Asses the patients circulation (pulse and bleeding) if needed start chest compressions or defibrilation (see below).

C: Compressions

• Start chest compressions depth 5-6cm, rate of 100-120 per minute with combined 2 inflations (mouth-to-mouth).
• Continue at a 30 compression then 2 inflations (mouth-to-mouth is till gold standard treatment)
• If unwilling to or unable to perform mouth-to-mouth continue with chest compressions only, until paramedics arrive.
• Remember that the elderly often have an irregular pulse which is rarely life threatening, however the speed of the pulse i.e. too fast or too slow, can be life threatening.

Defibrillator:

• Attach an AED (Automatic External Defibrillator) as soon as it arrives, if available at your workplace. Follow voice prompts.

IMPORTANT:

• Patient should be on a hard surface to allow you to perform quality chest compressions, beds are not ideal. Be careful not to injure yourself removing then from a bed.

REMEMBER:

Any resuscitation is better than no resuscitation at all.

SECONDARY SURVEY

A focused history and physical exam should be performed after the initial assessment. It is assumed that the life threatening problems have been found and corrected. If that process involved CPR you may not get to this stage.

The focused history and physical exam includes examination that focuses on specific injury or medical complaints, or it may be a rapid examination of the entire body as follows, which should take no more than 3 minutes.

The secondary survey is a systematic approach to identify any bleeding or fractures. This system starts at the head and works down to legs.

• Bleeding : Carryout out a head to toe check for bleeding.

• Head & Neck: Clues to look out for are: bruising, swelling, deformity or bleeding (See Spinal Injuries).

• Shoulders & Chest – Place both hands on opposite shoulders, run them down comparing both sides of the body. (See Fractures & Dislocation).

• Abdomen & Pelvis: Place palm of hand onto abdomen and push gently checking for painful responses from patient.

• Legs & Arms: Using both your hands compare both arms & legs for fractures, dislocations, look also for medic alerts.

• Pockets: Look for clues, which might indicate any existing medical condition.

• Recovery Position: If patient is unconscious place them in the recovery position (see Recovery Position).

It also includes obtaining a patient history and vital signs and the acronym used for this is SAMPLE:

S = Signs & symptoms

A = Allergies

M = Medications

P = Pertinent past medical history

L = Last oral intake

E = Events leading to the illness or injury

Poisoning:

Description:

A poison also called a toxin is a substance which, if taken into the body insufficient quantity, may cause temporary or permanent damage.

Thee 4 main entry routes into the body are:

• Inhaled:  When it is taken in to the lungs when we breath.
• Ingested: Swallowed either accidently or on purpose.
• Absorbed: Absorbed through the skin.
• Injected: Injected into the tissues or a blood vessel.

Poisons are common in the home and the workplace .There are 2 major types:

1. Corrosive:                 

This group contains products that were never intended to be ingested or inhaled.

Examples are: Household products cleaning products such as bleach, dishwasher powered, acids, carbon monoxide, plane leaves, paint thinners and shampoo.

2. Non-Corrosive:

This group contains products that are to be ingested in small quantities, but which are harmful taken in large amounts.

Examples are: Pharmaceuticals, alcohol, drugs, medicinal herbs etc.

Possible Signs & Symptoms:

The effects of poisons are numerous as the poisons themselves .The mechanism of many poisons is still not understood but some poisons interfere with metabolism, whilst others destroy the liver and kidneys. Some depress the CNS (Central Nervous System) leading to coma and eventual respiratory and circulatory collapse. Severity of symptoms can range from headache to convulsions and death.

Look for:

• Evidence of bottles , containers , plastic wrapping.
• Tablets or drugs.
• Syringes.

Other indicators of possible poisoning are:

• Low level of consciousness (AVPU).
• Headache.
• Possible fitting.
• Confusion or hallucination.
• Nausea and/or Vomiting (if vomiting keep a sample for testing in the hospital to determine exact composition of poison.
• Abdominal pains.
• Burns around the lips and mouth.
  

Treatment:

Corrosive substance:

• Personal safety – make sure it is safe.
• Dilute the substance or wash it away.
• Ingested substances-encourage patient to rinse out their mouth, then give frequent sips of milk or water.

Substances on the skin:

It’s important the first raiders are familiar with the corrosive substances used within the workplace and the correct treatment needed.

• Make sure of your personal safety first.
• Dry powder chemical can be carefully brushed of the skin, but make sure it is contained.
• Irrigate the burn with lots of running water away, at least 20 minutes – remove contaminated clothing carefully whilst irrigating the burn.
• If the patient’s eyes are affected, irrigate as above ensuring the water runs away from the unaffected eye.
• Some workplace chemicals cannot be safely diluted with water but may require an ‘Antidote’. ALL first aiders should be familiar with the correct procedure and use of this antidote should an emergency occur.
• If the patient becomes unconscious and is breathing normally, place in the recovery position and dial 999. Continually monitor patients airway and breathing until paramedics arrive.

Non-Corrosive substances:

• Dial 999 and answer the questions from the ambulance operator.
• If the patient becomes unconscious and is breathing normally, place in the recovery position.
• Continually monitor patients airway and breathing until paramedics arrive.

Useful information for paramedics:

• Evidence found in and around patient, containers or product information.
• How much may have been take.
• When it may have been take.
  

CAUTION:

• NEVER make the patient vomit.

Nose Bleed:

Description:

Bleeding from the nose or EPISTAXIS occurs when blood vessels within the nostrils are injured (ruptured). They are very common in children and are usually mild and easily treated. However sometimes in older people or people with other medical problems such as blood disorders, bleeding can be severe. If bleeding is severe or mild bleeding does not stop within 20-30 minutes then get medical help quickly.

Causes:

The common site for nosebleed is just inside the entrance of the nostril on the middle hard part of the nose (Nasal Septum). The blood vessels are quite fragile here and can rupture easily for no apparent reason. This area is most likely to bleed following:

• Picking
• Blowing the nose
• Colds and blocked stuffy nose
• Minor injury to the nose
• Cocaine use

In the above the bleeding tends to last only a short time and is usually easy to control however, it can be made more difficult if the person has heart failure, a blood clotting disorder or is taking anticoagulants (blood thinning drugs) such as warfarin or aspirin. Another underlying cause might well be high blood pressure.

Bleeding can occur further back in the nose and could be due to an uncommon disorder of the nose or serious injury.

Signs & Symptoms:

• History of a blow, sneezing or pickin.
• After a blow to the face/nose blood may appear to be thin and watery. This may indicate a fracture.
• Patients visual appearance (holding nose or leaning back wards).

Treatment:

• If the patient is feeling faint, sit then down, advise them to tilt head forward, allowing blood to   drain from the nostrils.
• Ask patient to breath through their mout.
• With a finger and thumb show them how to pinch the lower fleshy end soft of the nose for at least 10 minutes. (it is useless to put pressure on the root of the nose or the nose bones).
• If available a cold flannel or compress around the nose is helpful as the cold helps the blood vessels to constrict (close down) and stop bleeding.
• Advise patient if possible not to speak, swallow, cough, spit.
• Give patient a cloth or tissue to mop up any blood.
• After 10 minutes ask patient to release the pressure. If bleeding has not stopped reapply pressure.
• If bleeding has not stopped after 30 minutes, or the patient is taking ‘anti-coagulant ‘drugs i.e. warfarin, take them to hospital.
• Frequent nose bleeds requires a visit o their GP for further investigation.

CAUTION:

• Do not tilt the patient head backwards, blood to the back of the throat may induce vomiting.
• If the nosebleed last longer than 30 minutes take or send patient to hospita.