The new resuscitation protocols were introduced in Oct 2010 and I wondered if any successful resuscitation has been documented? I have always been a great advocate of chest compressions based upon 33 years experience within the NHS Ambulance Service dealing with cardiac arrests.

Stroke:

Description:

A stroke is a serious medical condition that occurs when the blood supply to part of the brain is cut off.

There are 2 main causes:

1. ISCHAEMIC: Where the blood supply is stopped due to a blood clot (accounts for approx 80% of cases).
2. HAEMORRHAGIC: Where a weakened blood vessel supplying the brain bursts and causes brain damage.

Like all organs the brain needs the oxygen and nutrients, provided by blood, to function properly. If the supply is restricted or stopped brain cells begin to die leading potentially to brain damage and even death.

This is a Medical Emergency and if you spot the early signs and symptoms using the pneumonic FAST (see below). An early response can save much of the brain from irreversible damage.

Signs & Symptoms:

If you suspect a stroke carry out the 'FAST' test:

• F = Facial Weakness – can the person smile? Has one side of their face drooped?
• A = Arm Weakness – can the person raise or hold both arms up?
• S = Speech Problems – can the person speak clearly and understand what you say?
• T = Test all three signs! – dial 999 if they do not pass any part of the assessment.

Treatment:

• Maintain Airway and Breathing.
• Dial 999 without delay, NOT your GP (though often advisable to ring GP after dialling 999 as may be very local and therefore to get there quicker than ambulance and instigate treatment).
• Lay the patient down, with head and shoulders slight raised.
• Reassure the patient – do not assume that they do not understand what you say.
• If patient becomes unconscious place in recovery position.
• The speed at which we respond to this medical emergency will have a dramatic impact on the patients recovery.

IMPORTANT:

There is a condition called TRANSIENT ISCHAEMIC ATTACK (TIA) where the blood supply to the brain is temporarily interrupted causing a MINI STROKE. This should be treated seriously as it is often a warning sign that a stroke is coming.

Strains & Sprains:

Description:

The symptoms of Sprains & Strains:

• Pain
• Swelling and inflammation
• Loss of movement

Strain:

A strain occurs when the muscle fibres stretch or tear. They occur usually for one of two reasons:

• When the muscle has been stretched beyond its limits.
• When the muscle has been forced to contract (shorten) too quickly.
• The most common types of strains are:
• Hamstring - the muscles that runs down the back of the leg and are attached to the knee and the hip.
• Gastrocnemius and soleus – medical names for the muscles in the calf.
• Quadriceps – muscle located at the front of the thigh.
• Lumbar –muscles found in the lower back .

Sprain:

A sprain occurs when one or more ligaments have been stretched, twisted or torn. (Ligaments are strong bands of tissue around joints that connect one bone to another and help top keep them together and stabilise them). The most common types of sprains to occur are:

• The knee –when turning quickly during sports or other physical activities.
• The ankle – if walking or running on an uneven surface.
• The wrist – possibly when falling onto the hand.
• The thumb –during intense and repetitive activity such as racquet games.

Signs & Symptoms:

• Pain
• Tenderness
• Swelling
• Difficulty in moving the injure limb

Treatment:

Treatment principle to follow R.I.C.E.

• Rice: Rest the injury.
• Ice: Apply an Ice pack ASAP. (Do not apply directly to the skin).
• Compression: Apply a supporting bandage to the injured limb.
• Elevation: Elevate the limb will reduce swelling.

The outlook for sprains is usually good and most people will be able to resume normal activity within 6-8 weeks

For muscle strains it depends on the location and the severity. For example a minor hamstring should resolve within about 3 weeks whereas a severe quadriceps strain may take several months.

CAUTION:

• Do not constrict blood flow to the injures limb by applying the compression bandage to tightly.
• If you have any doubt as to whether it's a strain or sprain you will need to eliminate a fracture by having an x-ray.
• Ice should be placed/wrapped in a piece of cloth, place on or around the limb for 10 minutes , every 2hours, 24 max.

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 when to dial 999.

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First Response. Training for life. Training to save a life.

Meningitis:

Description:

Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the MENINGES. The inflammation may be caused by infection by virus, bacteria or other micro organisms and less commonly by certain drugs.

• VIRAL MENINGITIS is usually a mild disease but can make people feel very unwell. Although most people make a full recovery some can be left with debilitating effects such as deafness, epilepsy and cognitive defects.

• BACTERIAL MENINGITIS is life threatening and needs urgent medical attention

• NEONATAL MENINGITIS occurs in babies under 1 month old

Meningitis can be life threatening because of the inflammation's proximity to the brain and spinal cord so should be classified as a medical emergancy.

Signs & Symptoms:

• High temperature or fever.
• Violent vomiting.
• Loss of appetite.
• Severe headache.
• Neck stiffness.
• Joint or muscle pains.
• Drowsiness & Confused.
• Disorientated.
• Dislike of bright light (Photophobia).
• Dislike of loud noises (Phonophbia).
• Seizures.
• Skin rash (small purple/re "pin prick" Rash does not fade when the side of a glass is pressed against it.

Sometimes, especially with small children only non specific symptoms may present such as irritability and drowsiness. If a rash is present it may indicate a particular cause eg meningococcal bacteria. This rash is characterized as a small purple "pin prick" which does not fade when the side of a glass is pressed against it.

A rash does not fade under pressure is a sign of meningococcal septicaemia which is a medical emergency. However if someone is ill and getting worse do not wait for the rash as it can appear later or not at all.

Babies:

• Downiness, restless and high pitched crying.
• Reluctance to feed.
• Slight tenderness and swelling of the soft parts of the skull.

Treatment:

• Call your GP, If any delay Dial 999.
• If you think the child./baby may have meningitis , seek medical advice immediately Dial 999.

Diagnosis is usually made by performing a lumbar puncture which involves inserting a needle into the spinal canal to extract a sample of cerebrospinal fluid that envelopes the spine and brain. Depending on the type of meningitis treatment would involve antibiotics or anti viral or in some instances corticosteroids.

Caution:

• DO NOT delay seeking medical help or advice.

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. We also love bringing you useful infomration from other organisitions. One of our favourites is this video on recognising a cardiac arrest from the Resuscitation Council.

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Hypoxia:

Description:

Hypoxia is a pathogical condition in which the body as a whole (generalised) hypoxia) or a region of the body (tissue hypoxia) is deprived of an adequate oxygen supply. Variations in arterial oxygen concentrations can be part of normal physiology such as during strenuous exercise.

Generalised hypoxia occurs in healthy people when they ascend to high altitudes causing altitude sickness. It can also occur in healthy people due to breathing a mixture of gases with low oxygen content. For example when diving underwater defined as "Low Oxygen in the blood. This medical condition may arise when insufficient oxygen reaches the bodies tissues.

But there are a number of causes to be considered also:

External:

• Drowning.
• Lack of oxygen in the area, i.e. gas or smoke.
• Carbon monoxide.
• Suffocation.

Airway:

• Obstruction by the tongue.

• Vomit.
• Anaphylaxis.
• Burns.
• Hanging - Strangulation.

Breathing:

• Asthma.
• Poisoning.
• Chest Injury.
• Crush injury.
• Collapsed Lung.
• Lung Infections.

Circulation:

• Heart attack.
• Angina.
• Anaemia.
• Cardiac arrest.

Control Centre (Brain):

• Head injury.
• Strokes.
• Overdose.
• Electric shock.
• Spinal injury

Low levels of oxygen can prove to be potentially fatal; it is therefore essential that first aiders can recognise this condition and treat the patient accordingly.

Signs & Symptoms:

The symptoms of generalised hypoxia depend on its severity and acceleration of onset. In altitude sickness for example the onset is gradual and as well as the symptoms below the individual may have feelings of euphoria

• Pale, cold, clammy skin.
• Increased pulse rate.
• Increased breathing rate.
• Grey-blue skin (cyanosis).
• Anxiety.
• Restlessness.
• Headache.
• Nausea –Vomiting.
• Because haemoglobin is darker red when not bound to oxygen, when seen through the skin it can reflect blue light back to the eye, so in cases where the oxygen has been displaced by carbon monoxide the skin may appear cherry red rather than cyanotic.

Treatment:

• Remove the patient from the cause.
• Monitor patient level of consciousness (AVPU).
• Maintain patients airway.
• Unconscious patient to be placed in the recovery position.
• If available use a pulse oximeter on patients finger (a non invasive method of measuring the oxygenation of haemoglobin)
• Sats below 94% give patient oxygen therapy using a 100% non-rebreathing mask at 15 liters per minute.
• Monitor sats.

Caution:

• Do not allow your patient to eat, drink or smoke.

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. Many of the topics mentioned above are covered in our A-Z.

You might also be interested in our blog. In particular our post that talks about how we should control bleedng.

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Hypothermia:

Description:

Hypothermia happens when the body temperature falls below 35°c (95°f). Normal body temperature is around 37 degrees c (98.6 degrees F).

Hypothermia can quickly become life threatening and should be treated as a medical emergency.

Causes:

Hypothermia is usually caused by being in a cold environment. It can be triggered by a combination of things including being exposed to the cold for a long time. This may be outside in cold conditions or indoors in a poorly heated room or being in cold water.

Particularly vulnerable are elderly patients who often do not generate much body heat, due possibly to lack of mobility, poor heating or inadequate or inappropriate clothing. Young children are also vulnerable as their temperature control centre in the brain is under developed. The homeless suffer from lack of protection from the cold weather, poor intake of food, lack of activity and illness. All these can increase the risk of hypothermia

Signs & Symptoms:

When your body gets cold it will try to prevent further heat loss by:

• Shivering.
• Restricting blood flow to the skin.
• Releasing hormones to generate heat.

However, these responses use up energy and may not be enough to maintain body temperature if you have been exposed to the cold for a long time. When the body runs out of energy it gradually begins t shut down. Shivering stops and your heart beat begins to slow.

• Shivering.
• Tiredness.
• Confusion.

The symptoms vary depending on how low the body temperature has dropped. Mild symptoms include:

But as the body temperature drops:

• Shivering becomes violent.
• A person is likely to become delirious.
• They may struggle to breath.
• The may lapse into unconsciousness.
• Babies may by limp, refuse to feed or be unusually quiet.

Treatment:

• Protect from weather, remove wet clothing.
• Cover with warm dry clothing.
• If patient is young and able to climb into bath unaided, bathe them in warm water (40°c/104°f). DO NOT allow the elderly to enter a bath.
• If bath not possible, wrap them up in warm blankets and try to raise the room temperature to (25°c/77°f).
• Give patient warm drinks and food.
• If in any doubt Dial 999.

Caution:

• Do not give patient alcohol.
• Do not place patient in front of a direct heat source.
• Do not warm babies or the elderly to quickly.

Important:

Handle a hypothermic patient with great care, rough handling can induce cardiac arrest

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. In particular our post that talks about the difference in recognising hyperglycaemia when drunk.

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First Response. Training for life. Training to save a life.

Levels of Response AVPU:

Description:

The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system which is taught to healthcare professionals and first aiders on how to measure and record the patient's level of consciousness. It is a simplification of the GCS Scale (Glasgow Coma) which assesses a patient's response using Eyes, Voice and Motor skills as measures.

The AVPU has only one of four possible outcomes

These four outcomes are:

• Alert - Patient is fully awake (though not necessarily orientated), will have spontaneously open eyes, and will respond to voice (thought may be confused). They will have bodily motor function

• Voice – The patient makes some sort of response when you talk to them. This could be through the eyes which open when you speak to them, or by voice which may only be as little as a grunt. Or, it could be by moving a limb when prompted to do so by the rescuer.

• Pain - A patient may respond by using any of the three components when pain stimulus is used on them (Eyes, Voice, Movement). Recognised methods for causing pain are pinching the ear or pressing into the bed of a fingernail. A fully conscious patient will locate the pain and push it away, whereas a patient who is not alert and not responded to voice may only manifest involuntary flexion or extension of a limb. Performing pain stimulus should be used with caution as in extreme circumstances this could be considered assault.

• Unresponsive - This outcome is noted if the patient does not give any Eye, Voice or Motor response to voice or pain.

In first aid, an AVPU score less than A is a good indication of the need to get further help.

Treatment:

• If patient conscious level is below 'A' seek medical help.
• Monitor patient's level of response until medical help arrives.
• An unconscious patient is serious and the priority here is the patients airway.
• Place in recovery position.
• Dial 999.
• Treat any bleeding or cover open fractures.
• If first aiders have oxygen therapy, place pulse oximeter on patients finger and take reading, if below 94% place patient on oxygen therapy.

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. In this post, Clive talks about when you should or shouldn't call an ambulance.

First Response. Training for life. Training to save a life.

Hyperventilation:

Description:

Hyperventilation or over breathing is the state of breathing faster or deeper than normal. This causes excessive explosion of carbon dioxide, leaving low levels in the blood, and can be associated with a psychological state such as a panic attack or a physiological state such as metabolic acidosis (a condition whereby the body is producing too much acid or the kidneys are not getting rid of enough perhaps due to renal failure).

Excessive or fast breathing is commonly described as (Hyperventilation). It is usually the result of acute anxiety and can lead to the patient having a panic attack.

Hyperventilation can easily be mistaken for Asthma but: this can be identified because a patient having an asthma attack generates a wheeze in their breathing pattern, whereas in the Hyperventilating patient breathing can be heard entering and exiting the lungs normally

Signs & Symptoms:

• Patient will look anxious and be struggling to breath.
• Speech will be difficult.
• Dizziness or faintness.
• Palpitations.
• Feeling of choking or suffocation.
• Sweating.
• Trembling or marked tingling /pins and needles in the hands.
• Cramps in the hands & feet.
• Patient fearful of dying during an attack.

Treatment:

HYPERVENTILATION IS NOT A RESPIRATORY DISEASE BUT AN EMOTIONAL CONDITION. Therefore staying calm is the most important method to help control the symptoms. The aims of the treatment are to increase CO2 (Carbon dioxide) levels in the lungs and increase O2 (oxygen) levels to vital organs

THE USE OF A PAPER BAG IS NO LONGER ADVOCATED AS IT CAN CAUSE DANGEROUSLY LOW O2 LEVELS SO:

• Be firm but reassuring.
• Lead the patient to a quiete place.
• Explain to the patient what is happening.
• Ask patient to hold their breath, this will reduce the respiratory rate.
• Encourage slow deep breathing.
• Breathing through their nose will help reduce the loss of carbon dioxide.
• The patient could take sips of water to help reduce the numbers of breaths taken.

Caution:

• Care must be taken not to mistake Asthma with Hyperventilation.

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 most recent articles explores if you should call an ambulance.

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First Response. Training for life. Training to save a life.

Heat Stroke:

Description:

If someone with HEAT EXHAUSTION continues to be exposed to high temperatures then HEAT STROKE may develop.

The body becomes dangerously dehydrated in Heat Stroke. It's cooling mechanism malfunction and are no longer able to help the body to lose heat, so the body temperature starts to rise and the core temperature can reach high levels (40°c) within a short space of time.

Signs & Symptoms:

Include the symptoms of heat exhaustion as follows:

• Excessive sweating.
• Headache, dizziness.
• Feeling lightheaded/faint.
• Muscle cramping.
• Hot flushed dry skin.
• Rapid deterioration id level of consciousness (AVPU) Score.
• Nausea & Vomiting.

Plus additional symptoms of:

• Confusion.
• Disorientation.
• Rapid shallow breathing.
• Fits (seizures).

Treatment:

HEAT STROKE IS A MEDICAL EMERGENCY. If left untreated the patient could slip into a coma, develop heart or kidney failure or brain damage. In extreme the patient may die.

• Try and move patient to a cool area.
• Dial 999.
• Cool patient rapidly.
• Remove clothing and wrap the patient in a cold, wet sheet.
• Keep sheet wet and cold until temperature falls to normal level. Change wet sheet for a dry sheet.
• Sponging with cold water-use the garden hose pipe to spray with water.

Caution:

• Be aware of the use of "Recreational Drugs such as Ecstasy".
• Patient may dance for longer periods and sweat excessively and become hot and dehydrated.

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 quality or quantity when it comes to first aid training.

First Response. Training for life. Training to save a life.

Heat Exhaustion:

Description:

In hot weather older people, babies and young children are at greater risk of heat exhaustion, which left untreated, can result in heatstroke. This can be brought about by the working or exercising in hot conditions. Heat exhaustion will normally occur when the body’s temperature rises above 38c. If not recognized and treated this can lead to Heat Stroke (see under heat stroke).

Heat exhaustion is a collection of symptoms brought on as the body struggles to control its temperature. The body uses several mechanisms to cool itself down including sending more blood to the skin and by sweating. Salts and water are lost during sweating; if too much is lost then the symptoms of heat exhaustion develop.

Signs & Symptoms:

• Excessive sweating.
• Headache, dizziness.
• Nausea & vomiting .
• Tiredness.
• Muscle cramps.
• Patient may say they feel cold, BUT are hot to touch.

Treatment:

Heat Stroke is a medical emergency so it is important to prevent HEAT EXHAUSTION developing to heat stroke:

• Take patient to a cool area (an air conditioned room is ideal).
• Remove thier clothing and lie them down.
• But them in a cool shower or bath, soak feet in bucket of water.
• Give them plenty of water. Oral rehydration or isotonic drinks (sports drinks) are best as they also replace salt.
• If patient level of response changes or symptoms deteriorate (AVPU) place them in the recovery position.
• Dial 999.

Caution:

• Remember certain recreational drugs such as Ecstasy create more physical activity in people and therefore generates more heat.

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 quality or quantity when it comes to first aid training.

First Response. Training for life. Training to save a life.