Monday, July 10, 2017

Updates to the use of epinephrine auto-injectors

In an attempt to reduce injury and infection when administering epinephrine to victims suffering from a severe allergic reaction, the U.S. Food and Drug Administration has updated patient instructions for the use of epinephrine auto-injectors. Specifically, these updated instructions, which were issued in February 2017, include the following recommendations:
  • The amount of time for administration of epinephrine using an auto-injector should be reduced from 10 seconds to 3 seconds (or per manufacturer instructions)
  • Rescuers should hold the victim's leg to limit movement during administration of epinephrine, especially in children

Ice and Injuries; How and How Long?

The following was published by the National Safety Council in their July 2017 NSC Instructor Insider Newsletter and provides good advice when treating bone, joint and muscle injuries.

Ice and Injuries; How and How Long?


You already know that first aid guidelines include applying ice to an injured body part, such as a bone, joint or muscle injury. However, what type of ice is best? And how long should ice be applied? Here are some facts to remember when applying ice to an injury:
Ice from frozen water is best:  Several studies show that crushed ice, shaved ice and ice cubes are the most effective at cooling the body. Instant ice packs are not as effective at cooling the body, and often do not last as long.
Be careful with instant ice packs: The temperature of instant ice packs, which become cold via a chemical reaction, can vary greatly. Some instant ice packs can become too cold initially, which can damage the skin. Others may not become cold enough, or stay cold long enough to have a meaningful effect on an injury.
Use a wet barrier: If a barrier is used between the skin and ice, it should be wet. This helps the cold application penetrate deeper into body tissue.
Do not ice continuously: NSC First Aid programs recommend icing an injured body part for 20 minutes (or 10 minutes if it produces discomfort), remove for 30 minutes, then reapply. The "more is better" approach should not be used when icing an injury. Continuous icing can potentially cause tissue and nerve damage, and some studies show that it may actually have the reverse effect by increasing swelling.

Monday, January 30, 2017

SCA and Heart Attack: Understanding the Difference

HEART ATTACK: A "PLUMBING PROBLEM”

The Person is Awake and the Heart is Beating

Heart attack (the medical term is myocardial infarction or MI) occurs when part of the heart’s blood supply is reduced or blocked, causing the heart muscle to become injured or die. The person is awake (conscious) and may complain of one or more of the signs and symptoms of heart attack.

Signs and Symptoms of Heart Attack

Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back.
Some heart attack victims experience mild intermittent chest discomfort that comes and goes over a period of days. These are early “warning signs” that may precede a heart attack. (Some victims, however, do not experience any warning signs.)
Chest discomfort can feel like uncomfortable pressure, squeezing or fullness. It can evolve into crushing pain if nothing is done.
Other symptoms of heart attack include:
  • Pain or discomfort in one or both arms, spreading to the shoulder, upper back, neck or jaw
  • Shortness of breath
  • Nausea, sweating, lightheadedness
  • A general sense of anxiety
  • A tendency to deny that anything serious is happening.
It’s important to act right away if these symptoms occur to maximize the odds of survival and minimize potential permanent damage to the heart.

Signs and Symptoms of Heart Attack in Women

The most common symptom of heart attack in women is the same as it is for men: chest discomfort or pain. Women are more likely than men, however, to experience other common symptoms such as:
  • Shortness of breath
  • Fainting, nausea, vomiting
  • Back or jaw pain
  • Cold, sweaty skin, paleness.
Sometimes women experience additional symptoms including:
  • Stomach or abdominal pain
  • Weakness and/ or overwhelming fatigue
  • Swelling of the ankles and/ or lower legs.

Lifesaving Actions

When someone experiences a heart attack, he or she is awake and the heart is beating. There is no need to give cardiopulmonary resuscitation (CPR) or to use an automated external defibrillator (AED). Instead, the correct action is to call 9-1-1 immediately to get emergency medical services (EMS) on the way to help. The sooner the person is treated, the better the outcome.

How You Can Save a Life: Heart Attack

What to do:
  • Call 9-1-1 immediately
  • Have the person rest or lie down while waiting for EMS
What not to do:
  • Refrain from driving the person experiencing symptoms of heart attack to the hospital. The only rare exception might be when the hospital is very close by and you expect EMS to be delayed significantly in getting an ambulance to the scene.
  • Never drive yourself to the hospital if you are experiencing heart attack symptoms.
  • Do not delay more than five minutes from the onset of symptoms to call 9-1-1.
  • Do not hesitate to call 9-1-1 because you are embarrassed or don’t want to bother anyone. EMS is there for you. And, it is better to be safe than sorry.

Are You at Risk for Heart Attack?

The risk factors for heart attack include:
  • A family history of heart disease
  • Smoking
  • High blood pressure
  • High cholesterol
  • Obesity
  • Diabetes
  • A sedentary lifestyle
  • Stress.

SUDDEN CARDIAC ARREST: “AN ELECTRICAL PROBLEM”

The Person is Not Awake and the Heart is Not Beating

Sudden cardiac arrest (SCA) is different from heart attack. While heart attack is described as a “plumbing problem,” SCA is more of an “electrical problem” that prevents the heart from functioning effectively. Heart attack can lead to SCA, but there are many other causes, such as congenital abnormalities, severe heart failure, electrocution and drug overdose.

Signs and Symptoms

When SCA occurs, the heart stops beating altogether. As a result, blood no longer is pumped throughout the body, including the brain. The person suddenly passes out, loses consciousness, and appears lifeless—except for abnormal “gasping” which may last for several minutes.
Occasionally, SCA victims will experience 10-20 seconds of seizure activity (shaking of the arms and legs) at the onset of the event as the brain stops receiving blood and oxygen from the heart.
The SCA victim is never awake and needs immediate help. If nothing is done, the victim will die within minutes.

Lifesaving Actions

When SCA occurs, it is critically important that whoever is near the victim calls 9-1-1 immediately, checks for signs of life, and if there are none, gives CPR and uses the nearest automated external defibrillator (AED).
This is lifesaving care that any layperson can provide. It is best to be trained in CPR and the use of AEDs, but even without formal training, the rescuer can push hard and fast on the victim’s chest and follow the directions on the AED, while waiting for EMS to arrive.

How You Can Save a Life: Sudden Cardiac Arrest

What to do:
  • Call 9-1-1 immediately
  • Give CPR or at the very least chest compressions
  • Use AED
What not to do:
The worst thing for an SCA victim is to do nothing. Sometimes people hesitate to help because they are afraid they might do the wrong thing and hurt the victim. But the SCA victim is clinically dead and cannot get worse. Your actions can only help.

Are You at Risk for SCA?

How do you know whether you are at risk for SCA? Here are some risk factors:
  • A previous heart attack
  • A previous episode of cardiac arrest
  • A low (<35%) ejection fraction or EF (the heart’s ability to pump blood)
  • Underlying heart conditions such as coronary artery disease, congenital heart disease (e.g., hypertrophic cardiomyopathy), electrophysiological abnormalities (e.g., Long QT syndrome, Wolff-Parkinson-White disease, Brugada syndrome)
  • Severe heart failure
  • Marked changes in electrolytes in the blood
  • A tendency to faint
  • Hyperthyroidism
  • Electrocution
  • Drug abuse
  • A family history of heart disease or stroke.
If you have one or more of these risk factors, you may be a candidate for SCA. If you think may be at risk, you should see a cardiologist or heart rhythm specialist (e.g., electrophysiologist, or EP) for an evaluation. The specialist may recommend implantable cardioverter defibrillator (ICD) therapy, medications, or other measures to prevent sudden death.

Summary


Heart Attack
Sudden Cardiac Arrest
Type of heart problem

Usually “plumbing”
Heart muscle may be injured or die without immediate treatment. This could lead to SCA.

Usually “electrical”
The person will die within minutes without immediate treatment.
Signs and symptoms
  • Chest discomfort that may come and go or evolve into crushing pain
  • Discomfort/ pain may radiate to shoulders, neck, back
  • Sweating, nausea, fainting
  • A general sense of anxiety
  • A tendency to deny anything serious is happening
  • The person is awake and the heart is beating
  • Sudden loss of consciousness
  • Breathing is absent or abnormal
  • No heartbeat
  • The person is not awake and the heart is not beating
Additional signs and symptoms in women
  • Stomach or abdominal pain
  • Weakness, and/ or overwhelming fatigue
  • Swelling of the ankles and/or lower legs

What to do in case of emergency
  • Call 9-1-1 immediately
  • Have the person rest or lie down
  • Call 9-1-1 immediately
  • Give CPR or at least vigorous chest compressions
  • Use AED
What to do now
  • Live a healthy lifestyle
  • Find out if you or your loved ones are at risk for SCA
  • Find out about protective measures, such as implantable cardioverter defibrillator (ICD) therapy
  • Learn CPR
  • Learn how to use an AED

Take action todayShare this information with everyone you care about. Lives are at stake and your actions can mean the difference between life and death.
By Mary Newman, Sudden Cardiac Arrest Foundation
Reviewed by Norman S. Abramson, MD, FACEP, FCCM, Joseph P. Ornato, MD, FACC, and Allan Braslow, PhD

Tuesday, November 3, 2015

Heart Attack vs. Sudden Cardiac Arrest

It's a common misconception that heart attack and sudden cardiac arrest are the same thing. In fact, the two conditions are quite different.

Heart attack, or myocardial infarction, occurs when part of the heart's blood supply is reduced or blocked, causing the heart muscle to become injured or die. Victims may complain of various symptoms such as:

• Mild intermittent chest discomfort that lasts a few minutes and comes and goes over a
  period of days
• Pain or discomfort in one or both arms that spreads to the shoulders, upper back, neck,
  jaw and gums
• Shortness of breath
• Nausea, sweating, lightheadedness
• A general sense of anxiety
• A tendency to deny that anything serious is happening.

Women sometimes experience additional symptoms such as:
• Stomach or abdominal pain
• Weakness and fatigue
• Swelling of the ankles and lower legs.

When someone has a heart attack, they are responsive and their heart is beating. It's important to act right away to maximize the odds of survival and minimize permanent damage to the heart. Bystanders should call 911 and have the person lie down and rest until EMS arrives.

While heart attack is often described as a "plumbing problem," sudden cardiac arrest is more of an "electrical problem" that prevents the heart from functioning effectively. Heart attacks can lead to sudden cardiac arrest, but there are many other causes as well, including congenital and electrophysiological abnormalities, severe heart failure, electrocution, and drug overdose.

In contrast, when sudden cardiac arrest occurs, the heart stops beating altogether. As a result, blood is no longer pumped throughout the body, including the brain. The person suddenly passes out, loses consciousness, and appears lifeless -- except for abnormal gasping, which may last several minutes. Sometimes victims experience seizure activity at the onset of the event.

The sudden cardiac arrest victim is not awake and the heart is not beating. If no one provides immediate help, the victim will die within minutes.

When sudden cardiac arrest occurs, it is critically important for bystanders to call 911, give CPR, and use the nearest AED.

This is lifesaving care that anyone can provide. While it is best to be trained in CPR and the use of AEDs, even without formal training, bystanders can call 911, follow dispatcher instructions, push hard and fast on the center of the victim's chest, and follow the directions on the AED while waiting for EMS to arrive.

Sometimes people hesitate to help because they are afraid they might do something wrong and hurt the victim. But since the cardiac arrest victim is clinically dead and cannot get any worse, bystander actions can only help. In addition, state and federal Good Samaritan laws provide protection to bystanders who render aid to sudden cardiac arrest victims in good faith.
  
For more information, visit http://www.sca-aware.org.

Saturday, February 14, 2015

Automatic External Defibrillator (AED)

An AED is an electronic device that analyzes the heart rhythm and when necessary delivers a electric shock known as de-fibrillation. The purpose of this shock is to correct abnormal rhythms found by the AED.

All AEDs are attached to the victim by a cable connected to two adhesive pads or electrodes placed on the victim's chest. The pad and cable system sends the electrical signal from the heart into the device for analysis and delivers the electric shock to the victim as needed.

There are many manufacturers making AEDs today. The principles for use are the same for each, however the displays, controls and options will vary slightly. You should become familiar with the use of your specific AED. All AEDs have the following elements in common:
  • Power on/off mechanism
  • Cable and pads (electrodes)
  • Analysis capability
  • De-fibrillation capability
  • Prompts to guide you
  • Battery operation for portability
Using an AED
  1. Power on the AED by either pressing the on/off button or by opening the AED case lid. Listen carefully to the AED instructions.
  2. Expose the victim's chest. Dry wet skin as necessary to allow placement of the AED pads. Excessive chest hair may need to be removed using a razor prior to pad placement.
  3. Remove the backing from each pad and apply them firmly to the victim's bare chest according to the pictogram on the pads.
  4. Make sure the cable is attached to the AED and stand clear while the AED analyzes the victims heart electrical activity.
  5. When advised to shock the victim, ensure that no one is in contact with the victim prior to pressing the shock button. Be prepared to administer CPR when prompted by the AED.

Friday, November 9, 2012

Hypothermia

Hypothermia occurs when the body loses enough heat to cause the core body temperature to drop. Things like anxiety, injury, drugs, poor nutrition  and alcohol consumption can all contribute to hypothermia.

Wet clothing and wind are a lethal combination that chill a person more rapidly. Changing into dry clothing can be the most important first step in the first aid of all cold victims.

Mild Hypothermia- the core temperature of the body will range from 95 to 91 degrees Fahrenheit. Signs of mild hypothermia include cold, pale and blue-gray skin, shivering, uncharacteristic behavior such as slurred speech, lethargy, poor judgement and confusion.

Severe Hypothermia- the core temperature of the body falls below 90 degrees Fahrenheit. To practical way to differentiate between mild and servere hypothermia is to classify victims as shivering and non-shivering. A victim who is responsive and shivering is mildly hypothermia while a barely conscious victim who is no longer shivering is severely hypothermia. Other symptoms include: stiff muscles and uncoordinated movement, weak, slow, irregular pulse, slow breathing and coma.

What to do:
  1. Reduce further heat loss. Remove wet or freezing clothing and dress the victim in dry clothing. Put the victim in a sleeping bag or wrap with blankets and insulate the person from the cold ground.
  2. Provide heat to the victim's trunk during the first hslf hour after rescue by whatever means are available" body-to-body contact, hot water bottles, chemical heating pads, etc. Place heat soources in the groin and armpits and alongside the neck.
  3. Cover the victim's head with a wool cap to reduce heat loss.
  4. Provide warm, sweet liquids when he or she is able to drink. Hypothermia victims are often dehydrated and their energy is depleted.
Warming the victim too rapidly may cause them to suffer from shock. Do not warm too rapidly. Don't place the victim in a hot bath or shower. Do not place the victim too close to a hot fire or other heat source. 

Call 9-1-1 whenever a person is determined to be unresponsive. Monitor breathing and be prepared to provide CPR.

Thursday, April 14, 2011

Shock

Shock occurs when the body's issues do not receive enough oxygenated blood. To understand shock, think of the circulatory system as having three components: a working pump (heart), plumbing (blood vessels), adequate fluid (blood) pumped through the pipes. Damage to any of these components can deprive tissues of oxygen-rich blood and produce a condition known as shock.

Recognizing Shock
The signs of shock include:
  • Altered mental status
  • Pale or bluish, cold and clammy skin, lips and nail beds
  • Nausea and vomiting
  • Rapid breathing
  • Unresponsiveness

Care for Shock
  1. Place the victim on his or her back
  2. Keep the victim warm
  3. Call 9-1-1
 

Thursday, March 31, 2011

Recognizing a Stroke

A stroke occurs when part of the blood flow to the brain is suddenly cut off. This occurs when arteries in the brain rupture or become blocked.

Recognizing Stroke

The signs of a stroke include:
  • Sudden weakness or numbness of the face, an arm, or a leg on one side of the body
  • Blurred or decreased vision
  • Problems speaking
  • Dizziness or loss of balance
  • Sudden, severe headache
  • Sudden confusion
To assess for a possible stroke, use the mnemonic FAST:
Face - Ask the person to smile. Does one side of the face droop?
Arms - Ask the person to extend both arms out. Does one arm drift downwward?
Speech - Ask the person to repeat a simple sentence. Are the words slurred?
Time - If the person shows any of these signs, time is important. Call 9-1-1.

Care for Stroke
  1. Call 9-1-1
  2. Have the victim rest in a comfortable position
  3. Monitor breathing

Monday, March 21, 2011

Recognizing a Heart Attack

Quick action at the onset of a heart attack is vital to survival and the quality of recovery. Unfortunately this is sometimes easier said than done. Many heart attack victims deny they are experiencing something as serious as a heart attack. Do you know the signs of a possible heart attack?
  • Chest Pressure, squeezing, or pain that lasts for more than a few minutes or that goes away and comes back. However, not every heart attack victim will experience chest pain. Just because your chest doesn't hurt doesn't mean you are not experiencing a heart attack.
  • Pain spreading to the shoulders, neck, jaw or arms.
  • Dizziness, sweating, nausea.
  • Shortness of breath
  • Severe fatigue
  • Upset stomach
Care for a Heart Attack
  1.  Call 9-1-1
  2. Help the victim into the most comfortable resting position.
  3. If the victim is alert and not allergic to aspirin, give four (4) chewable aspirin (81 mg) or one (1) regular aspirin (325 mg)
  4. If the vitim has been prescribed medication for heart disease such as nitroglycerin, help the victim use it.
  5. Monitor breathing.
Angina
Angina symptoms are similiar to thjose of a heart attack, but seldom last longer than ten (10) minutes and almost always are relieved by nitroglycerin.

Care for Angina
  1. Have the victim rest
  2. If the victim has been prescribed nitroclycerin, help the victim use it
  3. If the symptoms continue for more than ten (10) minutes and a heart attack is suspected, call 9-1-1.

Tuesday, March 8, 2011

Abandonment and Negligence

Once you have started first aid, do not leave the victim until another trained person takes over. Leaving the victim without help is considered as abandonment.

Negligence occurs when a victim suffers further injury or harm because the care that was provided did not meet the standards expected from a person with similar training in a similar situation. Negligence involves the following:
  • Having a duty to act, but either not doing so or doing so incorrectly.
  • Causing injury and damages