Emergencies

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First

aid
➢ Diabetic emergencies

➢ Stroke

➢ Seizures

➢ Febrile convulsions
Diabetic emergencies

• Diabetes is a metabolic disorder characterized by hyperglycemia resulting from


defective insulin secretion and/or resistance to insulin action.

• There are two main forms of diabetes: type I and type II.

• Type I diabetes is primarily due to autoimmune-mediated destruction of pancreatic


β-cell islets, resulting in absolute insulin deficiency.

• People with type I diabetes must take exogenous insulin for survival to prevent the
development of ketoacidosis.

• Its frequency is low relative to type II diabetes, which accounts for over 90% of cases
globally.
• Type II diabetes is characterized by insulin resistance and/or abnormal insulin
secretion, either of which may predominate.

• People with type II diabetes are not dependent on exogenous insulin, but may
require it for control of blood glucose levels if this is not achieved with diet
alone or with oral hypoglycemic agents or in conditions such as pregnancy,
surgical operations and infections.

• Some diabetic casualties can regulate their condition through diet alone, while
others take regular medication or get insulin injections.


• In an emergency, it can be difficult or impossible for the first aider to diagnose
whether a diabetic has too much or too little blood sugar.

• Too little sugar is life threatening and casualties respond almost immediately when you
give sugar or a sugary food (or drink) to a responsive casualty.

• Too much sugar tends to build up slowly, and does not normally present as an emergency.

❑ Giving sugar to a casualty with too much sugar does not alter their condition dramatically,
whereas giving sugar to a casualty with low sugar levels can be a life-saving treatment.

Therefore, you should give sugar in all responsive (conscious)


diabetic casualty emergencies.
Both type 1 and type 2 diabetic patients can experience an
imbalance in the concentrations of glucose and insulin in their
blood, resulting in either:
Hypoglycaemia - too little sugar in the blood.
Hyperglycaemia - too much sugar in the blood.

Both conditions can cause altered states of consciousness and


represent potentially serious medical emergencies if not acted upon
immediately.
Hyperglycemia vs. Hypoglycemia:
Signs and symptoms
There is a difference between the signs and symptoms of hyperglycemia and
hypoglycemia - however the major ones are similar.
Low blood sugar (hypoglycaemia) High blood sugar (hyperglycaemia)

• Sweating
• Hot dry skin
• Pale skin
• Intense Thirst
• Hungry
• Weakness • Frequent urination
• Confused • Smell of acetone on breath (fruity
• tremors odor)
• Aggressive

• Changes in consciousness including dizziness, drowsiness and confusion, leading


to coma.
Management
The first aid treatment for both hyperglycemia and hypoglycemia is the same.
• Conscious casualty
• If the casualty tells you that he is diabetic, or he is wearing a necklace or
bracelet saying so, and he is displaying the signs and symptoms, suspect a
diabetic emergency.
• If you are not sure which form of diabetic emergency the casualty has, give
him fluid or food containing sugar, such as sugar enriched soft drinks, fruit
juice or water containing several teaspoons of sugar.
• If the patient already suffering from hyperglycemia (has too much sugar), the
extra will not cause further harm over a short period.
• Often the patient will know what’s wrong and will ask for either his anti-
diabetic medication or something sugary.
Low blood sugar (hypoglycaemic)
1. Give sugar, glucose or a sweet drink such as a soft drink (not ‘diet’ or sugar-free drinks).
2. Continue giving sugar every 15 minutes.
• Until the casualty recovers.
• Follow up with a sandwich or other food.
3. If no improvement, call 123.
High blood sugar (hyperglycaemic)
1. Allow the conscious casualty to self-administer insulin.
2. Seek medical aid.
3. Give casualty sugar-free drinks if help is delayed. (Improve dehydration)
Unconscious casualty
• Call 123.
• Be prepared to perform CPR or use an automated external defibrillator (AED)
and place in recovery position if breathing.
• Always assess for history of diabetes in unresponsive patients:
• Medical Alert Tag.
• Insulin injection marks on arms, thighs or abdomen.
• Insulin pump on the body
• Evidence of diabetic medicine near/on patient.
• Do not give anything to eat or drink.
• Maintain body temperature.
Stroke
• A stroke is the loss of brain function that occurs due to a disruption in the blood vessels
supplying blood to the brain. (i.e. problem with the blood supply to a part of the brain
the area of the brain becomes damaged)

• There are two ways in which this can occur:


1. A clot blocks an artery supplying blood to the brain (80% of strokes).
2. An artery in the brain ruptures.
• Strokes are one of the common causes of sudden death and can lead to extensive
damage to the brain that may result in paralysis.
• The key to surviving a stroke is urgent hospital treatment.
• The first aid focus is to get the casualty to hospital as soon as
possible.
• The airway and breathing should be managed and monitored at all
times before the arrival of an ambulance.
Signs and symptoms:
The signs and symptoms for someone who has experienced some type of
cerebral event are:
• Sudden weakness and/or numbness of the face, the arms, or the legs,
especially on one side of the body.
• Difficulty in understanding speech or speaking.
• Loss of vision.
• Confusion.
• Loss of movement control or balance.
• Severe headache.
• Loss of bladder control.
• Unresponsiveness.
Apply the F.A.S.T. diagnostic tool:

• F - Face - does the face look uneven.

• A - Arm - does one arm drift down when both at equal positions.

• S - Speech - does their speech sound different.

• T - Time - Call for an ambulance immediately if you suspect someone has


had a stroke. Time is of importance in treating the casualty with advanced
care and drugs.
The Cincinnati Prehospital Stroke Scale

• (Abbreviated CPSS) is a system used to diagnose a potential stroke in a pre-hospital


setting. It tests three signs for abnormal findings which may indicate that the
patient is having a stroke.

• If any one of the three tests shows abnormal findings, the patient may be having a
stroke and should be transported to a hospital as soon as possible.

• The CPSS was derived from the National Institutes of Health Stroke Scale developed
in 1997 at the University of Cincinnati Medical Center for pre-hospital use.
Method:
• Facial droop: Have the person smile or show his or her teeth. If one side
doesn't move as well as the other so it seems to droop, that could be a sign of
a stroke.
• Normal: Both sides of face move equally.
• Abnormal: One side of face does not move as well as the other (or at all).

• Arm drift: Have the person close his or her eyes and hold his or her arms
straight out in front with palms facing up for about 10 seconds. If one arm
does not move, or one arm winds up drifting down more than the other, that
could be a sign of a stroke.
• Normal: Both arms move equally or not at all.
• Abnormal: One arm does not move, or one arm drifts down compared with
the other side.
• Speech: Have the person say, "You can't teach an old dog new tricks," or
some other simple, familiar saying. If the person slurs the words, gets some
words wrong, or is unable to speak, that could be a sign of a stroke.

• Normal: Patient uses correct words with no slurring

• Abnormal: Slurred or inappropriate words or mute

• Patients with 1 of these 3 findings as a new event have a 72% probability of


an ischemic stroke. If all 3 findings are present the probability of an acute
stroke is more than 85%.
Management of stroke casualties:
The steps for the management of a responsive stroke casualty are:
• Seek medical attention (call 123).
• Lay casualty down with their head and shoulders raised and supported (use
pillows or cushions).
• Loosen any tight clothing.
• Maintain body temperature.
• Do not give him anything to eat or drink.
• Reassure the casualty.
• If possible, gain the casualty’s history through SAMPLE questioning.
The steps for the management of an unresponsive stroke casualty are:
• Seek medical attention (call123).
• If unresponsive and breathing is adequate, place the casualty in the recovery
position, on their unaffected side where gravity may assist blood to reach the
injured side of the brain, which is then below the unaffected side of the brain.
• Loosen any tight clothing.
• Be prepared for the deterioration of the casualty’s condition, follow (CPR and
AED).
Note:
Do not allow the use of any type of aspirin, as this may have detrimental effects
on the casualty if they are bleeding in the brain (hemorrhagic stroke).
Seizures

• Seizures occur when parts of the brain are affected by sudden, uncontrolled activity
(irregular electrical activity).

• They are usually short-lasting and can appear in different ways. The most common is
when the entire body of the casualty has uncontrolled jerking movements in the head,
the arms, and the legs.

• Most people who suffer from seizures take medication on a daily basis to control the
condition.

• Seizures are normally brief (less than 10 minutes) and will result in little injury to the
casualty. A seizure that is prolonged or recurring is a serious medical emergency and, if
untreated, can result in death.
A seizure may occur:

• In a person with epilepsy.

• As a result of almost any condition affecting the brain, such as head injury, stroke,
meningitis, brain tumor.

• In association with some poisons and drugs.

• During withdrawal from alcohol or other drugs of dependence.

• In young children, normally as a result of

a high temperature. This is called

a febrile convulsion.
Signs and symptoms:
A casualty experiencing a seizure may display one or more of the following signs and
symptoms:
• Aura, which is an unusual sensation preceding a seizure.
(Auras may come in many forms, such as a strange taste in the mouth, tingling in the limbs,
or the visual disturbance of "flashing lights"; often if the person is epileptic, they may be
aware that a seizure is imminent and may tell others or sit or lie down to prevent injury.)
• The casualty may go quiet and stare.
• Loss of bladder control.
• Jerking movements of the head, arms, and legs.
• Unusual breathing sounds.
• Clenched jaw.
• The skin may be warm to the touch in infants and children.
• Unconsciousness.
• The casualty may be wearing a Medic Alert bracelet.
Management:
The objective is to stop the person hurting themselves.
• Never attempt to hold the casualty in any way to stop their seizure - the victim is
unaware that it is occurring and is unable to control it.
Attempting to restrain an individual having a seizure may result in injuries to both
you and the victim.
• Also, do not attempt to stick anything into the victim's mouth - sticking something
in their mouth can cause further injury or death. The tongue may obstruct the airway
during the seizure, but this is normal.
• Seek medical attention (call123).
• Protect the casualty from injury, for example, move furniture away.
• Gently support the victim's head to prevent it from hitting the ground (such as
placing rolled up clothing underneath it).
• If possible, use SAMPLE questioning to obtain the casualty’s history from
family and/or bystanders.
• Request that all bystanders move away (persons having a seizure are often
embarrassed after their seizure).
• When the seizure stops, check airway and breathing and be prepared for CPR
and AED.
• If unresponsive and breathing is adequate, place the casualty in the recovery
position but only if you do not suspect a spinal injury.
• Deal with any injuries if present.
• After the seizure, the victim will slowly "awaken." Ensure that bystanders are
away and offer reassurance for the victim as they may be confused once the
seizure stops. The victim will be very tired after his seizure. Continue to
reassure the victim until he is fully aware of the surroundings or until medical
help arrives.
Febrile convulsions

• High body temperatures in infants and children (usually greater than 38°C)
can cause seizures, which is usually caused by infections.

• The body raises its temperature to assist with creating a fever, combating
infection, but this can result in seizure if their temperature becomes too high.

• Seizures in infants and children should be treated the same as adults.


Management of febrile convulsions caused by fever:

• Seek medical attention (call 123).

• Lower the casualty’s temperature by removing the child’s/infants clothing.

• Reduce temperature by sponging with a cool, wet towel or bathing with cool water
(beware of over cooling).

• Cool by fanning where possible.

Tepid sponging
Important tips to remember:

• Protect the casualty from injury by moving furniture or sharp objects that
may inflict harm and put thin padding under their head e.g. a folded jacket.

• Do not restrain the casualty or try to stop the seizure. Allow the seizure to
run its course.

• Do not put your fingers or any other objects in the casualty’s mouth.
Thank you

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