Choking
Heart disease kills between 400,000 and 500,000 people each year, while choking on food accounts for only about 5,000. Even though you are more apt to run across someone with a cardiac problem, it is still important to distinguish between the so-called cafe coronary and a genuine heart attack.The first clue is usually provided by the context in which an attack occurs - the victim has been eating and drinking. The upper airway obstruction occurs because the protective gag reflexes are blunted by age, disease, drugs or alcohol and the food is aspirated (inhaled).
When a person has a partial airway obstruction, you should do nothing except allow him or her to cough and watch the person carefully should a complete blockage occur. Another, not commonly known method is to put the victim in the sniffing position, as though he were bending over to smell something. That pulls the hypopharnyngeal musculature out and may increase the diameter of the airway enough to make things a little easier for the victim. Call the EMS system for immediate help.
When the obstruction is complete and the person cannot speak, perform the Heimlich maneuver. To perform the Heimlich maneuver, position yourself behind the victim and encircle him or her with your arms. Place your fist against the victim's abdomen, hold your other hand over the fist and pull in and up as hard as you can. If food flies out, as it often does, the victim will be able to speak. If no food flies out after five thrusts, recheck your technique and reassess the victim, and if he or she cannot speak, try another five abdominal thrusts (Heimlich maneuver).
For an unconscious victim in whom breaths of air do not go in, perform the Heimlich maneuver by straddling the victim's thighs and placing the heel of the hand slightly above the navel. Place the heel of the other hand over the top of the first hand. Give up to five abdominal thrusts by pushing upward and inward. If these do not work, move to the victim's head and perform a finger sweep (using two fingers from one cheek to the other). If this retrieves nothing, attempt two more breaths. If your air does not go into the victim, continue the cycle of thrusts, sweep and breaths until the object is removed or until the EMS system relieves you.
Asthma
People who have asthma are fairly well and then, usually late at night, they develop shortness of breath and audible wheezing. If you encounter it, you can do three things for such a person: make sure he or she is kept either sitting or standing, give psychological support, which is especially effective with asthma sufferers, and get the person to a hospital emergency room. Some would also give him or her a caffeinated drink, which may have a weak bronchodilating effect.
Angina pectoris (chest pain)
This type of chest pain will usually disappear within a few minutes if the person simply stops whatever activity is causing the pain. People with chronic angina often carry nitroglycerin, so if you encounter someone complaining of chest pain, find out whether he or she has taken their medication.
The major side effect of nitroglycerin is orthostatic hypotension, which means the blood pools in the vessels of the legs and abdomen and makes the person feel faint. The phenomenon is generally short lived because nitroglycerin works within a minute and a half and its effect is gone in about 20 minutes. But if the victim feels dizzy or feels worse with the medication, you can redistribute the blood back into the appropriate compartments just by laying him or her down and raising the legs.
However, if nitroglycerin does not relieve a person's pain, that is fairly good evidence that what he is suffering is not simply an angina attack but may very well be a heart attack.
Cardiac arrest
Many heart attacks are relatively small in terms of muscle damage, but people still die unnecessarily outside the hospital because they are not defibrillated soon enough.
If a person arrests in your presence and the EMS system is not readily available, perform basic life support until the EMS system arrives. The problem is that basic CPR provides a cardiac output about a quarter of normal or less, and the heart needs a jump-start that can only be acquired through defibrillation, which most EMS systems can give.
Shock
Care for shock is aimed at preventing irreversible shock. If a victim is allowed to remain in shock for any length of time, he or she may become unresuscitable, and since we cannot tell exactly when that will occur, we treat and overtreat if necessary. This may not happen in a city, but in remote settings it is always a possibility.
Since 60 percent or more of the blood volume is in the venous system, raise the legs above the trunk (usually 8-12 inches). If you are caring for a victim outside in midwinter, keep him warm or hypothermia may develop. However, in many cases keeping the victim warm is not a concern.
Victims of shock complain of thirst. Do not give liquids because you don't know how well the gag and swallowing reflexes are working, and if the victim has to go into surgery later on, intubation will be more dangerous. However, if it's clear from looking at the situation that the victim is suffering from dehydration, you should give fluids.
Fainting
Fainting is usually triggered by some distressing form of psychological event that affects the central nervous system. As a result, the victim's heart rate slows, the outer blood vessels dilate, and blood pools in the legs. Venous blood does not return to the brain and the victim loses consciousness and muscle tone and falls to the ground. Once the person has fallen, gravity decreases and the blood returns to the central circulation.
Do not give smelling salts for fainting. It used to be standard equipment in first-aid kits. Use of ammonia has caused chemical burns of the nose and upper airway. Moreover, if someone has lost consciousness from another cause, such as drug overdose or a toxic metabolic disturbance, the ammonia will mask the odor of the underlying disorder on the victim's breath. Besides, ammonia inhalants are not needed since fainting is self-correcting.
All that has to be done for a person who has fainted is to lay him or her down and raise the legs. If you help the victim up right away, the person will probably faint again. Wait about 20 minutes before helping them up and even then do it gradually. If the person feels dizzy or lightheaded, put the person down again.
Poisoning
In the case of swallowing a noncorrosive poison and if the victim is unconscious, make sure that the airway is open and that the victim is breathing. For conscious and unconscious victims, try to identify the poison and how much may have been swallowed. Next, call the poison control center for advice about what to do. Sometimes, syrup of ipacac for a conscious person may need to be given, but more and more toxicologists prefer activated charcoal.
In case of corrosive poisoning, monitor the breathing. If any of the corrosive materials is in the mouth, flush it out with water and, if possible, have him gargle to remove it from the throat. Use a shower or hose to wash the corrosive chemical. For example, lye sticks to the protein in the eye and continues to destroy tissue. It takes about 20 minutes of continuous washing to remove it. Unfortunately, lye is available everywhere because it is used to open clogged plumbing systems.
If a corrosive has been swallowed, don't have the victim vomit because the material will be just as corrosive on the way up as it was on the way down. Have the victim drink fluids to dilute the poison. Some have recommended giving a demulcent such as egg white, milk or mineral or salad oil - anything that will stick to the mucosa and create a barrier. Activated charcoal is not effective in corrosive ingestion.
The question of what to do for someone who has swallowed a petroleum product has not been settled by medical authorities. If you make the victim vomit, the victim could aspirate (inhale) the material and get a form of pneumonia that is untreatable and sometimes fatal. For these cases always seek the advice of a poison control center.
Heat stroke
Elderly people, especially those with underlying diseases such as diabetes or heart disease or those on drugs that affect sweating, are especially susceptible to heat stroke and have a high death rate from it. Heat stroke in the young usually happens when someone who is unacclimatized is suddenly doing vigorous athletic or other muscular activity under hot, humid conditions.
Heat stroke is having a very high body temperature and a change in mental state. The victim may be sweating - young people usually do - or you may see no sweating at all in an elderly person who may have sweat gland failure.
For these victims, use evaporation to cool the victim off if the humidity is under 75 percent. Do this by undressing the victim (keep modesty in mind), placing wet sheets, towels and cloths over the hottest parts of the body - scalp, groin, armpits, neck - and keeping them wet. Fanning the victim is also very important. For high humid areas (greater than 75 percent) place ice on the hottest parts of the body after undressing the victim.
Untreated heat stroke victims always die, so get medical attention for the victim immediately.
Hypothermia
Below-freezing temperatures are not necessary for hypothermia to develop. It can happen in any situation in which heat loss outpaces the body's ability to generate sufficient heat. Hypothermia is generally defined as a core temperature of less than 95 degrees. For victims above this temperature, external rewarming is effective. For those under 95 degrees Fahrenheit, core rewarming is needed and this is best done in a medical facility.
One of the most dangerous hypothermic situations occurs when a boat capsizes in large bodies of water. Often, survival time is no more than minutes.