8.3 Choking (Heimlich), Bleeding, Shock, Seizures, Sudden Change
Key Takeaways
- 3 CCR 716-1.11 requires safety and emergency procedures, including the Heimlich maneuver, in the first 16 pre-clinical hours — before any client contact.
- If the person is coughing effectively, encourage the cough; if the person cannot speak, cough, or breathe, perform abdominal thrusts (Heimlich) as trained.
- For bleeding: gloves, direct pressure, add dressings on top of soaked ones, elevate only if there is no fracture.
- For a seizure: protect the head, do not restrain, put nothing in the mouth, time it, turn the person on the side afterward, and report.
- Chest pain, FAST stroke signs, sudden shortness of breath, or a sugar extreme: stay, call the nurse immediately, do not leave to finish the shower, and never give insulin.
8.3 Choking (Heimlich), Bleeding, Shock, Seizures, Sudden Change
Quick Answer: If a person is coughing effectively, encourage the cough — do not start abdominal thrusts yet. If the person cannot speak, cough, or breathe, perform abdominal thrusts (the Heimlich maneuver) as you were trained. Colorado 3 CCR 716-1.11 requires safety and emergency procedures, including Heimlich, in the first 16 pre-clinical hours, before any client contact. For bleeding: gloves, direct pressure, add dressings on top of soaked ones, elevate if there is no fracture. For shock: keep warm, lie the person down if allowed, nothing by mouth, get the nurse. For a seizure: protect the head, do not restrain, nothing in the mouth, time it, turn on the side after, report. Chest pain, FAST stroke signs, or sudden shortness of breath: stay, call the nurse immediately, and do not leave to "finish the shower."
Why this section is on the exam
NNAAP I.B.2 tests whether you recognize a true emergency and stay inside CNA action. The Colorado Board put Heimlich in pre-clinical training on purpose: you may meet a choking person before you have finished the 75-hour program. After certification, the same sequence is still yours. You do not diagnose the blocked airway. You do not start an IV. You do clear an airway you were trained to clear, hold pressure on bleeding, protect a seizing head, and get the licensed nurse without abandoning the person.
Choking — encourage a strong cough; Heimlich when air does not move
Choking means food or a foreign body is blocking the airway.
- Effective cough (the person can cough, speak, or make sounds; color is not turning gray): encourage the cough. Stay. Do not slap the back as your first idea on an adult who is still moving air. Do not start abdominal thrusts on a person who can still talk. Do not offer water "to wash it down."
- Ineffective or silent (cannot speak, cannot cough, cannot breathe; hands at the throat; silent; cyanosis): call for help and begin abdominal thrusts (Heimlich) the way your approved program taught you. Rule 1.11 names this skill in the first 16 hours. Use the hand position and inward-and-upward thrusts you practiced. Continue until the object comes out or the person becomes unresponsive, then follow your training and the nurse's direction for the next step (lowering to the floor and starting the facility's unresponsive protocol).
- After the object is out, stay and report. Even a "successful" Heimlich can injure a rib or leave residual distress. The nurse assesses.
Pregnant or obese clients may need chest thrusts instead of abdominal thrusts if that is what you were trained to use. You do not invent a new method in the dining room. You use the method your program and the facility checked you on.
Prevention is still I.B.2: sit the person upright for meals, cut food, follow thickened-liquid orders, and do not mix a mouthful of meat with laughing and talking. Skill 10 (feeding) already requires an upright position of 75–90 degrees before the first bite. That angle is choking prevention, not only dignity.
Bleeding
Put on gloves first if you can reach them without letting the person bleed out in front of you. Standard precautions do not disappear in an emergency.
- Apply direct pressure with a clean dressing or the cleanest cloth you have.
- If the dressing soaks through, do not peel it off. Add more dressings and keep pressure. Pulling the first pad can pull off the clot.
- Elevate the limb if there is no sign of a fracture and elevation is allowed.
- Do not apply a tourniquet unless you have been trained and the nurse or the emergency protocol directs it.
- Stay, keep the person lying down if that is safe, and get the licensed nurse / activate the facility emergency system.
A nosebleed in a person on blood thinners is still a report. Spurting blood is a stay-and-pressure emergency, not a linen-change problem. Do not use a dirty washcloth from the sink as your first choice if a clean dressing is in reach.
Shock
Shock is poor blood flow to the brain and organs. After bleeding, a severe infection, a heart event, or a bad allergic reaction, the person may be pale or gray, cold and clammy, dizzy, thirsty, or confused, with a weak rapid pulse.
CNA actions:
- Get the licensed nurse immediately.
- Help the person lie down if the care plan and the nurse allow it and there is no reason to keep the head up (some breathing problems need the head elevated — follow the nurse).
- Keep the person warm with a blanket. Do not bake the person under a pile of quilts.
- Nothing by mouth (NPO) — no water, no ice chips, no "just a sip." The person may vomit or need a procedure.
- Do not put a pillow under the head unless directed. Do not leave to look up shock on your phone.
You treat the position and the warmth. You do not treat the cause. Thirst is a symptom, not a reason to offer juice.
Seizures
A seizure is uncontrolled electrical activity in the brain. The person may stare, jerk, drop, or lose urine.
| Do | Do not |
|---|---|
| Ease the person to the floor if you can do it safely | Hold the person down or restrain the limbs |
| Protect the head with your hands or a folded towel | Put a spoon, airway, or your fingers in the mouth |
| Move furniture and hard objects away | Force a bite block "so they do not swallow the tongue" (they will not swallow the tongue) |
| Time the seizure — start and stop | Leave to find the nurse before the person is protected |
| Loosen tight clothing at the neck | Give food, water, or pills during the event |
| When jerking stops, turn the person on the side so saliva drains | Crowd the person or shout in their face |
| Stay until the nurse has the person; report length, what the body did, and what happened just before | Chart "had a fit" without a time or a description |
A seizure that is new, that lasts longer than the care plan's usual pattern, that repeats, or that leaves the person blue or injured is an emergency report, not a "they do that." Afterward the person may be sleepy or confused. Stay. Protect privacy. Nothing in the mouth still applies while the person is post-ictal and not fully awake.
Sudden change — stay, do not finish the shower
Chest pain, sudden shortness of breath (SOB), a new severe headache, or FAST stroke signs are stay-and-call events.
FAST:
- F — Face. New droop on one side. Ask the person to smile.
- A — Arm. One arm drifts or will not lift.
- S — Speech. New slur, wrong words, or inability to speak.
- T — Time. Note the time the person was last known well and get the nurse now. Time is the treatment window. You do not diagnose the stroke. You do not give aspirin. You do not call the family instead of the nurse.
If this happens in the shower, you do not leave to finish the shower, to "just rinse the soap," or to tidy the bathroom. Sit the person safely if you can, keep them from falling, call out for the nurse, and stay. The same rule applies in the dining room and in the hall. "I will report it as soon as I finish this task" is how written items fail.
Hypoglycemia versus hyperglycemia — recognize and report
The CNA does not treat with insulin. The CNA does not decide the dose of juice unless the licensed nurse and the care plan have already given a clear, assigned hypoglycemia protocol — and even then, a person who cannot swallow safely gets the nurse, not a forced drink.
| Hypoglycemia (low blood sugar) | Hyperglycemia (high blood sugar) | |
|---|---|---|
| Typical speed | Sudden | Hours to days |
| What you may observe | Shaky, sweaty, hungry, pale, irritable or confused, rapid pulse, "not himself"; can progress to seizure or unresponsiveness | Very thirsty, frequent urination, dry flushed skin, drowsiness, fruity or sweet breath, deep breathing |
| CNA action | Stay; give a quick-acting carbohydrate only if the nurse or care plan already assigned it and the person can swallow safely; report immediately | Stay; report immediately; NPO if the person is vomiting or the nurse so directs |
| What you never do | Give insulin. Guess the number. Leave the person alone with a carton of juice | Give insulin. Withhold the report because "their sugar always runs high" |
Both pictures can look like "confusion" in a person with dementia. A sudden change from that person's baseline is a report, not a behavior problem. If you are not sure which sugar extreme you are seeing, you still stay and get the nurse. Wrong insulin from a CNA is a scope violation and can kill.
Colorado scenario
You are feeding breakfast on a Greeley long-term-care unit. Ms. Ortiz, who has dentures and a regular diet, suddenly stops talking, grabs her throat, and makes no sound. A coworker says, "Encourage her to cough — she is fine." She is not coughing. You call for help and begin abdominal thrusts as trained in your Rule 1.11 pre-clinical hours. A piece of sausage comes out. She is breathing but shaky. You stay and report to the licensed nurse. You do not hand her orange juice and walk away, and you do not go start Mr. Cole's shower "now that it is over."
Ten minutes later Mr. Cole, who has diabetes, is pale and sweaty in that shower and slurs that his "tongue feels thick." You sit him safely, keep him from standing alone, and call the nurse immediately. You do not give insulin. You do not leave him on the shower chair to finish rinsing soap off his back. If the nurse later says this was hypoglycemia and the care plan allows a swallow-safe carbohydrate, that is a nurse-directed action, not a CNA diagnosis. The same stay-and-call rule would apply if his face had drooped (FAST) or if he had grabbed his chest.
Exam traps
- Starting Heimlich on a person who is still coughing and speaking.
- Offering water to a choking person.
- Pulling off a soaked dressing.
- Restraining a seizing person or putting something in the mouth.
- Leaving a chest-pain or FAST client to finish a shower.
- Giving insulin because the person "looks high" or "looks low."
- Treating Rule 1.11's Heimlich requirement as optional because "I am only a student until I pass the NNAAP."
A resident is coughing forcefully after a bite of meat and can say, I'm okay. What should the CNA do?
A client begins to have a generalized seizure in a chair. What is the correct CNA action?
During a shower a resident grabs the chest, looks gray, and says the left arm is heavy. What should the CNA do first?