Acute Emergency Situations

Acute Emergency Situations

Domain IV of the Delaware Prometric written outline—Basic Nursing Care Provided by the Nurse Aide (~26%)—expects you to recognize acute changes and respond correctly. Domain II taught the facility emergency framework; this section focuses on bedside medical emergencies common in long-term care. The pattern is constant: recognize → call for help → stay if safe → protect airway/safety within training → notify the licensed nurse → document facts. CNAs do not diagnose, prescribe, start IVs, or give medications from the cart.

Universal CNA First Response

Before memorizing each condition, lock this sequence:

1. Ensure scene safety for you and the resident when possible.
2. Call for help — yell, emergency call light/pull, facility code, or internal emergency number. Do not assume someone else already called.
3. Stay with the resident unless you must leave briefly as the only way to get help and no one else is available; return immediately.
4. Do not leave a resident in crisis alone “to finish your assignment.”
5. Provide care within scope and training — for example CPR if certified and indicated, abdominal thrusts for severe choking if trained, direct pressure for bleeding, recovery position if appropriate and no spinal concern, raise head of bed for shortness of breath after help is activated when that position is safe and not contraindicated.
6. Never give medications — including “just an aspirin,” insulin, or someone else’s inhaler—unless you have a rare facility-specific certification and order pathway that truly covers you (standard CNA exam answer: do not give meds).
7. Report objectively — who, what, when, vital signs if obtained, what you did.
8. Follow nurse/EMS directions once they arrive.

Chest Pain and Cardiac Arrest

Chest pain

Treat new or severe chest pain, pressure, squeezing, or pain radiating to arm/jaw/neck/back, with or without sweating, nausea, or shortness of breath, as an emergency until the nurse says otherwise. Actions:

• Stay calm; keep the resident still and at rest
• Call for help / notify nurse immediately; activate EMS per facility policy
• Loosen tight clothing; do not leave alone
• Note time of onset and associated symptoms
• Do not give nitroglycerin or other drugs; licensed staff manage medications
• Be prepared to support CPR if the resident becomes unresponsive

Cardiac arrest / unresponsiveness

If the resident is unresponsive and not breathing normally:

• Call for help and activate emergency response
• Begin CPR if you are trained and facility policy directs it; send someone for the AED if available
• Continue until relieved by trained responders or an obvious valid reason to stop per training

Do not drag a large unresponsive resident alone in ways that injure you both unless the environment is immediately deadly (fire, structural collapse).

Respiratory Distress and Choking

Shortness of breath (dyspnea) and respiratory distress

Signs include rapid or labored breathing, inability to speak full sentences, sitting bolt upright, bluish lips, panic, or noisy breathing. Call for help, stay, help the resident into a position of comfort—often raising the head of the bed or sitting forward if safe and not contraindicated—and report. Do not crank oxygen flow rates on your own beyond what is ordered; notify nursing of concentrator alarms or empty tanks.

Dysphagia, choking, and aspiration

Dysphagia is difficulty swallowing. Aspiration is inhalation of food, fluid, or vomit into the airway/lungs. Prevention during meals (upright position, slow pace, diet texture per care plan) belongs with nutrition skills; acute response is Domain IV emergency care.

Mild choking (can cough forcefully, speak): encourage coughing; stay; do not blind finger sweeps.

Severe choking (cannot speak, cough, or breathe; silent; clutch throat): call for help and use trained relief method (for example abdominal thrusts / protocol for the resident’s body size and pregnancy status per your CPR/first-aid training). If the resident becomes unresponsive, lower to the floor and begin CPR sequences as trained, checking the mouth for visible objects only as instructed in current guidelines.

After any significant choking or aspiration event, the nurse must assess even if the resident “seems fine”—aspiration pneumonia risk and residual obstruction matter.

Vomiting

Support the resident’s head, turn to the side if lying flat to reduce aspiration when no spinal injury is suspected, provide emesis basin, gloves, and privacy. Observe color, amount, blood (coffee-ground or bright red), and force. Report large volume, blood, projectile vomiting, vomiting with severe abdominal pain, or vomiting with altered consciousness. Clean the resident promptly for dignity and skin protection; do not offer large amounts of fluid until nursing directs.

Seizures

During a seizure:

• Call for help; note the start time
• Protect the head with a pillow or folded blanket; clear hard objects
• Loosen clothing around the neck
• Do not force a spoon, tongue blade, or fingers into the mouth
• Do not try to hold the person down with full-body force
• Turn to the side when safe to help drainage of saliva if policy/training allows and spinal injury is not a concern
• After the seizure (postictal period), keep airway open, stay, reorient gently, and report length, body parts involved, injuries, incontinence, and recovery level

Prolonged seizure activity or first-time seizure is an emergency—activate full response per facility protocol.

Stroke Signs

Sudden face drooping, arm weakness or drift, speech difficulty (slurred or strange speech), sudden severe headache, sudden vision change, or sudden confusion/mobility change are stroke red flags. Many programs teach FAST (Face, Arms, Speech, Time). Time of onset is critical for medical decisions. Call for help, keep the resident safe and NPO (nothing by mouth) until assessed, note the last time known normal, and do not give food, fluid, or medications. Stay until the nurse or EMS takes over.

Diabetic High and Low Sugar Clues

CNAs do not independently diagnose hypo- or hyperglycemia, and many facilities restrict finger-stick testing to licensed staff or specially trained aides. You must recognize and report clues:

Immediate actions: call the nurse now, stay with the resident, do not force food into an unconscious resident’s mouth, and do not give insulin. If the resident is conscious and facility policy/nurse orders a defined response (for example glucose gel), follow only that order pathway—exam default remains get the nurse immediately.

Sudden Confusion, Agitation, and LOC Changes

Sudden agitation, combativeness, or level of consciousness (LOC) drop (hard to arouse, only responds to pain, unresponsive) can signal stroke, hypoxia, head injury, infection, medication effects, or metabolic crisis. Protect from injury, call for help, do not restrain punitively, reduce stimuli when safe, and report baseline comparison. Never ignore “sundowning” labels when the change is new or extreme—acute delirium still needs nursing evaluation.

Falls, Bleeding, and Burns

Falls

• Call for help; do not move the resident until the nurse assesses unless the environment is deadly
• Check responsiveness and obvious injury without diagnosing fracture
• Keep warm and calm; control bleeding with pressure if present and trained
• After nursing assessment and transfer back to bed/chair, continue frequent observation as directed; document and complete incident processes per policy

Bleeding

Apply direct pressure with a clean barrier (gloves + gauze), elevate the limb if appropriate and no fracture is suspected, and call for help. Do not remove impaled objects. For severe arterial spurting, activate emergency response and maintain pressure until relieved.

Burns

Stop the burning process (remove from heat source safely), cool with cool (not ice-packed) water as trained for minor heat burns, cover lightly, and notify the nurse. Chemical or electrical burns and large/facial/genital burns are emergencies. Do not apply butter, toothpaste, or random ointments.

Worked Scenario

During lunch, Mr. Patel grabs his throat, cannot speak, and no air movement is heard. Correct sequence: recognize severe choking → call for help loudly → perform trained choking relief → if unresponsive, begin CPR protocol as trained → nurse/EMS take over → report and document. Offering water, leaving to find the charge nurse two halls away without calling out, or waiting to “see if it passes” fails the exam and the resident.

Exam Focus

Acute emergency items almost always punish delay, abandonment, medication administration, and moving fall victims casually. They reward call for help, stay with the resident, scope-limited first aid, stroke time awareness, seizure safety, and objective reporting. If two answers both sound caring, pick the one that activates help immediately and keeps the CNA inside legal scope.