6.3 Choking, Burns, Poisoning, and Medical Emergencies

Choking, Burns, Poisoning, and Medical Emergencies

Quick Answer: The CNA's role in every emergency is to recognize the emergency, stay with the resident, call for help, and report to the nurse. You do NOT diagnose or treat — but you must know the signs so you can act fast. Memorize Heimlich for choking, FAST for stroke, and the seizure-response rules (protect, don't restrain, turn on side after).

Choking and the Heimlich Maneuver

Choking is a blocked airway. It is a life-threatening emergency. The CNA must recognize the signs and respond immediately.

Signs of Choking

• Universal sign of choking: the resident clutches their throat with one or both hands.
• Cannot speak, cough, or breathe.
• High-pitched wheezing or no sound at all.
• Cyanosis — blue lips, nail beds, or face (late sign).
• Loss of consciousness if the airway is not cleared.

Trap callout: If the resident can cough or speak, do NOT do the Heimlich. Encourage them to keep coughing. The Heimlich is only for a resident who CANNOT cough, speak, or breathe. Doing it on someone who is moving air can cause injury.

Heimlich for a Conscious Resident

1. Ask, "Are you choking?" If they cannot answer, act immediately.
2. Stand or kneel behind the resident.
3. Place the thumb side of your fist against the resident's abdomen, midline, just above the navel and well below the breastbone (xiphoid process).
4. Grasp your fist with your other hand.
5. Give quick, inward and upward thrusts. Each thrust is a separate, distinct motion.
6. Repeat until the object is expelled or the resident becomes unconscious.
7. If the resident becomes unconscious, lower them to the floor, call for help, and begin CPR (if trained) or follow facility protocol.

Heimlich for an Unconscious Resident

1. Call for help and lower the resident to the floor.
2. Open the airway (head-tilt/chin-lift or jaw-thrust if spinal injury suspected).
3. Look into the mouth. If you SEE an object, remove it with a finger sweep. Never do a blind finger sweep — you could push the object deeper.
4. Attempt to ventilate (if trained). If the chest does not rise, reposition the head and try again.
5. Give 30 chest compressions (same hand position as CPR).
6. Look in the mouth before each ventilation attempt. Remove the object only if you can see it.
7. Continue until the object is expelled, the resident breathes, or the nurse/EMS arrives.

Trap callout: Never do a blind finger sweep. Only reach into the mouth if you can see the object. Pushing an unseen object deeper into the airway makes things worse.

Burns

Burns are caused by heat (thermal), chemicals, electricity, or radiation. LTC residents are at high risk for burns from hot water, heating pads, spills, and radiator contact.

Burn Classification

Trap callout: Third-degree burns may be LESS painful than first or second-degree because nerve endings are destroyed. The absence of pain does not mean the burn is minor — it means the burn is severe.

Burn Response (CNA Role)

1. Remove the resident from the source of the burn — stop the burning process.
2. For thermal burns, cool the burn with cool (not ice-cold) running water for several minutes. Do NOT use ice — ice causes tissue damage.
3. Do NOT apply butter, grease, ointment, toothpaste, or any home remedy. These trap heat, cause infection, and make it harder for the nurse or doctor to assess.
4. Do NOT pop blisters. Blisters protect against infection. Popping them introduces bacteria.
5. Remove jewelry and tight clothing near the burn before swelling starts (if not stuck to the skin).
6. Cover with a sterile, dry dressing or clean cloth. Do not use cotton balls or fluffy material that can stick.
7. Notify the nurse immediately. Severe burns, burns over a large area, burns to the face, hands, feet, genitals, or major joints, and all third-degree burns are emergencies.
8. Document the cause, location, size, appearance, and what you did.

Trap callout: Never apply butter, ice, or any ointment to a burn without a doctor's order. Butter and oils trap heat and cause infection. Ice causes frostbite-like damage to already-injured skin. Cool running water is the only first aid for a thermal burn.

Poisoning

Poisoning in LTC can occur from medication errors, swallowing cleaning chemicals, or exposure to toxic substances. The CNA's role is to recognize, protect the resident, and report.

Poisoning Response

1. Stay with the resident.
2. Identify the poison if possible — look for the container, bottle, or label. Note the substance, amount, and time.
3. Call the nurse immediately. The nurse or facility will call Poison Control (1-800-222-1222) or 911.
4. Do NOT induce vomiting unless Poison Control or a doctor tells you to. Some substances (corrosives, petroleum products) cause more damage coming back up.
5. Save the container, the substance, and any vomitus for identification. Do not throw anything away.
6. Monitor the resident's breathing and level of consciousness while waiting for help.
7. If the poison is on the skin, remove contaminated clothing and rinse with running water for at least 15 minutes.
8. If the poison is in the eye, rinse the eye with running water for at least 15 minutes (unless the substance is reactive with water).

Trap callout: Never induce vomiting in a poisoning victim unless you are specifically told to by Poison Control or a medical professional. Corrosives (acids, alkalis) burn the esophagus again on the way up. Petroleum products can be inhaled into the lungs during vomiting, causing chemical pneumonia.

Medical Emergencies — Recognizing and Reporting

The CNA does NOT diagnose or treat medical emergencies. Your job is to recognize the signs, stay with the resident, call for help, and report to the nurse. Memorize these signs.

Stroke (CVA) — FAST

FAST is the national stroke-recognition acronym. Time is brain — every minute of delay kills brain cells. Know the time the symptoms started; the nurse and doctor need that for treatment decisions.

Other stroke signs: sudden severe headache, sudden confusion, sudden vision loss in one or both eyes, sudden trouble walking, loss of balance.

Trap callout: A transient ischemic attack (TIA) is a "mini-stroke" with the same signs as a stroke that resolves in minutes. It is a WARNING sign of a full stroke. Report every TIA to the nurse — do not assume it is over just because the resident looks fine now.

Seizure

A seizure is a sudden, uncontrolled electrical disturbance in the brain. The CNA's role is to protect the resident from injury during the seizure and report afterward.

Seizure Response

1. Stay calm. Note the time the seizure starts.
2. Protect the resident from injury:
   • Guide them to the floor if standing or sitting.
   • Clear the area of furniture and hard objects.
   • Put something flat and soft (folded towel, pillow) under their head.
   • Loosen tight clothing around the neck.
3. Do NOT restrain the resident. Holding them down causes fractures and muscle injury.
4. Do NOT put anything in the mouth. The old advice to put a spoon or wallet in the mouth is WRONG — it can break teeth, obstruct the airway, or choke the resident. People cannot "swallow their tongue."
5. After the seizure stops, turn the resident on their side (recovery position) to keep the airway open and allow secretions to drain, preventing aspiration.
6. Note the time the seizure ends. Report how long it lasted.
7. Stay with the resident and reassure them — they may be confused, tired, or incontinent after the seizure (postictal state).
8. Report to the nurse immediately.
9. A seizure lasting more than 5 minutes, repeated seizures without recovery in between, or a first-time seizure is a medical emergency — call 911 per facility protocol.

Trap callout: Never put anything in a seizing resident's mouth. The risk of broken teeth, airway blockage, and choking is real. "Swallowing the tongue" is a myth — it cannot physically happen. Protect, do not restrain, do not insert.

Heart Attack (Myocardial Infarction)

Recognize the signs and report immediately. Heart attack is life-threatening.

• Chest pain or pressure — crushing, squeezing, or tightness in the center or left chest; may spread to the arm, jaw, neck, or back.
• Shortness of breath.
• Nausea, vomiting.
• Sweating (diaphoresis), cold, clammy skin.
• Dizziness, lightheadedness.
• Fatigue, weakness.
• Women, older adults, and people with diabetes may have ATYPICAL symptoms: shortness of breath, nausea, back or jaw pain, fatigue — without classic chest pain.

CNA response: stay with the resident, call for the nurse, help them sit up and rest, loosen tight clothing, do NOT give food or drink, and be ready to start CPR if they become unconscious. Note the time symptoms started.

Hemorrhage (Severe Bleeding)

Severe bleeding is a life-threatening emergency.

1. Stay with the resident. Call for help.
2. Apply direct pressure on the wound with a sterile gauze pad or clean cloth. Press firmly.
3. If blood soaks through, add more layers — do NOT remove the first dressing. Removing it pulls the clot off.
4. Elevate the bleeding area above the heart if possible and if no fracture is suspected.
5. If bleeding does not stop, apply pressure to the artery supplying the area (pressure point) per training.
6. Do NOT use a tourniquet unless trained and authorized. A tourniquet can cause tissue death and limb loss.
7. Report to the nurse immediately. Note the location, amount, and color of blood (arterial = bright red, spurting; venous = dark red, steady).
8. Watch for signs of shock — pale, clammy skin, rapid pulse, rapid breathing, weakness, confusion. Report these immediately.

Trap callout: Never remove the first dressing when it soaks through — add more on top. Removing it pulls the forming clot away and restarts bleeding. Also, never apply a tourniquet unless you are specifically trained and your facility authorizes it. Direct pressure is the standard first aid for severe bleeding.