3.4 Emergency Procedures

Recognizing Distress and the CNA Role

The nursing assistant is often the first person to notice a resident in trouble. Signs of distress include difficulty breathing, chest pain or pressure, sudden weakness or slurred speech, clutching the throat, pale, gray, or bluish (cyanotic) skin or lips, cold sweating, confusion, or unresponsiveness.

In an emergency, a CNA's job is to call for help, stay with the resident, and keep them safe — not to diagnose or perform advanced medical procedures. The golden rule on the exam: when in doubt, call the nurse and never leave the resident alone. Use the call light, the emergency call system, or shout for help rather than leaving the room to find someone. If the resident is unresponsive and not breathing, summon the emergency response team (the nurse or code team) immediately; a CNA who is trained and certified in CPR begins it when no higher-trained responder is present.

Many emergencies are best prevented. Staying alert to early warning signs — a resident who feels dizzy, a tray of food being eaten too fast, an unsteady gait — lets the CNA act before a crisis develops.

Choking and the Heimlich Maneuver

Choking is a true emergency. The exam expects you to tell the difference between a mild and a severe airway obstruction.

• Mild obstruction: the person can still cough, speak, or breathe. Encourage them to keep coughing forcefully — do not perform abdominal thrusts or slap the back, which could lodge the object deeper.
• Severe obstruction: the person cannot cough, speak, or breathe and may clutch the throat with both hands (the universal choking sign). This requires immediate action.

Abdominal Thrusts (Heimlich Maneuver) for a Conscious Adult

1. Stand behind the resident and wrap your arms around their waist.
2. Make a fist and place the thumb side just above the navel, well below the breastbone (xiphoid process).
3. Grasp your fist with your other hand and give quick, inward and upward thrusts.
4. Repeat thrusts until the object is forced out or the person becomes unconscious.
5. If they become unconscious, lower them to the floor, call for help/the emergency team, and a CPR-trained responder begins chest compressions.

For a pregnant resident or a very large person whose waist you cannot reach around, give chest thrusts instead of abdominal thrusts. Choking risk is high during meals — sit residents fully upright, avoid rushing, and follow any ordered diet texture (such as pureed food or thickened liquids) for residents with swallowing problems (dysphagia).

Falls, Seizures, and Fainting

Responding to a Fall

If you find a resident who has fallen, do not move them. Moving a resident with a possible fracture or head or spine injury can cause permanent harm. Stay with the resident, check responsiveness and for visible injury or bleeding, and call the nurse immediately. The nurse assesses the resident before they are moved, and an incident report is completed afterward (see 3.5).

Seizures

During a seizure, your goal is to prevent injury, not to stop the seizure:

• If the resident is standing or sitting, ease them to the floor and clear away furniture and hard objects.
• Protect the head by cushioning it with a folded blanket or your hands, and loosen tight clothing at the neck.
• Turn the resident on their side if possible so saliva and secretions drain and the airway stays clear.
• Never force anything into the mouth (it can break teeth or block the airway) and never restrain the resident's movements.
• Note the start and stop time, observe what happened, stay until the nurse arrives, and report your observations.

Fainting (Syncope)

If a resident says they feel faint, dizzy, or lightheaded, help them sit or lie down before they fall. If they are lying down, you may elevate the legs about 12 inches to return blood to the brain. Stay with them, loosen tight clothing, keep them from getting up too quickly, and notify the nurse.

Basic First Aid Within Scope

CNAs provide simple first aid while waiting for the nurse, always applying standard precautions:

• Bleeding: apply firm, direct pressure over the wound with a clean cloth or gloved hand and call for help; if blood soaks through, add more layers rather than removing the first. Wear gloves to protect against bloodborne pathogens.
• Minor burns: cool with cool (not ice-cold) running water and cover with a clean, dry cloth; do not apply ice, butter, or ointments, and report to the nurse.
• Possible heart attack or stroke: help the resident rest, do not let them walk, keep them calm, and get the nurse immediately. Recognize stroke warning signs with F.A.S.T. — Face drooping, Arm weakness, Speech difficulty, Time to call for help — because rapid treatment saves brain tissue.
• Vomiting: turn the resident's head or whole body to the side to prevent choking/aspiration, then notify the nurse.

Always report what you observed, what you did, and the resident's response. Accurate documentation and an incident report follow any emergency, and you should never exceed your scope by attempting procedures reserved for licensed staff.