5.6 Medical Emergencies, Choking, and CPR Basics

Medical Emergencies, Choking, and CPR Basics

Quick Answer: Activate the emergency response system first, then act. Choking: abdominal thrusts; chest thrusts if pregnant or obese; CPR if the victim goes unconscious. CPR (AHA 2020): 100-120 compressions/min, 2-2.4 inches deep, full recoil, 30:2 ratio. Seizure: protect, time, side-lying after - never restrain or put anything in the mouth. Stroke: FAST + note last-known-well time. Bleeding: direct pressure first; tourniquet last. Hypoglycemia: 'Cold/Clammy = need Candy.'

The First 60 Seconds of ANY Emergency

1. Scene safety - is it safe for you to approach? No live wires, fire, fumes, violence?
2. Check responsiveness - tap and shout: "Are you okay?"
3. Activate the emergency response system - call the facility code or 911. Send a second person for the AED and call the nurse.
4. Position - if no spinal precautions are needed, place flat on the back on a firm surface.
5. Check breathing and pulse for no more than 10 seconds.
6. Begin the appropriate response (CPR, recovery position, Heimlich, etc.).

Choking (Foreign-Body Airway Obstruction)

Mild Obstruction (Partial)

Resident is coughing forcefully, can speak, can move air. Stand by, encourage coughing, do NOT slap the back, do NOT perform abdominal thrusts. Call the nurse if it does not clear.

Severe Obstruction (Complete) - Conscious Adult

Resident cannot speak, cough, or breathe. May give the universal choking sign (hands at throat).

1. Ask: "Are you choking? Can I help?" If they nod yes, act.
2. Stand behind the resident; place a fist with the thumb side against the abdomen just above the navel and below the xiphoid.
3. Grasp the fist with the other hand and deliver quick inward and upward abdominal thrusts.
4. Continue until the object is expelled or the resident becomes unconscious.

Special-Population Modifications

• Pregnant or obese victims: use chest thrusts (hands on the breastbone, sternum) instead of abdominal thrusts.
• Infants under 1 year: alternate 5 back blows and 5 chest thrusts (no abdominal thrusts).
• Unconscious victim: lower carefully to the floor, activate emergency response, and begin CPR starting with chest compressions. Each time you open the airway to give breaths, look in the mouth and remove a visible object - never blind finger sweep.

Adult CPR (AHA 2020 Guidelines, Current Through 2026)

The American Heart Association updates its Guidelines for CPR and ECC every five years. The 2020 update is the current standard through the next planned revision.

High-Quality CPR Principles

• Push HARD (full depth) and FAST (100-120/min).
• Allow complete chest recoil between compressions - leaning on the chest reduces blood flow.
• Minimize interruptions - keep compressions going for at least 80% of the resuscitation time (chest compression fraction).
• Switch compressors every 2 minutes (or every 5 cycles of 30:2) to prevent fatigue.
• Avoid excessive ventilation - just enough to see the chest rise.

Automated External Defibrillator (AED)

The AED is the single most important piece of equipment for cardiac arrest survival. Use it as soon as it arrives.

1. Turn it on and follow the voice prompts.
2. Expose and dry the chest. Shave dense chest hair if pads do not stick. Remove any medication patches.
3. Apply pads - one upper right chest, one lower left side (anterolateral), or anterior-posterior for small chests. Use pediatric pads / pediatric mode for children under 8 years or under 55 lb when available; if not, adult pads are acceptable.
4. Clear the victim and let the AED analyze. "I'm clear, you're clear, everyone clear."
5. If a shock is advised, ensure everyone is clear and deliver the shock.
6. Resume CPR immediately with compressions - do not delay to recheck pulse.
7. The AED re-analyzes every 2 minutes.

Seizures

What TO Do

• Stay with the resident.
• Protect from injury - move furniture away; place a pillow or folded blanket under the head; loosen tight clothing around the neck.
• Time the seizure (note start and end). Seizures lasting more than 5 minutes are status epilepticus - a true emergency.
• After the seizure (post-ictal phase), turn the resident on the side (recovery position) to prevent aspiration of saliva or vomitus.
• Call the nurse and document onset, length, body parts involved, incontinence, and post-ictal level of consciousness.

What NOT To Do

• Do NOT restrain the resident or attempt to hold the limbs still.
• Do NOT put anything in the mouth - no spoons, no tongue depressors, no fingers. The resident will not swallow their tongue, and you risk breaking teeth or being bitten.
• Do NOT give food or fluid until the resident is fully awake.

Stroke (Cerebrovascular Accident)

Use the FAST stroke screen (American Stroke Association):

Why time matters: IV tissue plasminogen activator (tPA / alteplase) must be given within 3 hours of onset, extended to 4.5 hours in select patients. Mechanical thrombectomy can go up to 24 hours in select cases. The CNA's job is to identify symptoms, call the nurse, document the time, and stay with the resident.

Bleeding Control

1. Apply direct pressure with a clean cloth or sterile dressing.
2. Elevate the injured part above heart level if no fracture is suspected.
3. If blood soaks through, add more dressings on top - do not remove the original.
4. If bleeding cannot be controlled, apply a tourniquet as a last resort, only on a limb, between the wound and the heart, and note the time.
5. Do not give food or fluid; treat for shock (lay flat, warm, calm).

Burns

Never apply butter, ointment, ice, or toothpaste to a burn. For chemical burns, flush with running water for 15-20 minutes while removing contaminated clothing.

Diabetic Emergencies

Memory aid: Cold and Clammy = need Candy. Hot and Dry = sugar high.

Heart Attack (Acute Myocardial Infarction)

Classic signs: crushing or pressure-like chest pain (may radiate to left arm, jaw, or back), shortness of breath, cold sweat, nausea, dizziness. Women, older adults, and people with diabetes may present atypically with fatigue, indigestion, or shortness of breath without chest pain.

CNA actions: Stop activity, place the resident in semi-Fowler's (sitting up at 45 degrees), loosen tight clothing, stay with the resident, call 911 and the nurse immediately, and be ready to start CPR if the resident becomes unresponsive and is not breathing normally. Do not give food or fluid; do not give nitroglycerin or aspirin unless the nurse instructs you.