Medical Emergencies: Choking, Cardiac Arrest, Falls, Bleeding & Seizures
Key Takeaways
- For a conscious choking adult, deliver abdominal thrusts above the navel and below the xiphoid process until the object clears or the person becomes unconscious.
- If a choking resident becomes unconscious, lower them to the floor and begin CPR with 30 chest compressions; perform a finger sweep only when the object is visible.
- After a fall, never move the resident and never help them up — stay, call for the nurse, and check for injury where they lie.
- Control external bleeding with direct pressure through gloves and a clean dressing; do not remove a soaked dressing, add layers on top.
- During a seizure, protect the head, turn the resident to the side if possible, time the event, and never put anything in the mouth or restrain the movements.
Medical Emergencies: Choking, Cardiac Arrest, Falls, Bleeding & Seizures
In an emergency the nurse aide is almost always the first person in the room. What you do in the first sixty seconds — and what you deliberately do not do — determines the outcome. The exam tests this heavily under Safety/Emergency, part of the 35% Basic Nursing Skills block.
The universal opening sequence: stay with the resident, call for help (call light, emergency call system, or shout for the nurse), and do not leave unless leaving is the only way to summon help.
Choking (Foreign Body Airway Obstruction)
Choking occurs most often at meals, and most often with residents who have dysphagia, dementia, poorly fitting dentures, or who are eating while reclined.
Partial vs. complete obstruction
| Partial (mild) | Complete (severe) | |
|---|---|---|
| Signs | Forceful coughing, wheezing, can speak | Cannot speak, cough, or breathe; clutches the throat (universal choking sign); high-pitched stridor or silence; face flushes then turns cyanotic |
| Action | Encourage coughing. Do nothing else. Stay with them and call the nurse | Act immediately — abdominal thrusts |
The most common wrong answer on this topic is intervening on a person who is coughing forcefully. A strong cough moves more air than any thrust you can deliver; interrupting it can convert a partial obstruction into a complete one.
Conscious adult — abdominal thrusts
- Ask, "Are you choking? Can you speak?" If they nod but cannot speak or cough, call for help and begin.
- Stand behind the resident and wrap your arms around the waist.
- Make a fist and place the thumb side against the abdomen, slightly above the navel and well below the tip of the xiphoid process.
- Grasp the fist with your other hand and deliver quick inward and upward thrusts.
- Continue until the object is expelled or the resident becomes unconscious.
Modifications: for a pregnant or markedly obese resident, deliver chest thrusts over the lower half of the sternum. For a resident in a wheelchair, thrusts can be delivered from behind the chair. If you cannot get your arms around the resident and cannot reposition them, chest thrusts are the alternative.
If the resident becomes unconscious
- Lower them gently to the floor, face up.
- Call a Code Blue / activate EMS.
- Begin CPR starting with 30 chest compressions.
- Open the airway (head-tilt, chin-lift) and look in the mouth. Perform a finger sweep only if you can see the object — a blind finger sweep drives objects deeper.
- Attempt rescue breaths; if air does not go in, reposition the airway and try once more, then resume compressions.
Cardiac Arrest and CPR
- Check responsiveness and look for normal breathing (gasping is not breathing).
- Call for help / activate the emergency response system and send for the AED.
- Begin compressions: center of the chest, at least 2 inches deep, 100–120 per minute, allowing full chest recoil, minimizing interruptions. Ratio 30 compressions to 2 breaths for adults.
- Use the AED as soon as it arrives; follow the voice prompts and stand clear during analysis and shock.
- Check the code status first if the facility system allows it. A resident with a valid DNR / Comfort One order is not resuscitated. Knowing which of your residents have advance directives is part of the job, not an optional detail.
Falls
Falls are the leading cause of injury in long-term care. What you do afterward matters as much as prevention.
If a resident starts to fall while you are with them: do not try to hold them upright — you will injure both of you. Widen your stance, bring the resident's body close to yours, and ease them down your leg to the floor, protecting the head. Then stay and call for help.
After any fall:
- Do not move the resident and do not help them up. Unrecognized hip fracture, spinal injury, and head injury are all made worse by movement.
- Stay with the resident; send someone else for the nurse or use the call system.
- Observe and report: level of consciousness, any complaint of pain and where, obvious deformity or shortening and outward rotation of a leg, bleeding, and how the resident was found (position, surroundings, footwear, whether the call light was in reach).
- Do not clean up the scene until the nurse has seen it.
- An incident report is completed per facility policy. It is a factual, objective record — no opinions, no blame, and it is not filed in the medical record.
Bleeding and Shock
External bleeding
- Put on gloves. Standard Precautions apply to all blood.
- Apply direct pressure with a clean cloth or dressing.
- Do not remove a blood-soaked dressing — adding layers on top preserves the clot that has begun to form.
- Elevate the bleeding extremity above heart level if there is no suspicion of fracture.
- Have the resident lie down; keep them warm and still. Call for the nurse and stay.
Signs of shock
Pale, cool, clammy skin; rapid weak pulse; rapid shallow breathing; low blood pressure; restlessness, anxiety, confusion; thirst. Keep the resident lying flat and warm; do not give anything by mouth; call for help immediately.
Seizures
| Do | Do NOT |
|---|---|
| Stay with the resident and call for help | Leave the resident alone |
| Lower them to the floor if standing; clear furniture away | Move the resident during the seizure unless they are in danger |
| Cushion and protect the head with a folded towel or your hands | Put anything in the mouth — no tongue blades, no fingers, no spoon |
| Loosen tight clothing at the neck | Restrain the arms or legs |
| Turn the resident to the side if possible so secretions drain | Try to stop the movements |
| Time the seizure and note what body parts were involved | Give food or fluids afterward until the nurse clears it |
| Provide privacy; stay after, as the resident will be confused and exhausted (postictal) | Treat the postictal confusion as a new cognitive change |
Other Emergencies a Nurse Aide Meets First
| Emergency | Signs | Immediate nurse-aide action |
|---|---|---|
| Stroke (CVA) | Balance loss, Eyes/vision change, Face droop, Arm weakness, Speech slurred, Time to call | Note the exact time symptoms began — it determines eligibility for clot-dissolving treatment. Call for help immediately, keep the resident lying with head slightly elevated, nothing by mouth |
| Fainting (syncope) | Dizziness, pallor, sweating, blurred vision | Help them sit or lie down before they fall; if seated, head between the knees; loosen clothing; stay and call the nurse |
| Low blood sugar (hypoglycemia) | Sudden shakiness, sweating, pallor, hunger, irritability, confusion, rapid pulse | Call the nurse immediately — this can progress to unconsciousness within minutes. Do not give food or drink to a resident who is not fully alert |
| High blood sugar (hyperglycemia) | Gradual onset, thirst, frequent urination, dry flushed skin, fruity breath, drowsiness | Report promptly; do not withhold ordinary fluids unless restricted |
| Burns | Redness, blistering, pain | Cool the area with cool (not ice) water; cover with a clean dry cloth; do not apply ointment, butter, or ice; do not break blisters; report immediately |
| Vomiting | Turn the head to the side to prevent aspiration; provide an emesis basin and oral care; save and report the emesis for the nurse to see |
⚠️ Blood sugar is a nurse's call. Rhode Island nursing assistants may not administer medication or advise on medical matters. "Drowsiness, thirst, and sweating" appear in 216-RICR-40-05-22.12.1(A)(9) as endocrine signs a nursing assistant is required to recognize and report — recognizing and reporting is the whole of your role.
A resident in the dining room begins coughing forcefully after a bite of chicken. He is red-faced but able to cough loudly. What should the nurse aide do?
A nurse aide finds a resident on the floor beside her bed. The resident is alert and says, "Just help me up, I'm fine." What should the aide do?
A resident has a generalized seizure while sitting in a chair. Which action is correct?
A Nursing Assistant observes a resident clutching their neck and unable to speak or cough. Where should the Nursing Assistant position their fist when performing abdominal thrusts (Heimlich maneuver)?