Section 4.3: Choking, CPR, & Urgent Medical Emergencies
Key Takeaways
- Severe airway obstruction is marked by the inability to speak, cough, or breathe; it requires immediate abdominal thrusts (Heimlich maneuver) on a conscious resident.
- For pregnant or obese residents, chest thrusts at the mid-sternum must be used instead of abdominal thrusts.
- Cardiac arrest is recognized by unresponsiveness, lack of normal breathing, and no carotid pulse; immediate CPR (30:2 ratio at 100-120 compressions/minute) and AED usage are required.
- During a seizure, the CNA's priority is to protect the resident from injury by clearing the area, placing a soft support under the head, and timing the seizure, while never restraining the resident or placing anything in their mouth.
- Severe hemorrhage is controlled by applying firm, direct pressure with a clean cloth, while fainting is managed by assisting the resident to lie down and elevating their legs.
Choking, CPR, & Urgent Medical Emergencies
In healthcare, a medical emergency can arise in seconds. Certified Nursing Assistants are often the first staff members to arrive at a resident’s side. Your ability to quickly recognize life-threatening signs and perform standard first-aid procedures—such as airway clearance, chest compressions, seizure management, and bleeding control—can save a resident's life.
Choking and Airway Obstructions
Choking occurs when the airway is blocked by food, a foreign object, or fluids. The CNA must distinguish between a mild and severe airway obstruction:
- Mild Airway Obstruction: The resident can cough forcefully and may be able to speak or make wheezing sounds.
- CNA Action: Do not perform abdominal thrusts. Encourage the resident to continue coughing forcefully to clear the object. Stay with them and monitor their breathing.
- Severe Airway Obstruction: The resident cannot speak, breathe, or cough, or can only make silent, high-pitched gasps. They may turn blue (cyanosis) and clutch their throat, which is the universal sign of choking.
- CNA Action: You must perform the Heimlich maneuver (abdominal thrusts) immediately.
Performing Abdominal Thrusts (Conscious Resident)
- Stand behind the resident. Wrap your arms around their waist.
- Make a fist with one hand. Place the thumb side of your fist against the resident's abdomen, slightly above the navel and well below the breastbone (sternum).
- Grasp your fist with your other hand.
- Press your fist into the resident’s abdomen with a quick, upward-and-inward thrust.
- Repeat thrusts until the object is expelled or the resident loses consciousness.
- Special Populations (Obese or Pregnant Residents): Wrap your arms around the resident's chest. Place your fist on the middle of the breastbone (sternum) and perform quick, backward chest thrusts.
- Unconscious Choking Sequence: If the resident becomes unresponsive, carefully lower them to the floor. Activate the emergency response system. Begin cardiopulmonary resuscitation (CPR), starting with chest compressions. Each time you open the airway to give breaths, look inside the resident's mouth. If you see the object, remove it. Never perform a blind finger sweep, as this can push the object deeper into the airway.
Recognizing Cardiac Arrest and Performing CPR
Cardiac arrest occurs when the heart suddenly stops beating, preventing oxygen-rich blood from reaching the brain and vital organs. It is a critical emergency requiring immediate intervention.
Emergency CPR Protocol
- Assess Responsiveness: Tap the resident's shoulders and shout, "Are you okay?"
- Call for Help: If they do not respond, call out for help immediately, instruct another staff member to activate the emergency system and retrieve the Automated External Defibrillator (AED), and remain with the resident.
- Check Breathing and Pulse: Check for normal breathing and a carotid pulse (located in the neck) simultaneously for at least 5 but no more than 10 seconds.
- Begin CPR: If there is no pulse and no normal breathing (or only agonal gasping), immediately begin high-quality chest compressions:
- Rate: 100 to 120 compressions per minute.
- Depth: Compress the chest 2.0 to 2.4 inches (5 to 6 cm) for adults.
- Recoil: Allow the chest to recoil completely after each compression.
- Ratio: Provide 30 compressions followed by 2 rescue breaths.
- Use the AED: As soon as the AED arrives, turn it on and follow the automated voice prompts. Apply the pads to the resident's bare chest, ensure no one is touching the resident while the AED analyzes the heart rhythm, and deliver a shock if prompted.
Seizure Management Protocols
A seizure is a sudden, uncontrolled electrical disturbance in the brain. The CNA’s primary role is to protect the resident from injury during the seizure.
Seizure Safety Interventions
- Note the Time: Look at a clock and note when the seizure begins.
- Protect the Head: If the resident is standing or sitting, assist them gently to the floor. Place a soft pillow, folded towel, or rolled blanket under their head to prevent head trauma.
- Clear the Environment: Move furniture, equipment, or sharp objects away from the resident.
- Loosen Clothing: Loosen tight clothing around the resident’s neck (like collars or ties) to help keep their airway open.
- Avoid Restraint: Do not try to hold the resident down or restrict their movements. This can cause muscle or bone injury.
- Do Not Insert Objects: Never put anything in the resident’s mouth. They cannot swallow their tongue, and placing objects (like spoons or tongue depressors) in their mouth can break teeth or block their airway.
- Recovery Position: Once the seizure ends, or if the resident begins to vomit or have excessive secretions, turn the resident onto their side into the recovery position to prevent aspiration.
- Report: Note the duration of the seizure and report all details (behavior, duration, post-seizure consciousness) immediately to the nurse.
Hemorrhage and Fainting (Syncope)
- Hemorrhage: Severe bleeding must be controlled immediately to prevent shock. Put on gloves. Apply firm, direct pressure to the wound using a clean cloth, sterile gauze, or gloved hand. If the bleeding is on an arm or leg, elevate the limb above heart level (if no fracture is suspected) while maintaining pressure. Do not remove blood-soaked dressings; place additional dressings directly over them.
- Fainting (Syncope): Syncope is a brief loss of consciousness caused by temporary decreased blood flow to the brain.
- Warning Signs: Paleness, dizziness, sweating, cold/clammy skin.
- Interventions: If a resident feels faint, assist them to lie down or sit. If lying down, elevate their legs 8 to 12 inches (if no injury) to help blood return to the brain. Loosen tight clothing. Do not let them get up quickly. If they lose consciousness, notify the nurse immediately.
Clinical Scenario: Seizure Response
While assisting Mr. Davis with his morning care, he suddenly stiffens, his eyes roll back, and his limbs begin to shake violently. You immediately note the time (08:14 AM). You guide him gently to the floor to prevent a fall, place a soft towel under his head, and push the bedside table out of the way. You do not try to hold him still or put anything in his mouth. You call out to the hallway for the nurse. The shaking stops at 08:16 AM. You gently turn Mr. Davis onto his side into the recovery position, check that he is breathing, and stay with him to provide reassurance as the nurse arrives.
A conscious resident is choking, cannot speak or cough, and clutches the throat. What should the CNA do?
While a resident is having an active seizure, which CNA action best prevents injury?
For high-quality adult CPR, which compression targets should the CNA meet?