Tag: cerebrovascular accident

Illness can be categorised under either acute or chronic. Whilst chronic illness is long-lasting, potentially worsening over time, sudden acute illness happens suddenly with immediate or rapidly developing symptoms, which is why it usually requires immediate care.

Altered Level of Consciousness

When normal brain activity is interrupted, a casualty may experience loss of awareness of their surroundings. At times the casualty may only show responsiveness when stimulated eg. through shaking, shouting, or pain stimulus.

Causes

• hypoglycaemia – most common cause of unconsciousness
• any issue with the airway, breathing or circulation leading to brain hypoxia
• neurological issues (eg. CVA)
• serious infection (eg. meningitis or infection in relation to the brain)
• brain injury following trauma to the head
• poisoning which affects the brain directly, or which leads to ABC compromise that induces brain hypoxia
• other sudden acute illness eg. myocardial infarction

Signs & Symptoms of Neurological Issues

• dizziness
• disorientation
• confusion
• lethargy
• drowsiness
• low level of response
• unequal pupil size
• abnormal pupil reaction
• limb weakness
• unresponsiveness
• seizures

NOTE: in CVA, limb weakness is commonly experienced on one side of the body.

A casualty’s level of consciousness is typically tested using the Glasgow Coma Scale, while the level of response is tested using the AVPU score.

Cerebrovascular Accident CVA

A cerebrovascular accident is considered to be a sudden acute illness. It can happen in 2 ways:

1. Haemorrhagic Stroke – a stroke which happens when weakened or deceased blood vessels rupture, causing blood leaks into the brain tissue
2. Ischaemic Stroke – a stroke caused by a blood clot that stops the normal flow of blood to a part within the brain

Signs & Symptoms of Cerebrovascular Accident

• sudden headache
• blurred vision
• facial asymmetry
• drooling
• slurred speech
• numbness and/or weakness focused on one side of the body

First Aid for CVA

In an unresponsive casualty:

1. maintain ABCs
2. assist into recovery position
3. call 112
4. monitor & provide reassurance

In a responsive casualty:

1. assist in a comfortable position, preferably on a bed if available
2. elevate head and shoulders to promote comfort and to minimise pressure
3. incline head towards affected (drooling) side to avoid aspiration pneumonia
4. loosen any tight clothing
5. call 112
6. monitor & provide reassurance

Hypoglycaemia

Hypoglycaemia, which can be considered as a sudden acute illness, can be defined as a glucose concentration of 3.9mmol/l or below.

Signs & Symptoms of Hypoglycaemia

• history of Type 1 Diabetes
• weakness
• fatigue
• hunger
• pale, cold, clammy skin (this side effect helps differentiate between hypoglycaemia and a CVA)
• aggressiveness or unusual behaviour
• possible speech slurring

First Aid for Hypoglycaemia

In an unresponsive casualty:

1. maintain ABCs
2. assist into recovery position
3. call 112
4. monitor & provide reassurance

In a responsive casualty:

1. give sugary drink (you may mix 2 tsp sugar in a little bit of water) or assist with own medication if available (eg. glucose gel)
2. provide privacy (casualty may become incontinent)
3. provide reassurance
4. monitor
5. if condition improves encourage casualty to seek medical advice; if condition deteriorates call 112

Seizure

A seizure is considered to be a sudden acute illness, however, it is not exactly an illness by itself, but a sign of another illness affecting the activity of the brain eg. fever, head trauma, cerebral hypoxia, epilepsy, etc.

Signs & Symptoms of a seizure

• face twitching
• lip smacking
• individual limb spasm
• uncontrollable muscle spasms
• convulsions
• staring spell
• drooling or frothing at the mouth
• abnormal sounds
• tongue biting
• incontinence

First Aid for Seizures

During a seizure:

1. notice starting time of seizure and time its duration
2. reduce injury risk – provide protection for the casualty’s head and remove any nearby items which may be of danger
3. DO NOT RESTRAIN
4. DO NOT PUT ANYTHING INTO THE CASUALTY’S MOUTH
5. ensure casualty’s privacy especially due to possible incontinent episode
6. apply tepid sponging in case of casualty being febrile

After a seizure:

1. perform primary assessment and assist if necessary
2. perform secondary assessment and assist if necessary
3. manage ABCs
4. assist in recovery position
5. call 112
6. monitor casualty’s condition

Fainting Episode

Fainting is a circulatory condition affecting consciousness. Fainting can present as follows:

• possible brief loss of consciousness
• slow pulse
• pale, cold, clammy skin

First Aid for Fainting

1. remove tight clothing
2. increase air circulation (eg. by opening windows)
3. assist to the floor to prevent casualty from getting hurt in case of a fall
4. elevate legs (approximately 30cm)
5. maintain casualty’s body temperature so as to help keep a stable blood pressure
6. provide privacy and reassurance
7. monitor
8. call 112 if required

Cerebral Infection

Signs & Symptoms

• fever
• stiffness in the neck area
• sensitivity to light
• signs of shock
• non-blanching rash – press area covered by rash and let go…a rash that still shows points to a neurological infection eg. meningitis

First Aid for Cerebral Infection

Seek medical advice immediately by calling 112!

Dyspnoea

Dyspnoea is otherwise known as experiencing difficulty in breathing. Dyspnoea can happen due to various reasons:

• Airway Obstruction
• Cardiac & Circulatory Disorders
• Respiratory Disorders affecting either the inhalation/exhalation process (eg. asthma), the lower airways, the diffusion process across the alveolar membrane, or the uptake of oxygen in pulmonary circulation (eg. anaemic patients)

Causes of Dyspnoea

• asthma
• pulmonary oedema – caused either by a cardiac problem or by accumulation of fluid in the alveoli within the lungs
• hyperventilation syndrome – stress => hyperventilation => not feeling well => anxiety => increased hyperventilation => increasing symptoms (respiration rate of more than 30 breaths per minute; numbness)
• chest infection
• inhalation of fumes/chemicals
• drowning syndrome
• choking
• strangulation or suffocation

Dyspnoea signs and symptoms

• inability to speak
• use of accessory muscles to breathe
• abnormal respiratory rate and rhythm pattern
• noisy breathing
• cyanosis
• disorientation, confusion, or unusual aggressiveness – these are classic signs of cerebral hypoxia irrespective of its cause

First Aid for Dyspnoea

1. provide reassurance to reduce anxiety and increased symptoms
2. encourage good breathing pattern
3. increase ventilation in casualty’s area
4. help sit up properly
5. release tight clothing
6. if casualty is on medication eg. inhalers, assist with self medication
7. call 112
8. monitor casualty and be prepared to resuscitate if need be

Foreign Body Airway Obstruction (FBAO)

Foreign Body Airway Obstruction can manifest in two ways: foreign bodies may cause partial, or complete airway obstruction.

Signs & symptoms of foreign body airway obstruction

In mild (partial) airway obstruction, the casualty is able to speak and cough.

In severe (complete) airway obstruction, the casualty:

• is unable to speak or cough
• has noisy breathing (wheezing)
• shows signs of severe dyspnoea
• shows signs of distress
• may be or become unresponsive

First Aid for Foreign Body Airway Obstruction

In a conscious patient:

1. 5 back blows followed by 5 abdominal thrusts
2. continue, alternating between the two methods until either foreign body gets dislodged, or else casualty becomes unresponsive

In an unconscious patient:

1. start CPR

NOTE: in casualties who are either obese, pregnant, or children, do not perform abdominal thrusts…instead do chest thrusts; after the intervention, the casualty should be taken to hospital to be assessed for possible internal damage.

Chest Pain

Chest pain can result due to Ischaemic Heart Disease – a disease in which there is an obstruction of blood flow to an area within the heart which causes hypoxia and death of that particular area in the heart.

Signs & Symptoms of Acute Ischaemia

• feeling generally unwell
• pale and cold skin
• profuse sweating
• feeling persistent pain or heaviness in the chest
• chest pain may radiate to the left arm, jaw and back
• may experience palpitations
• may experience nausea
• dyspnoea

First Aid for Acute Ischaemia

1. provide reassurance
2. ensure surrounding area is well ventilated
3. assist in a sitting position
4. release any tight clothing
5. assist with own medication if available on casualty eg. 300mg of aspirin
6. call 112
7. ask someone to get an AED
8. monitor
9. be prepared to resuscitate if need arises

Anaphylaxis & Anaphylactic Shock

Anaphylaxis happens when a person comes into contact or exposure to an allergen.

Signs & Symptoms of Anaphylaxis

• changes within the skin and mucous membranes eg. rash, burning sensation, swelling of the mouth and tongue
• sudden illness development
• rapid ABC deterioration eg. swelling of airway structures, altered level of consciousness, dyspnoea, wheezing, cyanosis, dizziness & weakness (neurological response)

NOTE: If a casualty experiences all the above PLUS signs of shock (including pale, clammy skin), the indication would be an ANAPHYLACTIC SHOCK, which is even worse than anaphylaxis!

First Aid for Anaphylaxis & Anaphylactic Shock

1. identify cause (eg. if cause was an insect sting, remove it)
2. if unconscious, resuscitate
3. if unresponsive but breathing, assist into the recovery position
4. if patient is responsive, assist in a supine position UNLESS patient is exhibiting signs of shock, in which case, elevate legs, OR if experiencing severe dyspnoea, in which case assist in fowlers position or elevate back as much as possible
5. administer high concentration of oxygen
6. if an epipen is available on the casualty and the casualty is responsive, administer, assist in self injecting Epinephrine

NOTE: Epinephrine helps DECREASE severity of anaphylaxis, EASE bronchospasms due to causing bronchial airways to dilate, and REDUCE circulatory collapse through a triggered increase in cardiac contraction as well as reversal of peripheral vasodilation.

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