Chapter 5: Sudden Illness

Epinephrine

is a drug that slows or stops the effects of anaphylaxis.

Causes of Respiratory Distress

A number of different conditions can cause respiratory distress, including acute flare-ups of chronic respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD); lung and respiratory tract infections (such as pneumonia or bronchitis); severe allergic reactions (anaphylaxis); heart conditions (such as a heart attack or heart failure); trauma; poisoning; drug overdose; electrocution; and mental health conditions (such as panic disorder).

Signs and Symptoms of Fainting

A person who is about to faint often becomes pale, begins to sweat and may feel weak or dizzy. The person may sense that he or she is about to faint and may attempt to sit down to prevent a fall.

Signs and Symptoms of Respiratory Distress

A person who is experiencing respiratory distress is, understandably, often very frightened. The person may feel like he or she cannot get enough air and may gasp for breath. Because the person is struggling to breathe, speaking in complete sentences may be difficult. You might hear wheezing, gurgling or high-pitched noises as the person tries to breathe. You may also notice that the person's breathing is unusually slow or fast, unusually deep or shallow, or irregular. The person's skin may feel moist or cool, and it may be pale, ashen (gray), bluish or flushed. Lack of oxygen can make the person feel dizzy or light-headed.

Signs and Symptoms of Diabetic Emergencies

A person who is having a diabetic emergency will seem generally ill. He or she may feel dizzy or shaky, have a headache, or have cool, clammy skin. The person's behavior may change (for example, he or she may become irritable, aggressive or argumentative). If the person is experiencing hyperglycemia, his or her breath may have a fruity or sweet odor. Severe hypoglycemia or hyperglycemia can result in confusion, seizures or loss of consciousness and may be life threatening.

Seizures

A seizure is the result of abnormal electrical activity in the brain, leading to temporary and involuntary changes in body movement, function, sensation, awareness or behavior. Seizures can have many different causes. One common cause is epilepsy, a chronic seizure disorder that can often be controlled with medication. Other causes of seizure include fever, infection, diabetic emergencies, heat stroke and injuries to the brain tissue.

First Aid Care for Seizures

Although a seizure can be frightening to see, it is easy to care for a person who is having a seizure. Most seizures only last a few minutes, and the person usually recovers fully without any complications. If the person is known to have occasional seizures, it may not be necessary to call 9-1-1 or the designated emergency number. However, under some circumstances, you should call 9-1-1 or the designated emergency number when a person is having a seizure. Call for help if: ■The seizure lasts more than 5 minutes, or the person has multiple seizures in a row. ■The person was injured as a result of the seizure. ■The person is unresponsive and not breathing or only gasping after the seizure. ■The person is pregnant or has diabetes. ■The person is a young child or infant and the seizure was brought on by a high fever. ■The person is elderly. ■This is the person's first seizure, or the cause of the seizure is unknown. ■The seizure took place in the water. When a person is having a seizure, do not try to hold the person down or stop the seizure from happening. Just let the seizure run its course and take steps to protect the person from injury. Move furniture or other objects that could cause injury out of the way. The person may be drowsy and disoriented for as long as 20 minutes after the seizure is over. Check the person for responsiveness and normal breathing. If the person is responsive and breathing normally but not yet fully awake, check the person from head to toe for injuries and then place the person in the recovery position. Stay with the person until he or she is fully recovered and aware of his or her surroundings, or until emergency responders arrive. If the person is not responsive and not breathing or only gasping after the seizure, begin CPR immediately and use an AED as soon as possible, if you are trained in these skills.

Signs and Symptoms of Allergic Reactions and Anaphylaxis

An allergic reaction can range from mild to very severe. A person who is having a mild to moderate allergic reaction may develop a skin rash, a stuffy nose, or red, watery eyes. The skin or area of the body that came in contact with the allergen usually swells and turns red.A person who is having a severe, life-threatening allergic reaction (called anaphylaxis) may develop one or more of the following signs and symptoms within seconds or minutes of coming into contact with the allergen: ■Trouble breathing ■Swelling of the face, neck, tongue or lips ■A feeling of tightness in the chest or throat ■Skin reactions (such as hives, itchiness or flushing) ■Stomach cramps, nausea, vomiting or diarrhea ■Dizziness ■Loss of consciousness ■Signs and symptoms of shock (such as excessive thirst; skin that feels cool or moist and looks pale or bluish; an altered level of consciousness; and a rapid, weak heartbeat)

First Aid Care for Diabetic Emergencies

Call 9-1-1 or the designated emergency number if the person is unresponsive, not fully awake or having a seizure. While you wait for help to arrive, provide appropriate care. For example, if the person is not fully awake, interview bystanders and conduct a head-to-toe check, then put the person in the recovery position. Make sure the person's airway is clear of vomit and monitor the person's breathing until help arrives. If the person is having a seizure, take steps to keep the person safe while you let the seizure run its course. If the person is known to have diabetes and thinks he or she is having a diabetic emergency, you may be able to help the person by giving him or her some form of sugar. Only offer the person sugar by mouth if the person is responsive, able to answer your questions and able to swallow. Some people may be responsive but not fully awake and therefore not able to safely swallow; in this case, do not attempt to give the person sugar by mouth. Instead, call 9-1-1 or the designated emergency number. You should also call 9-1-1 or the designated emergency number if you are not able to immediately obtain an acceptable form of sugar. Acceptable forms of sugar include: Glucose tablets. ■Candies that can be chewed. ■Fruit juice. ■Fruit strips. ■Regular (non-diet) soda. ■Milk. ■A spoonful of sugar mixed into a glass of water. If it is safe for the person to have sugar by mouth, give 15 to 20 grams of sugar. Check the label on packaged products to determine how much of the package's contents to give. Even if the person is experiencing hyperglycemia (too much glucose in the bloodstream), giving the person 15 to 20 grams of sugar will not cause additional harm. If possible, have the person check his or her blood glucose level. If the person is not feeling better in about 10 to 15 minutes, call 9-1-1 or the designated emergency number. Some people with diabetes may have a prescribed glucagon kit that they carry with them to use in case of a severe hypoglycemic emergency. Glucagon is a hormone that stimulates the liver to release glucose into the bloodstream. The glucagon kit is only used when the person is unresponsive or has lost the ability to swallow. Those who spend a significant amount of time with the person (for example, family members, teachers, coaches or co-workers) may receive additional training to learn how to administer a glucagon injection.

Triggers of Asthma

Common triggers include exercise, temperature extremes, allergies, air pollution, strong odors (such as perfume, cologne and scented cleaning products), respiratory infections, and stress or anxiety. The trigger causes inflammation and swelling, which causes the opening of the airways to become smaller and makes it harder for air to move in and out of the lungs. People who have asthma usually know what can trigger an attack and take measures to avoid these triggers.

Signs and Symptoms of an Asthma Attack

Even when a person takes steps to manage his or her asthma by avoiding triggers and taking prescribed long-term control medications, he or she may still experience asthma attacks occasionally. Signs and symptoms of an asthma attack include: ■Wheezing or coughing. ■Rapid, shallow breathing (or trouble breathing). ■Sweating. ■Being unable to talk without stopping for a breath in between every few words. ■Feelings of tightness in the chest or being unable to get enough air into the lungs. ■Anxiety and fear.

First Aid Care for Sudden Illness

Fortunately, you do not need to know exactly what is wrong to provide appropriate first aid care. If your initial check of the person reveals any life-threatening conditions (see Chapter 1, Box 1-5), make sure that someone calls 9-1-1 or the designated emergency number right away, and then provide care according to the signs and symptoms that you find and your level of training. Follow the same general guidelines as you would for any emergency: ■Do no further harm. ■Monitor the person's breathing and level of consciousness. ■Help the person rest in the most comfortable position. ■Keep the person from getting chilled or overheated. ■Reassure the person that you will help and that EMS personnel have been called (if appropriate). ■Give care consistent with your knowledge and training as needed, and continue to watch for changes in the person's condition.

If food intake, exercise and medication are not in balance, the person may experience a diabetic emergency.

Hypoglycemia (excessively low blood glucose levels) can result if a person misses a meal or snack, eats too little food, exercises more than usual, vomits or takes too much medication. Hyperglycemia (excessively high blood glucose levels) can result if a person eats too much food, takes too little medication, exercises less than usual or experiences physical or emotional stress.

Fainting

If a person suddenly loses consciousness and then "comes to" after about a minute, he or she may simply have fainted. Fainting is caused by a sudden decrease in blood flow to the brain. Usually the cause of fainting is not serious. For example, being dehydrated (not having enough fluid in the body), being too hot, being in a crowded room or feeling intense emotion can cause a person to faint. After the person faints, the head is at the same level as the heart. This helps blood flow return to the brain and the person quickly recovers.

First Aid Care for an Asthma Attack

If the person has an asthma action plan (a written plan that the person develops with his or her healthcare provider that details daily management of the condition as well as how to handle an asthma attack), help the person to follow that plan. ● Encourage the person to use their prescribed quick-relief (rescue) medication if they have it. ● Call 911 if the person's breathing does not improve after taking the medication. ● Stay with the person and monitor their condition until their condition improves or help arrives.

First Aid Care for Allergic Reactions and Anaphylaxis

If you know that the person has had a severe allergic reaction before, and the person is having trouble breathing or is showing signs and symptoms of anaphylaxis, have someone call 9-1-1 or the designated emergency number immediately. If the person carries medication (e.g., epinephrine) used for the emergency treatment of anaphylaxis, offer to help the person use the medication. If you are alone, help the person administer the medication and then call 9-1-1 or the designated emergency number. While you wait for help to arrive, make sure the person is sitting in a comfortable position, or have the person lie down if he or she is showing signs of shock.

First Aid Care for Stroke

If you think that a person is having (or has had) a stroke, call 9-1-1 or the designated emergency number immediately. Note when the signs and symptoms first started (or, if you do not know when the signs and symptoms started, note the last time the person was known to be well). This is important information to give to EMS personnel because some of the medications used to treat stroke are only effective within a certain time frame after the onset of signs and symptoms. Stay with the person and provide reassurance until help arrives. If the person is responsive but not fully awake, or if the person is drooling or having trouble swallowing, put the person in the recovery position and monitor the person's condition until EMS personnel arrive.

A person who has been diagnosed with asthma may take two forms of medication:

Long-term control medications are taken regularly, whether or not signs and symptoms of asthma are present. These medications help prevent asthma attacks by reducing inflammation and swelling and making the airways less sensitive to triggers. Quick-relief (rescue) medications are taken when the person is experiencing an acute asthma attack. These medications work quickly to relax the muscles that tighten around the airways, opening the airways right away so that the person can breathe more easily. Both long-term control medications and quick-relief (rescue) medications may be given through an inhaler, a nebulizer (Box 5-1) or orally.

Allergic Reactions and Anaphylaxis

Our immune systems help to keep us healthy by fighting off harmful pathogens that can cause disease. But sometimes our immune systems overreact and try to fight off ordinary things that are not usually harmful, like certain foods, grass or pet dander (tiny flakes of skin that animals shed). A person can have an allergy to almost anything. Common allergens (allergy triggers) include venomous insect stings, certain foods (like peanuts, tree nuts, shellfish, milk, eggs, soy and wheat), animal dander, plant pollen, certain medications (like penicillin and sulfa drugs) and latex

Asthma

a chronic illness in which certain substances or conditions, called triggers, cause inflammation and narrowing of the airways, making breathing difficult.

Transient ischemic attacks

Some people experience transient ischemic attacks (TIAs), or "mini-strokes." TIAs cause signs and symptoms similar to those of a stroke, but the signs and symptoms go away after a short period of time. A person who has had a TIA is at very high risk for having a stroke in the near future. In fact, more than 10 percent of people who have a TIA will have a stroke within 3 months, with half of these strokes happening within 48 hours of the TIA. For this reason, whenever a person experiences signs and symptoms of stroke, even if the signs and symptoms seem to go away, the person should seek immediate medical attention.

First Aid Care for Fainting

The person may faint before you even know what is happening, but sometimes it is possible to prevent a fainting spell by having the person sit down with his or her head near his or her knees, or lie down flat on his or her back. If the person does faint, check the person for responsiveness and normal breathing. If the person responds and is breathing normally, check the person from head to toe for injuries that might have happened as a result of the fall. If there are no injuries, place the person in the recovery position and loosen any tight clothing. Call 9-1-1 or the designated emergency number if you find any injuries or have any concerns about the person's condition. Although the cause of fainting is not usually serious, the person should still follow up with his or her healthcare provider. If the person does not respond and is not breathing or is only gasping, begin CPR immediately and use an AED as soon as possible, if you are trained in these skills.

Antihistamines

The person's healthcare provider may recommend that the person carry an antihistamine in his or her anaphylaxis kit, in addition to epinephrine. An antihistamine is a medication that counteracts the effects of histamine, a chemical released by the body during an allergic reaction. Antihistamines are supplied as pills, capsules or liquids and are taken by mouth. The person should take the antihistamine according to the medication label and his or her healthcare provider's instructions.

Signs and Symptoms of Stroke

The signs and symptoms of stroke can vary from person to person. A person who is having a stroke may suddenly develop one or more of the following signs and symptoms: ■Trouble with speech and language, including slurring of words, being unable to form words or being unable to understand what others are saying ■Drooling or difficulty swallowing ■Drooping of the features on one side of the face (for example, the eyelid and the corner of the mouth) ■Trouble seeing in one or both eyes ■Weakness ■Paralysis or numbness of the face, arms or legs, especially on one side of the body ■A sudden, severe headache ■Dizziness or loss of balance ■Confusion ■Loss of consciousness

Signs and Symptoms of Seizures

There are different types of seizures. One common type of seizure is called a grand mal seizure. A person having a grand mal seizure loses consciousness and has convulsions (uncontrolled body movements caused by contraction of the muscles). Another common type of seizure is called an absence seizure. The person experiences a brief, sudden lapse of consciousness, causing the person to momentarily become very quiet and have a blank stare. A person with epilepsy may experience an aura (an unusual sensation or feeling) before the onset of the seizure. If the person recognizes the aura, he or she may have time to tell someone what is happening and sit down before the seizure occurs.

Signs and Symptoms of Sudden Illness

Trouble breathing. ■Pain, such as chest pain, abdominal pain or a headache. ■Changes in level of consciousness, such as being confused or unaware of one's surroundings, or becoming unresponsive. ■Light-headedness or dizziness. ■Nausea, vomiting, diarrhea or stomach cramps. ■A fever. .■Pale or very flushed skin, which may be excessively sweaty or dry, or excessively hot or cold. ■Problems seeing or speaking (e.g., blurred vision or slurred speech). ■Numbness, weakness or paralysis. ■Seizures.

How Do I Know If It Is Anaphylaxis?

You do not know if the person has been exposed to an allergen: Any skin reaction (such as hives, itchiness or flushing) OR ■Swelling of the face, neck, tongue or lips PLUS ■Trouble breathing OR ■Signs and symptoms of shock You think the person may have been exposed to an allergen: Any TWO of the following: ■Any skin reaction ■Swelling of the face, neck, tongue or lips ■Trouble breathing ■Signs and symptoms of shock ■Nausea, vomiting, cramping or diarrhea You know that the person has been exposed to an allergen: ■Trouble breathing OR ■Signs and symptoms of shock

First Aid Care for Respiratory Distress

You usually can identify a breathing problem by watching and listening to the person's breathing and by asking the person how he or she feels. If a person is having trouble breathing, do not wait to see if the person's condition improves. Call 9-1-1 or the designated emergency number and provide appropriate first aid care until help arrives: ■If you know the cause of the respiratory distress (for example, an asthma attack or anaphylaxis) and the person carries medication used for the emergency treatment of the condition, offer to help the person take his or her medication. ■Encourage the person to sit down and lean forward. Many people find that this position helps to make breathing easier. Providing reassurance can reduce anxiety, which may also help to make breathing easier. ■If the person is responsive, gather additional information by interviewing the person and performing a head-to-toe check. Remember that a person having breathing problems may find it difficult to talk. Try phrasing your questions as "yes" or "no" questions so the person can nod or shake his or her head in response instead of making the effort to speak. You may also be able to ask bystanders what they know about the person's condition. ■Be prepared to give CPR and use an AED if the person becomes unresponsive and you are trained in these skills.

When a person becomes suddenly ill, it may be the result of an

cute illness, or it may be an acute flare-up of a chronic condition.

f a person is known to have an allergy that could lead to anaphylaxis, he or she may carry an

epinephrine auto injector (a syringe system, available by prescription only, that contains a single dose of epinephrine). Devices are available containing different doses because the dose of epinephrine is based on weight (0.15 mg for children weighing between 33 and 66 pounds, and 0.3 mg for children and adults weighing more than 66 pounds). Many healthcare providers advise that people with a known history of anaphylaxis carry an anaphylaxis kit containing at least two doses of epinephrine (two auto injectors) with them at all times. This is because more than one dose may be needed to stop the anaphylactic reaction. Have the person administer a second dose only if emergency responders are delayed and the person is still having signs and symptoms of anaphylaxis 5 to 10 minutes after administering the first dose. It is important to act fast when a person is having an anaphylactic reaction because difficulty breathing and shock are both life-threatening conditions. If the person is unable to self-administer the medication, you may need to help. You may assist a person with using an epinephrine auto injector when the person has a previous diagnosis of anaphylaxis and has been prescribed an epinephrine auto injector; the person is having signs and symptoms of anaphylaxis; the person requests your help using an auto injector

To gain a better understanding of the situation

interview the person (or bystanders, if necessary) using SAMPLE, and then check the person from head-to-toe (see Chapter 2). Signs and symptoms like trouble breathing, pain that is persistent or severe, problems seeing or speaking, problems feeling or moving, seizures or unresponsiveness require a call to 9-1-1 or the designated emergency number. If you are unsure about the severity of the illness, it is better to call for help early than to wait for the illness to progress.

Diabetic Emergencies

is a chronic condition characterized by the body's inability to process glucose (sugar) in the bloodstream.An organ called the pancreas secretes insulin, a hormone that causes glucose to be moved from the bloodstream into the cells, where it is used for energy. In a person with diabetes, either the pancreas fails to make enough insulin or the body's cells are unable to respond to insulin. Either situation causes glucose levels in the bloodstream to increase. A person with diabetes may manage the condition with insulin injections or oral medications. Diet and exercise also play an important role. To keep blood glucose levels within an acceptable range, food intake, exercise and medication must be balanced. A person with diabetes must follow a well-balanced diet, with limited sweets and fats. The timing of meals and snacks relative to exercise and medication is important as well.

Chronic Illness

is an illness that a person lives with on an ongoing basis and that often requires continuous treatment to manage.

Acute Illness

is an illness that strikes suddenly and usually only lasts for a short period of time

illness often strikes with little to

no warning, at work, at school, at home or while we are out having fun. When a person becomes suddenly ill, you can help by providing appropriate first aid care; summoning help, if needed; and keeping the person comfortable until help arrives.

Stroke

occurs when blood flow to part of the brain is interrupted by a blood clot, resulting in the death of brain cells. A stroke can also be caused by bleeding into the brain tissue. Strokes can cause permanent brain damage, but with quick action, sometimes the damage can be stopped or reversed. Although strokes are most common in older adults, a person of any age, even a child, can have a stroke.

Respiratory Distress

or difficulty breathing, is evidenced by signs and symptoms such as shortness of breath, gasping for breath, hyperventilation (breathing that is faster and shallower than normal), or breathing that is uncomfortable or painful. Respiratory distress can lead to respiratory arrest (absence of breathing).