Medical Emergencies

Heart attack, stroke, seizures, and other critical medical conditions.

Heart Attack

What's Happening

Blood flow to part of the heart is blocked. Heart muscle begins to die.

Time is critical. "Time is muscle."

Recognizing Heart Attack

Classic symptoms:

• Chest pain or pressure (may feel like squeezing, fullness, or aching)
• Pain radiating to arm(s), jaw, neck, back, or stomach
• Shortness of breath
• Cold sweat
• Nausea
• Lightheadedness

Atypical symptoms (more common in women):

• Unusual fatigue
• Indigestion
• Anxiety
• Back pain
• Jaw pain without chest pain

Treatment

1. Call 911 immediately

   • Don't drive to hospital (may need CPR en route)
   • Note time symptoms started

2. Have person rest

   • Sit in comfortable position
   • Loosen tight clothing
   • Stay calm

3. Give aspirin

   • If not allergic
   • 325 mg regular aspirin OR 4 baby aspirin (81 mg each)
   • Chew, don't swallow whole

4. If prescribed nitroglycerin

   • Help them take it
   • Follow their prescription instructions

5. Monitor

   • Be prepared for cardiac arrest
   • Start CPR if they become unresponsive and not breathing normally

6. Do NOT

   • Let them "wait and see"
   • Let them drive
   • Give anything other than aspirin/nitro

Stroke

What's Happening

Blood flow to part of the brain is interrupted. Brain cells begin to die.

"Time is brain." Every minute matters.

Recognizing Stroke: FAST

Other Symptoms

• Sudden confusion
• Sudden trouble seeing
• Sudden trouble walking
• Sudden severe headache (may indicate bleeding stroke)
• Sudden numbness (especially one side of body)

Treatment

1. Call 911 immediately

   • Note EXACT time symptoms started
   • Treatment windows are time-sensitive

2. Keep calm and reassuring

   • Person may be frightened
   • May not understand what's happening

3. Position

   • If conscious: Comfortable position, usually semi-upright
   • If unconscious but breathing: Recovery position

4. Do NOT

   • Give food or water (swallowing may be impaired)
   • Give aspirin (could worsen bleeding stroke)
   • Let them "sleep it off"

5. Monitor

   • Breathing
   • Level of consciousness
   • Be ready for CPR

Mini-Stroke (TIA)

Symptoms that resolve within minutes to hours.

Still an emergency. TIAs often precede full strokes. Seek immediate medical care.

Seizures

Types

During a Generalized Seizure

1. Stay calm
2. Protect from injury
   • Clear area of hard/sharp objects
   • Cushion head if possible
3. Time the seizure
   • Important for medical decisions
4. Do NOT
   • Restrain them
   • Put anything in their mouth
   • Try to hold tongue
5. Turn on side when jerking stops
   • Helps drain secretions
   • Recovery position

After the Seizure

Postictal state (after-seizure confusion):

• May be confused, tired
• May not know what happened
• Stay calm and reassuring
• Stay with them until fully alert

Call 911 If

• First seizure
• Seizure lasts more than 5 minutes
• Repeated seizures
• Difficulty breathing after
• Injury during seizure
• Seizure in water
• Person doesn't regain consciousness
• Person is pregnant
• Person has diabetes
• You're unsure

For Known Epilepsy

• If they have a seizure action plan, follow it
• They may not need 911 for every seizure
• Call if seizure differs from their normal

Diabetic Emergencies

Low Blood Sugar (Hypoglycemia)

Causes:

• Too much insulin
• Missed meal
• Unusual exercise
• Alcohol

Signs:

• Shakiness
• Sweating
• Pale
• Hungry
• Irritable/confused
• Rapid heartbeat
• May become aggressive
• Can progress to unconsciousness

Treatment:

1. If conscious, give sugar:
   • 4 oz juice or regular soda
   • Glucose tablets
   • Candy
2. Wait 15 minutes
3. Repeat if no improvement
4. Give snack once recovered
5. Call 911 if unconscious or no improvement

High Blood Sugar (Hyperglycemia)

Causes:

• Insufficient insulin
• Illness
• Stress
• Eating too much

Signs (develop slowly):

• Excessive thirst
• Frequent urination
• Fruity breath
• Drowsiness
• Nausea
• Flushing

Treatment:

1. Call 911 if:
   • Altered consciousness
   • Fruity breath with confusion
   • Severe symptoms
2. If mild and known diabetic:
   • They need their insulin
   • Follow their management plan

When Unsure

If you can't tell high from low: give sugar.

• If low: Sugar helps quickly
• If high: Small amount won't significantly worsen

Fainting (Syncope)

Causes

• Standing too long
• Dehydration
• Heat
• Emotional stress
• Blood pressure drop
• Heart problems (more serious)

Treatment

If about to faint:

1. Have them sit or lie down
2. Lower head (between knees if sitting)
3. Loosen tight clothing
4. Ensure fresh air

If they faint:

1. Check responsiveness
2. If responsive, keep lying down
3. Elevate legs 8-12 inches
4. Loosen tight clothing
5. Stay with them until fully recovered

Call 911 if:

• Doesn't regain consciousness quickly
• Injured during fall
• Chest pain or palpitations before fainting
• Pregnant
• Over 50 with no clear cause
• Repeated episodes

Severe Allergic Reaction

See Shock chapter for anaphylaxis details.

Quick reference:

1. Call 911
2. Help with epinephrine auto-injector
3. Position based on symptoms
4. Monitor airway
5. Be ready for CPR

Asthma Attack

Signs of Severe Attack

• Extreme difficulty breathing
• Can only speak in single words
• Blue lips
• Silent chest (too tight for wheezing)
• Confusion
• Exhaustion from breathing effort

Treatment

1. Help them sit upright

   • Leaning slightly forward
   • Arms supported

2. Help with their inhaler

   • Shake inhaler
   • 4 puffs, one at a time
   • 4 breaths per puff
   • Wait 4 minutes
   • Can repeat if needed

3. Stay calm

   • Panic worsens breathing
   • Reassure them

4. Call 911 if:

   • Inhaler not helping
   • Getting worse
   • Can't speak in full sentences
   • Blue color
   • Exhaustion

Poisoning

Call Poison Control First

Poison Control: 1-800-222-1222 (US)

Have ready:

• Person's age and weight
• What was taken
• How much
• When
• Current symptoms

General Rules

Do NOT:

• Induce vomiting (unless specifically instructed)
• Give anything by mouth (unless instructed)

Do:

• Follow Poison Control instructions
• Bring container to hospital
• Monitor breathing and consciousness

Inhaled Poisons

1. Get to fresh air immediately
2. Call 911 if symptoms severe
3. CPR if needed

Key Points

1. Heart attack: Call 911, give aspirin, prepare for CPR
2. Stroke: FAST recognition, note time, call 911
3. Seizure: Protect, don't restrain, time it, recovery position
4. Low blood sugar: Give sugar if conscious
5. Fainting: Lie flat, elevate legs
6. Asthma: Sit upright, help with inhaler, call 911 if severe
7. Poisoning: Call Poison Control before acting
8. For all: Monitor, stay calm, be ready for CPR