Are They Dying? (Pedestrian Emergencies)
Nobody text me in a crisis.
—RIHANNA
In These Situations, Time Is of the Essence
If you think you are witnessing any of the following situations, time is extraordinarily important, so never wait before calling 911:
Stroke
Heart attack
Anaphylaxis
Severe blood loss
Persisting asthma attack
If in doubt, think about the ABCs. If any one of them is in jeopardy, call 911 immediately:
Airway: If the airway is blocked by swelling or a foreign object
Breathing: If the person is not taking between twelve and twenty breaths per minute
Circulation: If, due to blood loss or an obstruction the naked eye can’t see, blood is not getting to the organs—this is hard to determine out in the world, but can be indicated by pain or a change in pallor, like the skin turning blue
If you are presented with the opportunity to save a life, we’ll assume you’ll take it—or at least give it a college try. But when we see someone lose their pulse, many of us will freeze in the ensuing chaos and fear. Here are tips to help better prepare you.
First, ask the nearest person to call 911. If it’s only you and the downed person, call before you do anything else.
Next, take the advice of the American Heart Association and look to the Bee Gees for help: Place the base of your palm on the nipple line. Then place your hands one on top of the other, with interlocked fingers. Focusing weight on the base of your palm, start hands-on compressions over the chest cavity to the beat of “Stayin’ Alive.” Truly! Everyone knows the beat of this song, and it’s the exact tempo needed to deliver the recommended one hundred beats per minute.
Rescue breaths should always come secondary to compressions. When you’re giving those compressions, you’re also causing the lungs to contract and expand, so if you’re the only one on the scene, always prioritize compressions. If you choose to give rescue breaths in addition, give two breaths after every thirty chest compressions: Tilt the person’s head back, plug their nose, cover their mouth with yours entirely like you’re blowing up a balloon, and give two breaths. Then, immediately go back to compressions. If another person is present, you can share these roles and switch off. If the individual is a stranger, you’re not expected to give mouth to mouth CPR without protective equipment.
Real-life CPR (cardiopulmonary resuscitation) is nothing like the movies. If you know this, you’re already a step ahead. People don’t always realize that in order for this intervention to work, all those chest compressions need to literally reach the heart. If you’ve never done it, the force you’ll need to use is probably more intense than you’d think. Sometimes it will cause fractures. I bring this up not to scare you but to reiterate the force needed to get the blood circulating. CPR can sometimes be ineffective because it’s too gentle!
When done properly, CPR will wear you out. It can be very physically exhausting, so call out for help if anyone is around, tell them what to do, and switch off with them. Just remember:
30 compressions
2 breaths
Saturday Night Fever
Quick Tips if You Witness a Seizure
With seizures, the thing that feels intuitive to do might actually run counter to what should be done to help. If the person hasn’t had a seizure before (or if you don’t know), or if the person is or appears pregnant, first call 911. Your next steps:
If the person is standing, gently lower them to the floor.
Clear the surroundings of furniture or other obstructive objects.
Roll the person on their side to prevent aspiration (choking).
Don’t try to hold the person down to protect them. This can cause injury.
Do not put anything in the person’s mouth.
Time the seizure if you can. (This might seem odd, but it’s very helpful for medical professionals to know the duration.)
Keep the person calm and safe, staying with them for at least thirty minutes post-seizure.
Quick Tips if You Witness a Severe Allergic Reaction
Anaphylaxis is the mother of all allergic reactions. It can come on like lightning and, if not treated, can be fatal within thirty minutes. Typically when we think of an allergic reaction, we think of hives, redness, and itching. Anaphylaxis, however, is characterized by these things plus a cascade of swelling, difficulty breathing, and sometimes nausea and vomiting. But mostly swelling which, as it progresses in the throat and airways, cuts off breathing.
Other signs of anaphylaxis include:
Wheezing
Itching, burning, or tingling skin
Rapid heartbeat
Loss of consciousness
In these situations, the patient needs an EpiPen immediately. When in doubt, always administer an EpiPen. Better safe than sorry in cases of anaphylaxis—it’s much worse not to give it when it’s needed than to give it when it’s not warranted. If there’s no EpiPen on hand, though, call 911 immediately. Be sure to tell the operator that you believe the person you’re with is experiencing anaphylaxis. The time frame for treating anaphylaxis before things get very dicey is thirty minutes, so don’t delay seeking emergency help.
If you do use an EpiPen, keep in mind:
Know how to use it before an emergency strikes. Read the instructions and get comfortable with the procedure. (It’s injected into the outer thigh.)
Always check the expiration date. Set a reminder on your calendar to replace the pen before its expiration date.
Stay alert for recalls. Set an alert on Google News so you’ll get an email any time an EpiPen recall pops up.
The generic option is less expensive and can save you upward of $300 for two pens. Ask your pharmacist about it.
Quick Tips if You Witness a Stroke
There are multiple schools of thought on how to recognize a stroke as it’s happening, but I think the best out there—and the easiest to remember—is the FAST acronym from the National Stroke Association. It’s the one I share with my own patients and family.
Remember the word FAST
Face: Ask the person to smile. Does one side of the face droop?
Arms: Ask the person to raise both arms. Does one arm drift downward?
Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?
Time: If the person shows any of these symptoms, time to call 911.
Other symptoms include sudden:
Numbness or weakness of the face, arm, or leg, especially on one side of the body
Confusion, trouble speaking or understanding
Trouble seeing in one or both eyes
Trouble walking, dizziness, loss of balance or coordination
Severe headache with no known cause
Unique symptoms of strokes in women can include:
A sudden and out-of-character change in mental status
Nausea and vomiting
Seizures
Hiccups
Difficulty breathing
Sudden pain or weakness
Fainting
Whether the above occur in tandem or show up on their own without a sound explanation, call for help. The acronym is FAST for a reason, so be quick. Time is especially of the essence when brain tissue is at stake.