I’m here at the 2010 American Heart Association instructor conference hosted at the McCormick Place. It was a wonderful weekend in the “Windy City” and worked out well for Jody Marvi(ProTrainings.com Compliance and Accreditation Manager) and I to attend the new guideline roll-out for BLS, ACLS, PALS and NeoNatal Resuscitation. I’m glad to announce that in the end, I don’t see any serious issues to any of the latest guidelines for resuscitation. I was afraid there was going to be some changes that were going to cause ethical issues for end of life issues but thankfully to the best of my knowledge, this didn’t materialize for 2010. So take a peek and let me know what you think of the latest ECC/ILCOR recommendations for resuscitation.
In this episode of RoyOnRescue, Roy offers an answer to an email question about using the assessment of Awake, Verbal, Painful Response, Unconscious(AVPU) method for deciding to begin CPR. He sheds some light on what AVPU is and how it can be blended with the guidelines to decide to start CPR.
A concerned Good Samaritan(G.S.) wrote me a question and I thought it would be good to share it with you on RoyOnRescue(ROR).
G.S.: “In my scenario, the person fell down hit their head twice and then fell onto the floor face down. I am now wondering if we did the right thing. We picked the person up and carried her outside for fresh air where she revived immediately. We then monitored the person but nothing else seemed to be wrong with her.”
ROR: It sounds like the story ends well regardless of the treatment given which is always great! There may be a few things that we cold improve upon for the future. Let’s analyze what happened and what we might be able to do differently next time to protect and help the fall victim even more.
Whenever a person falls, there is a risk for head and neck injury. As stated in your scenario, this particular person did hit their head… twice. This would be enough mechanism of injury that instead of moving the person right away, we would want to minimize movement while assessing the person for any signs or symptoms of other injuries. We can minimize movement by softly but confidently speaking to the patient who is either conscious or unconscious and place one hand carefully on the victims forehead to help remind them and us not to move their head and neck. Try to find out if the person is breathing on their own and if their skin color is somewhat normal while they are lying in the position found. If they are breathing and skin color is good, we do not have to move the person before Emergency Medical Services arrive.
If assessing the person’s airway is impossible in this position,(face down) we may need to carefully roll the person over onto their back even if we suspect that there may be a serious neck or back injury. We do not move spinal chord injury patients unless they need cpr, their airway is compromised or they are in danger due to the environment.
If we determine that we must roll, or move a person with a suspected spinal chord injury, utilize several people if available, in order to minimization spinal movement. If you are the only person, then do the job the best way you can and follow the “Life Over Limb” philosophy. If the person wakes and is not complaining of any pain or numbness and they don’t allow you to minimize movement because they want to get up, they should be allowed to do so. It is not wise to hold the person down as this can complicate injuries the patient already sustained trying to wrestle. Keep encouraging the person to stay still until help arrives by the ambulance service. Keep the person in a position of comfort with confident words of encouragement like, you are in good hands, I’m going to take good care of you and help is on the way. If they still refuse treatment, there is little you can do at that point other than inform 911 of what has happened.
It sounds as though you did the best you could for this person at the time. Remember, most people don’t even get involved when someone needs help. The fact that you did get involved and tried to help makes you a natural rescuer!
I thought a video clip of all different fainting episodes would not only get my point across that falls can cause injuries to the person even if the fainting spell or the reason they fell wasn’t serious. I hope you don’t feel faint watching others faint but if you want to see what happens to people when they fall from standing up, take a look at the clip below.
P.S. One of the most effective rescue moves for a person who is starting to faint, is to simply help them to the floor before they fall!