Heart attacks and shock

Shock is a life-threatening condition that occurs when the vital organs, such as the brain and heart are deprived of oxygen due to a problem affecting the circulatory system. The most common cause of shock is blood loss but can be caused by other fluid loss such as vomiting or severe burns. Shock may also be caused when the heart has been damaged in some way, such as heart attack or angina and is unable to pump an adequate supply to the body.

The recognition features of shock include:

• Pale, cold, clammy skin (skin could become blue/grey in appearance in severe shock, lips especially may appear blue)
• Sweating
• Weakness and dizziness
• Feeling sick and possibly vomiting
• Thirst
• Rapid, shallow breathing.

If shock is not treated the casualty will:

• Become restless and aggressive
• Start yawning and gasping for air
• Lose consciousness.

Eventually the heart will stop.

1. Severe allergic reactions (Anaphylaxis)

Introduction

A severe allergic reaction will affect the whole body, in susceptible individuals it may develop within seconds or minutes of contact with the trigger factor and is potentially fatal.

Possible triggers can include skin or airborne contact with particular materials, the injection of a specific drug, the sting of a certain insect or the ingestion of a food such as peanuts.

Recognition features

• Impaired breathing: this may range from a tight chest to severe difficulty
• There may be a wheeze or gasping for air.
• Signs of shock.
• Widespread blotchy skin eruption.
• Swelling of the tongue and throat.
• Puffiness around the eyes.
• Anxiety.

Treatment

Your aim is to arrange immediate removal of the casualty to hospital.

• Dial 999 or 112 for an ambulance.
• Give any information you have on the cause of the casualty’s condition.
• Check whether the casualty is carrying any necessary medication. If they are, help them to use it.

If the casualty is conscious:

• Help them to sit up in a position that most relieves any breathing difficulty, this is usually sitting up and leaning forward slightly.

If the casualty becomes unconscious:

• Open the airway and check breathing.
• Be prepared to give rescue breaths and chest compressions.
• Place them into the recovery position if the casualty is unconscious but breathing normally.

2. Heart attacks

Introduction

A Heart attack is most commonly caused by a sudden blockage of the blood supply to the heart muscle itself, for example a blood clot. The main risk is that the heart will stop beating so your aims are to make the casualty as comfortable as possible and rest and arrange urgent removal to hospital.

Recognition

• Persistent central chest pain - often described as a heavy pressure crushing or vice like pain.
• The pain often spreads (radiates) to the jaw, neck and down one or both arms
• Breathlessness.
• Discomfort high in the abdomen similar to indigestion.
• There could be collapse without warning.
• Ashen skin and blueness at the lips.
• Rapid, weak pulse which may be irregular.
• Profuse sweating, skin cold to the touch.
• Gasping for air (air hunger).
• Nausea and/or vomiting.

Treatment

Your aim is to make the casualty as comfortable as possible and arrange urgent removal to hospital.

• Sit the casualty down in the ‘W’ position: Semi-recumbent (sitting up at about 75° to the ground) with knees bent.
• Dial 999 or 112 for the ambulance.

If the casualty is fully conscious:

• Give him or her a 300mg aspirin tablet to chew slowly provided there are no reasons not to give the aspirin and provided the patient is not under 16 years of age.
• If the casualty has any medication for angina, such as tablet or spray, then assist them to take it.
• Constantly monitor and record the vital signs, breathing and pulse rate etc, until help arrives.

If the casualty becomes unconscious:

• you need to open the airway and check breathing and be prepared to start CPR if necessary, please refer to the tips on CPR for adults.

3. Shock

Recognition

In the case of a serious accident (and once you have treated any obvious injuries and called an ambulance), watch for signs of shock;

• Pale face.
• Cold, clammy skin.
• Fast, shallow breathing.
• Rapid, weak pulse.
• Yawning.
• Sighing.
• In extreme cases, unconsciousness.

Treatment

• Lay the casualty down, raise and support their legs.
• Use a coat or blanket to keep them warm – but not smothered.
• Do not give them anything to eat or drink.
• Check breathing and pulse frequently. If breathing stops, follow the resuscitation sequence – DRABC .
• Give lots of comfort and reassurance