Lesson 30: Sudden Illness I
Introduction
 Some illnesses develop over time, whereas others can strike
without a moment’s notice.
 By knowing the signals of sudden illness and paying careful
attention to details at the emergency scene, you can determine
how best to help a victim of sudden illness.
 You do not need to know the exact cause of the illness to give
appropriate care.
 Always follow the emergency action steps: CHECK—CALL—
CARE.
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Responding to a Medical Emergency
 Sudden illnesses often show the following signals:
 Change in a person’s level of consciousness
 Feeling lightheaded, dizzy or weak
 Nausea or vomiting
 Changes in breathing, circulation, skin temperature, color
or moisture
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Specific Sudden Illness
 Sudden illnesses become evident in a variety of ways.
 Common sudden illnesses include—
 Fainting.
 Diabetic emergencies.
 Seizures.
 Stroke.
 Poisoning.
 Heart attack.
 Shock.
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Specific Sudden Illness
(continued)
 Sudden illness can be—
 Acute.
 Chronic.
 General guidelines of care for sudden illnesses include—
 Do no further harm.
 Monitor breathing and consciousness.
 Help the victim rest in the most comfortable position.
 Keep the victim from getting chilled or overheated.
 Reassure the victim.
 Give any specific care needed.
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Fainting
 Fainting is a common sudden illness characterized by a partial
or complete loss of consciousness.
 Fainting is caused by a temporary reduction of blood flow to the
brain.
 The victim will commonly display shock-like signals, such as—
 Cool, pale or moist skin.
 Nausea.
 Numbness or tingling in the fingers and toes.
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Fainting
(continued)
 Additional signals that precede fainting include—
 Sweating.
 Vomiting.
 Distortion or dimming of vision.
 Head or abdominal pain.
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Care for Fainting
 Position the victim on his or her back on a flat surface. Elevate
the legs about 12 inches.
 Loosen any restrictive clothing.
 Check for any other life-threatening and non-life-threatening
conditions.
 Do not give the victim anything to eat or drink.
 Do not splash the victim with water or slap his or her face.
 As long as the fainting victim recovers quickly and has no lasting
signals, you may or may not need to call 9-1-1 or the local
emergency number.
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Diabetic Emergencies
 The condition in which the body does not produce enough insulin
or does not use insulin effectively is called diabetes mellitus.
 In the digestive process, the body breaks down food into simple
sugars such as glucose.
 Insulin is a hormone that helps sugar (glucose) pass from the
bloodstream into the cells.
 Without a proper balance of sugar and insulin, cells will starve
and the body will not function properly.
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Diabetic Emergencies
(continued)
 There are two major types of diabetes: Type I and Type II.
 In Type I diabetes the body produces little or no insulin.
 Most people who have Type I diabetes have to inject insulin
into their bodies daily.
 In Type II diabetes the body produces insulin, but either the cells
do not use the insulin effectively or not enough insulin is
produced.
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Diabetic Emergencies
(continued)
 A situation in which a victim becomes ill because of an
imbalance of insulin and sugar in the bloodstream is called a
diabetic emergency.
 There are two types of diabetic emergencies:
 Hyperglycemia: a condition where the insulin level in the
body is too low
 Hypoglycemia: a condition where the insulin level in the
body is too high.
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Diabetic Emergencies
(continued)
 Hyperglycemia and hypoglycemia are different conditions, but
their primary signals are similar. These include—
 Changes in the level of consciousness, including dizziness,
drowsiness and confusion.
 Irregular breathing.
 Abnormal pulse (rapid or weak).
 Feeling or looking ill.
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Care for a Diabetic Emergency
 Check and care for any life-threatening conditions.
 If the victim is conscious, check for non-life-threatening
conditions.
 Look for a medical alert tag or ask the victim if he or she
has diabetes.
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Care for a Diabetic Emergency
(continued)
 If the victim is conscious and able to swallow, give him or her
sugar in the form of fruit juice, candy or a non-diet soft drink.
 If the victim is unconscious—
 Call 9-1-1 or the local emergency number immediately.
 Do not give the victim anything by mouth.
 Monitor signs of life.
 Keep him or her from getting overheated or chilled.
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Seizures
 Seizures may be caused by an acute or chronic condition.
 The chronic form of seizure is known as epilepsy.
 Before a seizure occurs, the victim may experience an aura.
 Seizures can range from mild blackouts to sudden, uncontrolled
muscular contractions that can last several minutes.
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Seizures
(continued)
 Febrile seizures are most common in children under the age
of 5 and can be triggered by infections of the ear, throat or
digestive system or when an infant or child runs a fever of
over 102°F (38.9°C).
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Seizures
(continued)
 A febrile seizure may have some or all of the following signals:
 A sudden rise in body temperature
 A change in the level of consciousness
 Rhythmic jerking of the head and limbs
 Urinating or defecating
 Confusion
 Drowsiness
 Crying out
 Becoming rigid
 Holding the breath
 Upward rolling of the eyes
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Care for a Seizure
 Do not try to hold or restrain the victim.
 Protect the victim from injury and maintain an open airway.
 Remove nearby objects that could cause injury.
 After the seizure, position him or her on one side so that fluid can
drain from the mouth.
 Check for life-threatening conditions.
 Stay with the victim until he or she is fully conscious and aware of
his or her surroundings.
 Call 9-1-1 or the local emergency number, if necessary.
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Stroke
 A stroke, also called a cerebrovascular accident (CVA) or brain
attack, is a disruption of blood flow to a part of the brain, causing
permanent damage to brain tissue.
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Stroke
(continued)
 Stroke is commonly caused by a blood clot, called a thrombus or
embolus, an aneurysm or atherosclerosis.
 A transient ischemic attack (TIA) is a temporary episode that is similar
to a stroke and is sometimes called a “mini-stroke.” Like a stroke, TIA
results from reduced blood flow to the brain.
 Ways to reduce the risk of a stroke or TIA include the following:
 Controlling blood pressure
 Not smoking
 Eating a healthy diet
 Exercising regularly
 Controlling diabetes
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Stroke
(continued)
For a stroke, think F.A.S.T. —
 Face — Weakness on one side of the face. (Ask the person to smile
and note any weakness or drooping of the mouth.)
 Arm — Weakness or numbness in one arm. (Ask the person to
raise both arms and note any non-symmetry of the arms.)
 Speech — Slurred speech or trouble speaking. (Ask the person to
repeat a simple sentence such as, “I have the lunch orders ready”
and note any slurring or difficulty speaking.)
 Time — Time to call 9-1-1 if you see any of these signals. (Note
the time that the signals began.)
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Stroke
(continued)
 A victim of stroke may exhibit or experience some or all of the
following signals:
 Appearing or feeling ill, or displaying abnormal behavior
 Sudden weakness or numbness of the face, arm or leg, often
on only one side of the body
 Difficulty speaking or being understood
 Blurred or dimmed vision
 Pupils of unequal size
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Stroke
(continued)
 Sudden severe headache
 Dizziness
 Confusion
 Change in mood
 Ringing in the ears
 Loss of consciousness
 Loss of bowel or bladder control
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Care for a Stroke
 Care for life-threatening conditions.
 Call 9-1-1 or the local emergency number immediately.
 Position him or her on one side (affected or paralyzed side down)
to allow fluids to drain.
 Stay with the victim and check his or her breathing and signs of
life until EMS personnel arrive and take over.
 If the victim is conscious—
 Check for non-life-threatening conditions.
 Offer comfort and reassurance.
 Have the victim rest in a comfortable position.
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Closing
 Sudden illness can strike anyone, at any time. Even if you do not
know the cause of the illness, you can still give proper care.
 Knowing the signals of sudden illness, such as changes in
consciousness, profuse sweating, confusion and weakness, will
help you determine the necessary care to give the victim until
EMS personnel arrive.
 Questions?
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Lesson 31: Sudden Illness II/
Poisoning
Introduction
 A poison is any substance that can cause injury, illness or death
when introduced into the body.
 Poisoning is considered a sudden illness.
 Between 1 and 2 million poisonings occur each year in the
United States.
 More than 90 percent of all poisonings take place in the home.
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Poisoning
 How poisons enter the body:
 Inhalation
 Ingestion
 Absorption
 Injection
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Checking the Scene
 Often, the scene itself is the best clue that a poisoning may have
occurred. Factors to notice include—
 Unusual odors.
 Flames or smoke.
 An open medicine cabinet.
 Open or spilled containers.
 Overturned or damaged plants.
 Drug paraphernalia or empty containers.
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Signals of Poisoning
 The signals of poisoning include—
 Nausea or vomiting.
 Diarrhea.
 Chest or abdominal pain.
 Trouble breathing.
 Sweating.
 Changes in consciousness.
 Seizures.
 Headache.
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Signals of Poisoning
(continued)
 Dizziness.
 Weakness.
 Irregular pupil size.
 Burning or tearing eyes.
 Abnormal skin color.
 Burn injuries around the lips or tongue.
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Care for Poisoning
 The severity of a poisoning depends on—
 The type and amount of poison.
 How and where the poison entered the body.
 The time elapsed since the poisoning.
 The victim’s size, weight, medical condition and age.
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Care for Poisoning
(continued)
 General guidelines of care for any poisoning emergency:
 Check the scene.
 Check for life-threatening conditions. Call 9-1-1 or the local
emergency number if the victim is unconscious or is having
trouble breathing.
 If the victim is conscious, ask questions.
 What type of poison did the victim ingest, inhale, inject or
come into contact with?
 How much poison did the victim ingest, inhale, inject or
come into contact with?
 When did the poisoning take place (approximate time)?
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Care for Poisoning
(continued)
 Call the National Poison Control Center at
(800) 222-1222, 9-1-1 or the local emergency number.
 Give care as directed by Poison Control Center
personnel or the EMS call taker.
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Inhaled Poisons
 Poisoning by inhalation occurs when a person breathes in
toxic fumes.
 The danger associated with inhaled poisons makes checking
the safety of the scene important.
 Notice clues at the scene:
 Unusual odors
 Strong smell of fuel
 Hissing sound
 Call 9-1-1 or the local emergency number from a different
location.
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Inhaled Poisons
(continued)
 A commonly inhaled poison is carbon monoxide. It is a colorless,
odorless gas.
 Carbon monoxide exposure can cause death.
 Pale or bluish skin color indicates lack of oxygen, which may
indicate exposure.
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Care for Inhaled Poisons
 All victims of inhaled poison need oxygen as soon as possible.
 Help a conscious victim by getting him or her to fresh air.
 Call 9-1-1 or the local emergency number.
 If you find an unconscious victim—
 Remove him or her from the scene if it is safe to do so.
 Call 9-1-1 or the local emergency number.
 Give care for any other life-threatening conditions.
 Call 9-1-1 or the local emergency number if you suspect that toxic
fumes are present.
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Ingested Poisons
 The U.S. Centers for Disease Control and Prevention (CDC)
estimates that 76 million people suffer food-borne illnesses each
year in the United States.
 Two of the most common categories of food poisoning are
bacterial food poisoning and chemical food poisoning.
 Salmonella is the most common type of food poisoning.
 Botulism is the most deadly type of food poisoning.
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Ingested Poisons
(continued)
 Signals of food poisoning include:
 Nausea.
 Vomiting.
 Abdominal pain.
 Diarrhea.
 Fever.
 Dehydration .
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Care for Ingested Poisons
 In some cases of ingested poisoning, the National Poison Control
Center may instruct you to induce vomiting.
 Only induce vomiting if instructed to do so by a medical professional.
 Vomiting should not be induced if the victim—
 Is unconscious.
 Is having a seizure.
 Is pregnant (in the last trimester).
 Has ingested a corrosive substance (such as drain cleaner or
oven cleaner) or a petroleum product (such as kerosene or
gasoline).
 Is known to have heart disease.
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Absorbed Poisons
 An absorbed poison enters the body after it comes in contact
with the skin.
 Absorbed poisons come from plants such as poison ivy,
poison oak and poison sumac, as well as from fertilizers and
pesticides used in lawn and plant care.
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Care for Absorbed Poisons
 To care for a victim who has come into contact with a poisonous
plant:
 Immediately rinse the affected area.
 If a rash or weeping lesion (oozing sore) develops, seek
advice from a pharmacist or physician.
 If a victim’s condition worsens, seek a physician.
 To care for a victim who has come into contact with wet or dry
chemicals—
 Flush the area continuously with water.
 Call 9-1-1 or the local emergency number.
 If running water is not available, carefully brush off any dry
chemicals with a gloved hand.
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Injected Poisons
 Injected poisons enter the body through the bites or stings of
certain insects, spiders and scorpions, ticks, marine life, animals
and snakes or as drugs or misused medications injected with a
hypodermic needle.
 Insect and animal bites and stings are the most common sources
of injected poisons.
 Care for injected poisons will be discussed later.
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Anaphylaxis
 Severe allergic reactions to poisons are rare. But when one occurs,
it is a life-threatening medical emergency. This reaction is called
anaphylaxis.
 Anaphylaxis is a form of shock.
 Onset of anaphylaxis can be rapid and the signals include—
 Swelling and redness.
 Hives.
 Rash.
 Itching.
 Burning skin and eyes.
 Weakness.
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Anaphylaxis
(continued)
 Nausea.
 Vomiting.
 Restlessness.
 Dizziness.
 Dilated pupils.
 Slurred speech.
 Chest discomfort or pain.
 Weak or rapid pulse.
 Rapid or trouble breathing.
 Coughing or wheezing.
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Care for Anaphylaxis
 Call 9-1-1 or the local emergency number.
 Place the victim in a position of comfort for breathing.
 Comfort and reassure the victim.
 People who know they are extremely allergic to certain
substances may carry an anaphylaxis kit.
 The kit contains a dose of epinephrine that can be injected into
the body to counteract the anaphylactic reaction.
 In some cases, you may need to assist the victim in using his or
her kit.
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Preventing Poisoning
 By following these guidelines you will be able to prevent most
poisoning emergencies:
 Keep the household products and medications out of the
reach of children.
 Use childproof safety caps on containers of medications and
other potentially dangerous substances.
 Use special latches and clamps to keep children from opening
cabinets.
 Keep products in their original containers.
 Use poison symbols to identify dangerous substances.
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Preventing Poisoning
(continued)
 Dispose of outdated medications and household products.
 Use chemicals only in well-ventilated areas.
 Wear proper clothing.
 Immediately wash those areas of the body that may have
come in contact with a poison.
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Closing
 Poisoning can occur in any one of four ways: inhalation,
ingestion, absorption and injection.
 The severity of a poisoning depends on factors such as—
 The type and amount of poison.
 How and where the poison entered the body.
 The time elapsed since the poisoning.
 The victim’s size, weight, medical condition and age.
 For suspected poisoning call the National Poison Control
Center, 9-1-1 or the local emergency number.
 Follow the directions of Poison Control Center personnel or
the EMS call taker.
 Questions?
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Lesson 32: Sudden Illness III/
Bites and Stings
Introduction
 Bites and stings are among the most common forms of injected
poisonings.
 Some of the most common types of bites and stings are from—
 Insects.
 Ticks.
 Spiders and scorpions.
 Marine life.
 Snakes.
 Domestic and wild animals.
 Humans.
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Signals of Common Bites and Stings
 Specific signals of common bites and stings depend on—
 The type and location of the bite or sting.
 The amount of poison injected.
 The time elapsed since the poisoning.
 The victim’s size, weight, medical condition and age.
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Signals of Common Bites and Stings
(continued)
 Less severe reactions to bites and stings may trigger
signals including:
 A bite or sting mark.
 A stinger, tentacle or venom sac.
 Redness.
 Swelling.
 Pain or tenderness.
 Severe allergic reactions to bites and stings may bring on
a life-threatening condition, a form of shock known as
anaphylaxis.
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Insects
 Between 0.5 to 5 percent of Americans are severely allergic to
substances in the venom of bees, wasps, hornets and yellow
jackets.
 When a highly allergic person is stung, call 9-1-1 or the local
emergency number immediately for medical care.
 For most people, insect stings may be painful or uncomfortable
but are not life threatening.
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Care for Insect Stings
 To give care for an insect sting—
 Examine the sting site.
 If the stinger is still present, remove it to prevent any further
poisoning.
 Wash the area with soap and water and cover the site, then
apply ice or a cold pack.
 Observe the victim for signals of allergic reaction.
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Ticks
 Ticks can contract, carry and transmit disease to humans.
 Rocky Mountain spotted fever is caused by the transmission of
microscopic bacteria from the wood tick or dog tick host to
other warm-blooded animals.
 The main signal of Rocky Mountain spotted fever is a
spotted rash.
 Other signals of Rocky Mountain spotted fever include—
 Fever.
 Chills.
 Severe headache.
 Joint and muscle aches.
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Ticks
(continued)
 Lyme disease, or Lyme borreliosis, is another illness that people
can get from the bite of an infected tick.
 The first signal of Lyme disease is a rash.
 Other signals of Lyme disease include—
 Fever and chills.
 Headache.
 Weakness or fatigue.
 Flu-like joint and muscle aches.
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Ticks
(continued)
 In advanced stages, Lyme disease may cause—
 Arthritis.
 Numbness.
 Memory loss.
 Vision or hearing problems.
 High fever.
 Stiffness in the neck.
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Protection from Tick Bites
 To protect yourself from tick bites—
 Wear repellent and proper clothing.
 Check and clean your clothes thoroughly after having been
in wooded areas.
 Use precautions when removing a tick.
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Care for Tick Bites
 Remove the embedded tick.
 Do not try to burn the tick off.
 Do not apply petroleum jelly or nail polish to the tick.
 Place the tick in a sealable container for analysis.
 If you cannot remove the tick or parts remain, get medical care.
 Wash the bite area with soap and water.
 Apply antiseptic or antibiotic ointment.
 Wash your hands.
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Spider Bites
 Few spiders in the United States have venom that can cause
death.
 Two spiders that can cause illness and occasionally death are
the—
 Black widow spider.
 Brown recluse spider.
 Bites usually occur on the hands or arms.
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Spider Bites
(continued)
 A black widow spider bite usually causes a sharp pinprick pain
followed by a dull pain in the area of the bite.
 Other signals of this spider bite include—
 Muscular rigidity.
 Restlessness.
 Anxiety.
 Profuse sweating.
 Weakness.
 Drooping eyelids.
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Scorpion Stings
 Scorpions live in dry regions of the southwestern United States
and Mexico and are most active at night, which is when most
stings occur.
 Since it is hard to distinguish poisonous scorpions from the nonpoisonous scorpions, all scorpion stings should be treated as
medical emergencies.
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Signals of Spider Bites and Scorpion Stings
 Signals of spider bites and scorpion stings may include—
 A mark indicating a possible bite or sting.
 Severe pain in the area of the bite or sting.
 A blister, lesion or swelling at the entry or bite site.
 Nausea and vomiting.
 Trouble breathing or swallowing.
 Sweating or salivating profusely.
 Irregular heart rhythm.
 Muscle cramping or abdominal pain.
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Care for Spider Bites and Scorpion Stings
 If a person is bitten by a spider (i.e., brown recluse or black
widow) or stung by a scorpion—
 Call 9-1-1 or the local emergency number immediately.
 Wash the wound.
 Apply ice or a cold pack.
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Snakes
 Medical personnel are not in general agreement about care for
snakebites.
 Most deaths from snakebites occur because—
 The victim has an allergic reaction.
 The victim is in poor health.
 Too much time passes before the victim receives medical care.
 Signals that indicate a poisonous snakebite include—
 One or two distinct puncture wounds.
 Severe pain and burning at the wound site.
 Swelling and discoloration at the wound site.
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Care for Snakebites
 Follow these guidelines to care for someone bitten by a snake:
 Call 9-1-1 or the local emergency number.
 Wash the wound.
 Immobilize the affected part.
 Keep the affected area lower than the heart, if possible.
 Minimize the victim’s movement.

If the bite is from an elapid snake such as a coral snake:
• Apply an elastic roller bandage.
• Use overlapping turns, gently stretching the bandage as you wrap.
• Begin at the point furthest from the heart.
• Check for circulation of the limb beyond the point where bandaging
begins. (Note changes in skin color and temperature.)
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Care for Snakebites
(continued)
 Regardless of what you may have otherwise heard or read—
 Do not apply ice.
 Do not cut the wound.
 Do not apply suction.
 Do not apply a tourniquet.
 Do not use electric shock.
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Marine Life
 Some marine life, such as jellyfish, can inflict painful injuries
that can make you sick.
 The side effects of marine life stings include allergic reactions
that can cause—
 Trouble breathing.
 Heart problems.
 Paralysis.
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Care for Marine Life Stings
 Remove the victim from the water.
 Call 9-1-1 or the local emergency number if the victim—
 Does not know what stung him or her.
 Has a history of allergic reactions to marine life stings.
 Is stung on the face or neck.
 Develops trouble breathing.
360
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Care for Marine Life Stings
 For jellyfish, sea anemone or Portuguese man-of-war stings—
 Soak the injured part in vinegar.
 Do not apply fresh water or ammonia.
 Do not rub the area.
 For stingray, sea urchin or spiny fish stings—
 Flush the wound with tap water or ocean water.
 Immobilize the injured part.
 Soak the body part in hot water.
 Clean the wound.
 Bandage the wound.
361
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Domestic and Wild Animals
 The bite of a domestic or wild animal, like a human bite,
carries the risk of infection as well as soft tissue injury.
 One of the most serious diseases that can result from a wild or
domestic animal bite is rabies.
 Rabies is fatal if not treated. Professional medical attention is
needed as soon as possible.
 Tetanus is a potentially fatal infection that affects the central
nervous system.
 It is caused by the transmission of bacteria that produce a
toxin when someone is bitten by an animal or human.
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Domestic and Wild Animals
(continued)
 Signals of tetanus include—
 Irritability.
 Headache.
 Fever.
 Painful muscular spasms.
 One of the most common signals of tetanus is muscular
stiffness in the jaw, which is why tetanus is sometimes
known as “lockjaw.”
363
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Care for Domestic and Wild Animal Bites
 If someone is bitten by an animal, try to get the person safely
away from the animal.
 For a minor wound—
 Wash the wound with soap and water.
 Control bleeding.
 Apply a dressing.
 Seek medical care.
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Care for Domestic and Wild Animal Bites
(continued)
 If the wound is bleeding heavily—
 Control the bleeding.
 Seek medical care immediately.
 Contact animal control authorities.
365
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Human Bites
 Human bites differ from other bites because they may be
more contaminated, tend to occur in higher-risk areas of
the body and often receive delayed care.
 Human saliva has been found to contain at least 42
different kinds of species of bacteria.
 According to the CDC, human bites are not considered to
carry a risk of transmitting hepatitis B or HIV.
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Care for Human Bites
 If the wound is not severe:
 Wash the wound thoroughly with soap and water.
 Control the bleeding.
 Apply a dressing.
 Take the victim to a physician or medical facility.
 If the bite is severe:
 Control the bleeding.
 Call 9-1-1 or the local emergency number.
367
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Preventing Bites and Stings
 Preventing bites and stings from insects, spiders, ticks,
snakes, scorpions and marine life is the best protection
against the transmission of injected poisons.
368
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Preventing Bites and Stings
(continued)
 Follow these general guidelines to prevent bites and stings:
 Apply repellent.
 Wear sturdy boots.
 Wear long-sleeved shirts and long pants.
 Tuck pant legs into socks or boots and tuck shirt into pants.
 Wear light-colored clothing.
 Use a rubber band or tape where pants and socks meet to
prevent ticks or insects from getting under clothing.
 Inspect yourself carefully after being outdoors.
369
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Preventing Bites and Stings
(continued)
 Shower immediately after coming indoors.
 Keep an eye out for and avoid nests.
 Spray pets that go outdoors with repellent.
 Stay in the middle of trails when hiking.
 Avoid walking in areas known to be populated
with snakes.
 Make noise as you walk.
 If you encounter a snake, walk away on the same
path you were on.
370
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Preventing Bites and Stings
(continued)
 To prevent stings from marine animals, you might consider
wearing a wetsuit or drysuit or protective footwear in the
water.
 To prevent dog bites—
 Do not run past a dog.
 Avoid eye contact, try to remain motionless.
 Do not approach a strange dog.
 Always let a dog see and sniff you before you pet the
animal.
371
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Closing
 Learning how to recognize, care for and prevent some of the
most common types of bites and stings can help you give care
to a victim.
 For suspected injected poisonings, call the National Poison
Control Center, 9-1-1 or the local emergency number.
 The best way to avoid any kind of poisoning is to take steps to
prevent it.
 You will learn how the misuse and abuse of substances, such as
drugs and medications, can poison the body in the next lesson.
 Questions?
372
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Lesson 33: Sudden Illness IV/
Substance Misuse and Abuse
Introduction
 Substance abuse and misuse cost the United States billions
of dollars annually in medical care, insurance and lost
productivity.
 Even more important, however, are the lives lost or
permanently impaired each year from injuries or medical
emergencies related to substance abuse or misuse.
374
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Introduction
(continued)
 Legal substances are among those most often misused or abused.
 Such legal substances include—
 Nicotine (found in tobacco products).
 Alcohol (found in beer, wine and liquor).
 Over-the-counter medications, such as aspirin, sleeping pills
and diet pills.
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Introduction
(continued)
 According to the National Vital Statistics Reports, over 40,000
Americans died as a result of drug- or alcohol-induced deaths
in 2001.
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Activity
 Define and discuss the following terms:
 Substance misuse
 Substance abuse
 Drug
 Medication
 Dependency
 Addiction
 Tolerance
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Activity
(continued)
 Define and discuss the following terms:
 Overdose
 Withdrawal
 Synergistic effect
378
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Misused and Abused Substances
 Substances are categorized according to their effects on the body.
 The six major categories of commonly misused and abused
substances are—
 Stimulants.
 Depressants.
 Hallucinogens.
 Narcotics.
 Inhalants.
 Cannabis products.
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Stimulants
 Stimulants are drugs that affect the central nervous system by
increasing physical and mental activity.
 The effects of stimulants include—
 Temporary feelings of alertness and prevention of fatigue.
 Appetite suppression.
380
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Stimulants
(continued)
 Amphetamines, dextroamphetamines and methamphetamines
are stimulants.
 Cocaine is one of the most publicized and powerful stimulants.
 A purer form of cocaine is known as crack.
 The most common stimulants in the United States are legal:
 Caffeine
 Nicotine
 Other stimulants are used for medical purposes.
381
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Hallucinogens
 Hallucinogens, also known as psychedelics, are substances that
affect mood, sensation, thought, emotion and self-awareness.
 Hallucinogens sometimes cause what is called a bad trip.
 A bad trip can involve intense fear, panic, paranoid
delusions, vivid hallucinations, profound depression,
tension and anxiety.
 The victim may be irrational and feel threatened by any
attempt others make to help.
382
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Hallucinogens
(continued)
 Among the most widely abused hallucinogens are—
 Lysergic acid diethylamide (LSD), also known as acid.
 Psilocybin (mushrooms).
 Phencyclidine (PCP), called angel dust.
 Mescaline (peyote, buttons or mesc).
383
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Depressants
 Depressants are substances that affect the central nervous
system by decreasing physical and mental activity.
 Depressants are commonly used for medical purposes.
 Common depressants include—
 Barbiturates.
 Benzodiazepines.
 Narcotics.
 Alcohol.
384
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Narcotics
 Narcotics, derived from opium, are drugs that work on the
central nervous system to relieve pain.
 The most common natural narcotics are morphine and
codeine.
 Most other narcotics, including heroin, are synthetic or
semisynthetic.
385
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Inhalants
 Inhalants are substances inhaled to produce a mood-altering
effect.
 Inhalants also depress the central nervous system.
 Inhalants include medical anesthetics, such as amyl nitrite and
nitrous oxide (also known as laughing gas), as well as
hydrocarbons, known as solvents.
386
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Cannabis Products
 Cannabis products, including marijuana, tetrahydrocannabinol
(THC), and hashish, are all derived from the plant Cannabis
sativa.
 Marijuana is the most widely used illicit drug in the United
States.
 Marijuana, although illicit, has been used for some medicinal
purposes to treat—
 Nausea from chemotherapy.
 Glaucoma.
 Muscular weakness caused by multiple sclerosis.
 Weight loss from cancer and AIDS.
387
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Cannabis Products
(continued)
 The effects of marijuana include—
 Feelings of elation.
 Distorted perceptions of time and space.
 Throat irritation.
 Red eyes.
 Rapid pulse.
 Dizziness.
 Increased appetite.
388
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Designer Drugs
 These drugs are variations of other substances, such as
narcotics and amphetamines.
 The molecular structures of designer drugs include
substances used for medical purposes that are modified by
chemists.
389
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Designer Drugs
(continued)
 One of the more common designer drugs is methylenedioxymethamphetamine (MDMA), also known as “ecstasy.”
 Ecstasy is popular because it evokes a euphoric high.
390
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Designer Drugs
(continued)
 Other signals of ecstasy use include—
 Increased blood pressure.
 Rapid heartbeat.
 Profuse sweating.
 Paranoia.
 Sensory distortion.
 Erratic mood swings.
391
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Anabolic Steroids
 Anabolic steroids are sometimes used by athletes to enhance
performance and increase muscle mass.
 Their medical uses include stimulating weight gain.
 Chronic use of anabolic steroids can lead to sterility, liver
cancer and personality changes.
 Steroid abuse by young people may also disrupt normal
growth.
392
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Over-the-Counter Substances
 The most commonly misused and abused over-the-counter
substances are aspirin, laxatives and nasal sprays.
393
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Over-the-Counter Substances
(continued)
 Aspirin is used to relieve minor pain, reduce fever and treat heart
disease.
 Aspirin misuse can—
 Cause inflammation of the stomach and small intestine.
 Impair normal blood clotting.
394
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Over-the-Counter Substances
(continued)
 Laxatives are used to relieve constipation.
 Laxative misuse can cause uncontrolled diarrhea that may
result in dehydration.
 Laxative abuse is associated with attempted weight loss and
eating disorders, such as anorexia nervosa and bulimia.
395
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Over-the-Counter Substances
(continued)
 Antihistamines, such as decongestant nasal sprays, can help
relieve the congestion of colds or hay fever.
 If misused, they can cause physical dependency.
396
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Signals of Substance Misuse and Abuse
 Signals of substance misuse and abuse are similar to those of other
medical emergencies.
 Signals of abuse or misuse include—
 Moist or flushed skin.
 Sweating, chills, nausea, vomiting.
 Fever.
 Headache.
 Dizziness.
 Rapid pulse, rapid breathing.
 High blood pressure.
 Chest pain.
397
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Signals of Substance Misuse and Abuse
(continued)
 Respiratory distress, disruption of normal heart rhythm and even
death can result from using a stimulant.
 A victim of stimulant overdose may appear to be—
 Very excited.
 Restless.
 Talkative.
 Irritable.
 Unconscious.
398
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Signals of Substance Misuse and Abuse
(continued)
 Specific signals of hallucinogen abuse may include—
 Sudden mood changes.
 Flushed face.
 Seeing or hearing something that is not present.
 Anxiousness or being frightened.
 Specific signals of depressant abuse include—
 Drowsiness.
 Confusion.
399
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Signals of Substance Misuse and Abuse
(continued)
 Slurred speech.
 Slow heart and breathing rates.
 Poor coordination.
400
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Care for Substance Misuse and Abuse
 Follow these general principles as you would for any poisoning:
 Check the scene to make sure it is safe to help the person.
 Do not approach if the victim is behaving in a
threatening manner.
 Call 9–1–1, the local emergency number or the National
Poison Control Center.
 Care for any life-threatening conditions.
 Care for any other conditions you find.
 Withdraw from the area if the victim becomes violent or
threatening.
401
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Care for Substance Misuse and Abuse
(continued)
 Look for clues.
 Look for product or medicine containers, drug paraphernalia
and signals of other medical conditions.
 If you suspect that someone has taken a designer drug, tell
EMS personnel.
 After a substance abuse emergency, the victim may need
additional support to overcome addiction.
402
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Preventing Substance Misuse and Abuse
 Approaches vary, including educating people about substances
and their effects on health and attempting to instill fear of
penalties, which have not by themselves proved to be particularly
effective.
 To be effective, prevention efforts must address the various
underlying factors of and approaches to substance abuse.
403
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Preventing Substance Misuse and Abuse
(continued)
 The following factors may contribute to substance abuse:
 A lack of parental supervision
 The breakdown of traditional family structures
 A wish to escape unpleasant surroundings and stressful
situations
 The widespread availability of substances
 Peer pressure and the basic need to belong
 Low self-esteem, including feelings of guilt and shame
 Media glamorization
 History of substance abuse
404
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Preventing Substance Misuse and Abuse
(continued)
 Some poisonings from medicines occur when victims knowingly
increase the dosage beyond what is directed.
 The best way to prevent such misuse is to take medications only
as prescribed.
 On the other hand, many poisonings from medicines are not
intentional.
405
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Preventing Substance Misuse and Abuse
(continued)
 The following guidelines may help prevent unintentional
misuse or overdose:
 Read the product information and use only as directed.
 Ask your physician or pharmacist about the intended use
and side effects of prescriptions and over-the-counter
medications. If you are taking more than one medication,
check for possible interaction effects.
 Never use another person’s prescribed medications.
 Always keep medications in their appropriate, marked
containers.
 Destroy all out-of-date medications.
 Always keep medications out of the reach of children.
406
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Closing
 There are six major categories of substances that, when abused
or misused, can produce a variety of signals.
 You do not have to diagnose the condition to give care.
 If you suspect that the victim’s condition is caused by
substance misuse or abuse—
 Give care for a poisoning emergency.
 Call 9-1-1, the local emergency number or National Poison
Control Center personnel and follow their directions.
 Call the police, if necessary.
 Questions?
407
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Copyright © 2006 by The American National Red Cross
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Lesson 34: Heat- and Cold-Related
Emergencies
Introduction
 When the body is overwhelmed in its attempt to regulate body
temperature, a heat- or cold-related emergency can occur.
 A heat- or cold-related emergency can happen anywhere (indoors
or outdoors) and under a variety of conditions.
 The signals of a heat-or cold-related emergency are progressive
and can quickly become life threatening.
 A person can develop a heat- or cold-related emergency, even
when temperatures are not extreme.
409
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Introduction
(continued)
 The following effects determine an individual’s susceptibility:
 Humidity
 Wind
 Clothing
 Living and working environments
 Physical activity
 Age
 Health
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How Body Temperature Is Controlled
 When the body gets too hot…
411
 When the body gets too cold…
AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITION
Copyright © 2006 by The American National Red Cross
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How Body Temperature Is Controlled
(continued)
 The body maintains its temperature by constantly balancing
heat loss with heat production.
 The body generates heat primarily through converting food
to energy and through muscle contractions, such as during
exercise or when shivering.
412
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How Body Temperature Is Controlled
(continued)
 When the body gets too hot, blood vessels near the skin dilate,
or widen, to bring more blood to the surface, which allows
heat to escape.
 The body can also be cooled by the evaporation of sweat or by
air moving over the skin.
413
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How Body Temperature Is Controlled
(continued)
 When the body is cold, the opposite occurs.
 Blood vessels near the skin constrict (narrow) and move warm
blood to the center of the body. Thus, less heat escapes through
the skin and the body stays warm.
 When constriction of blood vessels fails to keep the body warm,
the body shivers to produce heat through muscle action.
414
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Factors Affecting Body Temperature Regulation
 The three main factors affecting how well the body maintains
normal body temperature are—
 Air temperature.
 Humidity.
 Wind.
 Other factors affect how well your body manages temperature
extremes. These factors include—
 Clothing.
 Breaks from exposure to extreme temperature.
 Water intake.
 Intensity of activity.
415
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Factors Affecting Body Temperature Regulation
(continued)
 People more susceptible to a heat- or cold-related emergency
include—
 Those involved in strenuous activity in a warm or cold
environment.
 Elderly people.
 Young children.
 Those who have predisposing health problems.
 Those who have had a previous heat- or cold-related emergency
in the past.
 Those who have cardiovascular disease.
 Those who take medications to eliminate water from the body
(diuretics).
416
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Heat-Related Emergencies
 Conditions associated with overexposure to heat are—
 Heat cramps.
 Heat exhaustion.
 Heat stroke.
417
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Heat Cramps
 Heat cramps are painful spasms of skeletal muscles.
 Heat cramps usually affect the legs and the abdomen.
 To recover from heat cramps—
 Rest.
 Lightly stretch the affected muscles.
 Replenish fluids.
418
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Heat Exhaustion
 Heat exhaustion is the earliest stage and the most common
form of heat-related illness.
 Heat exhaustion is an early indicator that the body’s
temperature-regulating mechanism is becoming overtaxed.
419
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Heat Exhaustion
(continued)
 The signals of heat exhaustion include—
 Cool, moist, pale, ashen or flushed skin.
 Headache, nausea, dizziness.
 Weakness, exhaustion.
 Heavy sweating.
 Heat exhaustion in its early stage can usually be reversed
with prompt care.
420
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Heat Stroke
 Heat stroke is the least common and most severe heat-related
illness.
 Heat stroke most often occurs when people ignore the signals
of heat exhaustion.
 Heat stroke develops when the body systems are so overtaxed
by heat and begin to stop functioning.
 Sweating often stops because body fluid levels are low.
421
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Heat Stroke
(continued)
 Heat stroke is a serious medical emergency.
 The signals of heat stroke include—
 Red, hot, dry skin.
 Changes in level of consciousness.
 Vomiting.
422
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Care for Heat-Related Illness
 If you recognize heat-related illness in its early stages, you
can usually reverse it. Follow these general steps:
 Cool the body.
 Give fluids if the victim is conscious.
 Take steps to minimize shock.
423
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Care for Heat-Related Illness
(continued)
 Care for someone in the late stages of heat-related illness
involves—
 Calling 9-1-1 or the local emergency number
immediately.
 Cooling the body.
 Monitoring breathing and consciousness.
 Being prepared to give rescue breathing or CPR,
if needed.
424
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Copyright © 2006 by The American National Red Cross
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Cold-Related Emergencies
 Frostbite and hypothermia are two types of cold-related
emergencies.
 Frostbite occurs in body parts exposed to cold.
 Hypothermia develops when the body can no longer generate
sufficient heat to maintain normal body temperature.
425
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Frostbite
 Frostbite is the freezing of body tissues.
 Frostbite usually occurs in exposed areas of the body,
depending on—
 Air temperature.
 Length of exposure.
 Wind speed.
 Frostbite can be either superficial or deep.
 Superficial frostbite—the skin is frozen but the tissues
below are not.
 Deep frostbite—both the skin and the underlying tissues
are frozen.
426
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Frostbite
(continued)
 Signals of frostbite include—
 Lack of feeling in the affected area.
 Skin that appears waxy.
 Skin that is cold to the touch.
 Skin that is discolored (flushed, white, yellow or blue).
427
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Care for Frostbite
 When caring for a victim of frostbite—
 Call 9-1-1 or the local emergency number.
 Attempt to remove jewelry or restrictive clothing.
 Handle the affected area gently; never rub the affected area.
 If there is no chance that the frostbitten part will refreeze,
you may begin rewarming the affected area.
 Loosely bandage the area with a dry, sterile dressing.
 If fingers or toes are frostbitten, place dry, sterile gauze
between them to keep them separated.
 Avoid breaking blisters.
428
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Hypothermia
 Hypothermia is the general cooling of the entire body. Body
temperature drops below 95°F (35°C).
 Signals of hypothermia include—
 Shivering (may be absent in the later stages of hypothermia).
 Numbness.
 Glassy stare.
 Apathy.
 Weakness.
 Impaired judgment.
429
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Hypothermia
(continued)
 In the case of severe hypothermia—
 The victim may be unconscious.
 Breathing may have slowed or stopped.
 The body may feel stiff as the muscles become rigid.
430
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Care for Hypothermia
 To care for hypothermia—
 Check and care for life-threatening conditions.
 Call 9-1-1 or the local emergency number.
 Carefully remove wet clothing and dry the
victim.
 Warm the body.
 Move the victim to a warm environment.
 If available, apply hot water bottles, chemical
heat packs or other heat sources to the body.
431
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Care for Hypothermia
(continued)
 If the victim is alert, give him or her warm nonalcoholic
and decaffeinated liquids to drink.
 Rewarm the victim gradually and handle him or her
gently.
 Monitor breathing and signs of life and continue to
warm the victim until EMS personnel arrive.
 Be prepared to give CPR if necessary.
432
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Preventing Heat- and Cold-Related Emergencies
 Emergencies resulting from overexposure to extreme
temperatures are usually preventable.
 You can prevent overexposure to extreme temperatures by
following these guidelines:
 Avoid being outdoors
 Dress appropriately
 Change your activity level
 Take frequent breaks
 Drink large amounts of nonalcoholic or decaffeinated fluids
433
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Scenario
Twenty-year-old Todd Wilson is doing construction work for his
uncle this summer. Todd is putting fiberglass insulation in an attic.
He is wearing long pants, a long-sleeved shirt, goggles, a face mask
and a hat to protect him from contact with fiberglass.
434
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Scenario
(continued)
Outdoor temperatures have been running about 95º F and this day is
exceptionally humid as well. Todd had hoped to have finished this
job the evening before but has to return to the job around noon the
next day. He expects that it will take about 5½ hours to complete the
work. Because Todd is in a hurry, he is working quickly to finish the
job. He figures he can save some time if he does not take any breaks.
About 2 hours later, drenched with sweat, Todd starts to feel dizzy,
weak and nauseated. He barely has the energy to get down from the
attic.
435
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Closing
 Overexposure to extreme heat and cold may cause a person to
become ill.
 The likelihood of illness also depends on factors such as—
 Physical activity.
 Clothing.
 Wind.
 Humidity.
 Working and living conditions.
 A person’s age and physical condition.
 Follow the general steps of care for heat- and cold-related
emergencies.
 Questions?
436
AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITION
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Lesson 35: Putting It All Together II/
Injuries and Sudden Illness
You Are the Responder
Activity:
 The plan of action
 Did the group’s plan follow the emergency action steps:
CHECK—CALL—CARE?
 Did the plan involve bystanders appropriately?
 Did the plan demonstrate proper care?
438
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Scenario 1
Conscious Person with Serious Head, Neck or Back Injury
At work, you are called to give care for a co-worker who has
fallen from an 8-foot ladder. As you arrive, you see the victim
lying on the ground. She is crying and moaning in pain. A
bystander says that she landed on her back. The victim has not
moved from this position. She says that she has tingling and
numbness in her legs and feet and pain in her back. She also has
a 2-inch laceration on the side of her head.
You want to help. How do you proceed?
439
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Scenario 2
Conscious Victim with Extremity Injury
You are coaching a little league baseball team. The pitcher is
struck with a line drive to the ankle and falls to the ground. He
is crying and in pain, unable to move the limb. Slight swelling
and discoloration are already present. You are about 3 minutes
away from the nearest hospital. The player’s parents are not at
the game. You have a signed consent form from the parents to
give care to all of the kids.
You want to help. How do you proceed?
440
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Scenario 3
Sudden Illness
For several hours, your 60-year-old aunt has been complaining
of indigestion while at your home for a seafood cookout. She now
says that she has severe stomach pain and feels nauseous. She
thinks pain and nausea relate to the food she ate. You notice that
her skin is rather pale, she is breathing rapidly and she looks ill.
You want to help. How do you proceed?
441
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Scenario 4
Heat-Related Emergency
It is late in the afternoon, and your team is finishing its third match
of the volleyball tournament on the beach. The day has been hot
with temperatures in the 90s. Suddenly, a teammate collapses. She
does not appear to be fully conscious, but is breathing rapidly. You
notice that her skin is very warm, sunburned and moist. Her pulse
is very fast. She is unable to get up from the ground.
You want to help. How do you proceed?
442
AMERICAN RED CROSS FIRST AID–RESPONDING TO EMERGENCIES FOURTH EDITION
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Scenario 5
Substance Abuse
A dangerous ritual is about to begin—21 drinks for the 21st
birthday. A group of close friends has gathered for a special party
for the “birthday boy.” Everyone knows it is a dangerous game,
but, because each of these friends went through it, they believe it is
a rite of passage into adulthood. The activities begin and the guest
of honor is soon chugging beers and downing shots of liquor at a
rapid pace. Two hours after the drinking began, you arrive at the
party. The guest of honor is vomiting violently in the bathroom.
He slumps to the floor and begins violent convulsions, then stops
moving. He seems to stop breathing and then takes a deep breath.
You are called to help. How do you proceed?
443
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Closing
 Questions?
444
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