Ready Hands · Seoyeon Kim
Chapter 13: Sudden Illness
What Can Happen
A care worker is helping a man in his seventies put on his coat for a short walk to the bus stop. The man stops halfway through the sleeve and says that his chest feels tight, as if a heavy weight is pressing on it. His face has turned pale and damp, and he wants to sit down. The care worker guides him back to his armchair and notices that he is breathing fast. For a moment she is not sure what is happening, and she wonders whether it will pass on its own.
Sudden illness often begins quietly, in the middle of an ordinary task, and the person may try to ignore it. This chapter explains how to recognise and respond to some of the sudden illnesses that care workers meet most often: chest pain that may be a heart attack, a stroke, a seizure, a diabetes emergency, and serious trouble with breathing, including a severe allergic reaction. In each case, the most important step is the same. You notice the signs, you call the emergency number early, and you stay with the person until help takes over.
Step by Step: Chest Pain and a Possible Heart Attack
Step 1. Notice the signs and take them seriously. A heart attack often causes pain, pressure, tightness or a squeezing feeling in the chest, and the feeling may spread to one or both arms, the neck, the jaw, the back or the upper stomach. The person may also be short of breath, sweaty, pale, sick or dizzy. In older people and in some women, the signs can be milder or unusual, such as sudden tiredness, breathlessness or discomfort that is hard to describe, so treat any new chest discomfort as an emergency.
Step 2. Call the emergency number at once, or ask someone nearby to call while you stay with the person. Do not wait to see whether the pain goes away, and do not let the person persuade you not to call. Put the phone on speaker so that your hands are free, and tell the operator that the person has chest pain, how old the person is and how the person is now.
Step 3. Help the person rest in the position that feels easiest. Many people are most comfortable sitting on the floor or in a chair, leaning against a wall or a cushion, with the knees bent. A person in a wheelchair can stay seated with the brakes on. Do not let the person walk around, climb stairs or carry anything, because any effort makes the heart work harder.
Step 4. Loosen tight clothing at the neck, chest and waist, and speak calmly. Tell the person that help is on the way and that you will stay. Fear makes the heart beat faster, so a quiet voice and a steady presence are part of your first aid.
Step 5. Follow the operator's instructions about medicine, and nothing else. Some people have their own prescribed medicine for chest pain. Whether the person takes any medicine is decided only by what the operator tells you and by what the person's care plan and your training at work say.
Step 6. Ask a colleague or a bystander to bring the nearest automated external defibrillator and the first aid kit, and to meet the ambulance. Note the time the pain started and any changes you see, because the paramedics will ask. If you are on a road or at a stop, describe where you are as clearly as you can, as Chapter 2 explains.
Step 7. Stay with the person and be ready to act. Watch the person's breathing and responses the whole time. If the person becomes unresponsive and is not breathing normally, start CPR and use the defibrillator as described in Chapter 4. If the person becomes unresponsive but is breathing normally, place the person in the recovery position, as Chapter 3 explains, and keep watching.
Stroke: Recognise the Signs and Act Fast
A stroke happens when the blood supply to part of the brain is blocked or when a blood vessel in the brain bleeds. Brain cells begin to be damaged very quickly, which is why every minute counts. Quick treatment in hospital can reduce the harm, but only if the person gets there fast. Your part is to recognise the signs, call at once and tell the paramedics what you saw.
The signs of a stroke usually appear suddenly. One side of the face may droop, so that the smile looks uneven or one eye or the corner of the mouth hangs lower. One arm or one leg may become weak or numb, so that the person cannot lift both arms and keep them up. Speech may become slurred, confused or difficult to understand, or the person may not understand what you say. Other sudden signs include trouble seeing with one or both eyes, trouble walking, loss of balance, dizziness and a very severe headache with no known cause.
If you notice any of these signs, call the emergency number at once, even if the signs seem small. Ask the person to smile, to raise both arms and to repeat a simple sentence, and tell the operator what happened. Note the time the signs started, or the last time you saw the person well. This time matters a great deal to the hospital team, so write it down or tell a colleague to remember it. If the person woke up with the signs, say when the person was last seen without them.
While you wait, help the person rest in a comfortable position, sitting up with support or lying on one side if the person is drowsy. Give nothing to eat or drink, because a stroke can affect swallowing and the person may choke. Speak calmly and simply, and do not assume that a person who cannot speak cannot hear you. If the person becomes unresponsive, check breathing and give first aid as Chapters 3 and 4 explain.
Sometimes the signs of a stroke fade and the person seems well again. This is still an emergency, because it can be a warning that a larger stroke may follow. Call the emergency number in the same way and report it at work. In care, the signs can be mistaken for tiredness or for a person's usual confusion, so a sudden change in how a person speaks, moves or understands always deserves a call. Some people already have weakness or slow speech from an earlier illness. The care plan usually describes what is normal for each person, and it is the change from that usual state that you report to the operator.
Step by Step: Helping a Person During a Seizure
Step 1. Stay calm and stay with the person. A seizure can be frightening to watch, but most seizures stop on their own. The person may fall, become stiff, jerk, stare, make sounds or lose control of the bladder. Note the time the seizure started, using the clock on your phone or a watch.
Step 2. Protect the person from injury. Move hard or sharp objects, furniture and hot drinks away, and ask other people to step back to give the person space and privacy. If the person is near a road, stairs, a fire or water, you may need to move the danger away from the person rather than moving the person. Put something soft, such as a folded jacket or a cushion, under the person's head. If the seizure happens outside on a hot day, slide a coat or a blanket under the person if you can do so safely, because a sunny pavement can burn the skin, and give shade when the movements stop.
Step 3. Do not hold the person down and do not try to stop the movements. Never put anything in the person's mouth, including your fingers, a spoon or a cloth. The person cannot swallow the tongue, and objects in the mouth can break teeth or block the airway. Loosen tight clothing at the neck if you can do it safely.
Step 4. If the person has the seizure while sitting in a wheelchair, leave the person in the chair. Put the brakes on, leave a fastened seat belt in place, and gently support the person's head with your hands or a cushion. Lifting a person out of the chair during a seizure can injure you both. When the movements stop, follow the person's care plan or the operator's instructions about moving the person.
Step 5. Call the emergency number if this is the person's first seizure or you do not know, if the seizure lasts longer than the person's care plan describes or, when there is no plan, longer than the time your first aid course teaches, if another seizure follows, if the person is injured, if the seizure happened in water, or if the person does not wake up afterwards. If the person has their own prescribed emergency medicine for seizures, follow only what the care plan, your training at work and the operator say.
Step 6. When the movements stop, check the person's breathing. If the person is breathing normally but is not yet awake, place the person in the recovery position to keep the airway open. If the person is not breathing normally, call the emergency number if no one has already, and start CPR as described in Chapter 4.
Step 7. Stay with the person until the person is fully awake. Many people are confused, sleepy or embarrassed after a seizure. Speak gently, tell the person where they are and what happened, and protect their dignity, for example by covering wet clothing with a blanket. Write down how long the seizure lasted and what you saw, because this helps the doctors and the care team.
Diabetes Emergencies, Breathing Difficulty and Severe Allergic Reactions
Many people who receive care live with diabetes. A diabetes emergency often happens when the level of sugar in the blood falls too low, for example after a missed meal, more activity than usual or a hot day outside. The signs can appear quickly: sudden confusion, sweating, shakiness, paleness, hunger, irritability or behaviour that seems strange or out of character. Without help, the person may become drowsy and lose consciousness. Low blood sugar can look like other problems, such as drunkenness, a stroke or the confusion of heatstroke on a hot day. If you are not sure what is causing the change, call the emergency number and tell the operator that the person has diabetes.
If the person is awake and can swallow safely, first aid courses teach giving a sugary drink, such as fruit juice or a non-diet soft drink, or sugary food such as sweets. Help the person sit down while they eat or drink. If the person feels better quickly, offer a snack or a meal as the care plan describes, and report the episode. If the person does not improve quickly, becomes drowsy or cannot swallow safely, call the emergency number and give nothing by mouth. If the person becomes unresponsive and is breathing normally, place the person in the recovery position. The person's care plan and your training at work tell you about any other steps for that person.
Sudden difficulty breathing is always serious. The person may be breathless, wheezing, unable to finish a sentence, anxious, or pale or bluish around the lips. Call the emergency number at once. Help the person sit in the position that makes breathing easiest, which is often sitting upright and leaning slightly forward with the arms resting on a table or on the knees. Open a window if the air is stuffy, loosen tight clothing and speak calmly. If the person has their own prescribed medicine for breathing, follow the care plan, your training at work and the operator's instructions.
A severe allergic reaction can develop within minutes after a food, an insect sting or another trigger. Signs include swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, a hoarse voice, wheezing, a raised itchy rash, feeling faint, and confusion. Call the emergency number at once and say that you think it is a severe allergic reaction. Let the person sit up if breathing is the main problem, or lie down if the person feels faint and is breathing comfortably. If the person carries their own prescribed emergency medicine for allergies, the operator, the care plan and your training at work tell you what to do.
Whatever the illness, stay with the person, watch their breathing and response, and be ready to give CPR if the person stops breathing normally. Keep the person warm in cool weather and shaded in hot weather. When help arrives, tell the paramedics what happened, when the signs started and what you did, as Chapter 15 explains.
Things to Check
Check the care plan of each person you support for health conditions such as heart problems, epilepsy, diabetes, asthma or allergies, and read what the plan says to do in an emergency. Knowing this before you need it saves time and worry.
Check whether a person has their own prescribed emergency medicine, where it is kept, and whether your workplace has trained you in what to do. Make sure it goes with the person on outings when the care plan says so.
Check that you can describe the signs of a stroke in your own words: one side of the face drooping, weakness in one arm or leg, and speech that is slurred or confused. Practise saying them aloud with a colleague so that they come to mind quickly.
Check that you have a sugary drink or a snack in your bag when you go out with a person who has diabetes, if the care plan says so. A hot day, a long wait or a delayed meal can make low blood sugar more likely.
Check that the allergies of each person you support are written where your team can find them, and take that information with you on outings and to meals out. Asking about ingredients before the person eats is a simple way to prevent a severe reaction.
Check where the nearest automated external defibrillator is at your workplace and along the routes you use most often. Knowing where it is lets you send someone for it without delay.
Check that you know how to time an event with your phone or a watch, such as the start of a seizure or of stroke signs. A clear time is one of the most useful things you can give the paramedics.
Check that you know how your workplace wants sudden illness reported and recorded, even when the person seems to recover fully. A short, accurate report helps the care team notice changes and keep the person safe.