December 2, 2024
Written by Clay Smith
Spoon Feed This is everything you need to know about first aid from the AHA guidelines, last updated in 2010.
As healthcare experts, we also need to know the basics
Here is the top ten list from the AHA. I will paraphrase, editorialize, and apply to your practice. And I can’t help myself. I am also going to point out some of the arcane aspects for your reading pleasure. Let’s go!
General care and safety: The gist here is – stay in your lane. Keep within your knowledge and skill set. For most readers, this is pretty extensive. Also, before rescuing others, make sure you and your environment are safe. That last thing we need is another victim!
First aid for bleeding: Hold direct pressure, then move to commercial (or improvised) tourniquet +/- wound packing.
First aid for chest pain: People with chest pain need ED evaluation, transport by EMS, and a chewed aspirin 325mg.
First aid for stroke: Use FAST (face, arms, speech, time) or Cincinnati Prehospital Stroke Scale. FAST can be used in kids but is not validated. FAST should just be FAS. T stands for “time,” which just means “time to call 911,” which is kind of lame.
First aid for opioid overdose: An unresponsive person needs high-quality CPR first if not breathing and pulseless. Consider naloxone if opioids are suspected, which is quite often when random people just forget to breathe. Healthcare providers are supposed to check for a pulse. Lay-rescuers should start CPR and skip the pulse check (See figures 1 and 2).
Assistance with administration of prescribed medications: Just because someone with anaphylaxis has an epinephrine auto-injector doesn’t mean they are able jab themselves. Strongly consider helping them. Also, inhalers without spacers are pretty useless, so I love this idea from the AHA. No spacer? No problem! Make your own improvised spacer device from a water bottle (figure 3). Genius!
First aid for open chest wounds: Here is a quote of AHA recommendations: “In the first aid setting, it is reasonable to leave an open chest wound exposed to ambient air; to place a clean, nonocclusive, dry dressing such as gauze or a clean piece of cloth; or to place a specialized dressing such as a vented chest seal.” For those in the ED, a “blowhole,” or finger thoracostomy is best. Maybe we should all just carry a scalpel around with us. Kind of creepy but could save a life. Just don’t try to take it on a plane!
First aid for tick bites: People try covering ticks with petrolatum, gasoline, or nail polish; they try burning them off or otherwise maiming the little guys. For the love, just grab the tick with tweezers and pull it out (figure 4). It’s not rocket science.
First aid for seizure: Call EMS if seizure is: first-time, >5 minutes, recurrent, accompanied by injury, labored breathing, choking, <6 months of age, pregnant, or not back to normal in 5-10 minutes. So, basically everybody.
Oxygen and pulse oximetry use in first aid: It is fine to use a pulse oximeter. But be skeptical about the accuracy of the cheap over-the-counter models. Avoid too much oxygen in COPD; aim for 92%.
Now for my random take-homes and funnies. Feel free to stop reading. Pretty much everything else is only slightly helpful or just for your amusement.
They note that first aid may be needed if someone is “walking into traffic.” You think?
The most powerful first aid tool may be your (or the victim’s) mobile phone. Learn ways to override the login screen and call EMS. For Android and Apple, just swipe up on the lock screen, tap Emergency, and call 911 (or your local emergency number).
Epinephrine re-dosing for anaphylaxis is needed up to 18% of the time.
It seems like this should go without saying, but the AHA wants you to know – don’t try to treat a febrile seizure with acetaminophen or ibuprofen while the patient is actively seizing.
There was a whole section on presyncope. Physical countermeasures – like squatting or lying supine, crossing the legs, and squeezing the leg muscles, or isometric fist squeezes – may prevent progression to syncope.
In Lyme-endemic areas, “a single dose of prophylactic doxycycline given within 72 hours after an Ixodes scapularis tick bite could prevent Lyme disease.”
If exposed to poison ivy, wash the area with soap and water as soon as possible. Special decontamination soaps are probably not that much better than dish soap. This has been studied in healthy volunteers. Sorry…who let another person rub poison ivy on them?!
Don’t ice, shock, suck, tourniquet, incise, pressure bandage, or, well…do anything but elevate the limb and seek care for a snakebite in the U.S.
Hot water (104ºF) submersion for jellyfish stings can help with pain. But pick off all tentacles with tweezers first.
For scorpion stings, ice may be more helpful plus NSAIDs.
And this document has oh so much more: hypothermia, hyperthermia, eye injuries, burns, abrasions, sprains, fractures, dental avulsion, chemical exposure, epistaxis, and on and on and on…61 pages of AHA goodness.
Figure 1: Lay rescuer opioid rescue, from AHA
Figure 2: Healthcare provider opioid rescue, from AHA
Figure 3: Improvised spacer for inhaler, from AHA
Figure 4: Tick removal, modified from AHA
How will this change my practice?
I am, perhaps, too excited about using a water bottle as a makeshift spacer for a rescue inhaler. This is just so MacGyver, (link provided for people who do not understand epic cultural reference). Most items are pretty basic for most of us, but there were a few pearls. And if we are not experts in the basics, we should be. So, this is worth a read!
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