What to do in a Medical Emergency by LJB

The Blogger’s note: It is reported that on May 23, 2011 at Kampung Morak, Tumpat, Kelantan, a man rushed to attend a cousin's funeral and forgot about his three-year-old daughter who was sleeping in the car under the blazing sun. By the time he remembered about her more than an hour later, the girl had already suffered serious heat stroke. The girl died of severe heat stroke while being rushed to a nearby clinic. This is a bitter lesson to all parents not to leave their child unattended in a vehicle. Dr JB Lim comments with the emphasis on learning first aid as follows:

Thursday, 26 May, 2011 10:52 PM
From: lim juboo

Yes, I read of this in yesterday’s newspapers. It is such a pitiful tragic and an unnecessary loss of life.

I read she was still conscious, but very pale, and her dress was completely drenched as seen from outside the car window.

I read some of the villagers wanted to break open the car window, but some idiotic ones wanted to wait for the car keys first. That was a medical emergency, and they should instantly break open the window and bring her out immediately, and transfer her to another car with the air-conditioner turned on at the lowest temperature at full blast over her head where the brain is.

Meantime someone should bring buckets of water and pour the water over her head and entire body while keeping her in the air-conditioner on – provided she is still conscious.

Another villager should have immediately prepared

1-2 glasses of water with 2 teaspoonful of salt dissolved in it and let her drink. Alternatively, since the incident was in a village where coconuts trees most likely are available, coconut water from old coconuts which is rich in potassium should be given by mouth with 1-2 teaspoonful of common salt (Sodium chloride) added to the coconut water. This should have been given to her instantly to correct dehydration and electrolyte imbalance that can affect the heart rhythm. They should check her pulse rate and its rhythm.

These are first-aid measures that could have been instituted instantly.

If she is unconscious open up her Airways (head tilt, chin lift position) and ensure Breathing and Circulation (ABC). If no pulse is felt over the carotid arteries (side of the neck), apply CPR (Cardio-Pulmonary Resuscitation) instantly. In the event she is unconscious, NOTHING should be given orally.

Meantime as CPR is applied, another helper should continue to sponge her head and entire body with cold water to bring her body temperature down. This procedure will also channel her peripheral blood circulation over the skin, back into her vital organs (brain, heart, kidneys).

In a heat stroke the body is overheated, and the body goes into an overdrive to channel the blood to the skin surface to dissipate heat directly or indirectly through sweat over the skin surface. The procedure is to instantly cool down the body. If this is not done, she might go into a hypovolemic shock where insufficient blood remains for the heart to pump efficiently (low cardiac output) while most of the blood remains in the vast network of sub-cutaneous capillaries. There will be a serious drop in blood pressures, and she can go into a cardiogenic shock.

But if she is breathing and has a pulse, but just fainted, then tilt her legs and body towards her head (Trendelenburg position) while still sponging her head and bathing her body in cold water. The lowering of skin temperature will drive back the blood to her vital organs where it is critically needed. When she recovers, and is conscious, only then give her a drink of coconut water with some salt in it. Do NOT give an unconscious person anything by mouth.

When this critical event is over, only then sends her to hospital where an intravenous drip with dextrose-saline to further correct dehydration may be administered. It is as simple as that.

This is pre-hospital care which every person should know. The administration of first-aid is the practice of emergency medicine at level 1 in a pre-hospital situation, and anyone trained in first-aid can administer. Untrained personnel are protected by the Good Samaritan Law.

This simple procedure could have saved her life – if only those villagers know first-aid, and the importance of it in a medical emergency.

It was so sad and unfortunate a life has been lost because of lack of knowledge of first-aid.

Learn First Aid!Jb lim

BSc (Physiol), PG Dip Nutr, MSc, MD, PhD (Medicine), FRSPH, FRSM
Regional Staff Officer for First Respondent Life Support Training
Advanced Cardiac Life Support
St John Ambulance Malaysia
Kuala Lumpur