Emergency First Aid: Throat Anatomy and Response

Emergency First Aid

• Importance of keeping oneself safe during an emergency: wear a face mask, gloves, and check the scene for safety before approaching the casualty
• Throat anatomy: tongue, epiglottis, oesophagus, and trachea

Dealing with the Throat

• Open-airway technique: support the casualty on the ground in the lazy W position to aid circulation and ease breathing
• Use GTN spray or angina medication to help the casualty
• If symptoms don't ease, give a 300mg aspirin and discreetly get an AED ready for resuscitation

Heart Attack

• Heart attack occurs when a blockage in the aorta or coronary artery reduces blood flow to the heart muscle
• Angina: cholesterol deposits narrow the artery and form a clot, blocking the artery
• Importance of early recognition, call, CPR, defibrillation, and advanced care

Safety Considerations

• Implanted devices, medication patches, and inappropriate shock can be hazardous
• Remove jewelry and avoid flammable atmospheres

Choking

• For babies: 5 back slaps and 5 chest thrusts
• For children and adults: cough, 5 back blows, and 5 abdominal thrusts; start CPR if they lose consciousness

Preparing for an Emergency

• Keep important phone numbers and addresses accessible
• Take regular puffs of a reliever inhaler during an asthma attack
• If symptoms don't improve, call 999

Early Warning Signs

• Needing to use a reliever inhaler three times a week or more
• Symptoms: tightness in the chest, breathlessness, coughing, wheezing, or waking up at night due to asthma
• If the reliever inhaler isn't helping, an asthma attack may be occurring

Head Injuries

• Traumatic brain injury: the brain crashes against the skull, causing cerebral compression
• Signs and symptoms: headache, pressure in the head, balance problems, nausea, vomiting, and sensitivity to light or noise

Concussions

• A concussion is a type of traumatic brain injury
• Management principles: remove from play or training, prioritize return to education/work over return to play
• A progressive exercise program is recommended after a concussion

Anaphylaxis

• Triggers: milk, egg, nuts, bee/wasp sting, food, latex, medication
• Fast for stroke: face, arms, speech, and time
• Anaphylaxis is life-threatening and can affect airway, breathing, and consciousness

Allergy Statistics

• Allergy is the most common chronic disease in Europe
• Up to 20% of patients with allergies live with a severe debilitating form of their condition
• The European Academy of Allergy and Clinical Immunology (EAACI) states that 1/3 of the UK population will develop an allergy at some point

Anaphylaxis Treatment

• Stay with the casualty, call for help if necessary, locate an adrenaline autoinjector, and give antihistamine
• Phone an ambulance and monitor the casualty closely
• Follow the child's Individual Healthcare Plan for prescribed medication

Anaphylaxis Algorithm

• Use ABCDE: airway, breathing, circulation, disability, and exposure
• Diagnosis: look for acute onset of illness, life-threatening airway and/or breathing, circulation problems, and skin changes

Adrenaline Autoinjector

• Hold the device in your dominant hand, remove the cap, and jab the tip into the upper outer thigh
• Hold for 10 seconds, massage the injection site for 10 seconds, and phone an ambulance

Seizures, Fits, and Convulsions

• Causes of seizures: head injury, brain tumor, CVA or stroke, drugs and alcohol, meningitis, and sepsis
• Managing seizures: don't put anything in their mouth, don't restrain them, protect their dignity, and time the seizure
• Call an ambulance if the seizure lasts more than 5 minutes or if it's the person's first seizure

Status Epilepticus

• A medical emergency that requires admission to hospital
• Mortality rate up to 20%

SUDEP (Sudden Unexpected Death in Epilepsy)

• Deaths in people with epilepsy that are not from injury, drowning, or other known causes
• Possible causes: breathing changes, heart rhythm changes, and a combination of both### Anaphylaxis
• Signs and symptoms of anaphylaxis:
  • Swelling of the conjunctiva, lips, tongue, and throat
  • Respiratory symptoms: shortness of breath, hoarseness, pain with swallowing, and cough
  • CNS symptoms: light headedness, anxiety, confusion, loss of consciousness, and headache
  • Heart and blood vessels symptoms: fast or slow heart rate, low blood pressure
  • Skin symptoms: hives, itchiness, and flushing
• Action to take when having an allergic reaction:
  • Stay with the casualty
  • Call for help if necessary
  • Locate adrenaline autoinjector
  • Give antihistamine
  • Phone emergency contact
  • Monitor closely and be ready to give adrenaline immediately if symptoms worsen
• Anaphylaxis Resuscitation Council Algorithm:
  • Use ABCDE: Airway, Breathing, Circulation, Disability, and Exposure
  • Diagnosis: look for acute onset of illness, life-threatening airway and/or breathing, circulation problems, and skin changes

Seizures and Epilepsy

• Symptoms of seizures:
  • Head injury
  • Brain tumour
  • CVA or stroke
  • Drugs and alcohol
  • Meningitis and Sepsis
  • Lack of oxygen
  • Fainting
  • Cardiac arrest
  • Raised temperature
  • Epilepsy – diagnosed when seizures cannot be attributed to any other cause
• Managing seizures:
  • Don't put anything in their mouth
  • Don't restrain them
  • Protect their dignity
  • If the seizure lasts more than 5 minutes, phone an ambulance
• Controlling seizures:
  • Ensure seizure medicine is taken regularly and as prescribed
  • Consider a seizure alert monitor if seizures happen at night
  • Avoid seizure triggers if known
  • Avoid drinking an excess of alcohol
  • Self-management programs can help to better control seizures and other symptoms

Asthma

• Asthma statistics:
  • 5.4 million people in the UK are currently receiving treatment for asthma
  • Asthma affects more boys than girls
  • Asthma in adults is more common in women than men
• Asthma triggers:
  • Allergens
  • Work
  • Respiratory infections
  • Strong odours
  • Cold air and temperature change
  • Exercise
  • Stress and emotions
  • Pollutants
  • Food additives
  • Gastic reflux
  • Tobacco
  • Medication
• How to deal with an asthma attack:
  • Sit up straight
  • Don't lie down
  • Try to keep calm
  • Follow the doctor's instructions

Bleeding

• Treatment for bleeding:
  • Sit or lie down
  • Examine the wound
  • Apply pressure
  • Dress the wound

Allergy Statistics

• Allergy is the most common chronic disease in Europe
• Up to 20% of patients with allergies live with a severe debilitating form of their condition
• The European Academy of Allergy and Clinical Immunology (EAACI) states that 1/3 of the UK population, 19 million people, will develop an allergy at some point
• Anaphylaxis statistics:
  • Seven times as many people were admitted to hospital with a severe allergic reaction in 2000 than in 1990
  • In the decade 2002-12, there was a doubling of admissions with anaphylaxis due to food allergy alone
  • For food-related anaphylaxis, the rise is even higher, going from just under 2,000 admissions twenty years ago to over 5,000 in 2022

Buccal Midazolam

• Buccal midazolam is available as:
  • Buccolam contains Midazolam Hydrochloride 5mg in 1ml in pre-filled oral syringes
  • Epistatus contains Midazolam Maleate 10mg in 1ml in a 5ml bottle with four oral syringes
• Buccal midazolam can only be administered by designated carers and staff who have received training from an appropriate health professional
• Buccal midazolam is used to treat prolonged seizures
• The NICE guideline for epilepsy sets out the following recommendations for the use of Buccal Midazolam:
  • Convulsive status epilepticus (seizures lasting 5 minutes or more)
  • Repeated/cluster seizures (usually 3 or more seizures which stop on their own in 24 hours)
  • Prolonged seizures (seizures lasting more than 2 minutes longer than a person's usual seizure)### Asthma Attack
• Take 1 puff of reliever inhaler every 30-60 seconds, max 10 puffs
• If symptoms improve, sit with casualty until they feel completely well and return to previous activity
• If not, call 999
• Steps to manage an asthma attack:
  • Step 1: Take reliever inhaler and sit with casualty
  • Step 2: Repeat after 15 minutes while waiting for ambulance
  • Step 3: Call 999
  • Step 4: Repeat step 2 after 15 minutes while waiting for ambulance
  • Step 5: Make urgent same-day appointment with GP or asthma nurse

Head Injuries

• Traumatic brain injury: brain crashes against skull, cerebral compression
• Signs and symptoms:
  • Headache or pressure in the head
  • Balance problems or dizziness
  • Nausea/vomiting
  • Sensitivity to light/noise
  • Does not feel right
  • Blurred vision or double vision
  • Feels dazed, sluggish, foggy, or groggy
  • Difficulty concentrating or remembering
  • Feeling irritable, sad, nervous, or more emotional
  • Sleep disturbances
• Observed by others:
  • Appears stunned or dazed
  • Loses consciousness (even briefly)
  • Is confused about events
  • Trouble thinking or concentrating
  • Can't recall events prior/after event
  • Shows behavior/personality changes
  • Answers questions slowly and repeats questions
  • Has difficulty remembering things and organizing themselves
• How to recognize and manage a concussion:
  • It's an injury to the brain
  • Most concussions can recover with complete management
  • All concussions should be regarded as potentially serious and managed according to appropriate guidelines
  • Loss of consciousness does not occur in the majority of concussions
  • Anyone with concussion symptoms following a head injury must be removed from playing or training
  • They must not return to play on the day of any suspected concussion
  • Return to education/work must take priority over return to play
  • A progressive exercise program that introduces an individual back to sport in a step-wise fashion is recommended after a concussion

Choking

• 5 back blows, then 5 abdominal thrusts
• For babies: 5 back slaps, then 5 chest thrusts
• If they lose consciousness and stop breathing, start CPR

Anaphylaxis

• Triggers:
  • Milk
  • Egg
  • Bee/wasp sting
  • Nuts
  • Food
  • Latex
  • Medication
• Signs and symptoms:
  • Swelling of the conjunctiva
  • Runny nose
  • Swelling of lips/tongue/throat
  • Respiratory: shortness of breath, hoarseness, pain with swallowing, cough
  • CNS: light-headedness, anxiety, confusion, loss of consciousness, headache
  • Heart and blood vessels: fast or slow heart rate, low blood pressure
  • Skin: hives, itchiness, flushing
• Action:
  • Stay with the casualty
  • Call for help if necessary
  • Locate adrenaline autoinjector
  • Give antihistamine
  • Phone emergency contact
  • If vomited, can repeat antihistamine dose
  • Monitor closely and be ready to give adrenaline immediately if symptoms worsen
• Resuscitation Council Algorithm:
  • Use ABCDE: Airway, Breathing, Circulation, Disability, Exposure
  • Diagnosis: look for acute onset of illness, life-threatening airway and/or breathing, circulation problems, skin changes
  • If so, call for help, lie patient flat (only if they are not struggling to breathe, if breathless, sit upright), raise patient's legs
  • Give adrenaline and call ambulance
• How to use adrenaline autoinjector:
  • Hold in your dominant hand
  • Remove the cap with your other hand
  • Swing and jab the tip of the autoinjector in your upper, outer thigh (with or without clothes, but avoiding seams)
  • Hold the injection in place for 10 seconds
  • Massage the injection site for 10 seconds
  • Phone for an ambulance
• Watch for signs of anaphylaxis:
  • Anaphylaxis may occur without skin symptoms
  • Always consider anaphylaxis in someone with a known food allergy who has sudden breathing difficulty
  • Airway: persistent cough, difficulty swallowing, vocal changes, swelling
  • Breathing: difficulty or noisy breathing, wheezing (like an asthma attack)
  • Consciousness: persistent dizziness, suddenly sleepy, pale/floppy, unconscious
  • If any one or more of these signs are present: lie casualty flat with legs raised (if breathing is difficult, allow casualty to sit), use adrenaline, dial 999 for ambulance
  • If in doubt, give adrenaline
• After giving adrenaline:
  • Stay with casualty until ambulance arrives
  • Do not stand casualty up
  • Commence CPR if there are no signs of life
  • If no improvement after 5 minutes, give a second adrenaline dose using a second autoinjector device if available

Test your knowledge of emergency first aid procedures, including throat anatomy and response to medical emergencies. Learn about keeping yourself safe, dealing with throat-related injuries, and administering medication.