The Layman Approach to Medical Emergencies

“Diseases desperate grown, By desperate appliance are relieved,

Or not at all”:William Shakespeare – Hamlet

 Introduction

Time and again, humanity has spent billions of dollars and thousands of hours, just to keep humankind at good state of health. We started with religious and supernatural approach to health, giving rise to several form of medicine like the Chinese ‘Yin’ and ‘Yang’, Indian Ayurveda and Greek medicine which gave rise to Hygiea and Panacea (Goddess of Health and Goddess of Medicine respectively). And the rest is history.

With the explosion of knowledge of biology and chemicals in 20th Century, revolution was brought about in how doctors or clinicians approach medicine. However, the history is evident that most of the literature of medicine written till date has been by clinicians and for clinicians. The domain of ‘Layman Approach to Medicine’ has remained a not-so-well-explored till date.

In this essay we aim to discuss the approach by layman to medical emergencies.

Why Layman Matters

Nearly 5 million people die worldwide out of Stroke⁽¹⁾, 1.25 million die worldwide out of RTA (Road Traffic Accidents), 17.7 million people die worldwide out of Coronary heart diseases –mainly Heart Attacks⁽²⁾. Here we also need to mention the deaths by Snake bite, Emergency labour and delivery at home, burns and uncontrolled bleeding. Another medical emergency that holds utmost political importance is – grievous injuries to soldiers during warfare. All these are conditions wherein first hand approach by layman is extremely important and could be lifesaving.

Layman Response

Basic aim of any approach to traumatic medical emergency would be to maintain the ABCDE’s of the patient i.e. Airway, breathing, circulation, disability and exposure.

RTA (Road Traffic Accidents)

Road traffic accidents are most common emergency condition we face every day. Most of the RTA involves either external or internal organ damages. It can present with excessive bleeding or damage to bones or delicate organs like eyes or brain. One of the most common causes of a road accident death is due to loss of oxygen supply. This is mostly caused by a blocked airway. Normally it takes less than 4 min for a blocked airway to cause death ⁽³⁾. Hence the golden-hour (first hour after trauma) is given utmost importance.

Public measures:

• Call emergency services firsthand
• Control bleeding by covering the wounds with a wet cloth
• To prevent post-traumatic wound infections, cover the wound with gauze-piece with povidone iodine if available.
• Try keeping the body of the patient in normal supine or prone position if there are no major fractures involved.

Snake Bite

90-95% of snakes found in India are non-poisonous. The most common poisonous snakes in India are Cobras (King Cobra) and Viperine snakes (Russell’s viper, Saw-scaled viper).

In case of snake bite:

• Try to identify the snake based on its skin and pupil⁽³⁾. Correct identification of the snake plays utmost important role in local management of snake bite since treatment approach to cobra bite or viper bite differs a lot.

Since Cobra venom is Neurotoxic, it mainly affects the Central Nervous System starting from peripheral nerves. Hence, in case of Cobra bite, tie a tight knot 4-5 cm above the location of bite.

Venom of Viperine snakes is Hemotoxic; it mainly affects the blood and causes hyper coagulation. Hence, typing a knot in case of Viper bite will leave no option but amputation of the remaining part. Hence, DONOT tie anything tight in case of viper bite, just cover the wound with a loose cotton cloth.

• Since the venom spreads by circulatory system, do not panic, or else the spread of venom in blood gets accelerated.

Obstetric Emergencies, Emergency Labour & Delivery at Home

A number of obstetric conditions like Ectopic pregnancy, placenta previa, pre-eclampsia and placental abruption requires emergency delivery and treatment of complications.

Apart from these, in the rural and tribal areas where the medical facilities aren’t easily approachable, delivery of the baby at home may be a pre-requisite.

In such situation, the following steps need to be taken:

• In the first stage of labour, make the mother sit comfortably on bed with cushions and gently massage her back and lower abdomen.
• In second stage of labour, mother will want to push, hence make sure her surroundings are free of infection and motivate her.
• Once the baby is delivered, handle the baby with care and clamp & cut the umbilical cord with utmost care and free of infection.
• If by chance, the baby doesn’t cry, try to maintain the airway and make the baby breathe.

 Stroke

It’s an extreme emergency medical condition. Stroke is mainly of three types:

• Ischemic Stroke (Blocked artery which causes Reduced Blood flow)
• Hemorrhagic Stroke (Bursting of a blood vessel)
• TIA (transient ischemic stroke) – temporary disruption of blood flow.

Symptoms of stroke depend upon the affected area of hemorrhage or ischemia. However WHO has defined FAST symptoms ⁽⁴⁾ in case of stroke as

F – Drooping of face

A – Arm weakness

S – Speech difficulty

T – Time to call emergency services

Here, the Golden hour plays a vital role in saving a patient’s life, hence symptom identification is necessary.

Myocardial Infarction

MI, commonly known is heart attack is reduction or stoppage of blood flow to myocardium. This causes excessive pain and tightness in the chest. The pain is described as choking sensation in the chest radiating to medial border of left arm or sometimes radiating towards back in females. Here golden hour plays important role.

If person is identified with these symptoms, as layman, giving 325mg Aspirin (acetylsalicylic acid) which suppresses the normal functioning of the platelets and this small step can prove to be lifesaving for heart attack patients.

References

(1)http://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries

(2)http://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

(3)https://www.encyclopedia.com/environment/encyclopedias-almanacs-transcripts-and-maps/cobras-kraits-seasnakes-death-adders-and-relatives-elapidae

(4) http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast

Mr Sneh Sonaiya

(Undergraduate Student) Govt. Medical College, The Maharaja Sayajirao University Of Baroda – Vadodara, Gujarat.