Amanda Wilde (Host): Do you know how you'd react in a medical emergency? Stay tuned for important tips on how to recognize and respond to a variety of situations with emergency medicine physician, Dr. Steve Shelton, Medical Director of Emergency Management at Prisma Health.

Host: This is Flourish, a podcast brought to you by Prisma Health. I'm Amanda Wilde. Dr. Shelton, welcome and thank you for being here.

Dr Steve Shelton: Thank you for having me.

Host: So right off, are there some general rules you can follow when someone is hurt or in an accident or having a medical emergency?

Dr Steve Shelton: Yes, and actually the answer may be a little unusual. The first is you want to make sure that you are safe. And we teach that as scene safety and awareness. So, it's very important that you're monitoring your environment so you don't become a casualty yourself. So, some things to look for specifically in accidents, are there electrical wires down? Is there gas? Is there flames? Maybe in a medical emergency, you have to consider the possibilities of poisons or fumes. So, it's very important that you as a responder do not become a casualty yourself, should be the first thing that you think about.

Host: Already I have learned a hundred percent more than I knew when we just started. Being aware of your environment and looking for those kinds of things as to what's causing the emergency situation. Let's go through a few common scenarios. If someone is bleeding, what do you do?

Dr Steve Shelton: Yes. Your goal is to stop the bleeding, and the first step would be to apply pressure. That would be taking your hand with some type of bandage and putting pressure directly on the wound itself. If you can have the person lie down, relax, that can help in this situation. If that wound happens to be on the extremity, you could raise that extremity above the heart and continue to apply that pressure. So, applying the pressure with bandage, adding additional bandages will be your primary response to this. If this is a wound that is likely arterial, which would show some squirting blood, and you're having difficulty controlling that, if you have access and the training with a tourniquet, we'd recommend that would be your next step for this situation.

Host: Otherwise, you have to go with what you know, right?

Dr Steve Shelton: Exactly. Don't go beyond what you're capable of doing.

Host: How do you know if someone is choking? That's a pretty common scenario.

Dr Steve Shelton: It is, and a very scary scenario. The universal sign for choking is one or two hands around your neck. Often these individuals have a very panicked look. You may notice that they have noisy breathing, or even worse, no breathing at all. So in these individuals, if they are breathing, your first response is to encourage them to cough. Your cough mechanism is much better than anything you can do. So if you can actively encourage them to cough to try to clear their airways. If they reach the point that they're not able to cough, then you would react by providing back blows, which is taking the palm of your hand and striking right between the shoulder blades in an upward motion. You do that about four times. If that doesn't clear the airway, your next response would be a Heimlich maneuver, which is where you reach around the individual with your arms. With a fist, you give an upward movement in the abdomen, again forcing up under the ribcage into the abdomen there four breast blows trying to clear that airway. And you would alternate doing those until whatever foreign body is cleared.

Host: So obviously, it helps if you have had some first aid training.

Dr Steve Shelton: It does, yes.

Host: But even if you haven't, these are some things you can do. Maybe you don't work your way to the Heimlich Maneuver, but you can do those other acts. You can pound on the back and encourage someone to cough.

Dr Steve Shelton: Yes, those first steps, encouraging them to cough. It's often a very panic state, but trying to encourage them to cough and to clear whatever's there is very important.

Host: Now, what if someone is having a heart attack? I would have a hard time knowing if someone's having a heart attack, a stroke or a seizure. How do you tell the difference between those things?

Dr Steve Shelton: Certainly. With the heart attack, classic symptoms are heavy chest pain. Folks often complain of having an elephant sitting on their chest. They may have some difficulty breathing and they're often sweaty. However, in medicine, there are very few things that are a hundred percent or classic, so there's lots of variations to that. Two specific groups which often have very different or atypical symptoms are women as well as diabetics. They will often present with indigestion or nausea or jaw pain as their presentation for a heart attack.

So if you have an individual that you think may be a heart attack, encourage them to sit down, cool off, get some rest. If you have aspirin available, have them chew and swallow an aspirin. If this is an individual who has some known heart disease and actually has been prescribed nitroglycerin, you can assist them with use of their nitroglycerin. Any individual that you think may be having a heart attack, that you activate the 911 system early, because we want to get them prompt relief and support into the hospital as fast as possible.

Host: Yeah. The first thing you want to do is get 911, right, in any of these cases.

Dr Steve Shelton: Yes. If you have a true emergency, yes, you want 911, because most of these have some type of treatment, but it's often time-critical. So yes, activating 911 early is very important.

Host: Yeah, which leads me to stroke, because we all know it's important to get to strokes quickly.

Dr Steve Shelton: Yes, you're exactly right. We often say time is brain. So, it's almost a stroke is defined as like a brain heart attack, so you have to consider that. So, the same urgency in that. We like to use the acronym BEFAST when we're evaluating or encouraging folks to look for strokes. And that acronym stands for B, balance, a sudden change in balance or coordination. E for eyes, sudden blurred double or loss of vision without any pain. F is for face drooping, if you notice that one side of the face starts to droop or feels numb, you can ask the individual to smile and notice they often have a crooked smile. Arm weakness, is there one arm that is weak or numb? You can have them hold up their arms and notice that one does not move as well as the other. S is for speech difficulty. Slurred, hard to understand or unable to speak are important signs here. And then, the last, the T as we talked about, time to call 911. Make sure that that's activated early. There are treatments for stroke, but they're often time-dependent on getting the individual to the hospital as quick as possible.

Host: Is there anything else you can do once you've determined someone's having a stroke, besides calling 911? Once you've done that, what can you do to make that person more comfortable?

Dr Steve Shelton: At this point, it's reassurance. Make sure they don't harm themselves. They're not able to move as they normally would. So, put them in a position where they are comfortable, and not a risk of harm to themselves.

Host: Now, what if someone has fainted or is having a seizure, what do you do in that case?

Dr Steve Shelton: Seizures are very scary, if you are not exposed to them on a regular basis. The good news is most seizures only last a couple minutes. While they seem very scary and very violent, they only last a couple minutes. So, a couple suggestions of things that you want to do for these individuals. First is do not try to hold the person down. That will not stop the seizure and can potentially cause injury to that individual. You often heard of individuals trying to put something in their mouth, to try to keep them from biting their tongue or some of the chewing mechanism that kind of goes on with some seizures, that's also very dangerous. It can impede the individual's airways or potentially harm you, especially if you try to use a finger or something to do that.

The best thing you can do is to try to protect the patient. Move any objects away from them that could harm them. If you're able to, roll them up on their side. They often have some difficulty breathing or often have a lot of spit and saliva associated with the seizure. So if you can roll them up on their side, it makes it much easier for them to breathe and to clear some of those secretions. I would encourage you while a lot of individuals have seizures, most of them are minor and only lasts a couple minutes, but if you have a seizure that goes longer than two minutes or you have multiple seizures, that's definitely a time to call 911 and get some assistance.

Host: What about someone who's fainted? And how do you know if they're still breathing,

Dr Steve Shelton: So as you go up and assess those individuals, you need to look and listen. So, you can look at their chest and see if the chest is rising, you can get your ears very close to their mouth and nose to hear if they're breathing, so that is a first step. If you recognize that an individual is not breathing, then you need to take additional steps, checking to see if they have a pulse. You can feel for a pulse easily by touching just next to the Adam's apple in that little recessed area there, and feel and see if they have a pulse. If you've reached the point that there's no pulse and the patient's not breathing, you need to begin a resuscitation. If you have some first aid experience, some CPR experience, you can initiate CPR. Even if you don't have any significant experience, you can get this individual on their back, tilt their head up so that their airway is open and you can start doing some chest compressions, which is essentially a downward motion on the breast bone or the sternum, trying to get some heart activity. In this point, you got another major emergency, so you want to make sure that the 911 system is activated, so that you've got additional help coming to you. If you happen to have some CPR experience or you happen to be in a public place, have someone look for an AED. We have reached a point where there is more and more public access AED devices out there, which can provide a next level of care for an individual.

Host: AED stands for?

Dr Steve Shelton: It is an automated external defibrillator, which is a device used to shock the heart. It will look for a heart rhythm that requires an electrical shock to get the heart beating normally. These are public access devices, but require training to operate them. It is important to start looking for them and for someone to use it if you do not know how

Host: I do know of a friend who was only in his 30s and he passed out on the basketball court, and they had one of those, and they used it on him and it did save his life.

Dr Steve Shelton: Yes. There are many great positive results and great stories about that, having that access to the public to use. Not many years ago, you'd have to rely on EMS and 911 system making it to you to use a similar device.

Host: Right. Doctor, are there any other common emergencies that you would like to mention that we haven't covered?

Dr Steve Shelton: Yes. There are numerous other emergencies out there, but one I'd specifically like to cover are allergic reactions. Fortunately, many allergic reactions are fairly minor. They're localized and you have a little bit of itching. But some can progress severely to severe emergencies. And those often have facial swelling or mouth swelling, difficulty breathing, patient will often have vomiting. If you reach this scenario, you're in a true emergency for these individuals. If you come upon this person, make sure that you remove them from whatever is causing the allergic reaction if you're able to do that. Sometimes that's some fresh air or something like that to help improve. If they have an own history of allergies, hopefully they have an EpiPen or have been prescribed one, so you can assist them with locating that and assist them with using that EpiPen. If Benadryl is available, that's another good medication to use early on. But again, like most emergencies, if this is a true emergency or you feel this is an emergency, make sure you activate that 911 system early. We want those paramedics and pre-hospital providers on their way to you as quickly as possible to provide any additional support.

Host: What should you do in these situations if you're unsure? Is it better to be more cautious and do less, or is it better to try the things you know?

Dr Steve Shelton: It's a very gray area between an emergency and non-emergency sometimes. What we encourage individuals to do, if you're not sure, again, some of those gray areas, we talked about the heart attacks, the strokes, and some of those others are obviously emergencies. But in those gray areas, if you have a primary care provider, you're able to get in touch with them, they're a great resource for you to ask advice of where you should go to seek help. But if you truly don't have access and you're really unsure, I would suggest erring on the side of caution, and that's a scenario where you would go to an urgent care or an emergency department to be evaluated to make sure you do not have an emergency.

Host: Dr. Shelton, thank you so much for this conversation, preparing us to handle these medical emergencies and just providing heightened awareness on what to look for.

Dr Steve Shelton: Thank you for having me.

Host: That was Dr. Steve Shelton, Medical Director of Emergency Management at Prisma Health. For more information and other health podcasts, visit prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Amanda Wilde. Be well.