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Dealing with the stubborn family member
Consider the following situation. You have been out for the evening; say to a meeting.
Coming home, you find a family member sitting on the couch. Rugged up for bed but it’s still a few hours from their normal bedtime. Their face is pale. Occasionally they give a small shudder but they greet you with their normal smile.
You know something is up. They’ve had a shower, there is a rug in their lap and the house is overly warm.
“I’m alright… Now,” they say. Sigh! “What happened?” you ask.
The family member tells you that they have been vomiting, feel light-headed, are thirsty, and nauseated. Oh and to top it all off, they fainted not long ago and believe they had been unconscious for a few seconds. You notice a small lump above their left eye which has not even begun to bruise yet.
What are your thoughts? What questions are going through your mind? You need to make some assessments but it is important not to get ahead of yourself. Before you help someone out, you need to determine what actually happened.
Do your primary survey. You remember what that is, don’t you? Of course you do and because they are talking to you, Primary Survey is done. Move on.
Now we need secondary survey. Your “head to toe” examination, Vital Signs Survey and questioning are all important in determining what is going on with this casualty.
Nothing appears obviously wrong with them, right? Perhaps. Look closely at how they look, sit and breath.
My key indicator that something is wrong is the loss of consciousness. With me, there is no argument. Off to hospital we go. “No! It’s not that serious,” they say. Think back in your training to the effects and potential injuries from head injuries. (Note the small lump over their left eye.) Backwards and forwards the discussion goes for some time about going/not going to hospital.
Funny how the same instruction from a health professional will be treated differently. Even if you do actually know what you are talking about. Persist with convincing the family member to go for medical assessment. If it’s not apparently too serious, try the likes of Nurse on Call (in Victoria) but if you have any concerns, ring triple zero straight away.
Never take head injuries, loss of consciousness or fainting for unknown reasons lightly.
Not just a bump on the head
When it comes to head injuries, we often dismiss a whack to the head as a tad embarrassing. Certainly they may be of no significance but they should never be underestimated.
Elderly casualties may, however, be at risk of greater injury from seemingly simple events. Sports players, being at a high risk of multiple blows, also are potential candidates for harm. Young children are often bumping into things. Really, when you think about it, we are all at risk.
Apart from my pet bugbear of the now rare situation of sports players being sent back onto the ground after being struck in the head, any one with first aid training should consider what they may be presented with. BTW, rural sports teams are unlikely to have a neurologist or GP on staff although it may be possible.
Understand the incident and what happened to the patient. Consider the mechanism of injury applied to the casualties body and what it may have done to the brain. Be wary of the potential of spinal insults along with the impact to the head.
Any loss of consciousness should be considered an immediate cause for professional medical assessment; even if it is for a few seconds. Use your questioning techniques to determine if the patient remembers hitting the ground, for example. Ask open ended questions rather than yes/no ones. Allow the casualty to show you how alert they are.
Fluid loss from eyes, ears or nose are immediate causes for concern along with blood loss on the outside of the scalp or bruising under the skin. Treat any casualty with bruising behind the ears combined with bruising under the eyes and/or fluid loss as potential spinal injuries.
Watch for nausea, vomiting, seizures or reports of seizures before you get to them, depressed breathing rates, slow heart rates, loss of or reduced sensation, headaches, drowsiness, or difficulties with vision. There are a range of other things and your first aid instructor will be able to help you recognise them.
All are causes for concern and require immediate assessment. Don’t ever worry if you have been over cautious. There is an old and valid saying “treat for the worst, hope for the best.” Meaning if you treat for the worst case scenario and it’s not that bad then you will have still done your very best for them.
Stay calm, remember your DRSABCD and you will be well on your way.