Malaise medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
The following step depends on the organization of the emergency medical assistance. Some countries provide free medical advice by phone (e.g., SAMU in France): it is then useful to call this service to know what to do. Otherwise, it is useful to contact the usual general practitioner of the person, to get his or her advice, or any medical or paramedical professional at least. The bystander who calls must mention all the elements collected so far. When it is not possible to contact the individual's primary-care physician, it is then necessary to assess the situation in order to decide whether it is necessary to call an ambulance.
Medical Therapy
Some specific situations require specific actions:
- The person is a casualty of an accident: the malaise is likely to be related to a physical trauma, the person should only be touched by professionals, except immediate danger (e.g. fire hazard, bleeding that must be stopped…); this is a life threatening situation (even if the casualty is conscious), which requires an immediate call for help;
- In case of chest pain or respiration difficulties, the most comfortable position is usually seated or half seated (back at 45°), because the weight pulls the viscera down, allowing the lungs to develop downwards (pushing the diaphragm), and it reduces the blood pressure inside the chest (pulmonary hypertension);
- In case of stomach pain, the most comfortable position is often with the thighs perpendicular to the body (this relaxes the abdominal muscles); this can be done with a lying person by lifting the legs and placing them on a chair, the bystander can also kneel besides the person and support his or her legs;
- When the person has a medical treatment for this situation, it is necessary to help this person taking the medication; this includes sugar for some diseases; otherwise, a non medical bystander should never propose food, drink or any medication;
- A pregnant woman should be laid on her left side, in order to release the pressure on the inferior vena cava);
- The person falls unconscious: this is a life threatening situation which requires immediate action (recovery position if the person breathes, cardiopulmonary resuscitation otherwise);
An important point is to watch the person until he or she recovers or the arrival of the ambulance, for the situation is likely to worsen.
See also First aid and Emergency action principles.
The first responder response is not very different from the first aid response. The assessment is completed by (according to the education and the available equipment):
- Measurement of the respiration frequency; mechanical ventilation should be performed if the person has 6 spontaneous breathings per minute or less;
- Checking the pulse: on a resting adult in good health, a pulse above 120 bpm or below 40 bpm is a severe warning; it is also important to check whether the radial pulse can be detected on both arms;
- Measurement of the blood pressure;
- Measurement of the blood oxygenation (with a pulse oximeter);
- Measurement of the glycemia (portable glucometer);
- Asking the bystanders or relatives for any details; at home, looking for empty medication packing (besides the patient, in the trash, in the toilets, in the bathroom).
Oxygen first aid is recommended for any sign of severity, or in any doubt. Although oxygen is considered as a medication in some countries, it is harmless (humans do breathe 21% of oxygen). There is controversy about patients suffering chronic respiratory insufficiency, and the so-called "paradoxical effect" of oxygen: the patient's body is used with oxygen lack and a massive saturation can lead alter the spontaneous breathing. However:
- This situation is not likely to happen until a few hours of pure oxygen breathing, which is far beyond the intervention time of first responders;
- It is the lack of oxygen that kills, especially in case of respiratory insufficiency;
- In case of doubt, the first should contact a medical authority to have instructions; in the meanwhile (few minutes), the patient can be put under oxygen inhalation without risk.
Even when it is not necessary, the oxygen breathing can have a placebo effect; on the contrary, the mask can cause a stress and be detrimental, it is thus necessary to explain the acts that are performed and to accept if the patient refuses.
Any other action should be performed only after a contact (by radio or by phone) with a medical authority (medical regulation).