Incidents and Emergencies Chapter 12 Incidents and Emergencies

Explain basic, immediate actions and initial treatment needed for selected types of patient injury or acute illnesses Differentiate between heat exhaustion and heat stroke through the observation of signs and symptoms and apply appropriate treatment Differentiate between an insulin reaction and acidosis through the observation of signs and symptoms and apply appropriate treatment Chapter Objectives

Chapter Objectives (cont’d) Differentiate between autonomic hyperreflexia and postural (orthostatic) hypotension through the observation of signs and symptoms and apply appropriate treatment Analyze patient care activities and determine the need to modify, reduce, or discontinue treatment Chapter Objectives (cont’d)

Preparing Crash carts Emergency evacuations Bomb threats Terrorist treats various codes Preparing Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.

Emergency Care: Support Devices Bandage materials Types Triangular-https://www.youtube.com/watch?v=As3r-eVprDE Cravat-https://www.youtube.com/watch?v=cFkGN-FQdF4 Ankle wrap Protective splints, sleeves, and slings Emergency Care: Support Devices

How do you respond? Allergic Reactions Mild/Moderate Itchy skin Rash Itchy eyes Sneezing Hives Severe Swelling of face/mouth Difficulty swallowing/speaking Wheezing Abdominal pain, vomiting Dizziness How do you respond? Allergic Reactions

Your patient just arrived for therapy and told you they had a great lunch at Panera. A few minutes later you notice the patient wheezing, and their mouth is starting swell. What is happening? What do you do? Patient case Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.

Reduce or remove cause and prevent or reduce extent of physiologic state of shock Signs/symptoms: Pale, moist, cool skin Shallow and irregular breathing Dilated pupils Weak and rapid pulse Diaphoresis Dizziness or nausea Syncope Treatment- remedy cause if able, place in supine head slightly lower than LEs, cool compress, avoid exertion, Shock

Orthostatic (Postural) Hypotension Most frequently occurs when one attempts to stand quickly Signs/symptoms: Dizziness or nausea Syncope Place in supine position or reclined until symptoms subside May need lower extremities ace wrapped or full body compression suit. Orthostatic (Postural) Hypotension

Falls Common occurrences in daily lives Joint Commission safety goal Causes: Risk-related activities Carelessness Ill health Process of aging See Box 12-3 for human factors vs environmental Common tests used in PT to determine fall risk Berg balance, timed up and go, tinetti Falls

What factors would be appropriate when educating a patient on fall prevention? Think-write-share Patient Education Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.

Protect fracture site and avoid further injury, prevent shock, reduce pain, and guard against wound contamination See Procedure 12-5 pg 340 Fractures

Burns Prevent wound contamination, relieve pain, and prevent shock See Procedure 12-6 pg 341 Burns

Convulsions/Seizures Protect person from injury Provide for person’s modesty and privacy Do not place anything in the mouth Do not restrain person or limbs Respiration rate may change or cease for 50-70 seconds When convulsions subside position with head to one side in case occurs See Procedure 12-7 pg 341 Convulsions/Seizures

Heat-Related Illnesses Heat Exhaustion Heat Stroke Least threatening to life Cause: hot, humid environment; vigorous physical activity; dehydration; depleted body electrolytes See Procedure 12-9 Medical emergency Cause: hot, humid environment; vigorous physical activity; dehydration; depleted body electrolytes See Procedure 12-10 Heat-Related Illnesses

Problem Solving Refer to pg. 347 problem #1 Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.

Insulin-Related Illnesses Hypoglycemia Hyperglycemia Too much systemic insulin, too little food intake, or excessive exercise Provide some form of sugar Too little systemic insulin, intake of too much or improper food, or insufficient physical activity Can lead to diabetic coma or death Medical emergency Do NOT give sugar Insulin-Related Illnesses

Patient Case Which is more serious hypoglycemia or acidosis? What would you do if you entered a patient room for their PT session and noticed a fruity breath odor. They reported feeling too tired for therapy today? Can you give a patient with diabetes juice if you notice signs of low blood sugar? Patient Case Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.

Autonomic Hyperreflexia (Dysreflexia) in Spinal Cord Injury Determine and remove noxious stimulus Most common in pt with new SCI to T6 level Signs/symptoms: severe hypertension, bradycardia, profuse diaphoresis, pounding headache, red skin blotches, and piloerection (goose bumps) Person may convulse, have difficulty with respiration, or lose consciousness Causes: urine retention/kink in line,fecal impaction, open pressure ulcers, tight straps, localized pressure, or exercise See Procedure 12-11 for treatment Autonomic Hyperreflexia (Dysreflexia) in Spinal Cord Injury

http://quizlet. com/17112483/test http://quizlet.com/17112483/test?mult_choic e=on&prompt-with=2&limit=16 #2 pg 347 Problem solving Copyright © 2013, 2008, 2002, 1999, 1994 by Saunders, an imprint of Elsevier Inc.