1. Emergency Procedures and First Aid
Chapter 9
Emergency Procedures and First Aid

2. Recognizing an Emergency
Definition
Any instance in which individual suddenly becomes ill and requires immediate attention
Signs of emergencies
Use your senses; be sensitive for strange behavior
First aid
Designed to render immediate and temporary care to persons injured before arrival of health care practitioner

3. Recognizing an Emergency
Emergency situations:
Choking and breathing crises
Chest pain
Bleeding
Shock
Stroke
Poisoning

4. Recognizing an Emergency
Emergency situations:
Burns
Wounds
Sudden illnesses (fainting/falling)
Illnesses related to heat and cold
Fractures

5. Recognizing an Emergency
Act quickly
Assess nature of situation
Screen situation
Assess patient
Check for universal emergency medical identification >>
[FIGURE 9-1]
(See Table 9-1: Examples of Emergency Categories)

6. Recognizing an Emergency
Primary survey
ABCDEs: Airway, Breathing, Circulation, Disability, Expose and Evaluate
[FIGURE 9-2A and FIGURE 9-2B]

7. Recognizing an Emergency
Using the 911 or EMS system
Emergency Medical Services (EMS) system: local network of police, fire, medical personnel trained to respond to emergency situations
Network activated by calling 911

8. Recognizing an Emergency
While waiting for EMS to arrive, check for following signs:
Degree of responsiveness
Airway/breathing ability
Heartbeat (rate and rhythm)
Bleeding
Signs of shock
Monitor vital signs
Keep patient warm

9. Recognizing an Emergency
Good Samaritan laws
Provide some degree of legal protection to health care professional who offers first aid
Generally protect off-duty health care professionals
Primary principle of first aid is to prevent further injury
Conditions of law vary from state to state

10. Recognizing an Emergency
Blood, body fluids, disease transmission
Always protect yourself and the patient
Establish and follow strict guidelines
Follow Standard Precautions

11. Preparing for an Emergency
Develop in-office handbook of policies and procedures
Keep telephone numbers for local EMS and poison control center posted
All personnel trained in first aid and CPR

12. Preparing for an Emergency
Proper documentation after any emergency situation
Keep office environment safe
Floors and corridors clean
Wipe up spills immediately to prevent falls
Medications out of sight

13. Preparing for an Emergency
Medical crash tray or cart
Carefully controlled inventory of supplies and equipment
Supplies customized to facility and type of emergencies frequently encountered
List of general supplies
[FIGURE 9-3]

14. Common Emergencies Shock
Condition in which circulatory system is not providing enough blood to all parts of body, causing body’s organs to fail to function properly
Always life-threatening
Activate EMS

15. Common Emergencies Shock Learn to recognize signs and symptoms
Defined by categories or by underlying cause
Cardiogenic
Hypovolemic
Neurogenic
Anaphylactic
Septic
Respiratory
Traumatic
(See Table 9-2: Common Types of Shock with Descriptions)

16. Common Emergencies Treatment for shock
Shock is progressive; if not treated immediately, most types can be life threatening
Treat underlying causative factors
Activate EMS

17. Common Emergencies Wounds Closed Have no break in skin
Do not usually present emergency situation
Bruise, contusion, hematoma common
RICE and MICE procedures: Rest or Movement, Ice, Compression, Elevation

18. Common Emergencies Wounds Open
Minor tears in skin or more serious breaks
All represent opportunity for infection
Tetanus injection may be indicated

19. Common Emergencies Wounds Types of open wounds Abrasions Avulsions
Incisions
Lacerations
Punctures

20. Common Emergencies Use of tourniquets in emergency care
“Constriction band” now substituted for tourniquet and is widely used
Applied tightly enough to stem rapid loss of blood but loosely enough to allow small amount of blood to continue to flow
If bleeding controlled, direct pressure still best method to handle blood loss

21. Common Emergencies Dressings and bandages
Critical to dress and bandage open wound to curtail infection
Dressings
Sterile gauze pads placed directly on wound
Bandages
Nonsterile wraps placed over dressings

22. Common Emergencies Dressings and bandages
Bandage application can take many shapes and forms, depending on type of injury and injury site
Avoid too tight or too loose a wrap

23. Common Emergencies Types of bandages Spiral Figure-eight
Tubular gauze bandage >>
Commercial arm sling >>
[FIGURE 9-8 and FIGURE 9-9]

24. Common Emergencies Burns
Caused by heat, chemicals, explosions, electricity, solar radiation
Critical burns can be life threatening and require immediate medical attention
Breathing difficulty
Cover more than one body part
Head, neck, hands, feet, genitals
Any burns to child or older adult (other than minor burns)

25. Common Emergencies Burns Degrees of burns First-degree
Superficial; top layer of skin
Second-degree
Skin red and blisters appear; very painful
Third-degree
Affect or destroy all layers of tissue; fat, muscles, bones, nerves
Can look charred or brown
Great pain or, if nerve endings destroyed, burn may be painless

26. Common Emergencies Rule of nines
Estimating percent of body surface areas burned
Treatment for burns depends on type of agent causing burn
Know general treatment strategies
[FIGURE 9-10A]
(See Table 9-3: First Aid for Burns)

27. Common Emergencies Musculoskeletal injuries Not life threatening
Painful
If not properly treated, can be disabling
Spinal cord injuries can be quite serious and result in paralysis

28. Common Emergencies Musculoskeletal injuries Sprain Strain
Injury to joint (ankle, knee, wrist); tearing of ligaments
Rapid swelling, discoloration at site, limited function
Treat with RICE or MICE method
Strain
Overuse or stretching of muscle, tendons, group of muscles
Applications of ice and heat as well as rest
Slings, crutches, removable splints help protect injury

29. Common Emergencies Musculoskeletal injuries Dislocations
Painful; separation of bone from its normal position
Treated urgently
Require x-rays or MRI

30. Common Emergencies Musculoskeletal injuries Fractures: break in a bone
Open: open wound; characterized by protruding bone
Closed: skin not broken
Incomplete or greenstick
Simple
Compound
Impacted
Comminuted
Spiral
Depressed
Colles

31. Common Emergencies Assessing injuries to muscles, bones, joints
Note extent of bruising and swelling
Pain is signal of injury
Noticeable deformity to bone or joint
Use of injured area limited
Talk to patient

32. Common Emergencies Caring for muscle, bone, joint injuries Rest
Some motion
Elevation of injured part
Immobilization
Application of ice to injury
Call EMS
(See Procedure 9-2: Applying an Arm Splint)

33. Common Emergencies Heat-related illnesses Cold-related illnesses
Heat cramps (least serious)
Heat exhaustion (more serious)
Heat stroke (least common, most dangerous)
Cold-related illnesses
Frostbite (affects extremities)
Hypothermia (serious; can result in death)

34. Common Emergencies Poisoning Can enter body in four ways: Ingestion
Inhalation
Absorption
Injection

35. Common Emergencies Poisoning
Signs and symptoms: dyspnea, nausea and vomiting, confusion, convulsions
Call poison control center or local emergency number
Activated charcoal may be prescribed
In most poisoning cases, there are specific antidotes
No specific treatment; symptoms treated
Treatment varies according to source of poisoning

36. Common Emergencies Poisoning Insect stings
Localized swelling, tenderness, slight redness
Remove stinger by scraping with something rigid (credit card)
May cause allergic reaction or hypersensitivity
Epinephrine may be prescribed to patients with known allergic reactions (EPIPEN)

37. Common Emergencies Poisoning Snake bite Most snakes not poisonous
Poisonous snakes: rattlesnake, copperhead snake, cottonmouth water moccasin, coral snake
Signs and symptoms: rapid pulse, nausea and vomiting, severe pain, swelling, blood and fang marks at wound site, convulsions, thirst, diaphoresis

38. Common Emergencies Sudden illness Fainting (syncope)
Loss of consciousness caused by insufficient supply of blood to brain
If patient feels faint, have individual lie down or sit with head level with knees
If patient faints, lower patient to flat surface, loosen tight clothing, check breathing, apply cool compresses to forehead
May indicate complex medical condition

39. Common Emergencies Sudden illness Seizures (convulsions)
When normal brain functioning disrupted
Caused by fever, diabetes, infection, brain injury, epilepsy, other conditions and diseases
Patient should never be restrained
Treat patient with compassion
Protect patient from injury
Determine if EMS should be called

40. Common Emergencies Sudden illness Diabetes
Inability of body to properly convert sugar from food into energy
Body does not produce insulin at all or does not produce enough
Type 1 (insulin-dependent)
Type 2 (noninsulin-dependent)
Diabetic coma and insulin shock or reaction may occur
(See Table 9-4: Causes and Symptoms of Diabetic Coma and Insulin Shock)

41. Common Emergencies Sudden illness Hemorrhage
External bleeding: capillary, venous, arterial bleeding
Epistaxis (nosebleeds)
Internal bleeding
Minor or serious depending on cause of injury
Important to recognize signs and symptoms
Stay with patient and have someone call EMS
(See Procedure 9-1: Control of Bleeding)

42. Control of Bleeding
[FIGURE 9-13A, FIGURE 9-13B, FIGURE 9-13C]

43. Common Emergencies Cerebral vascular accident (CVA)
Common term is stroke
Result of ruptured blood vessel in brain
Can be caused by occlusion of blood vessel or by a clot

44. Common Emergencies Cerebral vascular accident (CVA)
Numbness in face, arm, leg on one side of body
Loss of vision
Severe headache
Mental confusion
Slurred speech
Nausea, vomiting
Difficulty in breathing and swallowing
Paralysis

45. Common Emergencies Cerebral vascular accident (CVA) Treatment of CVA
Activate EMS; keep patient comfortable
Maintain open airway
Do not give anything by mouth
Monitor vital signs
Immediate emergency care critical

46. Common Emergencies Heart attack
Also known as myocardial infarction (MI)
Usually caused by blockage of coronary arteries
Symptoms: tightness of chest, pain radiating down one or both arms, pain radiating into left shoulder and jaw
Signs: rapid and weak pulse, excessive perspiration, agitation, nausea, cold and clammy skin
Symptoms in women may or may not be similar to men

47. Common Emergencies Heart attack Contact EMS immediately
Keep patient comfortable
Prepare to give oxygen and medications (aspirin)
Cardioversion or defibrillation may be necessary with AED
Begin CPR if necessary

48. Breathing Emergencies and Cardiac Arrest
When patient stops breathing, give artificial or rescue breathing immediately
Give chest compressions with rescue breathing (CPR) if patient has breathing emergency and cardiac arrest

49. Breathing Emergencies and Cardiac Arrest
Rescue breathing
Previously called mouth-to-mouth resuscitation
Provide oxygen until emergency personnel arrive
Resuscitation mouthpieces recommended

50. Breathing Emergencies and Cardiac Arrest
Cardiopulmonary resuscitation (CPR)
Combination of rescue breathing and chest compressions
Preliminary care until advanced medical help available
CPR plus shock with AED treatment for cardiac arrest
Early recognition, calling EMS, immediate CPR can double or triple victim’s chances of surviving
(See Table 9-5: Summary of American Heart Association 2010 CPR Guidelines)

51. Safety and Emergency Practices
Mass disasters
Floods
Hurricanes
Tornadoes
Tsunamis
Earthquakes
Explosions
Structural collapses
Transportation accidents
War or terrorism

52. Safety and Emergency Practices
Assisting at local shelters
Using first aid and CPR skills
Helping at clinic or hospital
Giving injections for mass immunizations
Supporting providers
Working with American Red Cross
Giving emotional support

53. Safety and Emergency Practices
Be prepared to respond to emergency in medical office or home environment
Medical Reserve Corps (MRC) volunteer units assigned to specific areas