1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 9 Emergency Procedures and First Aid

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing an Emergency Emergency situations: –Choking and breathing crises –Chest pain –Bleeding –Shock –Stroke –Poisoning

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing an Emergency Emergency situations: –Burns –Wounds –Sudden illnesses (fainting/falling) –Illnesses related to heat and cold –Fractures

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing an Emergency Act quickly Assess nature of situation Screen situation Assess patient Check for universal emergency medical identification >>

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing an Emergency Primary survey –ABCDEs: Airway, Breathing, Circulation, Disability, Expose and Evaluate

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recognizing an Emergency Blood, body fluids, disease transmission –Always protect yourself and the patient –Establish and follow strict guidelines –Follow Standard Precautions

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Shock –Learn to recognize signs and symptoms –Defined by categories or by underlying cause Cardiogenic Hypovolemic Neurogenic Anaphylactic Septic Respiratory Traumatic

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Wounds –Open Minor tears in skin or more serious breaks All represent opportunity for infection Tetanus injection may be indicated

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Wounds –Types of open wounds Abrasions Avulsions Incisions Lacerations Punctures

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Types of bandages –Spiral –Figure-eight Tubular gauze bandage >> Commercial arm sling >>

24. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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

27. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Musculoskeletal injuries –Sprain 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Musculoskeletal injuries –Dislocations Painful; separation of bone from its normal position Treated urgently Require x-rays or MRI

30. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Caring for muscle, bone, joint injuries –Rest –Some motion –Elevation of injured part –Immobilization –Application of ice to injury –Call EMS

33. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Heat-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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies Poisoning –Can enter body in four ways: Ingestion Inhalation Absorption Injection

35. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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

41. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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

42. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Control of Bleeding

43. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Breathing Emergencies and Cardiac Arrest Rescue breathing –Previously called mouth-to-mouth resuscitation –Provide oxygen until emergency personnel arrive –Resuscitation mouthpieces recommended

50. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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

51. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Safety and Emergency Practices Mass disasters –Floods –Hurricanes –Tornadoes –Tsunamis –Earthquakes –Explosions –Structural collapses –Transportation accidents –War or terrorism

52. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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