Transcript Emergency Preparedness and First Aid

CHAPTER
12
Emergency
Preparedness and
First Aid
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-2
Learning Outcomes
12.1 Discuss the importance of first aid during a
medical emergency.
12.2 Describe the purpose of the emergency
medical services (EMS) system and explain
how to contact it.
12.3 List items found on a crash cart or first-aid
tray.
12.4 List general guidelines to follow in
emergencies.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-3
Learning Outcomes (cont.)
12.5 Compare various degrees of burns and their
treatments.
12.6 Demonstrate how to help a choking victim.
12.7 Demonstrate cardiopulmonary resuscitation
(CPR).
12.8 Demonstrate four ways to control bleeding.
12.9 List the symptoms of heart attack, shock, and
stroke.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-4
Learning Outcomes (cont.)
12.10 Explain how to calm a patient who is under
extreme stress.
12.11 Discuss ways to educate patients about
ways to prevent and respond to
emergencies.
12.12 Describe your role in responding to natural
disasters and those caused by humans.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-5
Introduction
• Emergencies
– Acute illnesses
– Acute injuries
– Phone calls from
patients with urgent
problems
– Disasters
The medical assistant must be prepared to determine
the urgency of and handle any emergencies that
arise
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-6
Understanding Medical Emergencies
• Any situation in which a person becomes
ill or sustains an injury requiring immediate
care
• Prompt action may prevent disability or
death
• Can occur within or outside the healthcare setting
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-7
Understanding Medical Emergencies
• Quick response using
first aid is vital
• First aid can
–
–
–
–
Save a life
Reduce pain
Prevent further injury
Reduce risk of
permanent disability
– Increase the chance
of early recovery
• Patient education
– First aid
– Proper way to respond
in an emergency
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-8
Apply Your Knowledge
Why is it important to perform first aid in a
medical emergency?
ANSWER: First aid can:
 Save a life
 Prevent further injury
 Reduce pain
 Reduce risk of permanent disability
 Increase the chance of early recovery
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-9
Preparing the Office for Emergencies
•
Establish roles
•
Post emergency telephone numbers
–
–
–
–
•
EMS if different than 911 – Women’s shelter
Fire
– Rape hotline
Police
– Drug and alcohol
center
Poison control
Crash cart – rolling cart with emergency
supplies and equipment
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-10
Preparing the Office (cont.)
•
Provide information to EMS
–
–
–
–
–
–
Your name and location
Nature of the emergency
Number of people needing help
Condition of the injured or ill patient(s)
Summary of the first aid already given
Directions to your location
Do not hang up until the dispatcher gives
you permission to do so.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-11
Preparing the Office (cont.)
• Emergency and first-aid
supplies
– Crash cart/tray
• Basic drugs, supplies, and
equipment for medical
emergencies
• First-aid kit for minor injuries
and ailments
– Must be routinely checked
and restocked
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-12
Guidelines for Handling Emergencies
•
A medical emergency requires certain steps
– Medical assistant provides only first aid
•
Patient emergencies
– Assess the situation
– PPE
– Assess patient
•
Six steps to initial assessment
1. General impression
2. Level of responsiveness
3. Assess ABCs
4. Urgency of condition
5. Focused exam
6. Document
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-13
Handling Emergencies (cont.)
• Telephone emergencies
– Triaging
• Classification of injuries according to severity,
urgency of treatment, and place for treatment
• Follow office protocols
– General guidelines
• Stay calm
• Reassure the patient
• Act confidently in an organized manner
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-14
Handling Emergencies (cont.)
• Personal protection
– Take precautions to reduce chance of
exposure during an emergency
– Follow Standard Precautions
– Keep personal protective
equipment in first-aid kit
at home and work
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-15
Handling Emergencies (cont.)
• Documentation
– Assessment
– Treatment given
– Patient response
– If patient transported, location
of facility
– Date, time
– Signature, credentials
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-16
Apply Your Knowledge
What are the steps of the initial assessment of a
patient in an emergency?
Correct!
ANSWER: The steps of the initial assessment are:
1. Form a general impression of the patient
2. Determine the patient’s level of responsiveness
3. Assess ABCs
4. Determine the urgency of condition
5. Perform a focused exam (head to toe); vital signs; skin
color
6. Document findings/report to physician or EMT
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-17
Accidental Injuries
• Injuries requiring emergency
treatment
–
–
–
–
–
–
Bites and stings
Burns
Choking
Ear and eye traumas
Falls and fractures
Head injuries
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-18
Bites and Stings
• Animal bites
– Bruise, tear, or
puncture
– Cleanse wound, apply
ointment and dry,
sterile dressing
• Insect stings
– Remove stinger, if
present
– Wash area, apply ice
• Snake bites
– Poisonous bite will
need antivenin
– Immobilize and
position below heart
• Spider bites
– Refer patient to
physician
– Wash area, apply ice,
and keep below heart
level
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-19
Burns
• Thermal
– Hot liquids, steam,
flame, etc.
– Water, wet cloth, or
blanket
• Chemical
– Remove chemical
– Wash with cool water
for 15 minutes
– Cover with dry, sterile
dressing
• Electrical
– Entry and exit sites
– Tissue damage along
current’s pathway
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-20
Burns (cont.)
• Classifications of burns
– Severity determined by
•
•
•
•
•
Depth and extent of burn area
Source of burn
Age of patient
Body area burned
Other illness/injuries
– Categories
• Minor
• Moderate
• Major
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-21
Burns (cont.)
• Classifications of
burns
– By depth
• Superficial
• Partial-thickness
• Full-thickness
– Estimation of
extent of a burn
using rule of
nines
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-22
Choking
•
Foreign object or food blocks the
trachea or windpipe
•
Universal sign
– Hand up to throat with a fearful
look
Medical assistants should know first aid for
choking adult, child, or infant!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-23
Accidental Injuries (cont.)
• Ear trauma
– Lacerations, cuts
– Severed ear – wrap
ear and transport with
patient
• Eye trauma
– Falls, blows to eye,
puncture, foreign
objects
– Care depends on
severity
• Falls
– Have patient
examined before
moving
– Stabilize neck if injury
suspected
– Minor falls, notify the
physician; document
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-24
Fractures and Dislocations
• Fracture – break in
the bone
• Sprain – partial
tearing of ligaments
• Dislocation –
displacement of a
bone end from the
joint
• Strain – muscle injury
occurring from
overexertion
• Treatment
– Immobilize
– Ice
– Monitor patient
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-25
Head Injuries
• Concussion – jarring injury of the brain
– Patient may lose consciousness, have temporary loss
of vision, pallor, listlessness, memory loss, or
vomiting
• Severe head injuries – contusions, fractures,
and intracranial bleeding
– May require immediate hospitalization and/or CPR
• Scalp hematoma and laceration – blood under
the skin or break in the skin
– Control swelling with ice
– Control bleeding with direct pressure
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-26
Hemorrhaging
•
Heavy or uncontrollable bleeding
– Internal – keep patient warm,
quiet, and calm, and get
medical help
– External
•
•
Use direct pressure, apply
additional dressing as needed
Elevate body part, put pressure on nearest
pressure point between wound and heart
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-27
Multiple Injuries
• Often the result of automobile accident or
fall
• Assess ABCs, perform CPR if needed
– Only perform first aid after ABCs ensured
– Treat most life-threatening injuries first
• Notify EMS/physician
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-28
Poisoning
•
Substance that produces harmful
effects if it enters the body
– Majority of accidental poisonings
happen in children under age 5
– Post poison control center
number
– Patient education – prevention
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-29
Poisoning (cont.)
• Ingested poisons
– Only induce vomiting if directed
– Position patient on left side
– Send poison container with patient
• Absorbed poisons
– Remove contaminated
clothing
– Wash skin, alcohol,
rinse
• Inhaled poisons
– Get to fresh air
– Loosen clothing
– Check ABCs
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-30
Weather-Related Injuries
• Hypothermia
– Body temperature
below 95º
– Move patient inside,
cover with blankets,
give warm liquids
• Frostbite
– Ice crystals form
between tissue cells
– Warm with clothing or
other body part
• Heat stroke
– Prolonged exposure to
high temperatures and
humidity
– Move to cool place,
cool with whatever is
available
• Sunburn
– Soak in cool water,
cold compresses
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-31
Open Wounds
• Skin or mucous membrane is damaged
• Incisions and lacerations
– Control bleeding
– Clean and dress
wound
• Abrasion
– Wash with soap and water
– Remove debris, dressing
if needed
• Amputations
– Elevate extremity
– Transport body part
with patient
• Punctures
– Clean, dress
– Tetanus toxoid
immunization
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-32
Closed Wounds
• Injury occurring inside the
body without breaking the
skin
• Caused by blunt trauma
• Contusions – bruises
– Cold compresses
– Color changes are normal
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-33
Yeah!
Apply Your Knowledge
1. What is the universal sign of choking?
ANSWER: The patient holds his hand to his throat and looks afraid.
2. A patient arrives at the clinic with severe hemorrhaging
from the left thigh. What steps should you take to control
the bleeding?
ANSWER: The steps are:
1. Apply direct pressure with sterile gauze
2. Add additional dressing as necessary
3. Elevate the leg
4. Apply pressure to the left femoral artery
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-34
Common Illnesses
• Abdominal pain – a
variety of causes
• Asthma – spasmodic
narrowing of bronchi
• Dehydration – lack of • Diarrhea – can result
adequate water in the
in dehydration and
body
electrolyte imbalance
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-35
Common Illnesses (cont.)
• Fainting (syncope) –
partial or complete
loss of consciousness
• Nosebleed –
epistaxis
• Fever – usually
indicates infection
• Tachycardia – heart
rate greater than 100
bpm
• Hyperventilation –
breathing too rapidly
and too deeply
• Vomiting – can result
in dehydration and
electrolyte imbalance
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-36
Apply Your Knowledge
Matching:
ANSWER:
___
B Syncope
A. Nosebleed
___
D Pulse > 100 bpm
B. Fainting
F Spasmodic narrowing of bronchi
___
C. Dehydration
___
E Dehydration and electrolyte imbalance D. Tachycardia
___
A Epistaxis
E. Diarrhea/vomiting
___
G Rapid and deep breathing
F. Asthma
___
C Lack of adequate water
G. Hyperventilation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-37
Less Common Illnesses
• Anaphylaxis
– Severe, life-threatening allergic reaction
– Check ABC’s, perform CPR if needed
• Bacterial meningitis – usually a complication
of another bacterial infection
• Diabetic emergencies
– Insulin shock – severe hypoglycemia
– Diabetic coma – severe hyperglycemia
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-38
Less Common Illnesses (cont.)
• Gallbladder attack –
inflammation of the
gallbladder due to
obstruction of cystic duct
• Heart attack
– Myocardial infarction
– Chest pain –
cardinal symptom
– Cardiac arrest –
ventricular
fibrillation
• Hematemesis –
vomiting blood
• Obstetric
emergencies – office
protocols
• Respiratory arrest
– May follow distress
– Assess ABCs, perform
CPR, if needed
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-39
Less Common Illnesses (cont.)
• Seizures
– Convulsions
– Patient safety a
priority
• Shock
– Life-threatening
state related to
failure of the
cardiovascular
system
– Hypovolemic
shock
– Septic shock
• Stroke –
cerebrovascular accident
due to impaired blood
supply to brain
• Toxic shock
syndrome – acute
bacterial infection
originating in the uterus
• Viral encephalitis –
inflammation of the brain
due to a virus
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-40
CPR
• Provides ventilation and
circulation for an arrest victim
• Assess responsiveness, call EMS (911)
• Assess ABCs
• If available, connect patient to the
automated external defibrillator (AED)
• Start CPR
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-41
Apply Your Knowledge
Matching:
ANSWER:
B Hypo- or hyperglycemia
___
A. Stroke
___
F Myocardial infarction
B. Diabetic emergencies
D Vomiting blood
___
C. Seizures
___
A Impaired blood supply to brain
D. Hematemesis
___
C Convulsions
E. Shock
___
E May be hypovolemic or septic
F. Heart attack
S
U
PE
R!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-42
Common Psychosocial Emergencies
• Alcohol, spousal,
child, and elder abuse
– Report per state law
– Provide information on
community resources
• Violent behavior
– Office protocols
– Document
• Overdose on drugs
– Requires emergency
care
– Call EMS
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-43
Common Psychosocial Emergencies (cont.)
• Suicide
– Allow patient to
verbalize
– Report suspicions to
physician
– Always take patient
seriously
• Rape
– Provide privacy
– Contact authorities
and local rape hotline
– Follow protocol for
chain of custody of
specimens
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-44
Apply Your Knowledge
Mrs. Jamison tells you that she is very tired of being ill and
often thinks of “ending it all.” She then laughs and says she
was just kidding. What is/are your responsibilities in this
matter?
ANSWER: You should allow her to talk about her feelings and
despite the fact that she said she was “just kidding” you should
take her seriously. The physician should be told of her comments.
You may be asked to provide her with information on community
services available. You should document her comments and your
actions.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-45
The Patient Under Stress
• People react
differently to
emergency situations
– Detect stress
•
•
• Challenges
– Non-English speaking
– Visual impairments
– Hearing impairments
Behavior different
from normal
Unable to focus or
follow directions
• Keep victims and
family calm
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-46
Educating the Patient
• How to prevent and handle medical
emergencies
• Encourage patients and families
to learn first aid and CPR
• Provide first-aid kit checklist
• How to access EMS and to keep emergency
numbers by the phone
• How to childproof homes
• Provide appropriate, easy-to-read handouts
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-47
Apply Your Knowledge
True or False:
ANSWER:
differently
F All people react the same during an emergency.
___
T Patients should be encouraged to learn CPR and first aid.
___
F Challenges to dealing with patients during an emergency
___
include visual and hearing impairments and Englishspeaking people.
___
T Patients should be instructed on how to prevent
emergencies.
___
F It is not important to keep the victim of an emergency
calm.
non-
Very Good!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-48
Disasters
• Be familiar with standard protocols for
responding to disasters
• Participate in fire or other disaster drills to
familiarize yourself with emergency
procedures
• Triage –victims are tagged to classify the
victim
–Emergent – needing immediate care
–Urgent – needing care within several hours
–Nonurgent –needing care when time is not
critical, or dead
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-49
Disasters (cont.)
• Evacuation plans – maps of facility with
escape routes
• Shelter-in-place plans –interior room with
few/no windows
• Plans
– Communication during and after emergency
– Training in procedures and employee roles
– Means of alerting employees
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-50
Disasters (cont.)
• Weather-related
– Community command
post
– Accept assignments
appropriate to abilities
– Document carefully
• Office fires
–
–
–
–
Activate alarm system
Fire extinguisher
Turn off oxygen
Close windows and
doors
– Evacuate
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-51
Disasters (cont.)
• Bioterrorist attack
– Be alert for an
increased incidence of
disease
– Take isolation
precautions
– Use Standard
Precautions
– Inform local health
departments
• Chemical emergency
– Use PPE
– Identify the chemical;
report to local
authorities
– Assist with
decontamination
– Monitor patient
– Document patient care
– Arrange for patient
transport
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-52
Disasters (cont.)
• Mass casualties
– Assess safety
– Report to community
command post
– Triage
– Provide first aid
– Document care
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-53
Bioterrorism
• Intentional release of a biologic agent with
the intent to harm individuals
• Biologic agent = weapon
–Easy to disseminate
–High potential for mortality
–Cause public panic or social disruption
–Requires public health preparedness
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-54
Bioterrorism (cont.)
• Physician’s offices are the front lines
–Individual cases
–Common trends in syndromes/unusual
patterns
• Notify local public health department
of suspected cases
• Follow state and national guidelines
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-55
Apply Your Knowledge
1. What are the categories for triaging patients?
ANSWER: They are: emergent – needing immediate care; urgent –
needing care within several hours; nonurgent – needing care when time
is not critical, or dead
2. What criteria does a biologic agent have to meet to be a
biological weapon?
ANSWER: It must be easy to disseminate, have a high potential for
mortality, cause public panic, and require public health
preparedness.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-56
In Summary
12.1 Prompt and appropriate first aid can safe a life,
reduce pain, prevent further injury, reduce the risk of
permanent disability, and increase the chance of early
recovery.
12.2 An EMS system is a network of qualified emergency
services personnel who use community resources
and equipment to provide emergency care to victims
of injury or sudden illness. In most parts of the
country, the EMS system number is 911.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-57
In Summary (cont.)
12.3 The crash cart should include all appropriate drugs,
supplies, and equipment needed for emergencies.
These include but are not limited to activated
charcoal, atropine, dextrose 50%, epinephrine,
lactated Ringer’s solution, nitroglycerin tablets, and
sodium bicarbonate.
12.4 When faced with an emergency, a medical assistant
should first assess the surroundings to determine if
the area is safe. If the area is safe, the medical
assistant should don appropriate PPE and do an
initial assessment of the patient.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-58
In Summary (cont.)
12.5 The severity of a burn is determined by the depth and
extent of the burn area, the source of the burn, the
age of the patient, the body regions burned, and other
patient illnesses and injuries. The depth and extent of
the burn determines the type of treatment.
12.6 The goal of rendering first aid to a choking victim is to
restore an open airway. This is accomplished by
providing abdominal thrusts or chest thrusts until the
object is expelled.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-59
In Summary (cont.)
12.7 The essential steps of CPR include opening the
airway, giving 2 breaths of about 1 second each,
delivering 30 chest compressions, hard and fast,
following by 2 breaths, continuing until the patient
recovers, help arrives, or you are too exhausted to
continue.
12.8 Severe bleeding may be controlled by applying direct
pressure to the wound, applying pressure over the
nearest pressure point, elevating the injured body
part, or, as a last resort only, applying a tourniquet.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-60
In Summary (cont.)
12.9 The symptoms of heart attack include chest pain,
pain in the left arm, or pain in the neck and jaw,
pallor, shortness of breath, sweating, nausea, and
vomiting. The symptoms of shock include
restlessness, irritability, fear, rapid pulse, and
increased respiratory rate. The symptoms of stroke
include headache, confusion, dizziness, speech
difficulties, weakness of the limbs or paralysis on one
side of the body, and loss of consciousness.
12.10 A medical assistant can help calm a patient by
listening carefully and giving her or his full attention.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-61
In Summary (cont.)
12.11 Medical assistants should educate patients about
ways to prevent and handle various medical
emergencies by providing brief, easy-to-read
handouts containing local emergency contact
numbers and a first-aid kit checklist. The handouts
should be prepared in multiple languages if the
practice provides care for non-English-speaking
patients.
12.12 During a disaster, a medical assistant’s first-aid and
CPR training will be of enormous help. A medical
assistant must also be familiar with standard
protocols for responding to disasters.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
12-62
End of Chapter 12
In the sick room, ten cents' worth of
human understanding equals ten
dollars' worth of medical science.
~ Martin H. Fischer
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.