Response to Basic Emergencies& First Aid

Mod D

Dealing with Emergencies

• Emergency situations develop rapidly and unpredictably

• Emergency situations can occur at any time to anyone:• Automobile accidents

• Strokes (brain attacks)

• Suddenly feeling weak

• Fainting and falling

Dealing with Emergencies

• An emergency is any unexpected situation that requires immediate action and medical attention.

• In a true emergency:• Prompt action is needed to prevent further

complications and to save the life of the victim

• It is important to take immediate action.

Being Prepared

• Whatever course of action you choose:• The victim should not be further endangered

Standard Precautions• Emergencies are stressful and it is easy to

become distracted.

• Use standard precautions• Protect yourself from exposure to blood, body fluids,

secretions, excretions, mucous membranes, and nonintact skin.

• If accidental contact occurs, wash the exposed skin area well with soap and water.

• If mucous membrane contact occurs, rinse thoroughly with running water.

• Inform your supervisor of the exposure as soon as the emergency is over.

Basic Emergencies • Some basic emergencies:

• Cardiac arrest

• Choking

• Obstructed airway

• Bleeding

• Shock

• Fainting

• Heart attack

• Stroke (brain attack)

• Seizures

• Vomiting and aspiration

• Electric shock

• Burns

• Orthopedic injuries

• Head injury

• Accidental poisoning

Code Words

• Health care facilities announce various code words over the intercom to designate different emergencies.

• Facilities are standardizing the code words to minimize confusion.

• Memorize the code words used in your facility and learn what your responsibilities are in each.

• Common codes:• Code Blue: cardiac arrest

• Code Red: fire

DNR Orders• You must know which patients on your unit

have do not resuscitate (DNR) orders• Or know where you can find this information quickly

• Refer to Figure 52-4

Choking p. 939

• Occurs when airway is occluded; ex. Foreign body, blood, food, vomitus

• Tilt head back – sometimes clears airway

• If person can speak or coughs – do NOT intervene

• Complete blockage: unable to speak, high-pitched sounds on inhalation, grasping throat = universal distress signal

• Use standard precautions if possible (gloves, mask)

• Heimlich Maneuver = abdominal thrusts

Heimlich Maneuver p. 939

1. Ask if choking

2. Wait if coughing

3. If can’t speak, cough, or breath but is conscious, apply Heimlich maneuvera) Wrap your arms around waist from behind

b) Clench fist, keep thumb straight

c) Place thumb against abdomen, slightly above naval, below xiphoid process

d) Grasp fist with other hand

e) Avoid pressing on ribs with forearms

f) Thrust forcefully inward and upward, keep elbows bent and away from your body

Heimlich Maneuver p. 939

4. If object dislodged or begins coughing, wait, if not

5. Activate EMS system

6. Continue until obstruction is expelled or victim becomes unconscious

7. If victim becomes unconscious start steps for CPR

Bleeding p. 943

• Wear gloves, stay calm

• Locate area of bleeding

• Use gauze and have victim apply pressure on area; if victim can’t, apply pressure yourself

• Call for help

• If blood seeps through gauze, put more gauze on top and keep pressure

• If no broken bones, no pain: raise area above heart level, keep pressure

• Support elevated area

• Use binding (tape, curlex etc) to keep bandage in place

• Keep victim comfortable, warm, quiet until help arrives

Shock p.944

• Often result of severe injury, hemorrhage, severe pain, cardiac arrest

• Look for: pale, cold skin, weak, rapid pulse, irregular breathing, anxious, perspiration – if ongoing: mottled skin, dilated pupils, loss of consciousness, low blood pressure (BP)

1. Call for help

2. Keep victim calm and lying down

3. Maintain body temperature (warm)

4. Position feet/legs higher than head (Trendelenburg) to increase circulation unless contraindicated by injury

5. Do NOT give anything to eat or drink (you don’t know internal injuries)

6. Continue monitor pulse, respirations, stay calm, stay with victim

Fainting (Syncope) p.945

• Temporary, results from lack of blood to the brain

1. If victim feels faint – help to sit or lay down (prevent falls)

2. Loosen tight clothing

3. Position head lower than heart (circulation to brain)

4. Allow to rest for 10 minutes or more

5. Maintain body temperature (blanket)

6. Call for help

7. Monitor pulse, respirations, blood pressure

8. Do NOT give anything to eat or drink

Heart Attack p. 946

• S/S: crushing, radiating pain (elephant sitting on chest), cold, clammy skin, N/V, grayish color, difficulty breathing, irregular or no pulse

1. Call for help STAT, stay with patient

2. Get pt comfortable, keep calm

3. Elevate HOB to assist breathing, give O2 if available

4. If unconscious start CPR steps

Stroke p. 946

• S/S: weakness on one side of body, face, slurred speech, unequal pupils, leaning to one side, difficulty breathing, disoriented, dizzie, HA, memory loss, unconscious, seizure

1. Call for help – time is of the essence

2. Maintain airway

3. Provide CPR if necessary

4. Position victim on one side, so fluid can drain from mouth

5. Maintain body temperature

6. Stay calm and with pt until help arrives

Seizures p. 947

• Petit mal: absence seizure; momentary loss of contact with environment

• Grand mal: tonic-clonic seizure; loss of consciousness, fall, rigidness, uncontrolled voluntary movements, frothing at mouth, cyanotic (blue), bowel and bladder control is lost

1. Wear gloves, standard precautions – exposure to body fluids very likely

2. Do not hold person

3. Protect pt from injury – move objects out of the way

4. Loosen tight clothing

5. Maintain airway – do not put anything in pt mouth

6. Protect head

7. Observe seizure – will have to describe it to emergency personnel

Afterwards: turn pt to side, do CPR if necessary, allow rest, stay with person but call for medical assistance

Vomiting and aspiration p. 948

• S/S: coughing, choking, cyanosis, vomiting, inability to swallow or spit

1. Stay with pt, call for help

2. Use standard precautions (PPE)

3. Do NOT give anything to eat or drink

4. Keep HOB (head of bed) elevated

5. Turn pt body to the side if vomiting while lying down

6. Provided emesis basin if vomiting

7. If choking – follow choking procedure

8. Afterwards, assist with mouth care

• Observe any vomitus for color, odor, presence of food, coffee-ground appearance

• Measure or estimate amount for I/O (input/output)

Burns p. 949

• First-degree: only top layer of skin (epidermis); redness, temporary swelling, pain; no broken skin or blisters

• Second-degree: epidermis and dermis; pink – red, white, tan; blistering, pain, some scarring

• Third-degree: epidermis, dermis, subcutaneous tissue; bright red – tan, brown; no initial pain, then pain and scarring

1. Call for help

2. If pt on fire, use coat or blanket to smother flames

3. Cool water to burn – no ice; remove wet clothing over burn

Orthopedic injuries p. 949

• Fracture - break in bone

• Sprain – ligament injury due to overstretching

• Strain – muscle injury

• Dislocation – joint injury; dislocates bone form joint socket

1. Stay with pt

2. Immobilize injured extremity

3. Do NOT move pt

4. Call for help

5. After assessment from nurse or MD, transfer pt to bed or wherever instructed; use blankets and plenty of people

6. Monitor vital signs, report changes

7. Elevate injured extremity

8. Ice packs for up to 24 hrs, then warm packs

Head injury p. 950• S/S: AMS – altered mental status = change in alertness, confusion, memory, ability to recognize time, place,

person

• Unequal pupils; visual disturbances; fluid or blood from nose/ears

• Change in speech, ability to follow directions; Unresponsive

• Weakness of extremities, balance problems; HA (headache) N/V (nausea / vomiting)

1. Stay with pt and call for help

2. Monitor pulse, respirations

3. Keep environment calm, quiet

4. Nothing to eat or drink

5. Reassure / orient pt

6. Elevate head on pillow

7. Do not move pt if on the floor

8. Wait for further instructions

Poisoning p. 950

1. Call help immediately (nurse)

2. Try to find what pt has taken and save container

3. No food or drink

4. Medications administered by nurse only

5. Poison Control Center: 1-800-222-1222