Y khoa, dược - Emergency preparedness and first aid

43Emergency Preparedness and First Aid43-2Learning Outcomes43.1 Discuss the importance of first aid during a medical emergency.43.2 Describe the purpose of the emergency medical services (EMS) system and explain how to contact it.43.3 List items found on a crash cart or first-aid tray.43.4 List general guidelines to follow in emergencies. 43-3Learning Outcomes (cont.)43.5 Compare various degrees of burns and their treatments.43.6 Demonstrate how to help a choking victim.43.7 Demonstrate cardiopulmonary resuscitation (CPR).43.8 Demonstrate four ways to control bleeding. 43.9 List the symptoms of heart attack, shock, and stroke. 43-4Learning Outcomes (cont.)43.10 Explain how to calm a patient who is under  extreme stress.43.11 Discuss ways to educate patients about  ways to prevent and respond to  emergencies.43.12 Describe your role in responding to natural  disasters and those caused by humans.43-5Introduction EmergenciesAcute illnessesAcute injuriesPhone calls from patients with urgent problemsDisasters The medical assistant must be prepared to determine the urgency of and handle any emergencies that arise43-6Understanding Medical Emergencies Any situation in which a person becomes ill or sustains an injury requiring immediate carePrompt action may prevent disability or deathCan occur within or outside the health-care setting43-7Understanding Medical Emergencies Quick response using first aid is vitalFirst aid canSave a lifeReduce painPrevent further injuryReduce risk of permanent disabilityIncrease the chance of early recoveryPatient education First aidProper way to respond in an emergency43-8Apply Your KnowledgeWhy 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 recoveryGood Job!43-9Preparing the Office for EmergenciesEstablish rolesPost emergency telephone numbers EMS if different than 911FirePolice Poison controlCrash cart – rolling cart with emergency supplies and equipment Women’s shelterRape hotlineDrug and alcohol center43-10Preparing the Office (cont.)Provide information to EMSYour name and locationNature of the emergencyNumber of people needing helpCondition of the injured or ill patient(s)Summary of the first aid already givenDirections to your location Do not hang up until the dispatcher gives you permission to do so.43-11Preparing the Office (cont.)Emergency and first-aid suppliesCrash cart/trayBasic drugs, supplies, and equipment for medical emergenciesFirst-aid kit for minor injuries and ailmentsMust be routinely checked and restocked43-12Guidelines for Handling EmergenciesA medical emergency requires certain stepsMedical assistant provides only first aidPatient emergenciesAssess the situationPPEAssess patient Six steps to initial assessmentGeneral impression Level of responsivenessAssess ABCsUrgency of conditionFocused exam DocumentABCs43-13Handling Emergencies (cont.)Telephone emergenciesTriaging Classification of injuries according to severity, urgency of treatment, and place for treatmentFollow office protocolsGeneral guidelinesStay calmReassure the patientAct confidently in an organized manner43-14Handling Emergencies (cont.)Personal protectionTake precautions to reduce chance of exposure during an emergencyFollow Standard PrecautionsKeep personal protective equipment in first-aid kit at home and work43-15Handling Emergencies (cont.)DocumentationAssessmentTreatment givenPatient responseIf patient transported, location of facilityDate, timeSignature, credentials 43-16Apply Your KnowledgeWhat are the steps of the initial assessment of a patient in an emergency?ANSWER: The steps of the initial assessment are: Form a general impression of the patient Determine the patient’s level of responsiveness Assess ABCs Determine the urgency of condition Perform a focused exam (head to toe); vital signs; skin color Document findings/report to physician or EMTCorrect!43-17Accidental Injuries Injuries requiring emergency  treatmentBites and stingsBurnsChokingEar and eye traumasFalls and fracturesHead injuries43-18Bites and StingsAnimal bitesBruise, tear, or punctureCleanse wound, apply ointment and dry, sterile dressingInsect stingsRemove stinger, if presentWash area, apply iceSnake bitesPoisonous bite will need antivenin Immobilize and position below heartSpider bitesRefer patient to physicianWash area, apply ice, and keep below heart level43-19BurnsThermalHot liquids, steam, flame, etc.Water, wet cloth, or blanketChemical Remove chemicalWash with cool water for 15 minutesCover with dry, sterile dressingElectricalEntry and exit sitesTissue damage along current’s pathway43-20Burns (cont.)Classifications of burnsSeverity determined byDepth and extent of burn areaSource of burnAge of patientBody area burnedOther illness/injuriesCategories Minor ModerateMajor43-21Burns (cont.)Classifications of burnsBy depthSuperficialPartial-thicknessFull-thicknessEstimation of extent of a burn using rule of nines43-22ChokingForeign object or food blocks the trachea or windpipe Universal signHand up to throat with a fearful lookMedical assistants should know first aid for choking adult, child, or infant!43-23Accidental Injuries (cont.)Ear traumaLacerations, cutsSevered ear – wrap ear and transport with patientEye traumaFalls, blows to eye, puncture, foreign objectsCare depends on severityFalls Have patient examined before movingStabilize neck if injury suspected Minor falls, notify the physician; document43-24Fractures and DislocationsFracture – break in the boneDislocation – displacement of a bone end from the jointSprain – partial tearing of ligamentsStrain – muscle injury occurring from overexertionTreatmentImmobilize Ice Monitor patient43-25Head InjuriesConcussion – jarring injury of the brainPatient may lose consciousness, have temporary loss of vision, pallor, listlessness, memory loss, or vomitingSevere head injuries – contusions, fractures, and intracranial bleedingMay require immediate hospitalization and/or CPRScalp hematoma and laceration – blood under the skin or break in the skinControl swelling with iceControl bleeding with direct pressure43-26HemorrhagingHeavy or uncontrollable bleedingInternal – keep patient warm, quiet, and calm, and get medical helpExternalUse direct pressure, apply additional dressing as neededElevate body part, put pressure on nearestpressure point between wound and heart43-27Multiple InjuriesOften the result of automobile accident or fallAssess ABCs, perform CPR if neededOnly perform first aid after ABCs ensuredTreat most life-threatening injuries firstNotify EMS/physician43-28PoisoningSubstance that produces harmful effects if it enters the bodyMajority of accidental poisonings happen in children under age 5Post poison control center numberPatient education – prevention43-29Poisoning (cont.)Ingested poisonsOnly induce vomiting if directed Position patient on left sideSend poison container with patientAbsorbed poisonsRemove contaminated clothingWash skin, alcohol, rinseInhaled poisonsGet to fresh airLoosen clothingCheck ABCs43-30Weather-Related InjuriesHypothermiaBody temperature below 95ºMove patient inside, cover with blankets, give warm liquidsFrostbiteIce crystals form between tissue cellsWarm with clothing or other body partHeat strokeProlonged exposure to high temperatures and humidityMove to cool place, cool with whatever is availableSunburn Soak in cool water, cold compresses43-31Open WoundsSkin or mucous membrane is damagedIncisions and lacerationsControl bleedingClean and dress woundAbrasion Wash with soap and waterRemove debris, dressing if neededAmputationsElevate extremityTransport body part with patientPunctures Clean, dressTetanus toxoid immunization43-32Closed WoundsInjury occurring inside the body without breaking the skinCaused by blunt traumaContusions – bruises Cold compresses Color changes are normal 43-33Apply Your KnowledgeANSWER: The patient holds his hand to his throat and looks afraid.What is the universal sign of choking?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: Apply direct pressure with sterile gauze Add additional dressing as necessary Elevate the leg Apply pressure to the left femoral arteryYeah!43-34Common IllnessesAbdominal pain – a variety of causes Asthma – spasmodic narrowing of bronchiDehydration – lack of adequate water in the body Diarrhea – can result in dehydration and electrolyte imbalance43-35Common Illnesses (cont.)Fainting (syncope) – partial or complete loss of consciousnessFever – usually indicates infectionHyperventilation – breathing too rapidly and too deeplyNosebleed – epistaxisTachycardia – heart rate greater than 100 bpmVomiting – can result in dehydration and electrolyte imbalance43-36Apply Your KnowledgeMatching:___ Syncope A. Nosebleed___ Pulse > 100 bpm B. Fainting___ Spasmodic narrowing of bronchi C. Dehydration___ Dehydration and electrolyte imbalance D. Tachycardia___ Epistaxis E. Diarrhea/vomiting___ Rapid and deep breathing F. Asthma___ Lack of adequate water G. HyperventilationANSWER:GFEDCBABravo!43-37Less Common IllnessesAnaphylaxis Severe, life-threatening allergic reactionCheck ABC’s, perform CPR if neededBacterial meningitis – usually a complication of another bacterial infectionDiabetic emergencies Insulin shock – severe hypoglycemia Diabetic coma – severe hyperglycemia 43-38Less Common Illnesses (cont.)Gallbladder attack – inflammation of the gallbladder due to obstruction of cystic ductHeart attack Myocardial infarctionChest pain – cardinal symptomCardiac arrest – ventricular fibrillationHematemesis – vomiting bloodObstetric emergencies – office protocols Respiratory arrestMay follow distressAssess ABCs, perform CPR, if needed43-39Less Common Illnesses (cont.)Seizures ConvulsionsPatient safety a priorityShock Life-threatening state related to failure of the cardiovascular systemHypovolemic shockSeptic shockStroke – cerebrovascular accident due to impaired blood supply to brainToxic shock syndrome – acute bacterial infection originating in the uterusViral encephalitis – inflammation of the brain due to a virus43-40CPRProvides ventilation and circulation for an arrest victimAssess responsiveness, call EMS (911)Assess ABCsIf available, connect patient to the automated external defibrillator (AED) Start CPR43-41Apply Your KnowledgeMatching:___ Hypo- or hyperglycemia A. Stroke___ Myocardial infarction B. Diabetic emergencies___ Vomiting blood C. Seizures___ Impaired blood supply to brain D. Hematemesis___ Convulsions E. Shock___ May be hypovolemic or septic F. Heart attackFEDCANSWER:BASUPER!43-42Common Psychosocial Emergencies Alcohol, spousal, child, and elder abuseReport per state lawProvide information on community resourcesOverdose on drugsRequires emergency careCall EMSViolent behaviorOffice protocolsDocument 43-43Common Psychosocial Emergencies (cont.) SuicideAllow patient to verbalizeReport suspicions to physicianAlways take patient seriouslyRape Provide privacyContact authorities and local rape hotlineFollow protocol for chain of custody of specimens43-44Apply Your KnowledgeMrs. 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.Fantastic!43-45The Patient Under StressPeople react differently to emergency situationsDetect stressBehavior different from normalUnable to focus or follow directionsKeep victims and family calmChallenges Non-English speakingVisual impairments Hearing impairments43-46Educating the Patient How to prevent and handle medical emergenciesEncourage patients and families to learn first aid and CPRProvide first-aid kit checklistHow to access EMS and to keep emergency numbers by the phoneHow to childproof homesProvide appropriate, easy-to-read handouts43-47Apply Your KnowledgeTrue or False:___ All people react the same during an emergency.___ Patients should be encouraged to learn CPR and first aid.___ Challenges to dealing with patients during an emergency include visual and hearing impairments and English- speaking people.___ Patients should be instructed on how to prevent  emergencies.___ It is not important to keep the victim of an emergency calm.ANSWER:FFFTTdifferentlynon-Very Good!43-48DisastersBe familiar with standard protocols for responding to disastersParticipate in fire or other disaster drills to familiarize yourself with emergency proceduresTriage –victims are tagged to classify the victim Emergent – needing immediate careUrgent – needing care within several hoursNonurgent –needing care when time is not critical, or dead43-49Disasters (cont.)Evacuation plans – maps of facility with escape routesShelter-in-place plans –interior room with few/no windowsPlansCommunication during and after emergencyTraining in procedures and employee rolesMeans of alerting employees43-50Disasters (cont.)Weather-relatedCommunity command postAccept assignments appropriate to abilitiesDocument carefullyOffice firesActivate alarm systemFire extinguisherTurn off oxygenClose windows and doorsEvacuate 43-51Disasters (cont.)Bioterrorist attack Be alert for an increased incidence of diseaseTake isolation precautions Use Standard PrecautionsInform local health departmentsChemical emergencyUse PPEIdentify the chemical; report to local authoritiesAssist with decontaminationMonitor patientDocument patient careArrange for patient transport43-52Disasters (cont.)Mass casualtiesAssess safetyReport to communitycommand postTriage Provide first aidDocument care 43-53BioterrorismIntentional release of a biologic agent with the intent to harm individualsBiologic agent = weaponEasy to disseminateHigh potential for mortalityCause public panic or social disruptionRequires public health preparedness43-54Bioterrorism (cont.)Physician’s offices are the front lines Individual casesCommon trends in syndromes/unusual patternsNotify local public health department of suspected casesFollow state and national guidelines43-55Apply Your KnowledgeWhat 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 deadWhat 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.Impressive!43-56In Summary43.1 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. 43.2 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. 43-57In Summary (cont.)43.3 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. 43.4 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. 43-58In Summary (cont.)43.5 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. 43.6 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. 43-59In Summary (cont.)43.7 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.43.8 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. 43-60In Summary (cont.)43.9 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. 43.10 A medical assistant can help calm a patient by listening carefully and giving her or his full attention.43-61In Summary (cont.)43.11 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. 43.12 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.43-62End of Chapter 43In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science. ~ Martin H. Fischer