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Medical Emergencies and First Aid

PowerPoint presentation to accompany:

Medical Assisting Third Edition

Booth, Whicker, Wyman, Pugh, Thompson

2009 The McGraw-Hill Companies, Inc. All rights reserved

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Learning Outcomes
43.1 43.2 Discuss the importance of first aid during a medical emergency. Describe the purpose of the emergency medical services (EMS) system and explain how to contact it. List items found on a crash cart or first-aid tray. List general guidelines to follow in emergencies.

43.3 43.4

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Learning 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.
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Learning 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.

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Introduction
Emergencies
Acute

Phone

calls

from illnesses patients with urgent problems Acute injuries The medical assistant must be prepared to determine the urgency and handle any Disasters emergencies that arise
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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 health-care setting

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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

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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

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Preparing for Emergencies:

Office

Establish roles Post emergency telephone numbers

EMS if different than 911 Fire

Womens shelter Rape hotline

Police
Poison control

Drug and alcohol center

Crash cart rolling cart with emergency supplies and equipment

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Preparing for Emergencies: 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.

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Preparing for Emergencies: Office (cont.)

Emergency and first-aid supplies

Crash

cart / tray

Basic

drugs, supplies, and equipment for medical emergencies kit for minor injuries and ailments

First-aid

Must

be routinely checked and restocked

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Preparing for Emergencies:

Guidelines

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

4. Urgency of condition 5. Focused exam 6. Document

2.
3.

Level of responsiveness
Assess ABCs

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Preparing for Emergencies:

Guidelines (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

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Preparing for Emergencies:

Guidelines (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

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Preparing for Emergencies:

Guidelines (cont.)

Documentation

Assessment Treatment given Patient response If patient transported, location of facility Date, time Signature, credentials

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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 patients 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
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Accidental Injuries

Injuries requiring emergency treatment

Bites and stings Burns Choking Ear and eye traumas Falls and fractures Head injuries
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Accidental Injuries:
Bites and Stings

Snake bites

Animal bites

Poisonous bite will need antivenin Immobilize and position below heart

Bruise, tear, or puncture Cleanse wound, apply ointment, and dry, sterile dressing

Spider bites

Refer patient to physician Wash area, apply ice, and keep below heart level

Insect stings

Remove stinger, if present Wash area, apply ice

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Accidental Injuries: Burns

Thermal

Chemical

Hot liquids, steam, flame, etc. Water, wet cloth, or blanket

Remove chemical Wash with cool water for 15 minutes Cover with dry, sterile dressing

Electrical

Entry and exit sites Tissue damage along currents pathway

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Accidental Injuries: Burns

(cont.)
Classifications
Severity
Depth

of burns
Categories
Minor
Moderate Major

determined by
and extent of burn of burn

area
Source Age

of patient area burned illness / injuries

Body

Other

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Accidental Injuries: Burns

(cont.)
Classifications
By

of burns

depth

Superficial Partial-thickness Full-thickness

Estimation
Rule

of extent of a burn
of nines

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Accidental Injuries: 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!
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Accidental Injuries (cont.)

Ear trauma

Lacerations, cuts Severed ear wrap ear and transport with patient

Falls

Have patient examined before moving Stabilize neck if injury suspected Minor falls, notify the physician; document

Eye trauma

Falls, blows to eye, puncture, foreign objects Care depends on severity

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Accidental Injuries: Fractures and

Dislocations

Fracture break in the bone

Dislocation displacement of a bone end from the joint

Sprain partial tearing of ligaments

Strain muscle injury occurring from overexertion

Treatment

Immobilize Ice Monitor patient

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Accidental Injuries: 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 requires 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

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Accidental Injuries: 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
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Accidental Injuries: 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

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Accidental Injuries: 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

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Accidental Injuries: Poisoning

(cont.)
Ingested
Only

poisons

induce vomiting if directed Position patient on left side Send poison container with patient
Absorbed
Remove

poisons
contaminated

Inhaled
Get

poisons

clothing Wash skin, alcohol, rinse

to fresh air Loosen clothing Check ABCs

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Accidental Injuries: WeatherRelated Injuries

Hypothermia

Heat stroke

Body temperature below 95 Move patient inside, cover with blankets, give warm liquids Ice crystals form between tissue cells Warm with clothing or other body part

Prolonged exposure to high temperatures and humidity Move to cool place, cool with whatever is available Soak in cool water, cold compresses

Frostbite

Sunburn

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Accidental Injuries: Open

Wounds

Skin or mucous membrane is damaged Incisions and lacerations

Control bleeding Clean and dress wound

Amputations

Elevate extremity

Transport body part with patient

Abrasion

Wash with soap and water

Punctures

Remove debris, dressing if needed

Clean, dress Tetanus toxoid immunization

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Accidental Injuries: Closed Wounds

Injury occurring inside the body without breaking the skin Caused by blunt trauma
Contusions bruises
Cold

compresses
changes are normal

Color

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Apply Your Knowledge

Yeah!

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
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Common Illnesses

Abdominal pain a variety of causes Asthma spasmodic narrowing of bronchi

Dehydration lack of adequate water in the body

Diarrhea can result in dehydration and electrolyte imbalance

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Common Illnesses (cont.)

Fainting syncope: partial or complete loss of consciousness Fever usually indicates infection

Nosebleed epistaxis Tachycardia heart rate greater than 100 bpm

Hyperventilation breathing too rapidly and too deeply

Vomiting can result in dehydration and electrolyte imbalance

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Apply Your Knowledge

Matching:
B Syncope ___ D Pulse > 100 bpm ___

ANSWER:
A. Nosebleed B. Fainting

___ C. Dehydration F Spasmodic narrowing of bronchi E Dehydration and electrolyte imbalance D. Tachycardia ___
___ A Epistaxis G Rapid and deep breathing ___ C Lack of adequate water ___ E. Diarrhea / vomiting F. Asthma G. Hyperventilation
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Less Common Illnesses

Anaphylaxis

Severe, life-threatening allergic reaction Check ABCs, perform CPR if needed

Bacterial meningitis usually

a complication of another bacterial infection

Diabetic emergencies

Insulin shock severe hypoglycemia

Diabetic coma severe hyperglycemia
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Less Common Illnesses

(cont.)

Gallbladder attack

inflammation of the gallbladder due to obstruction of cystic duct

Heart attack

Hematemesis vomiting

blood

Obstetric emergencies office

protocols

Myocardial infarction Chest pain cardinal symptom Cardiac arrest ventricular fibrillation

Respiratory arrest

May follow distress Assess ABCs, perform CPR, if needed

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Less Common Illnesses

(cont.)

Seizures

Stroke cerebrovascular

Convulsions Patient safety a priority

accident due to impaired blood supply to brain

Toxic shock syndrome acute

Shock

Life-threatening state related to failure of the cardiovascular system Hypovolemic

bacterial infection originating in the uterus

Viral encephalitis

Septic

inflammation of the brain due to a virus

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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

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Apply Your Knowledge

Matching: ANSWER:
B Hypo- or hyperglycemia ___ F Myocardial infarction ___ A. Stroke B. Diabetic emergencies

___ D Vomiting blood

C. Seizures

___ A Impaired blood supply to brain D. Hematemesis ___ C Convulsions E. Shock F. Heart attack

E May be hypovolemic or septic ___

U P E R !

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Common Psychosocial Emergencies

Alcohol, spousal, child, and elder abuse

Violent behavior

Office protocols Document

Report per state law Provide information on community resources

Overdose on drugs

Requires emergency care Call EMS

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Common Psychosocial Emergencies (cont.)

Suicide

Rape

Allow patient to verbalize Report suspicions to physician Always take patient seriously

Provide privacy Contact authorities and local rape hotline Follow protocol for chain of custody of specimens

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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.

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The Patient Under Stress

People react differently to emergency situations

Challenges

Non-English speaking Visual impairments Hearing impairments

Detect stress

Behavior different from normal Unable to focus or follow directions

Keep victims and family calm

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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
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Apply Your Knowledge

True or False: differently F All people react the same during an emergency. ___
T Patients should be encouraged to learn CPR and first aid. ___

ANSWER:

___ F Challenges to dealing with patients during an emergency include visual and hearing impairments and Englishspeaking people. nonT Patients should be instructed how to prevent emergencies. ___
___ F It is not important to keep the victim of an emergency calm.

Very Good!

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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

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Disasters (cont.)

Weather-related

Office fires

Community command post Accept assignments appropriate to abilities Document carefully

Activate alarm system Fire extinguisher Turn off oxygen Close windows and doors Evacuate

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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

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Bioterrorism (cont.)

Physicians 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

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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.
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In Summary

Medical emergencies can occur anywhere

Notify physician or EMS Do not perform procedures out of your scope of practice Assess and provide first aid Remain calm and communicate clearly Educate patients about how to prevent and respond to emergencies

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End of Chapter

In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science.
~ Martin H. Fischer

2009 The McGraw-Hill Companies, Inc. All rights reserved