Lecture Clinical procedures for medical assisting (4/e): Chapter 12 – Booth, Whicker, Wyman

Chapter 12 - Emergency preparedness and first aid. After studying this chapter you will be able to: Discuss the importance of first aid during a medical emergency, identify items found on a crash cart, recognize various accidental emergencies and how to deal with them, list common illnesses that can result in medical emergencies, identify less common illnesses that can result in medical emergencies.

Emergency

Preparedness and

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

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

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.

– Disasters

The medical assistant must be prepared to determine

the urgency of and handle any emergencies that

arise

Understanding Medical Emergencies

• Any situation in which a person becomes

ill or sustains an injury requiring immediate

Understanding Medical Emergencies

• Quick response using

first aid is vital

• First aid can

of early recovery

• Patient education

– First aid– Proper way to respond

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

Preparing the Office for Emergencies

• Establish roles

• Post emergency telephone numbers

– EMS if different than 911

– Fire

– Police

– Poison control

• Crash cart – rolling cart with emergency

supplies and equipment

– Women’s shelter – Rape hotline

– Drug and alcohol center

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.

Preparing the Office (cont.)

• Emergency and first-aid

Guidelines for Handling Emergencies

• A medical emergency requires certain steps

– Medical assistant provides only first aid

6.Document

Handling Emergencies (cont.)

• Reassure the patient

• Act confidently in an organized manner

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

Handling Emergencies (cont.)

– Signature, credentials

Apply Your Knowledge

What are the steps of the initial assessment of a

patient in an emergency?

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

Correct!

– Ear and eye traumas

– Falls and fractures

– Head injuries

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

– Cover with dry, sterile dressing

• Electrical

– Entry and exit sites– Tissue damage along current’s pathway

Accidental Injuries (cont.)

• Ear trauma

– Lacerations, cuts

– Severed ear – wrap

ear and transport with patient

• Eye trauma

– Falls, blows to eye,

puncture, foreign objects

Fractures and Dislocations

• Treatment

– Immobilize – Ice

– Monitor patient

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

• Heavy or uncontrollable bleeding

– Internal – keep patient warm,

quiet, and calm, and get medical help

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

• 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

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

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

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

Closed Wounds

• Injury occurring inside the

body without breaking the

Apply Your Knowledge

ANSWER: The patient holds his hand to his throat and looks afraid.

1. What is the universal sign of choking?

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

Common Illnesses (cont.)

breathing too rapidly

and too deeply

• Nosebleed –

epistaxis

• Tachycardia – heart rate greater than 100 bpm

• Vomiting – can result

in dehydration and electrolyte imbalance

Apply Your Knowledge

Matching:

_ 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 Hyperventilation

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

Less Common Illnesses (cont.)

ventricular fibrillation

• Hematemesis –

vomiting blood

• Obstetric emergencies – office protocols

• Respiratory arrest

– May follow distress– Assess ABCs, perform CPR, if needed

Less Common Illnesses (cont.)

– Hypovolemic

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

• 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

Apply Your Knowledge

Matching:

_ Hypo- or hyperglycemia A Stroke

_ Myocardial infarction B Diabetic emergencies

_ Vomiting blood C Seizures

_ Impaired blood supply to brain D Hematemesis

!

Common Psychosocial Emergencies

• Alcohol, spousal,

child, and elder abuse

– Report per state law

• Violent behavior

– Office protocols– Document

• 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

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.

The Patient Under Stress

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

Apply Your Knowledge

True 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

• Be familiar with standard protocols for

responding to disasters

• Participate in fire or other disaster drills to

familiarize yourself with emergency

– Communication during and after emergency

– Training in procedures and employee roles

– Means of alerting employees

Disasters (cont.)

• Weather-related

– Community command

post– Accept assignments

appropriate to abilities– Document carefully

– Evacuate

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

– Provide first aid

– Document care

• 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

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

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.

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

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

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

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

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

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

End of Chapter 12

In the sick room, ten  cents' worth of human  understanding equals ten  dollars' worth of medical 

science.

~ Martin H. Fischer