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Emergency Preparedness and Assisting with Medical Emergencies Chapter 36 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Learning Objectives Define, spell, and pronounce the terms listed in the vocabulary. Apply critical thinking skills in performing patient assessment and care. Describe patient safety factors in the medical office environment. Evaluate the work environment to identify safe vs. unsafe working conditions. Identify environmental safety issues in the healthcare setting. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 Learning Objectives Develop environmental, patient, and employee safety plans. Discuss fire safety issues in a healthcare environment. Demonstrate the proper use of a fire extinguisher. Describe the fundamental principles for evacuation of a healthcare setting. Role play a mock environmental exposure event and evacuation of a physician’s office. Discuss requirements for responding to hazardous material disposal. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 Learning Objectives Define the important features of emergency preparedness in the ambulatory care setting. Describe the medical assistant’s role in emergency response. Maintain a current list of community resources for emergency preparedness. Summarize typical emergency supplies and equipment. Demonstrate the use of an automated external defibrillator. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Learning Objectives Summarize the general rules for managing emergencies. Demonstrate screening techniques and documentation guidelines for ambulatory care emergencies. Recognize and respond to life-threatening emergencies in the ambulatory care setting. Perform CPR for the professional. Administer oxygen through a nasal cannula to a patient in respiratory distress. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 Learning Objectives Identify and assist a patient with an obstructed airway. Determine appropriate action and documentation procedures for common ambulatory care emergencies. Assist and monitor a patient who has fainted. Control a hemorrhagic wound. Apply patient education concepts to medical emergencies. Discuss legal and ethical concerns regarding medical emergencies. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 The Medical Assistant’s Role in Patient Safety Make the facility as accident-proof as possible Wipe up spills immediately and pick up dropped objects Keep medications out of sight and away from busy patient areas Protect children from sharp objects and potentially toxic substances Never leave a seriously ill patient or a restless, depressed, or unconscious patient unattended Be vigilant for medication errors Identify patients before performing a procedure Perform frequent hand sanitization Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Features of a Safe Patient Environment Work as a team to safeguard patients. Policies and procedures exist to prevent repeated problems. Policies and Procedures Manual provides specific guidelines on how procedures should be performed. Facility provides ongoing staff training about patient safety factors. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Discussion: Procedure 36-1 The physician writes an order to be phoned into the pharmacy for a new patient diagnosed with depression. You think the order reads “Avinza, 30 mg po bid.” The pharmacist asks you for the physician’s DEA number because Avinza is a narcotic analgesic. You ask the physician for clarification and are told the order was for Avanza, an antidepressant. Look both medications up in a drug reference. What could have happened if the patient was ordered a powerful narcotic rather than the antidepressant that the physician intended? Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 OSHA Suggestions for Accident Prevention Consistently use proper body mechanics Constantly check the facility for possible tripping hazards Store supplies properly Clean up spills immediately Use step stool to reach for things Provide handrails where appropriate Do not overload electrical outlets Perform a safety check of the facility routinely Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Infection Control Procedures Protect staff from occupational exposure to bloodborne pathogens while at the same time safeguarding patients Manage sharps properly and use safety-engineered sharps devices Hepatitis B immunization for all employees at risk of exposure to blood and body fluids Use latex-free supplies as much as possible MSDS information for chemicals in facility; store chemicals properly Perform proper hand hygiene Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Workplace Violence Use problem-solving techniques, therapeutic communication, and assertive behaviors when dealing with difficult patients Employee training on how to identify potentially violent patients and discuss safe methods for managing difficult clients Be on the alert for possible safety hazards in and around the building such as proper lighting, limiting access to the facility, and using security systems Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Procedure 36-3: Managing a Difficult Patient You are working at the admissions desk when an extremely angry patient comes storming into the office screaming about a mistake in his bill. Although the facility uses an outside billing center, you recognize you should attempt to help the patient and try to diffuse the situation. Remember: Call 911 immediately and alert any available security if you or one of your co-workers is being threatened with violence. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Environmental Safety: Fire Extinguishers (Procedure 36-4) ABC fire extinguisher is effective against most common causes Small extinguishers will be empty within 15 seconds Immediately call 911 if the facility fire is not small and confined If the fire is small, there is no heavy smoke, and you have easy access to an exit route then use the closest fire extinguisher Do not hesitate to evacuate the facility if you believe there is any danger to yourself or others Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Fire Prevention and Management Properly store potentially flammable chemicals and supplies Maintain electrical equipment, cords, and outlets Immediately disconnect oxygen supplies or turn off oxygen tanks if fire is suspected Smoke alarms located throughout the facility, checked periodically, and replaced as needed Fire safety equipment is available and current; fire extinguishers inspected at least annually Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Fire Prevention and Management Fire extinguishers located in multiple sites Immediately call 911 if you suspect a fire and evacuate the facility Emergency evacuation routes posted throughout the facility Emergency exits clearly marked Designate a meeting place for all personnel after evacuation to make sure everyone got out Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Critical Thinking Application Cheryl is in the middle of a busy day, patients are in all of the examination rooms, and the waiting room is full. She walks past the patient bathroom and smells smoke. She opens the door and sees smoke and flames coming out of the waste basket. What should she do? Write down your response to this scenario and share it with your classmates. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Facility Evacuation Plan Emergency action coordinator in charge • Coordinator manages emergency at the facility as well as works with community emergency services • Exit doors must be clearly marked, well lit, and wide enough for everyone to evacuate • Identify any hazardous areas to avoid during evacuation • Provide assistance for employees and patients with special needs • Staff member clears facility, shuts fire doors, etc., before being last to leave • Assist co-workers or patients with special needs Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Procedure 36-5 Role play with your laboratory group the following scenario: The building next door to the physician’s office where you work is on fire. One member of the group is the designated emergency action coordinator, two individuals are responsible for helping patients with special needs out of the facility, and one person is designated to be the last to leave after the building is clear. In a community emergency situation, certain staff members may de designated to provide immediate assistance to survivors. Two medical assistants are sent to help with fire victims. How could medical assistants help in this situation? After the evacuation is complete, meet in a designated spot to discuss the process and see if there are any areas in which the evacuation plan could be improved. Document the steps taken throughout the mock environmental event. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Hazardous Waste Disposal OSHA regulated waste – contaminated items that might release blood or other potentially infectious material; contaminated supplies that are caked with infectious material; contaminated sharps; and waste products that contain blood or other potentially infectious materials Healthcare facilities must make special arrangements for biohazard waste disposal Frequently costs as much as 10 times more than regular garbage disposal Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Proper Disposal of Hazardous Waste Place signs on or near the biohazard container to identify its purpose and what materials should be deposited there Containers should be covered and have a foot peddle to operate opening and closing Place a regular garbage container next to the biohazard one so staff uses biohazard bags only as needed Place only sharps in sharps containers; gauze, bandages, etc., belong in contaminated waste container; noninfectious packaging material and other items belong in regular trash Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Community Emergency Preparedness Ambulatory care centers and hospitals may be the first to recognize and initiate a response to a community emergency Standard Precautions should be implemented immediately Access the communication network to notify local and state health departments and perhaps federal officials of a possible community emergency Your employer may participate in an annual community disaster preparedness drill Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Emergency Planning Staff members should discuss possible emergencies that may occur and have an emergency action plan for rapid, systematic intervention. Every healthcare facility should have a standard policy with specific procedures for emergency situations. With several employees, each should be assigned specific duties. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Local Emergency Management Authority (LEMA) LEMA coordinates police, fire, emergency medical services, public health, and area healthcare response to community-wide emergencies Responsible for developing an all-hazards response plan that would be appropriate for any community emergency Local officials would turn to state, regional, or federal officials for assistance as needed Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Emergency Preparedness Plans Evacuate facility as needed Protect the patient medical record; have back-up systems or flash drives If there is a community emergency, provide care within the facility Coordinate services between the ambulatory facility and other local healthcare systems Supply staff and supplies as needed Maintain current phone trees to notify staff Educate patients on emergency preparedness Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 Critical Thinking Application There is a chemical plant located about three blocks from Dr. Bendt’s office. The office staff is brainstorming ideas of what should be done if there is an accident at the plant. Based on what you have learned so far about emergency preparedness, what do you think should be included in the office’s emergency plan? Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Community Emergency Services Most communities have an emergency medical services (EMS) system or 911 service that is available 24 hours a day Poison control centers are ready to provide emergency information for treating victims of poisonings Every healthcare facility should post a list of local emergency numbers that is in plain sight and known to all office personnel Include on the list the local EMS system, poison control center, ambulance and rescue squad, fire department, and police department numbers Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Telephone Numbers for Community Emergency Preparedness Local hospital numbers including the Emergency Room, Infection Control Officer, administration contacts, and Public Affairs office Poison Control Fire and police departments EMS Local and state Health Department CDC Emergency Response Office: 770/448-7100 Complete Procedure 36-6 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28 Infection Control and Bioterrorism Sanitize hands routinely Wear disposable gloves Use masks/eye protection or face shields if there is a potential for splashing Wear gowns to protect skin and clothes as needed; remove them promptly and wash hands to prevent transmission of infectious material Sanitize, disinfect, and sterilize equipment, supplies, and environmental surfaces Dispose of contaminated waste in appropriate biohazard containers Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29 CDC Recommendations The CDC recommends all healthcare facilities be aware of possible agents of bioterrorism including anthrax, botulism, plague, and smallpox. The physician will diagnose and report any suspected cases. The medical assistant may be involved in patient care and participate in prevention of the spread of infection. Standard Precautions should be implemented with all patients regardless of their diagnosis or possible infection status. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30 Psychological Aspects of Emergencies Provide fact sheets for employees and patients to help them understand the dangers of certain emergencies and encourage employee participation in disaster drills. Plan in advance for effective communication. Explain emergency situations to patients and healthcare workers; offer immediate evaluation and treatment of an infectious outbreak. Treat acute anxiety with reassurance and explanation; physician may order medication if reassurance does not relieve acute anxiety; provide follow-up counseling as needed for employees. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31 Role of Medical Assistants in an Emergency Provide emergency first aid Conduct patient interviews in an empathetic manner using therapeutic communication tools Assist with mass vaccination efforts or antibiotic distribution Documentation and electronic health record management Follow Standard Precaution procedures Patient education Phlebotomy and laboratory procedures Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32 Supplies and Equipment for Emergencies Emergency supplies Crash cart Stored in easily accessible area Check expiration dates Restock supplies Emergency medications Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 33 Emergency Medications Epinephrine is a vasoconstrictor; it controls hemorrhage, relaxes bronchioles, treatment of acute anaphylactic reaction Atropine decreases secretions, increases respiration and heart rate, smooth-muscle relaxant Digoxin is a cardiac drug; treats arrhythmias and CHF Nitroglycerin is a vasodilator; relieves angina Lidocaine IV to treat cardiac arrhythmia and a local anesthetic Sodium bicarbonate corrects metabolic acidosis that occurs after cardiac arrest Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34 Emergency Medications Syrup of ipecac causes vomiting Activated charcoal is an antidote swallowed to absorb ingested poisons Narcan is a narcotic antidote administered IV for narcotic drug overdoses; raises BP and increases respiratory rate Antihistamines for the treatment of allergic reactions and anaphylaxis need to be available to treat potential allergic responses including Benadryl for minor reactions and Solu-Medrol, a corticosteroid for anaphylaxis Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35 Defibrillators Indicated during ventricular fibrillation Send electrical current through the myocardium by paddles applied to the chest Automated external defibrillator (AED) Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36 Example Defibrillator From Aehlert B: Mosby’s comprehensive pediatric emergency care, St Louis, 2005, Mosby. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 37 AED Precautions Avoid contact with metal during defibrillation. Do not use on children under the age of 8 years or <55 lb. All clothing must be removed; pads are applied directly to skin. Patient must be on a dry surface, chest dry. Apply AED pads at least 1 inch away from implants to avoid interference. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 38 General Rules for Emergencies 1. Stay calm 2. Assess the situation to determine the nature of the emergency. 3. Obtain as much information as possible to determine the appropriate action. 4. Immediately refer any concerns to the office supervisor or physician. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 39 Telephone Screening (Table 36-1) If the patient’s situation is life-threatening, activate EMS/911. Record name of caller, patient, location, phone number. Ask for help if unsure how to handle. Notify ER. Obtain information regarding patient’s condition. Detail what has been done for the patient. Document. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 40 Management of On-Site Emergencies Implement OSHA standard precautions. Activate EMS, stay with the patient. Document all details regarding the incident in the patient’s chart. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 41 Documentation of On-Site Emergency Patient’s name, address, age, and health insurance information Allergies, current medications, and pertinent health history Name and relationship of any person with patient Vital signs and chief complaint Sequence of events, beginning with how problem occurred, any changes in the condition, and any observations Details regarding procedures or treatments performed Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 42 Life-Threatening Emergencies Nonresponsive patient Notify physician immediately, activate EMS. Assess respirations. Position patient in supine position, apply head tilt-chin lift. Stabilize neck. Assess pulse. Perform CPR as needed. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 43 Cardiac Emergencies Report symptoms to clinician, activate EMS. Use wheelchair to move patient. Use Fowler’s position. Keep patient quiet and warm. Loosen tight clothing. Take vital signs, start O2. Gather crash cart. Obtain information from patient. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 44 Signs of a Heart Attack Usually caused by a blockage of the coronary arteries that decreases the amount of blood being delivered to the myocardium Most common signal of a heart attack is an uncomfortable pressure, squeezing, fullness, or pain in the center of the chest; may spread to the shoulder, neck, jaw, or arms Other symptoms include diaphoresis, nausea or indigestion, SOB, cold and clammy skin, and general malaise If these signs persist longer than 5 minutes, the patient should activate EMS Most people deny that the problem is serious Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 45 MI Signs and Symptoms in Women Include a combination of the following: Back pain or aching and throbbing in biceps or forearms Shortness of breath Clammy perspiration Vertigo—unexplained lightheadedness or syncopal episodes Edema—especially of the ankles and/or lower legs Fluttering heartbeat or tachycardia Gastric upset Feeling of heaviness or fullness in the mediastinum Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 46 Choking Usually caused by foreign objects Universal sign of choking: Refer to Procedure 36-6 for how to respond to an adult with an obstructed airway Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 47 Cerebrovascular Accident (Stroke) Disorder of the cerebral blood vessels that results in an impairment of the blood supply to part of the brain. TIA – temporary neurological indicators of problem with blood supply to brain Signs and symptoms: unconsciousness, paralysis, dyspnea, dysphagia, loss of bladder control, unequal pupil size, slurred speech May be treated with thrombolytics if diagnosed soon after incident occurs Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 48 Recovery Position Place the patient’s arm that is farthest from you along the side and above the head; place the other arm across the chest. Bend the leg that is closest to you and after placing one arm under the patient’s head and shoulder and the other hand on the flexed knee, roll the patient away from you while you stabilize the head and neck. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 49 Shock Anaphylactic Insulin Psychogenic or mental Hypovolemic or hemorrhagic Cardiogenic Neurogenic Septic Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 50 Common Office Emergencies Fainting Patient appears pale; may feel cold weak, dizzy, or nauseated; may have numbness Supine position, loosen clothes Refer to Procedure 35-6 Poisoning Patient may have burns on the hands and mouth, stains on clothing, changes in skin color, nausea, stomach cramps, shallow breathing, convulsions, heavy perspiration, dizziness, and unconsciousness Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 51 Questions If Poisoning Is Reported Name, weight, and age of the victim Name of poison taken and any information on the label How much was taken How long ago the poison was ingested Whether vomiting has occurred Any pertinent symptoms, such as difficulty breathing or an altered state of consciousness Any first aid given Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 52 Animal Bites Rabies, tetanus, and local skin infections Clean area Tetanus vaccination Rabies vaccination – five injections started as soon as possible Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 53 Insect Bites and Stings Typical symptoms Inflammation, itching, edema Watch for systemic allergic reaction Treatments Epinephrine, oxygen, corticosteroids Apply ice Calamine lotion, creams EpiPen for anaphylactic reactions Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 54 Asthma Attacks Symptoms: Wheezing, coughing, tightness in chest, SOB Bronchodilators May be advised to ER Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 55 Seizures Idiopathic; related to trauma, injury, or metabolic alterations; febrile seizures. Clear everything away; do not place anything in the patient’s mouth. Do not hold the patient down. Place the patient in recovery position after seizure. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 56 Seizure Management Call 911 for emergency assistance in any of the following situations: Has not regained consciousness within 10 to 5 minutes Seizure does not stop within a few minutes Second seizure begins immediately after the initial one Patient is pregnant Signs of head trauma are present Patient is a known diabetic Seizure was triggered by a high fever in a child Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 57 Abdominal Pain Keep the patient warm and quiet. Have an emesis basin available. Administer nothing by mouth. Do not apply heat, unless instructed. Check and record vital signs. Follow physician’s orders. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 58 Sprains and Strains Sprains: tears of the ligaments Strains: injuries to a muscle and tendon Treatment: elevate the affected area, applying mild compression and ice Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 59 Fractures Make patient comfortable Treatment: splinting, elevations of affected extremity, application of ice, control of bleeding Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 60 Burns Result from flame, heat, scalds, electricity, chemicals, or radiation Chemical burns – immediately remove all clothing that may have come into contact with the chemical and flood the affected area with running water Rule of Nines Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 61 Rule of Nines Classification of Burns Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 62 Tissue Injuries Contusion – closed wound; no evidence of injury to skin; caused by blunt trauma; a painful bruise but skin is intact Abrasion – surface of skin scraped Laceration – deeper, more jagged wound; may be additional tissue damage surrounding it; may need to be surgically repaired Puncture – object forced into the body; stabilize the object as much as possible with rolled up material before transporting Avulsion – tissue or body part torn away Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 63 Lacerations Apply gloves, notify physician. Cover area with sterile dressing. Clean area. Possible tetanus booster. Complete wound closure. Sterile dressing. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 64 Epistaxis Caused by: Injury, disease, HTN, strenuous activity, high altitudes, exposure to cold, overuse of anticoagulant Treatment Mild to moderate: apply direct pressure If bleeding is bilateral and continuous: EMS Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 65 Head Injuries Dizziness, headache, mental confusion, memory loss Vomiting, loss of bladder and bowel control, bleeding, changes to pupils Stabilize neck, NPO, watch pupils, obtain vital signs Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 66 Foreign Bodies in the Eye Tell patient not to touch the eye. Place patient in a darkened room. Apply wet compresses. Perform eye irrigation as ordered. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 67 Heat and Cold Injuries Heat exhaustion Heat stroke Frostbite Hypothermia Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 68 Dehydration Patient excretes more water than is taken in. Symptoms: Vertigo, dark yellow urine, or no urine output, extreme thirst, lethargy, confusion, or muscle cramps. Treatment: Replace fluids, ER Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 69 Diabetic Emergencies Hyperglycemia Diabetic coma Hypoglycemia Insulin shock Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 70 Patient Education The medical assistant must remain calm, assess the situation, call for help, and be prepared to administer appropriate first aid intervention. Provide brochures regarding home safety. Instruct patients to post emergency numbers. “Childproof” homes. Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 71 Legal Issues Good Samaritan laws protect individuals who provide medical assistance at the scene of an accident Statutes vary greatly from state to state Not legally obligated to give emergency care at the site of an accident Legal liability limited to gross neglect of the victim or willfully causing further injury to the victim Are protected as long as you work within your scope of competence Are only in effect at the site of an emergency, not at your place of employment Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. 72
