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Unit 52 Response to Basic Emergencies

Adonis K. Lomibao, R.N.

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Objectives

Spell & Define terms Recognize emergency situations & determine

sequence of actions Evaluate situations & determine sequence of

appropriate actions Describe how to maintain airway Recognize the need for CPR

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Objectives Cont.

List appropriate PCT actions for:

-Choking: vomiting & aspiration

-burns

-fainting

-seizure

-bleeding

-falls/ortho injuries/head injuries

-electric shock

-accidental poisoning

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Dealing With Emergencies

Develop rapidly & unpredictably EMERGENCY- any unexpected situation that

requires immediate action and medical attention. I.e: MVA,CVA,Sudden weakness, fainting/falling

Prompt action prevents further complications VICTIM-person needing help

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First Aid

Includes:

-Immediate care for injuries & sudden illness

-Care after if medical help is delayed/not available

You will deal with:

-emotional state

-physical injury

-management of whole accident situation

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First Aid Cont.

Life-threatening situations:

-No airway

-stopped breathing

-in shock

-poisoned

-choking

-bleeding profusely

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Evaluating the Situation

Accident scene-assess situation & find out extent of injuries.

-number of victims

-potential injuries

-dangerous factors i.e.:

-MVA

-Medical facility

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Code Emergencies

Emergency Codes-high risk, emergency situations

California Hospital shooting p. 932 Standardized Code words

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Standardized Code Words

Code Red-Fire Code Blue-Medical Emergency-adult Code White-Medical Emergency-peds Code Pink- infant abduction Code Purple-child abduction Code Yellow- bomb threat Code Gray-combative person Code Silver-weapon/hostage situation

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Code Words Cont.

Code Orange- hazardous material spill/release

Code Triage Internal- internal disaster Code triage external- external disaster

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Assisting with a Code

Responsibilities determined by employer “mock code” Follow directions of nurse or licensed HCP PCT may be messenger, recorder, etc. Know policies!!!

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Emergency Care Given right away to prevent loss of life

-summon help

-do not leave victim(except CPR) Check on:

-degree of responsiveness

-airway/breathing capability

-presence & rate of heartbeat

-signs of bleeding

-signs of shock

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Maintaining the Patient's Breathing

RESPIRATORY FAILURE- breathing is unsufficient to sustain life.

RESPIRATORY ARREST- breathing stops Abnormal respirations-impending crisis Report problems to the nurse!

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Opening the Airway

Remain with pt. & call for help Head-tilt, chin-lift maneuver- most common

way of opening airway

-NOT for pt. With neck injury Jaw-thrust maneuver- for those with neck

injury or if Head-tilt can't be used (head/face injuries)

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Head-tilt, Chin-lift

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Jaw-Thrust Maneuver

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Mask-to-Mouth Resuscitation

VENTILATION-breathing for the patient ADJUNCTIVE DEVICES- a secondary device

used to maintain respirations POCKET MASK-has a valve that prevents

patient's exhaled air and secretions from entering caregiver's mouth

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Pocket Mask

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Cardiac Arrest

CARDIAC ARREST-heart has stopped beating & respirations have ceased

Clinically DEAD Permanent damage to brain & organs in 4-6

minutes Unresponsive, no breathing, no pulse CPR-procedure used to maintain blood

circulation throughout the body DNR!!!

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The Recovery Position

If unresponsive, but breathing & with pulse-

-place in recovery position

-modified lateral position Positioning:

-stable

-avoid pressure on chest

-avoid pressure on lower arm

-allow open airway

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The Recovery Position

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Early Defibrillation

DEFIBRILLATION-method of treatment that uses an electric shock to reverse disorganized activity in the heart during cardiac arrest

Earlier=better <5 mins in community, <3 in HC facility

AUTOMATIC EXTERNAL DEFIBRILLATORS-computerized device

ONLY use when pt. Unresponsive, not breathing, & pulse-less

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AED

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4 Steps for AED Use

1. Turn unit ON

2.Apply electrodes to pt.'s chest

3. stand back to allow machine to analyze rhythm

4.stand back. Follow unit instructions.

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Choking

Airway is blocked:

-foreign body

-blood

-food

-vomitus Tilt head back-pulls tongue forward & may

clear airway If talking/coughing, stand by.

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Choking Cont.

Complete blockage:

- unable to speak

-high-pitched sounds on inhalation

-universal distress signal Standard Precautions! HEIMLICH MANEUVER(abdominal thrusts)

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Heimlich Maneuver

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Infant & Child CPR & Choking

Specific guidelines for infants & children (p.941)

Infant: birth to 1 yr Newborn: birth to 1 mon Child: 1-8 Over 8=Adult procedures

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Other Emergencies

If patient at home:

-initial emergency actions

-how & when to notify EMS

-how & when to notify nurse

-how & which family member to notify

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Bleeding

Injuries more severe if pt. Unconscious Standard Precautions! Internal or External Actions:

-identify

-pressure

-raise above heart

-HEMORRHAGE:heavy bleeding

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Shock!

SHOCK: a disturbance of oxygen supply to the tissues & return of blood to the heart

May follow:

-severe injury

-cardiac arrest

-acute hemorrhage

-severe pain

-excessive loss of body fluids (severe burn)

-serious infection

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Shock S&S

Pale, cold skin Weakness Weak, rapid pulse Rapid, irregular breathing Restlessness & anxiety Perspiration Later signs (p.945)

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Shock Preventative Measures

Call for help Keep person laying & quiet Maintain normal body temp Position with feet & legs slightly higher Do not provide food/drink IV Fluids & O2 Monitor pulse & respirations

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Fainting

Blood supply to brain is reduced for short period=loss of consciousness

Temporary Likely to fall & cause injury S&S: faint, light-headed, dizzy, nauseated,

pallor, cold skin, perspiration, visual changes

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Fainting Nursing Care

Help assume protected position laying/sitting Loosen tight clothing Position head lower than heart Rest Normal body temp Call for help Monitor vitals No food/drink

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Heart Attack

Block in blood flow to muscles of heart S&S:

-crushing pain that can radiate

-perspiration, cold & clammy skin

-N & V

-Pale/Grayish color to face

-difficulty/absence of breathing

-loss of consciousness

-irregular/loss of pulse

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Heart Attack Action

In Healthcare facility:

-help

-stay with pt.

-comfort

-elevate head of bed for breathing

-oxygen if available Unconscious:

-check for breathing & heartbeat

-CPR

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Heart Attack Action

In community (conscious):

-evaluate situation

-Activate EMS

-comfort/loosen clothing

-keep onlookers away

-provide fresh air/keep pt. Warm

-monitor pulse/respirations

-be prepared for CPR

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Stroke

CVA-interference with blood circulation to the brain

Caused by clot or ruptured blood vessel S&S:

-seizure activity

-loss of consciousness

-difficulty breathing

-weakness/paralysis one side of body/face

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Stroke

-unequal pupil reaction Less severe symptoms:

-disorientation

-dizzyness

-headache

-slurred speech

-memory loss

-loss of consciousness

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Stroke Action

Maintain airway Mask to mouth if needed CPR if needed Position on side Maintain normal body temp Keep quiet till help arrives

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Ischemic/ Hemorrhagic Stroke

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Seizures Can be caused by:

-drug overdose

-head injury

-degenerative brain disease

-stroke

-infectious disease & fever

-tumors

-hypoglycemic reactions

-seizure disorder

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Seizures S&S

Momentary loss of contact with environment (absence seizure) no movements, blank stare

Generalized tonic-clonic:

-loss of consciousness

-falls

-rigid

-uncontrolled movements

-cyanotic

-(p.947)

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Seizures Action

After recovery, pt will be:

-confused

-disoriented

-very tired

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Seizure Action

Standard precautions DO NOT RESTRAIN Protect from injury Loosen clothing around neck Maintain airway (positioning) Protect head Observe seizure AFTER seizure: (p.948)

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Vomiting & Aspiration Food,water,etc. Into trachea &

lungs=ASPIRATION S&S:

-coughing

-choking

-cyanosis

-vomiting (when supine)

-inability to swallow

-inability to spit vomitus,blood,secretions from mouth

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Aspiration Action

-stay with pt. & call for help

-standard precautions

-no fluids

-head elevated

-turn head/body to side

-emesis basin

-clear obstructed airway Make Observations & Report to nurse

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Electric Shock Severe burns & Cardiac/respiratory arrest can result Protect yourself!!! Actions:

-turn off electrical source

-if not, move pt. Away with non-conductor

-check for breathing/pulse

-summon help & CPR If needed

-breathing/circulation restored, check for injuries & give first aid

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Burns Result in loss of skin integrity Heat, chemicals, radiation Partial thickness:

-1st-degree: involving top layer. Redness, temp swelling, pain. Skin not broken or blistered

-2nd-degree: both epidermis & dermis. Pink to red or white to tan. Blistering, pain, scarring

Full-thickness:

-3rd-degree burn: epidermis,dermis, subcutaneous. Bright red/tan/brown. No pain initially(destroyed nerve endings)

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Burns

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Burn Emergency treatment

Call nurse Smother fire Cool water to lower temp & stop further tissue

damage 3rd-degree requires extensive treatment

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Orthopedic Injuries

Injuries to bones, joints, muscles, ligaments FRACTURE: break in bone SPRAIN: injury to ligament due to

overstretching STRAIN:excessive stretching of muscle DISLOCATION: in joint,one bone is displaced

from another

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Orthopedic Injury Treatment

Stay with pt. Immobilize DO NOT move Call nurse If on floor,move to bed AFTER nursing

assessment Monitor vital signs & report changes Notify nurse of suspected

sprain,strain,dislocation PCT Care (p. 950)

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Head Injury

Bleeding risk!!! Complications may not be apparent until 72

hours or more S&S:

-change in LOC

-change in orientation

-memory loss

-unequal pupils

-visual disturbances

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Brain Hematoma

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S&S Cont.

Blood/clear fluid from ears/nose Change in ability to speak Weakness of arms/legs HA N&V

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Head Injury Actions

Stay with pt. Monitor VS-HR & RR Keep environment quiet/calm No drinks Reassure & orient pt. Elevate head on pillow Do not move if on floor Monitor VS as ordered

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Accidental Poisoning

If poisoning suspected:

-call nurse

-try to determine what was taken & save container

-nurse may induce vomiting

-know where to find # for poison control!!!

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Thank You!