Group 7 Incidents & Emergencies PDF

INCIDENTS & EMRGENCIES Group 7  PRINCIPLES AND CONCEPTS RELATED TO EMERGENCY CARE Health care providers must be vigilant in maintaining a safe environment for treatment. It is the responsibility of the service unit director or department manager to develop and oversee safety education a...

INCIDENTS & EMRGENCIES Group 7  PRINCIPLES AND CONCEPTS RELATED TO EMERGENCY CARE Health care providers must be vigilant in maintaining a safe environment for treatment. It is the responsibility of the service unit director or department manager to develop and oversee safety education and awareness programs for all employees in the department. These programs should include staff meetings and orientation sessions focused on environmental, employee, and patient safety, which need to be developed, implemented, and periodically repeated. General guidelines aimed at reducing and preventing patient or employee injury should be incorporated into the unit's policy/procedures or safety manual. Employees are required to read this material regularly, and their understanding of the content should be assessed. Neglecting to provide adequate information and training on safety can increase the risk of organizational or personnel liability and diminish the quality of care provided.  WRITTEN PR OCEDURES 1. Patie nt Scheduli ng Patterns ratio of per : Define the sonnel to p acceptable when these atients and ratios are n the steps to ot met. take 2. Record Maintenanc thorough re e and M cords, inclu onitoring: d in g Keep documenta referrals, pa tion (e.g., p tient status protocols, a r o gress repo nd incident rts), treatm reports. ent 3. Emergenc y Plans: De for the eva velop and c cuation and ommunicat e plans the roles an c a re of patie d responsib nts, detailin ilities of all g emergencie personnel d s such as fir uring 4. Immediat e s o r other disast e Emergen ers. aid or imme cy C are Plans: diate emerg Establish fir ency care p st- rocedures. EMERGENCY CARE FOR SPECIFIC CONDITIONS  ALLERGIC RE ACTIONS An allergic reaction oc immune sys curs when tem overrea one’s substance, cts to a spe known as cific Allergic rea an allerge ctions can n. mild, mode be classifie rate, or s d as instances, evere. In a person most moderate r with a mi eaction exh ld or and sympto ibits severa ms that usu l signs threatening ally are not ). However, life reaction ca a severe n be life t requires pro hreatening mpt medica and l attention.  INITIAL TREATMENT FOR AN ALLERGIC REACTION MILD/MODERATE REACTION Calm and reassure the person. Identify the allergen and help the person avoid further contact with it or remove it (in the case of an insect stinger). Apply cool compresses or calamine to itchy areas. Observe the person for signs/symptoms of increased distress. Obtain medical assistance or refer the person for such assistance.  INITIAL TREATMENT FOR AN ALLERGIC REACTION SEVERE REACTION Check the person’s airway; if it is compromised, seek medical assistance and begin rescue breathing and cardiopulmonary resuscitation. Calm and reassure the person. Help the person ingest or inject emergency allergy medication if it is available; do not use an oral medication if the person has breathing difficulty. Position the person to prevent shock.  LACERATION S A laceration is a type of by a tear o wound caus r cut in the ed often resu skin or tissu lting from es, trauma. Un blunt or s like an inc harp typically a c ision, which lean and st is by a sharp raight cut m object (like ade laceration is a scalpel), often irregu a When trea lar and jagg ting a p ed. laceration, t erson with he objective a contaminat s are to pre ion of the w vent the bleeding ound and co. ntrol  INITIAL TREATMENT OF LACERATIONS Wash your hands, apply protective gloves, and apply a clean or sterile, nonabsorbent towel or similar object to the wound. Continue to wear protective gloves during the treatment of the wound. Obtain additional assistance and contact emergency services personnel as necessary. If the blood flow is excessive, elevate the wound above the level of the heart to reduce blood flow to the area.  INITIAL TREATMENT OF LACERATIONS In some instances, the wound can be cleansed with an antiseptic or by rinsing it with water. Place a clean towel or sterile dressing over the wound, and apply direct pressure to a bleeding wound. Encourage the patient to remain quiet and to avoid using the extremity  INITIAL TREATMENT OF LACERATIONS If arterial bleeding occurs (demonstrated by spurting blood), it may be necessary to apply intermittent, direct pressure to the artery above the level of the wound or directly over the wound. Such pressure is applied most frequently to the brachial and femoral arteries to restrict blood flow to the distal wound site. However, prolonged pressure with the use of a tourniquet should be avoided. The person should be transported to a site where appropriate medical care can be provided unless assistance can be brought to the patient.  S HOC K When treati ng a person the object who is in sh ives are ock, reduce or to identify remove th and possible, an e cause, w d to preven hen extent of t or reduce the physio the shock. Sign logical sta s and sym te of include pal ptoms of s e, moist, co hock and irregula ol skin; sha r breathing; llow weak, rapid dilated pup pulse; diaph ils; a or nausea; a oresis; dizzi nd syncope ness.  INITIAL TREATMENT OF SHOCK Determine the cause of the shock (e.g., excessive bleeding, the inability to adjust to moving from a supine to a sitting or standing position, or a response to excessive heat), and remedy it if possible. Monitor the person’s blood pressure and pulse rate. Obtain additional assistance and contact emergency support personnel as necessary.  INITIAL TREATMENT OF SHOCK Place the person in a supine position with the head slightly lower than the lower extremities. If head and chest injuries are present or if respiration is impaired, it may be necessary to place the person supine with the body flat or with the head and chest elevated slightly. If bleeding is the apparent cause of the shock and the wound is visible, attempt to control the bleeding as described for a laceration.  INITIAL TREATMENT OF SHOCK A cool compress may be applied to the person’s forehead for comfort, and a light blanket may be used to prevent loss of body heat. Have the person remain quiet and avoid exertion.  INITIAL TREATMENT OF SHOCK After the symptoms have been relieved, gradually return the person to an upright position and monitor him or her to ensure regression of the condition. Request transportation so the patient can be taken to a facility where proper care and treatment can be provided  ORTHOSTAT IC (POSTURA HYPOTENSI L) ON Orthostatic hypotension postural hy , also know potension, n as characterize is a cond d by a s ition blood pres udden dro sure when p in attempts t a the per o stand r son stooped, apidly from kneeling, a sitting pos recumben ition. This t, or pressure ca drop in b n reduce b lood brain, cau lood flow t sing symp o the dizziness or toms such fainting. as  INITIAL TREATMENT OF ORTHOSTATIC (POSTURAL) HYPOTENSION The initial measures used to resolve hypotension are the same as those listed in the initial treatment of shock but some measures that can be taken to prevent this condition  INITIAL TREATMENT OF ORTHOSTATIC (POSTURAL) HYPOTENSION Wrap the patient’s lower extremities from the feet to the groin with elastic bandages; apply an abdominal binder or corset; apply elastic hose (half or full length); instruct the patient to perform active ankle dorsiflexion-plantar flexion exercises (“ankle pumps”) and alternate knee-to-chest exercises frequently while supine or sitting; allow the patient to accommodate to the upright position gradually by slowly elevating the head of the bed to various levels; or use a tilt table to elevate the patient by increments.  INITIAL TREATMENT OF ORTHOSTATIC (POSTURAL) HYPOTENSION In a severe case, it may be necessary to apply a full-body pressurized garment (i.e., a G suit) to stabilize the patient’s venous circulation. The abdominal binder, elastic lower extremity wraps, elastic hose, and G suit provide external pressure to the veins of the extremities and trunk, which helps return venous blood to the heart and reduces the pooling or collection of venous blood in the lower extremities and abdomen.  INITIAL TREATMENT OF ORTHOSTATIC (POSTURAL) HYPOTENSION The active use of the lower extremity muscles will assist in “pumping” or moving the blood. The gradual elevation of the patient from a recumbent to a sitting or standing position allows the vascular system to accommodate physiologically to the changes in position.  FALLS Falls are one o f the leading ca especially amo uses of injury, ng older adults They can lead t and children. o a variety of in ranging from m juries, ild to severe, a in fractures, he nd may result ad trauma, or o ther physical damage.  FALLS CAUSES: FALLS CAN HAPPEN DUE TO VARIOUS REASONS, INCLUDING POOR LIGHTING, SLIPPERY SURFACES, UNEVEN FLOORS, AND MEDICAL CONDITIONS THAT AFFECT BALANCE (E.G., DIZZINESS OR LOW BLOOD PRESSURE). RISKS: OLDER ADULTS, PEOPLE WITH DISABILITIES, AND YOUNG CHILDREN ARE PARTICULARLY VULNERABLE.  ENVIRONMENTAL FACTORS SLIPPING ON A WET FLOOR: A COMMON HOUSEHOLD ACCIDENT THAT CAN CAUSE BRUISING, SPRAINS, OR EVEN FRACTURES. TRIPPING ON UNEVEN PAVEMENT: OUTDOOR FALLS CAN CAUSE CUTS, SCRAPES, OR MORE SERIOUS BONE INJURIES. FALLING FROM STAIRS OR LADDERS: THESE TYPES OF FALLS CAN LEAD TO SEVERE INJURIES, INCLUDING HEAD TRAUMA AND BROKEN BONES.  FRACTURES A FRACTURE IS A BREAK OR CRACK IN A BONE, WHICH CAN RANGE FROM MINOR CRACKS TO COMPLETE BREAKS. FRACTURES ARE OFTEN CAUSED BY HIGH- IMPACT INJURIES, SUCH AS FALLS OR CAR ACCIDENTS, BUT CAN ALSO OCCUR DUE TO OVERUSE (STRESS FRACTURES) OR MEDICAL CONDITIONS LIKE OSTEOPOROSIS.  TYPES OF FRACTURES There are several types, including simple (closed), compound (open), and stress fractures. Risks: Fractures are more common among athletes, the elderly, and individuals with bone- weakening conditions. Example: Hip fracture: Common among older adults after a fall, often requiring surgery. Wrist fracture: A common injury in children and athletes, typically occurring when trying to break a fall with the hand. Stress fracture in the foot: Often seen in runners and people who engage in high-impact sports.  INITIAL TREATMENT OF FRACTURES Obtain information about the injury from the patient if he or she is conscious (e.g., its cause, location, the extent of discomfort, and any restriction of motion). Obtain additional assistance and contact emergency services personnel as necessary. Observe the site of the injury or the position of the extremity; examine and evaluate the patient’s general appearance and condition. Monitor the patient’s blood pressure and pulse rate.  INITIAL TREATMENT OF FRACTURES Gently palpate the area and surrounding tissue toevaluate swelling or edema and tenderness. Deformity and soft- tissue bruising may indicate that a fracture has occurred. Avoid movement or activity that has the potential to cause additional damage to the site.  INITIAL TREATMENT OF FRACTURES Cover an open fracture site with a sterile towel or dressing, but do not attempt to reinsert the bone ends beneath the skin. If a spinal fracture is suspected, do not move the patient. Call 911 or the emergency response system if you are in an outpatient setting, or obtain immediate assistance from appropriate emergency personnel if you are working in an inpatient environment.  BURNS Burns are injuries to or deeper the skin tissues ca heat, radi used by ation, che electricity micals, , or sunlig are classi ht. They fied by se first-degr verity: ee, secon and third d -degree, -degree b urns.  Types of Burns: First-degree: Affect only the outer layer of skin, causing redness and minor pain (e.g., mild sunburn). Second-degree: Affect both the outer and underlying layers of skin, leading to blistering and more intense pain. Third-degree: Penetrate the full thickness of the skin, destroying nerves and tissue. Risks: Young children and older adults are at higher risk for serious burns due to their more delicate skin. Examples: Scald from hot liquids: Common in kitchens or with young children, causing second-degree burns. Chemical burn from cleaning products: Accidental exposure to chemicals can lead to severe skin or eye burns. Burn from open flames: House fires or grilling accidents can cause severe burns, including third-degree.  INITIAL TREATMENT OF BURNS Remove or eliminate the agent causing the burn or remove the patient from the agent and contact skilled personnel when the burn wounds are extensive or involve the face, hands, perineum, or feet. Cut away or remove clothing near the site of the burn,but do not attempt to remove clothing that lies over oris part of the wound. Remove jewelry from the patient if edema has not developed and if the jewelry can be removed without causing additional trauma.  INITIAL TREATMENT OF BURNS A clean or sterile dressing or towel can be loosely laid over the wound. In some instances a moist dressing will be more comfortable for the patient. Do not apply any cream, salve, ointment to the wound, because these substances will mask the appearance of the wound and may lead to infection or a delay in healing. If the wound has been caused by a toxic chemical, use a small amount of water to wash the wound site to dilute the substance. Observe the patient for shock, respiratory distress, and other symptoms or injuries. Prepare the patient for transportation or transport to a facility that is prepared to manage this type of injury.  CHOKING When a per son is choki objectives a ng, the re to restore maintain a p and atent airwa y and normal brea thing.  WHEN ASSISTING A CONSCIOUS ADULT OR A CHILD WHO IS OLDER THAN 1 YEAR: Ask the person if he or she is choking. If the person can speak, cough, or breathe, do not attempt to provide further assistance but remain close by until it appears that he or she is no longer in distress. If the person is unable to speak, cough, or breathe, check his or her mouth and remove any visible foreign object. If the person cannot speak, cough, or breathe, position yourself behind him or her. Clasp your hands over the person’s abdomen slightly above the umbilicus but below the diaphragm.  WHEN ASSISTING A CONSCIOUS ADULT OR A CHILD WHO IS OLDER THAN 1 YEAR: Make a closed fist of one hand, and cover it by your other hand; give three or four forceful abrupt thrusts against the person’s abdomen to forcefully compress the abdomen in and up. Continue to apply the thrusts until the obstruction becomes dislodged or is otherwise relieved or the person becomes unconscious. Obtain advanced medical assistance  WHEN ASSISTING AN UNCONSCIOUS ADULT OR CHILD WHO IS OLDER THAN 8 YEARS: Place the person in a supine position and ask others to contact advanced medical assistance. Open the person’s mouth and use your finger to attempt to locate and remove the foreign object (i.e., perform a finger sweep). Open the airway by tilting the head back and lifting the chin forward (i.e., a head tilt–chin lift) and attempt to provide ventilationusing the mouth-to-mouth technique.  WHEN ASSISTING AN UNCONSCIOUS ADULT OR CHILD WHO IS OLDER THAN 8 YEARS: If respiration does not occur, administer 6 to 10 subdiaphragmatic abdominal thrusts using the heel of one hand reinforced by the other hand (i.e., the Heimlich maneuver). If this approach is unsuccessful in initiating respiration, repeat the finger sweep, open the airway, attempt to provide ventilation, and perform the abdominal thrusts. Be persistent and continue these procedures until the object is removed or advanced medical assistance arrives. (Note: Avoid performing a blind finger sweep in children who are younger than 8 years. Instead, lift the chin to expose the oral cavity and remove a foreign body if you see it.)  WHEN ASSISTING AN UNCONSCIOUS ADULT OR CHILD WHO IS OLDER THAN 8 YEARS: After the object has been removed, it may be necessary to initiate cardiopulmonary resuscitation techniques to stabilize the person’s cardiopulmonary functions  WHEN ASSISTING A CONSCIOUS INFANT (YOUNGER THAN 1 YEAR): Support the head and neck with one hand and place the child in a prone position over your forearm, with the head lower than the trunk and your forearm supported on your thigh. Perform four gentle but forceful interscapular blows with the heel of your free hand. Immediately after applying the blows to the upper back, turn the infant supine with the head lower than the trunk, and perform four thrusts to the lower sternum with two fingers. Repeat the back blows and sternal thrusts until the object is expelled  WHEN ASSISTING AN UNCONSCIOUS INFANT: Place the infant supine and ask others to contact advanced medical assistance. Perform a tongue-jaw lift and remove any foreign object if it is visible. Open the airway using a slight head tilt–chin lift technique described previously and attempt to ventilate the infant. Perform four back blows and four sternal thrusts if respiration has not been started.  WHEN ASSISTING AN UNCONSCIOUS INFANT: If the foreign body has not been removed, repeat the sequence until the foreign object is extracted. If the foreign body has been removed and the infant is not breathing, initiate basic cardiopulmonary resuscitation techniques (i.e., open the airway, use mouth-to-mouth and nose ventilation, and perform chest compressions with two fingers to initiate a heart rate)  CONVULSIO NS/SEIZUR ES When a per son has a c or seizure, t onvulsion he objective are to prot s ect the pat injury shoul ient from d a fall or involuntary excessive movements extremities of the occur and t protect his o or her mo privacy. desty or  INITIAL TREATMENT OF SEIZURES Place the person in a safe location and position; do not attempt to restrain or restrict the convulsions. Obtain additional assistance and contact emergency services personnel as necessary. Monitor the rate and quality of respiration. A period of tonic contraction of all body muscles may occur, which will cause respiration to cease for up to 50 to 70 seconds, after which respirations may be slower and deeper than normal for a brief period Assist in keeping the patient’s airway patent, but do not attempt to open the mouth by placing any object between the teeth. Never place your finger or a wooden or metal object in the patient’s mouth, and do not attempt to grasp or position the tongue.  INITIAL TREATMENT OF SEIZURES When the convulsions subside, turn the person’s head to one side in case vomiting occurs. Allow the patient to rest after the convulsions cease and protect his or her modesty and privacy. It may be helpful to cover the person with a blanket or screen him or her from view. Sphincter control may be lost during or at the conclusion of the seizure, resulting in the involuntary discharge of bladder or bowel contents. The patient should be evaluated by a physician to determine the cause of the seizure if the cause is not known.  HEAT-RELA TED ILLNESSES When treati ng a person illness, the with a heat- objectives related reduce the are to rem cause of th ove or the individ e illness an ual to a d return homeostasi state of s. normal The two p rimary form illness are h s of heat- eat exhaust related Of the two, ion and hea heat exhaus t stroke. threat to tion poses t life, where he least considered as heat s a medical e troke is it can be life mergency b ecause threatening.  HEAT EXHA USTION When the signs and heat exhau symptoms stion are o of important bserved, it to cool the is counteract person and the effects dehydration of. You may the person need to tre for shock, a at be alert fo nd you shou r signs or ld heat stroke symptoms of  HEAT STRO KE Heat strok e is life thr signs and eatening, a nd its symptoms recognized must be quickly emergency so that first-aid tr be initiated eatment c promptly. an heat strok A person e will req with treatment uire care by qualif and personnel ied medi and must cal to a med be transpo ical facility rted possible. as quickly as  INITIAL TREATMENT OF HEAT EXHAUSTION Place the person in a comfortable position in a shady or covered area or in a room that is well ventilated. Loosen or remove the person’s outer clothing and monitor his or her vital signs. Obtain additional assistance and contact emergency service personnel as necessary. Sponge the person’s forehead and neck with a cold compress or ice bag. Cool wet towels or sheets can be used to cool the person, and water or a solution containing electrolytes may be given by mouth if the person is conscious.  INITIAL TREATMENT OF HEAT EXHAUSTION Observe the person for shock or other physiological changes and treat the symptoms as appropriate. Vomiting, refusal of fluids, or loss of consciousness indicates that the condition is becoming worse. Request transportation so the person can be taken to a facility where proper care and treatment can be provided if no relief of signs and symptoms occurs within a short time or if further progression of the signs  INITIAL TREATMENT OF HEAT STROKE Place the person in a semireclining position in a shady or well- ventilated covered area or room. Remove his or her outer clothing and monitor pulse and respiration rates. Obtain additional assistance and contact emergency services personnel immediately. Cool the person quickly with large amounts of cool or cold water or apply cold, wet compresses, towels, or sheets to the body. Ice bags can be applied to the wrists, ankles, each groin area, each axilla, and the lateral neck areas to cool the large blood vessels. Heat stroke is a life-threatening condition, and prompt emergency care must be provided. The person should be transported to a medical facility as quickly as possible.  INSULIN-RE LATED ILLNESSES When treat ing a perso related illn n with an in ess, the o sulin- restore him bjectives a or her to a re to glucose sta normal insu te and to re lin- compensate move, corre for the c ct, or condition. A ause of n insulin r the caused by t eaction ca oo much sy n be little food in stemic insul take, or exc in, too relation to essive exerc the metabo ise in person. lic state of the  ACIDOSIS (HYPERGLY CEMIA) Acidosis ca n lead to a and death diabetic co can occur ma, allowed to if this stat persist. It e is considered should be a medical e requires p mergency t rompt ac hat assistance f tion, inclu rom qualifie ding patient shou d personne ld not be gi l. The sugar. Usua ven any for lly an injec m of needed, and tion of insu a nurse or p lin is provide car hysician sho e as quickly uld as possible.  INSULIN RE ACTION (HYPOGLYC EMIA) Hypoglycem ia is not acidosis, b as serious ut the per as given the o son should pportunity be balanced m to return t etabolic sta o a possible. It te as quickl may be n y as provide co ecessary t unseling a o balance fo bout how od intake a to how to mo nd exercise nitor blood or and the ins glucose lev ulin dosage els with greater regularly a care. nd  CONCLUSIO Patient care N and the environmen treatment t, general consideratio patient safety ns, and th qualified, co e employm mpetent, an ent of personnel s d properly hould be re trained must be inf viewed. The ormed of th patient outcome o e intent and f treatmen desired should be p t. The ca repared to p regiver emergency rovide care or obt adverse re ain assistan action to ce if an Special ca treatment re and a occurs. provided to ttention sh any patien ould be has the po t whose co tential to d ndition serious prob evelop into lem. a more THANK YOU FOR LISTENING! The End