emergency final

8/6/2019 Emergency Final

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Emergency

I. Cardiac ArrestA. Adult/child/infant CPR


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1. Definition of agesa. adult and older child (15 and older)b. child 1 to 14 yearsc. infant less than 1 year

2. Assess responsivenessa. shake gently

b. shout "are you okay?"3. If unresponsive, activate the emergency response system

a. if hypoxic arrest call emergency response systemafter 2 minutes of CPR

b. if child or infant call after 2 minutes of CPR unlesssudden witnessed arrest call emergency responsesystem first

4. Call for a defibrillator5. Position the client to a resuscitation position, if no evidence

of trauma (if trauma, see section III of this lesson)6. Open the airway

a. head tilt-chin lift

b. jaw thrust (if trauma is evident or spinal injurysuspected)

7. Assess for breathing: look, listen and feela. if breathing, position in a recovery positionb. if not breathing, give 2 rescue breaths at 1

second/breathc. assess if breaths go into lungs by chest movementd. if air does not go in, reposition airway (see #4

above)e. if air still does not go in, check for foreign body

i. abdominal thrust for adults, older child andchild (Heimlich maneuver)


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ii. back blows and chest thrusts for infantsiii. do not proceed until airway and rescue

breathing is established

iv. no blind finger sweepsf. when airway is clear, check for presence of a pulse

i. check pulse for 10 seconds or less

ii. adult or older child check carotidiii. child check carotid or femoraliv. infant brachial or femoral

g. begin chest compressions if pulse is absent or inchild/infant if heart rate is < 60 with signs of poorperfusion

i. be sure client is on a firm surfaceii. hand position is critical

adult/older child center of chestbetween nipples; two hands withheel of one hand and the other handon top

child center of chest betweennipples; one hand or two hands withuse of the heel(s) of the hands

infant just below the nipple line;one rescuer - two fingers or tworescuers two thumbs encirclinghands around chest

iii. compression depth adults/older child - 1.5 to 2 inches child/infants 1/3 to 1/2 the depth of

the chest

iv. compression rate 100 compressions per

minute forall agesv. PUSH HARD, PUSH FAST for chest

compressionsvi. allow chest recoilvii. minimize interruptions in chest compression

keep at 10 seconds or lessviii. compressions-ventilation ratios

adult/child 30:2 [30 compressionsto 2 breaths] for one or two rescuers

child or infant one rescuers 30:2 (30

compressions to 2 breaths) two rescuers 15:2 (30

compressions to 2 breaths)

h. apply monitor or defibrillator when availablei. reassess cardiopulmonary status after every five

cycles of compressions to ventilationsj. continue until ACLS providers take over or the

client starts to movek. differences for lay persons

i. lay rescuers do not need to assess for pulseor signs of circulation for an unresponsive

victimii. lay rescuers do not need to provide rescue

breathing without chest compressionsII. Early defibrillation

In adults, the arrhythmia most correctable is ventricular fibrillationif treated promptly

Before starting CPR for ventricular fibrillation, call for help
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II. Shock - see the discussion of shock in Cardiovascular

III. Trauma Care

A. Airway with simultaneous cervical spine immobilization1. Must use jaw thrust2. Do not use head-tilt chin-lift: it could injure neck

B. Breathing1. Look, listen and feel for respirations2. Follow CPR procedure

C. Circulation1. Assess pulses

a. carotid pulse: BP at least 60b. femoral pulse: BP at least 70c. radial pulse: BP at least 80

2. Stop any active, visible bleeding by applying direct pressure3. After initial assessment, start two large-bore IVs


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D. Disability: brief neurological exam1. Level of consciousness2. Pupil response to light3. Ability to move extremities

4. Ability to move against resistanceE. Expose

1. Undress client2. Inspect for injuries or deformities

F. Fahrenheit1. Take temperature2. Maintain warmth

a. warm blanketsb. warming lights

G. Get vitals1. Pulse2. Respiratory rate

3. Blood pressureH. History and head-to-toe full assessment

1. How did injury occur - mechanism of injury2. Client's medical history3. Full body system assessment

I. Inspect the back1. Roll the client over - log roll with help2. Inspect for injuries or deformities

CPR

Early defibrillation is the key to successful resuscitation for many adults. Continually reassess during CPR to see if the client regains a pulse or begins

breathing. Reassess to see that the chest moves and pulses are palpable duringCPR.

SHOCK

In shock, the first hour of treatment is most critical. Early detection is key. There are different ways to categorize shock. Basically, shock presents three

potential problems:1. Not enough fluid in the blood vessels (hypovolemia) OR2. Fluid has moved outside the vessels, so cannot be pumped to the organs

(distributive) OR3. Heart cannot pump fluid that is present (cardiogenic)

Shock and Temperature

In septic shock, the skin and body temperature may increase. In other shockstates, body and skin temperature will decrease.

Shock and Heart Signs

Early stages of shock activate the sympathetic nervous system. So in earlystages, the client will not always be hypotensive.

Bradycardia is a very late sign in shock. Another late sign is cardiac arrhythmia (other than sinus tachycardia).

Arrhythmias reflect less perfusion of the coronary arteries and myocarditis. As the myocardium receives less perfusion, heart pumps less. Because less blood perfuses the brain, level of consciousness drops.

Shock and Urinary Output
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Average adult urinary output is 0.5 to 1.0 ml/kg/hr. Less than 30 ml/hour reflectsdecreased renal blood flow. Acute renal failure can result.

Shock and Respiration

As blood flow to lungs decreases, less gas exchange will occur. When tissues receive less oxygen, they produce more lactate and metabolic

acidosis sets in. Metabolic acidosis increases risk of cardiac arrhythmias. For a client in shock, body cells receive less oxygen and nutrients. Thus

treatment aims at increasing both available oxygen and volume of blood invessels (unless the heart has failed).

Medications can improve tone of blood vessels (inotropes) or treat the cause ofshock (corticosteroids, antibiotics).

When treating a trauma client, you must quickly assess ABCs. After you knowthe client is breathing and has a pulse, vital signs can wait while you stop anybleeding and start other interventions (such as starting IVs). Don't rely only onthe vital sign numbers.

Head and Spine Injury

If client has head injury, the most important assessment is level ofconsciousness; next is pupil response to light. Changes in vitals are very latesign.

With trauma clients, assume spine is injured until proven otherwise. While youopen the airway, you must keep cervical spine immobile.
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