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Chapter 54Basic Emergency Care

Key Terms

• Cardiac arrest

• Hemorrhage

• Respiratory arrest

Basic Life Support

• This will be discussed and CPR skills demonstrated when you have your CPR class.

• In nursing centers, a nurse decides when to activate the EMS system. The nurse tells you how to help, if a person has stopped breathing or is in cardiac arrest.

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General Rules of Emergency Care

• Know your limits. Do what you can under the circumstances. Even if you only call 911.

• STAY CALM. This helps the victim feel more secure.

• Know what type of EMS system you have in the area that you live. Post the numbers near the phone.

Cont.

• Post your address, & phone number near the phone. You may panic in an emergency and forget them.

• Post Poison Control Number

Hemorrhage

• Excessive loss of blood in a short time.

• May be internal or external

• Follow Standard Precautions and Bloodborne Pathogen Standard

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Internal Hemorrhage

• You can not see internal hemorrhage

• Pain, shock, vomiting blood, coughing up blood and loss of consciousness

• There is little that you can do.

• Activate the EMS system

• Keep the person warm, flat, and quiet until EMS arrives

• Do Not give fluids

External Hemorrhage

• Is usually seen

• Bleeding from an artery occurs in spurts

• Steady flow from a vein

• Do not remove any objects that have pierced or stabbed the person.

• Place a sterile dressing over the wound. Use any clean material if there is no sterile dressing.

Cont.

The victim should be lying down

Apply direct pressure with your hand over the bleeding site. Reinforce dressing if it becomes saturated, continue pressure.

May need to apply pressure to pressure points above the bleeding site see

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Fainting

• Is a sudden loss of consciousness from an inadequate blood supply to the brain.

• Hunger, fatigue, fear, and pain are some common causes. Some people faint at the sight of blood. Standing in one position for a long time and being in a crowded room are some other causes

Warning signals

• Dizziness

• Perspiration

• Blackness before the eyes

• Person looks pale

• Weak pulse

• Respirations are shallow if consciousness is lost

Fainting Emergency Care

Have the person sit or lie down

If sitting, the person bends forward and places their head between the knees

If the person is lying down, raise the legs

Loosen tight clothing

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• If they faint, raise their legs

• Do not let them get up until symptoms have subsided for about 5 minutes

Shock

• Results when organs and tissues do not get enough blood.

• Causes: Blood loss, heart attack (myocardial Infarction), burns, and severe infection.

Signs & Symptoms

• Low or falling blood pressure

• Rapid and weak pulse

• Rapid respirations

• Cold, moist, and pale skin

• Thirst

• Restlessness

• Confusion & loss of consciousness

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Prevent & Treat

•Activate EMS

• Keep the victim lying down.

•Maintain and open airway.

• Control hemorrhage.

• Keep the person warm.

• Reassure

• Follow Standard Precautions & Bloodborne

Pathogen standards

Anaphylactic Shock

Some people are allergic or sensitive to foods, insects, chemical, and drugs

May react with an area of redness, swelling, or itching. Or the reaction can involve the entire body.

Signs & Symptoms

•Anaphylaxis is life threatening sensitivity to an antigen.

• It can occur within seconds.

• Sweating

• Shortness of Breath

• Low blood pressure

• Irregular pulse

• Respiratory congestion

• Swelling of the larynx

•Hoarseness

•Dyspnea

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cont.

• The person needs special drugs to reverse the allergic reaction.

• Keep the person lying down and the airway open.

Stroke

• Cerebrovascular accident (CVA)

• Occurs when the brain is suddenly deprived of its blood supply

• Usually part of the brain is affected

• May be caused by a clot, or hemorrhage

Signs of Stroke

• Depend on the size and location of brain injury.

• Loss of consciousness or semi-consciousness, rapid pulse, labored respirations (breathing), elevated blood pressure and hemiplegia (left or right side paralysis)

• Slurred speech, or aphasia (can’t speak)

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Stroke cont.

• This is a medical emergency

• You must get them to the hospital immediately.

• There is a medications that they can give that will dissolve the clot, but it must be given within 3 hours of when the symptoms began. The person must meet certain criteria.

Stroke (cont)

• Loss of consciousness, rapid pulse, labored breathing, high B/P

• Blurred or loss of vision in one eye

• Unsteadiness, falling, numbness, or weakness on one side

• Sudden confusion, severe headache,

• Aphasia – inability to have normal speech

Stroke (cont)

• Ask person to smile - checking for facial drooping

• Ask person to say a simple sentence “It is sunny out today.” –checking for aphasia (receptive or expressive)

• Ask them to raise their arms – checking for hemiplegia

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Seizures

• (convulsions) are violent and sudden contractions or tremors of muscle groups.

• You cannot stop a seizure.

• You can protect the person from injury.

• This includes activating the EMS system. DO NOT LEAVE THE PERSON ALONE.

Cont.

• Lower the person to the floor

• Protect the persons head from striking the floor by placing folded blanket, towel, cushion, pillow, or other soft item under their head. Place their head in your lap

• Move objects such as furniture, equipment, sharp objects

Cont.

• Turn person onto their side.

• Loosen tight jewelry and clothing around the neck

• Do not give food or fluids

• Do not restrain body movements during the seizure

• Do not put objects or your fingers between the person’s teeth

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Burns

• Can severely disable a person

• They can also cause death

• Most occur in home

• Infants, children and older persons are at risk

Common Causes of Burns and Fires

• Scald from hot liquids

• Playing with matches and lighters

• Electrical injuries

• Cooking accidents (BBQ’s, microwaves, stoves, ovens

• Falling asleep while smoking

• Fireplaces

Cont.

• Space heaters

• No smoke detectors or nonfunctioning smoke detectors

• Sunburn

• Chemicals

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Cont. (burns)

• Do not touch the person if they are in contact with an electrical source

• Remove person from the fire or burn source

• Stop the burning process, with water, or roll the person in a blanket, coat, sheet, or towel

Cont.

• Do not remove burned clothing that is sticking to the skin.

• Remove hot clothing that is not sticking to the skin. If you cannot remove, cool with water

• Remove jewelry and any tight clothing that is not sticking to the skin

• Provide rescue breathing and CPR as needed

Cont. (burns)

• Cover burns with sterile, cool, moist coverings. Or use towels, sheets, or any other clean cloth. Keep the covering wet.

• Do not put oil, butter, salve, or ointment on the burns

• Cover the person with a blanket or coat to prevent heat loss

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Heat stroke

• Heat stroke is the most serious form of heat injury, and is a medical emergency (a.k.a. sunstroke)

• You should call 911 immediately and render aid until they arrive.

• It can kill or cause damage to the brain and other internal organs

• Usually affects persons over age 50, it also take a toll on healthy young athletes

Heat stroke (cont)

• Often occurs as a progression from milder heat related illnesses such as heat cramps (painful brief muscle cramps, Muscles may spasm or jerk involuntarily), heat syncope (fainting) and heat exhaustion. Heat exhaustion occurs due to high temperatures and dehydration. Signs include nausea, dizziness, headaches, cramps, and more. Heat exhaustion can progress to heat stroke if not treated quickly. Anyone experiencing signs of heat exhaustion should drink plenty of fluids, get into cool water (shower, bath, etc), and apply other cool items such as ice or cold compresses

Heat stroke

• Occurs from prolonged exposure to high temperatures

• Usually in combination with dehydration

• Which leads to failure of the body’s temperature control system

• The body’s core temperature greater than 105 degrees F.

• With complications involving the central nervous system.

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Common symptoms

• Nausea

• Seizures

• Confusion

• Disorientation

• Sometimes loss of consciousness or coma

• Other symptoms:

• Throbbing headache

• Dizziness & light headedness

• Lack of sweating

• Red, hot, dry skin

• Muscle weakness or cramps

• Nausea & vomiting

• Rapid heart rate which may be strong or weak

• Rapid, shallow breathing

• Behavioral changes such as confusion, disoriented staggering

• Seizures

• unconsciousness

Cooling strategies

• Ice packs or cool wet towels to armpits, groin, neck and back

• Immerse in a shower or tub of cool water

• Fan air while wetting the skin with a sponge or garden hose

• Call 911

• Kids in Hot Cars

• -Never leave kids alone in a hot car, even briefly.

• -Always check the front and back seats of the car before you lock it and leave.

• -See a kid alone in a hot car? Call 911 immediately. Get them out ASAP if they are in distress.

• -Put your purse, briefcase, or something else you need by the car seat so you don’t forget to check.

• -Always lock your car when it’s empty so kids can’t get in without you knowing.

• SOURCE: National Highway Traffic Safety Administration

• When you walk past a vehicle in a parking lot that has a car seat in it, please glance inside to make sure a child has not been left unattended.

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• SAFETY RECOMMENDATIONS

• NEVER LEAVE A CHILD UNATTENDED IN A VEHICLE. NOT EVEN FOR A MINUTE !

• IF YOU SEE A CHILD UNATTENDED IN A HOT VEHICLE CALL 9-1-1.

• Be sure that all occupants leave the vehicle when unloading. Don't overlook sleeping babies.

• Always lock your car and ensure children do not have access to keys or remote entry devices. IF A CHILD IS MISSING, ALWAYS CHECK THE POOL FIRST, AND THEN THE CAR, INCLUDING THE TRUNK. Teach your children that vehicles are never to be used as a play area.

• Keep a stuffed animal in the carseat and when the child is put in the seat place the animal in the front with the driver.

• Or place your purse or briefcase in the back seat as a reminder that you have your child in the car.

• Make "look before you leave" a routine whenever you get out of the car.

• Have a plan that your childcare provider will call you if your child does not show up for school.

• STUDY CONCLUSIONS

•Average elapsed time and temperature rise• 10 minutes ~ 19 deg F • 20 minutes ~ 29 deg F • 30 minutes ~ 34 deg F • 60 minutes ~ 43 deg F • 1 to 2 hours ~ 45-50 deg F

• “Cracking” the windows had little effect

•Vehicle interior color probably biggest factor • "Parents and other caregivers need to be educated

that a vehicle is not a babysitter or play area ... but it can easily become tragedy"

•Circumstances • An examination of media reports about the 561 child vehicular heatstroke

deaths for an thirteen year period (1998 through 2012) shows the following circumstances: • 51% - child "forgotten" by caregiver (288 Children)

• 29% - child playing in unattended vehicle (163)

• 18% - child intentionally left in vehicle by adult (101)

• 2% - circumstances unknown (9)