Y khoa - Dược - Chapter 57: Emergency preparedness

57Emergency Preparedness57.1 Discuss the importance of first aid during a medical emergency. 57.2 Identify items found on a crash cart. 57.3 Recognize various accidental emergencies and how to deal with them. 57.4 List common illnesses that can result in medical emergencies. 57.5 Identify less common illnesses that can result in medical emergencies. Learning Outcomes57.6 Discuss your role in caring for people with psychosocial emergencies.57.7 Carry out the procedure for calming a patient who is under extreme stress. 57.8 Discuss ways to educate patients about how to prevent and respond to emergencies. 57.9 Illustrate your role in responding to natural disasters and pandemic illness. 57.10 Discuss your role in responding to acts of bioterrorism.Learning OutcomesIntroduction EmergenciesAcute illnessesInjuriesPhone calls from patients with urgent problemsDisasters The medical assistant must be prepared to determine the urgency of and handle any emergencies that arise.Understanding Medical Emergencies Any situation requiring immediate careFirst aidSave a lifeReduce pain Prevent further injury Reduce the risk of permanent disability Increase the chance of early recovery Apply Your KnowledgeWhy is it important to perform first aid in a medical emergency?ANSWER: First aid can: Save a life  Prevent further injury Reduce pain  Reduce risk of permanent disability Increase the chance of early recoveryGood Job!Preparing Medical EmergenciesPreparing the OfficeKnow what is expected of youPost emergency telephone numbers At every telephoneOn the Crash cart or firstaid trayPreparing the Office (cont.)Provide information to EMSYour name and locationNature of the emergencyNumber of people needing helpCondition of the injured or ill patient(s)Summary of the first aid already givenDirections to your location Do not hang up until the dispatcher gives you permission to do so.Preparing for Medical Emergencies (cont.)Emergency and first-aid suppliesCrash cart / trayBasic drugs, supplies, and equipment for medical emergenciesFirst-aid kit for minor injuries and ailmentsMust be routinely checked and restockedGuidelines for Handling EmergenciesMedical assistantsRecognize life-threatening conditionTake appropriate actions Patient emergenciesAssess the situationPPEAssess patient Initial assessmentGeneral impression Level of responsivenessAssess CABsUrgency of conditionFocused exam DocumentGuidelines for Handling Emergencies (cont.)Telephone emergenciesTriaging Classification of injuriesFollow office protocolsGeneral guidelinesStay calmReassure the patientAct confidentlyGuidelines for Handling Emergencies (cont.)Personal protectionTake precautions to reduce chance of exposure during an emergencyFollow Standard Precautions and use PPEMinimize splashingWash handsKeep PPE in first-aid kit at home and workHandling Emergencies (cont.)DocumentationAssessmentTreatment givenPatient responseIf patient transported, location of facilityApply Your KnowledgeWhat are the steps of the initial assessment of a patient in an emergency?ANSWER: The steps of the initial assessment are: Form a general impression of the patientDetermine the patient’s level of responsivenessAssess CABsDetermine the urgency of conditionPerform a focused exam Document findings/report to physician or EMTCorrect!Accidental InjuriesProvide first aidBe able to help in emergency situationsBites and stingsBurns ChokingEye and ear injuries Falls, fractures, dislocationsHead injuries Bites and StingsAnimal bitesBruise, tear, punctureCleanse wound, apply ointment and dry, sterile dressingInsect stingsRemove stingerWash area, apply iceBites and Stings (cont.)Snake bitesMay need antivenin Immobilize and position below heartSpider bitesRefer to physicianWash area, apply ice, and keep below heart levelBurnsThermalHot liquids, steam, flame, etc.Water, wet cloth, or blanketChemical Remove chemicalWash with cool water for 15 minutesCover with dry, sterile dressingBurns (cont.)ElectricalEntry and exit sitesTissue damage along current’s pathwayClassifications of burns – severityDepth and extent Source of burnAge of patientBody area burnedOther illness or injuriesChokingFood or foreign object blocks the trachea or windpipeUnable to speakUniversal sign – hand up to throat with a fearful lookBe prepared to act promptly!Accidental Injuries (cont.)Ear traumaLacerations, cutsSevered ear ~ transport with patientEye trauma Care depends on severityForeign object in the eyeAccidental Injuries (cont.)Falls Have patient examined before movingStabilize neck if injury suspected Minor falls, notify the physicianDocumentFractures and DislocationsFracture – break in the boneDislocation – displacement of bone end from the jointImmobilization Sling or splint Cast Fractures and DislocationsSprain Partial tearing of a ligament supporting a jointSplint and apply iceStrain – muscle injury from overexertionHead InjuriesConcussion – jarring injury of the brainSevere head injuries – contusions, fractures, and intracranial bleedingScalp hematoma – bleeding under skin on headScalp lacerations – often bleed profuselyHemorrhagingInternal Keep patient warm, quiet, and calmGet medical helpExternalElevate body partPut direct pressure on nearestpressure point between wound and heartMultiple InjuriesAssess CABsCall EMSPerform CPR if neededOnly perform first aid after CABs ensuredTreat most life-threatening injuries firstPoisoningSubstance that produces harmful effects if it enters the bodyIngested Absorbed Inhaled Patient education – symptoms and treatmentsPoison control center telephone numberPoisoning (cont.)Ingested poisonsOnly induce vomiting if directed Position patient on left sideSend poison container with patientAbsorbed poisonsRemove contaminated clothingWash skin, alcohol, rinseInhaled poisonsGet to fresh airLoosen clothingCheck CABsWeather-Related InjuriesHypothermiaTemperature below 95ºMove patient inside, cover with blanketsFrostbiteIce crystals form between tissue cellsWarm with clothing or other body partWeather-Related InjuriesHeat strokeProlonged exposure to high temperatures and humidityMove to cool place, cool with whatever is availableSunburn Soak in cool water, cold compressesPatient educationWoundsIncisions and lacerationsControl bleedingClean and dress woundAmputationsElevate extremityTransport body part with patientLaceration WoundsAbrasion Wash with soap and waterRemove debrisApply dressing if large areaPunctures Rinse, clean, dressTetanus toxoid immunizationAbrasion PunctureContusionWoundsApply Your KnowledgeANSWER: The patient holds his hand to his throat and looks afraid.What is the universal sign of choking?A patient arrives at the clinic hemorrhaging from the left thigh. What steps should you take to control the bleeding?ANSWER: The steps are: Apply direct pressure with sterile gauze Add additional dressing as necessary Elevate the leg Apply pressure to the left femoral arteryYeah!Common IllnessesAbdominal pain – a variety of causes Asthma – spasmodic narrowing of bronchiDehydration – lack of adequate water in the body Diarrhea – can result in dehydration and electrolyte imbalanceCommon Illnesses (cont.)Fainting – partial or complete loss of consciousnessFever – usually indicates infectionHyperventilation – breathing too rapidly and too deeplyCommon Illnesses (cont.)Nosebleed – epistaxisTachycardia Rapid heartPalpitations Vomiting – can result in dehydration and electrolyte imbalanceApply Your KnowledgeMatching:___ Syncope A. Nosebleed___ Pulse > 100 bpm B. Fainting___ Spasmodic narrowing of bronchi C. Dehydration___ Dehydration and electrolyte imbalance D. Tachycardia___ Epistaxis E. Diarrhea/vomiting___ Rapid and deep breathing F. Asthma___ Lack of adequate water G. HyperventilationANSWER:GFEDCBABravo!Less Common IllnessesAnaphylaxis Severe, life-threatening allergic reactionCheck CABs, perform CPR if neededBacterial meningitis – usually a complication of another bacterial infectionDiabetic emergencies Insulin shock – severe hypoglycemia Diabetic coma – severe hyperglycemia Less Common Illnesses (cont.)Gallbladder attack – inflammation of the gallbladderHeart attack Myocardial infarctionChest pain ~ cardinal symptomCardiac arrest ~ ventricular fibrillationLess Common Illnesses (cont.)Hematemesis – vomiting bloodObstetric emergencies – office protocols Respiratory arrestLack of breathingMay follow respiratory distressAssess CABs, perform CPR, if neededLess Common Illnesses (cont.)Seizures ConvulsionsPrevent injuryShock Cardiovascular system failureHypovolemic shockSeptic shockLess Common Illnesses (cont.)Cerebrovascular accident (CVA) – due to impaired blood supply to brainToxic shock syndrome – acute bacterial infectionViral encephalitis – inflammation of the brain due to a virusApply Your KnowledgeMatching:___ Hypo- or hyperglycemia A. Stroke___ Myocardial infarction B. Diabetic emergencies___ Vomiting blood C. Seizures___ Impaired blood supply to brain D. Hematemesis___ Convulsions E. Shock___ May be hypovolemic or septic F. Heart attackFEDCANSWER:BASUPER!Common Psychosocial Emergencies Spousal, child, and elder abuseDrug or alcohol abuseDepression / suicideViolent behaviorOffice protocolsDocument Report of rape – chain of custodyRemember legal obligation to report spousal, child, and elder abuse as well as rape. Apply Your KnowledgeMrs. Jamison tells you that she is very tired of being ill and often thinks of “ending it all.” She then laughs and says she was just kidding. What is/are your responsibilities in this matter?ANSWER: You should allow her to talk about her feelings and despite the fact that she said she was “just kidding” you should take her seriously. The physician should be told of her comments. You may be asked to provide her with information on community services available. You should document her comments and your actions.Fantastic!The Patient Under StressExtreme stressBehavior different from normalUnable to focus or follow directionsKeep victims and family calmChallenges Non-English speakingVisual and hearing impairments Educating the Patient How to prevent and handle medical emergenciesEncourage patients and families to learn first aid and CPRHow to access EMS Post emergency phone numbersHow to childproof homesApply Your KnowledgeTrue or False:___ All people react the same during an emergency.___ Patients should be encouraged to learn CPR and first aid.___ Challenges to dealing with patients during an emergency include visual and hearing impairments and English- speaking people.___ Patients should be instructed on how to prevent  emergencies.___ It is not important to keep the victim of an emergency calm.ANSWER:FFFTTdifferentlynon-Very Good!Disasters and PandemicsBe familiar with standard protocols for responding to disastersParticipate in practice drills Evacuation and Shelter-in-Place PlansMeans of communication during and after an emergencyAlert should distinguish between the twoPandemic IllnessEstablish a planIdentification and isolation patientsCommunication and reportingOccupational healthEducation and training Respiratory hygieneBioterrorismIntentional release of a biologic agent with the intent to harm individualsBiologic agent = weaponEasy to disseminateHigh potential for mortalityCause public panic or social disruptionRequires public health preparednessBioterrorism (cont.)Physician’s offices are the front lines Individual casesCommon trends in syndromes/unusual patternsTriage – classification of injured victimsEmergentUrgentNonurgentDead Apply Your KnowledgeWhat is the difference between evacuation and sheltering-in-place?ANSWER: When an evacuation is called – everyone leaves the premises following routes on posted maps. For shelter-in-place everyone in the office take refuge in an internal room with few or no windows.What criteria does a biologic agent have to meet to be a biological weapon?ANSWER: It must be easy to disseminate, have a high potential for mortality, cause public panic, and require public health preparedness.Impressive!In Summary57.1 Prompt and appropriate first aid can save a life, reduce pain, prevent further injury, reduce the risk of permanent disability, and increase the chance of early recovery. 57.2 The crash cart should include all appropriate drugs, supplies, and equipment needed for emergencies. 57.3 Accidental injuries you may encounter include bites and stings; burns; choking; ear trauma; eye trauma; falls; fractures, dislocations, sprains, and strains; head injuries; hemorrhaging; multiple injuries; poisoning; weather-related injuries; and wounds.In Summary (cont.)57.4 Common illnesses that may cause a medical emergency include abdominal pain, asthma, dehydration, diarrhea, fainting, fever, hyperventilation, nosebleed, tachycardia, and vomiting.57.5 Less common illnesses you may encounter in a medical office include anaphylaxis, bacterial meningitis, diabetic emergencies, gallbladder attack, heart attack, hematemesis, obstetric emergencies, respiratory arrest, seizures, shock, stroke, toxic shock syndrome, and viral encephalitis.In Summary (cont.)57.6 Psychosocial emergencies in the medical office include drug or alcohol abuse, spousal abuse, child abuse, elder abuse, and rape. As a medical assistant, you may be involved in the direct care of someone suffering a psychosocial emergency or you may arrange for their care at an outside agency. 57.7 A medical assistant can help calm a patient under stress by listening carefully and giving her or his full attentionIn Summary (cont.)57.8 Medical assistants should educate patients about ways to prevent and handle various medical emergencies 57.9 During a disaster, a medical assistant’s first-aid and CPR training will be of enormous help. A medical assistant also must be familiar with standard protocols for responding to disasters and pandemic illness.57.10 Physicians’ offices will be on the front lines if a biologic agent is intentionally released as an act of terror. Be aware of unusual patterns of disease in patients being seen at your office. End of Chapter 57In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science. ~ Martin H. Fischer