1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 8 Emergency Conditions

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstructed Airway Blockage can be due to a variety of conditions –Solid foreign object –Fluids –Swelling in throat

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstructed Airway (cont’d) Partial obstruction –Some air exchange in the lungs –S&S Individual able to cough Typically grasps the throat (universal distress signal for choking) –Management: encourage coughing

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstructed Airway (cont’d) Total airway obstruction –No air is passing through the vocal cords –S&S Individual is unable to speak, breathe, or cough Universal distress signal is usually apparent –Perform rescue breathing and if breathing begins again, then monitor the ABC’s

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstructed Airway (cont’d) Total airway obstruction (cont’d) –Management Heimlich maneuver Unconscious individual Clear the airway and stimulate the breathing process. Activate emergency plan Waiting for EMS, continue to perform rescue breathing and if breathing begins again, then monitor the ABC’s

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Emergencies Sudden cardiac death (SCD) –Unexpected death owing to sudden cardiac arrest within 6 hours of an otherwise normal clinical healthy state

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Emergencies Sudden cardiac death (SCD) –Possible causes Hypertrophic cardiomyopathy Abnormal thickening of the left ventricular wall Symptoms of cardiac dysfunction do not appear until early adulthood and result in impaired ventricle filling Periods of arrhythmia Blood flow obstruction may produce syncope

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Emergencies (cont’d) Sudden cardiac death (cont’d) –Possible causes (cont’d) Atherosclerosis Excessive buildup of cholesterol within the coronary arteries, narrows arteries & impedes blood flow Angina due to diminished O 2 Risk for myocardial infarction

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Emergencies (cont’d) Heart attack and cardiac arrest –S&S Chest discomfort (e.g., uncomfortable pressure; squeezing; pain) Pain originating behind the sternum and radiating into either or both arms (usually the left) Pain radiating into the neck, jaw, teeth, or upper back

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Emergencies (cont’d) Heart attack and cardiac arrest (cont’d) –S&S (cont’d) Shortness of breath Nausea Lightheadedness Management Activate emergency plan, including summoning EMS Monitor; perform CPR & rescue breathing, if necessary

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Unconscious Individual Causes: variety; most often- head trauma S&S –Lacks conscious awareness and is unable to respond to superficial sensory stimuli –Coma – individual cannot be aroused even by stimuli as powerful as pin pricks

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Unconscious Individual (cont’d) Management –Assume a life-threatening condition –Activate emergency plan, including summoning EMS –Refer to Application Strategy 8.1

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock If the heart is unable to exert adequate pressure to circulate enough oxygenated blood, shock occurs Heart pumps faster but due to decreased volume, pulse is weak and BP drops, breathing will become rapid and shallow, sweating profuse, leading to unconsciousness and death

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock (cont’d) Could be due to damaged heart, low blood volume, blood vessel dilation Occurs in injuries involving severe pain, bleeding, fracture or intraabdominal or intrathoracic injuries Severity varies with age, physical condition, pain tolerance, fatigue, dehydration, extreme exposure to heat or cold, presence of any disease, improper handling or movement of an injured area Types of shock vary, but S&S same

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock (cont’d) S&S –Feeling of uneasiness or restlessness –Respiration: increased –Pulse: increased weakened heart rate –Skin: pale and clammy; profuse sweating; lips, nail beds, and membranes of mouth appear cyanotic

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock (cont’d) S&S (cont’d) –Thirst, weakness, nausea, and vomiting may develop –Later stages: rapid, weak pulse & labored, weakened respirations may lead to decreased BP & unconsciousness

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock (cont’d) Management –Activate emergency plan, including summoning EMS –Monitor and maintain Airway Normal body temperature

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Shock (cont’d) Management (cont’d) –Control any bleeding –Body position – depends on other possible conditions –Refer to Application Strategy 8.2

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anaphylaxis Shock-like, frequently fatal; hypersensitive reaction to an allergen Common substances –Medications –Foods –Insect stings –Inhaled substances

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anaphylaxis (cont’d) S&S –General feeling of warmth; intense itching, especially soles of feet and palms of hands –Skin reactions (e.g., localized rash or swelling) –Choking, wheezing, and shortness of breath –Rapid and weak pulse –Dizziness, lightheadedness, or fainting

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anaphylaxis (cont’d) S&S (cont’d) –Tightness and swelling – throat and chest; swelling of mucous membranes –Blueness – lips and mouth –Nausea, vomiting, or diarrhea –Anxiety; confusion

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anaphylaxis (cont’d) Management –Activate emergency plan, including summoning EMS –Monitor; perform CPR & rescue breathing if necessary –If the individual has medication (e.g., self- administered epinephrine device EpiPen®), administered immediately.

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hemorrhage Abnormal discharge of blood results in decrease in blood volume and BP –Causes heart action to increase, but pumping action is weakened –Result rapid, weak pulse S&S –Arterial: spurting, bright red color –Venous: steady flow, dark bluish-red color –Capillary: oozing, dull red color

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hemorrhage (cont’d) Management –External hemorrhage Follow universal precautions Apply direct pressure and elevate Elevation – injured area above the heart Continue pressure until blood coagulates If direct pressure is not effective, apply indirect pressure

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hemorrhage (cont’d) Management –Internal hemorrhage Can result from blunt trauma or certain fractures (such as those of the pelvis, rib, or skull) Not visible, so often overlooked S&S: history of trauma; S&S of shock

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Hemorrhage (cont’d) Management (cont’d) –Internal hemorrhage (cont’d) Emergency plan should be activated, including either immediate referral to a physician or emergent care facility or summoning of EMS Treat for shock even if there is no outward indication