1. Roosevelt Health Science Clinical Rotations Successful Nursing Assistant Care, 2 nd Ed.

2.  Define important words  Demonstrate how to respond to medical emergencies  Describe and demonstrate basic CPR and CPR for professional rescuer.  Describe and demonstrate knowledge of first aid procedures  Explain the code team  Describe guidelines for responding to disasters

3.  Medical emergencies can happen when you least expect them.  Choking, diabetic emergencies, falls, poisoning, heart attacks, strokes, and gunshot wounds are all medical emergencies.  The most serious medical emergencies involve one or more of the following:  The person is UNCONSCIOUS  The person is NOT BREATHING  The person has NO PULSE  The person is BLEEDING SEVERELY

4.  In an emergency,  Try to remain calm  Act quickly and communicate clearly  Take your gloves/face mask kit with you  Look around to make sure the area is safe. Make sure you are safe before providing necessary care.  Once you have gloves on follow these steps:  Assess the situation. Notice the time. Try to find out what has happened.  Assess the victim. Ask the injured or ill person what has happened.  If the person cannot respond, he/she may be unconscious.

5.  To determine if the person is conscious,  Tap the person and ask if he/she is alright  Speak loudly  Use the person’s name if you know it  If there is no response, assume that the person is unconscious.  This is an EMERGENCY  Call for help right away, or send someone else to call.

6.  When calling 911 or activating EMS, know the procedure for dialing an outside line.  Be prepared to let the operator know the phone number and address operator know the phone number and address of the emergency, directions, and the location of the building.  Report the victim’s condition, including any medical background you know.  Give your name and position and the details of any first aid being given.  Do not hang up the phone until the dispatcher hangs up or tells you to hang up.  If another person calls911, have him/her return after making the call so that you know the call was placed.

7.  If a person is conscious and able to speak, then he is breathing and has a pulse.  Talk with the person about what happened and check him for injury. Look for these things:  Severe bleeding  Changes in consciousness  Irregular breathing  Unusual color or feel to the skin  Swollen places on the body  Medical alert tags  Any complaints of pain  If any of these exist, you may need professional medical help.

8.  Always get help before doing anything else. If the inured or ill person is conscious, he/she may be frightened.  Listen to the person. Tell him/her what is being done to help him/her.  Be calm and confident.  Reassure him that he/she is being taken care of.  After the emergency, while still on duty, document the emergency in your notes or by completing an incident report.  Record all the details that you remember. Be sure to only record facts such as time, S/Sx, and V/S.

9.  When a person is involved in a serious accident, such as drowning or choking, respiratory arrest can occur.  Respiratory arrest means that breathing stops.  If the person is not helped quickly, cardiac arrest may soon follow.  Cardiac arrest is when the heart stops.  When respiratory or cardiac arrest occurs, CPR is necessary.  CPR is a medical procedure that should be performed until medical help arrives.  Only properly trained people should perform CPR. Never do anything that is beyond your ability or training.

12.  Patients who have difficulty chewing or swallowing, are confused, or have poor vision may be at risk of choking.  When something is blocking the tube through which air enters the lungs, the person has an obstructed airway.  People who are choking usually put their hands on their throats and cough.  As long as the person can speak, cough, breathe, do nothing.

13.  Encourage him/her to cough forcefully as possible to get the object out.  Stay with the person until he/she stops choking or can no longer speak, cough, or breathe.  If a person can no longer speak, cough, or breathe, or turns blue, call for help immediately. Time is of extreme importance.  Abdominal thrusts are a method of attempting to remove an object from the airway of someone who is choking.  These thrusts work to remove the blockage upward, out of the throat.

14.  Make sure the person needs help before giving abdominal thrusts. The person must show signs of a severely obstructed airway. These include:  Poor air exchange, an increase in trouble breathing, silent coughing, blue- tinged skin (cyanosis), or inability to breathe or speak  Be sure to ask the person, “Are you choking?”  If the person nods his/her head “Yes,” he/she has a severe airway obstruction and needs immediate help.  Give abdominal thrusts  If the person is obese or in the later stages of pregnancy, use chest thrusts

16.  Shock occurs when organs and tissues in the body do not receive an adequate blood supply.  Bleeding, heart attack, severe infection, and falling blood pressure can lead to shock.  Shock can become worse when the person is frightened or in severe pain. Shock is a dangerous, life-threatening situation.  S/Sx include pale or cyanotic skin, staring, increased pulse and RR, decreased BP, and extreme thirst.  Always call for help if you suspect a person is in shock.

17.  Call for help. Victims of shock should always receive medical care ASAP.  Control bleeding.  Have the person lie down on his/her back. If the person is bleeding from the mouth or vomiting, place him/her on his/her side (unless you suspect that the neck, back or spinal cord is injured).  Check pulse and respirations if possible. Begin CPR if breathing or pulse is absent.  Keep the person as calm and comfortable as possible. Loosen clothing or ties around the neck and any belts or waist strings.

18.  Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade.  Elevate the feet unless the person has a head, neck or abdominal injury, breathing difficulties, or a fractured bone or back. Never elevate a body part if a broken bone exists or if it causes pain.  Do not give the person anything to eat or drink.

20.  Severe bleeding can cause death quickly and must be controlled.  Always put on gloves. If the patient is able, he/she can old his/her hand over the wound until you can put on gloves.  Hold a thick, sterile pad, a clean pad, or a clean cloth, handkerchief, or towel against the wound.  Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads over the first pad if blood seeps through. Do not remove the first pad.  If possible, elevate the wound above the level of the heart to slow down the bleeding. If the wound is on arm, leg, hand, or foot (no fx), prop the limb on towels, blankets, coats, or other absorbent material.

21.  When bleeding is under control, secure the dressing to keep it in place. Check the person for symptoms of shock (pale skin, increased P and RR, decreased BP, and extreme thirst). Stay with the person until help arrives.  Remove gloves and wash hands thoroughly when finished.

22.  Care for a burn depends on its depth, size, and location.  There are three types of burns: 1 st, 2 nd, and 3 rd degrees.  We will discuss these types at length in Chapter 18  To treat a minor burn:  Use cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice as ice may case further skin damage. Dampen a clean cloth and place it over the burn  Once the pain is eased, you may cover the area with dry, sterile gauze.  Never use any kind of ointment, salve, or grease on a burn

23.  To treat more serious burns:  Remove the person from the source of the burn. If clothing has caught fire, smother it with a blanket or towel to put out flames. Protect yourself from the source of the burn.  Call for help immediately  Check for breathing, pulse, and severe bleeding  Do not apply water. It may cause infection.  Remove as much of the person’s clothing around the burned area as possible. Do not try to pull away clothing that sticks to the burn. Cover the burn with thick, dry, sterile gauze if available, or a clean cloth. A dry, insulated cool pack may be used over the dressing. Again, never use any kind of ointment, salve, or grease on a burn.

24.  Ask the person to lie down. Elevate the affect part if this does not cause greater pain.  If the burn covers a larger area, wrap the person or the limb in a dry, clean sheet. Take care not to rub the skin or break any blisters.  Wait with the person for emergency medical help

25.  Fainting, or syncope, occurs as a result of decrease blood flow to the brain, causing a loss of consciousness.  Syncope may be a result of hunger, fear, pain, fatigue, standing for a long time, poor ventilation, pregnancy, or overheating.  S/Sx include:  Dizziness  Perspiration  Pale skin  Weak pulse  Shallow respirations  Blackness in the visual field

26.  If someone appears likely to faint, follow these steps:  Have the person lie down or sit down before fainting occurs, have the person stay in position for at least five minutes after symptoms disappear  If the person is in a sitting position, have her bend forward and place his/her head between his/her knees. If the person is lying flat on his/her back, elevate the legs.  Loosen any tight clothing  Help the person get up slowly. Continue to observe him/her symptoms of fainting. Assist him/her to sit down if needed. Stay with her until she feels better.  If a person does faint, lower him/her to the floor or other flat surface onto his/her back. Raise feet 8-12 inches if not contraindicated.  Check for breathing.  Keep the person lying down for several minutes, even if he/she recovers quickly  Report the incident to supervisor, syncope can be a sign of a more serious medical condition.

28.  Many facilities contain many harmful substances that should not be swallowed.  Always have Poison Control Center phone number available.  Suspect poisoning when a person suddenly collapses, vomits, and has heavy, difficult breathing.  If you suspect poisoning, take the following steps:  Call for help and call Poison Control  Put on gloves. Look for a container that will help you determine what the person has taken or eaten. With your gloves on, open the mouth and look inside the mouth for chemical burns. Do not place your fingers inside the mouth. Note the breath odor.  Follow Poison Control Center’s instructions.

30.  A nosebleed can occur suddenly when the air is dry, when injury has occurred, or due to some medications.  The medical term for nosebleed is epistaxis.  If someone has a nosebleed, be sure to:  Elevate the head of the bed, or sit the person up. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues or cloths without gloves.  Put on gloves. Apply firm pressure over the bridge of the nose. Squeeze the bridge of the nose with your thumb and forefinger.  Apply pressure until the bleeding stops  Use a cool cloth or ice wrapped in a cloth on the back of the neck, the forehead, or the upper lip to slow the flow of blood. Never apply ice directly to skin.  Keep the person still and calm until help arrives.

32.  Vomiting, or emesis, is the act of ejecting stomach contents through the mouth. It can be a sign of a serious illness or injury.  Follow these steps for dealing with a patient that vomited:  Put on gloves  Place an emesis basin under the chin. If an emesis basin is not nearby, use the wash basin. Remove it when vomiting has stopped.  Provide comfort to the resident. Wipe his/her face and mouth. Position him comfortably, and offer a drink of water or sip to swish in the mouth and spit. Provide oral care. It helps to get rid of the taste of vomit in the mouth.  Remove soiled linens or clothes and replace with fresh linens or clothes.  If the patient’s I&O is being monitored, measure and note amount of vomitus.  Flush vomit down the toilet and wash and store the basin.  Put the soiled linen in proper containers. Remove gloves, and wash your hands.  Document time, amount, color, odor, and consistency of vomitus. Look for blood or blood- tinged vomitus.

33.  When blood flow to an area of the heart is completely blocked, oxygen and nutrients fail to reach its cells. Waste products are not removed and the cardiac muscle cells die.  This is called a Myocardial Infarction (MI) or heart attack.  The area of dead tissue may be large or small, depending on the artery involved.  An MI is an emergency that can result in serious heart damage or death.  The pain of a heart attack is commonly described as a crushing, pressing, squeezing, stabbing, piercing pain, or “like someone is sitting on my chest.” The pain may go down the left arm, up the neck or in the jaw.  The pain does not go away

34.  Sudden, severe pain in the chest, usually on the left side or in the center, behind the sternum  Pain or discomfort in other areas of the body, such as on or both arms, the back, neck, jaw or stomach  Indigestion or heartburn  Nausea and vomiting  Dyspnea or difficulty breathing  Dizziness  Pale, gray, or cyanotic skin color or mucous membranes, indicating lack of oxygen  Perspiration  Cold and clammy skin  Weak and irregular pulse rate  Low BP  Anxiety and a sense of doom  Denial of a heart problem

35.  You must take immediate action if a resident experiences any symptoms.  Follow these steps:  Place the patient in a comfortable position. Encourage him/her to rest. Reassure him/her that you will not leave him/her alone.  Loosen clothing around the resident’s neck  Do not give the resident liquids or food  Monitor the resident’s breathing and pulse. If the resident stops breathing or has no pulse, perform rescue breathing or CPR if you are trained to do so.  Stay with the patient until help has arrived.

37.  Hypoglycemia (insulin reaction) and diabetic ketoacidosis are complications of diabetes that can be life-threatening.  Hypoglycemia can result from either too much insulin or too little food.  It occurs when insulin is given and the person skips a meal or does not eat all the food required.  Even when a regular amount of food is eaten, additional physical activity may cause the body to rapidly absorb the food.  This causes too much insulin in the body.  Vomiting and diarrhea may also lead to insulin reaction in people with diabetes.

38.  The first signs of hypoglycemia include feeling weak or different, nervousness, dizziness, and perspiration.  These signal that the person needs food.  Food should be in a form that can be rapidly absorbed.  A lump of sugar, a hard candy, or a glass of orange or grape juice should be consumed right away.  A diabetic may have other quick sources of sugar handy, such as glucose tablets.  Always call for help if a person is showing signs of hypoglycemia.

39.  Perspiration  Hunger  Weakness or feeling different  Rapid pulse  Headache or dizziness  Low BP  Cold, clammy skin  Confusion  Trembling  Blurred vision  Numbness of the lips and tongue  Unconsciousness

41.  Having too little insulin in the body causes DKA, also known as ketoacidosis or hyperglycemia.  It can result from undiagnosed diabetes, not enough insulin, eating too much, not getting enough exercise, or physical and emotional stress.  If left untreated, DKA can lead to diabetic coma  Initial signs of DKA include increased thirst or urination, abdominal pain, deep or difficult breathing, and breath that smells sweet or fruity.  Call for help immediately if you suspect a person is experiencing DKA

42.  Increased thirst or urination  Abdominal Pain  Deep or difficult breathing  Sweet or fruity smelling breath  Hunger  Weakness  Weak, rapid pulse  Headache  Low BP  Dry skin  Flushed cheeks  Drowsiness  Nausea and vomiting  Unconsciousness

44.  Seizures are involuntary, often violent, contractions of muscles.  They can involve a small areas or the entire body.  Seizures are caused by an abnormality in the brain.  They can occur in young children who have a high fever, or in older children and adults who have serious illnesses, a fever, or a head injury.  The main goal of a caregiver during a seizure is to make sure that the person is safe.  During a seizure, a person may shake severely and thrust arms and legs uncontrollably.  He/she may clench his/her jaw, drool, and be unable to swallow.  Most seizures last a short amount of time.

45.  Call for help immediately.  Be sure to note the time of the seizure and when it ends  If you are able, lower the person to the floor.  Cradle and protect his/her head.  Loosen clothing to help with breathing.  Move furniture away to prevent injury.  Do not try to stop the seizure or restrain the person.  Do not force anything between the person’s teeth. Do not place your hands in his/her mouth for any reason. You could be bitten.  Do not give liquids or food.  When the seizure is over and if a head injury is not suspected, gently turn the person to his/her left side to reduce the risk of choking.  Monitor the person for breathing and pulse  If the person is not breathing/has no pulse, begin CPR

48.  A cerebrovascular accident (CVA), commonly referred to as a stroke, occurs when the blood supply to a portion of the brain is cut off.  A clot, a ruptured blood vessel, or pressure from a tumor compressing a vessel may cause a stroke  Beginning signs of a CVA include dizziness, ringing in the ears, blurred vision, headache, nausea, vomiting, slurring of words, and loss of memory.  Call for help immediately  A transient ischemic attack (TIA) is a warning sign of a CVA.  TIA occur as a result of a temporary lack of oxygen in the brain.  Symptoms may last up to 24 hours

49.  Dizziness  Confusion  Loss of consciousness  Seizures  Shaking or trembling  Redness in the face  Facial droop, inability to smile  Drooping of one eyelid or eye  Sudden loss of sight in one eye  Pupil of one eye is larger  Blurred vision  Trouble with hearing or ringing in ears  Intense headache that will not go away  Nausea and vomiting  Loss of bowel and bladder control  Numbness or tingling on one-side of the body  Paralysis on one side of the body (hemiplegia)  Weakness on one side of the body (hemiparesis)  Inability to express needs to others through speech or written words (expressive aphasia)  Inability to understand what others are communicating through speech or written words (receptive aphasia)  Use of strange words  Noisy breathing  Elevated blood pressure  Slow pulse rate

50.  Facilities often use codes to inform staff of emergencies without alarming residents and visitors.  For example, “Code Red” usually means fire, and “Code Blue” usually means cardiac arrest.  Know the codes for your facility  The code team is a team chosen for a specific shift to respond in case of a patient emergency.  Staff on the code team may be asked to get a special cart or other emergency equipment, such as a section machine, CPR equipment, oxygen, or other items.  Should a code be called, respond immediately and remain calm. Do not panic.

51.  Code BLUE-Cardiopulmonary Arrest  Code GREY-Disaster  Code BLACK-Bomb Threat  Code PINK-Infant/Pediatric Abduction  Code PURPLE-Missing Adult Patient  Code ORANGE- Hazard Chemical Exposure  Code RED- Fire  Code GREEN-Disturbance or Combative Person  Code WHITE-Active Shooter

52.  Disasters can include fire, flood, earthquake, hurricane, tornado, or severe weather. Many facilities now consider acts of terrorism as disasters.  Facilities will have an area-specific disaster plan available for employees to learn.  Know where the plan is located and what to do in the event of disasters.  Listen carefully to all directions. Know the locations of all exits and stairways. Know where the fire alarms/extinguishers are located.  Emphasize that everyone should keep calm in an emergency  Being educated and prepared for emergencies helps decrease panic and ensure the appropriate response in a timely fashion.  Facilities hold classes on disasters and disaster drills to prepare staff ahead of time.