1. Chapter 43 Emergency Care and First Aid

2. Emergency Care Trauma Wound or injury caused by an outside force
Principles of emergency care
Good Samaritan Laws
Assess safety
Identify problems
MedicAlert Tag, E-HealthKEY, Critical Access Standards

3. Emergency Care (cont’d)
Triage
Assess and treat for shock
Hypovolemic shock
Absolute hypovolemic shock
Relative hypovolemic shock
Late signs of hypovolemic shock
Hypovolemic shock sequel
Treatment of shock

4. Types of Shock Anaphylactic Cardiogenic Electric Hypoglycemic
Hypovolemic

5. Types of Shock (cont’d)
Irreversible
Lung
Neurogenic
Septic
Spinal
Traumatic

6. Treating Shock in an Emergency
Keep the person lying down and as calm as possible.
Establish, maintain, and monitor airway, breathing, and circulation.
Administer a high concentration of oxygen, if available. Assist breathing as needed.
Control bleeding.
Maintain body temperature.

7. Treating Shock in an Emergency (cont’d)
Try to put something under the person.
Keep the person dry.
Give nothing by mouth.
Elevate the lower extremities, unless contraindicated.
Use the position most comfortable for the person.
Immobilize fractures. Monitor level of consciousness.
Take and record vital signs at least every 5 minutes.

8. Question Is the following statement true or false?
When treating the client for shock in an emergency, cover the client with a blanket or coat, if necessary, but do not overheat the person.

9. Answer
True
It is necessary to maintain body temperature. Many people become chilled after an accident. The parasympathetic nervous system takes over in an emergency and reroutes blood to vital organs and away from the skin. Excessively low or high body temperature causes the heart to work harder.

10. Assessing a Person in an Emergency
The primary assessment
The secondary assessment
A = Airway and cervical spine
B = Breathing
C = Circulation and bleeding
D = Disability
E = Expose and examine

11. Question Is the following statement true or false?
In an emergency, the nurse must reach across the injured person’s neck to feel the pulse.

12. Answer
False
Reaching across the person’s neck to feel the pulse might accidentally cut off the airway. The nurse should feel the pulse on the side nearest to him or her.

13. Sudden Death and Life Support
Occurs when time breathing and the heartbeat stop abruptly or unexpectedly
Clinical death
May be reversible with basic and advanced life support
Biological death
Permanent damage and death of most brain cells due to lack of oxygen
Irreversible

14. Basic Cardiac and Advanced Life Support
Basic life support (BLS) or basic cardiac life support (BCLS)
Rapid entry into the EMS, performance of CPR, and use of techniques to clear an obstructed airway
Advanced cardiac life support (ACLS)
Starting intravenous (IV) lines, administering fluids and medications, using defibrillation and cardiac monitoring, administering oxygen, and opening and maintaining the airway, sometimes intubation

15. Code in a Healthcare Facility
Cardiopulmonary emergency call “Code Blue” or “Dr. Blue.”
Obtain necessary emergency equipment.
Assist the code team.
Mechanical ventilator, IV therapy, or vasopressor drugs may be needed for maintenance.
Close observation in the ED or intensive care unit (ICU).
Document procedure.

16. FIRST-AID MEASURES Chest, back, neck, and head injuries
Do not attempt to move or transport; supervise cautious extrication.
Chest injuries
Pneumothorax: Normal breathing fails.
Back and neck injuries
Use immobilizing devices.
Head injuries
Do not lower the person’s head.

17. Question Is the following statement true or false?
In an emergency, swiftly remove the article puncturing the chest, if it is still in place.

18. Answer
False
In an emergency, do not remove an article puncturing the chest if it is still in place. The article will help seal the hole; its removal may cause added damage. Surgical removal is necessary under controlled conditions.

19. Cold-Related Injuries
Frostbite
Freezing of body tissues due to cold temperatures
Immersion foot
Feet are kept in moist, cold boots for several days.
Hypothermia
Body loses heat faster than it can be replaced; gradual rewarming is necessary.
Careful monitoring

20. Heat-Related Injuries
Heat cramps
Severe muscle spasms after hard exertion
Heat exhaustion
Exertion in a hot environment over a length of time
Heat stroke
Develops rapidly and requires immediate treatment

21. Burns Burns Sunburn Inflicted burns Inhalation injury
Burned or singed nasal hairs or burns in or around the mouth
Flecks of soot in the client’s saliva
Smell of smoke on the client’s breath
Hoarse voice

22. Near Drowning Drowning Suffocation from submersion in liquid.
Recovery has occurred after submersion.
Initiate and continue lifesaving measures.
Electroencephalogram

23. Musculoskeletal Injuries
Fractures, sprains, and dislocations
R = Rest
I = Ice
C = Compression (such as with a roller bandage)
E = Elevation (keep the part above the level of the heart, if possible)

24. Musculoskeletal Injuries (cont’d)
Splint
If fracture of a wrist, knee, or elbow is suspected, splint the joint in its existing position.
Dress the wound.
Use bandages.
Apply cravat bandages and slings.
A triangular or handkerchief bandage from a square of cloth
May be used to make a sling for arm support

25. Dental Injuries and Missing Teeth
Intrusion injury
A tooth that is pushed up into the socket.
Avulsion injury
A tooth that is knocked out.
Immediate dental care is necessary.

26. Foreign Objects Foreign object
Any abnormal object or substance lodged in a body orifice or structure
Eyes: Remove contact lenses.
Nose: Blow the nose gently with both nostrils open.
Ears: Do not attempt to remove it.
Airway obstruction: Heimlich maneuver

27. Cardiovascular Emergencies
Fainting (syncope)
Caused by an insufficient supply of blood and oxygen to the brain
Myocardial infarction or heart attack
Caused when the heart’s blood supply is cut off, causing heart muscle tissue to die

28. First Aid in a Suspected Heart Attack
Call 911.
Keep the person completely quiet.
Loosen any tight clothing.
Cover the person with a blanket or coat.
If necessary, assist the person to sit up to breathe.
If the person shows signs of shock, keep him or her flat, unless this inhibits breathing.
Be prepared to initiate CPR.

29. Bleeding Epistaxis: Nosebleed
In case of fractured skull, do not attempt to stop the bleeding.
Place a sterile pad directly over a minor wound.
Adhesive bandage strip is adequate for a small cut or scratch.

30. Bleeding (cont’d)
Hemorrhage: Bleeding that is abundant or uncontrollable
Capillary bleeding, arterial bleeding, venous bleeding
Apply direct pressure in external hemorrhage.
Indirect pressure if direct pressure does not control hemorrhage.
Tourniquet
Used on an extremity over a pressure point.
MAST trousers
Massive internal hemorrhage or hypovolemia.

31. Anaphylaxis Anaphylaxis (anaphylactic shock)
Type I allergic, life-threatening reaction
Create an open airway.
S = Stabilize
I = Identify the toxin
R = Reverse the effect of the toxin
E = Eliminate the toxin
S = Support (respiration, circulation, etc.)

32. Animal Bites and Scratches
Rabies: Communicable disease transmitted through animal bites.
Cat-scratch disease
Do not delay in obtaining medical care.
Follow physician’s orders for further care.
Tetanus injection or antibiotics to prevent or treat infection.

33. Exposure to Hazardous Materials
Primary exposure
Secondary exposure
Precautions:
Wear PPE to help prevent secondary exposure.
Decontaminate the victim.
Poison
Any substance that threatens a person’s health when it is absorbed or comes into contact with the body

34. Psychiatric Emergency
Factors present in the individual:
Threat to harm self or others, suicidal thoughts, history of prior suicide attempts
Refusal to talk, severe depression
Intoxication or drug abuse with violent thoughts
Self-injurious, out-of-control or bizarre behavior
Evidence of self-harm or not caring for one’s self
Reports of any of the above by family or neighbors

35. End of Presentation