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Unit 52 Response to Basic Emergencies
Adonis K. Lomibao, R.N.
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Objectives
Spell & Define terms Recognize emergency situations & determine
sequence of actions Evaluate situations & determine sequence of
appropriate actions Describe how to maintain airway Recognize the need for CPR
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Objectives Cont.
List appropriate PCT actions for:
-Choking: vomiting & aspiration
-burns
-fainting
-seizure
-bleeding
-falls/ortho injuries/head injuries
-electric shock
-accidental poisoning
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Dealing With Emergencies
Develop rapidly & unpredictably EMERGENCY- any unexpected situation that
requires immediate action and medical attention. I.e: MVA,CVA,Sudden weakness, fainting/falling
Prompt action prevents further complications VICTIM-person needing help
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First Aid
Includes:
-Immediate care for injuries & sudden illness
-Care after if medical help is delayed/not available
You will deal with:
-emotional state
-physical injury
-management of whole accident situation
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First Aid Cont.
Life-threatening situations:
-No airway
-stopped breathing
-in shock
-poisoned
-choking
-bleeding profusely
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Evaluating the Situation
Accident scene-assess situation & find out extent of injuries.
-number of victims
-potential injuries
-dangerous factors i.e.:
-MVA
-Medical facility
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Code Emergencies
Emergency Codes-high risk, emergency situations
California Hospital shooting p. 932 Standardized Code words
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Standardized Code Words
Code Red-Fire Code Blue-Medical Emergency-adult Code White-Medical Emergency-peds Code Pink- infant abduction Code Purple-child abduction Code Yellow- bomb threat Code Gray-combative person Code Silver-weapon/hostage situation
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Code Words Cont.
Code Orange- hazardous material spill/release
Code Triage Internal- internal disaster Code triage external- external disaster
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Assisting with a Code
Responsibilities determined by employer “mock code” Follow directions of nurse or licensed HCP PCT may be messenger, recorder, etc. Know policies!!!
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Emergency Care Given right away to prevent loss of life
-summon help
-do not leave victim(except CPR) Check on:
-degree of responsiveness
-airway/breathing capability
-presence & rate of heartbeat
-signs of bleeding
-signs of shock
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Maintaining the Patient's Breathing
RESPIRATORY FAILURE- breathing is unsufficient to sustain life.
RESPIRATORY ARREST- breathing stops Abnormal respirations-impending crisis Report problems to the nurse!
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Opening the Airway
Remain with pt. & call for help Head-tilt, chin-lift maneuver- most common
way of opening airway
-NOT for pt. With neck injury Jaw-thrust maneuver- for those with neck
injury or if Head-tilt can't be used (head/face injuries)
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Head-tilt, Chin-lift
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Jaw-Thrust Maneuver
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Mask-to-Mouth Resuscitation
VENTILATION-breathing for the patient ADJUNCTIVE DEVICES- a secondary device
used to maintain respirations POCKET MASK-has a valve that prevents
patient's exhaled air and secretions from entering caregiver's mouth
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Pocket Mask
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Cardiac Arrest
CARDIAC ARREST-heart has stopped beating & respirations have ceased
Clinically DEAD Permanent damage to brain & organs in 4-6
minutes Unresponsive, no breathing, no pulse CPR-procedure used to maintain blood
circulation throughout the body DNR!!!
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The Recovery Position
If unresponsive, but breathing & with pulse-
-place in recovery position
-modified lateral position Positioning:
-stable
-avoid pressure on chest
-avoid pressure on lower arm
-allow open airway
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The Recovery Position
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Early Defibrillation
DEFIBRILLATION-method of treatment that uses an electric shock to reverse disorganized activity in the heart during cardiac arrest
Earlier=better <5 mins in community, <3 in HC facility
AUTOMATIC EXTERNAL DEFIBRILLATORS-computerized device
ONLY use when pt. Unresponsive, not breathing, & pulse-less
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AED
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4 Steps for AED Use
1. Turn unit ON
2.Apply electrodes to pt.'s chest
3. stand back to allow machine to analyze rhythm
4.stand back. Follow unit instructions.
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Choking
Airway is blocked:
-foreign body
-blood
-food
-vomitus Tilt head back-pulls tongue forward & may
clear airway If talking/coughing, stand by.
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Choking Cont.
Complete blockage:
- unable to speak
-high-pitched sounds on inhalation
-universal distress signal Standard Precautions! HEIMLICH MANEUVER(abdominal thrusts)
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Heimlich Maneuver
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Infant & Child CPR & Choking
Specific guidelines for infants & children (p.941)
Infant: birth to 1 yr Newborn: birth to 1 mon Child: 1-8 Over 8=Adult procedures
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Other Emergencies
If patient at home:
-initial emergency actions
-how & when to notify EMS
-how & when to notify nurse
-how & which family member to notify
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Bleeding
Injuries more severe if pt. Unconscious Standard Precautions! Internal or External Actions:
-identify
-pressure
-raise above heart
-HEMORRHAGE:heavy bleeding
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Shock!
SHOCK: a disturbance of oxygen supply to the tissues & return of blood to the heart
May follow:
-severe injury
-cardiac arrest
-acute hemorrhage
-severe pain
-excessive loss of body fluids (severe burn)
-serious infection
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Shock S&S
Pale, cold skin Weakness Weak, rapid pulse Rapid, irregular breathing Restlessness & anxiety Perspiration Later signs (p.945)
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Shock Preventative Measures
Call for help Keep person laying & quiet Maintain normal body temp Position with feet & legs slightly higher Do not provide food/drink IV Fluids & O2 Monitor pulse & respirations
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Fainting
Blood supply to brain is reduced for short period=loss of consciousness
Temporary Likely to fall & cause injury S&S: faint, light-headed, dizzy, nauseated,
pallor, cold skin, perspiration, visual changes
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Fainting Nursing Care
Help assume protected position laying/sitting Loosen tight clothing Position head lower than heart Rest Normal body temp Call for help Monitor vitals No food/drink
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Heart Attack
Block in blood flow to muscles of heart S&S:
-crushing pain that can radiate
-perspiration, cold & clammy skin
-N & V
-Pale/Grayish color to face
-difficulty/absence of breathing
-loss of consciousness
-irregular/loss of pulse
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Heart Attack Action
In Healthcare facility:
-help
-stay with pt.
-comfort
-elevate head of bed for breathing
-oxygen if available Unconscious:
-check for breathing & heartbeat
-CPR
-
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Heart Attack Action
In community (conscious):
-evaluate situation
-Activate EMS
-comfort/loosen clothing
-keep onlookers away
-provide fresh air/keep pt. Warm
-monitor pulse/respirations
-be prepared for CPR
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Stroke
CVA-interference with blood circulation to the brain
Caused by clot or ruptured blood vessel S&S:
-seizure activity
-loss of consciousness
-difficulty breathing
-weakness/paralysis one side of body/face
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Stroke
-unequal pupil reaction Less severe symptoms:
-disorientation
-dizzyness
-headache
-slurred speech
-memory loss
-loss of consciousness
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Stroke Action
Maintain airway Mask to mouth if needed CPR if needed Position on side Maintain normal body temp Keep quiet till help arrives
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Ischemic/ Hemorrhagic Stroke
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Seizures Can be caused by:
-drug overdose
-head injury
-degenerative brain disease
-stroke
-infectious disease & fever
-tumors
-hypoglycemic reactions
-seizure disorder
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Seizures S&S
Momentary loss of contact with environment (absence seizure) no movements, blank stare
Generalized tonic-clonic:
-loss of consciousness
-falls
-rigid
-uncontrolled movements
-cyanotic
-(p.947)
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Seizures Action
After recovery, pt will be:
-confused
-disoriented
-very tired
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Seizure Action
Standard precautions DO NOT RESTRAIN Protect from injury Loosen clothing around neck Maintain airway (positioning) Protect head Observe seizure AFTER seizure: (p.948)
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Vomiting & Aspiration Food,water,etc. Into trachea &
lungs=ASPIRATION S&S:
-coughing
-choking
-cyanosis
-vomiting (when supine)
-inability to swallow
-inability to spit vomitus,blood,secretions from mouth
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Aspiration Action
-stay with pt. & call for help
-standard precautions
-no fluids
-head elevated
-turn head/body to side
-emesis basin
-clear obstructed airway Make Observations & Report to nurse
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Electric Shock Severe burns & Cardiac/respiratory arrest can result Protect yourself!!! Actions:
-turn off electrical source
-if not, move pt. Away with non-conductor
-check for breathing/pulse
-summon help & CPR If needed
-breathing/circulation restored, check for injuries & give first aid
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Burns Result in loss of skin integrity Heat, chemicals, radiation Partial thickness:
-1st-degree: involving top layer. Redness, temp swelling, pain. Skin not broken or blistered
-2nd-degree: both epidermis & dermis. Pink to red or white to tan. Blistering, pain, scarring
Full-thickness:
-3rd-degree burn: epidermis,dermis, subcutaneous. Bright red/tan/brown. No pain initially(destroyed nerve endings)
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Burns
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Burn Emergency treatment
Call nurse Smother fire Cool water to lower temp & stop further tissue
damage 3rd-degree requires extensive treatment
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Orthopedic Injuries
Injuries to bones, joints, muscles, ligaments FRACTURE: break in bone SPRAIN: injury to ligament due to
overstretching STRAIN:excessive stretching of muscle DISLOCATION: in joint,one bone is displaced
from another
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Orthopedic Injury Treatment
Stay with pt. Immobilize DO NOT move Call nurse If on floor,move to bed AFTER nursing
assessment Monitor vital signs & report changes Notify nurse of suspected
sprain,strain,dislocation PCT Care (p. 950)
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Head Injury
Bleeding risk!!! Complications may not be apparent until 72
hours or more S&S:
-change in LOC
-change in orientation
-memory loss
-unequal pupils
-visual disturbances
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Brain Hematoma
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S&S Cont.
Blood/clear fluid from ears/nose Change in ability to speak Weakness of arms/legs HA N&V
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Head Injury Actions
Stay with pt. Monitor VS-HR & RR Keep environment quiet/calm No drinks Reassure & orient pt. Elevate head on pillow Do not move if on floor Monitor VS as ordered
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Accidental Poisoning
If poisoning suspected:
-call nurse
-try to determine what was taken & save container
-nurse may induce vomiting
-know where to find # for poison control!!!
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Thank You!