Emergency Care and First Aid Chapter 43

Code in a Healthcare Facility

1) 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.

Avulsion injury

A tooth that is knocked out.

intrusion injury

A tooth that is pushed up into the socket.

A is for

Airway and cervical spine

AVPUE

Alert Verbal Pain Unresponsive Eyes

Foreign object

Any abnormal object or substance lodged in a body orifice or structure

Poison

Any substance that threatens a person's health when it is absorbed or comes into contact with the body

The nurse is caring for a client involved in a house fire with burns to the chest and upper arms. What signs observed by the nurse indicates the client may have also sustained inhalation injuries? Select all that apply. A. Fever B. Neck pain. C. Flecks of soot in the saliva. D. Singed nasal hairs.

C. Flecks of soot in the saliva. D. Singed nasal hairs.

When a client has sustained a serious burn what is the immediate action by the nurse? A. Apply burn cream to the area. B. Apply ice to the burned area. C. Stop the burning process. D. Remove burning fabric or other material from the skin.

C. Stop the burning process. Stop the burning process by removing heat source. Make sure burning clothing is cooled. DO NOT remove burning fabric or other materials unless they fall off.

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.

Fainting (syncope)

Caused by an insufficient supply of blood and oxygen to the brain

Hemorrhage

Caused by blood loss

Myocardial infarction or heart attack

Caused when the heart's blood supply is cut off, causing heart muscle tissue to die

C is for

Circulation and bleeding

Rabies

Communicable disease transmitted through animal bites

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.

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.

Tourniquet

Used on an extremity over a pressure point.

Trauma

Wound or injury caused by an outside force

Precautions: to hazardous material

_ Wear PPE to help prevent secondary exposure. _ Decontaminate the victim.

A client has been camping in the woods in cold temperatures and is brought to the ER with suspected hypothermia. What ordered action is important at this time? A. Warm the client rapidly to body temp of 98.6 F. B. Apply hot packs to the skin. C. Give the client hot coffee or tea. D. Gradually rewarm the client.

D. Gradually rewarm the client.

Paradoxical chest movement

Describes an abnormal chest movement, with your chest moving inward during inhalation rather than outward

heat stroke

Develops rapidly and requires immediate treatment

D is for

Disability

What to do in Ears (foreign object)

Do not attempt to remove it

Heat exhaustion

Exertion in a hot environment over a length of time

E is for

Expose and examine

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

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.

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

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.

immersion foot (trench foot)

Feet are kept in moist, cold boots for several days

Frostbite

Freezing of body tissues due to cold temperatures

I for SIRES

identify the toxins

primary exposure

person exposed directly

Tracheal shift to unaffected side

pneumothorax

secondary exposure

rescuer is exposed to contaminated person

R for SIRES

reverse the effect of the toxins

What to do in Airway obstruction

Heimlich maneuver

Clinical death

May be reversible with basic and advanced life support

Primary shock

Nervous system's response immediately after a severe injury or other traumatic event

Epistaxis

Nosebleed

Sudden death

Occurs any time breathing and the heartbeat stop abruptly or unexpectedly

Secondary shock

One or more hours after an injury, perhaps up to 24 hours later

Biologic death

Permanent damage and death of most brain cells due to lack of oxygen Irreversible

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

What to do in Eyes (foreign object)

Remove contact lenses

Heat cramps

Severe muscle spasms after hard exertion

the first letter for S for Sires

Stabilize

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

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.

Cardiopulmonary emergency call

"Code Blue" or "Dr. Blue."

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.)

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

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

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

Signs of Increased ICP

* Confusion, disorientation, or agitation * Loss of memory * Any change in vision, such as blurred or double vision * Decreased LOC or difficulty arousing; extreme lethargy * Numbness, tingling weakness in arm or leg * Severe headache, speech problems * Seizures

Near Drowning

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

Bleeding

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

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

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

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) * 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

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

Principles of emergency care

* Good Samaritan Laws * Assess safety * Identify problems - MedicAlert Tag, E-HealthKEY, Critical Access Standards

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

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. * 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.

Major Categories of Shock

* Primary - Nervous system's response immediately after a severe injury or other traumatic event * Secondary (delayed or deferred shock) - One or more hours after an injury, perhaps up to 24 hours later * Hemorrhagic - Caused by blood loss

Assessing a Person in an Emergency

* Primary assessment: immediate nervous system's response * Secondary assessment: one or more hours after injury A—Airway and cervical spine B—Breathing C—Circulation and bleeding D—Disability E—Expose and examine

Exposure to Hazardous Materials

* Primary exposure: person exposed directly * Secondary exposure: rescuer is exposed to contaminated person * 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

Animal Bites and Scratches

* Rabies: Communicable disease transmitted through animal bites * Cat-scratch disease * Do not delay in obtaining medical care * Follow healthcare provider's orders for further care * Tetanus injection or antibiotics to prevent or treat infection

Sudden Death and Life Support

* Sudden death - Occurs any time breathing and the heartbeat stop abruptly or unexpectedly * Clinical death - May be reversible with basic and advanced life support * Biologic death - Permanent damage and death of most brain cells due to lack of oxygen - Irreversible

Factors Present in Psychiatric Emergency

* 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

Emergency Care

* Trauma - Wound or injury caused by an outside force * Principles of emergency care - Good Samaritan Laws - Assess safety - Identify problems 1) MedicAlert Tag, E-HealthKEY, Critical Access Standards * Triage * Assess and treat for shock - Hypovolemic shock 1) Absolute hypovolemic shock 2) Relative hypovolemic shock 3) Late signs of hypovolemic shock 4) Hypovolemic shock sequel * Treatment of shock

Types of Hypovolemic shock

- Absolute hypovolemic shock - Relative hypovolemic shock - Late signs of hypovolemic shock - Hypovolemic shock sequel

Types of shock

- Anaphylactic - Cardiogenic - Electric - Hypoglycemic - Hypovolemic - Irreversible - Lung - Neurogenic - Septic - Spinal - Toxic shock syndrome - Traumatic

hypothermia

- Body loses heat faster than it can be replaced; gradual rewarming is necessary - Careful monitoring

Suspect inhalation injury when

- 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

Drowning

- Suffocation from submersion in liquid. - Recovery has occurred after submersion.

Example of burns

- Sunburn - Inflicted burns

A client is being treated for frostbite of the toes of both feet after exposure to severe cold. The provider has issued orders. What are the likely actions that the nurse will take caring for the client? select all that apply. A. Rubbing clients toes to rewarm. B. Loosening tight cloths from the client. C. Separating the toes with cotton wedges. D. Rewarming the toes with tepid (lukewarm) water.E. Covering the feet with hot towels.

B. Loosening tight cloths from the client. C. Separating the toes with cotton wedges. D. Rewarming the toes with tepid (lukewarm) water.

A client is brought to the urgent care center with an injury to the left ankle sustained while running. X Ray determined that there is no fracture present but the client does have a sprain. What education will the nurse reinforce to the client? A. PASS B. RICE C. RACE D. CPR

B. RICE Remember the scronym RICE for sprains and strains. R-rest I-ice C-compression (with a roller bandage) E-elevation (keep above the level of heart if possible)

What to do in Nose (foreign object)

Blow the nose gently with both nostrils open

B is for

Breathing

Which actions should the emergency personnel perform when reporting an MVA? Select all that apply. a. note the vehicle's condition b. mark the area of accident c. note areas of intrusion such as the driver's side d. inquire about the cause of the accident e. check for any gasoline spill

a. note the vehicle's condition c. note areas of intrusion such as the driver's side e. check for any gasoline spill Rationale: When reporting an MVA, the emergency personell should note the vehicle's condition; note areas of intrusion such as the driver's side, passenger side, roof, front end; and check for gasoline spill if any. In addition the emergency personell will also check whether the client was wearing a seatbelt, a helmet, or pretective clothing. This information can help emergency personell anticipate the type of injury. The emergency personell need not to ask about the cause of the accident, because this information does not help the personnel to anticipate the type of injury.

What nursing interventions should the nurse perform for a client who has frostbite? Select all that apply. a. seperate frozen fingers and toes with cotton wedge b. loosen any tight clothing worn by the client c. instruct the client to avoid walking if the foot is frostbitten d. use bandages, ointment, or salves on the frostbitten parts e. rub the frostbitten parts of the client with snow

a. seperate frozen fingers and toes with cotton wedge b. loosen any tight clothing worn by the client c. instruct the client to avoid walking if the foot is frostbitten Rationale: When caring for a client with frostbite, the nurse should seperate the frozen fingers and toes of the client with cotton wedges, lossen tight clothing worn by the client, and instruct the client to avoid walking if the foot is frostbitten. The nurse needs to avoid using bandages, ointments, or salves on the frostbitten parts of the client, and should not rub the frost bitten parts of the client especially with snow.

Which procedure should a nurse follow to monitor the pupillary responses of a client during an emergency? a. ABCDE procedure b. PERRLA+C procedure c. APVU procedure d. BCLS procedure

b. PERRLA+C procedure Rationale: While assessing a clients eye at an emergency site, the nurse should follow the PERRLA+C procedure. (Pupils Equal Round Reactive to light Acoomodation OK and Coordinated)

A nurse is assigned the responsibility of caring for a client in a home-care setting who has severe anxiety. What should be the nurse's role for such a client? Select all that apply. a. encourage the client to engage in voluntary activity b. avoid making any assumptions or judgement c. encourage the client to remain calm d. encourage the client to talk about the cause of anxiety e. ask the client questions that elicit "yes or no" answers.

b. avoid making any assumptions or judgements c. encourage the client to remain calm d. encourage the client to talk about the cause of the anxiety. Rationale: When caring for a client with severe anxiety, the nurse should encourage the client to remain calm, encourage the client to talk about the cause of the anxiety, and avoid making any assumptions and judgements. The nurse need not encourage the client to take any voluntary activity because the client may not be in the condition for it. The nurse should avoid questions that elicit "yes or no" answers, because this would not encourage the client to talk further.

A nurse is caring for a client with a nose bleed and a possible skull fracture. What basic steps should the nurse take to treat the nose bleed? a. use a clean handkerchief or cloth to wipe the bleeding b. do not attempt to stop the bleeding c. place the person on a flat surface to help blood circulation d. cleanse the nose with warm, soapy water

b. do not attempt to stop the bleeding Rationale: If a person with a nosebleed has a fractured skull, the nurse should not attempt to stop the bleeding, because doing so could increase intracranal pressure. If a sterile dressing is not readily avaiable for a minor wound, the nurse should use a clean handkerchief or cloth. In any case of hemorrahage, but not nosebleed, the nurse should place the person on a flat surface and slightly elevate his or her feet. When person is bitten, the nurse should cleanse the wound with warm soapy water, and rinse the area thoroughly.

A client with excessive bleeding has been brought to a healthcare facility. How should the nurse stop the clients bleed? a. have the client sit down and lean forward b. place the client on a flat surface and slightly elevate the feet c. have the client lie on the side not affected by the wound d. use a tourniquet to stop's client feeding

b. place the client on a flat surface and slightly elevate the feet Rationale: The nurse should place the client on a flat surface and slightly elevate the feet to stop bleeding while caring for a client with hemorrhage (unless the person has a head injury). A client with a nosebleed is made to sit down and lean foward. In case of chest injury, the nurse can have the person lie on the affected side, to apply pressure to the chest wall, and not on the side not affected. The nurse should not use a tourniquet to stop the clients bleeding unless all other methods to stop bleeding have failed, because use of a tourniquet may necessitate limb amputation.

A nurse is assigned the responsibility of caring for a client who has been exposed to hazardous chemicals. Which additional precaution should the nurse undertake for this client? a. use soapy water on affected area b. apply salve over the affected area c. remove client's clothing and rinse off chemicals d. cover the area with a dry, non-stick, sterile dressing

c. remove client's clothing and rinse off chemicals Rationale: The nurse should remove all clothing off the client and rinse off the chemical from the clothes of the client. The nurse needs to use plenty of soapy water on the affected area when the client has been a victim of an animal bite. The nurse shouldnot use salve over the affected area. Extensive burns are covered with dry, non-stick, sterile dressings.

A nurse is caring for a client with a botulism. What are some steps the nurse can suggest to the clients relatives to prevent further poisoning from botulism? a. do not eat leafy and green salads b. do not eat items that are canned at home c. avoid eating fruits and berries d. do not used food from cans with bulging tops

d. Do not use food from cans with bulging tops. Rationale: The nurse should warn clients to never use a home-canned or comercially canned item if the top is bulging. Only those fruits, berries, greens, or vegetables that are classified as poisonous (eg toadstools or posonous mushrooms) should not be eaten.

What nursing interventions should the nurse perform for a client who has a fractured leg? a. raise the client injured leg b. replace the ends of the bones in the fracture c. apply a roller bandage on the fracture d. apply ice on the injury site

d. apply ice on the injury site Rationale: While caring for a client with a fractured leg, the nurse needs to apply ice on the injured site. The nurse does not need place the client's injured leg on a raised level. also the nurse should never attempt to replace the ends of bones in a fracture. The nurse needs to apply a roller bandage for sprains or strains, not for fractures.

Which of the following compensatory actions should the nurse perform for a client who has gone into shock as a result of serious illness? a. maintain the client's airway b. stabilize the client cervical spine c. move the client to well ventilated, cool room d. look for signs of change in the client's level of consciousness

d. look for signs of change in the client's level of consciousness Rationale: The nurse should look for signs of a change in the clients level of consciousness while caring for a client who has gone into a shock due to serious illness. When assessing a client in an emergency the nurse should maintain the persons airway even if breathing is present. If a possibility of spinal injury exists the nurse needs to stabalize the persons cervical spine before attempting other activities. Moving the client to a well ventilated cool room is required for treatment of heat stroke.

E for SIRES

eliminate the toxins

basilar fracture

fracture at the base of the skull

flail chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

SIRES

stabilize, identify the toxin, reverse the effect of the toxin, eliminate the toxin, support (respiration, circulation, etc)

The last word S for SIRES

support (respiration, circulation, etc)