Chapter 43
Emergency Care and First Aid
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Emergency Care
• Trauma
– Wound or injury caused by an outside force
• Principles of emergency care
– Good Samaritan Laws
– Assess safety
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Emergency Care
– Identify problems
• MedicAlert Tag
• Worn as a necklace, bracelet, or boot tag and
has an easily recognized symbol
• 2/3 of the tags contain condition related info
such as diabetes, epilepsy or high blood
pressure
• 1/3 of the tags contain allergy info or devices
such as pacemakers
• E-HealthKEY
• Critical Access Standards
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Emergency Care (cont’d)
• Triage
– Sort and classify to determine the priority of needs
– Important to identify victims and their next of kin
• Assess and treat for shock
– Hypovolemic shock
• Absolute hypovolemic shock –excessive blood loss
• Monitor serum electrolytes!
• Relative hypovolemic shock
• Late signs of hypovolemic shock
• Hypovolemic shock sequel
• Treatment of Copyright
shock
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Types of Shock
• **Shock is the first phase of the body’s alarm reaction to
trauma or severe tissue damage
• Anaphylactic
– Results from allergies
• Cardiogenic
– Failure of the heart to adequately pump
• Electric
• Hypoglycemic
• Hypovolemic
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Types of Shock (cont’d)
• Irreversible
• Lung
• Neurogenic
• Septic
– Widespread systemic infection
• Spinal
• Traumatic
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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.
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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.
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Assessing a Person in an Emergency
• **The primary assessment
– Assessment performed as soon as rescuers arrive at
an emergency scene
• **The secondary assessment
• Takes and records v/s and continues the head to toe
assessment
• A = Airway and cervical spine
– Patent airway
• B = Breathing
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Assessing a Person in an Emergency
• C = Circulation and bleeding
– Direct pressure to stop the bleeding FIRST!!
– Indirect pressure next
• D = Disability
– AVPU
– PERRLAC
• E = Expose and examine
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Sudden Death and Life Support
• Sudden death
– 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
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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
– AED is definitive initial treatment of victims in cardiac
arrest**
• Compression only CPR
• 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
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Client at Home
• Unless specified as DNR, DNI. The client receiving home
care is to be resuscitated**
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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.
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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.
• Seal the wound in any way possible, use
aluminum foil, petroleum jelly, plastic wrap or a
rolled up dressing
• When transporting a client with a foreign object,
make sure the object remains in place
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FIRST-AID MEASURES
• Tension Pneumothorax
– Occurs when air leaks out of the lung into the chest
cavity and cannot escape
– If untreated, the lung on the same side of the chest
will collapse because of the excess pressure
• Mediastinal Shift
– The heart, great vessels and trachea shift to the side
opposite the injury
– Primary healthcare provider or emergency person
may place a large bore needle or chest tube through
the chest wall to relieve excess air pressure
• Chest tube drains blood or fluid and assist in
reinflation of the lung
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First-Aid Measures
• Back and neck injuries
– Use immobilizing devices.
– Log roll!!
• Head injuries
– Blow to the head that causes a laceration may also
cause injury to the skull or brain. Observe for fluid or
blood draining from the nose or ears
– Do not lower the person’s head, have them lie flat
only while restricting his/her movements
• This increases intracranial pressure!!
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Increased Intracranial Pressure
• S/S
– Confusion
– Memory loss
– Persistent vomiting
– Fluid that leaks from the skull
• Basilar skull fracture!
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Cold-Related Injuries
• **Frostbite
– Freezing of body tissues due to cold temperatures
– Do not allow the person to walk on a frostbitten
foot, separate the frozen fingers and toes with
cotton wedges
– DO NOT use bandages, ointments or salves
• Immersion foot
– Feet are kept in moist, cold boots for several days.
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Cold-Related Injuries
• Hypothermia
– Body loses heat faster than it can be replaced;
gradual rewarming is necessary.
– Careful monitoring
– Sweating over time can cause hypothermia
– S/S include
• Sleepiness, loss of reflexes and slowed reaction
times, impaired judgement*
Treatment includes gradual rewarming, warm
beverages!
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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
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Heat exhaustion vs. heat stroke
Element
Heat exhaustion
Heat stroke
Skin
Cool
Hot
Sweat
May/may not
Dry-classic
Sweat-exertional
Body temp
Normal
HIGH >106
Symptoms
Rapid breathing
Confusion
TX
Cool
Cool rapidly
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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
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Near Drowning
• Drowning
– Suffocation from submersion in liquid.
– Recovery has occurred after submersion.
• Assess victims of near drowning for associated injuries or
illnesses, such as cardiac arrest, airway obstruction**
• Initiate and continue lifesaving measures.
• Electroencephalogram
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Musculoskeletal Injuries
• Fractures, sprains, and dislocations
• NEVER attempt to replace the ends of bones in a fracture
whether or not the skin is broken!!
– 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)
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Musculoskeletal Injuries (cont’d)
• *Splint
– If fracture of a wrist, knee, or elbow is suspected,
splint (immobilize) the joint in its existing position.
– Check for circulation
– Check for numbness
• 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
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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.
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Foreign Objects
• Foreign object
– Any abnormal object or substance lodged in a body
orifice or structure
• Eyes: Remove contact lenses.
– See nursing care guidelines 43-4**
• Nose: Blow the nose gently with both nostrils open.
• Ears: Do not attempt to remove it.
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*Airway obstruction:
• Abdominal thrusts (Heimlich maneuver)
• Partially obstructed airway
– Will cough forcefully
Poor air exchange may be identified by ineffective
coughing and sometimes by high pitched wheezing
sounds called stridor
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Cardiovascular Emergencies
• Fainting (syncope)
– Caused by an insufficient supply of blood and oxygen
to the brain
– S/S include dizziness, blackness or spots before the
yes, pallor and excessive perspiration*
• Myocardial infarction or heart attack
– Caused when the heart’s blood supply is cut off,
causing heart muscle tissue to die
– S/S
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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.
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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.
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Bleeding
• Hemorrhage: Bleeding that is abundant or uncontrollable
– Capillary bleeding
• Oozes, pink
–
arterial bleeding
• Spurts, bright red
– venous bleeding
• Steady flow, dark red
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Bleeding (cont’d)
• Apply direct pressure in external hemorrhage.
• Indirect pressure if direct pressure does not control
hemorrhage.
• Tourniquet
– Used on an extremity over a pressure point.
– Use as a last resort!!
• MAST trousers
– Massive internal hemorrhage or hypovolemia.
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Internal Bleeding
• S/S
– Cold, clammy
– Dizziness
– SHALLOW, rapid breathing
– Altered LOC
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Anaphylaxis
• Anaphylaxis (anaphylactic shock)
– Type I allergic, life-threatening reaction
• Causes: bee stings, foods, MSG, medications*
• S/S: hives, panic, wheezing!!, etc.
• 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.)
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Animal Bites and Scratches
• Clean wound with warm soapy water and rinse
thoroughly!
• Animal bites must be reported to public health dept. and
Police!!
• Rabies: Communicable disease transmitted through
animal bites.
• Cat-scratch disease
• Snake bites-immobilize area, seek medical attention!!!
• Jelly fish stings-bathe area in vinegar, apply shaving
cream
• Tetanus injection or antibiotics to prevent or treat
infection.
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Exposure to Hazardous Materials
• Primary exposure
• Secondary exposure
• Precautions:
– Wear PPE to help prevent secondary exposure.
– Decontaminate the victim.
– AVOID inhalation of gases, fumes and smoke!!
• Poison
– Any substance that threatens a person’s health
when it is absorbed or comes into contact with the
body
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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
• Avoid yes/no quesitions!! Encourage them to talk!!
– 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
– Show them respect and make no assumptions or
judgements!!
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