CHAPTER 7: EMERGENCY CARE

AND DISASTER PLAN

LEARNING OBJECTIVES

Discuss recognition and response to medical emergencies

Demonstrate knowledge of first aid procedures

Describe disaster guidelines

RECOGNITION AND RESPONSE TO MEDICAL EMERGENCIES NAs should memorize these steps in responding to an emergency: Assess the situation. Make sure you are not in danger and note the time. Assess the victim. Check the victim’s level of consciousness. Call for help or send someone to get help. Remain calm and confident. Properly document the emergency after it is over.

KNOWLEDGE OF FIRST AID PROCEDURES First aid Cardiopulmonary resuscitation (CPR)

First aid for: Choking Shock Myocardial Infarction (Heart Attack) Bleeding Poisoning Burns Fainting (syncope) Nosebleed (epistaxis) Insulin reaction and diabetic ketoacidosis Seizures CVA or stroke Vomiting Falls

CHOKING

1. Stand behind the person and bring your arms under her arms. Wrap your arms around the person’s waist.

2. Make a fist with one hand. Place the flat, thumb side of the fist against the person’s abdomen, above the navel but below the breastbone.

3. Grasp the fist with your other hand. Pull both hands toward you and up, quickly and forcefully.

4. Repeat until the object is pushed out or the person loses consciousness.

5. Report and document the incident properly.

SHOCK1. Notify the nurse immediately. Victims of shock should always

receive medical care as soon as possible.

2. If controlling bleeding, put on gloves first. This procedure is described later in the chapter.

3. Have the person lie down on her back. If the person is bleeding from the mouth or vomiting, place her on her side (unless you suspect that the neck, back, or spinal cord is injured).

4. Check pulse and respirations if possible (see Chapter 14). Begin CPR if breathing and pulse are absent and if you are trained to do so.

5. Keep the person as calm and comfortable as possible.

6. Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade

7. Elevate the legs approximately eight to 12 inches unless the person has a head, neck, back, spinal, or abdominal injury, breathing difficulties, or fractures. Elevating the legs allows blood to flow from the lower extremities back to the brain (and other vital areas.) Elevate the head and shoulders if a head wound or breathing difficulties are present. Never elevate a body part if the person has a broken bone or if it causes pain.

8. Do not give the person anything to eat or drink.

9. Report and document the incident properly.

MYOCARDIAL INFARCTION (HEART ATTACK)1. Notify the nurse immediately. If working in

the home, call 911 immediately and call your supervisor.

2. Place the person in a comfortable position. Encourage him to rest, and reassure him that you will not leave him alone.

3. Loosen clothing around the person’s neck.4. Do not give the person liquids or food.5. Monitor the person’s breathing and pulse.

If the person stops breathing or has no pulse, begin CPR if trained and allowed to do so.

6. Stay with the person until help arrives.7. Report and document the incident

properly.

BLEEDING

1. Notify the nurse immediately. 2. Put on gloves. Take time to do this. If the resident is

able, he can hold his bare hand over the wound until you can put on gloves.

3. Hold a thick sterile pad, clean cloth, handkerchief, or towel against the wound.

4. 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.

5. If you can, raise the wound above the level of the heart to slow down the bleeding. If the wound is on an arm, leg, hand, or foot, and there are no broken bones, prop up the limb. Use towels or other absorbent material.

6. When bleeding is under control, secure the dressing to keep it in place. Check for symptoms of shock (pale skin, staring, increased pulse and respiration rates, low blood pressure, and extreme thirst). Stay with the person until help arrives.

7. Remove and discard gloves. Wash hands thoroughly.8. Report and document the incident properly.

POISONING

1. Notify the nurse immediately. 2. Put on gloves. Look for a container

that will help you find out what the resident has taken or eaten. With your gloves on, check the mouth for chemical burns and note the breath odor.

3. The nurse may have you call the local or state Poison Control Center. Follow their instructions.

4. Remove and discard gloves. Wash your hands.

5. Report and document the incident properly.

BURNSTo treat a minor burn:1. Notify the nurse immediately. Put on gloves.2. Use cool, clean water to decrease the skin temperature and prevent further

injury. Do not use ice or ice water, as ice may cause further skin damage. Dampen a clean cloth with cool water, and place it over the burn.

3. Once the pain has eased, you may cover the area with dry, sterile gauze or clean dressing.

4. Remove and discard gloves. Wash your hands.5. Never use any kind of ointment, salve, or grease on a burn.For more serious burns:6. Remove the person from the source of the burn. If clothing has caught fire,

have the person stop, drop, and roll, or smother the fire with a blanket or towel to put out flames. Protect yourself from the source of the burn.

7. Notify the nurse immediately. Put on gloves.8. Check for breathing, pulse, and severe bleeding. If the person is not breathing

and has no pulse, begin CPR if trained and allowed to do so.9. Do not use any type of ointment, water, salve, or grease on the burn.10. Do not try to pull away any clothing from burned areas. Cover the burn with

thick, dry, sterile gauze, a clean cloth, or a clean white sheet. A dry, insulated cool pack may be used over the dressing. Take care not to rub the burned area.

11. Ask the person to lie down and elevate the affected part if this does not cause greater pain.

12. Wait for emergency medical help.13. Remove and discard gloves. Wash your hands.14. Report and document the incident properly.

SYNCOPE (FAINTING)1. Notify the nurse immediately. 2. Have the person lie down or sit down before fainting occurs. 3. If the person is in a sitting position, have him bend forward.

He can place his head between his knees if he is able. If the person is lying flat on his back, elevate the legs.

4. Loosen any tight clothing. 5. Have the person stay in position for at least five minutes

after symptoms disappear. 6. Help the person get up slowly. Continue to observe him for

symptoms of fainting. Stay with him until he feels better. If you need help but cannot leave the person, use the call light.

7. If a person does faint, lower him to the floor or other flat surface. Position him on his back. Elevate his legs eight to 12 inches. Loosen any tight clothing. Check to make sure the person is breathing. He should recover quickly, but keep him lying down for several minutes. Report the incident to the nurse immediately.

8. Report and document the incident properly. Fainting may be a sign of a more serious medical condition.

EPISTAXIS (NOSEBLEED)

1. Notify the nurse immediately. 2. Elevate the head of the bed, or tell the person

to remain in a sitting position, leaning forward slightly. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues, or cloths without gloves.

3. Put on gloves. Apply firm pressure over the bridge of the nose. Squeeze the bridge of the nose with your thumb and forefinger. Have the resident do this until you are able to put on gloves.

4. Apply the pressure until the bleeding stops.5. Use a cool cloth or ice wrapped in a cloth on

the back of the neck, forehead, or upper lip to slow the flow of blood. Never apply ice directly to skin.

6. Remove and discard gloves. Wash your hands.7. Report and document the incident properly.

INSULIN REACTION AND DIABETIC KETOACIDOSIS (DKA) Insulin reaction:

• Hunger • Weakness• Rapid pulse • Headache • Low blood pressure • Perspiration • Cold, clammy skin • Confusion • Trembling • Nervousness • Blurred vision • Numbness of lips and tongue • Unconsciousness

Diabetic Ketoacidosis:• Increased thirst • Increased urination• Abdominal pain• Deep or labored breathing• Breath that smells fruity or sweet• Hunger • Headache• Weakness• Rapid, weak pulse • Low blood pressure • Dry skin • Flushed cheeks • Drowsiness • Nausea and vomiting • Abdominal pain • Air hunger • Unconsciousness

SEIZURES

1. Note the time. Put on gloves.2. Lower the person to the floor. Loosen clothing to help

with breathing. Try to turn the person’s head to one side to help lower the risk of choking. This may not be possible during a violent seizure.

3. Have someone call the nurse immediately or use the call light. Do not leave a person during a seizure unless you must do so to get medical help.

4. Move furniture away to prevent injury. If a pillow is nearby, place it under his head.

5. Do not try to restrain the person or stop the seizure.6. Do not force anything between the person’s teeth. Do

not place your hands in the person’s mouth for any reason. You could be bitten.

7. Do not give the person liquids or food.8. When the seizure is over, note the time. Gently turn the

person to his left side if you do not suspect a head, neck, or spinal injury. This reduces the risk of choking on vomit or saliva. If the person begins to choke, get help immediately. Check for adequate breathing and pulse. Begin CPR if breathing and pulse are absent and if you are allowed and trained to do so. Do not begin CPR during a seizure.

9. Remove and discard gloves. Wash your hands.10. Report and document the incident properly, including

how long the seizure lasted.

CVA (STROKE)

Signs and symptoms of stroke

VOMITING1. Notify the nurse immediately. 2. Put on gloves.3. Make sure the head is up or turned to one side. Place an emesis

basin under the chin. Remove it when vomiting has stopped.4. Remove soiled linens or clothes and set aside. Replace with

fresh linens or clothes. 5. If resident’s intake and output (I&O) is being monitored (Chapter

15), measure and note amount of vomitus.6. Flush vomit down the toilet unless vomit is red, has blood in it,

or looks like wet coffee grounds. If these symptoms are observed, show this to the nurse before discarding the vomit. After disposing of vomit, wash and store basin.

7. Remove and discard gloves. 8. Wash your hands. 9. Put on fresh gloves.10.Provide comfort to resident. Wipe face and mouth. Position

comfortably, and offer a drink of water. Provide oral care (Chapter 13). It helps get rid of the taste of vomit in the mouth.

11.Put soiled linen in proper containers.12.Remove and discard gloves.13.Wash your hands again.14.Document time, amount, color, odor, and consistency of

vomitus.

FALLING

When a resident is falling, the NA should do the following:• Widen his stance and bring the resident’s body close to the NA’s body. • NA should have knees bent and support the resident as he lowers her to the

floor.• NA should not try to stop or reverse a fall.• NA should notify the nurse immediately

DISASTER GUIDELINES

Disasters

Disaster guidelines

TORNADO

The following are steps to take in case of a tornado:

• Seek shelter inside, ideally in a steel-framed or concrete building.• Stay away from windows.• Stand in the hallway or in a

basement, or take cover under heavy furniture.• Do not stay in a mobile home or

trailer.• Lie as flat as possible.

LIGHTENING

The following are steps to take in case of lightning: If outdoors, follow these guidelines:

• Avoid the largest objects, such as trees, and avoid open spaces.

• Stay out of the water.

• Seek shelter in buildings.

• Stay away from metal fences, doors, or other objects.

• Avoid holding metal objects, such as golf clubs, in your hands.

• Stay in automobiles.

• It is safe to perform CPR on lightning victims; they carry no electricity

If indoors, follow these guidelines:• Stay inside and away from open doors

and windows.

• Avoid the use of electrical equipment, such as hair dryers and televisions.

• Do not use the telephone.

FLOOD

The following are steps to take in case of a flood: Fill the bathtub with fresh water. Board up windows. Evacuate if advised to do so. Check the fuel level in automobiles. Have a portable battery-operated radio, flashlight, and cooking equipment available.

Do not drink water or eat food that has been contaminated with flood water.

Do not handle electrical equipment. Do not turn off gas yourself. Ask the gas company to turn off the gas.

BLACKOUT

The following are steps to take in case of a blackout: Get a flashlight. Take prompt action to keep calm and provide light.

Use a backup pack for electrical medical equipment, such as an IV pump. Backup packs do not last more than 24 hours, so contact emergency personnel when instructed.

HURRICANE

The following are steps to take in case of a hurricane: Know what category the hurricane is and track the expected path.

Know which residents or clients must go to shelters, hospitals, or other facilities, and which need assistance. Be aware of people with special needs. High-risk people include the elderly and those unable to evacuate on their own. High-risk areas include mobile homes or trailers.

Call your employer for instructions.

Fill the bathtub with fresh water. Board up windows. Evacuate if advised to do so. Check the fuel level in automobiles. Have a portable battery-operated radio, flashlight, and cooking equipment available.

EARTHQUAKE

The following are steps to take in case of an earthquake: If indoors, follow these guidelines:

Drop to the ground. If possible, get under a sturdy piece of

furniture, such as a heavy table, and hold on until the shaking stops.

If no table or desk is available, stay crouched down in the inside corner of a building, and cover your face and head with your arms.

Stay away from windows, outside walls, and anything that might fall over or fall down.

Do not exit a building during the shaking.

Do not use elevators.

If outdoors, follow these guidelines: Move away from buildings, electric

poles and wires, and streetlights. Falling or flying debris is a greater danger than ground movement.

If driving, stop as quickly as is safely possible and stay in the vehicle. Avoid stopping under overpasses or near buildings or wires if possible.

If trapped under debris after an earthquake, do not light a match or ignite a lighter, and avoid kicking up dust. Breathe through a handkerchief or clothing and make tapping noises or use a whistle, if available, to get rescuers’ attention. Do not shout. Shouting could cause you to inhale dangerous amounts of dust.

REVIEW

Recognize and respond to medical emergencies

First aid procedures for medical emergencies

Disaster guidelines