A situation in which an individual suddenly becomes ill or has an injury that requires immediate attention and help by a health-care professional.
Immediate care given to a person who has suddenly become injured or ill. First aid can save a life, reduce pain, prevent further injury, reduce the risk of permanent disability, and increase the chance of early recovery.
Emergency Medical Services (EMS)
A network of qualified police, fire, and medical personnel who use community resources and equipment to provide emergency care to victims of injury or sudden illness. Post the EMS telephone number, which is 911 in many communities, at every telephone and on the crash cart or first-aid tray.
Involving the EMS:To involve the EMS in an emergency, it is necessary to
1.Recognize that an emergency exists.
2.Decide to act.
3.Call the local emergency telephone number.
4.Provide care until help arrives.
Medical assistant's responsibilities
You may be responsible for providing first aid, but you are never responsible for diagnosing or providing other medical care. Note the presence of serious conditions and take the appropriate action. Perform only procedures that you have been trained to perform.
The classification of injuries according to severity, urgency of treatment, and place for treatment. If you receive an emergency call from a patient or patient's family member, follow the practice's triage protocols. Stay calm; reassure the patient or patient's family member(s); and act in a confident, organized manner.
When administering first aid and other emergency treatment, assume that all blood and body fluids are infected with blood-borne pathogens, and follow Universal Precautions, including wearing gloves and other personal protective equipment (PPE). Minimize your contact with blood by avoiding touching objects unnecessarily that have been contaminated with blood or other body fluids. Minimize the splattering or spraying of blood.
Document all office emergencies in the patient's chart, including information on assessment, treatment, and response.
Good Samaritan law
Permits emergency care on the condition that it is within the scope of competence of the person administering first aid. It holds individuals giving first aid responsible for any injury they cause as a result of negligence or failure to exercise reasonable care. If the victim is conscious or a family member is present, obtain verbal consent. If the victim is unconscious, consent is implied. State laws also apply.
A rolling cart that contains basic drugs, supplies, and equipment for medical emergencies. Most crash carts also contain a first-aid kit with supplies for managing minor injuries and ailments.
A medical emergency in which the body temperature is dangerously reduced below the normal range, below 96°F (rectal, child/adult) or 97.5°F (rectal, newborn). Major symptoms include mild shivering, cool skin, and pallor. Minor characteristics include tachycardia, cyanosis, and hypertension. Risk factors include exposure to a cool or cold environment, trauma, malnutrition, consumption of alcohol, specific medications, decreased metabolic rate, aging, and inactivity.
The traumatic effect of extreme cold on skin and subcutaneous tissues, particularly the toes, fingers, ears, and nose. Vasoconstriction of blood vessels causes anoxia, edema, vesiculation, and necrosis. Symptoms include white, waxy, or grayish yellow skin that may feel crusty, with possible softness in the underlying tissue.To treat frostbite, wrap warm clothing or blankets around the affected body part, or place the affected area in warm but not hot water.
Body temperature elevated above the normal range. Skin is warm to the touch and appears flushed. The patient may experience tachypnea, tachycardia, seizures, or convulsions. Major factors include exposure to a hot environment, vigorous activity, medications or anesthesia, increased metabolic rate, trauma or illness, and dehydration. Individuals who are in poor health, alcoholic, obese, very young, or elderly are less able to tolerate heat waves and constant high temperatures.
A severe and sometimes fatal condition generally caused by prolonged exposure to high temperatures. Symptoms include hot, dry skin; high body temperature; altered mental state; rapid pulse; rapid breathing; dizziness; and weakness. To treat heatstroke, call the EMS system. Move the patient to a cool place and remove the patient's outer clothing. Cool the patient, using any means available. Keep the patient's head and shoulders slightly elevated.
Painful spasms of the voluntary muscles in the leg, abdomen, or arm, which may be caused by depletion in the body of both water and salt. It occurs in an extremely hot environment.
Characterized by muscle cramps, weakness, nausea, dizziness, and loss of consciousness, caused by depletion of body fluids and electrolytes. It is the most frequent heat-related injury. Treatment includes moving the patient to a cool place and starting fluid and electrolyte replacement.
An injury to the tissues of the body caused by heat, electricity, chemicals, radiation, or gases. The severity of a burn depends on the depth of the burn and the percentage of the body involved. Burns are classified according to the depth of tissue injured. There are three types: first-degree, second-degree, and third-degree.
Superficial (first-degree) burns
The most common type of burn. They cause pain and make the surrounding skin turn red. A superficial burn damages only the epidermis and causes edema. Sunburn is a common example of a superficial burn. To treat superficial burns, apply cold-water dressings to the burn, or immerse the affected area in cold water. Gently pat the area dry, and apply a dry, sterile dressing.
Partial-thickness (second-degree) burns
These burns extend deeper into the skin than first-degree burns, damaging the epidermis and dermis. The injured area appears blistered, with redness and pain. The blisters should not be broken. They prevent infection of the burned area. They are usually very painful and heal within 3 to 4 weeks. To treat a partial-thickness burn, immerse the burned area in cold water until the pain subsides, pat the area dry, and apply a dry, sterile dressing.
Full-thickness (third-degree) burns
These burns involve all layers of skin and completely damage both the epidermis and the dermis, extending into the underlying connective tissues, such as fat, muscle, and even bone. A full-thickness burn is an emergency condition. Spontaneous healing is impossible. These burns require the removal of scars and the application of skin grafts. Victims of full-thickness burns may not feel any pain because of damage to the nerve endings in the skin.
Estimating the extent of the burn
To calculate the amount of skin surface burned on an adult, use the rule of nines. Each of the following parts of the body is considered to be 9% of the body's surface: the head and neck, each upper limb, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower limb, and the back of each lower limb. The remaining 1% is the genital area.
To treat a chemical burn, flood the area with large amounts of water, and cover it with a dry dressing. Call the EMS system.
Caused by contact with hot liquids, steam, flames, radiation, excessive heat from fire, or hot objects. Call the EMS system. Use water to cool a burning substance, or use a wet cloth or blanket to put out a flame.
Injuries from exposure to electrical currents, including lightning. These burns occur at the site where the electricity enters the body and where the current exits the body and enters the ground. Along the current's pathway, extensive tissue damage can occur from heat, followed by chemical changes to nerve, muscle, and heart tissue.
Causes redness, tenderness, pain, swelling, blisters, and peeling skin and can lead to skin damage or cancer. To treat sunburn, soak skin in cool water and apply cold compresses and calamine lotion. Have the patient elevate the legs and arms, drink plenty of water, and take a pain reliever.
A physical injury in which the skin or tissues under the skin are damaged. There are two types of wounds: open and closed.
Include punctures, lacerations, abrasions, and incisions.
A clean and smooth cut.
A cut with jagged edges.
Treating incisions and lacerations
For deeper wounds that involve muscle, tendons, the face, the genitals, the mouth, or the tongue, control the bleeding with direct pressure to the wound, elevation, and the use of pressure points; contact the physician or EMS system.
A scraping of the skin. Wash with soap and water, making sure to remove all dirt and debris. Use a bandage on a large abrasion.
A small hole created by a piercing object. Allow the wound to bleed freely for a few minutes, then clean it with soap and water and apply a dry, sterile dressing. A tetanus immunization may be required.
An injury that occurs inside the body without tearing the skin. Closed wounds are called contusions or bruises. They are caused by a sudden blow or force from a blunt object. Apply cold compresses to reduce swelling.
May range in severity from minor to serious. A wound that tears the skin should be seen by a physician and may need to be reported to the police, animal control office, and local health department. If the animal can be found, it should be checked for rabies.
Treating animal bites
If the bite is a puncture wound, try to make it bleed to flush out bacteria. Wash the area thoroughly with antiseptic soap and water. Apply an antibiotic ointment and a dry, sterile dressing. The physician will administer a tetanus shot if the patient has not had one for 7 to 10 years.
A viral infection normally transmitted through the saliva of rabid animals. Dogs, cats, skunks, squirrels, raccoons, bats, and foxes are more likely to carry rabies than other animals. Prevention involves vaccinating house pets. Immunization of a person who has been exposed to rabies should be started as soon as possible because treatment is ineffective once clinical symptoms develop. If left untreated, rabies can cause paralysis and death.
An annoyance to most patients, insect stings can be deadly to those who are allergic to the insect venom. The site of an insect sting can become red, swollen, itchy, and painful. To remove the stinger, scrape the skin with a flat, hard, sharp object, being careful not to release more venom.Wash the skin with soap and water, apply ice to reduce pain and swelling, and apply a paste of baking soda or a dressing soaked in aloe vera or vinegar to reduce discomfort.
A wound resulting from penetration of the skin by the fangs of a snake. Not all snakebites are poisonous. Symptoms of a poisonous snakebite include puncture marks, pain, swelling, rapid pulse, nausea, vomiting, and possibly unconsciousness and seizures. Bites from snakes known to be nonvenomous are treated as puncture wounds.The bitten area should be immobilized and positioned below heart level, and the patient should not walk. Wash the bite area with soap and water.
A puncture wound produced by the bite of venomous spiders, which in the United States include the black widow and the brown recluse. Symptoms include swelling, pain, nausea, vomiting, rigid abdomen, fever, rash, and difficulty breathing or swallowing. Any patient bitten by a spider should be seen by a doctor. Wash the area thoroughly with soap and water, apply an ice pack, and keep the area below heart level.
Of the different scorpion types in the American Southwest, some are more poisonous to young children. Antivenin may be available in some areas. Scorpion stings are treated similarly to spider bites.
Overstretching of muscles or tendons caused by trauma. The neck, back, thigh, and calf are the most common sites for muscle injuries caused by excessive physical force. Strains do not usually cause the intense symptoms associated with fractures, dislocations, and sprains.
An acute partial tear of a tendon, muscle, or ligament, characterized by pain and edema. The joints most commonly sprained are ankles, knees, wrists, and fingers. Treatment requires elevation, mild compression, and immediate application of ice. After 24 to 36 hours, application of mild heat is usually indicated. The patient also should rest the affected area.
The displacement of a bone from its normal articulation with a joint. It is caused by a violent pulling or pushing force that tears the ligaments. Symptoms include deformity of the joint, pain, edema, and loss of function.
A break in a bone. Review this section in Chapter 4, "Pathophysiology."
Treating fractures and dislocations
To reduce pain and continuing damage to soft tissue, immobilize the body area by the application of a splint or cast. In some cases, it is necessary to move the bone back into the proper position.
An orthopedic device for immobilization or support of any part of the body. It may be rigid (made of metal, plaster, or wood) or flexible (made of leather, rolled newspapers, or magazines). The body part should be splinted in the position in which it was found. The splint should immobilize the area above and below the injury.
A rigid external dressing, usually made of plaster or fiberglass, that is molded to the contours of the body part.
Scalp hematoma, scalp laceration, concussion. Severe head injuries include contusion, fracture, and intracranial bleeding. Some head injuries can be life-threatening.
A bump on the head caused by a buildup of blood under the skin. The swelling can be reduced by applying ice.
A wound that usually bleeds profusely. Direct pressure should be applied to stop the bleeding.
A jarring injury to the brain, the most common type of head injury. Symptoms include loss of consciousness, temporary loss of vision, pallor, listlessness, memory loss, and vomiting. Symptoms may disappear rapidly or last up to 24 hours. The patient should refrain from strenuous activity, rest, and then return to regular activity gradually. Unless the physician approves using other pain medications, only acetaminophen should be used.
Severe head injuries
Contusions, fractures, and intracranial bleeding. Mortality in severe injury approaches 50% and is only slightly reduced by treatment. Symptoms are more profound than in concussions and also include leakage of clear or bloody fluid from the ears or nose, seizures, and respiratory arrest. The patient requires immediate hospitalization to treat such an injury. Maintain the patient's airway and begin rescue breathing or cardiopulmonary resuscitation (CPR) if needed.
A brief loss of consciousness, also called syncope, that can result from a variety of causes. The most common direct cause of syncope is decreased cerebral blood flow. Before fainting, a patient may feel weak, dizzy, cold, or nauseated and may perspire or look pale and anxious. Have the patient lower his or her head between the legs and breathe deeply.
May be caused by injury, trauma, fever, infection, hypocalcemia, hypoglycemia, or idiopathic factors. Convulsions, also called seizures, usually last only a few minutes. To treat convulsions, remove objects in the environment that may cause injury. Lay the patient on the floor on his or her side. Loosen restrictive clothing. Protect the patient from injury, but do not try to hold the patient still. If necessary, begin rescue breathing.
Cerebrovascular accident (CVA)
Also known as a stroke. An abnormal condition of the brain characterized by occlusion by an embolus, thrombus, or cerebrovascular hemorrhage. Possible effects of stroke include paralysis, weakness, speech defects, aphasia, and death. Notify the physician and call the EMS system. Turn the patient's head toward the affected side to maintain the airway. Loosen tight clothing. If directed by the physician, monitor vital signs and administer oxygen.
A fairly common disorder of carbohydrate metabolism, diabetes can cause hyperglycemia and hypoglycemia, both of which may become medical emergencies.
A lower-than-normal level of glucose in the blood, usually caused by the administration of too much insulin, excessive secretion of insulin by the pancreas, or dietary deficiency. Symptoms of hypoglycemia include weakness, headache, hunger, ataxia, anxiety, and visual disturbances. Untreated hypoglycemia can result in delirium, coma, and death. The treatment is the administration of glucose in orange juice by mouth; if the patient is unconscious, an IV glucose solution must be started.
Very severe hypoglycemia. The symptoms include weakness, tachycardia, cold skin, tremors, convulsions, restlessness, confusion, and fainting. The treatment is the administration of some form of sugar.
A higher-than-normal level of blood glucose. Symptoms include dry mouth, intense thirst, muscle weakness, and blurred vision.
The end result of severe hyperglycemia. Symptoms are rapid breathing; flushed, warm, dry skin; thirst; acetone breath; and disorientation or confusion. If diabetic coma is suspected, a physician should be notified and the patient transported to a hospital.
A life-threatening state associated with failure of the cardiovascular system. It prevents the vital organs from receiving blood and can bring all normal metabolic functions to a halt. Several types of shock are possible, such as hypovolemic, cardiogenic, neurogenic, septic, and anaphylactic.
Inadequate intravascular volume producing diminished ventricular filling and reduced stroke volume, which results in decreased cardiac output. It occurs after an injury that causes major fluid loss. Patients should be transported to an emergency facility immediately.
Results from reduction in cardiac output due to factors other than inadequate intravascular volume (e.g., cardiac tamponade, pulmonary embolism, myocardial infarction, myocarditis, drugs, tachycardia, and bradycardia).
May occur following severe cerebral trauma or hemorrhage.
May be partly due to the effects of endotoxin or other chemical mediators on resistance vessels, resulting in vasodilation and decreased vascular resistance.
Occurs following allergic reactions. It is also called anaphylaxis.
Symptoms of shock
Restlessness; irritability; fear; rapid pulse; pale, cool skin; and increased respiratory rate.
Elevate the patient's feet 8 to 12 inches, unless there is head injury, in which case, keep the patient flat or elevate the head and shoulders. Monitor airways, breathing, and circulation, and control bleeding if necessary. Wrap the patient in a blanket, and call the EMS system.
The release of blood from the vascular system as a result of damage to a blood vessel. It is also called hemorrhaging and can be minor or very severe. A loss of 25% to 40% of a patient's total blood volume (approximately 2 to 4 pints of blood for the average adult) can be life-threatening and potentially fatal. There are two types of bleeding: external and internal.
Hemorrhaging from an internal organ or tissue, such as intraperitoneal bleeding into the peritoneal cavity, or intestinal bleeding into the bowel.
The vomiting of bright red blood, indicating rapid upper GI bleeding. The most common causes are esophageal varices and peptic ulcer.
The coughing up of blood from the respiratory tract.
Controlling internal bleeding
Cover the patient with a blanket, keep the patient quiet and calm, and get medical help immediately.
Bleeding that can be seen outside the body, such as bleeding from wounds, open fractures, and nosebleeds (epistaxis). The type of blood vessel that has been injured determines the classification of external bleeding: arterial, venous, or capillary. The most common type of external bleeding is capillary bleeding. The most serious and least common type of external bleeding is arterial.
A common type of external bleeding usually caused by trauma, hypertension, exposure to high altitudes, or an upper respiratory infection.
Controlling external bleeding
If time permits, wash your hands and put on personal protective equipment. Apply direct pressure over the wound, using a clean or sterile dressing. Apply an additional dressing on top if blood soaks through. Elevate the body part that is bleeding. If bleeding does not stop, apply pressure over the nearest pressure point between the bleeding and the heart.
A physical complaint that requires immediate diagnosis and evaluation. Chest pain may be indicative of cardiac disease, such as myocardial infarction, angina pectoris, or pericarditis; of respiratory disorders, such as pleurisy, pneumonia, or pulmonary embolism; or of nonmyocardial infarction. Another source of chest pain can be cocaine use.
Myocardial infarction (MI)
Ischemic myocardial necrosis of a portion of the cardiac muscle caused by obstruction in a coronary artery. It is also known as a heart attack. In more than 90% of patients with acute MI, an acute thrombus, often associated with plaque rupture, occludes the coronary artery. Chest pain is the major symptom of a heart attack. The pain may radiate down the left arm or into the jaw, throat, or both shoulders, and it may be accompanied by shortness of breath, sweating, nausea, and vomiting.
The sudden cessation of cardiac output and effective circulation, usually followed by ventricular fibrillation or ventricular asystole. It is also called cardiac standstill. Immediate initiation of CPR is required to prevent heart, lung, kidney, and brain damage.
Chain of Survival
The American Heart Association's term Chain of Survival provides useful information for emergency cardiovascular care (ECC). The ECC systems concept summarizes the present understanding of the best approach to the treatment of persons with sudden cardiac arrest.
The five links in the adult Chain of Survival are
•Immediate recognition of cardiac arrest and activation of the emergency response system
•Early cardiopulmonary resuscitation with emphasis on chest compressions
•Effective advanced life support
•Integrated post-cardiac arrest care
Cardiopulmonary resuscitation (CPR)
In collapsed or unconscious persons, the state of ventilation and circulation must be determined immediately. Speed, efficiency, and proper application of CPR directly affect success. Tissue anoxia for more than 4 to 6 minutes can result in irreversible brain damage or death.
A device that delivers an electrical shock at a preset voltage to the myocardium through the chest wall. It is used for restoring the normal cardiac rhythm and rate when the heart has stopped beating or is fibrillating. The office defibrillator is portable and is powered by standard 110V current or batteries.
Modifications to CPR for children
Although the steps for giving CPR to an adult and child are similar, there are a few differences: •Amount of air for breaths•Possible need to try more than twice to deliver two breaths that make the chest rise•Depth of compressions•Possible use of one-handed chest compressions for very small children•When to attach an AED•When to activate the emergency response system.
A condition in which the respiratory passage is blocked by an obstruction, usually food in the trachea. If the victim is coughing forcefully, do nothing but observe. If the victim is conscious but cannot speak, breathe, or cough, use the Heimlich maneuver. Give upward subdiaphragmatic abdominal thrusts until the foreign body is expelled. If the victim loses consciousness, lay the person down slowly on his or her back. Check the mouth for a foreign body.
Lack of breathing, usually preceded by symptoms of respiratory distress. If a patient shows such symptoms, notify the physician immediately. If the patient develops respiratory arrest, call the physician and the EMS system, and perform CPR.
A respiratory disorder characterized by (1) airway constriction that is reversible, either spontaneously or with treatment; (2) airway inflammation; and (3) increased airway sensitivity to a variety of stimuli. If a patient has an asthma attack, notify the physician. If the patient has a respiratory inhaler, help the patient use it.
Breathing too rapidly and too deeply, which can cause patients to feel light-headed and as if they cannot get enough air. Move the patient to a quiet area, and have the patient breathe into a paper bag that is held tightly around the nose and mouth. Encourage the patient to take slow, normal breaths.
A substance that impedes biological functions when taken into the body. The majority of accidental poisonings occur at home in children under the age of 5 years. A poison may enter the body by ingestion, absorption, injection, or inhalation. Clinically, poisons are divided into those that respond to specific antidotes or treatment and those for which there is no specific treatment.
Symptoms of ingested poisons
Abdominal pain; cramping; nausea; vomiting; diarrhea; odor, stains, or burns around the mouth; drowsiness; and unconsciousness.
Treating ingested poisons
Call a poison control center, hospital emergency room, physician, or the EMS system for instructions. Help the patient drink one or two glasses of water or milk as quickly as possible, and turn the patient on his or her left side.
Induce vomiting only if directed to do so by a medical authority. Use ipecac syrup to induce vomiting. When vomiting has stopped, administer 30 to 50 g of activated charcoal to absorb residual poison.
Symptoms of absorbed poisons
Rash, swelling, burning eyes, headache, fever, and abnormal pulse or respiration.
Treating absorbed poisons
Call a poison control center. Have the patient remove all contaminated clothing. Wash infected skin thoroughly with soap and water, drench it with alcohol, and rinse well. Apply wet compresses soaked in calamine lotion and suggest a bath in colloidal oatmeal or the application of a paste of baking soda and water to soothe the itching.
Symptoms of inhaled poisons
Headache, tinnitus, angina, shortness of breath, muscle weakness, nausea, vomiting, confusion, dizziness, blurred or double vision, unconsciousness, and cardiac arrest. Carbon monoxide is the most commonly inhaled poison.
Treating inhaled poisons
Get the patient into fresh air. Call the EMS system or a poison control center. Loosen tight-fitting clothing, and wrap the patient in a blanket to prevent shock.
Although many diseases can produce abdominal pain, acute and severe pain nearly always is a symptom of intra-abdominal abnormality (pathology). It may be the most important indication that an emergency operation or treatment is needed, such as for appendicitis, perforated peptic ulcer, intestinal obstruction, general peritonitis, twisted ovarian cyst, or ectopic pregnancy.
Treating abdominal pain
Call for transport, and have the patient lie on the back with the knees flexed. Keep the patient warm and quiet. Do not apply heat. Monitor the patient's pulse and consciousness, and check for signs of shock.
A common symptom of many disorders that can lead to dehydration and electrolyte imbalances. Notify the physician, and use a basin to collect the vomit. Place a cool compress on the patient's forehead, and offer water and a towel to clean the mouth.
Can cause dehydration and electrolyte imbalances and can lead to shock. The patient should lie on his or her back and elevate the legs. The physician may direct you to assist in administering IV fluids.
Abnormal black, tarry stool that has a distinctive odor and contains digested blood. It usually results from bleeding in the upper GI tract. In adults, it is often a sign of peptic ulcer or small bowel disease.
If a patient experiences gushing vaginal bleeding, call the EMS system, and have her lie down with her feet elevated.
The intentional release of a biological agent with the intent to harm individuals. The CDC defines a biological agent as a weapon when it is easy to disseminate, has a high potential for mortality, can cause a public panic or social disruption, and requires public health preparedness. There are numerous biological agents identified as weapons, including anthrax, tularemia, smallpox, plague, and botulism.