1. Demonstrate how to recognize and respond to medical emergencies

1. 1. Demonstrate how to recognize and respond to medical emergencies • Define the following term: • conscious • the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.

2. 1. Demonstrate how to recognize and respond 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.

3. 1. Demonstrate how to recognize and respond to medical emergencies NAs responding to an emergency need to recognize the following symptoms of injury: Severe bleeding Changes in consciousness Irregular breathing Unusual color or feel to the skin Swollen places on the body Medical alert tags Anything the resident says is painful

4. 1. Demonstrate how to recognize and respond to medical emergencies NAs should be prepared to give the following information to emergency services when reporting an emergency: Phone number and address, including directions, landmarks, and location in building Victim’s condition, including medical background if known NA’s name and position First aid given

5. 1. Demonstrate how to recognize and respond to medical emergencies REMEMBER: When speaking to an emergency services dispatcher it is important not to hang up until the dispatcher says to do so.

6. 1. Demonstrate how to recognize and respond to medical emergencies Home Care Focus REMEMBER: When an home health aide is in any doubt about calling for help, she should do it. If she is alone, she should make the call herself. If she is not alone, she can shout for help and have someone else make the call. The HHA should always notify her supervisor that she has called 911, and should unlock the front door so emergency personnel can get in.

7. 2. Demonstrate knowledge of first aid procedures Define the following term: first aid emergency care given immediately to an injured person. cardiopulmonary resuscitation (CPR) medical procedures used when a person’s heart or lungs have stopped working.

8. 2. Demonstrate knowledge of first aid procedures REMEMBER: Not all facilities permit NAs to start CPR - even those trained to do so. It is important to know the facility’s policy, and anyone who is not trained should never attempt to perform CPR.

9. 2. Demonstrate knowledge of first aid procedures The following are signs of shock: Pale or cyanotic skin Staring Increased pulse and respiration Low blood pressure Extreme thirst

10. Handout 7-1: CPR Review This handout is not meant to replace a CPR course. The following is a brief review for people who have had CPR training. It is a procedure to use on adults, not children. This may not be the procedure that your agency uses. Follow your agency’s policies and procedures. 1. After making sure that the scene is safe, check whether the person is responsive. Tap the person on the shoulder and shout, “Are you all right?” 2. If there is no response, call 911 immediately or send someone to call 911. Stay calm. 3. After calling 911, get an automated external defibrillator (AED) (if available and if trained in its use). Return to the person to provide CPR. More information on the AED is in step 10. 4. The person should be on his back on a hard surface (if he has no spinal injuries) before CPR is started.

11. Handout 7-1: CPR Review (cont’d) 5. Open the airway. Tilt the head back slightly. Lift the chin with one hand while pushing down on the forehead with the other hand (head tilt-chin lift method). This method is used if a neck injury is not suspected. 6. Look, listen, and feel for signs of life for no longer than 10 seconds: • Look for the chest to rise and fall. • Listen for sounds of breathing. Put your ear near the person’s nose and mouth. • Feel for the person’s breath on your cheek.

12. Handout 7-1: CPR Review (cont’d) 7. If you do not detect adequate breathing within 10 seconds, you will have to breathe for the person. Give two rescue breaths. To give rescue breaths: • Pinch the nose to keep air from escaping. Cover the person’s mouth completely with your mouth. You can use a barrier device, such as a special face mask, if available. • Blow into the person’s mouth slowly, watching for the chest to rise. Blow one breath for about one second, take a “regular” (not a deep) breath, and give a second rescue breath for about one second. Turn your head to the side to listen for air. If the chest does not rise when you give a rescue breath, reopen the airway using the head tilt-chin lift method. Try to give rescue breaths again.

13. Performing abdominal thrusts for the conscious person 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.

14. Performing abdominal thrusts for the conscious person 4. Repeat until the object is pushed out or the person loses consciousness. 5. Report and document the incident properly.

15. Clearing an obstructed airway in a conscious infant 1. Lay the infant face down on your forearm; if you are sitting, rest the arm holding the infant’s torso on your lap or thigh. Support her jaw and head with your hand. Keep her head lower than the rest of her body. 2. Using the heel of your free hand, deliver up to 5 back blows. Back blows are performed by striking the infant between the shoulder blades.

16. Clearing an obstructed airway in a conscious infant • If the obstruction is not expelled with back blows, turn the infant onto her back while supporting the head. Deliver up to five chest thrusts by placing two or three fingers in the center of the breastbone. 4. Repeat alternating five back blows and five chest thrusts until the object is pushed out or the infant loses consciousness.

17. Clearing an obstructed airway in a conscious infant 5. Report and document the incident properly. Call 911 immediately if the infant loses consciousness. Follow any instructions you are given.

18. 2. Demonstrate knowledge of first aid procedures REMEMBER: Facilities often use codes to inform staff of emergencies without causing panic and stress among residents and visitors. It is important for NAs to know the codes in their facilities and to respond calmly and professionally.

19. 2. Demonstrate knowledge of first aid procedures Define the following term: shock a condition that occurs when organs and tissues in the body do not receive an adequate blood supply.

20. Responding to shock 1. 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).

21. Responding to shock 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.

22. Responding to shock 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.

23. Responding to shock 8. Do not give the person anything to eat or drink. 9. Report and document the incident properly.

24. 2. Demonstrate knowledge of first aid procedures Define the following term: dyspnea difficulty breathing.

25. 2. Demonstrate knowledge of first aid procedures The following are symptoms of a heart attack: Sudden, severe pain in the chest, usually on the left side or in the center behind the sternum Pain or discomfort in other areas of the body, such as the arms, back, neck, jaw, or stomach Indigestion or heartburn Nausea and vomiting Dyspnea Dizziness Skin color that is pale or cyanotic Perspiration

26. 2. Demonstrate knowledge of first aid procedures Symptoms of a heart attack (cont’d): Cold and clammy skin Weak and irregular pulse rate Low blood pressure Anxiety and a sense of doom Denial of a heart problem Women can have MI without chest pressure or pain. Their most common symptoms are shortness of breath, pressure or pain in the lower chest or abdomen, dizziness, lightheadedness, fainting, pressure in the upper back, or extreme fatigue. Some women’s symptoms are more flu-like.

27. Responding to a 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. • Loosen clothing around the person’s neck. 4. Do not give the person liquids or food.

28. Responding to a heart attack 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.

29. 2. Demonstrate knowledge of first aid procedures REMEMBER: Severe bleeding must be controlled immediately, but NAs must take the time to put on gloves before trying to control bleeding.

30. Controlling 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.

31. Controlling bleeding • 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.

32. Controlling bleeding 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.

33. 2. Demonstrate knowledge of first aid procedures Think about this question: What is the phone number for Poison Control? Where should it be posted in the home?

34. Responding to 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.

35. Transparency 7-1: Burns

36. 2. Demonstrate knowledge of first aid procedures Burns are categorized in the following way: First-degree (superficial) Second-degree (partial-thickness) Third-degree (full-thickness) Care of the burn depends on its depth, size, and location.

37. 2. Demonstrate knowledge of first aid procedures REMEMBER: It is important to do no harm to severe burns. Ice, ointment, salve, and grease should never be applied to a burn.

38. 2. Demonstrate knowledge of first aid procedures Home Care Focus When working in the home, an HHA should call for emergency help in any of the following situations: An infant or child, or an elderly, ill, or weak person is burned, unless the burn is very minor. The burn occurs on head, neck, hands, feet, face, or genitals, or cover more than one body part. The person who has been burned is having trouble breathing. The burn was caused by chemicals, electricity, or an explosion.

39. Treating burns To treat a minor burn: 1. Notify the nurse immediately. Put on gloves. • 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.

40. Treating burns 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: 1. 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.

41. Treating burns 2. Notify the nurse immediately. Put on gloves. 3. 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. 4. Do not use any type of ointment, water, salve, or grease on the burn.

42. Treating burns • 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. 6. Ask the person to lie down and elevate the affected part if this does not cause greater pain. 7. Wait for emergency medical help.

43. Treating burns 8. Remove and discard gloves. Wash your hands. 9. Report and document the incident properly.

44. 2. Demonstrate knowledge of first aid procedures Define the following term: syncope loss of consciousness; also called fainting.

45. 2. Demonstrate knowledge of first aid procedures The following are signs and symptoms of fainting: Dizziness Nausea Perspiration Pale skin Weak pulse Shallow respirations Blackness in visual field

46. Responding to fainting 1. Notify the nurse immediately. 2. Have the person lie down or sit down before fainting occurs. • 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.

47. Responding to fainting 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.

48. Responding to fainting 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.

49. 2. Demonstrate knowledge of first aid procedures Define the following term: epistaxis a nosebleed.

50. 2. Demonstrate knowledge of first aid procedures REMEMBER: Gloves must be worn when helping a resident with a nosebleed.