EMERGENCY MEDICAL PROCEDURES

1
CHAPTER 21

• EMERGENCY MEDICAL PROCEDURES

2
PRETEST
True or False

1. A specially equipped cart for holding and
   transporting medications, equipment, and supplies
   need in an emergency is known as a crash cart.
2. Symptoms of an asthmatic attack include dyspnea
   and wheezing.
3. Symptoms of a heart attack include sudden
   weakness on one side of the body.
4. Another name for a stroke is a coronary
   occlusion.
5. Arterial bleeding is characterized by a slow and
   steady flow of blood that is dark red in color.

3
PRETEST, CONT.
True or False

1. A laceration is an example of a closed wound.
2. Symptoms of a fracture include pain, swelling,
   deformity and loss of function.
3. A sprain is a tearing of ligaments at a joint.
4. Heat stroke is a life-threatening emergency.
5. Insulin enables glucose to enter the body's cells
   and be converted to energy.

4
Content Outline
Introduction to Emergency Medical Procedures

• Medical emergencies occur both in and outside
  of workplace
• Can result in
• Sudden loss of life
• Permanent disability
• Emergency situations that occur in medical
  office
• Physician provides immediate care

5
Introduction to Emergency Medical Procedures,
cont.

• Some offices maintain a crash cart
• MA may assist physician in emergency care
• MA may also need to administer first aid
• For emergencies occurring outside of office

6
Introduction to Emergency Medical Procedures,
cont.

• First aid immediate care that is administered to
  an individual who is injured or suddenly becomes
  ill before complete medical care can be obtained
• Purpose
• To save a life
• Reduce pain and suffering
• Prevent further injury
• Reduce the incidence of permanent disability
• Increase the opportunity for an early recovery

7
Office Crash Cart

• Crash cart a specially equipped cart
• Holds and transports
• Medications
• Equipment
• Supplies
• Needed for performing life-saving procedures in
  an emergency

8
The Office Crash Cart, cont.

• Patient may
• Be brought to medical office for care
• Suddenly become ill at the office

9
The Office Crash Cart, cont.

• Examples of office emergencies
• Cardiac dysrhythmia
• Shock
• Cardiac arrest
• Poisoning
• Traumatic injury

10
The Office Crash Cart, cont.

• MA responsible for
• Checking and replenishing supplies on crash cart
• Checking medication expiration dates

11
Emergency Medical Services System (EMS)

• Provides emergency care to victims of injury or
  sudden illness
• Activating EMS most important step MA can take
  in an emergency
• Rapid arrival of EMS increases patient's chances
  of survival
• In majority of urban and some rural areas dial
  911

12
Emergency Medical Services System (EMS), cont.

• Emergency medical dispatcher (EMD)
• Trained to handle emergencies over the phone
• EMD responsibilities
• Answer call
• Listen to caller

13
Emergency Medical Services System (EMS), cont.

• Obtain information needed
• Determine what help is needed
• Send appropriate personnel and equipment
• Relay instructions to caller regarding emergency
  care
• Until EMS arrives

14
Emergency Medical Services System (EMS), cont.

• Guidelines when calling EMS
• Speak clearly and calmly
• Identify problem accurately and concisely
• So proper equipment and personnel can be sent

15
Emergency Medical Services System (EMS), cont.

• Specify
• Number of victims
• Condition of victims
• Emergency care that has been administered

16
Emergency Medical Services System (EMS), cont.

• EMD will ask for phone number and address
• With 911 address automatically appears on screen
• Do not hang up until EMD gives permission
• EMD may need additional information
• EMD may need to provide instructions on treatment
  of patient

17
First Aid Kit

1. Contains basic supplies needed to provide
   emergency care
2. Keep at home and in car
3. Available at most drug stores or can make your own

18
First Aid Kit
19
First Aid Kit, cont.

• Should include phone numbers of
• Local EMS
• Poison control center
• Police and fire departments

20
OSHA Safety Precautions

• First aid kit must contain personal protective
  equipment
• Gloves
• Face shield and mask
• Pocket mask

21
OSHA Safety Precautions, cont.

• Wear gloves when it is reasonably anticipated
  that you will have hand contact with
• Blood and other potentially infectious materials
  (OPIM)
• Mucous membranes
• Nonintact skin
• Contaminated articles or surfaces
• Minimize splashing, spraying, splattering, and
  generation of droplets of blood or OPIM when
  performing first aid

22
OSHA Safety Precautions, cont.

• Wear protective clothing and gloves to cover
• Cuts or other lesions
• Sanitize hands after removing gloves
• Avoid touching objects contaminated with blood or
  OPIM

23
OSHA Safety Precautions, cont.

• If hands come into contact with blood or OPIM
  wash immediately with soap and water
• If mucous membranes come in contact with blood or
  OPIM flush with water immediately
• Do not eat, drink, or touch mouth, eyes, or nose
  when providing emergency care
• If exposed to blood or OPIM report incident to
  physician
• Postexposure measures can be initiated

24
Guidelines for Providing Emergency Care

• Remain calm speak in normal tone of voice
• Helps to calm and reassure patient
• Make sure scene is safe before approaching
  patient
• Must protect yourself from harm

25
Guidelines for Providing Emergency Care, cont.

• Must have patient consent before administering
  emergency care
• Consent is assumed
• When a life-threatening condition is present and
  patient is unable to give consent (e.g.,
  unconscious)
• Assume if patient could give consent, he would

26
Guidelines for Providing Emergency Care, cont.

• Follow OSHA Standard to reduce or eliminate
  exposure to blood-borne pathogens and OPIM
• Know how to activate EMS
• Most important step
• Do not move patient unnecessarily
• Could result in further injury or be life
  threatening

27
Guidelines for Providing Emergency Care, cont.

• Obtain information as to what happened from
• Patient
• Family members
• Co-workers
• Bystanders

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Guidelines for Providing Emergency Care, cont.

• Look for medical alert tag on wrist or neck
• Provides information on a patient's medical
  condition

29
Guidelines for Providing Emergency Care, cont.

• Continue caring for patient until more highly
  trained personnel arrive
• On their arrival relay
• Condition in which you found patient
• Emergency care administered

30
Respiratory Distress

1. Patient is breathing but having great difficulty
   in doing so
2. May lead to respiratory arrest

31
Respiratory Distress, cont.

• Signs and symptoms of respiratory distress
• Noisy breathing
• Gasping for air
• Rasping, gurgling, or whistling sounds
• Breathing that is unusually fast or slow
• Painful breathing

32
Respiratory Distress, cont.

• General care
• Place patient in comfortable position that
  facilitates breathing
• Sitting
• Semi-reclining
• Remain calm

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Respiratory Distress, cont.

• Reassure patient to help reduce anxiety
• May help patient breathe easier
• If condition worsens contact EMS

34
Asthma

• Asthma
• Characterized by
• Wheezing
• Coughing
• Dyspnea

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Asthma, cont.

• During an asthmatic attack
• Bronchioles constrict
• Become clogged with mucus
• May occur at any age
• More common in children and young adults

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Asthma, cont.

• If not treated can lead to serious complications
• Example lung damage
• Frequently associated with family history of
  allergies

37
Asthma, cont.

• Common allergens that can trigger attack
• Dust
• Pollen
• Mold
• Animal dander

38
Asthma, cont.

• Also caused by
• Air pollutants
• Tobacco smoke
• Chemical fumes
• Vigorous exercise

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Asthma, cont.

• Respiratory infection
• Exposure to cold
• Emotional stress
• Usually controlled with meds to make breathing
  easier
• Stop muscle spasms and opens airway

40
Asthma, cont.

• Status asthmaticus severe, prolonged asthmatic
  attack
• Life-threatening
• Can only move a small amount of air

41
Asthma, cont.

• Symptoms
• Breathing may not be audible
• Bluish discoloration of skin
• Extremely labored breathing
• Requires immediate transportation to emergency
  care facility

42
Emphysema

• Emphysema
• Progressive lung disorder
• Terminal bronchioles that lead to alveoli become
  plugged with mucus
• Alveoli become damaged
• Less surface area to diffuse oxygen

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Emphysema, cont.

• Alveoli lose elasticity
• Inhaled air becomes trapped in lungs
• Breathing becomes difficult (especially
  exhalation)
• Air becomes trapped in lungs exhalation difficult

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Emphysema, cont.

• Usually develops over many years
• Occurs most frequently heavy smokers
• Occurs also in
• Patients with chronic bronchitis
• Elderly patients who have lost lung elasticity

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Emphysema, cont.

• Chronic emphysema
• One of the major causes of death in United States
• Lungs progressively become less efficient
• Breathing more difficult
• Patients in advanced stages may go into
  respiratory or cardiac arrest

46
Hyperventilation

• Hyperventilation
• Overbreathing
• Respirations become rapid and deep
• Causes patient to exhale too much carbon dioxide
• Accounts for many of the symptoms

47
Hyperventilation, cont.

• Often result of fear and anxiety
• More likely to occur in tense and nervous
  individuals
• Also caused by serious organic conditions
• Diabetic coma
• Pneumonia

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Hyperventilation, cont.

• Pulmonary edema
• Pulmonary embolism
• Head injuries
• High fever
• Aspirin poisoning

49
Hyperventilation, cont.

• Symptoms
• Rapid and deep respirations
• Dizziness, faintness, light-headedness
• Visual disturbances
• Chest pain, tachycardia, palpitations
• Fullness in throat
• Numbness and tingling of fingers, toes, and area
  around mouth

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Hyperventilation, cont.

• Patient complains they cannot get enough air
• Often think they are having a heart attack

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Hyperventilation, cont.

• Treatment
• Calm and reassure patient
• Encourage patient to slow respirations
• Helps carbon dioxide level return to normal
• Contact EMS immediately if suspect organic
  problem

52
Heart Attack

• Also known as myocardial infarction (MI)
• Cause obstruction of one or both of coronary
  arteries or branches
• Severity of attack depends on

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Heart Attack, cont.

• Size of artery obstructed
• Amount of muscle tissue nourished by the artery
• Example
• Small branch obstructed

1. Myocardial damage is usually mild
2. Symptoms are mild

54
Heart Attack, cont.

1. Coronary artery completely blocked

1. Damage is extensive
2. Symptoms are intense

55
Heart Attack, cont.

• Principal symptom chest pain
• Described as
• Squeezing or crushing pressure
• Severe indigestion
• Burning, heaviness, or aching

56
Heart Attack, cont.

• Pain can range in severity
• From mildly uncomfortable to intense
• Usually felt behind sternum
• May radiate to neck, throat, jaw, shoulders, and
  arms
• Pain not relieved by resting or nitroglycerin

57
Heart Attack, cont.

• Other symptoms
• Shortness of breath
• Profuse perspiration
• Nausea
• Fainting

58
Heart Attack, cont.

• If MA suspects MI call EMS immediately
• Loosen clothing
• Place patient in comfortable position
  facilitates breathing
• If cardiac arrest occurs begin CPR

59
Stroke

• Also called cerebrovascular accident (CVA)
• Artery to brain is
• Blocked
• Ruptures
• Results in interruption of blood flow to brain

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Stroke, cont.

• Symptoms
• Sudden weakness or numbness of face, arm, or leg
  on one side of body
• Difficulty speaking
• Dimmed vision or loss of vision in one eye
• Double vision

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Stroke, cont.

1. Dizziness
2. Confusion
3. Severe headache
4. Loss of consciousness

62
Stroke, cont.

• If MA suspects stroke contact EMS immediately
• Loosen tight clothing
• Have patient rest in comfortable position
• If respiratory or cardiac arrest occurs
• Administer as required
• Rescue breathing
• CPR
• Both

63
Shock

• For body to function properly
• Adequate blood flow must be maintained to vital
  organs by
• Adequate pumping action of heart
• Sufficient blood circulating in blood vessels
• Blood vessels being able to respond to blood flow

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Shock, cont.

• When individual suffers severe injury or illness
  one or more cardiovascular functions may be
  affected
• Can lead to shock

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Shock, cont.

• Shock failure of cardiovascular system to
  deliver enough blood to vital organs
• Accompanies different types of emergency
  situations
• Hemorrhaging
• MI
• Severe allergic reaction

66
Shock, cont.

• If not treated often become life-threatening
• Is progressive
• Once reaching a certain point
• Becomes irreversible
• Patient's life cannot be saved

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Shock, cont.

• Symptoms of shock caused by failure of vital
  organs to receive enough oxygen and nutrients
• Organs most affected (can be irreparably damaged
  in 4 to 6 minutes)
• Heart
• Lungs
• Brain

68
Shock, cont.

• Symptoms
• Weakness
• Restlessness
• Anxiety

69
Shock, cont.

• Disorientation
• Pallor
• Cold and clammy skin
• Rapid breathing
• Rapid pulse

70
Shock, cont.

• If not treated rapidly progresses
• Drop in blood pressure
• Cyanosis
• Loss of consciousness
• Death

71
Shock, cont.

• Signs and symptoms may be
• Subtle
• Pronounced
• No single symptom can determine the
• Presence of shock
• Severity of shock

72
Shock, cont.

• To determine if patient is in shock
• Must consider the nature of the
• Illness
• Injury

73
Shock, cont.

• Example Patient suffers a traumatic injury to
  abdomen
• Even if patient's signs and symptoms do not
  suggest shock
• Shock should be considered
• Requires immediate medical care activate EMS

74
Hypovolemic Shock

• Cause loss of blood or other body fluids
• Caused by
• External or internal hemorrhaging
• Plasma loss from severe burns

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Hypovolemic Shock, cont.

• Severe dehydration from
• Vomiting
• Diarrhea
• Profuse perspiration

76
Hypovolemic Shock, cont.

• First priority control bleeding
• Transport to emergency care facility as soon as
  possible
• Fluid volume must be replaced

77
Cardiogenic Shock

1. Failure of heart to pump blood adequately to
   vital organs
2. Occurs when heart has been injured or damaged
3. Most frequently seen with MI

78
Cardiogenic Shock, cont.

• Other causes
• Dysrhythmias
• Severe congestive heart failure
• Acute valvular damage
• Pulmonary embolism
• Hard to reverse
• High fatality rate (80 to 90)

79
Neurogenic Shock

• Nervous system is unable to control the diameter
  of blood vessels
• Normally nervous system instructs blood vessel
  to constrict or dilate
• Controls blood pressure

80
Neurogenic Shock, cont.

• In neurogenic shock
• Control of blood vessel is lost
• Blood vessels dilate
• Blood pools in peripheral areas of body
• Most often seen in brain and spinal injuries
• Blood pressure drops significantly

81
Anaphylactic Shock

• Serious life-threatening reaction of the body to
  an allergen
• Examples
• Drugs (e.g., penicillin)
• Insect venoms
• Foods (e.g., peanuts)
• Allergen extracts used in hyposensitization
  injections

82
Anaphylactic Shock, cont.

• Reaction causes release of large amounts of
  histamine
• Results in
• Dilation of blood vessels
• Drop in blood pressure

83
Anaphylactic Shock, cont.

• Symptoms
• Sneezing
• Hives
• Itching
• Angioedema
• Erythema

84
Anaphylactic Shock, cont.

• Disorientation
• Difficult breathing
• Dizziness and faintness
• Loss of consciousness
• Obtain medical care immediately
• Most fatalities occur within the first 2 hours

85
Anaphylactic Shock, cont.

• Emergency care administration of epinephrine
• Highly allergic individual provided with
  emergency treatment kit
• Contains
• Injectable epinephrine (e.g., EpiPen)
• Oral antihistamines
• Treatment can be started immediately

86
EpiPen (Injectable Epinephrine)
87
Psychogenic Shock

• Least serious type of shock
• Caused by unpleasant physical or emotional
  stimuli such as
• Pain
• Fright
• Sight of blood

88
Psychogenic Shock, cont.

• Sudden dilation of blood vessels blood pools in
  abdomen and extremities
• Temporarily deprives brain of blood
• Causes temporary loss of consciousness
• Usually lasts 1 to 2 minutes
• Generally occurs when patient in upright position

89
Psychogenic Shock, cont.

• Warning signals that fainting is about to occur
• Sudden light-headedness
• Pallor
• Nausea
• Weakness

90
Psychogenic Shock, cont.

• Yawning
• Blurred vision
• Feeling of warmth
• Sweating

91
Psychogenic Shock, cont.

• For an individual who is about to faint
• Place patient in a position that facilitates
  blood flow to brain
• Supine with legs elevated 12 inches and collar
  and clothing loosened

92
Psychogenic Shock, cont

• If patient is sitting lower head between legs
• Tell patient to breathe deeply

93
Psychogenic Shock, cont.

• Patient who has fainted
• Place in a supine position with leg elevated

94
Bleeding

1. Bleeding (hemorrhaging) escape of blood from a
   severed blood vessel
2. Ranges from minor to very serious
3. Loss of 25 to 40 of blood volume (2 to 4
   pints) fatal

95
External Bleeding

• Bleeding that can be seen
• Common examples include bleeding from
• Open fractures
• Lacerations
• Nose

96
External Bleeding, cont.

• Symptoms of serious external bleeding
• Obvious bleeding
• Restlessness
• Cold and clammy skin
• Thirst

97
External Bleeding, cont.

• Increased and thready pulse
• Rapid and shallow respirations
• Drop in blood pressure
• Decreasing levels of consciousness

98
External Bleeding, cont.

• Types of external bleeding
• Capillary Bleeding
• Most common type
• Slow oozing that is bright red
• Occurs with minor cuts, scratches, and abrasions

99
External Bleeding, cont.

• Venous Bleeding
• Caused by punctured or severed vein
• Slow and steady flow that is dark red

100
External Bleeding, cont.

• Arterial Bleeding
• Most serious
• Occurs when artery is punctured or severed
• Bleeding comes in spurts and is bright red

101
External Bleeding, cont.

• Arteries most frequently involved in accidents
• Carotid
• Brachial
• Radial
• Femoral

102
External Bleeding, cont.

• Emergency Care for External Bleeding
• Application of direct pressure to site
• Slows down or stops flow of blood
• Amount of pressure depends on type of bleeding
• Small amount capillary bleeding
• Significant amount arterial bleeding

103
External Bleeding, cont.

• If bleeding not controlled with direct pressure
  use pressure point
• Pressure point site on body where an artery lies
  close to the surface and is compressed against an
  underlying bone

104
Pressure Points

• From Miller BF, Keane CB Encyclopedia and
  dictionary of medicine, nursing, and allied
  health, ed 7, Philadelphia, 2003, Saunders.

105
External Bleeding, cont.

• Slows or stops the flow of blood
• Pressure points used most often
• Brachial artery to control severe bleeding in
  the arm
• Femoral artery to control severe bleeding in
  the leg

106
External Bleeding, cont.

• Steps for controlling bleeding
• Apply direct pressure to the wound with a clean
  covering

107
External Bleeding, cont.

1. Apply additional dressings if necessary

108
External Bleeding, cont.

• Apply a pressure bandage
• To maintain pressure on the wound
• Transport patient to emergency care facility or
  activate EMS

109
Nosebleeds

1. Also known as epistaxis
2. Usually not serious

110
Nosebleeds, cont.

• Cause
• Upper respiratory infection
• Direct blow from a blunt object
• Hypertension
• Strenuous activity
• High altitudes

111
Nosebleeds, cont.

• Emergency care for nosebleeds
• Position patient in sitting position with head
  tilted forward
• Prevents blood from running down back of throat
• May result in nausea

112
Nosebleeds, cont.

• Apply direct pressure by pinching nostrils
  together
• Takes approximately 15 minutes for clot formation

113
Nosebleeds, cont.

• Apply icepack to bridge of nose
• After bleeding has stopped tell patient not to
  blow nose for several hours
• Could loosen clot
• Bleeding may start again
• If cannot control bleeding transport to
  emergency facility

114
Applying Icepack
115
Internal Bleeding

• Bleeding that flows
• Into a body cavity
• Into an organ
• Between tissues
• Severe internal bleeding life-threatening
  emergency

116
Internal Bleeding, cont.

• No obvious blood flow
• Must be recognized by
• Nature of injury
• Symptoms of internal bleeding
• Bruises, pain, tenderness, or swelling at site
• Rapid weak pulse

117
Internal Bleeding, cont.

• Cold and clammy skin
• Nausea and vomiting
• Excessive thirst
• Drop in blood pressure
• Decreased levels of consciousness
• 4. EMS should be notified immediately
• Treatment patient for shock until EMS arrives

118
Wound

• Wound Break in the continuity of an external or
  internal surface caused by physical means
• Open wounds Break in skin surface or mucous
  membrane that exposes underlying tissue
• Primary concern Hemorrhaging and contamination
  of wound

119
Open Wounds, cont.

• Examples of open wounds
• Incisions
• Punctures
• Abrasions

120
Open Wounds, cont.

• Patient should receive prompt attention if
  following occur
• Spurting blood
• Bleeding that cannot be controlled
• Break in skin that is deeper than just outer skin
  layers
• Embedded debris or object in the wound

121
Open Wounds, cont.

• Involvement of nerves, muscles, or tendons
• Wound occurs on mouth, tongue, face, genitals, or
  other areas
• Where scarring would be apparent

122
Incisions and Lacerations

1. Incision clean, smooth cut caused by a sharp
   cutting instrument (knife, razor, glass)

123
Incisions and Lacerations, cont.

• Deep incisions accompanied by
• Profuse bleeding
• Damage to muscles, tendons, and nerves may occur
• Edges of incision are smooth and straight
• Usually heal better than lacerations

124
Incisions and Lacerations, cont.

• Laceration tissues are torn apart, leaving
  ragged and irregular edges
• Caused by dull knives, large objects driven into
  skin, heavy machinery

125
Incisions and Lacerations, cont.

• Deep lacerations result in
• Profuse bleeding
• Scar formation

126
Incisions and Lacerations, cont.

• Emergency Care for Incisions and Lacerations
• Assess length, depth, and location of wound
• Control bleeding cover wound with dressing and
  apply pressure

Minor Incisions and Lacerations
127
Incisions and Lacerations, cont.

• Clean with soap and water
• To remove dirt and debris

128
Incisions and Lacerations, cont.

• Cover with dry sterile dressing
• Instruct patient to check wound for
• Redness
• Swelling
• Discharge
• Increase in pain

129
Incisions and Lacerations, cont.

• Serious Incisions and Lacerations
• To control bleeding
• Cover wound with a large, thick, gauze dressing
• Apply firm pressure
• Do not clean or probe wound
• May result in more bleeding
• Transport to physician if serious activate EMS

130
Punctures

1. Wound made by sharp object piercing the skin
   layers

131
Punctures, cont.

• Objects causing a puncture
• Nail, splinter, needle, wire, knife, bullet,
  animal bite
• Small external skin opening
• Bleeding is usually minor

132
Punctures, cont.

• Tetanus booster may be required
• Tetanus bacteria grow best in warm, anaerobic
  environment

133
Punctures, cont.

• Emergency care
• Allow wound to bleed freely to wash out bacteria
• Clean wound with soap and water
• Apply sterile dressing
• Transport so that medical care can be provided
  (tetanus toxoid)

134
Abrasions

1. Outer layers of skin are scraped or rubbed off

135
Abrasions, cont.

• Blood may ooze from ruptured capillaries
• Caused by falls resulting in
• Floor burns
• Skinned knees and elbows

136
Abrasions, cont.

• Debris may be rubbed into wound
• Important to clean thoroughly
• Emergency Care for Abrasions to prevent
  infection
• Rinse with cold running water
• Wash gently with soap and water
• Embedded debris should be removed by physician

137
Abrasions, cont.

• Cover large abrasions with dry sterile dressing
• Small abrasions do not require a dressing
• Instruct patient to check wound for inflammation
• Redness
• Swelling
• Discharge
• Increased pain
• Contact physician if they occur

138
Closed Wounds

• Injury to underlying tissues without a break in
  the skin surface or mucous membrane
• Example Contusion (bruise)

139
Closed Wounds, cont.

• Tissues under skin are injured
• Caused by sudden blow or force from a blunt
  object
• Blood vessels rupture allows blood to seep into
  tissues
• Causes
• Bluish discoloration of skin
• Swelling

140
Closed Wounds, cont.

• Many heal without special treatment
• Cold compresses reduce swelling and relieve pain
• After several days turns greenish or yellow
• Caused by oxidation of blood pigments

141
Closed Wounds, cont.

• Contusions commonly occur with
• Fractures
• Sprains
• Strains
• Black eyes

142
Musculoskeletal Injuries

• Musculoskeletal System
• Made up of
• Bones
• Tendon
• Ligaments

143
Musculoskeletal Injuries, cont.

• Injuries of musculoskeletal system
• Fractures
• Dislocations
• Sprains
• Strains

144
Fracture

1. Fracture Any break in a bone
2. Can range from simple chip or a crack to complete
   break or shattering

145
Fracture, cont.

• 3. Caused by
• a. Direct blow
• b. Fall
• c. Bone disease
• d. Twisting force

146
Fracture, cont.

• Often causes severe pain
• Usually not life threatening
• Types of fractures
• Closed fracture
• Most common type
• Break in the bone with no break in the skin

147
Closed Fracture

• From Connolly JF DePalmas the management of
  fractures and dislocations an atlas.
  Philadelphia, 1981, Saunders.

148
Open Fracture

• Break in bone with penetration of the overlying
  skin surface
• More serious risk of blood loss and infection

From Connolly JF DePalmas the management of
fractures and dislocations an atlas.
Philadelphia, 1981, Saunders.
149
Fracture, cont.

• Symptoms of a fracture
• Pain and tenderness
• Deformity
• Swelling and discoloration
• Loss of function of body part
• Numbness or tingling

150
Fracture, cont.

• Patient may state
• Heard a snap or break
• Felt a grating sensation (crepitus)
• Caused by bone fragments rubbing against each
  other

151
Fracture, cont.

• Types of fractures
• Impacted
• Greenstick
• Transverse
• Oblique
• Comminuted
• Spiral

152
Types of Fractures
153
Dislocation

• Dislocation An injury in which one end of a
  bone making up a joint is separated or displaced
  from its normal position
• Caused by violent pulling or pushing force that
  tears ligaments
• Falls
• Sport's injuries
• Motor vehicle accidents

154
Dislocation, cont.

• Symptoms
• Significant deformity of the joint
• Pain and swelling
• Loss of function

155
Sprain

• Sprain A tearing of ligaments at a joint
• Results from
• Fall
• Sports injury
• Motor vehicle accident

156
Sprain, cont.

• Joints most often sprained
• Ankle
• Knee
• Wrist
• Fingers

157
Sprain, cont.

• Symptoms
• Pain
• Swelling
• Discoloration
• Can vary from mild to severe
• Depends on the amount of damage to ligaments

158
Strain

• Strain Stretching and tearing of muscles or
  tendons
• Most likely to occur
• Lifting a heavy object
• Overworking a muscle

159
Strain, cont.

• Muscles most commonly strained are those of
• Neck
• Back
• Thigh
• Calf

160
Strain, cont.

• Symptoms
• Pain
• Swelling
• Discoloration

161
Emergency Care for a Fracture

• Often difficult to determine if patient has
  fracture, dislocation, or sprain
• Symptoms are similar
• Treat any serious musculoskeletal injury to an
  extremity as if it were a fracture

162
Emergency Care for a Fracture, cont.

• Immobilize body part to prevent motion
• Reduces pain and prevents further damage

From Henry M, Stapleton E EMT prehospital care,
ed 2, Philadelphia, 1997, Saunders.
163
Emergency Care for a Fracture, cont.

• Splint immobilizes a body part
• In an emergency
• Use wood, cardboard, rolled newspapers, magazines
• Pad splint with soft material (towel)
• Splint body part in the position you found it

164
Emergency Care for a Fracture, cont.

• Immobilize area above and below injury
• Example To splint an injured wrist
• Also immobilize the hand and forearm

165
Emergency Care for a Fracture, cont.

• To splint an injury to the shaft of the bone
• Immobilize the joints above and below the injury
• Example To splint the forearm
• Also immobilize the elbow and wrist joints

166
Emergency Care for a Fracture, cont.

• Hold splint in place with gauze roller bandage
• Or other suitable material
• Neckties
• Scarves

From Henry M, Stapleton E EMT prehospital care,
ed 2, Philadelphia, 1997, Saunders.
167
Emergency Care for a Fracture, cont.

• Apply snugly but not tightly
• Too tightly interferes with proper circulation
• Check pulse below splint to make sure not too
  tight

From Henry M, Stapleton E EMT prehospital care,
ed 2, Philadelphia, 1997, Saunders.
168
Emergency Care for a Fracture, cont.

1. Elevate injured extremity reduces swelling

From Henry M, Stapleton E EMT prehospital care,
ed 2, Philadelphia, 1997, Saunders.
169
Emergency Care for a Fracture, cont.

• Apply ice pack to injured part
• Reduces swelling

170
Emergency Care for a Fracture, cont.

• After injury properly immobilized
• Transport patient to emergency care facility
• If serious activate EMS
• If injury to spine suspected always activate EMS

171
Burns

• Burn An injury to tissue caused by exposure to
  the following agents
• Thermal
• Chemical
• Electrical
• Radioactive

172
Burns, cont.

• Severity depends on
• Depth of burn
• Percentage of body involved
• Type of agent causing burn
• Duration and intensity of agent
• Part of body involved

173
Superficial Burns

• Superficial Burns
• (First-Degree Burn)
• Most common type of burn
• Involves top layer of skin (epidermis)
• Skin appears red, warm, and dry to touch

174
Superficial Burns, cont.

• Usually painful
• Example sunburn
• Heals in 2 to 5 days
• Does not cause scarring

175
Partial-Thickness Burns

• Partial-Thickness Burns
• (Second-Degree Burn)
• Involves epidermis and dermis
• Appears red, mottled, and blistered
• Do not break blisters provide a barrier against
  infection

176
Partial-Thickness Burns, cont.

1. Usually very painful
2. Area often swells
3. Heals in 3 to 4 weeks
4. May result in some scarring

177
Full-Thickness Burns

• Full-Thickness Burns
• (Third-Degree Burn)
• Completely destroys epidermis and dermis
• Extends into underlying tissues (fat, muscle,
  bone, nerves)
• Appears charred black, brown, and cherry red
• With damaged tissues underneath appear pearly
  white

178
Full-Thickness Burns, cont.

• Patient may experience intense pain
• If substantial damage to nerve endings
• Patient may feel no pain at all
• Dense scars typically result
• Infection major concern

179
Types of Burns
From Polaski AL, Tatro SE Luckmanns core
principles and practice of medical-surgical
nursing. Philadelphia, 1996, Saunders.
180
Thermal Burns

• Usually occur in the home from
• Fire
• Scalding water
• Coming into contact with a hot object (stove)

181
Thermal Burns, cont.

• Emergency Care for Major Thermal Burns
• Stop burning process prevents further injury
• Individual on fire and covering available
• Wrap in a blanket, rug, heavy coat
• Push to ground to smother flame
• Individual on fire and cover not available
• Shout at individual drop to ground and roll
  around to smother flame

182
Thermal Burns, cont.

• Cool the burn using large amounts of cold water
• Do not use ice or ice water
• May result in further tissue damage
• Causes heat loss from body
• If burn covers large surface area do not use
  water
• Results in hypothermia
• Activate local EMS

183
Thermal Burns, cont.

• Cover patient with clean nonadherent material
  (tablecloth or sheet)
• Function
• Maintains warmth
• Reduces pain
• Reduces risk of contamination
• Do not apply ointment, antiseptic, or other
  substance to area

184
Thermal Burns, cont.

• Emergency Care for Minor Thermal Burns
• Immerse area in cold water for 2 to 5 minutes
• Do not break blisters
• Blisters protect area from infection
• Cover with dry sterile dressing

185
Chemical Burns

• Occur in the workplace and at home
• Severity depends on
• Type and strength of chemical
• Duration of exposure to chemical
• Chemical continues to burn as long as it is on
  skin
• Remove chemical as quickly as possible and then
  activate EMS

186
Chemical Burns, cont.

• Liquid chemical burn
• Flood with large amounts of cool running water
  until EMS arrives
• Solid substance (e.g., lime)
• Brush off before flooding with water
• Dry chemical is activated by contact with water

187
Seizures

• Seizure A sudden episode of involuntary
  muscular contractions and relaxation
• Often accompanied by change in
• Sensation
• Behavior
• Level of consciousness

188
Seizures, cont.

• Normal electrical activity of brain is disturbed
• Causes brain cells to become irritated and
  overactive
• Conditions that may trigger a seizure
• Epilepsy
• Encephalitis
• Recent or old head injury

189
Seizures, cont.

1. High fever in infants and young children
2. Drug and alcohol abuse withdrawal
3. Eclampsia associated with toxemia of pregnancy
4. Diabetic conditions
5. Heat stroke

190
Partial Seizures

• Partial seizures (most common) abnormal
  electricity is localized into very specific areas
  of the brain
• Simple partial seizure twitching or jerking in
  just one part of the body
• Lasts less than a minute
• Patient remains awake and alert
• Complex partial seizure level of consciousness
  affected
• Patient has little or no memory afterward

191
Partial Seizures, cont.

• Symptoms
• Abnormal behavior (e.g., confusion)
• Glassy stare
• Aimless wandering
• Lip smacking or chewing
• Fidgeting with clothing
• Simple and complex partial seizures can
  progress to a generalized seizures

192
Generalized Seizures

• Generalized seizure abnormal electrical activity
  spreads throughout brain
• Tonic-clonic seizure (grand mal)
• Tonic phase lasts up to 30 seconds
• Loss of consciousness
• Rigid muscular contractions
• Respirations inhibited
• May lose control of bladder and bowels

193
Generalized Seizures, cont.

• Clonic phase
• Patient's body jerks violently
• Jaw muscles contract may cause patient to bite
  tongue or lips
• Postictal last 10 to 30 minutes
• Patient exhibits depressed level of consciousness
• Disoriented
• Headache
• Little or no memory of seizure
• Feels confused and exhausted for several hours

194
Seizures, cont.

• Aura may precede seizure
• Aura sensation perceived by patient that
  something is about to happen (e.g., strange
  taste, smell, or sound)
• Gives patient a warning signal that a seizure is
  about to begin

195
Seizures, cont.

• Most patients fully recover after seizure
• Status epilepticus seizures are prolonged or
  come in rapid succession
• Life threatening and requires immediate medical
  care

196
Seizures, cont.

• Emergency Care for Seizures
• Protect patient from harm
• Remove hazards from area
• Protects patient from injury

197
Seizures, cont.

• Do not restrain patient
• Could injure patient's muscles, bones, or joints
• Loosen clothing that may interfere with breathing

198
Seizures, cont.

• Do not insert anything into the mouth
• Could damage teeth or mouth
• Could interfere with breathing
• Could trigger gag reflex
• Patient may vomit and aspirate

199
Seizures, cont.

• If patient vomits
• Roll onto side
• So vomitus can drain from mouth

200
Seizures, cont.

• Activate EMS
• If uncertain of cause
• If patient is having a status epilepticus seizure
• Otherwise wait until seizure is over
• Than transport to local treatment facility

201
Poisoning

• Poison any substance that causes illness,
  injury, or death if it enters the body
• Most poisonings
• Occur in the home
• Are accidental
• Occur in children under age 5

202
Poisoning, cont.

• Usually involves
• Cleaning agents
• Medications
• Pesticides
• Poisoning reaction more serious in
• Children and elderly

203
Poisoning, cont.

• Poison control center
• Regional control centers
• Usually located in emergency department of large
  community hospitals
• Information about almost all poisons
• Open 24 hours
• Toll-free number

204
Poisoning, cont.

• National Poison Control Hotline
• Toll-free number 1-800-222-1222
• Open 24 hours

205
Ingested Poisons

• Enter the body by being swallowed
• Most common route of entry for poisons

206
Ingested Poisons, cont.

• Examples
• Cleaning products
• Pesticides
• contaminated food
• Petroleum products (gasoline, kerosene)
• Poisonous plants
• Abuse of drugs and alcohol

207
Ingested Poisons, cont.

• Symptoms
• Based on substance that has been consumed
• Often include
• Strange odors, burns, or stains around mouth
• Nausea, vomiting, abdominal pain, diarrhea

208
Ingested Poisons, cont.

• Difficulty in breathing
• Profuse perspiration
• Excessive salivation
• Dilated or constricted pupils
• Unconsciousness
• Convulsions

209
Ingested Poisons, cont.

• Emergency care for poisoning by ingestion
• Acquire information about
• Type of poison
• Amount ingested
• When ingested

210
Ingested Poisons, cont.

• Call poison control center or local EMS
• Never induce vomiting unless told to do so by
  medical authority
• May cause more injury when vomited back up

211
Ingested Poisons, cont.

• Example corrosive poison (strong acid or base)
• Causes more injury if vomited back up to
• Esophagus
• Throat
• Mouth

212
Ingested Poisons, cont.

• If patient vomits collect sample and take to
  hospital
• For analysis by a toxicologist
• Take containers of substances ingested to
  hospital
• Empty medication bottles
• Household cleaner containers
• Label lists ingredients in product

213
What Would You Do?What Would You Not Do?
214
What Would You Do?What Would You Not Do?
215
Inhaled Poisons
Inhaled Poisons

• Breathed into the body in the form of gas, vapor,
  or spray
• Examples
• Carbon monoxide most common
• Car exhaust
• Malfunctioning furnace
• Fire

216
Inhaled Poisons, cont.

• Carbon dioxide
• Wells
• Sewers

217
Inhaled Poisons, cont.

• Fumes from household products
• Glue
• Paint
• Insect spray
• Cleaners (ammonia, chlorine)

218
Inhaled Poisons, cont.

• Symptoms
• Severe headache
• Nausea and vomiting
• Coughing or wheezing
• Shortness of breath

219
Inhaled Poisons, cont.

1. Chest pain or tightness
2. Facial burns
3. Burning of mouth, nose, eyes, throat, or chest
4. Cyanosis
5. Confusion, dizziness, unconsciousness

220
Inhaled Poisons, cont.

• Emergency care for inhaled poisons
• Determine if safe to approach pt
• Toxic gases and fumes are dangerous
• Remove individual from source of poison
• Place in fresh air immediately

221
Inhaled Poisons, cont.

• Call poison control center or EMS
• If oxygen available
• May be directed to administer it

222
Absorbed Poisons

• Enter body through skin
• Examples
• Fertilizers
• Pesticides
• For lawn and garden care

223
Absorbed Poisons, cont.

• Symptoms
• Irritation, burning, itching
• Burning of skin and eyes
• Headache
• Abnormal pulse and/or respiration

224
Absorbed Poisons, cont.

• Emergency care for absorbed poisons
• Remove patient from source of poison
• Avoid contact with toxic substance

225
Absorbed Poisons, cont.

• Call poison control center or EMS
• Will usually be instructed to
• Brush dry chemicals from skin
• Flood area with water

226
Injected Poisons

• Enters body through bites, stings, or a needle
• Examples
• Venom of insects, spiders, snakes and marine
  creatures (jellyfish)
• Bite of rabid animal
• Drugs (e.g., heroin)

227
Injected Poisons, cont.

• Symptoms
• Altered state of awareness
• Evidence of stings, bites, or puncture marks on
  skin
• Mottled skin