Chapter 6: Safety, Emergency Care, & Disaster Preparation

conscious

the state of being mentally alert and having awareness of surroundings, sensations, and thoughts

steps for responding to an emergency

1. assess the situation— make sure you are not in danger and note the time

2. access the victim— check the victim’s levels of consciousness

3. call for help or send someone to get help

4. remain calm and confident

5. after the emergency is over, complete an incident report

Observations to make in an emergency

severe bleeding, changes in consciousness, irregular breathing, unusual color/feeling to skin, swelling on the body, medical alert tags, pain

first aid

emergency care given immediately to an injured person by the first people to respond to an emergencyc

cardiopulmonary recuscitation (CPR)

medical procedures used when a person’s heart or lungs have stopped working

carotid pulse

the pulse located on the side of the neck, just below the jaw

brachial pulse

the pulse located inside the elbow, about one to one-and-a-half inches above the elbow

automated external defibrillator (AED)

a device attached to a patient to analyze heart rhythm and deliver a shock, if needed, to restore a normal heart rhythm

obstructed airway

a conditon in which something is blocking the rube though which air enters the lungs

abdominal thrusts

a method of attempting to remove an object from the airway of someone who is choking

points about CPR

1. know your facility’s policies on initiating CPR, such as whether an MA may begin without the direction of a licensed professional

2. because a patient may have advance directives in place, it is important to notify the provider immediately in case of an emergency

CPR steps

1. access the situation and access the victim for unconsciousness

2. call for help

3. check for signs of circulation

4. if pulse is absent, begin CPR

5. use AED (if available)

6. continue until someone else takes over or the patient becomes conscious

7. report and document the procedure properly

shock

a condition that occurs when organs and tissues in the body do not receieve an adequate blood supply

myocardial infarction (MI)

a condition that occurs when the heart muscle doe snot receive enough oxygen because blood flow to the heart is blocked; aka heart attack

syncope

loss of consciousness; aka fainting

epistaxis

a nosebleed

insulin reaction

a complication of diabetes that can result from either too much insulin or too little food; aka hypoglycemia

epilepsy

a brain disorder that results from a disruption in normal electrical impulses in the brain, which causes repeated seizures

cerebrovascular accident (CVA)

a condition that occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain; aka stroke

transient ischemic attack (TIA)

a warning sign of a CVA/stroke resulting from a temporary lack of blood supply to the brain

emesis

the act of vomititng, or ejecting stomach contents through the mouth and/or nose

signs of obstructed airway

poor air exchange; increased trouble breathing; silent coughing; cyanosis; inability to speak, breathe, or cough

choking

patient shows signs of severely obstructed airway

when are abdominal thrusts performed

performed only when a person is choking

signs of shock

pale or cyanotic skin; staring; increased pulse and respiration; low blood pressure; extreme thirst

signs and symptoms of a heart attack

sudden, severe pain, pressure, or equeezing in the chest, usually on the left side or in the center behind the breastbone; pain or discomfort in other areas of the body, such as the arms, back, neck, jaw, or stomach; indigestion or heartburn; nausea and vomiting; shortness of breath; dizziness; pale or cyanotic skin color or mucous membranes; perspiration; cold and clammy skin; weak and irregular pulse rate; low blood pressure; anxiety and a sense of doom; denial of a heart problem

heart attacks in women

can have no chest pain or pressure; shortness of breath; nausea; lightheadedness; stomach pain; sweating; fatigue; back, neck, or jaw pain; flu-like symptoms

responding to a heart attack

1. notify provider

2. place person in comfortable position and reassure

3. lossen clothing around the neck

4. no food or liquid

5. monitor breathing and pulse— CPR if necessary

6. wait for help

7. report and document

responding to shock

1. notify provider

2. control bleeding— if necessary

3. lay the person down on back

4. elevate legs 8-12 inches

5. check pulse and respirations— CPR if necessary

6. keep person calm and comfortable

7. no food or liquid

8. report and document

If the patient is bleeding from the mouth or vomiting

lay patient on side

If the patient has a head, neck, back, or spinal, or abdominal injury

do not elevate legs

responding to choking

1. stand behind person

2. wrap your ams around the waist

3. make a first and place thumb side against the abdomen

4. grasp the first with your other hand

5. pull both hands in and up

6. repeat until object is ejected

7. report and document

controlling bleeding

1. notifying provider

2. put gloves on

3. hold thick, sterile pad, clean cloth, or clean towel against the wound

4. press down hard on the bleeding wound— add additional pads if necessary, but do not remove original pads

5. raise the wound above heart level

6. secure dressing when bleeding is controlled

7. check for shock

8. discard gloves, wash hands

9. report and document

symptoms of poisoning

vomiting; heavy, difficult breathing; acting drowsy or confused'; burns or red areas around the mouth

points about burns

burns may be first through third degree; do not pull away clothing or rub the burned area; ice, ointment, salve, or grease should not be used

required for chemical burns

special care that is different from typical burns

treating a minor burn

1. notify provider

2. apply gloves

3. apply cool, clean water to skin

4. cover area with dressing or nonadhesive bandage

5. remove gloves and wash hands

treating serious burns

1. remove person from burn source— stop, drop, and roll if necessary

2. notify provider

3. put on gloves

4. check for breathing, pulse, and severe bleeding— CPR if necessary

5. monitor vital signs

6. wait for help

7. remove gloves and wash hands

8. document and report

fainting symptoms

dizziness; lightheadedness; nausea; perspiration; pale skin'; weak pulse; shallow respirations; blackness in visual field

responding to fainting

1. notify provider

2. have person lie down or sit before fainting

3. if in sitting position, bend person foward where head is between the knees

4. elevate legs about 12 inches

5. loosen any tight clothing

6. keep person in position for at least 5 minutes after symptoms disappear

7. help person get up slowly and observe symptoms

8. if person faints, lower to floor or flat surface on back, and elevate legs 8-12 inches if there are no injuries

9. report and document

responding to nosebleed

1. notify the provider

2. tell person to stay sitting and lean forward slightly

3. offer tissues and clean cloth

4. put on gloves and apply pressure on both sides of the nose, on the soft part, up near the bridge

5. squeeze the sides

6. apply pressure until bleeding stops

7. use cool cloth or ice wrapped in a cloth on the bridge of the nose

8. remove and discard gloves

9. report and document

signs and symptoms of insulin reaction

hunger: headache; rapid pulse,;low blood pressure; perspiration; cold, clammy skin; confusion; trembling; nervousness; blurred vision; numbness of lips and tongue; unconsciousness

what is administered in response to an insulin reaction

glucose

signs and symptoms of diabetic ketoacidosis

increased hunger or thirst; increased urination; abdominal pain; deep or labored breathing; breath that smells sweet or fruity; headache; weakness; rapid, weak pulse; low blood pressure; dry skin; flushed cheeks; drowsiness; nausea and vomiting; shortness of breath or air hunger; unconsciousness

signs of seizures

severe shaking; thrusting arms and legs uncontrollably; jaw clenching; drooling; inability to swallow

primary goal during a seizure

keep the patient safe; do not try to force anything into the mouth; do not leave person unattended

responding to a seizure

1. note the time

2. put on gloves

3. lower person to the floor

4. protect the head and loosen clothing

5. turn person to the side

6. have someone call the provider

7. move furniture away

8. do not restrain person

9. do not force anything into the person’s mouth

10. no food or liquid

11. note time at the end

12. turn person to left side— if no injuries of the head, neck, back, spine, or abdomen

13. check for choking

14. check for pulse and breathing—CPR if necessary

15. remove and discard gloves

16. clean hands

17. report and document

signs of TIA or CVA

facial numbness, weakness, or drooping; paralysis on one side; arm numbness or weakness; slurred speech or inability to speak; inability to understand spoken or written words; use of inappropriate words; severe headache; blurred vision; ring in ears; redness in the face; noisy breathing; elevated blood pressure; slow pulse rate; nausea or vomiting; loss of bowel and bladder control; seizures; dizziness; loss of consciousness

hemiparesis

weakness on one side of the body

signs of TIA or CVA in women

pain in the face, arms, and legs; hiccups; weakness; chest pain; shortness of breath; palpitations

FAST

Face, arms, speech, time

points about vomiting

can be a sign of illness; parents in chemo may do it frequently; can happen unexpectedly; MA should talk soothingly to the patient

responding to vomiting

1. notify provider

2. gloves

3. make sure the head it up orturned to one side

4. place basin under chin

5. move soiled gown if necessary

6. clean patient if necessary

7. flush vomit down toilet unless it’s red, has blood in it, or looks like wet coffee founds— report to provider

8. place basin in biohazardous waste container or disinfect

9. remove gloves and discard

10. wash hands

11. put on clean gloves

12. comfort patient

13. discard soiled linen appropriately

14. change gloves and wash hands

15. document

response to falling

1. widen stance and bring patient’s body close to MA’s body— bend knees and support the patient as they are lowered to the floor

2. do not stop or reverse

3. notify the provider

ergonomics

science of designing equipment, areas, and work tasks to make them safer and to suit the worker’s abilities

chemical hazards

create dangerous fumes and may damage skin or catch fire easily

biological hazards

includes bloodborne pathogens and disease causing microbes; serious risks in healthcare

physical hazards

poor ergonomics and exposure to radiation or excessive noise

safety hazards

electrical hazards, fire, burns, uneven/slippery floors

ways to promote workplace safety

know evacuation and disaster prep plans; participate in regular drills; observe and report potential problems

hazard communication standard

OSHA’s system of identifying potential hazards in the workplace

safety data sheet (SDS)

document describing the composition and possible hazards of chemicals in the workplace

Occupational Safety and Health Act

established in 1970; requires employers to provide a safe, hazard-free workplace

engineering controls

built into a device and prevent contact with a hazardex

example of an engineering control

needle sheaths

administrative controls

procedures or policies that limit dangers

example of administrative control

procedures for handling blood

work practices

ways of working that reduce risk

example of work practices

choosing the least caustic cleaning product that is still effective

information in safety data sheets

ingredients, dangers, safe handling, storage, disposal, and emergency response proceduresb

body mechanics

the way parts of the body work together when a person moves

posture

the way a person holds and positions their body

lever

something that moves an object by resting on a base of support

alignment

1. try to keep both sides of the body as mirror images of each other

2. keep object close when carrying or lifting

3. point feet and body toward the direction you are moving

4. avoid twisting at waist

base of support

1. wide is more stable

   1. stand with legs shoulder-width apart

fulcrum and lever

1. arm and elbow

2. rest object against the forearm; makes it easier to lift

center of gravity

1. center weight in pelvis when standing

2. low center provides greater base of support

3. bend knees when lifting; lowers center

steps to lift heavy objects from the floor

1. spread feet apart

2. bend knees

3. use muscles in thighs, upper arms, and shoulders

4. pull object close to body

5. push hip and thigh muscles to stand up

aerosolized

to disperse a substance through the air in such a way that might be inhaled

points about chemical hazards

can cause harm to the skin, eyes, or mucous membranes; can cause breathing difficulties; may cause other symptoms depending on the specific material

guidelines for dealing with chemical hazards

do not use any chemical agents you are not trained or permitted to use; wear appropriate gloves when using disinfectants; do not store food or drink in an area where hazardous chemicals are used or stored; do not eat or drink anything in the workplace if you are not certain of its origin; do not place pens/pencils in the mouth, apply makeup, or touch face/eyes while working; keep all liquids in their original containers— do not remove labels/instructions/warnings; know how to access SDS information; know where eyewash stations, sinks, showers, and other safety facilities are located; in case of exposure, flush with running water or wash exposed area immediately; report known or unknown exposures; seek medical attention if needed

guidelines for dealing with biological hazards

seal tubes and other specimen containers properly; place specimens to be carried to another area of the facility a rigid. latching container that can contain spills; in the event of broken specimen containers and/or spills, follow facility policy for cleaning; never scrape dried blood or other body fluids off any surface or floor; use centrifuges and other equipment with care and only if trained to use; in case of exposure to blood of body fluids, wash or flush the area immediately with soap

guidelines for dealing with physical hazards

pay attention to ergonomics; standard precautions are adequate to protect against exposure to the low-level radiation that might be present in patient samples; pay attention to signs, lights, or other warnings about x-ray and other radiation exposure; follow facility policies about tracking radiation exposure, wearing a dosimeter if required to do so; use ear protection when working with noisy machines or entering rooms in which loud machines are operating

guidelines to help prevent falls and related injuries

make sure walkways are dry and free of clutter, chords, and other tripping hazards; wear nonskid, closed toes shoes and keep laces tied; uneven flooring or stairs should be marked with tape of a contrasting color to indicate a hazard; always close drawers and cabinets immediately after use

guidelines for electrical and burn hazards

immediately report frayed electrical cords or electrical equipment that looks unsafe; do not put combustile material near any appliance or machine that generates heat; do not touch the surface of any appliance or machine in operation if it might be not; do not overload electrical sockets; do not use extension cords or two-prong electrical plugs; report damaged or malfunctioning equipment

guidelines about fire safety

fire alarms and exit doors should never be blocked; know facility’s fire evacuation plan; stay calm and don’t panic; learn where fire extinguishers are located and remember the PASS acronym; remember RACE acronym; follow the directions of the fire department; do not get into an elavator; stay low in a room; check for heat before opening doors; stop, drop, and roll if clothing or hair catches fire; use a damp covering over mouth and nose to reduce smoke inhalation; after leaving a building, move away from it

general disaster guidelines

remain calm; know the locations of exits and stairways; know where fire alarms and extinguishers are located; know the appropriate action to take in various situations based on facility training; use the internet to stay informed (radio and television too)