Medical Emergencies

Medical Emergencies• As a healthcare provider you may encounter a

variety of medical emergencies.

• In these situations you may be required to take quick action.

• You have already learned about medical emergencies that may require CPR, rescue breathing and the Heimlich maneuver.

Asthma

• Most people with asthma have their condition controlled. Often they use an inhaler and/or take oral medications.

• Signs and Symptoms of an Acute Asthma Attack: coughing, wheezing, shortness of breath and

recession (drawing in the flesh between the ribs and sternum). The symptoms will persist, and may become more marked or even change in nature.

What should you do?

Actions the PTA should take• If the patient has an inhaler have them use it.

• Keep the patient calm.

• Have the patient sit up or lean back in a semi-reclining position, whichever is the most comfortable. Do not let the person lie flat; it can make breathing even more difficult.

• If symptoms do not subside after a reasonable amount of time additional medical attention is needed…

• outpatient call 911• inpatient call nurse

Chest Pain(Angina)/Heart AttackSigns and Symptoms:• uncomfortable pressure, fullness, squeezing, pain, or discomfort in

the center of the chest that lasts for more than two minutes. This pain may be persistent, or may go away and return.

• pain or discomfort that spreads to the shoulders, neck, or arms• pain, sweating, nausea, or shortness of breath.• any chest discomfort that causes anxiety or concern• any chest discomfort that is accompanied by lightheadedness,

fainting, or dizziness• any of the above symptoms that disappear with rest, then return

with exertion• unexplained weakness or fatigue• palpitations, cold sweat, or paleness• Pain that lasts for 10 to 15 minutes while you are resting should

also be evaluated immediately.

What should you do?

Actions the PTA should take• Immediately stop activity.

• Assess vital signs. (When would a change in vital signs would be considered an emergency?)

• If symptoms do not subside within 10-15 minutes seek medical assistance.

• OP – call 911• IP – call RN or MD

Dehydration• When a person becomes so sick with fever, diarrhea,

or vomiting or if an individual is overexposed to the sun, dehydration occurs. This is caused when the body loses water content and essential body salts such as sodium, potassium, calcium bicarbonate and phosphate.

• Occasionally, dehydration can be caused by drugs, such as diuretics, which deplete body fluids and electrolytes.

DehydrationSymptoms may include:• thirst• less-frequent urination• dry skin• fatigue• light-headedness• dizziness• confusion• dry mouth and mucous

membranes• increased heart rate and

breathing

In children, additionalsymptoms may include:• dry mouth and tongue• no tears when crying• no wet diapers for more than 3

hours• sunken abdomen, eyes or cheeks• high fever• listlessness• irritability• skin that does not flatten when

pinched and released

What should you do?

Actions a PTA should take

• In cases of mild dehydration, simple rehydration is recommended by drinking fluids.

• For moderate dehydration, intravenous fluids may be required, although if caught early enough, simple rehydration may be effective. Cases of serious dehydration should be treated as a medical emergency, and hospitalization, along with intravenous fluids, is necessary. Immediate action should be taken.

Stroke (CVA)

Warning signs and symptoms may include:– sudden weakness or numbness of the face, arm,

or leg on one side of the body– sudden difficulties with speech and understanding

what others are saying– sudden problems with vision -- dimness or loss of

vision, particularly in one eye– sudden dizziness– sudden problems with walking

What should you do?

What action should PTA take?

• Seek immediate medical assistance– OP : call 911– IP : call for RN or MD

Anaphylaxis

• A severe allergic reaction (anaphylaxis) can produce shock and life-threatening respiratory distress and circulatory collapse.

Anaphylaxis• Signs and Symptoms:

– Hives – Eyes or lips may swell severely– The inside the throat may swell causing difficulty breathing

and shock– Blood pressure drops– Dizziness– Mental confusion– Abdominal cramping– Nausea– Vomiting – Diarrhea

What will you do ?

Actions of the PTA• Call 911 or a code in the facility.• Check for special medications that the person might be carrying to treat

an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.

• Have the person lie still on his or her back with feet higher than the head.• Loosen tight clothing and cover the person with a blanket. Don't give

anything else to drink.• If there's vomiting or bleeding from the mouth, turn the person on his or

her side to prevent choking.

• If there are no signs of circulation (breathing, coughing or

movement),begin CPR.

Head Trauma

• If a patient suffers a head trauma while in your care what will you do?

If injuries are minor you need see that patient receives appropriate medical care. You then must report the incident to the appropriate parties and complete a medical report

A head trauma is considered a medical emergency if any of the following signs are apparent:

• Severe head or facial bleeding

• Bleeding from the nose or ears

• Severe headache• Change in level of

consciousness for more than a few seconds

• Black-and-blue discoloration below the eyes or behind the ears

• Confusion• Loss of balance• Weakness or an inability to

use an arm or leg• Unequal pupil size• Repeated vomiting• Slurred speech• Seizures• Cessation of breathing

What do you do?

Actions of the PTA

• First, address any bleeding by putting firm compression on the wound. Then call for help.

• If patient stops breathing begin CPR/Rescue Breathing

• Call for medical assistance and watch for changes in breathing and alertness.

Severe Bleeding

• You encounter a patient or person who is bleeding severely. What will you do?

Severe Bleeding

• If possible, before you try to stop severe bleeding, wash your hands to avoid infection and put on synthetic gloves. Don't reposition displaced organs. If the wound is abdominal and organs have been displaced, don't try to push them back into place. Cover the wound with a dressing.

• Have the injured person lie down. If possible, position the person's head slightly lower than the trunk or elevate the legs. This position reduces the risk of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.

• While wearing gloves, remove any obvious dirt or debris from the wound. Don't remove any large or more deeply embedded objects. Don't probe the wound or attempt to clean it at this point. Your principal concern is to stop the bleeding.

• Apply pressure directly on the wound. Use a sterile bandage, clean cloth or even a piece of clothing. If nothing else is available, use your hand.

• Maintain pressure until the bleeding stops. Hold continuous pressure for at least 20 minutes without looking to see if the bleeding has stopped. You can maintain pressure by binding the wound tightly with a bandage (or even a piece of clean clothing) and adhesive tape.

• Don't remove the gauze or bandage. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, don't remove it. Instead, add more absorbent material on top of it.

• Squeeze a main artery if necessary. If the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood to the area of the wound. Pressure points of the arm are on the inside of the arm just above the elbow and just below the armpit. Pressure points of the leg are just behind the knee and in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.

• Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

Diabetic Emergency• Insulin Reaction - This condition occurs when there is TOO

MUCH INSULIN in the body. This condition rapidly reduces the level of sugar in the blood and brain cells suffer.

• Insulin reaction can be caused by taking too much medication, by failing to eat, by heavy exercise and by emotional factors.

• SIGNS & SYMPTOMS: Fast breathing, fast pulse, dizziness, weakness, change in the level of consciousness, vision difficulties, sweating, headache, numb hands or feet, and hunger.

What should you do?

• ASK "HAVE YOU EATEN TODAY?“– Someone who has eaten, but has not taken

prescribed medication may be in a diabetic coma.

• ASK "HAVE YOU TAKEN YOUR MEDICATION TODAY?“– Someone who has not eaten, but did take their

medication, may be having an Insulin reaction.

• A PERSON IN INSULIN SHOCK NEEDS SUGAR, QUICKLY!

• IF THE PERSON IS CONSCIOUS, GIVE SUGAR IN ANY FORM: CANDY, FRUIT JUICE OR A SOFT DRINK!

• Call for medical assistance if symptoms do not improve after this action

• This is a list of just some of the more common medical emergencies that may be encountered as you practice in the physical therapy field.

• As you begin to study specific patient populations you will learn specific medical emergencies that can arise in each population.

Resources

• http://www.umm.edu/non_trauma/condhub.htm

• http://www.mayoclinic.com/

• http://www.survival-center.com/firstaid/diabetic.htm