1229 Exam 6: Emergency Care and First Aid

Question 1

Special factors when caring for infants and young children

Answer 1

• If a parent is available have them hold the child (if doesn’t interfere with care)
• Explain what you are doing to the child in simple terms
• If injury isn’t critical assess from toes and work up. (if a critical injury or condition assess the area injured)
• Allow parent(s) to participate if possible
• Keep in mind young children and infants get cold more easily than adults (more subject to hypothermia)
• Look before you touch. If an area is injured avoid touching if possible. If you need to touch warn the child there may be pain. (if you fail to do this you may lose their trust.)

Question 2

Best indications of a child’s condition

Answer 2

• Look at overall condition even with a specific injury. While it is important to assess the specific injury/condition be aware of the overall status of the victim.
• Example: a child with a crushing leg injury may go into shock while you are focused on the injured leg.
• Skin color: important indicator in anyone with a serious injury/condition
• Cap. Refill: < 2 seconds
• Pulse rate: check at any site available (check quickly-get 6 sec. and x10)-apical if you have stethoscope. Remember infants and children have elevated PR.

Question 3

The ABC’s & sometimes D

Answer 3

Airway, Breathing, and Circulation
D is disability due to inability to respond to commands or answer questions.
In emergency situations clients often cannot respond to questions or commands, or cannot respond coherently
Adapt accordingly-you will need to rely on your assessment

Question 4

Emergency Assessment (in and outside the clinical setting)

Answer 4

-Basic first aid care is same, in and out of clinical setting. The difference is the clinical setting allows rapid professional assistance
General Guidelines for Non-clinical
-Be aware- keep safety for you and the client in mind.
-BSI- body substance isolation. Protect yourself. Use all protective equipment available. In non-clinical settings use what is available-improvise
-Mental status-speak to victim, tell them your name, who you are and you are going to help.

Question 5

Emergency Assessment continued…

Answer 5

• Spinal injuries-if suspected, DON’T MOVE
• Airway, breathing, circulation. Review CPR guidelines if needed
• Basic steps. Check airway. Obstructed? Remove obstruction. Breathing? If not started rescue breathing. Pulse? If not start CPR. If Carotid not accessible use any pulse.
• Review Box 51.2(LOC) and Fig. 51-1 (Glascow) on page 1553 in Perry.
• If you know these simple scales you can use them in non-clinical settings as quick and accurate assessment tools.

Question 6

Pediatric Safety Measures (Teaching)

Answer 6

• Infants and toddlers
• Be aware that most infants can roll off changing table at 4 months. Bath water not too hot. Gates in homes with stairs. Dogs. Recommended toys for age. No baby powder-aspirate. Talc is especially bad.
• Guns, medications, and poisons out of reach or locked.
• Cribs away from curtains, blinds

Question 7

Pediatric Safety Measures continued

Answer 7

• Electric outlet covers
• Don’t leave in cars unattended for any length of time-regardless of outside temp
• Follow state child seat belt laws for children 12 and under. State laws vary and federal recommendations are vague.
• Remember you can always exceed your state law and current recommendations are that children up to a year be placed in rear-facing restraints in the back seat. Children up to 12 and below 60” restrained in back seat.

Question 8

Pediatric Safety Measures continued

Answer 8

• Remember car restraint laws and safety measures are in a constant state of flux due to technology and new finding. Review them at least annually.
• With toddlers and < 4 be aware that objects not normally considered dangerous might be-fingernail files, clippers, combs, hard candy, dried fruit and nuts. Dog and Cat food.
• To really “toddler proof” a home make an inventory of items could be a problem and remove them. Get down on their level in every room and look around.

Question 9

Pediatric Safety Measures continued

Answer 9

• School and Adolescent
• Make sure they use safety equipment for sports and activities. Bikes and skateboards-Helments
• Adolescents (Risk Takers)
• Drugs, Seat belts, Guns, High risk activities-rollerblading, off-road biking. Automobile safety-distracted driving.

Question 10

Fractures (Assess the 5 P’s)

Answer 10

Pain and point tenderness
Pulse
Pallor
Paresthesia (numbness/tingling)
Paralysis
All fractures will exhibit one or more of these symptoms

Question 11

Fractures continued

Answer 11

Immobilize (if possible)
Check neuromuscular status (temp, movement, pulse)
Don’t try to replace protruding Fx
If artery lacerated you must stop blood loss at all cost
If possible remove jewelry or any restrictive clothing

Question 12

Hypothermia

Answer 12

• Get them out of cold environment and warmed ASAP
• First check breathing and pulse. Check pulse (maybe weak) for 60 seconds before starting CPR
• Second priority is re-warming. Remove wet clothing after getting inside. Force warm-not hot-fluids. No alcohol or caffeine. If coffee is all that is available-use it.
• Wrap in dry blankets and place in sleeping bag if available. In moderate to severe don’t use heaters, radiators, electric blankets. Room temp should be about normal-70-80 degree range.
• In mild to moderate hypothermia get the person to move around ASAP
• In severe cases, best method to warm is to remove clothing “skin-skin” and get under a blanket or bag with victim

Question 13

Frostbite1

Answer 13

• Get victim out of the cold-once indoors remove any wet clothing
• Warm area in warm water at 104-107 degrees. If warm water not available cover affected or place in your armpits to warm
• Avoid walking on frostbitten feet if possible
• If there is a chance the area will freeze again do not thaw
• Don’t rub area. Common misconception is to rub snow on frostbite area-DO NOT DO THIS!

Question 14

Hyperthermia

Answer 14

Severity-Heat cramps, heat exhaustion, and heat stroke
Heat Cramps-Common in hot climes. Usually getting out of heat and drinking fluids and rest is enough. Can be a precursor to H.E.
Heat Exhaustion(HE)- Temp 104, skin dry flushed. SOB and confusion. Can occur suddenly without H.E. or cramps

Question 15

Emergency Treatment for Hyperthermia

Answer 15

Emergency first aid for heat exhaustion and stroke is basically the same.
For both: move out of heat into a shaded or air conditioned area and loosen clothing. Have to drink cool fluids. NO ALCOHOL OR CAFFEINE. Do not use alcohol rub. If available, GatorAid or fluid with some Sodium added should be given.
In addition for Heat Stroke, spray with cool water or cover with damp sheets. Use fan. Elevate feet.

Question 16

Snack Bites

Answer 16

Only 4 poisonous snake species in MS (and one is extremely rare and unlikely to bite)
-Pit Vipers: Rattlesnake, Copperhead, Water Moccasin, and Coral Snake (not a PV)
The Coral Snake is uncommon in MS and very docile. However it’s poison is a neurotoxin and deadliest of the four.
The Pit Vipers are more common and more likely to bite. Their poison is a nasty hemotoxin, but less likely to cause death than a neurotoxin.

Question 17

Snake Bite First Aid: Coral Snake

Answer 17

Keep victim quiet. If bite on extremity, immobilize affected limb. If victim is more than 3-4 hours from medical treatment, apply wide bandage (“The Australian Wrap”), 2-4 inches above bite. Not so tight as to cut off blood supply. This might slow venom somewhat. Do not use if victim is within 4 hours of medical care.
Do not rub ice or cut or try to suck the wound
Coral Snake bite victims usually have no symptoms for several hours and symptoms may not appear for up to 12 hours.
Basically, all you can really do for a Coral Snake victim is to keep quiet and calm, monitor status and get help ASAP

Question 18

Snake Bite First Aid: Pit Vipers

Answer 18

Copperheads are somewhat less venomous than the other two vipers in MS.
First Aid for all 3:
DO:
Wash the area with soap and water. Keep bite area lower than heart. Keep victim calm. Cover bite with clean moist compress or moistened cloth. Carry victim to medical treatment if possible. Monitor vital signs. BP if cuff and steth, available. If more than an hour from medical help you may apply a bandage, “The Australian Wrap,”
DON’T:
Cut or attempt to suck the poison out with your mouth. Apply ice or alcohol to the bite area.

Question 19

Burns (Minor: 1st and 2nd degree)

Answer 19

• Stop the burning
• With small first degree burn you may cool with water and/or apply Bactine
• Cool water or saline for several minutes. No Ice or alcohol.
• If blisters, don’t burst. Don’t apply butter, ointment, etc to burn. If blisters do burst cover with sterile bandage and use an antibiotic ointment
• Cover with gauze or lint free bandage. Wrap loosely to avoid putting pressure on affected area.
• Usually first aid is all that is needed for minor burns over small areas
• Take Tylenol or OTC pain med, if needed
• With 1st degree burns infection is usually not an issue

Question 20

Burns continued

Answer 20

• Minor burns are usually defined as 1st degree burns
• 2nd degree less than 3 inches in area. Any 2nd degree below 3 inches not on the face, groin, hands or feet.
• Any 3rd degree burn regardless of size or location are considered major.
• 2nd and 3rd degree burn victims are at risk for infection

Question 21

Major Burn First Aid

Answer 21

• Don’t remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
• Don’t immerse large severe burns in cold water. Doing so could cause drop in body temperature and deterioration of blood pressure and circulation (shock).
• Check for signs of circulation (breathing, coughing, or movement). If there is no breathing or other sign of circulation, begin CPR
• Elevate the burned body part or parts. Raise above heart level, when possible
• Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth, or moist towels

Question 22

Burn Classifications

Answer 22

• Superficial: 1st degree. Dry, red, painful, some slight swelling. Most sunburns are 1st degree. Epidermis. Infection is not usually a concern. Usually first aid is enough.
• 2nd degree: involves dermis. Blisters, Mottled appearance, pink or red. Painful. Infections. Severe sunburns. Medical care probable.
• 3rd degree: Deep, involves muscle and sometimes bone. Painless at site-local nerves are gone. Always a medical emergency. Medical care always needed.

Question 23

Calculating Burn Area

Answer 23

In emergency situations a quick, rough, assessment is enough.
Rule of 9's:
-Head, Face, and Neck=18
-Arms=9 (each)
-Chest and Abdomen=18 (count 9 each)
-Back=18
-Legs=14 (each)
--Quick reference-palm about 1% each

Question 24

Poisons

Answer 24

First assess, then do!
Treat victim first and then the poison
Terminate exposure (plants, pills, etc)
ID the type of poison
If at all possible the best way to deal with poisons is (after above steps) call Poison Control Center

Question 25

Poisons continued..

Answer 25

FIRST, do no harm. The worst thing you can do with a poison victim is to do the wrong thing.
Example: Inducing vomiting in a victim who has swallowed gasoline
If a child has been poisoned look for the container and read the instructions
Try to determine the poison before calling poison control. But don’t wait more than a few minutes

Question 26

Poisons continued…

Answer 26

If victim doesn’t appear in immediate crisis call poison control center and follow their directions.
If victim is in immediate crisis, not breathing, very lethargic or comatose; Call 911 and stay with victim until help arrives. Perform CPR or breathing as needed.

Question 27

Ingested Poisons

Answer 27

Meds, Household cleaners, and insecticides are the main cause of ingested poisons in < 5. This is a major cause of death in this age group.
TYLENOL is the #1 cause of ingestion poisoning in children. Causes severe liver damage if not treated.
Many household plants are poisonous and are a major cause of ingestion poisoning in child 3 and under.
Ipecac to induce vomiting is no longer recommended. The current trend is to use activated charcoal.

Question 28

Head Injuries

Answer 28

Check LOC
Stabilize neck and spine
Assess pain and for S/S of shock
Observe for complications: Vomiting, swelling, confusion

Question 29

Hemorrhage

Answer 29

Control bleeding:
-Direct pressure: use whatever you have to make a pressure dressing and hold. Don’t stop pressure. Stopping pressure can dislodge clot and start bleeding.
-Pressure Point: use artery point above the bleeding for pressure. Apply pressure there.
-Elevate: elevating feet with body flat will reduce chance of shock
If applied pressure: pressure points and pressure dressing don’t stop bleeding use tourniquet as last resort.

Question 30

Nose Bleeds

Answer 30

Victim sit up straight
Press finger against outside of nostrils x5 minutes, stop 1 minute, repeat as needed. Apply ice to forehead and seek medical help if cause unknown.

Question 31

Fainting

Answer 31

Get victim flat.
Loosen tight clothing
Make sure they aren’t having a seizure.
Most revive in a few minutes

Question 32

Convulsions and Seizures

Answer 32

• Protect from injury. Don’t grab or hold firmly. If in bed try to keep them there. If not, assist to low position while preventing injury.
• Do not put anything is mouth-including your fingers or airway during seizures. Rarely do seizure victims have problems breathing and you can do more harm-including to yourself-trying to place an airway in.
• Observe, protect, and restrain only enough to protect victim from injury
• In clinical setting: one nurse, opposite side rail up and side rail down on your side. Two nurses: side rails down on both sides, nurse on each side. Rationale: victim can injure self on metal side rails.

Question 33

Bites and Stings (or any anaphylactic emergency)

Answer 33

• Symptoms: uticaria to severe brochospasms, shock and death. Tightness in throat, raspy voice, audible wheezing and dyspnea.
• Bee stings: (Honey Bee) scrap off the stinger with credit card or something flat-DON’T PULL. Leave it in and it will keep pumping poison for a few minutes. Wasp and Bumble Bee stings do not remain in victim.
• Unless the victim is allergic first aid is all that is usually needed for wasp, bee, ant and other insect bites. Scorpions exist in MS and their stings are similar to wasp stings in severity.

Question 34

General Firs Aid for Insect Bites

Answer 34

Wasp, Ant, and Bee stings are acidic or alkaline.

• A slurry (paste) of baking soda and vinegar is a good treatment. OTC med such as Bactine are also good.
• Emergency Treatment: Check victim to see if they have a med alert bracelet. They may have an epi kit/pen. Epinephrine is the only Tx for emergency allergic reactions. Otherwise, do rescue breathing and/or CPR until help arrives.