Emergency handling From PPT and scenarios. exam 3

Question 1

Safety Recomendations

Answer 1

• Perform hand hygiene before and after treatments - obviously in an emergency you may need to forget this step.
• Implement maintenance program for equipment and materials
• Secure equipment, furniture, and assistive aids and store them when not in use
• Awareness of physiologic changes with aging

Question 2

Standards for Environment & Equipment

Answer 2

• OSHA: Occupational Safety and Health Administration
• The Joint Commission
• DPH: Department of Public Health
• CARF: Commission on Accreditation of Rehabilitation Facilities
• CORF: Comprehensive Outpatient Rehabilitation Facility
• NIOSH: National Institute of Occupational Safety and Health

Question 3

Joint Commission

Answer 3

• An independent, non-for-profit organization
• Accredits and certifies more than 20,500 healthcare organizations and programs in the United States
• Routinely surveys healthcare facilities
• Standards for organizational quality of care and safety

Question 4

Joint CommissionNational Patient Safety Goals

Answer 4

• https://www.jointcommission.org/standards_information/npsgs.aspx
• Pt identification (use at least 2 forms to ID pt)
• Medication use safety
• Improve staff communication
• Prevent healthcare-associated infections
• Prevent patients from falling
• Prevent healthcare-associated bed sores
• Identify safety risks (ie: suicide risk, use of O2 in home)
• Use alarms safely
• Prevent mistakes in surgery

Question 5

Preventing Medical Errors

Answer 5

• Root cause analysis (RCA) for sentinel events (Joint Commission standard)
• Properly functioning and maintained equipment
• Obstacle free, with no congestion in the physical environment
• Adequate availability of personnel
• Maintenance of Safety Data Sheets (SDS) manual/file
• Awareness of physiologic changes associated with aging

Question 6

Responses to Patient Injuries

Answer 6

• Scan environment for conditions that might threaten your safety.
• Quickly assess patient/situation. Pulse? Breathing? Bleeding?
• Provide emergency care. Call support team if needed.
• Remain calm. Introduce yourself, ask questions.
• Don’t leave patient unattended if possible.
• Document the incident – include the time of event
• Notify immediate supervisor.
• File incident report. Do not discuss with anyone except need to know.
• Risk manager notifies insurance carrier

Question 7

Patient Safety

Answer 7

• EVERYONE is responsible for patient safety
• CPR and first aid
• Facility policies and procedures
• Should I call an internal “code” or dial 911?
• Should I pull the fire alarm or call the hospital operator?
• Scope of practice-what are you allowed to do?
• Good Samaritan Law: legal protection for those providing emergency volunteer care

Question 8

Patient Safety 2

Answer 8

• Discuss recent changes in medication, changes in status, falls, etc. Document
• Treatment should be stopped if there is a change in patient condition (vitals, subjective complaints, pain). Document

Question 9

Patient SafetyTake Responsibility

Answer 9

• Communicate with referring physician – clarification of orders, restrictions, precautions
• Know when to refer
• Delay treatment until concerns or problems are addressed

Question 10

Incident Report

Answer 10

• Report of unintended incident resulting in accident, near-miss error
• Usually a separate form that is not included in the medical report
• Includes time, date, place
• Person(s) involved
• Objective information
• If preventable – ways to prevent in future will be included

Question 11

Common Hospital Emergency Codes

Answer 11

• Code Red: FIRE
• Code Blue: Heart or respiratory emergency
• Code Orange: Hazardous material spill or release
• Code Grey: Combative person
• Code Silver: Person with weapon/hostage situation
• Amber Alert: Infant or child abduction
• External Triage: External disaster
• Internal Triage: Internal emergency

Question 12

Fire Safety

Answer 12

• R – Rescue
• A – Alarm
• C – Confine
• E – Extinguish
• This acronym is used as a reminder of the duties of personnel in the case of a fire

Question 13

Fire Safety 2

Answer 13

General Principles:
* Check the door temperature before opening – Hot = don’t open the door
* Know escape routes
* Know location of extinguishers and fire pull alarms

Question 14

Fire Extinguishers

what to use them on

Answer 14

First defense for small fires
Types:
* A – Wood/paper/cloth
* B – Chemical
* C – Electrical
* ABC – Combination “most facilities”
* D – Combustible metals and metal alloys
* K – Combustible media (cooking oils, animal fats)

Question 15

Fire Extinguishers

how to use them

Answer 15

• P – Pull (the pin)
• A – Aim (nozzle at the base of the fire)
• S – Squeeze (the handle)
• S – Sweep (the extinguisher back and forth)

Anacronymthat personnel use to remember their duties for discharging afireextinguisher

Question 16

Weather Safety

Answer 16

• Know where to go in your facility
• Each facility should have an evacuation plan posted
• Severe weather vs tornado watch/warning
• Inner room with no windows. Pillows to cover head/face

Question 17

Chemical Safety

Answer 17

Safety Data Sheets (SDS)
* Hazardous chemical “Right to Know”

Label requirements:
* Product identification
* Pictogram (health hazard, flammable)
* Signal word (danger, warning)
* Hazard statement (class/category)
* Precaution statement (prevention, response, storage, disposal)
* Name, address, telephone # of manufacturer

Question 18

Electrical Safety

Answer 18

• Always check equipment/cords/outlets
• Remove kinks and curls from cords
• Handle plug when unplugging
• Do not wrap cord around equipment
• Remove cords from path of equipment
• Don’t overload outlets
• Dry hands before using electrical equipment
• Do not use electrical devices while standing in water

Question 19

Common Causes of Electrical Hazard

Answer 19

• Human judgment
• Inadequate grounding
• Damaged plugs/cords
• Plug polarity
• Miscellaneous instrument faults

Question 20

Electrical Safety: Equipment

Answer 20

• Keep proper maintenance/monitoring records
• Scheduled inspection
• Take equipment out of use until repaired
  ~~~
• Stop use of equipment if:
• Odor, smoke, shock
  ~~~

Question 21

ElectricalSafety

Effects of electrical shock

Answer 21

Physiological effect of electricity
* Electrical stimulation of excitable cells (nerves & muscles)
* Ventricular fibrillation
* Injury to tissues
* Electrical burns
* Chemical burns (for DC currents)
* Muscular paralysis, injuries, pain and fatigue
* Breaking bones/tendons
* Secondary effects such as falling off ladder or spilling hot oil on self

Question 22

Allergies

Answer 22

• Reaction of immune system to an allergen; body releases histamine
• Can be severe—peanuts, bees, fish/shellfish
• Mild reactions: remove allergen if possible, and control symptoms (anti-itch cream, antihistamine medication). Monitor for worsening of symptoms
• Severe reactions: call 911. Administer rescue breathing if necessary. Administer EpiPen if patient has one. Patient should go to emergency department regardless of whether symptoms resolve
• Life-threatening: anaphylaxis
  * Can cause shock, difficulty breathing, sudden drop in BP
• Treatment: Review BOX 12-1

Question 23

Shock

Answer 23

• Results from traumatic event or injury
• From AI: “a life-threatening condition that occurs when the body’s circulatory system fails to deliver enough blood and oxygen to the body’s tissues and organs”
• Pale, moist, cool skin; shallow, irregular breathing; rapid pulse; dilated pupils; sweating; nausea; dizziness; syncope
• Remove cause of shock if able
• Call 911 if necessary—take vitals, CPR?
• Position patient in supine with lower extremities elevated; cover with blanket and do not let patient eat/drink or move, remove tight clothing
• If patient is bleeding, apply pressure; if vomiting, turn to side (caution: suspected SCI)
• Can lead to organ damage

Question 24

Lacerations

Answer 24

• Cut or tear in tissue caused by stretching, shearing or tearing (none of the skin is missing)
• Address blood loss: apply pressure, elevate body part, prevent patient from using affected body part
• Clean the wound with cool water, mild soap
• Apply antibiotic and cover with sterile gauze
• Stitches/staples
• Call 911 if necessary
• Follow infection control procedures-can get contaminated!

Question 25

Choking

Answer 25

• Treatment is determined by patient age and whether conscious or unconscious
• Conscious infant: series of back blows and chest compressions until object is dislodged or baby becomes unconscious
• Unconscious infant: administer cardiopulmonary resuscitation (CPR)
• Conscious child/adult: administer Heimlich maneuver until object is dislodged or person becomes unconscious
• Unconscious child/adult: remove object if you see it; administer CPR

Question 26

Orthostatic Hypotension

Answer 26

• Sudden drop in blood pressure of 20mmHg systolic or 10 diastolic within 3 min of change of position/posture
• Symptoms are dizziness, nausea, blurry vision, or syncope, as well as drop in blood pressure
• If symptoms are mild, have patient sit or stand quietly until they resolve
• If symptoms are severe, have patient return to sitting or supine
• Can use LE wraps, abdominal binder or tilt table to help patient acclimate to upright postures
• Get plenty of fluids, avoid alcohol, get up slowly

Question 27

Autonomic Hyperreflexia (Dysreflexia)

Answer 27

• Patients with spinal cord injuries in which a noxious stimulus causes life-threatening changes to blood pressure
• Symptoms are HIGH blood pressure, headache, flushed face, sweating above the lesion level, piloerection below the lesion level, nausea, SLOW pulse, and cold/clammy skin below the lesion level
• Remove the noxious stimulus if able—bladder/bowel, wrinkle, infection, pressure, tight socks, etc
• Call 911 or staff emergency—to monitor even if irritant is removed

Question 28

Cardiac Arrest

Answer 28

• The heart abruptly stops functioning
• Symptoms include sudden loss of responsiveness and abnormal or no breathing
• Call 911
• Administer CPR—know the steps, compression rate/depth, breathing rate, compression/ventilation ratio
• AED use

Question 29

Stroke (Cerebrovascular Accident)

Answer 29

• CVA
• Loss of blood supply to the brain
• FAST acronym
• Call 911—can give TPA within time frame
• Administer CPR if necessary**

Question 30

FAST

Answer 30

F: Face drooping or weakness
A: Arm weakness or inability to raise both arms
S: Speech difficulty or inability to speak clearly
T: Time to call 911 immediately

Question 31

Diabetes

Answer 31

• Type I
• Type II
• Hypoglycemia: too low blood sugar; fatigue, anxiety, sweating, hunger, irritability, shakiness; loss of consciousness, confusion, visual changes
• Hyperglycemia: too high blood sugar; frequent urination, blurred vision, fatigue, headache, nausea/vomiting, shortness of breath, weakness, coma
• Have patient check blood sugar
• If too low, administer some form of sugar (juice, candy)
• If too high, have patient take insulin

Question 32

Burns

Answer 32

• Treatment may depend on severity-more on this later
• Call 911 if needed and prevent shock, CPR?
• Protect person from further harm
• Prevent infection in minor burns
• Follow safety data sheets procedures for chemical burns
• Initiate CPR for severe burns if needed, elevate burned area
• Cool water or cloth over burn, remove tight clothing and jewelry
• Cover burn, elevate
• Watch for shock

Question 33

Seizures

Answer 33

• Electrical activity in brain surges/changes
• Patient may have aura, migraine, or other signs the seizure is coming
• Patient may lose consciousness, stare off into space, see flashing lights, difficulty talking, drooling, or have increased/decreased muscle tone and convulsions
• Make sure patient is safe on the floor, turn to side
• Do not put anything in patient’s mouth or try to stop seizure, don’t stop pt from moving
• Move glasses, loosen shirts/ties
• If seizure lasts longer than 5 minutes, call 911

Question 34

Falls 1

Answer 34

• Common in elderly but can happen to anyone
• Know the risk factors for falls
• Prevent shock and treat injury as needed
• May need to call 911 if injury is severe

Question 35

Falls

Answer 35

Causes of Falls
* Risk-related activities
* Carelessness
* Health/wellness issues
* Process of aging
Prevention
* Environment
* Exercise
* Caution
Assessments Predictive of Falls
* Tinetti Assessment
* Berg Balance Test
* Timed Up and Go Test (TUG)
* Time One-Legged Standing Test
* Czuka’s Sit-to-Stand Test
* Dynamic Gait Index

Question 36

Fractures

Answer 36

• Broken bone
• Protect/immobilize fracture site and prevent shock
• Call 911 if fracture is severe; otherwise transport to emergency department
• Apply towel or dressing if fracture is open and there is bleeding (apply pressure)
• Apply ice cubes wrapped in clean cloth
• If fracture is to the spine, do not move the patient-call 911

Question 37

Heat Exhaustion Versus Heat Stroke

Answer 37

Heat Exhaustion:
* sweating, dizziness, rapid pulse, nausea, muscle cramps
* Patient should rest and stay cool while also hydrating

Heat Stroke:

• high body temps (over 104), altered mental status, nausea/vomiting, flushed skin, rapid breathing, racing pulse, headache
• Call 911; patient semireclined in the shade; remove outer clothing; monitor vitals; apply cold, wet compresses to wrists, ankles, groin, axilla, and neck

Question 38

Documentation of medical emergencies

Answer 38

• Signs/symptoms you observed
• Vital signs measured & when measurement was taken
• How you addressed the situation
• Other info?

Question 39

Safety/Red Flags

Answer 39

• Know patient’s past medical history if treating patient in the clinic and monitor vitals
• Be attentive to signs/symptoms of emergency situations
• Prevent falls with use of gait belt and safe practices, footwear/obstacles
• Maintain BLS certification to stay current in practice

Question 40

Signs: flushed
and dry and he is having a hard time
breathing.

Answer 40

Could be Anaphylaxis or Heat stroke:
Take vitals including temperature:
Heat Stroke/Dehydration:
* Move the patient to a cooler environment.
* Encourage them to drink water if they are alert and able to swallow. (this will potentially cause harm to someone in anaphylaxis so make sure.)
* Apply cool compresses to the forehead, neck, and wrists.
* If there are signs of shock, call 911 and monitor vitals.
Anaphylaxis:
* Ask if the patient carries an EpiPen and administer if necessary.
* Call 911 immediately.
* Monitor breathing and be prepared to administer rescue breathing or CPR if necessary.
* Avoid giving water if the patient has difficulty swallowing or may lose consciousness.

Question 41

Scenario 3
* You are assisting a patient with a T1 complete
spinal cord injury into a mechanical stander.
Once in the standing position, the patient
complains of headache, and you notice that
his face is getting red and blotchy. What
should you do next?

Answer 41

Correct Steps for Managing Autonomic Hyperreflexia:
1. Immediately lower the patient to a sitting or semi-reclined position:
* This helps reduce blood pressure, which tends to spike during autonomic hyperreflexia. Keeping the head elevated is crucial.
2. Check for and remove any noxious stimuli:
* As you mentioned, pinched or tight straps on the mechanical stander could be triggering the response. Other common causes include a full bladder, bowel impaction, tight clothing, or pressure ulcers.
* Loosen any constricting garments or devices.
3. Monitor blood pressure:
* If available, check the patient’s blood pressure frequently. Autonomic hyperreflexia often leads to dangerously high blood pressure.
4. Assess the patient’s bladder and bowel:
* If the patient uses a catheter, check for any blockages or kinks. Autonomic hyperreflexia is frequently triggered by bladder distension or bowel impaction.
5. Call for emergency medical help
* If the cause isn’t easily identified or resolved, call for assistance immediately as autonomic hyperreflexia can escalate quickly.

Question 42

Scenario 4
* Your patient performs several lower extremity
exercises while lying on mat table. She gets up
to leave and has sudden “dizziness”
(lightheadedness). What should you do next?

Answer 42

Correct Steps to Manage Orthostatic Hypotension:
1. Guard the patient to prevent a fall:
* Support the patient to ensure they don’t lose their balance or fall. Stay close and ready to assist.

2. Encourage the patient to clench and unclench muscles:
   * Having the patient clench and unclench their leg muscles can help push blood back up toward the heart and increase blood pressure. This is a good initial step to try and stabilize the patient without having to sit them down immediately.
3. If symptoms persist, sit the patient back down:
   * If clenching muscles doesn’t resolve the dizziness, have the patient sit down again, either on the mat or a nearby chair, until the symptoms subside.
4. Monitor the patient’s condition:
   * Ask the patient how they’re feeling and watch for worsening symptoms, like nausea, fainting, or visual disturbances. Take their blood pressure if possible.
5. Reassess before standing again:
   * Once the patient feels better, help them stand up slowly, reassessing how they feel before they leave. Make sure they are steady on their feet.

Question 43

Scenario 5
* Your patient has had 3 falls in the past 2
weeks. What questions would you ask this
patient? What education would you provide to
help the patient prevent future falls.

Answer 43

What activities were you performing when you fell?
Is there anything in your environment that you typically trip on?
Is there good lighting in the rooms where you typically fall?
Do you need help keeping walking paths clear from clutter?
Were you dizzy or lightheaded before the falls?
* Were you using any assistive devices at the time of the falls?

Education for Fall Prevention:
1. Environmental Modifications:
* Clear walking paths: Emphasize the importance of removing clutter, cords, or rugs that could be tripped over. Suggest organizing the home so that pathways are wide and free of obstacles.
* Improve lighting: Encourage the use of adequate lighting, especially in hallways, staircases, and any areas where falls have occurred. Recommend nightlights for dark areas at night.
2. Footwear:
* Advise wearing proper footwear with non-slip soles, and discourage walking in socks or slippers without adequate grip.
3. Assistive Devices:
* If needed, suggest using a cane, walker, or grab bars in high-risk areas such as bathrooms or staircases. Make sure the patient understands how to use these devices properly to prevent falls.
4. Balance and Strengthening Exercises:
* Educate the patient about the importance of maintaining or improving their balance and strength through regular exercise. Specific exercises, like practicing standing on one foot or heel-to-toe walking, can improve stability. If appropriate, suggest physical therapy for balance training.
5. Medication Review:
* Encourage the patient to speak with their physician or pharmacist about any medications they are taking that may cause dizziness or affect balance. A medication review can help identify any side effects that may increase the risk of falls.
6. Postural Awareness:
* Advise the patient to take their time when changing positions, such as when standing up from sitting or lying down, to avoid dizziness or orthostatic hypotension.
7. Home Safety Assessment:
* Recommend having a home safety assessment if the patient is open to it. A healthcare professional can visit their home to identify potential fall risks and suggest specific changes.

Question 44

• You witness a hospital visitor fall to the ground
  and start shaking all over. What should you
  do?

Answer 44

Steps to Take During a Seizure:
1. Ensure Safety:
* Clear the area around the person to prevent injury. Remove any sharp or dangerous objects from the vicinity.
2. Gently roll the person onto their side:
* This helps keep the airway clear and prevents choking, especially if the person vomits or has excessive saliva.
3. Do not restrain or try to stop their movements:
* Allow the seizure to run its course. Restraining them could cause injury to both you and the person having the seizure.
4. Time the seizure:
* Start timing the seizure as soon as it begins. If it lasts more than five minutes, or if the person has repeated seizures without regaining consciousness, call for emergency help immediately (911 or internal code in a hospital setting).
5. Protect the head:
* If possible, place something soft (like a jacket or pillow) under their head to prevent injury.
6. Do not put anything in their mouth:
* Contrary to common myths, do not put anything in their mouth. This could cause more harm, including choking or injury to the teeth or jaw.
7. Stay with the person:
* Remain with the person until the seizure is over and they are fully alert. After the seizure, they may be confused or disoriented, so reassure them calmly.
8. After the Seizure:
* Once the seizure stops, check the person’s breathing and pulse. If necessary, be prepared to administer CPR if the person doesn’t start breathing normally after the seizure ends.

Question 45

• Your patient comes to his 4:30pm
  appointment with a flushed appearance and
  labored breathing. He states he just got hot
  while working on his deck. He is not sweating
  and has a headache. What would you assess?
  What would you do then?

Answer 45

Assessment:
1. Take the patient’s temperature:
* A core temperature of 104°F (40°C) or higher is a strong indicator of heat stroke.
2. Check vital signs:
* Assess heart rate, breathing rate, and blood pressure.
3. Assess the patient’s level of consciousness:
* Heat stroke can cause confusion, disorientation, or even loss of consciousness.
4. Check for signs of dehydration:
* Dry skin, dry mouth, or lack of sweat are common signs. Ask if the patient has been drinking enough fluids.
Actions for Heat Stroke/Dehydration:
1. Move the patient to a cooler environment:
* Immediately get the patient out of the hot area and into a cooler, shaded, or air-conditioned room.
2. Apply cool compresses:
* Place cool, damp cloths on the patient’s forehead, neck, wrists, groin, and underarms to help lower body temperature. If available, use ice packs in these areas, but do not apply ice directly to the skin.
3. Encourage hydration:
* If the patient is alert and able to swallow, provide cool water to drink, but avoid giving large amounts too quickly.
4. Position the patient in a semi-reclined position:
* This helps keep them comfortable and ensures proper breathing.
5. Monitor for shock and worsening symptoms:
* If there are signs of shock (weak, rapid pulse, cold or clammy skin, shallow breathing), call 911 immediately. Also, monitor for signs of confusion, fainting, or seizures, and be prepared to perform CPR if necessary.
6. Call for emergency medical assistance if symptoms worsen:
* Heat stroke can escalate quickly, so if there is no improvement or the patient’s condition deteriorates, seek emergency medical help immediately.

Question 46

Scenario 8
* Your patient is walking on the treadmill and
complains of pain in left jaw and arm. What
should you do?

Answer 46

Actions to Take:
1. Immediately help the patient off the treadmill:
* Safely stop the treadmill and assist the patient to sit or lie down in a comfortable, supported position to avoid further strain on the heart.
2. Check vital signs:
* Take their pulse, blood pressure, and respiration rate to assess their cardiovascular status. Monitor for any signs of distress, such as an irregular pulse, rapid breathing, or extreme fluctuations in blood pressure.
3. Assess for additional symptoms:
* Ask if the patient is experiencing chest pain, shortness of breath, nausea, or sweating—other common signs of a heart attack.
4. Call 911 immediately:
* Based on the symptoms (left jaw and arm pain), this is a potential cardiac emergency, so call for emergency medical assistance right away. Time is critical in cases of ischemic heart attacks.
5. Be prepared to administer CPR:
* If the patient’s pulse or respiration ceases, you should immediately begin CPR and use an AED (Automated External Defibrillator) if available, until emergency medical personnel arrive.
6. Administer aspirin if appropriate:
* If the patient is conscious and not allergic, you may offer them a chewable aspirin (usually 325 mg), as this can help thin the blood and limit the damage of a heart attack. However, this should only be done if recommended by your facility’s protocol or if instructed by emergency personnel.
7. Monitor the patient closely:
* Stay with the patient, providing reassurance, and continue monitoring their vital signs until emergency help arrives.