S

T
E
R
N
A OC E
D
U

T
SL PR
S I
A S I C
A

A L M
E
D

I C NCY
D
E GE
M MER
E
Introduction to Emergency
Medical Procedures

• First aid: Immediate care that is administered to an individual

who is injured or suddenly becomes ill before complete
medical care can be obtained
• List 5 Purposes of First Aid:
1. To save a life
2. Reduce pain and suffering
3. Prevent further injury
4. Reduce the incidence of permanent disability
5. Increase the opportunity for an early recovery

2
Define and Identify Types of Emergencies

1. Cardiac dysrhythmia (irregular heart beats)

2. Shock (various types, know that they result in vasodilation)
3. Cardiac arrest (MI-give NTG, per MD order, crash cart, 911)
4. Poisoning (determine the type, inhaled, absorbed, ingested)
5. Traumatic injury (laceration, puncture, bite, head injury such
as concussion, assault)
6. Wounds (closed-hematoma, concussion, open-laceration, abrasion)
7. Fractures: impacted, greenstick, transverse, oblique, comminuted,
and spiral.
8. Diabetic emergencies (hypo or hyperglycemia)
9. Seizure (and MA response)
10. Burns (1st, 2cnd, 3rd) 3

11. Hypothermia
Medical Assistant’s
Role and Responsibility

• What does the MA do if the Patient “Crashes?”

• Patient safety (first)
• Determine responsiveness, Look and Listen for rise and fall of
chest to indicate breathing or not, then Feel for Pulse
• Call for help, look directly at the person helping and, give
instructions

• Contact EMS (911)

• Remain on the line, remain calm, gather facts and, provide
4
information to dispatch-do not hang up
Emergency Medical Services
System
• Emergency medical dispatcher (EMD):
• EMD responsibilities
• Obtain information needed
• Determine what help is needed
• Send appropriate personnel and equipment
• MA and EMD stay on the line
• MA and EMD relay and communicate regarding emergency
care – until EMS Arrives
• MA must speak clearly, articulate words correctly, speak
clearly refraining from drama
• Identify the problem accurately and concisely
• So proper equipment and personnel can be sent 5
 Emergency Medical Services
System
• Stay Calm
• Get the Facts
• Pull Up the Chart then:
• Specify:
• Number of victims
• Condition of victims
• Emergency care that has been administered

6
 Call for Help, Do not Leave the
Patient and Get the Crash Cart
• Crash cart: a specially equipped cart
• Holds and transports:
• Medications
• Equipment
• Supplies needed for performing lifesaving procedures in an emergency

7
First-Aid Kit
• Contains basic supplies needed to provide emergency care
• Keep at home and in car
• Available at most drug stores or can make your own
• Should include phone numbers of:
• Local EMS
• Poison control center
• Police and fire departments

8
First-Aid Kit-Know contents

9
OSHA Safety Precautions
• 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
• First-aid kit must contain personal protective equipment (PPE)
• Gloves
• Face shield and mask
• Pocket mask 10
OSHA Safety Precautions
• If hands come into contact with blood or OPIM: wash them
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 a physician
• Postexposure measures can be initiated
• Wear protective clothing and gloves to cover:
• Cuts or other lesions
• Sanitize hands after removing gloves
• Avoid touching objects contaminated with blood or OPIM 11
Guidelines for Providing
Emergency Care
• Remain Calm
• Speak in a normal tone of voice
• Stay calm for the patient and you!

• Make sure scene is safe before approaching the

patient

• Must protect yourself from harm

12
Guidelines for Providing
Emergency Care
• Consent is assumed
• You do not need to get a consent if assisting in an
emergency (Good Samaritan Law)
Protected as long as acting within Scope of Practice
• When a life-threatening condition is present and
the patient is unable to give consent (e.g.,
unconscious) – assume if patient could give
consent, he or she would
• Always consider safety first

13
Guidelines for Providing
Emergency Care
• Look for medical alert tag on wrist or neck
• Provides information on a patient's medical condition
• Called a Medic Alert Band (patients with chronic life- threatening
conditions diabetes, epilepsy which is seizure disorder).
• Continue caring for patient until more highly trained personnel
arrive
• On their arrival relay:
• Condition in which you found the patient
• Emergency care administered
• Stay with the patient!

14
Respiratory Distress
• 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
• Patient is breathing but having great difficulty in doing so we
call this increased work of breathing
• May lead to respiratory arrest
• In Children < 8 child will compensate then go into cardiac
arrest it is sudden, not a progression
15
Respiratory-Asthma
1. Characterized by:
a. Wheezing-inspiratory (whistling sound when patient breathes in)
b. Coughing-productive or non-productive
c. Dyspnea-increase SOB
• What happens during an asthmatic attack?
• Bronchioles constrict
• Become clogged with mucus
• May occur at any age
• More common in children and young adults
• If not treated: can lead to serious complications
• Example: lung damage
• Frequently associated with a family history of allergies 16

• Common allergens that can trigger attack

What can cause asthma?
• Also caused by:
• Air pollutants
• Tobacco smoke
• Chemical fumes
• Vigorous exercise
• Allergic Reaction to Foods-dust, dander, animals, molds

17
Asthma
• Also caused by:
• Respiratory infection
• Exposure to cold
• Emotional stress
• Usually controlled with medications to make breathing easier
• Stops muscle spasms and opens airway (bronchodilator)
• Status asthmaticus: severe, prolonged asthmatic attack
• Life-threatening; Can move only a small amount of air
• Status asthmaticus: severe, prolonged asthmatic attack
• Symptoms:
• Breathing may not be audible
• Bluish discoloration of skin
• Extremely labored breathing
18
• Requires immediate transportation to emergency care facility
 Emphysema
• Progressive lung disorder
• Terminal bronchioles that lead to alveoli become plugged with mucus
• Alveoli become damaged
• Less surface area to diffuse oxygen
• Terminal bronchioles that lead to alveoli become plugged with mucus
• Alveoli lose elasticity
• Inhaled air becomes trapped in the lungs: breathing becomes difficult
(especially exhalation)
• Air becomes trapped in lungs: exhalation is difficulty; Usually develops over many
years; Occurs most frequently: heavy smokers and those who have chronic
bronchitis and in Elderly patients who have lost lung elasticity
• Chronic emphysema
• One of the major causes of death in the United States
• Lungs progressively become less efficient
• Breathing becomes more difficult
19
• Patients in advanced stages: may go into respiratory or cardiac
arrest
1
1
1
Call 9-1-1 and get the…

1
Heart Attack
• Also known as myocardial infarction (MI)
• Cause: obstruction of one or both of the coronary arteries or
branches
• Severity of attack depends on:
• Size of artery obstructed
• Amount of muscle tissue nourished by the artery
• Principal symptom: chest pain
• Described as:
• Squeezing or crushing pressure
• Severe indigestion
• Burning, heaviness, or aching
24
Heart Attack
• Principal symptom: chest pain
• Pain can range in severity
• From mildly uncomfortable to intense
• Usually felt behind the sternum – may radiate to the neck, throat,
jaw, shoulders, and arms
• Pain not relieved by resting or nitroglycerin
• Females-pain is not typical and may manifest as epigastric vs.
chest, jaw to arm
• Other symptoms
• Shortness of breath
• Profuse perspiration
• Nausea
25
• Fainting
Stroke
• Cerebrovascular accident (CVA)
• Artery to brain is:
• Blocked
• Ruptures
• Results in interruption of blood flow to brain

• (Low Blood Sugar may present as a stroke or symptoms of

hypoglycemia mimic a stroke, Check the patient’s blood sugar
by performing a capillary puncture or finger stick to rule out
low blood sugar)

26
Stroke
• Symptoms
• Sudden weakness or numbness of face, arm,
or leg on one side of the body
• Difficulty speaking
• Dimmed vision or loss of vision in one eye
• Double vision
• Think FAST
• Must be transported to Stroke Receiving
Center for high image CT no more than 20 27

minutes away
 Shock
• Shock: Failure of cardiovascular system to deliver enough blood to
vital organs (low BP, low blood to heart, and brain)
• Accompanies different types of emergency situations:
• Hemorrhaging-excessive bleeding
• MI-decreased oxygen to heart
• Severe allergic reaction
• If not treated: often becomes life-threatening
• 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
28
Shock
• Symptoms of shock: caused by failure of vital organs to receive
enough oxygen and nutrients
• Symptoms
• Weakness
• Restlessness
• Anxiety
• Disorientation
• Pallor
• Cold and clammy skin
• Rapid breathing
• Rapid pulse
• Loss of blood pressure
• Massive vasodilation (pooling of blood)
• No blood to the brain or vital organs----Death
29
Hypovolemic Shock
• Caused by
• Severe dehydration from:
• Vomiting
• Diarrhea
• Profuse perspiration
• Loss of blood, plasma, water, electrolytes
• Remember, fluid loss….regardless of the cause

30
Cardiogenic Shock
• Failure of heart to pump blood adequately to vital organs
• Occurs when heart has been injured or damaged
• Most frequently seen with an MI
• Other causes
• Dysrhythmias
• Severe congestive heart failure
• Acute valvular damage
• Pulmonary embolism

31
Neurogenic Shock
• Nervous system is unable to control the diameter of blood
Control of blood vessel diameter is lost
• Blood vessels dilate – blood pools in peripheral areas of body
• Most often seen in brain and spinal injuries
• Blood pressure drops, cannot support the vital organs,
including the brain
• MASSIVE VASODILATION

32
Anaphylactic Shock
• Serious life-threatening reaction of the body to an allergen
• Examples
• Drugs (e.g., penicillin)
• Insect venoms
• Foods (e.g., peanuts, tree nuts, proteins)
• Allergen extracts used in hyposensitization injections

33
Anaphylactic Shock
• Reaction causes release of large amounts of histamine
• Results in:
• Dilation of blood vessels
• Drop in blood pressure
• We give benadryl as an antihistamine
• To “Counteract” anaphylactic effects
• Or in more severe cases, Decadron (steroid)
• Symptoms
• Sneezing
• Hives
• Itching
• Angioedema 34

• Erythema
Anaphylaxis in the patient-can lead to shock and respiratory,
cardiac arrest if untreated.
Adult and Infant-swelling of airways-note, the infant has
acrocyanosis (blue coloring around lips)

35
Types of Shock that lead to
massive vasodilation

36
 Anaphylactic Shock
• Symptoms
• Disorientation
• Difficult breathing
• Dizziness and faintness
• Loss of consciousness
• 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
37
Anaphylactic Shock (Cont.)
• EpiPen (Injectable Epinephrine)

38
Psychogenic Shock
• Least serious type of shock
• Caused by unpleasant physical or emotional stimuli
• Sudden dilation of blood vessels: blood pools in abdomen and
extremities and temporarily deprives brain of blood
• Generally occurs when patient is in upright position
• Patient feels faint, dizzy, disoriented

39
Syncope and Fainting
• Warning signals that fainting is about to occur:
• Sudden light-headedness
• Pallor
• Nausea
• Weakness
• Warning signals that fainting is about to occur:
• Yawning
• Blurred vision
• Feeling of warmth
• Sweating
• 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 40

• If patient is sitting: lower head between legs

• Tell patient to breathe deeply
Bleeding
• Bleeding (hemorrhaging): escape of blood from a severed
blood vessel
• Ranges from minor to very serious
• Loss of 25% to 40% of blood volume (2 to 4 pints): fatal
• Bleeding that can be seen which is internal
• Common examples include bleeding from:
• Open fractures
• Lacerations
• Nose (epitaxis)

41
Arterial Bleeding
• Most serious
• Occurs when artery is punctured or severed
• Bleeding comes in spurts and is bright red
• Arteries most frequently involved in accidents:
• Carotid-Neck
• Brachial-Arm
• Radial-Wrist
• Femoral-Groin

42
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
• If bleeding is 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
• Steps for controlling bleeding
• Apply direct pressure to the wound with a clean covering
• Apply additional dressings if necessary
• Apply a pressure bandage 43

• Transport patient to emergency care facility or activate EMS

Emergency Care for External
Bleeding-How to Stop
• Pressure Points-Above the Site

44
Nosebleeds
Apply direct pressure by pinching nostrils together
Takes approximately 15 minutes for clot formation

• Also known as epistaxis

• Usually not serious
• Cause:
• Upper respiratory infection
• Direct blow from a blunt object
• Hypertension
• Strenuous activity
• High altitudes
• Apply ice pack to bridge of nose
• After bleeding has stopped: tell patient not to blow nose for
several hours may loosen clot and bleeding may start again.
• If you cannot control bleeding: transport patient to an 45

emergency facility
Internal Bleeding
• Bleeding that flows:
• Into a body cavity
• Into an organ
• Between tissues
• Severe internal bleeding: life-threatening emergency
• No obvious blood flow – must be recognized by:
• Nature of injury
• Symptoms of internal bleeding
• Bruises, pain, tenderness, or swelling at the site
• Rapid weak pulse
• Cold and clammy skin
• Nausea and vomiting
• Excessive thirst 46
• Drop in blood pressure
• Decreased levels of consciousness
Wounds
• 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
• Infection is a major concern and hemorrhage

47
Open Wounds
• Patient should receive prompt attention if the 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
• Patient should receive prompt attention if the following occur:
• Involvement of nerves, muscles, or tendons
• Wound occurs on mouth, tongue, face, genitals, or other areas
• Where scarring would be apparent

48
Incisions and Lacerations
• Incision: Clean, smooth cut caused by a sharp cutting
instrument (knife, razor, glass)
• 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

49
Incisions and Lacerations
• Laceration: Tissues are torn apart, leaving ragged and irregular
edges
• Caused by dull knives, large objects driven into skin, heavy
machinery
• Deep lacerations result in:
• Profuse bleeding
• Scar formation

50
Serious Incisions and
Lacerations
• To control bleeding
• Cover wound with a large, thick, gauze dressing
• Apply firm pressure
• Do not clean or probe the wound
• Transport to physician; if serious: activate EMS
• Wounds of violence-reportable conditions

51
Punctures
• Wound made by sharp object piercing the skin layers
• Objects causing a puncture:
• Nail, splinter, needle, wire, knife, bullet, animal bite
• Small external skin opening
• Bleeding is usually minor
• Tetanus booster may be required
• Tetanus bacteria grow best in a warm, anaerobic environment
• 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 52
toxoid)
Abrasions
• Outer layers of skin are scraped or rubbed off
• Blood may ooze from ruptured capillaries
• Caused by falls resulting in:
• Floor burns
• Skinned knees and elbows
• 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 a physician
53
Abrasions (Cont.)
• Emergency Care for Abrasions: to prevent infection
• Cover large abrasions with a 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

54
Closed Wounds-RICE
• Injury to underlying tissues without a break in the skin surface
or mucous membrane
• 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
• 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 55
Musculoskeletal Injuries

• Musculoskeletal System
• Made up of:
• Bones
• Tendons
• Ligaments
• Musculoskeletal System
• Injuries of the musculoskeletal system
• Fractures
• Dislocations
• Sprains
• Strains 56

• Compression-such as vertebral
1
Musculoskeletal Injury
• Fracture: Any break in a bone
Can range from a simple chip or a crack to a complete break
Symptoms of a fracture
• Pain and tenderness
• Deformity
• Swelling and discoloration
• Loss of function of body part
• Numbness or tingling
• Caused by:
• Direct blow
• Fall
• Bone disease 58
• Twisting force
Fracture (Cont.)
• Patient may state:
• Heard a snap or break
• Felt a grating sensation (crepitus)
• Caused by bone fragments rubbing against each other

• More dangerous if there are multiple breaks and, if the bone

punctures through the skin

• Then, the opening is at great risk for infection and bleeding

59
1
Emergency Care for a Fracture
• Often difficult to determine if a patient has a fracture,
dislocation, or sprain
• Patient needs diagnostic imaging (X-ray) to confirm
• Symptoms are similar for the fracture, dislocation or sprain
• Treat any serious musculoskeletal injury to an extremity as if it
were a fracture
• Immobilize body part to prevent motion
• Reduces pain and prevents further damage

61
 Emergency Care-Fracture
• 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
• Immobilize the area above and below the injury
• Hold splint in place with gauze roller bandage
• Elevate injured extremity, reduces swelling
• Rest, Ice, Compression, Elevate 20 on then off
• MA does not apply initial Splint or Casts-MA provides
instructions on signs of infection or decreased circulation

62
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 a violent pulling or pushing force that tears
ligaments
• Symptoms
• Significant deformity of the joint
• Pain and swelling
• Loss of function

63
Sprain
• Sprain: A tearing of ligaments at a joint
• Results from:
• Fall
• Sports injury
• Motor vehicle accident
• Joints most often sprained:
• Ankle
• Knee
• Wrist
• Fingers
• Sprain Symptoms:
• Pain
• Swelling
• Discoloration 64
• Can vary from mild to severe
• Depends on the amount of damage to the ligaments
Sprain
• Strain: Stretching and tearing of muscles or tendons
• Most likely to occur:
• Lifting a heavy object
• Overworking a muscle
• Muscles most commonly strained are those of the:
• Neck
• Back
• Thigh
• Calf
• Symptoms
• Pain
• Swelling 65

• Discoloration
Sprain and Strain
• RICE
• Rest, ICE, Compression, Elevation

• Initial injury provider may order ice then warm compresses,

alternating.
• Remember, no longer than 20 minutes per hour

• * For suspected injuries: sprains, strains, dislocations or fractures,

immobilize and elevate until patient has been evaluated by
physician/provider and, diagnostic imaging (X-rays) have been
performed.
66
Burns
• Severity depends on:
• Depth of burn
• Percentage of body involved
• Type of agent causing burn
• Duration and intensity of agent
• Part of body involved

67
1 ,2 ,3
st nd rd

• 1st red, painful

• 2nd blistering, red,
painful (partial
thickness burn)
• 3rd severe burn all the
way to bone
(requires
hospitalization)

1
Superficial (First-Degree) Burn

• Most common type of burn

• Involves top layer of skin (epidermis)
• Skin appears red, warm, and dry to touch
• Painful
• Heals in 2 to 5 days
• Does not cause scarring

69
Partial-Thickness (Second-
Degree) Burn
• Involves epidermis and dermis
• Appears red, mottled, and blistered
• Do not break blisters: provide a barrier against infection
• Usually very painful
• Area often swells
• Heals in 3 to 4 weeks
• May result in some scarring

70
Full-Thickness (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
• Patient may experience intense pain that is generalized
• Dense scars typically result
• If nerves damaged, no pain

71
Emergency Care for Major
Thermal Burns
• 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
• Cover patient with clean non-adherent material (tablecloth or sheet)
• Do not apply ointment, antiseptic, or other substances to area
• Immerse area in cold water for 2 to 5 minutes
• Do not break blisters
• Cover with a dry sterile dressing
• Usually very painful
• Area often swells 72
• Heals in 3 to 4 weeks
• May result in some scarring
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 if allowed to remain on the skin
• Remove chemical as quickly as possible and then activate EMS

73
Seizures
• Normal electrical activity of brain is disturbed
• Causes brain cells to become irritated and overactive
• Conditions that may trigger a seizure or recent or old head
injury
• Known diagnosis of Epilepsy or Encephalitis
• What to do:
• Protect patient from harm
• Remove hazards from area
• Protects patient from injury
• Do not restrain patient
• Could injure patient's muscles, bones, or joints
• Loosen clothing that may interfere with breathing
74
Seizures
• Conditions that may trigger a seizure
• High fever in infants and young children
• Drug and alcohol abuse withdrawal
• Eclampsia associated with toxemia of
pregnancy
• Diabetic emergencies
• Heat stroke
• Epileptic patient who is tapering 75

medicaiton
Seizures
• Partial seizures (most common): Abnormal electricity is
localized into very specific areas of the brain, very brief
• Abnormal behavior (e.g., confusion)
• Glassy stare
• Aimless wandering
• Lip smacking or chewing
• Fidgeting with clothing

76
Seizures
• Grand mal – postictal: lasts 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

• When patient becomes oriented, they are often embarrassed and

may have become incontinent.
• Preserve dignity and privacy, assist the patient as needed.

77
 Seizures
• 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
• Protect patient from harm, maintain airway and give them
privacy
• Remove hazards from area
• Do not restrain patient
• Could injure patient's muscles, bones, or joints
• Loosen clothing that may interfere with breathing
• NO tongue blade
78
Emergency Care for Seizures
• Activate EMS
• If uncertain of cause
• If patient is having a status epilepticus seizure
• Otherwise wait until seizure is over
• Then transport patient to local treatment facility
• 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

79
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 years because they explore their
world by putting things in their mouths, especially if they are small,
bright colored or look fun
• Usually involves
• Cleaning agents
• Medications
• Pesticides
80
• Poisoning reaction is more serious in:
• Children and the elderly
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
• National Poison Control Hotline
• Toll-free number: 1-800-222-1222
• Open 24 hours

81
Ingested Poisons
• Enter the body by being swallowed
• Most common route of entry for poisons
• Examples:
• Cleaning products
• Pesticides
• Contaminated food
• Petroleum products (gasoline, kerosene)
• Poisonous plants
• Abuse of drugs and alcohol

82
Ingested Poisons (Cont.)
• Symptoms
• Based on substance that has been consumed
• Often include:
• Strange odors, burns, or stains around the mouth
• Nausea, vomiting, abdominal pain, diarrhea
• Difficulty in breathing
• Profuse perspiration
• Excessive salivation
• Dilated or constricted pupils
• Unconsciousness
• Convulsions

83
Emergency Care for Poisoning
by Ingestion
• Acquire information about:
• Type of poison
• Amount ingested
• When ingested
• Call the poison control center or local EMS
• Never induce vomiting unless told to do so by a medical authority
• May cause more injury when vomited back up
• Have patient lie down, on left side

84
Emergency Care for Poisoning
by Ingestion
• If patient vomits: collect sample and take to the hospital
• For analysis by a toxicologist
• Take containers of substances ingested to the hospital
• Empty medication bottles
• Household cleaner containers
• Label lists ingredients in product

85
Inhaled Poisons-Give 02
• Breathed into the body in the form of gas, vapor, or spray
• Examples:
• Carbon monoxide
• Carbon dioxide
• Fumes from household products
• Symptoms
• Severe headache
• Nausea and vomiting
• Coughing or wheezing
• Shortness of breath
• Chest pain or tightness
• Facial burns
• Burning of mouth, nose, eyes, throat, or chest 86
• Cyanosis
• Confusion, dizziness, unconsciousness
Absorbed Poisons
• Enter body through skin
• Symptoms
• Irritation, burning, itching
• Burning of skin and eyes
• Headache
• Abnormal pulse and/or respiration
• Remove patient from source of poison
• Avoid contact with toxic substance
• Call poison control center or EMS
• Will usually be instructed to:
• Brush dry chemicals from skin
• Flood area with water 87
Injected Poisons
• Enters body through bites, stings, or a needle
• Examples:
• Venom of insects, spiders, snakes, and marine creatures (jellyfish)
• Bite of rabid animal, cat, dog, rat
• Drugs (e.g., heroin) dirty needles, contaminated solutions

88
Injected Poisons (Cont.)
• Symptoms
• Altered state of awareness, disoriented
• Evidence of stings, bites, or puncture marks on skin
• Mottled skin (looks purple, bluish red, blotchy)
• Localized pain or itching
• Burning, swelling, or blistering at site
• Difficulty breathing
• Abnormal pulse rate
• Nausea and vomiting
• Anaphylactic shock

89
Insect Stings
• Hymenoptera: Insect order that causes most allergic reactions
• Sting remains embedded in victim's skin: honeybees
• More aggressive and can sting repeatedly: bumblebees,
wasps, yellow jackets, hornets
• Incidence of death is low
• Most people know to obtain medical attention immediately
• If allergic reaction does not occur within 30 minutes after sting
• Usually no problem will occur but, if they develop hives, gSeek
medical care immediately
• Most fatalities occur within 2 hours
• Kit provided to patient contains:
• Injectable epinephrine 90

• Oral histamines (Benadryl)

Insect Stings (Cont.)
• Symptoms of allergic reaction to sting (anaphylactic reaction)
• Erythema (redness)
• Disorientation
• Progresses to:
• Difficulty breathing
• Dizziness
• Faintness
• Loss of consciousness

91
Emergency Care for Insect
Stings
• Scrape stinger and attached venom sac off the patient's skin
(credit card)
• Do not use tweezers: because this will squeeze venom sac
• Wash with soap and water
• Apply cold pack or cold moist bandage for 10 minutes at a
time to reduce pain and swelling
• Observe for signs of anaphylactic shock

92
Spider Bites
• Spiders are numerous throughout the United States
• Most do not cause injuries or serious complicationsBites usually occur on person's hands/arms
• When reaching into spider's hiding place
• Often patient does not know he or she has been bitten
• Until begins to feel ill or notices swelling or bite mark

• Only black widow and brown recluse cause serious or life-threatening complications
• Black widow spider
• Approximately 1 inch long
• Black with bright red hourglass on abdomen
• Venom: toxic to central nervous system
• Black widow spider
• Symptoms of black widow bite:
• Swelling and dull pain at site
• Nausea and vomiting
• Rigid, boardlike abdomen
• Difficulty breathing and swallowing
• Not usually fatal
• Antivenin available – has undesirable side effects; administer only to individuals with severe bites, fever
• Brown recluse spider
• Light brown with dark brown, violin-shaped mark on back 93
• Symptoms of brown recluse bite:
• Tenderness, redness, and swelling at site
• Systemic effects seldom occur but effects tissue surrounding bite
1
1
Snakebites
• Kills very few people in the United States
• Species that are poisonous in the United States
• Rattlesnakes
• Causes most bites
• Causes nearly all fatalities
• Copperheads
• Cottonmouths (water moccasins)
• Coral snakes

96
1
Emergency Care for Snakebites
• Do NOT:
• Apply ice
• Apply a treatment
• Cut or suction the wound
• If snake is dead
• Notify EMS of location
• So it can be transported for identification

98
Animal Bites
• Rabies
• Viral infection
• Transmitted through saliva of animal infected with rabies
• Rabies shots vaccination include: A fast-acting shot (rabies
immune globulin) to prevent the virus from infecting you. Part
of this injection is given near the area where the animal bit
you if possible, as soon as possible after the bite.
• A series of rabies vaccines to help your body learn to identify
and fight the rabies virus. Rabies vaccines are given as
injections in your arm.
• You receive four injections over 14 days.
• Tetanus needs to be current 99
Emergency Care for Animal
Bites
• All Animal Bites
• If rabies is suspected: inform appropriate authorities
• Medical personnel
• Police
• Animal control personnel
• Millions of animal bites occur in the United States each year.
• Dogs cause most animal bites. Other biting animals include cats, rodents, rabbits,
ferrets, farm animals, monkeys and reptiles.

The major concern of all animal bites is infection

Infections occur more frequently in cat bites because cats have sharp, pointed teeth
that cause deep wounds.

• Quick and proper treatment often can prevent or minimize the risk of infection.

Rabies is a rare but a potentially fatal infection that may result from an animal bite.
In the United States, wild animals such as bats, skunks, raccoons and foxes are most 100

likely to spread rabies. Bites from these animals should be reported to your public
health department.
Heat and Cold Exposure
• Individuals at higher risk for exposure
• Individuals with poor blood circulation
• Diabetes mellitus
• Cardiovascular disease
• Young and Old people
• Individuals who have had heat or cold injuries in the past
• Individuals under the influence of drugs or alcohol

Heat-related injuries: most likely to occur on:

Very hot, humid days
Little or no air movement
Cold-related injuries: most likely to occur in winter
101
Heat Exhaustion (Cont.)
• Treatment
• Put patient in a cool environment
• Fluid and electrolyte replacement
• Apply cold compress to forehead
• Rest
• Loosen clothing
• Remove excess layers of clothing
• After treatment: patient's condition usually improves within
30 minutes

102
1
Heatstroke
• Symptoms:
• Dizziness and weakness
• Rapid shallow breathing
• Decreased levels of consciousness
• Seizures
• Transport to emergency care facility immediately
• Life-threatening
• If not treated: heat stroke is always fatal
• During transport: attempt to lower body temperature
• Air conditioner to maximum
• Cover patient with cool, wet sheets
• Fan patient
104
Frostbite
• Localized freezing of the body tissue due to exposure to cold
• Severity depends on:
• Environmental temperature
• Duration of exposure
• Wind-chill factor
• Most commonly affects:
• Hands
• Fingers
• Feet
• Toes
• Ears
• Nose 105

• Cheeks
1
Diabetic Emergencies
• Glucose: end-product of carbohydrate metabolism
• Function: serves as the chief source of energy
• To carry out normal body functions
• To assist in maintaining body temperature
• Glucose that is not needed for energy:
• Stored as glycogen in muscle and liver tissue for later use
• When no more tissue storage is possible:
• Excess glucose is converted to fat – stored as adipose tissue

• Diabetes mellitus: body is unable to use glucose for energy

due to lack of insulin. Insulin Dependent
• Type 1 diabetes: 107
• Severe form of diabetes
• Usually occurs in childhood
Diabetic Emergencies (Cont.)
• Diabetes mellitus: body is unable to use glucose for energy due to lack of insulin
• Type 2 diabetes:
• Milder form of diabetes
• Usually occurs in adults
• Most common type of diabetes – 90% of patients with diabetes have type 2
• Two types of diabetic emergencies:
Hypoglycemia-also called insulin shock
Diabetic ketoacidosis also called diabetic coma

• No cure for diabetes

• Can control disease with:
• Drug therapy
• Diet therapy
• Activity

• Diabetes Type I-Early Onset, these patients require insulin since their bodies do not make
108
insulin
• Diabetes Type II-Person has enough cells within the pancreas but, these cells no longer
function or work properly, they have been abused due to over use
Insulin Shock (Hypoglycemia)
• Too much insulin and not enough glucose

• Symptoms
• Normal or rapid respirations
• Pale, cold, and clammy skin
• Sweating
• Dizziness and headache

• If the patient is a known diabetic, causes include:

• Administration of too much insulin
• Skipping meals
• Unexpected or unusual exercise 109
• Stress
• iIlness
Insulin Shock
• Symptoms
• Full rapid pulse
• Normal or high blood pressure
• Extreme hunger
• Aggressive or unusual behavior
• Fainting, seizure, or coma

• Onset of insulin shock

• Occurs rapidly after blood glucose begins to fall (5 to 20 minutes)
• Severe hypoglycemia can cause permanent brain damage or
death
• Because brain requires constant supply of glucose 110
Diabetic Coma (Diabetic
Ketoacidosis)
• Occurs when there is not enough insulin in the body
• Blood glucose level rises: hyperglycemia
• Glucose cannot be used for energy causes fat to break down
• Results in buildup of acid waste products in the blood
(ketoacidosis)
• If not treated: progresses to dehydration, hypotension, coma, death
• Onset is gradual: develops over 12 to 48 hours

111
Diabetic Coma (Diabetic
Ketoacidosis)
• Symptoms
• Polyuria
• Excessive thirst and hunger
• Vomiting and abdominal pain
• Dry warm skin
• Rapid and deep sighing respirations
• Fruity (acetone) odor to breath
• Rapid weak pulse
• If not treated: progresses to dehydration, hypotension, coma,
death
• Onset is gradual: develops over 12 to 48 hours
112
Diabetic Coma
(Diabetic Ketoacidosis)
• Abbreviated DKA
• Insulin Shock (Hypoglycemia)
• Needs sugar immediately – if conscious: administer by mouth
• Fruit juice
• Candy
• Nondiet soft drinks
• Patient needs sugar!
• Most individuals with diabetes:
• Have a thorough knowledge of diabetes and manage it effectively
• Diabetic emergencies most likely to occur
• During illness or infection
• Individual who has not yet been diagnosed
113
• Diabetic Patient’s should wear a medic alert band
Diabetic Emergencies
• May be difficult to tell difference between insulin shock and
diabetic coma
• If patient is unconscious: observe respirations:
• Insulin shock: normal or rapid respirations
• Diabetic coma: deep, labored respirations
• Most diabetic patients: carry medical alert
• INSULIN Shock (Hypoglycemia)
• Needs sugar immediately – if conscious: administer by mouth
• Fruit juice
• Candy
• Nondiet soft drinks

114
Diabetic Emergencies
• Insulin Shock (Hypoglycemia)
• Needs sugar immediately – if conscious: administer by mouth
• Improvement is usually rapid after administration
• If unconscious: do not given anything by mouth: may be aspirated
into the lungs
• Transport to emergency care facility immediately
• Diabetic Coma (Diabetic Ketoacidosis)
• Needs insulin
• Transport to emergency care facility immediately

115
Doubtful Situations
• If unable to determine if patient is in insulin shock or diabetic
coma
• Give sugar (even though diagnosis may be diabetic coma)
• Reason:
• Insulin shock develops more quickly than diabetic coma
• Insulin shock can cause permanent brain damage or death
• If sugar is given to patient in diabetic coma:
• Little risk of making condition worse
• Patient can withstand high blood glucose longer than low blood
glucose level

116