Medical emergencies can occur at any time and you must be prepared to identify the emergency and react appropriately. By thinking ahead and having a plan of action, you will be able to respond appropriately to bring about the best possible outcome for the patient. Each office should have a set of emergency protocols and procedures for patient care management during common medical emergencies. You should also have any special plans that are unique to your patient population. The protocols should consider both office-based and home-based emergencies. They should provide the office staff with the treatment and care that your employing physicians recommend in a variety of emergency situations.
For office-based emergencies, it is important to have a “crash cart” or an area stocked with emergency supplies. Supplies should include personal protective equipment including a cardiopulmonary resuscitation (CPR) mask. This breathing device has a one-way valve that prevents contact with body fluid during CPR. A bag-valve-mask (BVM) with or without oxygen may also be available for use in the office. In any emergency, there are general items to keep in mind.
- Stay calm and do not panic. Reassure the patient and any others in the area that you are in control of the situation. If there is a coworker in the area, send them to notify the doctor and to bring emergency equipment. If the doctor is not in, have someone reach him or her by phone.
- Quickly assess the situation using CAB (see the cardiopulmonary resuscitation section later in this chapter). Make sure the patient has a pulse and a patent airway and is breathing. If there is no spontaneous respiration, rescue breathing should be started. If there is no carotid pulse, chest compressions must be started. If the patient is breathing and has an adequate pulse, then you can do a more complete assessment to determine what is occurring. When in doubt, call 911 or your local emergency response system.
- Take steps to ensure that the patient is safe and not in danger of any further injury. Remedy the situation if it is in your ability and training. Otherwise call for assistance. Remember,
you must not do anything that you have not been trained to do, no matter what the
situation. Be able to concisely relate the details of what has happened to the physician or to emergency medical responders.
- The medical assistant should maintain current CPR and first aid training at all times in order to provide the best possible patient care in an emergency situation.
- Periodically review the policies of the office so that you are familiar with them in an emergency. Make sure that emergency phone numbers of such facilities as local emergency rooms, poison control centers, and ambulance services are posted in a prominent area in the office for easy access.
- If the emergency is phoned from a patient or patient’s family member, follow office policy in suggesting a plan of action. Do not suggest that the patient drive himself to the office or emergency room. If necessary, stay on the line with the patient and have someone else in the office call for emergency assistance to the patient’s location. Do not hang up the phone until you are sure that assistance has arrived or until you have spoken to someone else who is with the patient to ensure that medical help is there.
- Carefully document in the patient’s chart the details of the patient’s emergency, what care was suggested or delivered, and the outcome of intervention.
Hemorrhage
The three types of bleeding are arterial, venous, and capillary. While arterial bleeding is the most serious and life threatening, venous bleeding can also be an emergency situation. Capillary bleeding is usually easily controlled with minor first aid. The goal of treatment is to control the bleeding as soon as possible. Severe bleeding can quickly lead to shock and even death, so timely intervention is necessary. Apply direct pressure to the area. You should use sterile dressing material if available or any clean fabric to hold pressure. If the dressing becomes soaked with blood, apply another dressing over the top and continue to apply pressure. The bleeding area can be elevated higher than the level of the heart if there is not an injury that prevents this. This will help to reduce the pressure of the blood as it moves through the vessels and can reduce bleeding. If these measures do not work, a pressure dressing can be applied by adding an elastic bandage or roller gauze over the bandage Additionally, pressure points can be used to decrease blood flow to the area. Apply pressure over an artery in an area that lays on a bone or a large muscle. Pressure will decrease blood flow into the affected extremity. There are seven pressure areas on each side of the body.
- Temporal artery: located on the side of the head above the ear; compression between the fingers and the facial bones can decrease bleeding in the forehead and the scalp.
- Facial artery: pressure on the facial artery against the jawbone can control bleeding in the facial area.
- Carotid artery: compression of the carotid artery against the neck muscles is used only for severe bleeding in the head. Care must be taken to not compress both carotid arteries. Never use a pressure dressing around the neck.
- Subclavian artery: downward pressure between the fingers and the collar bone can decrease bleeding in the arm and shoulder.
- Brachial artery: compression of the artery against the humerus can control bleeding in the arm and hand.
- Radial artery: compression against the radius can control bleeding in the hand.
- Femoral artery: compression against the pelvic bone can control bleeding in the leg.
Application of a tourniquet is not recommended unless there is no alternative to prevent the loss of life.
Be alert to signs and symptoms of shock with any large amount of bleeding.
BURNS
Burns are classified as first-, second-, or third-degree depending on the thickness of tissue damage.
- First-degree burns involve superficial damage only. The skin is reddened and painful. Treatment is application of cool water or a cool compress to relieve pain. The goal is to prevent infection. Dry dressings can be used if there is the possibility of the skin being irritated. Sunburn is an example of a first-degree burn.
- Second-degree burns are also called partial-thickness burns. You will note blistering of the skin. These blisters should not be broken, nor should tissue be removed from areas where the blister has broken. The goal is to relieve pain and to prevent infection. The burn should be immersed in cool water or covered with a cool compress. The area can be covered loosely with sterile, dry dressings to prevent infection. If the burned patient is a child, the burn is extensive, or is on the hands or feet, it must be closely monitored by the physician.
- Third-degree or full-thickness burns are the most serious. The burn involves all layers of skin and may extend into the muscle and bone. Burn injury to the respiratory tract must be considered and the patient must be monitored very closely for signs and symptoms of shock. Airway assessment is the first priority. Then a careful assessment of the burned area is necessary. Any loose clothing or jewelry in the burned area should be removed, but do not try to remove anything that is stuck to burned tissue. Cover the injured area with sterile cloth if available and apply cool water or sterile, normal saline to the area. If there is no other injury or difficulty breathing, place the patient in a supine position with the head slightly lower than the body. If there are respiratory problems, elevate the head. The patient should be transported to an emergency facility as soon as possible for treatment. Check the vital signs so you can give a concise report to them about the patient’s condition. Be alert for changes in the vital signs that may signal that the patient is going into shock. Keep the patient warm and quiet.