This course is designed for nurses in emergency room in hospital

1. Heart Attack

2. Heart Attack
• Sudden reduced blood flow to heart muscle
• Medical emergency that often leads to cardiac arrest
• Can occur at any age
• Usually results from atherosclerosis

3. Facts about Heart Attack
• 180,000 people in U.S. die every year
• More likely in those with family history
• One-fifth of patients do not have chest pain
• Victims often have other symptoms

4. Signs and
Symptoms of
Heart Attack
• Persistent chest pressure,
tightness, ache, or pain
• Pain spreads to neck, shoulders, or
arms
• Shortness of breath
• Dizziness, lightheadedness, feeling
of impending doom

5. Signs and
Symptoms of
Heart Attack
• Pale, moist skin or heavy
sweating
• Nausea
• May have no signs and symptoms
before suddenly collapsing
• Milder symptoms that come and
go before heart attack

6. Symptoms of Heart Attack
• In women chest pain or discomfort most common symptom
• Also more likely to have shortness of breath, jaw or back pain, nausea
and vomiting
• Consider possibility of a heart attack with wide range of symptoms
• Don’t expect a clearly defined situation
• Patients occasionally in denial

7. Emergency Care for Heart Attack
• Perform standard patient care
• Help patient rest comfortably (often sitting)
• Loosen tight clothing
• Ask if patient takes heart medication
• Follow local protocol to help with medication

8. Emergency Care for Heart Attack continued
• Follow local protocol –
• to allow patient to take one adult aspirin (unless allergic)
• to administer oxygen
• Stay with patient, reassure and calm
• Be prepared to give BLS

9. Nitroglycerin
• Increases blood flow by dilating arteries
• Often prescribed for angina
• Type of chest pain caused by narrowed coronary
arteries
• Comes in tablets, sprays, and patches

10. Nitroglycerin continued
• To administer
• Follow local protocol and prescription instructions
• Patient should be seated
• Do not give to unresponsive patient

11. • Chest pain caused by
heart disease
• Usually after activity or
exertion
• Pain usually lasts only
few minutes
• People usually know they
have angina and carry
medication
Angina

12. Care for Angina
• Help person with angina take medication and
rest
• If pain persists > 10 minutes or stops and
returns or person has other symptoms of heart
attack give first aid as for heart attack

13. Cold and Heat
Emergencies

14. Cold and Heat Emergencies
• Body temperature problems occur when
body becomes cold or hot
• Infants and elderly more susceptible to
temperature extremes

15. Body Temperature
• Constant internal temperature necessary
• Body has several mechanisms to create or lose heat
• Mechanisms cannot maintain constant temperature when
exposed to temperature extremes for extended period

16. Mechanisms For Staying Warm
• Metabolic processes
• Most body heat produced this way
• Contraction of muscle tissue
• Including shivering
• Vasoconstriction
• Less radiation of heat away from skin

17. Mechanisms For Staying Cool
• Vasodilation
• More warm blood to surface of skin to be radiated away
• Primary heat loss method
• Sweating
• Evaporation from skin surface cools body

18. Prolonged Exposure to Cold
• Especially when wet,
• The body cannot conserve heat
• Shivering cannot produce enough heat
• Hypothermia develops
• Organ systems gradually begin to fail, leading eventually to death

19. Prolonged Exposure to Heat
• The body cannot maintain normal temperature
• Profuse sweating leads to dehydration
• Blood volume and blood pressure decrease
• Without fluid, the body cannot cool itself
• Heatstroke occurs
• Without treatment, organ damage/death occurs

20. Heat and Cold Injuries
Risk Factors
• Young children
• Elderly
• Injuries
• Chronic health problems
• Mental impairment
• Dehydration
• Too little body fat
• Too much body fat
• Activity in extreme
environments
• Medications and drugs
(including alcohol)
• Environmental variables
(water immersion, wind
chill, humidity)

21. Hypothermia
• Occurs when body cannot make heat as fast as
it loses it
• Body temperature < 95° F
• Can occur whenever and wherever person
feels cold
• Progressive
• May occur gradually or quickly
• Almost 700 people die each year in U.S.

22. Signs and Symptoms of Hypothermia
• Pale, cool skin—even under clothing
• Slow breathing
• Uncontrollable shivering
• Patient seems apathetic, confused, or irrational
• Lethargy, clumsy movements, drowsiness, dizziness

23. Signs and Symptoms of Hypothermia con’t
• Memory disturbances/confusion
• Reduced/loss of touch or sensation
• Speech difficulty
• Poor judgment
• Stiff or rigid posture, muscular rigidity

24. Hypothermia: Early Signs and Symptoms
• Shivering
• Numbness
• Lethargy
• Poor coordination
• Slurred speech
• Infants may have bright red skin and little energy

25. Hypothermia: Late Signs and Symptoms
• Shivering typically stops
• Victim may not feel cold
• Breathing becomes shallow
• Mental status deteriorates
• Victim may become unresponsive and stop breathing

26. Emergency Care for Hypothermia
• Perform standard patient care
• Remove patient from cold environment
• Protect from further heat loss
• Remove wet clothing, cover with blanket
• Have patient lie down, handle gently
• Follow local protocol re: oxygen
• Don’t allow patient to walk/exert self
• Don’t give patient any food/drink

27. Emergency Care for Hypothermia continued
• Stimulants (coffee, tea) or smoking make condition worse
• Don’t massage skin or extremities
• Don’t immerse patient in hot water
• Don’t use direct heat
• Assess unresponsive patient for pulse for 30-45 seconds
before CPR

28. Frostbite
• Freezing of skin or deeper tissues
• More common in exposed skin areas (head, hands,
feet)
• Wind chill increases risk
• Severe frostbite kills tissue and can result in
gangrene and amputation

29. Signs and Symptoms of Frostbite
• Early or superficial frostbite:
• Skin color doesn’t return after palpation
• Skin remains soft
• Area is numb or tingles/aches when re-warmed

30. • Skin looks waxy,
white, gray, yellow,
or bluish
• Area feels hard
• Swelling or
blisters
Severe
Frostbite

31. • Affected area
becomes painless
• After warming,
area becomes
swollen, blistered,
flushed, mottled
and cyanotic
Severe
Frostbite

32. Emergency Care for Frostbite
• Perform standard patient care
• Remove patient from environment
• Remove wet or constrictive clothing
• Check for hypothermia
• Protect the cold-injured area from further injury

33. Emergency Care for Frostbite con’t
• For early or superficial injury
• Manually stabilize and cover extremity
• Do not rub or massage area
• Prevent another exposure to cold
• For late or deep cold injury
• Remove constricting items
• Put dry gauze or fluffy cloth between frostbitten fingers or toes.
Protect area.

34. Emergency Care for Frostbite con’t
• Do not:
• Break blisters
• Rub or massage the area
• Apply heat
• Re-warm the area
• Allow patient to walk on affected extremity

35. Rewarming
Frostbite
• If help is delayed, rewarm severe frostbite by
immersing area in lukewarm water for 20 – 45
minutes
• Do this only if there is no risk of refreezing

36. Heat Emergencies
• Heat cramps
• Least serious and usually occurs first
• Heat exhaustion
• Develops when body becomes dehydrated
• Heatstroke
• Medical emergency
• If untreated, can cause death

37. Heat Emergencies con’t
• Most occur during hot weather but can also
occur in hot settings (furnace room, factory,
vehicle)
• Average of 400 deaths/year
• Heatstroke is progressive – starts with milder
symptoms

38. Signs and Symptoms of Heat Exhaustion
• Sweating, pale/ashen moist skin
• Thirst
• Fatigue, weakness, exhaustion
• Muscle cramps
Later signs and symptoms:
Headache, dizziness, fainting
Nausea, vomiting
Fast, shallow breathing
Rapid heart rate

39. Emergency Care for Heat Exhaustion
1. Move patient from
heat to rest in cool
place. Loosen or
remove clothing.
2. Give sports drink or
water
3. Raise legs 8-12
inches
4. Cool patient

40. Heatstroke vs. Heat Exhaustion
Heatstroke
• Victim’s skin is
flushed and feels hot
to touch
• Victim becomes
confused and
irrational and may
become unresponsive
or have convulsions
Heat Exhaustion
• Skin is pale, or ashen,
and clammy
• Victim dizzy or tired
or may be irritable
and have a headache

41. Signs and Symptoms of Heatstroke
• Skin is flushed, dry, hot
• Sweating usually has stopped
• Fast breathing
• Headache, dizziness, extreme confusion
• Irrational behavior
• Possible convulsions or unresponsiveness

42. Emergency Care for Heatstroke
• Perform standard patient care
• Move to a cool place
• Remove outer clothing
• Cool quickly with any means at hand
• Follow local protocol for oxygen
• Cool until temperature drops to 101°F (38.3°C)
• Do not apply rubbing alcohol to skin

43. Emergency Care for Heatstroke continued
• No pain relievers or salt tablets
• No caffeine or alcohol
• No liquids if nauseous, vomiting, diminished mental status
• Monitor patient and provide needed care
• Put unresponsive patient in recovery position

44. Diabetic Emergencies

45. Diabetic Emergencies
• Blood glucose levels not regulated by body
• Insulin needed for cells to use glucose
• When insulin level too low, glucose level too high
• Over 18 million people in U.S. have diabetes
• 5 million not diagnosed

46. Diabetic Emergencies
Hypoglycemia
• Person takes too much
insulin
• Person doesn’t eat
enough or right foods
• Uses blood sugar too
fast
• Exercise
• Emotional stress
Hyperglycemia
• Person takes too little
insulin
• Person eats too much
or wrong foods
• Does not use blood
sugar with activity

47. Assessing Diabetic Emergencies
• Perform the standard assessment
• During SAMPLE history ask about diabetes
• Look for a medical alert ID

49. Emergency Care for Low Blood Sugar
1. Confirm victim has diabetes. Look for medical ID.
2. Give victim sugar
3. Give more sugar after 15 minutes if victim still feels ill

50. Glucose Paste for Hypoglycemia
• If trained to use oral glucose paste or gel,
• Squeeze small amount onto tongue depressor
• Spread between cheek and gums
• Administer small doses until all used

51. Swallowed & Inhaled
Poisons

52. Swallowed Poisons
• Most cases of poisoning involve swallowed substances
• Effects may be immediate or delayed
• Give first aid as soon as possible
• Victim may be unresponsive, or confused and disoriented
• Most important thing is recognition

53. Assess the Situation
• Look for containers nearby or clue of substance
or product use
• Ask others at scene what happened
• Try to find out how much person may have
swallowed and how long ago

54. Signs and Symptoms:
Swallowed Poisons
• May look and feel ill
• Abdominal pain
• Nausea, vomiting, diarrhea
• Altered mental status, unresponsive
• Burns, stains, or odors around mouth
• Dilated or constricted pupils
• Abnormal breathing

55. Emergency Care for Swallowed Poison continued
• Perform standard patient care
• Emergency care depends on patient’s condition
• Follow local protocol for oxygen
• For unresponsive patient:
• Ensure EMS has been activated
• Check breathing and provide BLS
• Put breathing, unresponsive patient in recovery position

56. Emergency Care for Swallowed Poison continued
• For responsive patient:
• If mouth/lips burned by corrosive chemical,
rinse with cold water (without swallowing)
• Follow local protocol to call PCC/medical
direction

57. Emergency Care for Swallowed Poison continued
• For responsive patient:
• Don’t give food or drink unless instructed by
PCC/medical direction
• Don’t follow instructions on household
product labels

58. Poison Control Centers
• Provide information and treatment advice for all types of
poisonings
• Can be reached at 1-800-222-1222
• Has more accurate information
• Follow local protocol re: calling the PCC/medical direction or
waiting for EMS
• Can advise on prevention

59. • Gases and fumes at
home and work
• Examples are paints,
thinners, and chemicals
Inhaled Poisons

60. • Include gases that may
escape from pipelines
or transport tanks
• If you smell gas or
there’s evidence of
leak, stay away
• Allow hazardous
materials team to
handle
Inhaled Poisons

61. Carbon Monoxide
• Invisible, odorless, and tasteless
• May be present from exhaust, faulty furnace, kerosene
heater, industrial equipment, fireplace, wood stove, fire
• Exposure to large amounts can be lethal
• Exposure to small amounts may cause gradual poisoning

62. Assessing Inhaled Poisoning
• Perform the standard assessment
• Do not enter scene without protection

63. Signs and Symptoms of Inhaled Poison
• Breathing difficulty
• Headache
• Dizziness, lightheadedness, confusion, weakness
• Nausea, vomiting
• Chest pain
• Convulsions
• Changing levels of responsiveness

64. Emergency Care for Inhaled Poisoning
• Perform standard patient care
• Immediately move patient to fresh air
• Monitor breathing and vital signs, give BLS
• Put unresponsive patient in recovery position
• Loosen tight clothing

65. Alcohol and Drug
Emergencies

66. Assessing Alcohol and Drug Emergencies
• Perform the standard assessment
• Question patient/others at scene. Give information to
arriving EMS
• Assess for injuries or illness. Don’t assume alcohol/drug is
only factor involved

67. Signs and Symptoms of Alcohol Poisoning
• Smell of alcohol about person
• Flushed, moist face
• Vomiting
• Slurred speech, staggering
• Fast heart rate
• Impaired judgment and motor skills
• Agitated or combative behavior
• Changing levels of responsiveness, coma

68. Signs and Symptoms of
Drug Abuse or Overdose
• Similar to alcohol poisoning
• Dilated or constricted pupils
• Stumbling, clumsiness, drowsiness, incoherent
speech
• Difficulty breathing (very slow or fast)
• Changing levels of responsiveness
• Unusual or erratic behavior
• Agitated or combative behavior
• Presence of drug paraphernalia

69. Emergency Care for Alcohol and Drug Emergencies
• Perform standard patient care.
• For a responsive patient:
• Protect patient from injury
• Don’t let patient lie on back
• Care for any injuries
• Follow local protocol to call PCC

70. Emergency Care for Alcohol and Drug Emergencies
continued
• For an unresponsive patient:
• Position patient in recovery position (preferably on left
side)
• Be prepared for vomiting
• Give BLS if needed
• Keep patient warm in cold environments

71. Emergency Care for Alcohol and Drug Emergencies
continued
• For injured intoxicated patient:
• Don’t rely on patient’s perception of injury
• Give care as for unresponsive patient
• If possible spinal injury, don’t move patient

72. Bites and Stings

73. Snakebites
• Poisonous snakes include:
• Rattlesnakes
• Copperheads
• Water moccasins
(cottonmouths)
• Coral snakes

74. Poisonous Bites and Stings continued
• Spiders
• Black widow
• Brown recluse
• Some scorpion species
• Portuguese man-of-war and some jellyfish
• Stings from bees, wasps, etc. can cause life-
threatening in patients with severe allergies

75. Assessing Bites and Stings
• Perform the standard assessment
• Try to identify the biting or stinging creature, but do not
capture it
• Check skin for signs of a bite/sting

76. Signs and Symptoms of Many Bites and Stings
• Pain/burning, redness and swelling at site
• Depending on the species:
• Difficulty breathing
• Numbness or muscle paralysis

77. Signs and Symptoms of Many Bites and Stings
• Depending on the species:
• Nausea and vomiting
• Blurred vision
• Drowsiness or confusion, weakness
• Signs of shock
• Possible allergic reaction

78. Emergency Care for Bites and Stings
• Perform standard patient care
• Have patient lie down and stay calm
• Wash wound with soap/water
• Remove jewelry/tight clothing before swelling begins
• Don’t use tourniquet

79. Emergency Care for Bites and Stings continued
• Don’t cut wound or suck venom
• Remove the stinger and venom sac by scraping it gently
• Watch for allergic reaction
• Treat for shock

80. • Place unresponsive patient in recovery position
• Monitor vital signs
• Give BLS as needed
Emergency Care for Bites and Stings
continued

81. Allergic Reactions

82. Allergic Reactions
• Anaphylaxis is a severe allergic reaction
• Airway may swell, making breathing difficult or impossible
• Signs and symptoms may begin within seconds
• The more quickly it occurs, the more serious

83. Causes of Anaphylaxis
• Common allergens:
• Certain drugs
• Certain foods
• Insect stings and bites

84. Signs and Symptoms of Anaphylaxis
• Early signs and symptoms:
• Skin flushing, itching/burning, rash
• Swelling of face, neck, puffy eyes
• Sneezing, watery eyes and nose
• Coughing or a feeling of a tickle or lump in the throat that
persists
• Nausea, vomiting

85. Signs and Symptoms of Anaphylaxis continued
• Developing signs and symptoms:
• Anxiety, agitation
• Feel throat is closing, chest is tight
• Rapid, weak pulse
• Difficulty breathing
• Coughing, wheezing, or hoarseness

86. Signs and Symptoms of Anaphylaxis continued
• Developing signs and symptoms:
• Altered mental status
• Severe headache
• Weakness or dizziness
• Pale or ashen skin or cyanosis

87. Emergency Care for Anaphylaxis
• Perform standard patient care
• Follow local protocol
• Help into easiest breathing position
• Put a breathing, unresponsive patient in the recovery
position

88. • May be carried by people with severe allergies
• Medication stops anaphylactic reaction
• Ask a patient about it
• Help patient open and use kit
Emergency Epinephrine Kit

89. Using an EpiPen®
• Remove from its case
and remove cap
• Press tip firmly against
the outer thigh,
• Hold tip in place 5 to 10
seconds. Properly
dispose of injector
• Massage injection site

90. Abdominal Pain

91. Severe Abdominal Pain
• May result from medical condition
• Not necessary to determine the cause

92. Emergency Care for Severe Abdominal Pain
• Perform standard patient care
• Follow local protocol re: oxygen
• Put patient in position of comfort
• Be prepared for vomiting
• Don’t give food or drink

93. Behavioral Emergencies

94. Behavioral Emergencies
• Process of giving emergency care may be complicated by
patient’s behavior
• Many injuries/medical emergencies may cause altered
mental status or emotional responses
• Patients may have emotional problems
• Patient may be a danger to self or others

95. Common Causes of Altered Behavior
• Situational stresses
• Illness or injury
• Low blood sugar, oxygen levels
• Inadequate blood flow to brain
• Head trauma
• Temperature extremes

96. Common Causes of Altered Behavior
• Poisoning; mind-altering substances
• Seizures
• Stroke
• High fever
• Psychiatric problems

97. Assessing Behavioral Emergencies
• Perform standard assessment
• Assess mental status by observing:
• Appearance
• Actions
• Speech
• Orientation for time, person, and place

98. Signs That Violent
Behavior May Occur
• Person holding weapon
or something that can
be used as weapon
• Person in threatening
posture
• Person is verbally
abusive, threatening

99. Signs That Violent
Behavior May Occur
• Person uncontrollably
angry, kicking, or
throwing things
• Person known to be
violent

100. Suicide Risk Factors
• Mental disorders (including depression)
• History of substance abuse
• Feelings of hopelessness
• Recent emotional crisis or painful illness
• Impulsive or aggressive tendencies
• Previous attempts

101. Suicide Warning Signs
• Talking about suicide
• Comments about hopelessness or
worthlessness
• Taking risks that could cause death
• Loss of interest in past activities
• Suddenly and unexpectedly seeming calm or
happy after being sad

102. Emergency Care for Behavioral Emergencies
• Perform standard patient care
• Do not leave patient alone
• Consider need for law enforcement
• Be prepared to leave scene
• Give medications/drugs to arriving EMS
• Don’t assume the patient is drug impaired

103. Emergency Care for Behavioral Emergencies
continued
• Calm and reassure the patient
• Identify yourself
• Say you are there to help
• Ask patient for name, and use it
• Tell patient what you plan to do

104. Emergency Care for Behavioral Emergencies
continued:
• Ask questions in calm, reassuring voice
• In cultures where acceptable, make eye contact
• Let patient tell you what happened and what troubles him or
her
• Rephrase or repeat what patient says

105. Emergency Care for Behavioral Emergencies
continued
• Acknowledge patient's feelings
• Maintain a comfortable distance
• Avoid unnecessary physical contact
• Do not make quick moves
• Respond honestly to questions
• Don’t threaten, challenge, or argue
• Don’t "play along" with hallucinations
• Involve family members or friends

106. Restraining Patients
• If patient is danger to self or others
• Most First Responders do not restrain patients
• Restrain only if you have been trained and it is part of local
protocol
• Before using restraint, have police present and work with
responding EMS

107. Restraining Patients continued
• Avoid unreasonable force. Use only as much
force as needed to keep the patient from
injuring himself or others
• Use reasonable force to defend yourself
• Avoid acts or physical force that may injure
patient

108. Reasonable Force for Restraints Depends On:
• Patient's size, strength, and gender
• Patient’s abnormal behavior
• Patient’s mental state
• Method of restraint

109. Legal Considerations in Behavioral Emergencies
• Patients may threaten or falsely accuse
responders
• Document abnormal behavior factually
• Ensure others are present (witnesses)
• When possible, have same-sex responders
provide care

110. Emotionally Disturbed Patients Resisting
Treatment
• Get patient’s consent, witnessed by others
• If patient threatens self-harm or you believe
this may occur, provide care against patient's
will if safe to do so
• Assistance of law enforcement usually required