Emergency
Procedures
911
Module 12
Signs and symptoms of
Distress
A. Myocardial infarction (MI, heart attack)
1. A disruption of the flow of blood to an area of the muscle of the heart
with subsequent death of the tissue at that area.
Signs and symptoms of
Distress
2. Signs and symptoms
a. Chest pain.
1) May be described as crushing, squeezing, or pressure.
2) May radiate down arms or to jaw, back.
3) Complaint may be severe indigestion, heartburn, or
stomach pain.
Signs and symptoms of
Distress
b. Shortness of breath, Dyspnea or absence of breathing.
c. Diaphoresis.
d. Wet, cold, clammy skin.
e. Confusion, mental status change, anxiety.
f. Syncope, fainting.
g. Weakness, fatigue.
h. Nausea, vomiting.
i. Irregular pulse
Signs and symptoms of
Distress
3. Nurse Assistant Role
a. Call for help loudly and pull the emergency/call light if available.
b. Remain calm.
c. Stay with the resident.
d. Place resident in comfortable position (some heart attack victims can
breathe easier in a sitting rather than lying position)
Signs and symptoms of
Distress
e. Reassure the resident.
f. Intervene at level of competence as directed by licensed nurse.
g. Assess condition and vital signs while awaiting assistance from
licensed nurse.
h. Keep the resident warm as needed.
Signs and symptoms of
Distress
B. Cardiac Arrest
1. Absence of heart function.
2. Signs and symptoms
a. No Pulse, no circulation.
b. Loss of consciousness.
c. No effective breathing (may be agonal breathing).
d. Enlargement of pupils.
e. Gray color to skin, cyanotic nail beds
Signs and symptoms of
Distress
C. Cerebrovascular accident (CVA, Stroke, or brain attack)
1. A disturbance or obstruction of the flow of blood to a particular area
of the brain with subsequent death of tissue.
2. Signs and Symptoms
a. Hemiplegia or weakness of one side of the body or numbness or tingling on one side of the body.
b. Aphasia-difficulty in speaking or understanding speech.
c. Headache.
d. Vision changes, blurred vision, pupils unequal.
Signs and symptoms of
Distress
e. Facial changes
1) Cheeks may “puff “on exhalation.
2) One eyelid or eye may droop.
3) Face may appear asymmetrical.
4) Drooling.
f. Loss of bowel or bladder control.
g. Shaking or trembling.
Signs and symptoms of
Distress
3. Give Me 5 for Stroke Tool from American Stroke Association
a. Walk (Is their balance off?)
b. Talk (Is their speech slurred or is their face droopy?)
c. Reach (Is one side weak or numb?)
d. See (Is their vision all or partly lost)
e. Feel (Is their headache severe?)
Signs and symptoms of
Distress
4. FAST from American Stroke Association
a. Face drooping.
b. Arm weakness.
c. Speech difficulty.
d. Time to call 9-1-1
Signs and symptoms of
Distress
5. Nurse Assistant Role
a. Call for help loudly and pull emergency call light if available.
b. Remain calm
c. Stay with the resident.
d. Place resident in a position of comfort.
Signs and symptoms of
Distress
e. Reassure resident.
f. Intervene at level of competence as directed by the licensed
nurse.
g. Assess resident’s condition and take vital signs while awaiting
assistance from the licensed nurse.
h. Keep resident warm as needed.
Signs and symptoms of
Distress
D. Syncope, fainting episode
1. A feeling of dizziness with possible temporary loss of consciousness.
2. Signs and Symptoms
a. Dizziness.
b. Visual changes-temporary loss of vision.
c. Pallor or paleness of the skin.
Signs and symptoms of
Distress
d. Cool, moist skin.
e. Eyes may roll back.
f. Unsteadiness or loss of upright position (resident may fall).
g. Weak pulse.
Signs and symptoms of
Distress
3. Nursing Assistant Role
a. Before loss of consciousness and during dizziness
1) Remain calm, call for help loudly, pull call light.
2) Assist to floor, protect from injury.
3) If sitting, place head towards knees.
Signs and symptoms of
Distress
4) If lying flat on back, elevate legs slightly if no spinal, head or
back injuries (If unsure, leave flat on back).
5) Loosen tight or binding clothing.
6) Observe for any changes in condition.
Signs and symptoms of
Distress
b. After loss of consciousness
1) Raise legs approximately 8-12 inches if no spinal, head or back
injuries (If unsure, leave flat on back).
2) Loosen tight or binding clothing.
3) Observe for any changes in condition and monitor vital
signs while waiting for help to arrive
Signs and symptoms of
Distress
E. Seizures; convulsions or epilepsy
1. An interference with the normal electrical activity of the brain with
subsequent changes in mental status.
2. Types of seizures and related Signs and Symptoms
a. Absence or partial (petit mal) seizure
1) A mild blackout.
2) Looks as though daydreaming.
Signs and symptoms of
Distress
b. Generalized tonic-clonic or grand mal seizure
1) Uncontrolled muscular contractions.
2) Can be minimal to major with possible violent head jerking.
3) May be frothing at the mouth.
4) May be loss of bowel and bladder control
Signs and symptoms of
Distress
3. Nurse Assistant Role
a. Assist resident to ground safely.
b. Note time.
c. Cushion head.
d. Remain calm, call for help loudly, and pull emergency call light.
e. Stay with resident and observe
Signs and symptoms of
Distress
f. If possible, gently turn head to one side to reduce risk of choking (This
may not be possible in a violent seizure).
g. Loosen clothing and/or jewelry.
h. Pad any items that may be dangerous to the resident or move items
away from resident (i.e. furniture).
i. Do NOT attempt to restrain nor put anything into resident’s mouth.
j. Note time seizure ends.
k. Follow licensed nurse instructions to assist with putting resident into
recovery position.
Signs and symptoms of
Distress
F. Insulin Shock
1. Definition
a. Hypoglycemia.
b. Condition resulting from an overdose of insulin resulting in
reduction of the blood sugar level below normal.
c. May develop due to an insulin-dependent resident skipping meals
or snacks, to much insulin, stress, diarrhea and vomiting or possible
medication reaction.
Signs and symptoms of
Distress
2. Signs and Symptoms
a. Pale, moist skin.
b. Rapid bounding pulse.
c. Headache, confusion, weakness.
d. Anxiety, excitement.
e. Hunger.
f. Low blood pressure (hypotension).
g. Unconsciousness.
Signs and symptoms of
Distress
3. Nurse Assistant Role
a. Stay with resident.
b. Remain calm, call for help loudly, and pull emergency call light.
c. Administer orange juice, milk, or snack if instructed by licensed
nurse.
Signs and symptoms of
Distress
G. Hemorrhaging, severe bleeding
1. An extreme or unexpected loss of blood.
2. Signs and Symptoms a. External bleeding
1) Bleeding in spurts (arterial).
2) Steady flow of blood (venous).
3) Slow oozing of blood (capillary).
b. Internal bleeding
1) Coughing up bright red blood.
2) Vomit that has the appearance of coffee grounds.
3) Blood in urine or stool (stool may be black and tarry in appearance).
Signs and symptoms of
Distress
3. Nurse Assistant Role
a. Remain calm, call for assistance loudly, and pull emergency call light.
b. Stay with resident.
c. Observe standard precautions, wear gloves.
d. Apply direct pressure, with gauze pad, over area that is bleeding.
e. Elevate affected limb.
f. Do not offer food or drink.
g. Keep resident calm and cover to keep warm.
H. Shock
Signs and symptoms of
Distress
1. Failure of the cardiovascular system to provide sufficient blood circulation to every part of
the body.
2. Signs and Symptoms
a. Skin pale, cold and clammy, or moist.
b. Pulse rapid (over 100) and weak; low or falling blood pressure.
c. Respiration shallow, irregular, or labored.
d. Eyes dull and lackluster.
e. Nausea, vomiting, and/or thirst.
f. Confusion, anxiety, restlessness.
g. May collapse (faint)
Signs and symptoms of
Distress
3. Nurse Assistant Role
a. Remain calm, call for help loudly, and pull emergency call light.
b. Stay with resident, give reassurance.
c. Maintain an open airway (head tilt-chin lift or modified chin lift).
d. Do not give food or drink.
e. Cover resident to keep warm.
Signs and symptoms of
I. Respiratory Distress
Distress
1. Increase or decrease in the effort and frequency of breathing movements.
2. Signs & Symptoms
a. Shortness of breath (SOB).
b. Cyanosis.
c. Dyspnea.
d. Hyper/Hypoventilation.
e. Hypoxia.
f. Bradypnea/Tachypnea.
g. Anxiety confusion.
Signs and symptoms of
Distress
3. Nursing Assistant Role
a. Stay with resident.
b. Elevate HOB, or allow resident to assume position of comfort.
c. Remain calm, call for help and pull emergency call light.
d. Reassure/calm resident.
e. Assess vital signs while awaiting assistance from licensed nurse.
f. Be prepared to gather equipment as instructed by nurse; i.e., oxygen tank
and tubing.
immediate interventions
in a medical
A. Advance directives emergency.
1. Signed document with instructions for care if you become unable to
make medical decisions (if you are in a coma, for example).
2. Full code.
3. Do Not Resuscitate (DNR).
4. Living will.
5. Durable Power of Attorney for Healthcare.
immediate interventions
in a medical emergency.
B. Immediate interventions
3. Perform CPR only if trained
a. Check to see if resident is conscious.
b. Circulation
1) Check for circulation by feeling for a pulse, palpating the carotid artery.
2) If no definite pulse within 10 seconds, give chest compressions.
c. Airway
1) Open the airway if resident unconscious.
2) Use head tilt, chin lift or modified chin lift.
immediate interventions
in a medical emergency.
d. Breathing
1) Check for breathing by looking, listening and feeling.
2) Give two full breaths using a barrier device (pocket mask).
3) A mask must be used by the Nurse Assistant to do rescue breathing.
e. Circulation
1) Check for circulation by feeling for a pulse, palpating the carotid artery. 2) If no definite
pulse within ten seconds, give chest compressions.
immediate interventions
in a medical
f. Sequence; continue per currentemergency.
standards with 30 compressions to 2
ventilations (30:2).
C. General guidelines for a emergency situation with a resident
1. Stay calm.
2. Call for help – gain assistance of licensed nurse.
3. Charge nurse will initiate EMS system by calling 911.
immediate interventions
in a medical emergency.
4. Remain with resident.
5. Intervene at level of competence as directed by licensed nurse.
6. Reassure/calm resident.
7. Emergency/crash cart; knowing the location of the crash cart is mandatory at most
facilities.
8. Automated External Defibrillator (AED)
a. Be aware of AED location.
b. Chance of survival is greater with early defibrillation.
c. Must be trained to use defibrillators.
Choking
A. Airway obstruction or choking can lead to cardiac arrest.
B. Causes
1. Foreign body – such as poorly chewed pieces of meat.
2. Tongue – in the unconscious resident the tongue can fall backward in
the throat and block the airway.
3. Small objects.
4. Vomitus – aspiration of vomit.
5. Thick mucus.
6. Dentures
Choking
C. Signs of choking
7. Respiratory difficulty – victim cannot breathe.
8. High pitched sounds.
9. Inability to speak or cough.
10. Universal choking sign – victim clutches throat.
D. Abdominal thrusts (Heimlich maneuver) are used to
relieve, obstructed airway in a conscious victim.
E. Chest compressions are used if the victim is unconscious
and rescuer is unable to ventilate.
Common Emergency Codes
A. Emergency code colors and meanings
1. Code Red – fire.
2. Code Blue – adult medical emergency (Cardiac or Respiratory).
3. Code Yellow –bomb threat.
4. Code Gray – combative person.
5. Code Silver – person with weapon or hostage.
6. Code Orange – hazardous waste spill or release.
B. Codes may vary according to facility.
C. Observe special consideration for hearing and sight impaired residents.