Assisting with medical emergencies
First aid is the immediate care given to a person who has been injured or has suddenly taken ill. Knowledge of first aid and related skills often can mean the difference between life and death, temporary and permanent disability, or rapid recovery and long-term hospitalization. The medical assistant may be responsible for initiating first aid in the office and continuing to administer first aid until the provider or the trained medical team arrives. Every medical assistant should successfully complete a course for the professional in cardiopulmonary resuscitation (CPR) and should continue to hold a current CPR card as long as he or she is employed.
Basic knowledge of CPR and life support skills needs to be updated regularly, because procedures change as new techniques are developed. For example, both the American Red Cross and the American Heart Association (AHA) now recommend training on automated external defibrillators (AEDs) for all healthcare workers.
Medical assistants need up-to-date training in current emergency practices. They should encourage their local professional chapters to offer workshops on the management of emergencies in an ambulatory care practice, in addition to community-wide emergency preparedness. Being prepared for both types of emergencies is important. The facility’s employees must be ready to respond both to emergencies on site and to natural disasters or other emergencies that affect the community.
Medical assistants are not responsible for diagnosing emergencies, especially over the telephone, but they are expected to make decisions about emergency situations on the basis of their medical knowledge and training. If any doubt exists about how to manage a particular situation or emergency phone call, the medical assistant should not hesitate to consult the provider, the office manager, or some other, more experienced member of the healthcare team.
The medical assistant’s role in performing emergency procedures
- Perform only the emergency procedures for which you have been trained.
- If an emergency occurs in the facility, notify the provider.
- If a provider cannot be located, immediately contact the local emergency medical services team (EMS or 911).
Emergency supplies
Emergency supplies consist of a properly equipped “crash cart” or box of items needed for a variety of emergencies. The contents vary to some degree, depending on the types of emergencies the particular office might expect to encounter and whether pediatric patients are seen in the practice. Emergency supplies should be kept in an easily accessible place that is known to all personnel in the office, and the supplies should be inventoried regularly. Expiration dates of medications and sterile supplies must be checked weekly or monthly, along with the status of available oxygen tanks and related materials. The cart should be replenished with fresh supplies after every use. Each time crash cart supplies are checked, a log must be completed and signed for legal purposes.
Emergency pharmaceutical supplies should include certain basic drugs, such as epinephrine, which has multiple uses in emergency situations. As a vasoconstrictor, it controls hemorrhage, relaxes the bronchioles to relieve acute asthma attacks, is administered for an acute anaphylactic reaction, and is an emergency heart stimulant used to treat shock. Epinephrine should be available in a ready-to-use cartridge syringe and needle unit. These units are supplied in 1-mL cartridges.
The table below maps the other emergency drugs commonly stocked to their class or action and their main emergency use.
The following table lists common crash-cart emergency drugs, the drug class or action of each, and its main emergency use.
| Drug | Class or action | Emergency use |
|---|---|---|
| Atropine | Reduces secretions, increases respiratory and heart rate, smooth muscle relaxant | Asystole in a cardiac emergency; bradycardia |
| Digoxin (Lanoxin) | Cardiac glycoside — strengthens heart contractions and slows the heart rate; onset is slower than epinephrine, so it is not relied on for immediate resuscitation | Arrhythmia and congestive heart failure (CHF) |
| Nitroglycerin (Nitrostat) | Vasodilator — dilates the coronary arteries so more oxygenated blood reaches the myocardium | Relieves angina |
| Lidocaine (Xylocaine) | Antiarrhythmic (IV); local anesthetic | Cardiac arrhythmia; local anesthesia |
| Sodium bicarbonate | Neutralizes excess acid | Corrects metabolic acidosis, which typically occurs after cardiac arrest |
| Syrup of ipecac | Emetic — causes vomiting soon after it is swallowed | Induces vomiting after poison ingestion |
| Activated charcoal | Antidote — swallowed to absorb ingested poisons | Poisoning by ingestion |
| Narcan (naloxone) | Antidote for narcotic overdose; given IV to raise blood pressure and increase respiratory rate | Narcotic (opioid) overdose |
| Benadryl (diphenhydramine) | Antihistamine | Minor allergic reactions |
| Solu-Medrol | Corticosteroid | Severe anaphylactic reactions |
| Isoproterenol (Isuprel, Medihaler-Iso, Norisodrine) | Antispasmodic; also a cardiac stimulant | Bronchospasm (for example, an asthma attack) |
| Phenobarbital and diazepam (Valium) | Sedatives | Convulsions and/or sedation |
| Furosemide (Lasix) | Diuretic | CHF |
| Glucagon | Raises blood glucose | Severe hypoglycemic reactions in patients with diabetes who are taking insulin |
Many of the medications administered during a medical emergency are given intravenously (IV), and advanced airway equipment (a laryngoscope, endotracheal tubes) may be needed to support the patient; both IV administration and advanced airway management are outside the medical assistant’s scope of practice and are performed by the provider or paramedic team.
Basic emergency supplies
Equipment:
Airway and ventilation
- Airways (variety of types and sizes)
- Ambu bag with assorted sizes of facial masks
- Cardiopulmonary resuscitation (CPR) masks (adult and pediatric)
- Endotracheal tubes (variety of sizes with stylets)
- Laryngoscope with blades
- Portable oxygen tank with regulator, mask, and nasal cannula
- Suction machine and catheters
Cardiac monitoring and resuscitation
- Defibrillator
- Sphygmomanometer (pediatric and adult regular and large sizes)
IV therapy and venipuncture
- Filter needles
- Intravenous catheters, tubing, solutions (variety of types, including D5W and Ringer’s lactate), and tourniquet
- Syringes and needles (assorted sizes and gauges)
- Tubex cartridge system
- Venipuncture supplies and butterfly units
Wound care and immobilization
- Adhesive tape in 1- and 2-inch widths
- Antimicrobial skin ointment
- Bandage scissors
- Cotton balls and cotton swabs
- Elastic bandages in 2- and 3-inch widths
- Gauze pads, 2 × 2- and 4 × 4-inch widths, and roller bandage (sterile and nonsterile)
- Roller gauze (Ace bandages and gauze dressing) in various sizes
- Splints (various sizes)
- Sterile dressings (miscellaneous sizes, including two abdominal pads)
- Steri-Strips, dermal glue, or suturing material
- Hot and cold packs (instant type)
Infection control and PPE
- Alcohol wipes
- Gloves (sterile and nonsterile) in multiple sizes
- Personal protective equipment (PPE), including impervious gowns, splash guards or goggles, and booties
- Sharps container
General
- Flashlight with batteries
- Lubricant
- Tongue blades
Defibrillators
The medical assistant may be required to assist the healthcare team with defibrillation of emergency patients. Defibrillation is indicated when a patient is in ventricular fibrillation (VF). VF is a severe cardiac arrhythmia that is caused by uncoordinated, rapid firing of the electrical system of the heart, which makes it impossible for the ventricles to empty. In the absence of ventricular emptying, the patient has no pulse, blood pressure drops to zero, and the patient could die within 4 minutes unless help is given immediately.
Defibrillators are devices that send an electrical current through the myocardium by means of handheld paddles (in a healthcare facility) or self-adhesive pads applied to the chest. This electrical shock causes momentary asystole, giving the heart’s natural pacemaker an opportunity to resume the heart rate at a normal rhythm.
An automated external defibrillator has a computerized system that analyzes a cardiac rhythm and delivers voice-prompt instructions on how to operate the device. AEDs use self-adhesive pads that record and monitor the cardiac rhythm, and the device instructs the rescuer when to deliver the electrical charge. The apex-anterior position is the most commonly used pad position, with the anterior (sternum) pad placed to the right of the upper sternum, and the apex pad placed under the individual’s left nipple at the left middle axillary line. To defibrillate a female individual, the apex pad is placed next to or underneath the left breast. The AED self-adhesive pads are packaged with expiration dates so these should be checked periodically.
Precautions for automated external defibrillators
- Neither the individual nor the rescuer should be in contact with any metal during defibrillation. Do not place the AED pad over jewelry, and remove the patient’s glasses to prevent injuries.
- When available, a pediatric-dose AED system should be used for infants and children younger than 8 years of age. These systems deliver a reduced shock dose for victims up to about 8 years old or weighing 55 pounds. For an infant younger than 1 year, a manual defibrillator is preferred; if one is not available, use a pediatric-dose AED, and if neither is available, a standard AED may be used.
- All clothing (including bras) must be removed; pads must be applied directly to the skin. If the individual has a great deal of hair on the chest, try to push the hair aside before applying the pads; or, apply the pads and quickly remove them to remove hair from the area, then reapply new pads. The machine will prompt you by stating “Check electrode” if the connection is poor.
- To prevent burns, make sure the individual is lying on a dry surface and the chest is dry before applying the pads.
- If the patient has an implanted defibrillator or pacemaker, it will be obvious from the bulged area under the surface of the skin on the chest. Apply the AED pads at least 1 inch away from implants to prevent interference.