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.
Other drugs used include atropine, digoxin (Lanoxin), nitroglycerin (Nitrostat), lidocaine (Xylocaine), and sodium bicarbonate. Atropine reduces secretions, increases the respiratory rate and heart rate, and is a smooth muscle relaxant. It is administered in a cardiac emergency for asystole, or it can be used to treat bradycardia. Digoxin is a cardiac drug used to treat arrhythmia and congestive heart failure (CHF); it is good for emergency use because it has a relatively rapid action. Nitroglycerin is a vasodilator that is given to relieve angina; it acts by dilating the coronary arteries so that an increased volume of oxygenated blood can reach the myocardium. Lidocaine is used intravenously to treat a cardiac arrhythmia and locally as an anesthetic, and sodium bicarbonate corrects metabolic acidosis, which typically occurs after cardiac arrest. Many of the medications administered during a medical emergency are given intravenously (IV), which is outside of the medical assistant’s scope of practice.
Emergency medical supplies also should include an emetic, such as syrup of ipecac, which causes vomiting soon after the syrup is swallowed, and activated charcoal, an antidote that is swallowed to absorb ingested poisons. Narcan, an antidote given intravenously for narcotic drug overdoses, is administered when indicated to raise blood pressure and increase the respiratory rate. Antihistamines for the treatment of allergic reactions and for anaphylaxis need to be available to treat any allergic responses to medications administered in the facility. Such antihistamines include Benadryl for minor reactions and Solu-Medrol, a corticosteroid, for severe anaphylactic reactions.
Other medications also may be found in a crash cart. For example, isoproterenol (e.g., Isuprel, Medihaler-Iso, Norisodrine), an antispasmodic used to treat bronchospasms (e.g., as in an asthma attack), also is effective as a cardiac stimulant. Phenobarbital and diazepam (Valium) are used for convulsions and/or sedative effects. Furosemide (Lasix) is used for CHF. Glucagon is used primarily to counteract severe hypoglycemic reactions (low blood glucose) in patients with diabetes who are taking insulin.
Basic emergency supplies
Equipment:
- Adhesive tape in 1- and 2-inch widths
- Airways (variety of types and sizes)
- Alcohol wipes
- Ambu bag with assorted sizes of facial masks
- Antimicrobial skin ointment
- Bandage scissors
- Cotton balls and cotton swabs
- Cardiopulmonary resuscitation (CPR) masks (adult and pediatric)
- Defibrillator
- Elastic bandages in 2- and 3-inch widths
- Filter needles
- Flashlight with batteries
- Gauze pads, 2 × 2- and 4 × 4-inch widths, and roller bandage (sterile and nonsterile)
- Gloves (sterile and nonsterile) in multiple sizes
- Hot and cold packs (instant type)
- Intravenous catheters, tubing, solutions (variety of types, including D5W and Ringer’s lactate), and tourniquet
- Laryngoscope with blades
- Lubricant
- Endotracheal tubes (variety of sizes with stylets)
- Personal protective equipment (PPE), including impervious gowns, splash guards or goggles, and booties
- Portable oxygen tank with regulator, mask, and nasal cannula
- Roller gauze (Ace bandages and gauze dressing) in various sizes
- Sharps container
- Sphygmomanometer (pediatric and adult regular and large sizes)
- Splints (various sizes)
- Sterile dressings (miscellaneous sizes, including two abdominal pad
- Steri-Strips, dermal glue, or suturing material
- Suction machine and catheters
- Syringes and needles (assorted sizes and gauges
- Tongue blades
- Tubex cartridge system
- Venipuncture supplies and butterfly units
Medications
- Activated charcoal (bottle of 29 to 50 g)
- Antihistamine (injectable and oral)
- Atropine
- Dextrose
- Diazepam (Valium)
- Digoxin (Lanoxin), injectable
- Diphenhydramine (Benadryl)
- Epinephrine (Adrenalin), injectable
- Furosemide (Lasix)
- Glucagon and/or glucose tablets
- Ipecac syrup
- Isoproterenol (Isuprel), injectable
- Lidocaine (Xylocaine), injectable and spray
- Naloxone (Narcan), injectable
- Nitroglycerin tablets
- Phenobarbital, injectable
- Sodium bicarbonate, injectable
- Methylprednisolone (Solu-Medrol), injectable
- Sterile water and saline for injection
Some offices may now include Narcan in their emergency kits/carts.
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 children 1 to 8 years of age (it should not be used on infants younger than 1 year old). These systems deliver a reduced shock dose for victims up to about 8 years old or weighing 55 pounds.
- 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.