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Textbook
Introduction
1. Medical assistant
2. Electronic records
3. Medical terminology and anatomy
4. The fundamentals of infection control
5. Introduction to vital signs
6. The patient interview and history
7. The physical examination
8. Appointment scheduling
9. Insurance billing
10. Diagnostic coding and the ICD-10-CM System
11. Procedural coding
12. Medical billing and reimbursement essentials
13. Assisting with medical specialties
14. Assisting with the musculoskeletal system
15. Assisting with the cardiovascular system
16. Assisting with the respiratory system
17. Assisting with the nervous system
18. Anatomy and physiology of the urinary system
19. Assisting in obstetrics and gynecology
20. Assisting in endocrinology
21. Assisting in ophthalmology & otolaryngology
22. Assisting in gastroenterology
23. Assisting in the immune & lymphatic systems
24. Assisting in pediatrics: the developmental stages and care
25. The medical assistant’s role in caring for the older patient
26. The role of the medical assistant in physical therapy examination and assessment
27. Preparing for minor surgery: room, solutions, and supplies
28. Introduction to the clinical laboratory
29. Urinalysis
30. Blood collection
31. Analysis of blood
32. Electrocardiography and heart structure
33. The principles of pharmacology
34. Essential calculations and measurement systems
35. Solid, liquid, & solutions medication doses
36. Administering medications
37. Metabolism and core nutrient roles
38. Medical emergencies in the healthcare setting
38.1 Safety and hazardous waste disposal in the healthcare facility
38.2 Emergency preparedness and community response
38.3 Assisting with medical emergencies
38.4 Management of emergencies (Initial assessment and unresponsive patient care)
38.5 Cardiac emergencies and choking
38.6 Stroke and shock
38.7 Common office emergencies
38.8 Pain and traumatic injury management
38.9 Special needs, metabolic, and final review
38.10 Diabetic emergencies, patient education, and professional issues
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38.6 Stroke and shock
Achievable CCMA
38. Medical emergencies in the healthcare setting

Stroke and shock

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Cerebrovascular accident (stroke)

A cerebrovascular accident (CVA), or stroke, is a disorder of the cerebral blood vessels that results in impairment of the blood supply to part of the brain. This interruption in normal circulation of blood through the brain leads to some degree of neurologic damage, temporary or permanent, depending on the severity of oxygen deprivation to the brain cells.

Scope of practice: During a stroke or shock emergency, the medical assistant’s role is to recognize the signs, activate EMS, provide basic first aid, and monitor and record vital signs for the provider. Definitive treatment - such as administering thrombolytics - is performed by the provider, and exactly which first-aid tasks an MA may carry out is set by state delegation laws and the supervising provider’s standing orders.

A minor stroke, or transient ischemic attack (TIA), usually does not cause unconsciousness, and symptoms depend on the location of the circulatory problem in the brain and the amount of brain damage. TIA symptoms are temporary and may include headache, confusion, vertigo, ringing in the ears (tinnitus), temporary paralysis or weakness of one side of the body, transient limb weakness, slurred speech, and vision problems. TIA episodes indicate that the patient is at risk for a major stroke.

Symptoms of a major stroke include unconsciousness, paralysis on one side of the body, difficulty breathing and swallowing, loss of bladder and bowel control, unequal pupil size, and slurring of speech.

Home recommendations for a patient who has suffered a major stroke should begin with notifying the provider and/or activating EMS. Keep the patient lying down and lightly covered. Maintain an open airway. To prevent choking, position the head so that any secretions drain from the side of the mouth. If the patient is lying on the floor, did not fall, and shows no indications of a head or neck injury, he or she can be placed in the recovery position as follows:

  1. Place the patient’s arm that is farthest from you alongside and above the head; place the other arm across the chest.
  2. Bend the leg that is closest to you, and after placing one arm under the patient’s head and shoulder and the other hand on the flexed knee, roll the patient away from you while you stabilize the head and neck. The patient’s head should be resting on the extended arm.

The recovery position uses gravity to drain fluids from the mouth and keep the trachea clear. Keep the patient in this position until the person is alert or help arrives. Do not give the patient anything to eat or drink. Vital signs should be measured at regular intervals and recorded for the provider.

Advances in early treatment of strokes show great promise in preventing long-term neurologic deficits. However, to prevent permanent brain damage, thrombolytics must be administered intravenously within 3 hours of the onset of symptoms. If a patient does not know when the symptoms began (e.g., the person woke up with the symptoms) or cannot accurately tell the provider when the symptoms started, the time allotted for administration begins from the point at which the patient last was known to be asymptomatic. Intracranial hemorrhage must be ruled out before treatment begins. The earlier the treatment starts, the better the neurologic outcomes. The best possible outcomes are seen in patients who receive thrombolytic therapy within 90 minutes of the onset of symptoms.

Warning signs of stroke: FAST

The American Stroke Association developed the mnemonic FAST to help people spot the signs of a sudden stroke. If any of these are present, 911 should be called immediately.

Face drooping

  • Does one side of the face droop or is it numb?
  • Ask the person to smile. Is the person’s smile uneven?

Arm weakness

  • Is one arm weak or numb?
  • Ask the person to raise both arms. Does one arm drift downward?

Speech difficulty

  • Is speech slurred? Is the person unable to speak or hard to understand?
  • Ask the person to repeat a simple sentence, such as, “The sky is blue.” Is the sentence repeated correctly?

Time to call 911

  • If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Note the time the first symptoms appeared.

Shock

Shock is a state of collapse caused by failure of the circulatory system to deliver enough oxygenated blood to the body’s vital organs. Injury, hemorrhage, infection, anesthesia, drug overdose, burns, pain, fear, or emotional stress can cause this physiologic reaction. Shock can be immediate or delayed, and it is potentially fatal. Many different types of shock can occur, but the signs and symptoms are universal. The most common indicators are a pale, gray, or cyanotic appearance; moist but cool skin; dilated pupils; a weak, rapid pulse; marked hypotension; shallow, rapid respirations; lethargy or restlessness; nausea and vomiting; and extreme thirst.

If a patient shows signs of shock, maintain an open airway and check for breathing and circulation. Place the patient supine with the legs elevated approximately 1 foot to return the blood from the legs to vital organs. Loosen all tight clothing and cover the patient with a blanket for warmth. Do not move the patient unnecessarily. Do not give the patient anything to eat or drink, even if the patient is alert. Because shock can evolve into a life-threatening situation, only basic first aid should be administered, and the patient should be transported to the hospital as soon as possible.

Types and causes of shock

  • Anaphylactic: A severe allergic reaction
  • Insulin: Severe hypoglycemia caused by an overdose of insulin
  • Psychogenic or mental: Excessive fear, joy, anger, or emotional stress
  • Hypovolemic or hemorrhagic: Excessive loss of blood
  • Cardiogenic: Myocardial infarction, pulmonary embolism, or severe congestive heart failure
  • Neurogenic: Dilation of blood vessels as a result of brain or spinal cord injury
  • Septic: Systemic infection

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Stroke and shock

Cerebrovascular accident (stroke)

A cerebrovascular accident (CVA), or stroke, is a disorder of the cerebral blood vessels that results in impairment of the blood supply to part of the brain. This interruption in normal circulation of blood through the brain leads to some degree of neurologic damage, temporary or permanent, depending on the severity of oxygen deprivation to the brain cells.

Scope of practice: During a stroke or shock emergency, the medical assistant’s role is to recognize the signs, activate EMS, provide basic first aid, and monitor and record vital signs for the provider. Definitive treatment - such as administering thrombolytics - is performed by the provider, and exactly which first-aid tasks an MA may carry out is set by state delegation laws and the supervising provider’s standing orders.

A minor stroke, or transient ischemic attack (TIA), usually does not cause unconsciousness, and symptoms depend on the location of the circulatory problem in the brain and the amount of brain damage. TIA symptoms are temporary and may include headache, confusion, vertigo, ringing in the ears (tinnitus), temporary paralysis or weakness of one side of the body, transient limb weakness, slurred speech, and vision problems. TIA episodes indicate that the patient is at risk for a major stroke.

Symptoms of a major stroke include unconsciousness, paralysis on one side of the body, difficulty breathing and swallowing, loss of bladder and bowel control, unequal pupil size, and slurring of speech.

Home recommendations for a patient who has suffered a major stroke should begin with notifying the provider and/or activating EMS. Keep the patient lying down and lightly covered. Maintain an open airway. To prevent choking, position the head so that any secretions drain from the side of the mouth. If the patient is lying on the floor, did not fall, and shows no indications of a head or neck injury, he or she can be placed in the recovery position as follows:

  1. Place the patient’s arm that is farthest from you alongside and above the head; place the other arm across the chest.
  2. Bend the leg that is closest to you, and after placing one arm under the patient’s head and shoulder and the other hand on the flexed knee, roll the patient away from you while you stabilize the head and neck. The patient’s head should be resting on the extended arm.

The recovery position uses gravity to drain fluids from the mouth and keep the trachea clear. Keep the patient in this position until the person is alert or help arrives. Do not give the patient anything to eat or drink. Vital signs should be measured at regular intervals and recorded for the provider.

Advances in early treatment of strokes show great promise in preventing long-term neurologic deficits. However, to prevent permanent brain damage, thrombolytics must be administered intravenously within 3 hours of the onset of symptoms. If a patient does not know when the symptoms began (e.g., the person woke up with the symptoms) or cannot accurately tell the provider when the symptoms started, the time allotted for administration begins from the point at which the patient last was known to be asymptomatic. Intracranial hemorrhage must be ruled out before treatment begins. The earlier the treatment starts, the better the neurologic outcomes. The best possible outcomes are seen in patients who receive thrombolytic therapy within 90 minutes of the onset of symptoms.

Warning signs of stroke: FAST

The American Stroke Association developed the mnemonic FAST to help people spot the signs of a sudden stroke. If any of these are present, 911 should be called immediately.

Face drooping

  • Does one side of the face droop or is it numb?
  • Ask the person to smile. Is the person’s smile uneven?

Arm weakness

  • Is one arm weak or numb?
  • Ask the person to raise both arms. Does one arm drift downward?

Speech difficulty

  • Is speech slurred? Is the person unable to speak or hard to understand?
  • Ask the person to repeat a simple sentence, such as, “The sky is blue.” Is the sentence repeated correctly?

Time to call 911

  • If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Note the time the first symptoms appeared.

Shock

Shock is a state of collapse caused by failure of the circulatory system to deliver enough oxygenated blood to the body’s vital organs. Injury, hemorrhage, infection, anesthesia, drug overdose, burns, pain, fear, or emotional stress can cause this physiologic reaction. Shock can be immediate or delayed, and it is potentially fatal. Many different types of shock can occur, but the signs and symptoms are universal. The most common indicators are a pale, gray, or cyanotic appearance; moist but cool skin; dilated pupils; a weak, rapid pulse; marked hypotension; shallow, rapid respirations; lethargy or restlessness; nausea and vomiting; and extreme thirst.

If a patient shows signs of shock, maintain an open airway and check for breathing and circulation. Place the patient supine with the legs elevated approximately 1 foot to return the blood from the legs to vital organs. Loosen all tight clothing and cover the patient with a blanket for warmth. Do not move the patient unnecessarily. Do not give the patient anything to eat or drink, even if the patient is alert. Because shock can evolve into a life-threatening situation, only basic first aid should be administered, and the patient should be transported to the hospital as soon as possible.

Types and causes of shock

  • Anaphylactic: A severe allergic reaction
  • Insulin: Severe hypoglycemia caused by an overdose of insulin
  • Psychogenic or mental: Excessive fear, joy, anger, or emotional stress
  • Hypovolemic or hemorrhagic: Excessive loss of blood
  • Cardiogenic: Myocardial infarction, pulmonary embolism, or severe congestive heart failure
  • Neurogenic: Dilation of blood vessels as a result of brain or spinal cord injury
  • Septic: Systemic infection

More from Medical emergencies in the healthcare setting

  • Safety and hazardous waste disposal in the healthcare facility
  • Emergency preparedness and community response
  • Assisting with medical emergencies
  • Management of emergencies (Initial assessment and unresponsive patient care)
  • Cardiac emergencies and choking