Surry County Health & Nutrition Center. Medical Emergency Response Policy

Transcription

1 Surry County Health & Nutrition Center Medical Emergency Response Policy Manual: Agency Program Policy Program Procedure Management/Department-wide Policy Personnel/Fiscal Policy Effective Date: 6/09 Revised: 7/10; 11/10 Reviewed: 2/11 Applicable Signatures/Title Program Director: Supervisor: Supervisor: Director of Nursing: Medical Director: Health Director: Board of Health Chair: QA Coordinator: Reviewed by QA Committee Policy: Surry County Health & Nutrition Center personnel will be able to provide initial evaluation and response to an emergency, manage life threatening symptoms, and cooperate in referring and/or transporting the patient to an advanced provider of care as may be necessary. To accomplish this, the Health & Nutrition Center staff will be prepared to respond to the following emergencies: a) Cardiac Arrest b) Respiratory Arrest c) Hemorrhage d) Anaphylaxis e) Shock f) Hypertensive Crisis g) Seizures This policy was developed in cooperation with emergency service providers, hospitals, and physicians, and includes professional responsibilities, training of staff, emergency care protocols, emergency referral resources, personnel assignments, notification of EMS, equipment and supplies, medication inventory for emergency cart in order to maintain adequate supplies and expiration dates, and routine inventory of emergency equipment to ensure proper functioning. It is not envisioned that the Health & Nutrition will be able to provide emergency care comparable to a hospital emergency room, but rather it is expected that Health & Nutrition Center personnel will be able to provide initial evaluation and response to an emergency. All clinic personnel shall complete a CPR course and maintain certification. Emergency equipment will be stored in a standard location as follows: a) AED, Emergency Cart and O2 equipment will be stored in the first interview room past immunization clinic. b) EKG machine will be stored in the first exam room in Primary Care Clinic. c) Pediatric emergency cart, AED, and O2 equipment will be stored in the lab area Purpose: To reduce the incidence of adverse health consequences of patients receiving Health & Nutrition Center services; to reduce the long term health costs and economic impact caused by Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 1

2 delay in appropriate management of life threatening emergencies; to provide a quality service to Health & Nutrition Center patients that is equal to the services of other health care providers. Definitions: EMS: Emergency Medical Services AED: Automated External Defibrillator O2: Oxygen EKG: Electrocardiogram AHA CPR: American Heart Association Cardiopulmonary Resuscitation Shock: Failure of the cardiovascular system to provide sufficient blood supply to all parts of the body Hypertensive Crisis: Serious complication of hypertension signaled by sudden marked rise in blood pressure to levels greater than 200/130mm Hg and characterized by severe headache, nausea, vomiting, followed by seizures, confusion, stupor, and finally, coma. VAERS: Vaccine Adverse Event Reporting System Applicable Rules, Laws, and References: Epidemiology and Prevention of Vaccine Preventable Diseases, DHHS, CDC & Prevention, 10 th edition, pp.d-27 and D-29, rev. 2/08; Immunization Clinic Manual; Procedures: 1. Cardiac Arrest a. Call for help, when help arrives, they will call switchboard operator to page medical emergency and location, and then dial b. The first response team will respond to the emergency. c. The first response team will bring the emergency equipment d. The first response team will perform AHA CPR as directed by the Medical Director or by another provider on the scene until emergency personnel arrives. 2. Respiratory Arrest a. Call for help, when help arrives, they will call switchboard operator to page CODE GREEN and location and then dial b. The first response team will respond to the scene with the emergency equipment. c. The first response team will maintain airway and assisted breathing as necessary until EMS arrives. 3. Bleeding/Hemorrhage a. Call for help, when help arrives, have them call the switchboard operator to page medical emergency and location, and then dial 9-911, if necessary, for hemorrhage. b. The first response team will arrive with the emergency equipment. First response team will apply a firm pressure dressing. They will elevate the injured area to stop venous and capillary bleeding. Immobilize an injured extremity to control blood loss. c. If there is a small amount of bleeding, and the above measures control and stop the bleeding, the patient may be transferred by car to the physician of choice or to the emergency room as needed. If there is hemorrhaging that involves a large amount of blood loss, stabilize the patient as much as possible and call for transport to the nearest hospital. Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 2

3 4. Anaphylactic (allergic) reactions. Signs and symptoms: Sudden or gradual onset of itching, erythema (redness), urticaria (hives), angioedema (swelling of the face, lips, or throat), bronchospasm (wheezing), shortness of breath, shock, abdominal cramping, or cardiovascular collapse. Call for help. When help arrives, have them call switchboard to page Medical Emergency and location, and then call a. The first response team will establish and maintain adequate airway. b. The first response team will administer Adrenalin (Epinephrine) as directed by Medical Director or other provider at the scene. c. Dosage of Epinephrine 1:1000 will be as follows: [1mg=1ml] Pediatric: 0.01mg/kg body weight (Maximum single dose 0.3ml) See chart p. 3 Adult: 0.3ml (0.3mg) Inject intramuscularly into the upper arm. d. Consider using Albuterol Nebulizer (located in Pediatrics) if bronchospasms are evident. The usual dose of Albuterol is mg/kg in 2cc of saline. See dosing chart next page and further medication instructions Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 3

4 5. Vaccine Adverse Reaction If itching and swelling are confined to injection site, observe patient closely for the development of generalized symptoms. a. If symptoms are generalized, activate medical emergency procedures, and continue to assess airway, breathing and circulation, and level of consciousness. b. Administer epinephrine 1:1000 according to chart below for children and teens.* Suggested Dosing of Epinephrine for Children & Teens Age Group Weight in Epinephrine Dose pounds 1 mg/ml 1:1000 dilution intramuscular 1-6 mos 9-15 lbs 0.05mg (0.05ml) 7-18 mos lbs 0.1 mg (0.1 ml) mos lbs 0.15 mg (0.15ml) mos lbs 0.15 mg (0.15ml) mos lbs 0.2 mg (0.2 ml) 5-7 yrs lbs 0.2 mg (0.2 ml) 8-10 yrs lbs 0.3 mg (0.3 ml) yrs lbs 0.3 mg (0.3 ml) 13 yrs-adult 99+ lbs mg (0.5ml) Adult Dose *CDC recommended dosage for children and teens. a. In addition to epinephrine, for anaphylaxis administer diphenhydramine either orally or by intramuscular injection. The standard dose is 1-2 mg/kg, up to 100 mg maximum single dose. Refer to chart next page for dosing instructions. b. For ADULT dosing, administer epinephrine 1:1000 intramuscularly, 0.01ml/kg/dose (adult dose ranges from 0.3ml to maximum single dose of 0.5 ml). c. Monitor patient closely until EMS arrives. Perform CPR if necessary and maintain airway. d. Patient s head may be elevated if breathing is difficult provided blood pressure is adequate to prevent loss of consciousness. Otherwise, keep patient supine. If blood pressure is low, elevate legs. e. Monitor blood pressure and pulse every 5 minutes. f. If EMS has not arrived, and symptoms are still present, give a repeat dose of epinephrine every minutes for up to 3 doses, depending on patient s response. Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 4

5 g. Record all vital signs, medications administered to the patient, including time, dosage, response, and name of medical personnel who administered the medication, and any other relevant clinical information in patient s chart. h. Notify patient s primary care physician. i. Complete a VAERS report. Diphenhydramine dosing for allergic reactions moderate to severe (Benadryl) 2.5 mg/1 ml 12.5 mg/5ml Liquid Dose (ml) 25 mg capsules 50mg/ml Injection Dose (ml) Wt lbs Max Dose Max Dose Max Dose Mild Reaction a. Give Benadryl 50 mg for adults over 110lbs. For pediatric patients, see above chart. Mild to Moderate Vaccine Reactions a. ADULT: Give epinephrine as above for wheezing or angioedema of lips, tongue, or eyelids. Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 5

6 b. Give Benadryl 25-50mg PO. Instruct patient about drowsiness and dry mouth. c. Constantly monitor for 20 minutes and refer if no improvement or worsening symptoms d. Document in patient s chart. Notify appropriate personnel. e. Complete a VAERS report. 6. Shock a. Signs and symptoms 1. Marked paleness of the skin 2. Cyanosis of lips, nails, tips of fingers, and lobes of ears 3. Face may be pinched or without expression 4. Staring (fixed) of the eyes, which often lose their luster 5. Pupils may be dilated 6. Pulse may be weak, rapid, irregular, or absent 7. Increased breathing rate, or may be shallow or absent 8. Low blood pressure 9. Urinary retention and incontinence of feces 10. Unusual restlessness or excitement 11. Extreme thirst 12. Disinterest in surroundings or feeling of impending doom 13. Little or no complaints of pain but may be groaning 14. Vomiting 15. Internal or external bleeding 16. Skin moist and cool 17. Weakness and dizziness b. Individuals with high risk for developing shock 1. Elderly, especially men with urinary tract infections 2. Patients with history of hemorrhage or trauma 3. Pregnant women 4. Patients with a possible source for septic shock, including women who have had a septic abortion, burn patients, and persons with diabetes or malignancy 7. General Principles for the Management of Shock from any cause 1. Call for help. When help arrives, they will notify switchboard operator to page Medical Emergency and location, and then call Assure adequate airway and breathing 3. If patient is breathing, maintain adequate airway by properly positioning patients head 4. If patient is not breathing, establish airway and provide pulmonary resuscitation as established by the AHA protocol for CPR 5. Check for pulse. If no pulse, start CPR 6. Position the patient according to suspected injury 7. Administer oxygen 8. Continue CPR until patients heart rate above 60 per minute and respiratory rate is greater than 12 per minute or until EMS arrives 9. Continue to monitor pulse and respiration during resuscitation 10. Look for immediate source of shock such as bleeding, head injury, bee stings, fractures, etc. Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 6

7 11. Check for bracelets that identify patient s clinical condition or medications such as allergies, diabetes, seizure disorder, etc. 12. If any signs of anaphylaxis, follow procedure listed above. 13. If bleeding, control source by applying pressure. 14. Splint fractures if applicable. Splinting will slow bleeding and reduce pain. Move gently as movement may aggravate shock. 15. If patient is conscious, keep still and reassure 8. Hypertensive Crisis a. Call for help, when help arrives, have them call switchboard operator to page Medical Emergency and location, and then call b. Assess vital signs and record. Repeat every 5 minutes. c. Secure airway and administer oxygen 2-3 liters/min by nasal cannula. d. Provide emotional support to patient to lessen anxiety e. Transport immediately to hospital by EMS. 9. Seizures a. Assist patient to lie down to prevent injury from falling b. Do not try to restrain patient c. Move anything away from patient such as furniture or hard objects that could cause injury d. Do not interfere with movements other than to loosen tight clothing if necessary to prevent airway obstruction e. Do not try to force anything between the teeth f. Seizures are not life threatening, unless the person is injured from falling, becomes unconscious, or seizures continue in rapid succession without intervals of consciousness (Status Epilepticus). If these occur, alert switchboard operator to page Medical Emergency and location, and then call First Response Team to respond to Medical Emergency: (First response team will bring emergency cart) Micheal Keller, PA Karen Draughn, Lab Deborah Creed, RN Pam Marion, RN Vicky Kirkman, RN Sherry Hiatt, RN Second Team: Jane Rountree, NP Jill Dockery, RN Amy Simpson, Lab Theresa Hughes, RN Verona Danley, RN Diane Sardler, LPN Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 7

8 First Response Team (Pediatric Building): (Will also respond to Environmental Health & Planning side of building) April Collins, LPN, Lab Ricky Vernon, PA-C and/or Wendy Smith, FNP-BC Kathy Branch, RN Linda Simmons, RN Attachments: Standing orders for: 1) Medical management of Vaccine Reactions in Children and Teens 2) Medical Management of Vaccine Reactions in Adult Patients 3) Conversion chart Non-compliance to this policy could result in a non-compliance notification and/or subject to the disciplinary process. Gov t/health/accreditation/2009policies/surrypolicies/agencypolicies 8