Emergency situations may occur at anytime and place. When emergencies do occur it is important to maintain a controlled and rapid response in order to provide the best possible care to the patients. The development and execution of an emergency action plan will help to ensure the best line of care in an emergency situation. Here are some guidelines and proper steps to follow in case of a medical emergency situation:
The development of an E.A.P. cannot be completed without the arrangement of an emergency team. The emergency team may consist of a number of healthcare providers including physicians, occupational therapist, physical therapist, athletic trainers, clinical assistants, and possibly bystanders. There are some basic roles within the emergency team. The first and most important role is the immediate care of our patients. The most qualified individual on the scene should provide acute care. Other individuals on the scene should comply and work with the most qualified individual for a smooth and controlled response. The second role, if needed, should be equipment retrieval which may be done by anyone on the emergency team who is familiar with the types and location of the specific equipment needed. The third role, EMS activation, may be necessary in situations where emergency transportation is not already present. This should be done as soon as the situation is determined to be an emergency or life-threatening condition. Activating the EMS system may be done by anyone on the emergency team. However, it is important to make sure the person chosen for this duty is someone who is calm under pressure and communicates well over the phone. This person should be familiar with the location and address of the recovery center.
Roles within the Emergency Team
- First Responder (Immediate care of our patients)
- Emergency equipment retrieval
- Activation of EMS
Activation of the Emergency Medial System
Provide the following information for the operator:
- State that an ambulance is needed at your location
- Give your name and phone number you are calling from
- Give the condition of the patient
- State if any first aid treatment has been given
- Give specific directions as to where you are located
- Any other information requested by the dispatcher
In the event of an emergency situation, the patient should be transported by ambulance, where the necessary staff and equipment is available to deliver appropriate care. Emergency care providers should refrain from transporting unstable patients.
The importance of being prepared when emergency situations arise cannot be stressed enough. A patient’s survival may depend on the well-trained and prepared health care providers. The emergency action plan should be reviewed at least once a year with all emergency personnel. Through the development of an emergency action plan the Brain and Spine Recovery Center insures that the best care will be provided during an emergency situation.
Possible SCI Conditions
Respiratory arrest is the involuntary discontinuation of breathing. Untreated respiratory arrest usually is followed by cardiac arrest. Signs and symptoms of respiratory arrest include a person turning blue at the face, confusion, struggling to breathe, becoming limp at the upper and lower limbs or remaining drowsy or unconscious. If someone is suffering from respiratory arrest they will require prompt and immediate medical attention which is why it is also important to activate the emergency medical system in this type of situation.
If someone you know is suffering from respiratory arrest you should immediately check to see if there is a foreign body obstructing the airway. Treatment is to clear the airway, maintain an open airway, and provide artificial respirations by the use of mouth-to-mouth resuscitation. Artificial respiration is a part of performing cardiopulmonary resuscitation (CPR) but can also be used separately. When stimulating artificial respiration it is better to use a CPR mask to get as much pure oxygenated air to the patient as compared to the mouth-to-mouth resuscitation technique.
When approaching the victim it is important to position the patient in a supine position. Begin by placing the patients head into extension, closing the nose with one hand, and using your other hand to keep the patients chin down as to keeping the patient’s mouth open. Being by giving the patient two rescue breaths. Complete this by taking a deep breath, putting your mouth on the patient’s mouth, and begin to blow into the mouth of the patient. After giving two rescue breaths you should check the carotid pulse of the patient. If there is a strong and/or present pulse it is possible that you either revived the patient to start breathing on their own or if there is no pulse, the patient might be in a state of cardiac arrest. If the patient is revived, put the patient into a recovery position, and monitor their respirations until a medical unit arrives. If the patient is in a state of cardiac arrest, you will have to perform CPR.
Cardiac arrest is the sudden cessation of normal circulation of the blood due to the failure of the heart to contract effectively. The resulting effect is a lack of oxygenated blood flow to vital organs and the brain. When cardiac arrest occurs the patient will fall unconscious, stop breathing, and have a diminished carotid pulse. Prior to falling unconscious, the patient will seem mentally confused, will have shallow and rapid breathing, may complain of left back and/or left shoulder pain, and will have a decrease in blood pressure. If someone is suffering from cardiac arrest they will require prompt and immediate medical attention which is why it is also important to activate the emergency medical system in this type of situation.
If you have determined that a patient is suffering from cardiac arrest you should immediately check to see if they have an open airway, are breathing and have a pulse. If they are not breathing and do not have a pulse, you will need to start CPR until an automated external defibrillator can be brought by the emergency medical system. An AED is used to analyze the heart rhythm and delivers a controlled electric shock to the heart if indicated. When performing CPR you should start out by performing 30 chest compressions followed by two rescue breaths. If the patient has not revived during your first attempt you should continue to perform CPR on the patient until EMS arrives.
Autonomic dysreflexia is an over activation of the autonomic nervous system that can occur in association with spinal cord injury or disease. People at risk for this condition usually have a spinal cord injury above T6. It triggers a variety of noxious stimuli, including bladder distension, extremely high blood pressure (250-300/140-160), skin ulcers, red at the face, bowel impaction, excessive sweating above the injury level, pounding headaches, presence of goose bumps, anxiety, slow pulse (< 60 beats per minute), and uterine contractions. However, you should be cautious because an individual with SCI above T6 often has a normal systolic blood pressure in the 90-110 mm Hg range. Therefore, a blood pressure of 20mm to 40mm Hg above baseline may be a sign of autonomic dysreflexia.
Autonomic dysreflexia is caused either due to a filled bladder or kink in a catheter or some type of noxious stimuli such as skin irritation, impacted bowl, or ingrown toenail. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.
If you have determined that a patient is suffering from autonomic dysreflexia you should immediately recognize the cause and correct it. You should start first by checking the catheter hose for kinks, folds, or constrictions and, then proceed to ask the patient when their last bowl movement occurred. After that, you should monitor their blood pressure and pulse very closely. If the blood pressure if elevated, immediately sit the person up if the individual is supine. A rule of thumb is to always keep the patients head above their heart. If their blood pressure can not be lowered, you should immediately activate the emergency medical system.
Blood Pressure Standards (High vs. Low)
Resting blood pressure in the SCI community may be in the range of 90-110 mm Hg for systolic readings and 60-70 mm Hg for diastolic readings. Usually, a patient dealing with SCI will have a blood pressure below the normal average of 120/80.
If a blood pressure is measured to be high (e.g. 160/95) you should first determine if the patient is having an autonomic dysreflexic episode or any other serious medical conditions. If you have eliminated all potentially serious medical conditions and the patient still has a relatively high blood pressure your next plan of action should be to instruct the patient to sit and relax. You should proceed to take several blood pressure readings and record all of them. If the blood pressure readings do not drop in a significant amount of time you should immediately activate the emergency medical system.
If a blood pressure is measured to be low (e.g. <90-100 mm Hg for systolic readings) you should start by identifying the cause. Low blood pressure is usually the cause of blood pooling in the lower extremities or ANS impairments. Low blood pressure is not uncommon with new quads first starting an exercise program. Characteristics of low blood pressure include extreme fatigue, nausea, dizziness, fainting and/or lightheadedness, paleness, and confusion. If you have determined that a patient has low blood pressure you should proceed to lay them flat and rub their lower legs in the case of blood pooling. You should proceed to take several blood pressure readings and record all of them. If the blood pressure readings do not increase in a significant amount of time you should immediately activate the emergency medical system.
High/Low Blood Glucose
Blood glucose is the amount of sugar found in your blood. Patients who have high blood glucose levels (>126 mg/dL) are termed as having hyperglycemic. Patients who have low blood glucose levels (<70 mg/dL) are termed as having hypoglycemic.
People with hyperglycemia need to test at least once per day to assess the effectiveness of their diet and exercise for controlling their blood glucose levels. Many people with high blood glucose will be using oral medication or injecting insulin to oppose their high blood glucose. They must also test their blood glucose levels before and after breakfast. Characteristics of high blood glucose include frequent urination, frequent thirst, increased hunger, blurry vision, dry mouth, and fatigue. If you have determined that a patient has high blood glucose you should ask the patient when was the last time they took their medication and determine if they feel it is time to administer the proper dosage at that time. The patient should also drink fluids that do not contain sugar and increase their physical activity. If the signs and symptoms do not resolve after repeated attempts you should immediately activate the emergency medical system.
Hypoglycemia can be caused by either being sensitive to the body’s normal release of epinephrine or being deficient in glucagon secretion. If left untreated, low blood glucose could lead to Diabetic Coma. Characteristics of low blood glucose can range from mild to severe signs and symptoms. Mild signs and symptoms include grouchiness, confusion, dizziness, sweating, pale skin, fast heart rate, poor coordination, slurred speech, inability to cooperate, and yawning. Severe signs and symptoms include falling unconscious and convulsions. Depending on the signs and symptoms, if you have determined that a patient has low blood glucose you should tell them to cease all physical activity and administer a combination of both carbohydrates and proteins. It is a good idea to first administer either milk, cheese, and/or a granola bar in order to slow down the break up of the sugars ingested. If absolutely none of these items are available for use, you should find some quick acting sugar to dispense. Quick acting sugars can include glucose tablets, honey, and/or regular soda pop. If signs and symptoms have not resolved or the patient is unconscious or convulsing, you should immediately activate the emergency medical system.
A headache is a condition of pain in the head. Headaches can have a variety of causes, ranging from eye strains, sinus issues, kinks in a patients catheter, high blood pressure, stress, dehydration, autonomic dysreflexia, medications, onset of a stroke, and/or awkward head positioning.
It is also important to check to see if the patient may be suffering from neurological signs and symptoms. Some neurological signs and symptoms include drooping at the face and eyes, slurred speech, unequal pupil sizes, and/or loss of balance.
When a headache is present it is also very vital to make sure the signs and symptoms present are not leading up to a stroke. Characteristics of a stroke would be presence of sudden numbness of the face, arm or legs, especially on one side of the body. There can also be a loss of sensation, muscles weakness, sudden onset of a severe headache with no known cause, trouble walking, dizziness, vomiting, and/or sudden vision problems. If you believe the patient is suffering from a stroke you should immediately activate the emergency medical system.
If you have determined a patient is suffering from a severe headache you should get a complete history from the patient in order to determine if there is a known cause for the headache. In your initial assessment you should always ask the patient:
• When was the last time they ate?
- What medications they have taken?
- When was the last time they emptied their bladder?
- Do they suffer from any other serious medical conditions such as high blood pressure?
- Are there any other abnormal signs and symptoms present that could present an episode of a stroke or autonomic dysreflexia?It is always essential to document everything the patient states about the headache and to monitor the headaches severity. If the headache has not resolved or the signs and symptoms get worse, you should immediately activate the emergency medical system.