Lesson 30 — Safety and Emergency Procedures

1. Check the floors and hallways for obstructions and possible tripping hazards, including torn carpets, possible spills, protruding electrical cords, and so on.

   Purpose

   To prevent accidental falls.

2. Check storage areas to make sure the tops of cabinets are clear and heavier items have been stored closer to the floor.

   Purpose

   To prevent injuries from items falling off shelves and to limit the lifting of heavy items.

3. Assess the location and security of handrails and grab bars placed around the facility. They should be placed at all stairs, in restrooms, and in any other areas where staff members or patients may need assistance.

   Purpose

   Handrails and grab bars help safeguard staff members and patients and provide assistance where needed.

4. Examine all electrical plugs and outlets to prevent electrical overload.

   Purpose

   Overloading electrical outlets could cause a fire.

5. Check all equipment to make sure it is in safe working condition.
6. Make sure all lights are working (both inside and outside the facility), that lighting is adequate, and that light fixtures are in good condition.

   Purpose

   Adequate lighting both inside and outside the facility helps prevent accidents, and faulty fixtures can be a fire hazard.

7. Check the working condition of smoke alarms, and examine all fire extinguishers.

   Purpose

   To monitor the function of smoke detectors and make sure fire extinguishers are charged.

8. Make sure evacuation routes are posted throughout the facility, along with floor plans with clearly marked exit routes.

   Purpose

   Every room in the facility must have a map with exit routes marked on it to make sure that even those who are unfamiliar with the facility's floor plan can safely reach an exit in case of an emergency.

9. Assess the laboratory's compliance with the safety signs, symbols, and labels required by the Occupational Safety and Health Administration (OSHA). Are all signs, symbols, labels in place and posted properly?
10. Record your observations.

    Purpose

    To compile a comprehensive list of problem areas.

11. Develop a plan of action for improving the safety of the laboratory.

    Purpose

    The student-generated safety plan can be incorporated into the laboratory's policies and procedures manual.

1. If the healthcare worker witnesses a cardiac arrest, an automated external defibrillator (AED) should be used as soon as possible.
2. If cardiopulmonary resuscitation (CPR) has already been started, continue performing CPR until the AED machine is turned on, pads are applied, and the machine is ready.
3. Place the AED near the victim's left ear. Turn on the AED.
4. Attach electrode pads to the victim's bare dry chest as pictured on the AED.
5. Place the electrodes at the sternum and apex of the heart.
6. Make sure the pads are in complete contact with the victim's chest and that they do not overlap.
7. All rescuers must clear away from the victim. Press the ANALYZE button.
8. The AED analyzes the victim's coronary status, announces whether the victim is going to be shocked, and automatically charges the electrodes.
9. All rescuers must clear away from the victim.
10. Press the SHOCK button if the machine is not automated. You may repeat 3 analyze-shock cycles.
11. Deliver 1 shock, leaving the AED attached, and immediately perform cardiopulmonary resuscitation (CPR), starting with chest compressions.
12. After 5 cycles (about 2 minutes) of CPR, repeat the AED analysis and deliver another shock, if indicated.
13. If a non-shockable rhythm is detected, the AED should instruct the rescuer to resume CPR immediately, beginning with chest compressions.
14. If the machine gives the No Shock Indicated signal, assess the victim.
15. Check the carotid pulse and breathing status and keep the AED attached until emergency medical services (EMS) arrives.

    Purpose

    Continue to monitor breathing and circulation because these can stop at any time. Keep the AED pads in place to diagnose ventricular fibrillation quickly if it occurs.

1. If warning is given that the patient feels faint, have the patient lower the head to the knees to increase the blood supply to the brain.
2. If this does not stop the episode, have the patient lie down on the examination table or lower the patient to the floor.
3. If the patient collapses to the floor when fainting, treat with caution because of possible head or neck injuries.
4. Immediately notify the provider of the patient's condition and assess the patient for life-threatening emergencies, such as respiratory or cardiac arrest.
5. If the patient is breathing and has a pulse, monitor the patient's vital signs.
6. If the patient has fainted and vital signs are unstable or the patient does not respond quickly, activate emergency medical services (EMS).

   Purpose

   Fainting may be a sign of a life-threatening problem.

7. Activate EMS if the patient shows signs of shock—pale, gray, or cyanotic appearance; moist but cool skin; dilated pupils; a weak, rapid pulse; marked hypotension; shallow, rapid respirations; or lethargy or restlessness.
8. Look, listen, and feel for breathing and check the pulse.
9. Maintain an open airway and continue to monitor vital signs.
10. Loosen any tight clothing and keep the patient warm, applying a blanket if needed.
11. If a head or neck injury is not a factor, elevate the patient's legs above the level of the heart using a footstool with pillow support if available.

    Purpose

    Elevating the legs assists with venous blood return to the heart. This may relieve symptoms of fainting or shock by elevating the blood pressure and increasing blood flow to vital organs.

12. Continue to monitor vital signs, and apply oxygen by nasal cannula if ordered by the provider until the patient recovers or EMS arrives.
13. If the patient vomits, roll the patient onto his or her side to prevent aspiration of vomitus into the lungs.
14. If the patient completely recovers, assist the patient into a sitting position.
15. Do not leave the patient unattended on the examination table.
16. Document the incident, including a description of the episode, the patient's symptoms and vital signs, the duration of the episode, and any complaints.
17. If oxygen was administered, document the number of liters and how long oxygen was administered.

    Purpose

    Procedure is not complete until it is recorded.

18. If warning is given that the patient might have a seizure, help lower the patient to the floor.
19. If the patient collapses with a seizure, clear everything away from the patient that could cause accidental injury.
20. If you cannot remove all hard items (e.g., the examination table), pad the hard edges with a blanket or pillow.

    Purpose

    The patient could be injured when uncontrollable muscular contractions occur with the seizure.

21. Immediately check the time on your watch and call for help.

    Purpose

    To time the length of the seizure and alert the provider of the patient's seizure activity.

22. Observe the patient throughout the seizure but do not restrain or confine the patient's movements.

    Purpose

    Stay with the patient for the entire seizure, but do not restrain movement. Restraining the patient may cause musculoskeletal injury.

23. Do not place anything in the patient's mouth during the seizure.

    Purpose

    The patient's jaw is typically clamped tight during the seizure and trying to force something between the teeth can cause injury.

24. After the muscular contractions have ended, roll the patient into the recovery position on his or her side, with the top knee bent and the head resting on the extended arm closest to the floor.

    Purpose

    This position helps maintain an open airway.

25. Loosen any tight clothing and keep the patient warm, using a blanket if needed.
26. Let the patient rest, but never leave the patient alone.

    Purpose

    To maintain patient safety and comfort.

27. If the provider is not in the facility, check the policies and procedures manual to determine how to follow up with the patient.
28. Activate emergency medical services (EMS) if any of the following conditions are present: The patient does not regain consciousness within 10 to 15 minutes; The seizure does not stop within a few minutes; The patient begins a second seizure immediately after the first one; The patient is pregnant; Signs of head trauma are present; The patient is known to have diabetes; The seizure was triggered by a high fever in a child.
29. If the patient completely recovers, assist him or her into a sitting position, check vital signs, and make sure there is someone to accompany the person home.
30. Document the incident, including a description of the episode, the patient's symptoms and vital signs, the duration of the seizure activity, and any complaints.

    Purpose

    Procedure is not complete until it is recorded.

31. Gather equipment and sanitize your hands.
32. Greet and identify the patient, introduce yourself, and explain the procedure.

    Purpose

    To relieve the patient's anxiety and earn his or her cooperation with the procedure.

33. Obtain vital signs.
34. Assess the area of the suspected fracture for swelling, bleeding, bruising, or protruding bones.
35. If the skin is broken, put on gloves and cover the area with a sterile dressing.

    Purpose

    Infection control and compliance with Standard Precautions procedures.

36. Moving the limb as little as possible, place the padded splint under the lower arm and wrist.

    Purpose

    Avoid moving the limb any more than necessary to prevent movement of the fracture and further pain.

37. The area must be immobilized by the splint above and below the suspected fracture.

    Purpose

    Immobilizing the joint above and below the injury keeps the joint in place, preventing further injury and pain.

38. Secure the splint in place by rolling an Ace bandage or roller bandage around the splint and arm, starting at the arm and rolling down to the wrist and hand.
39. Check the pulse in the affected arm.
40. Note the color and temperature of the skin and the color of the nails.

    Purpose

    To make sure the splint and bandage have not been applied too tightly.

41. Make sure the patient is comfortable, and answer any questions he or she may have.
42. Sanitize your hands.

    Purpose

    To ensure infection control.

43. Document the procedure, including the condition of the patient, the reported pain level, and application of the splint.

    Purpose

    Procedure is not complete until recorded.

1. Sanitize your hands and put on appropriate Personal Protective Equipment (PPE).

   Purpose

   To follow Standard Precautions.

2. Assemble equipment and supplies.
3. Apply several layers of sterile dressing material directly to the wound and exert pressure.

   Purpose

   Direct pressure to a wound slows or stops the bleeding. Sterile supplies are needed to prevent wound infection.

4. Wrap the wound with bandage material.
5. Add more dressing and bandaging material if the bleeding continues.
6. If bleeding continues and the wound is on an extremity, elevate the extremity above the level of the heart.
7. Notify the provider immediately if the bleeding cannot be controlled.
8. If the bleeding persists, maintain direct pressure and elevation.
9. Apply pressure to the appropriate artery.
10. If the bleeding is in the arm, apply pressure to the brachial artery by squeezing the inner aspect of the middle upper arm.
11. If the bleeding is in the leg, apply pressure to the femoral artery on the affected side by pushing with the heel of the hand into the femoral crease at the groin.
12. If the bleeding cannot be controlled, activate emergency medical services.
13. Once the bleeding has been brought under control and the patient has been stabilized, discard contaminated materials in an appropriate biohazard waste container.
14. Disinfect the area, then remove your gloves and discard them in a biohazard waste container.
15. Sanitize your hands.

    Purpose

    To ensure infection control.

16. Document the incident, including details of the wound, when and how it occurred, the patient's symptoms and vital signs, treatment provided by the provider, and the patient's current condition.

    Purpose

    Procedure is not complete until recorded.

17. Gather equipment and sanitize your hands.
18. Greet and identify the patient and introduce yourself.

    Purpose

    To relieve patient anxiety and earn patient cooperation.

19. Obtain vital signs.
20. If the patient is known to have diabetes, observe for signs and symptoms that indicate a diabetic emergency.
21. Immediately report patient's condition to the provider and follow his or her orders.

    Purpose

    A diabetic emergency can be life-threatening.

22. In an emergency situation, if a patient diagnosed with diabetes mellitus shows signs and symptoms of a diabetic emergency, the patient should be given glucose.

    Purpose

    If the problem is caused by insulin shock (hypoglycemia), the patient will improve quickly after receiving glucose; if it is caused by diabetic coma (hyperglycemia), a small amount of added glucose will not affect the patient's condition, and he or she must be transported to the hospital regardless.

23. Follow the provider's orders and administer 15 g of carbohydrate immediately, preferably in the form of glucose tablets because they have a known concentrated quantity of glucose.
24. If glucose tablets are not available give the patient 1/2 cup of fruit juice or 5 or 6 pieces of hard candy.

    Purpose

    To quickly stabilize the patient's blood glucose level.

25. Check the patient's blood glucose levels with a glucometer and monitor vital signs.

    Purpose

    To monitor the patient's current blood glucose level and the patient's condition so the provider can determine appropriate treatment.

26. If the patient's blood glucose levels are elevated (diabetic coma) administer insulin as ordered by the provider.

    Purpose

    To lower blood glucose levels to within a normal range.

27. If the blood glucose level is below 80 mg/dL (insulin shock), administer another 15 g of carbohydrate.
28. Wait 15 minutes and check the glucometer reading again.
29. If the level is still low, repeat the carbohydrate steps.
30. Continue to monitor the patient and follow the provider's orders for continued care.
31. A patient with insulin shock can be stabilized by continued monitoring of the blood glucose level and administration of glucose every 15 minutes until levels reach normal.
32. A patient with pending diabetic coma may need to be transported to the hospital.
33. Dispose of used supplies and gloves in the appropriate biohazard containers (sharps containers for used lancets and injection unit).
34. Sanitize your hands.

    Purpose

    To ensure infection control.

35. Document the actions taken and the patient's condition, including vital signs, glucometer readings, administration of glucose and/or insulin, and whether the patient was stabilized and discharged or emergency medical services (EMS) were activated and the patient was transported to the hospital.

    Purpose

    Procedure is not complete until it is recorded.

Knowledge-check items

Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.

L30-01 · Work Environment Safety

L30-02 · Use of AED

L30-03 · Emergency Response 1

L30-04 · Emergency Response 2