ACE CPT Chapter 16 – Emergency Procedures

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Policies and procedures

• Physical activity readiness questionnaire (PAR-Q)
  1. Used to identify individuals with high risk
  2. May need modified exercise programs or a reference from a medical doctor
• Informed consent
  1. Risk stratification
     • When necessary, obtain clearance from a medical doctor
• HIPPA
  1. The health insurance portability and accountability act
  2. Ensures victims that they will have privacy about who can access and see their personal medical and health information

Emergency assessments

• Checking the ABCs (airway, breathing, circulation, and severe bleeding)
• The secondary assessment
  1. Head-to-toe assessment and what to look for
     • Abrasions, swelling, deformities, tenderness, medical alert jewelry
     • Take blood pressure and pulse
• Call 911
  1. In life-threatening situations
  2. In situations that require medical attention, immediately

CPR/AED

• Ventricular fibrillation – This is the most commonly seen rhythm during cardiac arrest/heart function cessation.
  1. The spasmodic quivering of the heart
  2. Happens too fast and the chambers of the heart are not allowed to empty and fill
• AED
  1. Returns the heart to a normal rhythm from ventricular fibrillation
  2. Best if used in the first 3 to 5 minutes of the incident
  3. AED certified individuals fall under good Samaritan law
  4. The SA node restarts from the shock of the AED
• Dyspnea
  1. Labored and difficult breathing
  2. Caused by asthma, emotional stress, heart problems, and airway obstruction
• Respiratory distress signs
  1. Chest wall movement is poor
  2. Nostrils flare
  3. Straining of neck musculature
  4. Bad air exchange
  5. Diaphoretic/pale skin (sweaty)
  6. Cyanosis
     • This is a blue coloring around the nose, lips, fingernails, and inner lining of the eyes.
• Choking
  1. Blocked airway
  2. The individual becomes hypoxic (deficient in oxygen)
  3. Heimlich maneuver
• Asthma
  1. Severe inflammation of the airway
  2. Shortness of breath, coughing, tightness in the chest, and wheezing
  3. Avoid these triggers
     • High-intensity exercises and allergens
• Heart attack/Angina pectoralis
  1. A squeezing feeling/chest pressure
     • Often confused with indigestion or heartburn
     • Pain can travel up the neck, shoulder, jaw, or stomach (typically on the left side)
     • Nausea, shortness of breath, lightheadedness, and cold sweats
  2. Most typical symptom for women
     • Chest pain
• Fainting/Syncope
  1. Lack of blood flow to the brain causes a temporary loss of consciousness.
  2. Causes
     • Severe pain, overheating, emotional stress, dehydration(heavy sweating), exhaustion, sudden postural changes as well as violent spells of coughing (especially in men)
• Stroke
  1. The third leading cause of death in the United States
  2. The first leading cause of disability
  3. Results from blood vessels in the brain are blocked
     • An aneurysm
       1. This balloon-style bubble in the blood vessel is located at a weak point and can rupture if not treated.
     • Hemorrhagic stroke can be caused by malformations of blood vessels
  4. Warning signs
     • Balance in walking is off
     • Slurred speech or droopy face
     • One side of the body is numb and/or weak
     • Partial or full vision loss
     • A severe headache
• Diabetes
  1. Type I: insulin-dependent
     • Not enough insulin is produced by the pancreas
     • The client must pump, inject or inhale insulin manually to maintain normal levels
     • For years can go undiagnosed
  2. Type II diabetes: non-insulin-dependent
     • The body has normal insulin secretion
     • The body becomes insulin resistant over time.
  3. How it happens
     • Hyperglycemia – Insulin and blood sugar too high
       1. Victims become fatigued, thirsty, and weak.
     • Hypoglycemia – Blood sugar very low
       1. Victims show hunger, headache, sweating, weakness, and fatigue
     • At first signs of hypoglycemia, the victim should consume 20 to 30 g of carbohydrates
  4. Blood glucose
     • At least 100 mg/dl before returning/resuming exercise
       1. Snacks that are low in fat and high in complex carbohydrates are recommended
     • 300 mg/dl or 250 mg/dl (with ketones in urine)
       1. Do not exercise until blood sugar returns to normal
• Heat stress
  1. Signs and symptoms of heat exhaustion
     • Quick pulse, weak, fatigue, low blood pressure, dizziness, headaches, general weakness, cold and clammy skin, paleness, profuse sweating, elevated core temperatures of the body (higher than 40°C or 104 Fahrenheit)
  2. Treatment for heat exhaustion
     • Stop exercising immediately, lay down and elevate feet 12 to 18 inches, move to a cool area, provide fluids, and monitor the client’s temperature.
  3. Signs and symptoms of a heat stroke
     • Red skin color, dry and hot skin, strong and rapid pulse, labored breathing, change in mental state (irritable, aggressive, or has anxiety), elevated core temperature (over 41°C or 105 Fahrenheit)
  4. Treatment for heat stroke
     • Stop exercising immediately, cool the body immediately in any way that is possible, remove clothing, provide fluids, and get them to in emergency room right away
• Fluid intake for exercise
  1. Two hours before exercise
     • 17 to 20 ounces or 500 to 600 mL
  2. Every 10 to 20 minutes during exercise
     • 7 to 10 ounces or 200 to 300 mL, depending on sweat levels
  3. After exercise
     • 452 675 mL for every half of a kilogram of body weight loss (16 to 24 ounces for every pound lost)
• Seizures
  1. The most common type is a Tonic-clonic seizure
  2. Happens with an abnormal amount of electrical activity in the victim’s brain
• Soft tissue injuries
  1. Abrasion – A scrape caused by a fall
  2. Incision – This is a clean-cut on the skin from a sharp edge
  3. Laceration – This is a jagged tear that is caused by shear and tensile forces
  4. Avulsion – This is a severe laceration (skin completely torn away)
  5. Puncture – Skin penetration by an object
• Fractures
  1. Signs
     • Tenderness and pain, deformity, grading, swelling, crepitus (bone fragments grinding sound), disfiguration, bruising, severe weakness, joint in a locked position, exposed end of the bone.
• Neck and spine
  1. Kyphotic – Rounding off the upper back (The thoracic spine curves posteriorly)
  2. Lordotic – The lumbar spine curves anteriorly (lower back hyperextended)

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