Caregiver Tips Being Prepared

Author: Mark Parkinson RPh:  President  AFC-CE

Credit Hours 4- Approximate time required: 240 min.

 

Educational Goal:

To familiarize Adult Foster Care providers with various emergency and situational caregiving techniques.

Educational Objectives:

Suggest an emergency plan of action.

Provide caregiver techniques on what to do for specific life threatening occurrences.

Provide caregiver techniques on what to do for accidents and other non-life threatening occurrences.

Procedure:

Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.

Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

Caregiver Tips Being Prepared

Be in Adult Foster Care long enough and you will see the entire medical treatment continuum, from minor bruises to residents passing away. Practicing your occupation at the point of patient first contact the caregiver has to be prepared to get the ball rolling on a large variety of medical occurrences. This CE will give you some practical caregiver tips so you will be better able to act when you are needed. For those who are new to Adult Foster Care this lesson will really help you out. I suggest that you print out the lesson for a quick reference guide. For those who have been in the biz longer, periodically refreshing your knowledge base never hurts.Related image

 

Tips on getting ready for ….. anything

First things first, anything can and does happen in your homes. To be prepared for come what may it’s good to have a plan in place. I’m not talking about the nitty gritty details for each emergency; I’m talking about an overall generalized plan of action.  1. Be mentally prepared, 2. Assessment, 3. Act, 4. Follow through.

 

  1. Being Mentally Prepared

It may sound funny but everything starts in your head. You have to be always mentally ready to act. I know that there was a lot of eye rolling and mentally saying, “Duh, everyone knows that”.  I’m here to say to you not everyone is ready mentally. In fact most new caregivers fall into the trap of being mentally asleep at the wheel. It happens to be one of the common occurrence in our care home industry. Let me explain.

Most of what we do in Adult Foster Care is mundane household chores, day in and day out. It’s so easy to mentally go into autopilot. It’s what we as humans naturally do when tasks are repeated over and over.  Foster caregivers also slip into autopilot, but that auto pilot is set on a normal non-medical professional household chore mode.  The result is the caregiver becomes a reactionary responder, not proactive medical professional.  Think of the common saying “running around like a chicken with its head chopped off”.  What’s even worse is when really bad things happen and the caregiver freezes.  Here is a true story that illustrates my point.

 

I once worked in a pharmacy, and in the adjoining bathroom a customer had a heart attack. I found the victim slumped over on the toilet, and it appeared he’d been there for some time. I immediately notified the pharmacy manager and 911 was called. I went back in and placed the body flat on his back, but I knew it was too late because the arms had turned blue from the lack of circulation.  As a caregiver to the elderly, I had seen death before and recognized the signs. The pharmacy manager, though, was quite distressed. Later he confided in me that he felt really bad because he didn’t do anything. He had been trained in CPR, yet he froze. The moral of the story is being trained and being prepared to act on that training are two different things. If a pharmacist who had a 7 year doctorate in pharmacy and was a certified CPR responder can freeze in an emergency any one can.

 

Are you mentally prepared to act when it’s necessary?  What will help you to be prepared is to remember that you are a valuable medical PROFESSIONAL. You are not a glorified house keeper/ babysitter. You have more patient interaction than any other medical profession.  Get up every morning and tell yourself, “I can be proud of myself because I have a huge impact on the lives of those I service.  I am a proud medical professional - hear me roar!”  After that morning self-pep talk,  always be mentally ready to act like a medical professional when the need arises. Being calm and deliberate may be the difference between a quite peaceful home and house full of turmoil. When decisions are made in advance about how to act, responding to stressful situations becomes easier and quicker. In short being mentally prepared is being mentally relaxed and medically focused.  One of the secretes to our industry is that this is usually the main difference between a well-run full home and a poorly run, usually almost empty home.

 

  1. Assessment

Before you jump into any emergency whether it is great or small you have to size up the situation. Rushing in to help the resident is reactionary, doing so may cause even more harm. Assessing the situation first is what medical professionals do. First quickly look at the overall scene, then assess the patient.

Reviewing the scene

A.When assessing the overall scene there are a number of things to consider.

  • What caused the accident?
  • Are there dangers in the area?
  • How many victims are there?
  • What resources do you have?
  • Will bystanders need guidance so that they do not become injured or ill themselves?

B. Determine if professional emergency responders are needed.

  • Is the situation life threatening?
  • Are there intermediate or long-term medical concerns that require professional medical attention?
  • Are there hazardous conditions like live electrical wires, gas leaks or smoke?
  • Are you just not sure if extra help is needed?

     If you can answer yes to any of the above questions, it’s time to get help.  Assign someone else to call 911. That leaves you free to act. In addition, have them or someone else be responsible for directing the emergency responders to the scene.  In the case of doubt, it is always better get professional emergency responder help.

C. Prepare to respond

  • Make the scene safe to respond by removing threats.
  • If speed is required send someone else to gather supplies- first aid kits, etc. while you do to the patient assessment.
  • Use universal precautions.

     Just a reminder about universal precautions for care providers- There is always the risk of communicable disease transmission.  The risk of infection may be low, but treating all bodily fluids as potentially harmful substances is the safe way to proceed. Whenever possible, use medical exam gloves, mouth-to-mouth barrier devices, and isolation techniques when applying first aid. Safety first and always.

D. Initial victim assessmentRelated image

     Once it is safe to proceed, make a victim assessment. If there are multiple victims, make a quick assessment of each.  It is generally wise to start with the quiet and nonmoving victims because they may not be breathing or unconscious. Always look for the life-threatening emergencies of non-breathing, stroke, severe bleeding and heart attack first. How do you do that?

     Start by checking for responsiveness. If unresponsive, tap the resident and shout “Are you OK?” If there still is no response, check the airway by performing a head tilt-chin lift maneuver. This will open up the airway and you can make a breathing assessment by placing your ear near the victim’s nose and mouth. Listen for breathing and look for the chest to rise and fall.  Next, look for signs of severe bleeding.  Undo any outer clothing that might be hiding signs of injury.  Check for a pulse. If the residents eyes are open look at the pupils. Are they the right size for the lighting, are both eyes the same?

     Until you know what is going on it is important to move the victim’s body as little as possible. Stabilize the head and neck so that the spinal cord is protected. If necessary, have another person hold the head and neck steady to keep the victim in proper alignment.

E. Further physical exam

    When life-threatening issues have been resolved, conduct a more detailed examination of the body.

  • Look for unusual body occurrences or signs such as open wounds, tenderness, deformities and swelling, and skin color and temperature abnormalities.
  • Question the victim on how they feel and determine a chief complaint. Try to obtain any important medical information that might be helpful later. For example, was there dizziness or nausea beforehand?

 

  1. Act

Now that the scene is safe and you have made your assessments, it is time to do something to resolve the problem. As you know home caregivers have some limitations on what they can do. You can do simple first aid and resolve some temporary issues but for everything else your role switches from primary caregiver to patient advocate. Your job is to connect them to the right medical professional and stabilize the patient while they wait.   

 

  1. Follow through

As the caregiver and patient advocate it is up to you to act or start the process and most importantly continue acting until the situation is resolved.  Not only do you have to put the band aid on the cut, you have to keep it clean and infection free until the cut is healed. It may seem like such an obvious thing but in my experience how well it is done is the difference between an average home and a great care home.

My most important caregiver tip for you is to be tenacious. Keep at it until the problem goes away completely. That include being forceful with doctors, nurses and pharmacists. Get right in there faces and make them do the right thing. Do it professionally of course or you won’t get anywhere.

Image result for caregiver

Monitor and Report

Adult Foster Care providers also perform one more essential duty that they are uniquely positioned to perform best. That is monitor the patient and report to the doctor.  No other health professional lives with the patient 24/7/365. You will see things that no one else will.  If you don’t communicate what you see to the doctor who else will? The more information the doctor has the better decisions they make. That makes the patient healthier, which makes your job easier and keeps the resident in your home longer.  My tip on making this easier to do is becoming a better record keeper. Write lots of notes in the residents file and prn MARs. Then include these notes in the file you send with the patient when the ambulance or family member picks them up. Yes it is tedious task to do but it will pay off in the end.

Maintain the patient

    If emergency responders have been called, maintain the patient until they arrive.  If there are no injuries to prevent it, lie the patient down and slightly elevate the feet.  Keep the patient warm. These activities will help prevent shock and fainting.  When the emergency responders arrive, pass on the information you have gathered and any pertinent medical record print outs from your files. It looks very professional if you have then ready and in a folder along with any written patient condition notes. 

Most of the time you will not be dealing with life threatening situations. But you never know what’s around the corner or in the next bedroom. Make it a habit to be thorough in your assessments. Here’s another story for you:

     A resident was acting very agitated and literally bouncing off the walls. When I questioned him he was unresponsive. I grabbed his face and asked him to look me right in the eyes. One pupil was bigger than the other.  I immediately call 911. He was in the middle of a stroke. 

 

Image result for uneven pupils

 

Tips on what to do for specific life threatening occurrences

Choking

     If you see someone choking, they might be experiencing an obstructed airway and possibly need help. The goal of your effort is to dislodge the obstruction by applying ever increasing pressure until the airway is clear.

  • Verify the victim is truly choking.
  • Encourage the victim to cough harder.
  • Apply back blows. Apply hard blows with heal of your hand five to 20 times to the upper back between the shoulder blades.
  • Abdominal thrusts, also known as the Heimlich maneuver.
  • If they become unconscious, place the patient on the floor and begin CPR unless there is are advanced directives directing you not to.
  • Do not do the Heimlich maneuver or CPR unless your certified and comfortable doing so.

*Special Notes on Chocking.

  1. During difficult to dislodge cases, at some point 911 should be called.
  2. It is common for the patient to throw up after abdominal thrusts.

 

Heart Attacks

     Heart attacks occur to individuals that have reduced blood flow to their heart. Symptoms vary with each occurrence but may include uncomfortable pressure, fullness, squeezing, or angina (pain) in the center of the chest lasting more than a few minutes. Pain may be felt down the shoulders to the arms and in the neck and jaw. Signs may also include uncommon sweating patterns, dizziness, fainting, nausea, shortness of breath, and a feeling of weakness.

     Treatment for heart attack is to reduce the strain on the heart by sitting the patient in a relaxed position and loosening the clothing. Call 911, be calm, reassuring and monitor breathing. If the patient has no aspirin allergy have them take one adult aspirin (325mg) or four children’s aspirin (81mg). If the patient has nitroglycerin pills, place one underneath their tongue every five minutes if needed. The maximum amount is three doses. If after three pills there are still problems, call 911.

*Special Note on Heart AttacksImage result for nitro pills

1. Nitroglycerin evaporates out of the pills over time. The only way a first aid responder will know if the nitro pills are potent is to ask if they tingle when placed under the tongue. If the victim can’t feel the tingle, it would be wise to call 911. There is a chance that there is no lifesaving medicine left in the pills they are counting on to save the victim’s life.

2. It would be wise to have prn orders for emergencies from the doctor. For example, in case of heart attack or stroke administer aspirin.

 

Stroke

     A stroke happens when inappropriate blood flow to the brain occurs and portions of the brain are damaged (CVA- cardiovascular accident). Transient ischemic attacks (TIA) are less serious events, and the brain function returns to normal after a period time. During a stroke, the victim may not be able to perceive their surroundings correctly or understand what you are saying or doing. Time is of the essence.  With every minute that passes, more brain cells may be lost permanently.

 

     Because of this confusion and time crunch, you must be proactive in screening for a stroke.  Administer the F.A.S.T. procedure:

Image result for f.a.s.t

 

  • F- Face: Examine for appropriate and equal pupil dilation. Have the person smile or show their teeth. Look for drooping of one side.
  • A- Arms: Ask the person to raise their arms. Look for uneven arm raising.
  • S- Speech: As the person to repeat a simple sentence like, “It is not time for bed.” Watch for slurring.
  • T- Time: Time to call 911 if the victim cannot perform any of the fast procedure.

     Have the victim chew on an aspirin if you have the prn orders. Lie them down with the head slightly elevated to reduce blood pressure to the brain.

 

Asthma Attacks

     Asthma is a medical condition that prevents oxygen from reaching the blood of the lungs because of mucus build up and airway constriction. A person suffering from an asthma attack experiences:

  • Coughing
  • Bluish skin color in the checks, nose, and under the nails and finger tips (Cyanosis)
  • Difficulty catching their breath, wheezing, or speaking in short phrases.

Care for Asthma Attacks

  • Place the victim in a comfortable upright position.
  • Loosen restrictive clothing.
  • Retrieve the residents rescue inhaler medication (most often it is albuterol).
  • Call 911 if the patient collapses or the rescue medication is ineffective within the first few minutes of use.

Patient Recovery Position

     A victim who is unconscious but still breathing or who is at risk for vomiting should be placed in a recovery position. Lay the victim down flat upon their left side, with the top leg bent slightly at the knee and the bottom arm extended straight above the head, in line with the spine. If a spinal injury is suspected, keep movement at a minimum by rolling the body as one single object.

 

Tips on First Aid SuppliesImage result for boy scout logo

“You cannot render first aid if you do not have the tools and supplies necessary to treat an injured or ill person.  A well-stockedkit is an essential item for all first aiders.” Boy Scout First Aid Merit Badge Pamphlet 2010 pg. 21

     Just as every care home is different, first aid supplies should reflect the possible needs that our different care homes present. Commercially produced first aid kits can be purchased, but the supplies should be reviewed to see if the contents meet the changing needs of your residents and employees. As a former Boy Scout Master and as a pharmacist, I strongly advise going through your first aid kit yearly. Replace expired and damaged supplies and add new items as required. Tie the yearly review to your yearly inspection or taxes so that you can remember easier. I recommend the addition of the following to any kit.

  • Burn relieving gel, commonly called burn gel.  It contains numbing agents for the pain, has antiseptic qualities, and helps replace some of the lost moisture.
  • Sunburn spray. It contains a topical numbing agent for touch-free pain relief.
  • Hand sanitizer. It makes it easier to clean up. Be warned, though, it contains alcohol that will be painful to open sores.
  • Latex-free gloves, multiple pairs. Latex allergies are on the rise because of our increased exposure to the substance.
  • Breathing masks for mouth-to-mouth rescue breathing.
  • Instant Cold packs, good for cooling burns and reducing swelling
  • Tweezers, round pointed scissors, safety pins, and a magnifying glass.

Here’s a First Aid Kit story from my personal life.

When my children grew and moved out I did the dutiful pharmacist dad thing and gave them all first aid kits for Christmas. My youngest daughter just threw it in her husband’s truck and forgot about it. Many years later while visiting her home she cut herself pretty bad. (She was trying to show off some of her cooking skills). We grabbed the first aid kit from the truck and searched for some band aids. The kit had not been looked at since she placed in the truck. The bandage wrappers were falling apart and the adhesive did not stick to the skin. Fortunately she had some 4X4 in gauze and some paper tape that we were able to utilize to stop the bleeding.  The moral of the story is to check your first aid kit before you need them.

Image result for old first aid kit

 

Tips on what to do for burns

     Burns are defined as injuries to the skin and tissues caused mostly by heat (thermal), chemicals, and electricity. The degree of the burn is classified by how much tissue is involved. First degree (superficial) affects only the outer layer of the skin or epidermis. Second degree affects the inner layers of the skin or the dermis.  Third degree penetrates all the layers of the skin. The goal of burn care is to reduce pain, protect against infection, and prevent evaporation of skin fluids.

Care for Minor Burns

      Hold the burned area under cool water or apply cold compresses until the pain subsides.  If blisters form, do not break them. Keeping them intact prevents infection. Apply Mole skin dressings in layers to keep pressure off a blister.  (Mole skin should be an item in your first aid kit) If keeping the blister intact is impractical, pierce the blister at its base with a sterilized needle.  Save as much of the blistered skin as possible as a natural barrier to pathogens. After the initial cool-down time, clean and dry the area and apply burn gels and/or antibacterial ointments and bandages if needed. Cover the burn with non-stick sterile dressing. If toes or fingers have been burned, place dry dressings between them. Have the patient drink water.

Care for Chemical Burns

     Remove the harmful chemicals from the skin as soon as possible. Brush off dry chemicals from the area before flushing. Flush the area with cool water for at least 20 minutes to remove all traces of the chemical. Trying to neutralize the chemical is not recommended because some neutralizing reactions cause extra heat. Neutralize the chemical only if the manufacturer advises you to do so. Look for instructions on the package labeling. Remove contaminated clothing and jewelry while flushing with water. Flush a chemical out of the eye from the nose outward for 15 minutes.

Care for Third-Degree Burns

     After cooling the burn, cover the area with a dry, non-stick dressing or clean cloth for larger areas. Treat the victim for shock.

Care for Electrical Burns

    Look for entrance and exit burns. Cool both areas with cold water. Cover with non-stick dressing and treat for shock.

 

Urine or Feces Burns

   Naturally, keeping the resident clean and regularly taken to the toilet prevents troubles. There have been plenty of times though in my homes when the resident was put to bed just fine and dandy only to wake up with chemical burns from urine or feces accidents that occur during the middle of the night. Clean the bottom and pat it dry. I recommend putting on some gloves and applying a barrier cream, like A&D ointment for diaper rash or Budreaus Butt paste. It will give the burned area some extra protection from further accidents or sweat while the resident’s body heals itself. It also makes it less irritating for the resident. 

 

*Special Notes on Burns

  • Seek additional medical attention for burns covering 25 percent or more of the body, respiratory burns, electrical burns, and any third-degree burn.
  • Remove any jewelry before swelling prevents its removal.
  • Do not remove clothing that is stuck to the skin.
  • Treat all serious burn victims for shock.
  • If further medical attention is needed, do not apply burn gels or numbing sprays. They may interfere with advanced medical procedures.

Tips on Bleeding Wounds

     The red color of our blood is a sure sign of a wound and the need for first aid. The seriousness of the wound is determined by how much blood is lost. If the blood spurts from the wound, an artery has been severed and the patient is at the greatest risk. Deep vein bleeding can also be life threatening. The goal of therapy is to stop the loss of blood and retain as much flow as possible to the vital organs until help arrives.

Bruises

     Bruises are internal bleeding and for the most part can be reduced by applying a cold pack. Larger bruises may be an indication of greater internal damage, and medical follow up may be needed.

   The blood thinning medications; Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Eliquis), Heparin and Warfarin (Coumadin) makes it easier to bruise. If you see one of those medications on the resident’s MARs, especially Warfarin, you need to take extra care when handling them. It also would be wise to educate the resident’s friends and family about the extra bruising potential they have. Notify the doctor if excess bruising is occurring. Also tell any visiting nurses, government regulators, or other such visitors of the medication. It will help keep them from accusing you of patient abuse.

 

Internal Wounds

    Not all wounds can be seen. If the victim coughs up blood, vomits blood or black-coffee-ground-appearing substance, has black, tarry stools or red blood in the stool, notify the doctor, further medical attention is needed.  It’s a judgement call if the resident should go to the hospital, it all depends on of how much and why the blood is occurring.  As I always say, “When in doubt, send them out”.

 

Care for External Bleeding

     Protect yourself by using universal precautions (assume it’s infected) when handling any blood.

  • Expose the wound by removing or cutting away interfering material.
  • Place a dressing (gauze pad, clean clothing, clean wash cloth) over the wound and apply direct pressure for at least five minutes. The patient themselves can apply the pressure if your attention is needed elsewhere. If the bleeding continues and the wound becomes blood soaked, apply additional dressing on top of the original. Keep pressure on the area until the bleeding stops or help arrives
  • If the wound is on an arm or leg, elevate it so that gravity may assist in stopping the bleeding. If the bleeding does not stop, apply pressure on a pressure point to reduce blood flow to the wound. Tourniquets are not recommended and are used only as a last resort to save a life.
  • If needed, a pressure bandage can be applied by tightly wrapping the area with roller gauze. Be sure to roll on the gauze above and below as well as on the wound.
  • Extreme caution should be used with larger foreign objects in the wound like a nail or piece of glass. Generally speaking, they should be left in place and the dressing placed around the object. Attempting to remove the object may cause greater damage. A ring bandage can be made by wrapping rolled gauze or other material around your fingers then placing it around the object in the wound.
  • For minor cuts, when the bleeding stops wash the area with soap and water. Flush the wound with water under pressure to remove dirt and debris. Remove remaining small objects with tweezers. If bleeding restarts, reapply pressure again. Apply antibiotic ointment and place a clean bandage on the cut.
  • Replace bandages daily or more often if they get dirty. If the bandage sticks to the scab, soak the bandage in warm water before removing.

Skin Tears

     Skin tears are wounds where the outer most layer of skin has been peeled away and the skin is still attached. Gently clean the wound by flushing with water. Air dry or gently pat dry the area and put the skin back in place. Apply a tent bandage or other covering that will not disturb the wound. Seek medical help.

  • Tent bandages are made by creasing a larger non-stick gauze pad down the middle to form a tent-like shape. Place over the tear so that the tent bandage covers but not touches the wound. Secure it only on two opposite sides of the tent with easy-to-remove paper tape. They are handy on bad burns and other wounds where bandage contact with the wound is not desirable.

 

Nose Bleeds

     Noose bleeds are usually not serious and are controlled by leaning the victim forward and pinching the nose for about 10 minutes. If bleeding continues, pinch the nose again. If the bleeding continues after 15 more minutes, seek medical attention.

*Special Notes About Bleeding Wounds

  • Superficial head wounds tend to bleed more but are not as serious unless the skull has been fractured.
  • Do not apply pressure on a skull fracture, an eye injury, or foreign objects in the wound.
  • In serious cases, do not give food or drink. It may induce vomiting or complicate future medical procedures. If vomiting does occur, roll the victim on their side so that the material is not inhaled.
  • Seek medical attention for animal bites, cuts over joints, deep puncture wounds, and infected wounds, especially if red streaks appear leading from the wound (a sign of blood poisoning).
  • Save any body part that has been amputated from the body, including teeth. Do not clean the part. Wrap it with clean, dry material. Place the part in a bag or waterproof container and place it on ice.
  • If pressure wraps have been applied, monitor the color and feel of the fingers and toes to seek if blood flow has been restricted too much.
  • Treat all major wounds and amputation victims for shock.Image result for elderly with head wound

     When I was an adult foster caregiver, my patients would sometimes fall and bang their heads. Because elderly have naturally thin skin, the bump would often bleed. The first couple of times I became overly concerned and rushed the patients to the hospital. The emergency room personnel made us wait and wait and wait. I became even more concerned and got angry at the staff. They were kind enough to tell me that the bleeding was actually a minor skin wound. The nurse told me that superficial head wounds bleed a lot and look ugly but are not as serious as they tend to look.

 

 

Tips on Shock / Anaphylaxis

    Shock occurs when body parts do not get enough blood flow and can result in fainting and death. The goal of emergency care is to shunt the blood flow to essential body parts.

Caregiving to Prevent Shock

  • Lay the victim on their backs.
  • Raise the legs six to 12 inches to promote blood flow toward the trunk of the body.
  • Prevent heat loss with blankets or coats. This helps reduce the need for blood flow to the skin.
  • Victims with head injuries should be placed in a reclined sitting position.

Anaphylaxis

     Anaphylaxis is a severe allergic reaction and can be life threatening within minutes. The goal of therapy is to slow the allergic reactions by antihistamines or prescribed epinephrine auto injectors (EpiPen).  Antihistamines (Benadryl, Claritin, Allegra) can take up to 20 minutes to take effect. Watch for breathing difficulties and be prepared to perform mouth-to-mouth rescue breathing. EpiPens are used by removing the cap and stabbing it into a major muscle mass like the thigh. Treat for shock until the patient recovers or help arrives. If you see an EpiPen on the med list get instructions on how to use it, along with nurse delegations from a home health nurse. There will be side effects that will occur if the EpiPen is used. Count on at least a major head ache.

 

Tips on Muscle Bone and Joint Injuries

     Muscle, bone, and joint tissues all combine to give the body support and promote motion. Injuries to these tissues can be debilitating and easily lead to greater harm. The goal of therapy is to prevent further injury to the surrounding tissue while retaining necessary body movement.

Muscle Cramps

     Muscle cramps (charley horses) are an involuntary contraction of the muscles. They tend to happen when the body is fatigued, lacking hydration or electrolytes. Charley horses can be resolved by massage and stretching. Multiple or continued muscle cramps might be a sign of more serious issues. Proper hydration, stretching, rest, and electrolyte replacement are all acceptable treatment and prevention therapy.  

Sprains and Strains

     Sprains are caused from overstretched joint ligament while strains are overstretched muscles. Both create continued soreness, swelling, pain, and weakness that need external support for normal functioning.

     Minor occurrences can be treated by massage, OTC pain killers, and pain relieving sport creams. First aid for more serious events requires supporting wraps and cold packs. Do not attempt to straighten severely hurt limbs and joints.  It should be assumed that there is fractured bone in the more serious cases. Back strain is often a precursor or indicator of a more serious back injury and should not be taken lightly.

Image result for elderly falls

Major Trauma Events

     Major trauma such as falls, collisions, or violent blows can fracture and break bones and dislocate joints.

  • Open fractures are when the bones stick out of the skin and are serious situations. Control any bleeding by packing off the area without applying pressure. Do not move the victim. If needed, immobilize the fracture with as little movement as possible with soft or hard material splints.
  • Closed fractures are when the skin is intact and broken bones are harder to detect. Look for deformities, tenderness, pain, and open wounds that may indicate broken bones underneath. Rapid swelling frequently occurs after fractures. Immobilize the fracture with a splint. When investigating for broken bones, ask the victim these questions:
  1. Did you hear or feel a bone snap?
  2. Are you unable to move the injured limb?
  3. Do you feel pain when you press on the skin over the suspected fracture?
  • Dislocated joints happen when joints come apart. They appear as deformities and reduce the ability to move correctly.

Care for Fractures, Dislocated Joints, and Muscle Injuries

     Every major trauma case will require further medical attention, but first aid given in the first few hours can greatly reduce the pain and discomfort of an injury. Treat every injury as follows:

  • Rest or immobilize the injured area. Reducing movement prevents further injury and reduces blow flow in the area, subsequently reducing swelling.
  • Apply cold packs or ice. Cold also reduces blood flow and numbs the area. Be sure to provide insulation between the ice and the injury and monitor for circulation problems and tissue freezing.
  • Compress the injury with elastic wraps or securely tied soft splints. Monitor for proper blood flow.
  • Elevate the injury so to that gravity can help with swelling issues.

Related image

Splints

     A splint is any material used to stabilize a fracture and is useful in reducing pain and preventing further damage. For the most part you’ll never need to splint to anything. Apply splints only if it does not cause further pain to the victim and you have to significantly move the resident.

 

 

  1. Before applying a splint check the area for proper circulation. Look at the color, warmth, and feeling.
  2. Keep the area above and below the injury still and stable.
  3. Select a splint that extends beyond both ends of the injury.
  4. Providing support above and below the fracture, apply the splint with as little movement of the injury as possible.
  5. Secure the splint by ties above and below the injury.
  6. After the splint is secured, monitor for circulation and feeling.

Soft Splints

     Cushioning the injured area with large amounts soft material can also immobilize the injury. Pillows, folded blankets, and heavy coats can be used as soft splints.

 

*Special Notes on Muscle, Bones, and Joints

  • Slings can be used to support and immobilize injured arms and collar bones.
  • Tying the injury to the body (anatomical self-splint) can be a useful splinting alternative. Example- securing a sling to the torso of the patient to prevent collarbone movement
  • Pinching the upper lip hard can help reduce muscle fatigue and discomfort. (acupressure)
  • Continued cold pack applications for the first 24 hours after an injury can reduce healing time.
  • Provide cushioning under bulky knots for patient comfort.
  • Hip fractures are very serious. If suspected don’t move the resident and call 911. Major hip fractures will probably mean the resident will have to be moved out of your home.

 

Tips on Head, Neck, and Spine Injuries

     The brain and spinal cord are very fragile and can be harmed in trauma injuries. Nervous system damage may not be readily apparent. When rendering emergency care, it is wise to assume head, neck, and spine injury if:

  • There’s been an automobile wreck or a body blow involving heavy equipment.
  • There’s been a fall from higher than standing height.
  • The victim if fragile or over 65.
  • The victim is confused, acts intoxicated, or is not fully alert.
  • There’s a complaint of neck or back pain.
  • The victim feels a tingling or numbness in the finger or toes.
  • The pupils are dilated unequally or unnaturally (too large or too small).

Care for Brain and Spinal Injury

     Nervous system damage can cause permanent paralysis or death, so the goal of therapy is to immobilize the patient to prevent further harm.

  • Image result for stabilizing head and neckStabilize the neck and head if spinal cord injury is suspected. Additional help should be called on to hold the head still while you render emergency care.
  • Do not move the resident unless circumstances force you to.
  • If there is a breathing problem, make only slight adjustment until the airway is open.
  • Treat for shock without moving the victim.
  • Do not use a pillow under the head.
  • If the patient has to be moved, get assistance and move the body all at once as a single unit. For example, rolling to the side in the case of vomiting.
  • Do not apply pressure directly on skull fractures. Control bleeding by applying a bandage and putting pressure around the edges of the wound.
  • Do not stop the flow of blood or fluid from the ears or nose. Doing so may create increased pressure on the brain.

 

Tips on Other Body Injuries

     Accidents happen, and injuries can occur to any part of our body.  

Eye Injuries

  • Small foreign objects- Flush the eye with clean water or pull open the eye lid and remove the object with a cotton swab or sterile gauze.
  • Major trauma- Immobilize gently with sterile gauze any penetrating object, eyeballs knocked out of socket, or major cuts. Cover both eyes to further prevent eye movement. Seek additional medical attention
  • Minor blows to the eye- Apply cold pack to the eye for about 15 minutes.
  • Chemicals in the eye- Keep eye open as wide as possible. Flush with warm water for 20 minutes from the nose side out. Have the patient continuously roll the eye when flushing. Loosely bandage both eyes and seek additional medical help.

Image result for hockey player with no teeth

Teeth

Knocked out teeth-

Partially removed teeth should be pushed back in.

Completely removed teeth

 

  1. Control bleeding by rinsing the mouth and applying gauze to the socket.
  2. Retrieve the missing tooth by handling the crown only, rinse with saliva or milk. (do not use water, skim or powdered milk)
  3. If you cannot make it to a dentist in less than 30 minutes, try to reinsert the tooth while traveling.
  • Broken teeth or fillings- Clean the area with warm water. Apply a tooth-numbing agent if needed. Apply dental wax to the exposed end of the broken tooth if needed.
  • Broken jaw- Stabilize the jaw by wrapping a bandage under the jaw and over the head.

Excessive Blood Under Nails

     If a toe or fingertip has been crushed, blood may pool under the nail and creates painful pressure. The pressure can be relieved by heating a nail or paperclip and melting a small hole in the nail. Clean and apply dressing afterwards

Protruding Organ 

     Cover exposed organ part with a moist dressing that will not stick or fall apart when wet. Cover dressing with a towel to maintain warmth. Stabilize the area loosely.

 

Caregiving Tips on Internal Threats

Diabetes

     Our brain requires a constant supply of glucose as fuel to operate. Our digestion system is set up to convert most things we eat into that fuel. Diabetics have an impairment that prevents them from processing glucose properly. There is always a potential of having too much glucose in the blood stream and not enough in the brain or that their medication has worked too well and there is not enough glucose in the blood or the brain. This impairment leads to diabetic emergencies that can be life threatening. Suspect a diabetic emergency if you witness the sudden onset of a combination of these symptoms:

Staggering, poor coordination, nervousness, anger, confusion, pale color, sudden hunger, excessive sweating, trembling, fruity-smelling breath, rapid heartbeat, blurred vision, or eventual unresponsiveness.

Care for Diabetic Emergencies

     Measure their blood glucose and respond as follows

If the blood glucose readings are under 70mg/dl they are too low or hypoglycemic.

  • Treatment is to eat 15 grams of sugar (2 tsp. or ½ can soft drink or the equivalent of orange juice) wait 15 minutes. Repeat if symptoms persist. If symptoms still persist, seek immediate medical care.

If the blood glucose readings are over 240mg/dl they are too high or hyperglycemic.

  • Treatment is to give rest, fluids, and medication. If reading continues to increase or is over 350mg/dl, seek immediate medical care.

If the blood sugar cannot be determined, give 15 grams of sugar and wait 15 minutes for improvement. If none is seen, seek additional medical treatment.

Fainting

     Fainting is usually caused by low oxygen to the brain that can result from a variety of conditions. If a resident faints, check for breathing problems and additional injuries. Raise the victim’s legs six to 12 inches and loosen tight clothing. Supply fresh air and a cool, wet cloth if needed. Have the victim get up slowly and give them a cool drink. Monitor for continued dizziness.

   If the resident is on blood pressure medication check their too see if their Blood pressure is too low. If it’s okay then monitor the patient. Report the fainting to the doctor. Train the resident to get up in stages. Set up, move to the edge of the seat and then stand up slowly. If the resident stands up all at once gravity will pull the blood away from the brain and they will get dizzy and faint. It is a common occurrence in the elderly and residents who take blood pressure meds.

Seizures

     Seizures are abnormal firing of brain cells that results in sudden falling, unresponsiveness, rigid or arching of the back, and jerky muscle movements. The goal of therapy is to prevent further injury and to aid in the recovery of normal mental function after the seizure.

Care for Seizures

  • Remove any potentially harmful objects that are nearby.
  • Cushion the victims head.
  • Loosen tight clothing.
  • Roll the victim on their side.
  • Help orient the victim as the seizure ends.
  • Keep curious onlookers away. (Seizures are embarrassing.)
  • Do not put anything in their mouth or try to restrain any movement.
  • Seek additional medical help for seizure lasting more than five minutes, continued seizures, or if victim has other medical conditions.

     When I was a Scout Master, I took my boys to summer camp. We had a bon fire program and the presenters mesmerized my scouts with images and shadows that danced and flickered across their eager faces. Unfortunately, the flickering also triggered a seizure in one of my boys. There were several well-qualified first aid responders there in an instant. The boy soon recovered, and I took him back to the tents. With a whole camp full of curious boys and one very embarrassed seizure victim, I soon found out that crowd control, appropriate information dissemination, and privacy matters are very important seizure treatment considerations. 

Caregiver Tips for External Threats

Poisons

     Poisons are any substance that harms the body or causes death. The signs of poisonings are nausea and vomiting, stomach cramps, diarrhea, burns, odor, or stains in or around the mouth, drowsiness or dizziness, and poison containers nearby.

Treatment is dependent on what was ingested. Call the poison control center at 1-800-222-1222 for guidance. If they are unavailable, call 911. Save any vomit and suspected poisons that are nearby. Do not give any water unless told to do so. Do not induce vomiting. There is no evidence that it helps and may cause more damage as the poison comes up.  Lay the victim in the recovery position. Treat the victim for shock and monitor breathing.

Poisonous Plants

     Certain plant oils can cause a delayed severe allergic reaction in susceptible persons coming in contact with them.  Poison oak, poison ivy, and poison sumac are the most common. Reactions typically occur within 24 to 48 hours but can start to show six hours after contact. Watch for rash, itching, redness, blisters, and swelling.

Image result for poison oak rashRelated image

A certain diagnosis is difficult because of the delayed effect. If poison plants are seen in the area and if contact is suspected:

  • Change clothing. Handle soiled clothing with care or gloves.
  • Wash the contact area with plant oil dissolvent (commercial products are available at a pharmacy, Technu products and ivyblock) or flush the area with large amounts of water. Scrubbing the affected area with soap usually just spreads the oils to other parts of the body.
  • Apply numbing creams or sprays, hydrocolloidal oatmeal preparations, hydrocortisone or calamine lotion.
  • For those with a larger portion of the body affected, use oatmeal bath preparations like
  • Seek medical attention if ingested or smoke from burning plants was inhaled.
  • OTC antihistamines might slow or mute the reaction.

 

Animal and Human Bites

Consider all human and animal bites infectious, and seek further medical attention. Clean the wound the same as for a bleeding wound. Use extreme caution in handling the offending animal. It is safer to notify the police or an animal control specialist and let them collect the animal for rabies examination.

Insect and Spider Bites and Stings

     There are many insects and spiders that have been known to bite or sting humans. Often the victim does not even know they were bitten until a reaction starts to occur.   First aid is to clean the wound with soap and water or rubbing alcohol. Place a cold pack over the area to delay the effect of any venom and ease the pain. Take note of any venomous species seen in the area and monitor for serious signs and symptoms. Watch for muscle stiffness or cramps, headache chills, fever, heavy sweating, dizziness or vomiting, difficulty breathing, severe site reaction or blister, and anaphylactic reactions. Seek medical attention immediately if these occur.

  • Fire ant bites are very painful. Do not pop the blisters that form. The pain may be helped by applying a baking soda and water paste.
  • Ticks should be removed using tweezers very slowly. Grasp the tick as close to the body as possible and gently pull, using just enough force to lift the skin but not break the insect. After the tick has been removed, wash with soap and water or alcohol. Monitor the bite for one month for a rash. If one appears, seek medical attention. Other serious symptoms that may appear are muscle and joint aches, sensitivity to bright lights, and paralysis that starts with leg weakness.

 

Caregiver Tips for Heat Emergencies

     Medical heat emergencies occur when the body’s cooling mechanisms get overwhelmed and body temperatures exceed normal functioning levels (105 degrees).  It can happen over a period of days (dehydration) or occur more rapidly (overly hot weather conditions).  Certain medications can aggravate the situation for example water pills and other diuretics like caffeine.  The goal of therapy is to ensure proper hydration and cool the core body temperature so that vital systems may function. The elderly and infirm are more susceptible and have less ability to sense when warning symptoms occur. The elderly just don’t feel thirst like they used to. During a hot summer or on field trips they will have to be monitored more closely. Regularly scheduled drink breaks would be a good idea.

Heat Exhaustion

     Heat exhaustion is the first sign that the body’s cooling mechanisms are being overwhelmed. It can be brought on by a combination of dehydration and a hot environment. The symptoms are sweating, thirst, fatigue/exhaustion, nausea, headache, shortness of breath, and rapid heart rate. A quick dehydration test is loosely pinching the skin on the upper part of the hand. If it snaps back into place everything is okay. If a peak remains then the skin is dehydrated. The older one is the less effective this test is.  

Care for Heat ExhaustionImage result for cooling off  funny

  • Place the victim in a cool environment and remove excess clothing.
  • Give cool drinks. Sport drinks with electrolytes are best, but lightly salted water or nutritional supplement drinks can also replace missing electrolytes. Continue to maintain proper hydration.
  • Wet sponge the victim and fan them. (artificial sweating)
  • If no improvement is seen within 30 minutes, seek additional medical help.

 

Heat Stroke

     Heat stroke is a more serious condition where the victim’s cooling mechanisms have failed and harm to vital systems are occurring. It can be seen as extremely hot and or dry skin and altered mental status ranging from slight confusion to agitation and fainting.  The goal of therapy is to get additional medical help immediately and cool the body down.

Care for Heat Stroke

  • Call 911 especially if mental status has changed or the patient stops sweating.
  • Place the victim in a cool environment and remove excess clothing.
  • Add water to the skin and clothing and fan vigorously.
  • Encourage small amounts of fluid intake.
  • Raise the legs to help from feeling faint.
  • Place ice bags wrapped in wet towels around the neck, armpits, body trunk, and groin.

*Special Notes for Heat Emergencies

  • Rest is required for the remainder of the day for victims.
  • Heat stroke victims may become angry and uncooperative, which is a sign of the loss of mental control.
  • A cold shower with or without clothing might be appropriate in emergencies.

Image result for caregiver

Conclusion

   The residents in your homes count on you the caregiver for their comfort, health and tranquility, just about everything they need. No other health profession has so many expectations placed upon them. As the residents point of first contact with the health care system and as their advocate you either have to take care the problem yourself or know how to connect to with rest of the health care continuum to solve ANY the issue that may occur.   Being professional in your caregiving efforts helps with your burdens. It also entails being prepared for any emergency that may occur. It is your job to know what steps to take in the smallest to the largest of emergencies.  From a certain point of view that makes you the most important health care provider in your residents lives. Good luck in fulfilling that role.

 

References:

  1. Hypoglycemia (Low Blood Glucose). American Diabetes Association June 1, 2015 http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html
  2. Choking. Wikipedia the Free Encyclopedia, April 15 2017. https://en.wikipedia.org/wiki/Choking
  3. First Aid. English Wikibooks September 19, 2007 https://upload.wikimedia.org/wikipedia/commons/1/1d/First_Aid_for_Canada.pdf
  4. First aid. The Mayo Clinic. http://www.mayoclinic.org/first-aid
  5. First Aid & Emergencies. WebMD. http://www.webmd.com/first-aid/default.htm
  6. First Aid Merit Badge Manual. Boy Scouts of America. http://www.scouting.org/filestore/Merit_Badge_ReqandRes/First_Aid.pdf
  7. Rod Brouhard, EMT-P. OSHA Compliance for First Aid in the Workplace. VeryWell. July 10, 2016https://www.verywell.com/osha-compliance-for-first-aid-in-the-workplace-1298830
  8. Best Practices Guide:Fundamentals of a Workplace First-Aid Program. U.S. Department of Labor Occupational Safety and Health Administration, OSHA 3317-06N, 2006. https://www.osha.gov/Publications/OSHA3317first-aid.pdf
  9. Medical and First Aid. U.S. Department of Labor Occupational Safety and Health Administration. https://www.osha.gov/SLTC/medicalfirstaid/

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