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Ȃ_8U]XD&$9DVTXH]'++XLGREUR$&XUU(\H5HV Ȃ :HEHU6/HWDO$P-2SKWKDOPRO0DU_$OLSRXU).KHLUNKDK$-DEDUYDQG%HKURX]0&RQW/HQV$QWHULRU(\H'HF Workbook Page 9 of 46 8SFRPLQJ7HFKQRORJLHV &KDOOHQJH 7KDQN\RX4XHVWLRQV" HPDLOUQK#HDQZQHW Workbook Page 10 of 46 9/12/2016 Confident Management of Medical Objectives Emergencies that Present in the • Understand the value of proper Optometric Practice preplanning for medical emergencies. • Feel confident about the medical Tad Buckingham, OD, EMT-P - emergency exam September 2016 • Understand the likely medical emergencies that may occur in your practice. • Know the process for verbalizing a patient care transfer. Case Review Case Review cont. • 27 y/o male with a family history of • Pt. again gets anxious when asked to get OAG. “Hates Doctors” positioned into the slit lamp. You talk about the importance of accurate IOPs and • Staff state the pt. got sweaty and “He will try”. anxious during autorefraction and FDT • As you get in position you see him visual fields. sweating and breathing more rapidly. As • Pt. is calm and compliant during VAs, you get ready to stop the exam you notice Cover tests, and EOMS. instead of exhaling he bears down, his • Goldmann Tonometry is needed for pupils dilate and his eyes roll back as he pressures. starts shaking in minor movements Workbook Page 11 of 46 1 9/12/2016 Overview Case Review cont. • Not all medical maladies require 911 • The patient shakes with full body, very • Medical emergencies require a team approach to mitigate. The whole office needs low amplitude, muscle contractions as to take an active role. the slit lamp is moved away. ◦ The 911 caller ◦ The scribe • The full body movement lasts approx 5- ◦ The assistant 10 seconds. The pt. is unconscious. • All health care providers including Emergency Medical Services (EMS) professionals (both Fire and Ambulance) are bound by Federal As the Physician, what do you do? HIPPA regulations. • Paramedics act as extension of their supervising physician. • What occurs when 911 is called? Medical Emergency Activation Guidelines • Emergency Activation phone number (911) ◦ Type of medical emergency MEDICAL EMERGENCY ◦ Patient status • List of chart notes/"face sheet" to be copied for EMS PATIENT EVALUATION • The “Face Sheet” should include: ◦ Name, Address, DOB ◦ Contact phone number, Emergency contact name and number ◦ Primary Care Physician, list of allergies (drug and environmental) ◦ List of current medications, ocular and past medical history Other recommended phone numbers 1) American Association of Poison Control Centers Phone Number: 1-800-222-1222 2) Local Hospital phone numbers for needed consults. Workbook Page 12 of 46 2 9/12/2016 What is an acute Medical Emergency? Primary Exam-LOC, CABs • LOC (Level Of Consciousness) • An intrinsic or extrinsic influence that ◦ What is the patient’s level of consciousness? has acute durational (and not transient) • Circulation ◦ Is there evidence of circulation? effects on the: • Color? ◦ Level of Consciousness (LOC) • Evidence of Capillary refill? ◦ Cardiovascular system (C) • Distal pulses present? • Airway ◦ Respiratory system (A, B) ◦ Is the airway open? Can the patient talk? • Breathing *The Primary Exam is the core exam used for ◦ Is the patient moving air? • Mechanical evidence of chest rise/fall or abdominal evaluating a medical emergency. movement. Determine the level of Level of Consciousness Consciousness • AVPU ◦ Alert ◦ Verbal (responds to …?) ◦ Pain (responds to …?) ◦ Unresponsive What is the patient’s normal baseline? Workbook Page 13 of 46 3 9/12/2016 Alert Altered Consciousness • Patient is conscious and aware of their • Verbal surroundings ◦ Patient appears unconscious but responds to loud verbal stimuli. • An alert patient is further evaluated to • "Patient is stuporous responding to verbal stimuli" assess for any levels of confusion • Pain ◦ Four specific questions are asked ◦ Patient appears unconscious but responds to a shake • Alert to “Person”; "What is your full name?" or sternal rub stimuli. • Alert to “Place”; "What city are you in now?" • "Patient is stuporous responding to physical stimuli." • Alert to “Time”; "What month is it now?" • Alert to “Event”; "Why are you here?" • Unresponsive • If the patient is not 4/4 the are considered ◦ The patient is unconscious and will not respond to any confused. stimuli • "The patient is comatose." ◦ Describe the confusion level; “Pt. is confused 2/4” *To determine the depth/length of coma check for incontinence The AMS(Altered Mental Status) The AMS(Altered Mental Status) • S/Sx