think a CMA can handle,or should handle?

It probably depends on the type of emergency,and level of training you have received. ma's can provide cpr if needed, provided they have taking the bls course and give oxygen. Most ma's work in a office setting and are not exposed to emergencies on a daily bases, and are not comfortable when one arises. This is an area that I have tried to train my ma's but have difficulty because they cannot do assessments.
Here are some memory tips that I have given my ma's to use for minor emergencies? (syncope, dyspnea)

* If the face is red, raise the head.(which means if they are having difficulty breathing...sit them up...never lay down someone who cannot breathe

*if the face is pale, rasie the tail. (which means if they have passed out, don't sit them up, but rather lay them down and elevate their legs by lifting the legs up)

*never give more then 2 to 4 liters of oxygen on an elderly person as they may have COPD, and stop breathing if you give them to much oxygen.

* If you are able to give iv fluids...make sure you have the correct fluid type..isontonic, hypotonic or hypertonic..you can count on 9% aka normal saline to be ok to give to anyone.(check with the doc) BUT NEVER!!! open up the fluid to run at full speed on an elderly person as it could cause pulomnary edema and possible kill them...dito for small children too.

again you should check with the doctor you work with and your state scope of practice.

l.lopez lpn

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I see alot of cardiac emergencies working at urgent care. We always call 911 for transport, but I have orders to start O2, run and EKG, give nitro, baby ASA and get them outta there! We also have a had a few drug related concerns so I have given narcan. We see alot of anaphylaxis, so shots of epi are pretty common during the warmer months. It depends on where you work and how you are trained. None of that is done wuithout a physicians order.

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or... (to clarify the above for the newer medical assistants!) without the doctor present in the office and IMMEDIATELY notified, even if he/she is with another patient! One MA attends to the patient, while the other rushes to get the doctor.

The reason why I am adding this is to make sure MA's understand the difference between a routine standing order, and an emergency situation. The may not understand the last phrase regarding having doctor's orders. The more experienced professionals, of course do.



Danni

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Other acute emergencies beside anaphylaxis I often encountered: syncope (fainting), especially during venipuncture, and severe bleeding (when people rush into the doctor's office rather than the hospital emergency room).


Danni

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one way to reduce the risk of syncope is to have the patient laying down when drawing blood or giving injections. We used to have a rn that would give patients shots or draw their blood and send them on their way...of course we would also here a 'thump' by the check out windows..that would be the pt passing out.
I implemented the standard "lay them down" policy for venipuncture and injections and 'make them wait 5-10 minutes" before they go..this ensures that (1)if they are going to have a reaction to the medication, they are in the exam room and (2)if they are going to have a vaso vagul reaction they will be in the exam room.

This really serves a 2 fold purpose...it keeps the patients arm steady when drawing blood, the pt is more relaxed, and they are less likely to pass out due to vaso vagul because they are laying down.

l.lopez lpn

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When patients get woozy, I give them a cold compress and put it on the back of their neck. It also helps quite a bit :)

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Heres a wierd one, We get all the common chest pain, stitches, and venipunture passout - but friday we had a pt WALK (ok with a walker) but walk in with a broken pelvis - off course we transported 911, but that was a first. What a tuff old bird.....

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Lori-I know that a COPD patient is not supposed to be on oxygen therapy of more than 3 liters-but I can't explain why. It is just something I have read and heard. Respiratory problems are complex and I have noticed that even those that have them don't understand a lot. Recently my grandmother said her brother(both of them are on oxygen) told her that if she ever isn't getting enough from her portable tank because of a kink in the tubing,that she should turn up the liters as much as possible,like he does. He is the type to to set it at anything he wants. I told her not to do that but I couldn't explain why. What should I have said?

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"Giving too much supplemental oxygen to a person who is a CO2 retainer can cause the PO2 to rise, of course. Too high a PO2 level tricks the brain into thinking the CO2 is ok too. It is not. For our diseased lungs will not remove the CO2 easily. So, with too high level of oxygen supplementation, we can get into real trouble with the CO2 rapidly. This could lead to respiratory failure"

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When my grandmother had heart surgery a few years back,while recovering in the ICU her kids were told periodically that her "blood gases looked good" and they would nod. Finally one of them,with a PhD in physics,said "What are blood gases?" The average COPD patient doesn't know what PO2 is,and I had to stop and think about it. I am assuming that you are saying that certain blood gases will rise from a high level of oxygen,which is dangerous. If I told my grandmother that,she would say "But what are blood gases?"

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wendy,

The reason why you don't give copd patients a lot of oxygen is because they will forget to breath.
In an average person when your carbon dioxide level is high, a chemical reaction happens in your body and a 'message" is sent to tell the brain to 'exhale and breathe in", but copd patients have their 'wires' all messed up...their body detects when the oxygen levels are low and then they inhale....so if you give them to much oxygen...their body will detect the oxygen and think that the levels are fine...no message is sent to inhale...they will stop breathing.
l.lopez lpn

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