Patient Care Process
Basic Medical Information
• John FOWLER, MD
• Fecri BENGİ, MD
• Nesibe SÖNMEZ DEMİRYOĞURAN, MD
• Melek GÜRYAY, MD
• Sevilay KARADUMAN, MD
The most frequent reasons of applying to emergency service include head trauma, headache, fainting, sprain, chest pain and heart attack, diarrhea and vomiting, cut and burns. In such cases, it is significant to know what to do firstly.
Head trauma may occur due to accident, impact or hitting. Head trauma may result in permanent damages as a result of severe injury of brain tissue. For this reason, in time and correct intervention may be life saving. Emergency medicine specialists provide service for 24 hours at emergency service for emergency cases and neurosurgery specialists are consulted.
It is of vital significance to apply the closest emergency service in case of findings such as black-out, blood from ear, dizziness, headache, blurred vision, non-balancing or starting of contraction. Especially the earliest finding in the infants may be the baby’s rejection to being nourished and breastfed. The repetitive vomiting in spouting style is also very significant medically. This type of vomiting should be discriminated from the common vomiting that may always happen after nourishment in infants.
On the other hand, after a simple head trauma, we should observe our child or adult who was subjected to trauma at home. The person’s being exhibiting different behavior than usual is the most important condition that warns us. Conditions like crying more than ever that cannot be stopped, absentmindedness, delay or failure in answering the questions, inability to focus attention, inability to follow objects, tendency to sleep, inability to be awakened, headache should be monitored. These persons shouldn’t be left alone at home.
Short (1-2 minutes) loss of consciousness with the temporary decrease of the blood to the brain is called syncope (fainting). It may have a number of causes. Seeing blood, learning bad news, feeling severe pain, suddenly standing up, side effects of drugs, staying standing up for a long time may be causes of fainting. However, cardiac insufficiency, serious heart rhythm disorders, blood losses like gastric bleeding may also cause fainting.
When a person faints, she/he should be laid down on her/his back. They should not be tried to stand up, 112 should be called for help and the closest health institution should be applied.
Chest Pain And Heart Attack
Chest pain may be the symptom of many diseases mainly heart attack. What should be done if you suspect heart attack?
• Call ambulance (112) or apply to the emergency service of the closest hospital.
• Effort during this pain (climbing stairs, even walking) may increase your disease. For this reason, spend as little effort as possible.
• While waiting for the ambulance, chew 2 baby aspirins or half normal aspirin (at least 160 mg). Taking more may result in unexpected side effects. Chewing the aspirin before swallowing is important to accelerate its effect. If you have nitroglycerin tablet, place 1 under your tongue. This may help to increase the blood flow in the blocked or narrowed artery. If your chest pain continues, you may put one tablet more with five minute intervals for 3 times maximum.
Early diagnose and treatment of heart attack or coronary vein will contribute to the patient more.
The only reason of chest pain is not heart attack or other cardiovascular diseases. A number of diseases constituting life-threatening condition may show itself with chest pain. They are mainly aortic dissection, pulmonary emboli, pneumothorax, pericarditis, pneumonia, costochondritis, (inflammation of rib cartilage), esophagus diseases (reflux, esophagitis, esophageal spasm, etc.).
There are many causes to lead to headache. Tension type headaches are more frequent. Headache is often in throbbing character around the head in the form of a tight band. It starts mildly and gets more severe gradually. When you have a headache, resting in a quiet, dark environment may be relieving. In familiar headaches (had before) simple pain killers (paracetamol) may be used. However, in headaches not stopping, when fever, nausea or vomiting, numbness, altered level of consciousness, speech disorder, weakness or headache in severity that has never been experienced before occurs, you should apply to the closest health institution.
Straining the ligaments around a joint, the joint capsule and the other soft tissue structures beyond the normal movement range of the joint is called “Sprain”. Swelling, pain, bruise may be observed in the joint. These structures may stretch more than usual. They may even tear. The movements are painful.
What should be done in the event of sprain?
- Do not move the sprained joint.
• Apply an ice bag wrapped in towel on that joint for half an hour.
• Don’t step on the sprained foot.
• Put 4-5 pillows under the sprained foot, raise it above heart level.
• Do not hang down the sprained area.
• Swelling, bleeding and pain may occur.
• If there is pain and swelling and the pain increases by stepping on it, apply to a health institution.
Diarrhea And Vomiting
In the event of diarrhea lasting more than three days or fever accompanying diarrhea, severe abdominal pain, vomiting, extreme fluid loss, bloody diarrhea, you should apply to emergency service. Since the body will lose fluid with vomiting, diarrhea and fever, this fluid must be replaced with water and liquid foods at home. And in the hospital, it may sometimes be necessary to administer serum by establishing vascular access.
Since the old people the children are much less resistant to dehydration of the body, you must consult your doctor all the time when these people have the complaints of vomiting and diarrhea.
One of the most frequently seen accidents at home is cuts. As well as these may be only skin cuts, vein, nerve, muscle and tendon damage may occur. Also, in case of sharp object injuries severe organ damage and loss and even life threat may be observed.
The most significant hazard in cuts is blood loss. In cuts with serious blood loss, while the bleeding is tried to be stopped by pressing on the bleeding place, the person must immediately be transported to a health institution in the safest way. What can be done during this time?
• The cut place should be washed with soap water and clean cloth if dirty and if there is visible foreign object (a piece of broken glass, piece of stone or sand etc.), it should be removed. Do not touch inside that there may be invisible pieces and do not try to remove the stuck ones.
• If there is bleeding in form of a leakage in the cut, lift the bleeding part above the level of heart and press.
• Do not break off the fragmented skin, fasten them cleanly and take the person to health institution immediately.
• In bleeding cuts in arm and leg, press on the bleeding region at the strength to stop the bleeding. Hold that way until the bleeding stops. Do not apply tourniquet. To the contrary of the generally known, as the arterial circulation in the arm and leg cannot be prevented enough with tourniquet application, it hinders the venous flow and the extent of the tissue damage may increase.
• When there are ruptures of large skin pieces, fingers, hand, arm, foot, leg due to cut; the ruptured organ or tissue is wrapped in clean, wet gauze strip and put in a nylon bag and the bag is taken to the health institution in an ice filled container along with the patient.
You should prevent whose clothes have been inflamed to run with panic. If the accident has happened outdoors, the burning person’s going out should be prevented because the airflow and the person’s movements will increase burning. The burning person should be laid down on the ground immediately, wetted with water or a cover like rug, blanket, curtain to leave the flames without oxygen should be thrown on him/her. Nylon or easily combustible fabrics should not be used to suppress the flames. The victim should not roll on the ground, it will lead the unburned areas to burn.
Since burnt skin causes fluid loss from the body and due to infection hazard, it should be carefully examined.
In order to prevent tissue damage, to reduce pain and swelling, the burns must be immediately cooled down. The most effective method in cooling is to wash the burnt region with cold water. Direct ice should not be used. Minor burns may be treated on site, however the baby and old people burns and also the eye, face, neck, hand, foot and perineum burns require special treatment. Burns occurred by vapours, chemical substances, irritant gases and electric shock should be treated at the hospital.In these persons, the chemical substances and smoke may have damaged lungs also through inhalation.
The methods to be followed for the first-aid in burns are as follows:
• Hold the burned skin under unpressurized flowing cold water for 10 minutes. If the pain doesn’t stop, submerge for a longer time in cold water.
• Before the burnt area starts to swell, gently remove the tight items like the rings, watches, belts and shoes.
• Take away the burnt clothes or contaminated with the flammable material in the burnt area slowly and remove them from the skin by cutting them if possible after they start to cool down. Do not try to remove things that are stuck on the burn.
• Do not apply lotion or oily substances on the burns and pop the blisters or make any intervention to the burnt area.
• Apply to a health center for treatment.