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Prepare your staff for in-office emergencies
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ATLANTA – Preparedness is the key to dealing with in-office emergencies, which usually happen when a provider least expects them, according to UAB associate professors, Caroline Pate, OD, FAAO, and Elizabeth Steele, OD, FAAO, here at SECO.
“We want to be prepared in case an emergency happens. Thankfully they don’t happen every day, but, should they happen, we need to make sure we have preparations in place,” Pate said.
Together, they suggested having a response plan for ophthalmic emergencies such as, retinal detachment, central retinal artery occlusion, giant cell arteritis, orbital trauma, alkali burn and angle closure in addition to systemic emergencies such as, chest pain, seizure, collapse, diabetic emergency, stroke and anaphylaxis.
“Consider these emergencies and think: If these walked into your office, would you be prepared? Do you have what you need to stabilize them and take care of your patient until they can receive long-term care?” Pate proposed.
When dealing with systemic emergencies, it is important to assess a patient’s vital signs, Pate said. The blood pressure, temperature, heart rate and respiratory rate are important; every office should have the tools to assess these.
“With meaningful use and the quality care measures, we are doing a little better assessing these on a regular basis, but it’s important to assess these in terms of emergencies,” Pate continued.
Body mass index should also be regularly calculated.
Steele discussed cardiac and noncardiac chest pain. With cardiac chest pain, people think of angina and heart attack, she said. With noncardiac, it could be benign, such as muscle strain or indigestion, and will change as a patient breathes or alters their body position.
The American Red Cross offers a first aid response resource guide with tips on how to manage patients. She recommends using it as an office resource for staff.
“Males and females respond very differently during a heart attack; you want to be aware of that difference,” Steele noted.
Males have the classic symptoms of chest pain, radiating pain, pressure and squeezing, she said, whereas females will have more generic symptoms such as nausea, vomiting, shortness of breath, sweating and jaw pain.
“Be aware of that and keep in mind that 20% of heart attack sufferers won’t have any symptoms at all,” Steele said.
If a patient who may be suffering a heart attack is responsive, they can chew a baby aspirin or an enteric coated aspirin, so it can be absorbed right away, she said.
According to the American Red Cross, for every minute of delayed CPR, there is a 10% decrease in recovery because of possible brain damage, she said.
When responding to an adult, call 9-1-1 first, but this is not the case with children, Steele added.
“If you’re by yourself and you’re dealing with a child who may have undergone cardiac arrest, it’s always important to start CPR before you call 9-1-1; that delay can make a huge difference in their recovery,” she said.
CPR has changed a lot in the last decade, according to Steele.
“The biggest difference now, instead of 15 compressions for every two breaths, it’s now 30 compressions to two breaths,” she said. “That’s the rule across the board, for kids and adults ... the compressions are what really matter.”
She said it is important to have an AED in the office.
“It’s going to tell you what to do, and it will not give a shock unnecessarily,” Steele added.
She provided an emergency supply checklist for offices:
- OSHA-approved first aid kit;
- Epi-Pen;
- AED;
- In-office oxygen tank;
- Eyewash station;
- Ocular irrigation system;
- pH strips;
- Updated CPR training;
- Safety map showing exits, fire extinguishers, etc.; and
- Phone numbers to call in case of needlestick emergency, poison control and hospital emergency room.
Medications to keep in the office include:
- Acetazolamide oral 250 mg;
- Iopidine;
- Timolol 0.5%;
- 1% to 2% pilocarpine;
- Carbonic anhydrase inhibitor;
- Prednisolone;
- Atropine; and
- 10% phenylephrine;
“The main thing is that everyone in the office is mentally prepared for this, regarding what their role is and who going to do what in x, y and z scenarios. If you’ve thought about that for the different scenarios, you should be ready,” Steele said.
“There is no such thing as a routine exam until the exam is complete and the patient is out the door,” Pate concluded. – by Abigail Sutton
Reference:
Pate C, Steele E. In-office emergencies. Presented at: SECO; March 1-5, 2017; Atlanta.
Disclosures: Pate and Steele reported no relevant financial disclosures.