Emergency Medical Guide 2023

E M E R G E N C Y M E D I C A L G U I D E 2 0 2 3

Ivan N. Mefford MD, PHD

Motaz Ibrahim MD Anthony Lundquist MSN, APRN, AGNP-BC

A c u t e C a r e f o r t h e E l d e r l y ( A C E ) U n i t

C a r d i o l o g y & V a s c u l a r S e r v i c e s

C a r d i o p u l m o n a r y S e r v i c e s

E m e r g e n c y S e r v i c e s

F o o d & N u t r i t i o n S e r v i c e s

F u l l - S e r v i c e L a b o r a t o r y

H e a r t A t t a c k C a r e

I m a g i n g S e r v i c e s

Jackson Street Campus

1 7 0 5 J a c k s o n S t . R i c h m o n d , T X 7 7 4 6 9

( 2 8 1 ) 3 4 1 - 3 0 0 0

Williams Way Campus

2 2 0 0 3 S o u t h w e s t F w y

R i c h m o n d , T X 7 7 4 6 9

( 2 8 1 ) 3 4 1 - 2 0 0 0

Wharton Campus

1 0 1 4 1 U S H w y 5 9 R d

W h a r t o n , T X 7 7 4 8 8

( 2 8 1 ) 3 4 4 - 5 0 0 0

I n t e n s i v e C a r e U n i t ( I C U )

L a b o r & D e l i v e r y

L i f e s t y l e s a t O a k B e n d

M e d i c a l / S u r g i c a l I n p a t i e n t U n i t

N e o n a t a l I n t e n s i v e C a r e U n i t ( N I C U )

O u t p a t i e n t S e r v i c e s

P h y s i c a l T h e r a p y S e n i o r B e h a v i o r i a l H e a l t h U n i t ( S B H U )

S k i l l e d N u r s i n g F a c i l i t y

S l e e p L a b

S t r o k e S e r v i c e s

S u r g i c a l S e r v i c e s

T r a u m a S e r v i c e s

W o m e n ' s I m a g i n g W o u n d C a r e S e r v i c e s

O a k B e n d i s t h e l a s t r e m a i n i n g i n d e p e n d e n t n o n p r o f i t h o s p i t a l i n t h e G r e a t e r H o u s t o n A r e a . W e p r o u d l y s e r v e F o r t B e n d C o u n t y a n d s u r r o u n d i n g c o m m u n i t i e s

T o v i e w a f u l l l i s t o f o u r s u r g e r y c e n t e r s , p h y s i c a l t h e r a p y c l i n i c s , a n d p h y s i c i a n o f f i c e s , v i s i t u s o n l i n e t o d a y !

o a k b e n d m e d c e n t e r . o r g

C-A-B of CPR for Adults, Children, and Infants*

C-A -B of CPR for Adults, Children, and Infants*

Component

Recognition of Cardiac

Arrest

Component

Recognition of Cardiac Arrest

CPR sequence

Compression rate

Adults

Recommendations

Children

Unresponsive (for all ages)

Check for responsiveness and breathing simultaneously

No breathing or no normal breathing, or gasping and no pulse

Recommendations

Infants

Adults Children

No breathing or only gasping and no pulse

Unresponsive (for all ages)

Check for responsiveness and breathing simultaneously

Activate 911 and get the AED or send second rescuer (if available) to do this

Ensure a pulse is felt within 10 seconds

No breathing or no normal breathing, or gasping and no pulse

C-A-B Chest compressions, Airway, Breathing

At least 100-120/min on the lower half of the breastbone

Compression depth At least 2 inches (5 cm)

Chest wall recoil

CPR sequence

Compression interruptions

Air way

Compression rate

Compression depth

Ventilations with advanced air way

No breathing

Activate 911 and get the AED or send second rescuer (if available) to do this

At least 1/3 AP diameter

Ensure a pulse is felt within 10 seconds

Allow complete recoil between compressions

C-A-B Chest compressions, Airway, Breathing

Rotate compressors every 2 minutes

Minimize interruptions in chest compressions. Do not move victim. Attempt to limit interruptions to <10 seconds

At least 100-120/min on the lower half of the breastbone

Head tilt–chin lift (suspected trauma: jaw thrust). Avoid excessive ventilation.

At least 2 inches (5 cm)

At least 1/3 AP diameter About 2 inches (5 cm)

30:2 Single rescuer

Defibrillation

Compression interruptions

or 2-rescuers

15:2 Two rescuers

Chest wall recoil Allow complete recoil between comp Rotate compressors every 2 minutes

1 breath every 6-8 seconds (8-10 breaths/min)

Asynchronous with chest compressions (at least 100-120/min) About 1 second per breath with visible chest rise

Minimize interruptions in chest compressions

Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock; resume CPR beginning with compressions immediately after each shock.

Abbreviations: AED, Automated Exter nal Defibrillator; AP, Anterior-Posterior; CPR, CardioPulmonary Resuscitation.

Head tilt–chin lift (suspected trauma: jaw thrust). Avoid excessive ventilation.

Attempt to limit interruptions to <10 Air way

* Excluding the newly born, in whom the etiology of an arrest is nearly always asphyxial.

BLS for Healthcare Providers Critical Concepts

High–quality CPR improves a victim’s chances of survival. The critical characteristics of high-quality CPR include:

• Start compressions within 10 seconds of recognition of cardiac arrest.

Compressionventilation ratio (until advanced air way placed)

• Push hard, push fast: Compress at a rate of at least 100-120/min with a d epth of at least 2 inches (5cm) for adults, approximately 2 inches (5cm) for children, and approximately 1 ½ or 1.5 inches (4cm) for infants.

Ventilations with advanced air way

• Allow complete chest recoil after each compression.

1 breath every 6-8 seconds (8-10 b

Asynchronous with chest compressions (at About 1 second per breath with visible

• Minimize interruptions in compressions (try to limit interruptions to < 10 seconds).

• Give effective breaths that make the chest rise.

Defibrillation

• Avoid excessive ventilation

Automated External Defibrillator-AED

Attach and use AED as soon as available. Minimize interruptions in shock; resume CPR beginning with compressions immediately

• As soon as an AED becomes available, the first step the rescuer should perform is to turn on the AED.

Abbreviations: AED, Automated Exter nal Defibrillator; AP, Anterior-Posterior; CPR, CardioPulmonary

* Excluding the newly born, in whom the etiology of an arrest is nearly always asphyxial.

• Allow AED to analyze rhythm. After the AED delivers a shock, the rescuer should immediately restart CPR, beginning with chest compressions.

• Start compressions within 10 seconds of recognition of cardiac arrest.

Foreign Body Airway Obstruction - Choking

• The best way to relieve severe choking in responsive adult or child – Perform abdominal thrusts.

• The best action to relieve severe choking in a responsive infant – Begin cycles of 5 back slaps, followed by 5 chest thrusts.

• When choking victim becomes unresponsive (adult, child, or infant) – the rescuer should send someone to activate emergency response system and immediately start CPR beginning with compressions.

Child or Infant With A Heart Rate

• When a child/infant has a heart rate greater than 60 per minute and a pulse but is not breathing effectively, the rescuer should give breaths without chest compressions.

• When an unresponsive child/infant is not breathing and has a heart rate less than 60 per minute and signs of poor perfusion despite oxygenation and v entilation with a bag-mask, the rescuer should perform both compressions and breaths.

C-A-B is Chest Compressions–Airway–Breaths, Not A-B-C CHEST COMPRESSIONS

• The rescuer should initially ensure that the scene is safe when the rescuer first sees a potential victim.

• A victim who is unresponsive with no normal breathing and no pulse needs CPR.

• To identify cardiac arrest in an unresponsive victim with no breathing (or no normal breathing) , a healthcare provider should check a pulse for no more than 10 seconds.

• It is important to compress to the appropriate depth during CPR to create blood flow during compressions

• The depth of chest compression s for an adult victim should be at least 2 inches (5cm).

• The depth of chest compressions for an infant is at least one third the depth of the chest, approximately 1½ or 1.5 inches (4cm).

• Rate of performing chest compressions for victims of all ages is at least 100-120 compressions per minute.

• Hands are placed on the lower half of the breastbone to perform chest compressions on the adult.

• In 2-rescuer CPR, while the first rescuer begins chest compressions, the second rescuer maintains an open airway and gives ventilations. Switch every 2 minutes.

• Preferred chest compression technique for 2-rescuer CPR for the infant is the 2 thumb-encircling hands technique.

AIRWAY

• After the airway is opened, the proper technique for delivering mouth -to-mouth ventilation is the rescuer opens the airway, seals his or her mouth over the victim’s mouth, pinches the victim’s nose closed, and gives 2 breaths while watching for the chest to rise.

BREATHS

• The rescue breath for an adult, child, or infant is effective when the chest rises visibly.

• During bag-mask ventilation, giving a breath just until you see the chest rise is recommended to minimize the risk of gastric inflation.

• The compression -to-ventilation ratio for 1-rescuer or 2 rescuer adult CPR is 30:2

• The compression -to-ventilation (or breaths) ratio for 2-rescuer child/infant CPR is 15:2.

• Compression and ventilation rates for 2-rescuer CPR in the presence of an advanced airway is to compress at a rate of at least 100-120 per minute, 1 breath every 6 to 8 seconds.

• When administering breaths by using a bag-mask device for a child who is not breathing but does have a pulse, the rescuer should give breaths at the rate of 1 breath per 1 second.

• Bag-mask device/technique is not recommended for a single rescue r to provide breaths during CPR.

BLS Healthcare Provider Helpful Hints are courtesy of Helen McCracken

Heart Attack

sists...

Early Warning Signs

None of the symptoms below is conclusive proof of a heart attack. The more signs and symptoms present, the more likely it is that the patient is undergoing a heart attack.

•Chest discomfort

•Sweating (cold)

•Nausea & vomiting

•Difficulty breathing

•Weakness

•Paleness

How to cut the risk

•Anxiety & denial

Studies show that the danger of heart attack and stroke increases with the number of risk factors present.

RISK FACTORS THAT RISK FACTORS THAT CAN BE CHANGED CANNOT BE CHANGED

•Cigarette smoking

•High blood pressure

•High blood cholesterol

•Diabetes

•Excessive weight

•Exercise

•Stress

•Heredity

•Sex

•Race

•Age

YOU ARE IN CONTROL!

Practice prudent heart living to reduce your risk of heart attack and stroke.

How to survive a heart attack

You can best help - possibly save a life - if you know in advance:

•The nearest emergency center equipped to handle cardiac emergencies

•How to do CPR

•How to get medical help (call 911)

Knowing these things, you should:

•Help the victim to the most comfortable position - usually sitting, with legs up and bent at the knees.

•Phone for medical help.

•Loosen clothing around the neck and midriff.

•Be calm and reassuring; keep the patient calm.

•If the victim is a known cardiac patient, have him take three

NITROGLYCERIN tablets within 10 minutes, approximately one tablet every three minutes. If the pain per-

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•Comfort the victim and be prepared to initiate the ABCs of EMERGENCY ACTION...

The ABCs of first aid are the primary things that need to be checked when you approach the victim, Airway, Breathing, and Circulation. Prior to CPR, ensure that the airway is clear, check to see if the patient is breathing, and check for circulation (pulse or observation of color and temperature of hands/ fingers).

Emergency - 911

Fort Bend County Sheriff

Non-emergency - 281-342-6116

Fort Bend Emergency Medical Service

Non-emergency - 281-342-7233

Poison Control

800-764-7661

Fort Bend County Crime Stoppers

281-342-TIPS

NON-EMERGENCIES

Constable – Precinct 3

281-238-1430

Fire Marshall

281-238-1500

Poison Control Center

800-222-1222

Call B4 You Dig

811

UTILITIES

Electric – CenterPoint

800-332-7143

Gas – CenterPoint

800-332-7143

Water – Municipal District Services

281-290-6500

Trash – Waste Corporation of America

281-368-8397

HOSPITALS:

OakBend Medical Center Jackson Street Hospital

Campus

281-341-3000

OakBend Medical Center Williams Way Hospital

Campus

281-341-2000

OAKBEND MEDICAL GROUP CLINICS:

OakBend Medical Group – New Territory

281-238-7870

OakBend Medical Group – Richmond

281-342-9503

OakBend Medical Group – Sugar Land

281-265-7000

OakBend Medical Group – Williams Way

281-239-5037

NO WAIT EMERGENCY ROOMS

N e v e r w a i t f o r E m e r g e n c y C a r e

F a s t e r t r e a t m e n t t i m e s i m p r o v e p a t i e n t o u t c o m e s

H o m e t o t h e o n l y p e r m a n e n t l y - b a s e d a i r a m b u l a n c e i n F o r t B e n d C o u n t y

A t a n y o f o u r t h r e e n o w a i t e m e r g e n c y r o o m s i n F o r t B e n d C o u n t y , w e t a k e y o u t o a t r e a t m e n t r o o m i m m e d i a t e l y a f t e r a q u i c k r e g i s t r a t i o n . Y o u w i l l n e v e r s p e n d t i m e i n a w a i t i n g r o o m d e l a y i n g c a r e t h a t c o u l d s a v e y o u r l i f e . P a t i e n t s w a n t t o b e a s s u r e d t h a t n o t o n l y a r e t h e y g e t t i n g t h e q u i c k e s t p o s s i b l e c a r e , b u t t h a t t h e m e d i c a l a t t e n t i o n t h e y r e c e i v e i s t o p - q u a l i t y a n d t h o r o u g h W e g u a r a n t e e b o t h

E M E R G E N C Y C A R E C E N T E R F E A T U R E S :

L e v e l I V T r a u m a C e n t e r a t t h e J a c k s o n S t r e e t a n d W i l l i a m s W a y C a m p u s e s

E m e r g e n c y M e d i c i n e C e r t i f i e d

S t r o k e C e r t i f i e d

S T E M I P r o g r a m ( S T E M I , w h i c h s t a n d s f o r S T - E l e v a t i o n M y o c a r d i a l I n f a r c t i o n , i s t h e m o s t

d a n g e r o u s t y p e o f h e a r t a t t a c k i n v o l v i n g a s u d d e n b l o c k a g e o f o n e o f t h e t h r e e c o r o n a r y

a r t e r i e s t h a t s u p p l y b l o o d t o t h e h e a r t )

O n l y p e r m a n e n t l y - b a s e d a i r a m b u l a n c e i n F o r t B e n d C o u n t y p r o v i d e d b y

P H I A i r M e d i c a l

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