Disaster according to ONSET &

DISASTER PREDICTABILITY
Note: Time, Impact
o Typhoon Haiyan – strongest storm
o July 16, 1990 – M7.8 Earthquake – Baguio,
Cabanatuan, Dagupan
o 1991 – Pinatubo – Aetas
Defined as an ecologic disruption of a severity and
magnitude that results in deaths, injuries, illness and
property damage that cannot be effectively managed
using routine procedures or resources and that
require outside assistance (Landesman, et. al, 2001).
a) SHORT ONSET
b) SUDDENT ONSET
o Predictable – cyclones, volcanic eruptions
o Unpredictable – Earthquake, Landslide
Disaster according to NUMBER OF VICTIMS
INVOLVED
a) MULTIPLE PATIENT – 10 casualties
b) MULTIPLE CASUALTY – 100 casualties
c) MASS CASUALTY - >100 casualties

EMERGENCY PHASES OF DISASTER

o Serious, unexpected, and often dangerous a) Pre- Impact – begins prior to onset of a disaster
situation requiring immediate action. b) Impact – (Rescue Phase) – continues to the
initiation of post-impact
Disaster according to OCCURRENCE c) Post Impact – (Recovery Phase) – disaster has
a) MAN-MADE been evaluated, Development of independence
o Disasters in which the principal direct causes are o Measure vulnerability – a)
identifiable human actions, deliberate or Preparedness, b) Finances (relocation
otherwise (war, bombing) site), c) man involved
o E.g. Fire in Ozone, Transportation accidents (Oil Disaster according to different FACTORS/
Spills), 9-11 VULNERABILITIES
b) NATURAL:
o Results of an ecological disruption or threat that a) Personal Factors – a) Uncontrolled (age –
exceeds the adjustment capacity of the young and old, disabilities), b) Controlled
community (Preparation, Physical Fitness)
NATURAL DISASTER CATEGORIES, TYPES, AND SUBTYPES
HYDROMETEOROLOGICAL
BIOLOGICAL GEOPHYSICAL
HYDROLOGICAL METEOROLOGICAL
~Epidemic ~Earthquake ~Flood ~Storm
Viral, Bacterial, ~Volcano General Flood Tropical Cyclone
Parasitic, Fungal, Prion ~Mass Movement (dry) Storm Surge/ coastal flood Extra-tropical cyclone
Infectious Disease Rockfall Local Storm
Landslide Mass Movement (Wet)
~Insect Infestation Avalanche Rockfall CLIMATOLOGICAL
Subsidence Landslide
~Animal Stampede Avalanche ~Extreme Temperature
Subsidence Heat wave
Cold wave
Extreme winter condition

~Drought/ Wildfire
Forest Fire
Land Fire

#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 1|Page

b) Socio-Economic – Poor population – lack
resources and abilities to construct safe buildings
c) Location: proximity to known hazards (cliffs,
Risk for fires)
d) Social Structure: diversion of resources towards
the majority has unintentionally created a greater
vulnerability for the minorities
PHASES OF DISASTER MANAGEMENT
PROGRAM
1) MITIGATION: any activity or steps taken to
lessen the impact of a disaster (e.g. Prevention)
Activities:
o Building codes – minimum acceptable level
of safety on constructions
o Zoning and Land Use Management – set for
urban planning  determine vulnerability
o Building Use Regulations and Safety Codes
– fire exits, alarms, signs (Should not be
locked)
o Resource Allocations
o Preventive Health care – toilets, water filters
o Public Education – regarding disaster
prevention
** Cross train nursing staff to perform other tasks to
maintain services during staffing crisis
Fire Safety Measures:
1. Provide adequately wide entrances and exits in
all buildings to facilitate quick dispersal of
children and staff in the event of emergency
2. Ensure that wall openings in classrooms are not
<20% of floor area
3. Remove/Replace all inflammable material in
school buildings
4. Construct kitchen shed for mid-day meals in a
manner so as to minimize fire hazards
5. Provide Fire-Fighting arrangements in all
schools
6. Regular training of teachers and children in fire
safety and evacuation drills
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS)
2) PREPAREDNESS: Proactive Planning Efforts
Goal: to achieve a satisfactory level of readiness to
respond to any emergency though programs that
strengthen the technical and managerial capacity of
government, organizations, and communities (E.g.
Drills)
General Measures
1. Preparedness plans – vulnerability
2. Emergency exercise and training
3. Warning systems – differentiate signals
4. Emergency communication systems – translating
information
5. Evacuation plans
6. Resource inventories
7. Preventive health care
8. Public information and education
** also includes the hospital vulnerabilities, location
of the facility, staff plans, hospital supplies.
3) RESPONSE: the actual implementation of the
disaster plans which is simple, routinely
practiced, & periodically modified
Aim: to provide immediate assistance
Focus: meet basic needs (Food, Water, Shelter,
Safety, Clothing) of the people
4) RECOVERY: (short and long term) – includes
actions of responders, government, victims that
help return an affected community to normal by
stimulating community cohesiveness and
government movement
a) Short term:
o Restoring necessary lifeline systems
(communication, water, electricity,
transportation)
o Providing for basic human needs
o Provide crisis interventions
o Needs assessment
b) Long Term:
o Recovery may continue for a number
of years after a disaster whose
purpose is to return life to a normal or
improved levels.
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 2 TYPES OF DISASTER PLANNING  Emergency Medical Services: 2 weeks
training
A. Agent-Specific Approach
o Communities focused on preparedness
C. Hospital Preparedness:
activities
o Degree, ability, preparedness to manage
o Basis: geographical location
certain injuries
o Communities only plan for threat most likely
to occur in their region
D. Emergency Preparedness:
o In hospital – Hospital disaster
B. All Hazards Approach
 Internal: Occurs when there is an
o Incorporates disaster management across all
event within the facility (e.g. terrorist,
major types of disasters (e.g. spills, toxic
chemical spills)
inhalation exposure, outbreak of infectious
 ** Determine area of
disease, geophysical disasters)
vulnerability
PRINCIPLES OF DISASTER MANAGEMENT  Management: a) Maintain safe
environment for the patients, b)
1. Preventing occurrence (mitigating) continue to provide essential
2. Minimizing casualties (preparedness) services, c) restore normal
3. Preventing further casualties (response) services ASAP
4. Rescuing the injured (response)  External: although the disaster did not
5. Evacuating the injured (response) occur in the facility, this becomes a
6. Providing first aid (response) problem when the consequences of the
7. Providing definitive care (recovery) event creates a demand for services that
8. Facilitating reconstruction (recovery) exceed the usual available resources.
COMPONENTS OF DISASTER  Combined: Internal + External =
PREPARATION increase # of patients = higher rate of
infection
A. Community Preparation
o Community Disaster Plan HOSPITAL DISASTER PLAN: plan of action for
o Community Emergency Plan a disaster
o Self-reliance and o Traffic flow
o Sustenance of community o Triage
o Treatment areas
B. Field Triage: o Officer in charge (medical director,
o Process by which EMV decide the most president)
appropriate destination hospital for victims. o Command center
o Involved in assessing the extent of injuries o Emergency operation center
o Determines type, degree, category of injury o Reporting center
(tagging – Yellow, Green, Black, Red) – in o Documentation
order to determine priority o Volunteer
 Lessen impact of injuries o Media
 Treatment and management of o Decontamination
patients o Proper communication
o Paramedics:
 Emergency Medical Technologists: 2 months o ** Prepared to reduce the pressure on the
training; 2-3 years undergraduate program hospital management when a large number of

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 casualties arriving suddenly in the hospital at a
time requiring different level of care.
o Mock drill to be conducted periodically to
acquaint the staff to meet any eventuality.
o The action plan begins with formation of
disaster committee  (Promotes command/
control)
o Keeping adequate storage of supplies in
emergency department  allocation of
resources
o Keeping disaster SOP in the casualty 
promote quality services; promotes controls and
process
GENERAL GOALS OF A HOSPITAL IN THE
EVENT OF EMERGENCY AND DISASTER
1. the continuity of essential services
2. The well-coordinated implementation of hospital
operations at every level
3. Clear and accurate internal and external
communication
4. Swift adaptation to increase demands
5. Effective use of scarce resources
6. Safe environment for HCWs
PHASES IN HOSPITAL DISASTER
RESPONSE
1. ALERT PHASE:
o Staff remain in place
o Uninterrupted services
o Faculty, Supervisor, family  wait for
instructions
2. RESPONSE PHASE:
o Staff report to supervisor – determine extent
of disaster
o Receive instructions from supervisor
o Activation of disaster plan
o Non-essential services interrupted
3. EXPANDED RESPONSE:
o Activate on call nurses
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS)
POTENTIAL SCENARIOS and NURSING
ROLES COPING with the UNEXPECTED
o Loss of power and ancillary power
o Loss of medical gases/ compressed air & vacuum
(suction)
o Loss of telecommunication systems
o Loss of information technology systems
o Address threats to safety of patients and staff
o Panic
o Coping with staff and patient death
o Dealing with victims and their families
o Dealing with media
o Evaluation
LEVELS OF TRAUMA CENTERS:
LEVEL I:
o Tertiary referral center located in large
metropolitan areas and have a strong
commitment to manage all types of trauma
and emergencies
o Availability of specialists (specific) is a must
o 24 hours in house coverage by surgeons
(consultants who can perform sx)
LEVEL II:
o Non-availability of in-house specialists
o On call basis
o Can care but may need referrals
LEVEL III:
o Located in smaller institutions in
communities where level I and level II
facilities are not available
o * may provide first aid
EMERGENCY NURSING
o The practice of emergency care by a professional
nurse.
o ** Registered professional nurses committed to
safe and effective emergency nursing practice are
known as EMERGENCY NURSES
Emergency Team: individuals who have direct or
indirect responsibility for the care of emergency
patients – May be professionals, non-professionals,
para professionals, ancillary supports
4|Page
Emergency Care: a. Assessment, diagnosing, and treatment of
problem/ conditions of individuals of all
o Assessment, diagnosing, treatment
ages, often with limited database
o Perceived/ actual/ potential/ sudden/ urgent
b. Triage and prioritization
o Physical/ psychosocial
c. Disaster preparedness
o Acute or episodic events which requires minimal
d. Stabilization and resuscitation
care; life support measures; health education;
e. Crisis intervention – lose life (family, psych,
appropriate referrals and knowledge of legal
money), family, property
implications in a variety of settings.
f. Provision of care in uncontrolled and
Emergency Care Environment: the setting in which unpredictable environments
a patient requires intervention by emergency care g. Roles and Behaviors
providers. i. Patient care
ii. Research
Emergency Patient: people with problems requiring iii. Administrative/ management
exact intervention due to rapidly changing iv. Education
physiological or psychological status v. Consultation
o ** an emergency is whatever the patient or the vi. Advocacy
family considers it to be h. Systematic: Utilizes nursing process 
SMART objectives
THE SPECIALTY OF EMERGENCY
NURSING 3. BOUNDARIES:
The unconscious patient should be treated as if a. External: includes: legislation, regulation,
conscious. That is, the patient should be touched, societal, demands, and health care delivery
called by name, and given explanation of every trends
procedure that is performed b. Internal: focuses within the practice of
professional nursing which includes: a)
As the patient regains consciousness, the nurse guidelines for practice, b) institutional and
should orient the patient by stating his or her name, departmental policies & procedure  quality
the date, and the location. This basic information service, guided care
should be provided repeatedly, as needed, in a
reassuring way. 4. INTERSECTIONS: emergency nursing
~excerpts from the emergency nursing interfaces with other professional groups for
improvement of care
SCOPE OF PRACTICE AND STANDRADS
THE GOOD SAMARITAN LAW
1. CORE of PRACTICE:
a. Essence – involves assessment, diagnosis,  Compassion knows no boundaries
treatment, and evaluation of problems  Law does not exempt a nurse from acts that
b. Environment – setting where patients and constitute gross negligence
emergency nurses interact (primary: renders  There is no obligation to help/ render first aid,
care in community; secondary: governed by but if you do, you should continue at least
specialists, no special resources; tertiary: until:
with special resources)  Victim recovers
c. Consumers – patients  Another trained person replaces you
 You are too physically exhausted to
2. DIMENSION: characteristics continue

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 PROPERTIES OF EMERGENCY
MANAGEMENT
Preserve Life:
 ABCD (Priorities)
 Prioritize eyesight
 Preserve Limb
 Preserve Property
Prevent Deterioration: before more deformities,
management can be given (e.g. control Hge, promote
circulation)
Restore: the patient to a meaningful living
PRINCIPLES OF EMERGENCY
MANAGEMENT
 One of the first principles of emergency care
is TRIAGE
 URGENT: serious health condition
but without life limiting instances –
may require immediate attention
 EMERGENT: must be immediately
attended to by a professional
 NON-URGENT: non-serious health
conditions, observations can be
delayed within 24 hours
 End: is to assess and intervene
 Physical Examination – rapid and
quick
 Prevent and treat SHOCK (control
hge)
 Restore cardiac output (fluids resus,
administer IV-isotonic, inotropes)
 Hemorrhage
 Airway management – maintain
patency (Heimlich, abdominal thrust,
back tap)
 Fractures (splint)
 Protect wounds
 Medic alert bracelet
 Size and reactivity of the pupils and
motor responses (caloric test (mov’t
of eve depending on stimulus – cold
& warm), direct and consensual)
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS)
 Can patient follow commands? –
assess cognitive ability (nose to
finger, heel – shin test)
 Document
PRIMARY SURVEY
 Designed to identify life threatening
problems
 ABCDE (Evaluate neurologic status)
 Assessments are executed very rapidly and
are always performed in a systemic way.
SECONDARY SURVEY
1. To detect medical and injury-related problems
that do not pose an immediate threat to survival
but if left untreated may do so (e.g. Fracture 
embolism, rib fracture  flail chest 
paradoxical breathing  imbalanced
oxygenation  hypoxia  acidosis 
atelectasis)
2. History:
o Existing disease entity, possible
uprising problem
o VS: predict any detrimental problem
(BP, PR, RR, T, Pain)
3. Quick Physical Examination: do assessment
interventions Simultaneously
o Note last meal – anticipate Surgery
STANDARDS OF CARE GUIDELINES
 Minimally accepted practice that reflect the
competence of the nurse
 Determine level of outcome nurse can
provide
 Keep calm and ask for help
 Remove potential dangers – e.g. dirt
 Removal of other people who might
impose danger (e.g. s/o, bystander)
 Determine consciousness of client 
**unconscious with sustained injury
= assume SCI
 Assess airway (use senses),
breathing, circulation
 Undress client – look into extent of
damage; determine other injuries
(back, leg, arms)
 Provide immediate interventions
6|Page
  Assist and transport to nearest
institution
 ** Endorsement needed to take
responsibility away from you.
DISASTER MANAGEMENT
TRIAGE:
 A RAPID, FOCUSED ASSESSMENT of
people who seek emergency care in a way
that allows for the most efficient use of
manpower, equipment, and facility
 ** its purpose is to sort and set priorities for
care
How Long? : 2-5 minutes (total); 30-60 seconds/
patient
Who Should Perform Triage Functionally?
Practice Standard
o RN educated in the principles of triage
o Minimum of 6 months experienced in the
Emergency Department
o With ACLS
o With emergency pediatric nursing course,
training nurse core curriculum, certified
emergency nurse
Personal Abilities of an Effective Triage Officer
o Clinically experienced
o Good judgment and leadership
o Calm and cool under stress
o Decisive
o Knowledgeable of available resources
o Sense of humor
o Creative problem solver
o Available
o Experience and knowledgeable regarding
expected casualties
Advantage
1. Early recognition and assessment of patient
2. Immediate intervention  HOT ZONE:
rescue zone, WARM ZONE: triage, short
assessment, COLD ZONE: safety area,
treatment
3. Alleviation of fear, anxiety, and tension in
patient
4. Employs team concept
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS)
5. Responsible for liaison with families and
friends of patients (disclose status, location,
ID, extent of injury)
6. Expedites preliminary diagnostic studies
7. Results in smooth flow and traffic pattern
TYPES OF TRIAGE
1. DAILY TRIAGE:
o Performed by nurses routinely at the ED
o Prioritize based on severity of case
2. INCIDENT TRIAGE:
o Large number of patient due to an acute
incident, medical crisis (e.g. vehicular
accident, avian flu outbreak)
o Emergency management is NOT YET
activated
3. DISASTER TRIAGE:
o Employ EMS
o External disaster outside hospital that
requires hospital services
4. TACTICAL MILITARY TRIAGE:
o Employed in military
o Prioritize those with lesser injuries
o Done during wars
5. SPECIAL CONDITIONS TRIAGE:
o Require use of PPE (e.g. nuclear exposure,
EBOLA outbreak)
o Indication: chemical, biological, and
radioactive involvement
PHASES
A. PRIMARY
o Gross sorting of patients in the field
o Aim to maximize the outcome for the
greatest possible number of victim
o Facilitate transfer from hot to cold
o PHYSIOLOGY IS THE FOCUS
rather than identification of specific
injuries
o Tagging
B. SECONDARY:
o Done when transport is delayed
7|Page
 o Aim: determine patients who can be
treated in the area (e.g. splinting,
apply pressure on hge) 1. START system (Simple,
o For transport priority
C. TERTIARY
o We revert to the DAILY TRIAGE o Basis: patient’s ability to respond verbally,
philosophy  in hospital
o Adult , pre-hospital
ACTIVITIES o Assessment
A. SPOT CHECK (aka QUICK LOOK)
o Assessment and category in 2-3 mins
o Most immediate need
o ** Determine ambulatory  command them
B. COMPREHENSIVE ABCDE
o Involves an initial “Across-the-room”
assessment that notes:
i. General appearance – injuries
ii. ABC
iii. LOC/ disability – understand
iv. E
o Patient is reassessed at appropriate intervals
while awaiting other treatment
C. TWO-TIER
o A 2nd individual acts as a screened or sorter
to:
i. Establish patient priorities
ii. A more detailed assessment
o First person: assist diagnostic tests. Act as
mediator for family and visitors
D. EXPANDED / ADVANCED
o Includes protocol (first aid, extensive x-ray)
o Advanced triage
o Includes protocols to initiate treatment in the
triage area (OTC meds)
o Assess and manage glucose, visual acuity
E. BED SIDE TRIAGE
o Places patient in the treatment area
regardless of triage level
o All info (Triage assessment, nursing
assessment, medical assessment,
demographic information) is obtained at the
bedside, simultaneously when possible
PRE HOSPITAL DISASTER TRIAGE SYSTEM
Triage And
Rapid Treatment )
ambulate, & RPM
(Parameters): respiration,
perfusion, mental status (RPM)
A) GREEN (Minor, Non-urgent)
o “walking wounded”
o “All who can walk, move away from the
incident area”
o Injured or ill, but stable and not likely to
deteriorate if treatment is delayed
o Injuries of MINOR NATURE (e.g. H/A,
sprain, strain, soreness of body)
o People that can be tolerated
B) RED (Immediate, Emergent)
o Unstable
o With acute problem; immediate
intervention is likely to save life or limb
o RPM: (RR: > 30) (P: >2 sec) (M: unable
to follow command)
C) YELLOW (Delayed, Urgent)
o Acute problem and stable, but may
deteriorate
o Transfer after Red cases
o Chest pains associated with URTI
o Burns
o Multiple Minor Fracture
o Dulled or obtunded LOC  only
stimulated by pain
o Back injuries with or without SCI  risk
for herniated nucleus pulpusus
(herniated disc)
o Persistent N/V and diarrhea
o Temperature 39-40.5 C  increase TNR,
PG release  Inflammation
o Acute panic states, drug overuse,
apparent or suspected poisoning (e.g.
organophosphates)
o Sexual assault
o ** Tx can be delayed for 2 hours

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D) BLACK (Expectant) o All patients who are able to walk are
o Dead/ Dying immediately tagged green
o Lowest transport priority o Is patient breathing?
o No rise and fall of chest: consider dead o YES  proceed with RPM
o Obviously mortal wounds where death o NO  after an immediate airway
appears reasonably certain maneuver?
o Obviously Dead on arrival  limp/ flaccid  No return of spontaneous
respirations  BLACK
CODING o (-) respiration, (+) pulse:  deliver 5
assisted ventilations
GREEN Minor All walking wounded o Remains apneic  BLACK
R: <30, o ROSR --. RED
YELLOW Delayed P: <2 secs
M: obeys command B) RED
R: >30 o RR: <15 or >45 OR
P: >2 secs o No Peripheral Pulse OR
RED Immediate o Mental status is age-inappropriate 
M: does not obey
command decorticate or decerebrate positions
Dead, dying or not
BLACK Expectant C) YELLOW
breathing
o RR: between 15 & 45, AND
Immediate: o Have a palpable peripheral pulse, AND
o Life-threatening injuries o Have an age appropriate mental status (A,V,
o Needs medical attention within an hour or P, on the AVPU scale)
o A – Awake
Delayed: o V- Verbal Stimuli (responsive)
o Non-life-threating o P- Pain Stimuli (responsive)
o Needs medical attention o U- Unresponsive
o Treatment can be delayed within 2 hours
SAMPLE SITUATION
Minor CONDITION CLASSIFICATION
o Treatment may be delayed for 24 hours Very severe pain
Chest pain – cardiac in
** The most basic way to use the START nature
classification is to transport victims in a fixed priority Prescription refill
manner, immediate victims, followed by delayed Persistent vomiting
victims, followed by the walking wounded Airway obstruction
Unresponsive/
2. JUMPSTART unconscious
o R – RR Severe blood loss
o P – CR Diarrhea without DHN
o M – Obey Small Abrasions
o < 8 years of age Chest pain – non cardiac
o Jump start should be used if the victim is a RR <10 cpm
child or looks like a child Suture removal
Hypotension with
hemodynamic effects
DHN
Minor Limb Trauma
A) GREEN Difference between START & JUMPSTART
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 9|Page
 o Call EMS
START JUMPSTART o Observe for patients position
Airway If positioning If positioning
the airway airway does 2. General Impression of the Patient:
does not not restart o Life-threatening condition
restart breathing, 5 o Determine mental status (neuro-status)
breathing. rescue breaths
Patient is (the jumpstart) 3. Airway:
tagged as is given o Ensure open airway
BLACK/ o look for evidence of other upper airway
DECEASED problems and potential obstructions
Perfusion/ Capillary Peripheral i. vomitus
Circulation Refill is used pulses are used ii. bleeding
to assess to asses iii. loose or missing teeth
perfusion perfusion iv. dentures
Mental Status Ability to AVPU is used v. facial trauma  upper airway obstruction
follow to assess
commands is mental status 4. Breathing:
used to assess o Look, listen, and feel; assess ventilation and
mental status oxygenation
o Expose chest and observe chest wall
movement if necessary
IN HOSPITAL TRIAGE o Determine approximate rate and depth;
assess character and quality
A) Three-Tier – Emergent, Urgent, Non-urgent o Interventions for inadequate ventilation
B) Four- Tier – Emergent, Urgent, Non-urgent, and/or oxygenation
Expectant
C) Five-Tier 5. Circulation:
 Ia – Emergent o Check for pulse and begin CPR if necessary
 Ib – Emergent o Control life threatening hge with direct
 II – Urgent pressure
o Palpate radial pulse
 III – Non-Urgent (with disaster cases/
injury) o Assess skin for signs of hypo-perfusion or
hypoxia (capillary refill)
 IV – Non-urgent (Ambulatory)
o Reassess mental status for signs of hypo-
perfusion
**MEDICOLEGAL – put hands of client inside
o Treat hypo-perfusion
plastic bag/ paper bag  preserve forensic evidence
6. Level of Consciousness and Disabilities:
ASSESSMENT & ROUTINE CARE
o Determine need for stabilization
o Determine GCS without delay
1. Scene Assessment:
o Recognize hazards
7. Expose, Examine, Evaluate:
o Ensure safety
o Expose and examine head, neck, back, and
o Secure safe area for treatment
extremities
o Apply universal body substance isolation
o Treat any newly discovered life-threating
precautions (hand washing, PPE  gown,
wounds as appropriate and begin transport
mask, gloves, goggles, turban)
o Recognize hazards to patient and to self 
manage them
o Identify number of patients
HEAD TO TOE ASSESSMENT
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 10 | P a g e
 o Cooper Nail’s Sign – ecchymosis and
A) SKULL purpura in labia, scrotum, perineum 
o Contour, shape  depression indicate pelvic fracture
o Face – lesions/ injuries, symmetry, deformity
F) GENITALIA/ PELVIS
B) HEAD o Hematoma, bldg, abrasion
o HEENT (Assess ears and nose for presence o Persistently erect penis – priapism  indicate
of CSF  HALO SIGN) abdominal injury  cause emboli to penile
o Behind ear  Ecchymosis (Battle’s sign) – artery
may indicate basilar skull fracture o Bladder distention  palpable above
o Note “Raccoon Sign” symphysis pubis
a) With SCI  Neurogenic Bladder
C) NECK b) Promote persistent Hypertension
o Herniation - hump in cervical spine
o ROM G) EXREMITIES
o Tracheal deviation – palpate from o Hematoma
suprasternal notch - ** Risk for atelectasis o Symmetry
o Note JVD, Jugular bldg o Lengthening – dislocation; shortening –
o Laryngeal damage: note presence of voice fracture
(should heal within 24-48 hours) o Dyspnea  r/t to pulmonary embolism (fat,
clot) 2° long bone fracture
D) CHEST o DTR
o Seatbelt ecchymosis – suspect MVA a) Normal : +2
o Note chest rise and fall b) Hypotonic : +1
o Observe for paroxysmal breathing c) Hyper: +3
a) Observe chest – check for depression
in ribs upon inhalation  contusion  Others:
atelectasis o Observation and palpation can be done while
b) Pons- rate; medulla- rhythm gathering patient’s history
o Auscultate breath sounds – determine other o Be systematic – cephalocaudal,
injuries proximodistal
o Chest heaviness o Minimize scene time
o Signs and symptoms of any wound o Reassess VS often
o Presence of retractions ** after these initial assessments and interventions,
o Use of Accessory muscles the secondary survey can be initiated
a) Inhalatory: SCM, Trapezius,
Pectoraliz HISTORY TAKING DURING TRIAGE
b) Exhalatory: Abdominal muscles
(Oblique, transverse) Adults and Geriatric

E) ABDOMEN A) OLDCART
o 1st intervention: identify painful area – assess o Onset of symptoms
last  pain may affect assessment findings o Location of problem
o Note: symmetry, color o Duration of symptoms
o Cullen’s Sign – ecchymosis and pruritus o Characteristics of symptoms
around umbilicus o Aggravating factors
o Grey Turner’s Sign – ecchymosis and o Relieving factors
pruritus on the flank area o Treatment administered
o Ker’s Sign – pain on ths tip of the shoulder to B) PAIN (PQRST)
the tip of the scapula  indicate splenic o Pain
rupture o Quality
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 11 | P a g e
 o Radiation
o Severity
o Timing
C) HISTORY (SAMPLE)
o Signs and Symptoms
o Allergies
o Medications
o Past Medical History
o Last oral Intake; Last day of menses
o Events preceding the injury
Pediatric Triage History
A) C.I.A.M.P.E.D.S
o Chief complaint
o Immunization, isolation
o Allergies
o Medication
o Past medical history
o Events surrounding problem
o Diet / Diaper
o Symptoms
B) Head to Toe (SAVE A CHILD)
o Skin
o Activity
o Ventilation
o Eye-contact
o Abuse – look into diagnostic tests &
P.E (different levels of healing
process & bone regeneration)
o Crying
o Heat/ Temperature
o Immune status
o Level of consciousness
o Dehydration
NURSING ROLES IN THE
PSYCHOLOGICAL MANAGEMENT OF
PATIENTS AND FAMILIES IN EMERGENCY
AND CRISIS SITUATIONS
A) POST-TRAUMATIC STRESS DISORDER
(PTSD)
o The development of characteristic symptoms
after a psychologically stressful event that is
generally outside the range of human
experience
o Common in soldiers
#TibayNgDamdamin #ALFIEPOGI
o Individuals with highest risk/ highest
possibility of suicide
Special considerations
o Pediatric Trauma
 Address not only the child’s behavior
but also the accompanying adult
 Fear of separation
 Disorganized behavior
o Geriatric Trauma
 All trauma in the elderly are
potentially life-threatening
 Limited physiologic reserves severely
affect the heart and lung dynamics 
oxygenation and hemodynamics are
prone to failures
 Decreased fat store, CHON reserves
 sources of glucose; muscles (stores
of glycogen)
 Fight/ Flight – increase epi and nor epi
 increased HR, RR, sugar, BP
 No compensation  increase Demise
 Atherosclerosis – decrease vasomotor
response  persistent hypertension
(complication)
 Limited Ejection fraction – decreased
cardiac output  compromise 
ischemia  infarct  MODS
DEBRIEFING - Psychological Debriefing:
o Encourage to verbalize
COMPLICATIONS OF TRAUMA
1. Compartment Syndrome:
o Result from bleeding or edema due to:
i. Fractures
ii. Crash injuries
iii. Arterial disruptions
iv. Burns
v. Prolonged compressions
** CASTS: assess for presence of tingling sensation,
pulse and circulation
5 P’s – pain, pallor, pulselesness, paresthesia,
paralysis + poikilothermia
Management:
o Remove cast – cause prolonged
compression
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 o Maintain level of the limb at the level of
the heart
o Apply Cold compress
o Remove constrictive clothing
o Fasciotomy – surgical decompression
2. Fat Embolism
o Due to mobilization of fat globules in
association with injury 2* to fracture of long
bone
o Pulmonary embolism
i. DOB, chest pain
ii. Ecchymosis of chest
iii. **Acute respiratory failure
Management
o Stabilize fracture ASAP  splints,
immobilize
o Minimize handling and moving patient
 decrease escape of fat globules
o Remove fat emboli
o Pulmonary angiogram
3. Disseminated Intravascular Coagulopathy
(DIC)
o Systemic activation of blood coagulation
which results in deposition of fibrin leading
to thrombi in various organs
o May result to bleeding  release of plasmin
(lyse clot) as body’s way to cope
Management:
o Prepare to administer clotting factors and
blood or blood products
o Administer heparin  prevent
coagulation
4. Adult Respiratory Distress Syndrome (ARDS)
o Cause: infections, chest-trauma  damage
alveoli (type I – epithelial cells, type II –
Surfactant, type III – macrophage);
destruction of elastin  lose ability to
expand
o Injury (inhalation, trauma)
o Causes lung swelling and fluid buildup in the
alveoli  inhibits oxygen passing in to the
bloodstream
Management:
o PEEP
o Corticosteroids
o Antibiotic
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS)
TRAUMA – COMMON EMERGENCIES
1. Traumatic Brain Injury:
o Alter cognitive activity and perception
o 2/3 of the affected are below 30 y/o
o More males are affected than females
o 50% have positive alcohol blood levels
o Main causes are vehicular accidents, falls,
and assaults
2. Focal Brain Injuries:
o Confined in one area of brain
o Result from severe blow to the head
o * open injury occurs when something
pierces the skill and enters brain tissue
o * closed injury occurs when parts of the
skull presses into the brain
o C1 & C2 – innervation of heart and lungs
o Optic chiasm – below PG
o Parietal lobe – cranial nerves
3. Penetrating Injury:
o Emergency management
i. Stabilization of ABC including
external hge should be achieved
ii. Inspect superficial wound
iii. ID entrance and exit wounds (*bullets)
iv. Note for CSR leaks, bleeding, or brain
parenchyma
4. Contusion:
o Bruising on the surface of the brain
o Cause: severe trauma to the head
o Common: Frontal and temporal
o Patient becomes unconscious immediately
(5 minutes)
o Loss of reflexes
o Transient cessation of respiration
o Brief period of bradycardia
o HPoN
5. Coup-Countrecoup
o injuries where the patient sustains a
combined injury
o at the point of impact & at the opposite
o ‘E’ Management:
i. Dexamethasone/ steroid therapy
ii. Surgery: craniotomy, burr-holing
iii. Decrease swelling by diuresis:
mannitol, acetazolamide
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 4. Subdural Hemorrhage:
6. Concussion o Bldg happens between dura and arachnoid
o Momentary interruption of brain function space
o No structural damage  quick recovery o Cause: MVA
o With or without loss of consciousness o Types
o Management: a) ACUTE:
i. Observe for: H/A. irritability,  Symptoms seen within 24* of the
insomnia, poor concentration and injury
memory (post-concussion syndrome)  Start with H/A, drowsiness,
ii. Gradual resumption of activities restlessness, agitation, slowed
cognition, confusion
OTHER HEAD INJURIES  Worsens over time & progress to
loss of consciousness, respiratory
1. Scalp Injuries: challenges (Biots breathing), and
o Damage underneath may be greater  even pupils dilate
small injuries are sutured b) SUB-ACUTE: 48* - 2 weeks
c) CHRONIC: weeks- months
2. Skull Fracture
o Break in the continuity of the skull caused 5 CATEGORIES OF NEUROLOGIC
by a force FUNCTION THAT ARE CRITICAL TO THE
o Depressed Skull Fracture  risk for EVALUATION PROCESS
piercing the brain
o Linear Skull Fracture 1. LOC
o Basilar Fracture – over the base of the skull, 2. Pattern of breathing
base of frontal, temporal 3. Pupillary changes
a) Leak CSF to nose, ear 4. Occulomotor responses
b) Raccoon’s eye 5. Motor responses
c) Battle’s sign
d) Hemotympanism SPINAL CORD INJURIES
e) Otorrhea, Rhinorrhea Compression along length of spinal cord, average
f) Meningeal Irritation (BONK): (18 inches)
Brudzinski, Opisthotonus, Nuchal
Rigidity, Kernig’s Sign

3. Epidural Hematoma
o Corrects between skull and dura
o Cannot be seen outside
o ** Brain atrophies with age  bldg in geria
is not evident because of the space
o A momentary loss of consciousness
followed by a lucid period where
consciousness is regained, followed by
rapid progression of unconsciousness

Signs of compression of the brain structures

o Deterioration of consciousness  Alert, Drowsy,
Lethargy, Stupor, Coma (**GCS)
o Rapid Deterioration  change in VS:
Bradyccardia, bradypnea, HPoN
o Ipsilateral dilatation and fixation of the pupils
o Contralateral hemiparesis
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Mechanism of Injury  Loss of bowel and bladder function
 Direct trauma  s/s: HPN  HPoN, diaphoresis,
 Compression/ hematoma/ disc material  Disturbed thermal regulation
fall
 Ischemia/ impingement  inflammation, NEUROGENIC SHOCK
blunt trauma  cervical and upper thoracic cord injury
 Common sites:  All sensory, motor, reflex, and autonomic
 5th – 7th C vert  quadriplegia flow below the transected area will cease
 12th T vet  breathing  HPoN, bradycardia, hypothermia
 1st lumbar  paraplegia
 Concussion, laceration, contusion. Complete
transection of the spinal cord, compression of RESPIRATORY EMERGENCY
cord (herniated disc),

Classification:  Aspiration – finger sweep maneuver

A) PRIMARY SCI:  Penetration
 Results from acceleration and  Loss of airway – 2* obstruction
deceleration process
 Hyper-flexion/ hyperextension of Obstruction
vertebrae  promote compression of Types:
cord  Complete:
 Cyanosis, unconsciousness
B) SECONDARY SCI:  3-5 minutes  brain injury
 Vascular, Cellular, Biochemical in  ** increase anxiety, grunting, no air
origin  Partial:
 Ischemia (V)  Stridor – upper airway
 Tumor (V)  Decreased O2 inflow, increase air
outflow  limited O2 and CO2
 Autoimmune (C)
 Apprehension
 Labored breathing  increase
C) COMPLETE
tendency to breathe
 Transection of cord
 Use of accessory muscles
 Loss of motor function, this is  Nasal flaring, cyanosis, restlessness
IRREVERSIBLE
 Loss of sensation Goal: Establish airway
 Spinal Shock  Assess for presence of obstruction
 Respiratory impairment  Attempt to remove  Heimlich, back tap,
 Quadriplegia  C6 abdominal thrust
 Paraplegia  lumbar spine
A. Pneumothorax
D) INCOMPLETE:
 Some activity below the injury  Primary
 More favorable prognosis overall  Occurs in healthy individuals
 Causes spinal shock  ** note familial history  bleb (hereditary)
 ISSUE: distended bladder  HPN  weakness in lung parenchyma 
increase tension (Valsalva)  increase
SPINAL SHOCK tidal volume  extend lungs  rupture
 Transient complete loss of reflex function bleb
 Flaccid paralysis
 Sensory deficit  Secondary/ Traumatic Pneumothorax
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  Rib fracture  Pain relief – OPIODS
 Trauma – penetrating/ non-penetrating (e.g.  Administer oxygen
contusion).  Chest tube insertion –
 Contusion  hematoma  pleurovac, 1 bottle, 2 bottle, 3
inflammation  necrosis  weakening bottle system
of parenchyma  rupture  Surgery

 Iatrogenic: 2* medical treatment

 Open heart surgery  loss of (-) pressure
 expect CTT post-op
 Mechanical ventilator  too high pressure
(note tidal volume, PEEP)

 Open- penetrating injury

Tension Pneumothorax
 Closed
 Primary due to ruptured bled
 Tachypnea
 Mild dyspnea
 Mediastinal shift - due to excess air pushing
heart (note for tracheal deviation)
 ** signs and symptoms depend on the size of
pneumothorax

B. Hemothorax

Cause:
 Chest trauma
 MVA
 Crushing injuries
 Management: cover with wet cloth  Check for fluctuations  (+)
to prevent air entrance close system
 Rib Fractures – 2* hitting steering wheel  Bubbles  leak in system
 **First 3 ribs – High mortality  No fluctuations 
 Puncture lung  detachment, kinks,
pneumothorax; puncture obstruction, re-expansion of
trachea, aorta, SVC lungs (**)
 5 - 10th rib – cardiopulmonary
th
 ** DO NOT MILK CORD 
compromise, liver and spleen injuries increase pressure in the lung
 Floating rib – renal injuries parenchyma  tension
 Assessment pneumothorax
 Pain on inspiration and  Transport bottle below
coughing patient’s body
 Bruising over the fractured  ** pressure – 2cm H2O – submerge
site  retroperitoneal bldg. tube 2cm ONLY  deeper
 Crepitus (subQ emphysema) submersion = higher pressure
 Management:
 No binders and strappings -
*risk of punctures
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 16 | P a g e
C. Flail Chest Primary Assessment
 Initiate immobilization of the spine
 Fractures of 2 or more ribs at multiple places  Airway obstruction can occur due to:
 leading to free floating ribs  Tongue swelling
 Bleeding or
Signs and symptoms  Broken teeth
 Dyspnea  Breathing may be impaired
 Paradoxical breathing  Cricoidotomy / Cricothyrotomy
 Rapid RR  Tracheostomy
 Crepitus
 Diminished breath sounds Subsequent Interventions
 A-B-B: Early (R. Alkalosis), Late (R.  Ice pack – control bldg
Acidosis)  Elevate HoB – control bldg.
 Pain medications
Management  ** Generally No Blowing of Nose,
 High fowlers Coughing, Sneezing  due to possibility of
 Prepare for intubation CSF leaks  cough out brain particles and
 Mechanical ventilation (PEEP) IICP
 O2 by BVM  DBE – for pain and anxiety
 Stabilize chest wall
 Turn towards affected side  improve ABDOMINAL TRAUMA
oxygenation  pool blood towards affected - Common area; vague in assessment due to # of
side  improve perfusion organs

D. Pulmonary Contusion

 A.k.a Lung Tissue Injury  2* blunt trauma

 Due to abrupt chest compression followed
by sudden decompression
 May lead to Acute Respiratory Failure
(ARF)
i. Hypoxic: brain regulates rate and
rhythm  injury
ii. Ventilatory: Oxygenation and
ventilation problem (e.g. V/Q
mismatch, alveolar bypass/
intrapulmonary shunt)

E. Maxillofacial Trauma
- Fractured mandible, maxilla, orbitals,
zygomatic bone

a) Le fort I – horizontal maxillary fracture

b) Le fort II – pyramidal: mandible, maxilla,
nasal bone
c) Le fort III – craniofrontal fractures

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a) Penetrating  Abdominal peristalsis is heard in thorax
 point of entry and exit  Acute chest pain and SOB
 Gunshot/ stab wounds
Signs and Symptoms of Stomach Injury
b) Blunt  Epigastric pain
 most common injured organs  spleen,  Epigastric tenderness
intestines, liver (largest solid internal organ  Signs of peritonitis  2* Hcl irritation 
 may rupture GB) boardlike abdomen, fever
 50 – 70% of MVA  abdominal trauma
 15% abdominal trauma  death Management of Penetrating Abdominal Trauma
 Higher mortality than stab wound
Assessment of Intra-abdominal trauma:  90% requires operative management 
 Look for signs of intraperitoneal injury Exlap
 Abdominal tenderness
 GI Hge  hypovolemia, HPoN Management for Blunt Abdominal Trauma
 VS  P.E – less reliable
VS EARLY LATE  Diagnostic studies
BP (N) ↓  Test hemoperitoneum  (+) 
RR ↑ 2* epi, n.e ↓ immediate surgery – Exlap
CR ↑ 2* epi, n.e ↓  Control bleeding
T (N) ↓  Post-op management
A-B-Balance R. Alkalosis Mixed Acidosis  Splintin
 Decreases bowel sounds – 2*  Eercisees
inflammation  Common complications –
 Peritonitis pneumonia, atelectasis  perform
 DRE : blood/ subQ emphysema incentive spirometry, coughing
 Hge exercise
 Cullen’s Sign
 Grey Turner’s ** NO COUGHING EXERCISE for HEADN AND
 Kehr’s FACE INJURY

Management Management
 Local wound exploration  Resuscitation prior to definitive repair
 Apply stabilizing dressing  Laparotomy is mandatory if shock,
 Prophylactic antibiotics – broad spectrum evisceration, or peritonitis
 ** IN GENERAL: leave the foreign bodies in  ** Pancreas rupture  amylase,
and remove in the OR lipase, trypsin, chymotrypsin  auto
digestion
Management of Peritoneal Abdominal Trauma  Diagnostic studies used to determine need for
 In the thoracoabdomen laparotomy
 Consider diaphragmatic injury  WoF abdominal compartment syndrome
 Note breathing pattern  Abdominal distention
 Paradoxical breathing –  Decrease peristalsis
sinking of abdomen  Muffled bowel sound
 Diagnostic evaluation
LIVER TRAUMA
Signs and Symptoms of Diaphragmatic Injury  Most common cause of death due to
 Decrease breath sounds abdominal trauma
 Paradoxic breathing
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 18 | P a g e
  Perforated liver  rupture GB  bile into direct bilirubin)  indirect bilirubin
peritoneum  peritonitis & breakdown of  blood  skin
interstitial organ (cirrhosis)
Signs and Symptoms of Large Intestine
Signs and Symptoms of Liver injuries Obstruction
 Persistent HpON  Abdominal pain
 Guarding over RUQ/LUQ  Peritoneal irritation
 (+) murphy’s sign  Blood on rectal examination
 Rebound abdominal tenderness – Peritoneal  Fever
involvement
 Direct – indicates organ involvement POISONING
 Dullness to percussion  90% of events occurring at home
 Abdominal distention and peritoneal  Cause: loose paint, (preservatives)
irritation
 Persistent thoracic bleeding – 2* Poison
emulsification of diaphragm  Substance that causes : Injury, Illness, Death
 Enters through – Ingestion, Inhalation,
Absorption
SPLEEN INJURIES
 Lymphatic A) Ingested Poison
 Sequestration of old RBC, WBC,
Platelet 2 Categories of Poisoning
 Use raw materials: Fe,
albumin  Bacterial Food Poisoning
 Produce lymphocytes  Hives, N/V
 ** 3-5 months for body to recuperate  **most common: Salmonella typhi
from injury  ** most dangerous: Botulism
 **Any injury to the spleen can cause  Chemical Poisoning
severe internal hge & shock
Corrosive Poisons
Signs and Symptoms of Spleen Injuries  Agents that cause tissue destruction
 HPoN, tachycardia, SOB  late signs
 Peritoneal irritation Alkaline
 LUQ pain  Encourage vomiting if within 1 hour of
ingestion
BOWEL INJURIES  Toilet bowl cleaners
 Associated as complications of trauma  Bleach
 Infection, abscess, fistula  Non-phosphate detergents
 Oven cleaners
Signs and Symptoms of Small Intestine Injuries  Button batteries
 Abdominal pain – radiating to the testicles
 Referred pain to shoulders, chest, and back Acid
 Peritoneal irritation  Hcl
 Fever, jaundice, intestinal obstruction  Toilet bowl cleaners
 Jaundice : 2* obstruction to sphincter  Swimming pool cleaners
of oddi  backflow of pancreatic  Metal cleaners
juice (autodigestion  pancreatitis   Rust removers
bldg); backflow of bile to GB & liver
(decrease conjugation of indirect to
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Signs and Symptoms
 Immediate – burning sensation ( mouth, ** DO NOT IDUCE VOMITING WITH
throat, esophagus, stomach) CORROSIVE AGENTS
 Intense thirst
 Dysphagia, retching Other Important Treatments:
 Hematemesis  Stomach tubes and emetics are
contraindicated
Nursing Assessment  Levin tubes can be passed within 1*
Note for:
 Unusual odors B) Inhaled Poison
 Flames/ smoke
 An open medicine cabinet  lead to what Carbon Monoxide
 Binds to circulating Hgb to decrease the
type of poison was ingested
oxygen carrying capacity (CarboxyHgb)
 Open or spilled containers
 ** Hgb absorbs CO approximately 200x
 Overturned or damaged plants more readily than it absorbs oxygen
 Bring paraphernalia or empty container  * Odorless
Important Assessment Signs of CO poisoning
Determine
 H/A
 What – type  help determine proper  Nausea
treatment
 Dizziness
 When – time  to encourage vomiting
 Breathlessness
 How much substance was ingested
 Collapse
 Loss of consciousness
Signs and Symptoms of Poisoning and Tissue
** CO causes encephalopathy  deficits
Damage
 Decreased Level of consciousness
General Management
 Decreased DTR
 Expose patient to fresh air ASAP
 Pinpoint pupils
 Administer O2 at 100% - Face mask @
10Lpm
Interventions for those with Ingested Poisons
 Remove the toxin or decrease its absorption
C) Absorbed Poisons
 Use emetics, cathartics when
 Comes into contact with the skin
appropriate
 Absorbed poisons come from plants such as
 Gastric lavage
poison ivy, poison oak, and poison sumac, as
 Activated charcoal
well as from fertilizers and pesticides
 Administration of specific antagonist
as early as possible
Care for Absorbed Poisons
Emergency Management  Immediately rinse the area
 Note for:
 ACIDS  Rashes or weeping lesions
 Weak Alkalis e.g. Ca & Mg OH  cold, running water for 5-10 minutes
 Along with plenty of water  ** EPINEPHRINE 0.3 mL – first line
 Neutralizing agents like Milk or Egg
Albumin Management for Chemical Contact
 ALKALIS  If chemical is dry:
 Neutralize poison by giving acids like  Brush off the chemicals using gloves
Acetic acid, citric acid  Flush with running tap H2O
 Mix with large quantities of water  If chemical is wet
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 20 | P a g e
  Flush with large amounts of cool, NEAR DROWNING
running tap water at least 20 minutes.  Episode in which a person initially survives
immersion in liquid
D) Injected Poisons  Fresh Water Drowning: destroys
 Injected poisons enter the body through: surfactant  atelectasis
 Bites or stings of certain insects (bees,  Salt Water Drowning  increase Na
hornets, wasps) or + H2O  osmosis  pleural effusion
 Drugs or
 Misused Management
 Maintain cerebral perfusion
Signs and Symptoms  Oxygen by mask with reservoir –
 Generalized urticarial 10Lpm
 Anxiety, malaise  Treat hypothermia if suspected
 Anaphylaxis  bronchospasms  Insert NGT
 Decompress the stomach and
Management:  Prevent the patient from aspirating
 Epinephrine injected SubQ gastric content  ARDS  RF
 Assess patient for anaphylactic reactions
(dyspnea, urticarial, bronchospasm)

**Hypersensitivity Reactions (ACID)

SPORTS RELATED INJURIES
Anaphylactic (IgE)
Common Sports Related Injuries
Cytotoxic (Ig M, G) – ABO, Rh incomp
 Traumatic fracture
Immune Mediated (Ig M, G) – tissues, grave’s dse,
thyroiditis  Contusion
Delayed – GVHD  Strains
 Sprains
POISONS/ TOXICITIES and ANTIDOTES  Knee injuries
Substance Antidote  Dislocation
Acetaminophen (Tylenol) Acetylcysteine
(Mucomyst) Mechanism of Injury
Anticholinergic Pysostigmine  Critical Force
(Antilirium)  Limit of tissues to withstand pressure
Benzodiazepines Flumazenil (Romazicon) or forces
Calcium Channel Blocker Calcium Chloride,  Varies for each type of tissue
Calcium Gluconate  Depends on:
Cyanide or Nitrate Methylene Blue (Urolene
i. Age
Blue)
ii. Skeletal maturity
Digoxin (Lanoxin) Digoxin Immune Fab
(Digibind) iii. Sex
Heparin Protamine Sulfate iv. Weight
Iron Deferoxamine (Desferal)
Insulin Glucagon Injuries
Lead Succimer (Chemet)  ACUTE – single force  complication
Opioids Naloxone (Narcan);  CHRONIC – repetitive injury/ stress to the
Nalmefene (Revex) area
Warfarin Sodium Vitamin K  CATASTROPHIC – direct damage to brain or
(Coumadin) (AquaMEPHYTON) spinal cord

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A) Soft Tissue Injuries
1. Sprain
 Stretching or tear of stabilizing
connective tissue, ligaments
 2* overstretching, overloading
 Inversion sprain – sprained lateral
ligament
 Eversion – sprained medial ligament
2. Strain
 A stretching injury to muscle or
musculoskeletal unit
 Caused by a mechanical overloading
 pulled muscle
Types:
 Transverse – break in a straight line
 Oblique – diagonal break in bone
 Spiral – jagged, shaped like “S”
 Avulsion – bony fragments that extends or
pulled off from the tendon or skin
 Comminuted – bone fragments
 Greenstick – (+) break, no separation
 Impacted – caused by pressure to the bone
 Compression – vertebra crushes from within
 Complete – involves separation of the injured
bone

3. Contusion:
 Damage of soft tissue
 Ecchymosis and hematoma
 Tears

Management
 RICE
 Hot – Cold Modalities
 ICE injury within 24 - 48* 
vasoconstriction
 Warm – relief of pain
 ** If severe – cast immobilization or surgical
repair may be necessary
 Assess neurovascular status frequently
 Capillary refill
 6 P’s

B) Lacerations
 Disrupted continuity of the skin
 Management
 Clip or shave hair D) Dislocations
 Clean wound with NSS  Misalignment of the bone on the articulating
 Debridement – remove necrotic surfaces
portions  A temporary separation b/n articulating ends
 Dressing and a joint
 Signs and symptoms: athlete often reports
C) Fractures  Snapping or popping sound
 Disruptions in the continuity of the bone  Followed by dysfunction deformity
(lengthening)
a. Simple – bone ends remain intact within
surrounding soft tissue E) Subluxation
b. Compound – bone fragments have broken  incomplete separation b/n articulating ends
through the skin. (+) Avulsion
 Management

#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 22 | P a g e

  Immobilize the site while patient is 3. Heat Stroke
transported to the hospital  Affects CNS
 Assess neurovascular status  **Most serious heat related illness

Nursing Management for Fractures Symptoms

 Assessment  Absent sweating
 Pain  T> 40*C
 Loss of function  Alteration in mentation (LOC)  confusion,
 Deformity irritability, coma
 Shortening of extremity
 Crepitus Management of clients with Heat Illness
 Local swelling and dislocation  Remember ABC
 Diagnosed by symptom and x-ray  Decrease temperature to 39*C as quickly as
 Complication possible
 DVT  Cooling methods
 Ischemic thrombosis  Ice packs
 Embolism  Cooling blanket
 Immobilize, Rest, Elevate  Ice lavage (caution: cause Valsalva)
 Pain management  Monitor temp, VS, ECG, CVP, LOC,
 Position of comfort UO
 Realign if possible  Use IVs to replace fluid losses
 **hyperthermia may recur in 3-4 (rebound);
HEAT & COLD EMERGENCIES avoid hypothermia

Patient Teaching
1. Heat Illness
 Ensure adequate fluid intake
 Due to salt loss from sweating
 Use sunscreen
 DHN  ARF
 Rest frequently when in hot env’t
 Causes spasms in large muscles
 Wear light weight, light colored, loose
 ** decreased Na  increased K+  tingling
clothing
 Treatment:
 Stop activity
 Cool environment COLD EMERGENCIES
 Balance salt solution  Frostbite
 Do not rub  blisters
2. Heat Exhaustion  Assess NVS
 Caused by DHN  Cause: extreme cold temperature
 Stems from heavy perspiration  Manage: warm IV, blankets
 Poor electrolyte consumption
 ** decreased Na  decreased “Don’t Pray for your grades, Make it Happen!”
Neurotransmission  weakness , flu like ~ Anonymous
symptoms, tachycardia, N/V “Study HARD, no matter if it seems impossible, no matter if it
 Field Tx: takes time, no matter if you have to up all night, just remember
 Stop activity that the feeling of success is the best feeling in the entire
 Move to cold place world”
~Anonymous
 Cold packs – armpit & groin
 Remove constrictive clothing “Trust yourself. You know more than you think you do” ~
 Re-hydrate (water, sports drink) Anonymous

GOOD LUCK!! ^_^

#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 23 | P a g e
#TibayNgDamdamin #ALFIEPOGI Emergency Disaster Nursing (MIDTERMS) 24 | P a g e