EMERGENCY

AND
DISASTER
NURSING
BY:
Darran Earl Gowing, BSN, RN 1
 TERMS USE:
Trauma
- Intentional or unintentional wounds/injuries on the
human body from particular mechanical mechanism
that exceeds the bodys ability to protect itself from
injury

Emergency Management
- traditionally refers to care given to patients with urgent
and critical needs.

DaRRaN 2
 Triage
- process of assessing patients to
determine management priorities.

First Aid
- an immediate or emergency treatment
given to a person who has been injured
before complete medical and surgical
treatment can be secured.

BLS
- level of medical care which is used for
patient with illness or injury until full
medical care can be given.

DaRRaN 3
 ACLS
- Set of clinical interventions for the urgent
treatment of cardiac arrest and often life
threatening medical emergencies as well
as the knowledge and skills to deploy
those interventions.

Defibrillation
- Restoration of normal rhythm to the heart
in ventricular or atrial fibrillation

Disaster
- Any catastrophic situation in which the
normal patterns of life (or ecosystems)
have been disrupted and extraordinary,
emergency interventions are required to
save and preserve human lives and/or the
environment
DaRRaN 4
 Mass Casualty Incident
- situation in which the number of
casualties exceeds the number of
resources

Post Traumatic Stress Syndrome

- characteristic of symptoms after a
psychologically stressful event was out of
range of an normal human experience

5
SCOPE AND PRACTICE OF
EMERGENCY NURSING
The emergency nurse has had
specialized education, training, and
experience.
The emergency nurse establishes
priorities, monitors and continuously
assesses acutely ill and injured patients,
supports and attends to families,
supervises allied health personnel, and
teaches patients and families within a
time-limited, high-pressured care
environment.

6
Nursing interventions are
accomplished interdependently, in
consultation with or under the
direction of a licensed physician.
Appropriate nursing and medical
interventions are anticipated
based on assessment data.
The emergency health care staff
members work as a team in
performing the highly technical,
hands-on skills required to care
for patients in an emergency
situation.
DaRRaN 7
Patients in the ED have a wide
variety of actual or potential
problems, and their condition may
change constantly.
Although a patient may have
several diagnosis at a given time,
the focus is on the most life-
threatening ones

DaRRaN 8
ISSUES IN EMERGENCY
NURSING CARE
Emergency nursing is demanding
because of the diversity of conditions
and situations which are unique in the
ER.
Issues include legal issues,
occupational health and safety risks for
ED staff, and the challenge of providing
holistic care in the context of a fast-
paced, technology-driven environment
in which serious illness and death are
confronted on a daily basis.

DaRRaN 9
 The emergency nurse must
expand his or her knowledge base
to encompass recognizing and
treating patients and anticipate
nursing care in the event of a
mass casualty incident.
Legal Issues Includes:
Actual Consent
Implied Consent
Parental Consent

DaRRaN 10
 Good Samaritan Law
- Gives legal protection to the rescuer
who act in good faith and are not
guilty of gross negligence or willful
misconduct.

DaRRaN 11
Focus of Emergency Care
Preserve or Prolong Life
Alleviate Suffering
Do No Further Harm
Restore to Optimal Function

12
Golden Rules of Emergency Care
Dos
- Obtain Consent
- Think of the Worst
- Respect Victims Modesty & Privacy
Donts
- let the patient see his own injury
- Make any unrealistic promises

DaRRaN 13
Guidelines in Giving Emergency
Care
A Ask for help

I Intervene

D Do no Further Harm

14
 Stages of Crisis
1. Anxiety and Denial
encouraged to recognize and talk about their
feelings.
asking questions is encouraged.
honest answers given
prolonged denial is not encouraged or
supported
2. Remorse and Guilt
verbalize their feelings
3. Anger
way of handling anxiety and fear
allow the anger to be ventilated
4. Grief
help family members work through their grief
letting them know that it is normal and
acceptable
DaRRaN 15
Core Competencies in
Emergency Nursing
Assessment
Priority Setting/Critical Thinking
Skills
Knowledge of Emergency Care
Technical Skills
Communication

16
DaRRaN 17
DaRRaN 18
DaRRaN 19
DaRRaN 20
DaRRaN 21
DaRRaN 22
DaRRaN 23
24
DaRRaN 25
DaRRaN 26
 Assess and Intervene
Check for ABCs of life

A Airway

B Breathing

C - Circulation

27
 Team Members
Rescuer
Emergency Medical Technician
Paramedics
Emergency Medicine Physicians
Incident Commander
Support Staff
Inpatient Unit Staff

28
Emergency Action Principle

I. Survey the Scene

Is the Scene Safe?
What Happened?
Are there any bystanders who can
help?
Identify as a trained first aider!

29
II. Do a Primary
- Survey
organization of approach so that
immediate threats to life are
rapidly identified and effectively
manage.

Primary Survey
A - Airway/Cervical Spine
- Establish Patent Airway
- Maintain Alignment
- GCS 8 = Prepare
Intubation
30
DaRRaN 31
B Breathing
- Assess Breath Sounds
- Observe for Chest Wall
Trauma
- Prepare for chest
decompression

C Circulation
- Monitor VS
- Maintain Vascular Access
- Direct Pressure
DaRRaN 32
Estimated Blood Pressure
SITE SBP

Radial 80

Femor 70
al

Caroti 60
d

DaRRaN 33
Control of Hemorrhage

DaRRaN 34
D Disability
- Evaluate LOC
- Re-evaluate clients LOC
- Use AVPU mnemonics

E Exposure
- Remove clothing
- Maintain Privacy
- Prevent Hypothermia

DaRRaN 35
III. Activate Medical
Assistance
Information to be Relayed:
- What Happened?
- Number of Persons Injured
- Extent of Injury and First Aid
given
- Telephone number from where
youre calling

DaRRaN 36
IV. Do Secondary
Survey
Interview the Patient
S Symptoms
A Allergies
M Medication
P Previous/Present Illness
L Last Meal Taken
E Events Prior to Accident
Check Vital Signs

DaRRaN 37
V. Triage

comes from the French

word trier, meaning to
sort
process of assessing
patients to determine
management priorities

DaRRaN 38
 Categories:
1. Emergent
-highest priority, conditions are
life threatening and need
immediate attention
Airway obstruction, sucking chest
wound, shock, unstable chest and
abdominal wounds, open fractures
of long bones

DaRRaN 39
2. Urgent
have serious health problems but
not immediately life threatening ones.
Must be seen within 1 hour

Maxillofacial wounds without airway

compromise, eye injuries, stable
abdominal wounds without evidence of
significant hemorrhage, fractures

DaRRaN 40
3. Non-urgent
patients have episodic illness than can be
addressed within 24 hours without increased
morbidity

Upper extremity fractures, minor burns,

sprains, small lacerations without significant
bleeding, behavioral disorders or psychological
disturbances.

DaRRaN 41
DaRRaN 42
 Field TRIAGE

1. Immediate:
Injuries are life-threatening but
survivable with minimal
intervention. Individuals in this
group can progress rapidly to
expectant if treatment is delayed.

DaRRaN 43
2. Delayed:
Injuries are significant and
require medical care, but can
wait hours without threat to life
or limb. Individuals in this
group receive treatment only
after immediate casualties are
treated.
3. Minimal:
Injuries are minor and treatment
can be delayed hours to days.
Individuals in this group should
be moved away from the main
triage area.
DaRRaN 44
4. Expectant:
Injuries are extensive and
chances of survival are unlikely
even with definitive care.

5. Fast-Track:
Psychological support
needed
DaRRaN 45
FIRST AID

DaRRaN 46
 Role of First Aid
Bridge the Gap Between the Victim and
the Physician
Immediately start giving interventions in
pre-hospital setting

DaRRaN 47
Value of First Aid Training

Self-help

Health for Others

Preparation for Disaster

Safety Awareness

DaRRaN 48
BASIC LIFE
SUPPORT
DaRRaN 49
Artificial Respiration
a way of breathing air to
persons lungs when breathing
ceased or stopped function.
Respiratory Arrest
a condition when the
respiration or breathing pattern
of an individual stops to
function, while the pulse and
circulation may continue.

Causes: Choking, Electrocution,

strangulation, drowning and
suffocation.
DaRRaN 50
 Methods:
mouth to mouth

mouth to nose

mouth to stoma

mouth to mouth and nose

mouth to barrier device

DaRRaN 51
 Procedure Infant(0-1yr) Child(1-8 yrs) Adult
1. Safe Approach Approach and assess situation

2. Assess for Shout and gently pinch Gently shouting

Response are you ok?
then shake
the victim
3. Positioning Placed Supine on a firm and flat surface
4. Open the Check for foreign bodies then remove using finger
Airway sweep
Head-tilt-chin-lift maneuver
Jaw-thrust Maneuver
5. Assess for Bring cheek over the mouth and nose of the casualty
Breathing Look for chest movement
Listen for breath sounds
Feel for breathing on your cheek

DaRRaN 52
DaRRaN 53
DaRRaN 54
 The Casualty is Breathing:
Place in recovery position
Before moving casualty remove any objects safely from her pockets
Kneel beside casualty, place arm nearest at right angles, and then
bend elbow keeping the palm uppermost.
Bring far arm across the casualtys chest and hold back of the
casualtys hand against the nearest cheek
With your other hand grasp the far thigh just above the knee, then
pull the casualty towards you and on to his or her side

DaRRaN 55
 The Casualty is NOT Breathing:
6. Go for Help - if someone responds to your shout for help send that
person to phone for ambulance
- if youre on your own, leave the casualty and make the
phone call for yourself
* never leave if the patient has collapsed as a result of
trauma or drowning or if the casualty is a child
7. Give Rescue 5 rescue breaths 2 rescue breaths
Breaths - Place mouth over - pinch nose and -seal lips around
the nose and ventilate via the mouth and
mouth of the mouth blow steadily
infant - look for chest for 1.5 2
- look for chest rising seconds
rising - look for chest
rising

DaRRaN 56
 When to Stop AR:
when the patient has spontaneous breathing

when the first aider is too exhausted to continue

when another first aider takes over

when EMS arrives and takes over

DaRRaN 57
 Cardiopulmonary
Resuscitation (CPR)

Cardiac Arrest
a condition when the persons
breathing and circulation/pulse
stop at the same time

Causes: Cardiovascular Disease,

Heart Attack, MI

DaRRaN 58
Management:

External Chest Compression

- consist of rhythmic application of
pressure over the lower portion of the
sternum just in between the nipple

Cardiopulmonary Resuscitation =
AR + ECC

Goal: Rapid return of pulse, BP and

consciousness

DaRRaN 59
Procedure Infant Child Adult
( 0-1 year) (1-8
yrs)
1. Assess Check brachial Check carotid pulse and if
circulation pulse < 60 no pulse
for 10 bpm or below
seconds or absent
Commence chest compression
2. Positioning Draw imaginary One hand on the sternum
of line between two fingers up from the
compressio nipples and xyphoid process
n place two
fingers on the
sternum 1
finger breadth
below this line

DaRRaN 60
3. AR:ECC 1 breath: 5 2 breaths: 30
compression compression

4. Rate and 100/min

Depth of 1/3 or 1.5 2 inches
compressio
n
Number of 5 cycles per minute
Cycle/
minute

DaRRaN 61
DaRRaN 62
When to STOP CPR:
S SPONTANEOUS BREATH
RESTORED

T TURNED OVER THE MEDICAL

SERVICES

O OPERATOR IS EXHAUSTED
TO CONTINUE

P PHYSICIAN ASSUMES
RESPONSIBILITY

DaRRaN 63
COMPLICATIONS OF CPR:
RIB FRACTURE

STERNUM FRACTURE

LACERATION OF THE LIVER OR

SPLEEN

PNEUMOTHORAX, HEMOTHORAX

DaRRaN 64
CHAIN OF SURVIVAL
EARLY ACCESS early recognition
of cardiac arrest, prompt activation of
emergency services

EARLY BLS prevent brain damage,

buy time for the arrival of defibrillator

DaRRaN 65
 EARLY DEFIBRILLATION
- 7-10% decrease per minute without
defibrillation

EARLY ACLS technique that

attempts to stabilize patient

DaRRaN 66
67
TRAUMA

68
Head trauma

Result of an external force applied to the

head and brain causing disruption of
physiologic stability locally, at the point of
injury, as well as globally with elevations in
ICP and potentially dramatic changes in
blood flow within the brain.
Trauma to the skull resulting in mild to
extensive damage to the brain.
Causes: vehicular accidents, fall, acts
of violence, sports

69
 Types of Head Injuries
1. Open
Scalp lacerations
Fractures in the skull
Interruption of the dura mater
2. Closed
Concussions a jarring of the brain within the skull with
temporary loss of consciousness
Contusions a bruising type of injury to the brain; may occur
with subdural or extradural collections of blood.
Contrecoup decelerative forces throwing the brain back and
forth
Fractures e.g. linear, depressed, compound comminuted
3. Hemorrhage
causes hematoma or clot formation

70
 Types of Hemorrhage/Hematoma:
the most serious type of
1. epidural hematoma hematoma; forms rapidly and
results from arterial bleeding
forms between the dura and
the skull from a tear int the
meningeal area

2. Subdural hematoma - forms slowly and results from a venous

bleed
- a surgical emergency

3. Intracerebral - bleeding directly into the brain matter

hemorrhage

71
 Clinical manifestations:
Altered level of consciousness
Confusion
Papillary abnormalities
Altered or absent gag reflex or vomiting
Absent corneal reflex
Sudden onset of neurologic deficits
Changes in vital signs
Vision and hearing impairment
CSF drainage from ears or nose
Sensory dysfunction
Spasticity
Headache and vertigo
Movement disorders or reflex activity changes
Seizure activity

72
 Assessment
What time did the injury occur?
What caused the injury?
What was the direction and force of the
blow?
Was there a loss of consciousness?
What was the duration of
unconsciousness?
Could the patient be aroused?
73
 Emergency interventions:
Goal: maintain oxygen and nutrient rich cerebral blood flow
Monitor respiratory status and maintain a patent airway
monitor neurological status and vital signs (TPR,BP)
monitor for increased ICP
Head elevation 20 -30 degrees
restrict fluids and monitor I & O
immobilization of neck
initiate normothermia measures
assess cranial nerve function, reflexes and motor and sensory function
initiate seizure precautions
monitor for pain and restlessness
avoid administration of morphine sulfate
monitor for drainage from the nose or ears
if there is CSF leak, monitor for nuchal rigidity
do not attempt to clean the nose, suction or allow the client to blow the nose if
drainage occurs
do not clean te ear of drainage when noted but apply a loose, dry sterile
dressing
do not allow the client to cough

74
 Medical intervention:
Osmotic diuretics pulling water out of the
extracellular space of the edematous brain
tissue
Loop diuretic reduce incidence of rebound
from osmotic diuretics
Opioids decreased agitation
Sedatives reduced anxiety and promote
comfort and agitation
Antiepileptic drugs to prevent seizures

75
 Surgical intervention:
Craniotomy

a surgical procedure that involves an incision

through the cranium to remove accumulated
blood or tumor

complications include increased ICP from

cerebral edema, hemorrhage or obstruction of
the normal flow of CSF

76
 DENTAL TRAUMA
1. Tooth Ache
Rinse mouth vigorously with warm water to clear out debris
Use dental floss to remove any food that might be wedged in
between the teeth
Use cold pack on the outside of the cheek to manage swelling
Soak cotton with Oil of Cloves and place it on aching tooth
2. Knocked- out tooth
- Place a sterile gauze pad or cotton ball into the tooth
socket to prevent further bleeding

DaRRaN 77
3. Broken tooth
Gently clean dirt and blood from the injured area
with the use of clean cloth and warm water
Use cold compress to minimize swelling
4. Bitten Tongue or Lip
Using a clean cloth, apply direct pressure to the
bleeding area
If swelling is present, apply cold compress
5. Objects wedged between the teeth
Try to remove object with a dental floss
Guide the floss carefully to prevent bleeding
Do not remove the object with a sharp or pointed
object

DaRRaN 78
6. Orthodontic Problems
If a wire is causing irritation, cover the end of
the wire with the use of a cotton ball/ piece
of gauze until you can get to a dentist
Do not attempt to remove a wire embedded
in the gums, cheek or tongue. Instead, go
immediately to the dentist
7. Possible fractured jaw
Immobilize the jaw by any means
Apply cold compress to prevent swelling

DaRRaN 79
 CHEST TRAUMA
Approximately a quarter of deaths due to
trauma are attributed to thoracic injury.

Immediate deaths are essentially due to major

disruption of the heart or of great vessels.

Early deaths due to thoracic trauma include

airway obstruction, cardiac tamponade or
aspiration.

DaRRaN 80
 Classification of Chest Trauma:
Blunt Trauma results from sudden
compression or positive pressure
inflicted to the chest wall.

Penetrating Trauma occurs when

foreign object penetrates the chest wall.

DaRRaN 81
 Types of Chest Trauma
A. Blunt Chest Trauma
RIB FRACTURES
- Fractured ribs may occur at the point of impact and damage to
the underlying lung may produce lung bruising or puncture.
- Commonly a result of crushing chest injuries
Assessment:
- Severe Pain - Muscle spasm
- Tenderness - Subcutaneous Crepitus
- Shallow Respirations - Reluctance to move
- Client splints chest

DaRRaN 82
Management:
1. Rest

2. Ice Compress then Local Heat

3. Analgesia

4. Splint the chest during coughing or deep

breathing

DaRRaN 83
FLAIL CHEST
- The unstable segment moves separately
and in an opposite direction from the rest
of the thoracic cage during the respiration
cycle
Assessment:
Paradoxical respirations
Severe chest pain
Dyspnea/ Tachypnea
Cyanosis
Tachycardia
DaRRaN 84
Management:

1. High Fowlers position

2. Humidified O2
3. Analgesia
4. Coughing & deep breathing
5. Prepare for intubation with mechanical
ventilation with positive end-expiratory
pressure ( PEEP ) for severe respiratory
failure
DaRRaN 85
B. Penetrating Chest Trauma
- occurs when a foreign object
penetrates the chest wall
1.Pneumothorax
- Accumulation of atmospheric air in the
pleural space
may lead to lung collapse
Types:
1. Spontaneous Pneumothorax
2. Open Pneumothorax
3. Tension Pneumothorax

DaRRaN 86
DaRRaN 87
Assessment:
Dyspnea Tachycardia
Tachypnea Sharp chest pain
Absent breathe sounds
Sucking sound
Cyanosis

Tracheal deviation to the unaffected side

with tension pneumothorax

DaRRaN 88
Management:
1. Apply dressing over an open chest wound
2. O2 as Rx
3. High Fowlers
4. Chest tube placement
- Monitor for chest tube system
- Monitor for subcutaneous emphysema
Chest Tube Drainage System
- returns (-) pressure to the intra-pleural space
- remove abnormal accumulation of air & fluids
serves as lungs while healing is going on
DaRRaN 89
 Pulmonary Embolism
- Dislodgement of thrombus to the pulmonary
artery

- Caused by thrombus & pulmonary emboli

- Other risk factors: deep vein thrombosis,

immobilization, surgery, obesity, pregnancy,
CHF, advanced age, prior History of
thromboembolism

DaRRaN 90
Assessment:
Dyspnea
Chest pain
Tachypnea & tachycardia
Hypotension
Shallow respirations
Rales on auscultation
Cough
Blood-tinged sputum
Distended neck veins
Cyanosis
DaRRaN 91
Management:
1. O2 as Rx
2. High Fowlers
3. Maintain bed rest
4. Incentive spirometry as Rx
5. Pulse oximetry
6. Prepare for intubation & mechanical ventilation
7. IV heparin (bolus)
8. Warfarin (Coumadin)
9. Monitor PT & PTT closely
10. Prepare the client for embolectomy, vein
ligation, or insertion of an umbrella filter as Rx

DaRRaN 92
 ABDOMINAL TRAUMA
A. Penetrating Abdominal Trauma
Causes:
- Gunshot wound
- Stab wound
- Embedded object from explosion

Assessment:
- Absence of bowel sound - Hypovolemic shock
- Orthostatic hypotension - Pain and tenderness

Management:
1. Maintain hemodynamic status IVF & blood transfusion
2. Surgery- EXLAP
3. Peritoneal Lavage

DaRRaN 93
B. Blunt Abdominal Trauma
Assessment:

- Left upper quadrant pain (Spleen)

- Right upper quadrant pain (liver)
- Signs of hypovolemic shock
Management:

1. Maintain hemodynamic status

2. Monitor VS and oxygen supplements
3. Assess signs and symptoms of shock
DaRRaN 94
FOREIGN BODY
AND AIRWAY
OBSTRUCTION
DaRRaN 95
CAUSES:

improper chewing of large pieces of food

aspiraton of vomitus, or a foreign body

position of head, the tongue

resulting to difficulty of breathing or

respiratory arrest

DaRRaN 96
Types of obstruction

anatomical
tongue and
epiglottis

mechanical
coins, food, toy etc
DaRRaN 97
 Assessment and clinical
manifestations:
Mild airway obstruction
can talk, breath and cough with high
pitch breath sound
cough mechanism not effective to
dislodge foreign body
Severe airway obstruction
cant talk, breath or cough
Nasal flaring, cyanosis, excessive
salivation

DaRRaN 98
Intervention:
CONCIOUS PATIENT:

ask the victim, are you choking?

if the victims airway is obstructed partially, a crowing sound
is audible; encourage the victim to cough.
relieve the obstruction by heimlick maneuver
Heimlich maneuver:
stand behind the victim
place arms around the victims waist
make a fist
place the thumb side of the fist just above the umbilicus and
well below the xyphoid process. Perform 5 quick in and up
thrusts.
Use chest thrusts for the obese or for the advanced pregnancy
victims.
continue abdominal thrusts until the object is dislodged or
the victim becomes unconscious.

DaRRaN 99
 UNCONSCIOUS PATIENT:

assess LOC
call for help
check for ABCs
open airway using jaw thrust technique
finger sweep to remove object
attempt ventilation
reposition the head if unsuccessful; reattempt ventilation
relieve the obstruction by the Heimlich maneuver with five thrust;
then finger sweep the mouth
reattempt ventilation
repeat the sequence of jaw thrust, finger sweep, breaths and
Heimlich maneuver until successful
be sure to assess the victims pulse and respirations
perform CPR if required

DaRRaN 100
 Choking child or infant:
choking is suspected in infants and
children experiencing acute respiratory
distress associated with coughing,
gagging, or stridor.
allow the victim to continue to cough if
the cough is forceful
if cough is ineffective or if increase
respiratory difficulty is still noted,
perform CPR

DaRRaN 101
 Foreign objects in the ear

Dont probe the ear with a tool

Remove the object if clearly visible

Try using gravity and shake the head gently

Try using oil for an insect

Dont use oil to remove any other object than an

insect

DaRRaN 102
 Foreign objects in the eye

Flush eye clear with use of water

DaRRaN 103
 Foreign objects in the nose

Dont probe at the object with cotton ball

or other tool

Breathe thru your mouth until the object is

removed

Blow your nose gently to try to free the

object
DaRRaN 104
POISONING

DaRRaN 105
 Poison

Any substance that impairs health

or destroys life when ingested,
inhaled or otherwise absorbed by
the body.

DaRRaN 106
 Suspect poisoning if:
1. Someone suddenly becomes ill for no
apparent reason and begins to act
unusually
2. Is depressed and suddenly becomes ill
3. Is found near a toxic substance and is
breathing any unusual fumes, or has
stains, liquid or powder in his or her
clothing, skin or lips

DaRRaN 107
 Ingestion Poisoning
Botulism Clostridium botulinum. From canned foods
Note: Save the Vomitus
Staphylococcus Aureus from unrefrigerated cram filled
foods, fish
Note: Save the Vomitus
Petroleum Poisoning includes poisoning with a
substance such as kerosene, fuel, insecticides and
cleaning fluids
Note: Never induce vomiting! May result in
Chemical Pneumonia

DaRRaN 108
 Acetaminophen Poisoning most
common drug accidentally ingested by
children
Antidote: Acetylcysteine
Corrosive Chemical Poisoning strong
detergents and dry cleaners
results in drooling of saliva, painful burning
sensation and pain and redness in the mouth
Note: Never induce vomiting, may cause
further injury
Activated Charcoal, Milk of Magnesia

DaRRaN 109
Diagnostics:
Baseline ABG should be obtained periodically
Baseline blood samples (CBC, BUN, electrolytes)
ECG (since many toxic agents affect cardiac
rhythm)
Assessment:
Headache
Double vision
Difficulty in swallowing, talking and breathing
Dry sore throat
Muscle incoordination
Nausea and vomiting

DaRRaN 110
Management:
Check victims ABCs. Begin rescue
breathing if necessary
If ABCs are present but the victim is
unconscious, place him in recovery
position
If victim starts having seizures, protect
him from injury
If victim vomits, clear the airway
Calm and reassure the victim while
calling for medical help
DaRRaN 111
P Prevention. Child Proofing
O Oral fluids in large amount
I - Ipecac
S Support respiration and circulation
O - Oral Activated Charcoal
N - Never induce vomiting if substance
ingested is corrosive

LAVAGE

DaRRaN 112
 Inhalation Poisoning
Carbon Monoxide Poisoning
Carbon monoxide is a colorless, odorless & tasteless gas
Assessment:
- appears intoxicated
- Muscle weakness
- Headache & dizziness

- Pink or cherry red skin (not a reliable sign)

- Confusion which may eventually lead to coma

DaRRaN 113
Management:
1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery)

5. Initiate CPR if required

DaRRaN 114
SPECIAL
WOUNDS
DaRRaN 115
 Human Bites
staphylococcus and streptococcus
infection
Management:
1. Cleanse and irrigate the wound
2. Assist with wound exploration
3. Culture the wound site
4. Tetanus toxoid and vaccine to
stimulate antibody production
DaRRaN 116
 Animal bite
dog and cat bite

Management:
1. Wash wound with soap and water
2. Tetanus toxoid and vaccine to stimulate
antibodies
3. Rabies Vaccine and immunoglobulin

DaRRaN 117
 Snake Bite
Infection can be neurotoxic or hemotoxic
Assessment:
Edema
Ecchymosis
Petechiae
Fever
Nausea and Vomiting
Possible hypotension
Muscle fasciculation
Hemorrhage, shock and pulmonary edema

DaRRaN 118
Management:
1. Establish ABCs
2. Immobilize bitten arm or extremity
3. Remove constricting items
4. Provide warmth
5. Cleanse the wound
6. Cover wound with light sterile dressing
7. Dont attempt to remove the venom
8. Anti venom therapy

DaRRaN 119
 Insect Bites/ Bee stings

Assessment:
Itching, dyspnea
Chest tightness, dizziness, urticaria
Nausea, vomiting,diarrhea
Abdominal cramps, flushing
Laryngeal edema
Respiratory arrest

DaRRaN 120
Management:

1. Remove stinger by scraping

2. Cleanse the site

3. If anaphylaxis occurs, give oxygen and

medications

DaRRaN 121
TRAUMA RELATED
TO
ENVIRONMENTAL
EXPOSURE

DaRRaN 122
 HEAT EXHAUSTION
Assessment:
Nausea and vomiting
increased temperature
Muscle cramps
Tachypnea and Tachycardia
Orthostatic hypotension
Malaise
Irritability and anxiety

123
Management:
Check ABCs

Move to cool area

Give salted water for vomiting periods

Relieve cramps by firm pressure

ECG and ABG monitoring

124
 FROSTBITE

Assessment:

Hard, cold extremities

White or mottled blue extremity

Extremity insensitive to touch

125
Management:
Remove constrictive clothing and jewelry

Prevent ambulation if lower extremity is involved

Institute rewarming measures

Once rewarmed, elevate extremity to prevent

swelling

Apply sterile gauze or cotton in between digits to

prevent maceration

126
NEAR DROWNING

127
 Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist

4. Wading Assist

128
 Assessment:

Abdominal distention
Confusion
Irritability
Lethargy
Shallow gasping respirations
Unconsciousness
vomiting
Absent breathing

129
 Management:
Assess ABCs

Give CPR and AR as necessary

Check patients temperature

Administer rewarming measures as necessary

Monitor lab results(electrolytes) and ECG

130
BURN TRAUMA

Is the damage caused to skin and

deeper body structures by heat
(flames, scald, contact with heat) ,
electrical, chemical or radiation
131
 FACTORS DETERMINING
SEVERITY OF BURN:
1. age mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of
age
2. Patients medical condition debilitating disorders such as cardiac, respiratory,
endocrine and renal disorders negatively influence the clients response to injury
and treatment.
mortality rate is higher when the client has a pre-existing disorder at the time
of the burn injury
3. location
burns on the head, neck and chest are associated with pulmonary complications;
burns on the face are associated with corneal abrasion;
burns on the ear are associated with auricular chondritis;
hands and joints require intensive therapy;
the perineal area is prone to autocontamination by urine and feces;
circumferential burns of the extremities can produce a tourniquet-like effect and
lead to vascular compromise (compartment syndrome).
4. Depth

132
 4. Depth

Affected Part Description of Wound What to Expect

Classification

1st degree Epidermis Pin, painful sunburn Discomfort last after 48 hrs; heals in 3-7 days
superficial Blisters form after 24
hours

2nd degree Pediermis and part of Red, wet blisters, Heals in 2-3 weeks, in no complication
partial thickness the dermis bullae very painful

2nd degree Only the skin Waxy white, difficult Slow to heal 94-8 weeks) surgical incision and grafting
deep partial appendages in the to distinguish from 3rd unless has complication
thickness hair follicle remain degree except hair
growth becomes
apparent in 7-10
days, little or no pain

3rd degree Epidermis, dermis -Dry, Requires excision and grafting.

Full thickness and subcutaneous leathery, 10- 14 days for graft to revascularize
tissue . no skin may be red
appendages or black
-May have
thrombosed
veins
-Marked
edema
-Distal
circulation
may be
decreased
-Painless

4th degree Skin, muscle, tendon, Dry, charred,DaRRaN

bone 133
Requires excision, grafting and sometimes amputation
deep full thickness bonde may be visible
5. Size: Rule of nine

Child < 3 years Adult

Assessment old

Head and neck 18% 9%

1 arm 9% 9%

Posterior trunk 18% 18%

Anterior trunk 18% 18%

1 leg 14% 18%

Perineum 1% 1%

DaRRaN 134
6. Temperature
determines the extent of injury
7. Exposure to the Source
Thermal Burns caused by exposure to
flames, hot liquids, steam or hot objects
Chemical Burns caused by tissue contact
with strong acids, alkalis or organic
compounds
Electrical Burns result in internal tissue
damaging, alternating current is more
dangerous than direct current for it is
associated with cardiopulmonary arrest,
ventricular fibrillation, titanic muscle
contractions, and long bone and vertebral
fractures.
Radiation Burns are caused by exposure to
ultraviolet light, x-rays or a radioactive source

135
 Types of Burns and their
Treatment:
Scald
burn caused by hot liquid
immediately flush the burn area with water (under a tap or hose for up to 20 min)
if no water is readily available, remove clothing immediately as clothing soaked
with hot liquid retains heat
Flame
Smother the flames with a coat or blanket, get the victim on the floor or ground
(stop, drop, and Roll)
Prevent victim from running
If water is available, immediately cool the burn area with water
If water is not available, remove clothing; avoid pulling clothing across the burnt
face
Cover the burn area with a loose, clean, dry cloth to prevent contamination
Do not break blisters or apply lotions, ointments, creams or powder
Airway
if face or front of the trunk is burnt, there could be burns to the airway
there is a risk of swelling or air passage, leading to difficulty in breathing

136
 Smoke inhalation
Urgent treatment is required with care of the airway, breathing and
circulation
When 02 in the air is used up by fire, or replaced by other gases,
the oxygen level in the air will be dangerously low
Spasm in the air passages as a result of irritation by smoke or
gases
Severe burns to the air passages causing swelling and obstruction
Victim will show signs and symptoms of lack of O2. He may also be
confused or unconscious

Electrical
check for Danger
turn of the electricity supply if possible
avoid any direct contact with the skin of the victim or any
conducting material touching the victim until he is disconnected
once the area is safe, check the ABCs
if necessary, perform rescue breathing or CPR

DaRRaN 137
 Chemical
Flood affected area with water for 20-30 min
Remove contaminated clothing
If possible, identify the chemical for possible
subsequent neutralization
Avoid contact with the chemical
Sunburn
Exposure to ultraviolet rays in natural sunlight
is the main cause of sunburn
General skin damage and eventually skin
cancer develops
The signs and symptoms of sunburn are pain,
redness and fever

138