EMERGENCY AND DISASTER NURSING

BY: Darran Earl Gowing, BSN, RN, MN

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Objectives:
Explain emergency care as a collaborative, holistic approach that includes the patient, the family, and significant others. Discuss how triaging technique works. Discuss the new guidelines in instituting BLS and ACLS.
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Identify the priorities of care for the patient with multiple injuries. Specify the similarities and differences for the emergency management of patients with trauma. Develop a plan of care for a patient experiencing different types of disaster.

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

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.
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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
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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
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SCOPE AND PRACTICE OF EMERGENCY NURSING

The emergency nurse has had specialized education, training, and experience.

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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.

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Nursing interventions are accomplished interdependently, in consultation with or under the direction of a licensed physician.

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Appropriate nursing and medical interventions are anticipated based on assessment findings.

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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.

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Patients in the ED have a wide variety of actual or potential problems, and their condition may change constantly.

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Although a patient may have several diagnosis at a given time, the focus is on the most life-threatening ones

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ISSUES IN EMERGENCY NURSING CARE

Emergency nursing is demanding because of the diversity of conditions and situations which are unique in the ER.

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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.

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Legal Issues Includes:

Actual Consent Implied Consent Parental Consent

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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.

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Good Samaritan Law

Gives legal protection to the rescuer who act in good faith and are not guilty of gross negligence or willful misconduct.

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Focus of Emergency Care

Preserve or Prolong Life Alleviate Suffering Do No Further Harm Restore to Optimal Function

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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

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Guidelines in Giving Emergency Care

A Ask for help I Intervene D Do no Further Harm

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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

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2. Remorse and Guilt

verbalize their feelings

3. Anger
way of handling anxiety and fear allow the anger to be ventilated

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4. Grief
help family members work through their grief letting them know that it is normal and acceptable

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Core Competencies in Emergency Nursing

Assessment Priority Setting/Critical Thinking Skills Knowledge of Emergency Care Technical Skills Communication

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Assess and Intervene

Check for CABs of life

C Circulation
A Airway B Breathing
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Blunt Trauma Punctured foot Unconscious

laceration

GCS - 3

No
hematoma

Pulse
Abrasion

Not Breathing

BP 100/50

1st degree Burn

Temp 37.7 Fracture

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Team Members
Rescuer Emergency Medical Technician Paramedics Emergency Medicine Physicians Incident Commander Support Staff Inpatient Unit Staff
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Emergency Action Principle I. Survey the Scene

Is the Scene Safe?

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

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II. Do a Primary Survey

organization of approach so that immediate threats to life are rapidly identified and effectively manage.

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Primary Survey C Circulation

- Monitor VS - Maintain Vascular Access - Direct Pressure

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Estimated Blood Pressure

SITE SBP

Radial
Femoral Carotid

80
70 60

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Control of Hemorrhage

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A - Airway/Cervical Spine
- Establish Patent Airway - Maintain Alignment - GCS 8 = Prepare Intubation

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B Breathing
- Assess Breath Sounds - Observe for Chest Wall Trauma - Prepare for chest decompression

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

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E Exposure
- Remove clothing - Maintain Privacy - Prevent Hypothermia

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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

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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
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V. Triage
comes from the French word trier, meaning to sort process of assessing patients to determine management priorities

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1. Emergent

Categories:

-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

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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

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3. Non-urgent
patients have episodic illness that 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.

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4. Fast-Track:
- Psychological support needed - patients require simple first aid or basic primary care. - They may be treated in the ED or safely referred to a clinic or physicians office.

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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.

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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.

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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.

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4. Deceased or Expectant:
Injuries are extensive and chances of survival are unlikely even with definitive care.

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5. Fast-Track: Psychological support needed

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Expectant/Deceased

Fast Track
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Expectant/Deceased

Minimal/Non-urgent
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Urgent/Delayed
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Urgent/Delayed
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Minimal/Non-urgent

Emergent/Immediate

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FIRST AID

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Role of First Aid

Bridge the Gap Between the Victim and the Physician Immediately start giving interventions in pre-hospital setting

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Value of First Aid Training

Self-help Health for Others Preparation for Disaster

Safety Awareness
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BASIC LIFE SUPPORT

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KEY CHANGES OF BLS

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2005
Use of the A-B-C basic life support sequence.

2010
C-A-B (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants, excluding newborns).

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2005
Look, Listen and Feel Included in BLS algorithm

2010
Look, Listen and Feel has been removed from the BLS algorithm.

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2005

2010

A compression rate A compression rate of of at least 100/min. approximately 100/min.

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2005
Depress adult breastbone approximately 1 1/2 to 2 inches (approximately 4 to 5 cm).

2010
The new recommendation for chest compression depth: push down on the adult breastbone at least 2 inches (5 cm).

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Cardiopulmonary Resuscitation
Cardiac Arrest
a condition when the persons breathing and circulation/pulse stop at the same time Causes: Cardiovascular Disease, Heart Attack, MI
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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

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Procedure
1. Assess circulation for 10 seconds 2. Positioning of compression

Infant ( 0-1 year)

Check brachial/femoral pulse < 60 bpm or below or absent

Child (1-8 yrs)

Adult

Check carotid pulse and if no pulse

Commence chest compression Draw imaginary One hand on the sternum two line between fingers up from the xyphoid nipples and process place two fingers on the sternum 1 finger breadth below this line

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Compression-Decompression
Compression Heart is squeezed between sternum & spine. intrathoracic pressure Increase to force blood out of the heart .

Decompression
Allow complete chest recoil after each compression to maximize the vacuum in the thoracic cavity to force blood flow back to the heart
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Procedure 3. AR:ECC 4. Rate and Depth of compression Number of Cycle/ minute

Infant Child Adult ( 0-1 year) (1-8 yrs) 2 breaths: 30 compression 100/min 1/3 or 1.5 2 inches 5 cycles or two minutes

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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.
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Methods: mouth to mouth mouth to nose

mouth to stoma mouth to mouth and nose mouth to barrier device
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Procedure
1. Safe Approach 2. Assess for Response

Infant(0-1yr)

Child(1-8 yrs)

Adult
Gently shouting are you ok? then shake the victim

Approach and assess situation Shout and gently pinch

3. Positioning 4. Open the Airway

Placed Supine on a firm and flat surface Check for foreign bodies then remove using finger sweep Head-tilt-chin-lift maneuver Jaw-thrust Maneuver Bring cheek over the mouth and nose of the casualty Look for chest movement Listen for breath sounds Feel for breathing on your cheek

5. Assess for Breathing

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Jaw Thrust

Head tiltchin lift

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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

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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
5 rescue breaths - Place mouth over the nose and mouth of the infant - look for chest rising - pinch nose and ventilate via mouth - look for chest rising 2 rescue breaths -seal lips around the mouth and blow steadily for 1.5 2 seconds - look for chest rising

7.

Give Rescue Breaths

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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
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Important Points
Rate Depth Release

Five key aspects to Great CPR

Ventilation

Rescue & Amblance

Trainning Section

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When to STOP CPR:

S SPONTANEOUS BREATH
RESTORED

T TURNED OVER THE MEDICAL

SERVICES

O OPERATOR IS EXHAUSTED TO
CONTINUE

P PHYSICIAN ASSUMES
RESPONSIBILITY
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COMPLICATIONS OF CPR:
RIB FRACTURE STERNUM FRACTURE LACERATION OF THE LIVER OR SPLEEN PNEUMOTHORAX, HEMOTHORAX

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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

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EARLY DEFIBRILLATION
- 7-10% decrease per minute without

defibrillation

EARLY ACLS technique that

attempts to stabilize patient

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TRAUMA
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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.

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Causes: vehicular accidents, fall, acts of violence, sports

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Monro-Kellie hypothesis
states that because of the limited space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others. Without such changes, ICP will begin to rise.

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Primary Injury

Forms of Brain Injury

Initial damage to the brain that results from the traumatic event. This may include contusions, lacerations, and torn blood vessels from impact, acceleration/deceleration, or foreign object penetration

Secondary Injury
Evolves over the ensuing hours and days after the initial injury and is due primarily to brain swelling or ongoing bleeding.
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PATHOPHYSIOLOGY
Force of Blow to the Head Concussion Contussion Contrecoup Fracture Blood flow to the brain slows

Hematoma

Loss of AutoRegulation

ICP
ICP
Cushings Response

Cerebral hypoxia & Ischemia occur

DEATH
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Brain Herniation
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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
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Fractures e.g. linear, depressed, compound, comminuted

3. Hemorrhage
- causes hematoma or clot formation

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Types of Hemorrhage/Hematoma:
1. Epidural Hematoma
hematoma; forms rapidly and results from arterial bleeding - forms between the dura and the skull from a tear in the meningeal area - Forms slowly and results from a venous bleed - A surgical emergency
- the most serious type of

2.

Subdural Hematoma

3. Intracerebral -

Hemorrhage

bleeding directly into the brain matter

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Clinical manifestations:
Altered level of consciousness Confusion Pupillary abnormalities Altered or absent gag reflex or vomiting Absent corneal reflex Sudden onset of neurologic deficits Changes in vital signs

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Vision and hearing impairment CSF drainage from ears or nose Sensory dysfunction Spasticity Headache and vertigo Movement disorders or reflex activity changes Seizure activity
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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?
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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

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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
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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 the ear of drainage when noted but apply a loose, dry sterile dressing do not allow the client to cough
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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 agitation and promote comfort Antiepileptic drugs to prevent seizures
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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
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BURN TRAUMA
Is the damage caused to skin and deeper body structures by heat (flames, scald, contact with heat) , electrical, chemical or radiation

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FACTORS DETERMINING SEVERITY OF BURN:

1. AGE mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of age

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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
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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;

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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).

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4. Depth
Classification Affected Part Description of Wound What to Expect

1st degree Superficial

Epidermis

Pin, painful sunburn Discomfort last Blisters form after 24 after 48 hrs; heals hours in 3-7 days
Heals in 2-3 weeks, in no complication

2nd degree partial thickness

Pediermis Red, wet blisters, and part of bullae very painful the dermis

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2nd degree deep partial thickness

Only the skin appendages in the hair follicle remain

Epidermis, dermis and subcutaneous tissue . no skin appendages

Waxy white, difficult to distinguish from 3rd degree except hair growth becomes apparent in 7-10 days, little or no pain
Dry, leathery, may be red or black May have thrombosed veins Marked edema Distal circulation may be decreased Painless Dry, charred, bone may be visible

Slow to heal 94-8 weeks) surgical incision and grafting unless has complication
Requires excision and grafting. 10- 14 days for graft to revascularize

3rd degree Full thickness

4th degree deep full thickness

Skin, muscle, tendon, bone

Requires excision, grafting and sometimes amputation

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5. Size: Rule of nine

Assessment
Head and neck 1 arm

Child < 3 years old

Adult

18% 9%

9% 9%

Posterior trunk
Anterior trunk 1 leg Perineum

18%
18% 14% 1%
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18%
18% 18% 1%
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LUND AND BROWDER METHOD

which recognizes that the percentage of TBSA of various anatomic parts, especially the head and legs, and changes with growth.

PALM METHOD
In patients with scattered burns, a method to estimate the percentage of burn is the palm method. The size of the patients palm is approximately 1% of TBSA.
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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
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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.
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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

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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

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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
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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 140
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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

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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

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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

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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

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2. Knocked- out tooth

- Place a sterile gauze pad or cotton ball into the tooth socket to prevent further bleeding

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

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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
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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
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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.
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Classification of Chest Trauma:

Blunt Trauma results from sudden compression or positive pressure inflicted to the chest wall.

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Penetrating Trauma occurs when foreign object penetrates the chest wall.

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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

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Assessment:
Severe Pain Muscle spasm Tenderness Subcutaneous Crepitus Shallow Respirations Reluctance to move Client splints chest

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Management:
1. Rest 2. Ice Compress then Local

Heat

3. Analgesia

4. Splint the chest during

coughing or deep breathing

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FLAIL CHEST
- The unstable segment moves separately and in an opposite direction from the rest of the thoracic cage during the respiration cycle

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Assessment:
- Paradoxical respirations - Severe chest pain

- Dyspnea/Tachypnea
- Cyanosis - Tachycardia

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Management:

High Fowlers position Humidified O2 Analgesia Coughing & deep breathing Prepare for intubation with mechanical ventilation with positive end-expiratory pressure ( PEEP ) for severe respiratory failure
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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

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Types Of Pneumothorax:
Spontaneous Pneumothorax
- may occur in an apparently healthy

person in the absence of trauma due to rupture of an air-filled bleb, or blister, on the surface of the lung, allowing air from the airways to enter the pleural cavity.

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Tension Pneumothorax
- air is drawn into the pleural space from a lacerated lung or through a small hole in the chest wall

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Open Pneumothorax
- wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration

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Assessment:
Dyspnea Tachypnea Sharp chest pain Absent breathe sounds Sucking sound Cyanosis Tachycardia Tracheal deviation to the unaffected side with tension pneumothorax

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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
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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

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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

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Assessment:
-

Dyspnea Chest pain Tachypnea & tachycardia Hypotension Shallow respirations Rales on auscultation Cough Blood-tinged sputum Distended neck veins Cyanosis
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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
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ABDOMINAL TRAUMA
A. Penetrating Trauma
Causes:
- Gunshot wound - Stab wound - Embedded object from explosion

Assessment:
- Absence of bowel sound - Hypovolemic shock - Orthostatic hypotension - Pain and tenderness
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Management: 1. Maintain hemodynamic status IVF & blood transfusion 2. Surgery-EXLAP 3. Peritoneal Lavage

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B. Blunt Abdominal Trauma

Assessment:
- Left upper quadrant pain (Spleen) - Right upper quadrant pain (liver) - Signs of hypovolemic shock

174 DaRRaN

Management:
1. Maintain hemodynamic status 2. Monitor VS and oxygen supplements 3. Assess signs and symptoms of shock

175 DaRRaN

FOREIGN BODY AND AIRWAY OBSTRUCTION

176 DaRRaN

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
177 DaRRaN

Types of Obstruction
Anatomical
- tongue and epiglottis

Mechanical
- coins, food, toy etc

178 DaRRaN

Assessment & Clinical Manifestations:

Mild airway obstruction
-

can talk, breath and cough with high pitch breath sound cough mechanism not effective to dislodge foreign body
cant talk, breath or cough Nasal flaring, cyanosis, excessive salivation

Severe airway obstruction

-

Hands crossed at the neck is the universal sign for choking

179 DaRRaN

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 Heimlich maneuver Continue abdominal thrusts until the object is dislodged or the victim becomes unconscious.
180 DaRRaN

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.

181 DaRRaN

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
182 DaRRaN

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
183 DaRRaN

184 DaRRaN

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
185 DaRRaN

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
186 DaRRaN

Foreign objects in the eye

Flush eye clear with use of

water

187 DaRRaN

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
188 DaRRaN

POISONING
189 DaRRaN

Poison
Any substance that impairs health or destroys life when ingested, inhaled or otherwise absorbed by the body.

190 DaRRaN

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

191

Botulism Clostridium botulinum From canned foods Note: Save the Vomitus Staphylococcus Aureus from unrefrigerated cram filled foods, fish Note: Save the Vomitus Acetaminophen Poisoning most common drug accidentally ingested by children Antidote: Acetylcysteine
192 DaRRaN

Ingestion Poisoning

Petroleum Poisoning includes poisoning with a substance such as kerosene, fuel, insecticides and cleaning fluids Note: Never induce vomiting! May result in Chemical Pneumonia Corrosive Chemical Poisoning results in drooling of saliva, painful burning sensation, pain and redness in the mouth Note: Never induce vomiting, may cause further injury
Activated Charcoal, Milk of Magnesia
193 DaRRaN

Diagnostics:
Baseline ABG should be obtained periodically Baseline blood samples (CBC, BUN, electrolytes) ECG (since many toxic agents affect cardiac rhythm)

194 DaRRaN

Assessment:
Headache Double vision Difficulty in swallowing, talking and breathing Dry sore throat Muscle incoordination Nausea and vomiting

195 DaRRaN

 To remove or inactivate the poison before it is absorbed To provide supportive care in maintaining vital organ systems To administer a specific antidote to neutralize a specific poison To implement treatment that hastens the elimination of the absorbed poison
DaRRaN

Emergency treatment is initiated with the following goals:

196

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
197 DaRRaN

P O I S O N

Prevention, Child Proofing

Oral fluids in large amount Ipecac Support respiration & circulation Oral Activated Charcoal Never induce vomiting if substance ingested is corrosive
LAVAGE
198 DaRRaN

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 - Confusion which may eventually lead to coma
199 DaRRaN

Management:
1. 2. 3. 4. 5.

Check ABCs Remove victim from exposure Loosen tight clothing Administer O2 (100% delivery) Initiate CPR if required
200 DaRRaN

SPECIAL WOUNDS
201 DaRRaN

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
202 DaRRaN

Animal bite
Management:
Wash wound with soap and

water Tetanus toxoid and vaccine to stimulate antibodies Rabies Vaccine and immunoglobulin

203 DaRRaN

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

204

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
205 DaRRaN

Insect Bites / Bee stings

Assessment:
Itching, urticaria Dyspnea Chest tightness, dizziness, Nausea, vomiting, diarrhea Abdominal cramps, Flushing Laryngeal edema Respiratory arrest
DaRRaN

206

Management:
1. Remove stinger by scraping
2. Cleanse the site 3. If anaphylaxis occurs, give oxygen and medications

207 DaRRaN

TRAUMA RELATED TO ENVIRONMENTAL EXPOSURE

208 DaRRaN

HEAT STROKE
Occurs during extended heat waves, especially when they are accompanied by high humidity. Assessment:
- Hyperpyrexia (41.1 41.6C) - Hot flushed dry skin - Hypotension, dizziness, - Nausea and vomiting - Headache - Cessation of sweating - Seizures and decreased LOC
209 DaRRaN

Management:
Check ABCs Move out source of heat Loosen or remove clothing Apply cool sheets or towel Rapid cooling by sponging or immersing in cold water Oxygen supplements or IVF Ice applied to the neck, groin, chest, and axillae while spraying with tepid water Iced saline lavage of the stomach or colon if the temperature does not decrease
210 DaRRaN

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

Management:
Check ABCs

Move to cool area

Give salted water for vomiting periods Relieve cramps by firm pressure ECG and ABG monitoring
212 DaRRaN

FROSTBITE
trauma from exposure to freezing temperatures and actual freezing of the

tissue fluids in the cell and intercellular spaces.

Assessment:
Hard, cold extremities White or mottled blue extremity Extremity insensitive to touch

213 DaRRaN

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
214 DaRRaN

NEAR DROWNING

215 DaRRaN

Four Methods of Water Rescue:

1. Reaching Assist 2. Throwing Assist 3. Rowing Assist

4. Wading Assist
216 DaRRaN

Assessment:
Abdominal distention Confusion Irritability Lethargy Shallow gasping respirations Unconsciousness Vomiting Absent breathing
217 DaRRaN

Management:
Assess ABCs Give CPR and AR as necessary Check patients temperature Administer rewarming measures as necessary Monitor lab results (electrolytes) and ECG
218 DaRRaN