Emergency Nursing

by: Elmer G. Organia, RN

 Emergency Nursing

Emergency Nursing is a nursing specialty in

which nurses care for patients in the emergency
or critical phase of their illness or injury.
• the key difference is that an emergency nurse is
skilled at dealing with people in the phase when
a diagnosis has not yet been made and the
cause of the problem is not known.
• An emergency nurse establishes priorities,
monitors and continuously assesses
acutely ill and injured patients, supports
and attends to families within a time-
limited and high pressured environment.
• Must be rendered without delay
Issues in Emergency Nursing Care

• Documentation of Consent
– for invasive procedures
– procedure must be documented for
unconscious patient without relatives.
• Limitation of Exposure to Health Risks
 HIV infections
 Communicable Diseases

Nurses must protect themselves

Providing Holistic Care

• Patient Focused Interventions

• Family Focused Intervention

 Anxiety and Denial
 Guilt
 Anger
 Grief
Continuum of Care

• Discharge Planning

• Community Services
Principles of Emergency Nursing
A. Triage
is a process of prioritizing patients
based on the severity of their
condition so as to treat as many as
possible when resources are
insufficient for all to be treated
immediately. The term comes from
the French verb trier, meaning "to
sort, sift or select."
Types of Triage
1. Simple Triage

Simple triage is used in a scene of

mass casualty, in order to sort patients into
those who need critical attention and immediate
transport to the hospital and those with less
serious injuries. This step can be started before
transportation becomes available. The
categorization of patients based on the severity
of their injuries can be aided with the use of
printed triage tags or colored flagging
Categories of Severity

Black / Expectant

They are so severely injured that they will die

of their injuries, possibly in hours or days (large-
body burns, severe trauma, lethal radiation
dose), or in life-threatening medical crisis that
they are unlikely to survive given the care
available (cardiac arrest, septic shock, severe
head or chest wounds); they should be taken to
a holding area and given painkillers as required
to reduce suffering.
Cont…

Red / Immediate
They require immediate surgery or other
life-saving intervention, and have first
priority for surgical teams or transport to
advanced facilities; they "cannot wait" but
are likely to survive with immediate
treatment.
Cont…

Yellow / Observation
Their condition is stable for the moment
but requires watching by trained persons
and frequent re-triage, will need hospital
care (and would receive immediate priority
care under "normal" circumstances).
Cont…

Green / Wait (walking wounded)

They will require a doctor's care in several
hours or days but not immediately, may
wait for a number of hours or be told to
go home and come back the next day
(broken bones without compound
fractures, many soft tissue injuries).
Cont…

White / Dismiss (walking wounded)

They have minor injuries; first aid and
home care are sufficient, a doctor's care is
not required. Injuries are along the lines
of cuts and scrapes, or minor burns.
2.Advanced Triage

• Advanced triage
In advanced triage, doctors may decide that
some seriously injured people should not receive
advanced care because they are unlikely to
survive. Advanced care will be used on patients
with less severe injuries. Because treatment is
intentionally withheld from patients with certain
injuries, advanced triage has ethical implications.
It is used to divert scarce resources away from
patients with little chance of survival in order to
increase the chances of survival of others who
are more likely to survive.
 Three Categories of Triage
System
• Emergent -patients with the highest
priority and must be seen immediately
• Urgent – patients with serious health problems
but not immediately life threatening, they must
be seen within 1 hour.
• Non-Urgent-patients have episodic illnesses
that can be addressed within 24 hours without
increased morbidity.
B. Prioritization

• A systematic approach
Airway

Breathing

Circulation

Disability
1.Respiratory Emergencies
A. Airway Obstruction

• The airway is partially or completely

occluded

• Permanent brain damage or death will

occur within 3-5 minutes
Anatomy of the Respiratory
System
 Clinical Manifestations

• Labored Breathing
• Use of Accessory Muscles
• Cyanosis
• Confusion
• Flaring Nostrils
• Hypoxia
• Loss of Consciousness
 Assessment and Diagnostic
Findings
• If Conscious-simply ask the patient
• If Conscious
Inspection
X-ray
Laryngoscopy
Bronchoscopy
Management
1. Head-tilt/chin-lift maneuver
Check Breathing.
Opening the airway.
Place patient in a supine position.
Place one hand in a patients forehead.
Apply pressure to tilt the head back.
Place the other hand under the bony part
of lower jaw near the chin and lifted up.
Top: Airway obstruction produced by the
tongue and the epiglottis.
Bottom: Relief by head-tilt/chin-lift.
• Note:
Do not use this maneuver if you suspect
cervical spine injury.
2.Jaw-Thrust Maneuver

• One hand is placed on each side of patient

jaw.

• Displace our mandible forward.

3.Oropharyngeal Airway Insertion

• An oropharyngeal airway (also known as

an oral airway,OPA or Guedel pattern
airway) is a medical device called an
airway adjunct used to maintain a patent
(open) airway. It does this by preventing
the tongue from (either partially or
completely) covering the epiglottis, which
could prevent the patient from breathing.
• designed by Arthur E. Guedel
• Oropharyngeal airways come in a variety
of sizes, from infant to adult, and are used
mostly in pre-hospital emergency care
4. Endotracheal Intubation
•  refers to the placement of a tube into an
external or internal orifice of the body. Tracheal
intubation is the placement of a flexible plastic
tube into the trachea to protect the patient's
airway and provide a means of mechanical
ventilation. The most common intubation is
orotracheal intubation where, with the
assistance of a laryngoscope, an
endotracheal tube is passed through the mouth,
larynx, and vocal cords, into the trachea. A bulb
is then inflated near the distal tip of the tube to
help secure it in place and protect the airway
from blood, vomit, and secretions
 Indications

Comatose or intoxicated patients who are unable to protect

their airways. In such patients, the throat muscles may lose
their tone so that the upper airways obstruct or collapse
and air can not easily enter into the lungs.
General anesthesia. In anesthetized patients spontaneous
respiration may be decreased or absent due to the effect of
anesthetics, opioids, or muscle relaxants. To enable
mechanical ventilation, an endotracheal tube is often used,
although there are alternative devices such as face masks
or laryngeal mask airways.

Cardiopulmonary Resuscitation.
5. Heimlich Maneuver

• Abdominal thrusts, also known as the Heimlich

Maneuver (after Henry Heimlich)
• Performing abdominal thrusts involves a rescuer
standing behind a patient and using their hands
to exert pressure on the bottom of the
diaphragm. This compresses the lungs and
exerts pressure on any object lodged in the
trachea, hopefully expelling it. This amounts to
an artificial cough .
 Alternatives to Intubation

 Tracheostomy - a surgical technique,

typically for patients who require
long-term respiratory support
B.Hypoxia

• Hypoxia literally means "a deficiency

in oxygen."
• Hypoxia (medical), a shortage of
oxygen in the body.
• Hypoxemia is the reduction of
oxygen specifically in the blood;
• Anoxia is when there is no oxygen
available at all.
Types of Hypoxia
• Hypoxemic Hypoxia is a generalized hypoxia, an
inadequate supply of oxygen to the body as a
whole.
• Anemic Hypoxia - total oxygen content of the
blood is reduced.
• Hypemic Hypoxia - the blood fails to deliver
oxygen to target tissues.
• Histotoxic Hypoxia – the quantity of oxygen
reaching the cells is normal, but the cells are
unable to effectively use the oxygen .
• Ischemic Hypoxia - there is a local restriction in
the flow of otherwise well-oxygenated blood
Symptoms

• Headache
• Fatigue
• Nausea
• Cyanosis
• Seizure
• Coma
• Death
Management

• Remove Obstruction/Cause
• Oxygen Inhalation
• Bypass Airway
• Rest
C. Hanging and Strangulation

• Hanging is the lethal suspension of a

person by a ligature.
• A method of suicide in which a person
applies a ligature to the neck and brings
about unconsciousness and then death.
• Strangling involves one or several
mechanisms that interfere with the normal
flow of oxygen into the brain.
• Strangulation - is a compression of the
neck that leads to unconsciousness or
death by causing an increasingly hypoxic
state in the brain. Fatal strangling typically
occurs in cases of violence, accidents, and
as the mechanism of suicide.
• Ligature strangulation — Strangulation
without suspension using some form of
cord-like object .
• Manual strangulation — Strangulation
using the fingers or other extremity
Aims of Care

• Restore adequate breathing

• To arrange urgent transport in the hospital

Recognition

• A constricting article around the neck.

• Marks around the casualty neck.

• Cyanosis or impaired consciousness.

• Prominent veins on the face.

Special Precautions

• Observe proper transport

• Do not destroy materials used in

constricting the neck, police may need it
as evidence.
D. Drowning

• Drowning is death as caused by

suffocation when a liquid causes
interruption of the body's absorption of
oxygen from the air leading to asphyxia.
The primary cause of death is hypoxia and
acidosis leading to cardiac arrest .
Cont…….

• Near drowning is the survival of a

drowning event involving unconsciousness
or water inhalation and can lead to serious
secondary complications, including death,
after the event
Aims of Care

• To restore adequate breathing

• To keep casualty warm
• To arrange urgent transport in the
hospital.
Risks factors
In no particular order:

• Lack of supervision of young children (less

than 5 years old).
• Water conditions exceed the swimmer's
ability - turbulent or fast water, water out
of depth, falling through ice,
• Entrapment - physically unable to get out
of the situation because of a lack of an
escape route, snagging or by being
hampered by clothing or equipment.
Cont….
• Impaired judgment and physical
incapacitation arising from the use of
drugs, principally alcohol.
• Incapacitation arising from acute illness
while swimming - heart attack, seizure or
stroke.
• Forcible submersion by another person -
murder or misguided children's play.
• Drowning following a car crash or
submersion.
Incidence
• Victims are more likely to be male, young or
adolescent. Surveys indicate that 10% of
children under 5 have experienced a situation
with a high risk of drowning. The causes of
drowning cases as follows:
• 44% are related to swimming
• 17% are related to boating
• 14% are un attributed
• 10% related to scuba diving
• 7% related to car accidents
Prevention

• Learn to swim
• Keep a watch out for others.
• Swim in areas where adequate supervision
is present ie a trained and certified
Lifeguard.
• Ensure that boats are reliable, properly
loaded and that functional emergency
equipment is onboard.
Cont….
• Wear a properly fitting lifejacket while
enjoying water sports such as sailing,
surfing.
• Pay attention to the weather, tides and
water conditions.
• Keep children under a watchful eye .
• Do not dive into an unknown depth and or
bottom contour area.
Cont…

• Avoid swimming alone

• Avoid swimming at night
• Avoid swimming under the influence of
drugs and or alcohol .
• Be aware of your personal limits
Drowning Rescue

• Do not endanger yourself during this

process.
• Throw a rope.
• Use a long stick.
• The focus of the first aid for a near-
drowning victim in the water is to get
oxygen into the lungs without aggravating
any suspected neck injury.
E. Inhalation of Fumes
• Smoke inhalation is the primary cause of
death in victims of indoor fires.
• Smoke inhalation injury refers to injury due to
inhalation or exposure to hot gaseous products
of combustion. This can cause serious
respiratory complications
• This refers to the inhalation of smoke or gases
such as carbon monoxide.
• The casualty is most likely to have low levels of
oxygen in his body tissues.
Smoke Inhalation

• A person who is confined in a space

during fire is assumed to have inhaled
smoke.
• A smoke from burning plastics, foams and
synthetic wall covering is likely to contain
poisonous fumes.
Inhalation of Carbon Monoxide

• Carbon Monoxide is a poisonous gas that

is produced by burning. It acts directly on
the red blood cells preventing them from
carrying oxygen to the body tissues.
• Carbon Monoxide has no taste or smell.
Signs and Symptoms

Coughing
Vomiting
Nausea,
Sleepiness
Confusion
Difficulty Breathing
Treatment

• Treatment consists of humidified

oxygen, bronchodilators, suction,
endotracheal tube and chest
physiotherapy.
• Other measures include adequate fluids
and control of infection by daily sputum
stains and appropriate antibiotics.
F. Penetrating Chest Wound

• Depending on its size, a penetrating

chest wound may cause varying
degrees of damage to bones, soft
tissue, blood vessels, and nerves.
• The risk of death and disease from a chest
wound depends on the size and severity of
the wound. Gunshot wounds are usually
more serious than stab wounds because
they cause more severe lacerations and
rapid blood loss.
• With prompt, aggressive treatment,
up to 90% of patients with
penetrating chest wounds recover.
Causes

• Stab wounds from a knife or an ice

pick and gunshot wounds are the
most common penetrating chest
wounds. Explosions or firearms fired
at close range are the usual source of
large wounds.
Aims of Care

• To seal the wound and maintain breathig

• To minimize shock
• Arrange immediate transport to the
hospital
Diagnostic tests

• X-rays
• Physical Assessment
Treatment
• In a penetrating chest wound, treatment
involves maintaining a patent airway and
providing ventilatory support as needed.
Chest tube insertion allows the
reestablishment of intrathoracic pressure
and drainage of blood from a hemothorax.
• The patient's wound needs surgical repair.
The patient also may need analgesics and
antibiotics.
• Tetanus prophylaxis, and infusion of blood
products and I.V. fluids.
G. Hyperventilation

• Hyperventilation (or overbreathing) is the

state of breathing faster and/or deeper
than necessary, thereby reducing the
carbon dioxide concentration of the blood
below normal.
Causes

• Stress or anxiety commonly are causes of

hyperventilation; this is known as
hyperventilation syndrome .
• Hyperventilation can also be brought
about voluntarily, by taking many deep
breaths.
• Hyperventilation can also occur as a
consequence of various lung diseases.
Signs and Symptoms

• Unnaturally fast deep breathing.

• Cramps in the hands.
• Dizziness
• Faintness
Management

• Ask casualty to regain control of her

breathing.
• Rebreath her own exhaled air in a paper
bag.
• Encourage to seek medical attention
H. Asthma
• Asthma is a chronic condition involving the
respiratory system in which the airways
occasionally constrict, become inflamed, and are
lined with excessive amounts of mucus, often in
response to one or more triggers.
• These episodes may be triggered by such things
as exposure to an environmental stimulant such
as an allergen, environmental tobacco smoke,
cold or warm air, perfume, pet dander, moist air,
exercise or exertion, or emotional stress
Signs and symptoms

• Wheezing
• Shortness of breath
• Chest tightness
• Coughing
• Inability for physical exertion
• Tachycardia
• Use of accessory muscles
Causes

• Hereditary
• Poor air quality
• Environmental tobacco smoke
• Viral respiratory infections
• Antibiotic use
• Psychological stress
Management

• Identify allergens
• Remove source of stress
• Bronchodilators
• Nebulization
• Steroids
• Antibiotics
• Rest
11. WOUNDS and BLEEDINGS
A. Hemorrhage
• Bleeding, technically known as hemorrhage is
the loss of blood from the circulatory system.
• Bleeding can occur internally, where blood leaks
from blood vessels inside the body or externally,
either through a natural opening such as the
vagina, mouth or anus, or through a break in
the skin.
• Loss of 10-15% of total blood volume can be
endured with clinical problem in a healthy
person.
 Causes

• Hemophilia
• low platelet count (thrombocytopenia)
• Anticoagulant medications, such as
warfarin
• Trauma and Injuries
Four Classes of Hemorrhage

 Class I Hemorrhage involves up

to 15% of blood volume. There is
typically no change in vital signs
and fluid resuscitation is not
usually necessary.
• Class II Hemorrhage involves 15-30%
of total blood volume. A patient is often
tachycardic (rapid heart beat) with a
narrowing of the difference between the
systolic and diastolic blood pressures.
• The body attempts to compensate with
peripheral vasoconstriction. Skin may start
to look pale and be cool to the touch. The
patient might start acting differently.
Volume resuscitation with crystaloids (
Saline solution or
Lactated Ringer's solution) is all that
is typically required. Blood transfusion
is not typically required.
• Class III Hemorrhage involves loss of 30-
40% of circulating blood volume. The
patient's blood pressure drops, the heart
rate increases, peripheral perfusion, such
as capillary refill worsens, and the mental
status worsens. Fluid resuscitation with
crystaloid and blood transfusion are
usually necessary.
 Class IV Hemorrhage involves loss of
>40% of circulating blood volume.
The limit of the body's compensation
is reached and aggressive
resuscitation is required to prevent
death.
B. Wounds

• Wound is a type of injury in which in the

skin is torn, cut or punctured (an open
wound), or where blunt force trauma
causes a contusion (a closed wound). In
pathology, it specifically refers to a sharp
injury which damages the dermis of the
skin.
Types of Wounds

a. Incisions or incised wounds, caused

by a clean, sharp-edged object such as a
knife, a razor or a glass splinter.
b. Lacerations, irregular wounds caused
by a blunt impact to soft tissue that lies
over hard tissue (e.g. laceration of the
skin covering the skull) or tearing of skin
and other tissues such as caused by
childbirth.
c. Abrasions (grazes), superficial wounds
in which the topmost layer of the skin (the
epidermis) is scraped off. Abrasions are
often caused by a sliding fall onto a rough
surface.
d.Puncture wounds, caused by an object
puncturing the skin, such as a nail or
needle .
f. Gunshot wounds, caused by a bullet or
similar projectile driving into or through
the body. There may be two wounds, one
at the site of entry and one at the site of
exit .
g. Contusions, more commonly known as
bruises, caused by blunt force trauma that
damages tissue under the skin.
h. Hematomas, also called blood tumors,
caused by damage to a blood vessel that
in turn causes blood to collect under the
skin.
i. Crushing Injuries , caused by a great or
extreme amount of force applied over a
long period of time.
Management

• Wound Care
• Antibiotics
• Pain Reliever
• Tetanus Toxoid and HTIG
• Control Bleeding
The pattern of injury, evaluation and
treatment will vary with the mechanism of
the injury
C. Infected Wounds

Diabetes is a known factor in the host

response, especially if the patient’s blood
sugar is not well controlled.
Signs and Symptoms

• A wound becomes red,hot,swollen and

painful.
• It has Pus
• Lymph nodes becomes swollen and
tender.

Danger of tetanus is very great to people

who have not been vaccinated.
Management

• Proper Wound Care

• Use of Antibiotics
• Pain Relievers
• Health Teachings
D. Nosebleeding

• Nose bleeding occurs frequently in

patients with a deviated septum.
Septal perforations, or holes in the
septum, frequently bleed. Foreign
bodies placed in the nose by children
or disturbed people may result in
bleeding.
Causes

• Direct trauma to the nose, accidental

or self-inflicted is probably the most
common cause of nose bleeds.
• Extreme Heat
• High Blood Pressure
Aims of Care

• Control Blood Loss

• Maintain an Open Airway
Management

• Ask the casualty to sit down and tilt her

head move forward.
• Ask the casualty to breath through her
mouth.
• See for any foreign object on the nose
• Advise not to spit, cough or exert effort
• Advise to rest.
E. Varicose Veins

• Varicose veins are veins that have become

enlarged and twisted.
Aims of Care

• To bring blood loss under control.

• To minimize shock.
• To arrange immediate transfer to Hospital
Management

• Put on Gloves
• Raise and Support the injured leg as high
as possible
• Apply firm and direct pressure.
• Remove garments such as stockings and
garters.
111. Orthopedic Emergencies
A. Bone Fractures

• A bone fracture (sometimes abbreviated

as Fx) is a medical condition in which a
bone is cracked or broken. It is a break in
the continuity of the bone
• Although fractures are commonly referred
to as bone breaks, the word break is not
part of formal orthopedic terminology.
Categories of Fracture

• Closed fractures are those in which the

skin is intact, while open (compound)
fractures involve wounds that
communicate with the fracture and may
expose bone to contamination.
• Open Fractures the broken bone end
pierce the skin surface. This carries high
risk for infection.
Type of Fractures
 Compacted Fracture- A fracture
caused when bone fragments are
driven into each other.
 Comminuted Fracture- A fracture
which results in several fragments.
 Spiral Fracture- A fracture where at
least one part of the bone has been
twisted.
 Compression Fracture- A fracture
that usually occurs in the vertebrae.
 Oblique Fracture- A fracture that is
diagonal to a bone's long axis.
 Transverse Fracture- A fracture that
is at a right angle to the bone's long
axis.
 Linear Fracture- A fracture that is
parallel to the bone's long axis.
 Incomplete Fracture- A fracture in
which the bone fragments are still
partially joined.

 Complete Fracture- A fracture in

which bone fragments separate
completely.
Diagnosis

• X-ray
• Physical Assessment
Management
• Immobilization
• Splinting
• Pain Relief
• Antibiotic
• I and D ( Irrigation and Drainage)
• Realignment
• Surgery
B. Joint dislocation

• Joint dislocation (Latin: luxatio) occurs

when bones in a joint become displaced or
misaligned. It is often caused by a sudden
impact to the joint. The ligaments always
become damaged as a result of a
dislocation .
Common Sites

• Shoulders

• Fingers

• Knees
Treatment

• Anyone experiencing a joint should seek

medical assistance as soon as possible. A
dislocated joint can only be successfully
'reduced' into its normal position by a
trained medical professional. Trying to
reduce a joint without any training could
result in making the injury substantially
worse.
• X-rays are usually taken to confirm a
diagnosis and detect any fractures
which may also have occurred at the
time of dislocation.
• Once a diagnosis is confirmed, the
joint is usually manipulated back into
position. This can be a very painful
process, therefore this is typically
done under local or in an Operating
Room under a General Anaesthetic.
Management
• After a dislocation, injured joints are
usually held in place through a splint (for
straight joints like fingers and toes) or a
bandage (for complex joints like
shoulders). Additional to this, the joint
muscles, tendons and ligaments must also
be strengthened. This is usually done
through a course of Physiotherapy, which
will also help reduce the chances of
repeated dislocations of the same joint.
C. Sprain and Strain

• A sprain is a stretch and/or tear of a

ligament, the fibrous band of
connective tissue that joins the end
of one bone with another. Ligaments
stabilize and support the body's
joints. For example, ligaments in the
knee connect the upper leg with the
lower leg, enabling people to walk
and run.
• A strain is an injury of a muscle
and/or tendon. Tendons are fibrous
cords of tissue that attach muscles to
bone.
 What causes sprains and
strains?

• A sprain is caused by direct or indirect

trauma (a fall, a blow to the body, etc.)
that knocks a joint out of position, and
overstretches, and, in severe cases,
ruptures the supporting ligaments .
• Chronic strains are the result of
overuse (prolonged, repetitive
movement) of muscles and tendons.
Inadequate rest breaks during
intensive training precipitates a
strain. Acute strains are caused by a
direct blow to the body,
overstretching, or excessive muscle
contraction.
Who gets sprains and strains?

• Professional and amateur athletes

and the general public, as well, can
sustain this injury. People at risk for
the injury have a history of sprains
and strains, are overweight, and are
in poor physical condition.
 What are the signs of a sprain?

• While the intensity varies, pain, bruising,

swelling, and inflammation are common to all
three categories of sprains: mild, moderate,
severe. The individual will usually feel a tear
or pop in the joint. A severe sprain produces
excruciating pain at the moment of injury, as
ligaments tear completely, or separate from
the bone.
What are the signs of a strain?

• Typical indications include pain, muscle

spasm, muscle weakness, swelling,
inflammation, and cramping. In severe
strains, the muscle and/or tendon is
partially or completely ruptured, often
incapacitating the individual.
 How are sprains and strains
treated?
• Rest

• Ice

• Compression

• Elevation
• Rest: Stop all activities which cause pain
to avoid the strain becoming more serious.
• Ice: Helps reduce swelling. Never ice for
more than 10-15 minutes at a time. Use a
layer of fabric or paper in between the ice
and the injury to avoid burning the skin.
• Compression: Wrap the strained area to
reduce swelling.
• Elevation: Keep the strained area as
close to the level of the heart as is
conveniently possible to keep blood from
pooling in the injured area
Prevention Tips

• No one is immune to sprains and

strains
• Participate in a conditioning program to
build muscle strength.
• Do stretching exercises daily.
• Always wear properly fitting shoes .
• Nourish your muscles by eating a well-
balanced diet.
• Warm up before any sports activity,
including practice
• Use or wear protective equipment
appropriate for that sport .
D. Spinal Cord Injury

• Spinal cord injury causes myelopathy

or damage to white matter or
myelinated fiber tracts that carry
sensation and motor signals to and
from the brain.
• Trauma such as
automobile accidents, falls, gunshots
, diving accidents, war injuries, etc.
Cervical injuries
• C4 : May have some use of biceps and
shoulders, but weaker
• C5 : May retain the use of shoulders and
biceps, but not of the wrists or hands.
• C6 : Generally retain some wrist control,
but no hand function.
• C7 and T1 : Can usually straighten their
arms but still may have dexterity problems
with the hand and fingers. C7 is generally
the level for functional independence.
Thoracic Injuries

 T1 to T8 : Most often have control of

the hands, but lack control of the
abdominal muscles so control of the
trunk is difficult or impossible.
Effects are less severe the lower the
injury.
• T9 to T12 : Allows good trunk and
abdominal muscle control, and sitting
balance is very good .

• The effect of injuries to the lumbar or

sacral region of the spinal canal are
decreased control of the legs and hips,
urinary system, and anus.
Management

• Mobilize Patient as one unit

• Provide a C-Collar
• ABC
• Resuscitate if necessary
• Arrange urgent transfer to the hospital
E. Ribcage Injury
• There are 12 ribs on each side of the chest that
protect the heart, lungs, and the upper
abdominal contents. All of the ribs are attached
to the vertebrae (backbone) in the rear. In the
front, 10 of them are attached to the sternum
(breastbone) by pieces of cartilage. Direct blows
to the ribs may bruise or break the ribs or injure
to the rib cartilage. The ribs may tear away from
the cartilage that attaches them to the
breastbone. This tearing away from the cartilage
is called a costochondral separation.
 How does it occur?

• Rib injuries usually result from a direct

blow to the chest wall. Breaks usually
occur in the curved portion of the outer
part of the rib cage. A costochondral
separation may occur when you land hard
on your feet or even when you cough or
sneeze violently.
What are the symptoms?

• A rib injury causes pain and tenderness

over the place of injury. You may have
pain when you breathe, move, laugh, or
cough.
How is it diagnosed?

• Your doctor will review your symptoms,

examine your rib cage, and listen to your
lungs. Your doctor may order a chest x-
ray to look for any rib damage, lung
damage, or bleeding around the lungs.
Treatment

• Rest
• Putting an ice pack over the injured rib for
20 to 30 minutes every 3 to 4 hours for 2
to 3 days, or until the pain goes away.
• Taking an anti-inflammatory or other pain
medication
When can I return to my usual
activities?
• If you broke a rib it may take 4 to 6 weeks to
heal. Your doctor may take an x-ray to see that
the bone has healed before he or she allows you
to return to your activity, especially if it is a
contact sport. You may participate in non-
contact activities sooner if you can do so without
pain in your ribs and without pain when you
breathe. If you have bruised your ribs or
separated the cartilage from the ribs, you may
return to your activity when you can do so
without pain.
How can I prevent Ribcage Injury?

• Ribs are often injured in accidents that are

not preventable. However, in contact
sports such as football it is important to
wear appropriate protective equipment
1V. Nervous System Emergencies
a. Concussion

• Concussion, from the Latin concutere ("to shake

violently").
• The terms mild brain injury, mild traumatic
brain injury (MTBI), mild head injury
(MHI), and minor head trauma and
concussion may be used interchangeably.
• concussion can cause a variety of physical,
cognitive, and emotional symptoms
Causes
• The leading causes of MTBI in adults are
falls and vehicle accidents.
• sports injuries
• assaults,
• industrial and work-related injuries,
• and injuries that occur in the home and
school.
• Among children aged 5 to 14, sports and
bicycle accidents cause the greatest
number of concussions.
• The relative contribution of causes of mild head
injury differs by region, gender, and age. For
example, in Scotland and Sweden, falls account
for the greatest percentage of MHIs, while in the
U.S. and Australia, transportation is the largest
cause.
• Soldiers are at elevated risk for concussion from
causes such as bomb blasts, with as many as
15% of U.S. infantry soldiers who return from
the Iraq War meeting the criteria for MTBI.
 Mechanism
• Punches in boxing deliver more rotational
force to the head than impacts in sports such
as football, and boxing carries a higher risk
of concussion than football.
• The brain is surrounded by
cerebrospinal fluid, one of the functions of
which is to protect it from light trauma, but
more severe impacts or the forces associated
with rapid acceleration and deceleration may
not be absorbed by this cushion
• Concussion may be caused by impact
forces, in which the head strikes or is
struck by something, or impulsive forces,
in which the head moves without itself
being subject to blunt trauma (for
example, when the chest hits something
and the head snaps forward).
Signs and Symptoms
• Headache and difficulty concentrating
• dizziness,
• vomiting,
• nausea,
• lack of motor coordination,
• difficulty balancing,.
• light sensitivity seeing bright lights,
• blurred vision
• double vision.
• Tinnitus, or a ringing in the ears, is also
commonly reported
• Convulsions
Diagnosis
• Diagnosis of MTBI is based on physical
and neurological exams, duration of
unconsciousness (usually less than
30 minutes) and post-traumatic amnesia
(PTA; usually less than 24 hours), and the
Glasgow Coma Scale (MTBI sufferers have
scores of 13 to 15 )
• CT Scan
b. Contusion
• Cerebral contusion, Latin contusio cerebri, a
form of traumatic brain injury, is a bruise of the
brain tissue. Like bruises in other tissues,
cerebral contusion can be caused by multiple
microhemorrhages, small blood vessel leaks into
brain tissue.
• Treatment aims to prevent dangerous rises in
intracranial pressure, the pressure within the
skull. Contusions are likely to heal on their own
without medical intervention
Signs and Symptoms

• Contusion can present with weakness, lack

of motor coordination, numbness, aphasia,
and memory and cognitive problems.[3]
Signs depend on the contusion's location
in the brain.
Causes

• The interior of the skull has sharp

ridges by which a moving brain can
be injured.
• Often caused by a blow to the head.
Treatment
• Since cerebral swelling presents a danger to the
patient, treatment of cerebral contusion aims to
prevent swelling. Measures to avoid swelling
include prevention of hypotension (low blood
pressure).
• Due to the danger of increased intracranial
pressure, surgery may be necessary to reduce it.
People with cerebral contusion may require
intensive care and close monitoring.
c. Skull Fracture
• A skull fracture is a break in one or more of the
bones in the skull caused by a head injury.
Isolated skull fractures are not very serious
injuries, but the presence of a skull fracture may
indicate that significant enough impact occurred
to cause brain trauma, which is quite serious.
• Broken fragments of skull can lacerate or
bruise the brain or damage blood vessels. If the
fracture occurs over a major blood vessel,
significant bleeding can occur within the skull, so
head injury patients with skull fracture have
many more intracranial hematomas .
Types of Skull Fracture

• Linear skull fractures- the most

common type of skull fracture, occur in
69% of patients with severe head injury.
• Usually caused by widely distributed
forces, linear fractures often occur when
the impact causes the area of the skull
that was struck to bend inward, making
the area around it buckle outward.
• Diastatic fractures are linear fractures
that cause the bones of the skull to
separate at the skull sutures in young
children whose skull bones have not yet
fused.
• Comminuted skull fractures- those in
which a bone is shattered into many
pieces, can result in bits of bone being
driven into the brain, lacerating
it.Depressed skull fractures, a very serious
type of trauma occurring in 11% of severe
head injuries, are comminuted fractures in
which broken bones are displaced inward.
This type of fracture carries a high risk of
increasing pressure on the brain, crushing
the delicate tissue.
• Basilar skull fractures-breaks in bones at
the base of the skull, require more force
to cause than cranial vault fractures. Thus
they are rare, occurring as the only
fracture in only 4% of severe head injury
patients.[2][5] Basilar fractures have
characteristic signs: blood in the sinuses;
a clear fluid called cerebrospinal fluid
(CSF) leaking from the nose or ears;
raccoon eyes (bruising of the orbits of the
eyes that result from blood collecting
there as it leaks from the fracture site);
and Battle's sign (caused when blood
collects behind the ears and causes
bruising).
D. Stroke
• Stroke is the rapidly developing loss of
brain functions due to a disturbance in the
blood vessels supplying blood to the brain.
This can be due to ischemia (lack of blood
supply) caused by thrombosis or embolism
, or due to a hemorrhage.
• In the past, stroke was referred to
as cerebrovascular accident or CVA,
but the term "stroke" is now
preferred.
• Stroke is a medical emergency and can cause
permanent neurological damage, complications
and death if not promptly diagnosed and
treated.
Risk factors
• Advanced age
• Hypertension (high blood pressure),
• Previous stroke or
transient ischemic attack (TIA)
• Diabetes
• High cholesterol
• Cigarette smoking
• Atrial fibrillation, the contraceptive pill,
• migraine with aura, and thrombophilia (a
tendency to thrombosis).
• High blood pressure is the most important
modifiable risk factor of stroke.
Classification
• Ischemic Stroke-blood supply to part of
the brain is decreased, leading to
dysfunction and necrosis of the brain
tissue in that area. There are four reasons
why this might happen: thrombosis
(obstruction of a blood vessel by a
blood clot forming locally), embolism
(idem due to a embolus from elsewhere in
the body, see below), systemic
hypoperfusion (general decrease in blood
supply, e.g. in shock) and
venous thrombosis. Stroke without an
obvious explanation is termed
"cryptogenic" (of unknown origin).
Thrombotic stroke -In thrombotic stroke, a
thrombus (blood clot) usually forms around
atherosclerotic plaques.
Embolic stroke refers to the blockage of an
artery by an embolus, a traveling particle or
debris in the arterial bloodstream originating
from elsewhere. An embolus is most
frequently a thrombus, but it can also be a
number of other substances including fat (e.g.
from bone marrow in a broken bone), air,
cancer cells or clumps of bacteria (usually
from infectious endocarditis .
Diagnosis

• CT scans (most often without contrast

enhancements) or MRI scans,
Doppler ultrasound, and arteriography.
• For detecting chronic hemorrhages, MRI
scan is more sensitive
• A systematic review found that acute
facial paresis, arm drift, or abnormal
speech are the best findings.
Prevention

• Given the disease burden of stroke,

prevention is an important public health
concern.
• The most important modifiable risk
factors for stroke are high blood pressure
and atrial fibrillation
• Other modifiable risk factors include high blood
cholesterol levels, diabetes, cigarette smoking
(active and passive), heavy alcohol consumption
and drug use,lack of physical activity, obesity
and unhealthy diet .
• Hypertension accounts for 35-50% of stroke
risk.
• High cholesterol levels have been consistently
associated with (ischemic) stroke.
• Patients with diabetes mellitus are 2 to 3 times
more likely to develop stroke .
Treatment

• Mechanical Thrombectomy
• Good nursing care is fundamental in maintaining
skin care, feeding, hydration, positioning, and
monitoring vital signs such as temperature,
pulse, and blood pressure. This is also to
prevent pneumonia or Bedsores.
• An ischemic stroke is due to a thrombus (blood
clot) occluding a cerebral artery, a patient is
given antiplatelet medication (aspirin,
clopidogrel, dipyridamole), or anticoagulant
medication (warfarin), dependent on the cause,
when this type of stroke has been found.
Prognosis

• Disability affects 75% of stroke survivors

enough to decrease their employability.
E. Seizure
• A seizure, also known as a convulsion or
fit, is a sudden loss of consciousness, a
change in one's state of consciousness, or
loss of control over one's body.
Seizure Types

– Epileptic Seizure
• Absence seizure
• Atonic seizure
• Focal seizures
• Simple partial seizure
• Jacksonian seizure
• Tonic-clonic seizure
– Non-epileptic seizure
• Febrile seizure
• Post-traumatic seizure
• Psychogenic non-epileptic seizures
Causes
• Seizures are caused by abnormal electrical
discharges in the brain. Symptoms may vary
depending on the part of the brain that is involved,
but seizures often cause unusual sensations,
uncontrollable muscle spasms, and loss of
consciousness.
• Some seizures may be the result of a medical
problem. Low blood sugar, infection, a head injury,
accidental poisoning, or drug overdose can cause a
seizure. A seizure may also be due to a brain tumor
or other health problem affecting the brain. In
addition, anything that results in a sudden lack of
oxygen to the brain can cause a seizure. In some
cases, the cause of the seizure is never discovered.
Management

• ABC
• Safety
• Arrange for immediate transfer to hospital