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EMERGENCY AND DISASTER NURSING

BY: Darran Earl Gowing, BSN, RN
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TERMS USE:
 Trauma
- Intentional or unintentional

wounds/injuries on the human body from particular mechanical mechanism that exceeds the body’s ability to protect itself from injury

Emergency Management
- traditionally refers to care given to

patients with urgent and critical needs.
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DaRRaN

 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

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Restoration of normal rhythm to the heart in ventricular or atrial fibrillation  Disaster . ACLS .Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary.  Defibrillation .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. emergency interventions are required to save and preserve human lives and/or the environment DaRRaN 4 .

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 DaRRaN 5 .Mass Casualty Incident .

supports and attends to families. supervises allied health personnel. and experience. DaRRaN 6 .  The emergency nurse establishes priorities.SCOPE AND PRACTICE OF EMERGENCY NURSING  The emergency nurse has had specialized education. and teaches patients and families within a time-limited. training. high-pressured care environment. monitors and continuously assesses acutely ill and injured patients.

hands-on skills required to care for patients in an emergency situation. Appropriate nursing and medical interventions are anticipated based on assessment data. in consultation with or under the direction of a licensed physician. The emergency health care staff members work as a team in performing the highly technical.Nursing interventions are accomplished interdependently. DaRRaN 7 .

Patients in the ED have a wide variety of actual or potential problems. and their condition may change constantly. the focus is on the most lifethreatening ones DaRRaN 8 . Although a patient may have several diagnosis at a given time.

 Issues include legal issues. technology-driven environment in which serious illness and death are confronted on a daily basis. and the challenge of providing holistic care in the context of a fast-paced.ISSUES IN EMERGENCY NURSING CARE  Emergency nursing is demanding because of the diversity of conditions and situations which are unique in the ER. DaRRaN 9 . occupational health and safety risks for ED staff.

Actual Consent .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.Parental Consent DaRRaN 10 . Legal Issues Includes: .Implied Consent .

DaRRaN 11 .Gives legal protection to the rescuer who act in good faith and are not guilty of gross negligence or willful misconduct. “Good Samaritan Law” .

Focus of Emergency Care  Preserve or Prolong Life  Alleviate Suffering  Do No Further Harm  Restore to Optimal Function DaRRaN 12 .

Respect Victim’s Modesty & Privacy  Don’ts .Obtain Consent .let the patient see his own injury .Golden Rules of Emergency Care  Do’s .Make any unrealistic promises DaRRaN 13 .Think of the Worst .

Guidelines in Giving Emergency Care  A – Ask for help  I – Intervene  D – Do no Further Harm DaRRaN 14 .

Anxiety and Denial  encouraged to recognize and talk about their feelings.  honest answers given  prolonged denial is not encouraged or supported 2. Grief  help family members work through their grief  letting them know that it is normal and acceptable DaRRaN 15 .  asking questions is encouraged. Remorse and Guilt  verbalize their feelings  way of handling anxiety and fear  allow the anger to be ventilated 3. Anger 4.Stages of Crisis 1.

Core Competencies in Emergency Nursing  Assessment  Priority Setting/Critical Thinking Skills  Knowledge of Emergency Care  Technical Skills  Communication DaRRaN 16 .

DaRRaN 17 .

DaRRaN 18 .

DaRRaN 19 .

DaRRaN 20 .

DaRRaN 21 .

DaRRaN 22 .

DaRRaN 23 .

DaRRaN 24 .

DaRRaN 25 .

DaRRaN 26 .

Circulation 27 DaRRaN .Assess and Intervene Check for ABCs of life A – Airway B – Breathing C .

Team Members  Rescuer  Emergency Medical Technician  Paramedics  Emergency Medicine Physicians  Incident Commander Support Staff  Inpatient Unit Staff 28 DaRRaN .

Survey the Scene     Is the Scene Safe? What Happened? Are there any bystanders who can help? Identify as a trained first aider! DaRRaN 29 .Emergency Action Principle I.

II.GCS ≤ 8 = Prepare Intubation DaRRaN 30 . Do a Primary Survey - organization of approach so that immediate threats to life are rapidly identified and effectively manage.Establish Patent Airway .Airway/Cervical Spine .Maintain Alignment . Primary Survey A .

DaRRaN 31 .

B – Breathing .Prepare for chest decompression C – Circulation .Monitor VS .Assess Breath Sounds .Maintain Vascular Access .Observe for Chest Wall Trauma .Direct Pressure DaRRaN 32 .

Estimated Blood Pressure SITE Radial SBP ≥ 80 Femoral Carotid ≥ 70 ≥ 60 DaRRaN 33 .

Control of Hemorrhage DaRRaN 34 .

D – Disability .Maintain Privacy .Use AVPU mnemonics E – Exposure .Re-evaluate clients LOC .Remove clothing .Prevent Hypothermia DaRRaN 35 .Evaluate LOC .

Activate Medical Assistance  - - Information to be Relayed: What Happened? Number of Persons Injured Extent of Injury and First Aid given Telephone number from where you’re calling DaRRaN 36 .III.

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 .IV.

V. Triage

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

DaRRaN

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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

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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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Non-urgent – patients have episodic illness than can be addressed within 24 hours without increased morbidity  Upper extremity fractures.3. DaRRaN 41 . small lacerations without significant bleeding. minor burns. behavioral disorders or psychological disturbances. sprains.

DaRRaN 42 .

Immediate:  Injuries are life-threatening but survivable with minimal intervention. DaRRaN 43 . Individuals in this group can progress rapidly to expectant if treatment is delayed.Field TRIAGE 1.

Minimal:  Injuries are minor and treatment can be delayed hours to days.2. DaRRaN 44 . Individuals in this group receive treatment only after immediate casualties are treated. Individuals in this group should be moved away from the main triage area. but can wait hours without threat to life or limb. Delayed:  Injuries are significant and require medical care. 3.

4. 5. Fast-Track:  Psychological support needed DaRRaN 45 . Expectant:  Injuries are extensive and chances of survival are unlikely even with definitive care.

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 .

Respiratory Arrest a condition when the respiration or breathing pattern of an individual stops to function. drowning and suffocation. strangulation. while the pulse and circulation may continue. DaRRaN 50 . Causes: Choking.Artificial Respiration a way of breathing air to person’s lungs when breathing ceased or stopped function. Electrocution.

Methods: mouth to mouth mouth to nose mouth to stoma mouth to mouth and nose mouth to barrier device DaRRaN 51 .

Assess for Breathing DaRRaN 52 . 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 Response Shout and gently pinch 3. Safe Approach Infant(0-1yr) Child(1-8 yrs) Adult Gently shouting “are you ok?” then shake the victim Approach and assess situation 2. Positioning 4.Procedure 1.

DaRRaN 53 .

DaRRaN 54 .

place arm nearest at right angles.  Bring far arm across the casualty’s chest and hold back of the casualty’s hand against the nearest cheek  With your other hand grasp the far thigh just above the knee. Place in recovery position  Before moving casualty remove any objects safely from her pockets  Kneel beside casualty. and then bend elbow keeping the palm uppermost. then pull the casualty towards you and on to his or her side The Casualty is Breathing: DaRRaN 55 .

5 – 2 seconds .pinch nose and ventilate via mouth .Place mouth over the nose and mouth of the infant .The Casualty is NOT Breathing: 6. Give Rescue Breaths DaRRaN 56 .look for chest rising 2 rescue breaths -seal lips around the mouth and blow steadily for 1. Go for Help .if someone responds to your shout for help send that person to phone for ambulance . 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 .if you’re on your own.look for chest rising .look for chest rising 7.

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 .

MI DaRRaN 58 .Cardiopulmonary Resuscitation (CPR) Cardiac Arrest  a condition when the persons breathing and circulation/pulse stop at the same time Causes: Cardiovascular Disease. Heart Attack.

BP and consciousness DaRRaN 59 .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.

Procedure 1. Positioning of 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 DaRRaN 60 . Assess circulation for 10 seconds Infant ( 0-1 year) Check brachial pulse < 60 bpm or below or absent Child (1-8 yrs) Adult Check carotid pulse and if no pulse Commence chest compression 2.

3.5 – 2 inches 5 cycles per minute DaRRaN 61 . Rate and Depth of compression Number of Cycle/ minute 100/min 1/3 or 1. AR:ECC 1 breath: 5 compression 2 breaths: 30 compression 4.

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 .

buy time for the arrival of defibrillator DaRRaN 65 .CHAIN OF SURVIVAL EARLY ACCESS – early recognition of cardiac arrest. prompt activation of emergency services EARLY BLS – prevent brain damage.

7-10% decrease per minute without defibrillation EARLY ACLS – technique that attempts to stabilize patient DaRRaN 66 .EARLY DEFIBRILLATION .

DaRRaN 67 .

TRAUMA DaRRaN 68 .

as well as globally with elevations in ICP and potentially dramatic changes in blood flow within the brain. at the point of injury. sports DaRRaN 69 .Head trauma   Result of an external force applied to the head and brain causing disruption of physiologic stability locally. Trauma to the skull resulting in mild to extensive damage to the brain. acts of violence.  Causes: vehicular accidents. fall.

Contrecoup – decelerative forces throwing the brain back and forth Fractures – e. depressed.g. Open     Scalp lacerations Fractures in the skull Interruption of the dura mater Concussions – a jarring of the brain within the skull with temporary loss of consciousness Contusions – a bruising type of injury to the brain. Closed    3. Hemorrhage causes hematoma or clot formation DaRRaN 70 . may occur with subdural or extradural collections of blood.Types of Head Injuries 1. linear. compound comminuted 2.

Subdural hematoma .bleeding directly into the brain matter DaRRaN 71 .Types of Hemorrhage/Hematoma:  the most serious type of hematoma.a surgical emergency 3. epidural hematoma forms rapidly and results from arterial bleeding  forms between the dura and the skull from a tear int the meningeal area 2.forms slowly and results from a venous bleed . Intracerebral hemorrhage . 1.

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 DaRRaN 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? DaRRaN 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. 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 DaRRaN 74 .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.

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 DaRRaN 75 .

hemorrhage or obstruction of the 76 normal flow of CSF DaRRaN .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.

out tooth . 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.DENTAL TRAUMA 1. Knocked.Place a sterile gauze pad or cotton ball into the tooth socket to prevent further bleeding DaRRaN 77 .

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 . apply direct pressure to the bleeding area  If swelling is present. 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.3. apply cold compress 5.

go immediately to the dentist 7. 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. Possible fractured jaw  Immobilize the jaw by any means  Apply cold compress to prevent swelling DaRRaN 79 . cheek or tongue.6. Instead. Orthodontic Problems  If a wire is causing irritation.

CHEST TRAUMA Approximately a quarter of deaths due to trauma are attributed to thoracic injury. 80 DaRRaN . cardiac tamponade or aspiration. Early deaths due to thoracic trauma include airway obstruction. Immediate deaths are essentially due to major disruption of the heart or of great vessels.

DaRRaN 81 .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.

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.Types of Chest Trauma A.Tenderness .Muscle spasm .Reluctance to move .Subcutaneous Crepitus .Client splints chest DaRRaN 82 .Severe Pain .Shallow Respirations .Commonly a result of crushing chest injuries Assessment: .

Ice Compress then Local Heat 3. Rest 2.Management: 1. Analgesia 4. Splint the chest during coughing or deep breathing 83 DaRRaN .

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

Coughing & deep breathing 5. Analgesia 4. High Fowler’s position 2. Prepare for intubation with mechanical ventilation with positive end-expiratory pressure ( PEEP ) for severe respiratory failure DaRRaN 85 . Humidified O2 3.Management: 1.

Pneumothorax .Accumulation of atmospheric air in the pleural space  may lead to lung collapse  Types:  1. Spontaneous Pneumothorax  2. Tension Pneumothorax DaRRaN 86 . Open Pneumothorax  3.B. Penetrating Chest Trauma  .occurs when a foreign object penetrates the chest wall 1.

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 .

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

Pulmonary Embolism .Other risk factors: deep vein thrombosis. immobilization. advanced age.Dislodgement of thrombus to the pulmonary artery . pregnancy. obesity. surgery.Caused by thrombus & pulmonary emboli . CHF. prior History of thromboembolism DaRRaN 90 .

Tachypnea & tachycardia .Distended neck veins .Dyspnea .Chest pain .Shallow respirations .Assessment: .Blood-tinged sputum .Cyanosis DaRRaN 91 .Rales on auscultation .Cough .Hypotension .

vein ligation. Prepare the client for embolectomy. IV heparin (bolus) 8. O2 as Rx 2. High Fowler’s 3. or insertion of an umbrella filter as Rx DaRRaN 92 . Pulse oximetry 6.Management: 1. Prepare for intubation & mechanical ventilation 7. Maintain bed rest 4. Warfarin (Coumadin) 9. Monitor PT & PTT closely 10. Incentive spirometry as Rx 5.

Penetrating Abdominal Trauma Causes:  .Hypovolemic .Stab wound  .Embedded object from explosion Assessment:  .ABDOMINAL TRAUMA A. Peritoneal Lavage DaRRaN 93 .Pain and tenderness Management:  1.Orthostatic hypotension .Gunshot wound  .Absence of bowel sound shock  . Maintain hemodynamic status – IVF & blood transfusion  2.EXLAP  3. Surgery.

Monitor VS and oxygen supplements 3. Assess signs and symptoms of shock DaRRaN 94 . Blunt Abdominal Trauma Assessment: .B. Maintain hemodynamic status 2.Signs of hypovolemic shock Management: 1.Left upper quadrant pain (Spleen) .Right upper quadrant pain (liver) .

FOREIGN BODY AND AIRWAY OBSTRUCTION DaRRaN 95 .

the tongue resulting to difficulty of breathing or respiratory arrest DaRRaN 96 . or a foreign body position of head.CAUSES: improper chewing of large pieces of food aspiraton of vomitus.

food. toy etc 97 DaRRaN .Types of obstruction  anatomical tongue epiglottis – and  mechanical – coins.

Assessment and clinical manifestations:  Mild airway obstruction  can talk. cyanosis. breath and cough with high pitch breath sound  cough mechanism not effective to dislodge foreign body  Severe airway obstruction  can’t talk. excessive salivation DaRRaN 98 . breath or cough  Nasal flaring.

Use chest thrusts for the obese or for the advanced pregnancy victims. relieve the obstruction by heimlick maneuver Heimlich maneuver: stand behind the victim place arms around the victim’s waist make a fist place the thumb side of the fist just above the umbilicus and well below the xyphoid process. encourage the victim to cough.  continue abdominal thrusts until the object is dislodged or the victim becomes unconscious. a crowing sound is audible. DaRRaN 99 .Intervention: CONCIOUS PATIENT:          ask the victim. Perform 5 quick in and up thrusts. “are you choking?” if the victim’s airway is obstructed partially.

then finger sweep the mouth reattempt ventilation repeat the sequence of jaw thrust. breaths and Heimlich maneuver until successful be sure to assess the victim’s pulse and respirations perform CPR if required DaRRaN 100 . finger sweep. reattempt ventilation relieve the obstruction by the Heimlich maneuver with five thrust.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.

 allow the victim to continue to cough if the cough is forceful  if cough is ineffective or if increase respiratory difficulty is still noted. gagging.Choking child or infant:  choking is suspected in infants and children experiencing acute respiratory distress associated with coughing. or stridor. perform CPR DaRRaN 101 .

Foreign objects in the ear  Don’t 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  Don’t 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 Don’t 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 .

inhaled or otherwise absorbed by the body. DaRRaN 106 .Poison Any substance that impairs health or destroys life when ingested.

Is depressed and suddenly becomes ill 3. liquid or powder in his or her clothing. Someone suddenly becomes ill for no apparent reason and begins to act unusually 2. or has stains. Is found near a toxic substance and is breathing any unusual fumes.Suspect poisoning if: 1. skin or lips DaRRaN 107 .

From canned foods Note: Save the Vomitus  Staphylococcus Aureus – from unrefrigerated cram filled foods.Ingestion Poisoning  Botulism – Clostridium botulinum. insecticides and cleaning fluids Note: Never induce vomiting! May result in Chemical Pneumonia DaRRaN 108 . fuel. fish Note: Save the Vomitus  Petroleum Poisoning – includes poisoning with a substance such as kerosene.

may cause further injury Activated Charcoal. Milk of Magnesia DaRRaN 109 . painful burning sensation and pain and redness in the mouth Note: Never induce vomiting.Acetaminophen Poisoning – most common drug accidentally ingested by children Antidote: Acetylcysteine Corrosive Chemical Poisoning – strong detergents and dry cleaners results in drooling of saliva.

talking and breathing Dry sore throat Muscle incoordination Nausea and vomiting DaRRaN 110 . electrolytes)  ECG (since many toxic agents affect cardiac rhythm) Assessment:       Headache Double vision Difficulty in swallowing. BUN.Diagnostics:  Baseline ABG should be obtained periodically  Baseline blood samples (CBC.

protect him from injury  If victim vomits. clear the airway  Calm and reassure the victim while calling for medical help DaRRaN 111 . Begin rescue breathing if necessary  If ABCs are present but the victim is unconscious. place him in recovery position  If victim starts having seizures.Management:  Check victim’s ABCs.

Never induce vomiting if substance ingested is corrosive LAVAGE 112 DaRRaN .P – Prevention. Child Proofing O – Oral fluids in large amount I .Ipecac S – Support respiration and circulation O .Oral Activated Charcoal N .

odorless & tasteless gas Assessment: .Headache & dizziness .appears intoxicated .Inhalation Poisoning  Carbon Monoxide Poisoning  Carbon monoxide is a colorless.Muscle weakness .Pink or cherry red skin (not a reliable sign) .Confusion which may eventually lead to coma DaRRaN 113 .

Remove victim from exposure 3. Initiate CPR if required DaRRaN 114 .Management: 1. Check ABCs 2. Administer O2 (100% delivery) 5. Loosen tight clothing 4.

SPECIAL WOUNDS DaRRaN 115 .

Assist with wound exploration 3. Tetanus toxoid and vaccine to stimulate antibody production DaRRaN 116 .Human Bites – staphylococcus and streptococcus infection Management: 1. Cleanse and irrigate the wound 2. Culture the wound site 4.

Animal bite – dog and cat bite Management: 1. Wash wound with soap and water 2. Rabies Vaccine and immunoglobulin DaRRaN 117 . Tetanus toxoid and vaccine to stimulate antibodies 3.

shock and pulmonary edema DaRRaN 118 .Snake Bite – Infection can be neurotoxic or hemotoxic Assessment:  Edema  Ecchymosis  Petechiae  Fever  Nausea and Vomiting  Possible hypotension  Muscle fasciculation  Hemorrhage.

Management: 1. Cleanse the wound 6. Establish ABCs 2. Anti venom therapy DaRRaN 119 . Immobilize bitten arm or extremity 3. Don’t attempt to remove the venom 8. Cover wound with light sterile dressing 7. Provide warmth 5. Remove constricting items 4.

Insect Bites/ Bee stings
Assessment:  Itching, dyspnea  Chest tightness, dizziness, urticaria  Nausea, vomiting,diarrhea  Abdominal cramps, flushing  Laryngeal edema  Respiratory arrest
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Management: 1. Remove stinger by scraping

2. Cleanse the site 3. If anaphylaxis occurs, give oxygen and medications

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TRAUMA RELATED TO ENVIRONMENTAL EXPOSURE
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HEAT EXHAUSTION
Assessment:  Nausea and vomiting  increased temperature  Muscle cramps  Tachypnea and Tachycardia  Orthostatic hypotension  Malaise  Irritability and anxiety
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Management:  Check ABCs  Move to cool area  Give salted water for vomiting periods  Relieve cramps by firm pressure  ECG and ABG monitoring DaRRaN 124 .

cold extremities  White or mottled blue extremity  Extremity insensitive to touch DaRRaN 125 .FROSTBITE Assessment:  Hard.

elevate extremity to prevent swelling  Apply sterile gauze or cotton in between digits to prevent maceration DaRRaN 126 .Management:  Remove constrictive clothing and jewelry  Prevent ambulation if lower extremity is involved  Institute rewarming measures  Once rewarmed.

NEAR DROWNING DaRRaN 127 .

Rowing Assist 4.Four Methods of Water Rescue: 1. Reaching Assist 2. Wading Assist DaRRaN 128 . Throwing Assist 3.

Assessment:        Abdominal distention Confusion Irritability Lethargy Shallow gasping respirations Unconsciousness vomiting  Absent breathing 129 DaRRaN .

Management:  Assess ABCs  Give CPR and AR as necessary  Check patient’s temperature  Administer rewarming measures as necessary  Monitor lab results(electrolytes) and ECG DaRRaN 130 .

chemical or radiation DaRRaN 131 .BURN TRAUMA Is the damage caused to skin and deeper body structures by heat (flames. scald. contact with heat) . electrical.

neck and chest are associated with pulmonary complications. Depth DaRRaN 132 . burns on the ear are associated with auricular chondritis. hands and joints require intensive therapy. respiratory. the perineal area is prone to autocontamination by urine and feces. Patient’s medical condition – debilitating disorders such as cardiac.  mortality rate is higher when the client has a pre-existing disorder at the time of the burn injury 3. 4. location –       burns on the head.FACTORS DETERMINING SEVERITY OF BURN: 1. endocrine and renal disorders negatively influence the client’s response to injury and treatment. age – mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of age 2. circumferential burns of the extremities can produce a tourniquetlike effect and lead to vascular compromise (compartment syndrome). burns on the face are associated with corneal abrasion.

charred. difficult to distinguish from 3rd degree except hair growth becomes apparent in 7-10 days. bullae very painful Heals in 2-3 weeks. bonde Requires excision. bone may be visible Requires excision and grafting. little or no pain Slow to heal 94-8 weeks) surgical incision and grafting unless has complication 3rd degree Full thickness Epidermis. heals in 3-7 days 2nd degree partial thickness Pediermis and part of the dermis Red. grafting and sometimes amputation DaRRaN 133 . leathery. tendon. no skin appendages -Dry.14 days for graft to revascularize 4th degree deep full thickness Skin. Depth Classification Affected Part Description of Wound What to Expect 1st degree superficial Epidermis Pin. dermis and subcutaneous tissue . may be red or black -May have thrombosed veins -Marked edema -Distal circulation may be decreased -Painless Dry. in no complication 2nd degree deep partial thickness Only the skin appendages in the hair follicle remain Waxy white. wet blisters.4. painful “sunburn” Blisters form after 24 hours Discomfort last after 48 hrs. 10. muscle.

Size: Rule of nine Child < 3 years old 18% 9% 18% 18% Adult Assessment Head and neck 1 arm Posterior trunk Anterior trunk 9% 9% 18% 18% 1 leg Perineum 14% 1% 18% 1% DaRRaN 134 .5.

alternating current is more dangerous than direct current for it is associated with cardiopulmonary arrest. Temperature  determines the extent of injury 7. DaRRaN 135 .  Radiation Burns – are caused by exposure to ultraviolet light. steam or hot objects  Chemical Burns – caused by tissue contact with strong acids. hot liquids. ventricular fibrillation. x-rays or a radioactive source.6. and long bone and vertebral fractures. Exposure to the Source  Thermal Burns – caused by exposure to flames. titanic muscle contractions. alkalis or organic compounds  Electrical Burns – result in internal tissue damaging.

there could be burns to the airway  there is a risk of swelling or air passage. dry cloth to prevent contamination  Do not break blisters or apply lotions.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. and Roll)  Prevent victim from running  If water is available. remove clothing immediately as clothing soaked with hot liquid retains heat Flame  Smother the flames with a coat or blanket. avoid pulling clothing across the burnt face  Cover the burn area with a loose. ointments. creams or powder Airway  if face or front of the trunk is burnt. get the victim on the floor or ground (stop. remove clothing. drop. clean. leading to difficulty in breathing DaRRaN 136 . immediately cool the burn area with water  If water is not available.

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. or replaced by other gases. Smoke inhalation      Urgent treatment is required with care of the airway. perform rescue breathing or CPR DaRRaN 137 . check the ABCs if necessary. breathing and circulation When 02 in the air is used up by fire.

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 DaRRaN 138 . Chemical  Flood affected area with water for 20-30 min  Remove contaminated clothing  If possible.