EMERGENCY AND DISASTER NURSING Mass Casualty Incident - situation in which the number of INCIDENT COMMANDER - The head

of the incident
casualties exceeds the number of resources. command system
TERMS USE:
Post Traumatic Stress Syndrome - characteristic of  He must be continuously informed of all the
Trauma - Intentional or unintentional wounds/injuries on symptoms after a psychologically stressful event was out activities and informed about any deviation from
the human body from particular mechanical mechanism
of range of an normal human experience. the established plan
that exceeds the body’s ability to protect itself from injury
EMERGENCY – IT IS WHATEVER THE PATIENT OR THE
Emergency Management - traditionally refers to care
FAMILY CONSIDERS IT TO BE. SCOPE AND PRACTICE OF EMERGENCY NURSING
given to patients with urgent and critical needs.  The emergency nurse has had specialized
EMERGENCY NURSING - It is the nursing care given to
Triage - process of assessing patients to determine education, training, and experience.
patients with urgent and critical needs
management priorities.  The emergency nurse establishes priorities,
EMERGENCY NURSE - has a specialized education, training, monitors and continuously assesses acutely ill and
First Aid - an immediate or emergency treatment given to and experience to gain expertise in assessing and
a person who has been injured before complete medical injured patients, supports and attends to families,
identifying patients’ health care problems in crisis supervises allied health personnel, and teaches
and surgical treatment can be secured. situations patients and families within a time-limited, high-
BLS - level of medical care which is used for patient with  establishes priorities, monitors and continuously pressured care environment.
illness or injury until full medical care can be given. assesses acutely ill and injured patients, supports
 Nursing interventions are accomplished
ACLS ADVANCE CARDIAC LIFE SUPPORT- Set of clinical and attends to families, supervises allied health interdependently, in consultation with or under
interventions for the urgent treatment of cardiac arrest personnel, and teaches patients and families the direction of a licensed physician.
and often life threatening medical emergencies as well as within a time-limited, high-pressured care
the knowledge and skills to deploy those interventions. environment  Appropriate nursing and medical interventions are
anticipated based on assessment data.
Defibrillation - Restoration of normal rhythm to the heart DISASTER NURSING - a branch of emergency nursing, it
in ventricular or atrial fibrillation refers to nursing care given to patients who are victims of  The emergency health care staff members work as
disasters, whether it is manmade or natural phenomena. a team in performing the highly technical, hands-
Disaster - Any catastrophic situation in which the normal on skills required to care for patients in an
patterns of life (or ecosystems) have been disrupted and emergency situation.
INCIDENT COMMAND SYSTEM - It is a management tool
extraordinary, emergency interventions are required to
for organizing personnel, facilities, equipment, and
save and preserve human lives and/or the environment.
communication for any emergency situation.

Respect Victim’s Modesty & Privacy  Priority Setting/Critical Thinking Skills basis. Obtain Consent Core Competencies in Emergency Nursing paced. let the patient see his own injury  Technical Skills knowledge base to encompass recognizing and . Grief  Issues include legal issues. technology-driven environment in which . Guidelines in Giving Emergency Care Assess and Intervene  A – Ask for help Check for ABCs of life  Legal Issues Includes:  I – Intervene  A – Airway  D – Do no Further Harm  B – Breathing  Actual Consent  C .  Although a patient may have several diagnosis at a negligence or willful misconduct.  asking questions is encouraged. Make any unrealistic promises  Communication treating patients and anticipate nursing care in the event of a mass casualty incident.  honest answers given threatening ones Focus of Emergency Care  prolonged denial is not encouraged or supported  Preserve or Prolong Life 2. Anxiety and Denial change constantly. Patients in the ED have a wide variety of actual or  “Good Samaritan Law” Stages of Crisis potential problems.  Gives legal protection to the rescuer who  encouraged to recognize and talk about their act in good faith and are not guilty of gross feelings. given time.  Don’ts  Knowledge of Emergency Care  The emergency nurse must expand his or her . occupational health and Golden Rules of Emergency Care  help family members work through their grief safety risks for ED staff. Think of the Worst  Assessment serious illness and death are confronted on a daily . and the challenge of  Do’s  letting them know that it is normal and acceptable providing holistic care in the context of a fast- .Circulation  Implied Consent Team Members  Parental Consent  Rescuer  Emergency Medical Technician .  allow the anger to be ventilated 4. and their condition may 1. Anger diversity of conditions and situations which are  Restore to Optimal Function  way of handling anxiety and fear unique in the ER. the focus is on the most life. Remorse and Guilt ISSUES IN EMERGENCY NURSING CARE  Alleviate Suffering  verbalize their feelings  Emergency nursing is demanding because of the  Do No Further Harm 3.

Maintain Alignment P – Previous/Present Illness .Re-evaluate clients LOC  Emergency Medicine Physicians .Assess Breath Sounds  Check Vital Signs .Remove clothing  Inpatient Unit Staff .Prepare for chest decompression C – Circulation . Activate Medical Assistance  Is the Scene Safe? Femoral ≥ 70  Information to be Relayed:  What Happened?  What Happened?  Are there any bystanders who can help?  Number of Persons Injured  identify as a trained first aider!  Extent of Injury and First Aid given  Telephone number from where you’re calling II.GCS ≤ 8 = Prepare Intubation L – Last Meal Taken B – Breathing E – Events Prior to Accident .Monitor VS V. Do a Primary Survey .Use AVPU mnemonics SITE SBP  Incident Commander E – Exposure  Support Staff Radial ≥ 80 . Survey the Scene III.  Paramedics Estimated Blood Pressure .Direct Pressure .Airway/Cervical Spine A – Allergies .organization of approach so that immediate threats to life are rapidly identified and Carotid ≥ 60 IV.Evaluate LOC . Triage .Maintain Vascular Access D – Disability . Do Secondary Survey effectively manage.Observe for Chest Wall Trauma .  Interview the Patient Primary Survey S – Symptoms A .Prevent Hypothermia Emergency Action Principle I.Establish Patent Airway Control of Hemorrhage M – Medication .Maintain Privacy .

sprains. Fast-Track: sort small lacerations without significant bleeding. minimal intervention. stable abdominal wounds without progress rapidly to expectant if treatment is BASIC LIFE SUPPORT . consists of recognizing respiratory or cardiac arrest or both 2. Emergent . Non-urgent – patients have episodic illness than moved away from the main triage area. Individuals in this group can eye injuries. Delayed: the proper application of CPR to maintain life until a victim 3. 5. hours to days.  a way of breathing air to person’s lungs when after immediate casualties are treated. FIRST AID Categories: Role of First Aid 1. sucking chest wound. fractures delayed. Individuals in this group should be 3. Immediate:  Safety Awareness  Injuries are life-threatening but survivable with  Maxillofacial wounds without airway compromise. Expectant: increased morbidity  Injuries are extensive and chances of survival are Respiratory Arrest unlikely even with definitive care. conditions are life TRIAGE PRIORITY COLOR  Bridge the Gap Between the Victim and the CATEGORY threatening and need immediate attention Physician IMMEDIATE 1 RED  Immediately start giving interventions in pre-  Airway obstruction.  Injuries are significant and require medical care. sprains. minor burns. breathing ceased or stopped function. Must be seen Field TRIAGE  Preparation for Disaster within 1 hour 1. can be addressed within 24 hours without 4. meaning to  Upper extremity fractures. minor burns. small lacerations without significant bleeding. DELAYED 2 YELLOW hospital setting unstable chest and abdominal wounds. can be addressed within 24 hours without but can wait hours without threat to life or limb. 3. Non-urgent – patients have episodic illness than recovers or advance life support is available.  Psychological support needed  process of assessing patients to determine behavioral disorders or psychological management priorities disturbances.  comes from the French word ”trier”. Urgent – have serious health problems but not  Health for Others immediately life threatening ones. Artificial Respiration increased morbidity Individuals in this group receive treatment only  Upper extremity fractures. Minimal: behavioral disorders or psychological  Injuries are minor and treatment can be delayed disturbances.an emergency procedure that evidence of significant hemorrhage.highest priority. . open MINIMAL 3 GREEN Value of First Aid Training fractures of long bones EXPECTANT 4 BLACK  Self-help 2. shock.

Electrocution. MOUTH-TO-STOMA = used if the pt. (Trismus. Depth Approximately 1 Approximately Approximately help send that person to phone for ½ to 2 inches 1 to 1 ½ inches ½ to 1 inch 2. has a stoma. 1 finger from below the The Casualty is NOT Breathing: substernal imaginary 1. MOUTH-TO-NOSE = recommended when it is How to Heel of 1 hand.5 – 2 seconds  (1.5 . MOUTH-TO-MOUTH = a quick. leave the mouth. Child Open the  Check for foreign bodies then remove pattern of an individual stops to function. Go for Help  if someone responds to your shout for provide O2 and ventilation to the victim. 2 fingers ambulance impossible to ventilate through the victim’s compress other hand on (middle & ring  if you’re on your own. fingertips) casualty and make the phone call for Compression 30:2 (1 or 2 30:2 (1 or 2 30:2 (1 or 2 yourself 3. is an -ventilation rescuers) rescuers) rescuers) * never leave if the patient has collapsed as a infant ratio result of trauma or drowning or if the casualty is Number of 5 cycles in 2 5 cycles in 2 5 cycles in 2 a child 4.5 sec/breath) ( 1 breath every 3 secs) Assess for Shout and gently pinch Gently Response shouting “are you ok?” then shake the victim Positioning Placed Supine on a firm and flat surface . drowning Compression Lower half of the Lower half of Lower half of Assess for  Bring cheek over the mouth and nose Area sternum but not the sternum the sternum and suffocation. nipple line. Heel of 1 hand.  a condition when the respiration or breathing Table of Cardiopulmonary Resuscitation for Adult. while & Infant Airway using finger sweep  Head-tilt-chin-lift maneuver the pulse and circulation may continue. hitting the xiphoid but not hitting but not hitting Breathing of the casualty process: measure the xiphoid the xiphoid  Look for chest movement up to 2 fingers process: process: 1  Listen for breath sounds from substernal measure up to finger width  Feel for breathing on your cheek WAYS TO VENTILATE THE LUNGS notch. a cycles per minutes minutes minutes Give Rescue 5 rescue breaths 2 rescue permanent opening that connects the trachea minute Breaths breaths directly to the front of the neck. MOUTH-TO-NOSE and MOUTH = if the pt. mouth injury) top. strangulation. Place mouth pinch nose seal lips around Procedure Infant(0-1yr) over the nose and the mouth and For Rescue Breathing Alone: Child(1-8 Adult and mouth of ventilate via blow steadily yrs)  Rate is 10-12 breaths in ADULT the infant mouth for 1. effective way to notch. Adult Child Infant  Jaw-thrust Maneuver Causes: Choking.2 sec/breath) ( 1 breath every 4 to 5 secs) Safe Approach and assess situation look for chest look for look for chest  Rate is 20 breaths for a CHILD and INFANT Approach rising chest rising rising  (1 – 1.

buy time for . place arm nearest at right angles.7-10% decrease per  when the patient has spontaneous breathing minute without defibrillation The Casualty is Breathing:  EARLY ACLS – technique that attempts to stabilize  when the first aider is too exhausted to continue  Place in recovery position patient  when another first aider takes over  Before moving casualty remove any objects safely  when EMS arrives and takes over from her pockets  Kneel beside casualty. The pt. prompt activation of emergency services birthweight less than 400 grams  EARLY BLS – prevent brain damage. has a valid DNR order COMPLICATIONS OF CPR: 2. and then bend elbow keeping the palm uppermost. has signs of irreversible death: rigor mortis. then pull the casualty towards S – SPONTANEOUS BREATH RESTORED you and on to his or her side T – TURNED OVER THE MEDICAL SERVICES O – OPERATOR IS EXHAUSTED TO CONTINUE CRITERIA FOR NOT STARTING CPR P – PHYSICIAN ASSUMES RESPONSIBILITY . HEMOTHORAX 4. decapitation  RIB FRACTURE 3.Confirmed gestation less than 23 weeks or arrest. Witholding attempts to resuscitate in the DR is appropriate for newly born infants with: CHAIN OF SURVIVAL  EARLY ACCESS – early recognition of cardiac . livor mortis.All patients in cardiac arrest receive resuscitation unless: 1.  With your other hand grasp the far thigh just When to STOP CPR: above the knee. algor mortis. The pt. No physiological benefit can be expected because  STERNUM FRACTURE the vital functions have deteriorated despite  LACERATION OF THE LIVER OR SPLEEN maximal therapy  PNEUMOTHORAX.Anencephaly the arrival of defibrillator When to Stop  EARLY DEFIBRILLATION .  Bring far arm across the casualty’s chest and hold back of the casualty’s hand against the nearest cheek .

Each C. and lifting the (patient may clutch the neck between the thumb and mandible.AIRWAY OBSTRUCTION For patient lying (unconscious): D. . E. apprehensive appearance. choking. with trauma to head and neck. MANAGEMENT FOR AIRWAY OBSTRUCTION pregnancy or in markedly obese clients and in allergic reaction causing laryngeal edema a. • Make a quick INWARD and UPWARD thrust. Conscious Patient standing or sitting • use of gauge 11 needle or scalpel blade HEIMLICH MANEUVER • Stand behind the client with arms under patient’s (Subdiaphragmatic Abdominal Thrusts) axilla to encircle patient’s chest Nursing Actions: • Place thumb side of fist on the MIDDLE of • Extend the neck. placing thumb side of the fist against of the cricoid cartilage the pt’s abdomen. kneel astride Indications: KINDS OF AIRWAY OBSTRUCTION: the patient’s thigh  To establish an airway for patients cannot be 1. Opening the pt’s  To facilitate removal of tracheobronchial mouth by grasping both tongue and lower jaw secretions Clinical Manifestations: UNIVERSAL DISTRESS SIGNAL between the thumb and fingers. stridor.  To bypass upper airway obstruction TYPES OF AIRWAY OBSTRUCTION • Make a quick UPWARD thrust  To permit connection to ambubag or mechanical 1. Place towel roll beneath the For Standing or sitting conscious patient: STERNUM. ENDOTRACHEAL INTUBATION • position patient at the back (supine). • Insert index finger of other hand to scrape across • a puncture or incision of the cricothyroid restlessness. OROPAHRYNGEAL AIRWAY thrust is separated. Anatomic Airway Obstruction • Place HEEL of one HAND against the pt’s adequately ventilated with an oropharyngeal 2. in the midline SLIGHTLY ABOVE MEASURES TO ESTABLISH AIRWAY • Listen for air passing back and forth the UMBILICUS and WELL BELOW the XIPHOID A. and PROCESS B. JAW-THRUST MANEUVER tape it. CYANOSIS and LOSS of CONSCIOUSNESS the back of the throat membrane to establish an emergency airway in develop as hypoxia worsens. grasp with the other hand and perform shoulders • Stand behind the patient. CHEST THRUST: used only in patients in advanced stages of • indicated to pts. place the second hand directly on the airway top of the fist. • Insert the needle at a 10 to 30 degree caudal the patient’s waist direction in the midline jest above the upper part • Make a FIST. Partial Airway Obstruction with Poor Air Exchange FINGER SWEEP: used only in unconscious adult client  To prevent aspiration 3. • Use a hooking action certain emergency situations where endotracheal intubation or tracheostomy is not possible. CRICOTHYROIDOTOMY fingers). wrap your arms around BACKWARD thrust until foreign body is expelled. Mechanical Airway Obstruction abdomen. HEAD-TILT-CHIN-LIFT MANEUVER • Direct the needle downward and posteriorly. Partial Airway Obstruction with Good Air Exchange ventilator 2. Complete Airway Obstruction • Make a TONGUE-JAW LIFT.

shows cause BLINDNESS  Change in LOC – most sensitive indicator in the evidence of neurologic deterioration IF TEMPORAL Fx: may cause unilateral deafness or pt’s condition facial paralysis . SPINE. CONCUSSION – temporary loss of consciousness indicating a possible BASAL SKULL FRACTURE • COMMINUTED Fx – splinters or crushes the bone that results in transient interruption if the brain’s  Rhinorrhea or otorrhea – indicative of CSF leak in several fragments normal functioning  Periorbital Ecchymosis – indicates anterior basilar • DEPRESSED Fx – pushes the bone toward the 4. agitation and irritability. don’t apply deep tendon reflexes. until proven otherwise. loose dressing. w/o 2. causing cerebral vasoconstriction and • S/Sx: scalp wounds. Mannitol IF SPHENOIDAL Fx: damages the optic nerve and may SECONDARY ASSESSMENT:  Prepare of immediate surgery if pt. INJURIES TO HEAD. abnormal  Apply a bulky. AND FACE  CUSHING’S TRIAD ( bradypnea. a. severe b. SKULL FRACTURES widened pulse pressure) – indicating increased • SIMPLE – closed A. skull’s thinness and elasticity allows a orally if needed depression w/o a break in the bone  forms between the dura and the skull  Administer high flow oxygen: most common from a tear int the meningeal area death is CEREBRAL ANOXIA CAUSES: Traumatic blows to the head. loss bleed minimizing cerebral edema of consciousness. HEAD INJURIES intracranial pressure • COMPOUND – open 1. labored breathing. impaired vision • LINEAR Fx – common hairline break. suction • In children. displacement of structure 3. INTRACRANIAL HEMORRHAGE – significant • CRANIAL VAULT Fx – top of the head bleeding into a space or potential space between ALERT: If basilar skull fracture or severe midface fractures are • BASILAR Fx – base of the skull and frontal sinuses the skull and the brain suspected. bradycardia. forms MANAGEMENT: considered a neurosurgical condition rapidly and results from arterial bleeding  Open airway by Jaw-Thrust Manuever. Intracerebral hemorrhage  IV line of PNSS or Plain LR IF CONSCIOUS: complains of persistent localized  bleeding directly into the brain matter  prepare to manage seizures headache  maintain normothermia IF JAGGED BONE FRAGMENTS: may cause cerebral ALERT: Assume cervical spine fracture for any patient  Medications: bleeding with a significant head injury. it is  the most serious type of hematoma. OPEN HEAD INJURY – skull is fractured  unequal or unresponsive pupils. B. altered pupillary and moor  a surgical emergency pressure response c. CLOSED HEAD INJURY – skull is intact  Battle’s sign – bluish discoloration of the mastoid. Steroids ring PRIMARY ASSESSMENT: Assess for ABC c. Diazepam HALO SIGN – blood-tinged spot surrounded by lighter b. Subdural hematoma  In general. hyperventilate the patient to 20-25 beatings  forms slowly and results from a venous bpm. CONTUSSSION – bruising of the brain tissue fracture brain 5. VA. Epidural hematoma • Damage to the brain is the first concern. a nasogastric tube(NGT) is CONTRAINDICATED! ALERT: a.

RESS PRIMARY INTERVENTIONS: C. may go home with instruction sheet  Nasotracheal intubation beneath the skin For VAULT and BASILAR FRACTURES:  initaite IV access. arm or leg  suction pt. can be NURSING CONSIDERATIONS: PRIMARY ASSESSMENT: penetrating or perforating  maintain patent airway. admit for level of injury tissue evaluation MANAGEMENT: B. hypothermia .TREATMENT: SUBSEQUENT ASSESSMENT: INJURIES TO SOFT TISSUES. apply ice to areas of than the bone can absorb breathing) swelling . SURGERY  Maintain a supine position with bed elevated to below the orbit – indicates ZYGOMA (cheekbone) A. INJURIES TO BONES AND JOINTS PRIMARY ASSESSMENT:  Nasopharyngeal airway should only be used if no 1.OAK. CONTUSION – bleeding beneath the skin into the soft  If conscious: observed for 4 hours. don’t let him blow it! • Paralysis if the upward gaze – indicative of D.LEVATION don’t pack it! • Crepitus on nose – indicates nasal fracture P. CLOSED WOUND  cleaning and debridement of wounds • Total sensory loss and motor paralysis below the A. BONES AND JOINTS For LINEAR FRACTURES: • Hypotension. AMPUTATION – traumatic cutting or tearing off of a  support with O2 administration • ABC – (tongue swelling.IRECT PRESSURE  OTORRHEA – cover it lightly with sterile gauze.RRIGATE  don’t give narcotics or sedative • Malocclussion of teeth. CERVICAL SPINE INJURIES  Insertion of oral airway or intubation B. if not. ANTIBIOTICS 30 degrees FX I. bradycardia. FRACTURE – a break in he continuity of the bone. monitor blood gas 2. MAXILLOFACIAL TRAUMA C. OPEN WOUND  Craniotomy to remove fragemnts  indwelling urinary catheterization A. maintaining sterile technique MAXILLA FX D. SCRUB. loose dressing. trismus – indicative of  assist in surgery. SOFT TISSUE INJURIES  supporative (mild analgesics) suggests SPINAL SHOCK 1. A. toe. ABRASION – superficial loss of skin from rubbing or  anti-biotics  prepare to manage seizures scraping  Dexamethasone  Meds: High dose steroids and diazepam B. through mouth not nose if CSF leak is missed teeth) present SUBSEQUENT ASSESSMENT: PRIMARY MANAGEMENT  RHINORRHEA – wipe it. HEMATOMA – well-defined pocket of blood and fluid  if VS stable. broken or finger. • immediate immobilization of the spine evidence of nasal fracture or rhinorrhea occurs when stress is placed on a bone is greater • A B C ( Intercoastal paralysis w/ diapragmatic  Apply bulky. PUNCTURE – penetration of a pointed object. LACERATION – tear in the skin. AVULSION – tearing off or loss of a flap of skin contraindicated to basilar fx assessment E.NTI-TETANUS. SOAP. can be insicional or  Osmotic Diuretics (MANNITOL) if increased ICP is jagged present D. nasal airway • Immobilization of spine while performing D.RESSURE POINTS  Position head on side • Flattening of the cheek and loss of sensation S. INFERIOR ORBIT FX E. bleeding.

refers to the restoration of the elevate limb above the level of the cast • discoloration. usually caused by a wrench or twist  Avoid resting cast on hard surfaces or sharp edges resulting in a decrease joint stability EMERGENCY Management: IMMOBILIZE.occurs when the REHABILITATION surfaces of the bones forming the joint no longer in Clinical Manifestations:  Regaining normal function of the affected part anatomic position • Pain with isometric contractions • Swelling and tenderness  use of cast and splint to immobilize extremity and ALERT: this is a medical emergency because of associated • Hemorrhage in muscle maintain reduction disruption of surrounding blood and nerve supplies  Skin Traction – force applied to the skin using * Subluxation – partial disruption of the articulating foam rubber. Secure reduction of produce life threatening injuries. pelvis and femur may  Endoprosthetic Replacement – implantation of Management: Immobilize part. and limited use or movement fracture fragments into anatomic position and  Notify the physician alignment  Bivalve the cast 4.  Elevate to prevent or limit swelling  Assess neurovascular status before and after  Apply ice packs or cold compress. STRAIN – a microscopic tearing of the muscle cause by IMMOBILIZATION excessive force. SPRAIN – an injury to the ligamentous structure of extremity holding a wet cast surrounding a joint. pins.and limb-threatening emergencies due to NURSING CONSIDERATIONS: Nursing Considerations: potential blood loss. reduction. INITIATE IV  Do neurovascular checks hourly for the first 24 hours Clinical Manifestations: MANAGEMENT PROCESS OF FRACTURES  Assess for COMPARTMENT SYNDROME – check • Rapid swelling due to extravasation of blood w/n for 6 P’s tissues REDUCTION  If Compartment syndrome is suspected. or overuse  maintains reduction until bone healing occurs 2. use the palm of your hands in 3. tongs placed in • Pain and deformity the bone • Loss of normal movement  ORIF – operative intervention to achieve • X-ray confirmation of dislocation w/o assoc. TRAUMATIC JOINT DISLOCATION . using wires. do not • Pain on passive movement of joint  setting the bone. alignment and stabilization fracture .ALERT: fractured cervical spine. splints) • swelling and edema  Give pain medications as ordered • Deformity. stretching. not place reduction of dislocation Clinical Manifestations: directly in skin  Administer pain medications (NSAIDs) • Pain and tenderness over fracture site  Splint and maintain in good alignment. tapes surfaces  Skeletal Traction – force applied to the bony Clinical Manifestations: skeleton directly. shortening of an extremity or rotation  Assist in casting. posterior dislocations of metal device dislocations manually (usually preferred under anesthesia) the hip are life. immobilize  Ensure proper use of immobilization device • Crepitus or grating over fracture site the joint above and below the fracture (elastic bandage.

1 hr on.Inadequate tissue perfusion.MANAGEMENT OF SPRAINS AND STRAINS . pump failure of the heart shock) T WAVE: Ventricular Repolarization b. ABG. Blood volume o Assess capillary perfusion c. SEPTIC SHOCK – from bacteria and their products  Continue to monitor VS. decrease edema. and Anti- discomfort  Administer O2 to augment O2-carrying capacity of biotics  Apply warm compress after 24 hrs to promote arterial blood circulation and absorption (20 to 30 minutes at a  Start cardiac monitoring ELECTROCARDIOGRAM time)  Control hemorrhage . R WAVE: first positive deflection .It is a useful tool in the diagnosis of those  Educate to rest injured part for a month to allow conditions that may cause abberations in the healing SUBSEQUENT ASSESSMENT: electrical activity  Educate to resume activities gradually and to o Assess LOC. after R wave one or more of the ff: o Assess urinary output (25ml/hr may indicate QRS COMPLEX: Ventricular Depolarization a. ECG. Lactate. fluid shifts) acidosis) REST B. tension pneumothrorax. first positive deflection SHOCK AND INTERNAL INJURIES pressure. and reduce  Resuscitate as necessary  Medications: Inotropics. burns. CARDIOGENIC – occurs when the heart fails as a  Fluid resuscitation (2 large-bore IV lines. decreasing LOC indicates progression warm up of shock WAVE INTERPRETATIONS: o Monitor arterial blood pressure (narrowing pulse P WAVE : Atrial Depolarization. HCT. BT) hours) Secondary causes includes mechanical restriction  Insertion of an indwelling catheter MEDICATIONS ( NSAIDs) of cardiac function or venous obstruction like in  Maintain patient in a supine position with legs ELEVATION Cardiac Tamponade. Vasopressor.and electrolytes. may be hyperventilated to control Hemorrhage.Can be classified as: MANAGEMENT: A. Primary causes includes MI. resulting in failure of weak and thready) S WAVE: negative deflection. dysrhythmias. fall in systolic pressure) Q WAVE: first negative deflection A. hyperthermia on septic shock . refer changes on the following NURSING CONSIDERATIONS: PRIMARY INTERVENTIONS:  Maintain normothermia (high fever will increase  Apply ice compress for the first 24 hrs to produce  Assess for ABC the cellular metabolism effects of shock vasoconstriction. UO. CVP. capacity of venous beds metabolism of cells o Assess for excessive thirst. SHOCK o Assess pulse quality and rate change (tachycardia.occurs when significant amount  Administer O2 via ET or nonrebreather face mask COMPRESSION (Elastic Bandage) of fluid is lost in the intravascular space (Ex. (if intubated. Ringer’s ICE (for the first 24 hrs. splints) circulating in the blood Hgb. VCO elevated C. HYPOVOLEMIC . SUPPORT (Use of crutches. 2 hrs off during waking pump. arterial resistance levels o Assess for metabolic acidosis due to anaerobic d.

prepare 1. coughing and splinting V3: Green. CARDIAC TAMPONADE  Thoracentesis SIGNS/SYMPTOMS:  rapid unchecked rise in intrapericardia pressure RIB FRACTURES: tenderness. BLUNT CHEST INJURIES abdominal viscera may herniate. respiratory acidosis • X-ray . blast injuries 4.Hemothorax: Dullness Aortic Rupture/Laceration chest movements . cyanosis and severe dyspnea. 5th ICS.Nursing Responsibilities during ECG COMPLICATIONS: • Thoracentesis – yeilds blood and serosanguinous  Check order for ECG. IV . Left MCL 2. pain that that impairs diastolic filling of the heart TREATMENT: worsens with deep breathing and movement. TENSION PNEUMOTHORAX fluid the machine at the bedside at ER  a condition in which air enters the chest but can’t • ECG  Provide Privacy be ejected during exhalation • Retrograde aortography – reveals aortic  Instruct patient to lie still and avoid movement  There is lung collapse and mediastinal shift laceration  Remove metal objects on the patients (jewelries) S/Sx: tracheal deviation. Blood Transfusion . extreme pain • Auscultation: . 4th ICS. Right foot results from ribs. administer O2 V6: Violet.FLAIL CHEST (loss of chest wall integrity) • Percussion:  Surgical Repair . usually Simple Rib Fractures Neutralizer: Black. Distress. lacerating lung tisssue or an  mild analgesics. shallow  results from blood or fluid accumulation in the Tension Pneumothorax and splinted respirations pericardial sac  insertion of spinal. 4th ICS. LMAL 3. apply heat V1: Red. DIAPHRAGMATIC RUPTURE Hemothorax  causes severe respi.Cardiac tamponade: muffled heart tones  O2. • Computed Tomography Lead 1: Red.aortic anastomosis . Left Arm 2.Tension Pnuemothorax: tymphany  immediate surgery . LACERATION or RUPTURE of AORTA  intercoastal nerve blocks V5: Black. agitation. 5th ICS. slight edema. 14G or 16G needle into the 2nd STERNAL FRACTURES: persistent chest pain ICS at MCL to release pressure MULTIPLE RIB FRACTURES: ASSESSMENT AND DIAGNOSIS:  Chest Tubes . • Echocardiography  Place Chest leads as labeled: absent breath sound on the affected side. Right Arm JVD Lead 2: Yellow.It is a trauma in the chest without an open wound both circulation and vital capacity of lungs  Thoracotomy . cyanosis . in cases of arrest. O2.synthetic grafts . rapid and shallow respirations .Tension Pnemothorax: PMI is deviated . BT. decreased lung inflation. Right Sternal Border intercoastal artery  incentive spirometry V2: Yellow. 5th ICS. HEMOTHORAX TREATMENT: Lead 3: Green. Left Foot  collection of blood in the pleural cavity. midway between V2 and V4 chest trauma Severe Rib Fractures V4: Brown. Left sternal border  It is the most common cause of shock following  deep breathing. compromising  administer IV fuids. bed rest. paradoxical . usually cause by VA. LAAL  immediately fatal  position for semi-fowlers. if untreated  Chest tube insertion at 5th-6th ICS anterior to MAL B. hypotension.

hypotension. by 2. most effective. SHOCK MANAGEMENT: cool fluid bladder irrigation • IF THERE IS AN IMPALED OBJECT IN THE  Move patient to a cool environment. LEAVE IT THERE AND STABILIZE THE clothing reaches 39 degrees Celcius OBJECT WITH BULKY DRESSINGS  Position the patient supine with the feet slightly  Oxygenate the pt. at start it maybe collapse integrity of urethra is ensured. and neurologic status . HEATSTROKE . tachycardia. moist progressing to dryness (Anhidrosis)  Assist with proper positioning  Meds: Tetanus Prophylaxis. don’t attempt to place back the • bizarre behavior or irritability.  in case of dislodgment. NURSING CONSIDEARTIONS: GENERAL INTERVENTIONS:  Monitor VS every 15 mins and cardiac rhythm  monitor VS. mechanical blockage or  Cover protruding abdominal viscera w/ sterile CLINICAL MANIFESTATIONS: lung has already expanded saline dressings. remove all  Discontinue active cooling when the temp. BLUNT ABDOMINAL INJURY – caused by vehicular of peripheral circulation due to volume and electrolyte spraying tepid water on skin while fans are used to accidents or falls depletion blow ASSESSMENT: temperature may be normal or slightly  Apply ice packs to necks. tachycardia. fails to decrease. breathing exersises look for entrance and exit wounds 2. for surgery if the condition persists. HEAT EXHAUSTION . catheter should not be placed until • skin may appear flushed and hot. syncope patient • INITITATE RESUSCITATION AS NEEDED DIAGNOSTICS: hemoconcentration.6 degrees Celcius. ABDOMINAL INJURIES (Exploratory Laparotomy) reduce patient’s temperature 1. groin. quiet in the stretcher. and scalp PRIMARY ASSESSMENT AND INTERVENTIONS: elevated. axillae. tachypnea.  if BUBBLING. cool fluid peritoneal dialysis. hypotension. hyponatremia or  If temp. via ET or nonrebreather mask elevated  Monitor VS. cover the opening with  Insert indwelling catheter. delirium and coma gauze at bedside  Cover open wounds with dry dressings • 40.It is the inadequacy or the collapse  EVAPORATIVE COOLING. PENETRATING ABDOMINAL INJURY – usually the result of gunshot wound or stab wounds. air leak is suspected  Insert NGT to decompress the abdomen  if FLUCTUATION STOPS. • Once diagnosis is confirmed. ECG may show dysrhythmias iced saline lavage. ECG.It is a combination of hyperpyrexia and  Chest tubes should have continuous  Apply compression to external bleeding wounds neurologic symptoms. initiate core cooling: • CONTROL BLEEDING AND PREPARE TO TREAT hypernatremia. may ENVIROMENTAL EMERGENCIES MANAGEMENT: cross the diaphragm and enters the chest 1. It caused by a shutdown or failure FLUCTUATIONS  double IV line and infuse Ringer’s Lactate of the heat-regulating mechanisms of the body. Antibiotics NURSING ALERT:  Bed Rest  Assist in peritoneal lavage • Elderly clients are high-risk to develop heat-stroke  Prepare pt. first hour post thoracentesis  Keep pt. it is imperative to C. encourage cough and  Cut the clothing. pale and  Soak sheets/towels in ice water and place on • ASSESS ABC moist skin. if pelvic fracture is tachypnea sterile/petroleum gauze to prevent rapid lung suspected. clamps and sterile protruding organs confusion. dizziness. any movement  Educate to avoid immediate reexposure to high and post CTT) may dislodge a clot temperatures  After CTT insertion. ABDOMEN. progressing to  have an extra bottle with PNSS. fatigue. (q 15. headache. count the number of wounds.

 Start IV infusion using Ringer’s Lactate GOAL of MANAGEMENT: Rewarm without 4. . Saltwater aspiration.It is a survival for atleast 24 hours after  Indwelling catheterization submersion.Remove all wet clothing. peripheral vasoconstriction – to decrease heat Disadvantage: slow process b.It is a condition where the core temp. Cardiopulmonary bypass • cold diuresis Disadvantage: invasiveness of the procedure • fruity or acetone odor of breath . Acidosis due to “washing out” of lactic acid from the MANAGEMENT: peripheral tissue  Immediate CPR CLINICAL MANIFESTIONS: 3. seizures MANAGEMENT: hypoxemia. and replace with warm . causes peripheral vasodilation. . causing an initial lowering of the core temp.  Passive External Rewarming (temp above 28 . raising basal metabolic rate degrees) . initiate CPR .  VS. 3 compensatory mechanisms: several blankets a. Fresh water aspiration.Disadvantages: -cyanosis • Extreme caution should be used in moving or 1. An increased in metabolic demands before the heart is  Endotracheal intubation with PEEP • slow. neck. Provide insulation by wrapping the patient in volume aspirated.Resultant pathophysiologic changes and 35 degrees Celcius as a result in the exposure to clothing pulmonary injury depend on type of fluid and the cold. or groin -difficulty of breathing • Elderly are greater risk for hypothermia due to .leads to pulmonary edema from loss  Active External Rewarming (temp above 28 the osmotic effect of salt within the lungs. Warm water immersion -hypothermia altered compensatory mechanisms . warmed IV fluids  ECG • drowsiness progressing to coma .Hypoxia and acidosis are common problems of the 3.Provide external heat for patient. below 32.warm hot water Clinical Manifestations: NURSING ALERT: bottles to the armpits.Peritoneal dialysis with warmed standard dialysis  NGT insertion degrees solution • ataxia .Inhalation of warm. metabolic acidosis. Provide warm fluids hence an inability to expand lungs b. no BP.. . with most common consequence of  WOF hypokalemia.results in loss of surfactant. is less than . c. . HYPOTHERMIA degrees) victim. no pulse. spontaneous respirations warmed to meet these needs. Warm gastric lavage  Indwelling catheterization • shivering is suppressed on temp.3 . humidified O2 by mask or  Intravascular volume expansion and inotropic • BP is extremely difficult to hear ventilator agents • fixed dilated pupils. check degree of hypothermia • heart sounds may not be audible even if its  Active Core Rewarming (temp below 28 degrees)  Rewarming procedures beating . a. shivering – produces heat thru muscular activity . because the heart the core. is near fibrillation threshold 2. NEAR-DROWNING  Anti-pyretics are not useful precipitating cardiac dysrhythmias. returning cool blood to -chills transporting hypothermic pts.

ABG: carboxyhemoglobin level is 12% (Normal). • Monitor fluid and electrolytes 3. To remove liquid or small particles of material CLINICAL MANIFESTATIONS glasses of water. relatively clear and no particular matter is seen. petroleum distillates. . 2. only in patients with good gag reflex and is 3. cherry red. 150 – 200 ml.  Insertion of NGT or OGT. MANAGEMENT:  Procedure to enhance the removal of ingested  Repeat lavage procedure until the returns are  Provide 100% oxygen by tight-fitting mask (the substance if the patient is deteriorating. of water. hydrocarbons. Save before allowed to drain gastric aspirate for toxicology screen. GENERAL INTERVENTIONS: 4. • Initiate large-bore IV access.  Gastric lavage for the obtunded patient. monitor shock 5. Skin is pink in color. procedures. stridor.  Adult dose is 30 ml by mouth followed by 2 4. ASSESSMENT: enhance renal clearance. 2. Pedia dose is15 ml followed by 8 from the stomach. • Identify the poison an extracorporeal circuit and a cartridge 3. Carbon monoxide exerts its toxic effects by GASTRIC LAVAGE binding to circulating hemoglobin to reduce the MINIMIZING ABSORPTION PURPOSES: oxygen carrying capacity of the blood. Repeated dose of charcoal. Providing an antidote – antidote is a chemical or 2.  Lavage fluid is left in place for about one minute 30 – 40% severe carbon monoxide poisoning. . such as charcoal. To cleanse stomach before endoscopic .It is an example of inhaled poison and results in positioning head on side poison. or cyanotic. the incomplete hydrocarbon combustion • Maintain seizures precaution .  Administration of activated charcoal with a 1. CARBON MONOXIDE POISONING • Prevent aspiration of gastric contents by physiologic antagonist that will neutralize the . iodides. silver nitrates. To remove unabsorbed poison after ingestion. Respiratory depression. palpitation. – 16 oz. gastric contents may containing an adsorbent. after  Pinch off the tube during removal or maintain be sent to laboratory which the detoxified blood is returned to the suction while tubing is being withdrawn. A saline cathartic may be instilled in the tube. charcoal. Headache. lower 15 degrees downward. • Monitor neurologic status patient)  Give the patient a cathartic if prescribed.TOXICOLOGIC EMERGENCIES 1.  Save samples of first two washings. pregnant patient. NURSING CONSIDERATIONS . Confusion progressing to coma. muscular weakness. . done the arrest of hemorrhage. and NURSING ALERT: Do not induce emesis after ingestion of  Place patient on left lateral position with head dizziness. anoxia. in  At the completion of the lavage: serum. To diagnose and treat gastric hemorrhage and for times affinity compared to oxygen and  Induction of emesis with syrup of ipecac. Hemoperfusion (process of passing blood through allowed to remain in the stomach. hemoglobin. . Hemodialysis – to purify and accelerate the  Warn patient that stool will turn black from the elimination of circulating toxins. elimination half life of carboxyhemoglobin. Carbon monoxide and hemoglobin is 200 – 300 cathartic to hasten secretion. Stomach may be left empty. Creation of carboxyhemoglobin resulting to tissue conscious. Forced diuresis with urine pH alteration – to 1. An Adsorbent may be instilled in the tube and • ABC 2. . caustic substances. for a person breathing room air is 5 hours . • Obtain blood and urine tests. to a patient having seizure or to  Elevate funnel and pour approx.

.  Prepare for CPR. initial At . Hemorrhagic blisters may occur after few hours of . treat dysrhythmias. and deterioration of personality may persist after resuscitation and 4. COMMON WITHDRAWAL SIGNS AND SYMPTOMS:  Administer bronchodilator. remove stinger with one quick  Intubate if necessary to protect airway. sweating.If sting occurs. WOF signs of systemic reactions (nausea. . and numbness of the site. and stupor local or systemic reactions.  Administer O2 and start IV line.a Delirium Tremens or Alcoholic Hallucinosis DENIAL  Administer anti histamine for local reaction. .Do not squeeze venom sack. and coma). If patient breaths 100% oxygen .k. there is unconsciousness erythema and edema at the site of injury. Local reactions are characterized by pain.2%.  An acute toxic state that follows a prolonged bout  Clean wounds thoroughly with soap and water or of steady drinking or sudden withdrawal from RATIONALIZATION antiseptic solution. ALCOHOLISM – a chronic disease or disorder  Continuous ECG monitoring. D-ependency bronchospasm. laryngeal edema. keep the patient calm and D-estructive  ABC immobilize extremity.48  100% oxygen in hyperbaric chamber reduces hypersensitivity. seizures. At . because this may characterized by excessive alcohol intake and  Correct acid-base and electrolyte imbalances. interpersonal  Continuous observation of psychoses.  a. there is low coordination 3. reaction..Have epinephrine on hand  Symptoms begins as early as 4 hours after the half life is reduced to 80 minutes .Avoid insect feeding areas. euphoria followed by drowsiness. D-omineering  Epinephrine is the drug of choice give SQ.2 . MANAGEMENT: D-emanding MANAGEMENT:  Wash the site of bite. D-enial (Unconsciousness. hours but may last up to 2 weeks.1% or 10 may be symptoms of permanent CNS damage. weakness. shock.3%. CLINICAL MANIFESTATIONS: ml for every 1000 ml of blood . irritability.These are injected poisons that can produce either bite and entire extremity may become edematous. cause additional venom to be injected. Systemic reactions usually begin within minutes. INSECT STINGS . and 20 minutes.  Administer vasopressors in the treatment of INCREASED VITAL SiGNS NURSING CONSIDERATIONS: shock. scrape of fingernail. ALCOHOL WITHDRAWAL DELIRIUM COMMON DEFENSE MECHANISMS: reaction. lightheadedness. Considered to be present when there is .. halflife to 20 minutes. tremors.Burning pain. At . paralysis of various muscle groups.3 and above. dysphagia. PROJECTION .  Administer anti-venin and be alert to allergic HALLUCINATIONS (VISUAL AND TACTILE)  Initiate IV with Ringers Lactate. interference in the individuals health. swelling. . SNAKE BITES . spastic . realtionship and economic functioning paralysis. COMMON BEHAVIORAL PROBLEMS: 5 D’s . visual disturbances. . prolonged intake of alcohol. and cardiovascular collapse.1 . SWEATING AND SIEZURE  Elevate extremities with large edematous local 5. . there is ataxia. ISOLATION  Educate patient.Wear emergency medical bracelet indicating reduction of alcohol intake and peaks at 24 . TREMORS  Apply ice packs to site to relieve pain.

ELEMENTS OF RAPE: UNSUCCESSFUL PREVIOUS ATTEMPT  Maintain electrolyte balance and hydration. nonconfrontational approach  Monitor for signs of impending suicide (giving AFTERSHAVE LOTIONS d. or thought that makes . RAPE refers to the insertion  Protect patient from injury. toxicologic screen for other drug abuse. IDENTIFICATION with family member committed suicide • lack of consent of the victim  Administer thiamine followed by parenteral CHRONIC • Actual penetration of the penis into the vagina dextrose if liver glycogen is depleted. and be in  Avoid use of metals and glass utensils OVER THE COUNTER COLD REMIDIES clear veiw of staff  Remove shampoos. • Insertion of any object into the mouth or anus  Monitor VS every 30 minutes.  Provide one-on-one monitoring Instruct patient to avoid. “cry for help” • According to RA 8353. Provide emotional support. anus of a victim phenytoin for seizure control as prescribed. Establish control. fear and hopelessness about a NURSING INTERVENTIONS: . SUICIDE 3. diazepam or . perfumes.Major Interventions: PREVENTION and LISTEN of penis into the mouth. Self-directed DRUG OF CHOICE for aversion therapy of an alcoholic: feelings of anger. It refers to a group of signs and symptoms the patient unable to cope with his life situation and experienced by a victim in reaction to rape interpersonal relationship . draw blood SEX (female attempts. Adopt a calm.INEFFECTIVE INDIVIDUAL COPING . RAPE TRAUMA SYNDROME MANAGEMENT: . • Use of threat/force  Observe for hypoglycemia. Ask if he has a weapon. affect.  Use a non-alcohol skin preparation. RISK FACTORS • It is generally considered as an act of hostility. gatorade.DISULFIRAM (antabuse) situation. or other ILLNESS • POWER – done to prove one’s masculinity carbohydrates to stabilize blood sugar.PRIORITY NURSING DIAGNOSIS: 1. Different Kinds of Rape:  Give orange juice. vagina.Ultimate form of self-destruction. AGE (18-25 AND ABOVE 40)/ALCOHOLISM • SADISTIC – done to express erotic feelings LETHALITY OF PREVIOUS ATTEMPTS BEHAVIORAL EMERGENCIES . medicines at the FOOD SAUCES MADE UP OF WINE b. VIOLENT PATIENTS PRIORITY NURSING DIAGNOSIS: . DEPRESSION/DEPENDENT PRERSONALITY • ANGER – done as a means of retaliation  Place patient in a private room with close observation. or violence for measurement of ethanol concentration. serious RAPE TRAUMA SYNDROME disturbances of behavior. CRISIS INTERVENTION away of valued possession) VINEGAR SKIN PRODUCTS 2. bedside FRUIT FLAVORED EXTRACTS c. keeping the door open.Is usually episodic and is a means of expressing Risk for Injury.It is an urgent. when taking Disulfiram: Manage through:  Have frequent unscheduled rounds MOUTH WASH a. male commits suicide) anger. avoid touching an agitated pt.

 Distal circulation may  burns on the ear are associated with be decreased auricular chondritis. DENIAL – characterized by victim’s refusal to talk can produce a tourniquet-like effect and about the event lead to vascular compromise 3. and disbelief  circumferential burns of the extremities 2.  Painless  hands and joints require intensive therapy. Patient’s medical condition – debilitating disorders such 2nd degree Only the skin Waxy white. location – Full thickness and subcutaneous red or black 10. dermis  Dry. little or  mortality rate is higher when the client no pain has a pre-existing disorder at the time of the burn injury 3rd degree Epidermis. charred. ACUTE PHASE – characterized by shock. contact with heat) .4 Phases  the perineal area is prone to 1. muscle. may be Requires excision and grafting.14 days for graft to  burns on the head. wet blisters. chemical or radiation 2nd degree Pediermis and part Red. electrical. in no FACTORS DETERMINING SEVERITY OF BURN: partial thickness of the dermis painful complication 1. bullae very Heals in 2-3 weeks. age – mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of age 2. respiratory. no skin  May have thrombosed revascularize associated with pulmonary complications. numbness autocontamination by urine and feces. (compartment syndrome). 3. bone may be Requires excision. HEIGHTENED ANXIETY – characterized by fear. leathery. REORGANIZATION – victim’s life normalizes PRIORITY NURSING CARE: Preservation of evidences Classification Affected Part Description of Wound What to Expect TREATMENT: Crisis Intervention 1st degree Epidermis Pin. apparent in 7-10 days. difficult to Slow to heal 94-8 weeks) surgical as cardiac. Dry.Is the damage caused to skin and deeper superficial Blisters form after 24 hours in 3-7 days body structures by heat (flames. scald. tension. neck and chest are tissue . Depth 4. 4th degree Skin. heals BURN TRAUMA . endocrine and renal disorders deep partial appendages in the distinguish from 3rd degree incision and grafting unless has negatively influence the client’s response to injury and thickness hair follicle remain except hair growth becomes complication treatment. and nightmares 4. grafting and deep full thickness tendon. appendages veins  burns on the face are associated with  Marked edema corneal abrasion. painful “sunburn” Discomfort last after 48 hrs. bonde visible sometimes amputation .

Temperature  If water is not available. titanic muscle  Urgent treatment is required with care of cancer develops contractions.  Exposure to ultraviolet rays in natural dangerous than direct current for it is leading to difficulty in breathing sunlight is the main cause of sunburn associated with cardiopulmonary arrest. steam or hot objects  Do not break blisters or apply lotions. check the ABCs burn area with water  if necessary.5. the victim or any conducting material 1 leg 14% 18% drop.  Remove contaminated clothing  Chemical Burns – caused by tissue contact ointments. redness and fever  Radiation Burns – are caused by exposure replaced by other gases. identify the chemical for with strong acids. immediately cool the  once the area is safe. remove clothing. alternating current is more  there is a risk of swelling or air passage. there  Avoid contact with the chemical  Electrical Burns – result in internal tissue could be burns to the airway  Sunburn damaging. clean. x-rays or a radioactive in the air will be dangerously low source. creams or powder  If possible. Size: Rule of nine Types of Burns and their Treatment:  Spasm in the air passages as a result of Assessment Child < 3 Adult  Scald irritation by smoke or gases years  burn caused by hot liquid  Severe burns to the air passages causing old  immediately flush the burn area with swelling and obstruction water (under a tap or hose for up to 20  Victim will show signs and symptoms of Head and neck 18% 9% min) lack of O2. Exposure to the Source  Cover the burn area with a loose. CPR  determines the extent of injury avoid pulling clothing across the burnt face  Chemical 7. remove unconscious 1 arm 9% 9% clothing immediately as clothing soaked  Electrical Posterior trunk 18% 18% with hot liquid retains heat  check for “Danger”  Flame  turn of the electricity supply if possible Anterior trunk 18% 18%  Smother the flames with a coat or blanket. He may also be confused or  if no water is readily available. alkalis or organic  Airway possible subsequent neutralization compounds  if face or front of the trunk is burnt.  Flood affected area with water for 20-30  Thermal Burns – caused by exposure to dry cloth to prevent contamination min flames. and long bone and vertebral the airway.  avoid any direct contact with the skin of get the victim on the floor or ground (stop.  When 02 in the air is used up by fire. breathing and circulation  The signs and symptoms of sunburn are fractures. perform rescue breathing or 6. and Roll) touching the victim until he is Perineum 1% 1%  Prevent victim from running disconnected  If water is available. the oxygen level to ultraviolet light. hot liquids. .  Smoke inhalation  General skin damage and eventually skin ventricular fibrillation. or pain.