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Bio-Crisis Ms.

Lina Navarro
Curative and Rehabilitative Nursing Care Management of Clients in Acute Biologic Crisis

Lina B. Navarro, RN

4 Days

Grading System

Q 50%
T 40%
P 10%
Course Content

Basic Concepts of Emergency First Aid


Intensive/Critical Care Nursing
Specific Biologic Crisis Situations
Disasters
Basic Concepts of Emergency First Aid Nursing

Definition of Terms

o Emergency a situation which poses an immediate risk to life, heath, property or environment
o Emergency Care care given to clients with urgent or critical needs
o Emergency Nursing a nursing specialty in which nurses care for patients in the emergency or critical phase
of their illness of injury
o Paramedics health care professional specializing in emergency medicine
o Emergency Medical Service (EMS) a service providing out of hospital acute care and transport to definitive
care

Characteristics of Emergency Nurses

o Skilled at dealing with clients in the phase when a diagnosis has not yet been made and the cause of the
problem is not known
o Specialize in rapid assessment and treatment when every second counts
o Tackle diverse tasks with professionalism efficiency, and above all caring
o Possess both general and specific knowledge about health care
o Ready to treat a wide variety of illnesses or injury situation, ranging from a sore throat to a heart attack

First Aid

o Immediate and temporary care given to a person who is injured or who suddenly becomes ill before
professional medical care is available
o Goals: 3 Ps
Preserve life
Prevent further injury
Promote recovery

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Bio-Crisis Ms. Lina Navarro
Characteristics of a Good First Aider

o Gentle
o Resourceful
o Observant
o Tactful
o Empathic
o Respectable

Contents of a First Aid Kit

o Hemorrhagic Control
- Tourniquet
- Gauze
- Bandage
- Clamps
o Spinal Immobilization
- Backboard
- Cervical collar
o Extremity Immobilization
- Splint
- Bandage
- Slings
o Labor and Delivery
- Clamps
- Scissors
- Suction
- Linen
- Gauze
o Resuscitation
- Ambu bag
- Bag Valve Mask Device
- O2 tank (mask and cannula)
o Emergency Drugs
- Epi
- AtSo4
- Dopamine
o Wound Care
- Betadine
- Gauze
- Alcohol
- PNSS

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Ethical, Legal and Medical Issues in Nursing

Ethical Principles

o Autonomy pertains to the right to make ones own choices


o Beneficence the duty of health care providers to be a benefit to the patient as well as to take positive
steps to prevent and to remove harm from the patient
o Non-maleficence is the principle of doing no harm
o Justice an equal distribution of risks and benefits. It is usually defined as a form of fairness.
o Veracity is the ethical principles of honesty
o Fidelity being true to our commitments and obligations to others

Ethical Responsibility

o Makes the physical/emotional needs of the patient a priority


o Practice/maintain skills to the point of mastery
o Critically review performances self critical
o Attend continuing education/refreshes/programs
o Be honest in reporting documentation

Duty to Act

o Legal obligation to provide patient care


1. When employment requires
2. When a pre-existing responsibility exists
3. When first aid has begun

Good Samaritan Acts

o Immunity from civil liability when providing assistance at the scene of an emergency; unless you did
something negligent
1. Do not leave the scene until the injured person leaves or another qualified person takes over
(Abandonment)
2. Limit actions to those considered first aid, if possible
3. Offer assistance, but dont insist
4. Have someone call or go for additional help
5. Do not accept any compensation

Privacy and Confidentiality

o Sharing of confidential information by the nurse about a patients condition is legal when:
- Information is shared with other members of the health care team
- With clients consent (signs a written release)

Negligence failure to provide care what another prudent person would allow do under the same circumstances

Malpractice professional negligence

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Elements of Malpractice

1. Duty
2. Breach of Duty
3. Damages
4. Causation

Terms

o Abandonment
o Assault and Battery
- Assault verbal threat
- Battery threats into action; procedure without explaining
o Consent
- Informed (client is aware or told of procedure)
- Implied
- Minors (cant sign consent except those who are married, pregnant, parents, emancipated,
military)
- Mentally-ill (they can sign consent)
o Refusal of treatment
o Restraints needs doctors order
o Advance Directives written statement that specifies medical treatment desired, if px is unable to make
decisions
o Do Not Resuscitate (DNR) Orders
o Organ Donors (save particular organ)
o Medical Identification Devices
o Special reporting requirements
- Abuse of children, elderly, and spouse
- Drug-related injury
- Childbirth
- Infections disease exposure
- Crime scene
- Deceased

Emergency Action Principles

o Scene Size-up/Survey the Scene


- Scene safety/potential hazard
- Mechanism of injury 4Ws and 1H
- Number of casualties account for all
- Bystanders observe bystanders that can help
- Body Substance Isolation (BSI)
o Primary Survey
- Rapid assessment of life threatening conditions
- Must be treated before the assessment continuous
A Airways
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B Breathing
C Circulation

The Bodys Need for O2


Time is Critical
0-1 minutes: Cardiac irritability
0-4 minutes: brain damage not likely
4-6 minutes: brain damage possible
6-10 minutes: brain damage very likely
More than 10 minutes: irreversible brain damage

The Golden Hour


Discovery of incidents and activation of EMS 20 minutes
The Golden Ten Minutes Initial Assessment and Intervention
EMS intervention
EMS packaging and transport 10 minutes
Initial Stabilization 20 minutes
o Medical Assistance
o Secondary Survey
Identifies non-life threatening problems
o Neurologic Assessment: GCS, LOC, Pupil reaction
o General Overview: baseline V/S
o Head-to-Toe Assessment: IPPA, DCAPBTLS
o History Information: OPQRST, SAMPLE
Glasgow Coma Scale
Generally, comas are classified as:
Severe, with GCS </= 8
Moderate GCS 9-12
Minor, GCS >/= 13

Eye opening
Spontaneous 4
To Voice 3
To Pain 2
None 1

Verbal response
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible words 2
None 1

Motor Response
Obeys Commands 6
Localizes Pain 5
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Withdraw 4
Flexion 3
Extension 2
None 1

Level of Consciousness
A-Alert
V-Response to Verbal stimulus
P-Responsive to Pain
U-Unresponsive
Golden Rule
Altered level of consciousness is characteristic of nervous system dysfunction and warrants
thorough examination to rule out all possible causes

Change in Pupil Size

- Unequal pupil size (anisocoria) may indicate increased pressure on one side of the brain

General Overview

- Respirations
- Pulse
- Blood pressure
- Temperature
- Pain scale
- Capillary refill
Used as a basis whether clients conditions is improving or deteriorating

Head-to-Toes Assessment
- Inspections
- Palpation
- Percussion
- Auscultation
DCAPBTLS
- Deformities
- Contusions
- Abrasions/Penetrations
- Punctures
- Burns
- Tenderness
- Lacerations
- Swelling
History Information
- Onset
- Provoking factors

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- Quality of pain
- Radiation of pain
- Severity
- Time
SAMPLE
- Signs and Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading to the episode

Priority Setting/Triage

o trier which means to sort out or prioritize


o To assess and determine the severity or acuity of the presenting problem
o Not a static process
o Purpose:
- Rapidly identify patients with urgent, life-threatening conditions
- Initiate appropriate and immediate interventions

Triage and Acuity Scale Category

Level 1: Resuscitation

- Conditions that threatens life and limb


- Requires immediate and aggressive interventions
- Time to Physician: Immediate
Code/arrest
Major trauma
Shock state
Unconsciousness
Severe respi distress

Level 2: Emergent

- potential threat to life, limb or function, requiring rapid medical intervention


- Time to physician assessment/interview: 15minutes
Altered mental state/CVA
Head injury/severe trauma
Neonates
Chest pain/abdominal pain
Drug overdose
GI Bleed
Asthma/dyspnea
Chemotherapy

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Anaphylaxis
Vaginal bleeding/acute lower abdominal pain
Serious infections/fevers
Diabetes
Diarrhea and vomiting
Acute psychosis/drug withdrawal

Level 3: Urgent

- Potentially progress to a serious problem


- Time to physician: 30 minutes
Head injury/moderate trauma
Asthma/dyspnea, mild/moderate
Chest pain
GI bleed
Vaginal bleeding and pregnancy
Acute pain, moderate
Diarrhea and vomiting
Dialysis

Level 4: Less Urgent (Semi-urgent)

- Conditions related to patient age, distress, or potential for deterioration or complications that would
benefit from intervention or reassurance within 1-2 hours
- Time to physician: 1 hour
Head injury
Minor trauma
Abdominal pain
Chest pain
Head act/earache
Suicidal/depressed
Chronic back pain
URI symptoms
Diarrhea and
Vomiting with no signs of dehydration

Level 5: Non urgent

- Investigations or interventions could be delayed or even referred to other areas


- Time to physician: 2 hours
Minor trauma
Sore throat/URI
Vaginal Bleeding (scanty)
Vomiting alone, diarrhea alone
Psychiatric cases

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Triage Coding

Priority Treatment Color


1 Immediate Red
2 Urgent Yellow
3 Delayed Green
4 Expectant Blue
Dead Black
Deaths

1. Clinical patient has stopped breathing


2. Biological brain dead
3. Terminal cancer patients; process of dying
4. Temporary Death caused by general anesthesia
5. Sudden reversible death; CP arrest

Causes of Sudden Death

o V-fib most common in cardiac arrest


o Electrocution
o Drowning/near drowning
o Drug overdose
o Suffocation
o Insect bites
o Falls/trauma
o Stroke
o Respiratory arrest
- Cessation of breathing
- Occurs first followed by cardiac arrest
o Cardiac arrest
- Stoppage of circulation
o Give BLS

Basic Life Support

BLS

- emergency treatment, to a client/victim having respiratory or cardiac arrest, through cardiopulmonary


resuscitation and emergency cardiac care
- Save heart and brain

Goals

- Emergency oxygenation
- Maintain airway patency
- Support breathing
- Support circulation
- No equipment
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Bio-Crisis Ms. Lina Navarro
Cardio Pulmonary Resuscitation (CPR)

- Combination of rescue breathing (one person breathing into another person) and chest compression in
lifesaving procedure
- Performed when a person has stopped breathing or a persons heart has stopped breathing

History of Basic Life Support

- Books of Kings II (4:34), wherein the Hebrew prophet Elisha warms a dead boys body and places his
mouth over his
- Peter Safar father of CPR; wrote the book of ABC of Resuscitation in 1957

Basic Life Support

- D-Check for Danger


- R-Responsive? If not, shout for help
- A-open Airway
- B-check Breathing. If non, give 2 initial breath
- C-Circulation. If non, compression 30:2
- D-attach Defibrillator; continue CPR

Phone First

- Cardiac
- Adults
- Children at high risk for cardiac arrhythmias

Phone Fast (act now, call later)

- Respiratory
- Children
- Submersion
- Drowning
- Arrest associated with trauma
- Drug overdose

Steps in CPR

1. Check safety
2. Determine responsiveness
o Are you okay? 2x
o If he responds, no need for CPR; keep safe and reassess
o If no response:
Adults: call EMS immediately
Child/Infant: perform 30:2 x 5 cycles, then call EMS
Lay him face up on a firm, flat surface, moving his head and body simultaneously

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Assess for Breathing:

3. Open airway: head tilt, chin lift.


o If you see foreign object in his mouth or throat, remove them
4. Place your face close to his mouth and observe his chest
o Look for chest movement
o Listen at the mouth for breath sounds
o Feel for airflow on your cheek
Within 5-10 seconds

2 Rescue Breaths

5. If breathing normally, turn to recovery position.


o If no breathing, give 2 rescue breaths at 1 second/breath. (Maintain an open airway. Pinch his nose
and give 2 blows into his lungs)
o The victims chest should rise with each blow
o If unsuccessful (no chest rise), reposition head and try again

AR Method

o Adult/Child
- Mouth to mouth, nose pinched
- Mouth to barrier device
- Mouth to nose
- Mouth to stoma
o Infant
- Mouth to mouth and nose

6. Next, feel for pulse at the carotid (neck area) up to 10 seconds


- If there is a pulse, perform artificial respiration at the rate of 12 times per minute, until natural
breathing is restored
- If there is no pulse, immediately begin CPR
- Precordial thumb
7. No Pulse: CPR
- Center the heal of one hand at the center of chest, between nipples, keeping your fingers off the
ribs
- Cover this hand with the heel of your other hand
- Arms straight and elbows locked; push down vertically about 4 to 5 cm and then release
- Compress 5 cycles of 30 compression and 2 full vent in 2 minutes (30:2 X 5 x 2 minutes)
- Do not lift your hands off the chest between compressions. Avoid interruptions
- Repeat pulse check after 2 minutes and every 5 cycles thereafter

Chest Compressions

o Infants
- Just below the nipple line within 2 fingers

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- 1/3 to of the depth of the chest
o Child
- Lower half of the sternum, falling at the nipple line using 1 or 2 hands; 1/3 to in depth
o Adults
- Center of the chest at the nipple line
- Both hands, 1 to 2 inches in depth
8. The moment his pulse returns, immediately stop compression and check for breathing

No breathing, With Pulse

- If the victim is not breathing, perform rescue breathing at 12 times/minute (1 breath every 5
seconds) until victims natural breathing is restored

- If both pulse and breathing have returned, place victim in the recovery position and maintain an
open airway
- Continue to monitor for both breathing and pulse every few minutes until heap arrives

2 Rescuer CPR

o Adult: 30:2 x 5 cycles x 2min


o Child/Infant: 15:2 x 5 cycles x 2

Ways to Know if CPR is Effective

o Pupils are constricted


o Px has circulation
o Px has respi
o Px has regained consciousness

Problems During CPR

o Gastric Distention
o Lacerations of internal organs
o Punctured lungs
o Fractured ribs or sternum

When BLS Should not Be Started

o Rigor mortis or stiffening of the body


o Putrefaction of decomposition
o Evidence of non-survivable injury
o Existing DNR or no-CPR order
o Alive

When to Stop CPR

o S patient Starts breathing and has pulse


o T patient is Transferred to another person or a higher facility
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o O you Out of strength (exhaustion)
o P a Physician asks you to stop (beyond resuscitation)

Foreign Body Airway Obstruction

Causes of Foreign Body Obstruction

o Vomited stomach contents


o Blood clots, bone fragments, damaged tissue
o Foreign objectives
o Swelling caused by allergic reactions
o Relaxation of the tongue (during general anesthesia, mouth guard )

General Signs of Choking

o Attack occurs while eating


o Victim may clutch his neck
o 2 types of Choking
o Mild
o Severe

Mild/Partial Obstruction

Signs of mild airway obstruction:

Are you choking?

- Victim speaks and answers yes


- Victim is able to speak, cough and breath
o Encourage to continue coughing but do nothing else
o Administer 100% O2
o Continue to check for deterioration or relief of obstruction

Severe Airway Obstruction

Are you choking?

Response

o Unable to speak
o May respond by nodding
o Unable to breath
o Breathing sounds wheezy
o Attempts at coughing are silent
o Victim may be unconscious

Severe Airway Obstruction: Conscious Adult

o Abdominal thrust

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o Heimlich Maneuver are a series of under-the-diaphragm abdominal thrusts
o Lifts the diaphragm and force enough air from the lungs to create an artificial cough to move and expel the
foreign body.

Abdominal Thrust: Heimlich Maneuver

Step 1: Ask the choking person to stand if he or she is sitting

Step 2: Place yourself slightly behind the standing victim

Step 3: Reassure the victim that you know the Heimlich maneuver and you are willing to help

Step 4: Place your arms around the victims waist.

Step 5: Make a fist with one hand and place your thumb toward the victim, just above the umbilicus and below the
Xiphoid process

Step 6: Grab your fist with your other hand

Step 7: Deliver 5 inward and upward thrusts

Step 8: Repeat until the foreign body is expelled or until the victim becomes unconscious

Severe Airway Obstruction: Unconscious Adult

o Place the patient in a supine position


o Straddle the patients hips or legs
o Place the heel of one hand against the abdomen
o Press into the patients abdomen with quick inward and upward thrust
o Repeat 5 times

Finger Sweep

o Open the mouth with tongue-jaw lift


o Using the index finger, do a hooking action to dislodge the foreign body
o Done only in unconscious patients
o Done only when the foreign body is visible
o Blind finger sweep should not be performed
o Contraindicated with seizure

Advance Cardiac Life Support

Airway

- ET Intubation
- Give a source of air to be effective O2

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Confirm Placement of ET

- CXR
- Auscultate chest while ventilated by ambubag
- (+) Breaths sounds on both lung fields
- (+) chest wall rise
- Auscultate the stomach

Intubation Complication

- Intubating the right main stem bronchus


- Intubating the esophagus
- Aggravating spinal injuries
- Taking too long to ventilate
- Patient vomiting
- Soft tissue trauma
- Mechanical failure
- Patient intolerant of ETT
- Dec in HR

Airway Adjuncts

- Oropharyngeal airway oral airway


- Guedel pattern airway
- Maintain a patent airway by preventing the tongue from covering the epiglottis
- Inserted upside down

Cricothyrotomy

Breathing

Respiration

- Spontaneous
- Rate, depth, and symmetry
- Breath sounds
- Bag, valve, mask device
- No breathing: Deliver 8-12 breaths/min
- Spontaneous breathing: together with chest rise

O2 Saturation

- Pulse oximetery
- 96-100% at room air
- No not suction when O2 Sat is below 95%

Bag-valve-mask delivers more than 90% O2 use; 10-15lpm

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Circulation

- Pulses
- Cardiac rhythm and rate
- Blood pressure
- Capillary refill and skin color
- CPR; 100compresssion/min
- IV lines

Types of Solution

Hypotonic Isotonic Hypertonic


Hydrates Cells Stays Put Expands Volume
.45% NaCl, .33% NaCl D5W LR NSS D10W, D5NS, Albumin

Drugs

Cardiac Stimulants

Epinephrine adrenergic agonist

- Restores electrical activity


- Bronchodilator
- Vasoconstrictor
- No C/I in cardiac arrest or anaphylactic shock
- Can be given via ET

Atropine SO4 anticholinergic;

- Red hot, dry, blind, mad

Isoproterenol bradycardia

Cardiac Stimulant

Drug Action Side Effects


AtSo4 Blocks vagal stimulation Red, hot, dry, blind, mad
IV, ET, PO, IM I: Bradycardia, organophosphate
poisoning
Isoproterenol (Isuprel) IV Enhances myocardial contractility Tachycardia, Inc BP
I: Bradycardia

Dopamine HCl sympathetic agents

- Shock drug
- Enhances force (inotropic) of heart contractions
- Increase rate (chronotropic) of heart contractions
- Renal dose, cardiac dose, vasopressor dose
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Dobutamine

Norepinephrine

- Potent vasoconstrictor

Cardiac Glycosides (Digitalis)

Lanoxin, Digoxin

- CHF, atrial fibrillation


- Slows and strengthens heart beat
- Toxicity
Bradycardia and/or dysrhythmias
Anorexia, nausea and vomiting
Green and yellow vision
Check K levels, PR > 90

Antianginal Drugs:

Nitrates and Nitrites

- Isordil, NTG, Nitrostat


- Vasodilator
- Check for Hypotension and potency

Morphine SO4

- Narcotic analgesic
- Relieves pain, vasodilation
- N and V, hypotension, respiratory depression
- Antidote: Narcan

Drugs Used to Treat Ventricular Dysrhythmias:

Adenosine

Lidocaine HCl

- Watch out for toxicity

Procainamide (Pronestyl)

Amiodarone (Cordarone)

- Watch our for bradycardia, very potent

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Antihypertensives

Central Acting

- Clonidine (Catapres)
- Methyldopa (Aldomet)

Alpha Adrenergic Blockers zosins

- Prazosin, Terazosin

B Adrenergic Blockers - olols

- Propanolol (Inderal), Atenolol

Ca Channel Blockers: Nifedipine, Verapamil, Diltiazem (Slows down conduction, vasodulating effect)

ACE inhibitors Prils, Captopril, Enalapril, Fosipril

Other Drugs

Diuretics inhibits sodium reabsorption

- Edema, CHF, mild hypertension


- Hypotension, MIO, weight, serum electrolytes

Anticoagulants prevent further formation of blood clots

- Heparin, Coumadin, warfarin


- Bleeding

Thrombolytics dissolve clots

- Alteplase (tPA), Streptokinase, Urokinase


Must be given within 6 hours of infarct
Followed by heparin therapy
- Bleeding

Antihistamines blocks histamine effects in allergic reactions

- Sedative, inhibits motion sickness


- Diphenhydramine, chlorphenamine

Antidotes

- Naloxone, Flumazenil, AtSO4, activated charcoal

Steroids

- Anti-inflammatory, diminishes severity of allergic and inflammatory reactions

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Antacids

- NaHCO3
- Watch for extravasation

Bronchodilators as nebulizers; Albuterol, Salbutamols

Electrocardiography

- Records the electrical conduction of the heart


- Does not assess the contractility of the heart
- 12 tracings I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6

Lead Placement

- May be placed in the shoulder or groin in case of amputation or cast

Limb Leads

Right Arms: Read


Right Leg: Black
Left Arm: Yellow
Left Leg: Green

Precordial Leads

C1 4th ICS right sternal borders


C2 4th ICS left sternal border
C3 midway between C2 and C4
C4 5th ICs MCL or below the nipple
C5 in line with C4, anterior axillary line
C6 in line with C4, mid axillary line

Nursing Responsibilities

- Explain the procedure


- Provide privacy and assist in draping hte client
- Remove all metals from the clients body
- Attach the leads and apply conduction gel
- Operate the machine according to the manufacturers instructions
- Remove the lead and wipe off the gel
- Label the strip. Date, time, clients name, age and sex
- Report the result immediately

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The Normal ECG

1. normal sinus rhythm


2. Atrial Flutter: the atria are contracting rapidly about 300 bpm, and the ventricles are responding to every
third or fourth impulse
3. Premature Ventricular Contraction
4. Ventricular Tachycardia R wave, QRS wave
5. Ventricular Fibrillation
6. Ventricular Asystole (Standstill)

HR absent

Rhythm absent

P wave Absent or present

PR interval absent

Atrial Flutter

- The atria are contracting rapidly at about 300bpm, and the ventricles are responding every third or fourth
impulse

Premature Ventricular Contraction

Ventricular Tachycardia

Ventricular Fibrillation

Ventricular Asystole (P-wave may be present)

Ventricular Fibrillation

- Dysrhythmia in cardiac arrest


- Heart quivers and does not beat
- No cardiac output, no pulse
- Converts to Asystole in a few minutes
- Clinical death

Defibrillation

- Stop the fibrillation


- An asynchronous countershock used to stop pulseless V tack or VF
- Convert VF to an effective rhythm

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Rationale for Early Defibrillation

- Third link in the chain of survival


- Within 2 minutes
- Success probability decreases over time
- Precordial thump

Non-Shockable Rhythms

- Asystole
- PEA (Premature Electrical Activity)

Fibrillation Treatment

- Process in which an electronic devise gives an electric shock to the heart


- Helps re-establish normal contraction rhythms

Procedure

- Apply gel to hand-held paddles or used electrode pads


- Turn on machine and choose appropriate energy level
- Charge the capacitor
- Position paddles/electrodes
- Apply firm pressure (25lbs) to hand held devices
- Clear the area

Defibrillators

Monophasic

- The CPR algorithm recommends single socks started at and repeated at 360J

Biphasic

- The CPR attachment algorithm recommends shocks initially of 150-200J and subsequent shocks of 150-360J

Automated External Defibrillator (AED)

AEDs come in two forms

- Automated
- Semiautomated

A specialized computer recognizes heart rhythms that require defibrillator

W no Water

I no Internal pacemaker

P Patches; removed

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E Eight years and below, no defib

Cardioversion

- Organized rhythms
- Delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle
- A synchronized countershock to convert an undesirable rhythm to a stable rhythm
- Lowe amount of energy is used
- Synchronized with the R-waves
- Informed consent is needed and client is sedated

What things should I do after Cardioversion/Defibrillation

- Monitor the patient carefully ABCs, V/S, LOC


- Keep the patient well oxygenated
- Check up on your patients lab studies...K+, Magnesium, CPK, Troponin
- Get a 12 lead after the Cardioversion for documentation
- Assess the patients skin for evidence of burns

Advance Cardiac Life Support

Critical Care

Prolonged life support

Goal: Cerebral Resuscitation and post resuscitation intensive therapy (providing mechanical ventilation

G Gauging: determine cause of the disease (specific biologic crisis)

H Human mentation: cerebral resuscitation (brain damage)

I Intensive Care: Multiple organ support

Intensive Care

- Provision of life support or organ support systems in patients who re critically ill and who usually require
intensive monitoring
- Condition is potentially reversible and who have a god chance of surviving with intensive are support
- System by system approach to treatment
CV, CNS,ENDO, GIT (and nutritional condition), hematology, microbiology (including sepsis
status), peripheries (and skin), renal (and metabolic), respiratory system

Critical Care Nursing

- Deals specifically with human responses to life-threatening problems


- Patient advocate
- CCU nurses are responsible for ensuring that acutely and critically ill patients and their families receive
optimal care
- Frequent assessment, monitoring, rapid intervention, access to technology

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Goals

- Pursue continuous optimal nursing care to patients in life threatening situations


- Remain alert to the physiologic, Psychologic and social needs of the patient as an integrated being

- intensive Care Unit (ICU) or critical care unit (CCU)


- coronary care unit (CCU) for heart disease
- medical intensive care unit (MICU)
- Surgical intensive care unit (SICU)
- Pediatric intensive care unit (NCCU)

Equipments and Systems

Patient monitoring equipment

- Acute care physiologic monitoring system


- Pulse oximeter
- Intracranial pressure monitor
- Apnea monitor

Life Support and Emergency resuscitative equipment

- Ventilator (also called a respirator)


- Infusion pump
- Crash cart
- Intra-aortic balloon pump

Diagnostic Devices

- Mobile x-ray units


- Point of care analyzers

Other ICU Equipment

- Urinary (Foley Catheters)


- Catheters used for arterial ad central venous lines
- Swan-Ganz catheters
- Chest and endotracheal tubes
- GI and NG feeding tubes
- Monitoring electrodes

Basic Trauma Life Support

A Airway and C-Spine control

B breathing; chest injury

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C Circulation; no pulse, CPR; control hemorrhage, immobilize

D Disability; neuro assessment: AVPU (LOC), GCS V/S

E Expose, environment control

F Foley Cath

Trauma Assessment DCAPBTLS

Bleeding

- Hemorrhage
- Average adult has 5L of circulating blood
- Body cannot tolerate greater than 20% blood loss
- Blood loss of 1l can be dangerous in adults; in children, loss of 100-200mL is serious

Safety

- Universal and standards precautions


- Wear gloves and eye protection in all situations
- Avoid direct contact with body fluids
- Thorough hand washing between patient is important

Controlling External Bleeding

- Direct pressure (10 minutes) and elevation


- Ice
- Pressure bandage
- Indirect pressure (pressure points)
- Pneumatic Anti-shock garment (PASG)
- Splints/air splint
- tourniquet

PASG

- An inflatable garment that surround the legs and torso and can generate up to around 100mmHg of
pressure
- Controls significant internal bleeding by placing pressure on the abdomen
- Controls massive soft-tissue bleeding of the lower extremities
- Increases blood flow to vital organs
- May effectively increase the blood pressure

Tourniquet Precautions

- Place as close to injury as possible, but not over the joint


- Never use a narrow material. Mark the area with a letter T
- Use wide padding under the tourniquet
- Never cover a tourniquet with a bandage
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Bio-Crisis Ms. Lina Navarro
- Do not loosen the tourniquet once applied
- Rotate the site every 2 hours

Open Wounds

- Control hemorrhage; immobilize injured area


- Check dressing every few minutes; if soaked with blood, do not remove, apply another dressing on top of it
and reapply pressure
- Irrigate the wound with scope and water or saline solution
- Impaled objects: do not remove; stabilize object with a bulky dressing
- Butterfly enclosures
- Sutures and ligation of bleeders

Controlling a Nosebleed

- Help the patient sit and lean forward


- Pinching the nostrils together
- Place a rolled gauze under the upper lip and gum; and press with your fingers
- Cold compress over the nose nad face
- Nasal packing with epinephrine

Internal Bleeding

- May not be readily apparent


- Causes
Blunt trauma
Penetrating trauma
Fractures
- Assess for:
Signs and symptoms
Mechanism of injury

S/Sx of Internal Bleeding

- Ecchymosis
- Hematoma
- Hemoptysis
- Hematemesis
- Hematochezia
- Melena
- Hematuria
- Pain, tenderness, bruising, or swelling
- Broken ribs; bruises over the lower chest; shallow rapid respiration
- Rigid, distended abdomen, guarding

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Bio-Crisis Ms. Lina Navarro
First Aid

- Prioritize
Chest cavity
Abdominal cavity
Pelvic cavity (2-8 units)
Femoral area (2-8 units)
- EMS
- ABCDs
- Treat for shock

Soft Tissue Injuries

- Close injuries
Soft tissue damage beneath the skin
- Open injuries
Break in the surface of the skin
- Burn
Soft tissue receives more energy than it can absorb
- Amputations

Contusion

- Results from blunt force striking the body


- Epidermis is intact, dermis damage and blood vessels are torn

Hematoma

- Pool of blood collected beneath the skin


- Tearing of large blood vessels

Abrasions

- Caused by rubbing, scraping or shearing

Laceration

- Smooth or jagged cut, irregular edges

Avulsion

- Tearing loos of a flap of skin

Penetrating Wound

- Penetration from a sharp pointed object

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Bio-Crisis Ms. Lina Navarro
Gunshot Wound

Crushing Open Wound

- May involve damage internal organs or broken wounds

Amputation

- Loss of a body part

Traumatic Emergencies

- Trauma assessment
DCAPBTLS
Mechanism of injury
Loss of consciousness
Vomiting
Current symptoms
Intake of drugs or alcohol

Tissue Perfusion

- The heart demands a constant supply of blood


- The brain and spinal cord can survive for 4-6 minutes without perfusion
- The kidneys may survive 45
- Skeletal muscles may last 2 hours

Normal Perfusion requires 3 intact mechanisms

1. A functioning PUMP: the heart


2. Adequate VOLUME: the blood and the plasma
3. An INTACT VASCULAR SYSTEM: blood vessels are able to constrict and dilate

Shock

- A state of collapse and failure of the CVS due to the inadequate tissue perfusion and less oxygenation
Leads to inadequate circulation
Without adequate blood flow, cells cannot get rid of metabolic wastes
- Not a disease in itself, but a secondary cause

Death is a severe stage of shock, or shock is a pause in the act of dying

Phases of Shock

I. Compensated shock
- The preservation of vital organ function: body uses normal defense mechanism to maintain normal function

Signs and Symptoms

- Restlessness, agitation, confusion


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Bio-Crisis Ms. Lina Navarro
- Slightly increased respiratory rate
- Slightly increase heart rate
- Normal BP slightly decreased capillary refill
- Oliguria
- Pallor, cold, clammy, skin/warm and flushed
II. Uncompensated Shock
- Vital organ function is impaired and clinical deterioration professes; blood is shunted away from extremities
and abdomen towards the heart, brain and lungs

Signs and Symptoms

- Decreasing LOC (Stuporous, unconscious)


- Dilated sluggish pupils
- Rapid breathing; shallow, irregular respirations
- Rapid heart rate; weak, ready pulse
- Hypotension
- Anuria
- Clod, clammy, cyanic
- Metabolic acidosis
III. Irreversible Shock
- Terminal, irreversible changes to vital organs
- Blood is shunted from the liver and kidneys to heart and brain
- Organs die
- Death
Signs and Symptoms
- Bradycardia
- Bradypnea
- Mottled skin
- Coma

Classification of Shock

1. Hypovolemic Shock
- An absolute reduction in circulating volume
2. Cardiogenic
- Reduction in cardiac output secondary to pump failure
3. Distributive
- An increase in the volume of the circulatory system (vasodilation)
Septic/Anaphylactic/Neurogenic
4. Obstructive
- Resistance to the flow (respi insufficiency)
5. Psychogenic
- psychological
6. Metabolic

Management of Shock

- Maintain airway
- Oxygen
- Positioning shock position
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Bio-Crisis Ms. Lina Navarro
- Control bleeding
- Splint fractures
- Keep warm
- Keep safe
- NPO
- Monitor V/S
- Monitor Output
- Trendelenburg

Medical Mgt

- Establish proper airway


- Hydration (IVF: NSS, PLR)
- Drugs
Dopamine
NaHCO3
- BT
- Correct cause of shock
- Foley catheter

Anaphylactic Shock

- Administer Epi, Diphenhydramine, corticosteroids


- Provide all possible support
O2
Ventilatory assistance

Psychogenic Shock

- Usually self-resolving
- Assess patient for injuries from fall
- Anxiety attack

Eye Injuries

- Considered as an emergency
- Foreign objects
Victim to blink several times
Irrigates with saline
- Lacerations
Never exert pressure on or manipulate eye
Cover with protective metal eye shield
- Burns
Flush for 20 minutes
Remove contact lenses

Injuries to the Face

- Injuries about the face can lead to upper airway obstructions


Bleeding, loose teeth
- Clear airway
- Immobilize fracture
- Control bleeding
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Bio-Crisis Ms. Lina Navarro
- Monitor airway constantly
- Blunt trauma to the nose can result in fractures and soft-tissue injuries

Neck Injuries

- An open neck injury can be life threatening


- Air can get into the vein and cause an air embolism
Cover the wound with an occlusive dressing
Apply manual pressure
- Subcutaneous emphysema
Protect airway

Chest Wounds

- A penetrating wound to the chest may cause air to enter the chest
- Air enters through a hole causing the lungs to collapse in a few seconds or minutes
- Sucking chest wound

Rib Fractures

- Rib fractures may lacerate surface of the lungs; common in the elderly
- Flail chest
Three or more fractured ribs
Sternum in fractures along with several ribs
Creates paradoxical movement
Immobilize flail segment with a pad of dressing or a small pillow; secure with a wide tape
Do not ever place anything completely around the chest!

Pneumothorax

- Spontaneous Pneumothorax
Weak areas in the surface of the lungs and rupture spontaneously
- Tension pneumothorax
Can occur from sealing all four sides of the dressing on a sucking chest wound
Can also occur from a fractured rib puncturing the lung or bronchus
Can also result from a spontaneous pneumothorax
Let air escape by inserting a needle

Cardiac Tamponade

- Collection of blood or other fluids in the pericardium


- Causes
Stab wounds
Blunt chest trauma
Recent cardiac catheterization
- S/Sx
Rapid, thready pulse
Hypotension
JVD
Muffled heart sounds
- Treatment
Ensure open airway
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Bio-Crisis Ms. Lina Navarro
O2
IV line
Pericardiocentesis
CPR

Abdominal Wounds

- An open wound in the abdomen may expose organs


- An organ protruding through the abdomen is a called an evisceration

Abdominal Wound Management

- Do not touch exposed organs


- Cover organs with a most sterile dressing
- Manage for shock
- Prepare for surgery

Blunt Abdominal Wounds

- Severe bruises of the abdominal wall


- Laceration of the liver and spleen
- Rupture of the intestine
- Tears in the mesentery
- Rupture or tearing of the kidneys (hematuria)
- Rupture of the bladder
- Sever intra-abdominal hemorrhage
- Peritonitis

Assessment

- Tenderness
- Rebound tenderness
- Guarding
- Rigidity
- Distention
- Pain

Management

- Prevent shock
- Control bleeding
- Positioning
- NPO

Injuries to the Genitalia

- Male
Painful by not life-threatening
Cut off zipper fastener and separate teeth
Ice or cold compress
- Female
Extreme pain, bleeding

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Bio-Crisis Ms. Lina Navarro
Straddle injuries, sexual assault, blows to the perineum or abortion attempt, childbirth, or
when foreign objects are inserted into the vagina
Direct pressure, moist compress (bleeding)
Ice packs or cold compress (pain, swelling)
Sexual assault, preserve chain of evidence

Skull Fracture

- Indicates significant force


- Signs
Obvious deformity
Visible crack in the skull
Raccoon eyes Periorbital ecchymoses
Battles sign ecchymosis behind the ears
Basal skull fracture
- Signs and Symptoms
Lacerations, contusions, hematomas to scalp
Soft areas or depression upon palpation
Visible skull fractures or deformities
Ecchymosis around eyes and behind the ear
Clear or pink CSF leakage
Unequal pupils
Cerebral edema
Period of unconsciousness, amnesia, seizures
Numbness or tingling in the extremities
Irregular respirations
Dizziness
Visual complaints
Combative or abnormal behavior
Nausea and vomiting
- Bleeding from Skull Fracture
Do not attempt to stop the blood flow
Loosely cover bleeding site with sterile gauze
Leakage of clear fluid from ears or nose
If cerebrospinal fluid is present, a target sign will be apparent

Head Injuries

- The most important sign in evaluating head injury is a changing state ofconsciousness
- A head-injured patient has a cervical spine injury until proven otherwise
- Shock means injury elsewhere

Cerebral Concussion

- Brain is jarred around the skull


- Mild, diffuse brain injury transient dysfunction of the cerebral cortex
- Resolved rapidly and spontaneously
- No structural damage or permanent neuro impairment

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Bio-Crisis Ms. Lina Navarro
- S/Sx transient confusion and disorientation (lasts several minutes), with or without loss of consciousness,
retrograde amnesia or anterograde amnesia

Cerebral Contusion

- Brain tissue is bruised and damaged in a local area


- Physical damage/injury to the brain causes greater neurologic deficits
- Swelling of injured tissue leads to increase ICP

Coup-contrecoup

- Acceleration-deceleration injury
- Head comes to a sudden stop, but brain continues to move back and forth inside the skull, resulting in
massive injury
- Two sites of injury
Point of impact
Point on the opposite side when the head hits the skull

Brain Injury

- Increase blood flow (vasodilation)


- Leakage of blood and plasma to the affected area (bleeding)
Decreased brain perfusion
CO2 build-up in brain tissue
vasodilation
- Increase pressure in the skull
- Brain tissues become compressed and stop functioning
- Decreased blood flow to the brain as pressure increases
- Brain stem is compressed due to swelling
- Heart, breathing and blood pressure fails

Complications of Head Injuries

- Cerebral Edema
- Convulsions and seizures
- Vomiting
- Leakage of CSF
***Check for increase ICP

Increased Intracranial Pressure

- Increased BP (Systolic)
- Widening of pulse pressure
- Decreased Pulse (bradycardia)
- Abnormal respiration
- Increased temp
- Vomiting

Shock (Hemorrhage Elsewhere)

- Decreased BP
- Narrowing of pulse pressure
- Increased Pulse (tachycardia)

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Bio-Crisis Ms. Lina Navarro
- Increased Respiratory Rate

First Aid

- Immediate medical attention


- Support victim until medical help arrives
- Stabilize head and neck
- ABCD
- Prevent aspiration
- Treat for shock
- Do not elevate legs

Interventions

- Manage airway and breathing


- Circulation
- Medications
Dexamethasone
Mannitol
Furosemide
- Positioning
- Do not allow patient to become overheated; keep cool
- Craniotomy

Spinal Cord Injury

- Anything below the level of damage cord is affected


- Suspect in
Vehicular trauma
Falls from a height
Diving accidents
Cave-ins
With head or facial injuries
Lightning injuries
Any unconscious victim of trauma

Complications

- Inadequate breathing
Respiratory paralysis
Chest wall muscles are paralyzed
Diaphragm continues to function
- Paralysis
Weakness, loss of sensation or paralysis below level of injury
Paralysis of arms or legs most reliable sign

S/Sx

- Pain and tenderness of spine


- Deformity of spine
- Numbness and paresthesias
- Loss of sensations
- Incontinence
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Bio-Crisis Ms. Lina Navarro
- Injuries to the head
- Diaphragmatic breathing

Management

- Ensure open Airway (jaw thrust); suction


- Assist breathing
- Support circulation stop bleeding, IV
- Immobilization (cervical collar, backboard)
- Keep warm
- V/S, neurologic status

Types of Musculoskeletal Injuries

- Fractures broken bone


- Dislocation disruption of a joint
- Sprain joint injury with tearing of ligaments
- Strain stretching or tearing of a muscle

Management of Fractures

- Assessment ABC, DCAPBTLS


- Immobilization by splinting or casting
- Be alert compartment syndrome
Permanent damage in 6-8 hours
- Check neurovascular status
Pulse
Capillary refill
Sensation
Motor function

Common Medical Emergencies

Airway Problems

- Upper airway obstructions


- COPD
- Atelectasis
- Consolidation
- Fluid (Pulmonary Edema)

Management of Airway Problems

- Airway maintain patency


Assist ventilations with BVM
Protect by endotracheal intubation
Suction secretions
Remove foreign bodies (Heimlich)
tracheostomy
- Oxygen
- Establish IV line
- Drugs
- Chest Tubes
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Bio-Crisis Ms. Lina Navarro
Acute Myocardial Infarction (AMI)

- Pain signals death of cells


- Opening the coronary artery within the first hour can prevent damage

S/Sx

- Severe, crushing chest pain (Levines sign)


- Cold, clammy skin
- Feeling of impending doom
- Apprehension anxiety
- Sudden death
- Pulmonary edema

Treatment

- Oxygen
- IV line
- Bed rest; semi fowlers
- Cardiac monitor
- I and O
- Drugs vasodilators, hemolytics (<6 hours), analgesics, anti-arrhythmics, anticoagulants, stool softeners

Cardiac Arrest

Ventricular Fibrillation

Aim: To convert to an effective rhythm

- Defibrillate
- Intubation
- Oxygen
- IV line, fluids
- Drugs lidocaine

Asystole

Aim: To convert to an effective rhythm or to VF

- Start CPR
- Intubation
- Oxygen
- IV line, fluids
- Drugs Epi, AtSO4
- Defibrillate if in V Fib

Cerebrovascular Accident (CVA or Stroke)

- Hemorrhagic arterial rupture


High blood pressure is a risk factor
Rapid onset
- Ischemic blockage, occlusion of blood supply
Thrombosis
Embolus
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Bio-Crisis Ms. Lina Navarro
- Stroke symptoms typically develop rapidly (seconds to minutes)
- Symptoms are related to the anatomical location of the damage
Ischemic strokes: affect regional areas of the brain perfused by the blocked artery
Hemorrhagic strokes: affect local areas, but often can also cause more global symptoms
due to bleeding and increased ICP
- History, neurological examination, and presence of risk factors

General S/Sx of Stroke

- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sometimes
weakness in the muscles of the face can cause drooling
- Sudden confusion or trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble waking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause

Central Nervous System Pathways

- If the area of the brain affected contains of the three prominent CNS pathways the spinothalamic tract,
corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:
Hemiplegia and muscle weakness of the face
Numbness
Reduction in sensory or vibratory sensation

Brain Stem

Brain Stem also consists of the 12 cranial nerves

- Altered smell, taste, hearing, or vision (total or partial)


- Drooping of eyelid (ptosis) and weakness of ocular muscles
- Decreased reflexes: gag, swallow, pupil reactivity to light
- Decreased sensation and muscle weakness of the face
- Balance problems and Nystagmus
- Altered breathing and heart rate
- Weakness in sternocleidomastoid muscle with inability to turn head to one side
- Weakness in tongue in tongue (inability to protrude and/or move from side to side)

Cerebral Cortex

If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following
symptoms

- Aphasia inability to speak or understand spoken language (Brocas)


- Apraxia altered voluntary movements
- Visual field defect
- Memory deficits (temporal lobe memory)
- Hemineglect
- Disorganized thinking, confusion, hypersexual gestures
- Anosognosia persistent denial of the existence of a usually stroke related deficit

Cerebellum

- Trouble walking

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Bio-Crisis Ms. Lina Navarro
- Altered movement coordination
- Vertigo and/or disequilibrium

Hemorrhagic Stroke (Inc ICP)

- Loss of consciousness
- Headache
- Vomiting

Emergency Care for Stroke

- Patent airway, O2
- IV line
- Drugs
Treat within 3 hours for thrombolytic drugs
Antiplatelet, anticoagulants
Antihypertensives
Osmotic diuretics
- Protect paralyzed extremities
- CR Scan, MRI
- Surgery to remove blood
- Supportive care physiotherapy, occupational therapy

Seizures

- Generalized (Grand Mal) - last 2-5 minutes


- Petit mal seizure blank state, few seconds
- Status Epilepticus sing seizure more than 5 minutes or series of seizures without regaining consciousness
Brain deprived of oxygen
- Goal: support victim, prevent injury

Emergency Care

- Airway (turn to side)


- O2
- Assess for duration
- Do not restrain
- NPO
- IV line
- Drugs: Diazepam, phenytoin, phenobarbital

Diabetes Mellitus

Hyperglycemia diabetic coma

- Lack of insulin causes glucose to build-up in blood in extremely high levels


- Diabetic ketoacidosis (DKA)

Hyperglycemia insulin shock

- Excess insulin

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Bio-Crisis Ms. Lina Navarro
First Aid

- When in doubt, give sugar


- Look for medical alert tag
- Hyperglycemia
EMS
ABC
Rule out other emergencies
- Hypoglycemia death in a few minutes
EMS
Administer sugar if responsive
ABC, NPO, and lateral recumbent if unresponsive

Common Environmental Emergencies

- Normal body temperature is 98.6F


- Body cools itself by sweating (evaporation) and dilatation of blood vessels
- High temperature and humidity decrease effectiveness of cooling mechanisms

Heat Stroke

***Sweating mechanisms fails; body overheats; profound emergency

***Peripheral vasodilation; Neurogenic shock

- No cramping
- Headache, dizziness, impaired thinking; stupor, coma, seizure
- Hot flushed skin
- Hyperthermia
- Rapid, bounding pulse
- Hypertension, early stage, then drops

Care for Heat Stroke

- Move patient out of the hot environment


- ABCD, O2
- Keep the patient cool
Remove the patients clothing
Provide air conditioning at a high setting
Apply cold packs to the patients neck, armpits, and groin
Cover the patients with wet towels or sheets
Aggressively fan the patient
- IV line KVO
- Cardiac monitor
- Treat seizures

Hypothermia

- Lowering of the body temperature below 95F (35C)


- Elderly persons and infants are at higher risk
- People with other disabilities with other illnesses and injuries are susceptible to hypothermia

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Bio-Crisis Ms. Lina Navarro
S/Sx

Mild

- Conscious, apathetic, lethargic


- Shivering
- Rapid pulse and respirations
- Pale, cyanotic skin, cold to touch
- May have acetone odor to breath

Severe

- Unconscious or stuporous
- Shivering stops
- Weak or absent V/S
- Muscular activity decreases
- Fine muscle activity ceases
- Eventually, all muscle activity tops
- Pupils unreactive

Hypothermic Patient is Not Dead, until he is Warm and Dead

Frost Bite

- Freezing of a body part; ears, nose hands and feet

Emergency Care

- Remove patient from cold environment


- Remove wet clothing, cover with blankets
- Passive rewarming
Immerse the frostbitten extremity at 37.7-40.6G. Gently Dry
- Recumbent position, do not elevate legs
- Very gentle handling VF
- Give warm, humidified oxygen; assist ventilations prn
- Sugar and sweets, warm fluid
- Assess pulse for 30-45 seconds before considering CPR

Frostbite Donts

1. Dont rub snow in a frostbitten part


2. Dont massage or rub the area
3. Dont use dry or radiant heat for rewarming
4. Dont rupture blisters
5. Dont apply ointments to frostbitten skin
6. Dont apply tight bandages
7. Dont allow a thawed extremity to refreeze
8. Dont handle a frostbitten extremity roughly
9. Dont allow the patient to smoke, eat, or use any stimulants

Drowning and Near Drowning

- Drowning
Death as a result of suffocation after submersion in water
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Bio-Crisis Ms. Lina Navarro
- Near Drowning
Survival, at least temporarily, after suffocation in water

***Freshwater

***Saltwater

Emergency Medical Care

- Do not enter the water to save a drowning victim if you are not a qualified swimmer
- Begin rescue breathing as soon as possible, even before victim is removed from the water
- Continue AR and remove victim from water
- Maintain cervical spine stabilization
- If air does not enter the patients lungs, treat for obstructed airway
- Check pulse and start CPR if needed; intubate and administer O2
- IV line, drugs (bicarbonate)

Poisoning

- Ingested treat for shock


- Inhaled move to fresh air immediately
- Absorbed remove from patient as rapidly as possible
- Injected impossible to remove or dilute once injected
Stings or bite

Ingested Position

- Poison Control Center PGH, IDH


- EMS
- ABCDs
- Left side-lying
- NPO (except acid or alkali)
- Never induce vomiting until told to do so
- Send samples
- Kerosene ingestion pneumonitis

Identifying Patient and the Poison

If you suspect poisoning, ask the patient the following poison

- What substance did you take?


- When did you take it or (become exposed to i)?
- How much did you get?
- What actions have been taken?
- How much do you weigh?

Food Poisoning

- Ingestion of food that contains bacteria, toxins or chemicals


- Salmonella bacterium causes severe GI symptoms within 72 hours
- Staphylococcus is a common bacteria that grows in foods kept too long
- Botulism often results from improperly canned foods
- Dehydration, shock. Rehydrate

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Bio-Crisis Ms. Lina Navarro
Drugs and Alcohol

- Aspirin acid
N/V, hyperventilation, tinnitus, confusion, seizures, coma, fever, sweating
Induce vomiting; inactivated charcoal; NaHCO3
- Acetaminophen
Generally not very toxic
Liver failure might not be apparent after a full week
- CNS depressants alcohols, narcotics
Main concern is respiratory depression
Airway clearance and ventilatory support
- Stimulants cocaine, metamphetamines
Cardiac arrhythmias, seizures
Violent, burn out and crash

Inhaled Poisons

- Carbon monoxide tasteless, colorless, odourless; mild drowsiness to coma


Formed by incomplete combustion of gasoline, coal, kerosene, plastic, wood and natural
gas
- Freons cardiotoxic
- Glue similar to alcohol intoxications

First Aid

- Move to fresh air immediately (150ft)


- ABCDs

Absorbed-Cholinergic Agents

- Nerve agents for warfare


- Overstimulates parasympathetic nervous system
- Me be treated as a HazMat incident
- Ingested wild mushrooms, organophosphate insecticides
- Inhaled sarin gas

First Aid

- Avoid exposure; wear gloves


- Decontaminate
- Decrease the secretions in the mouth and trachea
- Provide airway support
- Atropine sulfate

Insect Bites and Stings

- Anaphylactic reactions to stings


Histamine is a potent arterial dilator
- Death from insect stings outnumber those from snakebites
- Venom is injected through stinging organ
- Some insects and ants can sting repeatedly

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Bio-Crisis Ms. Lina Navarro
Assess

- Respiratory system
Bronchospasm and wheezing, dyspnea
Chest tightness and coughing
- Circulatory system
Hypotension
- Mental status
Anxiety
- Skin
Swelling of the lips and tongue
Itching and burning
Widespread urticaria
- Muscle Spasms, cramps

General First Aid

- Standard airway procedures


- Give oxygen
- History of allergies
- Baseline vital signs
- Epinephrine, steroids

Snake Bites

- Minimize all activity. Do not let the victim walk


- Clean wound with soap and water; splint
- Maintain extremity at heart level, do not elevate
- Apply cool compresses, not ice
- Australian wrap
- Transport
- Oxygen, monitor, IV
- Watch, constrictive bands, bandages, splints, are carefully for vascular compromise secondary to edema

Snakebite Management

Do NOT

- Apply ice
- Apply arterial tourniquet
- Cut and suck
- Use electrical shock
- Actively attempt to locate a venomous snake
- Bring a live venomous snake to the hospital

Spiders

- Neurotoxin (muscle spasms)


- Local necrosis

Bee Stings

- Anaphylactic reactions in some

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Bio-Crisis Ms. Lina Navarro
- Remove stinger by scraping it out
- Cold compress or ice
- Diphenhydramine, H2 Blockers, Epi
- Research has shown that the best course of action is to pull the stinger out as soon as possible with your
fingers
- The remaining venom in the sac of the stinger does not increase the reaction should you inadvertently push
more venom into your wound

Scorpion Stings

- Allergic reactions same with bees


- the bigger, the better, the small ones, dont keep it to yourself
- Ice at the bite site and elevation
- Muscles spasms may occur in severe cases
- Calcium Gluconate, bed rest and NPO for the first 24 hours
- Anti-venom is available for severe reaction but rarely needed. Do not skin test

Coelenterate

- Nematocysts venom glands


- Functions even when separated
- Sea water, vinegar, baking soda deactivates the toxin
- Irrigate with hot water/soak for 30 minutes

Emergency Care for Severe Burns

- Move the patient away from the burning area


- ABCDs, O2
- Immerse the affected area in cool sterile water or saline solution for 10minutes
- Gently remove any rings, watches, belts or constricting clothing from the injured area before it starts to
swell
- Cover with a cool, wet dressing
- Prevent body heat loss
- Rapidly estimate burn severity
- Check for traumatic injuries
- Cover the injured area with clean, preferably sterile, non-fluffy material
- A burnt face may be covered with a gauze mask, with holes cut into it to assist the victims in breathing
- Do not break blisters or remove anything that is sticking to a burn
- Do not apply lotions, ointments or fat to the injured area
- Call EMS for severe burns
- Treat the patient for shock, IVF
- Silver nitrate, flammazine
- Tetanus

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