PART 1

CEREBROVASCULAR ACCIDENT/ TRANSIENT ISCHEMIC ATTACK

Medical term for stroke.
What is a stroke? It is a condition that develops when blood rich in oxygen can NOT reach brain cells (due to
either a blockage or bleeding). This causes the brain cells to die.
Type of Strokes

–Ischemic (most common): due to a blood clot within a blood vessel or stenosis of an artery that feeds the brain
tissue. This limits the blood that can reach the brain cells. This type of stroke can happen due to:

 Embolism: where a clot has left a part of the body (example the heart: this can happen due to a heart
valve problem or atrial fibrillation). The clot develops in the heart and travels to the brain, which
stops blood flow.
 Thrombosis: Clot forms within the artery wall within the neck or brain. This is seen in patients with
hyperlipidemia or atherosclerosis
–Hemorrhagic: this occurs when there is bleeding in the brain due to a break in a blood vessel. Therefore, no
blood will perfuse to the brain cells. In addition, this can lead to excessive swelling from the leakage of blood in
the brain. Causes of this type of stroke includes: brain aneurysm, uncontrolled hypertension, or aging blood vessels
(older age).

TRANSIENT ISCHEMIC ATTACK (TIA)

 also called a mini stroke. This is where signs and symptoms of a stroke occurs but last only a few minutes
to hours and resolves. It is a warning signs an impending stroke may occur.
 A neurologic deficit typically lasting less than 1 hour. It’s reversible and temporary.
 A TIA is manifested by a sudden loss of motor, sensory, or visual function. The symptoms result from
temporary ischemia (impairment of blood flow) to a specific region of the brain but when brain imaging is
performed there is no evidence of ischemia.
 Lack of evaluation and treatment of a patient who has experienced previous TIAs may result in a stroke and
irreversible deficits

Now strokes tend to affect ONE side of the body.

The right side of the brain is the CREATIVE side while the left side is the LOGICAL side.

Right Side’s Functions:

 Attention span
 Showing emotions
 Ability to solve everyday problems by making decisions/plans
 Reasoning (understanding jokes…reading in between the lines)
 Memory
 Music/art awareness
  Control the left side of the body
If a patient has  right side brain damage,  what do you think the patient will experience?

 Left side weakness: Hemiplegia

 Impairment in creativity: arts and music
 Confused on date, time, place
 Cannot recognize faces or the person’s name
 Loss of depth perception
 Trouble staying on topic when talking
 Can’t see things on left side: LEFT SIDE NEGLECT (unilateral neglect)

o (Ignores left side of body)

 Emotionally: not going to think things through….very impulsive
 Poor ability to make decisions and assessing spatial qualities….shapes
 Denial about limitations
 Not able to read nonverbal language or understand the hidden meaning of things
 Very short attention span
Left Side’s Functions:

 Speaking
 Writing
 Reading
 Math skills
 Analyzing info
 Planning
If a patient has  left side brain damage,  what do you think the patient will experience?:

 Right side Hemiplegia
 Aphasia (trouble formulating words and comprehending them)
 Aware of their limits…experiences depression, anger, frustration
 Trouble understanding written text
 Can’t write (agraphia)
 Impaired math skills
 Issues with seeing on the right side

Risk Factors for stroke

 Smoking
  Thinners (blood)
 Rhythm changes (a-fib/flutter)
 Oral Contraceptive
 Kin (family history)
 Excessive weight
 Senior citizens
 Hypertension
 Atherosclerosis
 Physical inactivity
 Previous TIA
 Elevated blood sugar (diabetes mellitus)
 aNeurysm (brain)

Signs and Symptoms of a Stroke

Happens suddenly: need to act fast as the nurse to help save brain cells

 call rapid response so patient can receive appropriate treatment or call 911 (if outside of the hospital
in the United States)
 NOTE the exact time the signs and symptoms appears…important for stroke treatment

“FAST”  

 Face: drooping or uneven smile

 Arm: numbness, weakness, drift (raise both arms)
 Speech: can’t repeat a phrase, slurred speech
 Time: to call rapid response and note the time

The patient can also have the following as well:

 Bowel and bladder incontinence or retention

Important Stroke Terms:

 Aphasia: unable to speak (comprehending or producing it)

 Dysarthria: unable to hear speech clearly due to weak muscles (hard to understand the patient’s
speech….it may be slurred)
 Apraxia: can’t perform voluntarily movements (winking/moving arm to scratch an itch) even though
muscles function is normal.
 Agraphia: loss the ability to write
 Alexia: loss the ability to read…doesn’t understand or recognize the words
 Agnosia: doesn’t understand sensations or recognize known objects or people
 Dysphagia: issues swallowing (weak muscles)
 Hemianopia: limited vision in half of the visual field
 Hemiparesis: weakness on one side of the body

Diagnosed?

 CT scan
  MRI
Medication for Ischemic Strokes:

 TPA (tissue plasminogen activator): for ischemia strokes ONLY not hemorrhagic!

How does it work? It dissolves the clot within the blood vessel by activating the protein that causes fibrinolysis.

Nurse’s Role: monitor for BLEEDING, neuro checks around the clock, blood pressure medication if needed for
hypertension, vital signs, labs, glucose, preventing injury (bedrest), avoid unnecessary venipunctures, avoid IM
injections, will go to ICU to be monitored

Nursing Interventions for Stroke

Monitor vital signs and neuro status:

 especially blood pressure (notify MD is hypertensive)

 airway (difficulty swallowing….at risk for aspiration HOB 30’ with suction at bedside)
 turn every 2 hours with proper alignment and watch for increased ICP (intracranial pressure) during
acute stage

o headache, nausea and vomiting, increased blood pressure and decreased HR and
decreased RR, decrease in mental status from baseline, pupils don’t respond

 Thrombolytic Agents
 Aspirin
 Anticoagulants
 Antiplatelets
 Statin
 Ace inhibitors
 Angioplasty and stents

For hemorrhagic
 Surgical clipping
 Coiling
ANGINA PECTORIS
 A clinically syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior
chest.
 There’s partial obstruction of the artery and it is still has the capacity to supply some part of the heart
muscles.
 Main problem is deprivation of oxygen, it means it deprives oxygen directly in the myocardium.
AG- deprivation of oxygen in the myocardium but directly in the muscle of the heart.
Warning signs of impending doom – MI
- Narrowing of the arteries

PATHOPHYSIOLOGY
Narrowing or partial obstruction of the artery ----- increase oxygen demand, decrease supply of oxygen (because of
the narrowing) ----- (leads now to) ---- Ischemia ----- (once ischemia is developed, there would be) reduction in the
pumping functions of the heart -------further deprive the cells from oxygenation, not just only in the heart but rather
throughout the body ----- (the body will try to compensate through) Anaerobic Metabolism ----- (the body is trying
to fix the pumping of the heart and the supply of the oxygen) ----- (waste or by product known as) Lactic Acid ----
(lactic acid would accumulate now to the heart that would lead now to the ---- (development of) pain or chest pain
--- ANGINA PECTORIS

Hallmark symptoms
 Chest pain – that could alleviate or relieve by rest and responsive to Nitroglycerin
 Nitroglycerin – potent vasodilator --- 5 minutes interval (3 doses)
 Sublingual, buccal (outside
 IM, IV (inside the hospital)
 Palpitations
 Pain in retrosternal that radiates to jaw and left arm
 Indigestion – 50 years up
 Heart burn
 Other signs and symptoms– nausea, fatigue, shortness of breath, sweating, dizziness
Treatment
 Nitroglycerin
o Side effects: headaches, burning sensation, tingling sensation
o Prevent patient to walk or stand because prone to develop orthostatic hypertension
o Patient will have a Flush face
o Avoid sunlight exposure
o Do not keep to wallet to avoid tearing
o Replace 4 to 6 mons so that drug is still potent
 Anticoagulation
  Antiplatelet

Surgical management
 Angioplasty
 Coronary artery bypass surgery

AP
REST ----- OXYGENATION ------ NITROGLYCERIN

ANOTHER TYPES
 Stable angina ----
 Unstable angina – relive by surgical management only --- lead to MI
 Intractable or refractory angina
 Variant angina
 Silent ischemia

MYOCARDIAL INFARCTION
-it when there is limited blood supply to the myocardial tissue that causes it to die or become necrotic or necrose 
-the most common cause is blockage in a coronary artery due to coronary artery disease, or uncontrolled
hypertension 
-what happens is that the coronary artery it constricts and when that happens no blood supply going to the heart
muscles so it starts to die.
From total obstruction led to necrosis (death of the cells in the heart). Happens more than 15 minutes
It could lead now to the death of myocardial cells from inadequate oxygenation due to the complete or total
blockage of the arteries.
- Irreversible – once the muscle or tissue is dead, it is really dead, the dead cells could lead to scarring of the
heart muscle (fibrotic tissue muscle). Life- threatening, emergency type
- GI involvement – general compensation, the body will try to compensate, so oxygen is directly to the
important systems
o Decrease supply in mesenteric artery

 Pain is not relieved with rest and nitroglycerin

 Same with angina pectoris manifestation – cold clammy skin, nausea and vomiting, dyspnea

Signs and Symptoms 

  -intense chest pain (women may not have a heavy chest pain but they feel shortness of breath and have pain
in the lower part of their chest, and they feel fatigued)
 -radiating chest pain (left arm, the jaw or the back)
 -chest pain is unrelieved by nitroglycerin or rest
 -cold sweat
 -difficulty in breathing or shortness of breath 
 -increased heart rate or blood pressure 
 -nausea and vomiting 
 -anxious and scared 
Laboratory test
 Troponin I – confirmatory test, would only increase if the injury is in the heart muscle.
 Troponin P
 Creatinine kinase – mb, mm, bb – does not detect
 Assess the problems that involve the heart
 Isoenzymes
 Myoglobin
Further management
 Shunting
 Angiography
 PTCA – percutaneous transluminal coronary angiography
 bypass draft - cabg

Management
 oxygenation
 Morphine
 Lidocaine – for ventricular fibrillation (deadliest arrythmia)
 Anti-arrythmias drugs
 Monitor intake and output (more than 30ml)
 Betablocker
 Aspirin
 Anticoagulant
 Calcium channel blockers
 Beta-adrenergic blockers- watchout heart rate of the patient
o Main purpose – reduction of the stimulation of the heart to pump, but it increases the contractility.
 Vasodilators
 No valvalsa maneuver
 Increase hydration
 Provide food rich in fiber

Complications
 Cardiogenic shock
 Heart failure
HEART FAILURE
- it is used to describe when a body cannot supply enough blood to meet the body’s demand.

This can happen in 2 ways, either the hearts’ ventricles can’t pump blood hard enough during systole,
called the SYSTOLIC HEART FAILURE or not enough blood fills the ventricles during diastole called
the DIASTOLIC HEART FAILURE
In both cases, blood backs up into the lungs, causing congestion or fluid build-up which is why it’s also
often known as congestive heart failure or just CHF.

Major classification or two types; systolic and diastolic

diastolic heart failure
The main problem is on the filling of the blood on the chamber means the heart could not fill in properly there or it
could there is problem on the muscle as to receiving the supposed to be preload from inferior or superior venacava.
systolic heart failure, the heart’s ability to eject, ability to contract and pagawas the blood throughout the
circulation. The main problem is the ejection of the blood from the left side ventricle throughout the body.
Complications – hepatomegaly, splenomegaly, jugular vein distention

CLINICAL MANIFESTATIONS
RIGHT SIDED HEART FAILURE AND LEFT SIDE HEART FAILURE

Left SIDED HEART FAILURE – usually systolic

Systolic problems that may lead to left side heart failure –
 coronary artery disease, it damages now the myocardium it could lead to heart attack. When there are
chances of heart attack, there is also scar tissue formation (fibrosis) or fibrotic tissues in the chambers of the
heart, the contractility now will be decrease and that lead now to the left sided heart failure, problem in
contraction and at the same time systolic heart failure, it is because of the fibrotic tissue created of the
CAD. The muscle could no longer stretch as it was.
 Hypertension – (could be both in diastolic and systolic), increase arterial pressure, so that heart would pump
harder to compensate and as a result of working or pumping hard, the cells in the heart would try to
remodel it, and they would develop hypertrophy, it means purpose is to be able to pump the heart harder as
it was. Once there is hypertrophy, it means that it could also lead now to squeezing of the arteries and it
 could also squeeze now the chamber of heart lead to the decrease supply of oxygen to the muscle for
contraction. Decrease contractility means the ejection of the blood from the chamber is compromised and
this is related to systolic heart failure and left side heart failure due to its location.
 Dilated cardiomyopathy
Diastolic problems
 Hypertrophic cardiomyopathy –
 Aortic stenosis
 Hypertension

Left sided HEART FAILURE

Clinical manifestation
The affected area is on the left chambers of the heart, it could be the left ventricle or left atrium
Common manifestation is pulmonary congestion, (there is a fluid buildup directly on the pulmonary or respiratory
system.)
 Respiratory or pulmonary manifestation- crackles, chest pain, edema (pulmonary congestion), cough,
extra heart sounds such as ventricular gallop (due to the backflow and the filling of the blood), decrease
cardiac output.
 It could also affect the renal system – fluid retention
 Pulmonary embolism, cough colds

Medications
 Oxygenation
 ACE inhibitors
 Diuretics
 Focus on the main cause -

RIGHT SIDED HEART FAILURE

the main problem is already now in the right chamber of the heart. Often caused by the left sided heart failure
causes
- Shunt (severe types of v/q mismatch)
- Chronic lung disease
Manifestation is systemic congestion, (the chamber cannot fill or receive enough from venacava, the excess fluid or
back flow could) lead now to jugular vein distention.
(backflow) – to liver and spleen, the patient would develop hepatomegaly and splenomegaly, ascites
(Preload decrease) – decrease cardiac output
- Peripheral edema. Worst cases the patient would develop generalized edema (anasarca)
Commonly due to left sided failure, left follow the right (highest rate)

CARDIAC TAMPONADE
Cardiac tamponade is compression of the heart resulting from fluid or blood within the pericardial sac. It usually is
caused by blunt or penetrating trauma to the chest.
Life threatening Complications of heart failure.
(Pericardial effusion) There is excess fluid in the pericardium. Once there are excess fluids in the pericardium,
cardiac tamponade happens. It means the chambers now will be compress and the heart could no longer pump
properly as it was. In effect with it, there will be always decrease cardiac output.
Clinical manifestation
 Pulsus paradoxus (paradoxical pulse) – decrease of systolic blood pressure
 Hypotension
 Jugular vein distention
 Muffled heart sounds
Dx:
 EKG
 chest x-ray

Treatment
 Pericardiocentesis - Remove the fluid of the pericardial effusion.

COR PULMONALE
Complications that may arise due to the heart failure and the involvement of the pulmonary in nature problem in
the right sided failure.
With COR PULMONALE, COR is Latin for heart and PULMONALE is Latin for lungs. Its when a disorder of the
lungs causes dysfunction of the heart. Normally, deoxygenated venous blood from the body goes into the right
atrium of the heart. From there, it goes into the right ventricle and gets pumps into the lungs where it is
reoxygenated as it goes through the pulmonary circulation.
The pulmonary circulation is a low-resistance system with pressures ranging between 10mmhg and 14mmhg. After
going through the lungs, oxygenated blood goes into the left atrium, and then into the left ventricle, and finally gets
pumped back out to the body. When the heart can’t pump enough blood to meet the body’s demands, it’s initially
called heart dysfunction and can worsen to the point where it’s called heart failure. This can happen in two ways,
either it’s systolic heart failure, where ventricles can’t pump blood hard enough during systole or diastolic heart
failure, where not enough blood fills the ventricles during diastole.
COR Pulmonale is when a lung disorder causes right sided heart dysfunction that can develop into right sided heart
failure. Lung disorders make it harder to oxygenate the blood, which can lead to hypoxia, or low oxygen levels. In
response, this triggers a process called hypoxic pulmonary vasoconstriction.
Let’s say you have a couple pulmonary arterioles, meaning they’re in the lungs, and there is alveoli of the lung, and
oxygen exchange between the two. If one of these alveoli is poorly ventilated, the corresponding arteriole
vasoconstricts to divert blood away from it. This works pretty well, but when lots of alveoli are poorly ventilated
like with a lung disorder, they all start to vasoconstrict and the mechanism backfires. When lots of arterioles
vasoconstrict together, there’s an increase in resistance and it leads to pulmonary hypertension – with the
pulmonary blood pressure rising above 25 mmHg. The high pulmonary pressure makes it hard for the right
ventricle to pump blood into the pulmonary circulation.

Cor Pulmonale results from pulmonary hypertension, which typically comes from one of three categories of
disease –
 something that damages the lung tissue, like chronic obstructive pulmonary disease
 something that damages the pulmonary vessels themselves, like chronic thromboembolisms or recurrent
blood clots
 something that affects the spine or ribcage, like kyphoscoliosis, where the spine is curved and the lungs
can’t fully expand

Symptoms - related to backflow of blood in the venous system

 Severe shortness of breath
 Fatigue
 Fainting
 Jugular venous distention
 Hepatomegaly
 Edema
Diagnosis
 Echocardiogram
 Spirometry
 Right heart catherization
Treatment
 Treat the underlying condition – target lung disease
 Supplemental oxygen
COR PULMONALE is right heart hypertrophy, dysfunction or caused by pulmonary hypertension from lung a
condition. This results in systemic fluid congestion leading to jugular venous distention, hepatomegaly, and edema.

PART 2

RESPIRATORY FAILURE (HYPOXEMIC AND VENTILATORY)

- the respiratory system has one major task and that is to facilitate gas exchange of oxygen and carbon dioxide
however in acute respiratory failure this function is limited or completely non-functional
-there are two types of respiratory failure hypoxemic respiratory failure and hypercapnic or ventilatory respiratory
failure

Pathophysiology of Hypoxemic

-for the hypoxemic respiratory failure this is also known as oxygenation failure, normally oxygen is inhaled goes to
the alveoli and effaces within the pulmonary blood vessels.

-but in hypoxemic respiratory failure that is simply compromised

-hypoxemic respiratory failure is defined as a partial pressure of oxygen or pao2 (The partial pressure of oxygen,
also known as PaO2, is a measurement of oxygen pressure in arterial blood.) of less than 16 millimeters of
mercury despite the fact that we are given the patient at least 60% of fraction of inspired oxygen

-again a PAO2 of less than 60 mmhg despite an Fraction of inspired oxygen of at least 60%

-now there are 4 major physiologic events in hypoxemic respiratory failure they are:

- ventilation/perfusion mismatch also known as the VQ mismatch V refers to the ventilation and it is the amount
of gas that reaches the alveoli, Q refers to the perfusion and it is the amount of blood perfusing the lungs.

-so basically the amount of gas that reaches the alveoli is equal to the volume of blood that is perfusing the lungs.
Meaning if there’s 4ml of oxygen going to the alveoli there should be also 4ml of blood receiving this oxygen

-so if this fails to match, we have a ventilation/perfusion mismatch

-pneumonia could be the cause of this, asthma, COPD and pain. ARDS

-shunting it is an exaggerated VQ mismatch meaning there’s no gas exchange that is happening in shunting, the
blood exits the heart without participating in gas exchange
-can be caused by conditions such as ARDS and septal defects of the heart

-diffusion limitation happens when the alveolar membranes thicken or get destroyed

-there’s gas exchange however, as the name implies it is limited

-classic signs is hypoxemia during exercise but not during rest

-and alveolar hypoventilation (thickening of the alveoli’s lining) it is a mechanism of hypercapnia respiratory
failure, this condition will eventually lead to hypoxemia

Pathophysiology of the Hypercapnic Respiratory failure

-to understand fully we will talk about ventilator supply and the ventilator demand

-first, the ventilatory supply is the maximum ventilation that a body can sustain without developing respiratory
muscle fatigue

-the second is the ventilatory demand this is the amount of ventilation needed to keep the PaCO2 within normal
limits

-we will put this 2 together, normally the respiratory supply is always greater than the respiratory demand

-like we breathe about 16 to 20 breathe per minute at rest, during exercise this increases to about 40-50 breathe per
minute. And even with that sudden increase the supply is still always greater than the demand. That simply means
that under normal condition even with rapid respiration we still won’t go beyond the supply.

-the problem occurs when we have obstructive disease such as COPD or bronchitis

-because of the obstruction there’s less Carbon exhaled, our body then breathes double time in an attempt to release
the excess CO2

-the increase in respiration is so great that eventually the respiratory demand exceeds respiratory supply, exceeding
the respiratory supply causing the respiratory muscles a fatigue which eventually leads to respiratory failure.

HALLMARK SYMPTOMS
 Increase carbon dioxide level
 Inability of respiratory system to function properly as it delivers carbon dioxide outside
 Decrease oxygenation pasulod sa alveoli

3 COMMON FACTORS VENTILATORY failure

 Problem of resistance to moving air in and out the lungs – asthma,
 Impaired ability of the lungs to expand and contract – elastic recoil problem, common in COPD
 Condition that increases the production of carbon dioxide and decrease the surface available for exchange
of gases –
 another factor – impaired transmission of signal to the chest diagram or muscles fatigue – involvement of
the CNS, drug toxicity, direct trauma
Signs and Symptoms

-respiratory failure can be acute or chronic, acute is sudden and can be a life-threatening emergency example is: a
child with asthma and suddenly experiencing bronchospasm

-chronic is tolerated better because changes are not sudden which allows ample time for the kidneys to compensate
changes in arterial ph

-manifestations varies according to the onset and whether it is acute or chronic

-early signs: change in mental status, tachycardia, tachypnea, and mild hypertension, the patient could become
restless, confused or agitated because our brain is very sensitive to variation of oxygenation.

-For Hypoxemic we have paradoxical breathing, retractions, cyanosis, nasal flaring and tachypnea

-for hypercapnia we have pursed lip breathing, morning headache, rapid and shallow breathing

Diagnosis

-physical assessment

-Arterial Blood Gasses (ABGs) allow us to determine the patients oxygenation and ventilation status

-pulse oximeter

-chest x ray

-CBC, serum electrolytes, urinalysis, and culture can help identify the cause and what might be the consequence of
this condition

-EKG for monitoring the heart

-V/Q scan to rule out pulmonary embolism

Nursing intervention

-physical: positioning (elevate tour patient head at least 45degrees to help expand the lungs if your patients has
secretions you can position them laterally) laterally or side lying for good lung down allows postural drainage and
prevents aspiration

-if you need to suction the patient make sure you hyperventilate in between suctions, suction for only 10 seconds
with a total of 15 seconds including the insertion of catheter make sure to watch for increased intracranial pressure

-hydration (through mouth or through IV)

-nutrition since they are risk for aspiration tube feeding or parenteral nutrition

-Oxygenation

-bronchodilators
-mucolytics

Nursing diagnosis
Impaired gas exchange
Ineffective airway clearance
Ineffective breathing pattern

Interventions
Physical
 Positioning – side lying or lateral position with the good lung down,
 Postural drainage
 Prevent aspiration
 High or low fowlers position
 CTT
Chemical
 Bronchodilators
 Corticosteroids
 Antibacterial
 antiviral,
 oxygenation – watch out for oxygen toxicity or barrow trauma
 iv or parental – watchout overload (manifestation crackles)

Supportive therapy
ACUTE RESPIRATORY DISTRESS SYNDROME / ATELECTASIS
One of the main causes that would develop respiratory failure and one the factors that would lead to hypoxemia.
Main problems are the capillary membrane surrounding the alveolar or alveolus due to inflammation or severe
burns, any lung injuries that activated the inflammatory response. Once activated, permeability occurs lead to cell
damage, constriction of vessels. There is hypoxemia on the end stage.
There is a capillary membrane problem that is surrounding the alveolar or alveolus, it has an injury and most likely
lead to inflammation, and if there is inflammation it would alter now the permeability membrane of that area. Most
likely occur when there is sepsis or septic shock or severe trauma that would to general inflammatory infections.
Pathophysiology

 severe shortness of breath

 labored and unusually rapid breathing
 confusion and extreme tiredness
ARDS is combination of four damages or symptoms could be found – Atelectasis, Refractory hypoxemia, decrease
lung compliance because of the assault of the tissues, Surfactant cell damage
Management
 Mechanical ventilation and peep (positive end expiratory pressure) – watchout for complications of barrow
trauma, intrathoracic pressure
 Intubation
Nursing Interventions
 Prone position for the patient, because the heart kay ma pull down gamay and it will not compress the lung
or respiratory system
 Monitor intake and output, if modecrease ang oxygenation moworse ang hypoxemia it will affect the renal
system, it means oliguria or anuria is happening
If nag ka gamay ang output means grabe ang hypoxemia, the kidney is trying to compensate by holding the
water inside the body that would increase now the cardiac output and will be able to supply throughout the
body
Complications
 Progressive stage pulmonary edema
 Atelectasis
 Confusion

Medications
  corticosteroids (help with inflammation),
 antibiotics (preventing and treating infection),
 fluids colloids or crystalloids solutions if cardiac output decreased along with drugs like that have an
inotropic effect (helps with heart muscle contraction),
 GI drugs for stress ulcers
Prevent GI problems – GI drugs

ARDS symptoms could be found – Atelectasis, refractory hypoxemia, decrease lung compliance it’s because of the
stiffness and the hardened of the tissues and the cells in the lungs, surfactant cell damage or collapse.

ATELECTASIS
- Atelectasis refers to closure or collapse of alveoli or A complete or partial collapse of a lung or lobe of a
lung
- May occur as a result of reduced ventilation or any blockage that obstructs passage of air to and from the
alveoli, thus reducing alveolar ventilation.
- May develop because of excessive pressure on the lung tissue, which restricts normal lung expansion on
inspiration.
CAUSES

Atelectasis occurs from a blocked airway (obstructive) or pressure from outside the lung (nonobstructive).

General anesthesia is a common cause of atelectasis. It changes your regular pattern of breathing and affects the
exchange of lung gases, which can cause the air sacs (alveoli) to deflate. Nearly everyone who has major surgery
develops some amount of atelectasis. It often occurs after heart bypass surgery.

Obstructive atelectasis may be caused by many things, including:

 Mucus plug. Accumulation of mucus in the airway

 Foreign body. Inhaled an object, such as peanut

 Narrowing of major airways from disease. Chronic infections

 Tumor inside the airway. 

Possible causes of nonobstructive atelectasis include:

 Injury. Chest trauma — from a fall or car accident, for example — can cause you to avoid taking
deep breaths (due to the pain), which can result in compression of your lungs.
  Pleural effusion. This condition involves the buildup of fluid between the tissues (pleura) that line
the lungs and the inside of the chest wall.

 Pneumonia. Various types of pneumonia, a lung infection, can cause atelectasis.

 Pneumothorax. Air leaks into the space between your lungs and chest wall, indirectly causing some
or all of a lung to collapse.

 Scarring of lung tissue. Scarring could be caused by injury, lung disease or surgery.

 Tumor. A large tumor can press against and deflate the lung, as opposed to blocking the air passages.

SIGNS AND SYMPTOMS

 Difficulty breathing (dyspnea)
 cough
 sputum production
 tachycardia
 tachypnea
 pleural pain
 central cyanosis
 decreased breath sounds and crackles are heard over the affected area

ASSESSMENT AND DIAGNOSTIC FINDINGS

 Chest x-ray
 Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen (less than 90%) or a
lower-than-normal partial pressure of arterial oxygen (PaO2).

Complications

 Low blood oxygen (hypoxemia). 

 Pneumonia. 
 Respiratory failure. 

MEDICAL MANAGEMENT
 Antibiotics
SURGICAL MANAGEMENT
 Bronchoscopy
PART 3
BURNS
Wounds produced by various kinds of thermal, electrical, radioactive, or chemical agents which kill cells by
changing the protein substance of the cell.
Causes
First Degree (Superficial)
 Sunburn
 Low-intensity flash
 Superficial scald
Skin involvement
 Epidermis
Clinical manifestations
 Tingling
 Hyperesthesia (hypersensitivity)
 Pain that is soothed by cooling
 Peeling
 Itching
Wound appearance
 Reddened: blanches with pressures; dry
 Minimal or no edema
 Possible blisters
Recuperative Course and Treatment
 Complete recover within a few days
 Oral pain medications, cool compresses, skin lubricants (ointment), topical antimicrobial agent

Second degree (partial thickness)

 Scalds
 Flash flame
 Contact
Skin involvement
 Epidermis, portion of dermis
Clinical manifestations
 Pain
 Hyperesthesia
 Sensitive to air current
Wound appearance
 Blistered, mottled red base, disrupted epidermis, weeping surface
 Edema

Treatment
  Recovery in 2-3 weeks
 Some scarring and depigmentation possible, may require grafting

Third degree (full thickness)

 Flame
 Prolonged exposure to hot liquids
 Electric current
 Chemical
 Contact
Skin involvement
 Epidermis, dermis and sometimes subcutaneous tissue, may involve connective tissue, and muscle.
Clinical manifestations
 Shock
 Myoglobinuria (red pigment in urine) and possible hemolysis (blood cell destruction)
 Possible contact points (entrance or exit wounds in electrical burns)
Wound appearance
 Dry, pale white, red brown, leathery or charred
 Coagulated vessels may be visible
 Edema
Treament
 Grafting necessary
 Scarring and loss of contour and function

Fourth degree (full thickness that includes fat, fascia, muscle and/or bone)
 Prolonged exposure or high voltage electrical injury
Skin involvement
 Deep tissue, muscle and bone
Clinical manifestations
 Shock
 Myoglobinuria (red pigment in urine) and possible hemolysis (blood cell destruction)
Skin apperance
 Charred
Treatment
 Amputations likely
 Grafting of benefit, given depth and severity wounds
Management of burn injury
 Emergent or resuscitative phase – from onset of injury to completion of fluid resuscitation
o Priorities: first aid (abcde), prevention of shock, prevention of respiratory distress, detection and
treatment of concomitant injuries, wound assessment, and initial care
 Acute/ intermediate phase – from beginning of diuresis to near completion of wound care
o Priorities: wound care and closure, prevention, or treatment of complication, including of infection,
nutritional support.
 Rehabilitation phase – from major wound closure to return to individuals’ optimal level of physical and
psychosocial adjustment.
o Priorities: prevention of scars and contractures, physical, occupational, and cosmetic reconstruction,
psychosocial counselling

SHOCKS
 - Is a life-threatening condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to
support vital organs and cellular function.
- Results from cardiac failure, insufficient blood volume, increased vascular bed size.

Classification
o Hypovolemic shock
o Cardiogenic shock
o Distributive shock
o Septic shock
o Neurogenic shock
o Anaphylactic shock

STAGE OF SHOCKS
 COMPENSATORY STAGE
o The patients’ blood pressure remains within a normal limit. Vasoconstrictions, increase heart rate
and increased contractility of the heart contribute to maintaining adequate cardiac output. This result
from stimulations of the sympathetic nervous system and subsequent release of catecholamines
(epinephrine and norepinephrine). The patient displays the often-described "fight to flight' response.
o CLINICAL MANIFESTATIONS
 Despite a normal blood pressure, the patients show numerous clinical signs indicating
inadequate organ perfusions. The result of inadequate perfusions is anaerobic metabolism
and a buildup of lactic acid, producing metabolic acidosis.
o MEDICAL MANAGEMENT
 Medical treatment is directed toward identifying the cause of the shocks, correcting the
underlying disorder so that shocks does not progress, and supporting those physiologic
processes that thus far have responded successfully to the threat.
o NURSING MANAGEMENT
 a. monitoring tissue perfusion
 b. reducing anxiety
 c. promoting safety

 PROGRESSIVE STAGE
o In the progressive stage of shocks, the mechanisms that regulate blood pressure can no longer
compensate and the MAP falls below normal limits, with an average systolic blood pressure of less
than 90mm Hg.
o ASSESSMENT AND DIAGNOSTIC FINDINGS
 Chances of survival depend on the patient’s general health before the shocks state as well as
the amount of time it takes to restore tissue perfusion. As shocks progresses, organs systems
decompensate.
 a. respiratory effects
 b. cardiovascular effects
 C. neurologic effects
 d. renal effects
 e. hepatic effects
 gastrointestinal effects
 g. hematologic effects
 o MEDICAL MANAGEMENT
 These include use of appropriate intravenous fluids and medications to restore tissue
perfusion by: 1. optimizing intravascular volume 2. supporting the pumping action of the
heart 3. improving the competence of the vascular system
o NURSING MANAGEMENT
 a. preventing complications b. promoting rest and comfort C. supporting family members

 IRREVERSIBLE STAGE
o The irreversible stage (or refractory) stage of shocks represents the point along the shocks
continuum at which organ damage is so severe that the patients does not respond to treatment and
cannot survive.
o MEDICAL MANAGEMENT
 During the irreversible stage of shock is usually the same as for the progressive stage.
Although the patient’s conditions may have progressed from the progressive to the
irreversible stage, the judgment that the shocks are irreversible can be made of only
retrospectively on the basis of the patients failure to respond to treatment.
o NURSING MANAGEMENT
 The nurse focuses on carrying out prescribed treatments, monitoring the patients, preventing
complications, protecting the patients from injury, and providing comfort. Offering brief
explanations to the patients about what is happening is essential even if the there is no
certainty that the patients hear or understand what is being said.
Early signs
 Low bp
 Congested by increase heart rate
Compensatory
 Increase ADH
 Vasoconstriction
 Increase heart rate
 Low PH
Progressive signs
 Tissue hypoxia
 Cold extremities
 Oliguria
 CNS changes
 Low BP
Refractory stage
 Organ failure
 Low PH
 Death
Overall Management Strategies in Shock (management in all types and all phases of shocks includes the ff.)
A. fluid replacement to restore intravascular volume
B. vasoactive medications to restore vasomotor tone and improve cardiac function
 C. nutritional support to address the metabolic requirements that are dramatically increased in shock

HYPOVOLEMIC SHOCKS
o The most common type of shocks is characterized by decreased intravascular volume.
o Due to inadequate circulating blood volume resulting from hemorrhage with actual blood loss, burns with
a loss of plasma proteins and fluid shifts or dehydration with a loss of fluid volume
o 750-1000 ml of blood loss (4,500 to 5,700 ml)
o 15-25 percent decrease in intravascular volume
Symptoms
 Anxiety or agitation.
 Cool, clammy skin.
 Confusion.
 Decreased or no urine output.
 Generalized weakness.
 Pale skin color (pallor)
 Rapid breathing.
 Sweating, moist skin.

Risk Factor for Hypovolemic Shock

- Internal: Fluid Shifts, hemorrhage, burns
- External: Fluid losses, Trauma, Surgery, Vomiting, dehydration, Diarrhea, n Diabetes insipidus
MEDICAL MANAGEMENT
Depending on the severity of shocks and the patient’s conditions, it is likely that the efforts will be made to address
all three goals simultaneously.
a. treatment of the underlying cause
b. fluid and blood replacement
C. redistribution of fluid
d. pharmacologic therapy

CARDIOGENIC SHOCK
Cardiogenic shocks occurs when the heart’s ability to contract and to pump blood is impaired and the supply of
oxygen is inadequate for the heart and tissues. The cause of cardiogenic shocks is known as either coronary or
noncoronary.
PATHOPHYSIOLOGY
In cardiogenic shocks, cardiac output, which is a function of both stroke volume and heart rate, is compromised.
when stroke volume and heart rate decreased or become erratic, blood pressure drops, and tissue perfusion is
compromised.
CLINICALLY MANIFESTATIONS
Patients in cardiogenic shocks may experience angina pain and develop dysrhythmias and hemodynamic
instability.
MEDICAL MANAGEMENT
The goals of medical management are to:
1. limit further myocardial damage and preserve the healthy myocardium
2. improve the cardiac function by increasing cardiac contractility

CORRECTION OF UNDERLYING
The underlying cause of cardiogenic shock must be corrected. It is necessary first to treat the oxygenation needs of
the heart muscle to ensure its continued ability to pump blood to other organs.
INITIATION OF FIRST LINE TREATMENT
Involves the following actions:
a. supplying supplemental oxygen
b. controlling chest pain
c. providing selected fluid support
d. administering vasoactive medications
e. controlling heart rate with medications or by implementations of a transthoracic or intravenous pacemaker
f. implementing mechanical cardiac support (intra-aortic balloon counter pulsation therapy, ventricular assist
systems, or extracorporeal cardiopulmonary bypass)

CIRCULATORY/ DISTRIBUTIVE SHOCK

Circulatory or distributive shocks occurs when the blood volume is abnormally displaced in the vasculature. (a
network of blood vessels connecting the heart with all other organs and tissues in the body.)
Three type 1. septic shock 2. neurogenic shock 3. anaphylactic shocks

SEPTIC SHOCK
o is the common type of circulatory shock and is caused by widespread infection.
Symptoms of septic shock include:
 low blood pressure (hypotension) that makes you feel dizzy when you stand up.
 a change in your mental state, such as confusion or disorientation.
 diarrhoea.
 nausea and vomiting.
 cold, clammy and pale skin.
Management
 o broad spectrum antibiotic
o fluid replacement
o crystalloids, colloids and blood produce to increase intravascular volume
o nutritional support
o medical handwashing
o aseptic technique in invasive procedures
o monitor signs of infection

NEUROGENIC SHOCK
In neurogenic shocks vasodilation occurs as a result of sympathetic tone. Neurogenic shock is caused by damage
to the central nervous system, usually a spinal cord injury. This causes blood vessels to dilate, and the skin may
feel warm and flushed. The heart rate slows, and blood pressure drops very low.
MEDICAL MANAGEMENT
Treatment of neurogenic shock involves restoring sympathetic tone either through the stabilization of a spinal cord
injury or in the instance of spinal anesthesia, by positioning the patient properly. specific treatment of neurogenic
shock depends on its cause
NURSING MANAGEMENT
It is important to elevate and maintain the head of the bed at least 30 degrees to prevent neurogenic shock when a
patient is receiving spinal or epidural anesthesia. Elevation of the head of the bed helps to prevent the spread of the
anesthetic agent up the spinal cord.

ANAPHYLACTIC SHOCK
Cause by a severe allergic reaction when a patient who has already produced antibodies to a foreign substance
(antigen) develops a systematic antigen-antibody reaction.

Signs and symptoms

 skin reactions
 hypotension
 Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble
breathing.
 A weak and rapid pulse.
 Nausea, vomiting or diarrhea.
 Dizziness or fainting.

MEDICAL MANAGEMENT
Treatment of anaphylactic shock requires removing the causative antigen, administering medications that restore
vascular tone, and providing emergency support of basic life functions. Epinephrine is given for its
vasoconstrictive action. Diphenhydramine (Benadryl) is administered to reverse the effect of histamine.
NURSING MANAGEMENT
The nurse has an important role in preventing anaphylactic shock: assessing all patients for allergies or previous
reactions to antigen and communicating the existence of these allergies or reactions to other. The must be
knowledgeable about the clinical signs of anaphylaxis, must take immediate actions if signs and symptoms occur,
and must be prepared to begin cardiopulmonary resuscitation if cardiorespiratory arrest occurs.

Diagnostic Examinations (General)

 CBC
 ECG
 CHEST X-RAY
MODS
Multiple Organ Dysfunction Syndrome
Multiple organ dysfunction syndrome (MODS) is altered organ function in acutely ill patients that requires medical
intervention to support continued organ function.
 It is another phase in the progression of shock states. The actual incidence of MODS is difficult to
determine because it develops with acute illnesses that compromise tissue perfusion.
 Condition that occurs when two or more organs or organ system are unable to function in their role of
maintaining homeostasis.
 MODS results from SIRS. These two syndromes represent the ends of a continuum.

(Pathophysiology)
MODS may be a complication of any form of shock, but it is most commonly seen in patients with sepsis and is a
result of inadequate tissue perfusion.
In MODS, the sequence of organ dysfunction varies depending on the patient’s primary illness and comorbidities
before experiencing shock. Advanced age, malnutrition, and coexisting disease appear to increase the risk of
MODS in acutely ill patients. For simplicity of presentation, the classic pattern is described.
 Typically, the lungs are the first organs to show signs of dysfunction.
o The patient experiences progressive dyspnea and respiratory failure that are manifested as ALI or
ARDS, requiring intubation and mechanical ventilation. The patient usually remains
hemodynamically stable but may require increasing amounts of IV fluids and vasoactive agents to
support BP and cardiac output.
 Signs of a hypermetabolic state, characterized by
o hyperglycemia (elevated blood glucose level),
o hyperlactic acidemia (excess lactic acid in the blood),
o and increased BUN, are present.
 At this time, there is a severe loss of skeletal muscle mass (autocatabolism) to meet the high energy
demands of the body.
 After approximately 7 to 10 days, signs of hepatic dysfunction (e.g., elevated bilirubin and liver function
tests) and renal dysfunction (e.g., elevated creatinine and anuria) are evident.
 As the lack of tissue perfusion continues, the hematologic system becomes dysfunctional, with worsening
immunocompromise, increasing the risk of bleeding.
 The cardiovascular system becomes unstable and unresponsive to vasoactive agents, and the patient’s
neurologic response progresses to a state of unresponsiveness or coma.
Medical Management
Prevention remains the top priority in managing MODS. Older adult patients are at increased risk for MODS
because of the lack of physiologic reserve and the natural degenerative process, especially immune compromise.
Early detection and documentation of initial signs of infection are essential in managing MODS in older adult
patients. Subtle changes in mentation and a gradual rise in temperature are early warning signs. Other patients at
greater risk for MODS are those with chronic illness, malnutrition, immunosuppression, or surgical or traumatic
wounds.
If preventive measures fail, treatment measures to reverse MODS are aimed at
(1) controlling the initiating event,
(2) promoting adequate organ perfusion,
(3) providing nutritional support, and
(4) maximizing patient comfort.

SIRS (SYSTEMIC INFLAMMATORY RESPONSE SYNDROME)

o Inflammatory state affecting the whole body. It is the body’s response to an infectious or noninfectious
insult.
o A systemic inflammatory response can be triggered by many different mechanisms, including the
following:
o Mechanical tissue trauma: Burns, crush injuries, surgical procedures
o Abscess formation: Intraabdominal, extremities
o Ischemic or necrotic tissue: Pancreatitis, vascular disease, MI
o Microbial invasion: Bacteria, viruses, fungi, parasites
o Endotoxin release: Gram-negative and gram-positive bacteria
o Global perfusion deficits: Postcardiac resuscitation, shock states
o Regional perfusion deficits: Distal perfusion deficits
Manifestations of SIRS include, but are not limited to:

 Body temperature less than 36 °C (96.8 °F) or greater than 38 °C (100.4 °F)

 Heart rate greater than 90 beats per minute
 Tachypnea (high respiratory rate), with greater than 20 breaths per minute
 White blood cell count less than 4000 cells/mm³ or greater than 12,000 cells/mm³; or the presence of
greater than 10% immature neutrophils (band forms).
 Tachycardia
 Tachypnea
 o SIRS – TEMP: >38 OR <36, HR: >90, RR: >20, OR PACO2 <32, WBC: >12,000 TO <4,000 OR
10% BANDS, TACHYCARDIA, TACHYPNEA,
o SIRS + INFECTION = SEPSIS (EXTREME RESPONSE)
o SEPSIS + END ORGAN DAMAGE = SEVERE SEPSIS
o SEVERE SEPSIS + HYPOTENSION = SEPTIC SHOCK (life treathening condition that
(hypotension)
o
o ----- MODS

Complications
SIRS is frequently complicated by failure of one or more organs or organ systems. The complications of SIRS
include

Acute kidney injury


Shock

Multiple organ dysfunction syndrome

Management
 Fluid resuscitation
 Antimicrobial therapy
 Infectious source control
 Supportive care (pain control, nutrition)
BIOTERRORISM
o Intentional or threatened use of bacteria, fungi, or toxins from living organisms to produce death or
disease in humans, animals, and plants and involves intimidation of nations or people to accomplish
political or social ends.

Characteristics of an ideal bioterrorism agent

o High attack rate
o High case fatality rate
o Low level of immunity in the population
o No effective or available treatment
o Can be transmitted person to person
o Easy to produce and disseminate
o Difficult to diagnosis either clinically or diagnostically (ie. laboratary identification)

Agents of Bioterrorism
Category A
o Highest-priority agents include organisms that pose a risk to national security because they
o 1. can be easily disseminated or transmitted from person to person
o 2. result in high mortality rates and have the potential for major public health impact
o 3. might cause public panic and social disruption; and
o 4. require special action for public health preparedness.

Category A Agents
o Anthrax (Bacillus anthracis)
o Botulism (Clostridium batulinum toxin)
o Plague (Yersinia pestis)
 o Smallpox (variola major)
o Tularemia (Francisella tularensis)
o Viral hemorrhagic fevers (filoviruses [le-g. Ebola, Marburgl and arenaviruses [e.g, Lassa, Machupo])
Category B
Second highest priority agents include those that are:
1. are moderately easy to disseminate.
2. result in moderate morbidity rates and low mortality rates; and
3. require specific enhancements of diagnostic capacity and enhanced discase surveillance.

Category B Agents
o Brucellosis (Brucella species)
o Epsilon toxin of Clostridium perfringens
o Food safety threats (e.g., Salmonella species, Escherichia coli 0157:H7, Shigello)
o Glanders (Burkholderia mallei)
o Melioidosis (Burkholderio pseudomalel)
o Psittacosis (Chlamydia psittoci)
o Q fever (Coxiela burneti)
o Ricin toxin from Ricinus communis (castor beans)
o Staphylococcal enterotoxin B
o Typhus fever (Rickettsia prowozeki)
o Viral encephalitis (alphaviruses le 8. Venezuelan equine ence phalitis, eastern equine encephalitis, western
equine encephalitis])
o Water safety threats (e.g., Vibrio choleroe, Cryptosporidium parvum)

Category C
Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the
future because of availability, ease of production and dissemination; and potential for high morbidity and mortality
rates and major health impact.

Category C agents
o Emerging infectious diseases such as Nipah virus and hantavirus
o Pandemic Influenza SARS
o Coronavirus

Modes of dissemination
o Aerosols
o Water
o Foodborne
 o Injection
o Vectors
o Mailed envelopes

PART 5
TRIAGE
- First principle in emergency care
- Comes from the French word ‘trier” which means “to sort”
o Severity of their health problems
o Immediacy with which these problems must be treated
- Classify an injury to ensure that patients most in need of care do not needlessly wait to receive it

2 types of Triages
o Emergency department triage
o Field triage
 Disaster/mass casualties
 Multiple casualties
Triage
 Sorting of patient to determine the priority of their health care needs and priority site
treatment
o Non disaster situations
 High priority and allocate the most resources to those who are most critically ill
 Ex. Chest injury, blood, intubations, IVF, CRP
o Large number of casualties
 Fundamental guiding principle
  to do the greatest good for the greatest number of people
 decisions are based on the likelihood of survival and consumptions of available resources
 low chance of survival – assigned a low triage priority

 COLOR CODING
o Four Color Coded Triage System
o 0-Black Dead
o 1-Red: Priority 1 (Highest) Threatening (Emergent)
 These victims have a reasonable chance of survival only if they receive immediate treatment.
 Victims with respiratory insufficiency, cardiac arrest, hemorrhage, and severe abdominal
injury
o Yellow Priority 2 Serious (Urgent)
 These victims can wait for transportation after they received initial emergency treatment
 Immobilized closed fractures, soft tissue injuries without hemorrhage and burns on less than
40% of the body
 This classification is given to clients who require treatment and whose injuries have
complications that are not life threatening, provided they are treated within 1 to 2 hours,
these clients require continuous evaluation every 30 to 60 minutes thereafter
 Such clients include those with a simple fracture, asthma without respiratory distress, fever,
hypertension, abdominal pain, or a client with a renal stone.
o 3 – green: Minimal priority 3 (non-urgent)
 Victims are ambulatory, have minor tissue injuries and maybe dazed.
 Can be treated by non-professionals and held for observation if necessary.
 This classification is given to clients with local injuries who do not have immediate
complications and who can wait several hours for medical treatment; these clients require
evaluation every 1 to 2 hours thereafter.

 STAGES OF DISASTER
 Phases of Disaster Management
o Mitigation
o Actions or measures that can prevent the occurrence of a disaster or reduce the damaging effects of
a disaster.
o Determination of the community hazards and community risks (actual and potential) before a
disaster occurs
o Awareness of available community resources and community health personnel to facilitate
mobilization of activities and minimize chaos and confusion if a disaster occurs.
o Determination of the resources available for care of infants, older people, the disabled, and those
with chronic health problems
o Preparedness
o Plans for rescue, evacuation, and caring for disaster victims
o Plans for training disaster personnel and gathering resources, equipment, and other materials needed
for dealing with the disaster
o Establishment of a community disaster plan and an effective public communication system
o Verification of proper functioning of emergency equipment
o Collection of anticipatory provisions and creation of a location for providing food, water, clothing,
shelter, other supplies and needed medicine
 o Inventory of supplies on a regular basis and replenishment of outdated supplies
o Practice of community of disaster plans (mock disaster drills)
o Response
o Includes putting disaster planning into action and the action taken to save lives and prevent further
damage
o Primary concerns include safety, physical heath of the victims and members of the disaster response
team
o Recovery
o Includes actions taken to return to a normal situation following the disaster
o Includes preventing debilitating effects and restoring personal economic, and environmental health
and stability to the community

ACLS/ BCLS/ CPR (ADULT/ PEDIA)

ADVANCED CARDIAC LIFE SUPPORT (ACLS)

Group of procedures and techniques that treat immediately life-threatening conditions, including cardiac arrest,
shock, stroke, and trauma.
Performed anywhere it is needed in a hospital or clinic. This includes the intensive care unit (ICU), emergency
room (ER), operating room (OR)
TYPES:
• Airway stabilization and treatment including placing a breathing tube in the windpipe (intubation).
• Arterial line insertion to take continuous blood pressure readings
• Breathing treatments to open constricted airways due to asthma, allergic reactions, or COPD (chronic
obstructive pulmonary disease)
• Cardiopulmonary resuscitation (CPR) to keep oxygenated blood pumping through the body until the
heart and lungs can perform this on their own.
• Cardioversion to treat certain cardiac arrhythmias (abnormal heartbeats). A common example is atrial
fibrillation.
• Chest tubes or needle decompression to re-inflate a collapsed lung
• Defibrillation to restore a normal heartbeat using a high-energy electrical shock
• Intravenous (IV) or central venous catheter placement to deliver fluids, medications, and blood
transfusions
• IV medications to treat many conditions. IV medications can reverse life-threatening allergic reactions,
correct acidosis, and suppress abnormal heartbeats.
• Oxygen therapy to increase the amount of oxygen in the blood
• Pacing to correct certain abnormal heartbeats
PERFORMED FOR:
• Coma
• Drug toxicity
• Electrolyte imbalances
• Heart conditions
• Arrythmias
• Respiratory failure
 • Severe allergic reactions
• Shock
• Terminal illness
• Trauma & injuries
WHO PERFORMS:
• Cardiac surgeons
• Cardiologists
• Critical care med doctors
• Emergency med
• Thoracic surgeons
STEPS:
• Assesses the patient, including alertness, airway (windpipe), respirations, and pulse and heart rhythm
• Performs CPR if needed until equipment is available to defibrillate or cardiovert the patient.
• Re-analyzes the heart rhythm and provides more shocks as needed.
• Inserts a tube through the mouth or nose if the patient isn’t breathing effectively.

BASIC CARDIAC LIFE SUPPORT (BCLS)

Type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is
experiencing cardiac arrest, respiratory distress, or an obstructed airway.
“Save hearts too good to die” while preserving cerebral viability
Early access > early CPR > early defibrillation > early ACLS
STEPS:
• Make sure the victim, any bystanders and you, are safe
• Check the victim for a response
• Gently shake his shoulders and ask loudly ‘are you alright?’
• If he responds:
 Leave him in the position in which you find him
 Try to find out what’s wrong with him and get help if needed
 Reassess him regularly
• If he doesn’t respond:
 Shout for help
 Turn the victim supine aligned position or stable side
Airway
• Chin lift maneuver
• Jaw thrust maneuver
• Manual cleaning of mouth & throat
• Endotracheal intubation & tracheobronchial suctioning
• Oropharyngeal & nasopharyngeal airway
Breathing
• Position your cheek close to victim’s nose & mouth, “Look, listen & feel’ for breathing (5-10 secs)
 • Not breathing: pinch victim’s nose closed and give 2 full breaths into mouth
• If breaths won’t go in: reposition the head and give breaths
• If still blocked: suspect choking & perform Heimlich maneuver
Look – chest movement
Listen – for breaths sound
Feel – air on cheek
Breathing support
• mouth-mouth
• manual bag mask ventilation
• hand triggered ventilation
• mechanical ventilation
• mouth-nose (can’t open mouth, severely injured mouth)
Circulation
• check for carotid pulse for 5-10 secs of neck
• pulse but no breathing: rescue breathing at rate of 1 breath every 5 secs
• no pulse: chest compressions

CPR

Lifesaving technique that's useful in many emergencies, such as a heart attack or near drowning, in which
someone's breathing, or heartbeat has stopped.
Follow these steps before starting CPR. (Use the phrase “doctor’s ABCD” — DRS ABCD — to help you
remember the first letter of each step.)

Letter Representing What to do

D Danger Ensure that the patient and everyone in the area is safe. Do not put yourself
or others at risk. Remove the danger or the patient.
R Response Look for a response from the patient — loudly ask their name, squeeze their
shoulder.
S Send for help If there is no response, call emergency service or ask another person to call.
Do not leave the patient.
A Airway Check their mouth and throat if it is clear. Remove any obvious blockages in
the mouth or nose, such as vomit, blood, food or loose teeth, then gently tilt
their head back and lift their chin.
B Breathing Check if the person is breathing abnormally or not breathing at all after 10
seconds. If they are breathing normally, place them in the recovery
position and stay with them.
C CPR If they are still not breathing normally, start CPR. Chest compressions are the
most important part of CPR. Start chest compressions as soon as possible
after calling for help.
D Defibrillation Attach an Automated External Defibrillator (AED) to the patient if one is
available and there is someone else who is able to bring it. Do not get one
yourself if that would mean leaving the patient alone.
ADULT
 1. Conduct a rapid assessment. Check for Airway, Breathing, Circulation.
2. If the person does not respond and is not breathing or only gasping, call emergency service and get
equipment, or tell someone to do so.
3. Place the patient on a firm, flat surface.
4. Give 30 chest compressions
5. Hand position: Two hands centered on the chest
6. Body position: Shoulders directly over hands; elbows locked
7. Depth: At least 2 inches
8. Rate: 100 to 120 per minute
9. Allow chest to return to normal position after each compression
10. Give 2 breaths.
11. Open the airway to a past-neutral position using the head-tilt/chin-lift technique
12. Ensure each breath lasts about 1 second and makes the chest rise; allow air to exit before giving the next
breath
13. Continue giving sets of 30 chest compressions and 2 breaths until emergency help arrives.
14. Use an AED (Automated External Defibrillator) as soon as one is available
PEDIA/INFANT
1. Check to see if the child/baby is conscious
2. Check breathing
3. Begin chest compressions
 For a baby, place two fingers on breastbone. For a child, place heel of one hand on center of chest
at nipple line. You also can push with one hand on top of the other.
 For a child, press down about 2 inches. Make sure not to press on ribs, as they are fragile and prone
to fracture.
 For a baby, press down about 1 1/2 inches, about 1/3 to 1/2 the depth of chest. Make sure not to
press on the end of the breastbone.
 Do 30 chest compressions, at the rate of 100 per minute. Let the chest rise completely between
pushes.
4. Do rescue breathing
 To open the airway, lift the child or baby’s chin up with one hand. At the same time, tilt the head
back by pushing down on the forehead with the other hand. Do not tilt the head back if the child is
suspected of having a neck or head injury.
 For a child, cover their mouth tightly with yours. Pinch the nose closed and give breaths.
 For a baby, cover the mouth and nose with your mouth and give breaths.
5. Continue this cycle of 30 compressions and 2 breaths until the child/baby starts breathing or emergency
help arrives.
6. Use an AED (automated external defibrillator) as soon as one is available
7. Do not use an AED on children under 1 year of age

FIRST AID: ANAPHYLAXIS, SPINAL CORD INJURIES, CHEST DISCOMFORT

FIRST AID: ANAPHYLAXIS

Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of
exposure to something you're allergic to, such as peanuts or bee stings.

Anaphylaxis causes the immune system to release a flood of chemicals that can cause you to go into shock —
blood pressure drops suddenly, and the airways narrow, blocking breathing.
STEPS:

 Immediately call local medical emergency number.

 Ask the person if he or she is carrying an epinephrine autoinjector to treat an allergic attack.
 If the person says he or she needs to use an autoinjector, ask whether you should help inject the
medication. This is usually done by pressing the autoinjector against the person's thigh.
 Have the person lie still on his or her back.
 Loosen tight clothing and cover the person with a blanket. Don't give the person anything to drink.
 If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
 If there are no signs of breathing, coughing or movement, begin CPR. Do uninterrupted chest presses —
about 100 every minute — until paramedics arrive.
 Get emergency treatment even if symptoms start to improve. After anaphylaxis, it's possible for
symptoms to recur. Monitoring in a hospital for several hours is usually necessary.

If you're with someone having signs and symptoms of anaphylaxis, don't wait to see whether symptoms get better.
Seek emergency treatment right away. In severe cases, untreated anaphylaxis can lead to death within half an hour.

FIRST AID: SPINAL CORD INJURY

A spinal cord injury — is the damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda
equina) — it is often causes permanent changes in strength, sensation and other body functions below the site of
the injury.
If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other
serious complications can result. Assume a person has a spinal injury if:
 There's evidence of a head injury with an ongoing change in the person's level of consciousness
 The person complains of severe pain in his or her neck or back
 An injury has exerted substantial force on the back or head
 The person complains of weakness, numbness, or paralysis or lacks control of his or her limbs, bladder or
bowels
 The neck or body is twisted or positioned oddly
FIRST AID: SPINAL CORD INJURIES
1. Call for emergency services. Tell them about the complete details like exact location, kind of accident, no. of
persons involved, and patient’s injury.
2. Check if there’s spinal cord injury by:
 Lower extremity check – hawakan ang toes kung na-feel nyaba ito or hindi. I-instruct ang patient
kung kaya nyabang pagalawin ang mga paa nya. Pisilin ang paa nya kung na-feel nyaba or hindi.
Upper extremity check – hawakan ang fingers kung nafeel nyaba ito. Ipagalaw ang daliri. Pisilin
ang hands ng biktima kung nafeel nyaba ito.
Kung nagagawa nya ito pero medyo may sakit syang nararamdaman, may kunting pressure sa
kanyang spine. Pero kung di nya ito magawa, may spinal cord injury sya.

3. Position your hands on the side of his/her head firmly to keep it steady. Spread your fingers to leave
their ears uncover. Keep steady to align their spine, neck, and head.
4. Roll towels or blankets and place it on the side of patient’s head.
5. Keep the head on neutral position until medical responders arrive.

FIRST AID: CHEST DISCOMFORT

Minor problems, such as heartburn or emotional stress, to serious medical emergencies, such as a heart attack or
blood clot in the lungs (pulmonary embolism).
STEPS:
• Call ambulance
• Assist to rest
• Assist for take any prescribed med
• Sit them in a comfortable position if conscious
• Monitor and record vital signs
HEART ATTACK
A heart attack generally causes chest pain for more than 15 minutes. The pain may be mild or severe. Some heart
attacks strike suddenly, but many people have warning signs hours or days in advance.
SIGNS AND SYMPTOMS
• Chest pain
• Nausea, indigestion
• Shortness of breath
• Lightheadedness
STEPS:
If you or someone else may be having a heart attack, follow these first-aid steps:
 Call 911 or emergency medical assistance
 Chew aspirin
 Take nitroglycerin, if prescribed
 Begin CPR on the person having a heart attack
 If an automated external defibrillator (AED) is immediately available and the person is unconscious,
follow the device instructions for using it.
ANGINA
Chest pain or discomfort caused by reduced blood flow to your heart muscle.
 Stable - usually occurs with activity and is relatively predictable. The chest pain tends to follow a
pattern.
 Unstable - sudden or new or changes from the typical pattern.
STEPS:
• Make victim comfortable
• Assist to any prescribed med
• Reassure and monitor condition
• Call ambulance

PULMONARY EMBOLISM
Blood clot in the lung.  It occurs when a clot, usually in the leg or pelvis, breaks free and gets stuck in a lung artery
(pulmonary artery). 

SIGNS AND SYMPTOMS

 Sudden, sharp chest pain often with shortness of breath
 Sudden, unexplained shortness of breath, even without pain
 Cough that may produce blood-streaked spit
STEPS:
 Call for emergency medical assistance
 Chew a regular-strength aspirin
 Take nitroglycerin, if prescribed
 Begin CPR on the person having a heart attack

FIRST AID: ELECTRIC INJURIES, ANIMAL BITES, FRACTURES, WOUNDS AND ABRASIONS

ELECTRIC INJURIES
The danger from an electrical shock depends on the type of current, how high the voltage is, how the current
traveled through the body, the person's overall health and how quickly the person is treated.

FIRST AID: ELECTRIC INJURIES

1. Shut down the electricity, if the current can’t be turned off, then remove the person from the electricity
source using an object that does not conduct electricity (sticks, plastics, rubber materials).
 2. Make sure the environment is completely dry.
3. Avoid touching objects that can conduct electricity.
4. Call for a professional help.
5. Check if the injured person is conscious. If conscious, it’s still important to provide him professional
medical help to rule out internal injuries and heart injury.
6. If unresponsive, cover the victim with blanket or cotton cloth, then begin cpr.
7. Don’t leave him alone until medical help arrives.

ANIMAL BITES
FIRST AID GUIDE
Minor bite wounds are wounds where the skin is only slightly broken or when the bite is from a human (e.g., child)
or a domestic animal that is vaccinated against rabies.

FIRST AID FOR MINOR BITE WOUNDS:

1. Thoroughly wash the wound with soapy water.

2. Apply an antibiotic cream (such as bacitracin) to the affected area.
3. Cover the wound with a clean bandage.
4. Watch for signs of infection (i.e., the affected area is very red or warm to the touch, painful, oozing pus, or
blood-filled).
5. If the bite is on the hand or finger, call your doctor, as antibiotics are often given for bites in this area.
Severe bite wounds are wounds that are torn, deep (including deep punctures), or bleeding badly.

FIRST AID FOR SEVERE BITE WOUNDS:

1. Attempt to stop the bleeding by applying pressure to the affected area with a clean, dry cloth.
2. Seek medical assistance.
GET MEDICAL CARE:
The bite was from:
 A wild or stray animal
 A pet that isn't up-to-date on rabies shots
 An animal that is acting strangely
 The bite has broken the skin.
 The bite is on the face, head, neck, hand, foot, or near a joint.
 A bite or scratch becomes red, hot, swollen, or more painful.
 Your child is behind on shots or has not had a tetanus shot within 5 years.

FRACTURES
A fracture is a partial or complete break in the bone. Bone fractures are often caused by falls, injury, or because of
a direct hit or kick to the body.
STEPS:
1. Call for emergency services immediately.
2. Tell them the complete details like exact location, kind of accident, no. of persons involved, and patient’s
injury.
3. Know the situation of the victim. Signs if there’s fracture:
 Deformity
 Swelling or bruising
 Extreme pain
 Wound/ lumabas na sa balat ang nabaling buto
4. Speak with the victim. Make him understand that he’s not allowed to move until the emergency services
arrived.
5. Support of hold the joints that surround the suspected fractured area. Immobilize it.
6. If the fractured area is in the arm, put a splint/any straight and hard object to support the arm.
7. Using clean cloth, tie it in both sides of affected area.
8. Then put a sling and swathe (swad) to immobilize.
9. If the leg is injured, you may put it together with the uninjured leg.
10. Using clean cloth, tie the joint to immobilize the injured leg.
11. If the affected area is in the lower leg, tie the knee joint and the ankle joint.
Note: Tie only the uninjured part, not the injured one.
12. Talk with the patient to comfort him. Give him the assurance that the emergency services will arrive to help
him.

WOUNDS

A wound is any damage or break in the surface of the skin. Applying appropriate first aid to a wound can speed up
the healing process and reduce the risk of infection.

STEPS:

Wounds including minor cuts, lacerations, bites and abrasions can be treated with first aid. 
 Use a clean towel to apply light pressure to the area until bleeding stops (this may take a few minutes). Be
aware that some medicines (e.g., aspirin and warfarin) will affect bleeding, and may need pressure to be
applied for a longer period of time.
 Prior to cleaning or dressing the wound, ensure your hands are washed to prevent contamination and
infection of the wound.
 Gently rinse the wound with clean, lukewarm water to cleanse and remove any fragments of dirt, e.g.,
gravel, as this will reduce the risk of infection.
 Gently pat dry the surrounding skin with a clean pad or towel.
 If there is a skin flap and it is still attached, gently reposition the skin flap back over the wound as much as
possible using a moist cotton bud or pad.
 Use a non-stick or gentle dressing and lightly bandage in place; try to avoid using tape on fragile skin to
prevent further trauma on dressing removal.
 Call for emergency services immediately for further treatment and advice to ensure the wound heals
quickly.
  Wounds can be painful, so consider pain relief while the wound heals. 
FIRST AID: WOUNDS
1. Stop the bleeding. Use some gauze or cloth and apply direct pressure to the wound.
2. Wash it under running water.
3. Clean it using antiseptic cleaning solution to clean the wound.
4. Dress it up. Use a cotton bud and apply a thin layer of antiseptic cream over the wound.
5. Followed by covering it by either a plaster or some gauze and tape.
6. Clean and dress the wound every day to make sure that it stays clean and uninfected.

HEAT EMERGENCIES: HYPERTHERMIA, HEAT CRAMPS, HEAT EXHAUSTION, HEATSTROKE

HYPERTHERMIA

Hyperthermia is an abnormally high body temperature caused by a failure of the heat-regulating mechanisms of the
body to deal with the heat coming from the environment.
TREATMENT:
1. Check the temperature using thermometer. If it’s above 37OC, then its fever.
2. Give them cool drinks to replace the fluids they lose from sweating.
3. If they are feeling unwell, you can give the recommended dose of paracetamol.
4. If their temperature is above 39OC, call their doctor.
5. If their condition gets worse, call for an ambulance.
6. If it’s a child, be prepared to treat for seizure.
HEAT CRAMPS
Heat cramps are painful, involuntary muscle spasms that usually occur during heavy exercise in hot environments.
The spasms may be more intense and more prolonged than are typical nighttime leg cramps. Fluid and electrolyte
loss often contribute to heat cramps.
1. Move the person into a cool area whether that be indoors or even the shade.
2. Have them rest and stretch the muscle even massaging the area can really be of help and ice the area.
3. Give them half of glass water or sports drink to replenish lost fluids every 15 mins.

HEAT EXHAUSTION
This condition usually develops gradually and is caused by loss of salt and water from the body through excessive
sweating. This usually happens to people who are unaccustomed to hot, humid environment and those who had
been ill.
Recognition:
 Headache, dizziness and confusion
 Loss of appetite and nausea
  Sweating with pale and clammy skin
 Cramps in the arm, legs and abdominal wall
 Rapid, weakening pulse
 Rapid, weakening breathing

HEATSROKE
There is a failure in the “thermostat” of the brain. The body becomes dangerously overheated due to a high fever or
prolonged exposure to heat. In some cases, it follows heat exhaustion when sweating ceases and the body cannot be
cooled by evaporation. Heatstroke can occur suddenly, causing unconsciousness within minutes. This may be
signaled by the casualty feeling uneasy and ill.
Recognition:
 Headache, dizziness, and discomfort
 Relentless and confusion
 Hot, flushed, and dry skin
 A rapid deterioration in the level of response
 A full, bounding pulse
 Body temperature above 40

MANAGEMENT OF HEAT- RELATED

 Help casualty to a cool place. Lay him down and raise his legs. Give him plenty of water; follow, if
possible, with weak salt solution (one teaspoon of salt to one liter of water). Even if the casualty recovers
quickly, ensure he sees a doctor.
 Call for ambulance or medical team
 Help the casualty to a cool place
 In heat stroke and humidity is not high, cool the casualty by outing ice packs and pouring water
 In casualties of heat stroke of high humidity, aggressively try to cool patient
 If mental status improves, you may stop cold treatment. monitor and record breathing, pulse and response
every 10 minutes, and be ready to resuscitate if needed
 Call for an ambulance or medical team

COLD EMERGENCIES: HYPOTHERMIA, FROSTBITE. FROSTNIP

HYPOTHERMIA
This condition develops when the body temperature falls below 35-degree Celsius

Recognition:
 Shivering with cold, pale and dry skin
 Lethargy or failing consciousness
 Slow and shallow breathing
  Cardiac arrest in extreme condition

Management
 Take or carry the casualty to a sheltered place as quickly as possible. Replace any clothing with warm
garments. Insulate the casualty with extra clothing or blanket and cover his head. Protect the casualty from
the ground and elements
 Check ABC of BLS
 Call for an ambulance or medical team. Do not leave the casualty alone.
 Wait for medical team to arrive.
 In severe hypothermia, check for ABCs and resuscitate if necessary. Continuously monitor the patient while
waiting for help to arrive.
 Give the conscious casualty warm drinks if available.

FROSTBITE

Frostbite is an injury caused by freezing of the skin and underlying tissues

TREATMENT:
 Encourage them to put their hands in their armpits.
 Move them to somewhere warm.
 Remove constricting clothes or jewelry.
 Keep them warm using warm clothes or blankets.
 Warm the body part with your hands or under their armpits. Don’t rub because it can damage the skin
tissue.
 Place the body part in warm water around 40O centigrade not hot water because it may cause more damage
to skin.
 Dry it carefully and put on a light dressing like gauze pad.
 Help them to raise their limb to reduce swelling.
 You can give them pain killers for pain.
 Take or send them to hospital.

FROSTNIP

Frostnip is a milder form of cold injury. It usually affects areas of skin exposed to the cold, such as the cheeks,
nose, ears, fingers, and toes, leaving them red and numb or tingly. Frostnip can be treated at home and gets better
with rewarming.
TREATMENT:
 Immerse the body part that’s affected in lukewarm water. Water that’s been warmed to the temp of
approximately 104 – 108 degrees fahrenheit would be ideal.
 Immerse it to the lukewarm water until the coloration appears to be normal again and the skin becomes soft
and pliable once again.
 Taking it to emergency room or the doctor’s office may be an order.
 If you’re in the outdoors, then make sure that you keep yourself warm and don’t allow frostnip to occur
again.
NEAR DROWNING/ CARBON MONOXIDE POISONING (POISON EMERGENCY)
NEAR DROWNING

"Near drowning" means a person almost died from not being able to breathe (suffocating) under water
TREATMENT:
 If they are unconscious in water, remove them from it as quickly as you can, but never put yourself in
danger. Do not enter the water to rescue a drowning casualty unless you have been trained to do so.
Throw a lifebelt or rope, if possible, otherwise get help fast.
 Once on dry land, turn them on their back, tilt their head and lift the chin to open the airway.
 If they’re not breathing start resuscitation. Use a defibrillator immediately if there is one available.
 If it is warm and they haven’t been in the water very long, you may find they start to regain
consciousness quickly. If this happens, swiftly put them into the recovery position to help them drain
water and vomit. Keep checking they’re still breathing.
 If it is cold, they will not start to regain consciousness until their body is warm enough.
 For an adult, start with 30 chest compressions then 2 rescue breaths. For a child or baby, start with 5
rescue breaths then 30 compressions to 2 breaths. Push hard and fast and keep going.
 If they start to regain consciousness swiftly put them into the recovery position.
 Keep checking they’re breathing.
 Ensure you have called the emergency services.

CARBON MONOXIDE

Carbon monoxide poisoning occurs when carbon monoxide builds up in your bloodstream. When too much carbon
monoxide is in the air, your body replaces the oxygen in your red blood cells with carbon monoxide. This can lead
to serious tissue damage, or even death.
TREATMENT:
Scenario 1: conscious patient
1. Open immediately the windows and doors to not take the risks.
2. Turn off the device. If possible, turn off the faulty device suspected of causing the carbon monoxide leak.
3. Evacuate the casualty and if possible, get them out into the open air.
4. Place them in a comfortable position in which they feel most at ease.
5. Call the emergency services.
Scenario 2: unconscious patient
1. Open immediately the windows and doors to not take the risks.
2. Turn off the device. If possible, turn off the faulty device suspected of causing the carbon monoxide leak.
3. Perform an emergency evacuation and take the victim out into the open air.
4. Check the breathing pattern.
5. Act according to the condition of the victim.
6. If they are breathing, place them into recovery position. Call the emergency services and cover and monitor
them until their arrival.
7. If they are not breathing, alert the emergency services or ask someone nearby to do it and begin CPR, 30:2.
 8. If you don’t know how to give mouth to mouth, only perform chest compressions.

TRAUMATIC PNEUMOTHORAX/ HEMOTHORAX/ FLAIL CHEST

TRAUMATIC PNEUMOTHORAX

Traumatic pneumothorax is air in the pleural space resulting from trauma and causing partial or complete lung
collapse.
- Car wreck, gun, knife wound, rib fracture
TREATMENT:
 Expose his chest. Remove or cut the clothes to expose it.
 Seal the wound. Make sure that there’s no air movement between it.
 Cover it with your hands or put pressure to the wound using your hands.
 Clean the wound with some gauze.
 Perform tube thoracostomy

HEMOTHORAX

Hemothorax is a collection of blood in the space between the chest wall and the lung.
Causes: chest trauma, complications of disease (lung cancer)
TREATMENT:
 The most important treatment for hemothorax is draining the blood out of your chest cavity. Your doctor
will likely put a tube through your chest muscles and tissues, through your ribs, and into your chest cavity
to drain any pooled blood, fluid, or air. This is called a thoracentesis or thoracostomy.
 The tube may remain in your chest for several days if your lung has collapsed so that it can expand again.
 If the bleeding continues even as the tube drains the blood, you may need chest surgery to treat the cause of
the bleeding. Chest surgery is also known as thoracotomy.
 The type of thoracotomy needed is based on which part of your chest or organs your surgeon needs to
operate on. After your surgeon finishes the operation, a tube will remain inserted in your chest to drain any
remaining blood or fluid.

FLAIL CHEST

Flail chest is a particular kind of rib fracture that is defined as three (or more) ribs that are broken in two (or more)
places. This means that your ribs have a segment that is not connected to the other bones around them. This part of
your chest wall, since it is not connected to surrounding structure, it can seriously impair your ability to breathe
properly.
- Result of major blunt trauma to the chest wall
TYPES:
 • Sternal
• Lateral
TREATMENT:
 Emergency medical treatment will first involve the delivery of oxygen, usually through a facemask.
 Intubation and mechanical ventilation will likely be used for those presenting with lung damage related to
flail chest, as well as those who doctors worry will experience a chest cavity collapse.
 Surgery may be required, but the decision for this will be based on an individual's case and how stable they
are.
 Pain control is essential, which may involve an epidural and opioids, though the latter must be carefully
prescribed due to the risk of inducing further respiratory concerns in some people.

abnormally high body temperature.

Types:
• Heat cramps
• Heat exhaustion
• Heat rash
• Heart stress
 • Heatstroke
S/sx;
• Blurred vision.
• Dizziness.
• Fast breathing or heart rate.
• Fatigue.
• Headache.
• Light-headedness or syncope (fainting).
• Low blood pressure
Treatment:
• Immerse them in cool water, if possible.
• Mist them with water and blow air across their bodies (evaporative cooling).
• Apply ice packs to the neck, groin and armpits.
• Avoid giving any medications, including aspirin and acetaminophen.

HEAT EMERGENCIES: HEAT CRAMPS

mildest form of heat illness.
S/sx:
• Painful cramps, especially in the legs
• Flushed, moist skin
Treatment:
• Move to a cool place and rest.
• Remove excess clothing and place cool cloths on skin; fan the skin.
• Give cool sports drinks containing salt and sugar.
• Stretch cramped muscles slowly and gently.

HEAT EMERGENCIES: HEAT EXHAUSTION

conditions of extreme heat and excessive sweating without adequate fluid and salt replacement
S/sx:
• Muscle cramps
• Pale, moist skin
• Often has a fever over 100.4°F (or 38°C)
• Nausea
• Vomiting
• Diarrhea
T:
• Move to a cool place and rest
• Remove excess clothing and place cool cloths on skin; fan the skin.
 • Give cool sports drinks containing salt and sugar.
• If no improvement or unable to take fluids, take your child to an emergency room right away.

HEAT EMERGENCIES: HEAT STROKE

occurs when the body's heat-regulating system is overwhelmed by excessive heat.

S/sx:
• Warm, dry skin
• High fever, often over 104°F (or 40°C)
• Rapid heart rate
• Loss of appetite
T:
• Move to a cool place and rest.
• Call 911
• Remove excess clothing and drench skin with cool water; fan the skin.
• Place ice bags on the armpits and groin areas.
• Offer cool fluids if your child is alert and able to drink.

COLD EMERGENCIES: HYPOTHERMIA

body begins to lose heat faster than it can be produced.

• Move the victim into a warm room or shelter.
• Warm the center of their body first-chest, neck, head, use skin-to-skin contact under loose, dry layers of
blankets, clothing, towels, or sheets.
• Warm beverages may help increase the body temperature
• After their body temperature has increased, keep the victim dry and wrapped in a warm blanket, including
the head and neck.

COLD EMERGENCIES: FROSTBITE

injury to the body that is caused by freezing.

causes a loss of feeling and color in the affected areas.
S/sx:
• Reduced blood flow to hands and feet (fingers or toes can freeze)
• Numbness
• Tingling or stinging
• Aching
T:
 • Get into a warm room as soon as possible.
• Unless absolutely necessary, do not walk on frostbitten feet or toes-this increases the damage.
• Immerse the affected area in warm-not hot
• Warm the affected area using body heat; for example, the heat of an armpit can be used to warm frostbitten
fingers.
• Don’t use heating pad, lamp, stove. Affected areas are numb and can be easily burned.

COLD EMERGENCIES: FROSTNIP

 Mild form of frostbite. Doesn’t cause permanent skin damage

 the stage before frostbite begins
 constriction of blood vessels and the resulting inadequate blood supply to the area.
S/sx:
Sting, prickle, burn deep cold feeling > tingling numbness > skin becomes red, white/yellowish
T:
• Warming skin up. Wear warm, dry clothing
• Aloe vera gel to reduce inflammation/discomfort
• Ibufopren

NEAR DROWNING

person almost died from not being able to breathe (suffocating) under water.
C:
• Attempted suicide
• Attempting to swim too far
• Behavioral/developmental disorders
• Blows to the head or seizures while in the water
• Drinking alcohol or using other drugs while boating or swimming
• Heart attack or other heart issues while swimming or bathing
S/sx:
• Abdominal distention (swollen belly)
• Bluish skin of the face, especially around the lips
• Chest pain
• Cold skin and pale appearance
• Confusion
• Cough with pink, frothy sputum
T:
• Extend a long pole or branch to the person or use a throw rope attached to a buoyant object, such as a life
ring or life jacket. Toss it to the person, then pull them to shore.
 • If you are trained in rescuing people, do so right away only if you are absolutely sure it will not cause you
harm.
• Give CPR if unconscious and no pulse

CARBON MONOXIDE

occurs when carbon monoxide builds up in your bloodstream. Replaces the oxygen in RBC with monoxide
S/sx:
• Dull headache
• Weakness
• Dizziness
• Nausea or vomiting
• Shortness of breath
• Confusion
Complication:
• Permanent brain damage
• Damage to your heart, possibly leading to life-threatening cardiac complications
• Fetal death or miscarriage
• Death
T:
• Get person to fresh air
• Call 911
• CPR if unresponsive

TRAUMATIC PNEUMOTHORAX

air in the pleural space resulting from trauma and causing partial or complete lung collapse.
S/sx:
• Chest pain
• Dypsnea
Diagnosis: chest x-ray
T: tube thoracostomy, pleural decompression
Goal: remove the air from the pleural space and allow the lung to reinflate.
Steps: Finger thoracostomy
• Skin decontamination with iodine
• Abduct arms to >90 degree and locate triangle of safety (level of nipple/mammary fold)
• Identify incision site (4th intercostal space, anterior to mid axillary line)
• Dissect bluntly to enter intercostal muscles and pleura
• Finger introduced allowing evacuation of air/blood
• Decompression of pleural
 HEMOTHORAX

blood collects between your chest wall and your lungs.

S/sx:
• pain or feeling of heaviness in your chest
• feeling anxious or nervous
• dyspnea, or having trouble breathing
• breathing quickly
T: draining the blood out of your chest cavity, thoracotomy
• Wedge resection removes a wedge-shaped piece from the area of your lung that contains cancer and some
healthy tissue around it.
• Segmentectomy removes one segment of a lung.
• Lobectomy removes the lobe of your lung that contains cancer.
• Pneumonectomy removes an entire lung.
• Extra pleural pneumonectomy removes a lung, the lining of your lungs and heart (pleura), and part of
your diaphragm.
Side effects:
• infection
• bleeding
• air leaking from your lungs
• pneumonia
• DVT & pulmonary embolism

FLAIL CHEST

Segment of rib cage breaks under extreme stress and becomes detached
Flail segment will be pulled in with the decrease pressure while the rest of rib cage expands
Types:
• Sternal
• Lateral
T:
• Facemask oxygen
• CPAP (delivering stream of oxygenated air into airways)
• Chest physiotherapy
• Intubation & ventilation
• Chest tube insertion
• Rib fracture fixation