MAKILALA INSTITUTE OF SCIENCE AND TECHNOLOGY

Brgy. Concepcion, Makilala Cotabato

Midwifery Program

Course Title: Foundations of Midwifery Practice 1 (M100)

Course Credit: 3 units
Hours to complete: 10th week & 11th week
Instructor: Jackylin P. Bermejo, RN,RM,MAN
Course Description: the course provides the student with the basic/ necessary knowledge, skills
and acceptable attitudes in the care of individuals and families. It includes the beginning concepts of
man, communication, health care process which teaches the students the basic health care skills in
the care of the client. It also includes the first aid, emergency and disaster management, basic life
support (BLS) and drug administration.

I. Topic: Common Emergency Measures

II. REFERENCES:

Cooper, K., and Gosnell, K., 2014. Foundations and Adult Health Nursing. 7 th Edition. Elsevier Health
Sciences

III. Learning Outcomes:

Upon completion of this information sheet, the student will be able to:

1. Identify the principles of Emergency Care Common Emergency Conditions

2. evaluate the veracity of the statements pertaining to the concepts of burn, poisoning, fracture,
bleeding, shock and unconsciousness;
3. identify the management and interventions of burn injury;
4. discuss Basic Life Support , Artificial Life Support and CPR
IV. Learning Content
1. First aid is the immediate initial assistance given to a person who is injured or has become ill.
2. First aid includes assessing the victim for life-threatening conditions, performing appropriate
interventions to sustain life, and keeping the person in the best possible physical and mental
condition until the assistance of emergency medical services (EMS) (a national network
of services that provides coordinated aid and medical assistance from primary response to
definitive care) is obtained.
3. It is important to remember that first aid does not replace medical care but is used to preserve
life until medical help is obtained. Because permanent disability and injury can occur within
minutes, the midwife should be prepared to handle emergency conditions and administer first aid.
4. In the case of multiple injuries, patients are surveyed quickly for severity of injuries so that
health care providers are able to treat life-threatening problems first. This process of classifying a
group of patients according to the severity of injury and need of care is called triage.
5. The triage process is based on the premise that patients who have a threat to life, vision, or limb
should be treated before other patients. In a disaster, triage is a process in which numerous
patients are "sorted" so that it is possible to concentrate care and resources on those who are more
likely to survive. Any person certified to perform CPR and first aid may assist with these activities.

OBTAINING MEDICAL EMERGENCY AID

◼ The ability to recognize the need for medical assistance and an understanding about how to
obtain medical emergency aid sometimes means the difference between life and death to an
injured or ill person.
◼ It is important for the nurse to know the right phone number to call, both in the community
and in the institutional setting. In most communities, the emergency medical number is 911.
However, in some areas and in some situations it may be best to call the number for the fire
department, police department, or local hospital.

1
MORAL AND LEGAL RESPONSIBILITIES

Good Samaritan laws (legal protection for those who give first aid in an emergency situation) have
been enacted in most states to protect health professionals from legal liability when they provide
emergency first aid. If a midwife follows a reasonable and prudent course of action, the chances of
legal problems are very small. Nurses are obliged to obtain permission to treat any conscious
patient, even in an emergency situation. Before first aid is administered, verbal permission should
be obtained from the victim because the victim has the right to refuse first aid. The law assumes
consent from an unconscious person. After the midwife has initiated first aid, there is a moral and
legal obligation to continue the aid until someone with comparable or better training is able to care
for the victim; for example, an emergency medical technician (FMT), or paramedic, or a health care
provider may arrive at the scene and assume first aid care of the victim,

ASSESMENT OF THE EMERGENCY SITUATION

◼ Assessment of life-threatening problems is the first priority in an emergency situation. The
midwife should assess the scene for potential safety hazards. Sometimes the midwife will need
the aid of another person, whether to help care for victims with some injuries or illnesses or to
call EMS. If necessary, the midwife may shout to get someones attention or request that
someone call 911 or another emergency number.While the midwife is seeking help, he or she
should continue the primary survey by assessing the patient's circulation, airway
and breathing (CAB).
◼ An immediate life-threatening situation of highest priority is abnormal circulation; ar
absent or abnormal pulse is a life-threatening situation. The midwife should assess the rate,
rhythm, and strength of the carotid pulse for no longer than 10 seconds. The midwife’s
assessment also includes monitoring the victim for signs of external bleeding and internal
bleeding which may lead to shock.
◼ Additional assessment includes the person's skin color, temperature, pupil
reaction, pulse and respiration.
◼ Poisonings may also be life-threatening. The midwife should observe for burns or stains in and
around the person’s mouth or hands.
◼ Depressed respiration and circulatory collapse are other possible results of poisoning.
The midwife ensures that the victim’s airway is open. The airway is opened with a
head-tilt/chin-lift maneuver unless a neck injury is suspected.
◼ If a cervical spine injury is suspected, the midwife should use a jaw-thrust maneuver without
tilting the head to open the airway. Caution is used in order not to move the neck out of proper
alignment. Because of the potential for causing or exacerbating a cervical spine injury, the
midwife should not hyperextend the patient’s neck to establish an airway.
◼ The midwife assesses the victim’s ability to breathe by determining whether the chest is rising,
listening for breath sounds, and placing his or her cheek near the victims mouth to feel the
passage of air from the victim’s breathing. The midwife should assess rhythm, depth, and rate
of respiration.
◼ The following clinical manifestations indicate that the victim is having trouble breathing:
cyanosis, gasping, wheezing, stridor and snoring. After the initial assessment for
life-threatening problems, the nurse assesses the victim for indications of skull injury and brain
or spinal cord damage, which necessitate immediate interventions.
◼ A decreasing level of consciousness, abnormal pupil reaction, and lack of movement in the
arms or the legs are indicative of a possible injury to the head or spinal cord. The midwife
should focus on the victim’s fractures, dislocations, and superficial ecchymoses or wounds only
after treating the more serious conditions.

BURN INJURIES
⚫ Burns are a leading cause of accidental injuries; 450,000 burns per year necessitate medical
treatment in the United States (American Burn Association, 2012).
⚫ Burns are caused by heat from fire, hot
liquids or steam, electricity from faulty
wiring, chemicals such as: lye, strong
cleaning products, acids, solar radiation and
radioactive materials.
⚫ The initial management of the patient with
burns begins at the time of injury. The first
priority is to stop the burning process.
⚫ Burns are often classified according to their
depth or the extent of the body surface area
burned. The principal complications of all

2
 burns are shock, from loss of fluids and electrolytes, and trauma and infection as results of the
loss of the skin as a barrier. The extent of burns can be calculated according to the rule of nines.

SHALLOW
PARTIAL-THICKNESS BURNS
Shallow
partial-thickness burns (also
classified as first-degree burns)
are the least serious of all
burns,involving only the outer
layer of the skin. The most
common first-degree burns are
simple sunburns or burns from
contact with hot objects.
Healing usually is spontaneous
or occurs within 2 to 5 days and
is uncomplicated. Signs and
symptoms includes erythema
and pain.

Interventions
The burn should be cooled
immediately by soaking the affected area in cold (not icy) water, or the application of cold
compresses to the area for as long as it takes to decrease pain (up to 30 minutes ) . Grease, butter,
or salt water should not be applied to the burn. A sterile dressing should be placed over the burn
site to help prevent infection.

DEEP PARTIAL-THICKNESS BURNS

Deep partial-thickness burns (also classified as second degree burns) fully involve the first layer of
skin (epidermis), as well as some of the underlying tisue (dermis); scarring from vesicles and
infection is possible. Common causes of second-degree burns are severe sunburn, scalding liquids,
direct flame, and chemical substances. Healing may take 5t0 21 days.

Assessment
Signs and symptoms include deep erythema or mottled skin with blister formation. Considerable
edema after results, lasting several days. Fluid typically weeps through the skin surface (loss of
plasma), and the patient complains of intense pain.

FULL-THICKNESS BURNS
⚫ Full-thickness burns (also classified as third-degree burns) involve destruction of the skin and
underlying tissue, including fat, muscle, and bone.
⚫ The area is usually charred, and healing is difficult. The skin is usually thick and leathery, with
the presence of black or dark brown, cherry red, or dry and milky white colors.
⚫ Many victims do not complain of pain because nerve endings are so severely damaged by the
burn.
⚫ Capillaries become hyperpermeable, so that plasma seeps into the interstitial spaces, resulting
in edema and vesiculation (blistering).
⚫ The larger the burned area involved, the greater the shift of fluid from intravascular area into
the interstitial area.
⚫ Fluid loss causes a fluid and electrolyte imbalance. Hypovolemic shock and infection are
common complications. Medical attention is urgent.
⚫ Common causes of full-thickness burns are direct flame (such as ignited clothing), explosions,
and gasoline and oil fires.

Nursing Interventions for Moderate to Severe Burns (Deep Partial-Thickness and Full-Thickness
Burns)
It is crucial to establish an airway before edema occurs. The nurse should assess respiratory and
cardiac function. CAB are the priority concerns. All of the victim clothing should be removed, as well
as shoes and jewelry, which may be constricting and even smoldering. It is possible to increase the
severity of the burns by leaving clothing on. The victim should he kept warm, with the burned area
elevated. The midwife should inspect for burns or the presence of soot around the mouth and nose,
which may indicate that the patient’s respiratory status has been affected. The midwife should

3
immediately flush chemical burns with copious amounts of water. If medical help will arrive within
15 to 30 minutes, the nurse may withold oral fluids. If medical help is delayed, the nurse may be
advised to give oral rehydration therapy with formulations suggested by the World
Health Organization (WHO) or with sports drink to replace electrolytes (Vyas and Wong, 2013).

⚫ If vomiting occurs, they should not provide the victim with fluids to drink. They should attempt
to cool a partial-thickness burn immediately, using cool compresses. It is not appropriate to do
this for other types of burns.
⚫ Cool compresses sometimes cause hypothermia in victims with more extensive burns. Vesicles
(blisters) should not be intentionally broken, and they should avoid touching the burn with
anything except sterile dressings.
⚫ It is not appropriate to apply antiseptics, ointments, sprays, or creams to the burn because
they may potentially interfere with medical treatment and cause further complications.
⚫ Loose, sterile dressings should be applied to the burned area. The victim should be monitored
frequently to be sure that edema has not caused further constriction of the area near the burn.

V. ACTIVITY
A. Multiple Choice: Read carefully and choose the letter of your answer.

1. A 23 year old male client who has had a full thickness burn is being discharged from the hospital.
Which information is most important for the nurse to provide prior to discharge?
A. How to maintain home smoke detectors.
B. Joining a community reintegration program.
C. Learning to perform dressing changes.
D. Options available for scar removal.
2. The nurse assigns a client who has open wound burn to the midwife. Which instruction is most
important for the nurse to provide by the midwife?
A. Administer the prescribed tetanus toxoid vaccine.
B. Assess wounds for signs of infection.
C. Encourage the client to cough and breathe deeply.
D. Wash hands on entering the client’s room.
3. Three days after a burn injury, the client develops a temperature of 100ᴼF, a white blood cell
count of 15,000/mm3, and a white, foul smelling discharge from the wound. The midwife
recognizes that the client is most likely exhibiting symptoms of which conditions?
A. Acute phase of injury.
B. Autodigestion of collagen.
C. Granulation of burned tissue.
D. Wound infection.
4. What statement indicates the client needs further education regarding skin grafting
(allografting)?
A. “Because the graft is my own skin, there is no chance it won’t take.”
B. “For the first few days after surgery, the donor sites will be painful.”
C. “I will have some scarring in the area when the skin is removed for grafting.”
D. “I am still at risk for infection after the procedure.”
5. When providing care for a client with an acute burn injury, which nursing intervention is most
important to prevent infection by auto contamination?
A. Avoid sharing equipment such as blood pressure cuffs between patients.

4
 B. Changing gloves between wound care on different parts of the client’s body.
C. Using the closed method of burn wound management.
D. Using the proper and consistent handwashing.

Effect of Culture During Emergencies

1. At a time of emergency, patients often fall back on their language of origin. An interpreter is able
help with language barriers.
2. Emergency equipment is frightening to many people. The nurse should ensure that the patient
understands the rationale for any nursing interventions that are being performed and the purpose
of any equipment.
5. People from some cultures believe in the use of of a local medicine person and are distrustful in
Western health care providers. Try to work within a patient’s belief rather contradicting them
outright. In an emergency, patients will refer to what they know best.

POISONS
⚫ Each year thousands of people die from self-inflicted or accidental poisonings. The majority of
these people are children. A poison is any substance (solid, liquid, or gas) that even in small
amounts causes damage to the body or interferes with the function of its systems.
⚫ Poison control centers throughout the United States are equipped to give information about
poisons and methods of treatment on a 24-hour-a-day, 7-day-a-week basis. Most poisons act
rapidly and thus necessitate immediate first aid.
⚫ Poison control centers need the following
information:
-Patient s weight
-Patient/s age
-Substance ingested, inhaled, or injected
-Amount of substance taken -Time
when substance was taken -Any
medications patient has taker
-Current status of patient

GENERAL ASSESSMENT OF POISONINGS

Acute signs and symptoms of poisonings are sometimes delayed for hours. The following are
possible indications of poisonings: respiratory distress; pulmonary edema; bronchospasm; severe
nausea, vomiting, or diarrhea; seizures, twitching, or paralysis; decreased level of consciousness or
unconsciousness; restlessness, delirium, agitation, or panic; color changes; pale, flushed, or cyanotic
skin, signs of burns or edema around the mouth or other areas of the body; pain, tenderness, or
cramps on swallowing; characteristic odor on the breath; unusual urine color (red, green, bright
yellow, black, bronze); slow, labored breathing or wheezing; abnormal constriction or dilation of
pupils; abnormal eye movements, such as nystagmus (constant, involuntary, cyclic movement of the
eyeball); skin irritation, erythema, or edema; and shock or cardiac arrest.

INGESTED POISONS
Poison ingestion-by mouth is the most common type of poisoning, especially in children. Common
substances include household cleaning products such as drain cleaners, oven cleaners, laundry
detergents, floor or furniture polish, rat poison, cockroach sprays and baits, diaper pail deodorants,
garden and garage supplies (e.g., insecticides, gasoline), drugs, medications, food, and plants, such
as poinsettias. Older adults sometimes require special precautions .

Immediate Response
⚫ The person who determines that another person has been poisoned should call the poison
control center immediately to describe the poison ingested and to receive instructions. The
poison control center will give instructions for any treatment to start in the home or
recommend immediately bringing the patient to an emergency center for treatment. The
poison control center number should be kept by the telephone in the home and programmed
into a person's cell phone for easy access.

5
⚫ Keeping syrup of ipecac in the home to induce vomiting is no longer recommended.The nurse
should treat the patient for clinical manifestations associated with shock and, if necessary,
administer CPR. The nurse should ensure that the substance's container and any vomitus are
brought to the medical facility to help identify and treat the poison. No one should ever give an
antidote until consulting with the poison control center.

INHALED POISONS
Poisons that can be inhaled are often present without anyone’s knowing, and thus there may be no
advance warning of a problem. Once inhaled, poisons are absorbed very rapidly; therefore, prompt
first aid measures are important. Common sources of inhaled poisons include carbon monoxide
(from automobiles, fires, heating systems, propane engines, and paint remover), carbon dioxide
(from sewers or industry), and refrigeration gases. Chlorine (used in cleaning and industry) and
other spray and liquid chemicals also have the potential to give off poisonous fumes, typically when
cleaning chemicals are mixed together.

Interventions
Before assisting any victim of an inhaled poison, the nurse or rescuer should first assess the danger.
The victim should be removed from the area of exposure as soon as possible, but only if there is no
danger to the nurse or any other rescuers. Clothing is loosened from the victim s throat and chest,
and the victim is assessed to determine whether CPR is necessary. The victim should be kept quiet
and inactive while being transported immediately to the nearest medical facility.

ABSORBED POISONS
Poisons, caustic chemicals, and substances from poisonous plants that come in contact with the skin
are often rapidly absorbed, causing burning, skin irritation, allergic responses, or severe systemic
reactions. Most signs and symptoms occur within 1 to 2 hours after absorption. Signs and
symptoms include nausea, vomiting, diarrhea, flushed skin, dilated pupils, cardiovascular
abnormalities, and central nervous system and respiratory reactions. Poison ivy, poison oak, and
poison sumac are the plants that most commonly elicit a poison response.

Nursing Interventions
The first action that should be performed by the victim or anyone assisting the victim is to quickly
remove the source of the irritation and then to wash the contacted area with soap and water. Skin
preparations that are area with soap and water. Skin preparations that are effective in the
treatment of contact poisonings include baking soda, Burow's solution, and oatmeal. Calamine
lotion and hydrocortisone cream (5%) are effective in relieving pruritus.

INJECTED POISONS
A person can develop an allergic reaction if the person is injected with a drug to which the person is
allergic or if the person receives a venomous sting or bite from an insect, reptile, or animal.
Additionally, immediate follow-up treatment is recommended because bites from animals, reptiles,
or rodents may lead to infection. Prophylactic antibiotic treatment is often prescribed (Thomas and
Brook, 2011). If an animal is thought to be rabid, the person should wash the bite immediately with
soap and water for at least 5 minutes and then seek emergency care for treatment of rabies
(Immunization Action Coalition, n.d ). Emergency care for bites from a reptile such as a snake
include the following:
⚫ Restrict the movement of the affected extremity and keep it below heart level to reduce the
amount of toxin flowing towards the heart and re-circulating. Remove rings and any restrictive
clothing in case swelling occurs.
⚫ Monitor the person for signs of shock and seek medical attention immediately.
⚫ Attempt to suction the toxin from the site if a suction device is available.
⚫ If the snake is dead it should be brought to the hospital for testing (National Library of
Medicine, 2012).

Minor Reactions to Insect Bites

If a person has been stung by a bee or wasp, the nurse should remove the stinger with gauze or
some other clean material in a scraping motion. An attempt to grasp the barbed stinger with
tweezers sometimes forces venom further into the skin. Interventions include washing the area
with soap and water.

Assessment
Signs and symptoms of mild intoxication include nausea, vomiting, diarrhea, lack of coordination,
and poor muscle control. Flushing, erythema of the face and eyes, visual disturbances, and rapid

6
mood swings are often present. Slurred or inappropriate speech, inappropriate behavior, and
lethargy (sleepiness) are also typical. Serious alcohol intoxication is usually caused by consuming a
large quantity of alcohol over a short period of time. Signs and symptoms include drowsiness that
progresses to coma; rapid, weak pulse; and depressed, labored breathing or respiratory arrest.
Loss of control of urinary and bowel functions, and disorientation, restlessness, and hallucinations
are possible, as are tremors that have the potential to progress to grand mal seizures, nausea,
vomiting, expectoration of blood from the respiratory tract, and diarrhea. Some affected people also
experience loss of memory, visual disturbances, lack of muscle coordination, and depressed reflexes.

DRUGS
⚫ Abuse of drugs is a major problem in the world today. Not only are illegal drugs abused but so
are prescription and over-the-counter medications.
⚫ When assessing the drug abuser, the nurse should observe for signs and symptoms of
disorientation, hallucinations, and changes in the victim’s level of consciousness; coma and
death are possible results.
⚫ Slurred speech, extremes in mood swings, inappropriate behavior, and anxiety are also present
in some cases. Sometimes the victim has a fever and flushed skin and experiences diaphoresis
(sweating). Because of lack of coordination and impaired judgment, safety is typically an issue.
⚫ Depending on the drug, the pulse and blood pressure often increase or decrease, the pupils
constrict or dilate and the appetite increases or decreases. Hypodermic needle marks ("track
marks ") on arms, legs, hands feet, and neck are often obvious.
⚫ Many victims complain of diarrhea or pain in the abdomen, legs, or joints and also experience
tremors or seizures.

Nursing Interventions
⚫ Because an accurate nursing history is important, the nurse should obtain as much information
as possible about the substance ingested and should identify any containers that contained the
substance if possible.
⚫ Life-threatening situations should be handled first. The airway should be established and
maintained. If the victim is unconscious, the victim is turned onto his or her side. The victim’s
clothing should be loosened to assist with ventilation. If the victim is having muscle twitching
and is drowsy, the victim should not be aroused because this may precipitate a seizure. If a
fever is present, the nurse should attempt to reduce the victim’s temperature by by applying
cool, wet compresses. Victims must be protected from self injury during a seizure or
hallucination by removing potential objects from the patient’s vicinity. The nurse should not
attempt to restrain a victim during seizure activity or place anything within the victim’s mouth.
⚫ A calm, supportive, non-judgemental approach is best when a victim is very agitated or excited.
An intoxicated person should not be left alone. The nurse should frequently perform a careful
assessment of the victim’s mental status and vital signs. It is possible for the victim of
substance abuse to go into respiratory arrest quickly. It is appropriate for the nurse to ensure
the victim is promptly transported to a medical facility.

FRACTURES
Fracture is a break in the continuity of the bone. Fractured bones are seldom an immediate threat
to life, although they do have the potential to cause serious complications. When administering first
aid to an injured victim, the nurse may need to initiate CPR and treat hemorrhage. Fracture
sometimes cause considerable blood loss (750 to 3000ml from a fractured pelvis and 500 to 1500
ml from a fractured femur ).

Types of Common Fractures

A. Open or compound fractures: an open wound exists over the fractured site. Often the affected

bone is visible as it protrudes through the skin.

B. Closed fracture: the skin overlying the injury is intact.

C. Comminuted fracture: the bones is shattered into two or more fragments or pieces.

D. Greenstick fracture: an incomplete break, occurring most commonly in children because their

bones are more pliable.

E. Spiral fracture: fracture resulting from a twisting force.

F. Impacted fracture: fracture resulting from trauma that causes the bone ends to jam together.

G. Compressed fracture: fracture to the vertebrae as the result of pressure.

7
H. Depression fracture: results from blunt trauma to a flat bone, causing an indentation in the bone.

INTERVENTIONS
They should not move the victim unless he or she is in danger. They should provide first aid and
attempt to control bleeding in open fractures by cutting away the clothing around the wound and
covering the wound with a large, sterile pressure dressing. No attempt should be made to reduce
the fracture because this may cause further damage to the bone and tissue. The victim may need to
be treated for shock. Immobilization of the fracture is necessary, but no attempt should be made to
realign a bone. The part should be splinted as it was found. It is possible to change a fracture from a
simple break to comminuted or splintered one by moving it improperly. They should use a
lightweight but rigid splint that is long enough to extend past the joints above and beyond the
fracture and is wider than the thickest part
of the injury. The splint should be padded on
the inner surface to prevent contact with the
skin. Fractures must be supported while the
nurse gently slides the splint under the limb.
Roller gauze or similar material is used to
secure the limb in place. The midwife
monitors the circulation in the affected limb
by assessing color, temperature, movement
and pulses below the injury; complaints of
numbness and tingling; and evidence of
edema. Ice or cold packs are used to reduce
edema.

BLEEDING AND HEMORRHAGE

An average adult has approximately 5 to 6 L (8-12 pints) of blood circulating in the bloodstream.
Blood is necessary to transport oxygen and nutrients to all parts of the body. The body may
compensate for some degree of blood loss without any changes noted, but at some point. The effects
of blood loss become evident. The body attempts to cause clotting of the blood to halt bleeding.
Clotting usually requires 6 to 7 minutes. Bleeding, if uncontrolled, can result in shock and death.

TYPES OF BLEEDING
1. Capillary bleeding results from damaged or broken capillaries and its characteristics from
wound such as oozing that occurs with minor cuts, scratches, and abrasions. This is the most
common type of external hemorrhage.
2. Venous bleeding occurs when a vein is severed or punctured. The result is a slow, even flow of
dark red blood. Besides shock from blood volume loss, a danger of venous bleeding is the entrance
of air into the severed vein , which creates the risk of an air embolism (an abnormal circulatory
condition in which air travels through the bloodstream and becomes lodged in a blood vessel) that
travels to the vital organs, including the heart, lungs, and brain.
3. Arterial bleeding is the least common type of injury because arteries are located deep in the
body and heart usually protected by bones, fat, and other structures. When an artery is severed or
punctured, the bleeding is characterized by the heavy spurting of bright red blood in the rhythm of
the heartbeat.
The following arteries are the most common sites of arterial bleeding:
⚫ Femoral (in the upper thigh and groin)
⚫ Radial (in the medial aspect of the lower arm
⚫ Brachial (in the medial aspect of the upper arm
⚫ Carotid (on either side of the neck )

8
 INTERVENTIONS
Direct Pressure
The most effective general treatment of
bleeding is to apply direct pressure ever the
bleeding site. They should place a dressing
or the cleanest material possible over the
wound and apply firm pressure with a
gloved hand. The nurse then applies a
bandage and secures it snugly over the
wound to exert direct pressure. This can be
accomplished by tying a knot in the bandage
over the wound or by using an elasticized
securing bandage. If bleeding continues after
the bandage is applied, the nurse should
resume pressure with a gloved hand over
the bandage. Bleeding is usually controlled
in 10 to 30 minutes. The nurse should not
allow anyone but a health care provider to
remove the bandage while exerting direct
pressure even if it becomes saturated with
blood. Instead, are additional layer of
dressing is placed on top of the saturated
bandage, and firm pressure is continued. The nurse may raise the bleeding part of the body above
the level of the heart to decrease blood flow and increase the victim's ability to clot at the injured
site. This technique should be use only if there are no suspected or known fractures or conditions
that are possible to exacerbate by use of this maneuver,It is acceptable to elevate a splinted fracture
if no other contraindications are present.

Indirect Pressure
If direct pressure and elevation do not control bleeding, the nurse may apply indirect pressure to
any of the pressure points situated along the main arteries. To apply indirect pressure, the nurse
should use the fingers or the heel of the hand to compress the artery against the underlying bone
located between the heart and the wound. The nurse should do this only if no fractures are
suspected in the area where pressure could be applied. The most common pressure points are over
the carotid, subclavian, brachial, and femoral arteries.

Application of a Tourniquet
Bleeding is almost always possible to control by the three-step measure of direct pressure,
elevation, and indirect pressure. The nurse should use a tourniquet only when these methods have
failed and the victim’s life is in danger. Extensive damage to the affected extremity is possible
because of the cessation of arterial blood flow to the area. A tourniquet also has the capacity to
damage nerves and vessels directly below or under the tourniquet. An improperly, loosely applied
tourniquet does not stop arterial flow but does hinder venous flow. Tourniquet use is often
considered beyond the scope of first aid and of persons acting in good faith, such as a Good
Samaritan, and is usually restricted to professionals such as health care providers and paramedics.

EPISTAXIS
⚫ Epistaxis (nosebleed) is common but is seldom a serious emergency. However, profuse
bleeding from the nose does have the potential to lead to shock.
⚫ Epistaxis has several causes: trauma (especially a directbblow to the nose); epistaxis
digitorum (self-inflicted digital trauma from nasal picking);
infections, including the common cold; snorting cocaine; over use
nasal sprays; high blood pressure; strenuous activity; hemophilia;
and low humidity in winter months.
⚫ Epistaxis in an older adult may be caused by underlying
conditions, such as hypertension. The nurse should always assess
an adults blood pressure if epistaxis is present.

Nursing Interventions
◼ The victim experiencing epistaxis is kept in a quiet sitting position, leaning forward. If the
victim is unable to sit up, it is best that he or she remain supine with
the head and shoulders raised (if this position is not contraindicated by other injuries).

9
◼ Other interventions include the following: Keep the victim’s head tilted slightly forward so
that blood will not run down the back of the throat and cause choking or vomiting.
◼ With the thumb and forefinger, apply steady pressure to the bridge of the nose for 10 to 15
minute before releasing.
◼ Remind the victim to breathe through the mouth and to expectorate any accumulated blood.
◼ Apply ice compresses over the nose, which may help control bleeding.
◼ Look in the victim’s mouth at the back of the throat to assess for bleeding from a posterior site.
If bleeding continues despite interventions, seek medical assistance because it is possible that the
victim is bleeding from a posterior site, which could necessitate fluid replacement and an
emergency procedure to control bleeding.

INTERNAL BLEEDING
Internal bleeding is a potentially life-threatening situation. It is difficult to diagnose and often
progresses rapidly. Common causes include fractures, knife or bullet wounds, crush injuries, organ
injuries, and medical conditions such as aneurysm rupture.

Assessment
All the signs and symptoms of shock are often present. Initially, some victims experience only
vertigo (dizziness). Some victims expectorate blood (hemoptysis) or vomit blood (hematemesis).
Dark, tarry stool (melena) or blood in the urine (hematuria) may occur. Pain, tenderness, or a
dislocation at the site of a suspected injury indicates possible internal bleeding, as does bleeding
from the mouth, rectum, or any other body opening.

Nursing Interventions.
◼ Internal bleeding is a priority medical emergency. The nurse should make every effort to
obtain medical care immediately.
◼ Victims receiving anticoagulant therapy are likely to develop significant blood loss from minor
injury.
◼ Significant blood loss also occurs in some victims with a history of alcohol abuse, as well as
victims with blood dyscrasias.
◼ The victim is placed on a flat surface with legs slightly elevated if this is not contraindicated by
other injuries.
◼ Treatment for shock is initiated.
◼ A cold compress or ice should be placed on the area of the suspected injury. The ice should not
be applied directly to the skin because it can damage the tissue, a towel or clean cloth should
be placed between the ice and the skin.
◼ The victim's body temperature should be maintained with blankets, and the victim’s vital signs
should be assessed every 5 minutes.
◼ Foods and fluids should be withheld in case surgical intervention is necessary. Oxygen should
be administered as ordered by the health care provider.
◼ The victim should be provided with emotional support and reassurance to help decrease his or
her anxiety.

SHOCK
◼ Shock is an abnormal condition of inadequate blood flow to the body s peripheral tissues
(decreased tissue perfusion). The cardiovascular system fails to provide sufficient blood
circulation (oxygen, nutrients, hormones, and electrolytes) to the body’s tissues and major
organs, and metabolic waste removal is decreased.
◼ Shock results in life-threatening cellular dysfunction, hypotension, and oliguria (diminished
amount of urine formation, less than 500 ml of urine produced within 24 hours). To maintain
circulatory homeostasis, there are several mechanisms that are necessary for the body to
perform. The heart must function efficiently enough to circulate blood and a sufficient volume
of blood must be available.
◼ The vascular system must be capable of maintaining adequate circulation. The heart pumps
Oxygen-rich blood to the capillaries and cells. Glucose,oxygen, and essential nutrients are
provided to the cells, and carbon dioxide is returned to the right side of the heart. Inability of
the body to compensate for failure of one or more of these mechanisms results in shock.

TYPES OF SHOCK
A. Anaphylactic shock: Anaphylaxis (an exaggerated hypersensitivity reaction to a previously
encountered antigen) results from a sudden, severe, allergic reaction to a foreign substance. Shock

10
occurs because of the sudden decrease in the amount of circulating blood caused by the sudden
release of histamine, which creates capillary hyper permeability which in turn causes the release of
plasma through the capillary walls.
B. Cardiogenic shock: This type results from poor heart function that results from various
cardiovascular abnormalities. The heart is unable to maintain efficient blood pressure to all body
parts.
C. Hypovolemic shock (also known as hemorrhagic shock): This type is caused by a decrease in fluid
volume from bleeding, prolonged vomiting or diarrhea, or by loss of fluid as a result of surgery
trauma, or burns.
D. Neurogenic shock: This type is caused by the nervous system's failure to maintain normal
contraction of the blood vessels. Common causes are spinal anesthesia quadriplegia, or medications
that cause vasodilation, which create a condition in which the blood pressure is lower because
there is not enough blood to fill the dilated blood vessels.
E. Psychogenic shock syncope: This type is caused by the nervous system's reaction to an emotional
stimulus. The blood vessels dilate temporarily, decreasing blood flow to the brain, which results in
unconsciousness, or syncope.
F. Septic shock: This type results from severe infection. Toxins from the microorganisms cause loss
of fluid through the blood vessel walls. This is often seen in people who have other infections such
as a urinary tract infection or wound infection; in patients who have recently had surgery; in people
receiving chemotherapy; or in other conditions that result in immunocompromised functioning,
such as acquired immunodeficiency syndrome (AIDS).

CLASSIFICATION OF SHOCK
Shock is classified according to its cause. The most common causes of shock are severe loss of blood,
intense pain, extensive trauma, burns, poisons, emotional stress or intense emotions, extremes of
heat and cold, electrical injury, allergic reactions, and a sudden or severe illness.

ASSESSMENT
The signs and symptoms of shock are sometimes disguised by other signs of injury, and some often
appear only in the late stages of shock. When assessing the patient for shock, the nurse should
monitor for the development of clinical manifestations in the following areas:
◼ Level of consciousness: The victim tends to experience changes in behavior, restlessness,
anxiety, disorientation, syncope, and agitation. As the condition worsens , the victim becomes
more lethargic. Coma and death are possible.
◼ Skin: The skin becomes cool and clammy. The skin and mucous membranes become pale and
ashen. As shock progresses, cyanosis (slightly bluish, grayish, slatelike, or dark purple
discoloration of the skin especially of the lips and nail beds, caused by an excess of
deoxygenated hemoglobin in the blood) develops, and the victim appears dehydrated.
◼ Blood pressure: Initially the blood pressure is often normal, but as shock progresses, there is a
steady decrease in blood pressure, and capillary refill time is delayed. In hypovolemic shock,
hypotension is a late manifestation.
◼ Pulse: The pulse rate usually increases (tachycardia, abnormal rapidity of heart action, usually
defined as a heart rate of more than 100 beats per minute in an adult) in all types of shock. The
pulse also becomes weak and thready in character.
◼ Respirations: The respiratory rate increases. Respirations are also frequently shallow, rapid,
labored, or irregular as a result of vasoconstriction in the lungs, which causes fluid to
accumulate.
◼ Urinary output: With decreased circulation of fluid volume, the patient may develop oliguria.
◼ Neuromuscular system: Decreased oxygen to the tissues results in weakness or tremors of the
arms and legs. Eyelids close, and the pupils dilate.
◼ Gastrointestinal system: Because of loss of fluids and fluid shifts, the victim complains of thirst.
Nausea, vomiting, and dryness of mucous membranes are also possible.

NURSING INTERVENTIONS
◼ It is essential to treat shock immediately. Priority interventions are to establish an airway,
control bleeding if present, and provide fluid replacement.
◼ Place the patient in a supine position with the legs slightly higher than the head. This position
helps improve venous flow to the right side of the heart and to the vital organs, as well as helps
increase cardiac output.
◼ When a patient is in shock, hypotension is possible. Trendelenburg's position is not
recommended. If the nurse suspects that the patient may have head, neck or spinal injuries, it is
essential to keep the victim flat and not move him or her unless it is absolutely necessary to
prevent further injury.

11
◼ If the victim is unconscious or is vomiting or bleeding around the nose and mouth, the nurse
should position him or her on the side to allow the airway to clear and to encourage drainage.
◼ The nurse should elevate the head and shoulders if the victim is having problems breathing.
It is important for the nurse to maintain the shock victim’s body temperature. Wrapping the
patient in blankets or other available material helps prevent heat loss.
◼ Foods and fluids are withheld in case internal injuries are present, which necessitate
immediate surgical intervention. The nurse may provide the victim with a moistened cloth to
help relieve dryness of the mouth or mucous membranes.
◼ In a clinical setting,venous access is established, usually with two large bore intravenous
catheters (ideally 14- to 16-gauge) to facilitate rapid administration of fluids and blood
products, if needed.
◼ If an injury is present, pain control should be addressed. Nursing interventions include
positioning, adjusting tight or uncomfortable clothing or bandages, and avoiding rough
handling.
◼ It is important for the nurse not to give analgesics or drugs unless directed by a health care
provider. Victims experiencing shock are likely to be very frightened, and so it is essential for
the nurse to give emotional support and reassurance.

WOUNDS AND TRAUMA

◆ A wound is an injury to the internal or external soft tissues of the body.
◆ The basic rules for first aid treatment of wounds are as follows:
1. Stop bleeding
2. Treat shock
3. Prevent infection

◼ Closed Wounds involves the underlying tissues of the body; the top layer layer of the skin is not
broken.
◼ Common close wounds:
Ecchymoses (discoloration of an area of the skin or mucous
membrane caused by extravassation of blood into the
subcutaneous tissues; also called bruises).

Contusions (injuries that do not break the skin, caused by a

blow and characterized by edema [swelling] discoloration and
pain), strains, sprains. They most commonly occur as a result of
falls, automobile accidents or contact sports.

CARDIOPULMONARY RESUSCITATION (CPR)

ETHICAL IMPLICATIONS
◼ Reasons that individuals choose not to become involved in performing CPR include feeling
panicked, fear of incorrectly administering CPR, and fear of hurting the patient. However, once
the nurse or anyone starts CPR, it should not be discontinued except for the following reasons:
⚫ the victim recovers.
⚫ An automated external defibrillator (AED) is available and CPR is discontinued before the
equipment is applied.
⚫ The scene becomes unsafe and evacuation of the victim is necessary.
⚫ The rescuer is exhausted and is not able to continue CPR.
⚫ Trained medical personnel arrive on the scene and take over CPR.
⚫ A licensed health care provider arrives on the scene, has the authority to pronounce the
victim dead, and orders CPR to be discontinued.
When a licensed practical nurse /licensed vocational nurse(LPN/LVN) is providing emergency care
to a patient, this nurse should stay with the patient until care is taken over by a registered nurse
(RN), a health care provider, or emergency medical personnel.

EVENTS NECESSITATING CARDIOPULMONARY RESUSCITATION

✓ Cardiac Arrest: The most common cause of cardiac arrest is myocardial infarction (MI).
In addition, shock from hemorrhage, trauma to the heart, respiratory arrest, and drugs
have potential to precipitate a cardiac arrest.
✓ Drowning: Children are common victims of drowning
and boating accidents. People using alcohol or other drugs near bodies of water are often
victims of drowning . It is important to note that near-drowning victims sometimes
recover completely after long periods of submersion. The low water temperature that

12
 produces hypothermia reduces the metabolic rate and decreases oxygen demands.
Because of this, it is necessary to initiate cardiopulmonary resuscitation
(CPR) even when 4 to 6 minutes of cardiac or respiratory arrest is known to have elapsed.
✓ Electrical shock: People who come near sources of high-voltage electricity run the risk of
accidental electrocution, Electrical shock paralyzes the breathing muscles and causes
cardiac arrest by interfering with the normal rhythm of the heart. It is essentlal for the
rescuer who is initiating CPR to be careful not to inadvertently come into contact with the
electric current. The rescuer needs to ensure that the
current is de-energized before beginning CPR.
✓ Anaphylactic Reaction: Exposure to a known allergen
(e.g., food, poisons, and drugs) or an insect bite has the capacity to produce the severe
allergic reaction known as anaphylaxis. This reaction often causes spasms or edema of the
upper airway and, in some cases, progresses to cardiovascular collapse. It is necessary to
initiate CPR immediately, as with an other emergency situation.
✓ Asphyxiation: Asphyxiation or suffocation caused by inhaling a gas other than oxygen is
possible as a result of fires, chemical spills, or gas leaks. In addition, children and adults
sometimes suffer respiratory arrest and ultimately cardiac arrest from choking on food or
small objects that are placed in the mouth. Abdominal thrusts and CPR are performed in
this instance.
✓ Drug overdose: Intentional or accidental abuse of alcohol and drugs poses a risk for
respiratory and cardiac arrest. Besides treating this as a poisoning emergency, perform
CPR as necessary.
✓ Sudden infant death syndrome (SIDS): SIDS is the unexpected and sudden death of an
apparently normal and healthy infant that occurs during sleep and with no evidence of
disease on physical examination or autopsy. Aspects of prevention include both readiness
to perform early CPR and home monitoring systems.

TWO PURPOSES OF CPR

1. To keep the blood circulating and carrying oxygen to the brain, the heart, and the other parts of
the body.
2. To keep the airway open and the lungs supplied with when the breathing has stopped.

◼ Clinical Death means that the heartbeat and respiration have stopped.
◼ Biologic Death results from permanent cellular damage caused by lack of oxygen.
◼ The brain is the first organ damaged by this lack of oxygen.
◼ If CPR is not started within 4 minutes of cardiopulmonary arrest, it may reverse clinical death.
◼ After 10 minutes without CPR, brain death most likely occurs. Therefore it is extremely
important to begin CPR as quickly as possible.
◼ Brain death is an irreversible form of unconsciousness characterized by a complete loss of
brain function while the heart continues to beat. Brain death is also referred to as irreversible
coma. The legal definition of this condition varies from state to state.
◼ The usual clinical criteria for brain death include the absence of reflex activity, movements, and
respiration. The pupils are dilated and fixed. Because hypothermia, anesthesia, poisoning, or
drug intoxication have the capacity to cause a deep physiologic depression that resembles
brain death, a diagnosis of brain death requires that the electrical activity be evaluated and
shown to be absent on two electroencephalograms obtained 12 to 24 hours apart. Cerebral
blood flow studies are permitted in some states to evaluate whether brain death has occurred.

INITIAL ASSESSMENT AND RESPONSE

◼ The initial assessment task in determining the need for CPR is to determine responsiveness.
◼ The trained rescuer-the nurse-should do this by gently shaking the victim and loudly asking,
"Are you OK?". This precaution will prevent the nurse from injuring a person who is sleeping.
◼ The nurse should immediately call for help when beginning a rescue. It is imperative to access
the EMS as quickly as possible.
◼ The nurse should shout for help, make a phone call for help, or direct another person to make a
phone call if another person is available.
◼ It is vitally important to obtain an automatic external defibrillator (AED) if one is available. The
nurse should use the AED to treat defibrillation if it is required.
◼ For the most successful treatment of cardiac arrest, CPR and the use of an AED should be
initiated within the first 3 to 5 minutes. AEDS are available in numerous non hospital settings
such as airports, schools, and business locations for use by laypersons who determine that
someone has suffered cardiac arrest.

13
◼ Basic life support education for health care providers, as well as for non-health care providers.
includes instruction in CPR and in how to use an AED.

THE CAB’s OF CPR

TO remember the steps of one-rescuer or two-rescuer CPR, remember to spell CAB, a mnemonic for
assessing the status of patients in an emergency:
◼ Circulation
◼ Airway
◼ Breathing
✓ CPR performed by the healthcare provider differs slightly from that performed by the
layperson.
✓ The health care provider and layperson verify unresponsiveness, activate the EMS, and retrieve
an AED.
✓ Both determine whether there is no breathing or abnormal breathing.
✓ Only the health care provider assesses for a carotid pulse, taking no more than 10 seconds to
palpate for the pulse. The layperson does not assess for a carotid pulse.

Circulation
◼ Respiratory arrest is possible without cardiac arrest. Once the nurse has determined that the
victim is not breathing, the nurse should assess the persons pulse.
◼ Pulselessness (cardiac arrest) indicates the need for external cardiac compressions.
◼ Performing external cardiac compression on a victim with a pulse, however, has the
potential to result in injury to the victim.
◼ To determine pulselessness, the carotid pulse is the most reliable and accessible to the nurse.
The nurse maintains the head tilt with one hand resting on the victim s forehead while
assessing for the presence of a pulse.
◼ With two or three fingers of the other hand, the nurse locates the victim’s thyroid cartilage.
Then the nurse gently slides the fingers into the groove between the trachea and the muscles
on the side of the neck until the carotid pulse is felt.
◼ The pulse is palpated gently only on one side so as not to obliterate arterial blood flow to the
brain. The absence of a pulse confirms the diagnosis of cardiac arrest (sudden cessation of
functional circulation).
◼ Performing external cardiac compressions helps blood circulate to the heart, the lungs, the
brain, and the rest of the body.
◼ If external cardiac compressions are performed properly, it is possible to maintain 20% to 50%
of the normal output of the heart.
◼ This provides enough oxygen to the body to sustain life. Proper hand position enables as much
blood to be circulated as possible.

Airway
◼ The nurse should assess the victim’s airway to confirm the absence of breathing and to
establish a patent airway.
◼ If there is no evidence of head or neck trauma, the nurse should use the head-tilt /chin-lift
maneuver to open the airway.
◼ Place one hand on the victim’s forehead and apply firm backward pressure to tilt the head
back.
◼ Place the fingers of the other hand under the jaw (avoiding the soft tissue under the chin) to lift
the chin forward.

Breathing
◼ Mouth-to-mouth ventilation is the quickest method of supplying oxygen to the victim’s lungs.
◼ The rescuer's exhaled air has enough oxygen to supply the victim’s needs until life-support
systems take over.
◼ It is necessary for the nurse to maintain the head-tilt/chin-lift position and an airtight seal
throughout rescue breathing. If the victim has a pulse, the nurse should initiate rescue
breathing at a rate of one breath every 6 to 8 seconds, or 8 to 10 times per minute, in an adult.
◼ Cardiac arrest follows if respiratory arrest continues. To preserve the open airway, the nurse
should kneel by the victim’s shoulders.
◼ To gently pinch the nostrils closed, the nurse should use the thumb and the index finger of the
same hand that he or she is using to maintain the head tilt.
◼ The nurse should take a deep breath seal the lips around the outside of the victim’s mouth
(creating an airtight seal), and give two full breaths and again attempt to ventilate.
◼ Improper chin and head position is the most common reason for difficulty with ventilation.

14
◼ If the second attempt at ventilation is also unsuccessful, the nurse should proceed with
procedures to manage airway obstruction by a foreign body.

STEPS FOR ADULT ONE-RESCUER CPR

1. Determine unresponsiveness.
2. Determine breathlessness.
3. Call for help. Activate the EMS system.

Circulation
1. Determine pulselessness.
2. If pulse is present, continue rescue breathing about 8 to 10 times per miute, or one breath every
6 to 8 seconds. Activate the EMS system.
3. If pulse is not present, perform 30 chest compressions at a rate of at least 10 per minute. Count
"one,two, three, four, five" until you have done 30 compressions, and follow them with two
slow breaths. The American Heart Association recommends that the layperson push hard and
fast for compressions and use the beat of the 1970’s disco song "Stayin Alive" to keep the pace
of at least 100 beats per minute (American Heart Association, 2010).
4. Continue with 30 compressions and two slow breaths until an AED becomes available or help
arrives.

Airway
◼ Open the victim s airway using the head-tilt/chin-lift maneuver. Gently lift the chin forward to
help open the victim’s airway. If the victim has a suspected neck injury, use the jaw-thrust (or
chin-lift) maneuver without tilting the head.

Breathing
1. If the victim is not breathing, give two slow breaths (1 second each). Allow for exhalation
between breaths.
2. If unable to give two breaths, reposition the victim’s head and reattempt to ventilate.
3. If still unable to give two breaths, proceed with procedures to manage airway obstruction by a
foreign body.

ADULT TWO-RESCUER CPR

◼ Because CPR expends a great deal of energy, it is less fatiguing if two rescuers perform. CPR. If
the EMS system has not already been activated, the nurse should direct the second rescuer to
initiate CPR before starting to assist with CPR.
◼ The rescuer at the victim’s head is referred to as the "ventilator," and the rescuer at the victim’s
chest is referred to as the "compressor." The ventilator should determine responsivenes. If
there is no response, the ventilator assesses for breathlessness for 5 to 10 seconds.
◼ The compressor or a bystander should activate the EMS and call for an AED. The ventilator
should assess for pulselessness for 5 to 10 seconds.
◼ If the victim has a pulse, the ventilator should initiate rescue breathing at a rate of one breath
every 6 to 8 seconds, or 8 to 10 times per minute, for an adult victim.
◼ If the victim does not have a pulse, then the compressor starts compressions. The compression:
ventilation ratio for two-person CPR is 30 chest compressions for every 2 breaths.
◼ Exhalation occurs during chest compressions. The compression rate for two-person CPR is at
least 10 per minute.
◼ The rescuer performing chest compressions is more likely to become fatigued. The rescuers
should switch positions every five cycles of 2 minutes in an effort to continue effective CPR.
◼ The switch is initiated by the rescuer performing chest compressions at the end of a 30:2
sequence.
◼ After giving a breath, the ventilator moves to the chest and gets into position to give
compressions.
◼ The compressor moves to the victim’s head and checks the pulse for 5 to 10 seconds. If no
pulse is felt, he or she gives the command "Resume CPR" and compressions are restarted,
followed by breaths.

PEDIATRIC CPR: CHILD OR INFANT

◼ The basic steps of CPR and procedures to manage airway obstruction by a foreign body are the
same whether the victim is an infant, a child, or an adult.
◼ For the purpose of basic life support, an infant is defined as anyone younger than 1 year
of age, and a child is defined as anyone between age 1 year and puberty.
◼ The nurse must first determine unresponsiveness. The nurse should gently shake a child. With
an infant, the nurse may try gently tapping the infant's heels.

15
◼ The nurse should position the victim on a firm, flat surface for the best CPR effectivenes. It is
sometimes advantageous for the nurse to carry a small child or infant while performing CPR,
although this technique is not as effective.
◼ The nurse should use the head tilt/ chin lift or jaw thrust technique to open the airway of the
child, while taking care not to hyperextend an infant’s neck because this sometimes allows the
infants shorter trachea to become occluded.
◼ In the case of a head injury, the nurse should not tilt the head but should use the jaw-thrust
technique instead. Caution is necessary with suspected neck injuries in infants and children, as
it is in adult cases.
◼ After establishing that the airway is open, the nurse should look for movement of the chest,
listen for breath sounds, and feel for exhaled airflow. If the infant or child is not breathing, the
nurse should begin the CAB sequence.

PROCEDURES TO MANAGE AIRWAY OBSTRUCTION BY A FOREIGN BODY

◼ Food particularly meat, is the most common cause of choking or airway obstruction in adults.
Factors that contribute to this include large or poorly chewed pieces of food, talking while
eating, the ingestion of alcohol, the use of sedatives, loose fitting dentures, and neurologic
deficits.
◼ In addition to food, foreign objects (e.g., marble, balloons, bead and buttons) are the most
common cause of airway obstruction in children.
◼ If the victim is unable to cough forcibly, the air exchange is good, although there may be
wheezing between coughs.
◼ The rescuer should not interfere with the victim at this point. The nurse should monitor the
victim closely because it is possible that air exchange may regress to poor state.
◼ The victim experiencing poor air exchange is likely to have weak, ineffective cough, make a
high pitched, “crowing” noise while inhaling, exhibit increased respiratory difficulty; and
develop cyanosis.
◼ With complete airway obstruction, the victim is not able to speak, breathe, or cough and
sometimes clutches the neck.
◼ This sign is a universal distress signal. To assess inability to speak, the nurse should ask the
victim, “Are you choking?” complete airway obstruction will prevent oxygen from entering the
lungs and being circulated to the brain and vital organs.
◼ Unless prompt action is initiated, the victim will become unconscious and death will result.
◼ Of all deaths form foreign body aspiration, many occur in infants. Aspirated materials include
foods such as candies and nuts, and small objects.
◼ Infants and children experience acute respiratory distress with coughing, gagging and stridor
(harsh sound during respirations, high pitched and resembling the blowing of the wind, caused
by obstruction of the air passage). The victim often becomes unconscious.

MANEUVERS EFFECTIVE IN REMOVING FOREIGN BODIES

◼ Abdominal Thrusts given just above the victim’s navel, an emergency procedure for dislodging
a bolus of food or other obstruction from the trachea to prevent asphyxiation, are
recommended for relieving airway obstruction by a foreign body.
◼ If the victim is unconscious, the nurse should lay him or her down in a face-up (supine)
position. The nurse should attempt only to remove an object from the victim’s mouth if the
object is visible. The nurse should check for the object each time he or she prepares to provide
breaths.
◼ If the nurse is assisting a child who has aspirated a foreign body, the nurse may treat the child
in a manner similar to that for an adult with performance of abdominal thrusts.
◼ However, there is a potential for injury if the nurse uses this maneuver in an infant. The nurse
should use the combination of back blows and chest thrusts with an infant.

ADVANCED CARDIAC LIFE SUPPORT (ACLS)

It is a systematic approach to provide early treatment of cardiac emergencies. ACLS include:

1. Basic life support
2. The use of adjunctive equipment and special techniques for establishing and maintaining
effective ventilation and circulation,
3. ECG monitoring and dysrhythmia recognition
4. Therapies for emergency treatment of patient with cardiac or respiratory arrest,
5. Treatment of patient with suspected acute MI.

16
V. ACTIVITY
B. Multiple Choice: Read carefully and choose the letter of your answer.

1. The emergency medical service has transported a client with severe chest pain. As the client is
being transferred to the emergency stretcher, you note unresponsiveness, cessation of breathing,
and unpalpable pulse. Which of the following task is appropriate to delegate to the midwife?
A. Assisting with the intubation.
B. Placing the defibrillator pads.
C. Doing chest compressions.
D. Initiating bag valve mask ventilation.
2. A client arrives in the emergency unit and reports that a concentrated household cleaner was
splashed in both eyes. Which of the following nursing action is a priority?
A. Examine a clients visual acuity.
B. Patch the eye.
C. Use Retasis (Allergan) drops in the eye.
D. Flush the eye repeatedly using sterile normal saline.
3. A 5-year-old client was admitted to the emergency unit due to the ingestion of an unknown
amount of chewable vitamins for children at an unknown time. Upon assessment, the child is alert
and with no symptoms. Which of the following information should be reported to the
physician immediately?
A. The child was nauseated and vomited once at home
B. The child has been treated several times for toxic substance ingestion
C. The vitamin that was ingested contains iron
D. The child has been treated multiple times for injuries caused by accidents
4. The following clients come to the emergency department complaining of acute abdominal
pain. Prioritize them for care in order of the severity of the conditions. Write the number from 1-5
in the box provided before the statement.
A 59-year-old man with a pulsating abdominal mass and sudden onset of persistent abdominal or
back pain, which can be described as a tearing sensation within the past hour.

A 27-year-old woman complaining of lightheadedness and severe sharp left lower quadrant pain
who reports she is possibly pregnant.

A 15-year-old boy with a low-grade fever, right lower quadrant pain, vomiting, nausea, and loss of
appetite for the past few days.

A 43-year-old woman with moderate right upper quadrant pain who has vomited small amounts of
yellow bile and whose symptoms have worsened over the week.

A 57-year-old woman who complains of a sore throat and gnawing midepigastric pain that is worse
between meals and during the night.

5. A nurse is providing discharge instructions to a woman who has been treated for contusions and
bruises due to domestic violence. What is the priority intervention for this client?
A. Arranging transportation to a safe house
B. Advising the client about contacting the police.
C. Making an appointment to follow up on the injuries.
D. Making a referral to a counselor

EVALUATION:
A. True or False: Write true if the statement is correct and write false if the statement is incorrect.
Write your answer on a separate sheet of white bond paper. And submit it to my E-mail add:
jaky_2424@yahoo.com.

____1. First aid does not replace medical care but is used to preserve life until medical help is
obtained.
____2. Triage is a process were patients are sorted to concentrate care and resources to those who
would likely to survive.
____3. Written permission should be obtained from the victim before giving first aid because the
victim has the right to refuse first aid.
____4. The midwife should hyperextend the patient’s neck to establish an airway, it places the
patient risk for cervical spine injury.

17
____5. The initial priority for the patient’s having burn injury is to remove the patient from the
source.
____6. It is not appropriate to apply antiseptics, ointments, sprays, or creams to the burn.
____7. In an emergency try to work within a patient’s belief rather contradicting them outright .
____8. The most common poisoning in children is the ingestion by mouth poison.
____9. Poisons that can be inhaled are often present with everyone’s knowledge.
____10. If a victim was stung by a bee, the nurse should remove the stinger with gauze in a scraping
motion.
____11. Drug abuse victims must be protected from self injury during a seizure or hallucination by
removing potential objects from the patient’s vicinity.
____12. Considerable loss of blood of 750 to 3000ml from a fracture in the femur.
____13. Green stick fracture is were the bones are shattered into two or more fragments or pieces.
____14. Arterial bleeding is the least common type of injury because arteries are located deep in the
body.
____15. Neurogenic shock is caused by the nervous system's reaction to an emotional stimulus.

B. Multiple Choice: Read carefully and choose the letter of your answer.

1. The 2010 AHA Guidelines for CPR recommended BLS sequence

of steps are:
a. Airway, Breathing, Check Pulse
b. Chest compressions, Airway, Breathing
c. Airway, Breathing, Chest Compressions
d. Airway, Check Pulse, Breathing
2. Critical characteristics of high-quality CPR include which of the
following?
a. Starting chest compressions within 10 seconds of recognition of cardiac
arrest
b. Allowing complete chest recoil after each compression
c. Minimize interruptions of CPR
d. All of the above
3. At what age is it necessary to use the child AED pads?
a. 8 years of age or older
b. 8 years of age or younger
c. 12 years of age or younger
d. 18 years of age or younger
4. The compression to ventilation ratio for the one-rescuer giving
CPR to victims of ANY age is:
a. 30:1
b. 30:2
c. 15:1
d. 15:2
5. Where should you attempt to perform a pulse check in an adult?
a. Brachial artery
b. Carotid artery
c. Popliteal artery
d. Temporal artery

END OF MODULE

18