EMERGENCY

NURSING
INCIDENT COMMANDER
❒ Handles the situation in a disaster operation
❒ Controls throughout the duration of the
disaster operation. AMBULANCE MUST-KNOWS:
1) DRIVER
USES OF AN AMBULANCE: ❒ MUST NOT LEAVE the ambulance
❒ Transports a patient to hospital and home ❒ TEAM LEADER: sat beside the driver
and vice versa (passenger seat)
❒ Rescues trauma patients from an accident 2) BEACONS
❒ Serves as a standby rescue vehicle during big a) Lights
gatherings and events b) Sirens
❒ DOES NOT bring recovered bodies to funeral c) is in front (In
homes for proper identification order to convey the vehicle in front that
it is an ambulance by using its side
mirror)
EMERGENCY PRINCIPLES 3) PATIENT POSITION: Head of patient must be
1) 90-5-5 the first to enter the ambulance
❒ 90% = Safety of yourself 4) NUMBER OF CREW (Philippine setting)
❒ 5% = Safety of patient a) Team Leader (passenger seat)
❒ 5% = Safety of bystander ✔ Delegator
2) BSI (Body Substance Isolation) b) Driver
❒ Before contact, isolate yourself from ✔ Never leave the ambulance
infectious conditions c) Documentator (fills in patient’s
❒ Hand hygiene first before in contact information and the run sheet)
with the patient d) Vital signs taker
3) RESCUE the patient FIRST e) Treat Man
4) DO NOT TREAT at the impact site ✔ Treats the patient
5) Ask for help
6) COMMON sense
7) Calmness
8) Patience

STAR OF LIFE
1) Early Detection
2) Early Reporting
3) Early Response
4) On-Scene Care
5) Care In Transit
6) Transfer To
Definitive Care
 d) PMS before and after
CRAMPS splinting.
❒ Unpleasant muscle contraction ❒ If (-) PMS after splinting,
❒ CAUSES: it is too tight.
a) Excessive Exercise
b) Prolonged Compression
c) Forced ROM
❒ MANAGEMENT:
a) Stretch out muscle CONCUSSION
b) Use WARM compress ❒ Jarring (Na-alog) of the brain
❒ CAUSES:
a) Blows to the head that does not injure
SPRAIN vs. STRAIN the skull (e.g. Coup-contra coup or
SPRAIN STRAIN Whiplash)
DEFINITION Ligament Muscle fibers
CAUSES Pulling or Excessive use
Twisting of body
mechanics
S/SX a) Inflammation a) Pain
b) Redness b) Bluish red
c) Pain c) Warmth
d) Warmth

NURSING a) Check PMS

MANAGEMENT ❒ Pulse
❒ Motor Movements ❒ COMPLICATIONS
❒ Sensory Sensation a) Confusion
b) Remove jewelries b) Temporary loss of consciousness
c) COLD compress c) Pain
d) Possible seizures
❒ MANAGEMENT:
a) Monitor LOC

DISLOCATION vs. FRACTURE

DISLOCATION FRACTURE CONTUSION
DEFINITION Misaligned bone Damage to ❒ Bruising of brain tissue, possible
from original bone integrity accompanied by hemorrhage (Na-untog)
position ❒ CAUSES:
NURSING a) DO NOT replace/stretch the
a) Direct blows and deep impact to the
MANAGEMENT bone (IMMOBILIZE)
head
❒ Treat the Fx (fracture) the
way you fx ❒ MANAGEMENT:
b) COLD packs b) Administer CPR if pulseless and
c) SPLINT breathless
❒ If fx is along the bone: c) Treat the bleeding
BANDAGE it from JOINT d) Apply COLD pack
to JOINT e) Transport to nearest hospital
❒ If fx is along the joint:
BANAGE it from BONE to
BONE.
 ❒ NOT OKAY to give warm drinks
✔ Swallowing reflex might be lost
prior to no more shivering reflex
✔ Risk of aspiration
C. SEVERE HYPOTHERMIA
❒ Possible seizures
❒ PRIORITY: Safety Precautions
HYPOTHERMIA D. PROFOUND HYPOTHERMIA
STAGES Core Axillary Sigs & Symptoms ❒ Possible death
Temp. Temp.
MILD 32-35°C 30.5-35°C a) Alert
(Normal) b) Vigorous
shivering

MODERATE 30-32°C 28.5-32°C a) Reduced LOC

b) Shivering FROSTBITE
diminishes
❒ Localized destruction of tissue due to
c) Loss of fine
exposure to freezing temperatures
motor control
a) Constriction of capillaries on to the distal
d) Loss of
parts of the body, causing lack of blood
coordination
supply.
e) Blue lips-
❒ SIGNS & SYMPTOMS:
cyanosis
a) Numbness
28-30°C 26.5-30°C a) Shivering b) Waxy appearance (INITIAL SIGN)
stops c) Black appearance (LATE SIGN)
b) Fixed dilated ❒ MANAGEMENT:
pupils a) Soak in WARM water (100°F)
✔ ONLY APPLICABLE on the initial sign
SEVERE 25-28°C 23.5-28°C a) Unconscious b) Transport to nearest hospital
b) Shivering has
stopped
c) Rigid muscles HEAT EMERGENCIES
d) Appears dead I. HEAT CRAMPS
e) Potential ❒ Painful severe cramps
arrhythmias ❒ Typically occurs on the calves, abdomen,
back and arms
20-25°C 18.5-25°C a) Cardiac Arrest
❒ EARLIEST sign of heat illness
PROFOUND <20°C <18.5°C a) NO detectable ❒ CAUSES:
V/S a) Due to excessive water/electrolyte
loss
b) Excessive performing activities
A. MILD HYPOTHERMIA without hydration
❒ NORMAL ❒ SIGNS & SYMPTOMS:
❒ Shivering a) Painful muscle spasms
❒ OKAY to give warm drinks b) Heavy sweating
B. MODERATE HYPOTHERMIA ❒ MANAGEMENT:
❒ NO MORE shivering a) Hydration ORALLY
❒ FIRST: give blanket II. HEAT EXHAUSTION
 ❒ If not immediately treated prior from b) Turning pale
heat cramps, it can lead to heat c) Tinnitus
exhaustion d) Blurry vision or tunnel vision
❒ SIGNS & SYMPTOMS: e) Feeling faint or light-headed
a) Body Temp: 38.8-102°C f) Suddenly feeling warm and sweaty
b) Headache ❒ MANAGEMENT:
c) Fatigue & Weakness a) Assess AVPU/LOC
d) Moist skin/Sweating ✔ Alertness
e) Orthostatic hypotension ✔ Verbal commands
f) Tachycardia ✔ Pain stimulus
g) Anxiety-Confusion ✔ Unconsciousness/LOC
❒ MANAGEMENT: b) If FACE is RED: RAISE Head
a) Salt & Water replacement c) If FACE is PALE: RAISE tail (legs)
b) Rest d) SUPINE if necessary
III. HEAT STROKE V. BEE STING
❒ If not immediately treated prior from ❒ INITIAL ACTIONS AFTER THE STING:
heat exhaustion, it can lead to heat stroke a) Swipe the stinger with a card
❒ SIGNS & SYMPTOMS: b) Wash the site with soap and water
a) Body Temp: 40.6-105°C c) Prioritize airway or watch out for
b) Sodium and Potassium depletion airway problems
c) Listlessness ❒ ACTIONS “MINUTES” AFTER THE STING
d) Weakness (if prominent swelling is indicated):
e) Hot & dry skin a) Use curved tweezers
f) Impaired sweating ❒ It can lead to:
g) Tachypnea a) ALLERGY
h) Tachycardia ✔ Increased temperature
i) Anxiety-Confusion ✔ Itchiness
❒ COMPLICATIONS: ✔ Mottled appearance
a) Cerebral Edema: (pantal-pantal sa balat)
✔ Seizures b) ANAPHYLAXIS
✔ Delirium ✔ Allergy S/Sx
✔ Coma ✔ Difficulty of breathing
❒ MANAGEMENT: ❒ FACTS:
a) Cooling a) When bee stings, it cannot pull the
b) Rest stinger back out. It leaves behind
c) Fluid & Electrolyte Support not only the stinger but also part
IV. FAINTING of its digestive tract, plus muscles
❒ Temporary loss of blood in the brain and nerves. This massive
❒ CAUSES: abdominal rupture and bleeding is
a) Excitement what kills the bee.
b) Lack of rest
c) Low or high temperatures
d) Did not eat meals
e) Overwork
f) Weak
g) No air (lead to asphyxiation)
❒ WARNING SIGNS OF A FAINTING SPELL:
a) Dizziness & Nausea
 ✔ STOP
✔ DROP
✔ ROLL
e) Medications via IV

FIRE/BURNS
❒ Elements of FIRE (FIRE TETRAHEDRON)
TYPES OF FIRE
EXTINGUISHERS

❒ OBJECTIVES:
a) RACE/ARCE
RACE ARCE

(WITH patient) (WITHOUT patient)

Rescue Alarm

Alarm Rescue

Contain/Confine Contain/Confine

Extinguish & Evacuate Extinguish &

Evacuate

b) Airway (ABCs): PRIORITY

✔ Equipment: face
mask/non-rebreather mask on O2 STEPS IN OPERATING A FIRE
c) NEVER REMOVE clothes
d) 3 Magic Words: EXTINGUISHER
 1) Position yourself to exit of infection or
2) Twist pin scarring
3) Pull pin
FULL 3RD DEGREE Underlying ❒ Hard,
4) Aim nozzle
THICKNESS tissues leathery, dry
5) Squeeze handle eschar
6) Swing nozzle ❒ Insensate to
light touch
and pin prick
❒ (-) Pain
❒ Large areas
require skin
grafting
❒ Small areas
will heal with
minimal scar
or
contracture
❒ High risk of
DEGREES OF BURNS infection
Nomenclature Traditional Depth Findings
Nomenclature 4TH DEGREE Muscle or ❒ Loss of
bone burned part
SUPERFICIAL 1ST DEGREE Epidermis ❒ Erythema
❒ (-) blisters
❒ (-) scar
❒ (+) Pain

SUPERFICIAL 2ND DEGREE Between ❒ (+) blisters &

PARTIAL epidermis weeps
THICKNESS and dermis ❒ Clear fluid
❒ (+) Pain
❒ (+) scar RULE OF NINES (ADULT)
❒ Do not
FRONT BACK (%) FRONT-BACK
require (%) (%)
surgery
HEAD-NEC 4.5 4.5 9
❒ Increase K
depth: CHEST-ABD 18 18 36
increase risk OMEN
of infection or WHOLE (R) 4.5 4.5 9
scarring ARM
WHOLE (L) 4.5 4.5 9
PARTIAL 2ND DEGREE Full dermis ❒ (+) blisters &
ARM
THICKNESS/ weeps
DEEP WHOLE (R) 9 9 18
❒ Whitish
PARTIAL LEG-THIGH
appearance
WHOLE (L) 9 9 18
❒ Requires
LEG-THIGH
surgery
GENITAL 1
❒ Forms more AREA
scars
❒ LESS painful
❒ Increase
depth:
increase risk
 FLUIDS OLIGURIC DIURETIC
RULE OF NINES (PEDIA)
TBSA (%) Intravascular to Interstitial to
interstitial intravascular
HEAD-NECK 21
HEMATOCRIT INCREASED DECREASED
CHEST-ABDOMEN 13 URINE DECREASED INCREASED
POTASSIUM INCREASED DECREASED
BACK 13
SODIUM DECREASED DECREASED
WHOLE (R) ARM 10 PROTEIN DECREASED DECREASED
pH METABOLIC METABOLIC
WHOLE (L) ARM 10 ACIDOSIS ACIDOSIS

WHOLE (R) 13.5 MANAGEMENT EMERGENT ACUTE CARE

LEG-THIGH CARE
WHOLE (L) 13.5
LEG-THIGH
GENITAL AREA 1

BUTTOCKS 5 GOAL OF BURNS

RULE OF PALM
❒ If there is an isolated burn wound/mark
that is BIGGER or the SAME AS THE SIZE
of his/her palm, consider it as 1%.
1) RETURN TO NORMAL OF ABCs
2) IV: Lactated Ringer’s Solution (LRS)
3) Whirlpool Therapy
❒ To promote debridement of eschar
4) ANALGESICS Before whirlpool therapy and
exercises
5) Antibiotics
6) Check temperature for fever
7) Check WEIGHT (indicator for fluid retention)

PHASES
EMERGENT CARE ❒ 24-48 hours post burn
❒ PARKLAND FORMULA:
✔ 4 cc X kg X %TBSA of
Lactated Ringer’s
Solution
✔ This is for the amount
of fluids to be given
for the first 24 hours
upon admission
ACUTE CARE ❒ 72nd hour (maintenance
techniques)
REHABILITATIVE CARE ❒ Therapy techniques
BURN RHABDOMYOLOSIS
❒ Products of muscle breakdown in urine of
major burn victim
❒ GOOD sign: KIDNEYS are still functioning!
ELECTROCUTION
❒ Electricity above tolerable current passes
or enters through body
❒ CAUSES:
1) Spaghetti wiring
2) Octopus wiring
❒ NURSING MANAGEMENT
1) DO NOT TOUCH patient
 2) Look for the SOURCE, SWITCH, 3) LACERATION
FUSE BOX 4) AVULSION
3) CPR 5) INCISION
4) NPO until fully recovered
MI/HEART CARDIAC FIRST AID MANAGEMENT
ATTACK ARREST 1) CONTROL the bleeding
Pumping Of
Heart
Muscles
✓ X 2)
❒ Put pressure on the wound
COVER the wound with dressing and secure
Blood with bandage
Supply To
The Heart
X ✓ 3) CARE for shock
❒ Proper positioning of the affected part
4) CONSULT or refer to physician

WOUNDS WITH SEVERE BLEEDING

WOUNDS (CLOSE/OPEN) 1) CONTROL the bleeding by:
❒ Is a break in the continuity of a tissue of ❒ DIRECT pressure
the body, either internal or external. ⮚ EXCEPT:
CLOSED WOUND OPEN WOUND a) Eye injury
❒ It involves the ❒ It is a break in the b) Wound with embedded
underlying tissue skin or mucous object
without break/ membrane; or the c) Possible skull fracture
damage in the skin protective barrier
2) ELEVATION
or mucous skin layer is
membrane. damaged. 3) PRESSURE POINT bleeding control
❒ Brachial artery
NURSING MANAGEMENT ❒ Femoral artery
1) ICE application (to
promote
vasoconstriction and
decrease bleeding)
2) Compression
3) Splinting

KINDS OF BLEEDING (OPEN WOUND)

INGESTED POISONING
1) ARTERIAL BLEEDING ❒ ASSESSMENT:
❒ Irregular spurting of blood 1) Identify FIRST if CORROSIVE or NOT
2) VENOUS BLEEDING CORROSIVE
❒ Even flow of blood ❒ CHECK the label of the poison
3) CAPILLARY BLEEDING CORROSIVE NOT
❒ Capillary oozing CORROSIVE
CLASSIFICATION OF OPEN WOUND DO NOT INDUCE INDUCE vomiting
1) PUNCTURE vomiting
2) ABRASION
 LEFT position LEFT position 4) DO NOT USE TOURNIQUET
✔ Yes, it can suppress the toxin on
TRANSPORT TRANSPORT the distal area of the affect
extremity.
❒ AVOID RIGHT position! ✔ THE PROBLEM IS: after
✔ The poison can easily removing, the toxin will circulate
pass through the in a “BOLUS-TYPE” fashion,
duodenum and leading to abrupt death to the
absorbed by the portal patient.
vein via the liver.
VENOMOUS NON-VENOMO
BITE US BITE
JELLYFISH STING BITE MARK TWO bite marks MULTIPLE bite
❒ MANAGEMENT: marks (Horseshoe-
shaped)
1) Rinse the affected area with
seawater to help gets rid of loose
EYES VERICAL pupils ROUNDED/OVAL
stingers. AVOID freshwater which
may irritate the wound by activating pupils
additional nematocysts.
✔ AVOID drying the site with tower HEAD ARROW-typed ROUNDED
or getting sand in it which it will
add to the irritation. ❒ SIGNS & SYMPTOMS:
2) Carefully scrape the remaining 1) CNS
stingers out of your skin using an ID a) Dizziness
or credit card. b) Fainting
3) Apply plain vinegar to the site or a c) Increased thirst
paste of baking soda and seawater d) Headache
which may deactivate nematocysts
2) VISION
and reduce the reaction
4) Rinse the area under hot water not a) Blurriness
to exceed 113 degrees F or apply ice 3) SYSTEMIC
packs. Choose the method that seems a) Fever
to offer you the most relief. b) Sever pain
5) Apply calamine lotion and take a 4) HEART & VESSELS
pain reliever or anti-inflammatory a) Rapid pulse
medication to help reduce swelling
b) Low BP
and irritation
6) Rest and monitor the site. See a c) Sever shock
doctor if a rash develops or you start 5) RESPIRATORY
to have DOB. a) DOB
6) MUSCULAR
a) Convulsions
b) Loss of coordination
c) Weakness

SNAKE BITE
❒ ASSESSMENT:
1) ASSESS the bite mark FIRST if it is 7) WOUND SITE
VENOMOUS or NON-VENOMOUS a) Bleeding
2) WASH the affected area b) Fang marks
3) KEEP the patient still c) Discoloration
 d) Burning sensation ❒ Advanced Life Support & Post-Arrest
e) Swelling Care
8) GASTRIC e) ICU
a) Nausea ❒ Advanced Life Support & Post-Arrest
b) Vomiting Care
9) INTESTINAL
a) Diarrhea OVERVIEW of BLS Steps
10)OTHER SKIN SITES 1) HAZARD (90-5-5)
a) Bleeding spots ❒ Survey the scene if it is safe
b) Numbness 2) HELLO
c) Tingling ❒ Introduce yourself
d) Sweating ❒ Ask: Sir/Ma’am, can you hear me?/can
you get up?
3) HELP
BASIC LIFE SUPPORT (AMERICAN ❒ Instruct bystander to call EMS
4) CIRCULATION
HEART ASSOCIATION GUIDELINES,
❒ Check circulation on the carotid
2019) artery for 10 seconds (ADULT)
❒ Check circulation on the brachial
IHCA & OHCA Chains of Survival artery for 10 seconds (INFANT)
5) AIRWAY
IHCA (Intra-Hospital Cardiac Arrest) ❒ Perform head tilt chin-lift maneuver
a) PRIMARY PROVIDERS in adults
❒ Surveillance & Prevention ❒ Lay the infant on a FLAT SUPINE
❒ Recognition And Activation Of The position
Emergency Response System 6) BREATHING
❒ Immediate High-Quality CPR WHEN NOT TO PERFORM CPR
b) CODE TEAMS 1) DNR (Do Not Resuscitate Order) or AND
❒ Rapid Defibrillation (Allow Natural Death Order)
c) CATH LAB 2) Dependent lividity
d) ICU 3) Obvious death
❒ Advanced Life Support & Post-Arrest
Care

OHCA (Outside Hospital Cardiac Arrest)

a) LAY RESCUERS
❒ Recognition And Activation Of The ADULT CHILD INFANT
Emergency Response System
❒ Immediate High-Quality CPR 2 HANDS 1 HAND 2 FINGERS
❒ Rapid Defibrillation
b) EMS 1.5-2 INCHES 1-1.5 INCHES 0.5-1 INCH
❒ Basic & Advanced Emergency Medical
Services
WAYS TO VENTILATE THE LUNGS
c) ED
❒ Advanced Life Support & Post-Arrest
Care
d) CATH LAB
1) Mouth-to-Mouth
2) Mouth-to-Nose
3) Mouth-to-Mouth and Nose
4) Mouth-to-Stoma

WHEN TO STOP CPR

1) Signs of Life
2) Turnover to ambulance
3) Operator is exhausted
4) Physician takes over
5) Scene is unsafe

BASIC LIFE SUPPORT AND

COVID-19
1) Don PPE
2) Limit personnel/bystanders
3) Check for responsiveness
4) If unresponsive:
a) Ask for help
b) Call medical assistance
c) Get AED
5) Check breathing and pulse for 10 seconds
 6) AFTER CHECKING BREATHING:

NORMAL 1) STAY with patient until

BREATHING assistance arrives
AND PULSE
(-) BREATHING 1) 30 compressions and 2
(-) PULSE respirations using bag
valve mask device (ambu
bag) or continuous
compression until AED
arrives

(-) BREATHING 1) Provide respirations for

(+) PULSE 5-6 seconds using bag
valve mask device with
filter and tight seal

7) AED ARRIVES:

SHOCKABLE 1) Give 1 shock and resume

CPR until instructions from
AED tells you to stop or:
a) AED goes to
rhythm check
b) Until patients starts
to move

NON 1) Do CPR until instructions

SHOCKABLE from AED tells you to stop
or:
a) AED goes to
rhythm check
b) Until patients starts
to move
PREGNANT/OBESE CHOKING
❒ NURSING MANAGEMENT:
1) DO NOT HEIMLICH maneuver
2) DO CHEST TRUSTS!
FOREIGN BODY AIRWAY OBSTRUCTION
(CHOKING)
❒ NURSING MANAGEMENT: INFANT CHOKING
1) DO NOT ASK if he is choking
2) DO NOT RAPPORT
3) ASK him if he can cough
4) If (+) Cough, Encourage to cough
5) If (-) Cough:
a) Perform back blows (5x)
b) Perform Heimlich maneuver (5x)
6) Repeat a & b.
ALONE AND CHOKING YELLOW URGENT ❒ Injury of the
extremities
❒ NO SHOCK
❒ ABCs are GOOD

BLACK EXPECTANT ❒ Expected to die

❒ Decapitated

DISASTER NURSING
DISASTER
⮚ A sudden event that causes great damage or loss
of life
1) PREPAREDNESS
✔ activities PRIOR TO a disaster
✔ EXAMPLES:
a) Preparedness Plans
b) Emergency Exercises/Trainings
TRIAGING c) Warning Systems
2) RESPONSE
❒ MCI = Mass Casualty Index
✔ activities DURING a disaster
✔ xMeet = SUPPLY = DEMAND
✔ EXAMPLES:
❒ the process by which patients classified
a) Public Warning Systems
according to the type and urgency of their
b) Emergency Operations
conditions to get the RIGHT PATIENT to the
c) Search & Rescue (Living)
RIGHT PLACE at the RIGHT TIME with the
d) Search & Retrieval/Recovery
RIGHT CARE PROVIDER.
(Deceased)
● FIRST: follow START Protocol (Simple 3) RECOVERY
Triage And Rapid Treatment) ✔ activities FOLLOWING a disaster
✔  to quickly classify victims during a mass ✔ EXAMPLES:
casualty incident (MCI) based on the a) Temporary Housing
severity of their injury (e.g. using tags). b) Claims Processing And Grants
TRIAGE c) Long-Term Medical Care And
GREEN NON-URGEN ❒ walking-wound Counseling (Psychological
T ed First-Aid)
❒ HOME first aid 4) MITIGATION
✔ Activities that REDUCE THE EFFECTS
RED EMERGENT ❒ Injury of VITAL
of a disaster
organs
✔ EXAMPLES:
❒ SHOCK
a) Building Codes And Zoning
❒ ABCs problems
b) Vulnerability Analyses
❒ Amputations
c) Public Education
❒ Spinal cord
WHO DECLARES A DISASTER?
injury
a) Mayor
b) Governor
 c) President

TYPES OF DISASTER
a) Natural
b) Man-Made
NATURAL TYPES OF DISASTER
a) Agricultural diseases & pests
❒ Drought
❒ Earthquakes
b) Emergency diseases (Pandemic)
❒ Extreme heat
❒ Floods
❒ Hail

MAN-MADE TYPES OF DISASTER

a) HAZMAT spills (Hazardous Materials)
b) Power Disruption & Blackout
c) Nuclear Power Plant And Nuclear Blast
d) Chemical Threat And Biological Weapons
e) Cyber Attacks
f) Explosion
g) Civil Unrest (Political Problems)
h) Terrorism

TROPICAL CYCLONE CLASSIFICATIONS

CATEGORY INTENSITY (wind speed)
TROPICAL DEPRESSION 61 kph or less
(td)
TROPICAL STORM (ts) 62-88 kph
SEVERE TROPICAL 89-117 kph
STORM (sts)
TYPHOON (ty) 118-220 kph
SUPER TYPHOON (sty) More than 220 kph

SAFETY MEASURES:
a) Safety
b) Relocation Sites
c) Resettlement
d) Evacuation Site
e) Empowerment
f) Disease Detection
g) Reverse Triage
❒ In order to accommodate a greater
number of the new critical patients,
the existing patients may be triaged,
and those who will not need
immediate care can be discharged.