EMERGENCY NURSING

Objectives: After 7 hours of varied learning discussion, the level IV students will be able to:

1. define emergency nursing

2. identify roles and responsibilities of an ER nurse 3. discuss the different emergency drugs 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 amiodarone atropine benadryl bretylium tosylate dubutamine epinephrine furosemide (lasix) hydrocortisone levophed

3.10 lidocaine 3.11 magnesium sulfate 3.12 naloxone 3.13 procainamide 3.14 sodium bicarbonate

3.15 valium

Emergency Nursing

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is a special area of the nursing profession deals with human responses to any trauma or sudden illness that requires immediate intervention to prevent severe damage or death care is provided in any setting to persons of all ages with actual or perceived alterations in physical or emotional health

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Emergency Nurses specialize in rapid assessment and treatment when every second counts, particularly during the initial phase of acute

illness and trauma. Emergency nurses must tackle diverse tasks with professionalism, efficiency, and above all—caring Roles of the Emergency Nurse 1. Care provider provides comprehensive direct care to the patient and family

2. Educator provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting health care needs

3. Manager coordinates activities of others in the multidisciplinary team to achieve the specific goal of providing emergency care

4. Advocate ensures protection of the patient’s rights

Responsibilities of the Emergency Nurse 1. Uses triage to determine priorities based on assessment and anticipation of the patient’s needs 2. Provides direct measures to resuscitate, if necessary 3. Provides preliminary care before the patient is transferred to the primary care area 4. Provides health education to the patient and family 5. Supervises patient care and ancillary personnel 6. Provides support and protection for the patient and family

DRUG & CLASSIFICATIO N AMIODARONE Antiarrhythmic

MECHANISM OF ACTION -slows sinus rate, increases

INDICATION, CONTRINDICATI ON, SIDE EFFECTS I: lifethreatening recurrent

PRINCIPLE OF CARE -avoid exposure to sunlight or

TREATMENT

- get emergency medical

{class III}

pulse rate and QT invtervals, decreases peripheral vascular resistance, increases refractory period of the AV node -causes blood vessels to dilate (enlarge). This effect can result in a drop in blood pressure.

ventricular arrhythmias, recurrent ventricular fibrillation CI: sinus node dysfunction, heart block, severe bradycardia, hypokalemia SE: irregular heartbeat pattern -wheezing, cough, chest pain, trouble breathing, coughing up blood -blurred vision, vision loss, headache or pain behind your eyes, sometimes with vomiting I: administration prior to anesthesia to reduce or prevent secretions of respiratory tract, to control rhinorrhea, treatment of parkinsonism, restoration of cardiac rate and arterial pressure in some

artificial UV rays -use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun

help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

ATROPINE parenteral anticholinergic agent and muscarinic antagonist.

-inhibits action of acetylcholine or other cholinergic stimuli at postganglioni c cholinergic receptors, including smooth muscles, secretory glands, and CNS sites.

- take prescribed dose 30 to 60 min before meals and at bedtime -ensure adequate hydration; provide environment al control (temperature ) to prevent hyperpyrexia

-carefully check concentratio n before administerin g medication to ensure that proper strength is being used.

or inflammation of stomach. agitation. treatment of peptic ulcers. dry mucous membranes. adhesions between iris and lens.situations. amnesia.abdominal . narrow-angle glaucoma. irritation. primary glaucoma or tendency toward glaucoma (ophthalmic). management of hypersecretion. dysmetria. intestines. dermatitis. ataxia dizziness. or pancreas CI: Hypersensitivit y to anticholinergics . dry warm skin . cyanosed skin. anxiety. fatigue. hallucinations. prostatic hypertrophy SE: abnormal movements. headache -cold skin. dysarthria.

leading to serious side effects. A very dangerous drug interaction could occur. CI: Lower respiratory tract symptoms including asthma. operating machinery. symptomatic relief of cough as may occur w/ allergies. Use alcohol cautiously. anaphylactic shock. motion sickness. Benadryl may cause dizziness or drowsiness. dermatographis m. pain. drug rash. SE: Urticaria. Alcohol may increase drowsiness and dizziness while taking Benadryl . -use caution when driving. nose & -do not take Benadryl if you have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazi d (Marplan). anaphylactic reactions adjunctive to epinephrine. If you experience dizziness or drowsiness. avoid these activities.BENADRYL antihistamine Diphenhydra mine blocks the effects of the naturally occurring chemical histamine in the body. chills. photosensitivity . hypersensitivity . or performing other hazardous activities. dry mouth. common colds or flu. uncomplicated allergic skin manifestations of urticaria & angioedema. or tranylcyprom ine (Parnate) in the last 14 days. amelioration of allergic reactions to blood. phenelzine (Nardil). mild. constipation I: Allergic rhinitis due to inhalant allergens & foods. excessive perspiration. lactation.

sleepiness. sedation. including cardiac rhythm. USP. Hallucination BRETYLIUM TOSYLATE Antidysrhythmi c (Class III) -causes a chemical sympathecto my-like state by inhibiting norepinephri ne release and depressing adrenergic nerve terminal excitability. produces a positive inotropic effect on the myocardium. prior to dysrhythmias intravenous SE: Vertigo. use vomiting. syncope. increased PVCs. or induced Sodium dysrhythmias. Hypotension. CI: digitalisUSP. angina. bradycardia.throat. dizziness. hypotension. Transient increase in arrhythmias and hypertensio n may occur within 1 hr after initial administrati on -especially note slow or irregular pulse or significant hypotension . currently the second drug of choice in the treatment of refractory or recurrent VF -tosylate injection should be diluted with a minimum of 50 mL of Dextrose Injection 5%. transient hypertension and tachycardia lasting approximately 20 minutes -instruct patient to make position changes slowly and to request assistance with ambulation -advise men to sit on toilet while urinating -monitor patient's vital signs frequently. I: VF and VT. disturbed coordination. palpitations. not effective in Chloride abolishing atrial Injection.

reactions. EPINEPHRINE Bronchodilator. within acceptable limits.. solutions: 5% Dextrose Injection. solutions should be used within 24 hours of preparation -protect the patient's airway and support ventilation and perfusion. is a direct-acting sympathomi metic.V. any the patient hypersensitivity adrenergic carefully. DOBUTAMINE -it increases myocardial Sympathomime contractility tic and increases CO without significant change in BP.v. I. or should be for and acute stopped. blood gases.v. hypertensio n. notify health care provider. an active principle of the adrenal medulla. etc.9% Sodium Chloride Injection. meticulously monitor and maintain. If needed. cardiac stimulant -epinephrine. vasopressor. and cardiac dysrhythmia s I: cardiac -therapy with -monitoring arrest. CI: acute narrow-angle -report the drug’s . It stimulates αand β- -observe for adverse effects: tachycardia. or Sodium Lactate Injection. It increases coronary blood flow and myocardial oxygen consumption I: heart failure -dobutamine and cardiogenic injection shock must be further CI: idiopathic diluted at the hypertrophic time of stenosis administratio n to at least 50 mL prior to administratio n in an i. If BP is less than 75 mm Hg. serum electrolytes. cardiovascul asthma attacks ar status. 0. bronchodilat especially anaphylaxis. chest pain. the patient's vital signs. container with one of the following i.

cardiac stimulation and dilation of skeletal muscle vasculature.adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree. weakness. nervousness. pale skin. headache. vomiting. shaking hands that you cannot control inability to maintain a desired effect despite increased doses . glaucoma and coronary insufficiency SE: upset stomach. dizziness. sweating.

-patients receiving Lasix (furosemide ) should be advised that they may experience symptoms from excessive fluid and/or electrolyte losses. pulmonary edema.FUROSEMIDE (LASIX) DIURETIC -it promotes the excretion of fluid and electrolytes and reduces plasma volume I: edematous states: congestive heart failure. dizziness. If affect urine needed. given not sooner than 6 to 8 hours after the previous dose until . rapid. fever. the glucose same dose tests. restlessness -Ttherapy should be individualize d according to patient response to gain maximal therapeutic response and to determine the minimal dose needed to maintain that response. excessive weight loss. muscle cramps. confusion. the effects The dose of sunlight may be raised by 20 while taking or 40 mg and furosemide. hepatic and renal disease. The can be administered skin of some patients 6 to 8 hours may be later or the dose may be more sensitive to increased. constipation. and hypertension CI: sensitivity to the drug and anuria SE: blurred vision. headache. blood Ordinarily a glucose prompt levels and diuresis thereby ensues. -patients with -the usual initial dose of diabetes mellitus Lasix (furosemide) should be told that is 20 to 80 furosemide mg given as may a single increase dose. difficulty breathing or swallowing. loss of hearing.

and shock states hydrocortiso ne comes as ointment. suppresses the immune response. and carbohydrate metabolism I: inflammatory diseases. If mouth sores do not begin to heal within 7 days. septic shock and spray for use on the SE: muscle skin. confusion. headache. -for mouth sores. and enema thirst. liquid. adrenal insufficiency. fat. and changing your diet. stopping smoking. cream. gel.HYDROCORTI SONE Short-acting corticosteroids -it decreases inflammation. dizziness. ointment. and vomiting. lotion. stimulates n=bone marrow and influences protein. hydrocortiso constipation ne is usually used one to four times a day for skin problems. -do not share this medication with others -lifestyle changes that may help this medication work better include exercising. LEVOPHED -vasopressor I: restoration of -monitor BP - . in the mouth. cramps. suppositories weakness. reducing stress. restlessness. upset for rectal stomach. foam. CI: systemic medicated fungal cloth infections and towelette. call your doctor. it usually is applied two or three times a day after meals and at bedtime. lurred paste for use vision. use. cream. .

potent vasoconstrict or (alpha effect) acting in arterial and venous beds. vomiting. increasing the force of myocardial contraction and increasing coronary blood flow. hypertension every 2min. increases ventricular fibrillation threshold BP controlling certain acute hypotensive states. fatigue. adjunct in the treatment of cardiac arrest and profound hypotension CI: hypovolemia. potent positive inotropic agent (beta1 effect). drowsiness. decreasing automaticity of ventricular cells. bradycardia. then monitor every 5min. nausea. effects are mediated by alpha1. mesenteric or peripheral vascular thrombosis SE: headache. cardiogenic shock SE: dizziness. to prevent extravasatio n norepinephr ine is used onlu in acute emergency situations. if infusion is continued -administer IV infusions into a large vein. from the start of infusion until desired BP is achieved. -decreases diastolic depolarizatio n. profound hypoxia or hypercarbia. rash I: seizures associated with -titrate dose to minimum needed for cardiac stability -reduce dosage when treating arrhythmias in CHF -oral lidocaine can cause numbness of tongue -dosage is changed frequently in response to cardiac rhythm MAGNESIUM SULFATE -it replaces and -do not give oral -use only temporary .or beta1adrenergic receptors in target organs. patient teaching will depend on patient’s awareness and will relate mainly to patient’s status and to monitoring being done I: acute ventricular arrhythmias during cardiac surgery and MI CI: CHF. preferably the antecubital fossa.Norepinephrine bitartrate LIDOCAINE antidysrhythmi c and cardiac stimulant.

excessive bowel activity -it competes I: narcoticwith induced narcotics for respiratory receptor sites depression in the CNS. sweating. and torsades de pointes CI: heart block. It depresses the CNS.Electrolyte replenisher maintains magnesium levels in body fluids. vomiting. hypotension. repeat doses may be needed. hypersensitivity to procaine.or third-degree heart block. CI: allergy to opioid antagonist SE: nausea. hypomagnese mia. flushing. around-theclock -monitor cardiac rhythm . fainting. sweating. palpitations. and atrial dysrhythmias CI: second. -monitor patient continuously after use of naloxone. hypertension I: premature ventricular complexes. dizziness. prodcing anticonvulsa nt effects eclampsia and preeclampsia. depending on duration of opioid and time of last dose -monitor patient response carefully. muscle tremors or twitching NALOXONE Narcotic antagonist SE: weakness. and renal failure magnesium sulfate with abdominal pain -monitor bowel function Maintain urine output at a level of 100ml measure to relieve constipation -report sweating. and conductivity -take drug at evenly spaced intervals. ventricular tachycardia. especially when beginning therapy -reduce dosage in patients <120lb -monitor respiratory depth and rate -provide oxygen and artificial ventilation PROCAINAMI DE antidysrhythmi c -it depresses cardiac automaticity. myocardial damage. excitability.

buffers excess hydrogen ion concentration . nausea SODIUM BICARBONAT E Alkalizer Antacid Electrolyte replenisher -it increases the plasma bicarbonate. hhypernatremi a I: anxiety disorders. systemic alkalosis. respiration during IV administratio n -reduced dose of opioid analgesics with IV -have periodic blood tests and medical evaluations -report irritability. This -take drug exactly as prescribed -do not stop taking this drug without consulting your healthcare provider . confusion. anticonvulsa nt and amnesic effects. rash. headache. and increases blood pH I: metabolic acidosis and need to alkalinize the urine CI: metabolic or repiratory acidosis. sedative. hypotension. hypokalemia. acute alcohol withdrawal. musclerelaxant. swelling extremities VALIUM Group of benzodiazepi Benzodiazepine ne s tranquilizers which exert anxiolytic. tremors. adjunct for the relief of skeletal muscle spasm. seizures.and myasthenia gravis SE: mental depression. convulsive disorders CI: myasthenia gravis (a muscle -check to see that patients with supraventric ular tachyarrhyth mias have been digitalized before giving procainamid e -have patient chew oral tablets thoroughly before swallowing. and follow them with a full glass water -do not give oral sodium bicarbonate within 2hr of other oral drugs to reduce risk of drug interaction -carefully monitor pulse. hypocalcemia SE: gastric rupture following ingestion. BP. confusion.

constipation. transfer and ambulation . or sleep apnea (breathing stops during sleep). a severe breathing problem. nausea RESCUE. narrow-angle glaucoma. diazepam weakness disorder). the level IV students will be able to: 1. identify factors that affect transfer and ambulation 3.2 transfer 1. depression.3 ambulation 2. severe liver disease. SE: confusion.1 rescue 1. headache.is known to be the result of facilitating the action of γaminobutyric acid (GABA). during and after rescue. define the following terms: 1. TRANSFER AND AMBULATION Objectives: After 7 hours of varied learning discussion. the most important inhibitory neurotransmi tter in the brain. enumerate guidelines before. dysarthria.

4 four-man carry 6.fireman’s carry .improvised stretcher .hand as a liter . or prevention of injury.piggyback carry .3 three-man carry .4-hand-seat 6.incline drag . cite the different commands used in rescue and transfer 5.assist to walk . Definition of terms: 1.blanket drag .2 two-man carry . Rescue.pack strap carry 6. discuss the materials/equipment used 6.A procedure that moves a victim of a disaster or accident from a dangerous location to a place of safety.blanket carry .carry by extremities .feet drag .ambulance or rescue van 1. -refers to operations that usually involve the saving of life.fireman’s carry w/ assistance .cloth drag .commercial stretcher .carry in arms . transfer and ambulation 6.blanket and poles stretcher . perform the different methods of rescue.arm drag .4.5 six-man carry .assist to walk .bearer’s alongside .1 one-man carry . .hammock carry 6.

person. 3. • Psychology .. Assistance from an appropriate staff should be taken into consideration.this should be the first concern of nurses who would assist. . Ambulation. FACTORS THAT AFFECT TRANSFER AND AMBULATION • Patient safety -falls are the most common hazard to a patient being transferred.To walk from place to place independently with or without assistive device.using correct techniques in performing certain functions in a manner that does not add undue strain to the body • Ability -one may need more than one person to transfer a heavy or severely disabled patient.An act to convey or cause to pass from one place. 2.implies feeling from imminent danger by prompt or vigorous action. Transfer. or thing to another.to provide a convenient and safe manner of doing the procedure . The patient may become dizzy or have less strength than expected or the nurse may not be strong enough to accomplish the task. Never leave the patient on his own during the activity • Body Mechanics .

illness. inactivity and chronic fatigue have unfavorable effects in musculoskeletal function. disability. • Nutrition . It is important for patient to be covered for both warmth and modesty.adequate nutrition supplies vitamins and minerals essential for body functioning General Health – the client’s general health status is reflected on how the individual moves . • GUIDELINES IN RESCUE: Before:   Recognize the hazard Survey the scene o Is there a fire involved? (Appendix A) o Is there a smell of raw or leaking fuel? .you should communicate with patient while guiding and assisting them • Neuromuscular and skeletal impediments – disease and injuries that affect the neuromuscular or skeletal systems can hinder movement.• -the patient should be properly dressed. Sociology -Explain the procedure to the patient and encourage questions so that patient can participate fully in transfer and ambulation .

After:   Relay everything you have done to emergency medical personnel Give all the information needed by the emergency medical personnel GUIDELINES IN TRANSFER Before:  Know patient’s diagnosis and any restrictions to be observed.  Assess patient’s capabilities. devise a plan to transfer the patient in the safest and most convenient manner  Wash hands for asepsis During: .  With the data in hand.  Find out what equipment is available or suited for the patient as well as who is available to assist you.o Is the bus likely to be hit by other vehicles? o Does the possibility exist that interventions will cause further threat to safety?  Assess if moving the victim would cause further injury During:  Monitor conditions and adjust procedures to meet unexpected circumstances   Move evacuated students to the nearest safe location at least 100 feet. Be prepared to give information to emergency medical personnel regarding victims medical or physical requirements.

Take vital signs as a baseline Set a tentative goal for how far you expect the patient to ambulate Explain procedure Obtain patient’s robe and shoes. Check on patient’s previous level of activity. Find out whether assistive devices were used. as well as how he is expected to participate  Evaluate patient’s body alignment and comfort After:  Document activity to keep a record for other members of the health care team GUIDELINES IN AMBULATION Before:       Identify patient’s capabilities and the activity ordered. ambulate the patient Watch the patient carefully for signs of fatigue or adverse responses. Identify the patient  Lower the bed itself as well as the headboard  Foot coverings are essential for patient’s security and to prevent slipping  As simply as possible. Using the direction for the type of ambulation. explain to patient what you intend to do or how you intend to help. During:  Position the bed and help patient to stand using techniques in transferring. .  After:  Return patient to bed and position for comfort.

bend down. position yourself with the injured leg next to you. Pass your forearms under patient’s knees and grasps his/her wrists. behind his back. Document the activity. Indications: . ONE-MAN CARRY Assist to walk Procedure: The patient’s arm is placed across the back of waist of the first aider. Bend over and lift patient. Place his/her arms over your shoulder so they cross your chest. and place your other arm behind the casualty's knees. Use a lifting motion to move patient unto your back.  Move to the casualty's side. Indications:  used only with a conscious casualty who can walk or at least hop on one leg  can be used to move a casualty a long distance or until the casualty tires Carry in arms Procedure:  Slide one of your arms under the casualty's arm. Indications:  to move a conscious or unconscious casualty who cannot walk  only used for short distances Piggyback Carry Procedure: Assist the patient to stand. crouch and grasp each thigh. While patient holds on with his/her arms.  Recheck vital signs and compare and note excessive changes. If the casualty has an injured leg. and under his other arm.

can be used in transporting both conscious or unconscious casualties.The two-man arms carry is useful in carrying a casualty for a moderate distance. Then. Three or more people kneel on each side and roll the edges of the blanket toward the casualty. Indications:  used whenever possible to transport casualties  only used in cases where there are no fractures nor extensive wounds of the body TWO-MAN CARRY Two-man support carry . If the casualty is taller than the bearers it may be necessary for the bearers to lift the casualty's legs and let them rest on their forearms. It is also useful for placing him on a litter. used only for a conscious casualty who can put his/her arm around your neck  can be used to move a casualty a moderate or long distance Fireman’s Carry Procedure: The carrier would grasp the subject’s wrist and put the casualty’s arm across one of his/her shoulders. the carrier would reach between the casualty’s legs. When the rolled edges are tight and large enough to grasp securely. the bearers should carry him high and as close to their chests as . To lessen fatigue. Indications:  a common way for firefighters to carry injured or unconscious people away from danger  can be used to move a casualty a moderate distance Blanket carry Procedure: The casualty is placed in the middle of the blanket lying on his back. passing carrier’s arm between the casualty’s legs and then grasping behind the casualty’s thigh. the casualty should be lifted and carried. Two-man arms carry .

possible. Hand as a litter . this manual carry is the safest one for transporting a casualty with a back/neck injury. waist. Use two additional bearers to keep his head and legs in alignment with his body. Carry by extremities . hips and knees. In extreme emergencies when there is no time to obtain a board.is a most useful two-man carry for transporting a casualty for a long distance. First aider lift victim to their knees After rolling victim to their chests. all first-aiders stand.Only a conscious casualty can be transported with the four-hand seat carry because he must help support himself by placing his arms around the bearers' shoulders. The taller of the two bearers should position himself at the casualty's head. This carry is especially useful in transporting the casualty with a head or foot injury and is used when the distance to be traveled is moderate. By altering this carry so that both bearers face the casualty. The commander will then command to face front and walk Then the procedure is reversed to lower the victim INDICATION: • • For narrow alley With no spinal cord injury CONTRAINDICATION: . it is also useful for placing him on a litter. THREE-MAN CARRY Bearers along side STEPS: • • • • • • First aiders position their arms and hands in preparation for lift The first aider kneel at one side of the victim and place their arms beneath the victim’s back (shoulder).is used in carrying a casualty for a short distance and in placing him on a litter. 4-Hand seat .

First aider B slides his top arm under the victim’s back above first aider A’s bottom arm and his other arm just below the buttocks. At the next signal “READY TO CARRY”. All carriers kneel on the knee towards the victim’s feet First aider A cradles the victim’s head and shoulders with the top arm. and all three lift the victim to their knees simultaneously. At a signal. First aider C slides his top arm under the victim’s thighs above first aider B’s bottom arm. His other arm is placed under the victim’s legs below the knees. To lower the victim to the ground. all carriers stand erect with the victim. The person at the victim's head gives the command.• With spinal cord injury Hammock Carry -Three to six people stand on alternate sides of the injured person and linked hands beneath the victim. the victim is lifted to the carriers’ knees and rested there while the hands are slide far enough under the victim to allow rotation of the hands inward to secure an interlocking grip. STEPS: • • • • • First-aiders A and C are on one side of the victim and B is on the other side. The other arm is placed under the lower back. merely reverse the procedure. • • • INDICATION: • • For wide spaces Spinal cord injury is not suspected CONTRAINDICATION: • • FOUR – MAN CARRY COMMAND USED FOR TWO OR MORE RESCUERS Narrow spaces .

. Likewise. leader shall only give the executory command for all members who answered “ready. The bearers position themselves as described below prior to performing the carry. Insert •Patient on your knees.. bearer one is the leader of the litter squad.…………………… Kneel •Hands over the patient…………………. On the command of execution "LIFT.. normally at the back of the litter. The other three-squad members position themselves at the remaining litter handles.. 1. In figure 3-28. All bearers face the direction of travel and kneel on one knee (the knee near the litter). This position allows him to observe the casualty and to direct the three other members of the squad." all bearers rise together. Kneel •Ready to unload…………………………Unload Reminders : All team members must answer “ready” after the leader gives preparatory command.. Move •Ready to insert…………………………. Stand •Face the Leg/Head……………………." each bearer grasps his litter handle with the hand closest to the litter and places his other hand on his raised knee. inner foot first………… Walk •Ready to stop…………………………… Stop •Face center……………………………… Move •On your knees and rest…………………. The leader of the litter squad (bearer one) positions himself at the litter handle nearest the casualty's right shoulder.” The four-man carry is the carry normally used to transport a casualty when the terrain is generally smooth and level. Move •Ready to walk.. lifting the litter and keeping it level.Preparatory Executory •Ready to kneel ……. Press Ready to stand…………………………. ready to lift ……. On the preparatory command "Prepare to Lift. 3.. 2 . Lift •Patient’s body press to the chest……….

b. Types of improvised Stretchers: a. Don't use non-rigid stretchers for casualties with suspected head or spinal injuries. door. Three or four people kneel on each side and roll the edges of the blanket toward the casualty. Knowing how to improvise stretchers will ensure the comfort and well being of casualties when transporting the casualty without the availability of an actual stretcher. c. as shown in the figure." This command is also used to change to the four-man carry from another carry without lowering the litter. not back muscles. the casualty should be lifted and carried. you can improvise one by using a tabletop. two rigid poles and a blanket or clothing. Each bearer uses the hand on his knee to help support and balance himself as he rises. are used when lifting a litter. they are in position for the four-man carry.4. This helps to prevent back injury. e. Leg muscles. 5. When the rolled edges are tight and large enough to grasp securely. The command to proceed is "Four-Man Carry. Rolled Blanket stretcher Blanket and 2 poles stretcher Belt or shirt and 2 poles stretcher Hammock stretcher Chair Stretcher Rolled Blanket stretcher The casualty is placed in the middle of the blanket in the supine position. MOVE. d. SIX-MAN CARRY IMPROVISED STRETCHERS If a commercially prepared stretcher is not available. After the bearers are standing. Blanket and poles stretcher .

3. such as blankets. and at the hips and legs. Six rescuers are recommended for this carry to ensure the victim's stability during the move. the level IV students will be able to: . Turn the casualty as a unit so that his/her body is not twisted during the logroll.  Roll the casualty back over the blanket roll to lay face up on the blanket. neck and body in line. Blanket Carry -A variety of materials. Position bearers at the head and feet to keep the head. Fold the remaining blanket over the two poles. The blanket carry can be used to remove victims who cannot be removed by other means.  Keep the blanket tight as the casualty is lifted and placed on the stretcher. about 15 cm (6 in) from the doubled edge. 2. Get ready to lift the casualty – have bearers grip the rolls at the head and shoulders. One rescuer must be designated to lead to ensure teamwork when performing the lift. -Don't use this lift if head/spinal injuries are suspected  Roll the blanket or rug lengthwise for half its width. Place the blanket flat on the ground and place a pole one-third of the way from the end.  Kneel at the casualty's shoulder and position a bearer at the waist to help logroll the casualty onto the uninjured side.1. Place the second pole parallel to the first so that it is on the doubled part of the blanket. Unroll the blanket and then roll the edges of the blanket to each side of the casualty. can be used as improvised stretchers. The casualty's weight on the blanket holds the folds in place. Fold the one-third length of the blanket over the pole. ADVANCED LIFE SUPPORT Objectives: After 7 hours of varied learning discussion.

4. explain endotracheal tube intubation 4. discuss the chain of survival 2. enumerate the types of : 4.1.3.3.5. 1. 1.2.1. 2. defibrillators defibrillations 5. demonstrate beginning skills in operating automated external defibrillator .2. 1. 1. cite specific nursing responsibilities before during and after automated external defibrillator and endotracheal tube intubation 6.1. easy access easy CPR easy defibrillation easy advanced cardiac life support 3.4. define the following terms: 1.1. 2. advanced cardiac life support defibrillation defibrillator endotracheal tube endotracheal tube intubation 2. 4. 2.2.

. It can be provided by trained medical personnel. Endotracheal tube intubation is a procedure by which a tube is inserted through the mouth down into the trachea Basic Life Support is the level of medical care which is used for patients with lifethreatening illnesses or injuries until the patient can be given full medical care at a hospital. Advanced Cardiac Life Support Includes the knowledge and skills necessary to provide the appropriate early treatment for cardiac arrest.Definition of Terms: 1. Defibrillator Depolarizes a critical mass of the heart muscle. as well as the management of situations likely to lead to it and the stabilization following successful cardiopulmonary resuscitation 2. paramedics and by laypersons who have received BLS training. and can be provided without medical equipment. Defibrillation - consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called defibrillator 3. BLS is generally used in the pre-hospital setting. Endotracheal Tube is a breathing tube and is used temporarily for breathing because it keeps airway open 5. including emergency medical technicians. terminates the arrhythmia and allows normal sinus rhythm to be reestablished by the body’s natural pacemaker in the sinoatrial node of the heart 4.

The 1-6-1 dispatcher will want to keep the caller on the phone to obtain continuous information about the scene and victim. Do not hang up. or AED. assess the patient's breathing and pulse. Then it is necessary to assess the victim's consciousness by asking "Are you okay?" Next. If other people are available. Early CPR o If the victim is non-responsive. emergency medical providers and certified civilian responders provide essential care to a victim of choking or cardiac or respiratory arrest. start cardiopulmonary resuscitation. or CPR. if available. activate EMS by calling 1-6-1. Three cycles of CPR should be done before calling 1-6-1 if the rescuer is alone. Early Access o To accomplish early access means first ensuring that the scene of the incident is safe. or other local emergency number. The victim's airway should be opened using a head tilt and chin lift only if no neck or spine injury is .Advanced Life Support - is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation (breathing). Be sure to tell the dispatcher if you are alone or need to leave the phone to get an AED. CHAIN OF SURVIVAL The chain of survival is a protocol that helps first responders. First. The goal of the chain of survival is to increase the victim's chance for recovery through early action. and obtain an automatic electronic defibrillator. the rescuer should designate a specific individual to make the emergency call and another to retrieve the AED.

either mechanical or from airway pathology. visually check for foreign objects that may be obstructing the airway. . emergency supplies. many have digitalized voice instructions. medications.suspected. Remove any objects with a finger sweep. upper airway obstruction. the airway can be opened using the jaw thrust technique. It is mandatory that a clinician responsible for airway management be familiar with airway anatomy and how it pertains to intubation. Advanced care will also be provided by nurses and physicians in the hospital where they have access to more diagnostic and life-preserving machines. prior to attempting EI. The AED sends a counter shock through the heart muscle to defibrillate or reorganize the cardiac current. all necessary equipment. Begin chest compressions and rescue breathing. most commonly from central nervous system derangements may benefit from elective intubation. Activating EMS early in the chain of survival helps ensure early access to advanced care. AEDs come with easy-to-understand directions. Patients at risk for aspiration. INDICATIONS of Endotracheal Tube Intubation • • • Endotracheal intubation is indicated in several clinical situations including acute hypoxemic or hypercapnic respiratory failure. If it is possible that spinal injury has occurred. When EMS personnel arrive at the scene. Early Advanced Care o ENDOTRACHEAL TUBE INTUBATION Endotracheal intubation (EI) is indicated in several clinical situations including respiratory failure. in patients at risk for aspiration. This procedure is also used to protect the airway in conditions of upper airway obstruction. Ideally. Early Defibrillation o Electrical signals become disorganized when the heart is in cardiac arrest. Advanced care can be started in the pre-hospital setting by certified paramedics. they will stabilize and then transport the patient to the hospital. This is called ventricular fibrillation. This helps them to be used efficiently by lay rescuers. Do not do a blind finger sweep. Next. cardiorespiratory arrest. Paramedics are trained in advanced life support techniques. Most public buildings and transportation centers are equipped with AEDs. and support staff should be in place. Complete five cycles of CPR before continuing on to the next step: early defibrillation. and for certain elective procedures. The impulses cannot effectively contract the heart muscle to pump blood into circulation. or impending respiratory failure.

elective EI is performed for many operative procedures. an instrument that permits the doctor to see the upper portion of the trachea. During the procedure the laryngoscope is used to hold the tongue aside while inserting the tube into the trachea. PROCEDURE The doctor often inserts the tube with the help of a laryngoscope. computed tomographic scan). Aid in respiratory hygiene. attempting to reduce intracranial pressure in patients with acute intracranial hypertension. Types of Defibrillators Defibrillators are classified as either being manual or automated.• • • In addition. at times to facilitate certain diagnostic procedures (ex. Pressure is often applied to the thyroid cartilage (Adam's apple) to help with visualization and prevent possible aspiration of stomach contents. Another potential indication for EI includes the need to hyperventilate by mechanical ventilation. Features:  Manual control of ECG size or display  Variable energy level choices  Cardioversion option  “quick look” paddle capabilities - • Automated External Defibrillator These devices are easier to operate than the manual defibrillator because they are based on computer technology which is designed to . just below the vocal cords. the electrical counterchange is administered by placing the paddles correctly on the patient’s body and holding them there for defibrillation. It is important that the head be positioned in the appropriate manner to allow for proper visualization. The steps that must be performed by the operator vary greatly with each type of defibrillator • Manual Defibrillators In operating a manual defibrillator.

Check wires are properly connected. Pace maker & Skin (wet). 3. . Medical patch. Jewelry. 4. Metal & Gas. 2. Ask everyone to stand clear and press the analyze button when prompted by the machine. Remove casualty’s clothing (including bra appropriately) to expose chest area where the pads need to be placed 3. 2. Check & remove obstacles to AED pads (HJMPS) – Hair. Switch on AED & follow AED Voice Prompt Step-by-Step Instructions. collar area. Do it systematically from neck. 2. Nursing Responsibilities Automated External Defibrillator BEFORE: 1. Check area for dangers: Water. 4. Make sure that no one is touching the patient or his bed and call out “Stand Clear. Follow AED voice prompt. Maintain open airway. chest and stomach areas. Check indicator to confirm AED is functional. Assess patient’s condition. level of consciousness and respiratory rate.” AFTER: 1.analyze the heart rhythm itself and then advise the user whether a shock is required. DURING: 1. If need be move patient to safer place. Firmly attach the pads on the chest area. Be careful not to touch or move the patient while the AED is in analysis mode.

including the voltage delivered with each attempt and rhythm strips before and after the procedure. suction patient’s pharynx observed for equal expansion and auscultation performed at the mid-axillary line Administer sedatives. Document the procedure. preventing gastric reflux and aspiration do open gloving or wear personal protective equipment  During: o o o o o nurse should calmly describe the vital-signs status of the patient regularly Be prepared to pass the ET tube and other equipment to the person intubating or physician If necessary. Endotrachael Tube Intubation  Before: o o o o o Gather all the materials needed Check the light of the laryngoscope the patient's position flat with their face at the level of the xiphoid cartilage of the standing person performing the procedure compresses the cricoid cartilage against the cervical vertebrae.3. per doctors order  After: o o o o o The tube should be secured patient attached to an appropriate ventilator and a check X-ray ordered arterial blood gases should be taken auscultate both sides of the chest suction secretions via the Endotracheal Tube .

the level IV students will be able to: 1.3 splinting .BANDAGING and SPLINTING Objectives: After 7 hours of varied learning discussion.2 bandaging 1. Define the following terms: 1.1 bandage 1.

Bandaging .forehead/eyes/neck . demonstrate beginning skills in bandaging and splinting 5. they can also be used to restrict a part of the body. or on its own to provide support to the body.2 splinting .arm sling .shoulders/hip .leg sling DEFINITION OF TERMS: 1. Bandage .forearm/foreleg . enumerate the types of bandages and splints 5.4 cravat 2. determine the purpose in bandaging and splinting 3.the act of applying a bandage which is used to hold a dressing in place over a bleeding wound for control of hemorrhage and to provide support to the injured part. identify the principles in bandaging and splinting 4.cuff sling .scalp bandage .1 bandaging • open phase .open/close palm 5.genital bandage • cravat . 2.elbow/knee straight/bent .burned hand & foot • semi-cravat . .is a piece of material used either to support a medical device such as a dressing or splint.underarm sling .arm sling .chest bandage .cheek/jaw/ear .1.

Phases of triangular bandage:  Broad  Semi-broad  Narrow  Cravat BANDAGING PURPOSE: • • • • Asepsis .3. figure-eight. It may be used as a circular.to prevent cross contamination Assist victim in a comfortable position . Splinting .to protect the injured part Increase the temperature of the injured part .. or spiral bandage to control bleeding or to tie splints in place.to prevent infection Pressure .to control bleeding Use few turns as possible . Cravat .to prevent bleeding Fixation of dressing . 4. folded lengthwise.to easily determine the injured part Apply dressing to open wound .a triangular bandage.to ensure safety Neatness of the bandage .to promote vasodilation PRINCIPLES • • • • • Wash hands . . and to make the individual more comfortable until treatment can be initiated. is the technique to secure the part of the body that is injured to decrease further damage or injury to that part of the body.

hands..could be used on many parts of the body to support and immobilize. . toes. • Crape bandage . head.lightly woven.type of woven gauze which has the quality of stretching. feet. cotton material. • Gauze/cotton bandage .to easily check the capillary refill time TYPES OF BANDAGES: • Triangular .to reasonably tighten the bandage • Tips of the fingers and toes should be left exposed . Frequently used to retain dressings on wounds of fingers.

• Adhesive bandage -use to retain dressing and also used where application of pressure to an area is needed. SPLINTING .

MAJOR TYPES OF SPLINTS Anatomic splints . a piece of plastic or metal. Ex:  Soft splints . Ex: • • Mechanical splint Rigid splints may be made from a board . or thick cardboard. a rolled newspaper or magazine . used in broken bones and strained. used for extremity injuries.involve splinting an injured to the uninjured leg or splinting fingers together. sprained or dislocated joints.

folded blanket or towel. movement and sensation distal to the injury Never allow patient to bear weight on the injured limb Elevate the injury above the level of the heart Avoid placing straps directly over the injured area Steps in Bandaging: .- may be made from a pillow. or triangular bandage folded into a sling. used in hand or wrist injuries PURPOSE: • • • • Decrease muscular spasm Relief of pain Prevention of additional damage to muscles and other soft tissue To immobilize the injured area PRINCIPLES: • • • • • • • Always consider life before limb Expose the injury Control bleeding Check for pulses.

Cross the 2 ends of the cravat just above and in front of the ear. 6. the beneath the chin. Fold the bandage into a cravat. 5. Ear and Chin 1. Place the bandage on a fat surface and fold the longest portion over about an inch. 2. If the flat rotion of the forehead is not used. across the flat portion of the head to prevent slipping. Secure in front with a square knot and tuck under the ends if they are long. Place a compress over the injury. Bring the 2 folded ends completely around the head. once or twice. the bandage will slip and not hold securely. 2. . Place the bandage on the head so that theh folded base rests on the forehead. Extend the angle (right angle) back over the head and down the back of the head and neck. then start with the cravat over the compress. Tuck the part behind the head into and under the 2 circular turns about the head. 4. just above the ears. 3. deending upon the size of the bandage and the victim. 3.Head 1. some 3-4 inches wide.

slightly elevated. Torso-Chest and Back 1. then a strip of gauze or muslin will be needed to make this connection and to tie. . 1 poit over the shoulder with the base in a vertical position. 3. Place the bandage in position on the side away from the injury. Extend the 2 long ends around the body and tie with a square knot. 2. With the 12 or 15 inches of bandage remaining. If this remaining portion is not long enough to reach the shoulder and tie. Extend the 2 ends of the cravat around the back of the head and across the forehead and tie on the opposite side of the head with a square knot. tie with the angle end above the shoulder and with the square knot. Move the injured arm across in a horizontal position.4. the angle pointed toward the injury. Place the point (right angle) over the shoulder for either chest or back inquiries. Arm Sling 1. this knot should be tied directly below the point (right angle). 2.

7. tie with a square knot. With 2 bandages. 2. continue around the head with the two ends of the cravat in opposite directions. Place one end of the bandage up the arm in a diagonal position. or pin with a safety pin. 5. Tie the 2 ends of the cravat on top of the head with a square knot. on an angle. on the side of the neck. Bring the downward long point of the bandage up and over the injured shoulder. Pull up with both ends of the first bandage to uncover the uninjured eye so that the victim can see. Place a sterile eye pad over the injured eye. Use the 2nd bandage. which has been folded as a cravat. over the midpoint of the upper arm. 3. Fold the bandage as a cravat. 4. Leave the fingers on the injured hand expose for observation. Place the cravat on n angle with the midportion covering the injured eye. Tie the 2 ends of the bandage with a square knot. Eye Injury 1. Tie and tuck the point of the bandage. . 6. tie around the head completely covering the injured eye with the cravat – the dressing will be over the eye and beneath the cravat.3. place one across the head with one extending downward and over the good eye. Extend this bandage around the body. 4. Forearm 1. 5. to secure the injured arm on the body. the around the neck. and tie with a square knot on the opposite side of the body. With the 2nd bandage. 6.

some 3-4 inches wide. 6. 3.2. 3. and secure with a square knot. Ankle 1. Take the shoe off. the bring to the front and tie with a square knot. Extend the cravat around the neck and under the opposite arm pit and tie with a square knot. . Hips and Shoulder 1. The bandage being applied to the hip should be extended the body and tied. Role the angle (right angle) of the first bandage around the cravat 2 or 3 times to fasten them together. the bandage should be extended around the leg. 5. If it is the hip. especially if a sprain is suspected. Hold the bandage in this position. 2. just above the elbow. above the knee. 4. wrap it firmly around the forearm overlapping each time and going up the arm as fast as possible. 2. Extend the end of the second bandage around the arm. Fold the second bandage into a cravat. Fold the triangular bandage into a 3 inch cravat. Tie the 2 ends with a square knot to secure the bandage. Place one bandage flat on a table. then with the longer end of the bandage. Place the bandages on the injured shoulder or hip.

19790.87 James E. pg. and AED: McGraw Hill. Funk: Fundamentals of Emergency Care: Delmar Thomson learning. around and under the cravat. pg.319 . 672 Warren H. Tie on top or in front of the foot with a square knot. 2006. 51 National Safety Council: Standard First Aid. Cole and Charles B. 7. 8. 6. pg. 1972.3. Pull up on the cravat from each side to tighten and until the wrap is reasonably secure. Source: Richard W. It must be secure. Place the middle part of the cravat in the instep portion of the foot. pg. Aaron: First aid and Emergency care: Macmillan. Test to make certain that the bandage will not pull off over the foot. 4. Pull the ends in opposite direction and down. 55. Puestow: Emengency Care: Meredith Corporation. 5. Beebe and Deborah L.O. CPR. Cross the 2 ends of the cravat behind the heel. 2001.

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