EMERGENCY NURSING • It is the nursing care given to patients with urgent and critical needs

EMERGENCY NURSE • has a specialized education, training, and experience to gain expertise in assessing and identifying patients’ health care problems in crisis situations • establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families, supervises allied health personnel, and teaches patients and families within a time-limited, highpressured care environment

DISASTER NURSING • a branch of emergency nursing, it refers to nursing care given to patients who are victims of disasters, whether it is manmade or natural phenomena.


• It is a management tool for organizing personnel, facilities, equipment, and communication for any emergency situation.

INCIDENT COMMANDER • The head of the incident command system • He must be continuously informed of all the activities and informed about any deviation from the established plan

safety officer. COMPONENTS of EOP  Activation Response  Internal/External Communication Plans  Plan for coordinated patient care  Security Plans  Identification of external resources  A plan for people management and traffic flow  Data Management Strategy  Deactivation Response  Post. evaluating the community to anticipate the type of disaster that might occur.EMERGENCY OPERATIONS PLAN (EOP) -It is done by a planning committee. composed of local/national administrators. ED manager.Incident Response  Plan for Practice Drills  Anticipated Resources  Mass Casualty Incident Planning  Educational Plan .

• from French word meaning “to sort” • it is used to sort patients into groups based on the severity of their health problems and the immediacy with which these problems must be treated TRIAGE NURSE – acts as a gatekeeper. ensuring that the more seriously ill are treated first . sorting patients into categories.

any delay in treatment is potentially life or limb threatening. Must be seen IMMEDIATELY! EXAMPLES: • AIRWAY COMPROMISE • CARDIAC ARREST • SEVERE SHOCK • CERVICAL SPINE INJURY • MULTISYSTEM TRAUMA • ALTERED LEVEL OF CONSCIOUSNESS • ECLAMPSIA . Conditions requiring immediate medical intervention.




open fractures of long bones • 2nd / 3rd degree burns of 15-40% TBSA . • incomplete amputations. tension pneumothorax • asphyxia • unstable chest and abdominal wounds. • shock • hemothorax.TYPICAL CONDITIONS: • Sucking chest wound • airway obstruction secondary to mechanical cause.

and external fixation .TYPICAL CONDITIONS: • Stable abdominal wounds w/o evidence of significant hemorrhage • soft tissue injuries • Maxillofacial wounds w/o airway compromise • Vascular injuries w/ adequate collateral circulation • Genitourinary Tract Disruption • Fractures requiring open reduction. debridement.

TYPICAL CONDITIONS: • Upper extremity fractures • Minor Burns • Sprains • Small Lacerations w/o significant bleeding • Behavioral disorders or Psychological disturbances .

no BP. pupils fixed and dilated .TYPICAL CONDITIONS: • Unresponsive patients w/ penetrating head wounds • High spinal cord injury • Wounds involving multiple anatomical sites and organs • 2nd/3rd degree burns in excess of 60% of BSA • Seizures or vomiting w/n 24 hours after Radiation Exposure • Profound shock with multiple injuries and agonal respirations • Patients with no Pulse.


reach the hospital?  What was the health status of the patient prior the accident or illness?  Is there history of present illness?  Is the patient taking any medications?  Does the patient have allergies?  Was treatment attempted before arrival at the hospital? . Purpose is to detect and prioritize additional injuries and detect signs of underlying medical conditions  What is the mechanism of injury?  When did the symptoms appear?  Was the patient unconscious after the accident?  How did the pt. brief (2-3 mins) examination from head to toe.SECONDARY ASSESSMENT: Systematic.

 Inform the family where the patient is. (Touch. call by name. to have and display their feelings  Maintain a calm and reassuring manner  Treat the unconscious patient as if CONSCIOUS. be aware of patient’s fear  Accept the rights of the patient and family. and give as much as information as possible about the treatment  Assist family to cope with sudden and unexpected death  take them on a private place and talk to them so they can mourn together  assure the family that everything was done  avoid giving sedation to family members . Understand and accept basic anxieties. explain every procedure)  Orient the patient as soon he becomes conscious.

an emergency procedure that consists of recognizing respiratory or cardiac arrest or both the proper application of CPR to maintain life until a victim recovers or advance life support is available.the use of special equipment to maintain breathing and circulation for the victim of a cardiac emergency. 3. 2. BASIC LIFE SUPPORT .for post resuscitative and long term resuscitation. ADVANCE CARDIAC LIFE SUPPORT . PROLONGEDLIFE SUPPORT .1. .

the probability of survival approximately doubles when it is initiated before the arrival of EMS.1. It is the key intervention to increase the chances of survival of patients with out-ofhospital cardiac arrest.The SECOND LINK: EARLY CPR If started immediately after the victim’s collapse. provision of advanced care outside the hospital would be possible.The FOURTH LINK: EARLY ACLS If provided by highly trained personnel like paramedics. 4. 2.The FIRST LINK: EARLY ACCESS It is the event initiated after the patient’s collapse until the arrival of Emergency Medical Services personnel prepared to provide care.The THIRD LINK: EARLY DEFIBRILLATION It is most likely to improve survival. . 3.

•Do handle the victim to a minimum. . •Do be as calm and as direct as possible.What to DO: •Do obtain consent when possible. •Do assist the victim with his/her prescription medication. •Do respect the victim’s modesty and physical privacy. •Do provide comfort and emotional support. •Do think the worst. •Do loosen tight clothing.1. •Do care for the most serious injuries first. It’s best to administer first aid for the gravest possibility.

•Do not leave the victim alone except to get help. •Do not assume that the victim’s obvious injuries are the only ones. •Do not make any unrealistic promises. •Do not trust the judgment of a confused victim and require them to make decision.What Not to DO: •Do not let the victim see his/her own injury.2. .

Danger of fire or explosion. Danger of electrocution. . 3. drag or pull the victim. Indications for emergency Rescue: 1.-is a rapid movement of patient from unsafe place to a place of safety. Methods of Rescue: 1. 5. For immediate rescue without any assistance. Natural Disasters 4. 6. Risk of drowning. Most of the one-man drags/carries and other transfer methods can be used as methods of rescue. 2. Danger of collapsing walls. 2. Danger of toxic gases or asphyxia due to lack of oxygen.

6. Factors to be considered in the selection of choosing the transfer method: 1. 7. 4. Physical capabilities of the first aider. Size of the victim. 3. 2.-is moving a patient from one place to another after giving first aid. Nature and severity of the injury. Nature of the evacuation route. (last consideration) . 5. Distance to be covered. Gender of the victims. Number of personnel and equipment available.

Regular check of the victim’s condition is made.Pointers to be observed during transfer: 1. comfortable and as speedy as circumstances permit. The patient’s body is moved as one unit. . 5.Victim’s airway must be maintained open. Supporting bandages and dressings as remain effectively applied. 8. Hemorrhage is controlled. 2. The method of transfer is safe. 4. Victim is safely maintained in the proper position. 6. 3. 7. First aiders/bearers must observed ergonomics in lifting and moving of patient.

Other vehicles. .Commercial stretchers 8.four/six/eight-man carry 5.Ambulance or rescue van 9.Improvised stretcher using two poles with: • • blanket Empty sacks • • Shirts or coats Triangular bandages 7.One man assist/carries/drags 2. Two man assist/carries 3.1.Three man carries 4.Blanket 6.

Ventricular Fibrillation b. INDICATIONS: 1. Drug Overdose i. Smoke inhalation e. Respiratory Arrest a. Foreign-body obstruction d. Drowning f. Ventricular Tachycardia c. Epiglottitis . Asystole d. Electrocution c. Accident/Injury b. Pulseless electrical activity 2. Suffocation g.a technique of basic life support for the purpose of oxygenating the brain and heart until appropriate. Coma h. definitive medical treatment can restore normal heart and ventilatory function. Stroke j.. Cardiac Arrest a.

ASSESSMENT: • Immediate loss of consciousness • Absence of breath sounds or air movement • Absence of palpable carotid or femoral pulse. Brain Damage . pulselessness in large arteries COMPLICATIONS: • Rib Fracture (most common) • Postresuscitation Distress Syndrome • Neurologic Impairment.

I. flat surface. Kneel at the level of the patient’s shoulders • • • • Open the airway: HEADTILT/CHIN LIFT MANEUVER. BREATHING Look. CIRCULATION Check carotid pulse . JAW THRUST MANEUVER 2. Listen and Feel Rescue breathing: 2 full breaths 3. • • • RESPONSIVENESS/AIRWAY Determine unresponsiveness. “ARE YOU OKAY?” Activate Emergency Medical Assistance Place patient supine on a firm.

MOUTH-TO-MOUTH = a quick. 2. is an infant MOUTH-TO-STOMA = used if the pt.WAYS TO VENTILATE THE LUNGS 1.(1 – 1. a permanent opening that connects the trachea directly to the front of the neck.Rate is 10-12 breaths in ADULT . (Trismus. has a stoma. For Rescue Breathing Alone: .Rate is 20 breaths for a CHILD and INFANT . MOUTH-TO-NOSE = recommended when it is impossible to ventilate through the victim’s mouth.2 sec/breath) ( 1 breath every 4 to 5 secs) . 4. effective way to provide O2 and ventilation to the victim.5 sec/breath) ( 1 breath every 3 secs) . mouth injury) MOUTH-TO-NOSE and MOUTH = if the pt.(1. 3.5 .

Table of Cardiopulmonary Resuscitation for Adult. Infant Lower half of the sternum but not hitting the xiphoid process: 1 finger width below the imaginary nipple line. Child & Infant Adult Compression Area Lower half of the sternum but not hitting the xiphoid process: measure up to 2 fingers from substernal notch. 30:2 (1 or 2 rescuers) Child Lower half of the sternum but not hitting the xiphoid process: measure up to 1 finger from substernal notch. Depth How to compress Compressionventilation ratio Approximately ½ to 1 inch 2 fingers (middle & ring fingertips) 30:2 (1 or 2 rescuers) 30:2 (1 or 2 rescuers) Number of cycles per minute 5 cycles in 2 minutes 5 cycles in 2 minutes 5 cycles in 2 minutes . other hand on top. Approximately 1 to 1 ½ inches Heel of 1 hand. Approximately 1 ½ to 2 inches Heel of 1 hand.

decapitation No physiological benefit can be expected because the vital functions have deteriorated despite maximal therapy 4. 3. Witholding attempts to resuscitate in the DR is appropriate for newly born infants with: Confirmed gestation less than 23 weeks or birthweight less than 400 grams Anencephaly . livor mortis. has signs of irreversible death: rigor mortis. All patients in cardiac arrest receive resuscitation unless: The pt.CRITERIA FOR NOT STARTING CPR 1. algor mortis. 2. has a valid DNR order The pt.

etc.PERATOR is already exhausted and cannot continue CPR .-PONTENEOUS signs of circulation are restored -URN OVER to medical services or properly trained authorized personnel . take-over.) .HYSICIAN assumes responsibility (declares death.

3.KINDS OF AIRWAY OBSTRUCTION: 1. restlessness. . stridor. Partial Airway Obstruction with Good Air Exchange Partial Airway Obstruction with Poor Air Exchange Complete Airway Obstruction Clinical Manifestations: UNIVERSAL DISTRESS SIGNAL ( patient may clutch the neck between the thumb and fingers). apprehensive appearance. CYANOSIS and LOSS of CONSCIOUSNESS develop as hypoxia worsens. choking. 2. 2. Anatomic Airway Obstruction Mechanical Airway Obstruction TYPES OF AIRWAY OBSTRUCTION 1.

• Make a quick UPWARD thrust . place the second hand directly on the top of the fist. For patient lying (unconscious): • position patient at the back (supine). in the midline SLIGHTLY ABOVE the UMBILICUS and WELL BELOW the XIPHOID PROCESS • Make a quick INWARD and UPWARD thrust.For Standing or sitting conscious patient: • Stand behind the patient. wrap your arms around the patient’s waist • Make a FIST. Each thrust is separated. kneel astride the patient’s thigh • Place HEEL of one HAND against the pt’s abdomen. placing thumb side of the fist against the pt’s abdomen.

and lifting the mandible. grasp with the other hand and perform BACKWARD thrust until foreign body is expelled. • • Conscious Patient standing or sitting Stand behind the client with arms under patient’s axilla to encircle patient’s chest Place thumb side of fist on the MIDDLE of STERNUM. Opening the pt’s mouth by grasping both tongue and lower jaw between the thumb and fingers. • • Insert index finger of other hand to scrape across the back of the throat Use a hooking action CHEST THRUST: used only in patients in advanced stages of pregnancy or in markedly obese clients a. .FINGER SWEEP: used only in unconscious adult client • Make a TONGUE-JAW LIFT.

ENDOTRACHEAL INTUBATION Indications:   To establish an airway for patients cannot be adequately ventilated with an oropharyngeal airway To bypass upper airway obstruction    To permit connection to ambubag or mechanical ventilator To prevent aspiration To facilitate removal of tracheobronchial secretions . HEAD-TILT-CHIN-LIFT MANEUVER B. JAW-THRUST MANEUVER OROPAHRYNGEAL AIRWAY D.A. C.

Place towel roll beneath the shoulders • Insert the needle at a 10 to 30 degree caudal direction in the midline jest above the upper part of the cricoid cartilage • Listen for air passing back and forth • Direct the needle downward and posteriorly. CRICOTHYROIDOTOMY • a puncture or incision of the cricothyroid membrane to establish an emergency airway in certain emergency situations where endotracheal intubation or tracheostomy is not possible.E. and in allergic reaction causing laryngeal edema • use of gauge 11 needle or scalpel blade Nursing Actions: • Extend the neck. and tape it. . • indicated to pts. with trauma to head and neck.

Epidural hematoma b.1. 2. . OPEN HEAD INJURY – skull is fractured CLOSED HEAD INJURY – skull is intact CONCUSSION – temporary loss of consciousness that results in transient interruption if the brain’s normal functioning CONTUSSSION – bruising of the brain tissue INTRACRANIAL HEMORRHAGE – significant bleeding into a space or potential space between the skull and the brain a. 5. Subarachnoid hemorrhages ALERT: Assume cervical spine fracture for any patient with a significant head injury. 3. until proven otherwise. Subdural hematoma c. 4.

indicating a possible BASAL SKULL FRACTURE  Rhinorrhea or otorrhea – indicative of CSF leak  Periorbital Ecchymosis – indicates anterior basilar fracture ALERT: If basilar skull fracture or severe midface fractures are suspected.PRIMARY ASSESSMENT: Assess for ABC SECONDARY ASSESSMENT:  Change in LOC – most sensitive indicator in the pt’s condition  CUSHING’S TRIAD ( bradypnea. bradycardia. a nasogastric tube(NGT) is CONTRAINDICATED! . impaired vision  Battle’s sign – bluish discoloration of the mastoid. widened pulse pressure) – indicating increased intracranial pressure  unequal or unresponsive pupils.

hyperventilate the patient to 20-25 bpm. Diazepam b. don’t apply pressure  IV line of PNSS or Plain LR  prepare to manage seizures  maintain normothermia  Medications: a. loose dressing. suction orally if needed  Administer high flow oxygen: most common death is CEREBRAL ANOXIA  In general. Steroids c.MANAGEMENT:  Open airway by Jaw-Thrust Manuever. causing cerebral vasoconstriction and minimizing cerebral edema  Apply a bulky. Mannitol  Prepare of immediate surgery if pt. shows evidence of neurologic deterioration .

w/o displacement of structure • COMMINUTED Fx – splinters or crushes the bone in several fragments • DEPRESSED Fx – pushes the bone toward the brain • CRANIAL VAULT Fx – top of the head • BASILAR Fx – base of the skull and frontal sinuses ALERT: • Damage to the brain is the first concern. it is considered a neurosurgical condition • In children. skull’s thinness and elasticity allows a depression w/o a break in the bone .• SIMPLE – closed • COMPOUND – open • LINEAR Fx – common hairline break.

abnormal deep tendon reflexes. VA. severe beatings S/Sx: scalp wounds. agitation and irritability. loss of consciousness. labored breathing. altered pupillary and moor response IF CONSCIOUS: complains of persistent localized headache IF JAGGED BONE FRAGMENTS: may cause cerebral bleeding HALO SIGN – blood-tinged spot surrounded by lighter ring IF SPHENOIDAL Fx: damages the optic nerve and may cause BLINDNESS IF TEMPORAL Fx: may cause unilateral deafness or facial paralysis PRIORITY NURSING DIAGNOSIS:  ALTERED CEREBRAL TISSUE PERFUSION r/t increased ICP  INEFFECTIVE BREATHING PATTERN r/t compression of brain stem  ALTERED THOUGHT PROCESSES r/t cerebral anoxia .CAUSES: Traumatic blows to the head.


 supporative (mild analgesics)
 cleaning and debridement of wounds If conscious: observed for 4 hours; if not, admit for evaluation  if VS stable, may go home with instruction sheet

For VAULT and BASILAR FRACTURES:  Craniotomy to remove fragemnts  anti-biotics  Dexamethasone  Osmotic Diuretics (MANNITOL) if increased ICP is present

NURSING CONSIDERATIONS:  maintain patent airway; nasal airway contraindicated to basilar fx  support with O2 administration  suction pt. through mouth not nose if CSF leak is present

 RHINORRHEA – wipe it, don’t let him blow it!
 OTORRHEA – cover it lightly with sterile gauze, don’t pack it!  Position head on side  Maintain a supine position with bed elevated to 30 degrees  don’t give narcotics or sedative  assist in surgery, maintaining sterile technique

• immediate immobilization of the spine • A B C ( Intercoastal paralysis w/ diapragmatic breathing) SUBSEQUENT ASSESSMENT: • Hypotension, bradycardia, hypothermia - suggests SPINAL SHOCK • Total sensory loss and motor paralysis below the level of injury MANAGEMENT:  Nasotracheal intubation  initaite IV access, monitor blood gas  indwelling urinary catheterization  prepare to manage seizures  Meds: High dose steroids and diazepam

bleeding. broken or missed teeth) SUBSEQUENT ASSESSMENT: • Paralysis if the upward gaze – indicative of INFERIOR ORBIT FX • Crepitus on nose – indicates nasal fracture • Flattening of the cheek and loss of sensation below the orbit – indicates ZYGOMA (cheekbone) FX •Malocclussion of teeth. loose dressing. apply ice to areas of swelling . trismus – indicative of MAXILLA FX PRIMARY INTERVENTIONS:  Insertion of oral airway or intubation  Nasopharyngeal airway should only be used if no evidence of nasal fracture or rhinorrhea  Apply bulky.PRIMARY ASSESSMENT: • Immobilization of spine while performing assessment • ABC – (tongue swelling.

1. AMPUTATION – traumatic cutting or tearing off of a finger. CONTUSION – bleeding beneath the skin into the soft tissue B. can be penetrating or perforating D. arm or leg . CLOSED WOUND A. toe. can be insicional or jagged C. AVULSION – tearing off or loss of a flap of skin E. PUNCTURE – penetration of a pointed object. LACERATION – tear in the skin. HEMATOMA – well-defined pocket of blood and fluid beneath the skin 2. OPEN WOUND A. ABRASION – superficial loss of skin from rubbing or scraping B.


and limb-threatening emergencies due to potential blood loss. occurs when stress is placed on a bone is greater than the bone can absorb ALERT: fractured cervical spine. FRACTURE – a break in he continuity of the bone. pelvis and femur may produce life threatening injuries. Clinical Manifestations: • • • Pain and tenderness over fracture site Crepitus or grating over fracture site swelling and edema • Deformity. shortening of an extremity or rotation of extremity EMERGENCY Management: IMMOBILIZE. posterior dislocations of the hip are life. INITIATE IV .1.

tapes  Skeletal Traction – force applied to the bony skeleton directly. pins. refers to the restoration of the fracture fragments into anatomic position and alignment -MMOBILIZATION .Regaining normal function of the affected part  use of cast and splint to immobilize extremity and maintain reduction  Skin Traction – force applied to the skin using foam rubber.EHABILITATION .maintains reduction until bone healing occurs . alignment and stabilization  Endoprosthetic Replacement – implantation of metal device . using wires. tongs placed in the bone  ORIF – operative intervention to achieve reduction.MANAGEMENT PROCESS OF FRACTURES -EDUCTION -setting the bone.

NURSING CONSIDERATIONS:  Elevate to prevent or limit swelling  Apply ice packs or cold compress. not place directly in skin  Splint and maintain in good alignment. immobilize the joint above and below the fracture  Give pain medications as ordered  Assist in casting. do not elevate limb above the level of the cast  Notify the physician  Bivalve the cast . use the palm of your hands in holding a wet cast  Avoid resting cast on hard surfaces or sharp edges  Do neurovascular checks hourly for the first 24 hours  Assess for COMPARTMENT SYNDROME – check for 6 P’s  If Compartment syndrome is suspected.

2.occurs when the surfaces of the bones forming the joint no longer in anatomic position ALERT: this is a medical emergency because of associated disruption of surrounding blood and nerve supplies * Subluxation – partial disruption of the articulating surfaces Clinical Manifestations: • • • Pain and deformity Loss of normal movement X-ray confirmation of dislocation w/o assoc. splints) . TRAUMATIC JOINT DISLOCATION . Secure reduction of dislocations manually (usually preferred under anesthesia) Nursing Considerations:  Assess neurovascular status before and after reduction of dislocation  Administer pain medications (NSAIDs)  Ensure proper use of immobilization device (elastic bandage. fracture Management: Immobilize part.

and limited use or movement 4. usually caused by a wrench or twist resulting in a decrease joint stability Clinical Manifestations: • Rapid swelling due to extravasation of blood w/n tissues • Pain on passive movement of joint • discoloration. STRAIN – a microscopic tearing of the muscle cause by excessive force. stretching. or overuse Clinical Manifestations: • Pain with isometric contractions • Swelling and tenderness • Hemorrhage in muscle . SPRAIN – an injury to the ligamentous structure surrounding a joint.3.

2 hrs off during waking hours) -EDICATIONS ( NSAIDs) -LEVATION -UPPORT (Use of crutches. decrease edema. 1 hr on.MANAGEMENT OF SPRAINS AND STRAINS -OMPRESSION (Elastic Bandage) -EST -CE (for the first 24 hrs. splints) NURSING CONSIDERATIONS:  Apply ice compress for the first 24 hrs to produce vasoconstriction. and reduce discomfort  Apply warm compress after 24 hrs to promote circulation and absorption (20 to 30 minutes at a time)  Educate to rest injured part for a month to allow healing  Educate to resume activities gradually and to warm up .

HYPOVOLEMIC . tension pneumothrorax. Blood volume Can be classified as: d. SEPTIC SHOCK – from bacteria and their products circulating in the blood . capacity of venous beds A. resulting in failure of one or more of the ff: c.occurs when significant amount of fluid is lost in the intravascular space (Ex. arterial resistance levels a. Hemorrhage. Secondary causes includes mechanical restriction of cardiac function or venous obstruction like in Cardiac Tamponade.- Inadequate tissue perfusion. pump failure of the heart b. VCO C. burns. dysrhythmias. CARDIOGENIC – occurs when the heart fails as a pump. fluid shifts) B. Primary causes includes MI.

weak and thready) o Assess urinary output (25ml/hr may indicate shock) o Assess capillary perfusion o Assess for metabolic acidosis due to anaerobic metabolism of cells o Assess for excessive thirst. decreasing LOC indicates progression of shock o Monitor arterial blood pressure (narrowing pulse pressure.PRIMARY INTERVENTIONS:  Assess for ABC  Resuscitate as necessary  Administer O2 to augment O2-carrying capacity of arterial blood  Start cardiac monitoring  Control hemorrhage SUBSEQUENT ASSESSMENT: o Assess LOC. hyperthermia on septic shock . fall in systolic pressure) o Assess pulse quality and rate change (tachycardia.

CVP.MANAGEMENT:  Administer O2 via ET or nonrebreather face mask (if intubated. Ringer’s Lactate. Vasopressor. refer changes on the following  Maintain normothermia (high fever will increase the cellular metabolism effects of shock  Medications: Inotropics.and electrolytes. HCT. UO. may be hyperventilated to control acidosis)  Fluid resuscitation (2 large-bore IV lines. Hgb. BT)  Insertion of an indwelling catheter  Maintain patient in a supine position with legs elevated  Continue to monitor VS. and Anti-biotics . ECG. ABG.

first positive deflection Q WAVE: first negative deflection R WAVE: first positive deflection S WAVE: negative deflection.-It is a useful tool in the diagnosis of those conditions that may cause abberations in the electrical activity WAVE INTERPRETATIONS: P WAVE : Atrial Depolarization. after R wave QRS COMPLEX: Ventricular Depolarization T WAVE: Ventricular Repolarization .

5th ICS. Left MCL V5: Black. Check order for ECG. 5th ICS. Right foot V1: Red. LMAL . 4th ICS. Right Arm Lead 2: Yellow. 5th ICS. midway between V2 and V4 V4: Brown. Right Sternal Border V2: Yellow. 4th ICS. LAAL V6: Violet. Left Foot Neutralizer: Black. prepare the machine at the bedside at ER  Provide Privacy  Instruct patient to lie still and avoid movement  Remove metal objects on the patients (jewelries)  Place Chest leads as labeled: Lead 1: Red. Left Arm Lead 3: Green. Left sternal border V3: Green. in cases of arrest.

paradoxical chest movements . blast injuries SIGNS/SYMPTOMS: RIB FRACTURES: tenderness.decreased lung inflation. pain that worsens with deep breathing and movement. shallow and splinted respirations STERNAL FRACTURES: persistent chest pain MULTIPLE RIB FRACTURES: -FLAIL CHEST (loss of chest wall integrity) . slight edema.rapid and shallow respirations .extreme pain .usually cause by VA.respiratory acidosis .It is a trauma in the chest without an open wound . cyanosis ..hypotension.

JVD 2. HEMOTHORAX – collection of blood in the pleural cavity. LACERATION or RUPTURE of AORTA – immediately fatal 4. usually results from ribs. compromising both circulation and vital capacity of lungs 5.COMPLICATIONS: 1. CARDIAC TAMPONADE – rapid unchecked rise in intrapericardia pressure that impairs diastolic filling of the heart . DIAPHRAGMATIC RUPTURE – causes severe respi. TENSION PNEUMOTHORAX . lacerating lung tisssue or an intercoastal artery absent breath sound on the affected side. if untreated abdominal viscera may herniate. -It is the most common cause of shock following chest trauma 3.results from blood or fluid accumulation in the pericardial sac .a condition in which air enters the chest but can’t be ejected during exhalation -There is lung collapse and mediastinal shift S/Sx: tracheal deviation. agitation. Distress. cyanosis and severe dyspnea.

Tension Pnuemothorax: tymphany • Auscultation: .Cardiac tamponade: muffled heart tones • X-ray • Thoracentesis – yeilds blood and serosanguinous fluid • ECG • Retrograde aortography – reveals aortic laceration • Echocardiography • Computed Tomography .Tension Pnemothorax: PMI is deviated .ASSESSMENT AND DIAGNOSIS: • Percussion: .Hemothorax: Dullness .

bed rest. coughing and splinting Severe Rib Fractures  intercoastal nerve blocks  position for semi-fowlers.TREATMENT: Simple Rib Fractures  mild analgesics. apply heat  incentive spirometry  deep breathing. O2. administer O2 Hemothorax  Chest tube insertion at 5th-6th ICS anterior to MAL  administer IV fuids. Blood Transfusion  Thoracotomy  Thoracentesis .

aortic anastomosis  O2.TREATMENT: Tension Pneumothorax  insertion of spinal. BT. IV .synthetic grafts . 14G or 16G needle into the 2nd ICS at MCL to release pressure  Chest Tubes  Surgical Repair Aortic Rupture/Laceration  immediate surgery .

NURSING CONSIDEARTIONS:  monitor VS. (q 15. first hour post thoracentesis and post CTT)  After CTT insertion. mechanical blockage or lung has already expanded  have an extra bottle with PNSS. encourage cough and breathing exersises  Chest tubes should have continuous FLUCTUATIONS  if BUBBLING. cover the opening with sterile/petroleum gauze to prevent rapid lung collapse  Assist with proper positioning  Bed Rest . air leak is suspected  if FLUCTUATION STOPS. clamps and sterile gauze at bedside  in case of dislodgment.


measure abdominal girth the umbilical level • Rectal and pelvic examination . a sign of blood beneath the diaphragm. rigidity and spasm • KEHR’S SIGN – pain radiating to the left shoulder. Dullness over regions containing gas may indicate presence of blood • Look for increasing abdominal distention. Pain in right shoulder can result from liver laceration • CULLEN’S SIGN – slight bluish discoloration around the navel. guarding.SUBSEQUENT ASSESSMENT: • Obtain hx of the mechanism of the injury • Evaluate signs and symptoms of hemorrhage • Note tenderness. rebound tenderness. a sign of hemoperitonium • Rebound tenderness and boardlike rigidity are indicative of a significant intra-abdominal injury • Loss of dullness over solid organs.

Antibiotics  Assist in peritoneal lavage  Prepare pt. quiet in the stretcher. if pelvic fracture is suspected. look for entrance and exit wounds  Apply compression to external bleeding wounds  double IV line and infuse Ringer’s Lactate  Insert NGT to decompress the abdomen  Cover protruding abdominal viscera w/ sterile saline dressings. don’t attempt to place back the protruding organs  Cover open wounds with dry dressings  Insert indwelling catheter.GENERAL INTERVENTIONS:  Keep pt. count the number of wounds.  Meds: Tetanus Prophylaxis. any movement may dislodge a clot  Cut the clothing. for surgery if the condition persists. (Exploratory Laparotomy) . catheter should not be placed until integrity of urethra is ensured.

fatigue.It is the inadequacy or the collapse of peripheral circulation due to volume and electrolyte depletion ASSESSMENT: temperature may be normal or slightly elevated. hyponatremia or hypernatremia. remove all clothing    Position the patient supine with the feet slightly elevated Monitor VS every 15 mins and cardiac rhythm Educate to avoid immediate reexposure to high temperatures . headache. tachycardia. tachypnea. pale and moist skin. ECG may show dysrhythmias MANAGEMENT:  Move patient to a cool environment. syncope DIAGNOSTICS: hemoconcentration. dizziness. hypotension.

at start it maybe moist progressing to dryness (Anhidrosis) NURSING ALERT: • Elderly clients are high-risk to develop heat-stroke • Once diagnosis is confirmed.It is a combination of hyperpyrexia and neurologic symptoms. tachycardia. progressing to confusion.. delirium and coma • 40. tachypnea • skin may appear flushed and hot. It caused by a shutdown or failure of the heatregulating mechanisms of the body CLINICAL MANIFESTATIONS: • bizarre behavior or irritability. hypotension.6 degrees Celcius. it is imperative to reduce patient’s temperature .

fails to decrease. seizures . metabolic acidosis. cool fluid bladder irrigation  Discontinue active cooling when the temp. groin. axillae. most effective. by spraying tepid water on skin while fans are used to blow  Apply ice packs to necks. via ET or nonrebreather mask  Monitor VS.MANAGEMENT:  EVAPORATIVE COOLING. and neurologic status  Start IV infusion using Ringer’s Lactate  Anti-pyretics are not useful  Indwelling catheterization  WOF hypokalemia. cool fluid peritoneal dialysis. initiate core cooling: iced saline lavage. reaches 39 degrees Celcius  Oxygenate the pt. ECG. and scalp  Soak sheets/towels in ice water and place on patient  If temp.

3 compensatory mechanisms: a. . shivering – produces heat thru muscular activity b.. is less than 35 degrees Celcius as a result in the exposure to cold. peripheral vasoconstriction – to decrease heat loss c. because the heart is near fibrillation threshold . raising basal metabolic rate NURSING ALERT: • Elderly are greater risk for hypothermia due to altered compensatory mechanisms • Extreme caution should be used in moving or transporting hypothermic pts.-It is a condition where the core temp.

no pulse. initiate CPR • drowsiness progressing to coma • shivering is suppressed on temp. spontaneous respirations • heart sounds may not be audible even if its beating • BP is extremely difficult to hear • fixed dilated pupils.CLINICAL MANIFESTIONS: • slow. no BP. below 32.3 degrees • ataxia • cold diuresis • fruity or acetone odor of breath GOAL of MANAGEMENT: Rewarm without precipitating cardiac dysrhythmias. .

causing an initial lowering of the core temp. or groin .Provide insulation by wrapping the patient in several blankets .Warm water immersion -Disadvantages: 1. Acidosis due to “washing out” of lactic acid from the peripheral tissue . returning cool blood to the core.MANAGEMENT:  Passive External Rewarming (temp above 28 degrees) -Remove all wet clothing. 2.warm hot water bottles to the armpits.Provide warm fluids Disadvantage: slow process  Active External Rewarming (temp above 28 degrees) -Provide external heat for patient. and replace with warm clothing . causes peripheral vasodilation. neck.

An increased in metabolic demands before the heart is warmed to meet these needs.3.Warm gastric lavage -Peritoneal dialysis with warmed standard dialysis solution .  Active Core Rewarming (temp below 28 degrees) -Inhalation of warm. humidified O2 by mask or ventilator .Cardiopulmonary bypass Disadvantage: invasiveness of the procedure .warmed IV fluids .

a.results in loss of surfactant. -Hypoxia and acidosis are common problems of the victim. -Resultant pathophysiologic changes and pulmonary injury depend on type of fluid and the volume aspirated. Saltwater aspiration. Clinical Manifestations: -difficulty of breathing -cyanosis -chills -hypothermia .-It is a survival for atleast 24 hours after submersion. with most common consequence of hypoxemia.leads to pulmonary edema from the osmotic effect of salt within the lungs. Fresh water aspiration. hence an inability to expand lungs b.

check degree of hypothermia  Rewarming procedures  Intravascular volume expansion and inotropic agents  ECG  Indwelling catheterization  NGT insertion .MANAGEMENT:  Immediate CPR  Endotracheal intubation with PEEP  VS.

gastric contents may be sent to laboratory • Monitor neurologic status • Monitor fluid and electrolytes GENERAL INTERVENTIONS: • Initiate large-bore IV access. monitor shock • Prevent aspiration of gastric contents by positioning head on side • Maintain seizures precaution .ASSESSMENT: • ABC • Identify the poison •Obtain blood and urine tests.

Gastric lavage for the obtunded patient. Save gastric aspirate for toxicology screen. Adult dose is 30 ml by mouth followed by 2 glasses of water.MINIMIZING ABSORPTION    Administration of activated charcoal with a cathartic to hasten secretion. of water. iodides.   1. hydrocarbons. petroleum distillates. Pedia dose is15 ml followed by 8 – 16 oz. done only in patients with good gag reflex and is conscious. . Forced diuresis with urine pH alteration – to enhance renal clearance. silver nitrates. to a patient having seizure or to pregnant patient. NURSING ALERT: Do not induce emesis after ingestion of caustic substances. Procedure to enhance the removal of ingested substance if the patient is deteriorating. Induction of emesis with syrup of ipecac.

 . Hemodialysis – to purify and accelerate the elimination of circulating toxins. 4. Repeated dose of charcoal. Providing an antidote – antidote is a chemical or physiologic antagonist that will neutralize the poison. Hemoperfusion (process of passing blood through an extracorporeal circuit and a cartridge containing an adsorbent. 5. such as charcoal. after which the detoxified blood is returned to the patient) 3.2.

4. To diagnose and treat gastric hemorrhage and for the arrest of hemorrhage.PURPOSES: 1. To remove liquid or small particles of material from the stomach. 3. 150 – 200 ml. Place patient on left lateral position with head lower 15 degrees downward. Lavage fluid is left in place for about one minute before allowed to drain . NURSING CONSIDERATIONS     Insertion of NGT or OGT. To remove unabsorbed poison after ingestion. Elevate funnel and pour approx. 2. To cleanse stomach before endoscopic procedures.

Give the patient a cathartic if prescribed. 3. Save samples of first two washings. At the completion of the lavage: Stomach may be left empty.    Pinch off the tube during removal or maintain suction while tubing is being withdrawn. Repeat lavage procedure until the returns are relatively clear and no particular matter is seen. Warn patient that stool will turn black from the charcoal. . 2.   1. A saline cathartic may be instilled in the tube. An Adsorbent may be instilled in the tube and allowed to remain in the stomach.

cherry red.ABG: carboxyhemoglobin level is 12% (Normal). 30 – 40% severe carbon monoxide poisoning. stridor.Headache.Confusion progressing to coma. palpitation.-It is an example of inhaled poison and results in the incomplete hydrocarbon combustion . . and dizziness.Carbon monoxide exerts its toxic effects by binding to circulating hemoglobin to reduce the oxygen carrying capacity of the blood. . . CLINICAL MANIFESTATIONS .Respiratory depression. muscular weakness. . . or cyanotic.Creation of carboxyhemoglobin resulting to tissue anoxia.Carbon monoxide and hemoglobin is 200 – 300 times affinity compared to oxygen and hemoglobin. .Skin is pink in color. .

for a person breathing room air is 5 hours and 20 minutes.  Correct acid-base and electrolyte imbalances.  Continuous ECG monitoring. visual disturbances. and deterioration of personality may persist after resuscitation and may be symptoms of permanent CNS damage.MANAGEMENT:  Provide 100% oxygen by tight-fitting mask (the elimination half life of carboxyhemoglobin. treat dysrhythmias.  Continuous observation of psychoses. If patient breaths 100% oxygen the half life is reduced to 80 minutes  100% oxygen in hyperbaric chamber reduces halflife to 20 minutes. .  Intubate if necessary to protect airway. spastic paralysis. in serum.

Local reactions are characterized by pain. laryngeal edema.  Administer bronchodilator. . bronchospasm.Systemic reactions usually begin within minutes. and cardiovascular collapse. . . erythema and edema at the site of injury.  Initiate IV with Ringers Lactate.-These are injected poisons that can produce either local or systemic reactions.  Prepare for CPR. MANAGEMENT:  ABC  Epinephrine is the drug of choice give SQ. (Unconsciousness.

Wear emergency medical bracelet indicating hypersensitivity. .Have epinephrine on hand .If sting occurs. because this may cause additional venom to be injected.  Clean wounds thoroughly with soap and water or antiseptic solution. remove stinger with one quick scrape of fingernail.  Elevate extremities with large edematous local reaction. .Do not squeeze venom sack.  Administer anti histamine for local reaction.Avoid insect feeding areas. . .  Educate patient.NURSING CONSIDERATIONS:  Apply ice packs to site to relieve pain. .

weakness.WOF signs of systemic reactions (nausea. swelling. sweating. .CLINICAL MANIFESTATIONS: -Burning pain. shock. and numbness of the site. and coma).  Administer vasopressors in the treatment of shock. .Hemorrhagic blisters may occur after few hours of bite and entire extremity may become edematous. initial euphoria followed by drowsiness.  Administer anti-venin and be alert to allergic reaction. seizures. lightheadedness.  Administer O2 and start IV line. paralysis of various muscle groups. keep the patient calm and immobilize extremity. MANAGEMENT:  Wash the site of bite. dysphagia. .

seizures. CLINICAL MANIFESTATIONS:  Shakes. increase temperature. .a. anxiety.Symptoms begins as early as 4 hours after reduction of alcohol intake and peaks at 24 . .  N/V.k. weakness.a Delirium Tremens or Alcoholic Hallucinosis -An acute toxic state that follows a prolonged bout of steady drinking or sudden withdrawal from prolonged intake of alcohol. diaphoresis.  History of drinking episodes. malaise..48 hours but may last up to 2 weeks. and hallucinations.  Autonomic hyperreactivity (tachycardia. dilated but reactive pupils).

ALCOHOLISM – a chronic disease or disorder characterized by excessive alcohol intake and interference in the individuals health, interpersonal realtionship and economic functioning -Considered to be present when there is .1% or 10 ml for every 1000 ml of blood - At .1 - .2%, there is low coordination - At .2 - .3%, there is ataxia, tremors, irritability, and stupor - At .3 and above, there is unconsciousness COMMON BEHAVIORAL PROBLEMS: 5 D’s D-enial D-ependency D-emanding D-estructive







DRUG OF CHOICE for aversion therapy of an alcoholic: - DISULFIRAM (antabuse) Instruct patient to avoid, when taking Disulfiram:



diazepam or phenytoin for seizure control as prescribed. . gatorade.  Place patient in a private room with close observation.  Administer thiamine followed by parenteral dextrose if liver glycogen is depleted.  Monitor VS every 30 minutes. or other carbohydrates to stabilize blood sugar.  Maintain electrolyte balance and hydration.  Give orange juice.  Observe for hypoglycemia.MANAGEMENT:  Protect patient from injury. toxicologic screen for other drug abuse. draw blood for measurement of ethanol concentration.  Use a non-alcohol skin preparation.

Establish control. Ask if he has a weapon. keeping the door open. affect. nonconfrontational approach d. c. and be in clear veiw of staff b. Adopt a calm. fear and hopelessness about a situation. Provide emotional support.-It is an urgent. serious disturbances of behavior. or thought that makes the patient unable to cope with his life situation and interpersonal relationship -Is usually episodic and is a means of expressing feelings of anger. . avoid touching an agitated pt. CRISIS INTERVENTION .Manage through: a.

“cry for help” -Major Interventions: PREVENTION and LISTEN . male commits suicide) -NSUCCESSFUL PREVIOUS ATTEMPT -DENTIFICATION with family member committed suicide -HRONIC -LLNESS -EPRESSION/DEPENDENT PRERSONALITY -GE (18-25 AND ABOVE 40)/ALCOHOLISM -ETHALITY OF PREVIOUS ATTEMPTS .-Ultimate form of self-destruction.RISK FACTORS -EX (female attempts.

medicines at the bedside  Monitor for signs of impending suicide (giving away of valued possession) . perfumes. Self-directed NURSING INTERVENTIONS:  Provide one-on-one monitoring  Have frequent unscheduled rounds  Avoid use of metals and glass utensils  Remove shampoos.PRIORITY NURSING DIAGNOSIS: Risk for Injury.

RAPE refers to the insertion of penis into the mouth. anger. anus of a victim • Insertion of any object into the mouth or anus • It is generally considered as an act of hostility. or violence ELEMENTS OF RAPE: • Use of threat/force • lack of consent of the victim • Actual penetration of the penis into the vagina Different Kinds of Rape: • POWER – done to prove one’s masculinity • ANGER – done as a means of retaliation • SADISTIC – done to express erotic feelings . vagina.• According to RA 8353.

2. 4 Phases ACUTE PHASE – characterized by shock. tension. 3.RAPE TRAUMA SYNDROME It refers to a group of signs and symptoms experienced by a victim in reaction to rape 1. numbness and disbelief DENIAL – characterized by victim’s refusal to talk about the event HEIGHTENED ANXIETY – characterized by fear. 4. and nightmares REORGANIZATION – victim’s life normalizes PRIORITY NURSING CARE: Preservation of evidences TREATMENT: Crisis Intervention .

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