ED Nursing '10
Transcript of ED Nursing '10
-
8/8/2019 ED Nursing '10
1/75
-
8/8/2019 ED Nursing '10
2/75
It is the nursing care
given to patients with
urgent and critical
needs
EMERGENCY IT IS WHATEVER THEPATIENT OR THE FAMILY CONSIDERS IT TO BE.
EMERGENCYNURSING
has a specialized education, training,
and experience to gain expertise inassessing and identifying patients
health care problems in crisis
situations
establishes priorities, monitors
and continuously assesses acutely illand injured patients, supports and
attends to families, supervises allied
health personnel, and teaches
patients and families within a time-
limited, high-pressured care
environment
EMERGENCYNURSE
-
8/8/2019 ED Nursing '10
3/75
DISASTER NURSING - a branch of emergencynursing, it refers to nursing care given to patients who are
victims of disasters, whether it is manmade or natural
phenomena.
INCIDENT COMMAND
SYSTEM 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 informedabout any deviation from
the established plan
-
8/8/2019 ED Nursing '10
4/75
EMERGENCY OPERATIONS PLAN (EOP)
It is done by a planning committee, composed of local/national
administrators, safety officer, ED manager, evaluating the
community to anticipate the type of disaster that might occur.
Activation Response
Internal/External Communication
Plans
Plan for coordinated patient care
Security Plans
COMPONENTS of EOP
Identification of external resources
A plan for people management and traffic
flow
Data Management Strategy
Deactivation Response
Post- Incident Response
Plan for Practice Drills
Anticipated Resources
Mass Casualty Incident Planning
Educational Plan
-
8/8/2019 ED Nursing '10
5/75
from French word trier
meaning to sort
it is used to sort patients
into groups based on theseverity of their health
problems and the
immediacy with which
these problems must be
treated
TRIAGENURSE acts as
a gatekeeper, sortingpatients into
categories, ensuring
that the more
seriously ill aretreated first
-
8/8/2019 ED Nursing '10
6/75
Conditions requiring immediate
medical intervention, any delay in treatment is potentially life
or limb threatening. Must be seen IMMEDIATELY!
AIRWAY COMPROMISE , CARDIAC ARREST
SEVERE SHOCK, CERVICAL SPINE INJURY
MULTISYSTEM TRAUMA, ALTERED LEVEL OF
CONSCIOUSNESS, ECLAMPSIA
-
8/8/2019 ED Nursing '10
7/75
Patients who present with Chronic or
minor injuries, no danger to life or limb, patient is in no
obvious cardiopulmunary distress
FEVER
MINOR BURNS
MINOR MUSCULOSKELETAL INJURIES
LACERATIONS
-
8/8/2019 ED Nursing '10
8/75
Patients who presents
as stable but whose condition requires medical
intervention w/in a few hours. No immediate treat to life
or limb to these patients.
CHRONIC LOW BACK PAIN
DENTAL PROBLEMS
MISSED MENSES
-
8/8/2019 ED Nursing '10
9/75
DO THE GREATEST GOOD FOR THE GREATEST
NUMBER -
TRIAGETRIAGE
CATEGORYCATEGORY
PRIORITYPRIORITY COLORCOLOR
IMMEDIATEIMMEDIATE 11 REDRED
DELAYEDDELAYED 22 YELLOWYELLOW
MINIMALMINIMAL 33 GREENGREEN
EXPECTANTEXPECTANT 44 BLACKBLACK
-
8/8/2019 ED Nursing '10
10/75
TRIAGE CATEGORYTRIAGE CATEGORY
Sucking chest wound
airway obstruction secondary to
mechanical cause,
shock
hemothorax, tension pneumothorax
asphyxia
unstable chest and abdominal
wounds,
incomplete amputations, openfractures of long bones
2nd / 3rd degree burns of 15-40%
TBSA
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, and
external fixation
-
8/8/2019 ED Nursing '10
11/75
TRIAGE CATEGORYTRIAGE CATEGORY
Upper extremity fractures
Minor Burns
Sprains
Small Lacerations w/o
significant bleeding
Behavioral disorders or
Psychological disturbances
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, no BP,
pupils fixed and dilated
-
8/8/2019 ED Nursing '10
12/75
1. PRIMARY ASSESSMENTMEANT TO IDENTIFY LIFE-THREATENING PROBLEMS
IRWAY
REATHING
IRCULATION
ISABILITY
XPOSE
-
8/8/2019 ED Nursing '10
13/75
2. SECONDARY ASSESSMENTSystematic, brief (2-3 mins) examination from head to toe
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. 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?
-
8/8/2019 ED Nursing '10
14/75
Understand and accept basic anxieties, be aware of patients fear
Accept the rights of the patient and family, to have and display theirfeelings
Maintain a calm and reassuring manner
Treat the unconscious patient as if CONSCIOUS. (Touch, call by name,
explain every procedure) Orient the patient as soon he becomes conscious.
Inform the family where the patient is, 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
-
8/8/2019 ED Nursing '10
15/75
an emergency procedure
that consists of recognizing
respiratory or cardiac arrest
or both the properapplication of CPR to
maintain life until a victim
recovers or advance life
support is available.
the use of special
e uipment to maintain
breathing and circulation
for the victim of a cardiac
emergency.
for post resuscitative and long
term resuscitation.
-
8/8/2019 ED Nursing '10
16/75
FIRST LINK - EARLY ACCESS
It is the event initiated after
the patients collapse until
the arrival of EmergencyMedical Services personnel
prepared to provide care.
-
8/8/2019 ED Nursing '10
17/75
SECOND LINK - EARLY CPR
If started immediately after
the victims collapse, the
probability of survivalapproximately doubles
when it is initiated before
the arrival of EMS.
-
8/8/2019 ED Nursing '10
18/75
THIRD LINK - EARLY DEFIBRILLATION
It is most likely to improve
survival. It is the key
intervention to increase thechances of survival of
patients with out-of-hospital
cardiac arrest.
-
8/8/2019 ED Nursing '10
19/75
SECOND LINK - EARLY ACLS
If provided by highly trained
personnel like paramedics,
provision of advanced careoutside the hospital would
be possible.
-
8/8/2019 ED Nursing '10
20/75
Do obtain consent when possible.
Do think the worst. Its best to administer first aid for the
gravest possibility.
Do provide comfort and emotional support.
Do respect the victims modesty and physical privacy.
Do be as calm and as direct as possible.
Do care for the most serious injuries first.
Do assist the victim with his/her prescription medication.
Do handle the victim to a minimum.
Do loosen tight clothing.
-
8/8/2019 ED Nursing '10
21/75
Do not let the victim see his/her own injury.
Do not leave the victim alone except to get
help.
Do not assume that the victims 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.
-
8/8/2019 ED Nursing '10
22/75
is a rapid movement of
patient from unsafe place
to a place of safety.
1. Danger of fire or explosion.
2. Danger of toxic gases or asphyxia due to lack
of oxygen.
3. Natural Disasters
4. Risk of drowning.
5. Danger of electrocution.
6. Danger of collapsing walls.
1. For immediate rescue without
any assistance, drag or pullthe victim.
2. Most of the one-man
drags/carries and other
transfer methods can be used
as methods of rescue.
-
8/8/2019 ED Nursing '10
23/75
is moving a patient from
one place to another
after giving first aid.
1. Nature and severity of the injury.
2. Size of the victim.
3. Physical capabilities of the first aider.
4. Number of personnel and equipment
available.
5. Nature of the evacuation route.
6. Distance to be covered.
7. Gender of the victims. (last consideration)
-
8/8/2019 ED Nursing '10
24/75
Pointers to be
observed during
transfer1.Victims airway must be maintained open.
2. Hemorrhage is controlled.
3. Victim is safely maintained in the proper position.4. Regular check of the victims condition is made.
5. Supporting bandages and dressings as remain
effectively applied.
6. The method of transfer is safe, comfortable and asspeedy as circumstances permit.
7. The patients body is moved as one unit.
8. First aiders/bearers must observed ergonomics in
lifting and moving of patient.
-
8/8/2019 ED Nursing '10
25/75
1.One man
assist/carries/drags
2. Two man assist/carries
3.Three man carries
4.four/six/eight-man carry
5.Blanket
-
8/8/2019 ED Nursing '10
26/75
6.Improvised stretcher using
two poles with:
blanket
Empty sacks
Shirts or coats
Triangular bandages
7.Commercial stretchers
8.Ambulance or rescue van
9.Other vehicles.
-
8/8/2019 ED Nursing '10
27/75
-
8/8/2019 ED Nursing '10
28/75
RESPONSIVENESS/AIRWAY
Determine unresponsiveness; ARE YOU OKAY?
Activate Emergency Medical Assistance
Place patient supine on a firm, flat surface. Kneel at
the level of the patients shoulders
Open the airway: HEADTILT/CHIN LIFT
MANEUVER, JAW THRUST MANEUVER
BREATHING
Look, Listen and Feel
Rescue breathing: 2 full breaths
CIRCULATION
Check carotid pulse
-
8/8/2019 ED Nursing '10
29/75
mouth to mouth
mouth to nose
mouth to stoma
mouth to mouth and nose
mouth to barrier device
-
8/8/2019 ED Nursing '10
30/75
AdultAdult ChildChild InfantInfant
CompressionCompression
AreaArea
Lower half of theLower half of the
sternum but notsternum but not
hitting thehitting the xiphoidxiphoid
process: measureprocess: measure
up to 2 fingers fromup to 2 fingers from
substernalsubsternal notch.notch.
Lower half of theLower half of the
sternum but notsternum but not
hitting thehitting the xiphoidxiphoid
process: measureprocess: measure
up to 1 finger fromup to 1 finger from
substernalsubsternal notch.notch.
Lower half of theLower half of the
sternum but not hittingsternum but not hitting
the xiphoid process: 1the xiphoid process: 1
finger width below thefinger width below the
imaginary nipple line.imaginary nipple line.
DepthDepth Approximately 1 Approximately 1 to 2 inchesto 2 inches
Approximately 1 to 1Approximately 1 to 1
inches inches
Approximately to 1Approximately to 1
inchinch
How toHow to
compresscompress
Heel of1 hand,Heel of1 hand,
other hand on top.other hand on top.
Heel of1 hand.Heel of1 hand. 2 fingers (middle &2 fingers (middle &
ring fingertips)ring fingertips)
CompressionCompression--
ventilation ratioventilation ratio
30:2 (1 or 230:2 (1 or 2
rescuers)rescuers)
30:2 (1 or 230:2 (1 or 2
rescuers)rescuers)
30:2 (1 or 2 rescuers)30:2 (1 or 2 rescuers)
Number ofNumber of
cycles percycles per
minuteminute
5 cycles in 25 cycles in 2
minutesminutes
5 cycles in 25 cycles in 2
minutesminutes
5 cycles in 2 minutes5 cycles in 2 minutes
-
8/8/2019 ED Nursing '10
31/75
-PONTENEOUS signs of circulation are
restored
-URN OVER to medical services or properly
trained authorized personnel
- PERATOR is already exhausted and cannot
continue CPR
- HYSICIAN assumes responsibility (declares
death, take-over, etc.)
-
8/8/2019 ED Nursing '10
32/75
KINDS OF AIRWAY OBSTRUCTION
Anatomic Airway Obstruction
Mechanical Airway Obstruction
Clinical Manifestations:
, choking,
stridor, apprehensive appearance, restlessness.
CYANOSIS and LOSS of CONSCIOUSNESS
develop as hypoxia worsens.
-
8/8/2019 ED Nursing '10
33/75
HEIMLICH MANEUVER
(Subdiagphramatic AbdominalThrust)
FINGER SWEEP
CHEST THRUST
-
8/8/2019 ED Nursing '10
34/75
-
8/8/2019 ED Nursing '10
35/75
-
8/8/2019 ED Nursing '10
36/75
-
8/8/2019 ED Nursing '10
37/75
1. OPEN HEAD INJURY
2. CLOSED HEAD INJURY
3. CONCUSSION temporary loss of
4. consciousness that results in transient
5. interruption if the brains normal functioning
6. CONTUSSSION bruising of the brain tissue
7. INTRACRANIAL HEMORRHAGE significant bleeding into a space or
potential space between the skull and the brain
a. Epidural hematoma
b. Subdural hematoma
c. Subarachnoid hemorrhages
ALERT: Assume cervical spine fracture for
any patient with a significant head injury,
until proven otherwise.
-
8/8/2019 ED Nursing '10
38/75
PRIMARY ASSESSMENT: Assess for ABC
SECONDARY ASSESSMENT:
Change in LOC, CUSHINGS TRIAD ( bradypnea,
bradycardia, widened pulse pressure) indicating
increased intracranial pressure
Pupils, Battles Sign
Rhinorrhea or otorrhea indicative of CSF leak
Periorbital Ecchymosis indicates anterior basilar
fracture
ALERT: If basilar skull
fracture or severemidface fractures are
suspected, a
nasogastric tube(NGT)
is CONTRAINDICATED!
-
8/8/2019 ED Nursing '10
39/75
MANAGEMENT:
Open airway by Jaw-Thrust Manuever, suction orally if needed
Administer high flow oxygen: most common death is CEREBRAL ANOXIA
In general, hyperventilate the patient to 20-25 bpm, causing cerebral
vasoconstriction and minimizing cerebral edema
Apply a bulky, loose dressing; dont apply pressure
IV line of PNSS or Plain LR
prepare to manage seizures
maintain normothermia
Medications:
a. Diazepam
b. Steroids
c. Mannitol
Prepare of immediate surgery if pt. shows evidence of neurologic deterioration
-
8/8/2019 ED Nursing '10
40/75
SIMPLE
COMPOUND
LINEAR Fx
COMMINUTED Fx
DEPRESSED Fx
CRANIAL VAULT Fx
BASILAR Fx
ALERT:
Damage to the brain is the first concern, it
is considered a neurosurgical condition
In children, skulls thinness and elasticity
allows a depression w/o a break in the bone
-
8/8/2019 ED Nursing '10
41/75
For LINEAR FRACTURES:
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 fragments antibiotics
Dexamethasone
Osmotic Diuretics (MANNITOL) if increased ICP is
present
-
8/8/2019 ED Nursing '10
42/75
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, dont let him blow it!
OTORRHEA cover it lightly with sterile gauze, dont pack it!
Position head on side
Maintain a supine position with bed elevated to 30 degrees
dont give narcotics or sedative
assist in surgery, maintaining sterile technique
-
8/8/2019 ED Nursing '10
43/75
PRIMARY ASSESSMENT:
immediate immobilization of the spine
A B C ( Intercoastal paralysis w/ diapragmatic breathing)
SUBSEQUENT ASSESSMENT:
Hypotension, bradycardia, hypothermia - suggestsSPINAL 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
-
8/8/2019 ED Nursing '10
44/75
PRIMARY ASSESSMENT
Immobilization of spine while performing assessment
ABC (tongue swelling, bleeding, broken or missed
teeth)
SUBSEQUENT ASSESSMENT
Paralysis if the upward gaze indicative of INFERIORORBIT 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, 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, loose dressing; apply ice to areas of swelling
-
8/8/2019 ED Nursing '10
45/75
1. FRACTURE a break in he continuity of the bone; occurs when stress is
placed on a bone is greater than the bone can absorb
ALERT: fractured cervical spine, pelvis and femur may produce life
threatening injuries; posterior dislocations of the hip are life- and limb-
threatening emergencies due to potential blood loss.
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, INITIATE IV
-
8/8/2019 ED Nursing '10
46/75
MANAGEMENT PROCESS OF FRACTURES
-EDUCTION
-setting the bone; refers to the restoration of the fracturefragments into anatomic position and alignment
-MMOBILIZATION
- maintains reduction until bone healing occurs
- EHABILITATION
- 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, tapes
Skeletal Traction force applied to the bony skeleton directly, using wires,pins, tongs placed in the bone
ORIF operative intervention to achieve reduction, alignment and
stabilization
Endoprosthetic Replacement implantation of metal device
-
8/8/2019 ED Nursing '10
47/75
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; use the palm of your hands in holding a wet castAvoid resting cast on hard surfaces or sharp edges
Do neurovascular checks hourly for the first 24 hours
Assess forCOMPARTMENT SYNDROME check for6 Ps
If Compartment syndrome is suspected, do not elevate limb above the levelof the cast
Notify the physician
-
8/8/2019 ED Nursing '10
48/75
SPRAIN an injury to the ligamentous structure surrounding a joint;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, and limited use or movement
STRAIN a microscopic tearing of the muscle cause by excessiveforce, stretching, or overuse
Clinical Manifestations:
Pain with isometric contractions
Swelling and tenderness
Hemorrhage in muscle
-
8/8/2019 ED Nursing '10
49/75
MANAGEMENT OF SPRAINS AND STRAINS
-OMPRESSION (Elastic Bandage)
-EST
-CE (for the first 24 hrs; 1 hr on, 2 hrs off during waking hours)
-EDICATIONS ( NSAIDs)
-LEVATION
-UPPORT (Use of crutches, splints)
NURSING CONSIDERATIONS:
Apply ice compress for the first 24 hrs to produce vasoconstriction,
decrease edema, 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
-
8/8/2019 ED Nursing '10
50/75
- It is a trauma in the chest without an open wound
- usually cause by VA, blast injuries
RIB FRACTURES: tenderness, slight edema, 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)
- decreased lung inflation, paradoxical chest movements
- extreme pain
- rapid and shallow respirations- hypotension, cyanosis
- respiratory acidosis
-
8/8/2019 ED Nursing '10
51/75
TENSION PNEUMOTHORAX
HEMOTHORAX
LACERATION or RUPTURE ofAORTA
DIAPHRAGMATIC RUPTURE
CARDIAC TAMPONADE
-
8/8/2019 ED Nursing '10
52/75
Simple Rib Fractures
mild analgesics, bed rest, apply heat
incentive spirometry
deep breathing, coughing and splinting
Severe Rib Fractures intercoastal nerve blocks
position for semi-fowlers, administer O2
Hemothorax Chest tube insertion at 5th-6th ICS anterior to MAL administer IV fuids, O2, Blood Transfusion
Thoracotomy
Thoracentesis
-
8/8/2019 ED Nursing '10
53/75
-
8/8/2019 ED Nursing '10
54/75
NURSING CONSIDEARTIONS:
monitor VS, (q 15, first hour post thoracentesis and post CTT)
After CTT insertion, encourage cough and breathing exersises
Chest tubes should have continuous FLUCTUATIONS
if BUBBLING, air leak is suspected
if FLUCTUATION STOPS, mechanical blockage or lung has already
expanded
have an extra bottle with PNSS, clamps and sterile gauze at bedside
in case of dislodgment, cover the opening with sterile/petroleum gauze to
prevent rapid lung collapse
Assist with proper positioning
Bed Rest
-
8/8/2019 ED Nursing '10
55/75
1. PENETRATING ABDOMINAL INJURY
2. BLUNT ABDOMINAL INJURY
-
8/8/2019 ED Nursing '10
56/75
-
8/8/2019 ED Nursing '10
57/75
temperature may be normal or
slightly elevated, hypotension,
tachycardia, tachypnea, paleand moist skin, fatigue,
headache, dizziness, syncope
It is the inadequacy or the
collapse of peripheral
circulation due to
volume and electrolyte
depletion
Move patient to a cool environment,
remove all clothing
Position the patient supine with the feet
slightly elevated
Monitor VS every 15 mins and cardiacrhythm
Educate to avoid immediate reexposure
to high temperatures
1. Hemoconcentration
2. hyponatremia or hypernatremia
3. ECG may show dysrhythmias
-
8/8/2019 ED Nursing '10
58/75
- It is a combination of hyperpyrexia
and neurologic symptoms. It caused
by a shutdown or failure of the heat-
regulating mechanisms of the body
CLINICAL MANIFESTATIONS:
bizarre behavior or irritability, progressing to confusion,
delirium and coma
40.6 degrees Celcius, hypotension, tachycardia, tachypnea
skin may appear flushed and hot; 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 imperative to reduce
patients temperature
-
8/8/2019 ED Nursing '10
59/75
-
8/8/2019 ED Nursing '10
60/75
3 compensatory mechanisms:
a. shivering produces heat thru muscular activity
b. peripheral vasoconstriction to decrease heat loss
c. 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., because the heart is
near fibrillation threshold
-It is a condition where the core
temp. is less than 35 degrees
Celcius as a result in the exposure
to cold.
-
8/8/2019 ED Nursing '10
61/75
slow, spontaneous respirations
heart sounds may not be audible even if its beating
BP is extremely difficult to hear
fixed dilated pupils, no pulse, no BP; initiate CPR
drowsiness progressing to coma
shivering is suppressed on temp. below 32.3 degrees
ataxia
cold diuresis
fruity or acetone odor of breath
GOAL of MANAGEMENT: Rewarm without precipitatingcardiac dysrhythmias.
CLINICAL MANIFESTIONS:
-
8/8/2019 ED Nursing '10
62/75
Passive External Rewarming (temp above 28 degrees)-Remove all wet clothing, and replace with warm clothing
- Provide insulation by wrapping the patient in several blankets
- Provide warm fluids
Disadvantage: slow process
Active External Rewarming (temp above 28 degrees)
-Provide external heat for patient- warm hot water bottles to the armpits, neck,
or groin
- Warm water immersionDisadvantages
1. causes peripheral vasodilation, returning cool blood to the core, causing an
initial lowering of the core temp.
2. Acidosis due to washing out of lactic acid from the peripheral tissue
-
8/8/2019 ED Nursing '10
63/75
-
8/8/2019 ED Nursing '10
64/75
Immediate CPR
Endotracheal intubation with PEEP
VS, check degree of hypothermia
Rewarming procedures
Intravascular volume expansion and inotropic agents
ECG
Indwelling catheterization
NGT insertion
-
8/8/2019 ED Nursing '10
65/75
ABC
Identify the poison
Obtain blood and urine tests;
gastric contents may be sentto laboratory
Monitor neurologic status
Monitor fluid and electrolytes
Initiate large-bore IV
access, monitor shock
Prevent aspiration of
gastric contents bypositioning head on side
, Maintain
seizures precaution
-
8/8/2019 ED Nursing '10
66/75
MINIMIZING ABSORPTION
Administration of activated charcoal with a
cathartic to hasten secretion.
Induction of emesis with syrup of ipecac; done
only in patients with good gag reflex and is
conscious.
Gastric lavage for the obtunded patient. Save
gastric aspirate for toxicology screen.
-
8/8/2019 ED Nursing '10
67/75
Procedure to enhance the removal of ingested
substance if the patient is deteriorating.
toenhance renal clearance.
2. Hemoperfusion (process of passing blood throughan extracorporeal circuit and a cartridge containing
an adsorbent, such as charcoal, after which thedetoxified blood is returned to the patient)
to purify and accelerate the
elimination of circulating toxins.
antidote is a chemical or
physiologic antagonist that will neutralize the poison
-
8/8/2019 ED Nursing '10
68/75
-
8/8/2019 ED Nursing '10
69/75
Th i j t d i
-
8/8/2019 ED Nursing '10
70/75
-These are injected poisons
from insects which produces
either local or systemic
reactions.
Apply ice packs to site to relieve
pain.
Elevate extremities with large
edematous local reaction.
Administer anti histamine for local
reaction.
Clean wounds thoroughly withsoap and water or antiseptic solution.
remove stinger with one quick
scrape of fingernail.
-
8/8/2019 ED Nursing '10
71/75
-
8/8/2019 ED Nursing '10
72/75
Shakes, seizures, and hallucinations.
History of drinking episodes.
N/V, malaise, weakness, anxiety.
Autonomic hyper reactivity
(tachycardia, diaphoresis, increase
temperature, dilated but reactive pupils).
COMMON BEHAVIORAL
PROBLEMS:5 Ds
-
8/8/2019 ED Nursing '10
73/75
-ALLUCINATIONS (VISUAL AND TACTILE)
-NCREASED VITAL SUGNS
-REMORS
-WEATING AND SIEZURE
-ENIAL
-ATIONALIZATION
-SOLATION
-ROJECTION
-
8/8/2019 ED Nursing '10
74/75
DRUG OF CHOICE:for aversion therapy of an alcoholic:
-OUTH WASH
-VER THE COUNTER COLD REMIDIES
-OOD SAUCES MADE UP OF WINE
-RUIT FLAVORED EXTRACTS
-FTERSHAVE LOTIONS
-INEGAR
-KIN PRODUCTS
-
8/8/2019 ED Nursing '10
75/75