Emergency and Disaster Nursing Rod

8/20/2019 Emergency and Disaster Nursing Rod

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EMERGENCY AND DISASTER NURSING

TERMS USE:

Trauma - Intentional or unintentional

wounds/injuries on the human body from

particular mechanical mechanism that exceeds

the body’s ability to protect itself from injury

Emergency Management - traditionally

refers to care given to patients with urgent and

critical needs.

Triage - process of assessing patients to

determine management priorities.

First Aid - an immediate or emergency

treatment given to a person who has been

injured before complete medical and surgical

treatment can be secured.

BLS - level of medical care which is used for

patient with illness or injury until full medical

care can be given.

ACLS ADANCE CARDIAC LIFE SU!!"RT-

Set of clinical interventions for the urgent

treatment of cardiac arrest and often life

threatening medical emergencies as well as

the knowledge and skills to deploy those

interventions.

De#$ri%%ati&n - estoration of normal rhythm

to the heart in ventricular or atrial !brillation

Disaster - "ny catastrophic situation in which

the normal patterns of life #or ecosystems$

have been disrupted and extraordinary%

emergency interventions are re&uired to save

and preserve human lives and/or the

environment.

Mass Casua%ty Incident - situation in whichthe number of casualties exceeds the number

of resources.

!&st Traumatic Stress Syndr&me -

characteristic of symptoms after a

psychologically stressful event was out of

range of an normal human experience.

EMERGENCY ' I( IS )*"(+,+ (*+ "(I+(

(*+ 0"1I23 4SI5+S I( ( 6+.

EMERGENCY NURSING - It is the nursing care

given to patients with urgent and critical needs

EMERGENCY NURSE - has a speciali7ed

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

pressured care environment

DISASTER NURSING - a branch of

emergency nursing% it refers to nurs

given to patients who are victims of

whether it is manmade or natural p

INCIDENT C"MMAND SYSTEM - I

management tool for organi7ing per

facilities% e&uipment% and communic

any emergency situation.INCIDENT C"MMANDER - (he hea

incident command system

*e must be continuously info

the activities and informed ab

deviation from the establishe

SC"!E AND !RACTICE "F EMERGNURSING

(he emergency nurse has ha

speciali7ed education% trainin

experience.

(he emergency nurse establi

priorities% monitors and contin

assesses acutely ill and injure

supports and attends to famil

supervises allied health perso

teaches patients and families


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time-limited% high-pressured care

environment.

ursing interventions are accomplished

interdependently% in consultation with or

under the direction of a licensed

physician.

"ppropriate nursing and medical

interventions are anticipated based on

assessment data.

(he emergency health care sta8

members work as a team in performing

the highly technical% hands-on skills

re&uired to care for patients in an

emergency situation.

atients in the +5 have a wide variety of

actual or potential problems% and their

condition may change constantly.

"lthough a patient may have several

diagnosis at a given time% the focus is on

the most life-threatening ones

ISSUES IN EMERGENCY NURSING CARE

+mergency nursing is demanding

because of the diversity of conditions

and situations which are uni&ue in the

+.

Issues include legal issues% occupational

health and safety risks for +5 sta8% and

the challenge of providing holistic care in

the context of a fast-paced% technology-

driven environment in which serious

illness and death are confronted on a

daily basis.

(he emergency nurse must expand his

or her knowledge base to encompass

recogni7ing and treating patients and

anticipate nursing care in the event of a

mass casualty incident.

2egal Issues Includes9

"ctual 4onsent

Implied 4onsent

arental 4onsent

'G&&d Samaritan La()

:ives legal protection to the

rescuer who act in good faith and

are not guilty of gross negligence

or willful misconduct.

F&cus &* Emergency Care

!reser+e &r !r&%&ng Li*e

A%%e+iate Su,ering

D& N& Furt-er .arm

Rest&re t& "/tima% Functi&n

G&%den Ru%es &* Emergency C

D&0s

- btain 4onsent

- (hink of the )orst

-

espect ,ictim’s 1oderivacy

D&n0ts

- let the patient see his o

- 1ake any unrealistic p

Guide%ines in Gi+ing Emergency

A 1 "sk for help

I 1 Intervene

D 1 5o no 0urther *arm

Stages &* Crisis


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>. Anger

way of handling anxiety and fear

allow the anger to be ventilated

?. Grie*

help family members work through their

grief

letting them know that it is normal and

acceptable

C&re C&m/etencies in Emergency Nursing

"ssessment

riority Setting/4ritical (hinking Skills

@nowledge of +mergency 4are

(echnical Skills

4ommunication

"ssess and Intervene

C-ec3 *&r ABCs &* %i*e

" ' Air(ay

6 ' Breat-ing 4 - Circu%ati&n

Team Mem$ers

Rescuer

Emergency Medica% Tec-nician

!aramedics

Emergency Medicine !-ysicians

Incident C&mmander

Su//&rt Sta,

In/atient Unit Sta,

Emergency Acti&n !rinci/%e

I4 Sur+ey t-e Scene

Is the Scene SafeA

)hat *appenedA

"re there any bystanders who can helpA

identify as a trained !rst aiderB

II4 D& a !rimary Sur+ey - organi7ation of

approach so that immediate threats to life are

rapidly identi!ed and e8ectively manage.

!rimary Sur+eyA 5 Air(ay6Cer+ica% S/ine

- +stablish atent "irway- 1aintain "lignment- :4S C D E repare Intubation

B 1 Breat-ing- "ssess 6reath Sounds- bserve for 4hest )all (rauma- repare for chest decompression

C 1 Circu%ati&n

- 1onitor ,S- 1aintain ,ascular "ccess- 5irect ressure

Estimated B%&&d !ressure

SITE SB!

Radia% 7 89

Fem&ra% 7 9

Car&tid 7 ;9

C&ntr&% &* .em&rr-age

D 1 Disa$i%ity

- +valuate 24

- e-evaluate clients 24

- Fse ",F mnemonics

E 1 E2/&sure

- emove clothing

- 1aintain rivacy

- revent *ypothermia

III4 Acti+ate Medica% Assistance

Information to be elayed9


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• )hat *appenedA

• umber of ersons Injured

• +xtent of Injury and 0irst "id given

• (elephone number from where you’re

calling

I4 D& Sec&ndary Sur+ey

Inter+ie( t-e !atient

S ' Symptoms

" ' "llergies

1 ' 1edication

' revious/resent Illness

2 ' 2ast 1eal (aken

+ ' +vents rior to "ccident

C-ec3 ita% Signs

4 Triage

comes from the 0rench word ” trier ” %

meaning to sort process of assessing patients to

determine management priorities Categ&ries:

:


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FIRST AIDR&%e &* First Aid

6ridge the :ap 6etween the ,ictim and

the hysician Immediately start giving interventions

in pre-hospital setting

a%ue &* First Aid Training Self-help *ealth for thers

reparation for 5isaster

Safety "wareness

BASIC LIFE SU!!"RT 5 an emergency

procedure that consists of recogni7ing

respiratory or cardiac arrest or both the proper

application of 4 to maintain life until a victim

recovers or advance life support is available.

Arti#cia% Res/irati&n

a way of breathing air to person’s lungs

when breathing ceased or stopped

function.

Res/irat&ry Arrest

a condition when the respiration or

breathing pattern of an individual stops

to function% while the pulse and

circulation may continue.

Causes: 4hoking% +lectrocution% strangulation%

drowning and su8ocation.

)"3S ( ,+(I2"(+ (*+ 2F:S

. 1F(*-(-S+ and 1F(* E if the pt.

is an infant

?. 1F(*-(-S(1" E used if the pt. has

a stomaH a permanent opening that

connects the trachea directly to the front

of the neck.

0or escue 6reathing "lone9

ate is


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okAL thenshakethevictim

ositioning

laced Supine on a !rm and Matsurface

pen the"irway

• 4heck for foreign bodies then

remove using !nger sweep• *ead-tilt-chin-lift maneuver

• Naw-thrust 1aneuver

"ssess for6reathing

• 6ring cheek over the mouth and

nose of the casualty

• 2ook for chest movement

• 2isten for breath sounds

• 0eel for breathing on your

cheek (he 4asualty is ( 6reathing9

:o for*elp

if someone responds to your

shout for help send that personto phone for ambulance

if you’re on your own% leave thecasualty and make the phonecall for yourself

O never leave if the patient hascollapsed as a result of trauma ordrowning or if the casualty is a child

:iveescue6reaths

G rescue breaths = rescuebreaths

lacemouth overthe noseand mouthof theinfant

pinchnose andventilatevia mouth

look forchest

seal lipsaround themouth andblowsteadily for


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when the !rst aider is too exhausted to

continue when another !rst aider takes over

when +1S arrives and takes over

-en t& ST"! C!R:

S ' S("+FS 6+"(* +S(+5

( ' (F+5 ,+ (*+ 1+5I4"2 S+,I4+S

' +"( IS +P*"FS(+5 ( 4(IF+

' *3SI4I" "SSF1+S +SSI6I2I(3

C"M!LICATI"NS "F C!R:

I6 0"4(F+

S(+F1 0"4(F+

2"4+"(I 0 (*+ 2I,+ S2++

+F1(*"P% *+1(*"P

C.AIN "F SURIAL EARLY ACCESS ' early recognition of

cardiac arrest% prompt activation ofemergency services

EARLY BLS ' prevent brain damage% buytime for the arrival of de!brillator

EARLY DEFIBRILLATI"N - Q-


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4*+S( (*FS(9 used only in patients inadvanced stages of pregnancy or in markedlyobese clients

a. 4onscious atient standing or sitting• Stand behind the client with arms under

patient’s axilla to encircle patient’s chest• lace thumb side of !st on the 1I552+

of S(+F1% grasp with the other hand

and perform 6"4@)"5 thrust untilforeign body is expelled.

MEASURES T" ESTABLIS. AIRAY ". .EAD5TILT5C.IN5LIFT MANEUER6. A5T.RUST MANEUER4. "R"!A.RYNGEAL AIRAY

5. END"TRAC.EAL INTUBATI"NIndications9

(o establish an airway for patients

cannot be ade&uately ventilated with anoropharyngeal airway

(o bypass upper airway obstruction

(o permit connection to ambubag or

mechanical ventilator (o prevent aspiration

(o facilitate removal of tracheobronchial

secretions

E4 CRIC"T.YR"ID"T"MY • a puncture or incision of the cricothyroid

membrane to establish an emergencyairway in certain emergency situations

where endotracheal intubation ortracheostomy is not possible.

• indicated to pts. with trauma to headand neck% and in allergic reactioncausing laryngeal edema

• use of gauge . C"NCUSSI"N ' temporary loss of

consciousness that results in transientinterruption if the brain’s normalfunctioning

?. C"NTUSSSI"N ' bruising of the braintissue

G. INTRACRANIAL .EM"RR.AGE 'signi!cant bleeding into a space orpotential space between the skull andthe brain

a. Epidural hematoma the most serious type

hematomaH forms rapid

results from arterial ble

forms between the dur

skull from a tear int thearea

b. Subdural hematoma forms slowly and resul

venous bleed a surgical emergency

c. Intracerebral hemorrhage bleeding directly into t

matter

ALERT: Assume cer+ica% s/ine *rany /atient (it- a signi#cant -eunti% /r&+en &t-er(ise4

!RIMARY ASSESSMENT: Assess *

S+45"3 "SS+SS1+(9 4hange in 24 ' most sensit

indicator in the pt’s condition 4FS*I:’S (I"5 # bradypne

bradycardia% widened pulse pindicating increased intracranpressure

une&ual or unresponsive pup

impaired vision 6attle’s sign ' bluish discolor

mastoid% indicating a possibleS@F22 0"4(F+

hinorrhea or otorrhea ' indi

4S0 leak


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eriorbital +cchymosis ' indicates

anterior basilar fracture

ALERT: I* $asi%ar s3u%% *racture &r se+eremid*ace *ractures are sus/ected< anas&gastric tu$e>NGT@ is C"NTRAINDICATED

MANAGEMENT:

pen airway by Naw-(hrust 1anuever%suction orally if needed

"dminister high Mow oxygen9 most

common death is 4++6"2 "PI" In general% hyperventilate the patient to

=-=G bpm% causing cerebralvasoconstriction and minimi7ing cerebraledema

"pply a bulky% loose dressingH don’t

apply pressure I, line of SS or lain 2

prepare to manage sei7ures

maintain normothermia

1edications9

a. 5ia7epamb. Steroidsc. 1annitol

repare of immediate surgery if pt.

shows evidence of neurologicdeterioration

B4 SULL FRACTURES• SI12+ ' closed• 41F5 ' open• 2I+" 0x ' common hairline break% w/o

displacement of structure

• 411IF(+5 0x ' splinters or crushesthe bone in several fragments

• 5++SS+5 0x ' pushes the bonetoward the brain

• 4"I"2 ,"F2( 0x ' top of the head• 6"SI2" 0x ' base of the skull and

frontal sinusesALERT:

• 5amage to the brain is the !rst concern%it is considered a neurosurgical condition

• In children% skull’s thinness andelasticity allows a depression w/o abreak in the bone

CAUSES: Traumatic $%&(s t& t-e -ead< A<se+ere $eatings

• S/Sx9 scalp wounds% agitation andirritability% loss of consciousness% laboredbreathing% abnormal deep tendonreMexes% altered pupillary and moorresponse

IF CONSCIOUS: complains of persistent

locali7ed headacheIF JAE! "ONE F#A$EN%S: may cause

cerebralbleeding*"2 SI: ' blood-tinged spot surrounded

by lighterringIF S&'ENOI!A( F) 9 damages the optic nerve

and maycause 62I5+SSIF %E$&O#A( F) 9 may cause unilateral

deafness orfacial paralysis

TREATMENT:F&r LINEAR FRACTURES:

supporative #mild analgesics cleaning and debridement of

If conscious9 observed for ? h

admit for evaluation if ,S stable% may go home w

instruction sheet

F&r AULT and BASILAR FRACTU 4raniotomy to remove frage

anti-biotics

5examethasone

smotic 5iuretics #1"I(

increased I4 is presentNURSING C"NSIDERATI"NS:

maintain patent airwayH nasa

contraindicated to basilar fx support with = administrati

suction pt. through mouth no

4S0 leak is present *I*+" ' wipe it% don’t

blow itB (*+" ' cover it lightly w

gau7e% don’t pack itB osition head on side

1aintain a supine position w

elevated to > degrees don’t give narcotics or sedat

assist in surgery% maintaining

techni&ue

C4 CERICAL S!INE INURIES!RIMARY ASSESSMENT:

• immediate immobili7ation of


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• " 6 4 # Intercoastal paralysis w/diapragmatic breathing$

SUBSEUENT ASSESSMENT:• *ypotension% bradycardia% hypothermia

- suggests SI"2 S*4@ • (otal sensory loss and motor paralysis

below the level of injury

MANAGEMENT: asotracheal intubation initaite I, access% monitor blood gas

indwelling urinary catheteri7ation

prepare to manage sei7ures

1eds9 *igh dose steroids and dia7epam

D4 MAILL"FACIAL TRAUMA!RIMARY ASSESSMENT:

• Immobili7ation of spine whileperforming assessment

• "64 ' #tongue swelling% bleeding%broken or missed teeth$

SUBSEUENT ASSESSMENT:• aralysis if the upward ga7e ' indicativeof I0+I 6I( 0P

• 4repitus on nose ' indicates nasalfracture

• 0lattening of the cheek and loss ofsensation below the orbit ' indicates3:1" #cheekbone$ 0P

• 1alocclussion of teeth% trismus 'indicative of 1"PI22" 0P

!RIMARY INTERENTI"NS: Insertion of oral airway or intubation

asopharyngeal airway should only be

used if no evidence of nasal fracture or

rhinorrhea

"pply bulky% loose dressingH apply ice to

areas of swelling

INURIES T" S"FT TISSUES< B"NES AND "INTSA4 S"FT TISSUE INURIES


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Skin (raction ' force applied to the skin

using foam rubber% tapes Skeletal (raction ' force applied to the

bony skeleton directly% using wires% pins%tongs placed in the bone

I0 ' operative intervention to achieve

reduction% alignment and stabili7ation +ndoprosthetic eplacement '

implantation of metal deviceNURSING C"NSIDERATI"NS:

+levate to prevent or limit swelling "pply ice packs or cold compressH not

place directly in skin Splint and maintain in good alignment%

immobili7e the joint above and belowthe fracture

:ive pain medications as ordered

"ssist in castingH use the palm of your

hands in holding a wet cast "void resting cast on hard surfaces or

sharp edges

5o neurovascular checks hourly for the!rst =? hours

"ssess for 41"(1+( S351+ '

check for T ’s If 4ompartment syndrome is suspected%

do not elevate limb above the level ofthe cast

otify the physician

6ivalve the cast

=. ("F1"(I4 NI( 5IS24"(I - occurswhen the surfaces of the bones forming the

joint no longer in anatomic position

"2+(9 this is a medical emergency because of associated disruption of surrounding blood andnerve supplies O Subluxation ' partial disruption of thearticulating surfacesC%inica% Mani*estati&ns:

• ain and deformity• 2oss of normal movement

• P-ray con!rmation of dislocation w/oassoc. fracture

1anagement9 Immobili7e part% Securereduction of dislocations manually #usuallypreferred under anesthesia$ursing 4onsiderations9

"ssess neurovascular status before and

after reduction of dislocation "dminister pain medications #S"I5s$

+nsure proper use of immobili7ation

device #elastic bandage% splints$

>. S"I ' an injury to the ligamentousstructure surrounding a jointH usually caused bya wrench or twist resulting in a decrease jointstability

4linical 1anifestations9• apid swelling due to extravasation of

blood w/n tissues• ain on passive movement of joint• discoloration% and limited use or

movement

?. S("I ' a microscopic tearing of the musclecause by excessive force% stretching% oroveruse

4linical 1anifestations9• ain with isometric contracti• Swelling and tenderness• *emorrhage in muscle

MANAGEMENT "F S!RAINS AND

C1+SSI #+lastic 6andage$R+S(I4+ #for the !rst =? hrsH < hr on% = hduring waking hours$

M+5I4"(IS # S"I5s$E2+,"(I

SF( #Fse of crutches% splints$

NURSING C"NSIDERATI"NS: "pply ice compress for the !

to produce vasoconstriction% dedema% and reduce discomfo

"pply warm compress after =

promote circulation and absoto > minutes at a time$

+ducate to rest injured part f

to allow healing +ducate to resume activities

and to warm up


12/21

S."C AND INTERNAL INURIESA4 S."C - Inade&uate tissue perfusion% resulting in

failure of one or more of the 89a. pump failure of the heartb. 6lood volumec. arterial resistance levelsd. capacity of venous beds

- Can $e c%assi#ed as:". .Y!""LEMIC 5 occurs when

signi!cant amount of Muid is lost in theintravascular space #+x. *emorrhage%burns% Muid shifts$

6. CARDI"GENIC 1 occurs when the heartfails as a pump. rimary causes includes1I% dysrhythmiasH Secondary causesincludes mechanical restriction ofcardiac function or venous obstructionlike in 4ardiac (amponade% tension

pneumothrorax% ,44. SE!TIC S."C 1 from bacteria and

their products circulating in the blood

!RIMARY INTERENTI"NS: "ssess for "64

esuscitate as necessary

"dminister = to augment =-carrying

capacity of arterial blood Start cardiac monitoring

4ontrol hemorrhage

SUBSEUENT ASSESSMENT:

o "ssess 24% decreasing 24 indicatesprogression of shock

o 1onitor arterial blood pressure#narrowing pulse pressure% fall in systolicpressure$

o "ssess pulse &uality and rate change#tachycardia% weak and thready$

o "ssess urinary output #=Gml/hr may

indicate shock$o "ssess capillary perfusiono "ssess for metabolic acidosis due to

anaerobic metabolism of cellso "ssess for excessive thirst%

hyperthermia on septic shockMANAGEMENT: "dminister = via +( or nonrebreather

face mask #if intubated% may behyperventilated to control acidosis$

0luid resuscitation #= large-bore I, lines%

inger’s 2actate% 6($ Insertion of an indwelling catheter

1aintain patient in a supine position

with legs elevated 4ontinue to monitor ,S% +4:% 4,% "6:%

F% *4(% *gb%and electrolytesH referchanges on the following

1aintain normothermia #high fever will

increase the cellular metabolism e8ectsof shock

1edications9 Inotropics% ,asopressor%

and "nti-biotics

ELECTR"CARDI"GRAM- It is a useful tool in the diagnosis of

those conditions that may cause

abberations in the electrical activity

)",+ I(++("(IS9 )",+ 9 "trial 5epolari7ationH !deMectionU )",+9 !rst negative deMection )",+9 !rst positive deMectionS )",+9 negative deMection% afteUS 412+P9 ,entricular 5epo

( )",+9 ,entricular epolari7atio

Nursing Res/&nsi$i%ities duri 4heck order for +4:% in cases

prepare the machine at the b+

rovide rivacy

Instruct patient to lie still and

movement emove metal objects on the

#jewelries$ lace 4hest leads as labeled

2ead 9 :reen% 2eft 0ooteutrali7er9 6lack% ight foot

,9 :reen% midway betand ,?

,?9 6rown% Gth I4S% 2eft

,G9 6lack% G

th

I4S% 2""2


13/21

,T9 ,iolet% Gth I4S% 21"2

B4 BLUNT C.EST INURIES- It is a trauma in the chest without an

open wound- usually cause by ,"% blast injuriesSIGNS6SYM!T"MS:RIB FRACTURES: tenderness% slight

edema% pain that worsens with deepbreathing and movement% shallow andsplinted respirationsSTERNAL FRACTURES: persistent chestpain1F2(I2+ I6 0"4(F+S9

- 02"I2 4*+S( #loss of chest wallintegrity$

- decreased lung inMation%paradoxical chest movements

- extreme pain- rapid and shallow respirations- hypotension% cyanosis- respiratory acidosis

C"M!LICATI"NS:?4 TENSI"N !NEUM"T."RA• a condition in which air enters the chest

but can’t be ejected during exhalation

• (here is lung collapse and mediastinal

shiftS/Sx9 tracheal deviation% cyanosis andsevere dyspnea% absent breath sound onthe a8ected side% agitation% N,5=4 .EM"T."RA • collection of blood in the pleural cavity%

usually results from ribs% lacerating lungtisssue or an intercoastal artery

• It is the most common cause of shock

following chest trauma=. LACERATI"N &r RU!TURE &* A"RTA • immediately fatal

H4 DIA!.RAGMATIC RU!TURE• causes severe respi. 5istressH if

untreated abdominal viscera mayherniate% compromising both circulation

and vital capacity of lungs4 CARDIAC TAM!"NADE

• rapid unchecked rise in intrapericardia

pressure that impairs diastolic !lling ofthe heart

• results from blood or Muid accumulation

in the pericardial sac

ASSESSMENT AND DIAGN"SIS:• ercussion9

- *emothorax9 5ullness- (ension nuemothorax9 tymphany

• "uscultation9

- (ension nemothorax9 1I is deviated- 4ardiac tamponade9 muVed hearttones• P-ray• (horacentesis ' yeilds blood and

serosanguinous Muid• +4:• etrograde aortography ' reveals aortic

laceration• +chocardiography• 4omputed (omography

TREATMENT:Simple ib 0ractures

mild analgesics% bed rest% ap

incentive spirometry

deep breathing% coughing an

Severe ib 0ractures intercoastal nerve blocks

position for semi-fowlers% ad

*emothorax 4hest tube insertion at G th-Tt

anterior to 1"2 administer I, fuids% =% 6loo

(ransfusion (horacotomy

(horacentesis

TREATMENT: (ension neumothorax insertion of spinal%


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if 02F4(F"(I S(S% mechanical

blockage or lung has already expanded have an extra bottle with SS% clamps

and sterile gau7e at bedside in case of dislodgment% cover the

opening with sterile/petroleum gau7e toprevent rapid lung collapse

"ssist with proper positioning

6ed est

C4 ABD"MINAL INURIES


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peritoneal dialysis% cool Muid bladderirrigation

5iscontinue active cooling when the

temp. reaches >W degrees 4elcius xygenate the pt. via +( or

nonrebreather mask 1onitor ,S% +4:% and neurologic status

Start I, infusion using inger’s 2actate

"nti-pyretics are not useful Indwelling catheteri7ation

)0 hypokalemia% metabolic acidosis%

sei7ures

H4 .Y!"T.ERMIA- It is a condition where the core temp. is

less than >G degrees 4elcius as a resultin the exposure to cold.

- > compensatory mechanisms9a. shivering ' produces heat thrumuscular activityb. peripheral vasoconstriction ' todecrease heat lossc. raising basal metabolic rate

NURSING ALERT:• +lderly are greater risk for hypothermia

due to altered compensatorymechanisms

• +xtreme caution should be used inmoving or transporting hypothermic pts.%because the heart is near !brillationthreshold

CLINICAL MANIFESTI"NS:• slow% spontaneous respirations

• heart sounds may not be audible even if its beating

• 6 is extremely diXcult to hear• !xed dilated pupils% no pulse% no 6H

initiate 4• drowsiness progressing to coma• shivering is suppressed on temp. below

>=.> degrees

• ataxia• cold diuresis• fruity or acetone odor of breathG"AL &* MANAGEMENT: Re(arm(it-&ut /reci/itating cardiacdysr-yt-mias4

MANAGEMENT: assive +xternal ewarming #temp

above =D degrees$- emove all wet clothing% and replace

with warm clothing- rovide insulation by wrapping the

patient in several blankets- rovide warm Muids

5isadvantage9 slow process "ctive +xternal ewarming #temp above

=D degrees$- rovide external heat for patient- warm

hot water bottles to the armpits% neck% orgroin

- )arm water immersion- 5isadvantages9


16/21

+ndotracheal intubation with ++

,S% check degree of hypothermia

ewarming procedures

Intravascular volume expansion and

inotropic agents +4:

Indwelling catheteri7ation

:( insertion

T"IC"L"GIC EMERGENCIES"SS+SS1+(9

• "64• Identify the poison• btain blood and urine testsH gastric

contents may be sent to laboratory• 1onitor neurologic status• 1onitor Muid and electrolytes

:++"2 I(+,+(IS9• Initiate large-bore I, access% monitor

shock• revent aspiration of gastric contents by

positioning head on side• 1aintain sei7ures precaution

1II1II: "6S(I "dministration of activated charcoal

with a cathartic to hasten secretion. Induction of emesis with syrup of

ipecacH done only in patients with goodgag reMex and is conscious.

"dult dose is > ml by mouth followed

by = glasses of waterH edia dose is. *emodialysis ' to purify and accelerate

the elimination of circulating toxins.?. epeated dose of charcoal.G. roviding an antidote ' antidote is a

chemical or physiologic antagonist thatwill neutrali7e the poison.

GASTRIC LAAGE!UR!"SES:

. (o cleanse stomach before enprocedures.

?. (o remove li&uid or small parmaterial from the stomach4

NURSING C"NSIDERATI"NS Insertion of :( or :(. lace patient on left lateral p

head lower


17/21

- 4arbon monoxide exerts its toxic e8ectsby binding to circulating hemoglobin toreduce the oxygen carrying capacity ofthe blood.

- 4arbon monoxide and hemoglobin is= ' > times aXnity compared tooxygen and hemoglobin.

- 4reation of carboxyhemoglobin

resulting to tissue anoxia.CLINICAL MANIFESTATI"NS- espiratory depression% stridor.- 4onfusion progressing to coma.- *eadache% muscular weakness%

palpitation% and di77iness.- Skin is pink in color% cherry red% or

cyanotic.- "6:9 carboxyhemoglobin level is ' ?R severe carbonmonoxide poisoning.

MANAGEMENT: rovide


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sudden withdrawal from prolongedintake of alcohol.

• Symptoms begins as early as ? hours

after reduction of alcohol intake andpeaks at =? - ?D hours but may last upto = weeks.

ALC"."LISM 1 a c-r&nic disease &r

dis&rder c-aracteried $y e2cessi+ea%c&-&% inta3e and inter*erence in t-eindi+idua%s -ea%t-< inter/ers&na%rea%ti&ns-i/ and ec&n&mic *uncti&ning

- C&nsidered t& $e /resent (-ent-ere is 4? &r ?9 m% *&r e+ery ?999m% &* $%&&d

- At 4? 5 4J< t-ere is %&(c&&rdinati&n

- At 4J 5 4H< t-ere is ata2ia< trem&rs<irrita$i%ity< and stu/&r

At 4H and a$&+e< t-ere is

unc&nsci&usnessC"MM"N BE.AI"RAL !R"BLEMS: K D0s

D5enia%D5e/endencyD5emandingD5estructi+eD5&mineering

C"MM"N IT.DRAAL SIGNS ANDSYM!T"MS:

."22F4I"(IS #,ISF"2 "5 ("4(I2+$I4+"S+5 ,I("2 Si:ST+1SS)+"(I: "5 SI+F+

C"MM"N DEFENSE MEC.ANISMS:

D+I"2R"(I"2I"(IIS2"(I!N+4(I!RI"RITY NURSING DIAGN"SIS:

5 I+00+4(I,+ I5I,I5F"2 4I:

DRUG "F C."ICE *&r a+ersi&n t-era/y &*an a%c&-&%ic:

5 DISULFIRAM >anta$use@Instruct patient to avoid% when taking5isul!ram9

MF(* )"S*",+ (*+ 4F(+ 425 +1I5I+SF5 S"F4+S 1"5+ F 0 )I+FFI( 02",+5 +P("4(SA0(+S*",+ 2(ISI+:"S@I 5F4(S

MANAGEMENT: rotect patient from injury% dia7epam or

phenytoin for sei7ure control asprescribed.

1onitor ,S every > minutes.

Fse a non-alcohol skin preparation%

draw blood for measurement of ethanolconcentration% toxicologic screen forother drug abuse.

1aintain electrolyte balance and

hydration. bserve for hypoglycemia.

"dminister thiamine followed

parenteral dextrose if liver glydepleted.

:ive orange juice% gatorade%

carbohydrates to stabili7e blo lace patient in a private roo

close observation.

BE.AI"RAL EMERGENCIES - It iserious disturbances of behavior% a8

thought that makes the patient una

with his life situation and interperso

relationship

?4 I"LENT !ATIENTS- Is usually episodic and is a m

expressing feelings of anger%

hopelessness about a situatioManage t-r&ug-: a. +stablish control% keeping the do

and be in clear veiw of sta8

b. "sk if he has a weapon% avoid touagitated pt.c. "dopt a calm% nonconfrontationald. rovide emotional supportH 4ISIS

I(+,+(I

J4 SUICIDE- Fltimate form of self-destruct

helpL- 1ajor Interventions9 +,+(

2IS(+

RIS FACT"RS


19/21


20/21

K4 Sie: Ru%e &* nine

"ssessment 4hildY >yearsold

"dult

*ead andneck


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if no water is readily available%

remove clothing immediately asclothing soaked with hot li&uidretains heat

F%ame Smother the Mames with a coat or

blanket% get the victim on the Mooror ground #stop% drop% and oll$

revent victim from running If water is available% immediately

cool the burn area with water If water is not available% remove

clothingH avoid pulling clothingacross the burnt face

4over the burn area with a loose%

clean% dry cloth to preventcontamination

5o not break blisters or apply

lotions% ointments% creams orpowder

Air(ay if face or front of the trunk is

burnt% there could be burns to theairway

there is a risk of swelling or air

passage% leading to diXculty inbreathing

Sm&3e in-a%ati&n Frgent treatment is re&uired with

care of the airway% breathing andcirculation

)hen = in the air is used up by

!re% or replaced by other gases%the oxygen level in the air will bedangerously low

Spasm in the air passages as a

result of irritation by smoke orgases

Severe burns to the air passages

causing swelling and obstruction ,ictim will show signs and

symptoms of lack of =. *e mayalso be confused or unconscious

E%ectrica% check for K5angerL

turn of the electricity supply if

possible avoid any direct contact with the

skin of the victim or any

conducting material tovictim until he is discon

once the area is safe% c

"64s if necessary% perform r

breathing or 4 C-emica%

0lood a8ected area wit

=-> min emove contaminated

If possible% identify the

for possible subse&uenneutrali7ation

"void contact with the

Sun$urn +xposure to ultraviolet

natural sunlight is the of sunburn

:eneral skin damage a

eventually skin cancer (he signs and symptom

sunburn are pain% rednfever

Emergency and Disaster Nursing Rod

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