emergency and critical care

Emergency and critical Emergency and critical care care

Review for Nursing BoardsReview for Nursing Boards

Basic life support (BLS)Basic life support (BLS) A means of providing oxygen to A means of providing oxygen to

the brain, heart and other the brain, heart and other organs until help arrivesorgans until help arrives

Also known as Also known as CARDIOPULMONARY CARDIOPULMONARY RESUSCITATIONRESUSCITATION

Basic life support (BLS)Basic life support (BLS) An adult is a person An adult is a person above age 8above age 8

A child is any person age A child is any person age 1 to 8 1 to 8 years oldyears old

An infant is anyone An infant is anyone under 1 yearunder 1 year

Basic life support (BLS)Basic life support (BLS) The BLS follows the A-B-C The BLS follows the A-B-C

principleprinciple

• A= airwayA= airway

• B= breathingB= breathing

• C= circulationC= circulation

Basic life support (BLS)Basic life support (BLS) Causes of cardiac arrestCauses of cardiac arrest

• Respiratory arrestRespiratory arrest• Direct injuryDirect injury• Drug overdoseDrug overdose• Cardiac arrhythmiasCardiac arrhythmias

Basic life Basic life supportsupport (BLS) (BLS)ADULTADULT

STEPS in CPR: First STEP!!!STEPS in CPR: First STEP!!!• ASSESSMENT: determine ASSESSMENT: determine

UnresponsivenessUnresponsiveness• Assess for 5-10 secondsAssess for 5-10 seconds• Shake the victim’s shoulder and ask: Shake the victim’s shoulder and ask:

“are you okay”“are you okay”


STEPS in CPR: Second StepSTEPS in CPR: Second Step• Survey the areaSurvey the area


STEPS in CPR: Third StepSTEPS in CPR: Third Step• Call for HELPCall for HELP• Activate emergency medical systemActivate emergency medical system

• Note: for child and infant this is done Note: for child and infant this is done LASTLAST


STEPS in CPR: Fourth stepSTEPS in CPR: Fourth step• Place Victim in Supine position on a Place Victim in Supine position on a

flat firm surfaceflat firm surface

• Log roll the patient when movingLog roll the patient when moving


STEPS in CPR: Fifth stepSTEPS in CPR: Fifth step•OPEN the airwayOPEN the airway

• Head tilt-Chin Lift methodHead tilt-Chin Lift method

• Jaw thrust maneuver if neck injury is Jaw thrust maneuver if neck injury is suspectedsuspected


STEPS in CPR: Sixth stepSTEPS in CPR: Sixth step•Assess BREATHINGAssess BREATHING

Place ear over the nose and mouthPlace ear over the nose and mouthLook for chest movementLook for chest movementPerform for 3-5 SECONDSPerform for 3-5 SECONDS


STEPS in CPR: Sixth stepSTEPS in CPR: Sixth step•Assess BREATHINGAssess BREATHING

If breathing: place on side if no If breathing: place on side if no neck injury; DO NOT move if with neck injury; DO NOT move if with neck injuryneck injury

If NOT BREATHING: deliver If NOT BREATHING: deliver INITIALLY 2 rescue breath via INITIALLY 2 rescue breath via mouth to mouthmouth to mouth

Then deliver 10-12 breaths/minuteThen deliver 10-12 breaths/minute


STEPS in CPR: Seventh stepSTEPS in CPR: Seventh step•Assess CIRCULATIONAssess CIRCULATION

Check for the carotid pulse on the Check for the carotid pulse on the side close to you for 5-10 SECONDSside close to you for 5-10 SECONDS

If with (+) pulse ; continue giving If with (+) pulse ; continue giving 10-12 breaths/minute10-12 breaths/minute



If If withOUTwithOUT pulse: START Chest pulse: START Chest CompressionCompression

Correct hand placement: LOWER HALF Correct hand placement: LOWER HALF of sternum one hand over the other of sternum one hand over the other with fingers interlacingwith fingers interlacing

Depress: Depress: 1 ½ to 2 INCHES1 ½ to 2 INCHES 80-100 compressions/min80-100 compressions/min



If If withOUTwithOUT pulse: START Chest pulse: START Chest CompressionCompression

ONE-rescuer: 30 chest: 2 breathsONE-rescuer: 30 chest: 2 breaths*before: 15:2*before: 15:2TWO-rescuer: 5 chest: 1 breathTWO-rescuer: 5 chest: 1 breath

DO FOUR cycles and re-assess for DO FOUR cycles and re-assess for pulsepulse

Basic life Basic life supportsupport (BLS) (BLS)CHILDCHILD

1-8 years old1-8 years old AIRWAY: assess unresponsiveness AIRWAY: assess unresponsiveness

and keep airway patent by HTCL or and keep airway patent by HTCL or JTJT

BREATHING: assess for airflow and BREATHING: assess for airflow and chest movementchest movement• If breathing: maintain patent airwayIf breathing: maintain patent airway• If NOT breathing : deliver 2 rescue If NOT breathing : deliver 2 rescue

breaths by mouth to mouthbreaths by mouth to mouth• DELIVER 20 breaths/minuteDELIVER 20 breaths/minute

Basic life Basic life supportsupport (BLS) (BLS)CHILDCHILD

1-8 years old1-8 years old CIRCULATION: assess the CIRCULATION: assess the carotid carotid

pulsepulse• If with pulse: continue to deliver If with pulse: continue to deliver 15-20 15-20

breaths/minutebreaths/minute• If WITHOUT pulse: start chest If WITHOUT pulse: start chest

compressioncompression• Correct hand placement: Correct hand placement: lower half of lower half of

sternum using heel of ONE HANDsternum using heel of ONE HAND• DELIVER: DELIVER: 1 to 1 ½ inches1 to 1 ½ inches 80-80- 100 chest compressions/min100 chest compressions/min 5:1 (do 20 cycles 5:1 (do 20 cycles EMS) EMS)

Basic life Basic life supportsupport (BLS) (BLS)INFANTINFANT

Less than 1Less than 1 Determine unresponsivenessDetermine unresponsiveness AIRWAY: Place head of infant in AIRWAY: Place head of infant in

NEUTRAL positionNEUTRAL position BREATHING: assess for rise-fall of BREATHING: assess for rise-fall of

chest and airflowchest and airflow• If breathing: maintain patent airwayIf breathing: maintain patent airway• If NOT breathing: initiate 2 rescue If NOT breathing: initiate 2 rescue

breathing via mouth to breathing via mouth to mouth and nosemouth and nose• DELIVER 20 breaths/min SLOWLY DELIVER 20 breaths/min SLOWLY

Basic life Basic life supportsupport (BLS) (BLS)INFANTINFANTLess than 1Less than 1

CIRCULATION: assess for pulse: CIRCULATION: assess for pulse: The The BRACHIAL pulse is utilized!!BRACHIAL pulse is utilized!!• If with pulse: continue to deliver 20 If with pulse: continue to deliver 20

breaths/minbreaths/min• If WITHOUT pulse, start chest If WITHOUT pulse, start chest

compressioncompression• Correct hand placement: just below the Correct hand placement: just below the

nipple line in the sternum using nipple line in the sternum using 2-3 2-3 fingers of one hand!!fingers of one hand!!

• DELIVER: ½ to 1 inch depthDELIVER: ½ to 1 inch depth 100 chest com/min100 chest com/min 5:1 ratio (do 20 cycles5:1 ratio (do 20 cycles EMS) EMS)

AIRWAY ObstructionAIRWAY Obstruction IncompleteIncomplete

• Crowing sound is heardCrowing sound is heard encourage to coughencourage to cough

CompleteComplete• Clutching of the neckClutching of the neck• Ask: “Are you choking?”Ask: “Are you choking?”• Perform Heimlich’sPerform Heimlich’s

AIRWAY ObstructionAIRWAY Obstruction CompleteComplete

• If patient becomes unconscious:If patient becomes unconscious: Place supine on flat surfacePlace supine on flat surface Perform tongue-jaw lift maneuver Perform tongue-jaw lift maneuver FINGERSWEEP to remove objectFINGERSWEEP to remove object Open airway and attempt ventilationOpen airway and attempt ventilation Perform Heimlich while supinePerform Heimlich while supine Reattempt ventilationReattempt ventilation SEQUENCE: TJLSEQUENCE: TJL finger-sweep finger-sweep rescue rescue

breathsbreaths Heimlich’s Heimlich’s TJL TJL

AIRWAY ObstructionAIRWAY Obstruction Pediatric considerations:Pediatric considerations: CHILD: NEVER DO Blind Finger CHILD: NEVER DO Blind Finger

sweepsweep

AIRWAY ObstructionAIRWAY Obstruction Pediatric considerations:Pediatric considerations: INFANT: never DO blind finger-INFANT: never DO blind finger-

sweepsweep Give five back blows in the Give five back blows in the

interscapular area and turn the interscapular area and turn the infant with head lower than infant with head lower than trunk then deliver chest thrust trunk then deliver chest thrust below the nipple linebelow the nipple line

AIRWAY ObstructionAIRWAY Obstruction Obstetric considerations:Obstetric considerations: Hand is placed over the middle Hand is placed over the middle

part of sternum: backward chest part of sternum: backward chest thrust thrust

If unconscious: place pillow If unconscious: place pillow below the RIGHT abdomen to below the RIGHT abdomen to displace uterusdisplace uterus

ShockShock An abnormal physiologic state An abnormal physiologic state

where an where an imbalance exists imbalance exists between the amount of between the amount of circulating blood volume and the circulating blood volume and the size of the vascular bedsize of the vascular bed. .

Pathophysiology of ShockPathophysiology of Shock

1. Cellular effects of shock1. Cellular effects of shock In the absence of oxygen, In the absence of oxygen, the cell the cell

will undergo Anaerobic metabolismwill undergo Anaerobic metabolism to to produce energy source and with it produce energy source and with it comes numerous by-products like comes numerous by-products like lactic acidlactic acid

The cell will swell due to the influx of The cell will swell due to the influx of Na and H20, mitochondria will be Na and H20, mitochondria will be damaged, lysosomal enzymes will be damaged, lysosomal enzymes will be liberated, and then cellular death liberated, and then cellular death ensues. ensues.

Pathophysiology of ShockPathophysiology of Shock

2. Organ System Responses2. Organ System Responses When the patient encounters When the patient encounters

precipitating causes of shock, precipitating causes of shock, the circulatory function the circulatory function diminishesdiminishes there is decreased there is decreased cardiac outputcardiac output Hypotension Hypotension and decreased tissue perfusion and decreased tissue perfusion will resultwill result

Shock StagesShock Stages

There are three stages of There are three stages of shockshock

Compensatory stageCompensatory stage Progressive stage Progressive stage Irreversible stage Irreversible stage

Shock StagesShock StagesTHE COMPENSATORY STAGE OF SHOCKTHE COMPENSATORY STAGE OF SHOCK In this stage, In this stage, the patient’s blood pressure is the patient’s blood pressure is

within normal limitswithin normal limits. . Patient’s blood is shunted from the kidney, Patient’s blood is shunted from the kidney,

skin and GIT to the vital organs- brain, liver skin and GIT to the vital organs- brain, liver and musclesand muscles

Manifestations of Manifestations of cold clammy skin, oliguria cold clammy skin, oliguria and hypoactive bowel sounds can be and hypoactive bowel sounds can be assessed.assessed.

Medical management includes IVF and Medical management includes IVF and medicationmedication

Nursing management includes monitoring of Nursing management includes monitoring of tissue perfusion & vital signs, reduction of tissue perfusion & vital signs, reduction of anxiety, administering IVF/ordered anxiety, administering IVF/ordered medications and promotion of safetymedications and promotion of safety

THE PROGRESSIVE STAGE OF SHOCKTHE PROGRESSIVE STAGE OF SHOCK In this stage, In this stage, the mechanisms that the mechanisms that

regulate blood pressure can no longer regulate blood pressure can no longer compensate and the mean arterial compensate and the mean arterial pressure falls.pressure falls.

The overworked heart becomes The overworked heart becomes dysfunctional. Heart rate becomes dysfunctional. Heart rate becomes very rapid (as high as 150 bpm)very rapid (as high as 150 bpm)

Blood flow to the brain becomes Blood flow to the brain becomes impaired, the mental status impaired, the mental status deteriorates due to decreased deteriorates due to decreased cerebral perfusion and hypoxia. cerebral perfusion and hypoxia.

Laboratory findings will reveal Laboratory findings will reveal increased BUN and Creatinine. increased BUN and Creatinine. Urinary output decreases to below 30 Urinary output decreases to below 30 mL/hour. mL/hour.

Shock StagesShock StagesTHE PROGRESSIVE STAGE OF SHOCKTHE PROGRESSIVE STAGE OF SHOCK Decreased blood flow to the liver Decreased blood flow to the liver

impairing the hepatic functions. Toxic impairing the hepatic functions. Toxic wastes are not metabolized wastes are not metabolized efficiently, resulting to accumulation efficiently, resulting to accumulation of ammonia, bilirubin and lactic acids. of ammonia, bilirubin and lactic acids.

The reduced blood flow to the GIT The reduced blood flow to the GIT causes stress ulcers and increased causes stress ulcers and increased risk for GI bleeding.risk for GI bleeding.

Hypotension, sluggish blood flow, Hypotension, sluggish blood flow, metabolic acidosis (due to metabolic acidosis (due to accumulation of lactic acid), and accumulation of lactic acid), and generalized hypoxemia can interfere generalized hypoxemia can interfere with normal blood function. with normal blood function.

Shock StagesShock StagesTHE IRREVERSIBLE STAGE OF SHOCKTHE IRREVERSIBLE STAGE OF SHOCK This stage represents the This stage represents the end point end point

where there is severe organ damage where there is severe organ damage that patients do not respond anymore that patients do not respond anymore to treatment. Survival is almost to treatment. Survival is almost impossible to maintain. impossible to maintain.

Despite treatment, the BP remains Despite treatment, the BP remains low, anaerobic metabolisms continues low, anaerobic metabolisms continues and multiple organ failure results.and multiple organ failure results.

Medical management is the use of life Medical management is the use of life supporting drugs like epinephrine supporting drugs like epinephrine and investigational medications. and investigational medications.

Assessment of ShockAssessment of ShockAssessment FindingsAssessment FindingsSkinSkin : Cool, pale, moist in hypovolemic and : Cool, pale, moist in hypovolemic and

cardiogenic shock cardiogenic shock: Warm, dry, pink in septic and neurogenic : Warm, dry, pink in septic and neurogenic shockshock

PulsePulse Tachycardia, due to increased sympathetic Tachycardia, due to increased sympathetic

stimulationstimulation Weak and threadyWeak and thready Blood pressureBlood pressure 1. Early stages: may be normal due to 1. Early stages: may be normal due to

compensatory mechanismscompensatory mechanisms 2. Later stages: systolic and diastolic blood 2. Later stages: systolic and diastolic blood

pressure drops.pressure drops.

Assessment of ShockAssessment of ShockAssessment FindingsAssessment FindingsRespirations: rapid and shallow, due to Respirations: rapid and shallow, due to

tissue anoxia and excessive amounts tissue anoxia and excessive amounts of CO (from metabolic Acidosis)of CO (from metabolic Acidosis)

Level of consciousness: restlessness Level of consciousness: restlessness and apprehension, progressing to and apprehension, progressing to comacoma

Urinary output: decreases due to Urinary output: decreases due to impaired renal perfusionimpaired renal perfusion

Temperature: decreases in severe Temperature: decreases in severe shock (except septic shock).shock (except septic shock).

Management of ShockManagement of Shock

Nursing InterventionsNursing Interventions Management in all types and Management in all types and

phases of shock includes the phases of shock includes the following:following:

Basic life supportBasic life support Fluid replacementFluid replacement Vasoactive medicationsVasoactive medications Nutritional supportNutritional support

Management of ShockManagement of ShockA. Maintain patent airway and adequate A. Maintain patent airway and adequate

ventilation.ventilation.B. Promote restoration of blood volume; B. Promote restoration of blood volume;

administer fluid and bloodreplacement as administer fluid and bloodreplacement as orderedordered

C. Administer drugs as ordered C. Administer drugs as ordered D. Minimize factors contributing to shock.D. Minimize factors contributing to shock.E. Maintain continuous assessment of the E. Maintain continuous assessment of the

client.client.F. Provide psychological support: reassure F. Provide psychological support: reassure

client to relieve apprehension, and keep client to relieve apprehension, and keep family advisedfamily advised

G. Provide Nutritional supportG. Provide Nutritional support

Hypovolemic ShockHypovolemic ShockThis is the This is the MOST common form of MOST common form of

shockshock characterized by a characterized by a decreased intravascular volumedecreased intravascular volume

Risk factors: external Fluid LossesRisk factors: external Fluid LossesTrauma, Surgery, Vomiting, Trauma, Surgery, Vomiting, Diarrhea, Diuresis, DIDiarrhea, Diuresis, DI

Risk factors: internal fluid shiftsRisk factors: internal fluid shiftsHemorrhage, Burns, Ascites, Hemorrhage, Burns, Ascites, Peritonitis, DehydrationPeritonitis, Dehydration

Hypovolemic ShockHypovolemic Shock

Decreased blood volumeDecreased blood volume decreased venous return to the decreased venous return to the heartheart decreased stroke decreased stroke volumevolume decreased cardiac decreased cardiac outputoutput decreased tissue decreased tissue perfusionperfusion

Assessment findings: cold Assessment findings: cold clammy skin, tachycardia, clammy skin, tachycardia, mental status changes, mental status changes, tachypneatachypnea

Hypovolemic ShockHypovolemic Shock MEDICAL MANAGEMENT: MEDICAL MANAGEMENT:

•The major medical goals are The major medical goals are to restore intravascular to restore intravascular volume, to redistribute the volume, to redistribute the fluid volume, and to correct fluid volume, and to correct the underlying cause of fluid the underlying cause of fluid loss promptlyloss promptly

Hypovolemic ShockHypovolemic Shock NURSNG MANAGEMENT: NURSNG MANAGEMENT:

• Primary prevention of shock is the most Primary prevention of shock is the most important intervention of the nurse.important intervention of the nurse.

• General nursing measures include- safe General nursing measures include- safe administration of the ordered fluids and administration of the ordered fluids and medications, documenting their medications, documenting their administration and effects. The nurse administration and effects. The nurse must monitor the patient for signs of must monitor the patient for signs of complications and response to complications and response to treatment. Oxygen is administered to treatment. Oxygen is administered to increase the amount of O2 carried by increase the amount of O2 carried by the available hemoglobin in the blood. the available hemoglobin in the blood.

Cardiogenic shockCardiogenic shockThis shock occurs when the heart’s This shock occurs when the heart’s

ability to contract and to pump ability to contract and to pump blood is impaired and the supply of blood is impaired and the supply of oxygen is inadequate for the heart oxygen is inadequate for the heart and tissuesand tissues

Risk factors: Coronary factor- Risk factors: Coronary factor- Myocardial infarctionMyocardial infarction

Risks factors: NON coronary:Risks factors: NON coronary:•CardiomyopathiesCardiomyopathies•Valvular damageValvular damage•Cardiac tamponadeCardiac tamponade•DysrhythmiasDysrhythmias

Cardiogenic shockCardiogenic shock Precipitating factorsPrecipitating factors will cause will cause

decreased cardiac contractilitydecreased cardiac contractility Decreased stroke volume and cardiac Decreased stroke volume and cardiac outputoutput leading to 3 things: leading to 3 things:

Damming up of blood in the Damming up of blood in the pulmonary vein will cause pulmonary vein will cause pulmonary congestionpulmonary congestion

Decreased blood pressure will Decreased blood pressure will cause decreased systemic cause decreased systemic perfusionperfusion

Decreased pressure causes Decreased pressure causes decreased perfusion of the decreased perfusion of the coronary arteries leading to coronary arteries leading to weaker contractility of the heartweaker contractility of the heart

Cardiogenic shockCardiogenic shockASSESSMENT FINDINGS: Angina, ASSESSMENT FINDINGS: Angina,

hemodynamic instability, dysrhythmiashemodynamic instability, dysrhythmias MEDICAL MANAGEMENT: MEDICAL MANAGEMENT:

• The goals of medical management are to The goals of medical management are to limit further myocardial damage and limit further myocardial damage and preserve and to improve the cardiac preserve and to improve the cardiac function by increasing contractility.function by increasing contractility.

NURSING MANAGEMENT: NURSING MANAGEMENT: • The nurse prevents cardiogenic shock by The nurse prevents cardiogenic shock by

early detection of patients at risk. early detection of patients at risk. • Safety and comfort measures like proper Safety and comfort measures like proper

positioning, side-rails, and reduction of positioning, side-rails, and reduction of anxiety, frequent skin care and family anxiety, frequent skin care and family education.education.

Circulatory shockCirculatory shock This is also called distributive This is also called distributive

shock. It occurs when the blood shock. It occurs when the blood volume is abnormally displaced volume is abnormally displaced in the vasculature.in the vasculature.• Septic ShockSeptic Shock• Neurogenic ShockNeurogenic Shock• Anaphylactic Shock Anaphylactic Shock

Circulatory shockCirculatory shock

Massive arterial and venous Massive arterial and venous dilationdilation allows pooling of blood allows pooling of blood peripherallyperipherally maldistribution of maldistribution of blood volumeblood volume decreased decreased venous returnvenous return decreased decreased stroke volumestroke volume decreased decreased cardiac outputcardiac output Decreased Decreased blood pressureblood pressure decreased decreased tissue perfusion.tissue perfusion.

Circulatory shockCirculatory shock Risk factors for Septic ShockRisk factors for Septic Shock

•ImmunosuppressionImmunosuppression•Extremes of age (<1 and Extremes of age (<1 and >65)>65)

•MalnourishmentMalnourishment•Chronic IllnessChronic Illness•Invasive proceduresInvasive procedures

Circulatory shockCirculatory shock Risk factors for Neurogenic ShockRisk factors for Neurogenic Shock

•Spinal cord injurySpinal cord injury•Spinal anesthesiaSpinal anesthesia•Depressant action of Depressant action of medicationsmedications

•Glucose deficiencyGlucose deficiency

Circulatory shockCirculatory shock Risk factors for Anaphylactic Shock Risk factors for Anaphylactic Shock

•Penicillin sensitivityPenicillin sensitivity•Transfusion reactionTransfusion reaction•Bee sting allergyBee sting allergy•Latex sensitivityLatex sensitivity

SEPTIC SHOCKSEPTIC SHOCKThis is the most common type of This is the most common type of

circulatory shock and is caused by circulatory shock and is caused by widespread infection.widespread infection.

The HYPERDYNAMIC PHASEThe HYPERDYNAMIC PHASE• High cardiac output with systemic High cardiac output with systemic

vasodilatation. vasodilatation. • The BP remains within normal The BP remains within normal

limits. limits. • TachycardiaTachycardia• Hyperthermic and febrile with Hyperthermic and febrile with

warm, flushed skin and bounding warm, flushed skin and bounding pulsespulses

SEPTIC SHOCKSEPTIC SHOCKThe HYPODYNAMIC or irreversible The HYPODYNAMIC or irreversible

phase phase • LOW cardiac output with LOW cardiac output with

VASOCONSTRICTIONVASOCONSTRICTION• The blood pressure drops, the skin The blood pressure drops, the skin

is cool and pale, with temperature is cool and pale, with temperature below normal. below normal.

• Heart rate and respiratory rate Heart rate and respiratory rate remain RAPID! remain RAPID!

• The patient no longer produces The patient no longer produces urine.urine.

SEPTIC SHOCKSEPTIC SHOCK MEDICAL MANAGEMENT:MEDICAL MANAGEMENT:

• Current treatment involves Current treatment involves identifying and eliminating the identifying and eliminating the cause of infection. Fluid cause of infection. Fluid replacement must be instituted replacement must be instituted to correct Hypovolemia, to correct Hypovolemia, Intravenous antibiotics are Intravenous antibiotics are prescribed based on culture and prescribed based on culture and sensitivity.sensitivity.

SEPTIC SHOCKSEPTIC SHOCK

NURSING MANAGEMENT: NURSING MANAGEMENT: • The nurse must adhere strictly to the The nurse must adhere strictly to the

principles of ASEPTIC technique in principles of ASEPTIC technique in her patient care. her patient care.

• Specimen for culture and sensitivity Specimen for culture and sensitivity is collected. Symptomatic measures is collected. Symptomatic measures are employed for fever, inflammation are employed for fever, inflammation and pain. IVF and medications are and pain. IVF and medications are administered as ordered.administered as ordered.

Neurogenic ShockNeurogenic ShockThis shock results from loss of This shock results from loss of

sympathetic tone resulting to sympathetic tone resulting to widespread vasodilatation. widespread vasodilatation.

The patient who suffers from The patient who suffers from neurogenic shock may have neurogenic shock may have warm, dry skin and warm, dry skin and BRADYCARDIA!BRADYCARDIA!

Neurogenic ShockNeurogenic Shock

MEDICAL MANAGEMENT: MEDICAL MANAGEMENT: • This involves restoring This involves restoring

sympathetic tone, either through sympathetic tone, either through the stabilization of a spinal cord the stabilization of a spinal cord injury or in anesthesia, proper injury or in anesthesia, proper positioning. positioning.

Neurogenic ShockNeurogenic Shock NURSING MANAGEMENT: NURSING MANAGEMENT:

• The nurse elevates and maintains The nurse elevates and maintains the head of the bed at least 30 the head of the bed at least 30 degrees to prevent neurogenic degrees to prevent neurogenic shock when the patient is shock when the patient is receiving spinal or epidural receiving spinal or epidural anesthesia.anesthesia.

Anaphylactic ShockAnaphylactic Shock

This shock is caused by a This shock is caused by a severe allergic reaction when severe allergic reaction when a patient who has already a patient who has already produced antibodies to a produced antibodies to a foreign substance develops a foreign substance develops a systemic antigen-antibody systemic antigen-antibody reactionreaction

Anaphylactic ShockAnaphylactic Shock MEDICAL MANAGEMENT: MEDICAL MANAGEMENT:

• Treatment of anaphylactic shock Treatment of anaphylactic shock requires removing the causative requires removing the causative antigen, administering antigen, administering medications that restore vascular medications that restore vascular tone, and providing emergency tone, and providing emergency support of basic life functions.support of basic life functions.

• EPINEPHRINE is the drug of choice EPINEPHRINE is the drug of choice given to reverse the given to reverse the vasodilatationvasodilatation

Anaphylactic ShockAnaphylactic Shock NURSING MANAGEMENT:NURSING MANAGEMENT:

• It is very important for nurses to It is very important for nurses to assess history of allergies to assess history of allergies to foods and medications! foods and medications!

• Drugs are administered as Drugs are administered as ordered and the responses to the ordered and the responses to the drugs are evaluated.drugs are evaluated.

TriageTriage ““trier”- to sorttrier”- to sort

To sort patients in groups based on To sort patients in groups based on the severity of their health problem the severity of their health problem and the immediacy with which these and the immediacy with which these problems must be addressed problems must be addressed

Triage in the E.R.Triage in the E.R. Berner’sBerner’s1.1. EmergentEmergent

2.2. UrgentUrgent

3.3. Non-urgent Non-urgent

Triage in DISASTER!Triage in DISASTER! NATONATO1.1. ImmediateImmediate

2.2. DelayedDelayed

3.3. Minimal Minimal

4.4. ExpectantExpectant

TriageTriage1. Emergent1. Emergent

• Patients have the highest priorityPatients have the highest priority• With life-threatening conditionWith life-threatening condition

2. Urgent2. Urgent• Patients with serious health Patients with serious health

problemsproblems• Not life-threatening, MUST be Not life-threatening, MUST be

seen in 1 hourseen in 1 hour3. Non-urgent3. Non-urgent

• Episodic illness that can be Episodic illness that can be addressed within 24 hoursaddressed within 24 hours

Triage in DisasterTriage in DisasterTriage Triage categorycategory

PriorityPriority ColorColor ConditionsConditions

ImmediateImmediate 11 REDRED Chest Chest wounds, wounds, shock, open shock, open fractures, 2-3 fractures, 2-3 burnsburns

Delayed Delayed 22 YELLOWYELLOW Stable Stable abdominal abdominal wound, eye wound, eye and CNS and CNS injuriesinjuries

MinimalMinimal 33 GREENGREEN Minor burns, Minor burns, minor minor fractures, fractures, minor minor bleedingbleeding

ExpectantExpectant 44 BLACKBLACK Unresponsive, Unresponsive, high spinal high spinal cord injurycord injury

Preparing for terrorismPreparing for terrorism

1.1. Recognition and AwarenessRecognition and Awareness2.2. Use of personal protective Use of personal protective

equipmentsequipments3.3. Decontamination of contaminantsDecontamination of contaminants

Biological WeaponsBiological Weapons

ANTHRAXANTHRAX Drug of choice is Ciprofloxacin or Drug of choice is Ciprofloxacin or

DoxycyclineDoxycycline

SMALLPOXSMALLPOX SupportiveSupportive

Chemical WeaponsChemical WeaponsOrganophosphatesOrganophosphates

• Supportive careSupportive care• Soap and waterSoap and water• AtropineAtropine• PralidoxinePralidoxine

CyanideCyanide• Sodium nitrite, Amyl Nitrite, Methylene BlueSodium nitrite, Amyl Nitrite, Methylene Blue• Sodium thiosulfateSodium thiosulfate• HydrocobalaminHydrocobalamin

CYANIDE POISONINGCYANIDE POISONING

RadiationRadiation

Alpha ParticlesAlpha Particles Cannot penetrate Cannot penetrate skinskinCauses local Causes local damagedamage

Beta ParticlesBeta Particles Moderately penetrate Moderately penetrate the skinthe skinCan cause skin damage Can cause skin damage and internal injury if and internal injury if prolongedprolonged

Gamma ParticlesGamma Particles Penetrate skinPenetrate skinCan cause serious Can cause serious damagedamageX-ray is an exampleX-ray is an example

emergency and critical care

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