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EMERGENCYAND

DISASTER NURSING

BY:

Darran Earl Gowing, BSN, RN

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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.

TERMS USE:

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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.

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ACLS- 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.

Defibrillation- Restoration of normal rhythm to the heart

in ventricular or atrial fibrillation

Disaster- Any catastrophic situation in which the

normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment

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Mass Casualty Incident

- situation in which the number of casualties exceeds the number of resources

Post Traumatic Stress Syndrome- characteristic of symptoms after a

psychologically stressful event was out of range of an normal human experience

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SCOPE AND PRACTICE OF EMERGENCY NURSINGThe emergency nurse has had

specialized education, training, and experience.

The emergency nurse 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, high-pressured care environment.

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Nursing interventions are accomplished interdependently, in consultation with or under the direction of a licensed physician.

Appropriate nursing and medical interventions are anticipated based on assessment data.

The emergency health care staff members work as a team in performing the highly technical, hands-on skills required to care for patients in an emergency situation.

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Patients in the ED have a wide variety of actual or potential problems, and their condition may change constantly.

Although a patient may have several diagnosis at a given time, the focus is on the most life-threatening ones

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ISSUES IN EMERGENCY NURSING CARE

Emergency nursing is demanding because of the diversity of conditions and situations which are unique in the ER.

Issues include legal issues, occupational health and safety risks for ED staff, 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.

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The emergency nurse must expand his or her knowledge base to encompass recognizing and treating patients and anticipate nursing care in the event of a mass casualty incident.

Legal Issues Includes:

- Actual Consent

- Implied Consent

- Parental Consent

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“Good Samaritan Law”

- Gives legal protection to the rescuer who act in good faith and are not guilty of gross negligence or willful misconduct.

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Preserve or Prolong Life

Alleviate Suffering

Do No Further Harm

Restore to Optimal Function

Focus of Emergency Care

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Do’s

- Obtain Consent

- Think of the Worst

- Respect Victim’s Modesty & Privacy

Don’ts

- let the patient see his own injury

- Make any unrealistic promises

Golden Rules of Emergency Care

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Guidelines in Giving Emergency Care

A – Ask for help

I – Intervene

D – Do no Further Harm

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Stages of Crisis1. Anxiety and Denial

encouraged to recognize and talk about their feelings.

asking questions is encouraged. honest answers given prolonged denial is not encouraged or

supported

2. Remorse and Guilt verbalize their feelings

3. Anger way of handling anxiety and fear allow the anger to be ventilated

4. Grief help family members work through their grief letting them know that it is normal and

acceptable

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Core Competencies in Emergency Nursing

Assessment

Priority Setting/Critical Thinking Skills

Knowledge of Emergency Care

Technical Skills

Communication

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Assess and Intervene

Check for ABCs of life

A – Airway

B – Breathing

C - Circulation

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Team Members

Rescuer

Emergency Medical Technician

Paramedics

Emergency Medicine Physicians

Incident Commander

Support Staff

Inpatient Unit Staff

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Emergency Action Principle

I. Survey the Scene Is the Scene Safe?

What Happened?

Are there any bystanders who can help?

Identify as a trained first aider!

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- organization of approach so that immediate threats to life are rapidly identified and effectively manage.

Primary Survey

A - Airway/Cervical Spine

- Establish Patent Airway

- Maintain Alignment

- GCS ≤ 8 = Prepare Intubation

II. Do a Primary Survey

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B – Breathing

- Assess Breath Sounds

- Observe for Chest Wall Trauma

- Prepare for chest decompression

C – Circulation

- Monitor VS

- Maintain Vascular Access

- Direct Pressure

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Estimated Blood Pressure

SITE SBP

Radial ≥ 80

Femoral ≥ 70

Carotid ≥ 60

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Control of Hemorrhage

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D – Disability

- Evaluate LOC

- Re-evaluate clients LOC

- Use AVPU mnemonics

E – Exposure

- Remove clothing

- Maintain Privacy

- Prevent Hypothermia

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Information to be Relayed:

- What Happened?

- Number of Persons Injured

- Extent of Injury and First Aid given

- Telephone number from where you’re calling

III. Activate Medical Assistance

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Interview the Patient

S – Symptoms

A – Allergies

M – Medication

P – Previous/Present Illness

L – Last Meal Taken

E – Events Prior to Accident

Check Vital Signs

IV. Do Secondary Survey

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V. Triage

comes from the French word ”trier”, meaning to sort

process of assessing patients to determine management priorities

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Categories:1. Emergent

-highest priority, conditions are life

threatening and need immediate attention

Airway obstruction, sucking chest wound, shock, unstable chest and abdominal wounds, open fractures of long bones

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2. Urgent – have serious health problems but not immediately life threatening ones. Must be seen within 1 hour

Maxillofacial wounds without airway compromise, eye injuries, stable abdominal wounds without evidence of significant hemorrhage, fractures

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3. Non-urgent – patients have episodic illness than can be addressed within 24 hours without increased morbidity

Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding, behavioral disorders or psychological disturbances.

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Field TRIAGE

1. Immediate: Injuries are life-threatening but

survivable with minimal intervention. Individuals in this group can progress rapidly to expectant if treatment is delayed.

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2. Delayed: Injuries are significant and require

medical care, but can wait hours without threat to life or limb. Individuals in this group receive treatment only after immediate casualties are treated.

3. Minimal:

Injuries are minor and treatment can be delayed hours to days. Individuals in this group should be moved away from the main triage area.

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4. Expectant: Injuries are extensive and

chances of survival are unlikely even with definitive care.

5. Fast-Track:

Psychological support needed

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FIRST AID

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Role of First Aid

Bridge the Gap Between the Victim and the Physician

Immediately start giving interventions in pre-hospital setting

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Self-help

Health for Others

Preparation for Disaster

Safety Awareness

Value of First Aid Training

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BASIC LIFE SUPPORT

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Artificial Respirationa way of breathing air to

person’s lungs when breathing ceased or stopped function.

Respiratory Arresta condition when the

respiration or breathing pattern of an individual stops to function, while the pulse and circulation may continue.

Causes: Choking, Electrocution, strangulation, drowning and suffocation.

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Methods:

mouth to mouth

mouth to nose

mouth to stoma

mouth to mouth and nose

mouth to barrier device

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Procedure Infant(0-1yr) Child(1-8 yrs) Adult

1. Safe Approach Approach and assess situation

2. Assess for

Response

Shout and gently pinch Gently shouting

“are you ok?”

then shake

the victim

3. Positioning Placed Supine on a firm and flat surface

4. Open the

Airway

Check for foreign bodies then remove using finger

sweep

Head-tilt-chin-lift maneuver

Jaw-thrust Maneuver

5. Assess for

Breathing

Bring cheek over the mouth and nose of the casualty

Look for chest movement

Listen for breath sounds

Feel for breathing on your cheek

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The Casualty is Breathing: Place in recovery position

Before moving casualty remove any objects safely from her pockets

Kneel beside casualty, place arm nearest at right angles, and then

bend elbow keeping the palm uppermost.

Bring far arm across the casualty’s chest and hold back of the

casualty’s hand against the nearest cheek

With your other hand grasp the far thigh just above the knee, then

pull the casualty towards you and on to his or her side

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The Casualty is NOT Breathing:

6. Go for Help - if someone responds to your shout for help send that

person to phone for ambulance

- if you’re on your own, leave the casualty and make the

phone call for yourself

* never leave if the patient has collapsed as a result of

trauma or drowning or if the casualty is a child

7. Give Rescue

Breaths

5 rescue breaths 2 rescue breaths

- Place mouth

over the nose

and mouth of

the infant

- look for chest

rising

- pinch nose and

ventilate via

mouth

- look for chest

rising

-seal lips around

the mouth and

blow steadily

for 1.5 – 2

seconds

- look for chest

rising

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When to Stop AR:

when the patient has spontaneous breathing

when the first aider is too exhausted to continue

when another first aider takes over

when EMS arrives and takes over

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Cardiopulmonary Resuscitation (CPR)

Cardiac Arrest

a condition when the persons breathing and circulation/pulse stop at the same time

Causes: Cardiovascular Disease, Heart Attack, MI

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Management:

External Chest Compression

- consist of rhythmic application of pressure over the lower portion of the sternum just in between the nipple

Cardiopulmonary Resuscitation = AR + ECC

Goal: Rapid return of pulse, BP and consciousness

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Procedure Infant( 0-1 year)

Child (1-8 yrs)

Adult

1. Assess circulation for 10 seconds

Check brachial pulse < 60 bpm or below or absent

Check carotid pulse and if no pulse

Commence chest compression

2. Positioning of compression

Draw imaginary line between nipples and place two fingers on the sternum 1 finger breadth below this line

One hand on the sternum two fingers up from the xyphoid process

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3. AR:ECC 1 breath: 5 compression

2 breaths: 30 compression

4. Rate and Depth of compression

100/min 1/3 or 1.5 – 2 inches

Number of Cycle/ minute

5 cycles per minute

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When to STOP CPR:S – SPONTANEOUS BREATH

RESTORED

T – TURNED OVER THE MEDICAL SERVICES

O – OPERATOR IS EXHAUSTED TO CONTINUE

P – PHYSICIAN ASSUMES RESPONSIBILITY

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COMPLICATIONS OF CPR:

RIB FRACTURE

STERNUM FRACTURE

LACERATION OF THE LIVER OR SPLEEN

PNEUMOTHORAX, HEMOTHORAX

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CHAIN OF SURVIVAL

EARLY ACCESS – early recognition of cardiac arrest, prompt activation of emergency services

EARLY BLS – prevent brain damage, buy time for the arrival of defibrillator

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EARLY DEFIBRILLATION- 7-10% decrease per minute without

defibrillation

EARLY ACLS – technique that attempts to stabilize patient

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TRAUMA

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Head trauma

Result of an external force applied to the head and brain causing disruption of physiologic stability locally, at the point of injury, as well as globally with elevations in ICP and potentially dramatic changes in blood flow within the brain.

Trauma to the skull resulting in mild to extensive damage to the brain.

Causes: vehicular accidents, fall, acts of violence, sports

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Types of Head Injuries

1. Open Scalp lacerations Fractures in the skull Interruption of the dura mater

2. Closed Concussions – a jarring of the brain within the skull

with temporary loss of consciousness Contusions – a bruising type of injury to the brain;

may occur with subdural or extradural collections of blood.

Contrecoup – decelerative forces throwing the brain back and forth

Fractures – e.g. linear, depressed, compound comminuted

3. Hemorrhagecauses hematoma or clot formation

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Types of Hemorrhage/Hematoma:

1. epidural hematoma the most serious type of hematoma;

forms rapidly and results from arterialbleeding

forms between the dura and the skullfrom a tear int the meningeal area

2. Subdural hematoma - forms slowly and results from a venous bleed- a surgical emergency

3. Intracerebral hemorrhage - bleeding directly into the brain matter

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Clinical manifestations:

Altered level of consciousness Confusion Papillary abnormalities Altered or absent gag reflex or vomiting Absent corneal reflex Sudden onset of neurologic deficits Changes in vital signs Vision and hearing impairment CSF drainage from ears or nose Sensory dysfunction Spasticity Headache and vertigo Movement disorders or reflex activity changes Seizure activity

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Assessment

What time did the injury occur?

What caused the injury?

What was the direction and force of the blow?

Was there a loss of consciousness?

What was the duration of unconsciousness?

Could the patient be aroused?

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Emergency interventions:Goal: “maintain oxygen and nutrient rich cerebral blood flow”

Monitor respiratory status and maintain a patent airway monitor neurological status and vital signs (TPR,BP) monitor for increased ICP Head elevation 20 -30 degrees restrict fluids and monitor I & O immobilization of neck initiate normothermia measures assess cranial nerve function, reflexes and motor and sensory function initiate seizure precautions monitor for pain and restlessness avoid administration of morphine sulfate monitor for drainage from the nose or ears if there is CSF leak, monitor for nuchal rigidity do not attempt to clean the nose, suction or allow the client to blow the nose

if drainage occurs do not clean te ear of drainage when noted but apply a loose, dry sterile

dressing do not allow the client to cough

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Medical intervention:

Osmotic diuretics – pulling water out of the extracellular space of the edematous brain tissue

Loop diuretic – reduce incidence of rebound from osmotic diuretics

Opioids – decreased agitation

Sedatives – reduced anxiety and promote comfort and agitation

Antiepileptic drugs – to prevent seizures

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Surgical intervention:

Craniotomy

a surgical procedure that involves an incision through the cranium to remove accumulated blood or tumor

complications include increased ICP from cerebral edema, hemorrhage or obstruction of the normal flow of CSF

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DENTAL TRAUMA

1. Tooth Ache Rinse mouth vigorously with warm water to

clear out debris

Use dental floss to remove any food that might be wedged in between the teeth

Use cold pack on the outside of the cheek to manage swelling

Soak cotton with Oil of Cloves and place it on aching tooth

2. Knocked- out tooth

- Place a sterile gauze pad or cotton ball into the tooth socket to prevent further bleeding

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3. Broken tooth Gently clean dirt and blood from the injured area

with the use of clean cloth and warm water

Use cold compress to minimize swelling

4. Bitten Tongue or Lip Using a clean cloth, apply direct pressure to the

bleeding area

If swelling is present, apply cold compress

5. Objects wedged between the teeth Try to remove object with a dental floss

Guide the floss carefully to prevent bleeding

Do not remove the object with a sharp or pointed object

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6. Orthodontic Problems

If a wire is causing irritation, cover the end of the wire with the use of a cotton ball/ piece of gauze until you can get to a dentist

Do not attempt to remove a wire embedded in the gums, cheek or tongue. Instead, go immediately to the dentist

7. Possible fractured jaw

Immobilize the jaw by any means

Apply cold compress to prevent swelling

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CHEST TRAUMA

Approximately a quarter of deaths due to trauma are attributed to thoracic injury.

Immediate deaths are essentially due to major disruption of the heart or of great vessels.

Early deaths due to thoracic trauma include airway obstruction, cardiac tamponade or aspiration.

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Classification of Chest Trauma:

Blunt Trauma – results from sudden compression or positive pressure inflicted to the chest wall.

Penetrating Trauma – occurs when foreign object penetrates the chest wall.

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Types of Chest Trauma

A. Blunt Chest Trauma RIB FRACTURES

- Fractured ribs may occur at the point of impact and damage to the underlying lung may produce lung bruising or puncture.- Commonly a result of crushing chest injuries

Assessment:- Severe Pain - Muscle spasm- Tenderness - Subcutaneous Crepitus - Shallow Respirations - Reluctance to move- Client splints chest

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Management:

1. Rest

2. Ice Compress then Local Heat

3. Analgesia

4. Splint the chest during coughing or deep breathing

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FLAIL CHEST

- The unstable segment moves separately and in an opposite direction from the rest of the thoracic cage during the respiration cycle

Assessment:

- Paradoxical respirations

- Severe chest pain

- Dyspnea/ Tachypnea

- Cyanosis

- Tachycardia

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Management:

1. High Fowler’s position

2. Humidified O2

3. Analgesia

4. Coughing & deep breathing

5. Prepare for intubation with mechanical ventilation with positive end-expiratory pressure ( PEEP ) for severe respiratory failure

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B. Penetrating Chest Trauma

- occurs when a foreign object penetrates the chest wall

1.Pneumothorax - Accumulation of atmospheric air in the

pleural space

may lead to lung collapse

Types:

1. Spontaneous Pneumothorax

2. Open Pneumothorax

3. Tension Pneumothorax

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Assessment:

Dyspnea Tachycardia

Tachypnea Sharp chest pain

Absent breathe sounds

Sucking sound

Cyanosis

Tracheal deviation to the unaffected side with tension pneumothorax

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Management:

1. Apply dressing over an open chest wound

2. O2 as Rx

3. High Fowler’s

4. Chest tube placement

- Monitor for chest tube system

- Monitor for subcutaneous emphysema

Chest Tube Drainage System

- returns (-) pressure to the intra-pleural space

- remove abnormal accumulation of air & fluids serves as lungs while healing is going on

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Pulmonary Embolism

- Dislodgement of thrombus to the pulmonary artery

- Caused by thrombus & pulmonary emboli

- Other risk factors: deep vein thrombosis, immobilization, surgery, obesity, pregnancy, CHF, advanced age, prior History of thromboembolism

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Assessment:

- Dyspnea

- Chest pain

- Tachypnea & tachycardia

- Hypotension

- Shallow respirations

- Rales on auscultation

- Cough

- Blood-tinged sputum

- Distended neck veins

- Cyanosis

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Management:1. O2 as Rx2. High Fowler’s3. Maintain bed rest4. Incentive spirometry as Rx5. Pulse oximetry6. Prepare for intubation & mechanical

ventilation 7. IV heparin (bolus)8. Warfarin (Coumadin) 9. Monitor PT & PTT closely10. Prepare the client for embolectomy, vein

ligation, or insertion of an umbrella filter as Rx

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ABDOMINAL TRAUMA

A. Penetrating Abdominal TraumaCauses:

- Gunshot wound - Stab wound - Embedded object from explosion

Assessment: - Absence of bowel sound - Hypovolemic

shock - Orthostatic hypotension - Pain and tenderness

Management: 1. Maintain hemodynamic status – IVF & blood transfusion 2. Surgery- EXLAP 3. Peritoneal Lavage

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B. Blunt Abdominal Trauma

Assessment:

- Left upper quadrant pain (Spleen)

- Right upper quadrant pain (liver)

- Signs of hypovolemic shock

Management:

1. Maintain hemodynamic status

2. Monitor VS and oxygen supplements

3. Assess signs and symptoms of shock

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FOREIGN BODY AND AIRWAY

OBSTRUCTION

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CAUSES:

improper chewing of large pieces of food

aspiraton of vomitus, or a foreign body

position of head, the tongue

resulting to difficulty of breathing or respiratory arrest

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Types of obstruction

anatomical –tongue andepiglottis

mechanical –coins, food, toy etc

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Assessment and clinical manifestations:

Mild airway obstruction can talk, breath and cough with

high pitch breath sound

cough mechanism not effective to dislodge foreign body

Severe airway obstruction can’t talk, breath or cough

Nasal flaring, cyanosis, excessive salivation

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Intervention:

CONCIOUS PATIENT:

ask the victim, “are you choking?” if the victim’s airway is obstructed partially, a crowing

sound is audible; encourage the victim to cough. relieve the obstruction by heimlick maneuver Heimlich maneuver:

stand behind the victim place arms around the victim’s waist make a fist place the thumb side of the fist just above the umbilicus and

well below the xyphoid process. Perform 5 quick in and up thrusts.

Use chest thrusts for the obese or for the advanced pregnancy victims.

continue abdominal thrusts until the object is dislodged or the victim becomes unconscious.

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UNCONSCIOUS PATIENT:

assess LOC call for help check for ABCs open airway using jaw thrust technique finger sweep to remove object attempt ventilation reposition the head if unsuccessful; reattempt ventilation relieve the obstruction by the Heimlich maneuver with five thrust;

then finger sweep the mouth reattempt ventilation repeat the sequence of jaw thrust, finger sweep, breaths and

Heimlich maneuver until successful be sure to assess the victim’s pulse and respirations perform CPR if required

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Choking child or infant:

choking is suspected in infants and children experiencing acute respiratory distress associated with coughing, gagging, or stridor.

allow the victim to continue to cough if the cough is forceful

if cough is ineffective or if increase respiratory difficulty is still noted, perform CPR

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Foreign objects in the ear

Don’t probe the ear with a tool

Remove the object if clearly visible

Try using gravity and shake the head gently

Try using oil for an insect

Don’t use oil to remove any other object than an insect

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Foreign objects in the eye

Flush eye clear with use of water

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Foreign objects in the nose

Don’t probe at the object with cotton ball or other tool

Breathe thru your mouth until the object is removed

Blow your nose gently to try to free the object

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POISONING

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Poison

Any substance that impairs health or destroys life when ingested, inhaled or otherwise absorbed by the body.

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Suspect poisoning if:

1. Someone suddenly becomes ill for no apparent reason and begins to act unusually

2. Is depressed and suddenly becomes ill

3. Is found near a toxic substance and is breathing any unusual fumes, or has stains, liquid or powder in his or her clothing, skin or lips

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Ingestion Poisoning

Botulism – Clostridium botulinum. From canned foods

Note: Save the Vomitus

Staphylococcus Aureus – from unrefrigerated cram filled foods, fish

Note: Save the Vomitus

Petroleum Poisoning – includes poisoning with a substance such as kerosene, fuel, insecticides and cleaning fluids

Note: Never induce vomiting! May result in Chemical Pneumonia

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Acetaminophen Poisoning – most common drug accidentally ingested by children

Antidote: Acetylcysteine

Corrosive Chemical Poisoning – strong detergents and dry cleaners

results in drooling of saliva, painful burning sensation and pain and redness in the mouth

Note: Never induce vomiting, may cause further injury

Activated Charcoal, Milk of Magnesia

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Diagnostics:

Baseline ABG should be obtained periodically

Baseline blood samples (CBC, BUN, electrolytes)

ECG (since many toxic agents affect cardiac rhythm)

Assessment:

Headache

Double vision

Difficulty in swallowing, talking and breathing

Dry sore throat

Muscle incoordination

Nausea and vomiting

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Management:

Check victim’s ABCs. Begin rescue breathing if necessary

If ABCs are present but the victim is unconscious, place him in recovery position

If victim starts having seizures, protect him from injury

If victim vomits, clear the airway

Calm and reassure the victim while calling for medical help

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P – Prevention. Child Proofing

O – Oral fluids in large amount

I - Ipecac

S – Support respiration and circulation

O - Oral Activated Charcoal

N - Never induce vomiting if substance ingested is corrosive

LAVAGE

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Inhalation Poisoning

Carbon Monoxide Poisoning Carbon monoxide is a colorless, odorless &

tasteless gas

Assessment:

- appears intoxicated

- Muscle weakness

- Headache & dizziness

- Pink or cherry red skin (not a reliable sign)

- Confusion which may eventually lead to coma

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Management:

1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery)

5. Initiate CPR if required

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SPECIAL WOUNDS

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Human Bites

– staphylococcus and streptococcus infection

Management:

1. Cleanse and irrigate the wound

2. Assist with wound exploration

3. Culture the wound site

4. Tetanus toxoid and vaccine to stimulate antibody production

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Animal bite

– dog and cat bite

Management:

1. Wash wound with soap and water

2. Tetanus toxoid and vaccine to stimulate antibodies

3. Rabies Vaccine and immunoglobulin

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Snake Bite

– Infection can be neurotoxic or hemotoxic

Assessment:

Edema

Ecchymosis

Petechiae

Fever

Nausea and Vomiting

Possible hypotension

Muscle fasciculation

Hemorrhage, shock and pulmonary edema

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Management:

1. Establish ABCs

2. Immobilize bitten arm or extremity

3. Remove constricting items

4. Provide warmth

5. Cleanse the wound

6. Cover wound with light sterile dressing

7. Don’t attempt to remove the venom

8. Anti venom therapy

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Insect Bites/ Bee stings

Assessment:

Itching, dyspnea

Chest tightness, dizziness, urticaria

Nausea, vomiting,diarrhea

Abdominal cramps, flushing

Laryngeal edema

Respiratory arrest

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Management:

1. Remove stinger by scraping

2. Cleanse the site

3. If anaphylaxis occurs, give oxygen and medications

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TRAUMA RELATED TO

ENVIRONMENTAL EXPOSURE

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HEAT EXHAUSTION

Assessment:

Nausea and vomiting

increased temperature

Muscle cramps

Tachypnea and Tachycardia

Orthostatic hypotension

Malaise

Irritability and anxiety

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Management:

Check ABCs

Move to cool area

Give salted water for vomiting periods

Relieve cramps by firm pressure

ECG and ABG monitoring

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FROSTBITE

Assessment:

Hard, cold extremities

White or mottled blue extremity

Extremity insensitive to touch

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Management:

Remove constrictive clothing and jewelry

Prevent ambulation if lower extremity is involved

Institute rewarming measures

Once rewarmed, elevate extremity to prevent swelling

Apply sterile gauze or cotton in between digits to prevent maceration

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NEAR DROWNING

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Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist

4. Wading Assist

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Assessment:

Abdominal distention

Confusion

Irritability

Lethargy

Shallow gasping respirations

Unconsciousness

vomiting

Absent breathing

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Management:

Assess ABCs

Give CPR and AR as necessary

Check patient’s temperature

Administer rewarming measures as necessary

Monitor lab results(electrolytes) and ECG

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BURN TRAUMA

Is the damage caused to skin and deeper body structures by heat (flames, scald, contact with heat) , electrical, chemical or radiation

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FACTORS DETERMINING SEVERITY OF BURN:1. age – mortality rates are higher for children < 4 yrs of age and for

clients > 65 yrs of age2. Patient’s medical condition – debilitating disorders such as cardiac,

respiratory, endocrine and renal disorders negatively influence the client’s response to injury and treatment.

mortality rate is higher when the client has a pre-existing disorder at the time of the burn injury

3. location – burns on the head, neck and chest are associated with pulmonary

complications; burns on the face are associated with corneal abrasion; burns on the ear are associated with auricular chondritis; hands and joints require intensive therapy; the perineal area is prone to autocontamination by urine and feces; circumferential burns of the extremities can produce a tourniquet-

like effect and lead to vascular compromise (compartment syndrome).

4. Depth

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4. Depth

ClassificationAffected Part Description of Wound What to Expect

1st degreesuperficial

Epidermis Pin, painful “sunburn”Blisters form after 24 hours

Discomfort last after 48 hrs; heals in 3-7 days

2nd degreepartial thickness

Pediermis and part of the dermis

Red, wet blisters, bullae very painful

Heals in 2-3 weeks, in no complication

2nd degreedeep partial thickness

Only the skin appendages in the hair follicle remain

Waxy white, difficult to distinguish from 3rd

degree except hair growth becomes apparent in 7-10 days, little or no pain

Slow to heal 94-8 weeks) surgical incision and grafting unless has complication

3rd degreeFull thickness

Epidermis, dermis and subcutaneous tissue . no skin appendages

-Dry, leathery, may be red or black-May have thrombosed veins-Marked edema-Distal circulation may be decreased-Painless

Requires excision and grafting.10- 14 days for graft to revascularize

4th degreedeep full thickness

Skin, muscle, tendon, bonde

Dry, charred, bone may be visible

Requires excision, grafting and sometimes amputation

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5. Size: Rule of nine

AssessmentChild < 3 years

oldAdult

Head and neck 18% 9%

1 arm 9% 9%

Posterior trunk 18% 18%

Anterior trunk 18% 18%

1 leg 14% 18%

Perineum 1% 1%

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6. Temperature determines the extent of injury

7. Exposure to the Source Thermal Burns – caused by exposure to flames,

hot liquids, steam or hot objects Chemical Burns – caused by tissue contact with

strong acids, alkalis or organic compounds Electrical Burns – result in internal tissue

damaging, alternating current is more dangerous than direct current for it is associated with cardiopulmonary arrest, ventricular fibrillation, titanic muscle contractions, and long bone and vertebral fractures.

Radiation Burns – are caused by exposure to ultraviolet light, x-rays or a radioactive source.

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Types of Burns and their Treatment:

Scald burn caused by hot liquid immediately flush the burn area with water (under a tap or hose for

up to 20 min) if no water is readily available, remove clothing immediately as

clothing soaked with hot liquid retains heat Flame

Smother the flames with a coat or blanket, get the victim on the floor or ground (stop, drop, and Roll)

Prevent victim from running If water is available, immediately cool the burn area with water If water is not available, remove clothing; avoid pulling clothing

across the burnt face Cover the burn area with a loose, clean, dry cloth to prevent

contamination Do not break blisters or apply lotions, ointments, creams or powder

Airway if face or front of the trunk is burnt, there could be burns to the

airway there is a risk of swelling or air passage, leading to difficulty in

breathing

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Smoke inhalation Urgent treatment is required with care of the airway, breathing

and circulation When 02 in the air is used up by fire, or replaced by other gases,

the oxygen level in the air will be dangerously low Spasm in the air passages as a result of irritation by smoke or

gases Severe burns to the air passages causing swelling and

obstruction Victim will show signs and symptoms of lack of O2. He may also

be confused or unconscious

Electrical check for “Danger” turn of the electricity supply if possible avoid any direct contact with the skin of the victim or any

conducting material touching the victim until he is disconnected once the area is safe, check the ABCs if necessary, perform rescue breathing or CPR

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Chemical

Flood affected area with water for 20-30 min

Remove contaminated clothing

If possible, identify the chemical for possible subsequent neutralization

Avoid contact with the chemical

Sunburn

Exposure to ultraviolet rays in natural sunlight is the main cause of sunburn

General skin damage and eventually skin cancer develops

The signs and symptoms of sunburn are pain, redness and fever