ncm 104 - emergency lecture (1)

8/4/2019 NCM 104 - Emergency Lecture (1)

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Acids and Alkalis

Acids: toilet bowel cleaners, antirust compounds

Alkalis: Drain cleaners, dishwashing detergents,ammonia

Manifestations:

Excess salivation, dysphagia. Epigastric pain,pneumonitis, burns of mouth, esophagus, &stomach.

Treatment: Immediate dilution ( water, milk), corticosteroids

(for alkali).

Induced vomiting is contraindicated.


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Aspirin & aspirin containing medications

Manifestation:

Restlessness, tinnitus, deafness, Burring of vision

Tachypnea, tachycardia, hyperthermia.

Epigastric pain, disorientation, coma.

Treatment:

treat respiratory depression

gastric lavage

Activated charcoal, urine alkalinizaton.

hemodialysis for severe acute ingestion.


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Bleaches

Manifestation

Irritation of lips, mouth, & eyes, superficial injuryto esophagus; chemical pneumonia.

Treatment: Washing of exposed skin & eyes

dilution with water & milk

Gastric Lavage prevention of vomiting and aspiration


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Carbon Monoxide Poisoning

Exerts its toxic effect by binding to circulatinghemoglobin & thereby reducing the oxygen-carrying capacity of the blood.

Hemoglobin absorbs carbon monoxide 200 timesmore readily than it absorbs oxygen.

Clinical Manifestation

Dyspnea, headache, tachypnea, confusion,impaired judgement, cyanosis, respiratory

depression.


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Carbon Monoxide Poisoning

Management

Carry the patient tofresh air immediately.

Loosen all tight

clothing. Initiate CPR if

required; administer100% oxygen.

Hyperbaric oxygentherpay.

Prevent chilling

Hyperbaric Oxygen Therapy


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Cocaine

Intranasally ( snorting). Smoking (freebasing).

Crack

Clinical Manifestation Is a CNS stimulant that can HR & BP &

cause hyperpyrexia, seizures & ventriculardysrhythmias.

It produces intense euphoria, then anxiety,sadness & insomnia. Cocaine hallucinationwith delusions; psychosis with extreme

paranoia.
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Opiods

Heroin, Opium, Morphine, Codeine,Fentanyl.

Clinical Manifestation:

Pinpoint pupils, BP & marked respiratory

depression.

Management

Support respiratory & cardiovascular

functions Establish an IV line.

Narcotic antagonist (naloxone[narcan]).

Send urine for urinalysis


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Drugs producing sedation( Nonbarbiturates sedative)

Diazepam, lorazepam, Midazolam

Flunitrazepam (roofies, date rape drug)

Manifestation

Seizures, coma, circulatory collapse, death.

Acute intoxication:

Respiratory depression

Decreasing mental alertness, confusion

Slurred speech, BP, Ataxia, coma, deathFlunitrazepam

Disinhibition with antegrade amnesia

Weakness & unsteadiness, powerlessness.


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Sudden Cardiac Arrest A Health Burden

Approximately 50% of deaths fromcardiovascular disease occur as SUDDEN

CARDIAC ARREST.

Sudden Cardiac Arrest is the mostcommon mode of death in patients withcoronary artery disease.


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Health Burden of Sudden Cardiac Arrest

Almost 80 percent of out-of-hospital cardiacarrestsoccur at homeand are witnessed bya family member.

Only 4-6 % of sudden cardiac arrest victimssurvivebecause majority of those witnessingthe arrest do not know how to perform CPR .


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Sudden Cardiac Arrest

Unpredictable and can happen to anyone,anywhere, at anytime

Risk increases with age

Pre-existing heart diseaseis a common cause

May strike people with no history of cardiacdisease or cardiac symptoms


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What is C P R ?

CPR = Cardio-

PulmonaryResuscitation


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The NEW Chain of Survival

Early access:immediate recognition and activationEarly CPR

Early defibrillation

Early advanced care

Integrated post-

cardiac arrest care


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A well-informed lay person- key in the early accesslink.

Recognition of signs ofheart attack andrespiratory failure

Call for help immediately if

needed Activate the Emergency

Medical System

The First Link- Early Access


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EARLY WARNING SIGNS OFHEART ATTACK

prolonged compressingpain or unusualdiscomfort in the centerof the chest

may radiate to shoulder,arm, neck or jaw,usually on the left side

may be accompanied by

sweating, nausea,vomiting and shortnessof breath


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EARLY WARNING SIGNS OFRESPIRATORY FAILURE

unable to speak,breath or cough

clutches neck(universaldistress signal)

bluish color ofskin and lips


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Life saving techniquefor cardiac & respiratoryarrest

Chest compressions +/-Rescue breathing

Lay persons andmedical personnel

Second Link - Early CPR


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Brain(Cerebral)

Heart(Cardiac)

Lungs(Pulmonary)

How does CPR work?

All the living cells of our

body need a steady

supply of oxygen to

keep us alive.

During CPR, you can breathe air into

the victims lungs to provide oxygeninto the blood.

When you press on the chest, you moveoxygen - carrying blood through thebody.


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When will you do CPR?

AS SOON AS POSSIBLE!

Brain cells begin to die after

4-6 minutes without oxygen.


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CHECKAREASAFETY.

Surveythe scene.Seeif the scene is safe to do CPR.Get an idea of what happened.

CHECKUNRESPONSIVENESS.

Tap or gently shakethe victim

Rescuer shoutsAre you OK?

Quick check for normal breathing

If the victim is unconscious,rescuercalls for help.

CALL FORHELP:Ambulance,Emergency Services,

Doctor

RescuerACTIVATEStheEMERGENCY MEDICALSERVICES.

GetAED/Defibrillator!


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NON-RESPONSIVE,

NO NORMAL BREATHING


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PULSE CHECK

Palpate for Carotid Pulsewithin 10 seconds

(at the same timeCHECK FORBREATHING)

For trained healthcareproviders only


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Do Mouth to MouthBreathing

Give one breath every5-6 secs (about 12

breaths/min) Recheck pulse every 2

minutes

If with definite pulsebut no breathing


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MOUTH TO MOUTH BREATHING

and PULSE CHECK Deemphasized in the new guidelines

For trained healthcare providers only

As short and quick as possible

Pulse check not more than 10 seconds

If unsure, proceed directly to CHESTCOMPRESSIONS!


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C A BC. COMPRESSION Do chest

compressions firstA. AIRWAY Does the victim have an

open airway (air passage

that allows the victim tobreathe)?

B. BREATHING Is the victim breathing?

After determining unconsciousness,


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After determining unconsciousness

and calling for help,proceed immediately to do

CHEST

COMPRESSIONS!

C COMPRESSION(to assist CIRCULATION)

Ch C i


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Chest Compressions

Kneel facing

victims chest

Place the heel of

your hand on thecenter of the victim'schest. Put your otherhand on top of thefirst with yourfingers interlaced.

Ch C i


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Place theheel of onehand on thesternum in

the center ofthe chestbetween thenipples andthen place

the heel ofthe secondhand on topof the first sothat thehands areoverlappedand parallel.

Chest Compressions


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Give 30 Compressions Compress breastbone at least 2

inches

(30 compressions should take 15-18sec)

Count aloud 1, 2, 3, 4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,and ONE!

Minimize interruptions

Allow recoil after each compression


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A - AIRWAYOpen the Airway:

Use the head tilt/chin

lift method Place one hand on

the victims forehead

Place fingers of otherhand under the bonypart of lower jawnear chin

Tilt head and lift jaw--avoid closingvictims mouth


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Head Tilt Chin Lift Maneuver

This maneuver prevents airway obstructionby the epiglottis.


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B - BREATHINGGive 2 one-secondbreaths

Maintain airway Pinch nose shut

Open your mouthwide, take a normal

breath, and make atight seal aroundoutside of victims

mouth

Give 2 full breaths(1 sec/ breath)

Observe chest rise &fall; listen & feel for

escaping air


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PULSE CHECK

RECHECK PULSE EVERY 2 MINUTES(equivalent to 5 cycles CPR)

Very brief pulse check should take

less than 10 seconds (at the same timecheck for normal breathing)

In case there is any doubt about the

presence or absence of pulse,CONTINUE CHEST COMPRESSIONS

For trained healthcare providers only


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UNTIL

HELP ARRIVES.(Emergency Services, Ambulance, Doctor, AED)

PERSON IS REVIVED.

If th i ti i b thi


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If the victim is breathing

The unresponsive victim with spontaneous

respirations should be placed in the recoveryposition if no cervical trauma is suspected.

Placement in this position consists of rolling thevictim onto his or her side to help protect theairway.

Maintain open airway & position the victimTHE RECOVERY POSITION

Summary of Key BLS Components for Adults and Children


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Maneuvers Adults Children

RECOGNITION UNRESPONSIVE

No breathing,

not breathing normally (eg. only gasping)

No breathing or only gasping

CPR Sequence CAB CAB

Compression Rate At least 100/min

Compression Depth At least 2 inches (5 cm) At least 1/3 AP depth; About 2 inches

Chest wall Recoil Allow complete recoil between compressions

HCPs rotate compressors every 2 minutes

Compressioninterruptions

Minimize interruptions in chest compressionsAttempt to limit interruptions to less than 10 seconds

Airway Head tilt chin lift (HCP suspected trauma: jaw thrust)

Compression-Ventilationratio

30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)

Ventilations: when rescuer

untrained or trained andnot proficient

Compressions only Compressions only

Ventilations withadvanced airway (HCP)

1 breath every 6-8 seconds (8-10 breaths/min)Asynchronous with chest compressions

About 1 second per breathVisible chest rise

DEFIBRILLATION ( AED ) Attach and use AED as soon as available. Minimize interruptions in chest

compressions before and after shock, resume CPR beginning with compressionsimmediately after each shock

Summary of Key BLS Components for Adults and Children


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MEMORIZE THE STEPS! Survey the scene.

Check responsiveness hey hey are you ok? Call for help! Activate EMS [Quick check pulse within 10 secs]

C Chest Compressions: 30 x; 100/min; 2 inchesdeep; push hard and fast

A - Airway: head tilt chin lift B Breathing: 2 breaths (1 second/breath) Chest compressions 30 x Continue cycles 30:2 compression-ventilation

[Quick check pulse every 2 mins] Until:

EMS arrives (AED, doctor, ambulance) Patient has signs of life


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Compression-only bystander CPR

Hands Only CPR


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Hands Only CPR shouldonly be used for adult

victims who havesuddenly collapsed orbecome unresponsive.


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Recommendations: All victims of cardiac arrest should receive

high-quality chest compressions

When an adult suddenly collapses, allbystanders should activate their community

EMS and provide high-quality chestcompressions, minimizing interruptions(Class I).

Hands Only CPR


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Recommendations: If not trained in CPR, provide hands-only

CPR (Class IIa) until

AED arrives EMS providers take over care of the victim

If trained in CPR, provide eitherconventional CPR using a 30:2compression-to-ventilation ratio (ClassIIa) or handsonly CPR (Class IIa)

Hands Only CPR


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K Ch g i th N G id li


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Key Changes in the New Guidelines

CAB instead of ABC

Compress first No more Look Listen and Feel

Harder! At least 2 inches compression (old: 1 to 2inches)

Faster! At least 100/min compression (old: up to100/min)

Deemphasize pulse checks

For trained healthcare providers not more than 10 secs Check for normal breathing together with check for

unresponsiveness

Hands only CPR for the untrained lay rescuer

I t t P i t


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Important Points There are no mistakes when you perform CPR.

The only harm is to delay responding.Start chest compressions now viewed as the most

effective procedure

All victims in cardiac arrest need chest compressions.

Don't stop pushing.Keep pushing as long as you can. Push until the AED is in

place and ready to analyze the heart. When it is time to do mouthto mouth, do it quick and get right back on the chest.

80-90% of cardiac emergencies occur at home.

Training is now simpler and more accessibleReduced number of steps and simplified process


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Being trained to do CPR can save a

loved one.

Effective CPR done immediately aftercardiac arrest can double a victims

chance of survival.


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Disaster Nursing

Adaptation of professional nursing skills inrecognizing and meeting the nursingphysical and emotional needs resulting

from a disaster. The overall goal of disaster nursing is to

achieve the best possible level of health

for the people and the community involvedin the disaster.


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1.Natural

2. Human-

Caused

3. Technological

Disaster Agents / Epidemiology
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Disaster Agents / Epidemiologyof Disaster

Agent1. Environment2. Host

Primary Agents:It includes falling of buildings, heat wind

rising waters and smoke. Secondary Agents:

It includes bacteria and viruses that producecontamination or infection after the primaryagent has caused injury or destruction.


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Primary or secondary agent will varyaccording to the type of disaster.

For example: - A hurricane with risingwater can cause flooding and high winds,

these are primary agents. The secondaryagents would include damaged buildingsand bacteria or viruses that thrive as a

result of the disaster. In an epidemic thebacteria or virus causing a disease is theprimary agent rather than the secondaryagent.

Factors affecting disaster


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Factors affecting disaster

Host factorsIn the epidemiological frame work asapplied to disaster the host is human-kind.Host factors are those characteristics of

humans that influence the severity of thedisaster effect. Host factors include:

Age

Immunization status

Degree of mobility

Emotional stability

Environmental factors


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1. Physical Factors- Weather conditions, the availability offood, time when the disaster occurs, theavailability of water and the functioning ofutilities such as electricity and telephoneservice.2. Chemical Factors

- Influencing disaster outcome includeleakage of stored chemicals into the air, soil,ground water or food supplies.

Eg: - Bhopal Gas Tragedy.



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3. Biological Factors

- Are those that occur or increase asresult of contaminated water, improper

waste disposal, insect or rodentproliferations improper food storage or lackof refrigeration due to interrupted electrical

services.Bioterrorism: Release of viruses, bacteria orother agents caused illness or death.



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4. Social Factors:- Are those that contribute to the individual

social support systems. Loss of family members,changes in roles and the questioning of religious

beliefs are social factors to be examined after adisaster.5. Psychological Factors:

- Psychological factors are closely related to

agents, host and environmental conditions. Thenature and severity of the disaster affect thepsychological distress experienced by the

victims.



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4. Social Factors:- Are those that contribute to the individual

social support systems. Loss of family members,changes in roles and the questioning of religious

beliefs are social factors to be examined after adisaster.5. Psychological Factors:

- Psychological factors are closely related to

agents, host and environmental conditions. Thenature and severity of the disaster affect thepsychological distress experienced by the

victims.

PHASES OF DISASTER &


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PHASES OF DISASTER &EMERGENCY


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Mitigation: Lessen the impact of a disaster before it strikes

Preparedness: Activities undertaken to handle a disaster when

it strikes

Response: Search and rescue, clearing debris, and feeding

and sheltering victims (and responders if

necessary). Recovery:

Getting a community back to its pre-disasterstatus

Mitigation


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Mitigation

Activities that reduce or eliminate a hazard

Prevention

Risk reduction

Examples

Immunization programs

Public education

P d


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Preparedness

Activities that are taken to build capacityand identify resources that may be used

Know evacuation shelters

Emergency communication plan

Preventive measures to prevent spread ofdisease

Public Education

Response


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Response

Activities a hospital, healthcare system, orpublic health agency take immediatelybefore, during, and after a disaster or

emergency occurs

Recovery


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Recovery

Activities undertaken by a community andits components after an emergency ordisaster to restore minimum services and

move towards long-term restoration. Debris Removal

Care and Shelter

Damage Assessments Funding Assistance
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What is Triage?

French verb triermeans to sort

Assigns priorities

when resourceslimited

Do the best for thegreatest number of

patients

Why is Disaster Triage needed
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Why is Disaster Triage needed

Inadequate resource to meet immediateneeds

Infrastructure limitations

Inadequate hazard preparation Limited transport capabilities

Multiple agencies responding

Hospital Resources Overwhelmed

Advantages of Triage


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Advantages of Triage

Helps to bring order and organization to achaotic scene.

It identifies and provides care to those who arein greatest need

Helps make the difficult decisions easier

Assure that resources are used in the mosteffective manner

May take some of the emotional burden awayfrom those doing triage

Who Decides in triage


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Who Decides in triage

Nurses dont act for legal fears of being blamedfor deaths, and lack of clarity on where they fit inthe command structure

Nurses function to the level of their training andexperience.

If nurses they are the most trained personnelthe site, they are in charge.

oTriage Categories during a


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o age Catego es du g aMass Casualty Incident (MCI)

Triage category Priority 1 Color: RedImmediate:

- Injuries are life-threatening but survival with

minimal interventions.- Individuals in this group can progress rapidly to

expectant if treatment is delayed.

e.g. Sucking chest wound, airway obstruction,

shock, hemothorax, tension pneumothorax,unstable chest and abdominal wounds, openfractures of long bones.



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g g gMass Casualty Incident (MCI)

Delayed: Priority 2 Color: Yellow- Injuries are significant & require medical care,

but can wait hours without threat to life or limb.

- Individuals in this group receive treatment onlyafter immediate casualties are treated.

e.g. Stable abdominal wounds without evidence ofsignificant hemorrhage, soft tissue injuries,

fracture requiring open reduction.



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Minimal: Priority 3 Color: Green

- Injuries are minor and treatment can be delayedhours to days. Individuals in this group should

be moved away from the main triage area.e.g. Upper extremity fractures, minor burns,

sprains, small laceration without significantbleeding.



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Expectant: Priority 4 Color: Black

- Injuries are extensive and chances of survivalare unlikely even with definitive care.

- Persons in this group should be separated fromother casualties, but not abandoned.

e.g. Unresponsive patients with penetrating headwounds, high spinal cord injuries, woundsinvolving multiple body surface area, no pulse,no BP, pupils fixed and dilated.

ncm 104 - emergency lecture (1)

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