EMERGENCY NURSING AND DISASTER NURSINGGILBE RT T. SALACUP RN,MSN
Emergency Action Principles Use to get an accident situation under control quickly. Survey the scene CALL 911/ EMERGENCY RESPONSE TEAM Do a primary survey A-- AIR WAY B-- BREATHING C-- CIRCULATION D-- DISABILITY E-- EXPOSURE H-- HEMORRHAGE S-- SPINALCORD INJURYGILBERT T. SALACUP RN,MSN
AIRWAY: IS IT OPEN? MINIMIZE NECK MOVEMENTS MUCHAS POSSIBLE; APPLY CERVICAL COLLAR IFAVAILABLE. 2 WAYS IN OPENING THE AIRWAY **HEAD TILT – CHIN LIFT MANEUVER **JAW THRUST MANEUVERBREATHING:IS THE VICTIM BREATHING? CHECK ( 3 – 5 SEC.) L ---- LOOK, L ---- LISTEN, F ---- FEEL.GILBERT T. SALACUP RN,MSN
CIRCULATION IS THERE A PALPABLE CAROTID PULSEFOR ADULT AND BRACHIAL PULSE FOR CHILD ANDINFANT. CHECK ( 10 SEC. )DISABILITY IS THERE INJURY TO THE NERVOUSAND MUSCULOSKELETAL SYSTEMS?STABILIZE “C”- SPINE.GILBERT T. SALACUP RN,MSN
EXPOSURE: REMOVE VICTIM FROM OFFENDING ENVIRONMENT. IF NECESSARY, PLACE TENT OVER VICTIM. HEMORRHAGE : LOOK FOR SEVERE BLOOD LOSS, CSF LEAK. SPINALCORD INJURY : CHECK FOR THE SENSORY RESPONSE, AND OBVIOUS DEFORMITY ON THE SPINE.GILBERT T. SALACUP RN,MSN
Triage Categories of severity Black / Expectant–Last priority**Dead person Red / Immediate**first priority**"cannot wait"GILBERT T. SALACUP RN,MSN
YELLOW / OBSERVATION **2ND PRIORITY** THEIR CONDITION IS STABLE FOR THE MOMENT BUT REQUIRES WATCHING. GREEN / WAIT (WALKING WOUNDED)* *3RD PRIORITY** REQUIRE A DOCTORS WHITE / DISMISS (WALKING WOUNDED) *4RTH PRIORITY* DOCTORS CARE IS NOT REQUIREDGILBERT T. SALACUP RN,MSN
REDA - irway Compromise,E - clampsiaI - mmediate Chest wounds,O - pen fractures,U –n Severe shock, 2-3 burnsCa - rdiac arrest,S - pine injury cervical,M -ultiple system trauma,A - ltered level of consciousnessGILBERT T. SALACUP RN,MSN
GILBERT T. SALACUP , RN Shock is a critical physical condition due to failure of the circulatory system to maintain adequate blood flow in the body and ceases the delivery of oxygen and nutrients to vital organs. BASIC CAUSES OF SHOCK . Pump-failure . Hypovolemia Relative HypovolemiaGILBERT T. SALACUP RN,MSN
THREE STAGES OF SHOCK THE COMPENSATORY STAGE OF SHOCK BP normal limits. shunted from the kidney, skin and GIT to the vital organs- brain, liver. PROGRESSIVE STAGE OF SHOCK regulate blood pressure can no longer compensate and the mean arterial The overworked heart becomes dysfunctional. IRREVERSIBLE STAGE OF SHOCK there is severe organ damage that patients do not respond anymore to treatment. Survival is almost impossibleGILBERT T. SALACUP RN,MSN
TYPES OF SHOCK 1. CARDIOGENIC – HEART STOP TO PUMP DUE TO HEART DSE. 2. ANAPHYLACTIC --- SEVERE ALLERGIC REACTION 3. HYPOVOLEMIC --- SEVERE FLUID LOSS 4. PSYCHOGENIC --- CAUSE BY ANXIETY, FEARS, ALTERED ADAPTATION IN TRAUMATIC EXPERIENCE 5. NEUROGENIC --- CAUSE BY SPINAL FRACTURE OR DISLOCATION 6. METABOLIC --- LOSS OF BODY FLUIDS 7. RESPIRATORY ---- AIR WAY OBSTRUCTION AND HYPERVENTILATION 8. SEPTIC --- SEVERE BACTERIAL INFECTIONGILBERT T. SALACUP RN,MSN
SIGNS AND SYMPTOMS 3. Early Stage: Pa- llor/cyanosis, Co- ld/clammy skin, Sha- llow and irregular breathing, Ra- pid and weak pulse, Dilated pupil. N - /V, Thirst, 2. Late Stage: V - acant eye, A - pathetic/unresponsive, De - creased blood pressure, De - creased temperature. MO - ttled appearance,GILBERT T. SALACUP RN,MSN
TRIAD SYMPTOMS OF SHOCK Hypo - tension; Tachy - cardia Tachy - pnea Co - nsciousness Altered Nsg Dx: FLD VOLUME DEFICIT r/t dec in blood Vol. Priority Intervention: Fld replacement (D5Lr, NSS. Bld Trans – for jehova’s use plasma expander) GILBERT T. SALACUP RN,MSN
BODY RESPONSE TO SHOCK Hyven - Hyper ventilation -> Respiratory alkalosis Flu - Fluid Shifts Intracellular to intracellular V - Vasoconstriction CT - Tachycardia IM - Impaired metabolism and organ functionGILBERT T. SALACUP RN,MSN
DRUGS USED TO TREAT SHOCK C – Corticostiroids – use in septic shock protect cellmembranes and decrease inflammatory response to stress A – Antibiotics –infectious process related to septic shock N - Norephineprine (levophed) improve cardiac contractility and cardiac output potent vasoconstrictor D – Dopamine (Intropin) perfusion of kidneys & urine output D - Dobutamine (Dobutrex) increase myocardial contractility, vasodilator. D - Digitalis preparation improve cardiac performance I - Isoproterenol (Isuprel)increase myocardial contractility S - Sodium Nitropusside Vasodilator, increase cardiac output, use in cardiogenic shock, and hypertensive emergency.GILBERT T. SALACUP RN,MSN
EMERGENCY NURSING MANAGEMENT A - irway P - Promote restoration of blood volume;administer fluid and blood replacement as ordered A - Administer drugs as ordered M - Minimize factors contributing to shock. Best Position Modified trendelenburgeGILBERT T. SALACUP RN,MSN
WOUND GILBERT T. SALACUP , RN A BODILY INJURY CAUSED BY PHYSICAL MEANS, WITH DISRUPTION OF THE NORMAL CONTINUITY OF STRUCTURES.GILBERT T. SALACUP RN,MSN
CLOSED WOUND Cause by a damage of a tissue with in the layer of the skins and to the layer of the skin without breaking the continuity of the skin. Contusions (more commonly known as a bruise) caused by blunt forc trauma that damages tissue under the skin. Hematoma- (also called a blood tumor) caused by damage to a blood vessel that in turn causes blood to collect under the skin. Crushing Injuries caused by a great or extreme amount of force applied over a long period of tissueGILBERT T. SALACUP RN,MSN
NURSING MANAGEMENT I – ICE APPLICATION (10 – 15 MIN ) C -- COMPRESSION ( DIRECT PRESSURE ) E – ELEVATION ( ABOVE THE HEART ) OPEN WOUND IS A BREAKE IN THE CONTINUITY OF THE SKIN RESULTING IN SHEDING OF BLOOD, AND CREATATING A PORTAL OF ENTRY FOR MICRO ORGANISM.GILBERT T. SALACUP RN,MSN
A – ABRAISION *( GRAZES) - A SUPERFICIAL WOUND IN WHICH THE TOPMOST LAYER OF THE SKIN (THE EPIDERMIS) IS SCRAPED OFF. S – SUCKING WOUND * A PENETRATING WOUND OF THE CHEST THROUGH WHICH AIR IS DRAWN IN AND OUT. A – AVULSION *THE FORCIBLE TEARING AWAY OF A BODY PART BY TRAUMA. L – LACERATION *TISSUES ARE TORN. AN EVEN CUT. I – ISCISION * ONE CAUSED BY A CUTTING INSTRUMENT. CLEAN CUT.GILBERT T. SALACUP RN,MSN
EMERGENCY CARE PROCEDURES: Wash --wash the wound Co – Control bleeding co – Cover the wound Lo – Look for drop BP and TEMP. Co – Consult a doctorGILBERT T. SALACUP RN,MSN
BRUISES, STRAINS, SPRAINS, DISLOCATIONS. Use rice. Amputation 3. Control Bleeding 4. Find the severed part Seek Immediate medical attention. Chest Injuries 6. Check ABC 7. Stabilize Chest using pillow, coat or blanket. 8. Seek medical attention 9. Do not remove impaled object. Eye injuries 1. Protect injured eye 2. Patch unaffected eye 3. Do not remove object stuck on the eye Do not apply hard pressureGILBERT T. SALACUP RN,MSN
FRACTURE EMERGENCY CARE PROCEDURES: A -- Avoid putting pressure on he affected area R – Rest ( 20-30 min q 2 – 3 hrs. in 1st 24 – 48 hrs ) I – Ice application S – splint ( use to stabilize ) Head and Spinal Injury EMERGENCY CARE PROCEDURES: S - Stabilized the spine Co - Control bleeding As - Asses for bladder distention and pineal erection Do - Do not irrigate or clean the skull wounds Do - Do not stop the flow of blood or CSF from the ear or nose N - NPO Co - Consult a doctorGILBERT T. SALACUP RN,MSN
CLASSIFICATION FIRST DEGREE: “ SUPERFICIAL” ONLY INVOLVES EPITHELIAL LAYER. OFTEN VERY PAINFUL BUT RESOLVES WITH NO RESIDUAL SCARRING. SKIN IS RED AND PAINFUL BUT NO BLISTERS. SECOND DEGREE:* PARTIAL THICKNESS* INVOLVES EPITHELIUM AND PART OF DERMIS. PAIN AND SCARRING VARY ACCORDING TO DEPTH OF BURN. WITH BLISTER FORMATION. THIRD DEGREE : *FULL THICKNESS*. USUALLY PAINLESS. USUALLY DRY AND HAVE MILKY WHITE OR TANNED LEATHER APPEARANCE.GILBERT T. SALACUP RN,MSN
EMERGENCY CARE PROCEDURES So -- Soak in cold water/ apply cold dressing ( w/o open wound or prick blister) 1st degree do not cover w/ dressing SO -- Soak in cold water/ apply cold dressing Cover the wound w/ non sticky dry sterile dressing /clean cloth ( 2nd degree w/ open wound and) CO -- Cover the wound w/ non sticky dry sterile dressing /clean cloth 3rd degree A – a blister has formed, Co -- Consult you Physician.GILBERT T. SALACUP RN,MSN
CHEMICAL BURNSWa – wash with water for 15 min.Kee – Keep eye open, flush with water or milk immediately.
Fluid Replacement Formula Consensus FormulaLRS: 2-4ml x kg wt x % tbsa½ 1st 8 hrs½ 16 hrs Parkland FormulaLRS: 4ml x kg wt x % tbsaDay 1.½ 1st 8 hrs½ 16 hrsDay 2Colloid is added
SILVER SULFADIAZINE - (MOST bactericidal Agent) 1-3x/dayActicoat – for yeast and molds( againts gram + & - )Mafenide actate 5-10% - Easily absorb (against gram + & - ) 2x a daySilver Nitrate- Anti bacterial does not penetrate escar fungicide, Cover dry gauze remoisten it q 2 hrs
•HEAT EMERGENCIES IN HUMANSUNEXPECTED CHANGES IN THE WEATHER 2 BASIC ENVIRONMENTAL EMERGENCIES 2E EXPOSURE TO HEAT EXPOSURE TO COLD SIGNS AND SYMPTOMS** RAPID, SHALLOW BREATHING ** COLD, CLAMMY SKIN,**HEAVY PERSPIRATION **GENERAL WEAKNESS, ** POSSIBLE LOSS OF CONSCIOUSNESS.
Heat Cramps CAUSE BY ELECTROLYTES IMBALANCE, ARTICULARLY EXESIVE LOSS OF SALT. EMERGENCY CARE PROCEDURES: Move - Move victim to a cool place. Give - Give fluids, preferably with electrolytes. Massage - Massage affected muscles (firm pressure massage). Apply - Apply moist towels to forehead and cramped muscles. Call - Call for transportation to medical care if symptoms persist.
HEAT SYNCOPERESULT FROM INTENSE SWEATING WHICH LEAD TO DEHYDRATION FOLLOWEDBY PERRIPHERAL VASODILATION.HEAT EXHAUSTION HEAT EXHAUSTION IS A MORE SERIOUS RESULT OFHEAT EXPOSURE. CAUSE BY ELECTROLYTES IMBALANCE,PARTICULARLY EXESIVE LOSS OF SALT.HEAT STROKECAUSE BY A EXTREME BODY TEMP. THAT THEBODY WAS NOT ABLE TO REGULATE IT ANDRELATED ALSO TO IMPAIRED SWEATINGMECHANISM.
EMERGENCY CARE PROCEDURESActivate EMS system (call 911)Move - Move victim to a cool place.Rest - Rest victim.Remove - Remove enough clothing to cool.Give - Give fluids with electrolytes (to conscious victims only).Treat for shock.Victim - Victim needs high concentration of oxygen.Call - Call for transportation to definitive medical care.
HYPOTHERMIA1. Get the victim out of the cold2. Replace wet cloths with dry warm cloths.3. Keep flat and provide other source of heat.NO. No. Things Do not give warm drinks Do not wrap with blanket unless with out other source of heat. Do not engage with physical exertion.
STROKE **occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die.S/S Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body. Trouble seeing in one or both eyes. You may have double vision, or things may look dim or blurry. Confusion or trouble understanding. Slurred or garbled speech. Trouble walking. You may feel unsteady, dizzy, or clumsy. Severe headache.
Causes** thrombus/ ischemic/ clot**Risk factors4. Atrial fibrillation5. Hypertension6. DM7. Smoking S/S of affected part of the BrainLeft hemisphere Right hemisphereLanguage problem/ Perceptual deficitaphasiaPt is cautious Impulsive behavior
2 type of strokeischemic stroke develops when a blood clot blocks a blood vessel in the brain.hemorrhagic stroke develops when an artery in the brain leaks or bursts.TIA – Acute neurogical deficit lasting for 24 hrs.S/S Pt is irritable2. Pt appears in a deist3. Disarchia4 Temporary blindness
EMERGENCY CARE PROCEDURES:** Check for ABSDEHS**** keep in side lying position****Seek immediately medical help.SEIZURES due to uncontrolled electrical activity in the brain causes involuntary muscle contraction.EMERGENCY CARE PROCEDURES:1. Do not move/stimulate the victim2. Ensure safety “ remove all near by objects”3. after seizure ‘’ loosen tight clothings turn to side’’4. Consult a doctor
DIABETIC EMERGENCYEMERGENCY CARE PROCEDURES:** provide sugar (candy, soda,frit juice)**Consult a doctorASTHMAEMERGENCY CARE PROCEDURES:1. RELAXATION TECHNIQUES ‘pursed lip breathing’2. SIT Up RIGTH3.Assist the victim in his meds.4. Consult a doctor
CARDIAC heart stop pump, or it pumps insufficient blood causing-- Occurs when the ARREST deprivation of o2 to the vital organs.THREE CONDITIONS OF CARDIAC ARREST1. CA -- CARDIO VASCULAR COLLAPSE2. VE -- VENTRICULAR FIBRILLATION3. CAR -- CARDIAC STANDSTILLMyocardial Infarction Angina PectorisPain at rest Pain upon ExertionNot Relive by Nitroglycerin Relive by NitroglycerinCrushing pain SameSevere MildNot Relive above 15 min. Relive by rest 2 -3 min.Severe chest pain Diaphoresis
EMERGENCY CARE PROCEDURESL --Limit Stressful activityS -- Stop the victim from what his doingO -- Open the airwayA -- Assist the victim in taking the his prescribe medsP -- Perform CPR If – P and – B (30:2)Priority Nx diagnosis Decrease cardiac outputCause of death in MI12. Arrhythmias13. Ventricular fibrillationChokingEMERGENCY CARE PROCEDURESInfant – 5 Back blows and 5 chest ThrustAdult & Child – Heimlich maneuver, abdominal and chest thrust.
ANY SUBSTANCE THAT CAUSING ILLNESS OR DEATH WHENEATEN, DRUNK, OR ABSORBED EVEN IN RELATIVELY SMALLQUANTITIES.INGESTED/ SWALLOWED – BY MOUTHEMERGENCY CARE PROCEDURES:1. SYRUP OF IPECAC IS NOT A ROUTINE TREATMENT FORPOISONING.2. ACTIVATED CHARCOAL IS NOT RECOMMENDEDFOR HOME USE.3. GIVE MILK OR WATER IMMEDIATELY4.. POSITION THE VICTIM IN LEFT SIDE LYING.5. IDENTIFY THE POISON AND HOW MUCH ANDWHEN TAKEN.6. CALL POISON CONTROL CENTER.
Inhaled – by breathing EMERGENCY CARE PROCEDURES 1. Remove the victim form the toxic environment and into fresh air immediately. 2. Give 100% of O2 3. Call poison control center.Injected poisoning poison that enters the body through a bite, sting, or syringe.EMERGENCY CARE PROCEDURES1. Remove the stinger2. Wash the wound3. cold compress
Absorbed poisoningEMERGENCY CARE PROCEDURES1. Remove the cloth ( cut the cloth )2. Flash it w/ water away from the body part3. observe for allergic reaction.
VENOMOUS NON VENOMOUSMovement Cortina, Semi cortinaor locomotionHead Semi-triangular RoundSkin Rough SmoothManner Non-constrictor Constrictorof attackPupil Vertical sphere/OblongBody Semi-triangular OblongatedBite mark fang mark Horseshoe shapevisible
SNAKE BITE1. Keep the affected area lower than the heart2. Clean w/ soap and water3. Splint part to reduce movement4. Limit annescerary movement5. Call poison control center.Motor Vehicle Accident Do not rush to get the victims out, contrary to opinion most vehicle crashes do not involve fire
Internal bleeding Check ABC Lie on side Treat shock Seek medical attentionExternal bleeding7. Direct wound pressure8. Elevate9. Pressure points10. Tourniquet
AIR WAY OBSTRUCTION1. Typesb. Anatomical b. Mechanical2. Classificationf. Mild b. SevereManagement8. Head tilt chin lift 2. jaw thrust3. Heimlich 4. Chest and abdominal thrust
NOSE BLEEDINGEMERGENCY CARE PROCEDURESSit upright , head bent slightly forward, pinch the nostrils, breath trough our mouth.Water rescue – “Reach, Throw, Row, Go”
GILBERT T. SALACUP , RNTEST TAKING TECHNIQUES1. Discern The Exam Concentrate on fundamentals Therapeutic Communication Aseptic Techniques Safety Nursing Priority Basic law touching the practice lot of Question from Community Ethical Practice select ans. Respecting human Rights
GILBERT T. SALACUP , RN2. Prepare your self Get enough rest Eat right Drink your vit. Exercise Avoid negative talk Release anxiety to your friends Seek help and verbalize Relaxation techniques3. Organize your study time. There maybe no two individuals who will have the same way of studying. Some prefer studying at night while some, early in the morning or during the day. Some, may have so much work at home, they can only spare a few hours studying. Whatever is your circumstances is, there are the basic rules in organizing study time:
GILBERT T. SALACUP , RN Make a checklist of all the things to review. Make a schedule of this checklist. Don’t overkill. Do not give so much time on one area while forgetting the others. Don’t just use your favorite area, give equal time even on those that you feel are not coming out of exam. Organize your study time by reviewing on the basic first, then at the last part of your schedule, make sure you test yourself by answering exam question. Allow much flexible to accommodate your other important activities. I always help to remove all distraction like cell phones and television. Boyfriends and girlfriends may schedule later.
GILBERT T. SALACUP , RN4. let’s dissects the Monkey. Read the question carefully from the first word to the last word. Remember not to miss out on key words that would lead you to what the question is really asking for. look for hints…-“most, first, best, initial”- indicate you must establish priorities.-“further teaching is necessary”- answer will contain incorrect information.-“understand the teaching”- answer will be correct information.3. rephrase the question in your own words so that it can be answered w/a ”yes” or a “no”, or w/ a specific bit of information. -“what”.”when”, “why”
GILBERT T. SALACUP , RNExample: The nurse should teach the patient who was cirrhosis of the liver to avoid w/c of the ff. food in the diet?a. Baked chickenb. Apple piec. Macaronid. SpinachRephrase: what is the metabolic problem of the patient w/ liver cirrhosis? Answer: he cannot digest fatWhat food is contraindicated for the patients w/ liver cirrhosis Answer: fatty foods. Thus, among the choices, baked chicken should not be given.
GILBERT T. SALACUP , RNHOW TO SCORE POINTS Step1. Read the question. Spend more time on reading the question. learn to rephrase. Underline the key words to increase tour understanding on the important aspect of the problem. Step2: after reading the question, stop. Before looking at the options, think of an answer. Step3: selection pass. In selecting the correct answer, read each option carefully and do this. Step 3.1 cover all answer choices except one.
GILBERT T. SALACUP , RNStep3.2 read answer choices1. then repeat the REWORDED QUESTION after reading answer choice. As yourself… “does this answer the REWORDED QUESTION. If it does not – eliminate Not sure- leave the answer choice for consideration Step 3.3 repeat the above process w/ each remaining answer choices. Step 3.4 note w/c answer choice remain. Step 3.5 reread the question to make sure you have correctly identified the REWORDED QUESTION
GILBERT T. SALACUP , RNREWORDED QUESTION. STEP 3.6 ask yourself “ w/c answer choices best answer the question?: THAT IS YOUR ANSWER!!!R E M E M B E R ! ! !1. eliminate only what you know is wrong. Once choice has been eliminated.. PUT IT OUT OF YOUR MIND!!!2. stay focus on the REWORDED QUESTION. Not on the back information!!! Don’t fall for distraction!!!3. if your “ideal” answer choice is not there… well don’t sit and moan because it will get you nowhere… read the question again, rephrase, and select the best answer.
GILBERT T. SALACUP , RNLook for Qualifiers“Never, always, all, none” Most often absolute terms, generalizations. Do not choose these options.Look for contrasting options.Usually contrasting option lead you to correct answer.1 of this is the right answer.Example.Mr. bean is suffering from gastric ulcer. As a nurse, you have to prevent dumping syndrome. Which of the ff. preventive measures should noy be taken? a. allow him to lie down after eating b. avoid giving fluids after meal. c. allow him to talk after eating. d. serve dry meals only.
GILBERT T. SALACUP , RNChoices a & c are contrasting option, thus one of these may be the correct option, eliminating b& d. the question may be rephrase to” what is the best position after meals to prevent dumping syndrome?” the answer is… a. allow him to lie down after meal, but the question is asking for the measure that should not be advice, thus the answer is… c3. PRIORITIES. The board exam is testing your ability to decide your priorities in patient care. The most common bases of prioritization are:a. ABC’s – airway, breathing & circulationb. Safety and protection- decide what will cause the least amount of harm. DO NO HARM!!!c. Rights of patient- will of the patient is the basis for action. We are safeguards and advocates of the patient well being.d. Assessment comes before any intervention.e. The less invasive procedures first before invasive one.f. Remember MASLOW!!! Physiologic needs comes as a priorityg. Patient first before equipment.
GILBERT T. SALACUP , RN4. NORMALS-decide if the assessment data being presented in the question is within normal range. If the answer is yes, you just have to look for the option that will not need further intervention.. only continue monitoring or assessment. If the answer is otherwise ,then go ahead and rephrase the question…and follow the steps in answering a question. Familiarize yourself with the values will be much easier than memorizing. Post them on your walls where you see them everyday.
GILBERT T. SALACUP , RN5. Always be therapeutic. Therapeutic simply means choosing the options that will solicit information from the patients and make him/her express his feelings. Usually, we eliminate options that will:6. It is your business not othersEliminate choices that what doctors midwife or social workers do7. Do every thing by the book.Every thing is taken from the books, based on ideal settings.