curative and rehabilitative nursing care management of clients in acute biologic crisis
DESCRIPTION
When I was in college, I used a laptop when typing my notes during lectures. Just want to share. -Arg, Top 8 July 2011 NLETRANSCRIPT
Bio-Crisis – Ms. Lina Navarro
1
Curative and Rehabilitative Nursing Care Management of Clients in Acute Biologic Crisis
Lina B. Navarro, RN
4 Days
Grading System
Q – 50% T – 40% P – 10% Course Content
Basic Concepts of Emergency First Aid
Intensive/Critical Care Nursing
Specific Biologic Crisis Situations
Disasters
Basic Concepts of Emergency First Aid Nursing
Definition of Terms
o Emergency – a situation which poses an immediate risk to life, heath, property or environment
o Emergency Care – care given to clients with urgent or critical needs
o Emergency Nursing – a nursing specialty in which nurses care for patients in the emergency or critical phase
of their illness of injury
o Paramedics – health care professional specializing in emergency medicine
o Emergency Medical Service (EMS) – a service providing out of hospital acute care and transport to definitive
care
Characteristics of Emergency Nurses
o Skilled at dealing with clients in the phase when a diagnosis has not yet been made and the cause of the
problem is not known
o Specialize in rapid assessment and treatment when every second counts
o Tackle diverse tasks with professionalism efficiency, and above all – caring
o Possess both general and specific knowledge about health care
o Ready to treat a wide variety of illnesses or injury situation, ranging from a sore throat to a heart attack
First Aid
o Immediate and temporary care given to a person who is injured or who suddenly becomes ill before
professional medical care is available
o Goals: 3 P’s
Preserve life
Prevent further injury
Promote recovery
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Characteristics of a Good First Aider
o Gentle
o Resourceful
o Observant
o Tactful
o Empathic
o Respectable
Contents of a First Aid Kit
o Hemorrhagic Control
- Tourniquet
- Gauze
- Bandage
- Clamps
o Spinal Immobilization
- Backboard
- Cervical collar
o Extremity Immobilization
- Splint
- Bandage
- Slings
o Labor and Delivery
- Clamps
- Scissors
- Suction
- Linen
- Gauze
o Resuscitation
- Ambu bag
- Bag Valve Mask Device
- O2 tank (mask and cannula)
o Emergency Drugs
- Epi
- AtSo4
- Dopamine
o Wound Care
- Betadine
- Gauze
- Alcohol
- PNSS
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Ethical, Legal and Medical Issues in Nursing
Ethical Principles
o Autonomy – pertains to the right to make one’s own choices
o Beneficence – the duty of health care providers to be a benefit to the patient as well as to take positive
steps to prevent and to remove harm from the patient
o Non-maleficence – is the principle of doing no harm
o Justice – an equal distribution of risks and benefits. It is usually defined as a form of fairness.
o Veracity – is the ethical principles of honesty
o Fidelity – being true to our commitments and obligations to others
Ethical Responsibility
o Makes the physical/emotional needs of the patient a priority
o Practice/maintain skills to the point of mastery
o Critically review performances – self critical
o Attend continuing education/refreshes/programs
o Be honest in reporting – documentation
Duty to Act
o Legal obligation to provide patient care
1. When employment requires
2. When a pre-existing responsibility exists
3. When first aid has begun
Good Samaritan Acts
o Immunity from civil liability when providing assistance at the scene of an emergency; unless you did
something negligent
1. Do not leave the scene until the injured person leaves or another qualified person takes over
(Abandonment)
2. Limit actions to those considered first aid, if possible
3. Offer assistance, but don’t insist
4. Have someone call or go for additional help
5. Do not accept any compensation
Privacy and Confidentiality
o Sharing of confidential information by the nurse about a patient’s condition is legal when:
- Information is shared with other members of the health care team
- With client’s consent (signs a written release)
Negligence – failure to provide care what another prudent person would allow do under the same circumstances
Malpractice – “professional negligence”
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Elements of Malpractice
1. Duty
2. Breach of Duty
3. Damages
4. Causation
Terms
o Abandonment
o Assault and Battery
- Assault – verbal threat
- Battery –threats into action; procedure without explaining
o Consent
- Informed (client is aware or told of procedure)
- Implied
- Minors (can’t sign consent except those who are married, pregnant, parents, emancipated,
military)
- Mentally-ill (they can sign consent)
o Refusal of treatment
o Restraints – needs doctor’s order
o Advance Directives – written statement that specifies medical treatment desired, if px is unable to make
decisions
o Do Not Resuscitate (DNR) Orders
o Organ Donors (save particular organ)
o Medical Identification Devices
o Special reporting requirements
- Abuse of children, elderly, and spouse
- Drug-related injury
- Childbirth
- Infections disease exposure
- Crime scene
- Deceased
Emergency Action Principles
o Scene Size-up/Survey the Scene
- Scene safety/potential hazard
- Mechanism of injury – 4W’s and 1H
- Number of casualties – account for all
- Bystanders – observe bystanders that can help
- Body Substance Isolation (BSI)
o Primary Survey
- Rapid assessment of life threatening conditions
- Must be treated before the assessment continuous
A – Airways
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B – Breathing
C – Circulation
The Body’s Need for O2 Time is Critical 0-1 minutes: Cardiac irritability 0-4 minutes: brain damage not likely 4-6 minutes: brain damage possible 6-10 minutes: brain damage very likely More than 10 minutes: irreversible brain damage The Golden Hour Discovery of incidents and activation of EMS 20 minutes The Golden Ten Minutes Initial Assessment and Intervention EMS intervention EMS packaging and transport 10 minutes Initial Stabilization 20 minutes
o Medical Assistance
o Secondary Survey
Identifies non-life threatening problems
o Neurologic Assessment: GCS, LOC, Pupil reaction
o General Overview: baseline V/S
o Head-to-Toe Assessment: IPPA, DCAPBTLS
o History Information: OPQRST, SAMPLE
Glasgow Coma Scale
Generally, comas are classified as:
Severe, with GCS </= 8
Moderate GCS 9-12
Minor, GCS >/= 13
Eye opening
Spontaneous 4
To Voice 3
To Pain 2
None 1
Verbal response
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible words 2
None 1
Motor Response
Obeys Commands 6
Localizes Pain 5
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Withdraw 4
Flexion 3
Extension 2
None 1
Level of Consciousness
A-Alert
V-Response to Verbal stimulus
P-Responsive to Pain
U-Unresponsive
Golden Rule
Altered level of consciousness is characteristic of nervous system dysfunction and warrants
thorough examination to rule out all possible causes
Change in Pupil Size
- Unequal pupil size (anisocoria) may indicate increased pressure on one side of the brain
General Overview
- Respirations
- Pulse
- Blood pressure
- Temperature
- Pain scale
- Capillary refill
Used as a basis whether client’s conditions is improving or deteriorating
Head-to-Toes Assessment
- Inspections
- Palpation
- Percussion
- Auscultation
DCAPBTLS
- Deformities
- Contusions
- Abrasions/Penetrations
- Punctures
- Burns
- Tenderness
- Lacerations
- Swelling
History Information
- Onset
- Provoking factors
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- Quality of pain
- Radiation of pain
- Severity
- Time
SAMPLE
- Signs and Symptoms
- Allergies
- Medications
- Past medical history
- Last oral intake
- Events leading to the episode
Priority Setting/Triage
o “trier” which means to sort out or prioritize
o To assess and determine the severity or acuity of the presenting problem
o Not a static process
o Purpose:
- Rapidly identify patients with urgent, life-threatening conditions
- Initiate appropriate and immediate interventions
Triage and Acuity Scale Category
Level 1: Resuscitation
- Conditions that threatens life and limb
- Requires immediate and aggressive interventions
- Time to Physician: Immediate
Code/arrest
Major trauma
Shock state
Unconsciousness
Severe respi distress
Level 2: Emergent
- potential threat to life, limb or function, requiring rapid medical intervention
- Time to physician assessment/interview: 15minutes
Altered mental state/CVA
Head injury/severe trauma
Neonates
Chest pain/abdominal pain
Drug overdose
GI Bleed
Asthma/dyspnea
Chemotherapy
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Anaphylaxis
Vaginal bleeding/acute lower abdominal pain
Serious infections/fevers
Diabetes
Diarrhea and vomiting
Acute psychosis/drug withdrawal
Level 3: Urgent
- Potentially progress to a serious problem
- Time to physician: 30 minutes
Head injury/moderate trauma
Asthma/dyspnea, mild/moderate
Chest pain
GI bleed
Vaginal bleeding and pregnancy
Acute pain, moderate
Diarrhea and vomiting
Dialysis
Level 4: Less Urgent (Semi-urgent)
- Conditions related to patient age, distress, or potential for deterioration or complications that would
benefit from intervention or reassurance within 1-2 hours
- Time to physician: 1 hour
Head injury
Minor trauma
Abdominal pain
Chest pain
Head act/earache
Suicidal/depressed
Chronic back pain
URI symptoms
Diarrhea and
Vomiting with no signs of dehydration
Level 5: Non urgent
- Investigations or interventions could be delayed or even referred to other areas
- Time to physician: 2 hours
Minor trauma
Sore throat/URI
Vaginal Bleeding (scanty)
Vomiting alone, diarrhea alone
Psychiatric cases
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Triage Coding
Priority Treatment Color
1 Immediate Red
2 Urgent Yellow
3 Delayed Green
4 Expectant Blue
Dead Black
Deaths
1. Clinical – patient has stopped breathing
2. Biological – brain dead
3. Terminal – cancer patients; process of dying
4. Temporary – Death caused by general anesthesia
5. Sudden – reversible death; CP arrest
Causes of Sudden Death
o V-fib – most common in cardiac arrest
o Electrocution
o Drowning/near drowning
o Drug overdose
o Suffocation
o Insect bites
o Falls/trauma
o Stroke
o Respiratory arrest
- Cessation of breathing
- Occurs first followed by cardiac arrest
o Cardiac arrest
- Stoppage of circulation
o Give BLS
Basic Life Support
BLS
- emergency treatment, to a client/victim having respiratory or cardiac arrest, through cardiopulmonary
resuscitation and emergency cardiac care
- Save heart and brain
Goals
- Emergency oxygenation
- Maintain airway patency
- Support breathing
- Support circulation
- No equipment
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Cardio Pulmonary Resuscitation (CPR)
- Combination of rescue breathing (one person breathing into another person) and chest compression in
lifesaving procedure
- Performed when a person has stopped breathing or a person’s heart has stopped breathing
History of Basic Life Support
- Books of Kings II (4:34), wherein the Hebrew prophet Elisha warms a dead boy’s body and “places his
mouth over his”
- Peter Safar – father of CPR; wrote the book of ABC of Resuscitation in 1957
Basic Life Support
- D-Check for Danger
- R-Responsive? If not, shout for help
- A-open Airway
- B-check Breathing. If non, give 2 initial breath
- C-Circulation. If non, compression 30:2
- D-attach Defibrillator; continue CPR
Phone First
- Cardiac
- Adults
- Children at high risk for cardiac arrhythmias
Phone Fast (act now, call later)
- Respiratory
- Children
- Submersion
- Drowning
- Arrest associated with trauma
- Drug overdose
Steps in CPR
1. Check safety
2. Determine responsiveness
o Are you okay? 2x
o If he responds, no need for CPR; keep safe and reassess
o If no response:
Adults: call EMS immediately
Child/Infant: perform 30:2 x 5 cycles, then call EMS
Lay him face up on a firm, flat surface, moving his head and body simultaneously
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Assess for Breathing:
3. Open airway: head tilt, chin lift.
o If you see foreign object in his mouth or throat, remove them
4. Place your face close to his mouth and observe his chest
o Look – for chest movement
o Listen – at the mouth for breath sounds
o Feel – for airflow on your cheek
Within 5-10 seconds
2 Rescue Breaths
5. If breathing normally, turn to recovery position.
o If no breathing, give 2 rescue breaths at 1 second/breath. (Maintain an open airway. Pinch his nose
and give 2 blows into his lungs)
o The victim’s chest should rise with each blow
o If unsuccessful (no chest rise), reposition head and try again
AR Method
o Adult/Child
- Mouth to mouth, nose pinched
- Mouth to barrier device
- Mouth to nose
- Mouth to stoma
o Infant
- Mouth to mouth and nose
6. Next, feel for pulse at the carotid (neck area) up to 10 seconds
- If there is a pulse, perform artificial respiration at the rate of 12 times per minute, until natural
breathing is restored
- If there is no pulse, immediately begin CPR
- Precordial thumb
7. No Pulse: CPR
- Center the heal of one hand at the center of chest, between nipples, keeping your fingers off the
ribs
- Cover this hand with the heel of your other hand
- Arms straight and elbows locked; push down vertically about 4 to 5 cm and then release
- Compress 5 cycles of 30 compression and 2 full vent in 2 minutes (30:2 X 5 x 2 minutes)
- Do not lift your hands off the chest between compressions. Avoid interruptions
- Repeat pulse check after 2 minutes and every 5 cycles thereafter
Chest Compressions
o Infants
- Just below the nipple line within 2 fingers
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- 1/3 to ½ of the depth of the chest
o Child
- Lower half of the sternum, falling at the nipple line using 1 or 2 hands; 1/3 to ½ in depth
o Adults
- Center of the chest at the nipple line
- Both hands, 1 ½ to 2 inches in depth
8. The moment his pulse returns, immediately stop compression and check for breathing
No breathing, With Pulse
- If the victim is not breathing, perform rescue breathing at 12 times/minute (1 breath every 5
seconds) until victim’s natural breathing is restored
- If both pulse and breathing have returned, place victim in the recovery position and maintain an
open airway
- Continue to monitor for both breathing and pulse every few minutes until heap arrives
2 Rescuer CPR
o Adult: 30:2 x 5 cycles x 2min
o Child/Infant: 15:2 x 5 cycles x 2
Ways to Know if CPR is Effective
o Pupils are constricted
o Px has circulation
o Px has respi
o Px has regained consciousness
Problems During CPR
o Gastric Distention
o Lacerations of internal organs
o Punctured lungs
o Fractured ribs or sternum
When BLS Should not Be Started
o Rigor mortis or stiffening of the body
o Putrefaction of decomposition
o Evidence of non-survivable injury
o Existing DNR or no-CPR order
o Alive
When to Stop CPR
o S – patient Starts breathing and has pulse
o T – patient is Transferred to another person or a higher facility
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o O – you Out of strength (exhaustion)
o P – a Physician asks you to stop (beyond resuscitation)
Foreign Body Airway Obstruction
Causes of Foreign Body Obstruction
o Vomited stomach contents
o Blood clots, bone fragments, damaged tissue
o Foreign objectives
o Swelling caused by allergic reactions
o Relaxation of the tongue (during general anesthesia, mouth guard )
General Signs of Choking
o Attack occurs while eating
o Victim may clutch his neck
o 2 types of Choking
o Mild
o Severe
Mild/Partial Obstruction
Signs of mild airway obstruction:
“Are you choking?”
- Victim speaks and answers yes
- Victim is able to speak, cough and breath
o Encourage to continue coughing but do nothing else
o Administer 100% O2
o Continue to check for deterioration or relief of obstruction
Severe Airway Obstruction
“Are you choking?”
Response
o Unable to speak
o May respond by nodding
o Unable to breath
o Breathing sounds wheezy
o Attempts at coughing are silent
o Victim may be unconscious
Severe Airway Obstruction: Conscious Adult
o Abdominal thrust
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o “Heimlich Maneuver” are a series of under-the-diaphragm abdominal thrusts
o Lifts the diaphragm and force enough air from the lungs to create an artificial cough to move and expel the
foreign body.
Abdominal Thrust: Heimlich Maneuver
Step 1: Ask the choking person to stand if he or she is sitting
Step 2: Place yourself slightly behind the standing victim
Step 3: Reassure the victim that you know the Heimlich maneuver and you are willing to help
Step 4: Place your arms around the victim’s waist.
Step 5: Make a fist with one hand and place your thumb toward the victim, just above the umbilicus and below the
Xiphoid process
Step 6: Grab your fist with your other hand
Step 7: Deliver 5 inward and upward thrusts
Step 8: Repeat until the foreign body is expelled or until the victim becomes unconscious
Severe Airway Obstruction: Unconscious Adult
o Place the patient in a supine position
o Straddle the patient’s hips or legs
o Place the heel of one hand against the abdomen
o Press into the patient’s abdomen with quick inward and upward thrust
o Repeat 5 times
Finger Sweep
o Open the mouth with tongue-jaw lift
o Using the index finger, do a hooking action to dislodge the foreign body
o Done only in unconscious patients
o Done only when the foreign body is visible
o Blind finger sweep should not be performed
o Contraindicated with seizure
Advance Cardiac Life Support
Airway
- ET Intubation
- Give a source of air to be effective O2
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Confirm Placement of ET
- CXR
- Auscultate chest while ventilated by ambubag
- (+) Breaths sounds on both lung fields
- (+) chest wall rise
- Auscultate the stomach
Intubation Complication
- Intubating the right main stem bronchus
- Intubating the esophagus
- Aggravating spinal injuries
- Taking too long to ventilate
- Patient vomiting
- Soft tissue trauma
- Mechanical failure
- Patient intolerant of ETT
- Dec in HR
Airway Adjuncts
- Oropharyngeal airway – oral airway
- Guedel pattern airway
- Maintain a patent airway by preventing the tongue from covering the epiglottis
- Inserted upside down
Cricothyrotomy
Breathing
Respiration
- Spontaneous
- Rate, depth, and symmetry
- Breath sounds
- Bag, valve, mask device
- No breathing: Deliver 8-12 breaths/min
- Spontaneous breathing: together with chest rise
O2 Saturation
- Pulse oximetery
- 96-100% at room air
- No not suction when O2 Sat is below 95%
Bag-valve-mask – delivers more than 90% O2 use; 10-15lpm
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Circulation
- Pulses
- Cardiac rhythm and rate
- Blood pressure
- Capillary refill and skin color
- CPR; 100compresssion/min
- IV lines
Types of Solution
Hypotonic Isotonic Hypertonic
Hydrates Cells Stays Put Expands Volume
.45% NaCl, .33% NaCl D5W LR NSS D10W, D5NS, Albumin
Drugs
Cardiac Stimulants
Epinephrine – adrenergic agonist
- Restores electrical activity
- Bronchodilator
- Vasoconstrictor
- No C/I in cardiac arrest or anaphylactic shock
- Can be given via ET
Atropine SO4 – anticholinergic;
- Red hot, dry, blind, mad
Isoproterenol – bradycardia
Cardiac Stimulant
Drug Action Side Effects
AtSo4 IV, ET, PO, IM
Blocks vagal stimulation I: Bradycardia, organophosphate poisoning
Red, hot, dry, blind, mad
Isoproterenol (Isuprel) IV Enhances myocardial contractility I: Bradycardia
Tachycardia, Inc BP
Dopamine HCl – sympathetic agents
- Shock drug
- Enhances force (inotropic) of heart contractions
- Increase rate (chronotropic) of heart contractions
- Renal dose, cardiac dose, vasopressor dose
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Dobutamine
Norepinephrine
- Potent vasoconstrictor
Cardiac Glycosides (Digitalis)
Lanoxin, Digoxin
- CHF, atrial fibrillation
- Slows and strengthens heart beat
- Toxicity
Bradycardia and/or dysrhythmias
Anorexia, nausea and vomiting
Green and yellow vision
Check K levels, PR > 90
Antianginal Drugs:
Nitrates and Nitrites
- Isordil, NTG, Nitrostat
- Vasodilator
- Check for Hypotension and potency
Morphine SO4
- Narcotic analgesic
- Relieves pain, vasodilation
- N and V, hypotension, respiratory depression
- Antidote: Narcan
Drugs Used to Treat Ventricular Dysrhythmias:
Adenosine
Lidocaine HCl
- Watch out for toxicity
Procainamide (Pronestyl)
Amiodarone (Cordarone)
- Watch our for bradycardia, very potent
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Antihypertensives
Central Acting
- Clonidine (Catapres)
- Methyldopa (Aldomet)
Alpha Adrenergic Blockers – zosins
- Prazosin, Terazosin
B Adrenergic Blockers - olols
- Propanolol (Inderal), Atenolol
Ca Channel Blockers: Nifedipine, Verapamil, Diltiazem (Slows down conduction, vasodulating effect)
ACE inhibitors – Prils, Captopril, Enalapril, Fosipril
Other Drugs
Diuretics – inhibits sodium reabsorption
- Edema, CHF, mild hypertension
- Hypotension, MIO, weight, serum electrolytes
Anticoagulants – prevent further formation of blood clots
- Heparin, Coumadin, warfarin
- Bleeding
Thrombolytics – dissolve clots
- Alteplase (tPA), Streptokinase, Urokinase
Must be given within 6 hours of infarct
Followed by heparin therapy
- Bleeding
Antihistamines – blocks histamine effects in allergic reactions
- Sedative, inhibits motion sickness
- Diphenhydramine, chlorphenamine
Antidotes
- Naloxone, Flumazenil, AtSO4, activated charcoal
Steroids
- Anti-inflammatory, diminishes severity of allergic and inflammatory reactions
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Antacids
- NaHCO3
- Watch for extravasation
Bronchodilators – as nebulizers; Albuterol, Salbutamols
Electrocardiography
- Records the electrical conduction of the heart
- Does not assess the contractility of the heart
- 12 tracings I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
Lead Placement
- May be placed in the shoulder or groin in case of amputation or cast
Limb Leads
Right Arms: Read Right Leg: Black Left Arm: Yellow Left Leg: Green
Precordial Leads
C1 – 4th ICS right sternal borders
C2 – 4th ICS left sternal border
C3 – midway between C2 and C4
C4 – 5th ICs MCL or below the nipple
C5 – in line with C4, anterior axillary line
C6 – in line with C4, mid axillary line
Nursing Responsibilities
- Explain the procedure
- Provide privacy and assist in draping hte client
- Remove all metals from the client’s body
- Attach the leads and apply conduction gel
- Operate the machine according to the manufacturer’s instructions
- Remove the lead and wipe off the gel
- Label the strip. Date, time, client’s name, age and sex
- Report the result immediately
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The Normal ECG
1. normal sinus rhythm 2. Atrial Flutter: the atria are contracting rapidly about 300 bpm, and the ventricles are responding to every
third or fourth impulse 3. Premature Ventricular Contraction 4. Ventricular Tachycardia – R wave, QRS wave 5. Ventricular Fibrillation 6. Ventricular Asystole (Standstill)
HR absent
Rhythm absent
P wave Absent or present
PR interval absent
Atrial Flutter
- The atria are contracting rapidly at about 300bpm, and the ventricles are responding every third or fourth
impulse
Premature Ventricular Contraction
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Asystole (P-wave may be present)
Ventricular Fibrillation
- Dysrhythmia in cardiac arrest
- Heart quivers and does not beat
- No cardiac output, no pulse
- Converts to Asystole in a few minutes
- Clinical death
Defibrillation
- Stop the fibrillation
- An asynchronous countershock used to stop pulseless V tack or VF
- Convert VF to an effective rhythm
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Rationale for Early Defibrillation
- Third link in the chain of survival
- Within 2 minutes
- Success probability decreases over time
- Precordial thump
Non-Shockable Rhythms
- Asystole
- PEA (Premature Electrical Activity)
Fibrillation Treatment
- Process in which an electronic devise gives an electric shock to the heart
- Helps re-establish normal contraction rhythms
Procedure
- Apply gel to hand-held paddles or used electrode pads
- Turn on machine and choose appropriate energy level
- Charge the capacitor
- Position paddles/electrodes
- Apply firm pressure (25lbs) to hand held devices
- Clear the area
Defibrillators
Monophasic
- The CPR algorithm recommends single socks started at and repeated at 360J
Biphasic
- The CPR attachment algorithm recommends shocks initially of 150-200J and subsequent shocks of 150-360J
Automated External Defibrillator (AED)
AEDs come in two forms
- Automated
- Semiautomated
A specialized computer recognizes heart rhythms that require defibrillator
W – no Water
I – no Internal pacemaker
P – Patches; removed
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E – Eight years and below, no defib
Cardioversion
- Organized rhythms
- Delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle
- A synchronized countershock to convert an undesirable rhythm to a stable rhythm
- Lowe amount of energy is used
- Synchronized with the R-waves
- Informed consent is needed and client is sedated
What things should I do after Cardioversion/Defibrillation
- Monitor the patient carefully – ABCs, V/S, LOC
- Keep the patient well oxygenated
- Check up on your patient’s lab studies...K+, Magnesium, CPK, Troponin
- Get a 12 lead after the Cardioversion for documentation
- Assess the patient’s skin for evidence of burns
Advance Cardiac Life Support
Critical Care
Prolonged life support
Goal: Cerebral Resuscitation and post resuscitation intensive therapy (providing mechanical ventilation
G – Gauging: determine cause of the disease (specific biologic crisis)
H – Human mentation: cerebral resuscitation (brain damage)
I – Intensive Care: Multiple organ support
Intensive Care
- Provision of life support or organ support systems in patients who re critically ill and who usually require
intensive monitoring
- Condition is potentially reversible and who have a god chance of surviving with intensive are support
- System by system approach to treatment
CV, CNS,ENDO, GIT (and nutritional condition), hematology, microbiology (including sepsis
status), peripheries (and skin), renal (and metabolic), respiratory system
Critical Care Nursing
- Deals specifically with human responses to life-threatening problems
- Patient advocate
- CCU nurses are responsible for ensuring that acutely and critically ill patients and their families receive
optimal care
- Frequent assessment, monitoring, rapid intervention, access to technology
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Goals
- Pursue continuous optimal nursing care to patients in life threatening situations
- Remain alert to the physiologic, Psychologic and social needs of the patient as an integrated being
- intensive Care Unit (ICU) or critical care unit (CCU) - coronary care unit (CCU) for heart disease - medical intensive care unit (MICU) - Surgical intensive care unit (SICU) - Pediatric intensive care unit (NCCU)
Equipments and Systems
Patient monitoring equipment
- Acute care physiologic monitoring system
- Pulse oximeter
- Intracranial pressure monitor
- Apnea monitor
Life Support and Emergency resuscitative equipment
- Ventilator (also called a respirator)
- Infusion pump
- Crash cart
- Intra-aortic balloon pump
Diagnostic Devices
- Mobile x-ray units
- Point of care analyzers
Other ICU Equipment
- Urinary (Foley Catheters)
- Catheters used for arterial ad central venous lines
- Swan-Ganz catheters
- Chest and endotracheal tubes
- GI and NG feeding tubes
- Monitoring electrodes
Basic Trauma Life Support
A – Airway and C-Spine control
B – breathing; chest injury
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C – Circulation; no pulse, CPR; control hemorrhage, immobilize
D – Disability; neuro assessment: AVPU (LOC), GCS V/S
E – Expose, environment control
F – Foley Cath
Trauma Assessment DCAPBTLS
Bleeding
- Hemorrhage
- Average adult has 5L of circulating blood
- Body cannot tolerate greater than 20% blood loss
- Blood loss of 1l can be dangerous in adults; in children, loss of 100-200mL is serious
Safety
- Universal and standards precautions
- Wear gloves and eye protection in all situations
- Avoid direct contact with body fluids
- Thorough hand washing between patient is important
Controlling External Bleeding
- Direct pressure (10 minutes) and elevation
- Ice
- Pressure bandage
- Indirect pressure (pressure points)
- Pneumatic Anti-shock garment (PASG)
- Splints/air splint
- tourniquet
PASG
- An inflatable garment that surround the legs and torso and can generate up to around 100mmHg of
pressure
- Controls significant internal bleeding by placing pressure on the abdomen
- Controls massive soft-tissue bleeding of the lower extremities
- Increases blood flow to vital organs
- May effectively increase the blood pressure
Tourniquet Precautions
- Place as close to injury as possible, but not over the joint
- Never use a narrow material. Mark the area with a letter T
- Use wide padding under the tourniquet
- Never cover a tourniquet with a bandage
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- Do not loosen the tourniquet once applied
- Rotate the site every 2 hours
Open Wounds
- Control hemorrhage; immobilize injured area
- Check dressing every few minutes; if soaked with blood, do not remove, apply another dressing on top of it
and reapply pressure
- Irrigate the wound with scope and water or saline solution
- Impaled objects: do not remove; stabilize object with a bulky dressing
- Butterfly enclosures
- Sutures and ligation of bleeders
Controlling a Nosebleed
- Help the patient sit and lean forward
- Pinching the nostrils together
- Place a rolled gauze under the upper lip and gum; and press with your fingers
- Cold compress over the nose nad face
- Nasal packing with epinephrine
Internal Bleeding
- May not be readily apparent
- Causes
Blunt trauma
Penetrating trauma
Fractures
- Assess for:
Signs and symptoms
Mechanism of injury
S/Sx of Internal Bleeding
- Ecchymosis
- Hematoma
- Hemoptysis
- Hematemesis
- Hematochezia
- Melena
- Hematuria
- Pain, tenderness, bruising, or swelling
- Broken ribs; bruises over the lower chest; shallow rapid respiration
- Rigid, distended abdomen, guarding
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First Aid
- Prioritize
Chest cavity
Abdominal cavity
Pelvic cavity (2-8 units)
Femoral area (2-8 units)
- EMS
- ABCDs
- Treat for shock
Soft Tissue Injuries
- Close injuries
Soft tissue damage beneath the skin
- Open injuries
Break in the surface of the skin
- Burn
Soft tissue receives more energy than it can absorb
- Amputations
Contusion
- Results from blunt force striking the body
- Epidermis is intact, dermis damage and blood vessels are torn
Hematoma
- Pool of blood collected beneath the skin
- Tearing of large blood vessels
Abrasions
- Caused by rubbing, scraping or shearing
Laceration
- Smooth or jagged cut, irregular edges
Avulsion
- Tearing loos of a flap of skin
Penetrating Wound
- Penetration from a sharp pointed object
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Gunshot Wound
Crushing Open Wound
- May involve damage internal organs or broken wounds
Amputation
- Loss of a body part
Traumatic Emergencies
- Trauma assessment DCAPBTLS Mechanism of injury Loss of consciousness Vomiting Current symptoms Intake of drugs or alcohol
Tissue Perfusion
- The heart demands a constant supply of blood - The brain and spinal cord can survive for 4-6 minutes without perfusion - The kidneys may survive 45 - Skeletal muscles may last 2 hours
Normal Perfusion requires 3 intact mechanisms
1. A functioning PUMP: the heart 2. Adequate VOLUME: the blood and the plasma 3. An INTACT VASCULAR SYSTEM: blood vessels are able to constrict and dilate
Shock
- A state of collapse and failure of the CVS due to the inadequate tissue perfusion and less oxygenation Leads to inadequate circulation Without adequate blood flow, cells cannot get rid of metabolic wastes
- Not a disease in itself, but a secondary cause
“Death is a severe stage of shock, or shock is a pause in the act of dying”
Phases of Shock
I. Compensated shock - The preservation of vital organ function: body uses normal defense mechanism to maintain normal function
Signs and Symptoms
- Restlessness, agitation, confusion
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- Slightly increased respiratory rate - Slightly increase heart rate - Normal BP slightly decreased capillary refill - Oliguria - Pallor, cold, clammy, skin/warm and flushed
II. Uncompensated Shock - Vital organ function is impaired and clinical deterioration professes; blood is shunted away from extremities
and abdomen towards the heart, brain and lungs
Signs and Symptoms
- Decreasing LOC (Stuporous, unconscious) - Dilated sluggish pupils - Rapid breathing; shallow, irregular respirations - Rapid heart rate; weak, ready pulse - Hypotension - Anuria - Clod, clammy, cyanic - Metabolic acidosis
III. Irreversible Shock - Terminal, irreversible changes to vital organs - Blood is shunted from the liver and kidneys to heart and brain - Organs die - Death
Signs and Symptoms - Bradycardia - Bradypnea - Mottled skin - Coma
Classification of Shock
1. Hypovolemic Shock - An absolute reduction in circulating volume
2. Cardiogenic - Reduction in cardiac output secondary to pump failure
3. Distributive - An increase in the volume of the circulatory system (vasodilation)
Septic/Anaphylactic/Neurogenic 4. Obstructive
- Resistance to the flow (respi insufficiency) 5. Psychogenic –
- psychological 6. Metabolic
Management of Shock
- Maintain airway - Oxygen - Positioning – shock position
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- Control bleeding - Splint fractures - Keep warm - Keep safe - NPO - Monitor V/S - Monitor Output - Trendelenburg
Medical Mgt
- Establish proper airway - Hydration (IVF: NSS, PLR) - Drugs
Dopamine NaHCO3
- BT - Correct cause of shock - Foley catheter
Anaphylactic Shock
- Administer Epi, Diphenhydramine, corticosteroids - Provide all possible support
O2 Ventilatory assistance
Psychogenic Shock
- Usually self-resolving - Assess patient for injuries from fall - Anxiety attack
Eye Injuries
- Considered as an emergency - Foreign objects
Victim to blink several times Irrigates with saline
- Lacerations Never exert pressure on or manipulate eye Cover with protective metal eye shield
- Burns Flush for 20 minutes Remove contact lenses
Injuries to the Face
- Injuries about the face can lead to upper airway obstructions Bleeding, loose teeth
- Clear airway - Immobilize fracture - Control bleeding
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- Monitor airway constantly - Blunt trauma to the nose can result in fractures and soft-tissue injuries
Neck Injuries
- An open neck injury can be life threatening - Air can get into the vein and cause an air embolism
Cover the wound with an occlusive dressing Apply manual pressure
- Subcutaneous emphysema Protect airway
Chest Wounds
- A penetrating wound to the chest may cause air to enter the chest - Air enters through a hole causing the lungs to collapse in a few seconds or minutes - Sucking chest wound
Rib Fractures
- Rib fractures – may lacerate surface of the lungs; common in the elderly - Flail chest
Three or more fractured ribs Sternum in fractures along with several ribs Creates paradoxical movement Immobilize flail segment with a pad of dressing or a small pillow; secure with a wide tape Do not ever place anything completely around the chest!
Pneumothorax
- Spontaneous Pneumothorax Weak areas in the surface of the lungs and rupture spontaneously
- Tension pneumothorax Can occur from sealing all four sides of the dressing on a sucking chest wound Can also occur from a fractured rib puncturing the lung or bronchus Can also result from a spontaneous pneumothorax Let air escape by inserting a needle
Cardiac Tamponade
- Collection of blood or other fluids in the pericardium - Causes
Stab wounds Blunt chest trauma Recent cardiac catheterization
- S/Sx Rapid, thready pulse Hypotension JVD Muffled heart sounds
- Treatment Ensure open airway
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O2 IV line Pericardiocentesis CPR
Abdominal Wounds
- An open wound in the abdomen may expose organs - An organ protruding through the abdomen is a called an evisceration
Abdominal Wound Management
- Do not touch exposed organs - Cover organs with a most sterile dressing - Manage for shock - Prepare for surgery
Blunt Abdominal Wounds
- Severe bruises of the abdominal wall - Laceration of the liver and spleen - Rupture of the intestine - Tears in the mesentery - Rupture or tearing of the kidneys (hematuria) - Rupture of the bladder - Sever intra-abdominal hemorrhage - Peritonitis
Assessment
- Tenderness - Rebound tenderness - Guarding - Rigidity - Distention - Pain
Management
- Prevent shock - Control bleeding - Positioning - NPO
Injuries to the Genitalia
- Male Painful by not life-threatening Cut off zipper fastener and separate teeth Ice or cold compress
- Female Extreme pain, bleeding
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Straddle injuries, sexual assault, blows to the perineum or abortion attempt, childbirth, or when foreign objects are inserted into the vagina
Direct pressure, moist compress (bleeding) Ice packs or cold compress (pain, swelling) Sexual assault, preserve chain of evidence
Skull Fracture
- Indicates significant force - Signs
Obvious deformity Visible crack in the skull Raccoon eyes – Periorbital ecchymoses Battles sign – ecchymosis behind the ears Basal skull fracture
- Signs and Symptoms Lacerations, contusions, hematomas to scalp Soft areas or depression upon palpation Visible skull fractures or deformities Ecchymosis around eyes and behind the ear Clear or pink CSF leakage Unequal pupils Cerebral edema Period of unconsciousness, amnesia, seizures Numbness or tingling in the extremities Irregular respirations Dizziness Visual complaints Combative or abnormal behavior Nausea and vomiting
- Bleeding from Skull Fracture Do not attempt to stop the blood flow Loosely cover bleeding site with sterile gauze Leakage of clear fluid from ears or nose If cerebrospinal fluid is present, a target sign will be apparent
Head Injuries
- The most important sign in evaluating head injury is a changing state ofconsciousness - A head-injured patient has a cervical spine injury until proven otherwise - Shock means injury elsewhere
Cerebral Concussion
- Brain is jarred around the skull - Mild, diffuse brain injury transient dysfunction of the cerebral cortex - Resolved rapidly and spontaneously - No structural damage or permanent neuro impairment
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- S/Sx – transient confusion and disorientation (lasts several minutes), with or without loss of consciousness, retrograde amnesia or anterograde amnesia
Cerebral Contusion
- Brain tissue is bruised and damaged in a local area - Physical damage/injury to the brain causes greater neurologic deficits - Swelling of injured tissue leads to increase ICP
Coup-contrecoup
- Acceleration-deceleration injury - Head comes to a sudden stop, but brain continues to move back and forth inside the skull, resulting in
massive injury - Two sites of injury
Point of impact Point on the opposite side when the head hits the skull
Brain Injury
- Increase blood flow (vasodilation) - Leakage of blood and plasma to the affected area (bleeding)
Decreased brain perfusion CO2 build-up in brain tissue vasodilation
- Increase pressure in the skull - Brain tissues become compressed and stop functioning - Decreased blood flow to the brain as pressure increases - Brain stem is compressed due to swelling - Heart, breathing and blood pressure fails
Complications of Head Injuries
- Cerebral Edema - Convulsions and seizures - Vomiting - Leakage of CSF
***Check for increase ICP
Increased Intracranial Pressure
- Increased BP (Systolic) - Widening of pulse pressure - Decreased Pulse (bradycardia) - Abnormal respiration - Increased temp - Vomiting
Shock (Hemorrhage Elsewhere)
- Decreased BP - Narrowing of pulse pressure - Increased Pulse (tachycardia)
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- Increased Respiratory Rate
First Aid
- Immediate medical attention - Support victim until medical help arrives - Stabilize head and neck - ABCD - Prevent aspiration - Treat for shock - Do not elevate legs
Interventions
- Manage airway and breathing - Circulation - Medications
Dexamethasone Mannitol Furosemide
- Positioning - Do not allow patient to become overheated; keep cool - Craniotomy
Spinal Cord Injury
- Anything below the level of damage cord is affected - Suspect in
Vehicular trauma Falls from a height Diving accidents Cave-ins With head or facial injuries Lightning injuries Any unconscious victim of trauma
Complications
- Inadequate breathing Respiratory paralysis Chest wall muscles are paralyzed Diaphragm continues to function
- Paralysis Weakness, loss of sensation or paralysis below level of injury Paralysis of arms or legs – most reliable sign
S/Sx
- Pain and tenderness of spine - Deformity of spine - Numbness and paresthesias - Loss of sensations - Incontinence
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- Injuries to the head - Diaphragmatic breathing
Management
- Ensure open Airway (jaw thrust); suction - Assist breathing - Support circulation – stop bleeding, IV - Immobilization (cervical collar, backboard) - Keep warm - V/S, neurologic status
Types of Musculoskeletal Injuries
- Fractures – broken bone - Dislocation – disruption of a joint - Sprain – joint injury with tearing of ligaments - Strain – stretching or tearing of a muscle
Management of Fractures
- Assessment – ABC, DCAPBTLS - Immobilization by splinting or casting - Be alert compartment syndrome
Permanent damage in 6-8 hours - Check neurovascular status
Pulse Capillary refill Sensation Motor function
Common Medical Emergencies
Airway Problems
- Upper airway obstructions - COPD - Atelectasis - Consolidation - Fluid (Pulmonary Edema)
Management of Airway Problems
- Airway – maintain patency Assist ventilations with BVM Protect by endotracheal intubation Suction secretions Remove foreign bodies (Heimlich) tracheostomy
- Oxygen - Establish IV line - Drugs - Chest Tubes
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Acute Myocardial Infarction (AMI)
- Pain signals death of cells - Opening the coronary artery within the first hour can prevent damage
S/Sx
- Severe, crushing chest pain (Levine’s sign) - Cold, clammy skin - Feeling of impending doom - Apprehension anxiety - Sudden death - Pulmonary edema
Treatment
- Oxygen - IV line - Bed rest; semi fowlers - Cardiac monitor - I and O - Drugs – vasodilators, hemolytics (<6 hours), analgesics, anti-arrhythmics, anticoagulants, stool softeners
Cardiac Arrest
Ventricular Fibrillation
Aim: To convert to an effective rhythm
- Defibrillate - Intubation - Oxygen - IV line, fluids - Drugs – lidocaine
Asystole
Aim: To convert to an effective rhythm or to VF
- Start CPR - Intubation - Oxygen - IV line, fluids - Drugs – Epi, AtSO4 - Defibrillate if in V Fib
Cerebrovascular Accident (CVA or Stroke)
- Hemorrhagic – arterial rupture High blood pressure is a risk factor Rapid onset
- Ischemic – blockage, occlusion of blood supply Thrombosis Embolus
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- Stroke symptoms typically develop rapidly (seconds to minutes) - Symptoms are related to the anatomical location of the damage
Ischemic strokes: affect regional areas of the brain perfused by the blocked artery Hemorrhagic strokes: affect local areas, but often can also cause more global symptoms
due to bleeding and increased ICP - History, neurological examination, and presence of risk factors
General S/Sx of Stroke
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sometimes weakness in the muscles of the face can cause drooling
- Sudden confusion or trouble speaking or understanding - Sudden trouble seeing in one or both eyes - Sudden trouble waking, dizziness, loss of balance or coordination - Sudden, severe headache with no known cause
Central Nervous System Pathways
- If the area of the brain affected contains of the three prominent CNS pathways – the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include:
Hemiplegia and muscle weakness of the face Numbness Reduction in sensory or vibratory sensation
Brain Stem
Brain Stem also consists of the 12 cranial nerves
- Altered smell, taste, hearing, or vision (total or partial) - Drooping of eyelid (ptosis) and weakness of ocular muscles - Decreased reflexes: gag, swallow, pupil reactivity to light - Decreased sensation and muscle weakness of the face - Balance problems and Nystagmus - Altered breathing and heart rate - Weakness in sternocleidomastoid muscle with inability to turn head to one side - Weakness in tongue in tongue (inability to protrude and/or move from side to side)
Cerebral Cortex
If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms
- Aphasia – inability to speak or understand spoken language (Broca’s) - Apraxia – altered voluntary movements - Visual field defect - Memory deficits (temporal lobe – memory) - Hemineglect - Disorganized thinking, confusion, hypersexual gestures - Anosognosia – persistent denial of the existence of a usually stroke related deficit
Cerebellum
- Trouble walking
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- Altered movement coordination - Vertigo and/or disequilibrium
Hemorrhagic Stroke (Inc ICP)
- Loss of consciousness - Headache - Vomiting
Emergency Care for Stroke
- Patent airway, O2 - IV line - Drugs
Treat within 3 hours for thrombolytic drugs Antiplatelet, anticoagulants Antihypertensives Osmotic diuretics
- Protect paralyzed extremities - CR Scan, MRI - Surgery to remove blood - Supportive care – physiotherapy, occupational therapy
Seizures
- Generalized (Grand Mal) - last 2-5 minutes - Petit mal seizure – blank state, few seconds - Status Epilepticus – sing seizure more than 5 minutes or series of seizures without regaining consciousness
Brain deprived of oxygen - Goal: support victim, prevent injury
Emergency Care
- Airway (turn to side) - O2 - Assess for duration - Do not restrain - NPO - IV line - Drugs: Diazepam, phenytoin, phenobarbital
Diabetes Mellitus
Hyperglycemia – diabetic coma
- Lack of insulin causes glucose to build-up in blood in extremely high levels - Diabetic ketoacidosis (DKA)
Hyperglycemia – insulin shock
- Excess insulin
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First Aid
- When in doubt, give sugar - Look for medical alert tag - Hyperglycemia
EMS ABC Rule out other emergencies
- Hypoglycemia – death in a few minutes EMS Administer sugar if responsive ABC, NPO, and lateral recumbent if unresponsive
Common Environmental Emergencies
- Normal body temperature is 98.6F - Body cools itself by sweating (evaporation) and dilatation of blood vessels - High temperature and humidity decrease effectiveness of cooling mechanisms
Heat Stroke
***Sweating mechanisms fails; body overheats; profound emergency
***Peripheral vasodilation; Neurogenic shock
- No cramping - Headache, dizziness, impaired thinking; stupor, coma, seizure - Hot flushed skin - Hyperthermia - Rapid, bounding pulse - Hypertension, early stage, then drops
Care for Heat Stroke
- Move patient out of the hot environment - ABCD, O2 - Keep the patient cool
Remove the patient’s clothing Provide air conditioning at a high setting Apply cold packs to the patient’s neck, armpits, and groin Cover the patients with wet towels or sheets Aggressively fan the patient
- IV line KVO - Cardiac monitor - Treat seizures
Hypothermia
- Lowering of the body temperature below 95F (35C) - Elderly persons and infants are at higher risk - People with other disabilities with other illnesses and injuries are susceptible to hypothermia
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S/Sx
Mild
- Conscious, apathetic, lethargic - Shivering - Rapid pulse and respirations - Pale, cyanotic skin, cold to touch - May have acetone odor to breath
Severe
- Unconscious or stuporous - Shivering stops - Weak or absent V/S - Muscular activity decreases - Fine muscle activity ceases - Eventually, all muscle activity tops - Pupils unreactive
Hypothermic Patient is Not Dead, until he is Warm and Dead
Frost Bite
- Freezing of a body part; ears, nose hands and feet
Emergency Care
- Remove patient from cold environment - Remove wet clothing, cover with blankets - Passive rewarming
Immerse the frostbitten extremity at 37.7-40.6G. Gently Dry - Recumbent position, do not elevate legs - Very gentle handling – VF - Give warm, humidified oxygen; assist ventilations prn - Sugar and sweets, warm fluid - Assess pulse for 30-45 seconds before considering CPR
Frostbite Don’ts
1. Don’t rub snow in a frostbitten part 2. Don’t massage or rub the area 3. Don’t use dry or radiant heat for rewarming 4. Don’t rupture blisters 5. Don’t apply ointments to frostbitten skin 6. Don’t apply tight bandages 7. Don’t allow a thawed extremity to refreeze 8. Don’t handle a frostbitten extremity roughly 9. Don’t allow the patient to smoke, eat, or use any stimulants
Drowning and Near Drowning
- Drowning Death as a result of suffocation after submersion in water
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- Near Drowning Survival, at least temporarily, after suffocation in water
***Freshwater
***Saltwater
Emergency Medical Care
- Do not enter the water to save a drowning victim if you are not a qualified swimmer - Begin rescue breathing as soon as possible, even before victim is removed from the water - Continue AR and remove victim from water - Maintain cervical spine stabilization - If air does not enter the patient’s lungs, treat for obstructed airway - Check pulse and start CPR if needed; intubate and administer O2 - IV line, drugs (bicarbonate)
Poisoning
- Ingested – treat for shock - Inhaled – move to fresh air immediately - Absorbed – remove from patient as rapidly as possible - Injected – impossible to remove or dilute once injected
Stings or bite
Ingested Position
- Poison Control Center – PGH, IDH - EMS - ABCDs - Left side-lying - NPO (except acid or alkali) - Never induce vomiting until told to do so - Send samples - Kerosene ingestion – pneumonitis
Identifying Patient and the Poison
If you suspect poisoning, ask the patient the following poison
- What substance did you take? - When did you take it or (become exposed to i)? - How much did you get? - What actions have been taken? - How much do you weigh?
Food Poisoning
- Ingestion of food that contains bacteria, toxins or chemicals - Salmonella bacterium causes severe GI symptoms within 72 hours - Staphylococcus is a common bacteria that grows in foods kept too long - Botulism often results from improperly canned foods - Dehydration, shock. Rehydrate
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Drugs and Alcohol
- Aspirin – acid N/V, hyperventilation, tinnitus, confusion, seizures, coma, fever, sweating Induce vomiting; inactivated charcoal; NaHCO3
- Acetaminophen Generally not very toxic Liver failure might not be apparent after a full week
- CNS depressants – alcohols, narcotics Main concern is respiratory depression Airway clearance and ventilatory support
- Stimulants – cocaine, metamphetamines Cardiac arrhythmias, seizures Violent, burn out and crash
Inhaled Poisons
- Carbon monoxide – tasteless, colorless, odourless; mild drowsiness to coma Formed by incomplete combustion of gasoline, coal, kerosene, plastic, wood and natural
gas - Freons – cardiotoxic - Glue – similar to alcohol intoxications
First Aid
- Move to fresh air immediately (150ft) - ABCD’s
Absorbed-Cholinergic Agents
- Nerve agents for warfare - Overstimulates parasympathetic nervous system - Me be treated as a HazMat incident - Ingested – wild mushrooms, organophosphate insecticides - Inhaled – sarin gas
First Aid
- Avoid exposure; wear gloves - Decontaminate - Decrease the secretions in the mouth and trachea - Provide airway support - Atropine sulfate
Insect Bites and Stings
- Anaphylactic reactions to stings Histamine is a potent arterial dilator
- Death from insect stings outnumber those from snakebites - Venom is injected through stinging organ - Some insects and ants can sting repeatedly
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Assess
- Respiratory system Bronchospasm and wheezing, dyspnea Chest tightness and coughing
- Circulatory system Hypotension
- Mental status Anxiety
- Skin Swelling of the lips and tongue Itching and burning Widespread urticaria
- Muscle Spasms, cramps
General First Aid
- Standard airway procedures - Give oxygen - History of allergies - Baseline vital signs - Epinephrine, steroids
Snake Bites
- Minimize all activity. Do not let the victim walk - Clean wound with soap and water; splint - Maintain extremity at heart level, do not elevate - Apply cool compresses, not ice - Australian wrap - Transport - Oxygen, monitor, IV - Watch, constrictive bands, bandages, splints, are carefully for vascular compromise secondary to edema
Snakebite Management
Do NOT
- Apply ice - Apply arterial tourniquet - Cut and suck - Use electrical shock - Actively attempt to locate a venomous snake - Bring a live venomous snake to the hospital
Spiders
- Neurotoxin (muscle spasms) - Local necrosis
Bee Stings
- Anaphylactic reactions in some
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- Remove stinger by scraping it out - Cold compress or ice - Diphenhydramine, H2 Blockers, Epi - Research has shown that the best course of action is to pull the stinger out as soon as possible with your
fingers - The remaining venom in the sac of the stinger does not increase the reaction should you inadvertently push
more venom into your wound
Scorpion Stings
- Allergic reactions same with bees - “the bigger, the better, the small ones, don’t keep it to yourself” - Ice at the bite site and elevation - Muscles spasms may occur in severe cases - Calcium Gluconate, bed rest and NPO for the first 24 hours - Anti-venom is available for severe reaction but rarely needed. Do not skin test
Coelenterate
- Nematocysts – venom glands - Functions even when separated - Sea water, vinegar, baking soda deactivates the toxin - Irrigate with hot water/soak for 30 minutes
Emergency Care for Severe Burns
- Move the patient away from the burning area - ABCDs, O2 - Immerse the affected area in cool sterile water or saline solution for 10minutes - Gently remove any rings, watches, belts or constricting clothing from the injured area before it starts to
swell - Cover with a cool, wet dressing - Prevent body heat loss - Rapidly estimate burn severity - Check for traumatic injuries - Cover the injured area with clean, preferably sterile, non-fluffy material - A burnt face may be covered with a gauze mask, with holes cut into it to assist the victims in breathing - Do not break blisters or remove anything that is sticking to a burn - Do not apply lotions, ointments or fat to the injured area - Call EMS for severe burns - Treat the patient for shock, IVF - Silver nitrate, flammazine - Tetanus