disaster final
TRANSCRIPT
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The nurse may be asked to perform outside ofhis or her expertise and may take onresponsibility held by the physicians or
advanced nursing practice Ex.intubate, inserting chest tubes
Debridement, suturing
Nurse may serve as triage officer
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4
Forces overwhelm a
community. Services are compromised.
Outside assistance isrequired.
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Natural disaster
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10
estimates that as many as 26
nations possess chemical orbiological agents.
10 countries are believed to
possess biological agents asweapons
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Bubonic plaque
Botulism
Anthrax
Sars
H1N1
SMALL POX
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Attack can take many forms
Aerosolized agents
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Fire
Bioterrorism
Illegal logging
Nuclear attack or bombing
Etc.
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15
Pre-disaster W
arning Impact Emergency
isolation
rescue remedy
Recovery
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Validate what you hear
Perform a thoroughassessment
Assess for otherinjuries/illnesses evenwhen symptoms are absent
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DISASTERMANAGEMENTDISASTERMANAGEMENT
It is a collaborative activities that include
preparedness and rehabilitation
eR
esponsePeriod immediately after the disaster
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DISASTER CONTINUUM
DISASTERDISASTER
e Responsee Response
REHABILITATIONREHABILITATION
PREVENTIONPREVENTIONRECONSTRUCTIONRECONSTRUCTION
DEVELOPMENTDEVELOPMENT
PREPAREDNESSPREPAREDNESS
WARNINGWARNING
MITIGATIONMITIGATION
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MASS CASUALTY INCIDENT
Situation in which the number ofcasualties exceeds the number ofresources
INCIDENT COMMAND SYSTEM
Management tool for organizing
personnels, facilities, equipment,and communication
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DISASTER LEVELSDISASTER LEVELS
Level I - Local e Response personnel andorganization can manage the disaster
Level II Regional efforts and aid from othercommunities are sufficient to managethe effects of the disaster
Level III Local and Regional assets are over-whelmed; National assistance is needed
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First Priority
Second Priority Third Priority
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To afford the great number ofpeople the greatest chance of
survival.
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To properly triage a group ofpatient, you shared quality classify
each patient into one of fourgroups.
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CATEGORIES
1ST PRIORITY (IMMEDIATE)RED Injuries are life threatening butsurvivable with minimal intervention
2nd PRIORITY (DELAYED)YELLOW Injuries are significant and
require medical care but can wait hourswithout threat to life or limb
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UNSTABLE CHEST AND ABDOMINALWOUNDS
INCOMPLETE AMPUTATIONS
OPEN FRACTURE OF LONG BONES
2ND & 3RD DEGREE BURNSOF15-40%OFTOTAL BODY SURFACE AREA
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Stable Abdominal wounds with out evidenceof hemorrhage
Soft tissue injuries
Maxillofacial wounds with out airwaycompromise
Vascular injuries with adequate collateral
circulations
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Genito-urinary tract disruption
fractures requiring openreduction
Debridement and external
fixationMost eyes or CNS injuries
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3rd PRIORITY (MINIMAL)
GR
EEN Injuries are minor and treatmentcan be delayed hours to days; moved awayfrom the triage area
4th PRIORITY (EXPECTANT)BLACK Injuries are extensive and chancesof survival are unlikely even with definitive
care; separated but not abandoned
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Upper extremity fractures
Minor burns
Sprains Small lacerations without significant
bleeding
Behavioral disorders Psychological disturbances
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Seizures or vomiting with in 24 hour afterradiation exposure
profound shock with multiple injuries
Agonal respirations
No pulse
No BP
Pupils fixed and dilated
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ROLE OF NURSES IN DISASTERRESPONSE PLANS
Depends on the specific needs of thefacility at the time; Personal protective
Equipments:
component of preparednessand response; donned before contact witha contaminated patient.
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Prevent the disaster
Minimize casualties
Prevent further casualties
Rescue the victims
First aid
Evacuate
Medical care Reconstruction
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You are the triage nurse
at the receiving facilityfor casualties after thetornado. 5 patients arriveat the same time.
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An elderly man with arespiatory rate of 8 breathsper minute, color ashen,tense abdomen and only
carotid pulse present
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A 7 year old childwith ableeding scalp lacerationwho has a glasgow comascore of 8 and needs
intubation
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30 year old mother of achild, who is cryinghysterically, is walking andappears to have no pain or
visible injuries
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A 15 year-old girl whocomplains of pain in her leftleg , with obvious deformityof the calfbut good pulses in
the foot
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65-year-old woman whoarrives in a police carholding her right wristwhich is cool,
ecchymoticand painful, withgood pulses
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DECONTAMINATION
Process of removing accumulatedcontaminants
Step:1. Remove the patients clothing and
jewelry
2. Soap and water wash, then rinse
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Cell destruction of the layers
of the skin and the resultantdepletion of fluid andelectrolytes
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Thermal
e.g. caused by exposure toflames, hot liquids, steam or
hot objects
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Caused by tissue contact with
strong acids, alkalis or organiccompounds
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caused by heat generated by
an electrical energy as it passesthrough the body
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caused by exposure to
ultraviolet light, x-rays or aradioactive source
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1st degree- involves epidermis, reddish andpainful
2nd degree- involves the dermis, moist
surface, with vesicles, painful 3rd degree- involves subcutaneous layer,
pearly white, no pain
4th degree- involves the muscles and bones,
blackish or charred, no pain
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Head, Face, Neck = 9%
Anterior Trunk = 18%
Posterior Trunk = 18% Upper Extremities (each) = 9%
Lower Extremities (each) = 18%
Genital = 1%
TOTAL: 100%
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Stop the burning process
- immerse affected part in coldwater- advise client to roll on theground if clothing is on fire
- throw a blanket over the client tosmother the flame
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Promoting comfort:Relief of pain
- Morphine SO4- IV
- Bed cradle to relieve pressure fromtopsheet
- Avoid exposure to draft, exposed nerve
endings are senstive Prevention of infection
- Asepsis
- Reverse isolation
- Tetanus immunization- Sterile NSS to irrigate area
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Anti microbials
- Silver NO3 0.5%
- Silver sulfadiazene 1% (Silvadene)- Mafedine Acetate 10% (Sulfamylon)
*drug of choice because it can penetrate
eshar-Gentamycin SO4 (Geramysin)
-Providone-Iodine (Betadine)
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Hydrotherapy Debridement
Skin grafting
Promoting G.I. support
Rehabilitation
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An acute medical
emergency caused byfailure of the heat
regulating mechanismof the body
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CONDUCTION-the
transfer of heat fromone material to another
through direct contactEx.cup of coffee
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Carrying away of heat by
currents of air or wateror other gases or liquids
Ex. Spoon
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Sending out energy, such
as heat, in waves intothe space
Ex. The sun
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The change to liquid to
gas, when the bodyperspires or gets wet,
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evaporation of the
perspiration or otherliquid into the air has s
cooling effect on thebody
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Breathing, during
respiration body heat islost as warm air is
exhaled from the body
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People at risk thosenot acclimatized toheat, elderly & very
young
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CNS dysfunctions:Confusion, delirium,
bizarre behavior, comaTemp - 40.6 C / 105 F or
higherHot dry skin
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Anhidrosis ( absence of
sweating)Tachypnea,
hypotension,tachycardia
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Numbness or reduced
sense of touchStiff or rigid posture
Drowsiness
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Loss of motor
coordinationJoint muscle stiffness
Skin may appear red
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Reduce high temp asquickly as possible
Remove clothingCool sheets and towels or
continuous sponging withcool water
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Apply ice to neck, groin,chest & axillae, spray
with tepid waterCooling blankets
Iced saline lavage iftemp does not decrease
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Immersion of thepatient in a cold waterbath if possible
Use electric fan to blowair towards the client
Constant monitoring oftemperature
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Use caution to avoid
hypothermiaMonitor vital signs, ECG
Assess for seizures (ifrecurrent hyperthermia)
Give O2
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IV NSS or LR
I&O monitoring ( acutetubular necrosis may occur
as a complication of heatstroke)
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CBC
ELECTROLYTESABG
ECGU/A
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WATER CHILL- chilling
caused by conduction ofheat from the body
when the body orclothing is wet
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Chilling caused by
convection of heat fromthe body in The
presence of air currents
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Exposure to freezing Temp;actual freezing of intra &intercellular fluid,resulting to cellular &
vascular damage.Commonly affects the ears,
nose, hands & feet
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Affected part is hard,
cold and insensitive totouch may appear white
or mottled blue white
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Goal: restore normalbody temp
Constrictive clothing
are removed
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If lower ext areinvolved the patient
should not beallowed to ambulate
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Controlled yet rapidrewarming is done(extremity is placed in a37-40 C / 98.6- 104Fcirculating bath for 30-40
minute). Repeated untilcirculation is restored
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During rewarminganalgesics are given
(affected part may be verypainful during procedure)
Massage is contraindicated
( to avoid further injury)
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After rewarming procedureextremities are elevated &
protected fr.F
urther injurySterile gauze or cotton are
placed in between fingers
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Blebs w/c develop 1hour to few days after
rewarming are leftintact and not ruptured
especially ifhemorrhagic
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The core temperature is35C / 95F or less as a result
of exposure to coldUrban hypothermia has a
high mortality rate in theelderly & infants
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Alcohol ingestion
increases susceptibilityto hypothermia becauseit causes systemicvasodilation
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Trauma px are
susceptible esp. if coldfluids, unwarmedoxygen and coldexposure duringtreatment
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If patient has frostbite &
hypothermia(Hypothermia is thepriority )
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Core Temp of 35 or less
DysarthriaDrowsiness
Pulmonary edemaComa
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Continuous monitoring
Rewarming
Removal of wet clothing
insulation
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Cardiopulmonary bypassWarm IV fluid
Warm O2 by ventilatorWarmed peritoneal lavage
Warm blanketsOverbed heaters
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Monitor for Vfib as
px temp increasesfrom 31 to 32 C
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Defibrillation isineffective in px w/
temp of lower than31C; px must be
rewarmed 1st
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Nitrogen bubbles are
formed withinmuscles tendons or
within bloodvessels(embolus)
Assessment:
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Assessment:
Joint ext. painNumbness
Loss ofROM
Neurologic (similar tostroke)
Hx of diving or high altflying
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Management
Patent airway
100%O2 ( while in transit)
IV LR
Wet clothing is removed &px kept warm
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In the hospital hyperbarrictreatment is done
If air transport is neededlow altitude flight is
needed less than 1000 feet
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PENETRATING ABDOMINAL INJURY=(GUNSHOTWOUND, STABWOUNDS) ARESERIOUSAND REQUIRE SURGERY ANDR
ES
ULTS
IN HIGH INCIDENCEOF
INJUR
YTO HOLLOWORGANS
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BLUNT TRAUMA= MAY RESULTSFROMMOTORVEHICULAR CRASHES, FALLSBLOWSAND EXPLOSIONSAND IS COONLY
ASSO
CIATEDW
ITH EX
TR
A AB
DOM
INALINJURIES TO THE CHEST HEAD ANDEXTREMITIES.
ASSESSMENT:
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PHYSICAL
EXAMINATION: INSPECTION
AUSCULTATION PERCUSSION
PALPATION
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AUSCULTATIONOFBOWEL SOUNDSPROVIDESBASELINE DATA FROMWHICHCHANGES CAN BE NOTED
ABSENCEOFBOWEL SOUNDSMAY BE ANEARLY SIGNSOF INTA PERITONEALINVOLVEMENT
ALTHOUGH STRESS CAN ELIMINATE
BOWEL SOUNDS
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FURTHER ABDOMINAL ASSESSMENTMAYREVEAL PROGRESSIVE
ABDOMINAL DISTENTION
INVOLUNTARY GUARDING TENDERNESS, PAIN ,RIGIDITY
AND REBOUND TENDERNESS
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URINALYSIS
Hematocrit
WBC
Serum amylase
TO DETECTHEMATURIA(indicativ
e of urinary tract injury)
To evaluate trendsreflecting the absence orpresence of bleeding
To detect elevation(indicative of trauma)
Suggest pancreaticinjury
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Blood loss/ml
Blood loss % bloodvolume
PR
BP
Capillary refill
RR
UO
Mental status
Fluid replacement
CLASS1
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Blood loss/ml
Blood loss % bloodvolume
PR
BP
Capillary refill
RR
UO
Mental status
Fluid replacement
CLASS 3
1500-2000
< 30-40%
>120
decreased
delayed
30
-40
5-15
anxious and confused
Crystalliod and blood
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Blood loss/ml
Blood loss % bloodvolume
PR
BP
Capillary refill
RR
UO
Mental status
Fluid replacement
CLASS4
2000
>40%
140
decreased
delayed
>35
> 30
Confused, lethargic
Crystalliod and blood
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Secure or support a patent airway
Optimize breathing
Maintain circulation
Establish intravascular access Replace intravascular volume(blood products
or crystalliod
Manage bleeding by applying direct pressureon a compression site
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Abdominal scan
MRI
X-ray
Cbc
Blood typing and xcrossmatching
PT,PTT
ABG
HCG (If pregnant)
TREATMENT
Fluidresuscitation(LR,NSS)
CRYSTALLIOD
Vasopressors
Steroids
Na bicarbonate
Tetanus serum
Broad spectrumantibiotic
Blood transfusion(o-
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: fluid volume deficit r/t severe blood losslosses
Pain r/t trauma
Risk for infection related to blunt/penetratinginjury
Decrease cardiac output r/t to decreasecirculating blood volume
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Acute dental trauma is a serious injury to one
or more parts of your mouth. The word acute is
used to define problems that start suddenly,worsen quickly, and last a short time. Your
injury may include damage to any of your
teeth, the socket the tooth sits in, or your jaw.
You can also have injuries to the soft tissues of
your mouth. These include your tongue,
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Dental trauma can affect teeth that are
primary or permanent. Primary teeth are alsocalled baby or milk teeth. They fall out over
time and are replaced by permanent teeth,
also called adult teeth. There are 20 primary
teeth in children and 32 permanent teeth in
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What are the types ofacute dental trauma?
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yDamage to tooth: Your tooth or teeth
may get chipped, cracked, or fractured
(broken). The damage can be to the
crown or root of the tooth, or both. With a
very bad crown fracture, the dentin and
pulp of your tooth may be exposed
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Tender tooth:
Y
our tooth is firmly in itssocket and not damaged, but you have pain
in it when you chew. The force of the impact
can lead to swelling in the socket, which
causes the pain
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.Loose tooth: The structures that
hold your tooth in place can get
damaged. When this happens, your
tooth becomes loose but stays in its
socket.
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Loss of tooth: Your tooth may be
knocked completely out of its socket
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Dental trauma usually occurs with a
direct blow to your mouth area or jaw.
The greater the impact of blow you
receive, the more likely for you to have
worse problems. Trauma may be fromany of the following:
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Accidents. These include a badfall from a height, bicycle or
motor vehicle crashes, andpedestrian and playgroundaccidents. The highest number of
accidents with dental traumahappens in children at 2 to 3years of age.
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Sports injuries. These include injuries
from diving, gymnastics, ice hockey,
football, or horseback riding. Dental
trauma may be from contact with other
players or from getting hit by a hard object,
such as a hockey stick.
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Street fights or other physical
assaults.
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Brittle or loose teeth.
Dental caries (tooth decay).
Overbite. This is when your upper teethstick out past your lower teeth.
Periodontal (gum) disease.
Short upper lip or your teeth do not close
or come together in the front of yourmouth.
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Bleeding or bruising:
Bruises on your lips and face.
Bleeding gums or other soft tissuesinside your mouth.
Cuts on your lips, chin, or labial
frenulum (tissue that attaches yourlip to your gum).
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Facial fracture: You may have abroken bone, such as in the jaw orface.
You have a change in how yourface or jaw looks.
You are not be able to move yourjaw or close your mouth.
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Tooth discomfort or pain:
Toothache.
Tooth that is very sensitive to pressure,temperature (hot or cold), or tapping.You may also feel pain when eating or
drinking something sweet or sour.
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Tooth damage: You may have atooth that is cracked, chipped, loose,out of position, or missing.
You can feel a sharp or rough edgeon your tooth. This can rub againstthe inside of your mouth or yourtongue.
Missing tooth or teeth.
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yBleeding: Put pressure on areasthat are bleeding. Use a clean
hand or towel to do this.
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yKnocked out tooth: Put the toothback in the socket that it came out
of if you can.
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yApply ice: Use an ice pack to reduce
pain and swelling. An ice pack can be
crushed ice in a plastic bag or a bag
of frozen vegetables. Wrap the ice
pack in a thin towel to protect your
face from getting too cold.
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yBreathing:Make sure nothing isblocking your ability to breath. Thiscan include knocked out teeth orblood in your throat.
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Analgesics: These include different kinds of
medicines that help decrease pain, such as
acetaminophen. The kind of analgesic that may
be given to you will depend on how bad your
pain is. Some analgesics may also be used to
decrease swelling and fever (high body
tem erature .
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Antibiotics: This medicine is given to fight or
prevent an infection caused by bacteria. Always
take your antibiotics exactly as ordered by your
caregiver. Keep taking this medicine until it is
completely gone, even if you feel better. Stopping
antibiotics without your caregiver'sOK may makethe medicine unable to kill all of the germs. Never
"save" antibiotics or take leftover antibiotics that
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yRoot canal: This may be done if your
tooth crown is broken and the pulp is
damaged. A root canal, also called apulpectomy (pulp removal), may be done
if the pulp is badly damaged. It may also
be done to help the exposed pulp heal.This is a procedure where a filling is
placed inside your tooth and covered with
a cap.
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y Splinting of teeth: A splint may beplaced on your teeth for a period oftime. This helps support the position
of your damaged tooth while itssupporting tissues heal
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Tooth bonding: This isdone if a small part ofyour tooth chipped off.
A special glue will beused to put the piecesof tooth back together.
Tooth replantation: Atooth that completelycame out from its
socket may be put back.This should be donewithin five minutesafter the trauma or assoon as possible.
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Tooth reshaping: This isdone to make the sharp
edge of your brokentooth smoother.
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Have your injurychecked right away.Seeing a caregiver
right away may helpyou from havingdental or otherproblems later. These
include tooth loss ordental infections.
Avoid using yourdamaged tooth.Chewing food on
your damaged toothmay put too muchpressure and worsenyour injury.
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yLiquid diet:Avoid hot foods and stay on a
liquid diet if a splint was placed on your teeth.Liquid diet means you may not be able to eat
solid foods for a period of time. You can drink
anything that is a liquid such as soup, milk,
and smoothies.
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y Soft diet: Limit your diet to soft
foods for 1 to 2 weeks if you have aloose tooth. Soft foods includeapplesauce, baby food, bananas,
cooked cereal, cottage cheese, eggs,gelatin, pudding, and yogurt
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Keep your wounds clean. Soft tissuecuts and other wounds must be keptclean. Gargle using a salt water
solution. You can also clean yourwounds using hydrogen peroxideswabs. Ask your caregiver for more
information on how to clean yourwounds.
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WHEN THE VICTIMSRECOVERS
S
PO
NTANEO
US
LYOR
IS
SUCCESFULLY
RESUSCITATED(ATLEAST
TEMPORARILY)
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DEATH CAUSED BY
CHANGES IN THE LUNGS
R
ES
ULTING IN IMM
ERS
IO
N
OFWATER
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Persons struggles to keep afloat in the water
Gulps in large of air as he thrashes about
(when he can no longer keep afloat and startsto submerge
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He tries to take and hold one more deep breath
Water may enter the airway
(there is a series of coughing and swallowingactions
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This spasms seals the airway effectively that nomore than a small amount of water reaches thelungs
Unconsciousness soon results fromhypoxia(oxygen starvation)
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occ
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occurring when the entranceof water causes a
laryngospasm occluding theairway bringing aboutsuffocation.
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1. Laryngospasm
2. Asphyxiation
3. Hypoxia
4. Cardiac arrest
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in which water fills thelungs, stopping gas
exchange.
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FRESHWATER
Hypotonic
Hypervolemia Hemodilution
Hemolysis
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SALTWATER
Hypertonic
Hypovolemia Hemoconcentration
Crenation of RB
C
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Immediate quality CPR
Cold water
Clean water
Short immersion time
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Monitor patients AB C(cervical spineprecautions
Initiate CPR
Establish IV access
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Correct hypoxia
Correct acidosis
Correct hypotension
Transport victim to nearest hospital
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Monitor patients AB C(cervicalspine precautions)
Initiate monitoring(cardiac and
pulse oximeter
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Remove wet clothing; wrapin dry blanket
Provide aggressive re-warming effort
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Gently handle patient toprevent arrythmia
Anticipate profoundneurologic changes
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Provide re-warming therapy
Determine the duration ofsubmersion
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Monitor ICP
monitor hypoxic seizures
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When there are 2 rescuespresent, perform the head tiltchin support technique toprovide in-line stabilization of apatient in shallow water
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When you find a patientface down in shallow
water,position yourselfalong side the patient
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Extend the arms straightup alongside his head to
create a splint
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Begin to rotate the torsotoward you
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PO
ISO
NS
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y AKA (rust remover, metal polishSE: PAIN GI tract chemical burns
Lip burns, vomiting
Rx. Give milk or water, mlk ofmagnesia, egg white, prevent
aspiration. Transport patient insitting position, if possible
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Do not induce vomiting
Contact poison control for moreadvise
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AKA- Tylenol SE: There may be s/sx but
acetaminophen is toxic to the liverN/V, anorexia RUQ PAIN, pallorand diaphresis
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RX; ABCSO2 IV, EKG fluids forhypotension, activated charcoal50-100mg orally.
Mucomist may be given in ED
CAUTION:CONTACT POISON
CONROL
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SE: pain GI Tract chemical burnsLip burnns and vomiting
Rx: give milk or water, preventaspiration if possible trasportpatient in sitting position
Caution:
do not induce vomitingContact poison control
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Attacks occur while eating Most are caused by impacted food
Victim may clutch neck
The choking event is commonly witnessed!
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If victim demonstrates the universal chokingsign, quickly ask, Are you choking?
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M O S O
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M
ildO
bstruction In response to
question: victimspeaks & answersyes
Victim able to speak,cough, & breathe
S
evereO
bstruction In response to
question: victimunable to speak ornods
Victim unable tobreathe
Wheezing
Silent Cough
Unconscious victim
M O S O
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Mild
Obstruction
Encourage victim tocontinue coughing
Do NOT interfere
with patientsspontaneous efforts tocough & breathe
Do NOTHING else
Severe
Obstruction
INTERVENE!
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Apply abdominal thrusts in rapid successionuntil obstruction is relieved
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Stand behind victim & putboth hands around upperpart of abdomen
Lean victim forwards
Clench fist & place it thumbside against victimsabdomen between theumbilicus & xiphoid
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Grasp this hand with theother
Pull sharply inwards &upwards
Repeat until object isexpelled or victim becomesunresponsive
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If you find aCONSCIOUSchoking victimlying on the
ground, doabdominalthrusts in thesupine position
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If victim becomes unresponsive Carefully support patient to the ground
Activate EMS
Begin CPR
Initiate chest compressions even if pulse ispresent in the UNCONSCIOUSCHOKINGVICTIM
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Look for object in victims mouth each timeairway is opened
Use finger sweep if solid material is SEENobstructing airway of unresponsive patient
FBAO victims treated with abdominal thrustsshould be examined by a doctor
Can cause internal injuries
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S i D dl !
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Scorpions: Deadly! Not all scorpions are poisonous, but those that
are can be deadly. Scorpions are found mostlyin the Southwest and Western states.
Symptoms of a sting include pain, swelling,itching, vomiting, increased sweating, andvision problems. Get medical careimmediately.
T i b d b
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Toxins-substance produce byanimals or plants that arepoisonous to humans
Venom-is a term for a toxinproduced by some animals suchas snakes, and spiders
Al d f
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Altered state of awareness Noticeably stings or bites in the
skin Puncture marks
Blotchy skin
Localized pain or itching
Numbness in the limb/body
B i i h i
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Burning sensation at the site Redness
Swelling/blister at the siteWeakness/collapse
DOB
H/A, DIZZINESS
CHILLS
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CHILLS FEVER
N/V
MUSCLE CRAMPS
EXCESSIVE SALIVA
ANAPHYLAXIS
T t f h k
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Treat for shock Pull the stinger/venom sac-
avoid using tweezers
Remove jewelry
Contact poison control
R i i l b t ll
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Require special care but usuallynot life threatening
Snake bites takes several hoursto appear.
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Pit i ( ttl k
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Pit vipers-(rattle snakes,copperheads, water
mocassins
Coral snakes
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When youre feeling stressedWhen youre feeling stressed
and about to break down. Justand about to break down. Just
remember STRESSED is justremember STRESSED is just
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remember STRESSED is justremember STRESSED is justDESSERTS spelledDESSERTS spelled
backwards Its just a piece ofbackwards Its just a piece of
cake!cake!