EMERGENCY AND DISASTER NURSING

TERMS USE:
Trauma - Intentional or unintentional wounds/injuries on
the human body from particular mechanical mechanism
that exceeds the bodys ability to protect itself from injury
Emergency Management - traditionally refers to care
given to patients with urgent and critical needs.
Triage - process of assessing patients to determine
management priorities.
First Aid - an immediate or emergency treatment given to a
person who has been injured before complete medical and
surgical treatment can be secured.
BLS - level of medical care which is used for patient with
illness or injury until full medical care can be given.
ACLS ADVANCE CARDIAC LIFE SUPPORT- Set of
clinical interventions for the urgent treatment of cardiac
arrest and often life threatening medical emergencies as
well as the knowledge and skills to deploy those
interventions.
Defibrillation - Restoration of normal rhythm to the heart
in ventricular or atrial fibrillation
Disaster - Any catastrophic situation in which the normal
patterns of life (or ecosystems) have been disrupted and
extraordinary, emergency interventions are required to save
and preserve human lives and/or the environment.

Mass Casualty Incident - situation in which the number of

casualties exceeds the number of resources.
Post Traumatic Stress Syndrome - characteristic of
symptoms after a psychologically stressful event was out of
range of an normal human experience.
EMERGENCY IT IS WHATEVER THE PATIENT OR
THE FAMILY CONSIDERS IT TO BE.
EMERGENCY NURSING - It is the nursing care given to
patients with urgent and critical needs
EMERGENCY NURSE - has a specialized education,
training, and experience to gain expertise in assessing and
identifying patients health care problems in crisis
situations
establishes priorities, monitors and continuously
assesses acutely ill and injured patients, supports
and attends to families, supervises allied health
personnel, and teaches patients and families within
a time-limited, high-pressured care environment
DISASTER NURSING - a branch of emergency nursing,
it refers to nursing care given to patients who are victims of
disasters, whether it is manmade or natural phenomena.
INCIDENT COMMAND SYSTEM - It is a management
tool for organizing personnel, facilities, equipment, and
communication for any emergency situation.
INCIDENT COMMANDER - The head of the incident
command system

He must be continuously informed of all the

activities and informed about any deviation from
the established plan
SCOPE AND PRACTICE OF EMERGENCY
NURSING
The emergency nurse has had specialized
education, training, and experience.
The emergency nurse establishes priorities,
monitors and continuously assesses acutely ill and
injured patients, supports and attends to families,
supervises allied health personnel, and teaches
patients and families within a time-limited, highpressured care environment.
Nursing interventions are accomplished
interdependently, in consultation with or under the
direction of a licensed physician.
Appropriate nursing and medical interventions are
anticipated based on assessment data.
The emergency health care staff members work as
a team in performing the highly technical, hands-on
skills required to care for patients in an emergency
situation.
Patients in the ED have a wide variety of actual or
potential problems, and their condition may change
constantly.

 Although a patient may have several diagnosis at a

given time, the focus is on the most life-threatening
ones
ISSUES IN EMERGENCY NURSING CARE
Emergency nursing is demanding because of the
diversity of conditions and situations which are
unique in the ER.
Issues include legal issues, occupational health and
safety risks for ED staff, and the challenge of
providing holistic care in the context of a fastpaced, technology-driven environment in which
serious illness and death are confronted on a daily
basis.
The emergency nurse must expand his or her
knowledge base to encompass recognizing and
treating patients and anticipate nursing care in the
event of a mass casualty incident.
Legal Issues Includes:
Actual Consent
Implied Consent
Parental Consent
Good Samaritan Law
Gives legal protection to the rescuer who
act in good faith and are not guilty of gross
negligence or willful misconduct.

Focus of Emergency Care

Preserve or Prolong Life

Alleviate Suffering
Do No Further Harm
Restore to Optimal Function

Golden Rules of Emergency Care

Dos
- Obtain Consent
- Think of the Worst
- Respect Victims Modesty & Privacy
Donts
- let the patient see his own injury
- Make any unrealistic promises
Guidelines in Giving Emergency Care
A Ask for help
I Intervene
D Do no Further Harm

Stages of Crisis
1. Anxiety and Denial
encouraged to recognize and talk about their
feelings.
asking questions is encouraged.
honest answers given
prolonged denial is not encouraged or supported
2. Remorse and Guilt

verbalize their feelings

3. Anger
way of handling anxiety and fear
allow the anger to be ventilated
4. Grief
help family members work through their grief
letting them know that it is normal and acceptable
Core Competencies in Emergency Nursing
Assessment
Priority Setting/Critical Thinking Skills
Knowledge of Emergency Care
Technical Skills
Communication
Assess and Intervene
Check for ABCs of life
A Airway
B Breathing
C - Circulation
Team Members
Rescuer
Emergency Medical Technician
Paramedics
Emergency Medicine Physicians
Incident Commander
Support Staff
Inpatient Unit Staff
Emergency Action Principle
I. Survey the Scene

Is the Scene Safe?

What Happened?
Are there any bystanders who can help?
identify as a trained first aider!

II. Do a Primary Survey - organization of approach so

that immediate threats to life are rapidly identified and
effectively manage.
Primary Survey
A - Airway/Cervical Spine
- Establish Patent Airway
- Maintain Alignment
- GCS 8 = Prepare Intubation
B Breathing
- Assess Breath Sounds
- Observe for Chest Wall Trauma
- Prepare for chest decompression
C Circulation
- Monitor VS
- Maintain Vascular Access
- Direct Pressure
Estimated Blood Pressure
SITE
Radial

Femoral

SBP
80

70

Carotid

Control of Hemorrhage

60

What Happened?
Number of Persons Injured
Extent of Injury and First Aid given
Telephone number from where youre calling

IV. Do Secondary Survey

Interview the Patient
S Symptoms
A Allergies
M Medication
P Previous/Present Illness
L Last Meal Taken
E Events Prior to Accident
Check Vital Signs

V. Triage

D Disability
- Evaluate LOC
- Re-evaluate clients LOC
- Use AVPU mnemonics
E Exposure
- Remove clothing
- Maintain Privacy
- Prevent Hypothermia
III. Activate Medical Assistance
Information to be Relayed:

comes from the French word trier, meaning to

sort
process of assessing patients to determine
management priorities
Categories:
1. Emergent - highest priority, conditions are life
threatening and need immediate attention
Airway obstruction, sucking chest wound, shock,
unstable chest and abdominal wounds, open
fractures of long bones

2. Urgent have serious health problems but not

immediately life threatening ones. Must be seen
within 1 hour

2.

Maxillofacial wounds without airway compromise,

eye injuries, stable abdominal wounds without
evidence of significant hemorrhage, fractures
3. Non-urgent patients have episodic illness than
can be addressed within 24 hours without increased
morbidity
Upper extremity fractures, minor burns, sprains,
small lacerations without significant bleeding,
behavioral disorders or psychological disturbances.
3. Non-urgent patients have episodic illness than
can be addressed within 24 hours without increased
morbidity
Upper extremity fractures, minor burns, sprains,
small lacerations without significant bleeding,
behavioral disorders or psychological disturbances.
TRIAGE
CATEGOR
Y

PRIORIT
Y

IMMEDIA
TE
DELAYE
D
MINIMAL

RED

YELLO
W
GREEN

COLOR

Field TRIAGE
1. Immediate:
Injuries are life-threatening but survivable with
minimal intervention. Individuals in this group can

3.

4.

5.

progress rapidly to expectant if treatment is

delayed.
Delayed:
Injuries are significant and require medical care,
but can wait hours without threat to life or limb.
Individuals in this group receive treatment only
after immediate casualties are treated.
Minimal:
Injuries are minor and treatment can be delayed
hours to days. Individuals in this group should be
moved away from the main triage area.
Expectant:
Injuries are extensive and chances of survival are
unlikely even with definitive care.
Fast-Track:
Psychological support needed

FIRST AID
Role of First Aid
Bridge the Gap Between the Victim and the
Physician
Immediately start giving interventions in prehospital setting
Value of First Aid Training
Self-help
Health for Others
Preparation for Disaster
Safety Awareness

BASIC LIFE SUPPORT - an emergency procedure that

consists of recognizing respiratory or cardiac arrest or both
the proper application of CPR to maintain life until a victim
recovers or advance life support is available.

Artificial Respiration
a way of breathing air to persons lungs when
breathing ceased or stopped function.

Respiratory Arrest
a condition when the respiration or breathing
pattern of an individual stops to function, while the
pulse and circulation may continue.
Causes: Choking, Electrocution, strangulation, drowning
and suffocation.

WAYS TO VENTILATE THE LUNGS

1. MOUTH-TO-MOUTH = a quick, effective way to
provide O2 and ventilation to the victim.
2. MOUTH-TO-NOSE = recommended when it is
impossible to ventilate through the victims mouth.
(Trismus, mouth injury)
3. MOUTH-TO-NOSE and MOUTH = if the pt. is an
infant
4. MOUTH-TO-STOMA = used if the pt. has a
stoma; a permanent opening that connects the
trachea directly to the front of the neck.
For Rescue Breathing Alone:
Rate is 10-12 breaths in ADULT

 (1.5 - 2 sec/breath) ( 1 breath every 4 to 5 secs)

Rate is 20 breaths for a CHILD and INFANT
(1 1.5 sec/breath) ( 1 breath every 3 secs)

Approach
Assess for
Response

Positioning

Table of Cardiopulmonary Resuscitation for Adult,

Child & Infant
Compression
Area

Depth
How to
compress
Compression
-ventilation
ratio
Number of
cycles per
minute

Procedure

Safe

Adult
Lower half of the
sternum but not
hitting the xiphoid
process: measure
up to 2 fingers
from substernal
notch.

30:2 (1 or 2
rescuers)

30:2 (1 or 2
rescuers)

Infant
Lower half of
the sternum but
not hitting the
xiphoid
process: 1
finger width
below the
imaginary
nipple line.
Approximately
to 1 inch
2 fingers
(middle & ring
fingertips)
30:2 (1 or 2
rescuers)

5 cycles in 2
minutes

5 cycles in 2
minutes

5 cycles in 2
minutes

Approximately 1
to 2 inches
Heel of 1 hand,
other hand on top.

Infant(0-1yr)

Child
Lower half of
the sternum but
not hitting the
xiphoid
process:
measure up to 1
finger from
substernal
notch.
Approximately
1 to 1 inches
Heel of 1 hand.

Child(1-8
yrs)

Approach and assess situation

Adult

Open the
Airway

Shout and gently pinch

Gently
shouting
are you
ok? then
shake the
victim
Placed Supine on a firm and flat surface

Assess for
Breathing

Check for foreign bodies then remove

using finger sweep
Head-tilt-chin-lift maneuver
Jaw-thrust Maneuver

Bring cheek over the mouth and nose of

the casualty
Look for chest movement
Listen for breath sounds
Feel for breathing on your cheek
The Casualty is NOT Breathing:

Go for Help

Give Rescue
Breaths

if someone responds to your shout for

help send that person to phone for
ambulance
if youre on your own, leave the
casualty and make the phone call for
yourself
* never leave if the patient has collapsed as a
result of trauma or drowning or if the casualty is
a child
5 rescue breaths
2 rescue breaths
Place mouth
over the nose
and mouth of
the infant
look for chest
rising

pinch nose
and ventilate
via mouth
look for
chest rising

seal lips around

the mouth and
blow steadily
for 1.5 2
seconds
look for chest
rising

The Casualty is Breathing:

Place in recovery position
Before moving casualty remove any objects safely
from her pockets
Kneel beside casualty, place arm nearest at right
angles, and then bend elbow keeping the palm
uppermost.

Bring far arm across the casualtys chest and hold

back of the casualtys hand against the nearest
cheek
With your other hand grasp the far thigh just above
the knee, then pull the casualty towards you and on
to his or her side

CRITERIA FOR NOT STARTING CPR

- All patients in cardiac arrest receive resuscitation
unless:
1. The pt. has a valid DNR order
2. The pt. has signs of irreversible death: rigor mortis,
livor mortis, algor mortis, decapitation
3. No physiological benefit can be expected because
the vital functions have deteriorated despite
maximal therapy
4. Witholding attempts to resuscitate in the DR is
appropriate for newly born infants with:
- Confirmed gestation less than 23 weeks or
birthweight less than 400 grams
- Anencephaly
When to Stop
when the patient has spontaneous breathing
when the first aider is too exhausted to continue
when another first aider takes over
when EMS arrives and takes over

When to STOP CPR:

S SPONTANEOUS BREATH RESTORED
T TURNED OVER THE MEDICAL SERVICES
O OPERATOR IS EXHAUSTED TO CONTINUE
P PHYSICIAN ASSUMES RESPONSIBILITY
COMPLICATIONS OF CPR:

RIB FRACTURE
STERNUM FRACTURE
LACERATION OF THE LIVER OR SPLEEN
PNEUMOTHORAX, HEMOTHORAX

CHAIN OF SURVIVAL
EARLY ACCESS early recognition of cardiac
arrest, prompt activation of emergency services
EARLY BLS prevent brain damage, buy time for
the arrival of defibrillator
EARLY DEFIBRILLATION - 7-10% decrease
per minute without defibrillation
EARLY ACLS technique that attempts to
stabilize patient

AIRWAY OBSTRUCTION
KINDS OF AIRWAY OBSTRUCTION:
1. Anatomic Airway Obstruction
2. Mechanical Airway Obstruction
TYPES OF AIRWAY OBSTRUCTION
1. Partial Airway Obstruction with Good Air
Exchange
2. Partial Airway Obstruction with Poor Air Exchange
3. Complete Airway Obstruction
Clinical Manifestations: UNIVERSAL DISTRESS
SIGNAL
(patient may clutch the neck between the thumb and
fingers), choking, stridor, apprehensive appearance,
restlessness. CYANOSIS and LOSS of CONSCIOUSNESS
develop as hypoxia worsens.
MANAGEMENT FOR AIRWAY OBSTRUCTION
HEIMLICH MANEUVER
(Subdiaphragmatic Abdominal Thrusts)
For Standing or sitting conscious patient:

Stand behind the patient; wrap your arms around

the patients waist

Make a FIST, placing thumb side of the fist

against the pts abdomen, in the midline
SLIGHTLY ABOVE the UMBILICUS and WELL
BELOW the XIPHOID PROCESS
Make a quick INWARD and UPWARD thrust.
Each thrust is separated.

A. HEAD-TILT-CHIN-LIFT MANEUVER
B. JAW-THRUST MANEUVER
C. OROPAHRYNGEAL AIRWAY
INJURIES TO HEAD, SPINE, AND FACE

For patient lying (unconscious):

position patient at the back (supine); kneel astride

the patients thigh

Place HEEL of one HAND against the pts

abdomen, place the second hand directly on the top
of the fist.

Make a quick UPWARD thrust

D. ENDOTRACHEAL INTUBATION
Indications:
To establish an airway for patients cannot be
adequately ventilated with an oropharyngeal
airway
To bypass upper airway obstruction
To permit connection to ambubag or mechanical
ventilator
To prevent aspiration
To facilitate removal of tracheobronchial secretions

FINGER SWEEP: used only in unconscious adult client

Make a TONGUE-JAW LIFT. Opening the pts

mouth by grasping both tongue and lower jaw
between the thumb and fingers, and lifting the
mandible.

Insert index finger of other hand to scrape across

the back of the throat

Use a hooking action

E. CRICOTHYROIDOTOMY

a puncture or incision of the cricothyroid

membrane to establish an emergency airway in
certain emergency situations where endotracheal
intubation or tracheostomy is not possible.

indicated to pts. with trauma to head and neck, and

in allergic reaction causing laryngeal edema

use of gauge 11 needle or scalpel blade

CHEST THRUST: used only in patients in advanced stages

of pregnancy or in markedly obese clients
a. Conscious Patient standing or sitting
Stand behind the client with arms under patients
axilla to encircle patients chest
Place thumb side of fist on the MIDDLE of
STERNUM, grasp with the other hand and perform
BACKWARD thrust until foreign body is expelled.

Nursing Actions:

Extend the neck. Place towel roll beneath the

shoulders

Insert the needle at a 10 to 30 degree caudal

direction in the midline jest above the upper part of
the cricoid cartilage

Listen for air passing back and forth

Direct the needle downward and posteriorly, and

tape it.

MEASURES TO ESTABLISH AIRWAY

A. HEAD INJURIES
1. OPEN HEAD INJURY skull is fractured
2. CLOSED HEAD INJURY skull is intact
3. CONCUSSION temporary loss of consciousness
that results in transient interruption if the brains
normal functioning
4. CONTUSSSION bruising of the brain tissue
5. INTRACRANIAL HEMORRHAGE
significant bleeding into a space or potential space
between the skull and the brain
a. Epidural hematoma
the most serious type of hematoma; forms
rapidly and results from arterial bleeding
forms between the dura and the skull from
a tear int the meningeal area
b. Subdural hematoma
forms slowly and results from a venous
bleed

a surgical emergency
c. Intracerebral hemorrhage
bleeding directly into the brain matter

ALERT: Assume cervical spine fracture for any patient

with a significant head injury, until proven otherwise.
PRIMARY ASSESSMENT: Assess for ABC
SECONDARY ASSESSMENT:
Change in LOC most sensitive indicator in the
pts condition

CUSHINGS TRIAD ( bradypnea, bradycardia,

widened pulse pressure) indicating increased
intracranial pressure
unequal or unresponsive pupils; impaired vision
Battles sign bluish discoloration of the mastoid,
indicating a possible BASAL SKULL FRACTURE
Rhinorrhea or otorrhea indicative of CSF leak
Periorbital Ecchymosis indicates anterior basilar
fracture

ALERT: If basilar skull fracture or severe midface fractures

are suspected, a nasogastric tube(NGT) is
CONTRAINDICATED!

MANAGEMENT:
Open airway by Jaw-Thrust Manuever, suction
orally if needed
Administer high flow oxygen: most common death
is CEREBRAL ANOXIA
In general, hyperventilate the patient to 20-25
bpm, causing cerebral vasoconstriction and
minimizing cerebral edema
Apply a bulky, loose dressing; dont apply pressure
IV line of PNSS or Plain LR
prepare to manage seizures
maintain normothermia
Medications:
a. Diazepam
b. Steroids
c. Mannitol
Prepare of immediate surgery if pt. shows
evidence of neurologic deterioration

B. SKULL FRACTURES

SIMPLE closed
COMPOUND open
LINEAR Fx common hairline break, w/o
displacement of structure

COMMINUTED Fx splinters or crushes the

bone in several fragments

DEPRESSED Fx pushes the bone toward the

brain

CRANIAL VAULT Fx top of the head

BASILAR Fx base of the skull and frontal
sinuses
ALERT:

Damage to the brain is the first concern, it is

considered a neurosurgical condition

In children, skulls thinness and elasticity allows a

depression w/o a break in the bone
CAUSES: Traumatic blows to the head, VA, severe
beatings
S/Sx: scalp wounds, agitation and irritability, loss
of consciousness, labored breathing, abnormal deep
tendon reflexes, altered pupillary and moor
response
IF CONSCIOUS: complains of persistent localized
headache
IF JAGGED BONE FRAGMENTS: may cause cerebral
bleeding
HALO SIGN blood-tinged spot surrounded by lighter
ring
IF SPHENOIDAL Fx: damages the optic nerve and
may
cause BLINDNESS
IF TEMPORAL Fx: may cause unilateral deafness or
facial paralysis
TREATMENT:

For LINEAR FRACTURES:

supporative (mild analgesics)
cleaning and debridement of wounds
If conscious: observed for 4 hours; if not, admit for
evaluation
if VS stable, may go home with instruction sheet
For VAULT and BASILAR FRACTURES:
Craniotomy to remove fragemnts
anti-biotics
Dexamethasone
Osmotic Diuretics (MANNITOL) if increased ICP
is present
NURSING CONSIDERATIONS:
maintain patent airway; nasal airway
contraindicated to basilar fx
support with O2 administration
suction pt. through mouth not nose if CSF leak is
present
RHINORRHEA wipe it, dont let him blow it!
OTORRHEA cover it lightly with sterile gauze,
dont pack it!
Position head on side
Maintain a supine position with bed elevated to 30
degrees
dont give narcotics or sedative
assist in surgery, maintaining sterile technique
C. CERVICAL SPINE INJURIES
PRIMARY ASSESSMENT:

immediate immobilization of the spine

A B C ( Intercoastal paralysis w/ diapragmatic

breathing)
SUBSEQUENT ASSESSMENT:

Hypotension, bradycardia, hypothermia - suggests

SPINAL SHOCK

Total sensory loss and motor paralysis below the

level of injury
MANAGEMENT:
Nasotracheal intubation
initaite IV access, monitor blood gas
indwelling urinary catheterization
prepare to manage seizures
Meds: High dose steroids and diazepam
D. MAXILLOFACIAL TRAUMA
PRIMARY ASSESSMENT:

Immobilization of spine while performing

assessment

ABC (tongue swelling, bleeding, broken or

missed teeth)
SUBSEQUENT ASSESSMENT:

Paralysis if the upward gaze indicative of

INFERIOR ORBIT FX

Crepitus on nose indicates nasal fracture

Flattening of the cheek and loss of sensation below

the orbit indicates ZYGOMA (cheekbone) FX
Malocclussion of teeth, trismus indicative of
MAXILLA FX
PRIMARY INTERVENTIONS:
Insertion of oral airway or intubation
Nasopharyngeal airway should only be used if no
evidence of nasal fracture or rhinorrhea
Apply bulky, loose dressing; apply ice to areas of
swelling
INJURIES TO SOFT TISSUES, BONES AND JOINTS
A. SOFT TISSUE INJURIES
1. CLOSED WOUND

A. CONTUSION bleeding beneath the skin into the soft

tissue
B. HEMATOMA well-defined pocket of blood and fluid
beneath the skin
2. OPEN WOUND
A. ABRASION superficial loss of skin from rubbing or
scraping
B. LACERATION tear in the skin, can be insicional or
jagged
C. PUNCTURE penetration of a pointed object, can be
penetrating or perforating
D. AVULSION tearing off or loss of a flap of skin
E. AMPUTATION traumatic cutting or tearing off of a
finger, toe, arm or leg
PRIMARY MANAGEMENT
D- IRECT PRESSURE
E- LEVATION
P- RESSURE POINTS
S- OAK, SOAP, SCRUB, SURGERY
A- NTI-TETANUS, ANTIBIOTICS
I- RRIGATE
D- RESS
B. INJURIES TO BONES AND JOINTS
1. FRACTURE a break in he continuity of the bone;
occurs when stress is placed on a bone is greater
than the bone can absorb
ALERT: fractured cervical spine, pelvis and femur may
produce life threatening injuries; posterior dislocations of
the hip are life- and limb-threatening emergencies due to
potential blood loss.
Clinical Manifestations:

Pain and tenderness over fracture site

Crepitus or grating over fracture site
swelling and edema
Deformity, shortening of an extremity or rotation of
extremity

EMERGENCY Management: IMMOBILIZE, INITIATE

IV
MANAGEMENT PROCESS OF FRACTURES
REDUCTION
setting the bone; refers to the restoration of the
fracture fragments into anatomic position and
alignment
IMMOBILIZATION
maintains reduction until bone healing occurs
REHABILITATION
Regaining normal function of the affected part
use of cast and splint to immobilize extremity and
maintain reduction
Skin Traction force applied to the skin using
foam rubber, tapes
Skeletal Traction force applied to the bony
skeleton directly, using wires, pins, tongs placed in
the bone
ORIF operative intervention to achieve
reduction, alignment and stabilization
Endoprosthetic Replacement implantation of
metal device
NURSING CONSIDERATIONS:
Elevate to prevent or limit swelling
Apply ice packs or cold compress; not place
directly in skin

Splint and maintain in good alignment, immobilize

the joint above and below the fracture
Give pain medications as ordered
Assist in casting; use the palm of your hands in
holding a wet cast
Avoid resting cast on hard surfaces or sharp edges
Do neurovascular checks hourly for the first 24
hours
Assess for COMPARTMENT SYNDROME
check for 6 Ps
If Compartment syndrome is suspected, do not
elevate limb above the level of the cast
Notify the physician
Bivalve the cast

2. TRAUMATIC JOINT DISLOCATION - occurs when

the surfaces of the bones forming the joint no longer in
anatomic position
ALERT: this is a medical emergency because of associated
disruption of surrounding blood and nerve supplies
* Subluxation partial disruption of the articulating
surfaces
Clinical Manifestations:

Pain and deformity

Loss of normal movement

X-ray confirmation of dislocation w/o assoc.

fracture
Management: Immobilize part, Secure reduction of
dislocations manually (usually preferred under anesthesia)
Nursing Considerations:
Assess neurovascular status before and after
reduction of dislocation
Administer pain medications (NSAIDs)
Ensure proper use of immobilization device
(elastic bandage, splints)

3. SPRAIN an injury to the ligamentous structure

surrounding a joint; usually caused by a wrench or twist
resulting in a decrease joint stability
Clinical Manifestations:

Rapid swelling due to extravasation of blood w/n

tissues

Pain on passive movement of joint

discoloration, and limited use or movement

4. STRAIN a microscopic tearing of the muscle cause by
excessive force, stretching, or overuse
Clinical Manifestations:

Pain with isometric contractions

Swelling and tenderness

Hemorrhage in muscle

MANAGEMENT OF SPRAINS AND STRAINS

COMPRESSION (Elastic Bandage)

REST
ICE (for the first 24 hrs; 1 hr on, 2 hrs off during waking
hours)
MEDICATIONS ( NSAIDs)
ELEVATION
SUPPORT (Use of crutches, splints)

NURSING CONSIDERATIONS:
Apply ice compress for the first 24 hrs to produce
vasoconstriction, decrease edema, and reduce
discomfort
Apply warm compress after 24 hrs to promote
circulation and absorption (20 to 30 minutes at a
time)
Educate to rest injured part for a month to allow
healing
Educate to resume activities gradually and to
warm up
SHOCK AND INTERNAL INJURIES
A. SHOCK
- Inadequate tissue perfusion, resulting in failure of
one or more of the ff:
a. pump failure of the heart
b. Blood volume
c. arterial resistance levels
d. capacity of venous beds

- Can be classified as:

A. HYPOVOLEMIC - occurs when significant
amount of fluid is lost in the intravascular space
(Ex. Hemorrhage, burns, fluid shifts)
B. CARDIOGENIC occurs when the heart fails as
a pump. Primary causes includes MI,
dysrhythmias; Secondary causes includes
mechanical restriction of cardiac function or
venous obstruction like in Cardiac Tamponade,
tension pneumothrorax, VCO
C. SEPTIC SHOCK from bacteria and their
products circulating in the blood

Maintain normothermia (high fever will increase

the cellular metabolism effects of shock
Medications: Inotropics, Vasopressor, and Antibiotics

PRIMARY INTERVENTIONS:
Assess for ABC
Resuscitate as necessary
Administer O2 to augment O2-carrying capacity of
arterial blood
Start cardiac monitoring
Control hemorrhage
SUBSEQUENT ASSESSMENT:
o Assess LOC, decreasing LOC indicates
progression of shock
o Monitor arterial blood pressure (narrowing pulse
pressure, fall in systolic pressure)
o Assess pulse quality and rate change (tachycardia,
weak and thready)
o Assess urinary output (25ml/hr may indicate
shock)
o Assess capillary perfusion
o Assess for metabolic acidosis due to anaerobic
metabolism of cells
o Assess for excessive thirst, hyperthermia on septic
shock
MANAGEMENT:
Administer O2 via ET or nonrebreather face mask
(if intubated, may be hyperventilated to control
acidosis)
Fluid resuscitation (2 large-bore IV lines, Ringers
Lactate, BT)
Insertion of an indwelling catheter
Maintain patient in a supine position with legs
elevated
Continue to monitor VS, ECG, CVP, ABG, UO,
HCT, Hgb,and electrolytes; refer changes on the
following

ELECTROCARDIOGRAM
- It is a useful tool in the diagnosis of those
conditions that may cause abberations in the
electrical activity
WAVE INTERPRETATIONS:
P WAVE : Atrial Depolarization; first positive
deflection
Q WAVE: first negative deflection
R WAVE: first positive deflection
S WAVE: negative deflection, after R wave
QRS COMPLEX: Ventricular Depolarization
T WAVE: Ventricular Repolarization

Nursing Responsibilities during ECG

Check order for ECG, in cases of arrest, prepare
the machine at the bedside at ER
Provide Privacy
Instruct patient to lie still and avoid movement
Remove metal objects on the patients (jewelries)
Place Chest leads as labeled:
Lead 1: Red, Right Arm
Lead 2: Yellow, Left Arm
Lead 3: Green, Left Foot
Neutralizer: Black, Right foot
V1: Red, 4th ICS, Right Sternal Border
V2: Yellow, 4th ICS, Left sternal border

V3: Green, midway between V2 and V4

V4: Brown, 5th ICS, Left MCL
V5: Black, 5th ICS, LAAL
V6: Violet, 5th ICS, LMAL
B. BLUNT CHEST INJURIES
- It is a trauma in the chest without an open wound
usually cause by VA, blast injuries
SIGNS/SYMPTOMS:
RIB FRACTURES: tenderness, slight edema, pain
that worsens with deep breathing and movement,
shallow and splinted respirations
STERNAL FRACTURES: persistent chest pain
MULTIPLE RIB FRACTURES:
- FLAIL CHEST (loss of chest wall
integrity)
decreased lung inflation, paradoxical chest
movements
extreme pain
rapid and shallow respirations
hypotension, cyanosis
respiratory acidosis
COMPLICATIONS:
1. TENSION PNEUMOTHORAX
a condition in which air enters the chest but cant
be ejected during exhalation
There is lung collapse and mediastinal shift
S/Sx: tracheal deviation, cyanosis and severe dyspnea,
absent breath sound on the affected side, agitation, JVD
2. HEMOTHORAX
collection of blood in the pleural cavity, usually
results from ribs, lacerating lung tisssue or an
intercoastal artery
It is the most common cause of shock following
chest trauma
2. LACERATION or RUPTURE of AORTA

 immediately fatal
3. DIAPHRAGMATIC RUPTURE
causes severe respi. Distress; if untreated
abdominal viscera may herniate, compromising
both circulation and vital capacity of lungs
4. CARDIAC TAMPONADE
rapid unchecked rise in intrapericardia pressure that
impairs diastolic filling of the heart
results from blood or fluid accumulation in the
pericardial sac
ASSESSMENT AND DIAGNOSIS:

Percussion:
- Hemothorax: Dullness
- Tension Pnuemothorax: tymphany

Auscultation:
- Tension Pnemothorax: PMI is deviated
- Cardiac tamponade: muffled heart tones

X-ray

Thoracentesis yeilds blood and serosanguinous

fluid

ECG

Retrograde aortography reveals aortic laceration

Echocardiography

Computed Tomography
TREATMENT:
Simple Rib Fractures
mild analgesics, bed rest, apply heat
incentive spirometry
deep breathing, coughing and splinting
Severe Rib Fractures
intercoastal nerve blocks
position for semi-fowlers, administer O2
Hemothorax

Chest tube insertion at 5th-6th ICS anterior to MAL

administer IV fuids, O2, Blood Transfusion
Thoracotomy
Thoracentesis

TREATMENT:
Tension Pneumothorax
insertion of spinal, 14G or 16G needle into the 2nd
ICS at MCL to release pressure
Chest Tubes
Surgical Repair
Aortic Rupture/Laceration
immediate surgery
- synthetic grafts
- aortic anastomosis
O2, BT, IV
NURSING CONSIDEARTIONS:
monitor VS, (q 15, first hour post thoracentesis
and post CTT)
After CTT insertion, encourage cough and
breathing exersises
Chest tubes should have continuous
FLUCTUATIONS
if BUBBLING, air leak is suspected
if FLUCTUATION STOPS, mechanical blockage
or lung has already expanded
have an extra bottle with PNSS, clamps and sterile
gauze at bedside
in case of dislodgment, cover the opening with
sterile/petroleum gauze to prevent rapid lung
collapse
Assist with proper positioning
Bed Rest

C. ABDOMINAL INJURIES
1. PENETRATING ABDOMINAL INJURY usually
the result of gunshot wound or stab wounds; may
cross the diaphragm and enters the chest
2. BLUNT ABDOMINAL INJURY caused by
vehicular accidents or falls
PRIMARY ASSESSMENT AND INTERVENTIONS:
ASSESS ABC
INITITATE RESUSCITATION AS NEEDED
CONTROL BLEEDING AND PREPARE TO
TREAT SHOCK
IF THERE IS AN IMPALED OBJECT IN THE
ABDOMEN, LEAVE IT THERE AND
STABILIZE THE OBJECT WITH BULKY
DRESSINGS
GENERAL INTERVENTIONS:
Keep pt. quiet in the stretcher, any movement may
dislodge a clot
Cut the clothing, count the number of wounds,
look for entrance and exit wounds
Apply compression to external bleeding wounds
double IV line and infuse Ringers Lactate
Insert NGT to decompress the abdomen
Cover protruding abdominal viscera w/ sterile
saline dressings; dont attempt to place back the
protruding organs
Cover open wounds with dry dressings
Insert indwelling catheter; if pelvic fracture is
suspected, catheter should not be placed until
integrity of urethra is ensured.
Meds: Tetanus Prophylaxis, Antibiotics
Assist in peritoneal lavage
Prepare pt. for surgery if the condition persists.
(Exploratory Laparotomy)


ENVIROMENTAL EMERGENCIES
1. HEAT EXHAUSTION - It is the inadequacy or the
collapse of peripheral circulation due to volume and
electrolyte depletion
ASSESSMENT: temperature may be normal or slightly
elevated, hypotension, tachycardia, tachypnea, pale and
moist skin, fatigue, headache, dizziness, syncope
DIAGNOSTICS: hemoconcentration, hyponatremia or
hypernatremia, ECG may show dysrhythmias
MANAGEMENT:
Move patient to a cool environment, remove all
clothing
Position the patient supine with the feet slightly
elevated
Monitor VS every 15 mins and cardiac rhythm
Educate to avoid immediate reexposure to high
temperatures
2. HEATSTROKE - It is a combination of hyperpyrexia
and neurologic symptoms. It caused by a shutdown or
failure of the heat-regulating mechanisms of the body.
CLINICAL MANIFESTATIONS:

bizarre behavior or irritability, progressing to

confusion, delirium and coma

40.6 degrees Celcius, hypotension, tachycardia,

tachypnea

skin may appear flushed and hot; at start it maybe

moist progressing to dryness (Anhidrosis)
NURSING ALERT:

Elderly clients are high-risk to develop heat-stroke

Once diagnosis is confirmed, it is imperative to

reduce patients temperature
MANAGEMENT:

EVAPORATIVE COOLING, most effective, by

spraying tepid water on skin while fans are used to
blow
Apply ice packs to necks, groin, axillae, and scalp
Soak sheets/towels in ice water and place on
patient
If temp. fails to decrease, initiate core cooling:
iced saline lavage, cool fluid peritoneal dialysis,
cool fluid bladder irrigation
Discontinue active cooling when the temp. reaches
39 degrees Celcius
Oxygenate the pt. via ET or nonrebreather mask
Monitor VS, ECG, and neurologic status
Start IV infusion using Ringers Lactate
Anti-pyretics are not useful
Indwelling catheterization
WOF hypokalemia, metabolic acidosis, seizures

3. HYPOTHERMIA
- It is a condition where the core temp. is less than
35 degrees Celcius as a result in the exposure to
cold.
3 compensatory mechanisms:
a. shivering produces heat thru muscular activity
b. peripheral vasoconstriction to decrease heat
loss
c. raising basal metabolic rate
NURSING ALERT:

Elderly are greater risk for hypothermia due to

altered compensatory mechanisms

Extreme caution should be used in moving or

transporting hypothermic pts., because the heart is
near fibrillation threshold
CLINICAL MANIFESTIONS:

slow, spontaneous respirations

heart sounds may not be audible even if its beating
BP is extremely difficult to hear
fixed dilated pupils, no pulse, no BP; initiate CPR
drowsiness progressing to coma
shivering is suppressed on temp. below 32.3
degrees

ataxia

cold diuresis

fruity or acetone odor of breath

GOAL of MANAGEMENT: Rewarm without
precipitating cardiac dysrhythmias.
MANAGEMENT:
Passive External Rewarming (temp above 28
degrees)
- Remove all wet clothing, and replace with warm
clothing
Provide insulation by wrapping the patient in
several blankets
Provide warm fluids
Disadvantage: slow process
Active External Rewarming (temp above 28
degrees)
- Provide external heat for patient- warm hot water
bottles to the armpits, neck, or groin
Warm water immersion
- Disadvantages:
1. causes peripheral vasodilation, returning cool blood to
the core, causing an initial lowering of the core temp.
2. Acidosis due to washing out of lactic acid from the
peripheral tissue
3. An increased in metabolic demands before the heart is
warmed to meet these needs.
Active Core Rewarming (temp below 28 degrees)

Inhalation of warm, humidified O2 by mask or

ventilator
warmed IV fluids
Warm gastric lavage
- Peritoneal dialysis with warmed standard dialysis
solution
Cardiopulmonary bypass
Disadvantage: invasiveness of the procedure
4. NEAR-DROWNING
- It is a survival for atleast 24 hours after
submersion, with most common consequence of
hypoxemia.
- Hypoxia and acidosis are common problems of the
victim.
- Resultant pathophysiologic changes and pulmonary
injury depend on type of fluid and the volume
aspirated.
a. Fresh water aspiration- results in loss of surfactant, hence
an inability to expand lungs
b. Saltwater aspiration- leads to pulmonary edema from the
osmotic effect of salt within the lungs.
Clinical Manifestations:
-difficulty of breathing
-hypothermia
-cyanosis
-chills
MANAGEMENT:
Immediate CPR
Endotracheal intubation with PEEP
VS, check degree of hypothermia
Rewarming procedures
Intravascular volume expansion and inotropic
agents

ECG
Indwelling catheterization
NGT insertion

1.
2.

TOXICOLOGIC EMERGENCIES
ASSESSMENT:

ABC

Identify the poison

Obtain blood and urine tests; gastric contents may
be sent to laboratory

Monitor neurologic status

Monitor fluid and electrolytes

GENERAL INTERVENTIONS:

Initiate large-bore IV access, monitor shock

Prevent aspiration of gastric contents by

positioning head on side

Maintain seizures precaution

MINIMIZING ABSORPTION
Administration of activated charcoal with a
cathartic to hasten secretion.
Induction of emesis with syrup of ipecac; done
only in patients with good gag reflex and is
conscious.
Adult dose is 30 ml by mouth followed by 2
glasses of water; Pedia dose is15 ml followed by 8
16 oz. of water.
NURSING ALERT: Do not induce emesis after ingestion of
caustic substances, hydrocarbons, iodides, silver nitrates,
petroleum distillates; to a patient having seizure or to
pregnant patient.

3.
4.
5.

Gastric lavage for the obtunded patient. Save

gastric aspirate for toxicology screen.
Procedure to enhance the removal of ingested
substance if the patient is deteriorating.
Forced diuresis with urine pH alteration to
enhance renal clearance.
Hemoperfusion (process of passing blood through
an extracorporeal circuit and a cartridge containing
an adsorbent, such as charcoal, after which the
detoxified blood is returned to the patient)
Hemodialysis to purify and accelerate the
elimination of circulating toxins.
Repeated dose of charcoal.
Providing an antidote antidote is a chemical or
physiologic antagonist that will neutralize the
poison.

GASTRIC LAVAGE
PURPOSES:
1. To remove unabsorbed poison after ingestion.
2. To diagnose and treat gastric hemorrhage and for
the arrest of hemorrhage.
3. To cleanse stomach before endoscopic procedures.
4. To remove liquid or small particles of material
from the stomach.
NURSING CONSIDERATIONS
Insertion of NGT or OGT.
Place patient on left lateral position with head
lower 15 degrees downward.
Elevate funnel and pour approx. 150 200 ml.
Lavage fluid is left in place for about one minute
before allowed to drain
Save samples of first two washings.
Repeat lavage procedure until the returns are
relatively clear and no particular matter is seen.
At the completion of the lavage:

1. Stomach may be left empty.

2. An Adsorbent may be instilled in the tube and
allowed to remain in the stomach.
3. A saline cathartic may be instilled in the tube.
Pinch off the tube during removal or maintain
suction while tubing is being withdrawn.
Give the patient a cathartic if prescribed.
Warn patient that stool will turn black from the
charcoal.
2. CARBON MONOXIDE POISONING
- It is an example of inhaled poison and results in the
incomplete hydrocarbon combustion
Carbon monoxide exerts its toxic effects by
binding to circulating hemoglobin to reduce the
oxygen carrying capacity of the blood.
Carbon monoxide and hemoglobin is 200 300
times affinity compared to oxygen and
hemoglobin.
Creation of carboxyhemoglobin resulting to tissue
anoxia.
CLINICAL MANIFESTATIONS
Respiratory depression, stridor.
Confusion progressing to coma.
Headache, muscular weakness, palpitation, and
dizziness.
Skin is pink in color, cherry red, or cyanotic.
ABG: carboxyhemoglobin level is 12% (Normal),
30 40% severe carbon monoxide poisoning.
MANAGEMENT:
Provide 100% oxygen by tight-fitting mask (the
elimination half life of carboxyhemoglobin, in
serum, for a person breathing room air is 5 hours
and 20 minutes. If patient breaths 100% oxygen the
half life is reduced to 80 minutes

100% oxygen in hyperbaric chamber reduces

halflife to 20 minutes.
Intubate if necessary to protect airway.
Continuous ECG monitoring, treat dysrhythmias.
Correct acid-base and electrolyte imbalances.
Continuous observation of psychoses, spastic
paralysis, visual disturbances, and deterioration of
personality may persist after resuscitation and may
be symptoms of permanent CNS damage.

3. INSECT STINGS
- These are injected poisons that can produce either
local or systemic reactions.
Local reactions are characterized by pain,
erythema and edema at the site of injury.
Systemic reactions usually begin within minutes.
(Unconsciousness, laryngeal edema,
bronchospasm, and cardiovascular collapse.
MANAGEMENT:
ABC
Epinephrine is the drug of choice give SQ.
Administer bronchodilator.
Initiate IV with Ringers Lactate.
Prepare for CPR.
NURSING CONSIDERATIONS:
Apply ice packs to site to relieve pain.
Elevate extremities with large edematous local
reaction.
Administer anti histamine for local reaction.
Clean wounds thoroughly with soap and water or
antiseptic solution.
Educate patient.
- Have epinephrine on hand
- Wear emergency medical bracelet indicating
hypersensitivity.

- If sting occurs, remove stinger with one quick

scrape of fingernail.
- Do not squeeze venom sack, because this may
cause additional venom to be injected.
- Avoid insect feeding areas.
4. SNAKE BITES
CLINICAL MANIFESTATIONS:
- Burning pain, swelling, and numbness of the site.
Hemorrhagic blisters may occur after few hours of
bite and entire extremity may become edematous.
WOF signs of systemic reactions (nausea,
sweating, weakness, lightheadedness, initial
euphoria followed by drowsiness, dysphagia,
paralysis of various muscle groups, shock, seizures,
and coma).
MANAGEMENT:
Wash the site of bite, keep the patient calm and
immobilize extremity.
Administer O2 and start IV line.
Administer anti-venin and be alert to allergic
reaction.
Administer vasopressors in the treatment of shock.
5. ALCOHOL WITHDRAWAL DELIRIUM
a.k.a Delirium Tremens or Alcoholic Hallucinosis
An acute toxic state that follows a prolonged bout
of steady drinking or sudden withdrawal from
prolonged intake of alcohol.
Symptoms begins as early as 4 hours after
reduction of alcohol intake and peaks at 24 - 48
hours but may last up to 2 weeks.
ALCOHOLISM a chronic disease or disorder
characterized by excessive alcohol intake and

interference in the individuals health, interpersonal

realtionship and economic functioning
-

Considered to be present when there is .1% or

10 ml for every 1000 ml of blood
At .1 - .2%, there is low coordination
At .2 - .3%, there is ataxia, tremors, irritability,
and stupor

At .3 and above, there is unconsciousness

COMMON BEHAVIORAL PROBLEMS: 5 Ds
D-enial
D-ependency
D-emanding
D-estructive
D-omineering
COMMON WITHDRAWAL SIGNS AND
SYMPTOMS:
HALLUCINATIONS (VISUAL AND TACTILE)
INCREASED VITAL SiGNS
TREMORS
SWEATING AND SIEZURE
COMMON DEFENSE MECHANISMS:
DENIAL
RATIONALIZATION
ISOLATION
PROJECTION
PRIORITY NURSING DIAGNOSIS:
- INEFFECTIVE INDIVIDUAL COPING
DRUG OF CHOICE for aversion therapy of an
alcoholic:
- DISULFIRAM (antabuse)
Instruct patient to avoid, when taking Disulfiram:
MOUTH WASH

OVER THE COUNTER COLD REMIDIES

FOOD SAUCES MADE UP OF WINE
FRUIT FLAVORED EXTRACTS
AFTERSHAVE LOTIONS
VINEGAR
SKIN PRODUCTS
MANAGEMENT:
Protect patient from injury, diazepam or phenytoin
for seizure control as prescribed.
Monitor VS every 30 minutes.
Use a non-alcohol skin preparation, draw blood for
measurement of ethanol concentration, toxicologic
screen for other drug abuse.
Maintain electrolyte balance and hydration.
Observe for hypoglycemia.
Administer thiamine followed by parenteral
dextrose if liver glycogen is depleted.
Give orange juice, gatorade, or other
carbohydrates to stabilize blood sugar.
Place patient in a private room with close
observation.
BEHAVIORAL EMERGENCIES - It is an urgent,
serious disturbances of behavior, affect, or thought that
makes the patient unable to cope with his life situation and
interpersonal relationship
1. VIOLENT PATIENTS
- Is usually episodic and is a means of expressing
feelings of anger, fear and hopelessness about a
situation.
Manage through:

a. Establish control, keeping the door open, and be in clear

veiw of staff
b. Ask if he has a weapon, avoid touching an agitated pt.
c. Adopt a calm, nonconfrontational approach
d. Provide emotional support; CRISIS INTERVENTION
2. SUICIDE
- Ultimate form of self-destruction; cry for help
- Major Interventions: PREVENTION and LISTEN
RISK FACTORS
SEX (female attempts, male commits suicide)
UNSUCCESSFUL PREVIOUS ATTEMPT
IDENTIFICATION with family member committed
suicide
CHRONIC
ILLNESS
DEPRESSION/DEPENDENT PRERSONALITY
AGE (18-25 AND ABOVE 40)/ALCOHOLISM
LETHALITY OF PREVIOUS ATTEMPTS

PRIORITY NURSING DIAGNOSIS:

Risk for Injury, Self-directed
NURSING INTERVENTIONS:
Provide one-on-one monitoring
Have frequent unscheduled rounds
Avoid use of metals and glass utensils
Remove shampoos, perfumes, medicines at the
bedside

Monitor for signs of impending suicide (giving

away of valued possession)

3. RAPE TRAUMA SYNDROME

According to RA 8353, RAPE refers to the
insertion of penis into the mouth, vagina, anus of a
victim

Insertion of any object into the mouth or anus

It is generally considered as an act of hostility,

anger, or violence
ELEMENTS OF RAPE:

Use of threat/force

lack of consent of the victim

Actual penetration of the penis into the vagina

Different Kinds of Rape:

POWER done to prove ones masculinity

ANGER done as a means of retaliation

SADISTIC done to express erotic feelings

RAPE TRAUMA SYNDROME
It refers to a group of signs and symptoms
experienced by a victim in reaction to rape
4 Phases
1. ACUTE PHASE characterized by shock,
numbness and disbelief
2. DENIAL characterized by victims refusal to talk
about the event
3. HEIGHTENED ANXIETY characterized by fear,
tension, and nightmares
4. REORGANIZATION victims life normalizes
PRIORITY NURSING CARE: Preservation of evidences
TREATMENT: Crisis Intervention

BURN TRAUMA - Is the damage caused to skin and

deeper body structures by heat (flames, scald, contact with
heat) , electrical, chemical or radiation
FACTORS DETERMINING SEVERITY OF BURN:
1. age mortality rates are higher for children < 4 yrs of
age and for clients > 65 yrs of age
2. Patients medical condition debilitating disorders such
as cardiac, respiratory, endocrine and renal disorders
Classification
Affected Part
Description of Wound
negatively influence the clients response to injury and
treatment.
1st degree
Epidermis
Pin, painful sunburn

superficial mortality rate is higher when the client

Blisters form after 24
has a pre-existing disorder at the time of the burn
hours
injury
2nd degree
Pediermis and
Red, wet blisters, bullae
3. location

partial
thickness
part
of
the
burns on the head, neck and chest arevery painful
dermis
associated with
pulmonary complications;

burns
on
the
face
are associated with
2nd degree
Only the skin
Waxy white, difficult to
corneal abrasion;
deep partial
appendages in
distinguish from 3rd

burns
on
the
ear
are
associated
with
thickness
the hair follicle
degree except hair
auricular chondritis;
remain
growth becomes
hands and joints require intensive therapy;
apparent in 7-10 days,
the perineal area is prone to
little or no pain
autocontamination by urine and feces;
3rd degree
Epidermis,
circumferential
burns of the extremities Dry, leathery,
Full thickness
dermis
and
may be red or
can produce a tourniquet-like
effect and
subcutaneous
lead to vascular
compromise (compartment black
syndrome). tissue . no skin
May have
appendages
4. Depth
thrombosed veins
Marked edema
Distal circulation
may be decreased
Painless
4th degree
deep full
thickness

Skin, muscle,
tendon, bonde

Dry, charred, bone may

be visible

What to Expect
Discomfort last after 48
hrs; heals in 3-7 days
Heals in 2-3 weeks, in no
complication
Slow to heal 94-8 weeks)
surgical incision and
grafting unless has
complication

Requires excision and

grafting.
10- 14 days for graft to
revascularize

Requires excision, grafting

and sometimes amputation

 Thermal Burns caused by exposure to

flames, hot liquids, steam or hot objects
Chemical Burns caused by tissue contact
with strong acids, alkalis or organic
compounds
Electrical Burns result in internal tissue
damaging, alternating current is more
dangerous than direct current for it is
associated with cardiopulmonary arrest,
ventricular fibrillation, titanic muscle
contractions, and long bone and vertebral
fractures.
Radiation Burns are caused by exposure
to ultraviolet light, x-rays or a radioactive
source.

5. Size: Rule of nine

Assessment

Child <
3 years
old

Adult

Head and neck

18%

9%

1 arm

9%

9%

Posterior trunk

18%

18%

Anterior trunk

18%

18%

1 leg

14%

18%

Perineum

1%

1%

6. Temperature
determines the extent of injury
7. Exposure to the Source

Types of Burns and their Treatment:

Scald
burn caused by hot liquid
immediately flush the burn area with water
(under a tap or hose for up to 20 min)
if no water is readily available, remove
clothing immediately as clothing soaked
with hot liquid retains heat
Flame
Smother the flames with a coat or blanket,
get the victim on the floor or ground (stop,
drop, and Roll)
Prevent victim from running
If water is available, immediately cool the
burn area with water
If water is not available, remove clothing;
avoid pulling clothing across the burnt face
Cover the burn area with a loose, clean, dry
cloth to prevent contamination

Do not break blisters or apply lotions,

ointments, creams or powder
Airway
if face or front of the trunk is burnt, there
could be burns to the airway
there is a risk of swelling or air passage,
leading to difficulty in breathing
Smoke inhalation
Urgent treatment is required with care of
the airway, breathing and circulation
When 02 in the air is used up by fire, or
replaced by other gases, the oxygen level
in the air will be dangerously low
Spasm in the air passages as a result of
irritation by smoke or gases
Severe burns to the air passages causing
swelling and obstruction
Victim will show signs and symptoms of
lack of O2. He may also be confused or
unconscious
Electrical
check for Danger
turn of the electricity supply if possible
avoid any direct contact with the skin of
the victim or any conducting material
touching the victim until he is disconnected
once the area is safe, check the ABCs
if necessary, perform rescue breathing or
CPR
Chemical
Flood affected area with water for 20-30
min
Remove contaminated clothing
If possible, identify the chemical for
possible subsequent neutralization

 Avoid contact with the chemical

Sunburn

Exposure to ultraviolet rays in natural

sunlight is the main cause of sunburn
General skin damage and eventually skin
cancer develops

The signs and symptoms of sunburn are

pain, redness and fever