EMERGENCY

AND DISASTER
NURSING
1
TERMS USE:

• Trauma
- Intentional or unintentional wounds/injuries on the
human body from particular mechanical mechanism that
exceeds the body’s ability to protect itself from injury

• Emergency Management
- traditionally refers to care given to patients with urgent
and critical needs.

DaRRaN 2
• 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.

DaRRaN 3
• ACLS
- 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

DaRRaN 4
• 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

DaRRaN 5
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, high-pressured care
environment.

DaRRaN 6
• 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.

DaRRaN 7
• 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

DaRRaN 8
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 fast-paced, technology-driven
environment in which serious illness and
death are confronted on a daily basis.

DaRRaN 9
• 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

DaRRaN 10
• “Good Samaritan Law”
- Gives legal protection to the rescuer who act in good faith and
are not guilty of gross negligence or willful misconduct.

DaRRaN 11
Focus of Emergency Care
• Preserve or Prolong Life
• Alleviate Suffering
• Do No Further Harm
• Restore to Optimal Function

DaRRaN 12
Golden Rules of Emergency Care
• Do’s
- Obtain Consent
- Think of the Worst
- Respect Victim’s Modesty & Privacy
• Don’ts
- let the patient see his own injury
- Make any unrealistic promises

DaRRaN 13
Guidelines in Giving Emergency Care

• A – Ask for help

• I – Intervene

• D – Do no Further Harm

DaRRaN 14
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

DaRRaN 15
Core Competencies in Emergency Nursing
• Assessment
• Priority Setting/Critical Thinking Skills
• Knowledge of Emergency Care
• Technical Skills
• Communication

DaRRaN 16
DaRRaN 17
DaRRaN 18
DaRRaN 19
DaRRaN 20
DaRRaN 21
DaRRaN 22
DaRRaN 23
DaRRaN 24
DaRRaN 25
DaRRaN 26
Assess and Intervene

Check for ABCs of life

• A – Airway

• B – Breathing

• C - Circulation

DaRRaN 27
 Team Members

• Rescuer
• Emergency Medical Technician
• Paramedics
• Emergency Medicine Physicians
• Incident Commander
• Support Staff
• Inpatient Unit Staff

DaRRaN 28
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!

DaRRaN 29
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
30
DaRRaN
DaRRaN 31
B – Breathing
- Assess Breath Sounds
- Observe for Chest Wall Trauma
- Prepare for chest decompression

C – Circulation
- Monitor VS
- Maintain Vascular Access
- Direct Pressure

DaRRaN 32
Estimated Blood Pressure
SITE SBP

Radial ≥ 80

Femoral ≥ 70

Carotid ≥ 60

33
DaRRaN
Control of Hemorrhage

DaRRaN 34
D – Disability
- Evaluate LOC
- Re-evaluate clients LOC
- Use AVPU mnemonics

E – Exposure
- Remove clothing
- Maintain Privacy
- Prevent Hypothermia

DaRRaN 35
III. Activate Medical Assistance
• Information to be Relayed:
- What Happened?
- Number of Persons Injured
- Extent of Injury and First Aid given
- Telephone number from where
you’re calling

DaRRaN 36
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

DaRRaN 37
V. Triage

 comes from the French

word ”trier”, meaning to
sort
 process of assessing patients
to determine management
priorities

DaRRaN 38
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

DaRRaN 39
2. Urgent
– have serious health problems but not
immediately life threatening ones. Must
be seen within 1 hour

• Maxillofacial wounds without airway

compromise, eye injuries, stable abdominal
wounds without evidence of significant
hemorrhage, fractures

DaRRaN 40
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.

DaRRaN 41
DaRRaN 42
Field TRIAGE

1. Immediate:
• Injuries are life-threatening but
survivable with minimal intervention.
Individuals in this group can progress
rapidly to expectant if treatment is
delayed.

DaRRaN 43
2. 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.
3. 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.

DaRRaN 44
4. Expectant:
• Injuries are extensive and chances of survival are
unlikely even with definitive care.

5. Fast-Track:
 Psychological support needed

DaRRaN 45
FIRST AID

DaRRaN 46
Role of First Aid

• Bridge the Gap Between the Victim and the Physician

• Immediately start giving interventions in pre-hospital setting

DaRRaN 47
Value of First Aid Training

• Self-help

• Health for Others

• Preparation for Disaster

• Safety Awareness

DaRRaN 48
BASIC LIFE
SUPPORT
DaRRaN 49
Artificial Respiration
• a way of breathing air to person’s 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.

DaRRaN 50
 Methods:
• mouth to mouth

• mouth to nose

• mouth to stoma

• mouth to mouth and nose

• mouth to barrier device

DaRRaN 51
 Procedure Infant(0-1yr) Child(1-8 yrs) Adult
1. Safe Approach Approach and assess situation

2. Assess for Shout and gently pinch Gently shouting

Response “are you ok?”
then shake
the victim
3. Positioning Placed Supine on a firm and flat surface
4. Open the Check for foreign bodies then remove using finger
Airway sweep
Head-tilt-chin-lift maneuver
Jaw-thrust Maneuver
5. Assess for Bring cheek over the mouth and nose of the casualty
Breathing Look for chest movement
Listen for breath sounds
Feel for breathing on your cheek

52
DaRRaN
DaRRaN 53
DaRRaN 54
 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 casualty’s chest and hold back of the
casualty’s 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

55
DaRRaN
 The Casualty is NOT Breathing:
6. Go for Help - if someone responds to your shout for help send that
person to phone for ambulance
- if you’re 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
7. Give Rescue 5 rescue breaths 2 rescue breaths
Breaths - Place mouth - pinch nose and -seal lips around
over the nose ventilate via the mouth and
and mouth of mouth blow steadily
the infant - look for chest for 1.5 – 2
- look for chest rising seconds
rising - look for chest
rising

56
DaRRaN
When to Stop AR:

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

DaRRaN 57
Cardiopulmonary Resuscitation (CPR)

Cardiac Arrest
• a condition when the persons breathing and
circulation/pulse stop at the same time

Causes: Cardiovascular Disease, Heart Attack, MI

DaRRaN 58
Management:

• External Chest Compression

- consist of rhythmic application of pressure
over the lower portion of the sternum just
in between the nipple

Cardiopulmonary Resuscitation = AR +
ECC

Goal: Rapid return of pulse, BP and

consciousness

DaRRaN 59
 Procedure Infant Child Adult
( 0-1 year) (1-8 yrs)
1. Assess Check brachial Check carotid pulse and if no
circulation pulse < 60 bpm pulse
for 10 or below or
seconds absent
Commence chest compression
2. Positioning of Draw imaginary One hand on the sternum two
compression line between fingers up from the xyphoid
nipples and process
place two fingers
on the sternum 1
finger breadth
below this line

60
DaRRaN
3. AR:ECC 1 breath: 5 2 breaths: 30
compression compression

4. Rate and 100/min

Depth of 1/3 or 1.5 – 2 inches
compression

Number of 5 cycles per minute

Cycle/
minute

61
DaRRaN
DaRRaN 62
When to STOP CPR:
S – SPONTANEOUS BREATH RESTORED

T – TURNED OVER THE MEDICAL

SERVICES

O – OPERATOR IS EXHAUSTED TO
CONTINUE

P – PHYSICIAN ASSUMES
RESPONSIBILITY

DaRRaN 63
COMPLICATIONS OF CPR:
• RIB FRACTURE

• STERNUM FRACTURE

• LACERATION OF THE LIVER OR SPLEEN

• PNEUMOTHORAX, HEMOTHORAX

DaRRaN 64
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

DaRRaN 65
• EARLY DEFIBRILLATION
- 7-10% decrease per minute without
defibrillation

• EARLY ACLS –
technique that attempts to
stabilize patient

DaRRaN 66
DaRRaN 67
TRAUMA

DaRRaN 68
Head trauma

• Result of an external force applied to the head

and brain causing disruption of physiologic
stability locally, at the point of injury, as well as
globally with elevations in ICP and potentially
dramatic changes in blood flow within the
brain.
• Trauma to the skull resulting in mild to
extensive damage to the brain.
• Causes: vehicular accidents, fall, acts of
violence, sports

DaRRaN 69
Types of Head Injuries

1. Open
• Scalp lacerations
• Fractures in the skull
• Interruption of the dura mater
2. Closed
• Concussions – a jarring of the brain within the skull with temporary
loss of consciousness
• Contusions – a bruising type of injury to the brain; may occur with
subdural or extradural collections of blood.
• Contrecoup – decelerative forces throwing the brain back and forth
• Fractures – e.g. linear, depressed, compound comminuted
3. Hemorrhage
causes hematoma or clot formation

DaRRaN 70
 Types of Hemorrhage/Hematoma:
 the most serious type of hematoma;
1. epidural hematoma forms rapidly and results from arterial
bleeding
 forms between the dura and the skull
from a tear int the meningeal area

2. Subdural hematoma - forms slowly and results from a venous bleed

- a surgical emergency

3. Intracerebral hemorrhage - bleeding directly into the brain matter

DaRRaN 71
Clinical manifestations:
• Altered level of consciousness
• Confusion
• Papillary abnormalities
• Altered or absent gag reflex or vomiting
• Absent corneal reflex
• Sudden onset of neurologic deficits
• Changes in vital signs
• Vision and hearing impairment
• CSF drainage from ears or nose
• Sensory dysfunction
• Spasticity
• Headache and vertigo
• Movement disorders or reflex activity changes
• Seizure activity

DaRRaN 72
Assessment

• What time did the injury occur?

• What caused the injury?
• What was the direction and force of the blow?
• Was there a loss of consciousness?
• What was the duration of unconsciousness?
• Could the patient be aroused?

DaRRaN 73
 Emergency interventions:
Goal: “maintain oxygen and nutrient rich cerebral blood flow”
• Monitor respiratory status and maintain a patent airway
• monitor neurological status and vital signs (TPR,BP)
• monitor for increased ICP
• Head elevation 20 -30 degrees
• restrict fluids and monitor I & O
• immobilization of neck
• initiate normothermia measures
• assess cranial nerve function, reflexes and motor and sensory function
• initiate seizure precautions
• monitor for pain and restlessness
• avoid administration of morphine sulfate
• monitor for drainage from the nose or ears
• if there is CSF leak, monitor for nuchal rigidity
• do not attempt to clean the nose, suction or allow the client to blow the nose if
drainage occurs
• do not clean te ear of drainage when noted but apply a loose, dry sterile dressing
• do not allow the client to cough

DaRRaN 74
Medical intervention:

• Osmotic diuretics – pulling water out of the

extracellular space of the edematous brain tissue
• Loop diuretic – reduce incidence of rebound from
osmotic diuretics
• Opioids – decreased agitation
• Sedatives – reduced anxiety and promote comfort
and agitation
• Antiepileptic drugs – to prevent seizures

DaRRaN 75
Surgical intervention:

Craniotomy

• a surgical procedure that involves an incision through the cranium to

remove accumulated blood or tumor

• complications include increased ICP from cerebral edema, hemorrhage or

obstruction of the normal flow of CSF

DaRRaN 76
DENTAL TRAUMA

1. Tooth Ache
• Rinse mouth vigorously with warm water to clear out debris
• Use dental floss to remove any food that might be wedged in
between the teeth
• Use cold pack on the outside of the cheek to manage swelling
• Soak cotton with Oil of Cloves and place it on aching tooth
2. Knocked- out tooth
- Place a sterile gauze pad or cotton ball into the
tooth socket to prevent further bleeding

DaRRaN 77
3. Broken tooth
• Gently clean dirt and blood from the injured area with
the use of clean cloth and warm water
• Use cold compress to minimize swelling
4. Bitten Tongue or Lip
• Using a clean cloth, apply direct pressure to the bleeding
area
• If swelling is present, apply cold compress
5. Objects wedged between the teeth
• Try to remove object with a dental floss
• Guide the floss carefully to prevent bleeding
• Do not remove the object with a sharp or pointed object

DaRRaN 78
6. Orthodontic Problems
• If a wire is causing irritation, cover the end of the wire with the use of a
cotton ball/ piece of gauze until you can get to a dentist
• Do not attempt to remove a wire embedded in the gums, cheek or tongue.
Instead, go immediately to the dentist
7. Possible fractured jaw
• Immobilize the jaw by any means
• Apply cold compress to prevent swelling

DaRRaN 79
CHEST TRAUMA

• Approximately a quarter of deaths due to trauma are attributed to thoracic

injury.

• Immediate deaths are essentially due to major disruption of the heart or of

great vessels.

• Early deaths due to thoracic trauma include airway obstruction, cardiac

tamponade or aspiration.

DaRRaN 80
Classification of Chest Trauma:
• Blunt Trauma – results from sudden compression or positive
pressure inflicted to the chest wall.

• Penetrating Trauma – occurs when foreign object penetrates the

chest wall.

DaRRaN 81
Types of Chest Trauma

A. Blunt Chest Trauma

• RIB FRACTURES
- Fractured ribs may occur at the point of impact and damage to the
underlying lung may produce lung bruising or puncture.
- Commonly a result of crushing chest injuries
Assessment:
- Severe Pain - Muscle spasm
- Tenderness - Subcutaneous Crepitus
- Shallow Respirations - Reluctance to move
- Client splints chest

DaRRaN 82
Management:
1. Rest

2. Ice Compress then Local Heat

3. Analgesia

4. Splint the chest during coughing or deep breathing

DaRRaN 83
FLAIL CHEST
- The unstable segment moves separately and in an opposite direction
from the rest of the thoracic cage during the respiration cycle
Assessment:
- Paradoxical respirations
- Severe chest pain
- Dyspnea/ Tachypnea
- Cyanosis
- Tachycardia

DaRRaN 84
Management:

1. High Fowler’s position

2. Humidified O2
3. Analgesia
4. Coughing & deep breathing
5. Prepare for intubation with mechanical ventilation with positive
end-expiratory pressure ( PEEP ) for severe respiratory failure

DaRRaN 85
B. Penetrating Chest Trauma
• - occurs when a foreign object penetrates the chest wall
1.Pneumothorax
• - Accumulation of atmospheric air in the pleural space
• may lead to lung collapse
Types:
• 1. Spontaneous Pneumothorax
• 2. Open Pneumothorax
• 3. Tension Pneumothorax

DaRRaN 86
DaRRaN 87
Assessment:
• Dyspnea Tachycardia
• Tachypnea Sharp chest pain
• Absent breathe sounds
• Sucking sound
• Cyanosis

Tracheal deviation to the unaffected side with tension pneumothorax

DaRRaN 88
Management:
1. Apply dressing over an open chest wound
2. O2 as Rx
3. High Fowler’s
4. Chest tube placement
- Monitor for chest tube system
- Monitor for subcutaneous emphysema
Chest Tube Drainage System
- returns (-) pressure to the intra-pleural space
- remove abnormal accumulation of air & fluids
serves as lungs while healing is going on

DaRRaN 89
Pulmonary Embolism

- Dislodgement of thrombus to the pulmonary artery

- Caused by thrombus & pulmonary emboli

- Other risk factors: deep vein thrombosis,

immobilization, surgery, obesity, pregnancy, CHF,
advanced age, prior History of thromboembolism

DaRRaN 90
Assessment:
- Dyspnea
- Chest pain
- Tachypnea & tachycardia
- Hypotension
- Shallow respirations
- Rales on auscultation
- Cough
- Blood-tinged sputum
- Distended neck veins
- Cyanosis

DaRRaN 91
Management:
1. O2 as Rx
2. High Fowler’s
3. Maintain bed rest
4. Incentive spirometry as Rx
5. Pulse oximetry
6. Prepare for intubation & mechanical ventilation
7. IV heparin (bolus)
8. Warfarin (Coumadin)
9. Monitor PT & PTT closely
10. Prepare the client for embolectomy, vein ligation, or
insertion of an umbrella filter as Rx

DaRRaN 92
ABDOMINAL TRAUMA

A. Penetrating Abdominal Trauma

Causes:
• - Gunshot wound
• - Stab wound
• - Embedded object from explosion

Assessment:
• - Absence of bowel sound - Hypovolemic shock
• - Orthostatic hypotension - Pain and tenderness

Management:
• 1. Maintain hemodynamic status – IVF & blood transfusion
• 2. Surgery- EXLAP
• 3. Peritoneal Lavage

DaRRaN 93
B. Blunt Abdominal Trauma
Assessment:

- Left upper quadrant pain (Spleen)

- Right upper quadrant pain (liver)
- Signs of hypovolemic shock
Management:

1. Maintain hemodynamic status

2. Monitor VS and oxygen supplements
3. Assess signs and symptoms of shock

DaRRaN 94
FOREIGN BODY AND
AIRWAY
OBSTRUCTION

DaRRaN 95
CAUSES:

• improper chewing of large pieces of food

• aspiraton of vomitus, or a foreign body

• position of head, the tongue

• resulting to difficulty of breathing or respiratory

arrest

DaRRaN 96
Types of obstruction

• anatomical – tongue
and epiglottis

• mechanical – coins,
food, toy etc

DaRRaN 97
Assessment and clinical manifestations:

• Mild airway obstruction

• can talk, breath and cough with high pitch breath sound
• cough mechanism not effective to dislodge foreign body
• Severe airway obstruction
• can’t talk, breath or cough
• Nasal flaring, cyanosis, excessive salivation

DaRRaN 98
Intervention:
CONCIOUS PATIENT:

• ask the victim, “are you choking?”

• if the victim’s airway is obstructed partially, a crowing sound is
audible; encourage the victim to cough.
• relieve the obstruction by heimlick maneuver
• Heimlich maneuver:
• stand behind the victim
• place arms around the victim’s waist
• make a fist
• place the thumb side of the fist just above the umbilicus and well
below the xyphoid process. Perform 5 quick in and up thrusts.
• Use chest thrusts for the obese or for the advanced pregnancy
victims.
• continue abdominal thrusts until the object is dislodged or the
victim becomes unconscious.

DaRRaN 99
 UNCONSCIOUS PATIENT:

• assess LOC
• call for help
• check for ABCs
• open airway using jaw thrust technique
• finger sweep to remove object
• attempt ventilation
• reposition the head if unsuccessful; reattempt ventilation
• relieve the obstruction by the Heimlich maneuver with five thrust; then
finger sweep the mouth
• reattempt ventilation
• repeat the sequence of jaw thrust, finger sweep, breaths and Heimlich
maneuver until successful
• be sure to assess the victim’s pulse and respirations
• perform CPR if required

DaRRaN 100
 Choking child or infant:
• choking is suspected in infants and children experiencing acute
respiratory distress associated with coughing, gagging, or stridor.
• allow the victim to continue to cough if the cough is forceful
• if cough is ineffective or if increase respiratory difficulty is still
noted, perform CPR

DaRRaN 101
Foreign objects in the ear
• Don’t probe the ear with a tool

• Remove the object if clearly visible

• Try using gravity and shake the head gently

• Try using oil for an insect

• Don’t use oil to remove any other object than an insect

DaRRaN 102
Foreign objects in the eye

 Flush eye clear with use of water

DaRRaN 103
Foreign objects in the nose

• Don’t probe at the object with cotton ball or other tool

• Breathe thru your mouth until the object is removed

• Blow your nose gently to try to free the object

DaRRaN 104
POISONING

DaRRaN 105
• Poison

•Any substance that impairs health or

destroys life when ingested, inhaled or
otherwise absorbed by the body.

DaRRaN 106
Suspect poisoning if:

1. Someone suddenly becomes ill for no apparent reason and

begins to act unusually
2. Is depressed and suddenly becomes ill
3. Is found near a toxic substance and is breathing any unusual
fumes, or has stains, liquid or powder in his or her clothing, skin
or lips

DaRRaN 107
Ingestion Poisoning

• Botulism – Clostridium botulinum. From canned foods

Note: Save the Vomitus
• Staphylococcus Aureus – from unrefrigerated cram filled
foods, fish
Note: Save the Vomitus
• Petroleum Poisoning – includes poisoning with a substance
such as kerosene, fuel, insecticides and cleaning fluids
Note: Never induce vomiting! May result in
Chemical Pneumonia

DaRRaN 108
• Acetaminophen Poisoning – most common drug accidentally ingested by
children
Antidote: Acetylcysteine
• Corrosive Chemical Poisoning – strong detergents and dry cleaners
• results in drooling of saliva, painful burning sensation and pain and redness in the mouth
• Note: Never induce vomiting, may cause further injury
• Activated Charcoal, Milk of Magnesia

DaRRaN 109
Diagnostics:
• Baseline ABG should be obtained periodically
• Baseline blood samples (CBC, BUN, electrolytes)
• ECG (since many toxic agents affect cardiac rhythm)
Assessment:
• Headache
• Double vision
• Difficulty in swallowing, talking and breathing
• Dry sore throat
• Muscle incoordination
• Nausea and vomiting

DaRRaN 110
Management:
• Check victim’s ABCs. Begin rescue breathing if necessary
• If ABCs are present but the victim is unconscious, place him in
recovery position
• If victim starts having seizures, protect him from injury
• If victim vomits, clear the airway
• Calm and reassure the victim while calling for medical help

DaRRaN 111
P– Prevention. Child Proofing
O– Oral fluids in large amount
I- Ipecac
S– Support respiration and circulation
O- Oral Activated Charcoal
N- Never induce vomiting if substance ingested is corrosive

• LAVAGE

DaRRaN 112
Inhalation Poisoning

• Carbon Monoxide Poisoning

• Carbon monoxide is a colorless, odorless & tasteless gas
Assessment:
- appears intoxicated
- Muscle weakness
- Headache & dizziness
- Pink or cherry red skin (not a reliable sign)
- Confusion which may eventually lead to coma

DaRRaN 113
Management:
1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery)

5. Initiate CPR if required

DaRRaN 114
SPECIAL WOUNDS

DaRRaN 115
Human Bites

– staphylococcus and streptococcus infection

Management:
1. Cleanse and irrigate the wound
2. Assist with wound exploration
3. Culture the wound site
4. Tetanus toxoid and vaccine to stimulate antibody production

DaRRaN 116
Animal bite

– dog and cat bite

Management:
1. Wash wound with soap and water
2. Tetanus toxoid and vaccine to stimulate antibodies
3. Rabies Vaccine and immunoglobulin

DaRRaN 117
Snake Bite

– Infection can be neurotoxic or hemotoxic

Assessment:
• Edema
• Ecchymosis
• Petechiae
• Fever
• Nausea and Vomiting
• Possible hypotension
• Muscle fasciculation
• Hemorrhage, shock and pulmonary edema
DaRRaN 118
Management:
1. Establish ABCs
2. Immobilize bitten arm or extremity
3. Remove constricting items
4. Provide warmth
5. Cleanse the wound
6. Cover wound with light sterile dressing
7. Don’t attempt to remove the venom
8. Anti venom therapy

DaRRaN 119
Insect Bites/ Bee stings

Assessment:
• Itching, dyspnea
• Chest tightness, dizziness, urticaria
• Nausea, vomiting,diarrhea
• Abdominal cramps, flushing
• Laryngeal edema
• Respiratory arrest

DaRRaN 120
Management:

1. Remove stinger by scraping

2. Cleanse the site

3. If anaphylaxis occurs, give oxygen and medications

DaRRaN 121
TRAUMA RELATED TO
ENVIRONMENTAL
EXPOSURE

DaRRaN 122
HEAT EXHAUSTION

Assessment:
• Nausea and vomiting
• increased temperature
• Muscle cramps
• Tachypnea and Tachycardia
• Orthostatic hypotension
• Malaise
• Irritability and anxiety

DaRRaN 123
Management:
• Check ABCs

• Move to cool area

• Give salted water for vomiting periods

• Relieve cramps by firm pressure

• ECG and ABG monitoring

DaRRaN 124
FROSTBITE

Assessment:

• Hard, cold extremities

• White or mottled blue extremity

• Extremity insensitive to touch

DaRRaN 125
Management:
• Remove constrictive clothing and jewelry

• Prevent ambulation if lower extremity is involved

• Institute rewarming measures

• Once rewarmed, elevate extremity to prevent swelling

• Apply sterile gauze or cotton in between digits to

prevent maceration

DaRRaN 126
NEAR DROWNING

DaRRaN 127
Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist

4. Wading Assist

DaRRaN 128
Assessment:

• Abdominal distention
• Confusion
• Irritability
• Lethargy
• Shallow gasping respirations
• Unconsciousness
• vomiting
• Absent breathing

DaRRaN 129
Management:

• Assess ABCs

• Give CPR and AR as necessary

• Check patient’s temperature

• Administer rewarming measures as necessary

• Monitor lab results(electrolytes) and ECG

DaRRaN 130
BURN TRAUMA

Is the damage caused to skin and deeper

body structures by heat (flames, scald,
contact with heat) , electrical, chemical or
radiation
DaRRaN 131
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. Patient’s medical condition – debilitating disorders such as cardiac, respiratory, endocrine
and renal disorders negatively influence the client’s response to injury and treatment.
• mortality rate is higher when the client has a pre-existing disorder at the time of the
burn injury
3. location –
• burns on the head, neck and chest are associated with pulmonary complications;
• burns on the face are associated with corneal abrasion;
• burns on the ear are associated with auricular chondritis;
• hands and joints require intensive therapy;
• the perineal area is prone to autocontamination by urine and feces;
• circumferential burns of the extremities can produce a tourniquet-like effect and lead to
vascular compromise (compartment syndrome).
4. Depth

DaRRaN 132
 4. Depth

Affected Part Description of Wound What to Expect

Classification

1st degree Epidermis Pin, painful “sunburn” Discomfort last after 48 hrs; heals in 3-7 days
superficial Blisters form after 24
hours

2nd degree Pediermis and part of Red, wet blisters, bullae Heals in 2-3 weeks, in no complication
partial thickness the dermis very painful

2nd degree Only the skin Waxy white, difficult to Slow to heal 94-8 weeks) surgical incision and grafting unless has
deep partial thickness appendages in the hair distinguish from 3rd complication
follicle remain degree except hair
growth becomes
apparent in 7-10 days,
little or no pain

3rd degree Epidermis, dermis and -Dry, leathery, Requires excision and grafting.
Full thickness subcutaneous tissue . no may be red or 10- 14 days for graft to revascularize
skin appendages black
-May have
thrombosed
veins
-Marked edema
-Distal
circulation may
be decreased
-Painless

4th degree Skin, muscle, tendon, Dry, charred, bone may Requires excision, grafting and sometimes amputation
deep full thickness bonde be visible
DaRRaN 133
5. Size: Rule of nine

Child < 3 years Adult

Assessment old

Head and neck 18% 9%

1 arm 9% 9%

Posterior trunk 18% 18%

Anterior trunk 18% 18%

1 leg 14% 18%

Perineum 1% 1%

DaRRaN 134
6. Temperature
• determines the extent of injury
7. Exposure to the Source
• 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.

DaRRaN 135
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

DaRRaN 136
• 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

DaRRaN 137
• 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

DaRRaN 138