EMERGENCY

AND
DISASTER
NURSING
BY:
Darran Earl Gowing, BSN, RN 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.

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 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.

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 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
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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

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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.

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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.
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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

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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.
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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

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

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

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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

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 Guidelines in Giving
Emergency Care
 A – Ask for help

 I – Intervene

 D – Do no Further Harm

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 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

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

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Assess and Intervene
Check for ABCs of life

A – Airway

B – Breathing

C - Circulation

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 Team Members
 Rescuer
 Emergency Medical Technician
 Paramedics
 Emergency Medicine Physicians
 Incident Commander
Support Staff
 Inpatient Unit Staff

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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!

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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

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B – Breathing
- Assess Breath Sounds
- Observe for Chest Wall Trauma
- Prepare for chest decompression

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

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Estimated Blood Pressure
SITE SBP

Radial ≥ 80

Femoral ≥ 70

Carotid ≥ 60

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Control of Hemorrhage

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

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

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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

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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

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V. Triage

 comes from the French

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

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 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

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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

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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.

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 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.

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

5. Fast-Track:
 Psychological support needed

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FIRST AID

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 Role of First Aid
 Bridge the Gap Between the
Victim and the Physician
 Immediately start giving
interventions in pre-hospital
setting

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Value of First Aid Training

Self-help

Health for Others

Preparation for Disaster

Safety Awareness

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BASIC LIFE
SUPPORT
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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.
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 Methods:
mouth to mouth

mouth to nose

mouth to stoma

mouth to mouth and nose

mouth to barrier device

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 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

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 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

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 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 over - pinch nose and -seal lips around
the nose and ventilate via the mouth and
mouth of the mouth blow steadily
infant - look for chest for 1.5 – 2
- look for chest rising seconds
rising - look for chest
rising

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 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

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 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

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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

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 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

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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

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When to STOP CPR:
S – SPONTANEOUS BREATH
RESTORED

T – TURNED OVER THE MEDICAL

SERVICES

O – OPERATOR IS EXHAUSTED TO
CONTINUE

P – PHYSICIAN ASSUMES
RESPONSIBILITY

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COMPLICATIONS OF CPR:
 RIB FRACTURE

 STERNUM FRACTURE

 LACERATION OF THE LIVER OR

SPLEEN

 PNEUMOTHORAX, HEMOTHORAX

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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

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EARLY DEFIBRILLATION
- 7-10% decrease per minute without
defibrillation

EARLY ACLS – technique that

attempts to stabilize patient

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TRAUMA

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 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

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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

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 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

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 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

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 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?
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 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

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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

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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

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 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

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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

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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

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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.

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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.

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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

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Management:
1. Rest

2. Ice Compress then Local Heat

3. Analgesia

4. Splint the chest during coughing or

deep breathing

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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
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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
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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

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Assessment:
Dyspnea Tachycardia
Tachypnea Sharp chest pain
 Absent breathe sounds
 Sucking sound
 Cyanosis

Tracheal deviation to the unaffected side

with tension pneumothorax

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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
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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

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

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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

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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

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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

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FOREIGN BODY
AND AIRWAY
OBSTRUCTION
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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

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Types of obstruction

 anatomical –
tongue and
epiglottis

 mechanical –
coins, food, toy etc
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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

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 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.

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 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

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 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

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 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

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Foreign objects in the eye

 Flush eye clear with use of water

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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
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POISONING

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DaRRaN
Poison

Any substance that impairs health

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

106
DaRRaN
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

107
DaRRaN
 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

108
DaRRaN
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

109
DaRRaN
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

110
DaRRaN
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
111
DaRRaN
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

112
DaRRaN
 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

113
DaRRaN
Management:
1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery)

5. Initiate CPR if required

114
DaRRaN
SPECIAL
WOUNDS
115
DaRRaN
 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
116
DaRRaN
 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
117
DaRRaN
 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

118
DaRRaN
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

119
DaRRaN
Insect Bites/ Bee stings

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

1. Remove stinger by scraping

2. Cleanse the site

3. If anaphylaxis occurs, give oxygen and

medications

121
DaRRaN
 TRAUMA
RELATED TO
ENVIRONMENTAL
EXPOSURE

122
DaRRaN
HEAT EXHAUSTION
Assessment:
 Nausea and vomiting
 increased temperature
 Muscle cramps
 Tachypnea and Tachycardia
 Orthostatic hypotension
 Malaise
 Irritability and anxiety

123
DaRRaN
Management:
 Check ABCs

 Move to cool area

 Give salted water for vomiting periods

 Relieve cramps by firm pressure

 ECG and ABG monitoring

124
DaRRaN
 FROSTBITE

Assessment:

 Hard, cold extremities

 White or mottled blue extremity

 Extremity insensitive to touch

125
DaRRaN
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
126
DaRRaN
 NEAR
DROWNING

127
DaRRaN
Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist

4. Wading Assist

128
DaRRaN
 Assessment:

 Abdominal distention
 Confusion
 Irritability
 Lethargy
 Shallow gasping respirations
 Unconsciousness
 vomiting

 Absent breathing

129
DaRRaN
 Management:
 Assess ABCs

 Give CPR and AR as necessary

 Check patient’s temperature

 Administer rewarming measures as

necessary

 Monitor lab results(electrolytes) and ECG

130
DaRRaN
BURN TRAUMA

Is the damage caused to skin and

deeper body structures by heat
(flames, scald, contact with heat) ,
electrical, chemical or radiation

131
DaRRaN
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

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DaRRaN
 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
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DaRRaN
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%

134
DaRRaN
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.

135
DaRRaN
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

136
DaRRaN
 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

137
DaRRaN
 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

138
DaRRaN