Académique Documents
Professionnel Documents
Culture Documents
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.
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
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
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:
2.
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.
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
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.
Approach
Assess for
Response
Positioning
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)
Adult
Open the
Airway
Gently
shouting
are you
ok? then
shake the
victim
Placed Supine on a firm and flat surface
Assess for
Breathing
Go for Help
Give Rescue
Breaths
pinch nose
and ventilate
via mouth
look for
chest rising
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:
A. HEAD-TILT-CHIN-LIFT MANEUVER
B. JAW-THRUST MANEUVER
C. OROPAHRYNGEAL AIRWAY
INJURIES TO HEAD, SPINE, AND FACE
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
E. CRICOTHYROIDOTOMY
Nursing Actions:
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
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
Hemorrhage in muscle
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
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
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
ECG
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
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:
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:
ataxia
cold diuresis
ECG
Indwelling catheterization
NGT insertion
1.
2.
TOXICOLOGIC EMERGENCIES
ASSESSMENT:
ABC
3.
4.
5.
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:
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.
Use of threat/force
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
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
Child <
3 years
old
Adult
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