Emergency and Critical Care: September 26, 2013 Seat Work Activity: 1.

You are the triage nurse at the receiving facility for casualties after a tornado. Five patients arrive at the same time. Together with the surgeon on duty, you must identify the patients needs. You are presented with an elderly man with a respiratory rate of 8 breaths per minute, color ashen, tense abdomen, and only carotid pulses present; a 7-year-old child with a bleeding scalp laceration who has a Glasgow Coma Score of 8 and needs intubation; the 30-year-old mother of the child, who is crying hysterically, is walking, and appears to have no pain or visible injuries; a 15-year-old girl who complains of pain in her left leg, with obvious deformity at the calf but good pulses in the foot; and a 65-year-old woman who arrives in a police car holding her right wrist, which is cool, ecchymotic, and painful with good pulses. How would you classify these patients? Family members, members of the press, and city officials begin arriving at the hospital in large numbers. How would you expect these people to be managed? How will the family members be cared for? 2. A patient arrives at the triage desk complaining of sudden onset of high fever and respiratory flu-like symptoms. What are the signs and symptoms that you should identify if considering a biological warfare agent? Which agents cause pneumonia-like signs and symptoms? What precautions would be taken to protect staff? 3. Multiple patients begin arriving at the ED complaining of burning eyes and difficulty breathing. All of these persons work at the railroad, where there is often tanker trucks transporting chemical agents. What should you do first? Where do you find information about chemical agents and their treatment? 4. You are a member of the disaster committee at your hospital. What are the elements of the disaster plan that you will be sure to include? How will you plan for triage? What types of PPE will you purchase?