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

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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.


TERMS USE:
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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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Preserve or Prolong Life
Alleviate Suffering
Do No Further Harm
Restore to Optimal Function


Focus of Emergency Care
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Dos
- Obtain Consent
- Think of the Worst
- Respect Victims Modesty & Privacy
Donts
- let the patient see his own injury
- Make any unrealistic promises

Golden Rules of Emergency
Care
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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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- 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
II. Do a Primary Survey
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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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Information to be Relayed:
- What Happened?
- Number of Persons Injured
- Extent of Injury and First Aid
given
- Telephone number from where
youre calling

III. Activate Medical Assistance
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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
IV. Do Secondary Survey
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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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Self-help

Health for Others

Preparation for Disaster

Safety Awareness

Value of First Aid Training
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BASIC LIFE
SUPPORT
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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.
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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
Response
Shout and gently pinch Gently shouting
are you ok?
then shake
the victim
3. Positioning Placed Supine on a firm and flat surface
4. Open the
Airway
Check for foreign bodies then remove using finger
sweep
Head-tilt-chin-lift maneuver
Jaw-thrust Maneuver
5. Assess for
Breathing
Bring cheek over the mouth and nose of the casualty
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 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
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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 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
7. Give Rescue
Breaths
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
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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
( 0-1 year)
Child
(1-8 yrs)
Adult
1. Assess
circulation
for 10
seconds
Check brachial
pulse < 60 bpm
or below or
absent
Check carotid pulse and if no
pulse
Commence chest compression
2. Positioning of
compression
Draw imaginary
line between
nipples and
place two fingers
on the sternum 1
finger breadth
below this line
One hand on the sternum two
fingers up from the xyphoid
process
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3. AR:ECC 1 breath: 5
compression
2 breaths: 30
compression
4. Rate and
Depth of
compression
100/min
1/3 or 1.5 2 inches
Number of
Cycle/
minute
5 cycles per 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:

1. 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
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 Fowlers 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 Fowlers
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 Fowlers
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
cant talk, breath or cough
Nasal flaring, cyanosis,
excessive salivation
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Intervention:
CONCIOUS PATIENT:

ask the victim, are you choking?
if the victims 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 victims 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 victims 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

Dont 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

Dont 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

Dont 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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Poison

Any substance that impairs health
or destroys life when ingested,
inhaled or otherwise absorbed by
the body.
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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
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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
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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
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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
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Management:
Check victims 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
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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

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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
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Management:
1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery)

5. Initiate CPR if required
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DaRRaN
SPECIAL
WOUNDS
116
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
117
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
118
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
119
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. Dont attempt to remove the venom
8. Anti venom therapy
120
DaRRaN
Insect Bites/ Bee stings

Assessment:
Itching, dyspnea
Chest tightness, dizziness,
urticaria
Nausea, vomiting,diarrhea
Abdominal cramps, flushing
Laryngeal edema
Respiratory arrest
121
DaRRaN
Management:

1. Remove stinger by scraping

2. Cleanse the site

3. If anaphylaxis occurs, give oxygen and
medications
122
DaRRaN
TRAUMA
RELATED TO
ENVIRONMENTAL
EXPOSURE
123
DaRRaN
HEAT EXHAUSTION
Assessment:
Nausea and vomiting
increased temperature
Muscle cramps
Tachypnea and Tachycardia
Orthostatic hypotension
Malaise
Irritability and anxiety
124
DaRRaN
Management:
Check ABCs

Move to cool area

Give salted water for vomiting periods

Relieve cramps by firm pressure

ECG and ABG monitoring
125
DaRRaN
FROSTBITE

Assessment:

Hard, cold extremities

White or mottled blue extremity

Extremity insensitive to touch
126
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
127
DaRRaN
NEAR
DROWNING
128
DaRRaN
Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist

4. Wading Assist
129
DaRRaN
Assessment:

Abdominal distention
Confusion
Irritability
Lethargy
Shallow gasping respirations
Unconsciousness
vomiting

Absent breathing
130
DaRRaN
Management:
Assess ABCs

Give CPR and AR as necessary

Check patients temperature

Administer rewarming measures as
necessary

Monitor lab results(electrolytes) and ECG
131
DaRRaN
BURN TRAUMA
Is the damage caused to skin and
deeper body structures by heat
(flames, scald, contact with heat) ,
electrical, chemical or radiation
132
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. Patients medical condition debilitating disorders such as cardiac,
respiratory, endocrine and renal disorders negatively influence
the clients 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

Classification
Affected Part Description of Wound What to Expect
1
st
degree
superficial
Epidermis Pin, painful sunburn
Blisters form after 24
hours
Discomfort last after 48 hrs; heals in 3-7 days
2
nd
degree
partial thickness
Pediermis and part of
the dermis
Red, wet blisters, bullae
very painful
Heals in 2-3 weeks, in no complication
2
nd
degree
deep partial thickness
Only the skin
appendages in the hair
follicle remain
Waxy white, difficult to
distinguish from 3
rd

degree except hair
growth becomes
apparent in 7-10 days,
little or no pain
Slow to heal 94-8 weeks) surgical incision and grafting unless has
complication
3
rd
degree
Full thickness
Epidermis, dermis and
subcutaneous tissue . no
skin appendages
-Dry, leathery,
may be red or
black
-May have
thrombosed
veins
-Marked edema
-Distal
circulation may
be decreased
-Painless
Requires excision and grafting.
10- 14 days for graft to revascularize
4
th
degree
deep full thickness
Skin, muscle, tendon,
bonde
Dry, charred, bone may
be visible
Requires excision, grafting and sometimes amputation
134
DaRRaN
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%
135
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.
136
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
137
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
138
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