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- involves the provision of nursing care for patient with acute injuries or life threatening illnesses.
- Usually, care is provided at ED, Urgent care, Trauma unit and/or ICU/CCU

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 Emergency

nurse specialized education, training and experience to assess and identify px health care problems in crisis Establishes priorities, monitors and assesses pxs Support and attention to families Supervision allied health personnel Teaching role to patients and families

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 Nursing

assessment continuous Nursing diagnoses change w/ pxs condition Nursing interventions accomplished interdependently in consultation with MDs

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 May

perform beyond his expertise ie Insertion of ET and CT, debridement and suturing TRIAGE officer May provide shelter in housing area, bereavement support Nonmedical personnel may be utilized EMERGENCY RESCUE AND TRANSPORT

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 French

word trier to sort Sorting of clients based on the severity of health problems Hierarchy based on the potential for life loss Advanced skills

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T A R T - SIMPLE TRIAGE AND RAPID TREATMENT - quick assessment of respiration, perfusion, mental status S A V E - SECONDARY ASSESSMENT OF VICTIM ENDPOINT -used to identify who may benefit from care available

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11


1. 2. 3.

3 categories of TRIAGE (Berners) Emergent Urgent Non-urgent

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I Emergent Highest priority Life threatening conditions, limbs Must be treated immediately

Airway compromise Cardiac arrest Shock Stroke Major Burns

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II Urgent Threatening conditions Not immediate Must be seen within 1 hour

Fever Minor Burns Lacerations

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III Non-urgent Can be addressed within 24 hours

Chronic conditions Dental problems Missed Menses

4th category Fast track simple first aid

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Assess and Intervene (Primary survey) A airway B breathing C circulation D disability E expose

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 HEAD
MOUTH EYES NOSE FACE SPINE LIMBS

, LIPS & TEETH

& EARS
& TRUNK

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done after the priorities has been addressed. a. Complete History and PE b. Diagnostic and laboratory testing c. ECG, Arterial lines, urinary catheters d. Splinting of suspected fractures e. Cleaning and dressing of wounds f. other necessary interventions

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Specific Body Injuries

1. Blows to the Eyes A. Chemical Burns

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B. Eye Knocked Out

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C. Foreign Object

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2. Nose bleeds

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3. Knocked Out Tooth

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4. Impaled Objects

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5. Amputation

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6. Sucking Chest Wound

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7. Abdominal Injuries

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 is

a system used by medical or emergency personnel to ration limited medical resources when the number of injured needing care exceeds the resources available to perform care so as to treat those patients in most need of treatment who are able to benefit first.

Simple

casualty incident to select patients into those who need immediate transport to the hospital in order to save their lives and those who can wait for help later. some seriously injured people should not receive certain care because they are unlikely to survive.

triage is used at the scene of a mass

Advanced

triage, doctors may decide that


1. 2. 3. 4.

Triage separates the injured into four groups: The DECEASED who are beyond help, the injured who can be helped by IMMEDIATE transportation, the injured whose transport can be DELAYED, and those with MINOR injuries the walking wounded who need help less urgently.

1.Black / Expectant
They

are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds); they should be taken to a holding area and given painkillers to ease their passing.

2. Red / Immediate
They

require immediate surgery or other life-saving intervention, first priority for surgical teams or transport to advanced facilities, "cannot wait" but are likely to survive with immediate treatment

3. Yellow / Observation
Their

condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under "normal" circumstances

4.Green / Wait (walking wounded)

They

will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).

5.White / Dismiss (walking wounded)

They

have minor injuries; first aid and home care are sufficient, a doctor's care is not required. Injuries are along the lines of cuts and scrapes, or minor burns.

In addition to the standard practices of triage as mentioned above, there are conditions where sometimes the less wounded are treated in preference to the more severely wounded. This may arise in a situation such as war where the military setting may require soldiers be returned to combat as quickly as possible. Other possible scenarios where this could arise include situations where significant numbers of medical personnel are among the affected patients where it may be advantageous to ensure that they survive to continue providing care in the coming days especially if medical resources are already stretched

 Triage

tags are designed to communicate the triage category, treatment rendered, and other medical information. By necessity, the information on the tag is brief. Triage tags are usually placed on the casualty by the triage officer although other members of the team may place or add information to the tags.

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To furnish the attending care provider during the evacuation of a casualty with essential information about the injury or disease and the treatment provided. - The sole or initial medical record for the troops injured in combat. - Each triage tag is coded with a unique sequential seven-character serial number used for identification and tracking of the casualty. The serial number is located on the top right and left diagonal tear-offs.

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Adult - Foreign Body Airway Obstruction Mgnt

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UNIVERSAL DISTRESS SIGNAL

( Choking )
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Two kinds of Airway Obstruction:

1. Partial Airway Obstruction
Signs:

Difficulty of breathing
Coughing Can still speak but with distorted sounds

2. Complete Airway Obstruction

Signs: Cannot Breath Cannot cough Cannot speak Change of facial color (Cyanosis)
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Classification of Airway Obstruction

1. Anatomical Airway Obstruction
( Tongue ) 2. Mechanical or Foreign Body Airway Obstruction ( Solids or Liquids ) 3. Pathological Airway Obstruction ( Asthma, Pneumonia, PTB, etc. )

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Responsive Adult and Child Airway Obstruction (Choking)

Check victim for choking. Ask Are you choke? Can you speak? A choking victim cannot speak, breathe or cough and may clutch the neck with the hand. Determine first whether it is Partial or Complete Airway Obstruction
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Foreign Body Airway Obstruction ( Choking ) Management

For Partial Airway Obstruction

Ask; Are you choke? Can you speak? Can you cough?. If the person is coughing, speaking with distorted sound, and with difficulty of breathing, then Do not intervene, just be with the person and encourage him or her to cough.
Warning ! Back-blows is no longer recommended because this may aggravate the condition such as conversion from Partial Airway Obstruction to a Complete Airway Obstruction and may also cause additional insult or injury to the victim.
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 For Complete Airway Obstruction

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Give abdominal thrust (Heimlich maneuver). Place a first against the victims abdomen just above the navel. Grasp the first with your other hand and press into victims abdomen with quick inward and upward thrust. Continue thrust until object is removed or victim becomes unresponsive.
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Tongue-Jaw lift And Finger sweep

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Give Chest Thrusts instead of abdominal thrusts for women in late stages of pregnancy or large victims.

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Chest thrusts for Pregnant Women / Large Victim Conscious victim:

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If the pregnant women / large victim become unconscious; Unconscious victim: Perform 5-6 chest Thrusts ( Chest Thrusts can be done as if you are doing CPR. )

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Basic Life Support

Unresponsive victim Call 9-1-1 (or emergency telephone number). Get AED if available. Open airway (headtilt/chin-lift or jaw thrust). No Breathing? Yes

Give 2 slow breaths (2 seconds each).

Place in recovery position. Monitor victims condition.

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Continuation

No

Chest rise?

Yes

Re-tilt head and try breaths again

No
Chest rise? No Begin first aid for foreign body airway obstruction protocol for unconscious victim, or Start CPR (30 chest compressions/2 breaths X 5 cycles). Before giving a breath, open airway and look for object. If seen, remove it.

Yes Signs of normal circulation (breathing, coughing, movement)? Yes

Start CPR. * 30 chest compression/2 breaths X 5 cycles * 100 per minute Use AED when it arrives After 5 cycles of CPR, recheck for signs of normal circulation. DOK OBET

If not breathing, give 1 breath every 5 seconds. Recheck circulation every minute.

CHILd - Foreign Body Airway Obstruction Mgnt

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RELIEVING AIRWAY OBSTRUCTION ( CHILD )

Universal Distress signal Check child for Choking: Ask Are you Choke? Can you speak? A choking child cannot speak,cough and may clutch the neck with one or both hands. Give abdominal thrusts (Heimlich maneuver) Call emergency hotlines, if the child becomes unconscious.

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C
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If the Child become unconscious: Deliver 5 to 6 abdominal thrusts Check the airway for a foreign body,Then remove if seen. Provide Basic Life Support (BLS) if necessary.

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Self management:

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Infant - Foreign Body Airway Obstruction Mgnt

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RELIEVING AIRWAY OBSTRUCTION ( INFANT )

If responsive infant:

4 5 Chest Thrusts 4 - 5 Back Blows or Tapping (if liquid )

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If Unresponsive infant:

Start CPR (30 chest compressions/2 breaths X 5 cycles). Before giving a breath, open airway and look for object. If seen, remove it.
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RELIEVING AIRWAY OBSTRUCTION IN A RESPONSIVE INFANT )

1. Recognize and assess for choking. Look for breathing difficulty, ineffective cough, and lack of strong cry.

2. Give up to 5 back blows and...

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3. 5 Chest Thrust

4. If the infant becomes UNRESPONSIVE, perform a tonguejaw lift and look for a foreign body. If you see one, use finger sweep to remove it. ( Never do blind finger sweeps in an infant or child. ) Attempt to ventilate. If this fails, reposition the head and try again. If you are not successful,

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5. Begin CPR (30 chest compressions and 2 breaths X 5 cycles (with an extra step to check for foreign body) before giving ventilations in each cycles If you are working alone, after 1 minute of resuscitation activate the EMS system ( or Call for HELP ) and continue airway clearance and ventilation efforts. Transport as quickly as possible.

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Basic Life Support in perspective

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BACKGROUND INFORMATION
Definition of First Aid:
Is an immediate care rendered to help an acutely ill and / or injured person before the arrival of the Doctor or arrival to the medical facility. Serve as a bridge between the victim and the doctor / or medical facility for survival.

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Goals of First Aid: Keep the victim alive Prevent the victims condition from getting worse Help promote recovery from the injury or illness Ensure the victim receives medical care

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Be Prepared:
Know what to do. The first aid course will teach you what to do. Stay ready. A first aid situation can occur anytime, anywhere. Think of yourself as a first aider who is always ready to step in and help. Other bystanders at the scene may feel helpless or hesitate to help, but you should feel confident that you can assist the victim. Have the personal first aid kit, and know where kits are in your work place. Be sure that first aid kits are well stocked with the right supplies. Keep emergency phone number, such as E.M.S., the Police Control Center, and other emergency agencies, in a handy place. Know whether your community uses 911 or a different Emergency Hotline Numbers.

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Characteristics of a good First Aider

1. Gentle - should not cause pain.

2. Resourceful - should make the best use of things at hand.

3. Observant - should notice all signs.

4. Tactful should not alarm the victim.

5. Empathetic - should be comforting.

6. Respectable - should maintain a professional and caring attitude.
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Hindrances in giving First Aid

1. Unfavorable surroundings

2. The Presence of Crowds 3. Pressure from Victim or Relatives

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Basic Life Support Cardiopulmonary Resuscitation

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Life Support
1. Basic Life Support is an emergency procedure that consist of recognizing respiratory arrest or cardiac arrest or both and the proper application of CPR to maintain life until a victim recovers or advanced life support is available.
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Advanced Cardiac Life Support

The use of special equipment to maintain breathing and circulation for the victim of cardiac emergency.
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The Chain Of Survival

Early Access

Early CPR

Early Defibrillation

Early Advanced Care

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FIVE LINKS for ADULT VICTIMS

1. The First Link: IMMEDIATE RECOGNITION & ACTIVATION OF EMS It is the event initiated after the patients collapse until the arrival of Emergency Medical Services personnel prepared to provide care. 2. The Second Link: EARLY CPR It is most effective when started immediately after the victims collapse. The probability of survival approximately doubles when it is initiated before the arrival of EMS. 3. The Third Link: RAPID DEFIBRILLATION It is the cornerstone therapy for patients who have just suddenly collapsed probably due to ventricular fibrillation and pulse-less ventricular tachycardia. 4. The Fourth Link: EFFECTIVE ACLS Provided by highly trained personnel like paramedics. 5. The Fifth Link: INTEGRATED POST-CARDIAC ARREST CARE Post cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life.
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TRANSMISSION OF DISEASES AND THE FIRST AIDERS

1. How Diseases are transmitted.

a. Direct Contact Transmission

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b. Indirect Contact Transmission

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c. Airborne Transmission

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 Disease precaution
Blood borne diseases Use of gloves, or protective cloths, or plastic, eye goggles, Air borne diseases Use of mask

NOTE: Therefore, we must practice the Body Substance Isolation (B.S.I.) precaution.
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3. BODY SUBSTANCE ISOLATION (BSI) A. Personal hygiene

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B. Equipment cleaning and disinfecting

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C. Protective Equipment

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Safety during C.p.r. training and actual rescue

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Scene survey
SURVEY THE SCENE FOR :
DANGER CLUES

# OF VICTIMS
NEED OF ADDITIONAL RESOURCES OR EQUIPMENTS

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and Check the scene.

Always check the scene when you recognize an emergency has occurred before rushing in to help a victim.

You must be safe yourself if you are to help another.

Look for any Hazards such as the following: Smoke, flames

Spilled chemicals, fumes

Downed electrical wires Risk of explosion, building collapse

Roadside dangers, high-speed traffic

Potential personal violence

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ALERT !!!
If the scene become unsafe, STAY AWAY and CALL FOR HELP. Do not become a victim yourself !

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Initial Assessment ( Primary Survey )

Check the Responsiveness:( in order )

1. Verbal Stimulation. Shout, Hey!!! Are you OK ? 2. Gentle Tapping of the shoulder

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No Suspected Spinal Injury

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Techniques:
It can be done by:

1. Head-Tilt Maneuver 2. Chin-Lift Maneuver 3. Jaw-Thrust Maneuver (for Trauma case )

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Head-tilt / Chin-Lift Maneuver

Jaw-thrust Maneuver

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A=Airway Open?
Head tilt/ chin lift and check mouth and nose for any foreign bodies. Ex. Vomitus, Blood, solid foods or objects, etc.
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B=Breathing? Look, Listen, and Feel.( for 5 to 10 seconds )

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initial rescue breaths

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ANATOMY AND PHYSIOLOGY

*Clinical death 0 - 1 min. - cardiac irritability 1 - 4 min. - brain damaged not likely 4 - 6 min. - brain damage possible *Biological death 6 - 10 min. - brain damaged very likely over 10 min. - irreversible brain damaged

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133

Artificial Respiration / Rescue Breathing

Techniques: Mouth-to-Mouth Mouth-to-Nose Mouth-to-Mouth and Nose Mouth-to- Barrier Devices (CPR mask,Face Shield) Mouth-to-Stoma

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PNRC DOH Tie-up Project

Basic Life Support CPR Visual Aids Respiratory Arrest & Rescue Breathing

1. Mouth-toMouth

2. Mouthto-Nose

3. Mouth-to-Mouth and Nose

4. Mouth-toStoma

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PNRC DOH Tie-up Project

Basic Life Support CPR Visual Aids Respiratory Arrest & Rescue Breathing

5. Mouth-toFace Shield

6. Mouth-toMask

7. Bag Mask Device

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TR 3-3

 FOR

10 SECS USING CAROTIS ARTERY IN ADULT

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C=Circulation? Check for signs of circulation

Locate the larynx (voice box) with your index and middle fingers and gently slide them down into the groove between the Trachea and the neck muscles.

Gently palpate the Carotid Artery while maintaining a head-tilt (if no trauma) for 5 10 seconds.
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Cardiac Arrest and Cardiopulmonary Resuscitation

ONE LIFE will help you keep it.

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How to perform Cardio-Pulmonary Resuscitation (C.P.R.)to an adult:

Compression site:

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Jerker Rocker Bender Massager Bouncer Double Crosser

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Use the index & middle fingers to locate the lower border of the rib cage.
Move your fingers along the rib cage to the point where the ribs meet the sternum, the sub-sternal notch. Keep your middle finger at the notch and your index finger resting on the lower tip of the sternum.

Move your hand to the midline. Place its thumb side against the index finger of the lower hand.
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Continuation

Depth of compressions : 1 to 2 inches

Ratio:
If Single rescuer CPR

- 2 full breaths : 30 chest compressions x 5 cycles/ 2 mins.

If 2 man rescuer CPR - 2 Full breaths : 30 chest Compressions X 5 cycles/ 2 mins.
As NEW standards Recommended by A.H.A.( American Heart Association )
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Single Rescuer CPR ( Adult )

1. Establish unresponsiveness and position patient. Call for help if you are working alone

2. Open the airway. ( Head-Tilt / Chin-Lift Maneuver )

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Continuation..

3. Look, Listen, and Feel for breath (5-10 seconds).

4. Ventilate twice (1 to 2 seconds / ventilation). If the first breath is unsuccessful, reposition the patients head before attempting the second breath. Clear airway if necessary.

5. Determine no pulse ( 5 10 seconds ).

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Continuation..

6. Locate the compression site.

7. Position Hands.

8. Begin compressions. (Compressions at depth of 1 to 2 inches, delivered at a rate of 100 / min.) Push Hard and Fast.
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Continuation..

9. Ventilate twice. ( Provide 2 ventilations then 30 compressions X 5 cycles / 2mins. As a New recommendation from American Heart Association )

10.Recheck pulse and breathing after 5 cycles, then every few minutes.

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Two - Man Rescuer CPR ( Adult )

1. Determine unresponsiveness. Position the patient.

2. Open the airway and look, listen and feel for breath ( 5 seconds ).

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Continuation..

3. Ventilate twice ( 1 to 2 sec./ ventilation ). If the first breath is unsuccessful, reposition the patients head before attempting the second breath. Clear the airway if necessary.

4. Determine pulselessness. Locate CPR compression site.

5. Say No Pulse , Begin compressions.

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Continuation..

6. Check compression effectiveness. Deliver 30 compressions in a rate of 80 100 / minute .

7. Stop for compressions for ventilation. Ventilate ( 2 ) twice ( 1 to 2 seconds interval ).

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Continuation..

8. Continue with 2 Full ventilations in every 30 Chest compressions.

9. After few minutes, reassess breathing and pulse. No pulse say Continue CPR, if (+) pulse say Stop CPR.

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Pediatric basic life support - 1

CHILD

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How to provide A.R. or Rescue Breathing to a child:

1 half breath in every three (3) seconds for twenty (20) cycles / minute Pattern: One and one and Blow 1 2 3 secs. One and two and blow One and three and blow One and four and blow One and five and blow One and six and blow . . . . . . One and twenty and blow

Re-check for the breathing for 5-10 secs

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How to perform Cardio-Pulmonary Resuscitation (C.P.R.)to a child:

Compression site: Place heel of one hand on the center of the chest between the nipples (lower half of the sternum) Place other hand on the childs forehead. Depth of compressions : 1 to 1 inches

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Ratio: If Single rescuer CPR - 30 Chest compressions + 2 Ventilations x 5 cycles/ 2 mins. If 2 man rescuer CPR -15 Chest Compressions + 2 Ventilations ( for Health Care Provider )

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Proper position while compressing the childs chest.

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Check the Responsiveness

If no response, Call E.M.S. or Local Emergency Hotlines Open the Airway by:( Head-Tilt/ Chin-Lift maneuver or Jawthrust maneuver)

Check for the Breathing: (look,listen &Feel) BUT, if not Breathing, deliver TWO slow initial breaths.
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Check for the signs of Circulation If No signs of Circulation, Perform immediately C.P.R. Place heel of 1 hand on the center of the chest between the nipples (lower half of the chest) Place other hand on childs forehead. Using 1 hand,depress chest downward to 1 to 1-1/2 inches. Give 30 chest compressions at a rate of about 100 per minute. Open the airway and give 2 slow breaths (1 to 1-1/2 seconds) Repeat cycles of 30 chest compressions and 2 rescue breath.

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Pediatric basic life support - 2

INFANT

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How to provide A.R. or Rescue Breathing to an infant:

1 Ventilation in every three (3) seconds for twenty (20) cycles / minute Pattern: One and one and PUFF 1 2 3 secs. One and two and PUFF One and three and PUFF One and four and PUFF One and five and PUFF One and six and PUFF . . . . . One and twenty and PUFF

Re-check for the breathing for 5-10 secs

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How to perform Cardio-Pulmonary Resuscitation (C.P.R.)to an Infant:

Compression site: Locate the nipple line and place three fingers in the middle of the chest, then lift one finger that is adjacent to the nipple line (allowing two fingers are lying on the center of the infants chest) Place other hand on the Infants forehead. Depth of compressions = to 1 inch

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Ratio: If Single rescuer CPR - 30 Chest compressions + 2 Ventilations x 5 cycles/ 2 mins. If 2 man rescuer CPR -15 Chest Compressions + 2 Ventilations ( for Health Care Provider )

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Infant (under 1 year) Rescue Breathing and CPR

Check responsiveness.

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Activate EMS. Ask a bystander to call the local emergency telephone number, usually 9-1-1. If you are alone, call EMS after one minute of resuscitation, unless a bystander can be sent.

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Open the airway (use slight headtilt/chin-lift method).

Place your hand that is nearest victims head on victims forehead and tilt head back slightly or ( in Neutral Position of the head ).
Place the fingers of your other hand under the chin and lift gently. Avoid pressing on the soft tissues under the jaw.
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Check for breathing (10 seconds). Place your ear over the victims mouth and nose while keeping the airway open. Look at the victims chest to check for rise and fall; listen and feel for breathing.

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If not breathing, give 2 slow breaths (to check for airway obstruction). Keep the airway open. Take a breath and place your mouth over the victims mouth and nose, or nose only. Give 2 slow breaths. Watch chest rise to see if your breaths go in. Allow for chest deflation after each breath.

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If breaths does not go in

Re-tilt the head slightly or maintain in neutral position of the infants head and try to breath again. But do not Hyperextend the neck it will only blocks the airway.

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If positive chest rise ;

Check for the circulation (PULSE) at brachial Artery (for infant)

NOTE:
If NO chest rise;

Perform Foreign Body Airway Obstruction Management

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Signs of circulation include: Breathing.

Coughing.
Movement. Normal skin condition (temperature and color).

Improved level of responsiveness.

Pulse. NOTE: If negative PULSE; Perform CPR for Infant
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Infant (under 1 year) Rescue Breathing and CPR

1. Place 2-3 fingers in the center of the chest. 2. Compress the chest 30 times. 3. Push sternum straight down 1/3 to1/2 the anterior posterior diameter of the chest. 4. Do smooth compressions, counting One, two, three, four, fivethirty Give 2 slow breaths. Enough to have chest rise
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Continue cycles of 30 compressions and 2 breaths by 5 cycles, then check for signs of circulation for 5 10 seconds. If absent, restart CPR with chest compressions. Recheck the signs of circulation every few minutes. If there are signs of circulation but no breathing, give rescue breathing. Give CPR until infant revives
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PNRC DOH Tie-up Project

Basic Life Support CPR Visual Aids Cardiac Arrest & Cardiopulmonary Resuscitation

1. SPONTANEOUS signs of circulation are restored. 2. TURNED over to medical services or properly trained and authorized personnel. 3. OPERATOR is already exhausted and cannot continue CPR. 4. PHYSICIAN assumes responsibility (declares death, takes over, etc.).

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TR 5-3

When to STOP (Continuation):

S - SPONTANEOUS signs of circulation are restored T -TURNED over to medical services or properly trained and authorized personnel O - OPERATOR is already exhausted and cannot continue CPR P - PHYSICIAN assumes responsibility (declares death, takes over, etc.) S SCENE becomes unsafe (such as traffic, impending or ongoing violencegun fires, etc) S SIGNED waiver to stop CPR

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