34317581 Emergency and Disaster Nursing

8/4/2019 34317581 Emergency and Disaster Nursing

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EMERGENCYEMERGENCYANDAND

DISASTERDISASTER

NURSINGNURSINGBY:BY:Mark Vincent C. Cenita, R.N.Mark Vincent C. Cenita, R.N.


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EMERGENCY NURSINGEMERGENCY NURSING

SCOPE AND PRACTICE OFSCOPE AND PRACTICE OFEMERGENCY NURSINGEMERGENCY NURSING

PRINCIPLES OF EMERGENCYPRINCIPLES OF EMERGENCYNURSINGNURSING

TRIAGETRIAGE comes from the French comes from the French

wordword triertrier, meaning, meaning to sortto sort


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ER NurseER Nurse Establishes prioritiesEstablishes priorities

Monitors & continuously assess acutelyMonitors & continuously assess acutely

ill and injured patientsill and injured patients

Supports & attends to familiesSupports & attends to families

Supervises allied health personnelSupervises allied health personnel

Teaches pts & familiesTeaches pts & families

SCOPE & PRACTICE OFSCOPE & PRACTICE OF



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Issues in Emergency Nsg CareIssues in Emergency Nsg Care Legal issuesLegal issues

Occupational hx & safety risks for ED staffOccupational hx & safety risks for ED staff

Challenge of providing holistic careChallenge of providing holistic care

Documentation of ConsentDocumentation of Consent

Limiting exposure to hx risksLimiting exposure to hx risks

Hep B, HIV, TBHep B, HIV, TB Pts w/ airborne diseases (HEPA-filter mask)Pts w/ airborne diseases (HEPA-filter mask)


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EMERGENCY NURSINGEMERGENCY NURSING Providing holistic careProviding holistic care

Goal = ANXIETY REDUCTIONGoal = ANXIETY REDUCTION Explanation @ pts level of understandingExplanation @ pts level of understanding Human contact & reassuring wordsHuman contact & reassuring words Orientation (name, date, location)Orientation (name, date, location) Family is kept informedFamily is kept informed

Stages of crisisStages of crisis Anxiety & DenialAnxiety & Denial

Remorse & GuiltRemorse & Guilt AngerAnger GriefGrief


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Emergency Nsg & Continuum of CareEmergency Nsg & Continuum of Care Rapid assessment & treatmentRapid assessment & treatment

Plan & facilitate discharge & follow-up care atPlan & facilitate discharge & follow-up care at

homehome Verbal & legibly written instructionsVerbal & legibly written instructions

MedicationsMedications

TreatmentsTreatments

DietDiet ActivityActivity

Schedule follow-up appointmentsSchedule follow-up appointments


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PRINCIPLES OF EMERGENCYPRINCIPLES OF EMERGENCY

NURSINGNURSING

CATEGORIESCATEGORIES

1.1. Emergent highest priorityEmergent highest priority Conditions are life-threateningConditions are life-threatening

Must be seen immediatelyMust be seen immediately

1.1. UrgentUrgent Have serious health problemsHave serious health problems Must be seen w/in 1 hourMust be seen w/in 1 hour

1.1. Non-urgentNon-urgent Have episodic illnessesHave episodic illnesses w/in 24 hoursw/in 24 hours

1.1. Fast-trackFast-track

Requires simple 1Requires simple 1

stst

aidaid


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NURSINGNURSING

5 LEVELS5 LEVELS

1.1. RESUSCITATIONRESUSCITATION

1.1. EMERGENTEMERGENT

2.2. URGENTURGENT

3.3. NON URGENTNON URGENT

4.4. MINORMINOR

TRIAGE NURSE takes VS, NVS, history, dx dataTRIAGE NURSE takes VS, NVS, history, dx data


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PRINCIPLES OFPRINCIPLES OF

EMERGENCY NURSINGEMERGENCY NURSING ASSESS & INTERVENEASSESS & INTERVENE Stabilize, provide txs, prompt transferStabilize, provide txs, prompt transfer

Primary surveyPrimary survey =Check for ABCs of life=Check for ABCs of life AAirway establish patent airwayirway establish patent airway BBreathing provide adequate ventilationreathing provide adequate ventilation

CCirculation evaluate & restore cardiacirculation evaluate & restore cardiac

outputoutput Control hemorrhageControl hemorrhage

Prevent & treat shockPrevent & treat shock

Maintain/restore circulationMaintain/restore circulation

D DisabilityD Disability


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NURSINGNURSING

Secondary surveySecondary survey Complete hx history & head-toe assessmentComplete hx history & head-toe assessment

Diagnostic & laboratory testsDiagnostic & laboratory tests Insertion/application of monitoring devicesInsertion/application of monitoring devices

Splinting of suspected fracturesSplinting of suspected fractures

Cleaning/dressing of woundsCleaning/dressing of wounds

Other necessary interventionsOther necessary interventions


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Focus of Emergency Care:Focus of Emergency Care:

Preserve or Prolong lifePreserve or Prolong life

Alleviate SufferingAlleviate Suffering

Do no further harmDo no further harm

Restore Optimal functionRestore Optimal function


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GOLDEN RULES OF EMERGENCYGOLDEN RULES OF EMERGENCY

NURSING:NURSING:

DOs DOs Obtain consent, Think ofObtain consent, Think of

the worst, Respect the victimsthe worst, Respect the victims

modesty and physical privacymodesty and physical privacy

DONTs DONTs Let the patient seeLet the patient see

his/her own injury, make unrealistichis/her own injury, make unrealistic

promisespromises


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Guidelines in Giving EmergencyGuidelines in Giving EmergencyCare:Care:

A A Ask for helpAsk for help

I I InterveneIntervene

D D Do no Further HarmDo no Further Harm


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FIRST AIDFIRST AID


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Value of First Aid Training:Value of First Aid Training:

Self-helpSelf-help

Health for OthersHealth for Others

Preparation for DisasterPreparation for Disaster

Safety AwarenessSafety Awareness


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BASIC LIFEBASIC LIFE

SUPPORTSUPPORT


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Artificial RespirationArtificial Respiration

(AR) a way of breathing air to(AR) a way of breathing air to

persons lungs when breathingpersons lungs when breathing

ceased or stopped function.ceased or stopped function.

Respiratory ArrestRespiratory Arrest a condition when the respiration ora condition when the respiration or

breathing pattern of an individual stopsbreathing pattern of an individual stops

to function, while the pulse andto function, while the pulse and

circulation may continue.circulation may continue.

Causes: Choking, Electrocution,Causes: Choking, Electrocution,

strangulation, drowning andstrangulation, drowning and

suffocation.suffocation.


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Methods:Methods:

mouth to mouthmouth to mouth

mouth to nosemouth to nose

mouth to stomamouth to stoma

mouth to mouth and nosemouth to mouth and nose

mouth to barrier devicemouth to barrier device


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ProcedurProceduree

InfantInfant

(0-1yr)(0-1yr)

ChildChild

(1-8 yrs)(1-8 yrs)

AdultAdult

1. Safe1. SafeApproachApproach Approach and assessApproach and assesssituationsituation

2. Assess for2. Assess for

ResponseResponseShout andShout and

gently pinchgently pinch

GentlyGentlyshoutingshouting

are youare youok? thenok? thenshake theshake the

victimvictim

3. Positioning3. Positioning Placed Supine on a firm andPlaced Supine on a firm andflat surfaceflat surface

4. Open the4. Open the

AirwayAirway


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The Casualty is Breathing :The Casualty is Breathing :Place in Recovery positionPlace in Recovery position

Before moving casualty remove anyBefore moving casualty remove anyobjects safely from her pocketsobjects safely from her pockets

Kneel beside casualty, place armKneel beside casualty, place arm

nearest at right angles, and then bendnearest at right angles, and then bendelbow keeping the palm uppermost.elbow keeping the palm uppermost.

Bring far arm across the casualtysBring far arm across the casualtyschest and hold back of the casualtyschest and hold back of the casualtys

hand against the nearest cheekhand against the nearest cheekWith your other hand grasp the farWith your other hand grasp the far

thigh just above the knee, then pull thethigh just above the knee, then pull thecasualty towards you and on to his orcasualty towards you and on to his or

her sideher side


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The Casualty is not Breathing:The Casualty is not Breathing:6.6. go forgo for

helphelp

if someone responds to your shoutif someone responds to your shout

for help send that person to phonefor help send that person to phonefor ambulancefor ambulance

if youre on your own, leave theif youre on your own, leave thecasualty and make the phone callcasualty and make the phone callfor yourself.for yourself.

* never leave if the patient has* never leave if the patient hascollapsed as a result of trauma orcollapsed as a result of trauma ordrowning or if the casualty is a childdrowning or if the casualty is a child

77.. givegiverescuerescue

breathsbreaths

5 rescue breaths5 rescue breaths 2 rescue2 rescuebreathsbreaths

- Place mouth- Place mouthover the noseover the noseand mouth ofand mouth ofthe infantthe infant

- pinch nose- pinch noseand ventilateand ventilatevia mouthvia mouth

- look for- look for

-seal lips-seal lipsaround thearound themouth andmouth andblow steadilyblow steadily


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When to Stop AR:When to Stop AR:

when the patient has spontaneouswhen the patient has spontaneous

breathingbreathing

when the first aider is too exhaustedwhen the first aider is too exhaustedto continueto continue

when another first aider takes overwhen another first aider takes over

when EMS arrives and takes overwhen EMS arrives and takes over


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CardiopulmonaryCardiopulmonary

Resuscitation (CPR)Resuscitation (CPR)

Cardiac ArrestCardiac Arrest

a condition when the personsa condition when the personsbreathing and circulation/pulsebreathing and circulation/pulse

stop at the same timestop at the same time

Causes:Causes:

Cardiovascular Disease, HeartCardiovascular Disease, Heart

Attack, MIAttack, MI


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Management:Management:

External Chest Compression consistExternal Chest Compression consistof rhythmic application of pressureof rhythmic application of pressure

over the lower portion of the sternumover the lower portion of the sternum

just in between the nipplejust in between the nipple

Cardiopulmonary Resuscitation = AR +Cardiopulmonary Resuscitation = AR +

ECCECC

Goal:Goal:

Rapid return of pulse, BP andRapid return of pulse, BP and

consciousnessconsciousness


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ProcedureProcedure Infant( 0-1 year)Infant( 0-1 year) Child (1-8 yrs)Child (1-8 yrs) AdultAdult

1. Assess circulation1. Assess circulationfor 10 secsfor 10 secs

Check brachial pulseCheck brachial pulse< 60 bpm or< 60 bpm orbelow or absentbelow or absent

Check carotid pulse and if no pulseCheck carotid pulse and if no pulse

Commence chest compressionCommence chest compression

2. Positioning of2. Positioning ofcompressioncompression

Draw imaginary lineDraw imaginary linebetween nipplesbetween nipples

and place twoand place twofingers on thefingers on the

sternum 1 fingersternum 1 fingerbreadth belowbreadth belowthis linethis line

One hand on the sternum two fingers upOne hand on the sternum two fingers upfrom the xyphoid processfrom the xyphoid process

3. AR:ECC3. AR:ECC 1 breath: 51 breath: 5compressioncompression

2 breaths: 30 compression2 breaths: 30 compression

4. Rate and Depth of4. Rate and Depth ofcompressioncompression

100/min 1/3 or 1.5 2 inches100/min 1/3 or 1.5 2 inches

Number of Cycle/Number of Cycle/minuteminute

5 cycles per minute5 cycles per minute


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When to stop CPR:When to stop CPR:

S SPONTANEOUS BREATH RESTOREDS SPONTANEOUS BREATH RESTORED

T TURNED OVER THE MEDICALT TURNED OVER THE MEDICALSERVICESSERVICES

O OPERATOR IS EXHAUSTED TOO OPERATOR IS EXHAUSTED TOCONTINUECONTINUE

P PHYSICIAN ASSUMESP PHYSICIAN ASSUMESRESPONSIBILITYRESPONSIBILITY


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COMPLICATIONS OF CPR:COMPLICATIONS OF CPR:

RIB FRACTURERIB FRACTURE

STERNUM FRACTURESTERNUM FRACTURE

LACERATION OF THE LIVER ORLACERATION OF THE LIVER ORSPLEENSPLEEN

PNEUMOTHORAX, HEMOTHORAXPNEUMOTHORAX, HEMOTHORAX


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CHAIN OF SURVIVALCHAIN OF SURVIVAL

EARLY ACCESS early recognition ofEARLY ACCESS early recognition of

cardiac arrest, prompt activation ofcardiac arrest, prompt activation of

emergency servicesemergency services

EARLY BLS prevent brain damage,EARLY BLS prevent brain damage,buy time for the arrival ofbuy time for the arrival of

defibrillatordefibrillator

EARLY DEFIBRILLATION 7-10%EARLY DEFIBRILLATION 7-10%

decrease per minute withoutdecrease per minute without

defibrillationdefibrillation

EARLY ACLS technique thatEARLY ACLS technique that

attempts to stabilize patientattempts to stabilize patient


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TRAUMATRAUMA


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Head traumaHead trauma

Result of an external force applied toResult of an external force applied tothe head and brain causingthe head and brain causingdisruption of physiologic stabilitydisruption of physiologic stability

locally, at the point of injury, as welllocally, at the point of injury, as wellas globally with elevations in ICP andas globally with elevations in ICP andpotentially dramatic changes in bloodpotentially dramatic changes in bloodflow within the brain.flow within the brain.

Trauma to the skull resulting in mildTrauma to the skull resulting in mildto extensive damage to the brain.to extensive damage to the brain.

Causes: vehicular accidents, fall,Causes: vehicular accidents, fall,acts of violence, sportsacts of violence, sports


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Types of Head InjuriesTypes of Head Injuries

1. Open1. Open Scalp lacerationsScalp lacerations Fractures in the skullFractures in the skull Interruption of the dura materInterruption of the dura mater

2. Closed2. Closed Concussions a jarring of the brain within theConcussions a jarring of the brain within the

skull with temporary loss of consciousnessskull with temporary loss of consciousness Contusions a bruising type of injury to theContusions a bruising type of injury to the

brain; may occur with subdural or extraduralbrain; may occur with subdural or extraduralcollections of blood.collections of blood.

Contrecoup decelerative forces throwing theContrecoup decelerative forces throwing thebrain back and forthbrain back and forth Fractures e.g. linear, depressed, compoundFractures e.g. linear, depressed, compound

comminutedcomminuted

3. Hemorrhage3. Hemorrhage

causes hematoma or clot formationcauses hematoma or clot formation


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Types of Hemorrhage/Hematoma:

1. epidural hematoma1. epidural hematoma

the most serious type ofthe most serious type of

hematoma; forms rapidly andhematoma; forms rapidly andresults from arterial bleedingresults from arterial bleeding

forms between the dura and theforms between the dura and theskull from a tear int theskull from a tear int themeningeal areameningeal area

2. Subdural hematoma2. Subdural hematoma - forms slowly and results from a- forms slowly and results from avenous bleedvenous bleed

- a surgical emergency- a surgical emergency

3. Intracerebral3. Intracerebralhemorrhagehemorrhage

- bleeding directly into the brain- bleeding directly into the brainmattermatter


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Clinical manifestations:Clinical manifestations:

Altered level of consciousnessAltered level of consciousness ConfusionConfusion Papillary abnormalitiesPapillary abnormalities Altered or absent gag reflex or vomitingAltered or absent gag reflex or vomiting

Absent corneal reflexAbsent corneal reflex

Sudden onset of neurologic deficitsSudden onset of neurologic deficits Changes in vital signsChanges in vital signs Vision and hearing impairmentVision and hearing impairment CSF drainage from ears or noseCSF drainage from ears or nose Sensory dysfunctionSensory dysfunction SpasticitySpasticity Headache and vertigoHeadache and vertigo Movement disorders or reflex activity changesMovement disorders or reflex activity changes Seizure activitySeizure activity


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AssessmentAssessment

What time did the injury occur?What time did the injury occur?

What caused the injury?What caused the injury?

What was the direction and forceWhat was the direction and forceof the blow?of the blow?

Was there a loss ofWas there a loss of

consciousness?consciousness?

What was the duration ofWhat was the duration of

unconsciousness?unconsciousness?

Could the patient be aroused?Could the patient be aroused?


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Emergency interventions:Emergency interventions:Goal: maintain oxygen and nutrient rich cerebral blood flowGoal: maintain oxygen and nutrient rich cerebral blood flow

Monitor respiratory status and maintain a patent airwayMonitor respiratory status and maintain a patent airway monitor neurological status and vital signs (TPR,BP)monitor neurological status and vital signs (TPR,BP) monitor for increased ICPmonitor for increased ICP Head elevation 20 -30 degreesHead elevation 20 -30 degrees restrict fluids and monitor I & Orestrict fluids and monitor I & O immobilization of neckimmobilization of neck initiate normothermia measuresinitiate normothermia measures

assess cranial nerve function, reflexes and motor and sensoryassess cranial nerve function, reflexes and motor and sensoryfunctionfunction initiate seizure precautionsinitiate seizure precautions monitor for pain and restlessnessmonitor for pain and restlessness avoid administration of morphine sulfateavoid administration of morphine sulfate monitor for drainage from the nose or earsmonitor for drainage from the nose or ears if there is CSF leak, monitor for nuchal rigidityif there is CSF leak, monitor for nuchal rigidity

do not attempt to clean the nose, suction or allow the clientdo not attempt to clean the nose, suction or allow the clientto blow the nose if drainage occursto blow the nose if drainage occurs

do not clean te ear of drainage when noted but apply a loose,do not clean te ear of drainage when noted but apply a loose,dry sterile dressingdry sterile dressing

do not allow the client to coughdo not allow the client to cough


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Medical intervention:Medical intervention:

Osmotic diuretics pulling water outOsmotic diuretics pulling water out

of the extracellular space of theof the extracellular space of the

edematous brain tissueedematous brain tissue

Loop diuretic reduce incidence ofLoop diuretic reduce incidence ofrebound from osmotic diureticsrebound from osmotic diuretics

Opioids decreased agitationOpioids decreased agitation

Sedatives reduced anxiety andSedatives reduced anxiety andpromote comfort and agitationpromote comfort and agitation

Antiepileptic drugs to preventAntiepileptic drugs to prevent

seizuresseizures


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Surgical intervention:Surgical intervention:

CraniotomyCraniotomy

a surgical procedure that involvesa surgical procedure that involves

an incision through the cranium toan incision through the cranium to

remove accumulated blood orremove accumulated blood or

tumortumor

complications include increased ICPcomplications include increased ICP

from cerebral edema, hemorrhagefrom cerebral edema, hemorrhage

or obstruction of the normal flow ofor obstruction of the normal flow of

CSFCSF


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DENTAL TRAUMADENTAL TRAUMA

1.1. Tooth AcheTooth Ache Rinse mouth vigorously with warm water toRinse mouth vigorously with warm water to

clear out debrisclear out debris Use dental floss to remove any food thatUse dental floss to remove any food that

might be wedged in between the teethmight be wedged in between the teeth Use cold pack on the outside of the cheek toUse cold pack on the outside of the cheek tomanage swellingmanage swelling

Soak cotton with Oil of Cloves and place it onSoak cotton with Oil of Cloves and place it onaching toothaching tooth

1.1. Knocked- out toothKnocked- out tooth-- Place a sterile gauze pad or cotton ballPlace a sterile gauze pad or cotton ballinto the tooth socket to prevent furtherinto the tooth socket to prevent furtherbleedingbleeding


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3. Broken tooth3. Broken tooth Gently clean dirt and blood from the injuredGently clean dirt and blood from the injured

area with the use of clean cloth and warmarea with the use of clean cloth and warmwaterwater

Use cold compress to minimize swellingUse cold compress to minimize swelling

4. Bitten Tongue or Lip4. Bitten Tongue or Lip Using a clean cloth, apply direct pressure toUsing a clean cloth, apply direct pressure to

the bleeding areathe bleeding area If swelling is present, apply cold compressIf swelling is present, apply cold compress

5. Objects wedged between the teeth5. Objects wedged between the teeth Try to remove object with a dental flossTry to remove object with a dental floss Guide the floss carefully to prevent bleedingGuide the floss carefully to prevent bleeding Do not remove the object with a sharp orDo not remove the object with a sharp or

pointed objectpointed object


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6. Orthodontic Problems6. Orthodontic Problems If a wire is causing irritation, cover theIf a wire is causing irritation, cover the

end of the wire with the use of a cottonend of the wire with the use of a cottonball/ piece of gauze until you can getball/ piece of gauze until you can get

to a dentistto a dentist

Do not attempt to remove a wireDo not attempt to remove a wireembedded in the gums, cheek orembedded in the gums, cheek or

tongue. Instead, go immediately to thetongue. Instead, go immediately to the

dentistdentist

7. Possible fractured jaw7. Possible fractured jaw Immobilize the jaw by any meansImmobilize the jaw by any means

Apply cold compress to preventApply cold compress to prevent

swellingswelling


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CHEST TRAUMACHEST TRAUMA

Approximately a quarter of deaths dueApproximately a quarter of deaths due

to trauma are attributed to thoracicto trauma are attributed to thoracic

injury.injury.

Immediate deaths are essentially due toImmediate deaths are essentially due to

major disruption of the heart or of greatmajor disruption of the heart or of great

vessels.vessels.

Early deaths due to thoracic traumaEarly deaths due to thoracic trauma

include airway obstruction, cardiacinclude airway obstruction, cardiac

tamponade or aspiration.tamponade or aspiration.


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Classification of Chest Trauma:Classification of Chest Trauma:

Blunt Trauma results from suddenBlunt Trauma results from sudden

compression or positive pressurecompression or positive pressure

inflicted to the chest wall.inflicted to the chest wall.

Penetrating Trauma occurs whenPenetrating Trauma occurs when

foreign object penetrates the chestforeign object penetrates the chest

wall.wall.


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Types of Chest TraumaTypes of Chest Trauma

A.A. Blunt Chest TraumaBlunt Chest Trauma RIB FRACTURESRIB FRACTURES

- Fractured ribs may occur at the point of impact- Fractured ribs may occur at the point of impactand damage to the underlying lung may produceand damage to the underlying lung may produce

lung bruising or puncture.lung bruising or puncture.- Commonly a result of crushing chest injuries- Commonly a result of crushing chest injuries

Assessment:Assessment:

- Severe Pain- Severe Pain - Muscle spasm- Muscle spasm

- Tenderness- Tenderness - Subcutaneous- SubcutaneousCrepitusCrepitus

- Shallow Respirations- Shallow Respirations - Reluctance to- Reluctance tomovemove

- Client splints chest- Client splints chest


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1.1. RestRest

2.2. Ice Compress then Local HeatIce Compress then Local Heat

3.3. AnalgesiaAnalgesia

4.4. Splint the chest during coughing orSplint the chest during coughing ordeep breathingdeep breathing


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FLAILFLAIL CHESTCHEST

- The unstable segment moves- The unstable segment moves

separately and in an oppositeseparately and in an oppositedirection from the rest of thedirection from the rest of thethoracic cage during the respirationthoracic cage during the respirationcyclecycle

Assessment:Assessment:- Paradoxical respirationsParadoxical respirations- Severe chest painSevere chest pain- Dyspnea/ TachypneaDyspnea/ Tachypnea- CyanosisCyanosis- TachycardiaTachycardia


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1.1. High Fowlers positionHigh Fowlers position

2.2. Humidified O2Humidified O2

3.3. AnalgesiaAnalgesia4.4. Coughing & deep breathingCoughing & deep breathing

5.5. Prepare for intubation withPrepare for intubation with

mechanical ventilation with positivemechanical ventilation with positiveend-expiratory pressure ( PEEP ) forend-expiratory pressure ( PEEP ) for

severe respiratory failuresevere respiratory failure


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B. Penetrating Chest TraumaB. Penetrating Chest Trauma - occurs when a foreign object- occurs when a foreign object

penetrates the chest wallpenetrates the chest wall1.Pneumothorax1.Pneumothorax - Accumulation of atmospheric air in- Accumulation of atmospheric air in

the pleural spacethe pleural space may lead to lung collapsemay lead to lung collapse

Types:Types: 1. Spontaneous Pneumothorax1. Spontaneous Pneumothorax

2. Open Pneumothorax2. Open Pneumothorax 3. Tension Pneumothorax3. Tension Pneumothorax


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DyspneaDyspnea TachycardiaTachycardia

TachypneaTachypnea Sharp chest painSharp chest pain

Absent breathe soundsAbsent breathe sounds

Sucking soundSucking sound CyanosisCyanosis

Tracheal deviationTracheal deviation to theto theunaffected side with tensionunaffected side with tension

pneumothoraxpneumothorax


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1. Apply dressing over an open chest wound1. Apply dressing over an open chest wound

2. O2 as Rx2. O2 as Rx

3. High Fowlers3. High Fowlers

4. Chest tube placement4. Chest tube placement

- Monitor for chest tube system- Monitor for chest tube system

- Monitor for subcutaneous emphysema- Monitor for subcutaneous emphysema

Chest Tube Drainage SystemChest Tube Drainage System

- returns (-) pressure to the intra-pleural- returns (-) pressure to the intra-pleuralspacespace

- remove abnormal accumulation of air &- remove abnormal accumulation of air &

fluids serves as lungs while healing isfluids serves as lungs while healing isoin on


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Pulmonary EmbolismPulmonary Embolism

- Dislodgement of thrombus to the- Dislodgement of thrombus to thepulmonary arterypulmonary artery

- Caused by thrombus & pulmonary- Caused by thrombus & pulmonaryemboliemboli

- Other risk factors: deep vein- Other risk factors: deep veinthrombosis, immobilization, surgery,thrombosis, immobilization, surgery,obesity, pregnancy, CHF, advancedobesity, pregnancy, CHF, advancedage, prior History ofage, prior History ofthromboembolismthromboembolism


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- DyspneaDyspnea

- Chest painChest pain- Tachypnea & tachycardiaTachypnea & tachycardia

- HypotensionHypotension

- Shallow respirationsShallow respirations- Rales on auscultationRales on auscultation

- CoughCough

- Blood-tinged sputumBlood-tinged sputum- Distended neck veinsDistended neck veins

- CyanosisCyanosis


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1. O2 as Rx1. O2 as Rx

2. High Fowlers2. High Fowlers3. Maintain bed rest3. Maintain bed rest

4. Incentive spirometry as Rx4. Incentive spirometry as Rx

5. Pulse oximetry5. Pulse oximetry6. Prepare for intubation & mechanical6. Prepare for intubation & mechanicalventilationventilation

7. IV heparin (bolus)7. IV heparin (bolus)

8. Warfarin (Coumadin)8. Warfarin (Coumadin)9. Monitor PT & PTT closely9. Monitor PT & PTT closely

10. Prepare the client for embolectomy, vein10. Prepare the client for embolectomy, veinligation, or insertion of an umbrella filterligation, or insertion of an umbrella filteras Rxas Rx


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ABDOMINAL TRAUMAABDOMINAL TRAUMA

A. Penetrating Abdominal TraumaA. Penetrating Abdominal TraumaCauses:Causes:

- Gunshot wound- Gunshot wound - Stab wound- Stab wound - Embedded object from explosion- Embedded object from explosion

Assessment:Assessment: - Absence of bowel sound- Absence of bowel sound - Hypovolemic shock- Hypovolemic shock - Orthostatic hypotension- Orthostatic hypotension - Pain and tenderness- Pain and tenderness

Management:Management: 1. Maintain hemodynamic status IVF & blood transfusion1. Maintain hemodynamic status IVF & blood transfusion 2. Surgery- EXLAP2. Surgery- EXLAP 3. Peritoneal Lavage3. Peritoneal Lavage


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B. Blunt Abdominal TraumaB. Blunt Abdominal Trauma


- Left upper quadrant pain (Spleen)- Left upper quadrant pain (Spleen)

- Right upper quadrant pain (liver)- Right upper quadrant pain (liver)

- Signs of hypovolemic shock- Signs of hypovolemic shockManagement:Management:

1. Maintain hemodynamic status1. Maintain hemodynamic status2. Monitor VS and oxygen supplements2. Monitor VS and oxygen supplements

3. Assess signs and symptoms of shock3. Assess signs and symptoms of shock


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FOREIGN BODYFOREIGN BODY

AND AIRWAYAND AIRWAY

OBSTRUCTIONOBSTRUCTION


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CAUSES:CAUSES:

improper chewing of large pieces ofimproper chewing of large pieces of

foodfood

aspiraton of vomitus, or a foreignaspiraton of vomitus, or a foreignbodybody

position of head, the tongueposition of head, the tongue

resulting to difficulty of breathing orresulting to difficulty of breathing or

respiratory arrestrespiratory arrest


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Types of obstructionTypes of obstruction

anatomical tongueanatomical tongueand epiglottisand epiglottis

mechanical coins,mechanical coins,

food, toy etcfood, toy etc

Assessment and clinicalAssessment and clinical


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Assessment and clinicalAssessment and clinical

manifestations:manifestations: Mild airway obstructionMild airway obstruction

can talk, breath and cough withcan talk, breath and cough withhigh pitch breath soundhigh pitch breath sound

cough mechanism not effective tocough mechanism not effective todislodge foreign bodydislodge foreign body

Severe airway obstructionSevere airway obstruction cant talk, breath or coughcant talk, breath or cough

Nasal flaring, cyanosis,Nasal flaring, cyanosis,excessive salivationexcessive salivation


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Intervention:Intervention:

CONCIOUS PATIENT:CONCIOUS PATIENT:

ask the victim, are you choking?ask the victim, are you choking? if the victims airway is obstructed partially, aif the victims airway is obstructed partially, a

crowing sound is audible; encourage the victim tocrowing sound is audible; encourage the victim tocough.cough.

relieve the obstruction by heimlick maneuverrelieve the obstruction by heimlick maneuver Heimlich maneuver:Heimlich maneuver:

stand behind the victimstand behind the victim place arms around the victims waistplace arms around the victims waist make a fistmake a fist place the thumb side of the fist just above the umbilicusplace the thumb side of the fist just above the umbilicus

and well below the xyphoid process. Perform 5 quick inand well below the xyphoid process. Perform 5 quick inand up thrusts.and up thrusts.

Use chest thrusts for the obese or for the advancedUse chest thrusts for the obese or for the advancedpregnancy victims.pregnancy victims.

continue abdominal thrusts until the object iscontinue abdominal thrusts until the object isdislodged or the victim becomes unconscious.dislodged or the victim becomes unconscious.


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UNCONSCIOUS PATIENT:UNCONSCIOUS PATIENT:

assess LOCassess LOC call for helpcall for help check for ABCscheck for ABCs open airway using jaw thrust techniqueopen airway using jaw thrust technique finger sweep to remove objectfinger sweep to remove object

attempt ventilationattempt ventilation reposition the head if unsuccessful; reattemptreposition the head if unsuccessful; reattemptventilationventilation

relieve the obstruction by the Heimlich maneuverrelieve the obstruction by the Heimlich maneuverwith five thrust; then finger sweep the mouthwith five thrust; then finger sweep the mouth

reattempt ventilationreattempt ventilation

repeat the sequence of jaw thrust, finger sweep,repeat the sequence of jaw thrust, finger sweep,breaths and Heimlich maneuver until successfulbreaths and Heimlich maneuver until successful

be sure to assess the victims pulse andbe sure to assess the victims pulse andrespirationsrespirations

perform CPR if requiredperform CPR if required


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Choking child or infant:Choking child or infant:

choking is suspected in infantschoking is suspected in infants

and children experiencingand children experiencing

acute respiratory distressacute respiratory distress

associated with coughing,associated with coughing,

gagging, or stridor.gagging, or stridor. allow the victim to continue toallow the victim to continue to

cough if the cough is forcefulcough if the cough is forceful

if cough is ineffective or ifif cough is ineffective or ifincrease respiratory difficultyincrease respiratory difficulty

is still noted, perform CPRis still noted, perform CPR

Foreign objects in the earForeig

n objects in the ear


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Foreign objects in the earForeign objects in the ear

Dont probe the ear with a toolDont probe the ear with a tool

Remove the object if clearly visibleRemove the object if clearly visible

Try using gravity and shake the head gentlyTry using gravity and shake the head gently

Try using oil for an insectTry using oil for an insect

Dont use oil to remove any other object thanDont use oil to remove any other object than

an insectan insect

Foreign objects in the eyeForeig

n objects in the eye


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Foreign objects in the eyeForeign objects in the eye

Flush eye clear with use of waterFlush eye clear with use of water

Foreign objects in the noseForeig

n objects in the nose


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Foreign objects in the noseForeign objects in the nose

Dont probe at the object with cottonDont probe at the object with cotton

ball or other toolball or other tool

Breathe thru your mouth until theBreathe thru your mouth until the

object is removedobject is removed

Blow your nose gently to try to freeBlow your nose gently to try to free

the objectthe object


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POISONINGPOISONING


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PoisonPoison

Any substance that impairsAny substance that impairshealth or destroys life whenhealth or destroys life when

ingested, inhaled or otherwiseingested, inhaled or otherwise

absorbed by the body.absorbed by the body.


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Suspect poisoning if:Suspect poisoning if:

1.1. Someone suddenly becomes ill forSomeone suddenly becomes ill for

no apparent reason and begins tono apparent reason and begins to

act unusuallyact unusually

2.2. Is depressed and suddenly becomesIs depressed and suddenly becomesillill

3.3. Is found near a toxic substance andIs found near a toxic substance and

is breathing any unusual fumes, oris breathing any unusual fumes, orhas stains, liquid or powder in his orhas stains, liquid or powder in his or

her clothing, skin or lipsher clothing, skin or lips


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Ingestion PoisoningIngestion Poisoning

BotulismBotulism Clostridium botulinum. From Clostridium botulinum. Fromcanned foodscanned foods

Note: Save the VomitusNote: Save the Vomitus Staphylococcus AureusStaphylococcus Aureus from from

unrefrigerated cram filled foods, fishunrefrigerated cram filled foods, fishNote: Save the VomitusNote: Save the Vomitus

Petroleum PoisoningPetroleum Poisoning includes poisoning includes poisoningwith a substance such as kerosene, fuel,with a substance such as kerosene, fuel,

insecticides and cleaning fluidsinsecticides and cleaning fluidsNote: Never induce vomiting! MayNote: Never induce vomiting! May

result inresult in Chemical PneumoniaChemical Pneumonia


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Acetaminophen PoisoningAcetaminophen Poisoning most most

common drug accidentally ingestedcommon drug accidentally ingested

by childrenby childrenAntidote: AcetylcysteineAntidote: Acetylcysteine

Corrosive Chemical PoisoningCorrosive Chemical Poisoning

strong detergents and dry cleanersstrong detergents and dry cleaners results in drooling of saliva, painful burningresults in drooling of saliva, painful burning

sensation and pain and redness in the mouthsensation and pain and redness in the mouth

Note: Never induce vomiting, mayNote: Never induce vomiting, maycause further injurycause further injury Activated Charcoal, Milk of MagnesiaActivated Charcoal, Milk of Magnesia

DiagnosticsDiag

nostics:


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Diagnostics:Diagnostics: Baseline ABG should be obtained periodicallyBaseline ABG should be obtained periodically

Baseline blood samples (CBC, BUN,Baseline blood samples (CBC, BUN,

electrolytes)electrolytes)

ECG (since many toxic agents affect cardiacECG (since many toxic agents affect cardiac

rhythm)rhythm)

Assessment:Assessment: HeadacheHeadache

Double visionDouble vision

Difficulty in swallowing, talking and breathingDifficulty in swallowing, talking and breathing

Dry sore throatDry sore throat Muscle incoordinationMuscle incoordination

Nausea and vomitingNausea and vomiting

M tManag

ement


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Check victims ABCs. Begin rescueCheck victims ABCs. Begin rescue

breathing if necessarybreathing if necessary If ABCs are present but the victim isIf ABCs are present but the victim is

unconscious, place him in recoveryunconscious, place him in recovery

positionposition If victim starts having seizures,If victim starts having seizures,

protect him from injuryprotect him from injury

If victim vomits, clear the airwayIf victim vomits, clear the airway Calm and reassure the victim whileCalm and reassure the victim while

calling for medical helpcalling for medical help

P i Child fiP ti Child P fi


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P P Prevention. Child ProofingPrevention. Child Proofing

O O Oral fluids in large amountOral fluids in large amount

I -I - IpecacIpecac

S S Support respiration and circulationSupport respiration and circulation

O -O -

Oral Activated CharcoalOral Activated Charcoal

N -N - Never induce vomiting ifNever induce vomiting if

substance ingested is corrosivesubstance ingested is corrosive

LAVAGELAVAGE


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Inhalation PoisoningInhalation Poisoning

Carbon Monoxide PoisoningCarbon Monoxide Poisoning Carbon monoxide is a colorless, odorless &Carbon monoxide is a colorless, odorless &

tasteless gastasteless gas


- appears intoxicated- appears intoxicated

- Muscle weakness- Muscle weakness

- Headache & dizziness- Headache & dizziness

- Pink or cherry red skin (not a reliable- Pink or cherry red skin (not a reliablesign)sign)

- Confusion which may eventually lead to- Confusion which may eventually lead to

comacoma

M


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1.1. Check ABCsCheck ABCs

2. Remove victim from exposure2. Remove victim from exposure

3. Loosen tight clothing3. Loosen tight clothing

4. Administer O2 (100% delivery)4. Administer O2 (100% delivery)

5. Initiate CPR if required5. Initiate CPR if required


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SPECIALSPECIAL

WOUNDSWOUNDS

i


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Human BitesHuman Bites

staphylococcus and streptococcusstaphylococcus and streptococcusinfectioninfection


1. Cleanse and irrigate the wound1. Cleanse and irrigate the wound

2. Assist with wound exploration2. Assist with wound exploration

3. Culture the wound site3. Culture the wound site4. Tetanus toxoid and vaccine to4. Tetanus toxoid and vaccine to

stimulate antibody productionstimulate antibody production

A i l bi


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Animal biteAnimal bite

dog and cat bitedog and cat bite


1.1. Wash wound with soap and waterWash wound with soap and water

2.2. Tetanus toxoid and vaccine toTetanus toxoid and vaccine to

stimulate antibodiesstimulate antibodies3.3. Rabies Vaccine andRabies Vaccine and

immunoglobulinimmunoglobulin

k iS k Bit


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Snake BiteSnake Bite

Infection can be neurotoxic or hemotoxicInfection can be neurotoxic or hemotoxicAssessment:Assessment: EdemaEdema EcchymosisEcchymosis PetechiaePetechiae FeverFever Nausea and VomitingNausea and Vomiting

Possible hypotensionPossible hypotension Muscle fasciculationMuscle fasciculation Hemorrhage, shock and pulmonaryHemorrhage, shock and pulmonary

edemaedema

M tManag

ement


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1. Establish ABCs1. Establish ABCs

2. Immobilize bitten arm or extremity2. Immobilize bitten arm or extremity

3. Remove constricting items3. Remove constricting items

4. Provide warmth4. Provide warmth

5. Cleanse the wound5. Cleanse the wound

6. Cover wound with light sterile6. Cover wound with light sterile

dressingdressing7. Dont attempt to remove the venom7. Dont attempt to remove the venom

8. Anti venom therapy8. Anti venom therapy

Insect Bites/ Bee stingsInsect Bites/ Bee stings


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Insect Bites/ Bee stingsInsect Bites/ Bee stings

Assessment:Assessment: Itching, dyspneaItching, dyspnea

Chest tightness, dizziness, urticariaChest tightness, dizziness, urticaria

Nausea, vomiting,diarrheaNausea, vomiting,diarrhea

Abdominal cramps, flushingAbdominal cramps, flushing

Laryngeal edemaLaryngeal edema Respiratory arrestRespiratory arrest

M

t


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1. Remove stinger by scraping1. Remove stinger by scraping

2. Cleanse the site2. Cleanse the site

3. If anaphylaxis occurs, give oxygen3. If anaphylaxis occurs, give oxygen

and medicationsand medications


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TRAUMATRAUMA

RELATED TORELATED TO

ENVIRONMENTALENVIRONMENTALEXPOSUREEXPOSURE

HEAT EXHAUSTIONHEAT EXHAUSTION


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HEAT EXHAUSTIONHEAT EXHAUSTION

Assessment:Assessment: Nausea and vomitingNausea and vomiting increased temperatureincreased temperature

Muscle crampsMuscle cramps Tachypnea and TachycardiaTachypnea and Tachycardia Orthostatic hypotensionOrthostatic hypotension

MalaiseMalaise Irritability and anxietyIrritability and anxiety

ManagementManag

ement:


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Management:Management: Check ABCsCheck ABCs

Move to cool areaMove to cool area

Give salted water for vomitingGive salted water for vomitingperiodsperiods

Relieve cramps by firm pressureRelieve cramps by firm pressure

ECG and ABG monitoringECG and ABG monitoring

FROSTBITEFROSTBITE


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FROSTBITEFROSTBITE


Hard, cold extremitiesHard, cold extremities

White or mottled blue extremityWhite or mottled blue extremity

Extremity insensitive to touchExtremity insensitive to touch

Management:Manag

ement:


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Management:Management: Remove constrictive clothing and jewelryRemove constrictive clothing and jewelry

Prevent ambulation if lower extremity isPrevent ambulation if lower extremity isinvolvedinvolved

Institute rewarming measuresInstitute rewarming measures

Once rewarmed, elevate extremity toOnce rewarmed, elevate extremity toprevent swellingprevent swelling

Apply sterile gauze or cotton in betweenApply sterile gauze or cotton in betweendigits to prevent macerationdigits to prevent maceration


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NEARNEAR

DROWNINGDROWNING

Four Methods of WaterFour Methods of WaterRR


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Rescue:Rescue:

1.1. Reaching AssistReaching Assist

2.2. Throwing AssistThrowing Assist

3. Rowing Assist3. Rowing Assist

4. Wading Assist4. Wading Assist



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ssess e

Abdominal distentionAbdominal distention ConfusionConfusion IrritabilityIrritability

LethargyLethargy Shallow gasping respirationsShallow gasping respirations UnconsciousnessUnconsciousness

vomitingvomiting Absent breathingAbsent breathing

Mana ementManag

ement:


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Assess ABCsAssess ABCs

Give CPR and AR as necessaryGive CPR and AR as necessary

Check patients temperatureCheck patients temperature

Administer rewarming measures asAdminister rewarming measures as

necessarynecessary

Monitor lab results(electrolytes) and ECGMonitor lab results(electrolytes) and ECG


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BURN TRAUMABURN TRAUMA

Is the damage caused to skin andIs the damage caused to skin anddeeper body structures by heatdeeper body structures by heat(flames, scald, contact with heat) ,(flames, scald, contact with heat) ,electrical, chemical or radiationelectrical, chemical or radiation

FACTORS DETERMININGFACTORS DETERMINING


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SEVERITY OF BURN:SEVERITY OF BURN:1. age mortality rates are higher for children < 4 yrs of age1. age mortality rates are higher for children < 4 yrs of ageand for clients > 65 yrs of ageand for clients > 65 yrs of age

2. Patients medical condition debilitating disorders such as2. Patients medical condition debilitating disorders such ascardiac, respiratory, endocrine and renal disorderscardiac, respiratory, endocrine and renal disordersnegatively influence the clients response to injury andnegatively influence the clients response to injury andtreatment.treatment.

mortality rate is higher when the client has a pre-mortality rate is higher when the client has a pre-

existing disorder at the time of the burn injuryexisting disorder at the time of the burn injury3. location 3. location

burns on the head, neck and chest are associated withburns on the head, neck and chest are associated withpulmonary complications;pulmonary complications;

burns on the face are associated with corneal abrasion;burns on the face are associated with corneal abrasion; burns on the ear are associated with auricular chondritis;burns on the ear are associated with auricular chondritis; hands and joints require intensive therapy;hands and joints require intensive therapy; the perineal area is prone to autocontamination by urine andthe perineal area is prone to autocontamination by urine and

feces;feces; circumferential burns of the extremities can produce acircumferential burns of the extremities can produce a

tourniquet-like effect and lead to vascular compromisetourniquet-like effect and lead to vascular compromise(compartment syndrome).(compartment syndrome).

4. Depth4. Depth

4. Depth

ClassificationClassificationAffected PartAffected Part Description of WoundDescription of Wound What to ExpectWhat to Expect


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11stst degreedegreesuperficialsuperficial

EpidermisEpidermis Pin, painfulPin, painfulsunburnsunburnBlisters form after 24Blisters form after 24hourshours

Discomfort last after 48 hrs; heals in 3-7 daysDiscomfort last after 48 hrs; heals in 3-7 days

22ndnd degreedegreepartial thicknesspartial thickness

Pediermis and part ofPediermis and part ofthe dermisthe dermis

Red, wet blisters,Red, wet blisters,bullae very painfulbullae very painful

Heals in 2-3 weeks, in no complicationHeals in 2-3 weeks, in no complication

22ndnd degreedegreedeep partial thicknessdeep partial thickness

Only the skinOnly the skinappendages in theappendages in thehair follicle remainhair follicle remain

Waxy white, difficultWaxy white, difficultto distinguish from 3to distinguish from 3rdrddegree except hairdegree except hairgrowth becomesgrowth becomesapparent in 7-10apparent in 7-10days, little or no paindays, little or no pain

Slow to heal 94-8 weeks) surgical incision and graftingSlow to heal 94-8 weeks) surgical incision and graftingunless has complicationunless has complication

33rdrd degreedegreeFull thicknessFull thickness

Epidermis, dermis andEpidermis, dermis andsubcutaneous tissue .subcutaneous tissue .no skin appendagesno skin appendages

-Dry, leathery,Dry, leathery,may be red ormay be red orblackblack-May haveMay havethrombosedthrombosedveinsveins-Marked edemaMarked edema-DistalDistal

circulation maycirculation maybe decreasedbe decreased-PainlessPainless

Requires excision and grafting.Requires excision and grafting.10- 14 days for graft to revascularize10- 14 days for graft to revascularize

44thth degreedegreedeep full thicknessdeep full thickness

Skin, muscle, tendon,Skin, muscle, tendon,bondebonde

Dry, charred, boneDry, charred, bonemay be visiblemay be visible

Requires excision, grafting and sometimes amputationRequires excision, grafting and sometimes amputation

5. Size: Rule of nine


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AssessmentAssessment

Child < 3 yearsChild < 3 years

oldold

AdultAdult

Head and neckHead and neck 18%18% 9%9%

1 arm1 arm 9%9% 9%9%

PosteriorPosteriortrunktrunk

18%18% 18%18%

Anterior trunkAnterior trunk 18%18% 18%18%

1 leg1 leg 14%14% 18%18%

PerineumPerineum 1%1% 1%1%

6. Temperature6. Temperature


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pp determines the extent of injurydetermines the extent of injury

7. Exposure to the Source7. Exposure to the Source

Thermal Burns caused by exposure toThermal Burns caused by exposure toflames, hot liquids, steam or hot objectsflames, hot liquids, steam or hot objects

Chemical Burns caused by tissueChemical Burns caused by tissuecontact with strong acids, alkalis orcontact with strong acids, alkalis ororganic compoundsorganic compounds

Electrical Burns result in internalElectrical Burns result in internaltissue damaging, alternating current istissue damaging, alternating current ismore dangerous than direct current formore dangerous than direct current forit is associated with cardiopulmonaryit is associated with cardiopulmonaryarrest, ventricular fibrillation, titanicarrest, ventricular fibrillation, titanic

muscle contractions, and long bone andmuscle contractions, and long bone andvertebral fractures.vertebral fractures. Radiation Burns are caused byRadiation Burns are caused by

exposure to ultraviolet light, x-rays or aexposure to ultraviolet light, x-rays or aradioactive source.radioactive source.

Types of Burns and theirTypes of Burns and their


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ypyp

Treatment:Treatment:

ScaldScald burn caused by hot liquidburn caused by hot liquid immediately flush the burn area with water (under a tap orimmediately flush the burn area with water (under a tap or

hose for up to 20 min)hose for up to 20 min) if no water is readily available, remove clothing immediatelyif no water is readily available, remove clothing immediately

as clothing soaked with hot liquid retains heatas clothing soaked with hot liquid retains heat FlameFlame

Smother the flames with a coat or blanket, get the victim onSmother the flames with a coat or blanket, get the victim onthe floor or ground (stop, drop, and Roll)the floor or ground (stop, drop, and Roll) Prevent victim from runningPrevent victim from running If water is available, immediately cool the burn area withIf water is available, immediately cool the burn area with

waterwater If water is not available, remove clothing; avoid pullingIf water is not available, remove clothing; avoid pulling

clothing across the burnt faceclothing across the burnt face

Cover the burn area with a loose, clean, dry cloth to preventCover the burn area with a loose, clean, dry cloth to preventcontaminationcontamination Do not break blisters or apply lotions, ointments, creams orDo not break blisters or apply lotions, ointments, creams or

powderpowder AirwayAirway

if face or front of the trunk is burnt, there could be burns toif face or front of the trunk is burnt, there could be burns tothe airwaythe airway

there is a risk of swelling or air passage, leading to difficultythere is a risk of swelling or air passage, leading to difficultyin breathingin breathing

Smoke inhalationSmoke inhalation


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Urgent treatment is required with care of the airway,Urgent treatment is required with care of the airway,breathing and circulationbreathing and circulation

When 02 in the air is used up by fire, or replaced byWhen 02 in the air is used up by fire, or replaced by

other gases, the oxygen level in the air will beother gases, the oxygen level in the air will bedangerously lowdangerously low Spasm in the air passages as a result of irritation bySpasm in the air passages as a result of irritation by

smoke or gasessmoke or gases Severe burns to the air passages causing swellingSevere burns to the air passages causing swelling

and obstructionand obstruction Victim will show signs and symptoms of lack of O2.Victim will show signs and symptoms of lack of O2.

He may also be confused or unconsciousHe may also be confused or unconscious

ElectricalElectrical check for Dangercheck for Danger turn of the electricity supply if possibleturn of the electricity supply if possible avoid any direct contact with the skin of the victim oravoid any direct contact with the skin of the victim or

any conducting material touching the victim until heany conducting material touching the victim until heis disconnectedis disconnected

once the area is safe, check the ABCsonce the area is safe, check the ABCs if necessary, perform rescue breathing or CPRif necessary, perform rescue breathing or CPR

ChemicalChemical


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Flood affected area with water for 20-30Flood affected area with water for 20-30

minmin

Remove contaminated clothingRemove contaminated clothing

If possible, identify the chemical forIf possible, identify the chemical for

possible subsequent neutralizationpossible subsequent neutralization

Avoid contact with the chemicalAvoid contact with the chemical

SunburnSunburn Exposure to ultraviolet rays in naturalExposure to ultraviolet rays in natural

sunlight is the main cause of sunburnsunlight is the main cause of sunburn

General skin damage and eventuallyGeneral skin damage and eventuallyskin cancer developsskin cancer develops

The signs and symptoms of sunburn areThe signs and symptoms of sunburn are

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34317581 Emergency and Disaster Nursing

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