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Acids and Alkalis
Acids: toilet bowel cleaners, antirust compounds
Alkalis: Drain cleaners, dishwashing detergents,ammonia
Manifestations:
Excess salivation, dysphagia. Epigastric pain,pneumonitis, burns of mouth, esophagus, &stomach.
Treatment: Immediate dilution ( water, milk), corticosteroids
(for alkali).
Induced vomiting is contraindicated.
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Aspirin & aspirin containing medications
Manifestation:
Restlessness, tinnitus, deafness, Burring of vision
Tachypnea, tachycardia, hyperthermia.
Epigastric pain, disorientation, coma.
Treatment:
treat respiratory depression
gastric lavage
Activated charcoal, urine alkalinizaton.
hemodialysis for severe acute ingestion.
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Bleaches
Manifestation
Irritation of lips, mouth, & eyes, superficial injuryto esophagus; chemical pneumonia.
Treatment: Washing of exposed skin & eyes
dilution with water & milk
Gastric Lavage prevention of vomiting and aspiration
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Carbon Monoxide Poisoning
Exerts its toxic effect by binding to circulatinghemoglobin & thereby reducing the oxygen-carrying capacity of the blood.
Hemoglobin absorbs carbon monoxide 200 timesmore readily than it absorbs oxygen.
Clinical Manifestation
Dyspnea, headache, tachypnea, confusion,impaired judgement, cyanosis, respiratory
depression.
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Carbon Monoxide Poisoning
Management
Carry the patient tofresh air immediately.
Loosen all tight
clothing. Initiate CPR if
required; administer100% oxygen.
Hyperbaric oxygentherpay.
Prevent chilling
Hyperbaric Oxygen Therapy
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Cocaine
Intranasally ( snorting). Smoking (freebasing).
Crack
Clinical Manifestation Is a CNS stimulant that can HR & BP &
cause hyperpyrexia, seizures & ventriculardysrhythmias.
It produces intense euphoria, then anxiety,sadness & insomnia. Cocaine hallucinationwith delusions; psychosis with extreme
paranoia.
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Opiods
Heroin, Opium, Morphine, Codeine,Fentanyl.
Clinical Manifestation:
Pinpoint pupils, BP & marked respiratory
depression.
Management
Support respiratory & cardiovascular
functions Establish an IV line.
Narcotic antagonist (naloxone[narcan]).
Send urine for urinalysis
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Drugs producing sedation( Nonbarbiturates sedative)
Diazepam, lorazepam, Midazolam
Flunitrazepam (roofies, date rape drug)
Manifestation
Seizures, coma, circulatory collapse, death.
Acute intoxication:
Respiratory depression
Decreasing mental alertness, confusion
Slurred speech, BP, Ataxia, coma, deathFlunitrazepam
Disinhibition with antegrade amnesia
Weakness & unsteadiness, powerlessness.
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Sudden Cardiac Arrest A Health Burden
Approximately 50% of deaths fromcardiovascular disease occur as SUDDEN
CARDIAC ARREST.
Sudden Cardiac Arrest is the mostcommon mode of death in patients withcoronary artery disease.
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Health Burden of Sudden Cardiac Arrest
Almost 80 percent of out-of-hospital cardiacarrestsoccur at homeand are witnessed bya family member.
Only 4-6 % of sudden cardiac arrest victimssurvivebecause majority of those witnessingthe arrest do not know how to perform CPR .
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Sudden Cardiac Arrest
Unpredictable and can happen to anyone,anywhere, at anytime
Risk increases with age
Pre-existing heart diseaseis a common cause
May strike people with no history of cardiacdisease or cardiac symptoms
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What is C P R ?
CPR = Cardio-
PulmonaryResuscitation
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The NEW Chain of Survival
Early access:immediate recognition and activationEarly CPR
Early defibrillation
Early advanced care
Integrated post-
cardiac arrest care
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A well-informed lay person- key in the early accesslink.
Recognition of signs ofheart attack andrespiratory failure
Call for help immediately if
needed Activate the Emergency
Medical System
The First Link- Early Access
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EARLY WARNING SIGNS OFHEART ATTACK
prolonged compressingpain or unusualdiscomfort in the centerof the chest
may radiate to shoulder,arm, neck or jaw,usually on the left side
may be accompanied by
sweating, nausea,vomiting and shortnessof breath
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EARLY WARNING SIGNS OFRESPIRATORY FAILURE
unable to speak,breath or cough
clutches neck(universaldistress signal)
bluish color ofskin and lips
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Life saving techniquefor cardiac & respiratoryarrest
Chest compressions +/-Rescue breathing
Lay persons andmedical personnel
Second Link - Early CPR
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Brain(Cerebral)
Heart(Cardiac)
Lungs(Pulmonary)
How does CPR work?
All the living cells of our
body need a steady
supply of oxygen to
keep us alive.
During CPR, you can breathe air into
the victims lungs to provide oxygeninto the blood.
When you press on the chest, you moveoxygen - carrying blood through thebody.
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When will you do CPR?
AS SOON AS POSSIBLE!
Brain cells begin to die after
4-6 minutes without oxygen.
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CHECKAREASAFETY.
Surveythe scene.Seeif the scene is safe to do CPR.Get an idea of what happened.
CHECKUNRESPONSIVENESS.
Tap or gently shakethe victim
Rescuer shoutsAre you OK?
Quick check for normal breathing
If the victim is unconscious,rescuercalls for help.
CALL FORHELP:Ambulance,Emergency Services,
Doctor
RescuerACTIVATEStheEMERGENCY MEDICALSERVICES.
GetAED/Defibrillator!
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NON-RESPONSIVE,
NO NORMAL BREATHING
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PULSE CHECK
Palpate for Carotid Pulsewithin 10 seconds
(at the same timeCHECK FORBREATHING)
For trained healthcareproviders only
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Do Mouth to MouthBreathing
Give one breath every5-6 secs (about 12
breaths/min) Recheck pulse every 2
minutes
If with definite pulsebut no breathing
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MOUTH TO MOUTH BREATHING
and PULSE CHECK Deemphasized in the new guidelines
For trained healthcare providers only
As short and quick as possible
Pulse check not more than 10 seconds
If unsure, proceed directly to CHESTCOMPRESSIONS!
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C A BC. COMPRESSION Do chest
compressions firstA. AIRWAY Does the victim have an
open airway (air passage
that allows the victim tobreathe)?
B. BREATHING Is the victim breathing?
After determining unconsciousness,
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After determining unconsciousness
and calling for help,proceed immediately to do
CHEST
COMPRESSIONS!
C COMPRESSION(to assist CIRCULATION)
Ch C i
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Chest Compressions
Kneel facing
victims chest
Place the heel of
your hand on thecenter of the victim'schest. Put your otherhand on top of thefirst with yourfingers interlaced.
Ch C i
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Place theheel of onehand on thesternum in
the center ofthe chestbetween thenipples andthen place
the heel ofthe secondhand on topof the first sothat thehands areoverlappedand parallel.
Chest Compressions
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Give 30 Compressions Compress breastbone at least 2
inches
(30 compressions should take 15-18sec)
Count aloud 1, 2, 3, 4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,and ONE!
Minimize interruptions
Allow recoil after each compression
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A - AIRWAYOpen the Airway:
Use the head tilt/chin
lift method Place one hand on
the victims forehead
Place fingers of otherhand under the bonypart of lower jawnear chin
Tilt head and lift jaw--avoid closingvictims mouth
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Head Tilt Chin Lift Maneuver
This maneuver prevents airway obstructionby the epiglottis.
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B - BREATHINGGive 2 one-secondbreaths
Maintain airway Pinch nose shut
Open your mouthwide, take a normal
breath, and make atight seal aroundoutside of victims
mouth
Give 2 full breaths(1 sec/ breath)
Observe chest rise &fall; listen & feel for
escaping air
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PULSE CHECK
RECHECK PULSE EVERY 2 MINUTES(equivalent to 5 cycles CPR)
Very brief pulse check should take
less than 10 seconds (at the same timecheck for normal breathing)
In case there is any doubt about the
presence or absence of pulse,CONTINUE CHEST COMPRESSIONS
For trained healthcare providers only
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UNTIL
HELP ARRIVES.(Emergency Services, Ambulance, Doctor, AED)
PERSON IS REVIVED.
If th i ti i b thi
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If the victim is breathing
The unresponsive victim with spontaneous
respirations should be placed in the recoveryposition if no cervical trauma is suspected.
Placement in this position consists of rolling thevictim onto his or her side to help protect theairway.
Maintain open airway & position the victimTHE RECOVERY POSITION
Summary of Key BLS Components for Adults and Children
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Maneuvers Adults Children
RECOGNITION UNRESPONSIVE
No breathing,
not breathing normally (eg. only gasping)
No breathing or only gasping
CPR Sequence CAB CAB
Compression Rate At least 100/min
Compression Depth At least 2 inches (5 cm) At least 1/3 AP depth; About 2 inches
Chest wall Recoil Allow complete recoil between compressions
HCPs rotate compressors every 2 minutes
Compressioninterruptions
Minimize interruptions in chest compressionsAttempt to limit interruptions to less than 10 seconds
Airway Head tilt chin lift (HCP suspected trauma: jaw thrust)
Compression-Ventilationratio
30 : 2 (one or 2 rescuers) 30:2(single rescuer); 15:2(2 rescuer)
Ventilations: when rescuer
untrained or trained andnot proficient
Compressions only Compressions only
Ventilations withadvanced airway (HCP)
1 breath every 6-8 seconds (8-10 breaths/min)Asynchronous with chest compressions
About 1 second per breathVisible chest rise
DEFIBRILLATION ( AED ) Attach and use AED as soon as available. Minimize interruptions in chest
compressions before and after shock, resume CPR beginning with compressionsimmediately after each shock
Summary of Key BLS Components for Adults and Children
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MEMORIZE THE STEPS! Survey the scene.
Check responsiveness hey hey are you ok? Call for help! Activate EMS [Quick check pulse within 10 secs]
C Chest Compressions: 30 x; 100/min; 2 inchesdeep; push hard and fast
A - Airway: head tilt chin lift B Breathing: 2 breaths (1 second/breath) Chest compressions 30 x Continue cycles 30:2 compression-ventilation
[Quick check pulse every 2 mins] Until:
EMS arrives (AED, doctor, ambulance) Patient has signs of life
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Compression-only bystander CPR
Hands Only CPR
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Hands Only CPR shouldonly be used for adult
victims who havesuddenly collapsed orbecome unresponsive.
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Recommendations: All victims of cardiac arrest should receive
high-quality chest compressions
When an adult suddenly collapses, allbystanders should activate their community
EMS and provide high-quality chestcompressions, minimizing interruptions(Class I).
Hands Only CPR
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Recommendations: If not trained in CPR, provide hands-only
CPR (Class IIa) until
AED arrives EMS providers take over care of the victim
If trained in CPR, provide eitherconventional CPR using a 30:2compression-to-ventilation ratio (ClassIIa) or handsonly CPR (Class IIa)
Hands Only CPR
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K Ch g i th N G id li
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Key Changes in the New Guidelines
CAB instead of ABC
Compress first No more Look Listen and Feel
Harder! At least 2 inches compression (old: 1 to 2inches)
Faster! At least 100/min compression (old: up to100/min)
Deemphasize pulse checks
For trained healthcare providers not more than 10 secs Check for normal breathing together with check for
unresponsiveness
Hands only CPR for the untrained lay rescuer
I t t P i t
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Important Points There are no mistakes when you perform CPR.
The only harm is to delay responding.Start chest compressions now viewed as the most
effective procedure
All victims in cardiac arrest need chest compressions.
Don't stop pushing.Keep pushing as long as you can. Push until the AED is in
place and ready to analyze the heart. When it is time to do mouthto mouth, do it quick and get right back on the chest.
80-90% of cardiac emergencies occur at home.
Training is now simpler and more accessibleReduced number of steps and simplified process
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Being trained to do CPR can save a
loved one.
Effective CPR done immediately aftercardiac arrest can double a victims
chance of survival.
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Disaster Nursing
Adaptation of professional nursing skills inrecognizing and meeting the nursingphysical and emotional needs resulting
from a disaster. The overall goal of disaster nursing is to
achieve the best possible level of health
for the people and the community involvedin the disaster.
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1.Natural
2. Human-
Caused
3. Technological
Disaster Agents / Epidemiology
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Disaster Agents / Epidemiologyof Disaster
Agent1. Environment2. Host
Primary Agents:It includes falling of buildings, heat wind
rising waters and smoke. Secondary Agents:
It includes bacteria and viruses that producecontamination or infection after the primaryagent has caused injury or destruction.
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Primary or secondary agent will varyaccording to the type of disaster.
For example: - A hurricane with risingwater can cause flooding and high winds,
these are primary agents. The secondaryagents would include damaged buildingsand bacteria or viruses that thrive as a
result of the disaster. In an epidemic thebacteria or virus causing a disease is theprimary agent rather than the secondaryagent.
Factors affecting disaster
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Factors affecting disaster
Host factorsIn the epidemiological frame work asapplied to disaster the host is human-kind.Host factors are those characteristics of
humans that influence the severity of thedisaster effect. Host factors include:
Age
Immunization status
Degree of mobility
Emotional stability
Environmental factors
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Environmental factors
1. Physical Factors- Weather conditions, the availability offood, time when the disaster occurs, theavailability of water and the functioning ofutilities such as electricity and telephoneservice.2. Chemical Factors
- Influencing disaster outcome includeleakage of stored chemicals into the air, soil,ground water or food supplies.
Eg: - Bhopal Gas Tragedy.
Environmental factors
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Environmental factors
3. Biological Factors
- Are those that occur or increase asresult of contaminated water, improper
waste disposal, insect or rodentproliferations improper food storage or lackof refrigeration due to interrupted electrical
services.Bioterrorism: Release of viruses, bacteria orother agents caused illness or death.
Environmental factors
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Environmental factors
4. Social Factors:- Are those that contribute to the individual
social support systems. Loss of family members,changes in roles and the questioning of religious
beliefs are social factors to be examined after adisaster.5. Psychological Factors:
- Psychological factors are closely related to
agents, host and environmental conditions. Thenature and severity of the disaster affect thepsychological distress experienced by the
victims.
Environmental factors
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Environmental factors
4. Social Factors:- Are those that contribute to the individual
social support systems. Loss of family members,changes in roles and the questioning of religious
beliefs are social factors to be examined after adisaster.5. Psychological Factors:
- Psychological factors are closely related to
agents, host and environmental conditions. Thenature and severity of the disaster affect thepsychological distress experienced by the
victims.
PHASES OF DISASTER &
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PHASES OF DISASTER &EMERGENCY
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Mitigation: Lessen the impact of a disaster before it strikes
Preparedness: Activities undertaken to handle a disaster when
it strikes
Response: Search and rescue, clearing debris, and feeding
and sheltering victims (and responders if
necessary). Recovery:
Getting a community back to its pre-disasterstatus
Mitigation
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Mitigation
Activities that reduce or eliminate a hazard
Prevention
Risk reduction
Examples
Immunization programs
Public education
P d
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Preparedness
Activities that are taken to build capacityand identify resources that may be used
Know evacuation shelters
Emergency communication plan
Preventive measures to prevent spread ofdisease
Public Education
Response
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Response
Activities a hospital, healthcare system, orpublic health agency take immediatelybefore, during, and after a disaster or
emergency occurs
Recovery
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Recovery
Activities undertaken by a community andits components after an emergency ordisaster to restore minimum services and
move towards long-term restoration. Debris Removal
Care and Shelter
Damage Assessments Funding Assistance
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What is Triage?
French verb triermeans to sort
Assigns priorities
when resourceslimited
Do the best for thegreatest number of
patients
Why is Disaster Triage needed
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Why is Disaster Triage needed
Inadequate resource to meet immediateneeds
Infrastructure limitations
Inadequate hazard preparation Limited transport capabilities
Multiple agencies responding
Hospital Resources Overwhelmed
Advantages of Triage
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Advantages of Triage
Helps to bring order and organization to achaotic scene.
It identifies and provides care to those who arein greatest need
Helps make the difficult decisions easier
Assure that resources are used in the mosteffective manner
May take some of the emotional burden awayfrom those doing triage
Who Decides in triage
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Who Decides in triage
Nurses dont act for legal fears of being blamedfor deaths, and lack of clarity on where they fit inthe command structure
Nurses function to the level of their training andexperience.
If nurses they are the most trained personnelthe site, they are in charge.
oTriage Categories during a
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o age Catego es du g aMass Casualty Incident (MCI)
Triage category Priority 1 Color: RedImmediate:
- Injuries are life-threatening but survival with
minimal interventions.- Individuals in this group can progress rapidly to
expectant if treatment is delayed.
e.g. Sucking chest wound, airway obstruction,
shock, hemothorax, tension pneumothorax,unstable chest and abdominal wounds, openfractures of long bones.
oTriage Categories during a
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g g gMass Casualty Incident (MCI)
Delayed: Priority 2 Color: Yellow- Injuries are significant & require medical care,
but can wait hours without threat to life or limb.
- Individuals in this group receive treatment onlyafter immediate casualties are treated.
e.g. Stable abdominal wounds without evidence ofsignificant hemorrhage, soft tissue injuries,
fracture requiring open reduction.
oTriage Categories during a
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g g gMass Casualty Incident (MCI)
Minimal: Priority 3 Color: Green
- Injuries are minor and treatment can be delayedhours to days. Individuals in this group should
be moved away from the main triage area.e.g. Upper extremity fractures, minor burns,
sprains, small laceration without significantbleeding.
oTriage Categories during a
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g g gMass Casualty Incident (MCI)
Expectant: Priority 4 Color: Black
- Injuries are extensive and chances of survivalare unlikely even with definitive care.
- Persons in this group should be separated fromother casualties, but not abandoned.
e.g. Unresponsive patients with penetrating headwounds, high spinal cord injuries, woundsinvolving multiple body surface area, no pulse,no BP, pupils fixed and dilated.