By: Roel Q.

Batang, RN
MAN
EMERGENCY – IT IS WHATEVER THE PATIENT
OR THE FAMILY CONSIDERS IT TO BE.

EMERGENCY EMERGENCY
NURSING NURSE
• has a specialized education, training,
•It is the nursing care
and experience to gain expertise in
given to patients with assessing and identifying patients’
urgent and critical health care problems in crisis
needs situations
• establishes priorities, monitors
and continuously assesses acutely ill
and injured patients, supports and
attends to families, supervises allied
health personnel, and teaches
patients and families within a time-
limited, high-pressured care
environment
DISASTER NURSING - a branch of emergency
nursing, it refers to nursing care given to patients who are
victims of disasters, whether it is manmade or natural
phenomena.
INCIDENT
INCIDENT
COMMAND
COMMANDER
SYSTEM • The head of the incident
• It is a management tool
for organizing personnel, command system
facilities, equipment, and • He must be continuously
communication for any informed of all the
emergency situation. activities and informed
about any deviation from
the established plan
 EMERGENCY OPERATIONS PLAN (EOP)
It is done by a planning committee, composed of local/national
administrators, safety officer, ED manager, evaluating the
community to anticipate the type of disaster that might occur.

COMPONENTS of EOP
• Activation Response  Identification of external resources

 Internal/External Communication  A plan for people management and traffic

Plans flow
 Data Management Strategy
 Plan for coordinated patient care
 Deactivation Response
 Security Plans
 Post- Incident Response
 Plan for Practice Drills
 Anticipated Resources
 Mass Casualty Incident Planning
 Educational Plan
 TRIAGE
• from French word “trier”
meaning “to sort”
• TRIAGE
• it is used to sort patients NURSE – acts as a
into groups based on the gatekeeper, sorting
severity of their health patients into
problems and the
immediacy with which
categories, ensuring
these problems must be that the more
treated seriously ill are
treated first
 Priorities of Care &
Triage Categories
Emergent - Conditions requiring immediate
medical intervention, any delay in treatment is potentially life
or limb threatening. Must be seen IMMEDIATELY!

• AIRWAY COMPROMISE , CARDIAC ARREST

• SEVERE SHOCK, CERVICAL SPINE INJURY
• MULTISYSTEM TRAUMA, ALTERED LEVEL OF
CONSCIOUSNESS, ECLAMPSIA
 Priorities of Care &
Triage Categories
Urgent – Patients who present with Chronic
or minor injuries, no danger to life or limb, patient is in
no obvious cardiopulmunary distress
• FEVER
• MINOR BURNS
• MINOR MUSCULOSKELETAL INJURIES
• LACERATIONS
 Priorities of Care &
Triage Categories
Non Emergent – Patients who
presents as stable but whose condition requires medical
intervention w/in a few hours. No immediate treat to life
or limb to these patients.

• CHRONIC LOW BACK PAIN

• DENTAL PROBLEMS
• MISSED MENSES
PRINCIPLE OF TRIAGE IN A DISASTER:
“DO THE GREATEST GOOD FOR THE GREATEST
NUMBER” - Decisions are based on the likelihood of
survival and consumption of available resources.

TRIAGE PRIORITY COLOR

CATEGORY

IMMEDIATE 1 RED

DELAYED 2 YELLOW

MINIMAL 3 GREEN

EXPECTANT 4 BLACK
 IMMEDIA
TRIAGE CATEGORY
TE DELAYED
• Sucking chest wound • Stable abdominal wounds w/o evidence of
• airway obstruction secondary to mechanical cause, significant hemorrhage
• shock • soft tissue injuries
• hemothorax, tension pneumothorax • Maxillofacial wounds w/o airway
• asphyxia compromise
• unstable chest and abdominal wounds, • Vascular injuries w/ adequate collateral
• incomplete amputations, open fractures of long circulation
bones • Genitourinary Tract Disruption
• 2 / 3 degree burns of 15-40% TBSA
nd rd
• Fractures requiring open reduction,
debridement, and external fixation
 EXPECTA
TRIAGE CATEGORY
MINIMAL NT
• Upper extremity fractures • Unresponsive patients w/ penetrating head
wounds
• Minor Burns • High spinal cord injury
• Sprains • Wounds involving multiple anatomical sites
• Small Lacerations w/o significant and organs
bleeding • 2nd/3rd degree burns in excess of 60% of BSA
• Behavioral disorders or Psychological • Seizures or vomiting w/n 24 hours after
disturbances Radiation Exposure
• Profound shock with multiple injuries and
agonal respirations
• Patients with no Pulse, no BP, pupils fixed
and dilated
 EMERGENCY ASSESSMENT
1. PRIMARY
ASSESSMENT
MEANT TO IDENTIFY LIFE-THREATENING PROBLEMS

A IRWAY
B REATHING
C IRCULATION
D ISABILITY
E XPOSE
 EMERGENCY ASSESSMENT
2. SECONDARY
ASSESSMENT
Systematic, brief (2-3 mins) examination from head to toe
Purpose is to detect and prioritize additional injuries and
detect signs of underlying medical conditions
What is the mechanism of injury?
 When did the symptoms appear?
 Was the patient unconscious after the accident?
 How did the pt. reach the hospital?
 What was the health status of the patient prior the accident
or illness?
 Is there history of present illness?
 Is the patient taking any medications?
 Does the patient have allergies?
 Was treatment attempted before arrival at the hospital?
 Understand and accept basic anxieties, be aware of patient’s fear
 Accept the rights of the patient and family, to have and display their
feelings
 Maintain a calm and reassuring manner
 Treat the unconscious patient as if CONSCIOUS. (Touch, call by name,
explain every procedure)
 Orient the patient as soon he becomes conscious.
 Inform the family where the patient is, and give as much as information
as possible about the treatment
 Assist family to cope with sudden and unexpected death
 take them on a private place and talk to them so they can
mourn together
 assure the family that everything was done
 avoid giving sedation to family members
 LIFE SUPPORT
BASIC LIFE SUPPORT ADVANCE CARDIAC
• an emergency procedure LIFE SUPPORT
that consists of recognizing the use of special
respiratory or cardiac arrest equipment to maintain
or both the proper breathing and circulation
application of CPR to for the victim of a cardiac
maintain life until a victim emergency.
recovers or advance life
support is available.

PROLONGED LIFE SUPPORT

for post resuscitative and long
term resuscitation.
 SURVIVAL
FIRST LINK - EARLY
ACCESS
• It is the event initiated after
the patient’s collapse until
the arrival of Emergency
Medical Services personnel
prepared to provide care.
 SURVIVAL
SECOND LINK - EARLY CPR
• If started immediately after
the victim’s collapse, the
probability of survival
approximately doubles
when it is initiated before
the arrival of EMS.
 SURVIVAL
THIRD LINK - EARLY
DEFIBRILLATION
• It is most likely to improve
survival. It is the key
intervention to increase the
chances of survival of
patients with out-of-hospital
cardiac arrest.
 CHAIN OF
SURVIVAL
SECOND LINK - EARLY ACLS
• If provided by highly trained
personnel like paramedics,
provision of advanced care
outside the hospital would
be possible.
 GOLDEN RULES IN PROVIDNG
EMERGENCY CARE – TO DO
• Do obtain consent when possible.
• Do think the worst. It’s best to administer first aid for the
gravest possibility.
• Do provide comfort and emotional support.
• Do respect the victim’s modesty and physical privacy.
• Do be as calm and as direct as possible.
• Do care for the most serious injuries first.
• Do assist the victim with his/her prescription medication.
• Do handle the victim to a minimum.
• Do loosen tight clothing.
 GOLDEN RULES IN PROVIDNG
EMERGENCY CARE – NOT TO DO
• Do not let the victim see his/her own injury.
• Do not leave the victim alone except to get
help.
• Do not assume that the victim’s obvious
injuries are the only ones.
• Do not make any unrealistic promises.
• Do not trust the judgment of a confused
victim and require them to make decision.
 is a rapid movement of
RESCUE patient from unsafe place
to a place of safety.

Indications for Emergency Rescue

1. Danger of fire or explosion.
2. Danger of toxic gases or asphyxia due to lack
of oxygen.
3. Natural Disasters
4. Risk of drowning. Methods of Rescue:
5. Danger of electrocution. 1. For immediate rescue without
any assistance, drag or pull
6. Danger of collapsing walls.
the victim.
2. Most of the one-man
drags/carries and other
transfer methods can be used
as methods of rescue.
 is moving a patient from

TRANSFER one place to another

after giving first aid.

Factors to consider in selecting

transfer method:
1. Nature and severity of the injury.
2. Size of the victim.
3. Physical capabilities of the first aider.
4. Number of personnel and equipment
available.
5. Nature of the evacuation route.
6. Distance to be covered.
7. Gender of the victims. (last consideration)
 Pointers to be
TRANSFER observed during
transfer
1.Victim’s airway must be maintained open.
2. Hemorrhage is controlled.
3. Victim is safely maintained in the proper position.
4. Regular check of the victim’s condition is made.
5. Supporting bandages and dressings as remain
effectively applied.
6. The method of transfer is safe, comfortable and as
speedy as circumstances permit.
7. The patient’s body is moved as one unit.
8. First aiders/bearers must observed ergonomics in
lifting and moving of patient.
METHODS TRANSFER
1.One man
assist/carries/drags
2. Two man assist/carries
3.Three man carries
4.four/six/eight-man carry
5.Blanket
METHODS TRANSFER
6.Improvised stretcher using
two poles with:
• blanket
• Empty sacks
• Shirts or coats
• Triangular bandages
7.Commercial stretchers
8.Ambulance or rescue van
9.Other vehicles.
 CARDIOPULMUNARY
RESUSCITATION
- a technique of basic
life support for the
purpose of oxygenating
the brain and heart until
appropriate, definitive
medical treatment can
restore normal heart
and ventilatory function.

Ax
CX
CARDIOPULMUNARY RESUSCITATION
- MANAGEMENT
RESPONSIVENESS/AIRWAY
• Determine unresponsiveness; “ARE YOU OKAY?”
• Activate Emergency Medical Assistance
• Place patient supine on a firm, flat surface. Kneel at
the level of the patient’s shoulders
• Open the airway: HEADTILT/CHIN LIFT
MANEUVER, JAW THRUST MANEUVER
BREATHING
• Look, Listen and Feel
• Rescue breathing: 2 full breaths
CIRCULATION
• Check carotid pulse
WAYS TO VENTILATE THE LUNGS
mouth to mouth

mouth to nose

mouth to stoma

mouth to mouth and nose

mouth to barrier device

 Table of Cardiopulmonary Resuscitation
for Adult, Child & Infant
Adult Child Infant
Lower half of the Lower half of the Lower half of the
Compression sternum but not sternum but not sternum but not hitting
hitting the xiphoid hitting the xiphoid the xiphoid process: 1
Area
process: measure process: measure finger width below the
up to 2 fingers from up to 1 finger from imaginary nipple line.
substernal notch. substernal notch.
Depth Approximately 1 ½ Approximately 1 to 1 Approximately ½ to 1
to 2 inches ½ inches inch
How to Heel of 1 hand, Heel of 1 hand. 2 fingers (middle &
compress other hand on top. ring fingertips)

Compression- 30:2 (1 or 2 30:2 (1 or 2 30:2 (1 or 2 rescuers)

ventilation ratio rescuers) rescuers)

Number of 5 cycles in 2 5 cycles in 2 5 cycles in 2 minutes

cycles per minutes minutes
minute
-PONTENEOUS signs of circulation are
restored

-URN OVER to medical services or properly

trained authorized personnel

- PERATOR is already exhausted and cannot

continue CPR

- HYSICIAN assumes responsibility (declares

death, take-over, etc.)
AIRWAY OBSTRUCTION
KINDS OF AIRWAY OBSTRUCTION
Anatomic Airway Obstruction
Mechanical Airway Obstruction

Clinical Manifestations: UNIVERSAL DISTRESS

SIGNAL ( patient may clutch the neck
between the thumb and fingers), choking,
stridor, apprehensive appearance, restlessness.
CYANOSIS and LOSS of CONSCIOUSNESS
develop as hypoxia worsens.
AIRWAY OBSTRUCTION
– MANAGEMENT
HEIMLICH MANEUVER
(Subdiagphramatic Abdominal
Thrust)

FINGER SWEEP
CHEST THRUST
 MEASURES TO ESTABLISH
AIRWAY
HEAD-TILT-CHIN-LIFT
MANEUVER
JAW-THRUST MANEUVER
OROPAHRYNGEAL AIRWAY
ENDOTRACHEAL
INTUBATION
CRICOTHYROIDOTOMY
CRICOTHYROIDOT
OMY
 HEAD INJURIES
1. OPEN HEAD INJURY
2. CLOSED HEAD INJURY
3. CONCUSSION – temporary loss of
4. consciousness that results in transient
5. interruption if the brain’s normal functioning
6. CONTUSSSION – bruising of the brain tissue
7. INTRACRANIAL HEMORRHAGE – significant bleeding into a space or
potential space between the skull and the brain
a. Epidural hematoma
b. Subdural hematoma
c. Subarachnoid hemorrhages

ALERT: Assume cervical spine fracture for

any patient with a significant head injury,
until proven otherwise.
 HEAD INJURIES
PRIMARY ASSESSMENT: Assess for ABC
SECONDARY ASSESSMENT:
 Change in LOC, CUSHING’S TRIAD ( bradypnea,
bradycardia, widened pulse pressure) – indicating increased
intracranial pressure
 Pupils, Battle’s Sign
 Rhinorrhea or otorrhea – indicative of CSF leak
 Periorbital Ecchymosis – indicates anterior basilar
fracture

ALERT: If basilar skull

fracture or severe
midface fractures are
suspected, a
nasogastric tube(NGT)
is CONTRAINDICATED!
 HEAD INJURIES
MANAGEMENT:
 Open airway by Jaw-Thrust Manuever, suction orally if needed
 Administer high flow oxygen: most common death is CEREBRAL ANOXIA
 In general, hyperventilate the patient to 20-25 bpm, causing cerebral
vasoconstriction and minimizing cerebral edema
 Apply a bulky, loose dressing; don’t apply pressure
 IV line of PNSS or Plain LR
 prepare to manage seizures
 maintain normothermia
 Medications:
a. Diazepam
b. Steroids
c. Mannitol
 Prepare of immediate surgery if pt. shows evidence of neurologic deterioration
 SKULL Fractures
• SIMPLE
• COMPOUND
• LINEAR Fx
• COMMINUTED Fx
• DEPRESSED Fx
• CRANIAL VAULT Fx
• BASILAR Fx –

ALERT:
• Damage to the brain is the first concern, it
is considered a neurosurgical condition
• In children, skull’s thinness and elasticity
allows a depression w/o a break in the bone
SKULL Fractures -Tx
For LINEAR FRACTURES:
 supporative (mild analgesics)
 cleaning and debridement of wounds
If conscious: observed for 4 hours; if not, admit for
evaluation
 if VS stable, may go home with instruction sheet

For VAULT and BASILAR FRACTURES:

 Craniotomy to remove fragments
 antibiotics
 Dexamethasone
 Osmotic Diuretics (MANNITOL) if increased ICP is
present
SKULL Fractures –Nx
Consideration
maintain patent airway; nasal airway contraindicated to basilar fx
 support with O2 administration
 suction pt. through mouth not nose if CSF leak is present
 RHINORRHEA – wipe it, don’t let him blow it!
 OTORRHEA – cover it lightly with sterile gauze, don’t pack it!
 Position head on side
 Maintain a supine position with bed elevated to 30 degrees
 don’t give narcotics or sedative
 assist in surgery, maintaining sterile technique
 Spinal Cord Injuries
PRIMARY ASSESSMENT:
• immediate immobilization of the spine
• A B C ( Intercoastal paralysis w/ diapragmatic breathing)

SUBSEQUENT ASSESSMENT:
• Hypotension, bradycardia, hypothermia - suggests
SPINAL SHOCK
• Total sensory loss and motor paralysis below the level of
injury

MANAGEMENT:
 Nasotracheal intubation
 initaite IV access, monitor blood gas
 indwelling urinary catheterization
 prepare to manage seizures
 Meds: High dose steroids and diazepam
MAXILLOFACIAL Injuries
PRIMARY ASSESSMENT
• Immobilization of spine while performing assessment
• ABC – (tongue swelling, bleeding, broken or missed
teeth)

SUBSEQUENT ASSESSMENT
• Paralysis if the upward gaze – indicative of INFERIOR
ORBIT FX
• Crepitus on nose – indicates nasal fracture
• Flattening of the cheek and loss of sensation below the orbit
– indicates ZYGOMA (cheekbone) FX
• Malocclussion of teeth, trismus – indicative of MAXILLA FX

PRIMARY INTERVENTIONS:
 Insertion of oral airway or intubation
 Nasopharyngeal airway should only be used if no evidence
of nasal fracture or rhinorrhea
 Apply bulky, loose dressing; apply ice to areas of swelling
 Injuries of the Bones & Joints
1. FRACTURE – a break in he continuity of the bone; occurs when stress is
placed on a bone is greater than the bone can absorb
ALERT: fractured cervical spine, pelvis and femur may produce life
threatening injuries; posterior dislocations of the hip are life- and limb-
threatening emergencies due to potential blood loss.
Clinical Manifestations:
• Pain and tenderness over fracture site
• Crepitus or grating over fracture site
• swelling and edema
• Deformity, shortening of an extremity or rotation of extremity

EMERGENCY Management: IMMOBILIZE, INITIATE IV

MANAGEMENT PROCESS OF FRACTURES

-EDUCTION
-setting the bone; refers to the restoration of the fracture
fragments into anatomic position and alignment
-MMOBILIZATION
- maintains reduction until bone healing occurs
- EHABILITATION
- Regaining normal function of the affected part

 use of cast and splint to immobilize extremity and maintain reduction

 Skin Traction – force applied to the skin using foam rubber, tapes
 Skeletal Traction – force applied to the bony skeleton directly, using wires,
pins, tongs placed in the bone
 ORIF – operative intervention to achieve reduction, alignment and
stabilization
 Endoprosthetic Replacement – implantation of metal device
 NURSING CONSIDERATIONS
Elevate to prevent or limit swelling
 Apply ice packs or cold compress; not place directly in skin
 Splint and maintain in good alignment, immobilize the joint above and below the
fracture
 Give pain medications as ordered
 Assist in casting; use the palm of your hands in holding a wet cast
 Avoid resting cast on hard surfaces or sharp edges
 Do neurovascular checks hourly for the first 24 hours

 Assess for COMPARTMENT SYNDROME – check for 6 P’s

 If Compartment syndrome is suspected, do not elevate limb above the level
of the cast
 Notify the physician
SPRAIN – an injury to the ligamentous structure surrounding a joint;
usually caused by a wrench or twist resulting in a decrease joint stability
Clinical Manifestations:
• Rapid swelling due to extravasation of blood w/n tissues
• Pain on passive movement of joint
• discoloration, and limited use or movement

STRAIN – a microscopic tearing of the muscle cause by excessive

force, stretching, or overuse
Clinical Manifestations:
• Pain with isometric contractions
• Swelling and tenderness
• Hemorrhage in muscle
MANAGEMENT OF SPRAINS AND STRAINS
-OMPRESSION (Elastic Bandage)
-EST
-CE (for the first 24 hrs; 1 hr on, 2 hrs off during waking hours)
-EDICATIONS ( NSAIDs)
-LEVATION
-UPPORT (Use of crutches, splints)

NURSING CONSIDERATIONS:
 Apply ice compress for the first 24 hrs to produce vasoconstriction,
decrease edema, and reduce discomfort
 Apply warm compress after 24 hrs to promote circulation and absorption
(20 to 30 minutes at a time)
 Educate to rest injured part for a month to allow healing
 Educate to resume activities gradually and to warm up
 BLUNT CHEST TRAUMA
- It is a trauma in the chest without an open wound
- usually cause by VA, blast injuries

RIB FRACTURES: tenderness, slight edema, pain that worsens with deep
breathing and movement, shallow and splinted respirations
STERNAL FRACTURES: persistent chest pain
MULTIPLE RIB FRACTURES:
- FLAIL CHEST (loss of chest wall integrity)
- decreased lung inflation, paradoxical chest movements
- extreme pain
- rapid and shallow respirations
- hypotension, cyanosis
- respiratory acidosis
COMPLICATIONS
TENSION PNEUMOTHORAX
HEMOTHORAX
LACERATION or RUPTURE of
AORTA
DIAPHRAGMATIC RUPTURE
CARDIAC TAMPONADE
 TREATMENT
Simple Rib Fractures
 mild analgesics, bed rest, apply heat
 incentive spirometry
 deep breathing, coughing and splinting

Severe Rib Fractures

 intercoastal nerve blocks
 position for semi-fowlers, administer O2

Hemothorax
 Chest tube insertion at 5th-6th ICS anterior to MAL
 administer IV fuids, O2, Blood Transfusion
 Thoracotomy
 Thoracentesis
 TREATMENT
Tension Pneumothorax
 insertion of spinal, 14G or 16G needle into the 2nd ICS at MCL to
release pressure
 Chest Tubes
 Surgical Repair
Aortic Rupture/Laceration
 immediate surgery
- synthetic grafts
- aortic anastomosis
 O2, BT, IV
NURSING CONSIDEARTIONS:
 monitor VS, (q 15, first hour post thoracentesis and post CTT)
 After CTT insertion, encourage cough and breathing exersises
 Chest tubes should have continuous FLUCTUATIONS
 if BUBBLING, air leak is suspected
 if FLUCTUATION STOPS, mechanical blockage or lung has already
expanded
 have an extra bottle with PNSS, clamps and sterile gauze at bedside
 in case of dislodgment, cover the opening with sterile/petroleum gauze to
prevent rapid lung collapse
 Assist with proper positioning
 Bed Rest
 ABDOMINAL INJURIES
1. PENETRATING ABDOMINAL INJURY
2. BLUNT ABDOMINAL INJURY
ABDOMINAL INJURIES - NxIx
Keep pt. quiet in the stretcher, any movement may dislodge a clot
 Cut the clothing, count the number of wounds, look for entrance and exit
wounds
 Apply compression to external bleeding wounds
 double IV line and infuse Ringer’s Lactate
 Insert NGT to decompress the abdomen
 Cover protruding abdominal viscera w/ sterile saline dressings; don’t attempt
to place back the protruding organs
 Cover open wounds with dry dressings
 Insert indwelling catheter; if pelvic fracture is suspected, catheter should not
be placed until integrity of urethra is ensured.
 Meds: Tetanus Prophylaxis, Antibiotics, Assist in peritoneal lavage
 Prepare pt. for surgery if the condition persists. (Exploratory Laparotomy)
 ENVIRONMENTAL EMERGENCIES
It is the inadequacy or the
collapse of peripheral
HEAT EXHAUSTION circulation due to
volume and electrolyte
depletion
ASSESSMENT
temperature may be normal or
slightly elevated, hypotension,
MANAGEMENT
tachycardia, tachypnea, pale
and moist skin, fatigue,  Move patient to a cool environment,
headache, dizziness, syncope remove all clothing
 Position the patient supine with the feet
slightly elevated
DIAGNOSTICS
 Monitor VS every 15 mins and cardiac
rhythm
1. Hemoconcentration
 Educate to avoid immediate reexposure
2. hyponatremia or hypernatremia
to high temperatures
3. ECG may show dysrhythmias
 ENVIRONMENTAL EMERGENCIES
- It is a combination of hyperpyrexia
and neurologic symptoms. It caused
HEAT STROKE by a shutdown or failure of the heat-
regulating mechanisms of the body
CLINICAL MANIFESTATIONS:
• bizarre behavior or irritability, progressing to confusion,
delirium and coma
• 40.6 degrees Celcius, hypotension, tachycardia, tachypnea
• skin may appear flushed and hot; at start it maybe moist
progressing to dryness (Anhidrosis)
NURSING ALERT:
• Elderly clients are high-risk to develop heat-stroke
• Once diagnosis is confirmed, it is imperative to reduce
patient’s temperature
 MANAGEMENT
EVAPORATIVE COOLING, most effective, by spraying tepid water on skin
while fans are used to blow
 Apply ice packs to necks, groin, axillae, and scalp
 Soak sheets/towels in ice water and place on patient
 If temp. fails to decrease, initiate core cooling: iced saline lavage, cool
fluid peritoneal dialysis, cool fluid bladder irrigation
 Discontinue active cooling when the temp. reaches 39 degrees Celcius
 Oxygenate the pt. via ET or nonrebreather mask
 Monitor VS, ECG, and neurologic status
 Start IV infusion using Ringer’s Lactate
 Anti-pyretics are not useful
 Indwelling catheterization
 WOF hypokalemia, metabolic acidosis, seizures
 ENVIRONMENTAL EMERGENCIES
-It is a condition where the core
HYPOTHERMIA temp. is less than 35 degrees
Celcius as a result in the exposure
3 compensatory mechanisms: to cold.

a. shivering – produces heat thru muscular activity

b. peripheral vasoconstriction – to decrease heat loss
c. raising basal metabolic rate

NURSING ALERT:
• Elderly are greater risk for hypothermia due to
altered compensatory mechanisms
• Extreme caution should be used in moving or
transporting hypothermic pts., because the heart is
near fibrillation threshold
 HYPOTHERMIA CLINICAL MANIFESTIONS:

• slow, spontaneous respirations

• heart sounds may not be audible even if its beating
• BP is extremely difficult to hear
• fixed dilated pupils, no pulse, no BP; initiate CPR
• drowsiness progressing to coma
• shivering is suppressed on temp. below 32.3 degrees
• ataxia
• cold diuresis
• fruity or acetone odor of breath

GOAL of MANAGEMENT: Rewarm without precipitating

cardiac dysrhythmias.
 HYPOTHERMIA – MGT.
Passive External Rewarming (temp above 28 degrees)
-Remove all wet clothing, and replace with warm clothing
- Provide insulation by wrapping the patient in several blankets
- Provide warm fluids
Disadvantage: slow process

Active External Rewarming (temp above 28 degrees)

-Provide external heat for patient- warm hot water bottles to the armpits, neck,
or groin
- Warm water immersion
Disadvantages
1. causes peripheral vasodilation, returning cool blood to the core, causing an
initial lowering of the core temp.
2. Acidosis due to “washing out” of lactic acid from the peripheral tissue
 NEAR
DROWNING
-It is a survival for atleast 24 hours after submersion, with most common
consequence of hypoxemia.
-Hypoxia and acidosis are common problems of the victim.
-Resultant pathophysiologic changes and pulmonary injury depend on type of fluid
and the volume aspirated.

Fresh water aspiration

results in loss of surfactant,
hence an inability to expand
lungs
Saltwater aspiration
leads to pulmonary edema
from the osmotic effect of salt
within the lungs.
 NEAR DROWNING –
 Immediate CPR MGT.
 Endotracheal intubation with PEEP
 VS, check degree of hypothermia
 Rewarming procedures
 Intravascular volume expansion and inotropic agents
 ECG
 Indwelling catheterization
 NGT insertion
TOXICOLOGIC EMERGENCIES
INGESTED POISONS

ASSESSM GENERAL INTERVENTION

• Initiate large-bore IV
• ABC
ENT
•Identify the poison access, monitor shock
•Obtain blood and urine tests; • Prevent aspiration of
gastric contents may be sent gastric contents by
to laboratory positioning head on side
• Monitor neurologic status
• Gastric lavage, Maintain
• Monitor fluid and electrolytes
seizures precaution
MINIMIZING ABSORPTION
 Administration of activated charcoal with a
cathartic to hasten secretion.
 Induction of emesis with syrup of ipecac; done
only in patients with good gag reflex and is
conscious.
 Adult dose is 30 ml by mouth followed by 2 glasses
of water; Pedia dose is15 ml followed by 8 – 16 oz.
of water.
NURSING ALERT: Do not induce emesis after ingestion of
caustic substances, hydrocarbons, iodides, silver
nitrates, petroleum distillates; to a patient having
seizure or to pregnant patient.
 Gastric lavage for the obtunded patient. Save
gastric aspirate for toxicology screen.
Procedure to enhance the removal of ingested
substance if the patient is deteriorating.
1. Forced diuresis with urine pH alteration – to
enhance renal clearance.
2. Hemoperfusion (process of passing blood through an
extracorporeal circuit and a cartridge containing an
adsorbent, such as charcoal, after which the detoxified blood
is returned to the patient)
3. Hemodialysis – to purify and accelerate the elimination of
circulating toxins.
4. Repeated dose of charcoal.
5. Providing an antidote – antidote is a chemical or
physiologic antagonist that will neutralize the poison
 Carbon Monoxide Poisoning
CLINICAL MANIFESTATIONS
Respiratory depression, stridor.
- Confusion progressing to
coma.
- Headache, muscular
weakness, palpitation, and
dizziness.
- Skin is pink in color, cherry
red, or cyanotic.
- ABG: carboxyhemoglobin level
is 12% (Normal), 30 – 40%
severe carbon monoxide
poisoning.
Carbon Monoxide Poisoning
MANAGEMEN
T
Provide 100% oxygen by tight-fitting mask (the elimination half
life of carboxyhemoglobin, in serum, for a person breathing room
air is 5 hours and 20 minutes. If patient breaths 100% oxygen the
half life is reduced to 80 minutes
 100% oxygen in hyperbaric chamber reduces half-life to 20
minutes.
 Intubate if necessary to protect airway.
 Continuous ECG monitoring, treat dysrhythmias.
 Correct acid-base and electrolyte imbalances.
 Continuous observation of psychoses, spastic paralysis, visual
disturbances, and deterioration of personality may persist after
resuscitation and may be symptoms of permanent CNS damage.
 -These are injected poisons

INSECT STING
from insects which produces
either local or systemic
reactions.

MANAGEMENT Nx Consideration
ABC Apply ice packs to site to relieve
pain.
 Epinephrine is the drug  Elevate extremities with large
of choice give SQ. edematous local reaction.
 Administer bronchodilator.  Administer anti histamine for local
reaction.
 Initiate IV with Ringers
 Clean wounds thoroughly with
Lactate. soap and water or antiseptic solution.
 Prepare for CPR. remove stinger with one quick
scrape of fingernail.
 SNAKE BITE
LINICAL MANIFESTATIONS:
MANAGEMEN
-Burning pain, swelling, and
numbness of the site. Wash the site of bite, keep the
- Hemorrhagic bullae may occur patient calm and immobilize
extremity.
after few hours of bite and entire
extremity may become  Administer O2 and start IV
edematous. line.
- WOF signs of systemic reactions  Administer anti-venin and be
(nausea, sweating, weakness, alert to allergic reaction.
lightheadedness, initial euphoria  Administer vasopressors in
followed by drowsiness, the treatment of shock.
dysphagia, paralysis of various
muscle groups, shock, seizures,
and coma).
 ALCOHOL WITHDRAWAL
DELIRIUM
COMMON BEHAVIORAL
CLINICAL MANIFESTATIONS
Shakes, seizures, and hallucinations.
PROBLEMS: 5 D’s
 History of drinking episodes.
 N/V, malaise, weakness, anxiety.
D-enial
 Autonomic hyper reactivity D -ependency
(tachycardia, diaphoresis, increase
temperature, dilated but reactive D-emanding
D –estructive
pupils).

D-omineering
COMMON WITHDRAWAL SIGNS AND
SYMPTOMS:

-ALLUCINATIONS (VISUAL AND TACTILE)

-NCREASED VITAL SUGNS

-REMORS

-WEATING AND SIEZURE

COMMON DEFENSE MECHANISM

-ENIAL

-ATIONALIZATION

-SOLATION

-ROJECTION
 DRUG OF CHOICE: DISULFIRAM (antabuse)
for aversion therapy of an alcoholic:

Instruct patient to avoid, when taking

Disulfiram:
-OUTH WASH
-VER THE COUNTER COLD REMIDIES
-OOD SAUCES MADE UP OF WINE
-RUIT FLAVORED EXTRACTS
-FTERSHAVE LOTIONS
-INEGAR
-KIN PRODUCTS
 ALCOHOL WITHDRAWAL
DELIRIUM – MGT.
Protect patient from injury, diazepam or phenytoin for seizure control as
prescribed.
 Monitor VS every 30 minutes.
 Use a non-alcohol skin preparation, draw blood for measurement of
ethanol concentration, toxicologic screen for other drug abuse.
 Maintain electrolyte balance and hydration.
 Observe for hypoglycemia.
 Administer thiamine followed by parenteral dextrose if liver glycogen is
depleted.
 Give orange juice, gatorade, or other carbohydrates to stabilize blood
sugar.
 Place patient in a private room with close observation.