EMERGENCY AND DISASTER NURSING

BY: Darran Earl Gowing, BSN, RN

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TERMS USE:
Trauma
- Intentional or unintentional

wounds/injuries on the human body from particular mechanical mechanism that exceeds the bodys ability to protect itself from injury

Emergency Management
- traditionally refers to care given to

patients with urgent and critical needs.

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 Triage
- process of assessing patients to determine

management priorities.

First Aid
- an immediate or emergency treatment

given to a person who has been injured before complete medical and surgical treatment can be secured.

BLS
- level of medical care which is used for

patient with illness or injury until full medical care can be given.
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 ACLS
- Set of clinical interventions for the urgent

treatment of cardiac arrest and often life threatening medical emergencies as well as the knowledge and skills to deploy those interventions.

Defibrillation
- Restoration of normal rhythm to the heart

in ventricular or atrial fibrillation

Disaster
- Any catastrophic situation in which the

normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment
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Mass Casualty Incident

- situation in which the number of

casualties exceeds the number of resources

Post Traumatic Stress Syndrome

- characteristic of symptoms after a

psychologically stressful event was out of range of an normal human experience

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SCOPE AND PRACTICE OF EMERGENCY NURSING

The emergency nurse has had

specialized education, training, and experience. The emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families, supervises allied health personnel, and teaches patients and families within a time-limited, high-pressured care environment.
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Nursing interventions are accomplished interdependently, in consultation with or under the direction of a licensed physician. Appropriate nursing and medical interventions are anticipated based on assessment data. The emergency health care staff members work as a team in performing the highly technical, hands-on skills required to care for patients in an emergency situation.
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Patients in the ED have a wide variety of actual or potential problems, and their condition may change constantly.

Although a patient may have several diagnosis at a given time, the focus is on the most lifethreatening ones

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ISSUES IN EMERGENCY NURSING CARE

Emergency nursing is demanding

because of the diversity of conditions and situations which are unique in the ER. Issues include legal issues, occupational health and safety risks for ED staff, and the challenge of providing holistic care in the context of a fast-paced, technology-driven environment in which serious illness and death are confronted on a daily basis.
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The emergency nurse must expand his or her knowledge base to encompass recognizing and treating patients and anticipate nursing care in the event of a mass casualty incident.
Legal Issues Includes:
- Actual Consent - Implied Consent

- Parental Consent

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 Good Samaritan Law

- Gives legal protection to the rescuer

who act in good faith and are not guilty of gross negligence or willful misconduct.

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Focus of Emergency Care

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

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Golden Rules of Emergency Care

Dos
- Obtain Consent - Think of the Worst
- Respect Victims Modesty & Privacy

Donts
- let the patient see his own injury - Make any unrealistic promises

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Guidelines in Giving Emergency Care

A Ask for help I Intervene D Do no Further Harm

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Stages of Crisis
1.

Anxiety and Denial

encouraged to recognize and talk about their

feelings. asking questions is encouraged. honest answers given prolonged denial is not encouraged or supported

2.

Remorse and Guilt

verbalize their feelings way of handling anxiety and fear allow the anger to be ventilated

3. Anger

4. Grief
help family members work through their grief letting them know that it is normal and

acceptable
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Core Competencies in Emergency Nursing

Assessment

Priority Setting/Critical Thinking Skills

Knowledge of Emergency Care Technical Skills Communication

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Assess and Intervene

Check for ABCs of life
A Airway
B Breathing C - Circulation
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Team Members
Rescuer

Emergency Medical Technician Paramedics Emergency Medicine Physicians

Incident Commander Support Staff Inpatient Unit Staff
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Emergency Action Principle

I. Survey the Scene

Is the Scene Safe? What Happened? Are there any bystanders who can help? Identify as a trained first aider!

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II. Do a Primary Survey

-

organization of approach so that immediate threats to life are rapidly identified and effectively manage.

Primary Survey

A - Airway/Cervical Spine
- Establish Patent Airway - Maintain Alignment - GCS 8 = Prepare Intubation
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B Breathing
- Assess Breath Sounds - Observe for Chest Wall Trauma - Prepare for chest decompression

C Circulation
- Monitor VS - Maintain Vascular Access - Direct Pressure

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Estimated Blood Pressure

SITE
Radial

SBP
80

Femoral
Carotid

70
60

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Control of Hemorrhage

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D Disability
- Evaluate LOC - Re-evaluate clients LOC - Use AVPU mnemonics

E Exposure
- Remove clothing - Maintain Privacy - Prevent Hypothermia

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III. Activate Medical Assistance

Information to be Relayed: What Happened? Number of Persons Injured Extent of Injury and First Aid given Telephone number from where youre calling

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IV. Do Secondary Survey

Interview the Patient S Symptoms A Allergies M Medication P Previous/Present Illness L Last Meal Taken E Events Prior to Accident

Check Vital Signs

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V. Triage

comes from the French word trier, meaning to sort process of assessing patients to determine management priorities

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Categories:
1. Emergent
-highest priority, conditions are life threatening and need immediate attention Airway obstruction, sucking chest wound, shock, unstable chest and abdominal wounds, open fractures of long bones

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2. Urgent
have serious health problems but not immediately life threatening ones. Must be seen within 1 hour
Maxillofacial wounds without airway

compromise, eye injuries, stable abdominal wounds without evidence of significant hemorrhage, fractures

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3. Non-urgent
patients have episodic illness than can be addressed within 24 hours without increased morbidity
Upper extremity fractures, minor

burns, sprains, small lacerations without significant bleeding, behavioral disorders or psychological disturbances.
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Field TRIAGE
1. Immediate:
Injuries are life-threatening but

survivable with minimal intervention. Individuals in this group can progress rapidly to expectant if treatment is delayed.

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2. Delayed:
Injuries are significant and require

medical care, but can wait hours without threat to life or limb. Individuals in this group receive treatment only after immediate casualties are treated.

3. Minimal: Injuries are minor and treatment can be delayed hours to days. Individuals in this group should be moved away from the main triage area.
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4. Expectant:
Injuries are extensive and chances of survival are unlikely even with definitive care.

5. Fast-Track:

Psychological support needed

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FIRST AID
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Role of First Aid

Bridge the Gap Between the Victim and the Physician

Immediately start giving interventions in pre-hospital setting

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Value of First Aid Training

Self-help
Health for Others

Preparation for Disaster

Safety Awareness
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BASIC LIFE SUPPORT

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Artificial Respiration
a way of breathing air to

persons lungs when breathing ceased or stopped function.

Respiratory Arrest
a condition when the

respiration or breathing pattern of an individual stops to function, while the pulse and circulation may continue.

Causes: Choking, Electrocution, strangulation, drowning and suffocation.

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Methods: mouth to mouth

mouth to nose mouth to stoma
mouth to mouth and nose

mouth to barrier device

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Procedure
1. Safe Approach

Infant(0-1yr)

Child(1-8 yrs)

Adult
Gently shouting are you ok? then shake the victim

Approach and assess situation

2. Assess for Response

Shout and gently pinch

3. Positioning 4. Open the Airway

Placed Supine on a firm and flat surface Check for foreign bodies then remove using finger sweep Head-tilt-chin-lift maneuver Jaw-thrust Maneuver
Bring cheek over the mouth and nose of the casualty Look for chest movement Listen for breath sounds Feel for breathing on your cheek

5. Assess for Breathing

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 Place in recovery position Before moving casualty remove any objects safely from her pockets Kneel beside casualty, place arm nearest at right angles, and then bend elbow keeping the palm uppermost. Bring far arm across the casualtys chest and hold back of the casualtys hand against the nearest cheek With your other hand grasp the far thigh just above the knee, then pull the casualty towards you and on to his or her side

The Casualty is Breathing:

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The Casualty is NOT Breathing:

6. Go for Help - if someone responds to your shout for help send that person to phone for ambulance - if youre on your own, leave the casualty and make the phone call for yourself * never leave if the patient has collapsed as a result of trauma or drowning or if the casualty is a child 5 rescue breaths - Place mouth over the nose and mouth of the infant - look for chest rising - pinch nose and ventilate via mouth - look for chest rising 2 rescue breaths -seal lips around the mouth and blow steadily for 1.5 2 seconds - look for chest rising

7.

Give Rescue Breaths

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When to Stop AR:

when the patient has spontaneous

breathing

when the first aider is too exhausted to

continue

when another first aider takes over

when EMS arrives and takes over

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Cardiopulmonary Resuscitation (CPR)

Cardiac Arrest
a condition when the persons

breathing and circulation/pulse stop at the same time

Causes: Cardiovascular Disease, Heart Attack, MI

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Management:
External Chest Compression
- consist of rhythmic application of

pressure over the lower portion of the sternum just in between the nipple

Cardiopulmonary Resuscitation = AR + ECC

Goal: Rapid return of pulse, BP and consciousness
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Procedure
1. Assess circulation for 10 seconds

Infant ( 0-1 year)

Check brachial pulse < 60 bpm or below or absent

Child (1-8 yrs)

Adult

Check carotid pulse and if no pulse

Commence chest compression

2. Positioning of compression

Draw imaginary One hand on the sternum two line between fingers up from the xyphoid nipples and process place two fingers on the sternum 1 finger breadth below this line

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3. AR:ECC

1 breath: 5 compression

2 breaths: 30 compression

4. Rate and Depth of compression

Number of Cycle/ minute

100/min 1/3 or 1.5 2 inches

5 cycles per minute

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When to STOP CPR:

S SPONTANEOUS BREATH
RESTORED

T TURNED OVER THE MEDICAL

SERVICES

O OPERATOR IS EXHAUSTED TO
CONTINUE

P PHYSICIAN ASSUMES
RESPONSIBILITY
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COMPLICATIONS OF CPR:
RIB FRACTURE
STERNUM FRACTURE

LACERATION OF THE LIVER OR

SPLEEN

PNEUMOTHORAX, HEMOTHORAX

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CHAIN OF SURVIVAL
EARLY ACCESS early recognition
of cardiac arrest, prompt activation of emergency services

EARLY BLS prevent brain damage,

buy time for the arrival of defibrillator

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EARLY DEFIBRILLATION
- 7-10% decrease per minute without

defibrillation

EARLY ACLS technique that

attempts to stabilize patient

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TRAUMA
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Head trauma

Result of an external force applied to the head and brain causing disruption of physiologic stability locally, at the point of injury, as well as globally with elevations in ICP and potentially dramatic changes in blood flow within the brain. Trauma to the skull resulting in mild to extensive damage to the brain.

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

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Types of Head Injuries

1. Open

Scalp lacerations Fractures in the skull Interruption of the dura mater Concussions a jarring of the brain within the skull with temporary loss of consciousness Contusions a bruising type of injury to the brain; may occur with subdural or extradural collections of blood. Contrecoup decelerative forces throwing the brain back and forth Fractures e.g. linear, depressed, compound comminuted

2. Closed

3. Hemorrhage causes hematoma or clot formation

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Types of Hemorrhage/Hematoma:
the most serious type of hematoma;

1. epidural hematoma

forms rapidly and results from arterial bleeding forms between the dura and the skull from a tear int the meningeal area

2. Subdural hematoma

- forms slowly and results from a venous bleed - a surgical emergency

3. Intracerebral hemorrhage

- bleeding directly into the brain matter

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Clinical manifestations:

Altered level of consciousness Confusion Papillary abnormalities Altered or absent gag reflex or vomiting Absent corneal reflex Sudden onset of neurologic deficits Changes in vital signs Vision and hearing impairment CSF drainage from ears or nose Sensory dysfunction Spasticity Headache and vertigo Movement disorders or reflex activity changes Seizure activity
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Assessment
What time did the injury occur?

What caused the injury? What was the direction and force of the blow?
Was there a loss of consciousness? What was the duration of unconsciousness?

Could the patient be aroused?

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Emergency interventions:
Goal: maintain oxygen and nutrient rich cerebral blood flow Monitor respiratory status and maintain a patent airway monitor neurological status and vital signs (TPR,BP) monitor for increased ICP Head elevation 20 -30 degrees restrict fluids and monitor I & O immobilization of neck initiate normothermia measures assess cranial nerve function, reflexes and motor and sensory function initiate seizure precautions monitor for pain and restlessness avoid administration of morphine sulfate monitor for drainage from the nose or ears if there is CSF leak, monitor for nuchal rigidity do not attempt to clean the nose, suction or allow the client to blow the nose if drainage occurs do not clean te ear of drainage when noted but apply a loose, dry sterile dressing do not allow the client to cough

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Medical intervention:
Osmotic diuretics pulling water out

of the extracellular space of the edematous brain tissue Loop diuretic reduce incidence of rebound from osmotic diuretics Opioids decreased agitation Sedatives reduced anxiety and promote comfort and agitation Antiepileptic drugs to prevent seizures
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Surgical intervention:
Craniotomy
a surgical procedure that involves

an incision through the cranium to remove accumulated blood or tumor

complications include increased

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DENTAL TRAUMA
1.

Tooth Ache

Rinse mouth vigorously with warm water to clear out debris Use dental floss to remove any food that might be wedged in between the teeth Use cold pack on the outside of the cheek to manage swelling Soak cotton with Oil of Cloves and place it on aching tooth

2.

Knocked- out tooth - Place a sterile gauze pad or cotton ball into the tooth socket to prevent further bleeding
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3. Broken tooth
Gently clean dirt and blood from the injured area

with the use of clean cloth and warm water Use cold compress to minimize swelling

4. Bitten Tongue or Lip

Using a clean cloth, apply direct pressure to the

bleeding area If swelling is present, apply cold compress

5. Objects wedged between the teeth

Try to remove object with a dental floss Guide the floss carefully to prevent bleeding Do not remove the object with a sharp or pointed

object

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

of the wire with the use of a cotton ball/ piece of gauze until you can get to a dentist Do not attempt to remove a wire embedded in the gums, cheek or tongue. Instead, go immediately to the dentist

7. Possible fractured jaw

Immobilize the jaw by any means

Apply cold compress to prevent swelling

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CHEST TRAUMA
Approximately a quarter of deaths

due to trauma are attributed to thoracic injury.

Immediate deaths are essentially

due to major disruption of the heart or of great vessels.

Early deaths due to thoracic trauma

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Classification of Chest Trauma:

Blunt Trauma results from sudden compression or positive pressure inflicted to the chest wall.

Penetrating Trauma occurs when foreign object penetrates the chest wall.
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Types of Chest Trauma

A. Blunt Chest Trauma RIB FRACTURES - Fractured ribs may occur at the point of impact and damage to the underlying lung may produce lung bruising or puncture. - Commonly a result of crushing chest injuries Assessment: - Severe Pain - Muscle spasm - Tenderness - Subcutaneous Crepitus - Shallow Respirations - Reluctance to move - Client splints chest

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Management: 1. Rest
2. Ice Compress then Local Heat 3. Analgesia
4. Splint the chest during coughing or deep breathing
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FLAIL CHEST - The unstable segment moves separately and in an opposite direction from the rest of the thoracic cage during the respiration cycle Assessment: - Paradoxical respirations - Severe chest pain - Dyspnea/ Tachypnea - Cyanosis - Tachycardia
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Management:
1. High Fowlers position 2. Humidified O2 3. Analgesia 4. Coughing & deep breathing
5. Prepare for intubation with mechanical ventilation with positive end-expiratory pressure ( PEEP ) for severe respiratory failure
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B. Penetrating Chest Trauma - occurs when a foreign object penetrates the chest wall 1.Pneumothorax
- Accumulation of atmospheric air in the pleural space may lead to lung collapse

Types: 1. Spontaneous Pneumothorax 2. Open Pneumothorax 3. Tension Pneumothorax

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Assessment: Dyspnea Tachycardia Tachypnea Sharp chest pain Absent breathe sounds Sucking sound Cyanosis Tracheal deviation to the unaffected side with tension pneumothorax
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Management: 1. Apply dressing over an open chest wound 2. O2 as Rx 3. High Fowlers 4. Chest tube placement - Monitor for chest tube system - Monitor for subcutaneous emphysema Chest Tube Drainage System - returns (-) pressure to the intra-pleural space - remove abnormal accumulation of air & fluids serves as lungs while healing is going on
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Pulmonary Embolism
- Dislodgement of thrombus to the pulmonary artery

- Caused by thrombus & pulmonary emboli

- Other risk factors: deep vein thrombosis, immobilization, surgery, obesity, pregnancy, CHF, advanced age, prior History of thromboembolism
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Assessment: - Dyspnea - Chest pain - Tachypnea & tachycardia - Hypotension - Shallow respirations - Rales on auscultation - Cough - Blood-tinged sputum - Distended neck veins - Cyanosis
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Management: 1. O2 as Rx 2. High Fowlers 3. Maintain bed rest 4. Incentive spirometry as Rx 5. Pulse oximetry 6. Prepare for intubation & mechanical ventilation 7. IV heparin (bolus) 8. Warfarin (Coumadin) 9. Monitor PT & PTT closely 10. Prepare the client for embolectomy, vein ligation, or insertion of an umbrella filter as Rx
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ABDOMINAL TRAUMA
A. Penetrating Abdominal Trauma Causes: - Gunshot wound - Stab wound - Embedded object from explosion Assessment: - Absence of bowel sound shock - Orthostatic hypotension - Hypovolemic - Pain and tenderness

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

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B. Blunt Abdominal Trauma Assessment: - Left upper quadrant pain (Spleen) - Right upper quadrant pain (liver) - Signs of hypovolemic shock Management: 1. Maintain hemodynamic status 2. Monitor VS and oxygen supplements 3. Assess signs and symptoms of shock
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FOREIGN BODY AND AIRWAY OBSTRUCTION

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CAUSES:
improper chewing of large pieces of food aspiraton of vomitus, or a foreign body

position of head, the tongue

resulting to difficulty of breathing or

respiratory arrest

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Types of obstruction

anatomical

tongue epiglottis

and

mechanical

coins, food, toy etc

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Assessment and clinical manifestations:

Mild airway obstruction
can talk, breath and cough with

high pitch breath sound cough mechanism not effective to dislodge foreign body

Severe airway obstruction

cant talk, breath or cough

Nasal flaring, cyanosis, excessive salivation

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Intervention:
CONCIOUS PATIENT:

ask the victim, are you choking? if the victims airway is obstructed partially, a crowing sound is audible; encourage the victim to cough. relieve the obstruction by heimlick maneuver Heimlich maneuver:

stand behind the victim place arms around the victims waist make a fist place the thumb side of the fist just above the umbilicus and well below the xyphoid process. Perform 5 quick in and up thrusts. Use chest thrusts for the obese or for the advanced pregnancy victims.

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

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UNCONSCIOUS PATIENT:

assess LOC call for help check for ABCs open airway using jaw thrust technique finger sweep to remove object attempt ventilation reposition the head if unsuccessful; reattempt ventilation relieve the obstruction by the Heimlich maneuver with five thrust; then finger sweep the mouth reattempt ventilation repeat the sequence of jaw thrust, finger sweep, breaths and Heimlich maneuver until successful be sure to assess the victims pulse and respirations perform CPR if required

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Choking child or infant: choking is suspected in infants and children experiencing acute respiratory distress associated with coughing, gagging, or stridor. allow the victim to continue to cough if the cough is forceful if cough is ineffective or if increase respiratory difficulty is still noted, perform CPR
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Foreign objects in the ear

Dont probe the ear with a tool
Remove the object if clearly visible Try using gravity and shake the head gently

Try using oil for an insect

Dont use oil to remove any other object than an

insect

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Foreign objects in the eye

Flush eye clear with use of water

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Foreign objects in the nose

Dont probe at the object with cotton ball or other tool Breathe thru your mouth until the object is removed

Blow your nose gently to try to free the object

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POISONING
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Poison

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

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Suspect poisoning if:

1. Someone suddenly becomes ill for no apparent reason and begins to act unusually 2. Is depressed and suddenly becomes ill

3. Is found near a toxic substance and is breathing any unusual fumes, or has stains, liquid or powder in his or her clothing, skin or lips
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Ingestion Poisoning
Botulism Clostridium botulinum. From

canned foods Note: Save the Vomitus Staphylococcus Aureus from unrefrigerated cram filled foods, fish Note: Save the Vomitus Petroleum Poisoning includes poisoning with a substance such as kerosene, fuel, insecticides and cleaning fluids Note: Never induce vomiting! May result in Chemical Pneumonia

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Acetaminophen Poisoning most common drug accidentally ingested by children

Antidote: Acetylcysteine Corrosive Chemical Poisoning strong detergents and dry cleaners
results in drooling of saliva, painful burning

sensation and pain and redness in the mouth

Note: Never induce vomiting, may cause further injury

Activated Charcoal, Milk of Magnesia
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Diagnostics:
Baseline ABG should be obtained periodically
Baseline blood samples (CBC, BUN, electrolytes) ECG (since many toxic agents affect cardiac

rhythm)

Assessment:

Headache Double vision Difficulty in swallowing, talking and breathing Dry sore throat Muscle incoordination Nausea and vomiting

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Management: Check victims ABCs. Begin rescue breathing if necessary If ABCs are present but the victim is unconscious, place him in recovery position If victim starts having seizures, protect him from injury If victim vomits, clear the airway Calm and reassure the victim while calling for medical help
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P Prevention. Child Proofing O Oral fluids in large amount I - Ipecac S Support respiration and circulation O - Oral Activated Charcoal N - Never induce vomiting if substance ingested is corrosive
LAVAGE
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Inhalation Poisoning
Carbon Monoxide Poisoning
Carbon monoxide is a colorless, odorless &

tasteless gas

Assessment: - appears intoxicated - Muscle weakness - Headache & dizziness - Pink or cherry red skin (not a reliable sign) - Confusion which may eventually lead to coma

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Management: 1. Check ABCs

2. Remove victim from exposure

3. Loosen tight clothing

4. Administer O2 (100% delivery) 5. Initiate CPR if required

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SPECIAL WOUNDS
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Human Bites
staphylococcus and streptococcus infection Management: 1. Cleanse and irrigate the wound 2. Assist with wound exploration 3. Culture the wound site 4. Tetanus toxoid and vaccine to stimulate antibody production
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Animal bite
dog and cat bite

Management: 1. Wash wound with soap and water 2. Tetanus toxoid and vaccine to stimulate antibodies 3. Rabies Vaccine and immunoglobulin
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Snake Bite
Infection can be neurotoxic or hemotoxic Assessment: Edema Ecchymosis Petechiae Fever Nausea and Vomiting Possible hypotension Muscle fasciculation Hemorrhage, shock and pulmonary edema

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Management: 1. Establish ABCs 2. Immobilize bitten arm or extremity 3. Remove constricting items 4. Provide warmth 5. Cleanse the wound 6. Cover wound with light sterile dressing 7. Dont attempt to remove the venom 8. Anti venom therapy
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Insect Bites/ Bee stings

Assessment: Itching, dyspnea Chest tightness, dizziness, urticaria Nausea, vomiting,diarrhea Abdominal cramps, flushing Laryngeal edema Respiratory arrest
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Management: 1. Remove stinger by scraping

2. Cleanse the site 3. If anaphylaxis occurs, give oxygen and medications

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TRAUMA RELATED TO ENVIRONMENTAL EXPOSURE

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HEAT EXHAUSTION
Assessment: Nausea and vomiting increased temperature Muscle cramps Tachypnea and Tachycardia Orthostatic hypotension Malaise Irritability and anxiety
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Management: Check ABCs

Move to cool area
Give salted water for vomiting periods

Relieve cramps by firm pressure ECG and ABG monitoring

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FROSTBITE
Assessment:
Hard, cold extremities

White or mottled blue extremity Extremity insensitive to touch

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Management: Remove constrictive clothing and jewelry

Prevent ambulation if lower extremity is

involved

Institute rewarming measures

Once rewarmed, elevate extremity to prevent

swelling

Apply sterile gauze or cotton in between digits

to prevent maceration

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NEAR DROWNING

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Four Methods of Water Rescue:

1. Reaching Assist

2. Throwing Assist

3. Rowing Assist 4. Wading Assist

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Assessment:

Abdominal distention Confusion Irritability Lethargy Shallow gasping respirations Unconsciousness vomiting

Absent breathing
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Management:
Assess ABCs Give CPR and AR as necessary Check patients temperature Administer rewarming measures as

necessary

Monitor lab results(electrolytes) and ECG

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BURN TRAUMA
Is the damage caused to skin and deeper body structures by heat (flames, scald, contact with heat) , electrical, chemical or radiation
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FACTORS DETERMINING SEVERITY OF BURN:

1. age mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of age 2. Patients medical condition debilitating disorders such as cardiac, respiratory, endocrine and renal disorders negatively influence the clients response to injury and treatment. mortality rate is higher when the client has a pre-existing disorder at the time of the burn injury 3. location

burns on the head, neck and chest are associated with pulmonary complications; burns on the face are associated with corneal abrasion; burns on the ear are associated with auricular chondritis; hands and joints require intensive therapy; the perineal area is prone to autocontamination by urine and feces; circumferential burns of the extremities can produce a tourniquetlike effect and lead to vascular compromise (compartment syndrome).

4. Depth

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4. Depth
Classification Affected Part Description of Wound What to Expect

1st degree superficial

Epidermis

Pin, painful sunburn Blisters form after 24 hours

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

2nd degree partial thickness

Pediermis and part of the dermis

Red, wet blisters, bullae very painful

Heals in 2-3 weeks, in no complication

2nd degree deep partial thickness

Only the skin appendages in the hair follicle remain

Waxy white, difficult to distinguish from 3rd degree except hair growth becomes apparent in 7-10 days, little or no pain

Slow to heal 94-8 weeks) surgical incision and grafting unless has complication

3rd degree Full thickness

Epidermis, dermis and subcutaneous tissue . no skin appendages

-Dry, leathery,

may be red or black -May have thrombosed veins -Marked edema -Distal circulation may be decreased -Painless Dry, charred, bone may be visible

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

4th degree deep full thickness

Skin, muscle, tendon, bonde

Requires excision, grafting and sometimes amputation

DaRRaN

133

5. Size: Rule of nine

Child < 3 years old 18% 9% 18% 18% Adult

Assessment
Head and neck 1 arm Posterior trunk Anterior trunk

9% 9% 18% 18%

1 leg Perineum

14% 1%

18% 1%

DaRRaN

134

6. Temperature

determines the extent of injury

7. Exposure to the Source

Thermal Burns caused by exposure to flames,

hot liquids, steam or hot objects Chemical Burns caused by tissue contact with strong acids, alkalis or organic compounds Electrical Burns result in internal tissue damaging, alternating current is more dangerous than direct current for it is associated with cardiopulmonary arrest, ventricular fibrillation, titanic muscle contractions, and long bone and vertebral fractures. Radiation Burns are caused by exposure to ultraviolet light, x-rays or a radioactive source.

DaRRaN

135

Types of Burns and their Treatment:

Scald burn caused by hot liquid immediately flush the burn area with water (under a tap or hose for up to 20 min) if no water is readily available, remove clothing immediately as clothing soaked with hot liquid retains heat Flame Smother the flames with a coat or blanket, get the victim on the floor or ground (stop, drop, and Roll) Prevent victim from running If water is available, immediately cool the burn area with water If water is not available, remove clothing; avoid pulling clothing across the burnt face Cover the burn area with a loose, clean, dry cloth to prevent contamination Do not break blisters or apply lotions, ointments, creams or powder Airway if face or front of the trunk is burnt, there could be burns to the airway there is a risk of swelling or air passage, leading to difficulty in breathing

DaRRaN

136

Smoke inhalation

Urgent treatment is required with care of the airway, breathing and circulation When 02 in the air is used up by fire, or replaced by other gases, the oxygen level in the air will be dangerously low Spasm in the air passages as a result of irritation by smoke or gases Severe burns to the air passages causing swelling and obstruction Victim will show signs and symptoms of lack of O2. He may also be confused or unconscious

Electrical

check for Danger turn of the electricity supply if possible avoid any direct contact with the skin of the victim or any conducting material touching the victim until he is disconnected once the area is safe, check the ABCs if necessary, perform rescue breathing or CPR

DaRRaN

137

 Chemical
Flood affected area with water for 20-30 min
Remove contaminated clothing If possible, identify the chemical for possible

subsequent neutralization Avoid contact with the chemical

Sunburn
Exposure to ultraviolet rays in natural sunlight is

the main cause of sunburn General skin damage and eventually skin cancer develops The signs and symptoms of sunburn are pain, redness and fever
DaRRaN

138