EMERGENCY AND DISASTER NURSING Mass Casualty Incident - situation in which the number of INCIDENT COMMANDER - The head
of INCIDENT COMMANDER - The head of the incident
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.
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.
ACLS ADVANCE CARDIAC LIFE SUPPORT- 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.
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.
EMERGENCY IT IS WHATEVER THE PATIENT OR THE
FAMILY CONSIDERS IT TO BE.
EMERGENCY NURSING - It is the nursing care given to
patients with urgent and critical needs
EMERGENCY NURSE - has a specialized education, training,
and experience to gain expertise in assessing and
identifying patients health care problems in crisis
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 COMMAND SYSTEM - It is a management tool
for organizing personnel, facilities, equipment, and
communication for any emergency situation.
command system
He must be continuously informed of all the
activities and informed about any deviation from
the established plan
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.
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.
 Patients in the ED have a wide variety of actual or Good Samaritan Law Stages of Crisis
potential problems, and their condition may 1. Anxiety and Denial
change constantly. Gives legal protection to the rescuer who encouraged to recognize and talk about their
act in good faith and are not guilty of gross feelings.
Although a patient may have several diagnosis at a negligence or willful misconduct. asking questions is encouraged.
given time, the focus is on the most life- honest answers given
threatening ones Focus of Emergency Care
prolonged denial is not encouraged or supported
Preserve or Prolong Life 2. Remorse and Guilt
ISSUES IN EMERGENCY NURSING CARE
Alleviate Suffering verbalize their feelings
Emergency nursing is demanding because of the Do No Further Harm 3. Anger
diversity of conditions and situations which are Restore to Optimal Function way of handling anxiety and fear
unique in the ER. allow the anger to be ventilated
4. Grief
Issues include legal issues, occupational health and Golden Rules of Emergency Care
help family members work through their grief
safety risks for ED staff, and the challenge of
Dos letting them know that it is normal and acceptable
providing holistic care in the context of a fast-
- Obtain Consent Core Competencies in Emergency Nursing
paced, technology-driven environment in which
- Think of the Worst Assessment
serious illness and death are confronted on a daily
- Respect Victims Modesty & Privacy Priority Setting/Critical Thinking Skills
basis.
Donts Knowledge of Emergency Care
The emergency nurse must expand his or her - let the patient see his own injury Technical Skills
knowledge base to encompass recognizing and - Make any unrealistic promises Communication
treating patients and anticipate nursing care in the
event of a mass casualty incident. Guidelines in Giving Emergency Care Assess and Intervene
A Ask for help Check for ABCs of life
Legal Issues Includes: I Intervene A Airway
D Do no Further Harm B Breathing
Actual Consent
C - Circulation
Implied Consent
Team Members
Parental Consent
Rescuer
Emergency Medical Technician
 Paramedics Estimated Blood Pressure - Re-evaluate clients LOC
Emergency Medicine Physicians - Use AVPU mnemonics
SITE SBP
Incident Commander E Exposure
Support Staff Radial 80 - Remove clothing
Inpatient Unit Staff - Maintain Privacy
- Prevent Hypothermia
Emergency Action Principle
I. Survey the Scene III. Activate Medical Assistance
Is the Scene Safe? Femoral 70 Information to be Relayed:
What Happened? What Happened?
Are there any bystanders who can help? Number of Persons Injured
identify as a trained first aider! Extent of Injury and First Aid given
Telephone number from where youre calling
II. Do a Primary Survey - organization of approach so that
immediate threats to life are rapidly identified and Carotid 60
IV. Do Secondary Survey
effectively manage.
Interview the Patient
Primary Survey S Symptoms
A - Airway/Cervical Spine A Allergies
- Establish Patent Airway Control of Hemorrhage M Medication
- Maintain Alignment P Previous/Present Illness
- GCS 8 = Prepare Intubation L Last Meal Taken
B Breathing E Events Prior to Accident
- Assess Breath Sounds Check Vital Signs
- Observe for Chest Wall Trauma
- Prepare for chest decompression
C Circulation
- Monitor VS V. Triage
- Maintain Vascular Access D Disability
- Direct Pressure - Evaluate LOC
 comes from the French word trier, meaning to Upper extremity fractures, minor burns, sprains, 5. Fast-Track:
sort small lacerations without significant bleeding, Psychological support needed
process of assessing patients to determine behavioral disorders or psychological
management priorities disturbances. FIRST AID
Categories: Role of First Aid
1. Emergent - highest priority, conditions are life TRIAGE PRIORITY COLOR Bridge the Gap Between the Victim and the
CATEGORY
threatening and need immediate attention Physician
IMMEDIATE 1 RED
Immediately start giving interventions in pre-
Airway obstruction, sucking chest wound, shock, DELAYED 2 YELLOW hospital setting
unstable chest and abdominal wounds, open MINIMAL 3 GREEN
Value of First Aid Training
fractures of long bones EXPECTANT 4 BLACK
Self-help
2. Urgent have serious health problems but not Health for Others
immediately life threatening ones. Must be seen Field TRIAGE Preparation for Disaster
within 1 hour 1. Immediate: Safety Awareness
Injuries are life-threatening but survivable with
Maxillofacial wounds without airway compromise, minimal intervention. Individuals in this group can
eye injuries, stable abdominal wounds without progress rapidly to expectant if treatment is BASIC LIFE SUPPORT - an emergency procedure that
evidence of significant hemorrhage, fractures delayed. consists of recognizing respiratory or cardiac arrest or both
2. Delayed: the proper application of CPR to maintain life until a victim
3. Non-urgent patients have episodic illness than recovers or advance life support is available.
Injuries are significant and require medical care,
can be addressed within 24 hours without
but can wait hours without threat to life or limb. Artificial Respiration
increased morbidity
Individuals in this group receive treatment only
Upper extremity fractures, minor burns, sprains, a way of breathing air to persons lungs when
after immediate casualties are treated.
small lacerations without significant bleeding, breathing ceased or stopped function.
3. Minimal:
behavioral disorders or psychological
Injuries are minor and treatment can be delayed
disturbances.
hours to days. Individuals in this group should be
3. Non-urgent patients have episodic illness than
moved away from the main triage area.
can be addressed within 24 hours without
4. Expectant:
increased morbidity
Injuries are extensive and chances of survival are Respiratory Arrest
unlikely even with definitive care.
 a condition when the respiration or breathing Table of Cardiopulmonary Resuscitation for Adult, Child Open the Check for foreign bodies then remove
pattern of an individual stops to function, while & Infant Airway using finger sweep
Head-tilt-chin-lift maneuver
the pulse and circulation may continue.
Adult Child Infant Jaw-thrust Maneuver
Causes: Choking, Electrocution, strangulation, drowning Compression Lower half of the Lower half of Lower half of
Assess for Bring cheek over the mouth and nose
Area sternum but not the sternum the sternum
and suffocation. hitting the xiphoid but not hitting but not hitting
Breathing of the casualty
process: measure the xiphoid the xiphoid Look for chest movement
up to 2 fingers process: process: 1 Listen for breath sounds
from substernal measure up to finger width Feel for breathing on your cheek
WAYS TO VENTILATE THE LUNGS notch. 1 finger from below the The Casualty is NOT Breathing:
substernal imaginary
1. MOUTH-TO-MOUTH = a quick, effective way to notch. nipple line.
Go for Help if someone responds to your shout for
provide O2 and ventilation to the victim. Depth Approximately 1 Approximately Approximately
help send that person to phone for
to 2 inches 1 to 1 inches to 1 inch
2. MOUTH-TO-NOSE = recommended when it is How to Heel of 1 hand, Heel of 1 hand. 2 fingers ambulance
impossible to ventilate through the victims compress other hand on (middle & ring if youre on your own, leave the
mouth. (Trismus, mouth injury) top. fingertips) casualty and make the phone call for
Compression 30:2 (1 or 2 30:2 (1 or 2 30:2 (1 or 2 yourself
3. MOUTH-TO-NOSE and MOUTH = if the pt. is an -ventilation rescuers) rescuers) rescuers) * never leave if the patient has collapsed as a
infant ratio result of trauma or drowning or if the casualty is
Number of 5 cycles in 2 5 cycles in 2 5 cycles in 2 a child
4. MOUTH-TO-STOMA = used if the pt. has a stoma; a
cycles per minutes minutes minutes Give Rescue 5 rescue breaths 2 rescue
permanent opening that connects the trachea minute
Breaths breaths
directly to the front of the neck.
Place mouth pinch nose seal lips around
Procedure Infant(0-1yr) over the nose and the mouth and
For Rescue Breathing Alone: Child(1-8 Adult
and mouth of ventilate via blow steadily
yrs)
Rate is 10-12 breaths in ADULT the infant mouth for 1.5 2
seconds
(1.5 - 2 sec/breath) ( 1 breath every 4 to 5 secs) Safe Approach and assess situation look for chest look for look for chest
Rate is 20 breaths for a CHILD and INFANT Approach rising chest rising rising
(1 1.5 sec/breath) ( 1 breath every 3 secs) Assess for Shout and gently pinch Gently
Response shouting
are you
ok? then
shake the
victim
Positioning Placed Supine on a firm and flat surface
 With your other hand grasp the far thigh just When to STOP CPR:
above the knee, then pull the casualty towards
S SPONTANEOUS BREATH RESTORED
you and on to his or her side
T TURNED OVER THE MEDICAL SERVICES
O OPERATOR IS EXHAUSTED TO CONTINUE
CRITERIA FOR NOT STARTING CPR
P PHYSICIAN ASSUMES RESPONSIBILITY
- All patients in cardiac arrest receive resuscitation
unless:
1. The pt. has a valid DNR order COMPLICATIONS OF CPR:
2. The pt. has signs of irreversible death: rigor mortis,
livor mortis, algor mortis, decapitation RIB FRACTURE
3. No physiological benefit can be expected because STERNUM FRACTURE
the vital functions have deteriorated despite LACERATION OF THE LIVER OR SPLEEN
maximal therapy PNEUMOTHORAX, HEMOTHORAX
4. Witholding attempts to resuscitate in the DR is
appropriate for newly born infants with: CHAIN OF SURVIVAL
EARLY ACCESS early recognition of cardiac
- Confirmed gestation less than 23 weeks or
arrest, prompt activation of emergency services
birthweight less than 400 grams
EARLY BLS prevent brain damage, buy time for
- Anencephaly the arrival of defibrillator
When to Stop EARLY DEFIBRILLATION - 7-10% decrease per
when the patient has spontaneous breathing minute without defibrillation
The Casualty is Breathing: EARLY ACLS technique that attempts to stabilize
when the first aider is too exhausted to continue
Place in recovery position patient
when another first aider takes over
Before moving casualty remove any objects safely
when EMS arrives and takes over
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
AIRWAY OBSTRUCTION
KINDS OF AIRWAY OBSTRUCTION:
1. Anatomic Airway Obstruction
2. Mechanical Airway Obstruction
TYPES OF AIRWAY OBSTRUCTION
1. Partial Airway Obstruction with Good Air Exchange
2. Partial Airway Obstruction with Poor Air Exchange
3. Complete 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.
MANAGEMENT FOR AIRWAY OBSTRUCTION
HEIMLICH MANEUVER
(Subdiaphragmatic Abdominal Thrusts)
For Standing or sitting conscious patient:
Stand behind the patient; wrap your arms around
the patients waist
Make a FIST, placing thumb side of the fist against
the pts abdomen, in the midline SLIGHTLY ABOVE
the UMBILICUS and WELL BELOW the XIPHOID
PROCESS
Make a quick INWARD and UPWARD thrust. Each
thrust is separated.
For patient lying (unconscious):
position patient at the back (supine); kneel astride
the patients thigh
Place HEEL of one HAND against the pts
abdomen, place the second hand directly on the
top of the fist.
Make a quick UPWARD thrust
FINGER SWEEP: used only in unconscious adult client
Make a TONGUE-JAW LIFT. Opening the pts
mouth by grasping both tongue and lower jaw
between the thumb and fingers, and lifting the
mandible.
Insert index finger of other hand to scrape across
the back of the throat
Use a hooking action
CHEST THRUST: used only in patients in advanced stages of
pregnancy or in markedly obese clients
a. Conscious Patient standing or sitting
Stand behind the client with arms under patients
axilla to encircle patients chest
Place thumb side of fist on the MIDDLE of
STERNUM, grasp with the other hand and perform
BACKWARD thrust until foreign body is expelled.
MEASURES TO ESTABLISH AIRWAY
A. HEAD-TILT-CHIN-LIFT MANEUVER
B. JAW-THRUST MANEUVER
C. OROPAHRYNGEAL AIRWAY
D. ENDOTRACHEAL INTUBATION
Indications:
To establish an airway for patients cannot be
adequately ventilated with an oropharyngeal
airway
To bypass upper airway obstruction
To permit connection to ambubag or mechanical
ventilator
To prevent aspiration
To facilitate removal of tracheobronchial
secretions
E. CRICOTHYROIDOTOMY
a puncture or incision of the cricothyroid
membrane to establish an emergency airway in
certain emergency situations where endotracheal
intubation or tracheostomy is not possible.
indicated to pts. with trauma to head and neck,
and in allergic reaction causing laryngeal edema
use of gauge 11 needle or scalpel blade
Nursing Actions:
Extend the neck. Place towel roll beneath the
shoulders
Insert the needle at a 10 to 30 degree caudal
direction in the midline jest above the upper part
of the cricoid cartilage
Listen for air passing back and forth
Direct the needle downward and posteriorly, and
tape it.
 INJURIES TO HEAD, SPINE, AND FACE
A. HEAD INJURIES
1. OPEN HEAD INJURY skull is fractured
2. CLOSED HEAD INJURY skull is intact
3. CONCUSSION temporary loss of consciousness
that results in transient interruption if the brains
normal functioning
4. CONTUSSSION bruising of the brain tissue
5. INTRACRANIAL HEMORRHAGE significant
bleeding into a space or potential space between
the skull and the brain
a. Epidural hematoma
the most serious type of hematoma; forms
rapidly and results from arterial bleeding
forms between the dura and the skull
from a tear int the meningeal area
b. Subdural hematoma
forms slowly and results from a venous
bleed
a surgical emergency
c. Intracerebral hemorrhage
bleeding directly into the brain matter
ALERT: Assume cervical spine fracture for any patient
with a significant head injury, until proven otherwise.
PRIMARY ASSESSMENT: Assess for ABC
SECONDARY ASSESSMENT:
Change in LOC most sensitive indicator in the
pts condition
CUSHINGS TRIAD ( bradypnea, bradycardia,
widened pulse pressure) indicating increased
intracranial pressure
unequal or unresponsive pupils; impaired vision
Battles sign bluish discoloration of the mastoid,
indicating a possible BASAL SKULL FRACTURE
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!
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; dont 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
B. SKULL FRACTURES
SIMPLE closed
COMPOUND open
LINEAR Fx common hairline break, w/o
displacement of structure
COMMINUTED Fx splinters or crushes the bone
in several fragments
DEPRESSED Fx pushes the bone toward the
brain
CRANIAL VAULT Fx top of the head
BASILAR Fx base of the skull and frontal sinuses
ALERT:
Damage to the brain is the first concern, it is
considered a neurosurgical condition
In children, skulls thinness and elasticity allows a
depression w/o a break in the bone
CAUSES: Traumatic blows to the head, VA, severe
beatings
S/Sx: scalp wounds, agitation and irritability, loss
of consciousness, labored breathing, abnormal
deep tendon reflexes, altered pupillary and moor
response
IF CONSCIOUS: complains of persistent localized
headache
IF JAGGED BONE FRAGMENTS: may cause cerebral
bleeding
HALO SIGN blood-tinged spot surrounded by lighter
ring
IF SPHENOIDAL Fx: damages the optic nerve and may
cause BLINDNESS
IF TEMPORAL Fx: may cause unilateral deafness or
facial paralysis
TREATMENT: SUBSEQUENT ASSESSMENT: INJURIES TO SOFT TISSUES, BONES AND JOINTS
For LINEAR FRACTURES: Hypotension, bradycardia, hypothermia - A. SOFT TISSUE INJURIES
supporative (mild analgesics) suggests SPINAL SHOCK 1. CLOSED WOUND
cleaning and debridement of wounds Total sensory loss and motor paralysis below the A. CONTUSION bleeding beneath the skin into the soft
If conscious: observed for 4 hours; if not, admit for level of injury tissue
evaluation MANAGEMENT: B. HEMATOMA well-defined pocket of blood and fluid
if VS stable, may go home with instruction sheet Nasotracheal intubation beneath the skin
For VAULT and BASILAR FRACTURES: initaite IV access, monitor blood gas 2. OPEN WOUND
Craniotomy to remove fragemnts indwelling urinary catheterization A. ABRASION superficial loss of skin from rubbing or
anti-biotics prepare to manage seizures scraping
Dexamethasone Meds: High dose steroids and diazepam B. LACERATION tear in the skin, can be insicional or
Osmotic Diuretics (MANNITOL) if increased ICP is jagged
present D. MAXILLOFACIAL TRAUMA C. PUNCTURE penetration of a pointed object, can be
NURSING CONSIDERATIONS: PRIMARY ASSESSMENT: penetrating or perforating
maintain patent airway; nasal airway Immobilization of spine while performing D. AVULSION tearing off or loss of a flap of skin
contraindicated to basilar fx assessment E. AMPUTATION traumatic cutting or tearing off of a
support with O2 administration ABC (tongue swelling, bleeding, broken or finger, toe, arm or leg
suction pt. through mouth not nose if CSF leak is missed teeth)
present SUBSEQUENT ASSESSMENT: PRIMARY MANAGEMENT
RHINORRHEA wipe it, dont let him blow it! Paralysis if the upward gaze indicative of D- IRECT PRESSURE
OTORRHEA cover it lightly with sterile gauze, INFERIOR ORBIT FX E- LEVATION
dont pack it! Crepitus on nose indicates nasal fracture P- RESSURE POINTS
Position head on side Flattening of the cheek and loss of sensation S- OAK, SOAP, SCRUB, SURGERY
Maintain a supine position with bed elevated to below the orbit indicates ZYGOMA (cheekbone)
A- NTI-TETANUS, ANTIBIOTICS
30 degrees FX
I- RRIGATE
dont give narcotics or sedative Malocclussion of teeth, trismus indicative of
assist in surgery, maintaining sterile technique MAXILLA FX D- RESS
PRIMARY INTERVENTIONS:
C. CERVICAL SPINE INJURIES Insertion of oral airway or intubation B. INJURIES TO BONES AND JOINTS
PRIMARY ASSESSMENT: Nasopharyngeal airway should only be used if no 1. FRACTURE a break in he continuity of the bone;
immediate immobilization of the spine evidence of nasal fracture or rhinorrhea occurs when stress is placed on a bone is greater
A B C ( Intercoastal paralysis w/ diapragmatic Apply bulky, loose dressing; apply ice to areas of than the bone can absorb
breathing) swelling
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
REDUCTION
setting the bone; refers to the restoration of the
fracture fragments into anatomic position and
alignment
IMMOBILIZATION
maintains reduction until bone healing occurs
REHABILITATION
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 Ps
If Compartment syndrome is suspected, do not
elevate limb above the level of the cast
Notify the physician
Bivalve the cast
2. TRAUMATIC JOINT DISLOCATION - occurs when the
surfaces of the bones forming the joint no longer in
anatomic position
ALERT: this is a medical emergency because of associated
disruption of surrounding blood and nerve supplies
* Subluxation partial disruption of the articulating
surfaces
Clinical Manifestations:
Pain and deformity
Loss of normal movement
X-ray confirmation of dislocation w/o assoc.
fracture
Management: Immobilize part, Secure reduction of
dislocations manually (usually preferred under anesthesia)
Nursing Considerations:
Assess neurovascular status before and after
reduction of dislocation
Administer pain medications (NSAIDs)
Ensure proper use of immobilization device
(elastic bandage, splints)
3. 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
4. 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 - Can be classified as:
A. HYPOVOLEMIC - occurs when significant amount
COMPRESSION (Elastic Bandage) of fluid is lost in the intravascular space (Ex.
Hemorrhage, burns, fluid shifts)
REST B. CARDIOGENIC occurs when the heart fails as a
ICE (for the first 24 hrs; 1 hr on, 2 hrs off during waking pump. Primary causes includes MI, dysrhythmias;
hours) Secondary causes includes mechanical restriction
MEDICATIONS ( NSAIDs) of cardiac function or venous obstruction like in
ELEVATION Cardiac Tamponade, tension pneumothrorax, VCO
C. SEPTIC SHOCK from bacteria and their products
SUPPORT (Use of crutches, splints) circulating in the blood
NURSING CONSIDERATIONS: PRIMARY INTERVENTIONS:
Apply ice compress for the first 24 hrs to produce Assess for ABC
vasoconstriction, decrease edema, and reduce Resuscitate as necessary
discomfort Administer O2 to augment O2-carrying capacity of
Apply warm compress after 24 hrs to promote arterial blood
circulation and absorption (20 to 30 minutes at a Start cardiac monitoring
time) Control hemorrhage
Educate to rest injured part for a month to allow
healing SUBSEQUENT ASSESSMENT:
Educate to resume activities gradually and to o Assess LOC, decreasing LOC indicates progression
warm up of shock
o Monitor arterial blood pressure (narrowing pulse
SHOCK AND INTERNAL INJURIES pressure, fall in systolic pressure)
A. SHOCK o Assess pulse quality and rate change (tachycardia,
- Inadequate tissue perfusion, resulting in failure of weak and thready)
one or more of the ff: o Assess urinary output (25ml/hr may indicate
a. pump failure of the heart shock)
b. Blood volume o Assess capillary perfusion
c. arterial resistance levels o Assess for metabolic acidosis due to anaerobic
d. capacity of venous beds metabolism of cells
o Assess for excessive thirst, hyperthermia on septic
shock
MANAGEMENT:
Administer O2 via ET or nonrebreather face mask
(if intubated, may be hyperventilated to control
acidosis)
Fluid resuscitation (2 large-bore IV lines, Ringers
Lactate, BT)
Insertion of an indwelling catheter
Maintain patient in a supine position with legs
elevated
Continue to monitor VS, ECG, CVP, ABG, UO, HCT,
Hgb,and electrolytes; refer changes on the
following
Maintain normothermia (high fever will increase
the cellular metabolism effects of shock
Medications: Inotropics, Vasopressor, and Anti-
biotics
ELECTROCARDIOGRAM
- It is a useful tool in the diagnosis of those
conditions that may cause abberations in the
electrical activity
WAVE INTERPRETATIONS:
P WAVE : Atrial Depolarization; first positive deflection
Q WAVE: first negative deflection
R WAVE: first positive deflection
S WAVE: negative deflection, after R wave
QRS COMPLEX: Ventricular Depolarization
T WAVE: Ventricular Repolarization
Nursing Responsibilities during ECG COMPLICATIONS: Thoracentesis yeilds blood and serosanguinous
Check order for ECG, in cases of arrest, prepare 1. TENSION PNEUMOTHORAX fluid
the machine at the bedside at ER a condition in which air enters the chest but cant ECG
Provide Privacy be ejected during exhalation Retrograde aortography reveals aortic
Instruct patient to lie still and avoid movement There is lung collapse and mediastinal shift laceration
Remove metal objects on the patients (jewelries) S/Sx: tracheal deviation, cyanosis and severe dyspnea, Echocardiography
Place Chest leads as labeled: absent breath sound on the affected side, agitation, Computed Tomography
Lead 1: Red, Right Arm JVD
Lead 2: Yellow, Left Arm 2. HEMOTHORAX TREATMENT:
Lead 3: Green, Left Foot collection of blood in the pleural cavity, usually Simple Rib Fractures
Neutralizer: Black, Right foot results from ribs, lacerating lung tisssue or an mild analgesics, bed rest, apply heat
V1: Red, 4th ICS, Right Sternal Border intercoastal artery incentive spirometry
V2: Yellow, 4th ICS, Left sternal border It is the most common cause of shock following deep breathing, coughing and splinting
V3: Green, midway between V2 and V4 chest trauma Severe Rib Fractures
V4: Brown, 5th ICS, Left MCL 2. LACERATION or RUPTURE of AORTA intercoastal nerve blocks
V5: Black, 5th ICS, LAAL immediately fatal position for semi-fowlers, administer O2
V6: Violet, 5th ICS, LMAL 3. DIAPHRAGMATIC RUPTURE Hemothorax
causes severe respi. Distress; if untreated Chest tube insertion at 5th-6th ICS anterior to MAL
B. BLUNT CHEST INJURIES abdominal viscera may herniate, compromising administer IV fuids, O2, Blood Transfusion
- It is a trauma in the chest without an open wound both circulation and vital capacity of lungs Thoracotomy
- usually cause by VA, blast injuries 4. CARDIAC TAMPONADE Thoracentesis
SIGNS/SYMPTOMS: rapid unchecked rise in intrapericardia pressure
RIB FRACTURES: tenderness, slight edema, pain that that impairs diastolic filling of the heart TREATMENT:
worsens with deep breathing and movement, shallow results from blood or fluid accumulation in the Tension Pneumothorax
and splinted respirations pericardial sac insertion of spinal, 14G or 16G needle into the 2nd
STERNAL FRACTURES: persistent chest pain ICS at MCL to release pressure
MULTIPLE RIB FRACTURES: ASSESSMENT AND DIAGNOSIS: Chest Tubes
- FLAIL CHEST (loss of chest wall integrity) Percussion: Surgical Repair
- decreased lung inflation, paradoxical - Hemothorax: Dullness Aortic Rupture/Laceration
chest movements - Tension Pnuemothorax: tymphany immediate surgery
- extreme pain Auscultation: - synthetic grafts
- rapid and shallow respirations - Tension Pnemothorax: PMI is deviated - aortic anastomosis
- hypotension, cyanosis - Cardiac tamponade: muffled heart tones O2, BT, IV
- respiratory acidosis X-ray
 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
C. ABDOMINAL INJURIES
1. PENETRATING ABDOMINAL INJURY usually the
result of gunshot wound or stab wounds; may
cross the diaphragm and enters the chest
2. BLUNT ABDOMINAL INJURY caused by vehicular
accidents or falls
PRIMARY ASSESSMENT AND INTERVENTIONS:
ASSESS ABC
INITITATE RESUSCITATION AS NEEDED
CONTROL BLEEDING AND PREPARE TO TREAT
SHOCK
IF THERE IS AN IMPALED OBJECT IN THE
ABDOMEN, LEAVE IT THERE AND STABILIZE THE
OBJECT WITH BULKY DRESSINGS
GENERAL INTERVENTIONS:
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 Ringers Lactate
Insert NGT to decompress the abdomen
Cover protruding abdominal viscera w/ sterile
saline dressings; dont 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)
ENVIROMENTAL EMERGENCIES
1. HEAT EXHAUSTION - It is the inadequacy or the collapse
of peripheral circulation due to volume and electrolyte
depletion
ASSESSMENT: temperature may be normal or slightly
elevated, hypotension, tachycardia, tachypnea, pale and
moist skin, fatigue, headache, dizziness, syncope
DIAGNOSTICS: hemoconcentration, hyponatremia or
hypernatremia, ECG may show dysrhythmias
MANAGEMENT:
Move patient to a cool environment, remove all
clothing
Position the patient supine with the feet slightly
elevated
Monitor VS every 15 mins and cardiac rhythm
Educate to avoid immediate reexposure to high
temperatures
2. HEATSTROKE - It is a combination of hyperpyrexia and
neurologic symptoms. It caused 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 patients 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 Ringers Lactate GOAL of MANAGEMENT: Rewarm without 4. NEAR-DROWNING
Anti-pyretics are not useful precipitating cardiac dysrhythmias. - It is a survival for atleast 24 hours after
Indwelling catheterization submersion, with most common consequence of
WOF hypokalemia, metabolic acidosis, seizures MANAGEMENT: hypoxemia.
Passive External Rewarming (temp above 28 - Hypoxia and acidosis are common problems of the
3. HYPOTHERMIA degrees) victim.
- It is a condition where the core temp. is less than - Remove all wet clothing, and replace with warm - Resultant pathophysiologic changes and
35 degrees Celcius as a result in the exposure to clothing pulmonary injury depend on type of fluid and the
cold. - Provide insulation by wrapping the patient in volume aspirated.
- 3 compensatory mechanisms: several blankets a. Fresh water aspiration- results in loss of surfactant,
a. shivering produces heat thru muscular activity - Provide warm fluids hence an inability to expand lungs
b. peripheral vasoconstriction to decrease heat Disadvantage: slow process b. Saltwater aspiration- leads to pulmonary edema from
loss Active External Rewarming (temp above 28 the osmotic effect of salt within the lungs.
c. raising basal metabolic rate degrees)
- Provide external heat for patient- warm hot water Clinical Manifestations:
NURSING ALERT: bottles to the armpits, neck, or groin -difficulty of breathing
Elderly are greater risk for hypothermia due to - Warm water immersion -hypothermia
altered compensatory mechanisms - Disadvantages: -cyanosis
Extreme caution should be used in moving or 1. causes peripheral vasodilation, returning cool blood to -chills
transporting hypothermic pts., because the heart the core, causing an initial lowering of the core temp.
is near fibrillation threshold 2. Acidosis due to washing out of lactic acid from the MANAGEMENT:
peripheral tissue Immediate CPR
CLINICAL MANIFESTIONS: 3. An increased in metabolic demands before the heart is Endotracheal intubation with PEEP
slow, spontaneous respirations warmed to meet these needs. VS, check degree of hypothermia
heart sounds may not be audible even if its Active Core Rewarming (temp below 28 degrees) Rewarming procedures
beating - Inhalation of warm, humidified O2 by mask or Intravascular volume expansion and inotropic
BP is extremely difficult to hear ventilator agents
fixed dilated pupils, no pulse, no BP; initiate CPR - warmed IV fluids ECG
drowsiness progressing to coma - Warm gastric lavage Indwelling catheterization
shivering is suppressed on temp. below 32.3 - Peritoneal dialysis with warmed standard dialysis NGT insertion
degrees solution
ataxia - Cardiopulmonary bypass
cold diuresis Disadvantage: invasiveness of the procedure
fruity or acetone odor of breath
TOXICOLOGIC EMERGENCIES
ASSESSMENT:
ABC
Identify the poison
Obtain blood and urine tests; gastric contents may
be sent to laboratory
Monitor neurologic status
Monitor fluid and electrolytes
GENERAL INTERVENTIONS:
Initiate large-bore IV access, monitor shock
Prevent aspiration of gastric contents by
positioning head on side
Maintain 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.
GASTRIC LAVAGE
PURPOSES:
1. To remove unabsorbed poison after ingestion.
2. To diagnose and treat gastric hemorrhage and for
the arrest of hemorrhage.
3. To cleanse stomach before endoscopic
procedures.
4. To remove liquid or small particles of material
from the stomach.
NURSING CONSIDERATIONS
Insertion of NGT or OGT.
Place patient on left lateral position with head
lower 15 degrees downward.
Elevate funnel and pour approx. 150 200 ml.
Lavage fluid is left in place for about one minute
before allowed to drain
Save samples of first two washings.
Repeat lavage procedure until the returns are
relatively clear and no particular matter is seen.
At the completion of the lavage:
1. Stomach may be left empty.
2. An Adsorbent may be instilled in the tube and
allowed to remain in the stomach.
3. A saline cathartic may be instilled in the tube.
Pinch off the tube during removal or maintain
suction while tubing is being withdrawn.
Give the patient a cathartic if prescribed.
Warn patient that stool will turn black from the
charcoal.
2. CARBON MONOXIDE POISONING
- It is an example of inhaled poison and results in
the incomplete hydrocarbon combustion
- Carbon monoxide exerts its toxic effects by
binding to circulating hemoglobin to reduce the
oxygen carrying capacity of the blood.
- Carbon monoxide and hemoglobin is 200 300
times affinity compared to oxygen and
hemoglobin.
- Creation of carboxyhemoglobin resulting to tissue
anoxia.
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.
MANAGEMENT:
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
halflife 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.
3. INSECT STINGS
- These are injected poisons that can produce either
local or systemic reactions.
- Local reactions are characterized by pain,
erythema and edema at the site of injury.
- Systemic reactions usually begin within minutes.
(Unconsciousness, laryngeal edema,
bronchospasm, and cardiovascular collapse.
MANAGEMENT:
ABC
Epinephrine is the drug of choice give SQ.
Administer bronchodilator.
Initiate IV with Ringers Lactate.
Prepare for CPR.
NURSING CONSIDERATIONS:
Apply ice packs to site to relieve pain.
Elevate extremities with large edematous local
reaction.
Administer anti histamine for local reaction.
Clean wounds thoroughly with soap and water or
antiseptic solution.
Educate patient.
- Have epinephrine on hand
- Wear emergency medical bracelet indicating
hypersensitivity.
- If sting occurs, remove stinger with one quick
scrape of fingernail.
- Do not squeeze venom sack, because this may
cause additional venom to be injected.
- Avoid insect feeding areas.
4. SNAKE BITES
CLINICAL MANIFESTATIONS:
- Burning pain, swelling, and numbness of the site.
- Hemorrhagic blisters may occur after few hours of
bite and entire extremity may become edematous.
- WOF signs of systemic reactions (nausea,
sweating, weakness, lightheadedness, initial
euphoria followed by drowsiness, dysphagia,
paralysis of various muscle groups, shock, seizures,
and coma).
MANAGEMENT:
Wash the site of bite, keep the patient calm and
immobilize extremity.
Administer O2 and start IV line.
Administer anti-venin and be alert to allergic
reaction.
Administer vasopressors in the treatment of
shock.
5. ALCOHOL WITHDRAWAL DELIRIUM
a.k.a Delirium Tremens or Alcoholic Hallucinosis
An acute toxic state that follows a prolonged bout
of steady drinking or sudden withdrawal from
prolonged intake of alcohol.
Symptoms begins as early as 4 hours after
reduction of alcohol intake and peaks at 24 - 48
hours but may last up to 2 weeks.
ALCOHOLISM a chronic disease or disorder
characterized by excessive alcohol intake and
interference in the individuals health, interpersonal
realtionship and economic functioning
- Considered to be present when there is .1% or 10
ml for every 1000 ml of blood
- At .1 - .2%, there is low coordination
- At .2 - .3%, there is ataxia, tremors, irritability,
and stupor
At .3 and above, there is unconsciousness
COMMON BEHAVIORAL PROBLEMS: 5 Ds
D-enial
D-ependency
D-emanding
D-estructive
D-omineering
COMMON WITHDRAWAL SIGNS AND SYMPTOMS:
HALLUCINATIONS (VISUAL AND TACTILE)
INCREASED VITAL SiGNS
TREMORS
SWEATING AND SIEZURE
COMMON DEFENSE MECHANISMS:
DENIAL
RATIONALIZATION
ISOLATION
PROJECTION
PRIORITY NURSING DIAGNOSIS:
- INEFFECTIVE INDIVIDUAL COPING
DRUG OF CHOICE for aversion therapy of an alcoholic:
- DISULFIRAM (antabuse)
Instruct patient to avoid, when taking Disulfiram:
MOUTH WASH
OVER THE COUNTER COLD REMIDIES
FOOD SAUCES MADE UP OF WINE
FRUIT FLAVORED EXTRACTS
AFTERSHAVE LOTIONS
VINEGAR
SKIN PRODUCTS
MANAGEMENT:
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.
BEHAVIORAL EMERGENCIES - It is an urgent, serious
disturbances of behavior, affect, or thought that makes
the patient unable to cope with his life situation and
interpersonal relationship
1. VIOLENT PATIENTS
- Is usually episodic and is a means of expressing
feelings of anger, fear and hopelessness about a
situation.
Manage through:
a. Establish control, keeping the door open, and be in
clear veiw of staff
b. Ask if he has a weapon, avoid touching an agitated pt.
c. Adopt a calm, nonconfrontational approach
d. Provide emotional support; CRISIS INTERVENTION
2. SUICIDE
- Ultimate form of self-destruction; cry for help
- Major Interventions: PREVENTION and LISTEN
RISK FACTORS
SEX (female attempts, male commits suicide)
UNSUCCESSFUL PREVIOUS ATTEMPT
IDENTIFICATION with family member committed suicide
CHRONIC
ILLNESS
DEPRESSION/DEPENDENT PRERSONALITY
AGE (18-25 AND ABOVE 40)/ALCOHOLISM
LETHALITY OF PREVIOUS ATTEMPTS
PRIORITY NURSING DIAGNOSIS:
Risk for Injury, Self-directed
NURSING INTERVENTIONS:
Provide one-on-one monitoring
Have frequent unscheduled rounds
Avoid use of metals and glass utensils
Remove shampoos, perfumes, medicines at the
bedside
Monitor for signs of impending suicide (giving
away of valued possession)
3. RAPE TRAUMA SYNDROME
According to RA 8353, RAPE refers to the insertion
of penis into the mouth, vagina, anus of a victim
Insertion of any object into the mouth or anus
It is generally considered as an act of hostility,
anger, or violence
ELEMENTS OF RAPE:
Use of threat/force
lack of consent of the victim
Actual penetration of the penis into the vagina
Different Kinds of Rape:
POWER done to prove ones masculinity
ANGER done as a means of retaliation
SADISTIC done to express erotic feelings
RAPE TRAUMA SYNDROME
- It refers to a group of signs and symptoms
experienced by a victim in reaction to rape
4 Phases the perineal area is prone to
1. ACUTE PHASE characterized by shock, numbness autocontamination by urine and feces;
and disbelief circumferential burns of the extremities
2. DENIAL characterized by victims refusal to talk can produce a tourniquet-like effect and
about the event lead to vascular compromise
3. HEIGHTENED ANXIETY characterized by fear, (compartment syndrome).
tension, and nightmares 4. Depth
4. REORGANIZATION victims life normalizes
PRIORITY NURSING CARE: Preservation of evidences Classification Affected Part Description of Wound What to Expect
TREATMENT: Crisis Intervention
1st degree Epidermis Pin, painful sunburn Discomfort last after 48 hrs; heals
BURN TRAUMA - Is the damage caused to skin and deeper superficial Blisters form after 24 hours in 3-7 days
body structures by heat (flames, scald, contact with heat) ,
electrical, chemical or radiation
2nd degree Pediermis and part Red, wet blisters, bullae very Heals in 2-3 weeks, in no
FACTORS DETERMINING SEVERITY OF BURN: partial thickness of the dermis painful complication
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 2nd degree Only the skin Waxy white, difficult to Slow to heal 94-8 weeks) surgical
as cardiac, respiratory, endocrine and renal disorders deep partial appendages in the distinguish from 3rd degree incision and grafting unless has
negatively influence the clients response to injury and thickness hair follicle remain except hair growth becomes complication
treatment. apparent in 7-10 days, little or
mortality rate is higher when the client no pain
has a pre-existing disorder at the time of the burn
injury 3rd degree Epidermis, dermis Dry, leathery, may be Requires excision and grafting.
3. location Full thickness and subcutaneous red or black 10- 14 days for graft to
burns on the head, neck and chest are tissue . no skin May have thrombosed revascularize
associated with pulmonary complications; appendages veins
burns on the face are associated with Marked edema
corneal abrasion; Distal circulation may
burns on the ear are associated with be decreased
auricular chondritis; Painless
hands and joints require intensive
therapy; 4th degree Skin, muscle, Dry, charred, bone may be Requires excision, grafting and
deep full thickness tendon, bonde visible sometimes amputation
5. Size: Rule of nine Types of Burns and their Treatment: Spasm in the air passages as a result of
Assessment Child < 3 Adult Scald irritation by smoke or gases
years burn caused by hot liquid Severe burns to the air passages causing
old immediately flush the burn area with swelling and obstruction
water (under a tap or hose for up to 20 Victim will show signs and symptoms of
Head and neck 18% 9% min) lack of O2. He may also be confused or
if no water is readily available, remove unconscious
1 arm 9% 9% clothing immediately as clothing soaked Electrical
Posterior trunk 18% 18% with hot liquid retains heat check for Danger
Flame turn of the electricity supply if possible
Anterior trunk 18% 18% Smother the flames with a coat or blanket, avoid any direct contact with the skin of
get the victim on the floor or ground (stop, the victim or any conducting material
1 leg 14% 18% drop, and Roll) touching the victim until he is
Perineum 1% 1% Prevent victim from running disconnected
If water is available, immediately cool the once the area is safe, check the ABCs
burn area with water if necessary, perform rescue breathing or
6. Temperature If water is not available, remove clothing; CPR
determines the extent of injury avoid pulling clothing across the burnt face Chemical
7. Exposure to the Source Cover the burn area with a loose, clean, Flood affected area with water for 20-30
Thermal Burns caused by exposure to dry cloth to prevent contamination min
flames, hot liquids, steam or hot objects Do not break blisters or apply lotions, Remove contaminated clothing
Chemical Burns caused by tissue contact ointments, creams or powder If possible, identify the chemical for
with strong acids, alkalis or organic Airway possible subsequent neutralization
compounds if face or front of the trunk is burnt, there Avoid contact with the chemical
Electrical Burns result in internal tissue could be burns to the airway Sunburn
damaging, alternating current is more there is a risk of swelling or air passage, Exposure to ultraviolet rays in natural
dangerous than direct current for it is leading to difficulty in breathing sunlight is the main cause of sunburn
associated with cardiopulmonary arrest, Smoke inhalation General skin damage and eventually skin
ventricular fibrillation, titanic muscle Urgent treatment is required with care of cancer develops
contractions, and long bone and vertebral the airway, breathing and circulation The signs and symptoms of sunburn are
fractures. When 02 in the air is used up by fire, or pain, redness and fever
Radiation Burns are caused by exposure replaced by other gases, the oxygen level
to ultraviolet light, x-rays or a radioactive in the air will be dangerously low
source.