Acids and Alkalis

Acids: toilet bowel cleaners, antirust compounds Alkalis: Drain cleaners, dishwashing detergents, ammonia Manifestations: Excess salivation, dysphagia. Epigastric pain, pneumonitis, burns of mouth, esophagus, & stomach. Treatment: Immediate dilution ( water, milk), corticosteroids (for alkali). Induced vomiting is contraindicated.

Aspirin & aspirin containing medications

Manifestation: Restlessness, tinnitus, deafness, Burring of vision Tachypnea, tachycardia, hyperthermia. Epigastric pain, disorientation, coma. Treatment: treat respiratory depression gastric lavage Activated charcoal, urine alkalinizaton. hemodialysis for severe acute ingestion.

Bleaches
Manifestation Irritation of lips, mouth, & eyes, superficial injury to esophagus; chemical pneumonia. Treatment: Washing of exposed skin & eyes dilution with water & milk Gastric Lavage prevention of vomiting and aspiration

Carbon Monoxide Poisoning

Exerts its toxic effect by binding to circulating hemoglobin & thereby reducing the oxygencarrying capacity of the blood. Hemoglobin absorbs carbon monoxide 200 times more readily than it absorbs oxygen. Clinical Manifestation Dyspnea, headache, tachypnea, confusion, impaired judgement, cyanosis, respiratory depression.

Carbon Monoxide Poisoning

Management Hyperbaric Oxygen Therapy Carry the patient to fresh air immediately. Loosen all tight clothing. Initiate CPR if required; administer 100% oxygen. Hyperbaric oxygen therpay. Prevent chilling

Cocaine
Intranasally ( snorting). Smoking (freebasing). Crack Clinical Manifestation Is a CNS stimulant that can HR & BP & cause hyperpyrexia, seizures & ventricular dysrhythmias. It produces intense euphoria, then anxiety, sadness & insomnia. Cocaine hallucination with delusions; psychosis with extreme paranoia.

Cocaine
Therapeutic Management Ensure airway & ventilation. Control seizures. Monitor Cardiovascular effects. Treat for hyperthermia. Evacuate stomach contents & Activated charcoal. Refer for Psychiatric evaluation & treatment.

Opiods
Heroin, Opium, Morphine, Codeine, Fentanyl. Clinical Manifestation: Pinpoint pupils, BP & marked respiratory depression. Management Support respiratory & cardiovascular functions Establish an IV line. Narcotic antagonist (naloxone[narcan]). Send urine for urinalysis

Drugs producing sedation ( Nonbarbiturates sedative) Diazepam, lorazepam, Midazolam Flunitrazepam (roofies, date rape drug) Manifestation Seizures, coma, circulatory collapse, death. Acute intoxication: Respiratory depression Decreasing mental alertness, confusion Slurred speech, BP, Ataxia, coma, death Flunitrazepam Disinhibition with antegrade amnesia Weakness & unsteadiness, powerlessness.

Drugs producing sedation ( Nonbarbiturates sedative) Endotracheal Intubation Assess for hypotension Evacuate stomach contents; emesis, lavage, activated charcoal, cathartic. Administer Flumazenil Refer for Psychiatric evaluation & treatment.

Adult Basic Life Support for the Health Care Worker

Based on the New 2010 CPR Guidelines of the AHA and ILCOR

Philippine Heart Association, Inc. Council on Cardio Pulmonary Resuscitation

A Full Member of the

The Asian Representative of

Sudden Cardiac Arrest A Health Burden

Approximately 50% of deaths from cardiovascular disease occur as SUDDEN CARDIAC ARREST.
Sudden Cardiac Arrest is the most common mode of death in patients with coronary artery disease.

Health Burden of Sudden Cardiac Arrest

Almost 80 percent of out-of-hospital cardiac arrests occur at home and are witnessed by a family member.

Only 4-6 % of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR .

Sudden Cardiac Arrest

Unpredictable and can happen to anyone, anywhere, at anytime Risk increases with age Pre-existing heart disease is a common cause May strike people with no history of cardiac disease or cardiac symptoms

What is C P R ?

CPR = CardioPulmonary Resuscitation

The NEW Chain of Survival

Early access: immediate recognition and activation

Early CPR
Early defibrillation Early advanced care Integrated postcardiac arrest care

The First Link- Early Access

A well-informed lay person - key in the early access link. Recognition of signs of heart attack and respiratory failure Call for help immediately if needed Activate the Emergency Medical System

EARLY WARNING SIGNS OF HEART ATTACK

prolonged compressing pain or unusual discomfort in the center of the chest may radiate to shoulder, arm, neck or jaw, usually on the left side may be accompanied by sweating, nausea, vomiting and shortness of breath

EARLY WARNING SIGNS OF RESPIRATORY FAILURE unable to speak, breath or cough clutches neck (universal distress signal) bluish color of skin and lips

Second Link - Early CPR

Life saving technique

for cardiac & respiratory arrest Chest compressions +/Rescue breathing Lay persons and medical personnel

How does CPR work?

Brain (Cerebral)
All the living cells of our body need a steady supply of oxygen to keep us alive.
During CPR, you can breathe air into the victims lungs to provide oxygen into the blood. When you press on the chest, you move oxygen - carrying blood through the body.

Lungs (Pulmonary)

Heart (Cardiac)

When will you do CPR?

AS SOON AS POSSIBLE! Brain cells begin to die after 4-6 minutes without oxygen.

Who may learn about CPR?

CPR is an easy and life saving procedure and can be learned by anyone. One does not need to be a doctor to learn how to do CPR.

THE TECHNIQUE AND STEPS IN CPR

IF YOU WITNESS A CARDIAC ARREST

CHECK AREA SAFETY.

Survey the scene.

See if the scene is safe to do CPR. Get an idea of what happened.

CHECK UNRESPONSIVENESS.
Tap or gently shake the victim Rescuer shouts Are you OK? Quick check for normal breathing If the victim is unconscious, rescuer calls for help.

CALL FOR HELP:

Ambulance, Emergency Services, Doctor

Rescuer ACTIVATES the EMERGENCY MEDICAL SERVICES.

Get AED/Defibrillator!

NON-RESPONSIVE, NO NORMAL BREATHING

PULSE CHECK
Palpate for Carotid Pulse within 10 seconds (at the same time CHECK FOR BREATHING) For trained healthcare providers only

If with definite pulse but no breathing

Do Mouth to Mouth Breathing

Give one breath every 5-6 secs (about 12 breaths/min) Recheck pulse every 2 minutes

MOUTH TO MOUTH BREATHING and PULSE CHECK

Deemphasized in the new guidelines For trained healthcare providers only As short and quick as possible Pulse check not more than 10 seconds If unsure, proceed directly to CHEST COMPRESSIONS!

After determining unconsciousness,

CAB
C. COMPRESSION Do chest compressions first A. AIRWAY Does the victim have an open airway (air passage that allows the victim to breathe)? B. BREATHING Is the victim breathing?

(to assist CIRCULATION)

After determining unconsciousness and calling for help,

COMPRESSION

proceed immediately to do

COMPRESSIONS!

CHEST

Chest Compressions

Kneel facing

victims chest
Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.

Chest Compressions

Place the heel of one hand on the sternum in the center of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.

Compress breastbone at least 2 inches deep Compress at a rate of 100 per minute or more Compress 30 times initially Allow the chest to return to its normal position

Give 30 Compressions
Compress breastbone at least 2 inches

(30 compressions should take 15-18 sec)

Count aloud 1, 2, 3, 4, 5,6,7,8,9,10,11,12,13,14,15,16,17,1 8,19,20,21,22,23,24,25,26,27,28,29, and ONE! Minimize interruptions Allow recoil after each compression

A - AIRWAY

Open the Airway: Use the head tilt/chin lift method

Place one hand on the victims forehead
Place fingers of other hand under the bony part of lower jaw near chin

Tilt head and lift jaw-avoid closing victims mouth

Head Tilt Chin Lift Maneuver

This maneuver prevents airway obstruction by the epiglottis.

B - BREATHING Give 2 one-second

breaths
Maintain airway Pinch nose shut Open your mouth wide, take a normal breath, and make a tight seal around outside of victims mouth Give 2 full breaths (1 sec/ breath) Observe chest rise & fall; listen & feel for escaping air

PULSE CHECK
RECHECK PULSE EVERY 2 MINUTES (equivalent to 5 cycles CPR) Very brief pulse check should take less than 10 seconds (at the same time check for normal breathing) In case there is any doubt about the presence or absence of pulse, CONTINUE CHEST COMPRESSIONS For trained healthcare providers only

UNTIL

HELP ARRIVES.
(Emergency Services, Ambulance, Doctor, AED)

PERSON IS REVIVED.

If the victim is breathing

THE RECOVERY POSITION Maintain open airway & position the victim
The unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Placement in this position consists of rolling the victim onto his or her side to help protect the airway.

Summary of Key BLS Components for Adults and Children

Maneuvers
RECOGNITION

Adults
UNRESPONSIVE No breathing, not breathing normally (eg. only gasping)

Children
No breathing or only gasping

CPR Sequence Compression Rate Compression Depth Chest wall Recoil Compression interruptions Airway Compression-Ventilation ratio Ventilations: when rescuer untrained or trained and not proficient Ventilations with advanced airway (HCP)

CAB At least 100/min At least 2 inches (5 cm)

CAB

At least 1/3 AP depth; About 2 inches

Allow complete recoil between compressions HCPs rotate compressors every 2 minutes

Minimize interruptions in chest compressions Attempt to limit interruptions to less than 10 seconds Head tilt chin lift (HCP suspected trauma: jaw thrust) 30 : 2 (one or 2 rescuers) Compressions only 30:2(single rescuer); 15:2(2 rescuer) Compressions only

1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume CPR beginning with compressions immediately after each shock

DEFIBRILLATION ( AED )

MEMORIZE THE STEPS!

Survey the scene. Check responsiveness hey hey are you ok? Call for help! Activate EMS
[Quick check pulse within 10 secs]

C Chest Compressions: 30 x; 100/min; 2 inches deep; push hard and fast A - Airway: head tilt chin lift B Breathing: 2 breaths (1 second/breath) Chest compressions 30 x Continue cycles 30:2 compression-ventilation [Quick check pulse every 2 mins] Until:
EMS arrives (AED, doctor, ambulance) Patient has signs of life

 Hands Only CPR

Compression-only bystander CPR

Hands Only CPR should only be used for adult victims who have suddenly collapsed or become unresponsive.

Hands Only CPR

Recommendations: All victims of cardiac arrest should receive high-quality chest compressions

When an adult suddenly collapses, all bystanders should activate their community EMS and provide high-quality chest compressions, minimizing interruptions (Class I).

Hands Only CPR

Recommendations: If not trained in CPR, provide hands-only CPR (Class IIa) until
AED arrives EMS providers take over care of the victim

If trained in CPR, provide either conventional CPR using a 30:2 compression-to-ventilation ratio (Class IIa) or handsonly CPR (Class IIa)

Key Changes in the New Guidelines

CAB instead of ABC Compress first No more Look Listen and Feel Harder! At least 2 inches compression (old: 1 to 2
inches)

Faster! At least 100/min compression (old: up to

100/min)

Deemphasize pulse checks

For trained healthcare providers not more than 10 secs

Check for normal breathing together with check for unresponsiveness Hands only CPR for the untrained lay rescuer

Important Points
There are no mistakes when you perform CPR. The only harm is to delay responding. Start chest compressions now viewed as the most effective procedure All victims in cardiac arrest need chest compressions. Don't stop pushing. Keep pushing as long as you can. Push until the AED is in place and ready to analyze the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.

80-90% of cardiac emergencies occur at home.

Training is now simpler and more accessible Reduced number of steps and simplified process

 Being trained to do CPR can save a loved one. Effective CPR done immediately after cardiac arrest can double a victims chance of survival.

DISASTER NURSING

Disaster Nursing
Adaptation of professional nursing skills in recognizing and meeting the nursing physical and emotional needs resulting from a disaster. The overall goal of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster.

1.Natural 2. HumanCaused 3. Technological

Disaster Agents / Epidemiology of Disaster

1. Environment 2. Host

Agent

Primary Agents: It includes falling of buildings, heat wind rising waters and smoke. Secondary Agents: It includes bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction.

 Primary or secondary agent will vary according to the type of disaster.

For example: - A hurricane with rising water can cause flooding and high winds, these are primary agents. The secondary agents would include damaged buildings and bacteria or viruses that thrive as a result of the disaster. In an epidemic the bacteria or virus causing a disease is the primary agent rather than the secondary agent.

Factors affecting disaster

Host factors In the epidemiological frame work as applied to disaster the host is human-kind. Host factors are those characteristics of humans that influence the severity of the disaster effect. Host factors include: Age Immunization status Degree of mobility Emotional stability

Environmental factors
1. Physical Factors - Weather conditions, the availability of food, time when the disaster occurs, the availability of water and the functioning of utilities such as electricity and telephone service. 2. Chemical Factors - Influencing disaster outcome include leakage of stored chemicals into the air, soil, ground water or food supplies. Eg: - Bhopal Gas Tragedy.

Environmental factors
3. Biological Factors - Are those that occur or increase as result of contaminated water, improper waste disposal, insect or rodent proliferations improper food storage or lack of refrigeration due to interrupted electrical services. Bioterrorism: Release of viruses, bacteria or other agents caused illness or death.

Environmental factors
4. Social Factors: - Are those that contribute to the individual social support systems. Loss of family members, changes in roles and the questioning of religious beliefs are social factors to be examined after a disaster. 5. Psychological Factors: - Psychological factors are closely related to agents, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by the victims.

Environmental factors
4. Social Factors: - Are those that contribute to the individual social support systems. Loss of family members, changes in roles and the questioning of religious beliefs are social factors to be examined after a disaster. 5. Psychological Factors: - Psychological factors are closely related to agents, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by the victims.

PHASES OF DISASTER & EMERGENCY

 Mitigation:
Lessen the impact of a disaster before it strikes

Preparedness:
Activities undertaken to handle a disaster when it strikes

Response:
Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary).

Recovery:
Getting a community back to its pre-disaster status

Mitigation
Activities that reduce or eliminate a hazard
Prevention Risk reduction

Examples
Immunization programs Public education

Preparedness
Activities that are taken to build capacity and identify resources that may be used
Know evacuation shelters Emergency communication plan Preventive measures to prevent spread of disease Public Education

Response
Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs

Recovery
Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration.
Debris Removal Care and Shelter Damage Assessments Funding Assistance

What is Triage?
French verb trier means to sort Assigns priorities when resources limited Do the best for the greatest number of patients

Why is Disaster Triage needed

Inadequate resource to meet immediate needs Infrastructure limitations Inadequate hazard preparation Limited transport capabilities Multiple agencies responding Hospital Resources Overwhelmed

Advantages of Triage
Helps to bring order and organization to a chaotic scene. It identifies and provides care to those who are in greatest need Helps make the difficult decisions easier Assure that resources are used in the most effective manner May take some of the emotional burden away from those doing triage

Who Decides in triage

Nurses dont act for legal fears of being blamed for deaths, and lack of clarity on where they fit in the command structure Nurses function to the level of their training and experience. If nurses they are the most trained personnel the site, they are in charge.

oTriage Categories during a Mass Casualty Incident (MCI)

Triage category Priority 1 Color: Red Immediate: - Injuries are life-threatening but survival with minimal interventions. - Individuals in this group can progress rapidly to expectant if treatment is delayed. e.g. Sucking chest wound, airway obstruction, shock, hemothorax, tension pneumothorax, unstable chest and abdominal wounds, open fractures of long bones.

oTriage Categories during a Mass Casualty Incident (MCI)

Delayed: Priority 2 Color: Yellow - Injuries are significant & require medical care, but can wait hours without threat to life or limb. - Individuals in this group receive treatment only after immediate casualties are treated. e.g. Stable abdominal wounds without evidence of significant hemorrhage, soft tissue injuries, fracture requiring open reduction.

oTriage Categories during a Mass Casualty Incident (MCI)

Minimal: Priority 3 Color: Green - Injuries are minor and treatment can be delayed hours to days. Individuals in this group should be moved away from the main triage area. e.g. Upper extremity fractures, minor burns, sprains, small laceration without significant bleeding.

oTriage Categories during a Mass Casualty Incident (MCI)

Expectant: Priority 4 Color: Black - Injuries are extensive and chances of survival are unlikely even with definitive care. - Persons in this group should be separated from other casualties, but not abandoned. e.g. Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple body surface area, no pulse, no BP, pupils fixed and dilated.