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1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 16 First Aid, Emergency Care, and Disaster Management.

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Presentation on theme: "1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 16 First Aid, Emergency Care, and Disaster Management."— Presentation transcript:

1 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 16 First Aid, Emergency Care, and Disaster Management

2 2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Learning Objectives List the principles of emergency and first aid care. List the steps of the initial assessment and interventions for the person requiring emergency care. Describe the components of the nursing assessment of the person requiring emergency care. Outline the steps of the nursing process for emergency or first aid treatment of victims of cardiopulmonary arrest, choking, shock, hemorrhage, traumatic injury, burns, heat or cold exposure, poisoning, bites, and stings. Discuss the roles of nurses and nursing students in relation to bioterrorism and natural disasters. Explain the legal implications of administering first aid in emergency situations.

3 3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. General Principles of Emergency Care Cardinal rule: Remain Calm! Priority is to preserve life and minimize effects of injuries; manner in which you conduct yourself also can soothe and reassure the victim Assessment and intervention must be done quickly and efficiently to identify and treat priority needs immediately

4 4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. General Principles of Emergency Care The primary survey looks for life-threatening injuries and intervenes immediately in the following sequence Assess ABCs: airway, breathing, circulation Initiate CPR or rescue breathing as needed Look for uncontrolled bleeding, identify the source, and apply pressure Assess for injuries from head to foot, and immobilize spine, limbs, or both as indicated Look for a medical alert necklace or bracelet

5 5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. General Principles of Emergency Care Splint injured parts in the position they are found Prevent chilling, but do not add excessive heat Do not remove penetrating objects Do not try to give anything by mouth to an unconscious person or one with serious injuries Stay with the injured person until medical care or transportation arrives

6 6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Assessment in Emergencies Chief complaint Determine problem, signs and symptoms, and how the injury or illness occurred If the victim is or has been unconscious, note the length of time unconscious if possible Medical treatment Determine treatment and its effect; note whether the victim has been moved

7 7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Assessment in Emergencies Medical history Determine known health problems; may provide clues to immediate problem or influence care provided Check for a medical alert tag; may provide essential information if the patient cannot Identify current medications and allergies Note any evidence of alcohol or other drugs

8 8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Physical Examination The first priority: ABCs Airway, breathing, and circulation Watch chest for rhythmic breathing; listen near mouth and nose for air movement Palpate the carotid and peripheral pulses Once respiration and circulation established, assess for uncontrolled bleeding and shock If none, assess systematic head-to-toe

9 9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Systematic Head-to-Toe Assessment

10 10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Systematic Head-to-Toe Assessment Evaluate comprehension: ask patient to follow simple commands, such as opening and closing the eyes Inspect eyes to assess pupil size, equality, and reaction to light Ask about neck pain or stiffness and the ability to swallow Inspect for chest wall movement symmetry

11 11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Systematic Head-to-Toe Assessment Assess breathing, dyspnea, and abnormal sounds associated with respirations Examine contour of abdomen for distention Light palpation to detect pain or tenderness Inspect the extremities for deformity or injury, and evaluate movement Assess peripheral pulses and warmth and sensation in the extremities

12 12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Cardiopulmonary Arrest Absence of a heartbeat and respirations Causes Myocardial infarction, heart failure, electrocution, drowning, drug overdose, anaphylaxis, and asphyxiation Signs and symptoms Collapse and quickly lose consciousness No pulse or respiration

13 13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-3

14 14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Cardiopulmonary Arrest Interventions Determine responsiveness Open airway Check for breathing (look, listen, feel) If nonresponsive and not breathing, palpate for a pulse If no pulse in 10 seconds, begin compression:ventilation cycles of 30:2 If a pulse, deliver 10-12 rescue breaths per minute In no advanced airway, continue the 30:2 ratio With advanced airway, compressions of 100 per minute without pausing for ventilations which are done at a rate of 8- 10 per minute

15 15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Cardiopulmonary Arrest Two-rescuer CPR One rescuer compresses the chest at a rate of 100 per minute without pausing for ventilations Second rescuer ventilates with 8-10 breaths/minute Swap roles about every 2 minutes to avoid tiring Recovery position Unresponsive victim who is breathing should be log- rolled to one side if no cervical trauma is suspected

16 16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Choking or Airway Obstruction Assessment Universal sign of choking is grabbing the throat with one or both hands First determine if airway completely blocked If victim is able to speak, breathe, or cough with good air exchange, do nothing If unable to speak, breathe, or cough with good air exchange, act quickly to prevent suffocation

17 17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-4

18 18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Choking or Airway Obstruction Victim is conscious Perform the Heimlich maneuver If effective, air expels foreign body from the airway If not, repeat maneuver until the object is expelled or victim loses consciousness

19 19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-5A

20 20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Choking or Airway Obstruction Victim unconscious/loses consciousness Lift the jaw and sweep a finger through the mouth to try to remove the object Tilt the head back, lift the chin, pinch the nostrils, and try to ventilate by breathing into the mouth once If the airway is still obstructed, attempts at ventilation will fail Reposition the head and attempt once more to ventilate If unsuccessful, proceed to the next step Straddle the victims thighs, place one hand on top of the other, and deliver up to five abdominal thrusts Repeat these three steps until the airway is clear

21 21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-5B

22 22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Shock Results from acute circulatory failure caused by inadequate blood volume, heart failure, overwhelming infection, severe allergic reactions, or extreme pain or fright

23 23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhage The loss of a large amount of blood Loss of more than 1 liter (L) of blood in an adult may lead to hypovolemic shock Death from continued uncontrolled bleeding Bleeding may be external or internal Internal bleeding is suspected if signs of shock but no external bleeding is evident

24 24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhage Immediate treatment for external bleeding is direct, continuous pressure Elevate and immobilize the injured part (unless fracture is suspected) After bleeding stops, secure a large dressing, if available, over the wound Reinforce the dressing but do not change it If direct wound pressure and elevation fail to control bleeding, apply indirect pressure to the main artery that supplies the area

25 25Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-6

26 26Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hemorrhage Epistaxis Blood from anterior or posterior portion of the nose Most anterior nosebleeds respond to pressure Instruct the patient to sit down and lean the head forward Pinch the nostrils shut for at least 10 minutes Advise patient not to blow or pick at nose for several hours Continued bleeding or bleeding from the posterior area of the nose requires medical treatment

27 27Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-7

28 28Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Fracture A break in a bone Simple (closed) fracture Does not break the skin Compound (open) fracture Broken bone protrudes through the skin Complete fracture Broken ends are separated Incomplete fracture Bone ends are not separated

29 29Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Fracture Assessment Primary symptom is pain Numbness/tingling from nerve injury and blood vessels Signs: deformity, swelling, discoloration, decreased function, and bone fragments protruding through the skin

30 30Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnoses, Goals, and Outcome Criteria Risk for Trauma related to movement of unstable fractures Immobilize the injured part Apply direct pressure to the artery above the injury to stop bleeding

31 31Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Strains and Sprains Strains Injuries to muscles or tendons, or both Sprains Injuries to ligaments These injuries are painful; may be swelling Emergency treatment is immobilization, elevation, and application of a cool pack Victim to see physician for further evaluation

32 32Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Head Injury Suspected with any type of blow to the head or any unexplained loss of consciousness Assessment Inspection and palpation of the head Evaluate for signs and symptoms of increased intracranial pressure Be alert for the leakage of cerebrospinal fluid that occurs with basilar skull fractures

33 33Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Head Injury Must be assessed by a physician as soon as possible Immobilize neck and keep victim flat with proper alignment of the neck and head Backboard used for transporting victim

34 34Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Neck and Spinal Injuries Assessment Assess breathing and circulation and then begin resuscitation if needed Remember to use the jaw-thrust method to open the airway! Assess movement and sensation in all extremities

35 35Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criteria Risk for trauma related to improper movement of the fractured spine Outcome criteria include continuous immobilization of the spine and transport for medical care

36 36Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Neck and Spinal Injuries Immediately summon expert emergency team In remote or life-threatening settings, the victim may have to be moved A rolled towel or article of clothing can be used as a collar to support the neck The victim can then be moved by log-rolling to one side and then rolling back onto a board, keeping the spine as straight as possible Throughout the movement, one rescuer supports the head while two others support the shoulders, hips, and legs

37 37Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Eye Injury Assessment Inspect eyelid for trauma and the eye for redness, foreign bodies, or penetrating objects To inspect for foreign bodies, evert the eyelids

38 38Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criteria Risk for injury related to foreign body, direct trauma, or exposure to harmful substances Goal is to minimize injury to the eye Outcome criteria may be removal of a foreign body or chemical or protection of the eye from further damage while medical attention is obtained

39 39Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-8

40 40Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Ear Trauma Assessment Assess extent of injury; note if any tissue is fully separated and severity of bleeding Apply direct pressure to injury to control bleeding

41 41Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criteria Impaired tissue integrity related to trauma Goal: preserve the tissue to maximize successful repair Outcome criteria for successful interventions are recovery and protection of avulsed tissue

42 42Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Ear Trauma If injured part is actually separated, reattachment may be possible Retrieve the tissue, wrap it in plastic, keep it cool, and transport it with the victim

43 43Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chest Injury Critical injuries: open pneumothorax, flail chest, massive hemothorax, and cardiac tamponade Assessment Note rate and character of respirations, skin color, pulse rate and rhythm, symmetry of the chest wall movement, and the presence of any apparent injuries to the chest Signs and symptoms of chest injuries that impair respirations are dyspnea, tachycardia, restlessness, cyanosis, asymmetric or other abnormal chest wall movement, abnormal sounds of breathing Note mental state and level of consciousness

44 44Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 16-9

45 45Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criteria Impaired gas exchange related to altered anatomic structure Goal is adequate oxygenation; outcome criteria are absence of dyspnea, normal pulse and respiratory rates, and normal skin color See Table 16-3, p. 234

46 46Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Injury: Assessment Assess abdomen for evidence of injury Ask patient about abdominal symptoms Inspect abdomen for abnormalities Suspect internal abdominal injuries if victim complains of abdominal pain or abdomen shows evidence of trauma or distention Protrusion of internal organs through a wound is called evisceration

47 47Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Abdominal Injury: Interventions Require medical evaluation Give nothing by mouth in preparing for transport Do not attempt to replace eviscerated organs in the abdomen; this may cause additional harm Cover organs with material, such as plastic wrap or foil, to conserve moisture and warmth A saline-soaked sterile dressing is ideal but is not likely to be available on the scene of an accident Cover wound with clean cloth; transport to hospital

48 48Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Traumatic Amputation If partially/completely detached, reattachment possible Clean the wound surfaces with sterile water or saline and place the tissue in its normal position A body part that is completely detached should ideally be wrapped in sterile gauze moistened with sterile saline, placed in a watertight container such as a resealable plastic bag, and placed in an iced saline bath The tissue should not be frozen or placed in contact with ice Amputated extremities may be healthy enough for reattachment for 4-6 hours; digits as long as 8 hours

49 49Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Burns: Assessment Determine the type of burn If patient has a flame burn or was in a closed, smoke- filled area, assess respirations first Determine the extent and depth of the burns Inspect skin for color, blisters, tissue destruction Superficial burns: typically pink or red and painful Deeper burns: red, white, or black; may destroy not only the skin but also the underlying tissues Electrical: difficult to assess; full extent of tissue damage may not be apparent for several days Chemical: immediately remove any remaining chemical

50 50Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Burns: Interventions Ensure a patent airway and respirations for burn victims Rescue breathing, if needed See Table 16-4, p. 235

51 51Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hyperthermia Body temperature >37.2° C (99° F) Heat edema and heat cramps are mild degrees of hyperthermia Can be treated by moving individual into cool place and providing fluids with electrolytes Heat exhaustion and heat stroke more serious See Table 16-5, p. 236

52 52Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hypothermia Decrease in body core temperature to <36° C (95° F) Caused by prolonged exposure to cold, extremely cold temperatures, or immersion in cold water Causes depression of vital functions, and if not corrected, death results from cardiac dysrhythmias

53 53Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Hypothermia Mild stage Patient shivers in an effort to generate body heat Blood vessels in the extremities are constricted, and performing complex motor tasks is impaired Moderate hypothermia Appears dazed, poor motor coordination, slurred speech, and violent shivering May behave irrationally Severe hypothermia Waves of shivering, rigid muscles, and pale skin Pulse rate is slow and the pupils are dilated

54 54Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Carbon Monoxide Poisoning Assessment Early signs and symptoms: headache and shortness of breath with mild exertion Then dizziness, nausea, vomiting, and mental changes As carbon monoxide in bloodstream rises, victim loses consciousness and develops cardiac and respiratory irregularities Cherry-red skin clear indicator of carbon monoxide poisoning, but skin color often found to be pale or bluish with reddish mucous membranes

55 55Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criteria Impaired gas exchange related to carbon monoxide poisoning The goal of nursing care for the emergency treatment of the victim of carbon monoxide poisoning is normal oxygenation

56 56Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Interventions Immediately move the victim to fresh air If person not breathing, start rescue breathing Seek emergency medical assistance immediately Give oxygen as soon as it is available At the hospital the patient may be placed in a hyperbaric oxygen chamber

57 57Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Drug or Chemical Poisoning Assessment History: data about relevant signs and symptoms Name of drug or chemical. If the victim cannot provide the information, look for clues and save the container Amount consumed Length of time since substance was taken Last food consumed: amount, time Signs and symptoms that may be caused by poisons Victims age and approximate weight Other medications, drugs, or alcohol ingested

58 58Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criterion Risk for injury related to poison Decrease or minimize risk for injury caused by the poison

59 59Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Drug or Chemical Poisoning Interventions Immediately call your poison center Some poisonings can be treated at home, others require a physician or a hospital Treatment of poisoning in an emergency facility may be with activated charcoal, total bowel lavage, and/or cathartics

60 60Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Food Poisoning Assessment Symptoms: nausea, vomiting, abdominal cramps, and diarrhea Botulism caused by Clostridium botulinum has neurotoxic effects: difficulty breathing, seeing, and swallowing Clue that food poisoning is causing victims symptoms is that all who consumed a certain food become ill To assist in identifying poisons, collect samples of stool or vomited materials for possible lab analysis

61 61Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Diagnosis, Goal, and Outcome Criterion Risk for Injury related to poisoning Type of injury depends on the action of the contaminant In general the treatment of food poisoning aims to identify the poison and decrease the symptoms The goal of nursing care for the victim of food poisoning is the absence or reduction of ill effects from the poison

62 62Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Food Poisoning: Interventions Medical care necessary if symptoms are severe or persistent The physician may order antiemetics and antidiarrheals Intravenous fluids may be prescribed with severe vomiting and diarrhea

63 63Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Bites and Stings Assessment Try to determine the type of bite Inspect bite to identify characteristics of bite site and any changes in surrounding tissue Ask about any symptoms that developed after the bite: pain, edema, numbness, tingling, nausea, fever, dizziness, and dyspnea Interventions: see Table 16-7, p. 239

64 64Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Acts of Bioterrorism Deliberate release of pathogens to kill people Anthrax, botulism, plague, smallpox, tularemia: most common biologic agents in terrorist attack Easily spread; potential to cause many deaths Health care providers must know how to protect themselves and others Staff should know where to obtain personal protective equipment and what types of precautions (i.e., patient isolation) should be taken

65 65Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Disaster Planning A challenge for the health care system is to be ready for natural disasters that often occur with short warning American Red Cross and the Salvation Army are experienced in handling these situations and quickly move in to help A call for nurse volunteers usually follows Regardless of the area of clinical expertise, there is certain to be a way each nurse can contribute

66 66Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Legal Aspects of Emergency Care Emergency doctrine In emergencies, person may be unable to consent to care Treatment can be provided under the assumption that the patient would have consented if able Good Samaritan laws Limit liability and provide protection against malpractice claims when health care providers render first aid at the scene of an emergency These laws do not protect the nurse in the event of gross negligence or willful misconduct


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