Presentation on theme: "First Aid, Emergency Care, and Disaster Management"— Presentation transcript:
1 First Aid, Emergency Care, and Disaster Management Chapter 16First Aid,Emergency Care, and Disaster Management
2 Learning ObjectivesList 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 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 victimAssessment and intervention must be done quickly and efficiently to identify and treat priority needs immediatelyThe nursing process is used in emergencies just as it is in other nursing situations.When does your assessment of the victim begin?Failure to recognize such hazards may result in injuries to the rescuer and additional injuries to the victim.
4 General Principles of Emergency Care The primary survey looks for life-threatening injuries and intervenes immediately in the following sequenceAssess ABCs: airway, breathing, circulationInitiate CPR or rescue breathing as neededLook for uncontrolled bleeding, identify the source, and apply pressureAssess for injuries from head to foot, and immobilize spine, limbs, or both as indicatedLook for a medical alert necklace or braceletWhat should the rescuer do after the primary survey?
5 General Principles of Emergency Care Splint injured parts in the position they are foundPrevent chilling, but do not add excessive heatDo not remove penetrating objectsDo not try to give anything by mouth to an unconscious person or one with serious injuriesStay with the injured person until medical care or transportation arrives
6 Nursing Assessment in Emergencies Chief complaintDetermine problem, signs and symptoms, and how the injury or illness occurredIf the victim is or has been unconscious, note the length of time unconscious if possibleMedical treatmentDetermine treatment and its effect; note whether the victim has been moved
7 Nursing Assessment in Emergencies Medical historyDetermine known health problems; may provide clues to immediate problem or influence care providedCheck for a medical alert tag; may provide essential information if the patient cannotIdentify current medications and allergiesNote any evidence of alcohol or other drugs
8 Physical Examination The first priority: ABCs Airway, breathing, and circulationWatch chest for rhythmic breathing; listen near mouth and nose for air movementPalpate the carotid and peripheral pulsesOnce respiration and circulation established, assess for uncontrolled bleeding and shockIf none, assess systematic head-to-toeBegin collecting objective data as soon as the victim is seen, and quickly determine whether the patient is responsive.
10 Systematic Head-to-Toe Assessment Evaluate comprehension: ask patient to follow simple commands, such as opening and closing the eyesInspect eyes to assess pupil size, equality, and reaction to lightAsk about neck pain or stiffness and the ability to swallowInspect for chest wall movement symmetry
11 Systematic Head-to-Toe Assessment Assess breathing, dyspnea, and abnormal sounds associated with respirationsExamine contour of abdomen for distentionLight palpation to detect pain or tendernessInspect the extremities for deformity or injury, and evaluate movementAssess peripheral pulses and warmth and sensation in the extremities
12 Cardiopulmonary Arrest Absence of a heartbeat and respirationsCausesMyocardial infarction, heart failure, electrocution, drowning, drug overdose, anaphylaxis, and asphyxiationSigns and symptomsCollapse and quickly lose consciousnessNo pulse or respirationThe cardiac and respiratory systems are so dependent on each other that when one fails, the other quickly fails as well.How long can the brain go without oxygen before brain cells begin to die?
14 Cardiopulmonary Arrest InterventionsDetermine responsivenessOpen airwayCheck for breathing (look, listen, feel)If nonresponsive and not breathing, palpate for a pulseIf no pulse in 10 seconds, begin compression:ventilation cycles of 30:2If a pulse, deliver rescue breaths per minuteIn no advanced airway, continue the 30:2 ratioWith advanced airway, compressions of 100 per minute without pausing for ventilations which are done at a rate of 8-10 per minuteAmerican Heart Association guidelines for CPR are revised at intervals.What changes were made in the 2005 Guidelines?
15 Cardiopulmonary Arrest Two-rescuer CPROne rescuer compresses the chest at a rate of 100 per minute without pausing for ventilationsSecond rescuer ventilates with 8-10 breaths/minuteSwap roles about every 2 minutes to avoid tiringRecovery positionUnresponsive victim who is breathing should be log-rolled to one side if no cervical trauma is suspected
16 Choking or Airway Obstruction AssessmentUniversal sign of choking is grabbing the throat with one or both handsFirst determine if airway completely blockedIf victim is able to speak, breathe, or cough with good air exchange, do nothingIf unable to speak, breathe, or cough with good air exchange, act quickly to prevent suffocationFear of suffocation is terrifying.What facial expressions may the victim display?
18 Choking or Airway Obstruction Victim is consciousPerform the Heimlich maneuverIf effective, air expels foreign body from the airwayIf not, repeat maneuver until the object is expelled or victim loses consciousnessThe Heimlich maneuver is a “bear hug” procedure named for the physician who first described it.Stand behind the victim and reach around the victim slightly above the umbilicus and below the xiphoid process.Make a fist with one hand and use the other to press the fist against the victim.Tighten your arms around the victim and perform quick upward thrusts into the victim’s abdomen.How does the Heimlich maneuver help to expel the object?
20 Choking or Airway Obstruction Victim unconscious/loses consciousnessLift the jaw and sweep a finger through the mouth to try to remove the objectTilt the head back, lift the chin, pinch the nostrils, and try to ventilate by breathing into the mouth onceIf the airway is still obstructed, attempts at ventilation will failReposition the head and attempt once more to ventilateIf unsuccessful, proceed to the next stepStraddle the victim’s thighs, place one hand on top of the other, and deliver up to five abdominal thrustsRepeat these three steps until the airway is clearHow could most choking deaths be prevented?
22 ShockResults from acute circulatory failure caused by inadequate blood volume, heart failure, overwhelming infection, severe allergic reactions, or extreme pain or fright
23 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 shockDeath from continued uncontrolled bleedingBleeding may be external or internalInternal bleeding is suspected if signs of shock but no external bleeding is evidentAssess for signs and symptoms of hemorrhage, which may include obvious bleeding; cool, sweaty, pale skin; thready pulse; rapid respirations; and decreasing alertness.What are the symptoms of internal bleeding?
24 HemorrhageImmediate treatment for external bleeding is direct, continuous pressureElevate and immobilize the injured part (unless fracture is suspected)After bleeding stops, secure a large dressing, if available, over the woundReinforce the dressing but do not change itIf direct wound pressure and elevation fail to control bleeding, apply indirect pressure to the main artery that supplies the areaIdeally, a sterile dressing is placed over the wound.When should a tourniquet be used?
26 HemorrhageEpistaxisBlood from anterior or posterior portion of the noseMost anterior nosebleeds respond to pressureInstruct the patient to sit down and lean the head forwardPinch the nostrils shut for at least 10 minutesAdvise patient not to blow or pick at nose for several hoursContinued bleeding or bleeding from the posterior area of the nose requires medical treatment
28 Fracture A break in a bone Simple (closed) fracture Does not break the skinCompound (open) fractureBroken bone protrudes through the skinComplete fractureBroken ends are separatedIncomplete fractureBone ends are not separatedWhat may cause a traumatic injury?
29 Fracture Assessment Primary symptom is pain Numbness/tingling from nerve injury and blood vesselsSigns: deformity, swelling, discoloration, decreased function, and bone fragments protruding through the skin
30 Nursing Diagnoses, Goals, and Outcome Criteria Risk for Trauma related to movement of unstable fracturesImmobilize the injured partApply direct pressure to the artery above the injury to stop bleedingWhat is the key to emergency management of fractures?Do not attempt to straighten a broken bone; splint the bone in the position in which it was found, with as little movement as possible.Severe bleeding may be present with compound fractures.
31 Strains and Sprains Strains Sprains Injuries to muscles or tendons, or bothSprainsInjuries to ligamentsThese injuries are painful; may be swellingEmergency treatment is immobilization, elevation, and application of a cool packVictim to see physician for further evaluation
32 Head InjurySuspected with any type of blow to the head or any unexplained loss of consciousnessAssessmentInspection and palpation of the headEvaluate for signs and symptoms of increased intracranial pressureBe alert for the leakage of cerebrospinal fluid that occurs with basilar skull fracturesWhat is a critical complication of a head injury?Older adults are at special risk for head injuries because they are more likely to have sensory deficits, unstable gait, or circulatory disorders.What are signs of increased intracranial pressure?
33 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 headBackboard used for transporting victimAlways treat the victim as if there were a spinal injury until it is ruled out.Why should a victim see a physician even if the head injury seems to be minor?
34 Neck and Spinal Injuries AssessmentAssess breathing and circulation and then begin resuscitation if neededRemember to use the jaw-thrust method to open the airway!Assess movement and sensation in all extremitiesSuspect neck and spinal injuries along with head injuries, especially if the victim has had a diving or motor vehicle accident.What is the priority nursing diagnosis for the person with a neck or spinal injury?
35 Nursing Diagnosis, Goal, and Outcome Criteria Risk for trauma related to improper movement of the fractured spineOutcome criteria include continuous immobilization of the spine and transport for medical care
36 Neck and Spinal Injuries Immediately summon expert emergency teamIn remote or life-threatening settings, the victim may have to be movedA rolled towel or article of clothing can be used as a collar to support the neckThe victim can then be moved by log-rolling to one side and then rolling back onto a board, keeping the spine as straight as possibleThroughout the movement, one rescuer supports the head while two others support the shoulders, hips, and legsHow is a victim “log-rolled”?
37 Eye InjuryAssessmentInspect eyelid for trauma and the eye for redness, foreign bodies, or penetrating objectsTo inspect for foreign bodies, evert the eyelids
38 Nursing Diagnosis, Goal, and Outcome Criteria Risk for injury related to foreign body, direct trauma, or exposure to harmful substancesGoal is to minimize injury to the eyeOutcome criteria may be removal of a foreign body or chemical or protection of the eye from further damage while medical attention is obtained
40 Ear TraumaAssessmentAssess extent of injury; note if any tissue is fully separated and severity of bleedingApply direct pressure to injury to control bleeding
41 Nursing Diagnosis, Goal, and Outcome Criteria Impaired tissue integrity related to traumaGoal: preserve the tissue to maximize successful repairOutcome criteria for successful interventions are recovery and protection of avulsed tissue
42 Ear TraumaIf injured part is actually separated, reattachment may be possibleRetrieve the tissue, wrap it in plastic, keep it cool, and transport it with the victim
43 Chest InjuryCritical injuries: open pneumothorax, flail chest, massive hemothorax, and cardiac tamponadeAssessmentNote 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 chestSigns and symptoms of chest injuries that impair respirations are dyspnea, tachycardia, restlessness, cyanosis, asymmetric or other abnormal chest wall movement, abnormal sounds of breathingNote mental state and level of consciousnessInjuries to the chest can result in serious impairment of respiratory function.What is the difference between an open and a closed chest injury?
45 Nursing Diagnosis, Goal, and Outcome Criteria Impaired gas exchange related to altered anatomic structureGoal is adequate oxygenation; outcome criteria are absence of dyspnea, normal pulse and respiratory rates, and normal skin colorSee Table 16-3, p. 234
46 Abdominal Injury: Assessment Assess abdomen for evidence of injuryAsk patient about abdominal symptomsInspect abdomen for abnormalitiesSuspect internal abdominal injuries if victim complains of abdominal pain or abdomen shows evidence of trauma or distentionProtrusion of internal organs through a wound is called evisceration
47 Abdominal Injury: Interventions Require medical evaluationGive nothing by mouth in preparing for transportDo not attempt to replace eviscerated organs in the abdomen; this may cause additional harmCover organs with material, such as plastic wrap or foil, to conserve moisture and warmthA saline-soaked sterile dressing is ideal but is not likely to be available on the scene of an accidentCover wound with clean cloth; transport to hospital
48 Traumatic AmputationIf partially/completely detached, reattachment possibleClean the wound surfaces with sterile water or saline and place the tissue in its normal positionA 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 bathThe tissue should not be frozen or placed in contact with iceAmputated extremities may be healthy enough for reattachment for 4-6 hours; digits as long as 8 hours
49 Burns: Assessment Determine the type of burn If patient has a flame burn or was in a closed, smoke-filled area, assess respirations firstDetermine the extent and depth of the burnsInspect skin for color, blisters, tissue destructionSuperficial burns: typically pink or red and painfulDeeper burns: red, white, or black; may destroy not only the skin but also the underlying tissuesElectrical: difficult to assess; full extent of tissue damage may not be apparent for several daysChemical: immediately remove any remaining chemicalWhen a burn accident occurs, the immediate concern is to stop the burning process.How can the burning process be stopped?
50 Burns: InterventionsEnsure a patent airway and respirations for burn victimsRescue breathing, if neededSee Table 16-4, p. 235If the burns have been caused by flames, fumes, or chemicals, the victim may have inhaled substances that cause respiratory impairment.
51 Hyperthermia Body temperature >37.2° C (99° F) Heat edema and heat cramps are mild degrees of hyperthermiaCan be treated by moving individual into cool place and providing fluids with electrolytesHeat exhaustion and heat stroke more seriousSee Table 16-5, p. 236Should victims of heat hyperthermia take salt tablets?
52 Hypothermia Decrease in body core temperature to <36° C (95° F) Caused by prolonged exposure to cold, extremely cold temperatures, or immersion in cold waterCauses depression of vital functions, and if not corrected, death results from cardiac dysrhythmias
53 Hypothermia Mild stage Moderate hypothermia Severe hypothermia Patient shivers in an effort to generate body heatBlood vessels in the extremities are constricted, and performing complex motor tasks is impairedModerate hypothermiaAppears dazed, poor motor coordination, slurred speech, and violent shiveringMay behave irrationallySevere hypothermiaWaves of shivering, rigid muscles, and pale skinPulse rate is slow and the pupils are dilatedHypothermia is classified on the basis of core body temperature as mild (32-35 C), moderate (28-32 C) or severe (<28 C).Why are older adults susceptible to hyopthermia?
54 Carbon Monoxide Poisoning AssessmentEarly signs and symptoms: headache and shortness of breath with mild exertionThen dizziness, nausea, vomiting, and mental changesAs carbon monoxide in bloodstream rises, victim loses consciousness and develops cardiac and respiratory irregularitiesCherry-red skin clear indicator of carbon monoxide poisoning, but skin color often found to be pale or bluish with reddish mucous membranesCarbon monoxide is an odorless, invisible gas emitted by automobile engines, gas stoves and furnaces, and burning charcoal and other combustible materials.What happens when carbon monoxide is inhaled?
55 Nursing Diagnosis, Goal, and Outcome Criteria Impaired gas exchange related to carbon monoxide poisoningThe goal of nursing care for the emergency treatment of the victim of carbon monoxide poisoning is normal oxygenationWhat is the criteria for evaluating the effects of nursing interventions?
56 Interventions Immediately move the victim to fresh air If person not breathing, start rescue breathingSeek emergency medical assistance immediatelyGive oxygen as soon as it is availableAt the hospital the patient may be placed in a hyperbaric oxygen chamberA hyperbaric chamber uses pressure to force oxygen into the blood and tissues.
57 Drug or Chemical Poisoning AssessmentHistory: data about relevant signs and symptomsName of drug or chemical. If the victim cannot provide the information, look for clues and save the containerAmount consumedLength of time since substance was takenLast food consumed: amount, timeSigns and symptoms that may be caused by poisonsVictim’s age and approximate weightOther medications, drugs, or alcohol ingested
58 Nursing Diagnosis, Goal, and Outcome Criterion Risk for injury related to poisonDecrease or minimize risk for injury caused by the poisonWhat is the criterion for evaluating successful intervention for drug or chemical poisoning?
59 Drug or Chemical Poisoning InterventionsImmediately call your poison centerSome poisonings can be treated at home, others require a physician or a hospitalTreatment of poisoning in an emergency facility may be with activated charcoal, total bowel lavage, and/or catharticsIt is helpful to have the product container with you because specific interventions depend on knowing exactly what poison was consumed.When should syrup of ipecac be used?
60 Food Poisoning Assessment Symptoms: nausea, vomiting, abdominal cramps, and diarrheaBotulism caused by Clostridium botulinum has neurotoxic effects: difficulty breathing, seeing, and swallowingClue that food poisoning is causing victim’s symptoms is that all who consumed a certain food become illTo assist in identifying poisons, collect samples of stool or vomited materials for possible lab analysisVictims of food poisoning often recognize the relationship between their symptoms and the ingestion of food.What are the most common symptoms of food poisoning?
61 Nursing Diagnosis, Goal, and Outcome Criterion Risk for Injury related to poisoningType of injury depends on the action of the contaminantIn general the treatment of food poisoning aims to identify the poison and decrease the symptomsThe goal of nursing care for the victim of food poisoning is the absence or reduction of ill effects from the poison
62 Food Poisoning: Interventions Medical care necessary if symptoms are severe or persistentThe physician may order antiemetics and antidiarrhealsIntravenous fluids may be prescribed with severe vomiting and diarrheaMost cases of food poisoning can be attributed to improper storage or preparation of perishable foods.How can food poisonings be prevented?
63 Bites and Stings Assessment Interventions: see Table 16-7, p. 239 Try to determine the type of biteInspect bite to identify characteristics of bite site and any changes in surrounding tissueAsk about any symptoms that developed after the bite: pain, edema, numbness, tingling, nausea, fever, dizziness, and dyspneaInterventions: see Table 16-7, p. 239Snakes, ticks, bees, wasps, household pets, and even humans are capable of causing serious harm by their bites or stings.What are the most serious affects of bites?
64 Acts of Bioterrorism Deliberate release of pathogens to kill people Anthrax, botulism, plague, smallpox, tularemia: most common biologic agents in terrorist attackEasily spread; potential to cause many deathsHealth care providers must know how to protect themselves and othersStaff should know where to obtain personal protective equipment and what types of precautions (i.e., patient isolation) should be takenA major problem in the United States is the lack of experience in recognizing and treating these infections.Health care facilities should have readily available information on resources, including the local health department and the Centers for Disease Control and Prevention (CDC).What events have made us aware that we are vulnerable to attacks using various means?
65 Disaster PlanningA challenge for the health care system is to be ready for natural disasters that often occur with short warningAmerican Red Cross and the Salvation Army are experienced in handling these situations and quickly move in to helpA call for nurse volunteers usually followsRegardless of the area of clinical expertise, there is certain to be a way each nurse can contributeThe Red Cross offers courses in disaster training for nurses and nursing students.What are the competencies for nurses in relation to emergency and disaster preparedness?
66 Legal Aspects of Emergency Care Emergency doctrineIn emergencies, person may be unable to consent to careTreatment can be provided under the assumption that the patient would have consented if ableGood Samaritan lawsLimit liability and provide protection against malpractice claims when health care providers render first aid at the scene of an emergencyThese laws do not protect the nurse in the event of gross negligence or willful misconductIn the first aid treatment of emergencies outside the hospital, the nurse is expected to demonstrate the same skill, knowledge, and care that would be provided by other nurses in the same community with the same credentials.What evidence should be preserved in cases involving possible criminal activity?