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Teresa Hunt RN, BSN University of Central Florida For University of Rhode Island : NUR433 EMERGENCY CARE
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Infant: Cry = stress parents, many indications Very little tolerance for physical or emotional pain or discomfort Parent – infant bond Toddler: Aware of self = autonomous and distinct beings Restraining and securing = vulnerability Preschooler: Fear and fantasy = reduce lag time Increasing independence = reduced separation anxiety School-Age: Risk-taking behavior Adequate coping and understanding Adolescent: Own unique identity Believe of being invisible, age of extremes GROWTH AND DEVELOPMENT ISSUES
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Primary ABCDEs Airway Breathing Circulation LOC (Disability) Exposure Secondary Full set of Vital Signs Family presence Give Comfort Measures Head-to-toe assessment SAMPLE Complete medical history Inspection of the back TRIAGE & ASSESSMENT
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Infant: 30:2 one rescuer 15:2 two rescuers Two fingers/thumbs encircling chest Child: Same as infant Heel of one hand or two hands Adults: 30:2 one or two rescuers Heel of two hands http://www.bhf.org.uk /heart-health/life- saving-skills/hands- only-cpr.aspx http://www.bhf.org.uk /heart-health/life- saving-skills/hands- only-cpr.aspx (adult) http://youtu.be/Ff_ka lDZfzU http://youtu.be/Ff_ka lDZfzU (Kids) CARDIOPULMONARY RESUSCITATION
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Most common causes: Hemorrhage, burns and dehydration Compensation Increase peripheral vascular resistance, stroke volume, and heart rate. The body also redistributes the blood flow to the vital organs. If untreated: Altered sensorium, oliguria, lethargy, confusion, dry mucus membranes, depressed fontanel, cold/clammy skin, poor skin turgor, delayed cap refill, tissue and organ damage (can be irreversible), death. Treament: IV crystalloid infusion of warm saline or LR, blood transfusion, Albumin (if needed after bolus) HYPOVOLEMIC SHOCK
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Abnormality in the distribution of blood flow or inability of the body to maintain vascular tone through vasoconstriction. Signs and Symptoms Early: Vasodilation, Extremities are warm to touch, Tachycardia, Tachypenia. Late: Rapid/Thready pulse, cyanosis, cold/clammy skin, purpuric skin lesions, narrow pulse pressure, oliguria or anuria Most common cause: Sepsis (bacteria, viruses, fungi or rickettsiae), Anaphylaxis, central nervous system or spinal injury, and drug intoxication. Treatment: IV antibiotics, Steroids, Hypoglycemic and electrolyte correction, vasoconstrictors, blood products, stabilize nervous system/spinal injury. DISTRIBUTIVE SHOCK
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Myocardial function is impaired and cardiac output is not sufficient to meet the body’s metabolic demands. Signs & Symptoms: Low cardiac output, cyanosis, respiratory distress, differentiated extremity blood pressures, poor tissue perfusion, and poor response to fluid resuscitation. Causes: Structural abnormalities, cardiomyopathies, intractable arrhythmias, trauma, ischemia, metabolic abnormalities, drug intoxication, and impaired cardiac function after intra- cardiac surgical repair Treatment: Identify the cause. Then treat with Dopampine, Dobutamine, milrinone, furosemide (Lasix) 1mg/kg, Extracorporeal life support (ECLS), oxygen supply CARDIOGENIC SHOCK
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Blunt Force: Motor Vehicle Accident Pedestrian Injury Penetrating Force: Stabbing, firearms, blasting and impaling. 20% of pediatric injuries. TRAUMA: BLUNT AND PENETRATING
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Motorcycle accident, trauma eval. http://youtu.be/kOaez U-TAQs http://youtu.be/kOaez U-TAQs MANAGE TRAUMA PATIENT
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Can cause Permanente damage. Do not place chemicals in drinking bottles. 90% occur in the home. Over half occur in children <6yrs old. OVERDOSE & INGESTION
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Tylenol/Acetaminophen Signs and Symptoms 1 st : (24hrs) Nausea, vomiting, sweating, pallor, weakness 2 nd : (24-48h) Increase in liver enzymes and bilirubin, RUQ pain, prolonged PTT 3 rd : (3-7 D) Jaundice, liver necrosis, hepatic failure 4 th : (5-7 D) recovery or progression to death. Treatment IV fluids, Mucomyst (N- acetylcysteine), 1-2 hrs activated charcoal Aspirin/Salicylates Signs and Symptoms 1 st : stimulation of respiratory center, leading to repirstory alkalosis. 2 nd : decreased K+, Increase metabolic rate, accumilation of ketones leading to metabolic acidosis, hypokalemia and dehydration, increased PTT, decreased platelet leves Treatment: Activated charcoal, IV fluids, Sodium Bicarbonate, Postassium replacement, Vitamin K, Glucose, Hemodialysis COMMON OVERDOSES IN KIDS
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Carbon Monoxide Signs and Symptoms Headache, visual disturbances, altered LOC, cherry red lips and cheeks, N/V Treatment 100% oxygen by rebreather mask, Serum carboxyhemoglobin levels, Hypebaric chamber (PRN) Lead Signs and Symptoms Dependent on exposure and length of exposure Treatment Based on exposure. OVERDOSE IN KIDS
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Submersion that results in asphyxia and death within 24 hrs. 2 nd & 3 rd unintentional deaths in children 1-4yrs old. Can happen in any body of water including toilets, tubs, ponds, rivers, ect. Prognosis base on: Age, submersion time, water temperature, elapsed time before CPR started, neurological status. NEAR DROWNING (SUBMERSION)
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Human bites higher incidence of infection. Spider bites are the brown recluse spider and the black widow: cause skin necrosis. Most animal bites are from dogs. Snakes: poisonous were Crotalids/Pit Vipers and Elapids BITES (HUMAN & ANIMALS)
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Treatment Depends on origin of the bit such as human, snake, spider or animal. Animal: irrigation and debridement. Extremity in the dependent position to reduce circulation issues. Identification of creature for antivenin, Possible antibiotics, hypothermic treatment reduce spread BITES: TREATMENT
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Nursing Education Consultants, INC. (2007b). Heat exhaustion. Retrieved from http://www.sy mptomsofexhau stion.net HEAT EXHAUSTION
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Nursing Education Consultants, INC. (2007a). Heat stroke. Retrieved from www.doctorsha ndout.com/pho to/heat-stroke HEAT STROKE
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Daily Mail Reporter. (2011). Boy, three, left with horrific facial injuries as Labrador savages him while his mother strokes puppy. Retrieved from http://www.dailymail.co.uk/news/article-2003849/Boy-3-left- horrific-facial-injuries-Labrador-savages-Poole-Harbour.html Forsythe, M. (2014). Blunt trauma. Retrieved from http://www.slideshare.net/ProfdrElghamry/blunt-trauma http://www.slideshare.net/ProfdrElghamry/blunt-trauma Mishra, B. (2008). Abdominothoracic trauma due to impalement by an iron bar. Retrieve from http://www.trauma.org/index.php/main/image/754/C13 Nursing Education Consultants, INC. (2007a). Heat stroke. Retrieved from www.doctorshandout.com/photo/heat-stroke Nursing Education Consultants, INC. (2007b). Heat exhaustion. Retrieved from http://www.symptomsofexhaustion.net REFERENCES
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