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EMERGENCYEMERGENCYAND AND

DISASTER DISASTER NURSINGNURSING

BY:BY:Darran Earl Gowing, BSN, RNDarran Earl Gowing, BSN, RN

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TraumaTrauma- Intentional or unintentional Intentional or unintentional

wounds/injuries on the human body wounds/injuries on the human body from particular mechanical from particular mechanical mechanism that exceeds the body’s mechanism that exceeds the body’s ability to protect itself from injuryability to protect itself from injury

Emergency ManagementEmergency Management- traditionally refers to care given to traditionally refers to care given to

patients with urgent and critical patients with urgent and critical needs.needs.

TERMS USE:TERMS USE:

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Triage Triage - process of assessing patients to process of assessing patients to

determine management priorities.determine management priorities.

First AidFirst Aid- an immediate or emergency an immediate or emergency

treatment given to a person who has treatment given to a person who has been injured before complete been injured before complete medical and surgical treatment can medical and surgical treatment can be secured.be secured.

BLSBLS- level of medical care which is used level of medical care which is used

for patient with illness or injury until for patient with illness or injury until full medical care can be given.full medical care can be given.

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ACLSACLS- Set of clinical interventions for the Set of clinical interventions for the

urgent treatment of cardiac arrest and urgent treatment of cardiac arrest and often life threatening medical often life threatening medical emergencies as well as the knowledge emergencies as well as the knowledge and skills to deploy those interventions.and skills to deploy those interventions.

DefibrillationDefibrillation- Restoration of normal rhythm to the Restoration of normal rhythm to the

heart in ventricular or atrial fibrillationheart in ventricular or atrial fibrillation

DisasterDisaster- Any catastrophic situation in which the Any catastrophic situation in which the

normal patterns of life (or ecosystems) normal patterns of life (or ecosystems) have been disrupted and extraordinary, have been disrupted and extraordinary, emergency interventions are required emergency interventions are required to save and preserve human lives to save and preserve human lives and/or the environmentand/or the environment

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Mass Casualty IncidentMass Casualty Incident- situation in which the number of situation in which the number of

casualties exceeds the number of casualties exceeds the number of resourcesresources

Post Traumatic Stress Post Traumatic Stress SyndromeSyndrome- characteristic of symptoms after a characteristic of symptoms after a

psychologically stressful event was out of psychologically stressful event was out of range of an normal human experiencerange of an normal human experience

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SCOPE AND PRACTICE OF SCOPE AND PRACTICE OF EMERGENCY NURSINGEMERGENCY NURSINGThe emergency nurse has had The emergency nurse has had

specialized education, training, and specialized education, training, and experience.experience.

The emergency nurse establishes The emergency nurse establishes priorities, monitors and priorities, monitors and continuously assesses acutely ill continuously assesses acutely ill and injured patients, supports and and injured patients, supports and attends to families, supervises attends to families, supervises allied health personnel, and teaches allied health personnel, and teaches patients and families within a time-patients and families within a time-limited, high-pressured care limited, high-pressured care environment.environment.

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Nursing interventions are Nursing interventions are accomplished interdependently, accomplished interdependently, in consultation with or under the in consultation with or under the direction of a licensed physician.direction of a licensed physician.

Appropriate nursing and medical Appropriate nursing and medical interventions are anticipated interventions are anticipated based on assessment data.based on assessment data.

The emergency health care staff The emergency health care staff members work as a team in members work as a team in performing the highly technical, performing the highly technical, hands-on skills required to care hands-on skills required to care for patients in an emergency for patients in an emergency situation.situation.

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Patients in the ED have a Patients in the ED have a wide variety of actual or wide variety of actual or potential problems, and their potential problems, and their condition may change condition may change constantly.constantly.

Although a patient may have Although a patient may have several diagnosis at a given several diagnosis at a given time, the focus is on the most time, the focus is on the most life-threatening oneslife-threatening ones

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ISSUES IN EMERGENCY ISSUES IN EMERGENCY NURSING CARENURSING CARE

Emergency nursing is demanding Emergency nursing is demanding because of the diversity of because of the diversity of conditions and situations which conditions and situations which are unique in the ER.are unique in the ER.

Issues include legal issues, Issues include legal issues, occupational health and safety occupational health and safety risks for ED staff, and the risks for ED staff, and the challenge of providing holistic care challenge of providing holistic care in the context of a fast-paced, in the context of a fast-paced, technology-driven environment in technology-driven environment in which serious illness and death which serious illness and death are confronted on a daily basis.are confronted on a daily basis.

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The emergency nurse must The emergency nurse must expand his or her knowledge expand his or her knowledge base to encompass recognizing base to encompass recognizing and treating patients and and treating patients and anticipate nursing care in the anticipate nursing care in the event of a mass casualty event of a mass casualty incident.incident.

Legal Issues Includes:Legal Issues Includes:- Actual ConsentActual Consent- Implied ConsentImplied Consent- Parental ConsentParental Consent

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“ “Good Samaritan Law”Good Samaritan Law”- Gives legal protection to the Gives legal protection to the

rescuer who act in good faith rescuer who act in good faith and are not guilty of gross and are not guilty of gross negligence or willful negligence or willful misconduct.misconduct.

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Preserve or Prolong Preserve or Prolong LifeLife

Alleviate SufferingAlleviate Suffering Do No Further HarmDo No Further Harm Restore to Optimal Restore to Optimal

FunctionFunction

Focus of Emergency Focus of Emergency CareCare

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Do’sDo’s- Obtain ConsentObtain Consent- Think of the WorstThink of the Worst- Respect Victim’s Modesty & Respect Victim’s Modesty &

PrivacyPrivacy Don’ts Don’ts

- let the patient see his own let the patient see his own injuryinjury

- Make any unrealistic promisesMake any unrealistic promises

Golden Rules of Golden Rules of Emergency CareEmergency Care

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Guidelines in Giving Guidelines in Giving Emergency CareEmergency Care

AA – – Ask for helpAsk for help

II – – InterveneIntervene

DD – – Do no Further HarmDo no Further Harm

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Stages of CrisisStages of Crisis1.1. Anxiety and DenialAnxiety and Denial

encouraged to recognize and talk about encouraged to recognize and talk about their feelings.their feelings.

asking questions is encouraged. asking questions is encouraged. honest answers givenhonest answers given prolonged denial is not encouraged or prolonged denial is not encouraged or

supportedsupported

2.2. Remorse and GuiltRemorse and Guilt verbalize their feelingsverbalize their feelings

3.3. AngerAnger way of handling anxiety and fearway of handling anxiety and fear allow the anger to be ventilatedallow the anger to be ventilated

4.4. GriefGrief help family members work through their help family members work through their

griefgrief letting them know that it is normal and letting them know that it is normal and

acceptableacceptable

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Core Competencies in Core Competencies in Emergency NursingEmergency Nursing Assessment Assessment Priority Setting/Critical Priority Setting/Critical

Thinking SkillsThinking Skills Knowledge of Emergency Knowledge of Emergency

CareCare Technical SkillsTechnical Skills CommunicationCommunication

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Assess and InterveneAssess and Intervene

Check for ABCs of lifeCheck for ABCs of life

A – A – AirwayAirway

B – B – BreathingBreathing

C - C - CirculationCirculation

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Team MembersTeam Members

RescuerRescuer Emergency Medical Emergency Medical

TechnicianTechnician ParamedicsParamedics Emergency Medicine Emergency Medicine

PhysiciansPhysicians Incident CommanderIncident CommanderSupport StaffSupport Staff Inpatient Unit StaffInpatient Unit Staff

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Emergency Action Emergency Action PrinciplePrinciple

I. Survey the SceneI. Survey the Scene Is the Scene Safe?Is the Scene Safe? What Happened?What Happened? Are there any bystanders who Are there any bystanders who

can help?can help? Identify as a trained first aider!Identify as a trained first aider!

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- organization of approach so organization of approach so that immediate threats to that immediate threats to life are rapidly identified and life are rapidly identified and effectively manage.effectively manage.

Primary SurveyPrimary Survey

AA - Airway/Cervical Spine - Airway/Cervical Spine

- Establish Patent Airway- Establish Patent Airway

- Maintain Alignment- Maintain Alignment

- GCS ≤ 8 = Prepare Intubation- GCS ≤ 8 = Prepare Intubation

II. II. Do a Primary Do a Primary SurveySurvey

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BB – Breathing – Breathing

- Assess Breath Sounds- Assess Breath Sounds

- Observe for Chest Wall - Observe for Chest Wall TraumaTrauma

- Prepare for chest - Prepare for chest decompressiondecompression

CC – Circulation – Circulation

- Monitor VS- Monitor VS

- Maintain Vascular Access- Maintain Vascular Access

- Direct Pressure- Direct Pressure

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Estimated Blood Estimated Blood PressurePressure

SITESITE SBPSBP

RadialRadial ≥ ≥ 8080

FemorFemoralal

≥ ≥ 7070

CarotiCarotidd

≥ ≥ 6060

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Control of Hemorrhage Control of Hemorrhage

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DD – Disability – Disability

- Evaluate LOC- Evaluate LOC

- Re-evaluate clients LOC- Re-evaluate clients LOC

- Use AVPU mnemonics- Use AVPU mnemonics

EE – Exposure – Exposure

- Remove clothing- Remove clothing

- Maintain Privacy - Maintain Privacy

- Prevent Hypothermia- Prevent Hypothermia

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Information to be Relayed:Information to be Relayed:- What Happened?What Happened?- Number of Persons InjuredNumber of Persons Injured- Extent of Injury and First Extent of Injury and First

Aid givenAid given- Telephone number from Telephone number from

where you’re callingwhere you’re calling

III. Activate Medical III. Activate Medical AssistanceAssistance

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Interview the PatientInterview the Patient SS – – SymptomsSymptoms

AA – – AllergiesAllergies

MM – – MedicationMedication

PP – – Previous/Present IllnessPrevious/Present Illness

LL – – Last Meal TakenLast Meal Taken

EE – – Events Prior to AccidentEvents Prior to Accident

Check Vital SignsCheck Vital Signs

IV. Do Secondary IV. Do Secondary SurveySurvey

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V. TriageV. Triage

comes from the French comes from the French word word ””triertrier””, meaning, meaning to to sortsort

process of assessing process of assessing patients to determine patients to determine management prioritiesmanagement priorities

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Categories:Categories:1.1. Emergent Emergent

-highest priority, conditions -highest priority, conditions are life threatening and need are life threatening and need immediate attentionimmediate attention

Airway obstruction, sucking Airway obstruction, sucking chest wound, shock, unstable chest wound, shock, unstable chest and abdominal wounds, chest and abdominal wounds, open fractures of long bonesopen fractures of long bones

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2.2. Urgent Urgent – – have serious health problems have serious health problems but not immediately life but not immediately life threatening ones. Must be seen threatening ones. Must be seen within 1 hourwithin 1 hour

Maxillofacial wounds without airway Maxillofacial wounds without airway compromise, eye injuries, stable compromise, eye injuries, stable abdominal wounds without abdominal wounds without evidence of significant hemorrhage, evidence of significant hemorrhage, fracturesfractures

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3.3. Non-urgent Non-urgent – – patients have episodic illness patients have episodic illness than can be addressed within 24 than can be addressed within 24 hours without increased hours without increased morbiditymorbidity

Upper extremity fractures, minor Upper extremity fractures, minor burns, sprains, small lacerations burns, sprains, small lacerations without significant bleeding, without significant bleeding, behavioral disorders or behavioral disorders or psychological disturbances.psychological disturbances.

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Field TRIAGEField TRIAGE

1.1. Immediate:Immediate: Injuries are life-threatening but Injuries are life-threatening but

survivable with minimal survivable with minimal intervention. Individuals in this intervention. Individuals in this group can progress rapidly to group can progress rapidly to expectant if treatment is delayed.expectant if treatment is delayed.

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2.2. Delayed: Delayed: Injuries are significant and Injuries are significant and

require medical care, but can require medical care, but can wait hours without threat to life wait hours without threat to life or limb. Individuals in this group or limb. Individuals in this group receive treatment only after receive treatment only after immediate casualties are treated.immediate casualties are treated.

3.3. Minimal:Minimal: Injuries are minor and Injuries are minor and

treatment can be delayed treatment can be delayed hours to days. Individuals in hours to days. Individuals in this group should be moved this group should be moved away from the main triage away from the main triage area.area.

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4.4. Expectant: Expectant: Injuries are extensive and Injuries are extensive and

chances of survival are chances of survival are unlikely even with definitive unlikely even with definitive care. care.

5.5. Fast-Track:Fast-Track: Psychological support Psychological support

neededneeded

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FIRST AIDFIRST AID

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Role of First AidRole of First Aid

Bridge the Gap Between Bridge the Gap Between the Victim and the the Victim and the PhysicianPhysician

Immediately start giving Immediately start giving interventions in pre-interventions in pre-hospital settinghospital setting

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Self-helpSelf-help

Health for OthersHealth for Others

Preparation for Preparation for DisasterDisaster

Safety AwarenessSafety Awareness

Value of First Aid Value of First Aid TrainingTraining

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BASIC LIFE BASIC LIFE SUPPORTSUPPORT

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Artificial RespirationArtificial Respirationa way of breathing air to a way of breathing air to

person’s lungs when person’s lungs when breathing ceased or stopped breathing ceased or stopped function.function.

Respiratory ArrestRespiratory Arresta condition when the a condition when the

respiration or breathing respiration or breathing pattern of an individual stops pattern of an individual stops to function, while the pulse to function, while the pulse and circulation may continue.and circulation may continue.

Causes: Causes: Choking, Choking, Electrocution, strangulation, Electrocution, strangulation, drowning and suffocation.drowning and suffocation.

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Methods:Methods:mouth to mouthmouth to mouth

mouth to nosemouth to nose

mouth to stomamouth to stoma

mouth to mouth and nosemouth to mouth and nose

mouth to barrier devicemouth to barrier device

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Procedure Infant(0-1yr) Child(1-8 yrs) Adult

1. Safe Approach Approach and assess situation

2. Assess for Response

Shout and gently pinch Gently shouting“are you ok?”

then shake the victim

3. Positioning Placed Supine on a firm and flat surface

4. Open the Airway

Check for foreign bodies then remove using finger sweepHead-tilt-chin-lift maneuverJaw-thrust Maneuver

5. Assess for Breathing

Bring cheek over the mouth and nose of the casualtyLook for chest movementListen for breath soundsFeel for breathing on your cheek

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The Casualty is Breathing: Place in recovery position Before moving casualty remove any objects safely 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 casualty’s chest and hold back of the

casualty’s hand against the nearest cheek With your other hand grasp the far thigh just above the knee, then

pull the casualty towards you and on to his or her side

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The Casualty is NOT Breathing:6. Go for Help - if someone responds to your shout for help send that

person to phone for ambulance- if you’re on your own, leave the casualty and make the

phone call for yourself* never leave if the patient has collapsed as a result of

trauma or drowning or if the casualty is a child

7. Give Rescue Breaths

5 rescue breaths 2 rescue breaths

- Place mouth over the nose and mouth of the infant

- look for chest rising

- pinch nose and ventilate via mouth

- look for chest rising

-seal lips around the mouth and blow steadily for 1.5 – 2 seconds

- look for chest rising

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When to Stop AR: When to Stop AR:

when the patient has spontaneous when the patient has spontaneous breathingbreathing

when the first aider is too when the first aider is too exhausted to continueexhausted to continue

when another first aider takes overwhen another first aider takes over

when EMS arrives and takes overwhen EMS arrives and takes over

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Cardiopulmonary Cardiopulmonary Resuscitation (CPR)Resuscitation (CPR)

Cardiac ArrestCardiac Arrest a condition when the persons a condition when the persons

breathing and circulation/pulse breathing and circulation/pulse stop at the same timestop at the same time

Causes: Causes: Cardiovascular Disease, Cardiovascular Disease, Heart Attack, MI Heart Attack, MI

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Management: Management:

External Chest CompressionExternal Chest Compression- consist of rhythmic application consist of rhythmic application

of pressure over the lower of pressure over the lower portion of the sternum just in portion of the sternum just in between the nipplebetween the nipple

Cardiopulmonary Resuscitation Cardiopulmonary Resuscitation = AR + ECC= AR + ECC

Goal: Rapid return of pulse, BP Goal: Rapid return of pulse, BP and consciousnessand consciousness

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Procedure Infant( 0-1 year)

Child (1-8 yrs)

Adult

1. Assess circulation for 10 seconds

Check brachial pulse < 60 bpm or below or absent

Check carotid pulse and if no pulse

Commence chest compression

2. Positioning of compression

Draw imaginary line between nipples and place two fingers on the sternum 1 finger breadth below this line

One hand on the sternum two fingers up from the xyphoid process

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3. AR:ECC 1 breath: 5 compression

2 breaths: 30 compression

4. Rate and Depth of compression

100/min 1/3 or 1.5 – 2 inches

Number of Cycle/ minute

5 cycles per minute

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When to STOP CPR:When to STOP CPR:S S – SPONTANEOUS BREATH – SPONTANEOUS BREATH

RESTOREDRESTORED

T T – TURNED OVER THE MEDICAL – TURNED OVER THE MEDICAL SERVICESSERVICES

OO – OPERATOR IS EXHAUSTED – OPERATOR IS EXHAUSTED TO CONTINUETO CONTINUE

PP – PHYSICIAN ASSUMES – PHYSICIAN ASSUMES RESPONSIBILITYRESPONSIBILITY

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COMPLICATIONS OF COMPLICATIONS OF CPR:CPR:

RIB FRACTURERIB FRACTURE

STERNUM FRACTURESTERNUM FRACTURE

LACERATION OF THE LIVER OR LACERATION OF THE LIVER OR SPLEENSPLEEN

PNEUMOTHORAX, HEMOTHORAXPNEUMOTHORAX, HEMOTHORAX

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CHAIN OF SURVIVALCHAIN OF SURVIVALEARLY ACCESSEARLY ACCESS – early – early

recognition of cardiac arrest, recognition of cardiac arrest, prompt activation of emergency prompt activation of emergency servicesservices

EARLY BLS EARLY BLS – prevent brain – prevent brain damage, buy time for the arrival damage, buy time for the arrival of defibrillatorof defibrillator

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EARLY DEFIBRILLATIONEARLY DEFIBRILLATION - 7-10% decrease per minute 7-10% decrease per minute

without defibrillationwithout defibrillation

EARLY ACLSEARLY ACLS – technique that – technique that attempts to stabilize patientattempts to stabilize patient

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TRAUMATRAUMA

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Head traumaHead trauma

Result of an external force applied Result of an external force applied to the head and brain causing to the head and brain causing disruption of physiologic stability disruption of physiologic stability locally, at the point of injury, as locally, at the point of injury, as well as globally with elevations in well as globally with elevations in ICP and potentially dramatic ICP and potentially dramatic changes in blood flow within the changes in blood flow within the brain.brain.

Trauma to the skull resulting in Trauma to the skull resulting in mild to extensive damage to the mild to extensive damage to the brain.brain.

Causes: vehicular accidents, fall, Causes: vehicular accidents, fall, acts of violence, sportsacts of violence, sports

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Types of Head Injuries Types of Head Injuries 1. Open1. Open

Scalp lacerationsScalp lacerations Fractures in the skullFractures in the skull Interruption of the dura materInterruption of the dura mater

2. Closed2. Closed Concussions – a jarring of the brain within Concussions – a jarring of the brain within

the skull with temporary loss of the skull with temporary loss of consciousnessconsciousness

Contusions – a bruising type of injury to Contusions – a bruising type of injury to the brain; may occur with subdural or the brain; may occur with subdural or extradural collections of blood.extradural collections of blood.

Contrecoup – decelerative forces throwing Contrecoup – decelerative forces throwing the brain back and forththe brain back and forth

Fractures – e.g. linear, depressed, Fractures – e.g. linear, depressed, compound comminutedcompound comminuted

3. Hemorrhage3. Hemorrhagecauses hematoma or clot formationcauses hematoma or clot formation

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Types of Hemorrhage/Hematoma:

1. epidural hematoma1. epidural hematoma the most serious type of the most serious type of

hematoma; forms rapidly and hematoma; forms rapidly and results from arterial bleedingresults from arterial bleeding

forms between the dura and forms between the dura and the skull from a tear int the the skull from a tear int the meningeal areameningeal area

2. Subdural hematoma2. Subdural hematoma - forms slowly and results from a venous - forms slowly and results from a venous bleedbleed

- a surgical emergency- a surgical emergency

3. Intracerebral 3. Intracerebral hemorrhagehemorrhage

- bleeding directly into the brain matter- bleeding directly into the brain matter

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Clinical manifestations:Clinical manifestations:

Altered level of consciousnessAltered level of consciousness ConfusionConfusion Papillary abnormalitiesPapillary abnormalities Altered or absent gag reflex or vomitingAltered or absent gag reflex or vomiting Absent corneal reflexAbsent corneal reflex Sudden onset of neurologic deficitsSudden onset of neurologic deficits Changes in vital signsChanges in vital signs Vision and hearing impairmentVision and hearing impairment CSF drainage from ears or noseCSF drainage from ears or nose Sensory dysfunctionSensory dysfunction SpasticitySpasticity Headache and vertigoHeadache and vertigo Movement disorders or reflex activity changesMovement disorders or reflex activity changes Seizure activitySeizure activity

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AssessmentAssessment

What time did the injury occur?What time did the injury occur?What caused the injury?What caused the injury?What was the direction and force What was the direction and force

of the blow?of the blow?Was there a loss of Was there a loss of

consciousness?consciousness?What was the duration of What was the duration of

unconsciousness?unconsciousness?Could the patient be aroused?Could the patient be aroused?

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Emergency interventions:Emergency interventions:Goal: “maintain oxygen and nutrient rich cerebral blood flow”Goal: “maintain oxygen and nutrient rich cerebral blood flow”

Monitor respiratory status and maintain a patent airwayMonitor respiratory status and maintain a patent airway monitor neurological status and vital signs (TPR,BP)monitor neurological status and vital signs (TPR,BP) monitor for increased ICPmonitor for increased ICP Head elevation 20 -30 degreesHead elevation 20 -30 degrees restrict fluids and monitor I & Orestrict fluids and monitor I & O immobilization of neckimmobilization of neck initiate normothermia measuresinitiate normothermia measures assess cranial nerve function, reflexes and motor and assess cranial nerve function, reflexes and motor and

sensory functionsensory function initiate seizure precautionsinitiate seizure precautions monitor for pain and restlessnessmonitor for pain and restlessness avoid administration of morphine sulfateavoid administration of morphine sulfate monitor for drainage from the nose or earsmonitor for drainage from the nose or ears if there is CSF leak, monitor for nuchal rigidityif there is CSF leak, monitor for nuchal rigidity do not attempt to clean the nose, suction or allow the client do not attempt to clean the nose, suction or allow the client

to blow the nose if drainage occursto blow the nose if drainage occurs do not clean te ear of drainage when noted but apply a loose, do not clean te ear of drainage when noted but apply a loose,

dry sterile dressingdry sterile dressing do not allow the client to coughdo not allow the client to cough

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Medical intervention:Medical intervention:

Osmotic diuretics – pulling water Osmotic diuretics – pulling water out of the extracellular space of out of the extracellular space of the edematous brain tissuethe edematous brain tissue

Loop diuretic – reduce incidence Loop diuretic – reduce incidence of rebound from osmotic diureticsof rebound from osmotic diuretics

Opioids – decreased agitationOpioids – decreased agitationSedatives – reduced anxiety and Sedatives – reduced anxiety and

promote comfort and agitationpromote comfort and agitationAntiepileptic drugs – to prevent Antiepileptic drugs – to prevent

seizuresseizures

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Surgical intervention:Surgical intervention:

CraniotomyCraniotomy

a surgical procedure that a surgical procedure that involves an incision through the involves an incision through the cranium to remove accumulated cranium to remove accumulated blood or tumorblood or tumor

complications include increased complications include increased ICP from cerebral edema, ICP from cerebral edema, hemorrhage or obstruction of hemorrhage or obstruction of the normal flow of CSFthe normal flow of CSF

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DENTAL TRAUMADENTAL TRAUMA

1.1. Tooth AcheTooth Ache Rinse mouth vigorously with warm water Rinse mouth vigorously with warm water

to clear out debristo clear out debris Use dental floss to remove any food that Use dental floss to remove any food that

might be wedged in between the teethmight be wedged in between the teeth Use cold pack on the outside of the cheek Use cold pack on the outside of the cheek

to manage swellingto manage swelling Soak cotton with Oil of Cloves and place it Soak cotton with Oil of Cloves and place it

on aching toothon aching tooth

2.2. Knocked- out toothKnocked- out tooth- - Place a sterile gauze pad or Place a sterile gauze pad or cotton ball into the tooth socket cotton ball into the tooth socket to prevent further bleedingto prevent further bleeding

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3. Broken tooth 3. Broken tooth Gently clean dirt and blood from the injured Gently clean dirt and blood from the injured

area with the use of clean cloth and warm area with the use of clean cloth and warm waterwater

Use cold compress to minimize swellingUse cold compress to minimize swelling

4. Bitten Tongue or Lip4. Bitten Tongue or Lip Using a clean cloth, apply direct pressure to Using a clean cloth, apply direct pressure to

the bleeding areathe bleeding area If swelling is present, apply cold compressIf swelling is present, apply cold compress

5. Objects wedged between the teeth5. Objects wedged between the teeth Try to remove object with a dental flossTry to remove object with a dental floss Guide the floss carefully to prevent bleedingGuide the floss carefully to prevent bleeding Do not remove the object with a sharp or Do not remove the object with a sharp or

pointed objectpointed object

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6. Orthodontic Problems6. Orthodontic Problems If a wire is causing irritation, cover the If a wire is causing irritation, cover the

end of the wire with the use of a cotton end of the wire with the use of a cotton ball/ piece of gauze until you can get to a ball/ piece of gauze until you can get to a dentistdentist

Do not attempt to remove a wire Do not attempt to remove a wire embedded in the gums, cheek or tongue. embedded in the gums, cheek or tongue. Instead, go immediately to the dentistInstead, go immediately to the dentist

7. Possible fractured jaw7. Possible fractured jaw Immobilize the jaw by any meansImmobilize the jaw by any means Apply cold compress to prevent swellingApply cold compress to prevent swelling

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CHEST TRAUMACHEST TRAUMA

Approximately a quarter of deaths Approximately a quarter of deaths due to trauma are attributed to due to trauma are attributed to thoracic injury. thoracic injury.

Immediate deaths are essentially Immediate deaths are essentially due to major disruption of the heart due to major disruption of the heart or of great vessels.or of great vessels.

Early deaths due to thoracic trauma Early deaths due to thoracic trauma include airway obstruction, cardiac include airway obstruction, cardiac tamponade or aspiration.tamponade or aspiration.

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Classification of Chest Classification of Chest Trauma:Trauma:

Blunt Trauma – results Blunt Trauma – results from sudden compression from sudden compression or positive pressure or positive pressure inflicted to the chest wall.inflicted to the chest wall.

Penetrating Trauma – Penetrating Trauma – occurs when foreign object occurs when foreign object penetrates the chest wall.penetrates the chest wall.

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Types of Chest TraumaTypes of Chest Trauma A. A. Blunt Chest Trauma Blunt Chest Trauma RIB FRACTURES RIB FRACTURES

- Fractured ribs may occur at the point - Fractured ribs may occur at the point of impact and damage to the underlying of impact and damage to the underlying lung may produce lung bruising or lung may produce lung bruising or puncture.puncture.- Commonly a result of crushing chest - Commonly a result of crushing chest injuriesinjuries

Assessment:Assessment:- Severe Pain- Severe Pain - Muscle - Muscle spasmspasm- Tenderness- Tenderness - - Subcutaneous Crepitus Subcutaneous Crepitus - Shallow Respirations- Shallow Respirations - - Reluctance to moveReluctance to move- Client splints chest- Client splints chest

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Management:Management:

1.1. RestRest

2.2. Ice Compress then Local HeatIce Compress then Local Heat

3.3. AnalgesiaAnalgesia

4.4. Splint the chest during Splint the chest during coughing or deep breathing coughing or deep breathing

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FLAIL FLAIL CHESTCHEST - The unstable segment moves - The unstable segment moves

separately and in an opposite separately and in an opposite direction from the rest of the direction from the rest of the thoracic cage during the thoracic cage during the respiration cyclerespiration cycle

Assessment:Assessment:- Paradoxical respirationsParadoxical respirations- Severe chest pain Severe chest pain - Dyspnea/ TachypneaDyspnea/ Tachypnea- CyanosisCyanosis- TachycardiaTachycardia

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Management:Management:

1.1. High Fowler’s position High Fowler’s position

2.2. Humidified O2Humidified O2

3.3. AnalgesiaAnalgesia

4.4. Coughing & deep breathingCoughing & deep breathing

5.5. Prepare for intubation with Prepare for intubation with mechanical ventilation with mechanical ventilation with positive end-expiratory pressure positive end-expiratory pressure ( PEEP ) for severe respiratory ( PEEP ) for severe respiratory failurefailure

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B. Penetrating Chest TraumaB. Penetrating Chest Trauma - occurs when a foreign object - occurs when a foreign object

penetrates the chest wallpenetrates the chest wall1.Pneumothorax1.Pneumothorax

- Accumulation of - Accumulation of atmospheric air in the pleural space atmospheric air in the pleural space

may lead to lung collapsemay lead to lung collapse

Types:Types: 1. Spontaneous Pneumothorax 1. Spontaneous Pneumothorax 2. Open Pneumothorax 2. Open Pneumothorax 3. Tension Pneumothorax3. Tension Pneumothorax

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Assessment:Assessment:DyspneaDyspnea Tachycardia TachycardiaTachypneaTachypnea Sharp chest pain Sharp chest pain Absent breathe sounds Absent breathe sounds Sucking soundSucking sound CyanosisCyanosis

Tracheal deviationTracheal deviation to the unaffected to the unaffected side with tension pneumothoraxside with tension pneumothorax

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Management:Management:

1. Apply dressing over an open chest wound1. Apply dressing over an open chest wound

2. O2 as Rx2. O2 as Rx

3. High Fowler’s3. High Fowler’s

4. Chest tube placement4. Chest tube placement

- Monitor for chest tube system- Monitor for chest tube system

- Monitor for subcutaneous emphysema- Monitor for subcutaneous emphysema

Chest Tube Drainage SystemChest Tube Drainage System

- returns (-) pressure to the intra-pleural - returns (-) pressure to the intra-pleural spacespace

- remove abnormal accumulation of air & - remove abnormal accumulation of air & fluids serves as lungs while healing is going fluids serves as lungs while healing is going onon

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Pulmonary EmbolismPulmonary Embolism

- Dislodgement of thrombus to - Dislodgement of thrombus to the pulmonary arterythe pulmonary artery

- Caused by thrombus & - Caused by thrombus & pulmonary embolipulmonary emboli

- Other risk factors: deep vein - Other risk factors: deep vein thrombosis, immobilization, thrombosis, immobilization, surgery, obesity, pregnancy, surgery, obesity, pregnancy, CHF, advanced age, prior CHF, advanced age, prior History of thromboembolism History of thromboembolism

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Assessment:Assessment:- DyspneaDyspnea- Chest painChest pain- Tachypnea & tachycardiaTachypnea & tachycardia- HypotensionHypotension- Shallow respirationsShallow respirations- Rales on auscultationRales on auscultation- CoughCough- Blood-tinged sputumBlood-tinged sputum- Distended neck veinsDistended neck veins- CyanosisCyanosis

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Management:Management:1. O2 as Rx1. O2 as Rx2. High Fowler’s2. High Fowler’s3. Maintain bed rest3. Maintain bed rest4. Incentive spirometry as Rx4. Incentive spirometry as Rx5. Pulse oximetry5. Pulse oximetry6. Prepare for intubation & mechanical 6. Prepare for intubation & mechanical

ventilation ventilation 7. IV heparin (bolus)7. IV heparin (bolus)8. Warfarin (Coumadin) 8. Warfarin (Coumadin) 9. Monitor PT & PTT closely9. Monitor PT & PTT closely10. Prepare the client for embolectomy, 10. Prepare the client for embolectomy,

vein ligation, or insertion of an vein ligation, or insertion of an umbrella filter as Rxumbrella filter as Rx

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ABDOMINAL TRAUMAABDOMINAL TRAUMAA. Penetrating Abdominal TraumaA. Penetrating Abdominal Trauma

Causes:Causes: - Gunshot wound- Gunshot wound - Stab wound- Stab wound - Embedded object from explosion- Embedded object from explosion

Assessment:Assessment: - Absence of bowel sound- Absence of bowel sound - -

Hypovolemic shockHypovolemic shock - Orthostatic hypotension- Orthostatic hypotension - Pain and - Pain and

tendernesstenderness

Management:Management: 1. Maintain hemodynamic status – IVF & blood 1. Maintain hemodynamic status – IVF & blood

transfusiontransfusion 2. Surgery- EXLAP2. Surgery- EXLAP 3. Peritoneal Lavage3. Peritoneal Lavage

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B. Blunt Abdominal TraumaB. Blunt Abdominal Trauma

Assessment:Assessment:

- Left upper quadrant pain (Spleen)- Left upper quadrant pain (Spleen)

- Right upper quadrant pain (liver)- Right upper quadrant pain (liver)

- Signs of hypovolemic shock - Signs of hypovolemic shock

Management:Management:

1. Maintain hemodynamic status1. Maintain hemodynamic status

2. Monitor VS and oxygen supplements2. Monitor VS and oxygen supplements

3. Assess signs and symptoms of shock3. Assess signs and symptoms of shock

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FOREIGN BODY FOREIGN BODY AND AIRWAY AND AIRWAY

OBSTRUCTIONOBSTRUCTION

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CAUSES:CAUSES:

improper chewing of large pieces improper chewing of large pieces of foodof food

aspiraton of vomitus, or a foreign aspiraton of vomitus, or a foreign bodybody

position of head, the tongueposition of head, the tongue

resulting to difficulty of breathing resulting to difficulty of breathing or respiratory arrestor respiratory arrest

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Types of obstructionTypes of obstruction

anatomical – anatomical – tongue and tongue and epiglottisepiglottis

mechanical – mechanical – coins, food, toy coins, food, toy etcetc

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Assessment and Assessment and clinical manifestations:clinical manifestations:

Mild airway obstructionMild airway obstruction can talk, breath and cough can talk, breath and cough

with high pitch breath soundwith high pitch breath sound cough mechanism not cough mechanism not

effective to dislodge foreign effective to dislodge foreign bodybody

Severe airway obstructionSevere airway obstruction can’t talk, breath or coughcan’t talk, breath or cough

Nasal flaring, cyanosis, Nasal flaring, cyanosis, excessive salivationexcessive salivation

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Intervention:Intervention:

CONCIOUS PATIENT:CONCIOUS PATIENT:

ask the victim, “are you choking?”ask the victim, “are you choking?” if the victim’s airway is obstructed partially, a if the victim’s airway is obstructed partially, a

crowing sound is audible; encourage the victim to crowing sound is audible; encourage the victim to cough.cough.

relieve the obstruction by heimlick maneuverrelieve the obstruction by heimlick maneuver Heimlich maneuver:Heimlich maneuver:

stand behind the victimstand behind the victim place arms around the victim’s waistplace arms around the victim’s waist make a fistmake a fist place the thumb side of the fist just above the place the thumb side of the fist just above the

umbilicus and well below the xyphoid process. umbilicus and well below the xyphoid process. Perform 5 quick in and up thrusts.Perform 5 quick in and up thrusts.

Use chest thrusts for the obese or for the Use chest thrusts for the obese or for the advanced pregnancy victims.advanced pregnancy victims.

continue abdominal thrusts until the object is continue abdominal thrusts until the object is dislodged or the victim becomes unconscious.dislodged or the victim becomes unconscious.

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UNCONSCIOUS PATIENT:UNCONSCIOUS PATIENT:

assess LOCassess LOC call for helpcall for help check for ABCscheck for ABCs open airway using jaw thrust techniqueopen airway using jaw thrust technique finger sweep to remove objectfinger sweep to remove object attempt ventilationattempt ventilation reposition the head if unsuccessful; reattempt ventilationreposition the head if unsuccessful; reattempt ventilation relieve the obstruction by the Heimlich maneuver with relieve the obstruction by the Heimlich maneuver with

five thrust; then finger sweep the mouthfive thrust; then finger sweep the mouth reattempt ventilationreattempt ventilation repeat the sequence of jaw thrust, finger sweep, breaths repeat the sequence of jaw thrust, finger sweep, breaths

and Heimlich maneuver until successfuland Heimlich maneuver until successful be sure to assess the victim’s pulse and respirationsbe sure to assess the victim’s pulse and respirations perform CPR if requiredperform CPR if required

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Choking child or infant:Choking child or infant: choking is suspected in infants and choking is suspected in infants and

children experiencing acute children experiencing acute respiratory distress associated respiratory distress associated with coughing, gagging, or stridor.with coughing, gagging, or stridor.

allow the victim to continue to allow the victim to continue to cough if the cough is forcefulcough if the cough is forceful

if cough is ineffective or if increase if cough is ineffective or if increase respiratory difficulty is still noted, respiratory difficulty is still noted, perform CPRperform CPR

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Foreign objects in the earForeign objects in the ear

Don’t probe the ear with a toolDon’t probe the ear with a tool

Remove the object if clearly visibleRemove the object if clearly visible

Try using gravity and shake the head gentlyTry using gravity and shake the head gently

Try using oil for an insectTry using oil for an insect

Don’t use oil to remove any other object than Don’t use oil to remove any other object than an insectan insect

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Foreign objects in the Foreign objects in the eyeeye

Flush eye clear with use of Flush eye clear with use of waterwater

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Foreign objects in the Foreign objects in the nosenose

Don’t probe at the object Don’t probe at the object with cotton ball or other with cotton ball or other tooltool

Breathe thru your mouth Breathe thru your mouth until the object is removeduntil the object is removed

Blow your nose gently to Blow your nose gently to try to free the objecttry to free the object

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POISONINGPOISONING

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PoisonPoison

Any substance that impairs Any substance that impairs health or destroys life when health or destroys life when ingested, inhaled or otherwise ingested, inhaled or otherwise absorbed by the body. absorbed by the body.

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Suspect poisoning if:Suspect poisoning if:

1.1. Someone suddenly becomes Someone suddenly becomes ill for no apparent reason and ill for no apparent reason and begins to act unusuallybegins to act unusually

2.2. Is depressed and suddenly Is depressed and suddenly becomes illbecomes ill

3.3. Is found near a toxic Is found near a toxic substance and is breathing substance and is breathing any unusual fumes, or has any unusual fumes, or has stains, liquid or powder in his stains, liquid or powder in his or her clothing, skin or lipsor her clothing, skin or lips

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Ingestion PoisoningIngestion Poisoning BotulismBotulism – Clostridium botulinum. – Clostridium botulinum.

From canned foodsFrom canned foodsNote: Save the VomitusNote: Save the Vomitus

Staphylococcus AureusStaphylococcus Aureus – from – from unrefrigerated cram filled foods, fishunrefrigerated cram filled foods, fish

Note: Save the VomitusNote: Save the Vomitus Petroleum PoisoningPetroleum Poisoning – includes – includes

poisoning with a substance such as poisoning with a substance such as kerosene, fuel, insecticides and kerosene, fuel, insecticides and cleaning fluidscleaning fluids

Note: Never induce vomiting! Note: Never induce vomiting! May result in May result in Chemical Chemical PneumoniaPneumonia

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Acetaminophen PoisoningAcetaminophen Poisoning – most – most common drug accidentally common drug accidentally ingested by childreningested by children

Antidote: AcetylcysteineAntidote: AcetylcysteineCorrosive Chemical PoisoningCorrosive Chemical Poisoning – –

strong detergents and dry strong detergents and dry cleanerscleaners

results in drooling of saliva, painful burning results in drooling of saliva, painful burning sensation and pain and redness in the mouthsensation and pain and redness in the mouth

Note: Never induce vomiting, may Note: Never induce vomiting, may cause further injury cause further injury

Activated Charcoal, Milk of MagnesiaActivated Charcoal, Milk of Magnesia

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Diagnostics:Diagnostics: Baseline ABG should be obtained periodicallyBaseline ABG should be obtained periodically Baseline blood samples (CBC, BUN, Baseline blood samples (CBC, BUN,

electrolytes)electrolytes) ECG (since many toxic agents affect cardiac ECG (since many toxic agents affect cardiac

rhythm)rhythm)

Assessment: Assessment: HeadacheHeadache Double visionDouble vision Difficulty in swallowing, talking and breathingDifficulty in swallowing, talking and breathing Dry sore throatDry sore throat Muscle incoordinationMuscle incoordination Nausea and vomiting Nausea and vomiting

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Management:Management: Check victim’s ABCs. Begin Check victim’s ABCs. Begin

rescue breathing if necessaryrescue breathing if necessary If ABCs are present but the If ABCs are present but the

victim is unconscious, place him victim is unconscious, place him in recovery positionin recovery position

If victim starts having seizures, If victim starts having seizures, protect him from injuryprotect him from injury

If victim vomits, clear the airwayIf victim vomits, clear the airway Calm and reassure the victim Calm and reassure the victim

while calling for medical helpwhile calling for medical help

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P – P – Prevention. Child ProofingPrevention. Child Proofing

O – O – Oral fluids in large amountOral fluids in large amount

I - I - IpecacIpecac

S – S – Support respiration and Support respiration and circulationcirculation

O - O - Oral Activated CharcoalOral Activated Charcoal

N - N - Never induce vomiting if Never induce vomiting if substance ingested is corrosivesubstance ingested is corrosive

LAVAGELAVAGE

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Inhalation PoisoningInhalation Poisoning Carbon Monoxide PoisoningCarbon Monoxide Poisoning

Carbon monoxide is a colorless, odorless & Carbon monoxide is a colorless, odorless & tasteless gas tasteless gas

Assessment:Assessment:- appears intoxicated - appears intoxicated

- Muscle weakness- Muscle weakness - Headache & dizziness- Headache & dizziness

- Pink or cherry red skin (not a - Pink or cherry red skin (not a reliable sign)reliable sign) - Confusion which may eventually - Confusion which may eventually lead to coma lead to coma

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Management:Management:1.1. Check ABCsCheck ABCs

2. Remove victim from exposure2. Remove victim from exposure

3. Loosen tight clothing3. Loosen tight clothing

4. Administer O2 (100% delivery)4. Administer O2 (100% delivery)

5. Initiate CPR if required5. Initiate CPR if required

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SPECIAL SPECIAL WOUNDSWOUNDS

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Human BitesHuman Bites

– – staphylococcus and staphylococcus and streptococcus infection streptococcus infection

Management: Management:

1. Cleanse and irrigate the 1. Cleanse and irrigate the woundwound

2. Assist with wound exploration2. Assist with wound exploration

3. Culture the wound site3. Culture the wound site

4. Tetanus toxoid and vaccine to 4. Tetanus toxoid and vaccine to stimulate antibody productionstimulate antibody production

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Animal biteAnimal bite

– – dog and cat bite dog and cat bite

Management:Management:

1.1. Wash wound with soap Wash wound with soap and waterand water

2.2. Tetanus toxoid and Tetanus toxoid and vaccine to stimulate vaccine to stimulate antibodiesantibodies

3.3. Rabies Vaccine and Rabies Vaccine and immunoglobulinimmunoglobulin

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Snake BiteSnake Bite

– – Infection can be neurotoxic or Infection can be neurotoxic or hemotoxichemotoxic

Assessment:Assessment: EdemaEdema EcchymosisEcchymosis PetechiaePetechiae FeverFever Nausea and VomitingNausea and Vomiting Possible hypotensionPossible hypotension Muscle fasciculationMuscle fasciculation Hemorrhage, shock and pulmonary Hemorrhage, shock and pulmonary

edema edema

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Management:Management:

1. Establish ABCs 1. Establish ABCs

2. Immobilize bitten arm or extremity2. Immobilize bitten arm or extremity

3. Remove constricting items3. Remove constricting items

4. Provide warmth4. Provide warmth

5. Cleanse the wound5. Cleanse the wound

6. Cover wound with light sterile 6. Cover wound with light sterile dressingdressing

7. Don’t attempt to remove the 7. Don’t attempt to remove the venomvenom

8. Anti venom therapy 8. Anti venom therapy

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Insect Bites/ Bee stingsInsect Bites/ Bee stings

Assessment:Assessment: Itching, dyspneaItching, dyspnea Chest tightness, dizziness, Chest tightness, dizziness,

urticariaurticaria Nausea, vomiting,diarrhea Nausea, vomiting,diarrhea

Abdominal cramps, flushing Abdominal cramps, flushing Laryngeal edemaLaryngeal edema Respiratory arrest Respiratory arrest

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Management:Management:

1. Remove stinger by scraping1. Remove stinger by scraping

2. Cleanse the site2. Cleanse the site

3. If anaphylaxis occurs, give 3. If anaphylaxis occurs, give oxygen and medicationsoxygen and medications

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TRAUMA TRAUMA RELATED TO RELATED TO

ENVIRONMENTAENVIRONMENTAL EXPOSUREL EXPOSURE

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HEAT EXHAUSTIONHEAT EXHAUSTION

Assessment:Assessment: Nausea and vomiting Nausea and vomiting increased temperature increased temperature Muscle crampsMuscle cramps Tachypnea and TachycardiaTachypnea and Tachycardia Orthostatic hypotensionOrthostatic hypotension MalaiseMalaise Irritability and anxietyIrritability and anxiety

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Management:Management: Check ABCsCheck ABCs

Move to cool areaMove to cool area

Give salted water for vomiting Give salted water for vomiting periodsperiods

Relieve cramps by firm pressureRelieve cramps by firm pressure

ECG and ABG monitoringECG and ABG monitoring

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FROSTBITEFROSTBITE

Assessment:Assessment:

Hard, cold extremitiesHard, cold extremities

White or mottled blue White or mottled blue extremityextremity

Extremity insensitive to Extremity insensitive to touchtouch

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Management:Management:Remove constrictive clothing and jewelryRemove constrictive clothing and jewelry

Prevent ambulation if lower extremity is Prevent ambulation if lower extremity is involvedinvolved

Institute rewarming measuresInstitute rewarming measures

Once rewarmed, elevate extremity to Once rewarmed, elevate extremity to prevent swellingprevent swelling

Apply sterile gauze or cotton in between Apply sterile gauze or cotton in between digits to prevent macerationdigits to prevent maceration

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NEAR NEAR DROWNINGDROWNING

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Four Methods of Water Four Methods of Water Rescue:Rescue:

1.1. Reaching AssistReaching Assist

2.2. Throwing AssistThrowing Assist

3. Rowing Assist3. Rowing Assist

4. Wading Assist4. Wading Assist

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Assessment:Assessment:

Abdominal distentionAbdominal distention ConfusionConfusion IrritabilityIrritability LethargyLethargy Shallow gasping respirationsShallow gasping respirations

UnconsciousnessUnconsciousness vomitingvomiting Absent breathingAbsent breathing

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Management:Management: Assess ABCsAssess ABCs

Give CPR and AR as necessaryGive CPR and AR as necessary

Check patient’s temperatureCheck patient’s temperature

Administer rewarming measures as Administer rewarming measures as necessarynecessary

Monitor lab results(electrolytes) Monitor lab results(electrolytes) and ECG and ECG

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BURN TRAUMABURN TRAUMA

Is the damage caused to skin and Is the damage caused to skin and deeper body structures by heat deeper body structures by heat (flames, scald, contact with heat) , (flames, scald, contact with heat) , electrical, chemical or radiationelectrical, chemical or radiation

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FACTORS FACTORS DETERMINING DETERMINING

SEVERITY OF BURN:SEVERITY OF BURN:1. age – mortality rates are higher for children < 4 yrs of age 1. age – mortality rates are higher for children < 4 yrs of age and for clients > 65 yrs of ageand for clients > 65 yrs of age

2. Patient’s medical condition – debilitating disorders such as 2. Patient’s medical condition – debilitating disorders such as cardiac, respiratory, endocrine and renal disorders cardiac, respiratory, endocrine and renal disorders negatively influence the client’s response to injury and negatively influence the client’s response to injury and treatment.treatment.

mortality rate is higher when the client has a mortality rate is higher when the client has a pre-existing disorder at the time of the burn injurypre-existing disorder at the time of the burn injury

3. location – 3. location – burns on the head, neck and chest are associated with burns on the head, neck and chest are associated with

pulmonary complications;pulmonary complications; burns on the face are associated with corneal burns on the face are associated with corneal

abrasion;abrasion; burns on the ear are associated with auricular burns on the ear are associated with auricular

chondritis;chondritis; hands and joints require intensive therapy;hands and joints require intensive therapy; the perineal area is prone to autocontamination by the perineal area is prone to autocontamination by

urine and feces;urine and feces; circumferential burns of the extremities can produce circumferential burns of the extremities can produce

a tourniquet-like effect and lead to vascular a tourniquet-like effect and lead to vascular compromise (compartment syndrome).compromise (compartment syndrome).

4. Depth4. Depth

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4. Depth

ClassificationClassificationAffected PartAffected Part Description of WoundDescription of Wound What to ExpectWhat to Expect

11stst degree degreesuperficialsuperficial

EpidermisEpidermis Pin, painful “sunburn”Pin, painful “sunburn”Blisters form after 24 Blisters form after 24 hourshours

Discomfort last after 48 hrs; heals in 3-7 daysDiscomfort last after 48 hrs; heals in 3-7 days

22ndnd degree degreepartial thicknesspartial thickness

Pediermis and part of Pediermis and part of the dermisthe dermis

Red, wet blisters, Red, wet blisters, bullae very painfulbullae very painful

Heals in 2-3 weeks, in no complicationHeals in 2-3 weeks, in no complication

22ndnd degree degreedeep partial deep partial thicknessthickness

Only the skin Only the skin appendages in the appendages in the hair follicle remainhair follicle remain

Waxy white, difficult Waxy white, difficult to distinguish from 3to distinguish from 3rdrd degree except hair degree except hair growth becomes growth becomes apparent in 7-10 apparent in 7-10 days, little or no paindays, little or no pain

Slow to heal 94-8 weeks) surgical incision and grafting Slow to heal 94-8 weeks) surgical incision and grafting unless has complicationunless has complication

33rdrd degree degreeFull thicknessFull thickness

Epidermis, dermis Epidermis, dermis and subcutaneous and subcutaneous tissue . no skin tissue . no skin appendagesappendages

-Dry, Dry, leathery, leathery, may be red may be red or blackor black-May have May have thrombosed thrombosed veinsveins-Marked Marked edemaedema-Distal Distal circulation circulation may be may be decreaseddecreased-PainlessPainless

Requires excision and grafting.Requires excision and grafting.10- 14 days for graft to revascularize10- 14 days for graft to revascularize

44thth degree degreedeep full thicknessdeep full thickness

Skin, muscle, tendon, Skin, muscle, tendon, bondebonde

Dry, charred, bone Dry, charred, bone may be visiblemay be visible

Requires excision, grafting and sometimes amputationRequires excision, grafting and sometimes amputation

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5. Size: Rule of nine

AssessmentAssessmentChild < 3 years Child < 3 years

oldoldAdultAdult

Head and neckHead and neck 18%18% 9%9%

1 arm1 arm 9%9% 9%9%

Posterior trunkPosterior trunk 18%18% 18%18%

Anterior trunk Anterior trunk 18%18% 18%18%

1 leg1 leg 14%14% 18%18%

PerineumPerineum 1%1% 1%1%

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6. Temperature6. Temperature determines the extent of injurydetermines the extent of injury

7. Exposure to the Source7. Exposure to the Source Thermal Burns – caused by exposure to Thermal Burns – caused by exposure to

flames, hot liquids, steam or hot flames, hot liquids, steam or hot objectsobjects

Chemical Burns – caused by tissue Chemical Burns – caused by tissue contact with strong acids, alkalis or contact with strong acids, alkalis or organic compoundsorganic compounds

Electrical Burns – result in internal Electrical Burns – result in internal tissue damaging, alternating current is tissue damaging, alternating current is more dangerous than direct current for more dangerous than direct current for it is associated with cardiopulmonary it is associated with cardiopulmonary arrest, ventricular fibrillation, titanic arrest, ventricular fibrillation, titanic muscle contractions, and long bone muscle contractions, and long bone and vertebral fractures.and vertebral fractures.

Radiation Burns – are caused by Radiation Burns – are caused by exposure to ultraviolet light, x-rays or exposure to ultraviolet light, x-rays or a radioactive source.a radioactive source.

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Types of Burns and Types of Burns and their Treatment:their Treatment:

ScaldScald burn caused by hot liquidburn caused by hot liquid immediately flush the burn area with water (under a tap immediately flush the burn area with water (under a tap

or hose for up to 20 min)or hose for up to 20 min) if no water is readily available, remove clothing if no water is readily available, remove clothing

immediately as clothing soaked with hot liquid retains immediately as clothing soaked with hot liquid retains heatheat

FlameFlame Smother the flames with a coat or blanket, get the Smother the flames with a coat or blanket, get the

victim on the floor or ground (stop, drop, and Roll)victim on the floor or ground (stop, drop, and Roll) Prevent victim from runningPrevent victim from running If water is available, immediately cool the burn area If water is available, immediately cool the burn area

with waterwith water If water is not available, remove clothing; avoid pulling If water is not available, remove clothing; avoid pulling

clothing across the burnt faceclothing across the burnt face Cover the burn area with a loose, clean, dry cloth to Cover the burn area with a loose, clean, dry cloth to

prevent contaminationprevent contamination Do not break blisters or apply lotions, ointments, Do not break blisters or apply lotions, ointments,

creams or powdercreams or powder AirwayAirway

if face or front of the trunk is burnt, there could be if face or front of the trunk is burnt, there could be burns to the airwayburns to the airway

there is a risk of swelling or air passage, leading to there is a risk of swelling or air passage, leading to difficulty in breathingdifficulty in breathing

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Smoke inhalationSmoke inhalation Urgent treatment is required with care of the Urgent treatment is required with care of the

airway, breathing and circulationairway, breathing and circulation When 02 in the air is used up by fire, or replaced by When 02 in the air is used up by fire, or replaced by

other gases, the oxygen level in the air will be other gases, the oxygen level in the air will be dangerously lowdangerously low

Spasm in the air passages as a result of irritation by Spasm in the air passages as a result of irritation by smoke or gasessmoke or gases

Severe burns to the air passages causing swelling Severe burns to the air passages causing swelling and obstructionand obstruction

Victim will show signs and symptoms of lack of O2. Victim will show signs and symptoms of lack of O2. He may also be confused or unconsciousHe may also be confused or unconscious

ElectricalElectrical check for “Danger”check for “Danger” turn of the electricity supply if possibleturn of the electricity supply if possible avoid any direct contact with the skin of the victim avoid any direct contact with the skin of the victim

or any conducting material touching the victim until or any conducting material touching the victim until he is disconnectedhe is disconnected

once the area is safe, check the ABCsonce the area is safe, check the ABCs if necessary, perform rescue breathing or CPRif necessary, perform rescue breathing or CPR

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ChemicalChemical Flood affected area with water for 20-Flood affected area with water for 20-

30 min30 min Remove contaminated clothingRemove contaminated clothing If possible, identify the chemical for If possible, identify the chemical for

possible subsequent neutralizationpossible subsequent neutralization Avoid contact with the chemicalAvoid contact with the chemical

SunburnSunburn Exposure to ultraviolet rays in natural Exposure to ultraviolet rays in natural

sunlight is the main cause of sunburnsunlight is the main cause of sunburn General skin damage and eventually General skin damage and eventually

skin cancer developsskin cancer develops The signs and symptoms of sunburn The signs and symptoms of sunburn

are pain, redness and feverare pain, redness and fever