NEW Triage and Disaster Nursing-Paul

7/29/2019 NEW Triage and Disaster Nursing-Paul

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BASIC LIFE SUPPORT, TRIAGE, DISASTER

Christian Paul S. Biluan, RN, USRN CPB

INDICATIONS:RESPIRATORY ARREST= withpulse presentCARDIAC ARREST = withoutpulse

1. Recognition and Activation of EMS

2. Early CPR

3. Defibrillation

4. ACLS

5. Post Cardiac Arrest CareCPB

Adult

10-12 breaths per min

Child / Infant


If with Advanced Airway


CPB

CPB CPB


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Common cause is SUDDENCARDIAC ARREST (SCA)

Latest Update: 2010

C-A-B method

CPB CPB

Adult / Child / Infant

30 compressions : 2 breaths

At least 100/min

*For 2-rescuer 15:2 in

children&infants

CPB CPB

CPB

P Power onA Attach Electrode

A Analyze Rhythm

S Shock if needed

Resume CPR 1 cycle then repeat

CPB


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CPB

From the French word trier whichmeans to sort out or to choose.Triage is a process which places theRIGHT PATIENT in the RIGHT PLACEat the RIGHT TIME to receive theRIGHT LEVEL OF CARE.Principle: to do the GREATEST GOODfor the GREATEST NUMBER OFAFFLICTED.

CPB

Triage is THE CLASSIFYING OFVICTIMS according to the severityof the injury, urgency of treatmentand place of treatmentNurses who specialize in triagingare called as TRIAGE NURSETriaging requires critical thinkingand prioritizing skills

CPB

INTERNAL:SICKEST PATIENTS ARE GIVEN PRIORITY.The highest intensity of care is provided to themost seriously ill patients, even if those patientshave a low probability of survival.

EXTERNAL:WISE ALLOCATION OF LIMITED RESOURCES.Treatment is directed towards the people whohave high chances of survival with immediatecare with the least use of resources or does notrequire extraordinary resources

CPB

3- tierEmergent requires treatmentimmediately or within 15 to 30minutesUrgent serious illness or injurythat must be attended to within 2hoursNon-urgent can wait more than 2hours

CPB

4-TierExpectant victim is dead or expectedto dieImmediate Critical; life threateningcompromised airway, shock, hemorrhageDelayed Minor illness or injury;requires treatment within 20 minutes to2 hoursMinimal/Fast-Track walking wounded;first aid treatment

CPB


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5-TierDOA/DyOA Victim is dead or dying.Emergent life threatening injuries,needs immediate attentionUrgent must be treated within 1-2hoursNon-Urgent Ambulatory, walking-woundedNo Injury No treatment is necessary

CPB

RedClients who have life threateningconditonsNeed IMMEDIATE CARE

YellowClients who have cases that are not life-threatening if treated promptlyCare should be given within 1-2 hours

GreenClients who have local injuries

BlackClients who are dead or dying

CPB

You are a triage nurse responding to a masscasualty after an MRT bombing withestimated 1000 victims. Which of thefollowing patients will you attend to first?a. 65yo with facial lacerations, cryingintenselyb. 40yo with arm bruises and unconsciousc. 29yo unconscious, no pulse with pupilsconstrictedd. 37yo with open fracture of femur

CPB

You are a triage nurse responding to a masscasualty after an MRT bombing withestimated 1000 victims. Which of thefollowing patients will you attend to first?a. 65yo with facial lacerations, cryingintenselyb. 40yo with arm bruises and unconsciousc. 29yo unconscious, no pulse with pupilsconstrictedd. 37yo with open fracture of femur

CPB

After a sustained earthquake in the hospital,the west wing collapsed and the followingpatients were brought to the ED. As anEmergency Nurse who will you prioritize?

a. 29yo unconscious, no pulse, irregularbreathingb. 2yo with head laceration, projectilevomitingc. 40yo disoriented and confusedd. 13yo with ear bleeding and facial bruises

CPB

After a sustained earthquake in the hospital,the west wing collapsed and the followingpatients were brought to the ED. As anEmergency Nurse who will you prioritize?

a. 29yo unconscious, no pulse, irregularbreathingb. 2yo with head laceration, projectilevomitingc. 40yo disoriented and confusedd. 13yo with ear bleeding and facial bruises

CPB


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1. A 63 yo Pt with Chest pain

2. A pt presenting sx of Bells palsy

3. An elderly with Pneumothorax4. A MVA victim Open leg fractures

5. A sportsman with sprains

6. A beggar with Multiple abdominal injury

7. A burn victim with 20% TBSA affected

8. A child with penetrating eye injury

9. A lady with wrist fractures

10. A GSW victim unresponsive, no BP, pulseCPB

FBAOShockHemothorax, pneumothorax, chest traumaAsphyxiaUnstable chest and abdominal woundsIncomplete amputationsOpen fractures of long bones2nd/3rd degree burns of 1540% total bodysurface area.

CPB

Stable abdominal wounds without evidenceof significant hemorrhage;soft tissue injuries;maxillofacial wounds without airwaycompromise;vascular injuries with adequate collateralcirculation;genitourinary tract disruption;fractures requiring open reduction,dbridement, and external fixation;most eye and CNS injuries. CPB

Upper extremity fracturesminor burnsSprainssmall lacerations withoutsignificant bleedingbehavioral disorders orpsychological disturbances.

CPB

Unresponsive patients with penetrating headwounds,high spinal cord injuries,wounds involving multiple anatomical sites andorgans,2nd/3rd degree burns in excess of 60% of bodysurface area,seizures or vomiting within 24 hr after radiationexposure,profound shock with multiple injuries,agonal respirations;no pulse, no BP, pupils fixed and dilated.

CPB

Never move a casualty backward (against theflow).Never hold a critical patient for further care.Salvage life over limb.Triage providers do not stop to treat patients.Never move patients before triage except incases of:Risks due to bad weather.Impending darkness or darkness has fallen.A continued risk of injury.Medical facilities are immediately available.

CPB


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A disaster is any human-made or

natural event that causes destruction

and devastation that cannot be

alleviated without assistance

Types:

Internal within the health care agency

External outside the health care agency

CPB

Natural Disasters typhoons, flashfloods,hurricanes, wildfires, thunderstorms, earthquake,blizzards, hailstorms, epidemics, droughts,landslideHuman-made Disasters

Biological WarfareChemical and Hazardous material (HAZMAT) IncidentsRadiologic DisastersTerrorism AttacksWarTransportation AccidentsStructural Collapse and Fires

CPB

CPB

Disasters are often classified by the resultant anticipatednecessary response:Level I: Local emergency response personnel andorganizations can contain and ef fectively manage thedisaster and its aftermath.Level II: Regional efforts and aid from surroundingcommunities are sufficient to manage the effects of thedisaster.Level III: Local and regional assets are overwhelmed;statewide or federal assistance is required.

CPB

1. Mitigation action or measures thatcan prevent the occurrence of adisaster or reduce its effects

2. Preparedness establishing disasterplans and disaster drills3. Response putting disaster plans intoaction; save lives and prevent damage4. Recovery actions taken to return to anormal situation5. Evaluation

CPB

CRITICAL INCIDENT STRESSMANAGEMENTis an approach to preventing andtreating the emotional trauma thatcan affect emergency responders asa consequence of their jobs and thatcan also occur to anyone involved ina disaster

CPB


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1. Defusing is a process by which theindividual receives education aboutrecognition of stress reactions andmanagement strategies for handlingstress.2. Debriefing is a more complicatedintervention; it involves a 2- to 3- hourprocess during which participants areasked about their emotional reactions tothe incident, what symptoms they may beexperiencing, and other psychologicalramifications.

CPB

Phases:Alert phase - during which staff remain at theirregular positions, service provision isuninterrupted, and faculty and staff await furtherinstructions from their supervisorsResponse phase - Response phase, during whichdesignated staff report to supervisors or thecommand post for instructions, the response planis activated, and nonessential services aresuspendedExpanded response phase - when additionalpersonnel are required, off-duty staff are called in,and existing staff may be reassigned based onpatient needs CPB

Biologic WafareChemical WarfareNuclear Radiation

CPB

VIRALSmallpox SEPSIS

BACTERIALAnthrax PeumoniaPlague PneumoniaTularemia PneumoniaBotulism Respiratory Arrest

CPB

1. VESICANT Agents Causes blister formation and burns Lewisite, Sulfur mustard, Nitrogen

mustard

2. NERVE Agents Inhibits Cholinesterase Excessive Parasympathetic effects Sarin, Soman Organophosphates CPB

3. BLOOD Agents Inhibits Aerobic Metabolism Cyanide Antidote: Na nitrite, Nathiocyanate, Amyl nitrite,hydroxycobalamin

4. PULMONARY Agents Separates alveoli and capillarymembrane

Phosgene, ChlorineCPB


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Acute Radiation Syndrome Phases1. Prodromal 48 to 72 hrs postexposure Anorexia, NV, Diarrhea High doses Fever, Respiratorydistress

2. Latent phase up to 3wks Bone marrow suppression

3. Ilness phaseInfection, bleeding, FE Imbalance, shock

4. Death (or Recovery)Increased ICP and seizure

CPB CPB

CPB CPB

Ensure SAFETY of respondersDon PPEDecontaminate VictimsTriage and TreatReport to Authorities

Philippines - NDCCCPB

LEVEL ASelf Contained Breathing Apparatus (SCBA)Chemical-resistant suit, gloves, bootsLEVEL BSCBAChemical-resistant suitLEVEL CAir-purified Respirator (APR)Chemical-resistant suit, splash hood, gloves, bootsLEVEL DRegular Uniform

CPB


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CPB CPB

CPB CPB

1.Go with the flow

2. Dont go slow

3. Life over limb

4. Dont go limp

5. Dont move patients before

triage, except in cases of risks

6. Triage first, dont make it worst

CPB CPB

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NEW Triage and Disaster Nursing-Paul