Emergency and Critical Care

Basic life support (BLS)



A means of providing oxygen to the brain, heart and other organs until help arrives Also known as CARDIOPULMONARY RESUSCITATION

Basic life support (BLS)



An adult is a person above age 8 A child is any person age 1 to 8 years old An infant is anyone under 1 year

Basic life support (BLS)



The BLS follows the A-B-C Aprinciple

A= airway B= breathing C= circulation

Basic life support (BLS)



Causes of cardiac arrest

Respiratory arrest Direct injury Drug overdose Cardiac arrhythmias

Basic life support (BLS) ADULT



STEPS in CPR: First STEP!!!

ASSESSMENT: determine Unresponsiveness Assess for 5-10 seconds 5 Shake the victims shoulder and ask: are you okay

Basic life support (BLS) ADULT



STEPS in CPR: Second Step

Survey the area

Basic life support (BLS) ADULT



STEPS in CPR: Third Step

Call for HELP Activate emergency medical system Note: for child and infant this is done LAST

Basic life support (BLS) ADULT



STEPS in CPR: Fourth step

Place Victim in Supine position on a flat firm surface Log roll the patient when moving

Basic life support (BLS) ADULT



STEPS in CPR: Fifth step

OPEN the airway

Head tilt-Chin Lift method tilt Jaw thrust maneuver if neck injury is suspected

Basic life support (BLS) ADULT



STEPS in CPR: Sixth step Assess BREATHING

Place ear over the nose and mouth  Look for chest movement  Perform for 3-5 SECONDS 3

Basic life support (BLS) ADULT



STEPS in CPR: Sixth step Assess BREATHING



If breathing: place on side if no neck injury; DO NOT move if with neck injury

If NOT BREATHING: deliver INITIALLY 2 rescue breath via mouth to mouth  Then deliver 10-12 breaths/minute 10

Basic life support (BLS) ADULT



STEPS in CPR: Seventh step Assess CIRCULATION

Check for the carotid pulse on the side close to you for 5-10 SECONDS 5 If with (+) pulse ; continue giving 1010-12 breaths/minute


Basic life support (BLS) ADULT



STEPS in CPR: Seventh step Assess CIRCULATION

If withOUT pulse: START Chest Compression  Correct hand placement: LOWER HALF of sternum one hand over the other with fingers interlacing  Depress: 1 to 2 INCHES 8080-100 compressions/min


Basic life support (BLS) ADULT



STEPS in CPR: Seventh step Assess CIRCULATION

If withOUT pulse: START Chest Compression  ONE-rescuer: 15 chest: 2 breaths ONE 

TWOTWO-rescuer: 5 chest: 1 breath DO FOUR cycles and re-assess for repulse

Basic life support (BLS) CHILD

1-8 years old  AIRWAY: assess unresponsiveness and keep airway patent by HTCL or JT  BREATHING: assess for airflow and chest movement
If breathing: maintain patent airway If NOT breathing : deliver 2 rescue breaths by mouth to mouth DELIVER 20 breaths/minute

Basic life support (BLS) CHILD

1-8 years old  CIRCULATION: assess the carotid pulse
If with pulse: continue to deliver 15-20 15breaths/minute If WITHOUT pulse: start chest compression Correct hand placement: lower half of sternum using heel of ONE HAND DELIVER: 1 to 1 inches 8080- 100 chest compressions/min 5:1 (do 20 cycles EMS)

Basic life support (BLS) INFANT

Less than 1  Determine unresponsiveness  AIRWAY: Place head of infant in NEUTRAL position  BREATHING: assess for rise-fall of risechest and airflow
If breathing: maintain patent airway If NOT breathing: initiate 2 rescue breathing via mouth to mouth and nose DELIVER 20 breaths/min SLOWLY

Basic life support (BLS) INFANT Less than 1



CIRCULATION: assess for pulse: The BRACHIAL pulse is utilized!!

If with pulse: continue to deliver 20 breaths/min If WITHOUT pulse, start chest compression Correct hand placement: just below the nipple line in the sternum using 2-3 fingers of one hand!! DELIVER: to 1 inch depth 100 chest com/min 5:1 ratio (do 20 cycles EMS)

AIRWAY Obstruction


Incomplete
Crowing sound is heard encourage to cough

Complete
Clutching of the neck Ask: Are you choking? Perform Heimlichs

AIRWAY Obstruction


Complete
If patient becomes unconscious:
Place supine on flat surface  Perform tongue-jaw lift maneuver tongue FINGERSWEEP to remove object  Open airway and attempt ventilation  Perform Heimlich while supine  Reattempt ventilation  SEQUENCE: TJL finger-sweep rescue fingerbreaths Heimlichs TJL


AIRWAY Obstruction


Pediatric considerations:  CHILD: NEVER DO Blind Finger sweep

AIRWAY Obstruction


Pediatric considerations:  INFANT: never DO blind fingerfingersweep  Give five back blows in the interscapular area and turn the infant with head lower than trunk then deliver chest thrust below the nipple line

AIRWAY Obstruction


Obstetric considerations:  Hand is placed over the middle part of sternum: backward chest thrust


If unconscious: place pillow below the RIGHT abdomen to displace uterus

Shock


An abnormal physiologic state where an imbalance exists between the amount of circulating blood volume and the size of the vascular bed. bed.

Pathophysiology of Shock
1. Cellular effects of shock  In the absence of oxygen, the cell will undergo Anaerobic metabolism to produce energy source and with it comes numerous by-products like bylactic acid  The cell will swell due to the influx of Na and H20, mitochondria will be damaged, lysosomal enzymes will be liberated, and then cellular death ensues.

Pathophysiology of Shock
2. Organ System Responses  When the patient encounters precipitating causes of shock, the circulatory function diminishes there is decreased cardiac output Hypotension and decreased tissue perfusion will result

Shock Stages
There are three stages of shock  Compensatory stage  Progressive stage  Irreversible stage

Shock Stages
THE COMPENSATORY STAGE OF SHOCK  In this stage, the patients blood pressure is within normal limits. limits.  Patients blood is shunted from the kidney, skin and GIT to the vital organs- brain, liver organsand muscles  Manifestations of cold clammy skin, oliguria and hypoactive bowel sounds can be assessed.  Medical management includes IVF and medication  Nursing management includes monitoring of tissue perfusion & vital signs, reduction of anxiety, administering IVF/ordered medications and promotion of safety

THE PROGRESSIVE STAGE OF SHOCK  In this stage, the mechanisms that regulate blood pressure can no longer compensate and the mean arterial pressure falls.  The overworked heart becomes dysfunctional. Heart rate becomes very rapid (as high as 150 bpm)  Blood flow to the brain becomes impaired, the mental status deteriorates due to decreased cerebral perfusion and hypoxia.  Laboratory findings will reveal increased BUN and Creatinine. Urinary output decreases to below 30 mL/hour.

Shock Stages
THE PROGRESSIVE STAGE OF SHOCK  Decreased blood flow to the liver impairing the hepatic functions. Toxic wastes are not metabolized efficiently, resulting to accumulation of ammonia, bilirubin and lactic acids.  The reduced blood flow to the GIT causes stress ulcers and increased risk for GI bleeding.  Hypotension, sluggish blood flow, metabolic acidosis (due to accumulation of lactic acid), and generalized hypoxemia can interfere with normal blood function.

Shock Stages
THE IRREVERSIBLE STAGE OF SHOCK  This stage represents the end point where there is severe organ damage that patients do not respond anymore to treatment. Survival is almost impossible to maintain.  Despite treatment, the BP remains low, anaerobic metabolisms continues and multiple organ failure results.  Medical management is the use of life supporting drugs like epinephrine and investigational medications.

Assessment of Shock
Assessment Findings Skin : Cool, pale, moist in hypovolemic and cardiogenic shock : Warm, dry, pink in septic and neurogenic shock Pulse  Tachycardia, due to increased sympathetic stimulation  Weak and thready Blood pressure  1. Early stages: may be normal due to compensatory mechanisms  2. Later stages: systolic and diastolic blood pressure drops.

Assessment of Shock
Assessment Findings Respirations: rapid and shallow, due to tissue anoxia and excessive amounts of CO (from metabolic Acidosis) Level of consciousness: restlessness and apprehension, progressing to coma Urinary output: decreases due to impaired renal perfusion Temperature: decreases in severe shock (except septic shock).

Management of Shock
Nursing Interventions  Management in all types and phases of shock includes the following:

Basic life support  Fluid replacement  Vasoactive medications  Nutritional support



Management of Shock
A. Maintain patent airway and adequate ventilation. B. Promote restoration of blood volume; administer fluid and bloodreplacement as ordered C. Administer drugs as ordered D. Minimize factors contributing to shock. E. Maintain continuous assessment of the client. F. Provide psychological support: reassure client to relieve apprehension, and keep family advised G. Provide Nutritional support

Hypovolemic Shock
This is the MOST common form of shock characterized by a decreased intravascular volume Risk factors: external Fluid Losses Trauma, Surgery, Vomiting, Diarrhea, Diuresis, DI Risk factors: internal fluid shifts Hemorrhage, Burns, Ascites, Peritonitis, Dehydration

Hypovolemic Shock
Decreased blood volume decreased venous return to the heart decreased stroke volume decreased cardiac output decreased tissue perfusion  Assessment findings: cold clammy skin, tachycardia, mental status changes, tachypnea


Hypovolemic Shock


MEDICAL MANAGEMENT: The major medical goals are to restore intravascular volume, to redistribute the fluid volume, and to correct the underlying cause of fluid loss promptly

Hypovolemic Shock


NURSNG MANAGEMENT: Primary prevention of shock is the most important intervention of the nurse. General nursing measures includeincludesafe administration of the ordered fluids and medications, documenting their administration and effects. The nurse must monitor the patient for signs of complications and response to treatment. Oxygen is administered to increase the amount of O2 carried by the available hemoglobin in the blood.

Cardiogenic shock
This shock occurs when the hearts ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues  Risk factors: Coronary factorfactorMyocardial infarction  Risks factors: NON coronary: Cardiomyopathies Valvular damage Cardiac tamponade Dysrhythmias

Cardiogenic shock


Precipitating factors will cause decreased cardiac contractility Decreased stroke volume and cardiac output leading to 3 things:  Damming up of blood in the pulmonary vein will cause pulmonary congestion  Decreased blood pressure will cause decreased systemic perfusion  Decreased pressure causes decreased perfusion of the coronary arteries leading to weaker contractility of the heart

Cardiogenic shock
ASSESSMENT FINDINGS: Angina, hemodynamic instability, dysrhythmias


MEDICAL MANAGEMENT:
The goals of medical management are to limit further myocardial damage and preserve and to improve the cardiac function by increasing contractility.

NURSING MANAGEMENT:
The nurse prevents cardiogenic shock by early detection of patients at risk. Safety and comfort measures like proper positioning, side-rails, and reduction of sideanxiety, frequent skin care and family education.

Circulatory shock


This is also called distributive shock. It occurs when the blood volume is abnormally displaced in the vasculature.
Septic Shock Neurogenic Shock Anaphylactic Shock

Circulatory shock


Massive arterial and venous dilation allows pooling of blood peripherally maldistribution of blood volume decreased venous return decreased stroke volume decreased cardiac output Decreased blood pressure decreased tissue perfusion.

Circulatory shock


Risk factors for Septic Shock Immunosuppression Extremes of age (<1 and >65) Malnourishment Chronic Illness Invasive procedures

Circulatory shock


Risk factors for Neurogenic Shock Spinal cord injury Spinal anesthesia Depressant action of medications Glucose deficiency

Circulatory shock


Risk factors for Anaphylactic Shock Penicillin sensitivity Transfusion reaction Bee sting allergy Latex sensitivity

SEPTIC SHOCK
This is the most common type of circulatory shock and is caused by widespread infection. The HYPERDYNAMIC PHASE High cardiac output with systemic vasodilatation. The BP remains within normal limits. Tachycardia Hyperthermic and febrile with warm, flushed skin and bounding pulses

SEPTIC SHOCK
The HYPODYNAMIC or irreversible phase LOW cardiac output with VASOCONSTRICTION The blood pressure drops, the skin is cool and pale, with temperature below normal. Heart rate and respiratory rate remain RAPID! The patient no longer produces urine.

SEPTIC SHOCK


MEDICAL MANAGEMENT: Current treatment involves identifying and eliminating the cause of infection. Fluid replacement must be instituted to correct Hypovolemia, Intravenous antibiotics are prescribed based on culture and sensitivity.

SEPTIC SHOCK


NURSING MANAGEMENT: The nurse must adhere strictly to the principles of ASEPTIC technique in her patient care. Specimen for culture and sensitivity is collected. Symptomatic measures are employed for fever, inflammation and pain. IVF and medications are administered as ordered.

Neurogenic Shock
This shock results from loss of sympathetic tone resulting to widespread vasodilatation.  The patient who suffers from neurogenic shock may have warm, dry skin and BRADYCARDIA!

Neurogenic Shock


MEDICAL MANAGEMENT: This involves restoring sympathetic tone, either through the stabilization of a spinal cord injury or in anesthesia, proper positioning.

Neurogenic Shock


NURSING MANAGEMENT: The nurse elevates and maintains the head of the bed at least 30 degrees to prevent neurogenic shock when the patient is receiving spinal or epidural anesthesia.

Anaphylactic Shock


This shock is caused by a severe allergic reaction when a patient who has already produced antibodies to a foreign substance develops a systemic antigen-antibody antigenreaction

Anaphylactic Shock


MEDICAL MANAGEMENT: Treatment of anaphylactic shock requires removing the causative antigen, administering medications that restore vascular tone, and providing emergency support of basic life functions. EPINEPHRINE is the drug of choice given to reverse the vasodilatation

Anaphylactic Shock


NURSING MANAGEMENT: It is very important for nurses to assess history of allergies to foods and medications! Drugs are administered as ordered and the responses to the drugs are evaluated.

CARDIOPULMONARY ARREST Complete failure of the heart to perfuse adequately and the lungs to ventilate adequately.

Nursing process:
Assessment/ Analysis Airway
Breathing Determine breathlessness Look for chest rise and fall Feel for flow of air

Circulation
Determine pulselessness Check carotid pulse

Plans, Implementation, Evaluation client will have an open airway and receive adequate ventilation


   

place client on a supine position on a flat, firm surface assume rescuer position do CPR use airway and ambubag administer 100% oxygen

 client will circulate adequately with oxygenated blood

 

   

 

check carotid pulse begin external chest compression if negative pulse do CPR monitor ECG defibrillatE client will receive appropriate emergency druG obtain cart with emergency drug Start IVF ( plain NSS or 0.9% NaCl is the fluid of choice)

EMERGENCY DRUGS  Atrophine sulfate  Calcium Chloride  Dobutamine HCl (Dobutrex)  Dopamine HCl (Inotropin)  Epinephrine  Lidocaine HCl  Sodium Bicarbonate  Verapamil ( Calan)

ADVANCED CARDIAC LIFE SUPPORT

Rapid Sequence Intubation Algorithm



Prepare necessary equipment IV access, cardiac monitor, pulse oximetry Bag-valve mask ( Ambu bag) Bag Suction equipment Laryngoscope with blade Endotracheal tube (7.0 for adult female & 8 for adult male) Insert stylet Medications Adjunct airway ( laryngeal mask airway, cricothyroidotomy tray) in case ETT is unsuccessful.

PrePre-treat:
lidocaine for head injuries ( to ICP) Atrophine for children ( prevent bradychardia)

Position patient:


raise bed to height appropriate for intubation Place head in sniffing position position with neck extended ( except for Cervical spine injury suspected)

PrePre-oxygenate patient
Bag-valve mask with 100% oxygen Bag Pulse oximetry should read 100% Hyperventilate patient to accomplish nitrogen washout

Pressure on Cricothyroid cartilage

Sellick maneuver compresses esophagus to limit risk of aspiration

Place the tube

Open the mouth and open the jaw inferiorly Insert the blade along the right side of the tongue If using curved (Macintosh) blade, the tip should be inserted to the vallecula ( the space between the base of the tongue and epiglottis) If using a straight ( Miller) blade, the tip is inserted beneath the epiglottis The laryngoscope is used to lift the tongue, soft tissues and epiglottis to reveal the vocal chords ( lifting motion not a rocking motion) Upon direct visualization of the cords, the stylet is removed, tube is connected into the oxygen source, and secured if proper placement is confirmed.

PRIMARY SURVEY  Focus on the ABCs of CPR and keep in mind defibrillation FIRST A-B-C-D A

 

Airway-n open airway (maintaining CirwayCspine control) Breathing- assess breathlessness and reathingprovide rescue breathing Circulation- give chest compression (CPR) irculationDefibrillation- shock ventricular fibrillation efibrillationand pulseless ventricular tachycardia

SECONDARY SURVEY


Focuses on the same ABCs in more detail. Establishing a definitive airway, establishing access to the circulation, assessing cardiac rhythms, pharmacologic interventions

SECOND A-B-C-D AAirwayAirway perform endotracheal intubations-establish a intubationsdefinitive airway that also protects against aspiration of blood, vomit and pharyngeal secretions.several cardiac meds can be given through ETT, usual dose is 2 to 2.5 times the IV dose followed by 10 ml of normal saline fluid and several ventilations by bag-valve bagventiations.  Nasal airway- rubber nasal trumpet inserted airwayinto the nostril and passed into the posterior pharynx to keep the tongue from falling back  Oral airway- curved rigid airway, inserted using airwaya tongue blade so that the distal edge prevents


Breathing assess bilateral chest rise and bilateral breath sounds  STAT portable chest X-Ray X If available, confirm ETT placenment with an end-tidal carbon dioxide endmonitor.  If doubt in placement, consider extubation and reintubation under direct visualization with a laryngoscope.


CirculationCirculation Establish IV access  Normal Saline is the fluid of choice  Cardiac monitors  Give emergency drugs  Differential DiagnosisDiagnosis history taking  diagnostic exams  dressing of wounds

AcidAcid-Base Balance ABG analysis:  Blood pH.7.5- 7.45 pH.7.5 pO .. 80-100 mmHg 80 pCO 3535-45 mmHg  HCO 22-26 mEq/L 22-

INTERPRETATIONS: pH 7.35. Aidosis  pH 7.45alkalosis  if pH is below or 7.8 and above.. death occurs  pCO 35. Alkalosis  pCO 45. Acidosis  HCO ..Acidosis  HCO acidosis
 

RESPIRATORY ACIDOSIS ( CARBONIC ACID EXCESS)  Caused by failure of the respiratory system to remove CO from body fluids as fast as it is produced in its tissues  Assessment:  Lightheadness  Numbness or tingling of fingers or toes  Late: tetany convulsions  Potassium

Nursing interventions: Treat underlying conditions  Sodium bicarbonate  Oxygenation  ECG  Pulse oximetry


METABOLIC ACIDOSIS (BICARBONATE DEFICIT) Result from an abnormal accumulation of fixed acids or loss of base.  Assessment:  Headache  Mental dullness  Kussmauls respiration  Potassium excess


Nursing intervention:

Treatment of underlying cause and restoration of electrolyte balance  Na bicarbonate IV  Maintain good respiratory function  Protect from injury


METABOLIC ALKALOSIS (BICARBONATE EXCESS)  Result from loss hydrogen ions or addition of base to body fluids.  Assessment:  Depressed breathing  Mental confusion  Dizziness  Numbness and tingling of fingers or toes  Muscle twitching  Late: tetany, convulsions  Potassium deficit

Nursing interventions: NaCI or Ammonium Chloride oral or IV  Carbonic Anhydrase inhibitor (Diamox) to increase excretion of bicarbonate by the kidneys  Maintain good respiratory function  Protect from injury


Traumatic brain injury

Etiology Pathophysiology Motor vehicle accident are the most common cause can result from assaults, falls, and sport related accident.  Cause by sudden force to the head


Open
Scalp laceration fracture in the skull interruption of the dura meter

CLOSED

concussions contusion fracture

Linear: simple break in the bone Depressed: break that result in

fragments of bone penerating brain tissue

BasilarBasilar- occurs over the base of

frontal and temporal lobes. Ecchymosis is common in the area involved

Location of Hemorrhage
EpiduralEpidural- between the dura and the skull. May result from laceration of the middle meningeal artery.  Subdural- between the dura and Subduralarachnoid levels (emergency surgery)  Intracerebral hematoma- multiple hematomahemorrhage around a contused area  Subarachnoid- directly into the brain, Subarachnoidthe ventricle or the subarachnoid space


Complications: cerebral edema brain abscess meningitis diabetes insipidus

HYPERTENSION


chronic elevation of systemic arterial BP in which the systolic pressure is consistently over 140 mmHg and the diastolic is 90 mmHg or higher. Types:  primary (essential)- etiology (essential)unknown  Secondary- caused by identifiable Secondaryprimary disease

History:


stress, familial history, obesity

Nursing process  Assessment:  BP elevated on at least 3 different occasions  headache, change in vision

epistaxis  change in level of consciousness,  change in motor and sensory response  Nursing Intervention:  Monitor BP at least every 15 minutes on acute phase


Pharmacologic interventions  diuretic agents  thiazides  potassium conserving diuretics Symphatetic inhibiting agents  Reserpine  Methyldopa  Propanolol  Vasodilating agent  Hydralazine

Interventions
 

O as indicated

NPO except meds  insert NGT, foley catheter  monitor intake and output

TOXICOLOGY ( POISONONG AND DRUG OVERDOSE) OVERDOSE)

POISONING IN CHILDREN  Leave medications or cleaning agents in original containers  Provide activities and play materials for children  Teach the need for supervision of young children  IPECAC ~ direct stimulation of vomiting center  Dose: 9 -12 mos ~ 10 ml only 1 12 yrs ~ 15 ml > 12 yrs ~ 30 ml Q 30 minutes  Follow each dose with about 4 8 oz of

IPECAC ~ position head lower than chest to prevent aspiration  ~ if no vomiting after 2 doses ER  Contraindication to IPECAC  Danger of aspiration, < LOC, severe shock seizures, diminished gag reflex  If substance is a petroleum distillate or corrosive (acid/alkali) which may damage the esophagus  Milk may delay vomiting  Dont neutralize strong acid/alkali,


Management: Maintain adequate airway, breathing and cardiac support.  Decontamination



External decontamination

Remove clothes  Wash skin with soap and water  Keep warm, use blanket


Gastric Lavage (NGT)  Contraindications: strong acids, alkalis, petroleum distillates  Airway must be protected wit ETT unless patient is awake, alert and has a gag reflex  Place patient in trendelenburg and left lateral decubitus position  Position head to one side to minimize aspiration

If patient has respiratory difficulty, consider placing a cuffed ETT, begin mechanical ventilation and oxygenation if indicated  Useful if performed within 12 hours of drug ingestion of other drugs that delay gastric emptying were ingested  client is intubated & positioned head down on left side  large oro/nasogastric tube inserted and  repeated irrigations of normal saline instilled until clear


Activated Charcoal


Single dose activated charcoal: always consider giving after emesis or lavage Multiple doses: 0.5 gram/kg/body weight every 4-6 hours, for 4metamphetamine, phenothiazine, digoxin, theophylline, Phenobarbital, organochlorine pesticides, because the substance have enterohepatic recirculation kinetics.

Not effective for alkalis, cyanide, mineral acids, ferrous sulfate and petroleum ingestion.  absorbs compounds forming a complex material which is nonabsorbable  give 5 10 gm for each gm of toxic subs.  give less than 1 hr of ingestion & after emetic  mix with water to make syrup then give PO or via NG tube


Cathartics ( Sodium sulfate)

Contraindicated in infants, acid and alkali ingestion, patients who will receive oral antidotes, dynamic ileus, severe diarrhea, abdominal trauma, surgery, suspected intestinal obstruction, severe electrolyte loss or dehydration. Magnesium sulfate is contraindicated in hypertension and heart failure Sodium sulfate 15-30 grams (or 250mg/kg) 15in 100 ml water goiven 30 minutes after the activated charcoal, if still without bowel movement within one hour, may repeat procedure.

Forced DiuresisDiuresis Should also be only be attempted in treatment centers that can monitor hydration and electrolyte status of the patients.  maintain urinary flow rate of 5-7 5ml/kg/hr by infusing normal saline and intermittent boluses of furosemide 20mg IV doses,  alternate with Mannitol, 20-100 gm 20IV maximum of 300 gms.  Monitor hydration and electrolytes

Forced alkaline diuresis: useful in Phenobarbital, mephobarbital, salicylates, lithium. Adult dose is sodium Bicarb 1-2 amp 1followed by continuous IV infusions of 1-2 1amp sodium bicarbonate in 1L Increase urine output to 2-3/ml/kg/hr. 2-

Chelation  used for heavy metals like mercury, lead & arsenic  a chelating agent binds with a heavy metal forming a complex that can be eliminated by kidneys (PD or HD)


ASPIRIN/SALICYLATE POISONING

Change in mental status,nausea,tinnitus  hyperthermia,hyperventilation (respiratory alkalosis)  Later ~ bleeding,hypovolemia,metabolic acidosis  Toxicity begins @ 150 -200 mg/kg


Nursing responsibilities: Induce vomiting,  monitor I&O,electrolytes, urine specific gravity  IV hydration, skin turgor & fontanelles in pads  tepid water baths and use hypothermia blankets to < temp and prevent  seizures  give vitamin K for elevated PT,PTT


ASPIRIN/SALICYLATE POISONING give NaHC03 to aid in excretion TYLENOL (ACETAMINOPHEN) POISONING  1st 2 hrs nausea & vomiting, pallor, slow  weak pulse and hypothermia  RUQ pain,jaundice,confusion,stupor and coagulation abnormalities = HEPATIC DAMAGE = NO TREATMENT  Late Sign kidney function (BUN/CREA)  Toxicity begins @ 150 mg/kg

Management: Induce vomiting  Give mucomyst (N-acetylcysteine) (NPO Q4 X 18 doses or IV over 20 hrs  Maintain IV hydration & monitor I & O


LEAD TOXICITY/PLUMBISM n/v, abdominal pain,sleepiness,irritability,  constipation,diarrhea,somnolence, > ICP  causing seizures & motor dysfunction  Lead based paints (primary source)source)lead  solder in pipes,crumbling plaster,pottery,


Nursing Considerations: antidotes are given immediately within one hour  always check for availability of antidote to the pharmacy.


GOOD DAY!!!!!!

Triage


triertrier- to sort To sort patients in groups based on the severity of their health problem and the immediacy with which these problems must be addressed

Triage in the E.R.


1.

Berners Emergent Urgent NonNon-urgent

2.

3.

Triage in DISASTER!

1.

NATO Immediate Delayed Minimal Expectant

2.

3.

4.

Triage
1. Emergent
Patients have the highest priority With life-threatening condition life-

2. Urgent
Patients with serious health problems Not life-threatening, MUST be seen lifein 1 hour

3. Non-urgent Non Episodic illness that can be addressed within 24 hours

Triage category
Immediate

Triage in Disaster
1 RED

Priority

Color

Conditions

Chest wounds, shock, open fractures, 2-3 2burns Stable abdominal wound, eye and CNS injuries Minor burns, minor fractures, minor bleeding Unresponsive, high spinal cord injury

Delayed

YELLOW

Minimal

GREEN

Expectant

BLACK

Preparing for terrorism

1. 2.

3.

Recognition and Awareness Use of personal protective equipments Decontamination of contaminants

Biological Weapons
ANTHRAX  Drug of choice is Ciprofloxacin or Doxycycline SMALLPOX  Supportive

Chemical Weapons
Organophosphates Supportive care Soap and water Atropine Pralidoxine

Cyanide
Sodium nitrite, Amyl Nitrite, Methylene Blue Sodium thiosulfate Hydrocobalamin

CYANIDE POISONING

Radiation
Alpha Particles Cannot penetrate skin Causes local damage
Moderately penetrate the skin Can cause skin damage and internal injury if prolonged

Beta Particles

Gamma Particles

Penetrate skin Can cause serious damage X-ray is an example