Acids: toilet bowel cleaners, antirust compounds Alkalis: Drain cleaners, dishwashing detergents, ammonia Manifestations: Excess salivation, dysphagia. Epigastric pain, pneumonitis, burns of mouth, esophagus, & stomach. Treatment: Immediate dilution ( water, milk), corticosteroids (for alkali). Induced vomiting is contraindicated.
Bleaches
Manifestation Irritation of lips, mouth, & eyes, superficial injury to esophagus; chemical pneumonia. Treatment: Washing of exposed skin & eyes dilution with water & milk Gastric Lavage prevention of vomiting and aspiration
Cocaine
Intranasally ( snorting). Smoking (freebasing). Crack Clinical Manifestation Is a CNS stimulant that can HR & BP & cause hyperpyrexia, seizures & ventricular dysrhythmias. It produces intense euphoria, then anxiety, sadness & insomnia. Cocaine hallucination with delusions; psychosis with extreme paranoia.
Cocaine
Therapeutic Management Ensure airway & ventilation. Control seizures. Monitor Cardiovascular effects. Treat for hyperthermia. Evacuate stomach contents & Activated charcoal. Refer for Psychiatric evaluation & treatment.
Opiods
Heroin, Opium, Morphine, Codeine, Fentanyl. Clinical Manifestation: Pinpoint pupils, BP & marked respiratory depression. Management Support respiratory & cardiovascular functions Establish an IV line. Narcotic antagonist (naloxone[narcan]). Send urine for urinalysis
Drugs producing sedation ( Nonbarbiturates sedative) Diazepam, lorazepam, Midazolam Flunitrazepam (roofies, date rape drug) Manifestation Seizures, coma, circulatory collapse, death. Acute intoxication: Respiratory depression Decreasing mental alertness, confusion Slurred speech, BP, Ataxia, coma, death Flunitrazepam Disinhibition with antegrade amnesia Weakness & unsteadiness, powerlessness.
Drugs producing sedation ( Nonbarbiturates sedative) Endotracheal Intubation Assess for hypotension Evacuate stomach contents; emesis, lavage, activated charcoal, cathartic. Administer Flumazenil Refer for Psychiatric evaluation & treatment.
Only 4-6 % of sudden cardiac arrest victims survive because majority of those witnessing the arrest do not know how to perform CPR .
What is C P R ?
EARLY WARNING SIGNS OF RESPIRATORY FAILURE unable to speak, breath or cough clutches neck (universal distress signal) bluish color of skin and lips
Lungs (Pulmonary)
Heart (Cardiac)
CHECK UNRESPONSIVENESS.
Tap or gently shake the victim Rescuer shouts Are you OK? Quick check for normal breathing If the victim is unconscious, rescuer calls for help.
PULSE CHECK
Palpate for Carotid Pulse within 10 seconds (at the same time CHECK FOR BREATHING) For trained healthcare providers only
CAB
C. COMPRESSION Do chest compressions first A. AIRWAY Does the victim have an open airway (air passage that allows the victim to breathe)? B. BREATHING Is the victim breathing?
COMPRESSION
proceed immediately to do
COMPRESSIONS!
CHEST
Chest Compressions
Kneel facing
victims chest
Place the heel of your hand on the center of the victim's chest. Put your other hand on top of the first with your fingers interlaced.
Chest Compressions
Place the heel of one hand on the sternum in the center of the chest between the nipples and then place the heel of the second hand on top of the first so that the hands are overlapped and parallel.
Compress breastbone at least 2 inches deep Compress at a rate of 100 per minute or more Compress 30 times initially Allow the chest to return to its normal position
Give 30 Compressions
Compress breastbone at least 2 inches
A - AIRWAY
PULSE CHECK
RECHECK PULSE EVERY 2 MINUTES (equivalent to 5 cycles CPR) Very brief pulse check should take less than 10 seconds (at the same time check for normal breathing) In case there is any doubt about the presence or absence of pulse, CONTINUE CHEST COMPRESSIONS For trained healthcare providers only
UNTIL
HELP ARRIVES.
(Emergency Services, Ambulance, Doctor, AED)
PERSON IS REVIVED.
THE RECOVERY POSITION Maintain open airway & position the victim
The unresponsive victim with spontaneous respirations should be placed in the recovery position if no cervical trauma is suspected. Placement in this position consists of rolling the victim onto his or her side to help protect the airway.
Adults
UNRESPONSIVE No breathing, not breathing normally (eg. only gasping)
Children
No breathing or only gasping
CPR Sequence Compression Rate Compression Depth Chest wall Recoil Compression interruptions Airway Compression-Ventilation ratio Ventilations: when rescuer untrained or trained and not proficient Ventilations with advanced airway (HCP)
CAB
Allow complete recoil between compressions HCPs rotate compressors every 2 minutes
Minimize interruptions in chest compressions Attempt to limit interruptions to less than 10 seconds Head tilt chin lift (HCP suspected trauma: jaw thrust) 30 : 2 (one or 2 rescuers) Compressions only 30:2(single rescuer); 15:2(2 rescuer) Compressions only
1 breath every 6-8 seconds (8-10 breaths/min) Asynchronous with chest compressions About 1 second per breath Visible chest rise Attach and use AED as soon as available. Minimize interruptions in chest compressions before and after shock, resume CPR beginning with compressions immediately after each shock
DEFIBRILLATION ( AED )
C Chest Compressions: 30 x; 100/min; 2 inches deep; push hard and fast A - Airway: head tilt chin lift B Breathing: 2 breaths (1 second/breath) Chest compressions 30 x Continue cycles 30:2 compression-ventilation [Quick check pulse every 2 mins] Until:
EMS arrives (AED, doctor, ambulance) Patient has signs of life
Hands Only CPR should only be used for adult victims who have suddenly collapsed or become unresponsive.
When an adult suddenly collapses, all bystanders should activate their community EMS and provide high-quality chest compressions, minimizing interruptions (Class I).
If trained in CPR, provide either conventional CPR using a 30:2 compression-to-ventilation ratio (Class IIa) or handsonly CPR (Class IIa)
Check for normal breathing together with check for unresponsiveness Hands only CPR for the untrained lay rescuer
Important Points
There are no mistakes when you perform CPR. The only harm is to delay responding. Start chest compressions now viewed as the most effective procedure All victims in cardiac arrest need chest compressions. Don't stop pushing. Keep pushing as long as you can. Push until the AED is in place and ready to analyze the heart. When it is time to do mouth to mouth, do it quick and get right back on the chest.
Being trained to do CPR can save a loved one. Effective CPR done immediately after cardiac arrest can double a victims chance of survival.
DISASTER NURSING
Disaster Nursing
Adaptation of professional nursing skills in recognizing and meeting the nursing physical and emotional needs resulting from a disaster. The overall goal of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster.
Agent
Primary Agents: It includes falling of buildings, heat wind rising waters and smoke. Secondary Agents: It includes bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction.
Environmental factors
1. Physical Factors - Weather conditions, the availability of food, time when the disaster occurs, the availability of water and the functioning of utilities such as electricity and telephone service. 2. Chemical Factors - Influencing disaster outcome include leakage of stored chemicals into the air, soil, ground water or food supplies. Eg: - Bhopal Gas Tragedy.
Environmental factors
3. Biological Factors - Are those that occur or increase as result of contaminated water, improper waste disposal, insect or rodent proliferations improper food storage or lack of refrigeration due to interrupted electrical services. Bioterrorism: Release of viruses, bacteria or other agents caused illness or death.
Environmental factors
4. Social Factors: - Are those that contribute to the individual social support systems. Loss of family members, changes in roles and the questioning of religious beliefs are social factors to be examined after a disaster. 5. Psychological Factors: - Psychological factors are closely related to agents, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by the victims.
Environmental factors
4. Social Factors: - Are those that contribute to the individual social support systems. Loss of family members, changes in roles and the questioning of religious beliefs are social factors to be examined after a disaster. 5. Psychological Factors: - Psychological factors are closely related to agents, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by the victims.
Mitigation:
Lessen the impact of a disaster before it strikes
Preparedness:
Activities undertaken to handle a disaster when it strikes
Response:
Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary).
Recovery:
Getting a community back to its pre-disaster status
Mitigation
Activities that reduce or eliminate a hazard
Prevention Risk reduction
Examples
Immunization programs Public education
Preparedness
Activities that are taken to build capacity and identify resources that may be used
Know evacuation shelters Emergency communication plan Preventive measures to prevent spread of disease Public Education
Response
Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs
Recovery
Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration.
Debris Removal Care and Shelter Damage Assessments Funding Assistance
What is Triage?
French verb trier means to sort Assigns priorities when resources limited Do the best for the greatest number of patients
Advantages of Triage
Helps to bring order and organization to a chaotic scene. It identifies and provides care to those who are in greatest need Helps make the difficult decisions easier Assure that resources are used in the most effective manner May take some of the emotional burden away from those doing triage