Emergency Nursing
Content
Emergency Nursing
by: Elmer G. Organia, RN
Emergency Nursing
Emergency Nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury. injury. the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known. known.
An emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families within a timetimelimited and high pressured environment. Must be rendered without delay
Issues in Emergency Nursing Care
Documentation of Consent
for invasive procedures procedure must be documented for unconscious patient without relatives. relatives.
Limitation of Exposure to Health Risks
HIV infections
Communicable Diseases
Nurses must protect themselves
Providing Holistic Care
Patient Focused Interventions Family Focused Intervention
Anxiety and Denial Guilt Anger Grief
Continuum of Care
Discharge Planning Community Services
Principles of Emergency Nursing
A. Triage
is a process of prioritizing patients based on the severity of their condition so as to treat as many as possible when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning "to trier, sort, sift or select."
Types of Triage
1. Simple Triage
Simple triage is used in a scene of mass
casualty, casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging
Categories of Severity
Black / Expectant They are so severely injured that they will die of their injuries, possibly in hours or days (large(largebody burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that lifethey are unlikely to survive given the care available (cardiac arrest, septic shock, severe (cardiac arrest, shock, head or chest wounds); they should be taken to a holding area and given painkillers as required to reduce suffering.
Cont
Red / Immediate They require immediate surgery or other lifelife-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they "cannot wait" but are likely to survive with immediate treatment.
Cont
Yellow / Observation Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital recare (and would receive immediate priority care under "normal" circumstances).
Cont
Green / Wait (walking wounded) They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).
Cont
White / Dismiss (walking wounded) They have minor injuries; first aid and home care are sufficient, a doctor's care is not required. Injuries are along the lines of cuts and scrapes, or minor burns.
2.Advanced Triage
Advanced triage
In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.
Three Categories of Triage System
Emergent -patients with the highest priority and must be seen immediately Urgent patients with serious health problems but not immediately life threatening, they must be seen within 1 hour. Non-UrgentNon-Urgent-patients have episodic illnesses that can be addressed within 24 hours without increased morbidity.
B. Prioritization
A systematic approach Airway Breathing Circulation Disability
1.Respiratory Emergencies
A. Airway Obstruction
The airway is partially or completely occluded Permanent brain damage or death will occur within 3-5 minutes 3-
Anatomy of the Respiratory System
Clinical Manifestations
Labored Breathing Use of Accessory Muscles Cyanosis Confusion Flaring Nostrils Hypoxia Loss of Consciousness
Assessment and Diagnostic Findings
If Conscious-simply ask the patient ConsciousIf Conscious Inspection X-ray Laryngoscopy Bronchoscopy
Management
1. Head-tilt/chin-lift maneuver Head-tilt/chinCheck Breathing. Opening the airway. Place patient in a supine position. Place one hand in a patients forehead. Apply pressure to tilt the head back. Place the other hand under the bony part of lower jaw near the chin and lifted up. Top: Airway obstruction produced by the tongue and the epiglottis. Bottom: Relief by head-tilt/chin-lift. head-tilt/chin-
Note: Do not use this maneuver if you suspect cervical spine injury.
2.Jaw2.Jaw-Thrust Maneuver
One hand is placed on each side of patient jaw. Displace our mandible forward.
3.Oropharyngeal Airway Insertion
An oropharyngeal airway (also known as an oral airway,OPA or Guedel pattern airway) is a medical device called an airway adjunct used to maintain a patent (open) airway. It does this by preventing airway. the tongue from (either partially or completely) covering the epiglottis, which epiglottis, could prevent the patient from breathing.
designed by Arthur E. Guedel Oropharyngeal airways come in a variety of sizes, from infant to adult, and are used mostly in pre-hospital emergency care pre-
4. Endotracheal Intubation
refers to the placement of a tube into an external or internal orifice of the body. Tracheal intubation is the placement of a flexible plastic tube into the trachea to protect the patient's airway and provide a means of mechanical ventilation. The most common intubation is orotracheal intubation where, with the assistance of a laryngoscope, an endotracheal laryngoscope, tube is passed through the mouth, larynx, and larynx, vocal cords, into the trachea. A bulb is then inflated near the distal tip of the tube to help secure it in place and protect the airway from blood, vomit, and secretions
Indications
Comatose or intoxicated patients who are unable to protect
their airways. In such patients, the throat muscles may lose their tone so that the upper airways obstruct or collapse and air can not easily enter into the lungs. General anesthesia. In anesthetized patients spontaneous respiration may be decreased or absent due to the effect of opioids, relaxants. anesthetics, opioids, or muscle relaxants. To enable mechanical ventilation, an endotracheal tube is often used, although there are alternative devices such as face masks airways. or laryngeal mask airways.
Cardiopulmonary Resuscitation. ardiopulmonary Resuscitation.
5. Heimlich Maneuver
Abdominal thrusts, also known as the Heimlich Heimlich) Maneuver (after Henry Heimlich) Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, trachea, hopefully expelling it. This amounts to it. an artificial cough .
Alternatives to Intubation
y Tracheostomy - a surgical technique, typically for patients who require longlong-term respiratory support
B.Hypoxia
Hypoxia literally means "a deficiency "a in oxygen." Hypoxia (medical), a shortage of (medical), oxygen in the body. Hypoxemia is the reduction of oxygen specifically in the blood; Anoxia is when there is no oxygen available at all.
Types of Hypoxia
Hypoxemic Hypoxia is a generalized hypoxia, an inadequate supply of oxygen to the body as a whole. Anemic Hypoxia - total oxygen content of the blood is reduced. Hypemic Hypoxia - the blood fails to deliver oxygen to target tissues. Histotoxic Hypoxia the quantity of oxygen reaching the cells is normal, but the cells are unable to effectively use the oxygen . Ischemic Hypoxia - there is a local restriction in the flow of otherwise well-oxygenated blood well-
Symptoms
Headache Fatigue Nausea Cyanosis Seizure Coma Death
Management
Remove Obstruction/Cause Oxygen Inhalation Bypass Airway Rest
C. Hanging and Strangulation
Hanging is the lethal suspension of a person by a ligature. A method of suicide in which a person applies a ligature to the neck and brings about unconsciousness and then death. Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain.
Strangulation - is a compression of the neck that leads to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the mechanism of suicide. Ligature strangulation Strangulation without suspension using some form of cordcord-like object . Manual strangulation Strangulation using the fingers or other extremity
Aims of Care
Restore adequate breathing To arrange urgent transport in the hospital
Recognition
A constricting article around the neck. Marks around the casualty neck. Cyanosis or impaired consciousness. Prominent veins on the face.
Special Precautions
Observe proper transport Do not destroy materials used in constricting the neck, police may need it as evidence.
D. Drowning
Drowning is death as caused by suffocation when a liquid causes interruption of the body's absorption of oxygen from the air leading to asphyxia. asphyxia. The primary cause of death is hypoxia and acidosis leading to cardiac arrest .
Cont
.
Near drowning is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious secondary complications, including death, after the event
Aims of Care
To restore adequate breathing To keep casualty warm To arrange urgent transport in the hospital.
Risks factors
In no particular order: Lack of supervision of young children (less than 5 years old). Water conditions exceed the swimmer's ability - turbulent or fast water, water out of depth, falling through ice, Entrapment - physically unable to get out of the situation because of a lack of an escape route, snagging or by being hampered by clothing or equipment.
Cont .
Impaired judgment and physical incapacitation arising from the use of drugs, principally alcohol. Incapacitation arising from acute illness attack, while swimming - heart attack, seizure or stroke. stroke. Forcible submersion by another person murder or misguided children's play. Drowning following a car crash or submersion.
Incidence
Victims are more likely to be male, young or adolescent. Surveys indicate that 10% of children under 5 have experienced a situation with a high risk of drowning. The causes of drowning cases as follows: 44% are related to swimming 17% are related to boating 14% are un attributed 10% related to scuba diving 7% related to car accidents
Prevention
Learn to swim Keep a watch out for others. Swim in areas where adequate supervision is present ie a trained and certified Lifeguard. Ensure that boats are reliable, properly loaded and that functional emergency equipment is onboard.
Cont .
Wear a properly fitting lifejacket while enjoying water sports such as sailing, sailing, surfing. surfing. Pay attention to the weather, tides and water conditions. Keep children under a watchful eye . Do not dive into an unknown depth and or bottom contour area.
Cont
Avoid swimming alone Avoid swimming at night Avoid swimming under the influence of drugs and or alcohol . Be aware of your personal limits
Drowning Rescue
Do not endanger yourself during this process. Throw a rope. Use a long stick. The focus of the first aid for a nearneardrowning victim in the water is to get oxygen into the lungs without aggravating any suspected neck injury.
E. Inhalation of Fumes
Smoke inhalation is the primary cause of death in victims of indoor fires. fires. Smoke inhalation injury refers to injury due to inhalation or exposure to hot gaseous products of combustion. This can cause serious combustion. respiratory complications This refers to the inhalation of smoke or gases such as carbon monoxide. The casualty is most likely to have low levels of oxygen in his body tissues.
Smoke Inhalation
A person who is confined in a space during fire is assumed to have inhaled smoke. A smoke from burning plastics, foams and synthetic wall covering is likely to contain poisonous fumes.
Inhalation of Carbon Monoxide
Carbon Monoxide is a poisonous gas that is produced by burning. It acts directly on the red blood cells preventing them from carrying oxygen to the body tissues. Carbon Monoxide has no taste or smell.
Signs and Symptoms
Coughing Vomiting Nausea, Sleepiness Confusion Difficulty Breathing
Treatment
Treatment consists of humidified oxygen, bronchodilators, suction, endotracheal tube and chest physiotherapy. Other measures include adequate fluids and control of infection by daily sputum stains and appropriate antibiotics.
F. Penetrating Chest Wound
Depending on its size, a penetrating chest wound may cause varying degrees of damage to bones, soft tissue, blood vessels, and nerves.
The risk of death and disease from a chest wound depends on the size and severity of the wound. Gunshot wounds are usually more serious than stab wounds because they cause more severe lacerations and rapid blood loss. With prompt, aggressive treatment, up to 90% of patients with penetrating chest wounds recover.
Causes
Stab wounds from a knife or an ice pick and gunshot wounds are the most common penetrating chest wounds. wounds. Explosions or firearms fired at close range are the usual source of large wounds. wounds.
Aims of Care
To seal the wound and maintain breathig To minimize shock Arrange immediate transport to the hospital
Diagnostic tests
X-rays Physical Assessment
Treatment
In a penetrating chest wound, treatment involves maintaining a patent airway and providing ventilatory support as needed. Chest tube insertion allows the reestablishment of intrathoracic pressure and drainage of blood from a hemothorax. The patient's wound needs surgical repair. The patient also may need analgesics and antibiotics. Tetanus prophylaxis, and infusion of blood products and I.V. fluids.
G. Hyperventilation
Hyperventilation (or overbreathing) is the state of breathing faster and/or deeper than necessary, thereby reducing the carbon dioxide concentration of the blood below normal.
Causes
Stress or anxiety commonly are causes of hyperventilation; this is known as hyperventilation syndrome . Hyperventilation can also be brought about voluntarily, by taking many deep breaths. Hyperventilation can also occur as a consequence of various lung diseases.
Signs and Symptoms
Unnaturally fast deep breathing. Cramps in the hands. Dizziness Faintness
Management
Ask casualty to regain control of her breathing. Rebreath her own exhaled air in a paper bag. Encourage to seek medical attention
H. Asthma
Asthma is a chronic condition involving the respiratory system in which the airways occasionally constrict, become inflamed, and are inflamed, mucus, lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant such as an allergen, environmental tobacco smoke, allergen, cold or warm air, perfume, pet dander, moist air, exercise or exertion, or emotional stress
Signs and symptoms
Wheezing Shortness of breath Chest tightness Coughing Inability for physical exertion Tachycardia Use of accessory muscles
Causes
Hereditary Poor air quality Environmental tobacco smoke Viral respiratory infections Antibiotic use Psychological stress
Management
Identify allergens Remove source of stress Bronchodilators Nebulization Steroids Antibiotics Rest
11. WOUNDS and BLEEDINGS
A. Hemorrhage
Bleeding, technically known as hemorrhage is the loss of blood from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the vagina, vagina, mouth or anus, or through a break in anus, the skin. skin. Loss of 10-15% of total blood volume can be 10endured with clinical problem in a healthy person.
Causes
Hemophilia emophilia low platelet count (thrombocytopenia) (thrombocytopenia) Anticoagulant medications, such as warfarin Trauma and Injuries
Four Classes of Hemorrhage
y Class I Hemorrhage involves up to 15% of blood volume. There is 15% volume. typically no change in vital signs and fluid resuscitation is not usually necessary. necessary.
Class II Hemorrhage involves 15-30% 15of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently.
Volume resuscitation with crystaloids (Saline solution or Lactated Ringer's solution) solution) is all that is typically required. required. Blood transfusion is not typically required. required.
Class III Hemorrhage involves loss of 303040% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystaloid and blood transfusion are usually necessary.
y Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.
B. Wounds
Wound is a type of injury in which in the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, pathology, it specifically refers to a sharp injury which damages the dermis of the skin.
Types of Wounds
a. Incisions or incised wounds, caused wounds, by a clean, sharp-edged object such as a sharpknife, knife, a razor or a glass splinter.
b. Lacerations, irregular wounds caused Lacerations, by a blunt impact to soft tissue that lies over hard tissue (e.g. laceration of the skin covering the skull) or tearing of skin and other tissues such as caused by childbirth.
c. Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
d.Puncture wounds, caused by an object wounds, puncturing the skin, such as a nail or skin, needle .
f. Gunshot wounds, caused by a bullet or wounds, similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit .
g. Contusions, more commonly known as Contusions, bruises, bruises, caused by blunt force trauma that damages tissue under the skin.
h. Hematomas, also called blood tumors, Hematomas, caused by damage to a blood vessel that in turn causes blood to collect under the skin. skin.
i. Crushing Injuries , caused by a great or extreme amount of force applied over a long period of time.
Management
Wound Care Antibiotics Pain Reliever Tetanus Toxoid and HTIG Control Bleeding The pattern of injury, evaluation and treatment will vary with the mechanism of the injury
C. Infected Wounds
Diabetes is a known factor in the host response, especially if the patient s blood sugar is not well controlled.
Signs and Symptoms
A wound becomes red,hot,swollen and painful. It has Pus Lymph nodes becomes swollen and tender. Danger of tetanus is very great to people who have not been vaccinated.
Management
Proper Wound Care Use of Antibiotics Pain Relievers Health Teachings
D. Nosebleeding
Nose bleeding occurs frequently in patients with a deviated septum. septum. Septal perforations, or holes in the septum, frequently bleed. Foreign bleed. bodies placed in the nose by children or disturbed people may result in bleeding. bleeding.
Causes
Direct trauma to the nose, accidental or self-inflicted is probably the most selfcommon cause of nose bleeds. bleeds. Extreme Heat High Blood Pressure
Aims of Care
Control Blood Loss Maintain an Open Airway
Management
Ask the casualty to sit down and tilt her head move forward. Ask the casualty to breath through her mouth. See for any foreign object on the nose Advise not to spit, cough or exert effort Advise to rest.
E. Varicose Veins
Varicose veins are veins that have become enlarged and twisted.
Aims of Care
To bring blood loss under control. To minimize shock. To arrange immediate transfer to Hospital
Management
Put on Gloves Raise and Support the injured leg as high as possible Apply firm and direct pressure. Remove garments such as stockings and garters.
111. Orthopedic Emergencies
A. Bone Fractures
A bone fracture (sometimes abbreviated as Fx) is a medical condition in which a Fx) bone is cracked or broken. It is a break in broken. the continuity of the bone Although fractures are commonly referred to as bone breaks, the word break is not part of formal orthopedic terminology.
Categories of Fracture
Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open Fractures the broken bone end pierce the skin surface. This carries high risk for infection.
Type of Fractures
y Compacted Fracture- A fracture Fracturecaused when bone fragments are driven into each other. other. y Comminuted FractureFractureA fracture which results in several fragments. fragments. y Spiral Fracture- A fracture where at Fractureleast one part of the bone has been twisted. twisted.
y Compression Fracture- A fracture Fracturethat usually occurs in the vertebrae. vertebrae. y Oblique Fracture- A fracture that is Fracturediagonal to a bone's long axis. axis. y Transverse Fracture- A fracture that Fractureis at a right angle to the bone's long axis. y Linear Fracture- A fracture that is Fractureparallel to the bone's long axis. axis.
y Incomplete Fracture- A fracture in Fracturewhich the bone fragments are still partially joined. joined. y Complete Fracture- A fracture in Fracturewhich bone fragments separate completely. completely.
Diagnosis
X-ray Physical Assessment
Management
Immobilization Splinting Pain Relief Antibiotic I and D ( Irrigation and Drainage) Realignment Surgery
B. Joint dislocation
Joint dislocation (Latin: luxatio) occurs luxatio) when bones in a joint become displaced or misaligned. It is often caused by a sudden impact to the joint. The ligaments always become damaged as a result of a dislocation .
Common Sites
Shoulders Fingers Knees
Treatment
Anyone experiencing a joint should seek medical assistance as soon as possible. A dislocated joint can only be successfully 'reduced' into its normal position by a trained medical professional. Trying to reduce a joint without any training could result in making the injury substantially worse.
X-rays are usually taken to confirm a diagnosis and detect any fractures which may also have occurred at the time of dislocation. dislocation. Once a diagnosis is confirmed, the joint is usually manipulated back into position. position. This can be a very painful process, therefore this is typically done under local or in an Operating Room under a General Anaesthetic. Anaesthetic.
Management
After a dislocation, injured joints are usually held in place through a splint (for straight joints like fingers and toes) or a bandage (for complex joints like shoulders). shoulders). Additional to this, the joint muscles, tendons and ligaments must also be strengthened. This is usually done strengthened. through a course of Physiotherapy, which Physiotherapy, will also help reduce the chances of repeated dislocations of the same joint. joint.
C. Sprain and Strain
A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments another. stabilize and support the body's joints. For example, ligaments in the joints. knee connect the upper leg with the lower leg, enabling people to walk and run. run.
A strain is an injury of a muscle and/or tendon. Tendons are fibrous tendon. cords of tissue that attach muscles to bone. bone.
What causes sprains and strains?
A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments .
Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. tendons. Inadequate rest breaks during intensive training precipitates a strain. strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. contraction.
Who gets sprains and strains?
Professional and amateur athletes and the general public, as well, can sustain this injury. People at risk for injury. the injury have a history of sprains and strains, are overweight, and are in poor physical condition. condition.
What are the signs of a sprain?
While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains: mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone.
What are the signs of a strain?
Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe cramping. strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual.
How are sprains and strains treated?
Rest Ice Compression Elevation
Rest: Stop all activities which cause pain Rest: to avoid the strain becoming more serious. serious. Ice: Ice: Helps reduce swelling. Never ice for swelling. more than 10-15 minutes at a time. Use a 10time. layer of fabric or paper in between the ice and the injury to avoid burning the skin. skin. Compression: Compression: Wrap the strained area to reduce swelling. swelling. Elevation: Keep the strained area as Elevation: close to the level of the heart as is conveniently possible to keep blood from pooling in the injured area
Prevention Tips
No one is immune to sprains and strains Participate in a conditioning program to build muscle strength. Do stretching exercises daily. Always wear properly fitting shoes .
Nourish your muscles by eating a wellwellbalanced diet. Warm up before any sports activity, including practice Use or wear protective equipment appropriate for that sport .
D. Spinal Cord Injury
Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber tracts that carry sensation and motor signals to and from the brain. Trauma such as automobile accidents, falls, gunshots, diving accidents, falls, gunshots, accidents, war injuries, etc. accidents, injuries,
Cervical injuries
C4 : May have some use of biceps and shoulders, but weaker C5 : May retain the use of shoulders and biceps, but not of the wrists or hands. C6 : Generally retain some wrist control, but no hand function. C7 and T1 : Can usually straighten their arms but still may have dexterity problems with the hand and fingers. C7 is generally the level for functional independence.
Thoracic Injuries
y T1 to T8 : Most often have control of the hands, but lack control of the abdominal muscles so control of the trunk is difficult or impossible. impossible. Effects are less severe the lower the injury. injury.
T9 to T12 : Allows good trunk and abdominal muscle control, and sitting balance is very good . The effect of injuries to the lumbar or sacral region of the spinal canal are decreased control of the legs and hips, hips, urinary system, and anus. anus.
Management
Mobilize Patient as one unit Provide a C-Collar CABC Resuscitate if necessary Arrange urgent transfer to the hospital
E. Ribcage Injury
There are 12 ribs on each side of the chest that protect the heart, lungs, and the upper abdominal contents. All of the ribs are attached to the vertebrae (backbone) in the rear. In the front, 10 of them are attached to the sternum (breastbone) by pieces of cartilage. Direct blows to the ribs may bruise or break the ribs or injure to the rib cartilage. The ribs may tear away from the cartilage that attaches them to the breastbone. This tearing away from the cartilage is called a costochondral separation.
How does it occur?
Rib injuries usually result from a direct blow to the chest wall. Breaks usually occur in the curved portion of the outer part of the rib cage. A costochondral separation may occur when you land hard on your feet or even when you cough or sneeze violently.
What are the symptoms?
A rib injury causes pain and tenderness over the place of injury. You may have pain when you breathe, move, laugh, or cough.
How is it diagnosed?
Your doctor will review your symptoms, examine your rib cage, and listen to your lungs. Your doctor may order a chest xxray to look for any rib damage, lung damage, or bleeding around the lungs.
Treatment
Rest Putting an ice pack over the injured rib for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain goes away. Taking an anti-inflammatory or other pain antimedication
When can I return to my usual activities?
If you broke a rib it may take 4 to 6 weeks to heal. Your doctor may take an x-ray to see that xthe bone has healed before he or she allows you to return to your activity, especially if it is a contact sport. You may participate in nonnoncontact activities sooner if you can do so without pain in your ribs and without pain when you breathe. If you have bruised your ribs or separated the cartilage from the ribs, you may return to your activity when you can do so without pain.
How can I prevent Ribcage Injury?
Ribs are often injured in accidents that are not preventable. However, in contact sports such as football it is important to wear appropriate protective equipment
1V. Nervous System Emergencies
a. Concussion
Concussion, from the Latin concutere ("to shake violently"). The terms mild brain injury, mild traumatic injury, brain injury (MTBI), mild head injury MTBI), (MHI), and minor head trauma and MHI), concussion may be used interchangeably. concussion can cause a variety of physical, cognitive, cognitive, and emotional symptoms
Causes
The leading causes of MTBI in adults are falls and vehicle accidents. accidents. sports injuries assaults, industrial and work-related injuries, workand injuries that occur in the home and school. school. Among children aged 5 to 14, sports and 14, bicycle accidents cause the greatest number of concussions. concussions.
The relative contribution of causes of mild head injury differs by region, gender, and age. For example, in Scotland and Sweden, falls account for the greatest percentage of MHIs, while in the U.S. and Australia, transportation is the largest cause. Soldiers are at elevated risk for concussion from causes such as bomb blasts, with as many as 15% 15% of U.S. infantry soldiers who return from the Iraq War meeting the criteria for MTBI. MTBI.
Mechanism
Punches in boxing deliver more rotational force to the head than impacts in sports such as football, and boxing carries a higher risk of concussion than football. The brain is surrounded by cerebrospinal fluid, fluid, one of the functions of which is to protect it from light trauma, but more severe impacts or the forces associated with rapid acceleration and deceleration may not be absorbed by this cushion
Concussion may be caused by impact forces, forces, in which the head strikes or is struck by something, or impulsive forces, in which the head moves without itself being subject to blunt trauma (for example, when the chest hits something and the head snaps forward).
Signs and Symptoms
Headache and difficulty concentrating dizziness, vomiting, nausea, nausea, lack of motor coordination, coordination, difficulty balancing,. balancing,. light sensitivity seeing bright lights, blurred vision double vision. vision. Tinnitus, Tinnitus, or a ringing in the ears, is also commonly reported Convulsions
Diagnosis
Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia post(PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15 ) CT Scan
b. Contusion
Cerebral contusion, Latin contusio cerebri, a cerebri, injury, form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, tissues, cerebral contusion can be caused by multiple microhemorrhages, microhemorrhages, small blood vessel leaks into brain tissue. Treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the pressure, skull. Contusions are likely to heal on their own without medical intervention
Signs and Symptoms
Contusion can present with weakness, lack of motor coordination, numbness, aphasia, coordination, numbness, aphasia, and memory and cognitive problems.[3] problems.[3] Signs depend on the contusion's location in the brain.
Causes
The interior of the skull has sharp ridges by which a moving brain can be injured. Often caused by a blow to the head. head.
Treatment
Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of hypotension (low blood pressure). Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it. People with cerebral contusion may require intensive care and close monitoring.
c. Skull Fracture
A skull fracture is a break in one or more of the injury. bones in the skull caused by a head injury. Isolated skull fractures are not very serious injuries, but the presence of a skull fracture may indicate that significant enough impact occurred to cause brain trauma, which is quite serious. trauma, Broken fragments of skull can lacerate or bruise the brain or damage blood vessels. If the vessels. fracture occurs over a major blood vessel, significant bleeding can occur within the skull, so head injury patients with skull fracture have many more intracranial hematomas .
Types of Skull Fracture
Linear skull fractures- the most fracturescommon type of skull fracture, occur in 69% of patients with severe head injury. Usually caused by widely distributed forces, linear fractures often occur when the impact causes the area of the skull that was struck to bend inward, making the area around it buckle outward.
Diastatic fractures are linear fractures that cause the bones of the skull to separate at the skull sutures in young children whose skull bones have not yet fused.
Comminuted skull fractures- those in fractureswhich a bone is shattered into many pieces, can result in bits of bone being driven into the brain, lacerating it.Depressed skull fractures, a very serious type of trauma occurring in 11% of severe head injuries, are comminuted fractures in which broken bones are displaced inward. This type of fracture carries a high risk of increasing pressure on the brain, crushing brain, the delicate tissue.
Basilar skull fractures-breaks in bones at fracturesthe base of the skull, require more force to cause than cranial vault fractures. Thus they are rare, occurring as the only fracture in only 4% of severe head injury patients.[2][5] patients.[2][5] Basilar fractures have sinuses; characteristic signs: blood in the sinuses; a clear fluid called cerebrospinal fluid (CSF) leaking from the nose or ears; raccoon eyes (bruising of the orbits of the eyes that result from blood collecting there as it leaks from the fracture site); and Battle's sign (caused when blood collects behind the ears and causes bruising).
D. Stroke
Stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism, embolism, or due to a hemorrhage. hemorrhage. In the past, stroke was referred to as cerebrovascular accident or CVA, but the term "stroke" is now preferred. preferred.
Stroke is a medical emergency and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated.
Risk factors
Advanced age Hypertension (high blood pressure), Previous stroke or transient ischemic attack (TIA) Diabetes High cholesterol Cigarette smoking Atrial fibrillation, the contraceptive pill, fibrillation, pill, migraine with aura, and thrombophilia (a tendency to thrombosis). High blood pressure is the most important modifiable risk factor of stroke.
Classification
Ischemic Stroke-blood supply to part of Strokethe brain is decreased, leading to dysfunction and necrosis of the brain tissue in that area. There are four reasons area. why this might happen: thrombosis happen: (obstruction of a blood vessel by a blood clot forming locally), embolism (idem due to a embolus from elsewhere in the body, see below), systemic hypoperfusion (general decrease in blood supply, e.g. in shock) shock) and venous thrombosis. Stroke thrombosis. without an obvious explanation is termed "cryptogenic" (of unknown origin). origin).
Thrombotic stroke -In thrombotic stroke, a thrombus (blood clot) usually forms around atherosclerotic plaques. Embolic stroke refers to the blockage of an embolus, artery by an embolus, a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most elsewhere. frequently a thrombus, but it can also be a number of other substances including fat (e.g. (e. from bone marrow in a broken bone), air, bone), cancer cells or clumps of bacteria (usually from infectious endocarditis .
Diagnosis
CT scans (most often without contrast enhancements) or MRI scans, Doppler scans, ultrasound, ultrasound, and arteriography. arteriography. For detecting chronic hemorrhages, MRI scan is more sensitive A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.
Prevention
Given the disease burden of stroke, prevention is an important public health concern. The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation
Other modifiable risk factors include high blood cholesterol levels, diabetes, cigarette smoking (active and passive), heavy alcohol consumption and drug use,lack of physical activity, obesity activity, and unhealthy diet . Hypertension accounts for 35-50% of stroke 35risk. High cholesterol levels have been consistently associated with (ischemic) stroke. Patients with diabetes mellitus are 2 to 3 times more likely to develop stroke .
Treatment
Mechanical Thrombectomy
Good nursing care is fundamental in maintaining skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure. This is also to prevent pneumonia or Bedsores. An ischemic stroke is due to a thrombus (blood clot) occluding a cerebral artery, a patient is given antiplatelet medication (aspirin, clopidogrel, dipyridamole), or anticoagulant medication (warfarin), dependent on the cause, (warfarin), when this type of stroke has been found.
Prognosis
Disability affects 75% of stroke survivors enough to decrease their employability.
E. Seizure
A seizure, also known as a convulsion or seizure, fit, is a sudden loss of consciousness, a fit, change in one's state of consciousness, or loss of control over one's body.
Seizure Types
Epileptic Seizure
Absence seizure Atonic seizure Focal seizures Simple partial seizure Jacksonian seizure TonicTonic-clonic seizure
NonNon-epileptic seizure
Febrile seizure PostPost-traumatic seizure Psychogenic non-epileptic seizures non-
Causes
Seizures are caused by abnormal electrical discharges in the brain. Symptoms may vary depending on the part of the brain that is involved, but seizures often cause unusual sensations, uncontrollable muscle spasms, and loss of consciousness. Some seizures may be the result of a medical problem. Low blood sugar, infection, a head injury, accidental poisoning, or drug overdose can cause a seizure. A seizure may also be due to a brain tumor or other health problem affecting the brain. In addition, anything that results in a sudden lack of oxygen to the brain can cause a seizure. In some cases, the cause of the seizure is never discovered.
Management
ABC Safety Arrange for immediate transfer to hospital
by: Elmer G. Organia, RN
Emergency Nursing
Emergency Nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury. injury. the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known. known.
An emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients, supports and attends to families within a timetimelimited and high pressured environment. Must be rendered without delay
Issues in Emergency Nursing Care
Documentation of Consent
for invasive procedures procedure must be documented for unconscious patient without relatives. relatives.
Limitation of Exposure to Health Risks
HIV infections
Communicable Diseases
Nurses must protect themselves
Providing Holistic Care
Patient Focused Interventions Family Focused Intervention
Anxiety and Denial Guilt Anger Grief
Continuum of Care
Discharge Planning Community Services
Principles of Emergency Nursing
A. Triage
is a process of prioritizing patients based on the severity of their condition so as to treat as many as possible when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning "to trier, sort, sift or select."
Types of Triage
1. Simple Triage
Simple triage is used in a scene of mass
casualty, casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging
Categories of Severity
Black / Expectant They are so severely injured that they will die of their injuries, possibly in hours or days (large(largebody burns, severe trauma, lethal radiation dose), or in life-threatening medical crisis that lifethey are unlikely to survive given the care available (cardiac arrest, septic shock, severe (cardiac arrest, shock, head or chest wounds); they should be taken to a holding area and given painkillers as required to reduce suffering.
Cont
Red / Immediate They require immediate surgery or other lifelife-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they "cannot wait" but are likely to survive with immediate treatment.
Cont
Yellow / Observation Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital recare (and would receive immediate priority care under "normal" circumstances).
Cont
Green / Wait (walking wounded) They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).
Cont
White / Dismiss (walking wounded) They have minor injuries; first aid and home care are sufficient, a doctor's care is not required. Injuries are along the lines of cuts and scrapes, or minor burns.
2.Advanced Triage
Advanced triage
In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.
Three Categories of Triage System
Emergent -patients with the highest priority and must be seen immediately Urgent patients with serious health problems but not immediately life threatening, they must be seen within 1 hour. Non-UrgentNon-Urgent-patients have episodic illnesses that can be addressed within 24 hours without increased morbidity.
B. Prioritization
A systematic approach Airway Breathing Circulation Disability
1.Respiratory Emergencies
A. Airway Obstruction
The airway is partially or completely occluded Permanent brain damage or death will occur within 3-5 minutes 3-
Anatomy of the Respiratory System
Clinical Manifestations
Labored Breathing Use of Accessory Muscles Cyanosis Confusion Flaring Nostrils Hypoxia Loss of Consciousness
Assessment and Diagnostic Findings
If Conscious-simply ask the patient ConsciousIf Conscious Inspection X-ray Laryngoscopy Bronchoscopy
Management
1. Head-tilt/chin-lift maneuver Head-tilt/chinCheck Breathing. Opening the airway. Place patient in a supine position. Place one hand in a patients forehead. Apply pressure to tilt the head back. Place the other hand under the bony part of lower jaw near the chin and lifted up. Top: Airway obstruction produced by the tongue and the epiglottis. Bottom: Relief by head-tilt/chin-lift. head-tilt/chin-
Note: Do not use this maneuver if you suspect cervical spine injury.
2.Jaw2.Jaw-Thrust Maneuver
One hand is placed on each side of patient jaw. Displace our mandible forward.
3.Oropharyngeal Airway Insertion
An oropharyngeal airway (also known as an oral airway,OPA or Guedel pattern airway) is a medical device called an airway adjunct used to maintain a patent (open) airway. It does this by preventing airway. the tongue from (either partially or completely) covering the epiglottis, which epiglottis, could prevent the patient from breathing.
designed by Arthur E. Guedel Oropharyngeal airways come in a variety of sizes, from infant to adult, and are used mostly in pre-hospital emergency care pre-
4. Endotracheal Intubation
refers to the placement of a tube into an external or internal orifice of the body. Tracheal intubation is the placement of a flexible plastic tube into the trachea to protect the patient's airway and provide a means of mechanical ventilation. The most common intubation is orotracheal intubation where, with the assistance of a laryngoscope, an endotracheal laryngoscope, tube is passed through the mouth, larynx, and larynx, vocal cords, into the trachea. A bulb is then inflated near the distal tip of the tube to help secure it in place and protect the airway from blood, vomit, and secretions
Indications
Comatose or intoxicated patients who are unable to protect
their airways. In such patients, the throat muscles may lose their tone so that the upper airways obstruct or collapse and air can not easily enter into the lungs. General anesthesia. In anesthetized patients spontaneous respiration may be decreased or absent due to the effect of opioids, relaxants. anesthetics, opioids, or muscle relaxants. To enable mechanical ventilation, an endotracheal tube is often used, although there are alternative devices such as face masks airways. or laryngeal mask airways.
Cardiopulmonary Resuscitation. ardiopulmonary Resuscitation.
5. Heimlich Maneuver
Abdominal thrusts, also known as the Heimlich Heimlich) Maneuver (after Henry Heimlich) Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, trachea, hopefully expelling it. This amounts to it. an artificial cough .
Alternatives to Intubation
y Tracheostomy - a surgical technique, typically for patients who require longlong-term respiratory support
B.Hypoxia
Hypoxia literally means "a deficiency "a in oxygen." Hypoxia (medical), a shortage of (medical), oxygen in the body. Hypoxemia is the reduction of oxygen specifically in the blood; Anoxia is when there is no oxygen available at all.
Types of Hypoxia
Hypoxemic Hypoxia is a generalized hypoxia, an inadequate supply of oxygen to the body as a whole. Anemic Hypoxia - total oxygen content of the blood is reduced. Hypemic Hypoxia - the blood fails to deliver oxygen to target tissues. Histotoxic Hypoxia the quantity of oxygen reaching the cells is normal, but the cells are unable to effectively use the oxygen . Ischemic Hypoxia - there is a local restriction in the flow of otherwise well-oxygenated blood well-
Symptoms
Headache Fatigue Nausea Cyanosis Seizure Coma Death
Management
Remove Obstruction/Cause Oxygen Inhalation Bypass Airway Rest
C. Hanging and Strangulation
Hanging is the lethal suspension of a person by a ligature. A method of suicide in which a person applies a ligature to the neck and brings about unconsciousness and then death. Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain.
Strangulation - is a compression of the neck that leads to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the mechanism of suicide. Ligature strangulation Strangulation without suspension using some form of cordcord-like object . Manual strangulation Strangulation using the fingers or other extremity
Aims of Care
Restore adequate breathing To arrange urgent transport in the hospital
Recognition
A constricting article around the neck. Marks around the casualty neck. Cyanosis or impaired consciousness. Prominent veins on the face.
Special Precautions
Observe proper transport Do not destroy materials used in constricting the neck, police may need it as evidence.
D. Drowning
Drowning is death as caused by suffocation when a liquid causes interruption of the body's absorption of oxygen from the air leading to asphyxia. asphyxia. The primary cause of death is hypoxia and acidosis leading to cardiac arrest .
Cont
.
Near drowning is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious secondary complications, including death, after the event
Aims of Care
To restore adequate breathing To keep casualty warm To arrange urgent transport in the hospital.
Risks factors
In no particular order: Lack of supervision of young children (less than 5 years old). Water conditions exceed the swimmer's ability - turbulent or fast water, water out of depth, falling through ice, Entrapment - physically unable to get out of the situation because of a lack of an escape route, snagging or by being hampered by clothing or equipment.
Cont .
Impaired judgment and physical incapacitation arising from the use of drugs, principally alcohol. Incapacitation arising from acute illness attack, while swimming - heart attack, seizure or stroke. stroke. Forcible submersion by another person murder or misguided children's play. Drowning following a car crash or submersion.
Incidence
Victims are more likely to be male, young or adolescent. Surveys indicate that 10% of children under 5 have experienced a situation with a high risk of drowning. The causes of drowning cases as follows: 44% are related to swimming 17% are related to boating 14% are un attributed 10% related to scuba diving 7% related to car accidents
Prevention
Learn to swim Keep a watch out for others. Swim in areas where adequate supervision is present ie a trained and certified Lifeguard. Ensure that boats are reliable, properly loaded and that functional emergency equipment is onboard.
Cont .
Wear a properly fitting lifejacket while enjoying water sports such as sailing, sailing, surfing. surfing. Pay attention to the weather, tides and water conditions. Keep children under a watchful eye . Do not dive into an unknown depth and or bottom contour area.
Cont
Avoid swimming alone Avoid swimming at night Avoid swimming under the influence of drugs and or alcohol . Be aware of your personal limits
Drowning Rescue
Do not endanger yourself during this process. Throw a rope. Use a long stick. The focus of the first aid for a nearneardrowning victim in the water is to get oxygen into the lungs without aggravating any suspected neck injury.
E. Inhalation of Fumes
Smoke inhalation is the primary cause of death in victims of indoor fires. fires. Smoke inhalation injury refers to injury due to inhalation or exposure to hot gaseous products of combustion. This can cause serious combustion. respiratory complications This refers to the inhalation of smoke or gases such as carbon monoxide. The casualty is most likely to have low levels of oxygen in his body tissues.
Smoke Inhalation
A person who is confined in a space during fire is assumed to have inhaled smoke. A smoke from burning plastics, foams and synthetic wall covering is likely to contain poisonous fumes.
Inhalation of Carbon Monoxide
Carbon Monoxide is a poisonous gas that is produced by burning. It acts directly on the red blood cells preventing them from carrying oxygen to the body tissues. Carbon Monoxide has no taste or smell.
Signs and Symptoms
Coughing Vomiting Nausea, Sleepiness Confusion Difficulty Breathing
Treatment
Treatment consists of humidified oxygen, bronchodilators, suction, endotracheal tube and chest physiotherapy. Other measures include adequate fluids and control of infection by daily sputum stains and appropriate antibiotics.
F. Penetrating Chest Wound
Depending on its size, a penetrating chest wound may cause varying degrees of damage to bones, soft tissue, blood vessels, and nerves.
The risk of death and disease from a chest wound depends on the size and severity of the wound. Gunshot wounds are usually more serious than stab wounds because they cause more severe lacerations and rapid blood loss. With prompt, aggressive treatment, up to 90% of patients with penetrating chest wounds recover.
Causes
Stab wounds from a knife or an ice pick and gunshot wounds are the most common penetrating chest wounds. wounds. Explosions or firearms fired at close range are the usual source of large wounds. wounds.
Aims of Care
To seal the wound and maintain breathig To minimize shock Arrange immediate transport to the hospital
Diagnostic tests
X-rays Physical Assessment
Treatment
In a penetrating chest wound, treatment involves maintaining a patent airway and providing ventilatory support as needed. Chest tube insertion allows the reestablishment of intrathoracic pressure and drainage of blood from a hemothorax. The patient's wound needs surgical repair. The patient also may need analgesics and antibiotics. Tetanus prophylaxis, and infusion of blood products and I.V. fluids.
G. Hyperventilation
Hyperventilation (or overbreathing) is the state of breathing faster and/or deeper than necessary, thereby reducing the carbon dioxide concentration of the blood below normal.
Causes
Stress or anxiety commonly are causes of hyperventilation; this is known as hyperventilation syndrome . Hyperventilation can also be brought about voluntarily, by taking many deep breaths. Hyperventilation can also occur as a consequence of various lung diseases.
Signs and Symptoms
Unnaturally fast deep breathing. Cramps in the hands. Dizziness Faintness
Management
Ask casualty to regain control of her breathing. Rebreath her own exhaled air in a paper bag. Encourage to seek medical attention
H. Asthma
Asthma is a chronic condition involving the respiratory system in which the airways occasionally constrict, become inflamed, and are inflamed, mucus, lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an environmental stimulant such as an allergen, environmental tobacco smoke, allergen, cold or warm air, perfume, pet dander, moist air, exercise or exertion, or emotional stress
Signs and symptoms
Wheezing Shortness of breath Chest tightness Coughing Inability for physical exertion Tachycardia Use of accessory muscles
Causes
Hereditary Poor air quality Environmental tobacco smoke Viral respiratory infections Antibiotic use Psychological stress
Management
Identify allergens Remove source of stress Bronchodilators Nebulization Steroids Antibiotics Rest
11. WOUNDS and BLEEDINGS
A. Hemorrhage
Bleeding, technically known as hemorrhage is the loss of blood from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the vagina, vagina, mouth or anus, or through a break in anus, the skin. skin. Loss of 10-15% of total blood volume can be 10endured with clinical problem in a healthy person.
Causes
Hemophilia emophilia low platelet count (thrombocytopenia) (thrombocytopenia) Anticoagulant medications, such as warfarin Trauma and Injuries
Four Classes of Hemorrhage
y Class I Hemorrhage involves up to 15% of blood volume. There is 15% volume. typically no change in vital signs and fluid resuscitation is not usually necessary. necessary.
Class II Hemorrhage involves 15-30% 15of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently.
Volume resuscitation with crystaloids (Saline solution or Lactated Ringer's solution) solution) is all that is typically required. required. Blood transfusion is not typically required. required.
Class III Hemorrhage involves loss of 303040% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystaloid and blood transfusion are usually necessary.
y Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.
B. Wounds
Wound is a type of injury in which in the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, pathology, it specifically refers to a sharp injury which damages the dermis of the skin.
Types of Wounds
a. Incisions or incised wounds, caused wounds, by a clean, sharp-edged object such as a sharpknife, knife, a razor or a glass splinter.
b. Lacerations, irregular wounds caused Lacerations, by a blunt impact to soft tissue that lies over hard tissue (e.g. laceration of the skin covering the skull) or tearing of skin and other tissues such as caused by childbirth.
c. Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
d.Puncture wounds, caused by an object wounds, puncturing the skin, such as a nail or skin, needle .
f. Gunshot wounds, caused by a bullet or wounds, similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit .
g. Contusions, more commonly known as Contusions, bruises, bruises, caused by blunt force trauma that damages tissue under the skin.
h. Hematomas, also called blood tumors, Hematomas, caused by damage to a blood vessel that in turn causes blood to collect under the skin. skin.
i. Crushing Injuries , caused by a great or extreme amount of force applied over a long period of time.
Management
Wound Care Antibiotics Pain Reliever Tetanus Toxoid and HTIG Control Bleeding The pattern of injury, evaluation and treatment will vary with the mechanism of the injury
C. Infected Wounds
Diabetes is a known factor in the host response, especially if the patient s blood sugar is not well controlled.
Signs and Symptoms
A wound becomes red,hot,swollen and painful. It has Pus Lymph nodes becomes swollen and tender. Danger of tetanus is very great to people who have not been vaccinated.
Management
Proper Wound Care Use of Antibiotics Pain Relievers Health Teachings
D. Nosebleeding
Nose bleeding occurs frequently in patients with a deviated septum. septum. Septal perforations, or holes in the septum, frequently bleed. Foreign bleed. bodies placed in the nose by children or disturbed people may result in bleeding. bleeding.
Causes
Direct trauma to the nose, accidental or self-inflicted is probably the most selfcommon cause of nose bleeds. bleeds. Extreme Heat High Blood Pressure
Aims of Care
Control Blood Loss Maintain an Open Airway
Management
Ask the casualty to sit down and tilt her head move forward. Ask the casualty to breath through her mouth. See for any foreign object on the nose Advise not to spit, cough or exert effort Advise to rest.
E. Varicose Veins
Varicose veins are veins that have become enlarged and twisted.
Aims of Care
To bring blood loss under control. To minimize shock. To arrange immediate transfer to Hospital
Management
Put on Gloves Raise and Support the injured leg as high as possible Apply firm and direct pressure. Remove garments such as stockings and garters.
111. Orthopedic Emergencies
A. Bone Fractures
A bone fracture (sometimes abbreviated as Fx) is a medical condition in which a Fx) bone is cracked or broken. It is a break in broken. the continuity of the bone Although fractures are commonly referred to as bone breaks, the word break is not part of formal orthopedic terminology.
Categories of Fracture
Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open Fractures the broken bone end pierce the skin surface. This carries high risk for infection.
Type of Fractures
y Compacted Fracture- A fracture Fracturecaused when bone fragments are driven into each other. other. y Comminuted FractureFractureA fracture which results in several fragments. fragments. y Spiral Fracture- A fracture where at Fractureleast one part of the bone has been twisted. twisted.
y Compression Fracture- A fracture Fracturethat usually occurs in the vertebrae. vertebrae. y Oblique Fracture- A fracture that is Fracturediagonal to a bone's long axis. axis. y Transverse Fracture- A fracture that Fractureis at a right angle to the bone's long axis. y Linear Fracture- A fracture that is Fractureparallel to the bone's long axis. axis.
y Incomplete Fracture- A fracture in Fracturewhich the bone fragments are still partially joined. joined. y Complete Fracture- A fracture in Fracturewhich bone fragments separate completely. completely.
Diagnosis
X-ray Physical Assessment
Management
Immobilization Splinting Pain Relief Antibiotic I and D ( Irrigation and Drainage) Realignment Surgery
B. Joint dislocation
Joint dislocation (Latin: luxatio) occurs luxatio) when bones in a joint become displaced or misaligned. It is often caused by a sudden impact to the joint. The ligaments always become damaged as a result of a dislocation .
Common Sites
Shoulders Fingers Knees
Treatment
Anyone experiencing a joint should seek medical assistance as soon as possible. A dislocated joint can only be successfully 'reduced' into its normal position by a trained medical professional. Trying to reduce a joint without any training could result in making the injury substantially worse.
X-rays are usually taken to confirm a diagnosis and detect any fractures which may also have occurred at the time of dislocation. dislocation. Once a diagnosis is confirmed, the joint is usually manipulated back into position. position. This can be a very painful process, therefore this is typically done under local or in an Operating Room under a General Anaesthetic. Anaesthetic.
Management
After a dislocation, injured joints are usually held in place through a splint (for straight joints like fingers and toes) or a bandage (for complex joints like shoulders). shoulders). Additional to this, the joint muscles, tendons and ligaments must also be strengthened. This is usually done strengthened. through a course of Physiotherapy, which Physiotherapy, will also help reduce the chances of repeated dislocations of the same joint. joint.
C. Sprain and Strain
A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments another. stabilize and support the body's joints. For example, ligaments in the joints. knee connect the upper leg with the lower leg, enabling people to walk and run. run.
A strain is an injury of a muscle and/or tendon. Tendons are fibrous tendon. cords of tissue that attach muscles to bone. bone.
What causes sprains and strains?
A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments .
Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. tendons. Inadequate rest breaks during intensive training precipitates a strain. strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction. contraction.
Who gets sprains and strains?
Professional and amateur athletes and the general public, as well, can sustain this injury. People at risk for injury. the injury have a history of sprains and strains, are overweight, and are in poor physical condition. condition.
What are the signs of a sprain?
While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains: mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone.
What are the signs of a strain?
Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe cramping. strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual.
How are sprains and strains treated?
Rest Ice Compression Elevation
Rest: Stop all activities which cause pain Rest: to avoid the strain becoming more serious. serious. Ice: Ice: Helps reduce swelling. Never ice for swelling. more than 10-15 minutes at a time. Use a 10time. layer of fabric or paper in between the ice and the injury to avoid burning the skin. skin. Compression: Compression: Wrap the strained area to reduce swelling. swelling. Elevation: Keep the strained area as Elevation: close to the level of the heart as is conveniently possible to keep blood from pooling in the injured area
Prevention Tips
No one is immune to sprains and strains Participate in a conditioning program to build muscle strength. Do stretching exercises daily. Always wear properly fitting shoes .
Nourish your muscles by eating a wellwellbalanced diet. Warm up before any sports activity, including practice Use or wear protective equipment appropriate for that sport .
D. Spinal Cord Injury
Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber tracts that carry sensation and motor signals to and from the brain. Trauma such as automobile accidents, falls, gunshots, diving accidents, falls, gunshots, accidents, war injuries, etc. accidents, injuries,
Cervical injuries
C4 : May have some use of biceps and shoulders, but weaker C5 : May retain the use of shoulders and biceps, but not of the wrists or hands. C6 : Generally retain some wrist control, but no hand function. C7 and T1 : Can usually straighten their arms but still may have dexterity problems with the hand and fingers. C7 is generally the level for functional independence.
Thoracic Injuries
y T1 to T8 : Most often have control of the hands, but lack control of the abdominal muscles so control of the trunk is difficult or impossible. impossible. Effects are less severe the lower the injury. injury.
T9 to T12 : Allows good trunk and abdominal muscle control, and sitting balance is very good . The effect of injuries to the lumbar or sacral region of the spinal canal are decreased control of the legs and hips, hips, urinary system, and anus. anus.
Management
Mobilize Patient as one unit Provide a C-Collar CABC Resuscitate if necessary Arrange urgent transfer to the hospital
E. Ribcage Injury
There are 12 ribs on each side of the chest that protect the heart, lungs, and the upper abdominal contents. All of the ribs are attached to the vertebrae (backbone) in the rear. In the front, 10 of them are attached to the sternum (breastbone) by pieces of cartilage. Direct blows to the ribs may bruise or break the ribs or injure to the rib cartilage. The ribs may tear away from the cartilage that attaches them to the breastbone. This tearing away from the cartilage is called a costochondral separation.
How does it occur?
Rib injuries usually result from a direct blow to the chest wall. Breaks usually occur in the curved portion of the outer part of the rib cage. A costochondral separation may occur when you land hard on your feet or even when you cough or sneeze violently.
What are the symptoms?
A rib injury causes pain and tenderness over the place of injury. You may have pain when you breathe, move, laugh, or cough.
How is it diagnosed?
Your doctor will review your symptoms, examine your rib cage, and listen to your lungs. Your doctor may order a chest xxray to look for any rib damage, lung damage, or bleeding around the lungs.
Treatment
Rest Putting an ice pack over the injured rib for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain goes away. Taking an anti-inflammatory or other pain antimedication
When can I return to my usual activities?
If you broke a rib it may take 4 to 6 weeks to heal. Your doctor may take an x-ray to see that xthe bone has healed before he or she allows you to return to your activity, especially if it is a contact sport. You may participate in nonnoncontact activities sooner if you can do so without pain in your ribs and without pain when you breathe. If you have bruised your ribs or separated the cartilage from the ribs, you may return to your activity when you can do so without pain.
How can I prevent Ribcage Injury?
Ribs are often injured in accidents that are not preventable. However, in contact sports such as football it is important to wear appropriate protective equipment
1V. Nervous System Emergencies
a. Concussion
Concussion, from the Latin concutere ("to shake violently"). The terms mild brain injury, mild traumatic injury, brain injury (MTBI), mild head injury MTBI), (MHI), and minor head trauma and MHI), concussion may be used interchangeably. concussion can cause a variety of physical, cognitive, cognitive, and emotional symptoms
Causes
The leading causes of MTBI in adults are falls and vehicle accidents. accidents. sports injuries assaults, industrial and work-related injuries, workand injuries that occur in the home and school. school. Among children aged 5 to 14, sports and 14, bicycle accidents cause the greatest number of concussions. concussions.
The relative contribution of causes of mild head injury differs by region, gender, and age. For example, in Scotland and Sweden, falls account for the greatest percentage of MHIs, while in the U.S. and Australia, transportation is the largest cause. Soldiers are at elevated risk for concussion from causes such as bomb blasts, with as many as 15% 15% of U.S. infantry soldiers who return from the Iraq War meeting the criteria for MTBI. MTBI.
Mechanism
Punches in boxing deliver more rotational force to the head than impacts in sports such as football, and boxing carries a higher risk of concussion than football. The brain is surrounded by cerebrospinal fluid, fluid, one of the functions of which is to protect it from light trauma, but more severe impacts or the forces associated with rapid acceleration and deceleration may not be absorbed by this cushion
Concussion may be caused by impact forces, forces, in which the head strikes or is struck by something, or impulsive forces, in which the head moves without itself being subject to blunt trauma (for example, when the chest hits something and the head snaps forward).
Signs and Symptoms
Headache and difficulty concentrating dizziness, vomiting, nausea, nausea, lack of motor coordination, coordination, difficulty balancing,. balancing,. light sensitivity seeing bright lights, blurred vision double vision. vision. Tinnitus, Tinnitus, or a ringing in the ears, is also commonly reported Convulsions
Diagnosis
Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia post(PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15 ) CT Scan
b. Contusion
Cerebral contusion, Latin contusio cerebri, a cerebri, injury, form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, tissues, cerebral contusion can be caused by multiple microhemorrhages, microhemorrhages, small blood vessel leaks into brain tissue. Treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the pressure, skull. Contusions are likely to heal on their own without medical intervention
Signs and Symptoms
Contusion can present with weakness, lack of motor coordination, numbness, aphasia, coordination, numbness, aphasia, and memory and cognitive problems.[3] problems.[3] Signs depend on the contusion's location in the brain.
Causes
The interior of the skull has sharp ridges by which a moving brain can be injured. Often caused by a blow to the head. head.
Treatment
Since cerebral swelling presents a danger to the patient, treatment of cerebral contusion aims to prevent swelling. Measures to avoid swelling include prevention of hypotension (low blood pressure). Due to the danger of increased intracranial pressure, surgery may be necessary to reduce it. People with cerebral contusion may require intensive care and close monitoring.
c. Skull Fracture
A skull fracture is a break in one or more of the injury. bones in the skull caused by a head injury. Isolated skull fractures are not very serious injuries, but the presence of a skull fracture may indicate that significant enough impact occurred to cause brain trauma, which is quite serious. trauma, Broken fragments of skull can lacerate or bruise the brain or damage blood vessels. If the vessels. fracture occurs over a major blood vessel, significant bleeding can occur within the skull, so head injury patients with skull fracture have many more intracranial hematomas .
Types of Skull Fracture
Linear skull fractures- the most fracturescommon type of skull fracture, occur in 69% of patients with severe head injury. Usually caused by widely distributed forces, linear fractures often occur when the impact causes the area of the skull that was struck to bend inward, making the area around it buckle outward.
Diastatic fractures are linear fractures that cause the bones of the skull to separate at the skull sutures in young children whose skull bones have not yet fused.
Comminuted skull fractures- those in fractureswhich a bone is shattered into many pieces, can result in bits of bone being driven into the brain, lacerating it.Depressed skull fractures, a very serious type of trauma occurring in 11% of severe head injuries, are comminuted fractures in which broken bones are displaced inward. This type of fracture carries a high risk of increasing pressure on the brain, crushing brain, the delicate tissue.
Basilar skull fractures-breaks in bones at fracturesthe base of the skull, require more force to cause than cranial vault fractures. Thus they are rare, occurring as the only fracture in only 4% of severe head injury patients.[2][5] patients.[2][5] Basilar fractures have sinuses; characteristic signs: blood in the sinuses; a clear fluid called cerebrospinal fluid (CSF) leaking from the nose or ears; raccoon eyes (bruising of the orbits of the eyes that result from blood collecting there as it leaks from the fracture site); and Battle's sign (caused when blood collects behind the ears and causes bruising).
D. Stroke
Stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism, embolism, or due to a hemorrhage. hemorrhage. In the past, stroke was referred to as cerebrovascular accident or CVA, but the term "stroke" is now preferred. preferred.
Stroke is a medical emergency and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated.
Risk factors
Advanced age Hypertension (high blood pressure), Previous stroke or transient ischemic attack (TIA) Diabetes High cholesterol Cigarette smoking Atrial fibrillation, the contraceptive pill, fibrillation, pill, migraine with aura, and thrombophilia (a tendency to thrombosis). High blood pressure is the most important modifiable risk factor of stroke.
Classification
Ischemic Stroke-blood supply to part of Strokethe brain is decreased, leading to dysfunction and necrosis of the brain tissue in that area. There are four reasons area. why this might happen: thrombosis happen: (obstruction of a blood vessel by a blood clot forming locally), embolism (idem due to a embolus from elsewhere in the body, see below), systemic hypoperfusion (general decrease in blood supply, e.g. in shock) shock) and venous thrombosis. Stroke thrombosis. without an obvious explanation is termed "cryptogenic" (of unknown origin). origin).
Thrombotic stroke -In thrombotic stroke, a thrombus (blood clot) usually forms around atherosclerotic plaques. Embolic stroke refers to the blockage of an embolus, artery by an embolus, a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most elsewhere. frequently a thrombus, but it can also be a number of other substances including fat (e.g. (e. from bone marrow in a broken bone), air, bone), cancer cells or clumps of bacteria (usually from infectious endocarditis .
Diagnosis
CT scans (most often without contrast enhancements) or MRI scans, Doppler scans, ultrasound, ultrasound, and arteriography. arteriography. For detecting chronic hemorrhages, MRI scan is more sensitive A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.
Prevention
Given the disease burden of stroke, prevention is an important public health concern. The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation
Other modifiable risk factors include high blood cholesterol levels, diabetes, cigarette smoking (active and passive), heavy alcohol consumption and drug use,lack of physical activity, obesity activity, and unhealthy diet . Hypertension accounts for 35-50% of stroke 35risk. High cholesterol levels have been consistently associated with (ischemic) stroke. Patients with diabetes mellitus are 2 to 3 times more likely to develop stroke .
Treatment
Mechanical Thrombectomy
Good nursing care is fundamental in maintaining skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure. This is also to prevent pneumonia or Bedsores. An ischemic stroke is due to a thrombus (blood clot) occluding a cerebral artery, a patient is given antiplatelet medication (aspirin, clopidogrel, dipyridamole), or anticoagulant medication (warfarin), dependent on the cause, (warfarin), when this type of stroke has been found.
Prognosis
Disability affects 75% of stroke survivors enough to decrease their employability.
E. Seizure
A seizure, also known as a convulsion or seizure, fit, is a sudden loss of consciousness, a fit, change in one's state of consciousness, or loss of control over one's body.
Seizure Types
Epileptic Seizure
Absence seizure Atonic seizure Focal seizures Simple partial seizure Jacksonian seizure TonicTonic-clonic seizure
NonNon-epileptic seizure
Febrile seizure PostPost-traumatic seizure Psychogenic non-epileptic seizures non-
Causes
Seizures are caused by abnormal electrical discharges in the brain. Symptoms may vary depending on the part of the brain that is involved, but seizures often cause unusual sensations, uncontrollable muscle spasms, and loss of consciousness. Some seizures may be the result of a medical problem. Low blood sugar, infection, a head injury, accidental poisoning, or drug overdose can cause a seizure. A seizure may also be due to a brain tumor or other health problem affecting the brain. In addition, anything that results in a sudden lack of oxygen to the brain can cause a seizure. In some cases, the cause of the seizure is never discovered.
Management
ABC Safety Arrange for immediate transfer to hospital
