mdc4 - chapter 10, 11, 12

How to assess suspected human trafficking

"Do you feel free to come and go anywhere as you please?" "Does anyone you work for make you feel unsafe?" "Have you ever felt like you cannot leave your employer?"

stop the bleed

1. apply pressure with hands 2. apply dressing and press 3. apply tourniquet(s)

APVU

ALERT responsive to VOICE responsive to PAIN UNRESPONSIVE

ABCDE

Airway/Cervical spine Breathing Circulation Disability Exposure in the presence of massive, uncontrolled external bleeding, hemorrhage control techniques are the HIGHEST priority (CAB)

B: breathing

Assess breath sounds and respiratory effort Observe for chest wall trauma or other physical abnormality Prepare for chest decompression if needed Prepare to assist ventilations if needed.

presence of a carotid pulse

BP at least 60 mmHg systolic

presence of a femoral pulse

BP at least 70 mmHg systolic

presence of a radial pulse

BP at least 80 mmHg systolic

level 2 & 3 trauma center

Both typically located in community hospitals Level II • Provides care to most injured patients • Transfers patient if needs exceed resource capabilities Level III • Stabilizes patients with major injuries • Transfers patient if needs exceed resource capabilities

common condition causing hypothermia

Cold-water immersion acute illness (e.g., sepsis) Traumatic injury Shock states Immobilization Cold weather (especially for people who are homeless or work outdoors) Older age Use of medications (e.g., phenothiazines, barbiturates) Inappropriate alcohol and substance use Undernutrition Hypothyroidism Inadequate clothing or shelter (e.g., the homeless population)

snake bite prevention

Do not keep venomous snakes or constricting snakes as pets. Be extremely careful in locations where snakes may hide, such as tall grass, rock piles, ledges and crevices, woodpiles, brush, boxes, and cabinets. Snakes are most active on warm nights. Wear protective attire such as boots, heavy pants, and leather gloves. When walking or hiking, use a walking stick or trekking poles. Inspect suspicious areas before placing hands and feet in them. Do not harass any snakes you may encounter. Striking distance can be up to two thirds the length of the snake. Even young snakes pose a threat; they are capable of envenomation from birth. Be aware that newly dead or decapitated snakes can inflict a bite for up to an hour after death because of persistence of the bite reflex. Do not transport the snake with the victim to the medical facility for identification purposes; instead, take a digital photo of the snake at a safe distance if possible.

A: airway

Establish a patent airway by positioning, suctioning, and administering oxygen as needed Protect the cervical spine by maintaining alignment; use a jaw-thrust maneuver if there is a risk for spinal injury If the Glasgow Coma Scale (GCS) score is 8 or lower or the patient is at risk for airway compromise, prepare for endotracheal intubation and mechanical ventilation.

D: disability

Evaluate the patient's level of consciousness (LOC) using the GCS or APVU Re-evaluate the patient's LOC frequently.

HAZMAT

Hazardous Materials training undergone by ED physicians, providers, and nursing staff learn how to recognize patterns of illness in patients who present for tx that potentially indicate biologic terrorism agents such as anthrax or smallpox

advanced cardiac life support (ACLS)

Invasive airway-management skills, pharmacology, and electrical therapies; special resuscitation situations

C: circulation

Monitor vital signs, especially blood pressure and pulse Maintain vascular access with a large-bore catheter Use direct pressure for external bleeding; anticipate need for a tourniquet for severe, uncontrollable extremity hemorrhage, wound packing, and/or use of a hemostatic dressing.

Pediatric Advanced Life Support (PALS)

Neonatal and pediatric resuscitation

Basic Life Support (BLS)

Noninvasive assessment and management skills for airway maintenance and cardiopulmonary resuscitation (CPR)

lightening strike prevention

Observe weather forecasts when planning to be outside. a lightning strike is imminent if your hair stands on end, you see a blue halo around objects, and you hear high-pitched or crackling noises. If you cannot move away from the area immediately, crouch on the balls of your feet and tuck your head down to minimize the target size; do not lie on the ground or make contact with your hands to the ground. Seek shelter when you hear thunder. Go inside the nearest building or an enclosed vehicle. Avoid isolated sheds and cave entrances. Do not stand under an isolated tall tree or structure (e.g., ski lift, flagpole, boat mast, power line) in an open area such as a field, ridge, or hilltop; lightning tends to strike high points. Instead, seek a low area under a thick growth of saplings or small trees. Leave water immediately (including an indoor shower or bathtub) and move away from any open bodies of water. Avoid metal objects such as chairs or bleachers; put down tools, fishing rods, garden equipment, golf clubs, and umbrellas; stand clear of fences, exposed pipes, motorcycles, bicycles, tractors, and golf carts. if inside a car with a solid hood, close the windows and stay inside. If in a convertible, leave the car at least 49 yards (45 meters) away and huddle on the ground. If inside a tent, stay away from the metal tent poles and wet fabric of the tent walls. If you are caught out in the open and cannot seek shelter, attempt to move to lower ground such as a ravine or valley; stay away from any tall trees or objects that could result in a lightning strike splashing over to you; place insulating material between you and the ground (e.g., sleeping pad, rain parka, life jacket). If inside a building, stay away from open doors, windows, fireplaces, metal fixtures, and plumbing. Turn off electrical equipment, including computers, televisions, and stereos to avoid damage. stay off land-line telephones. Lightning can enter through the telephone line and produce head and neck trauma, including cataracts and tympanic membrane disruption. Death can result. Avoid use of cellular phones, which can transmit loud static that can cause acoustic damage.

risk for errors and adverse effects

Obtain a thorough patient and family history Check the patient for a medical alert bracelet or necklace Search the patient's belongings for weapons or other harmful items such as drugs and drug paraphernalia when he or she has an altered mental status or presents with behavioral health concerns.

community relations or public information officer

Person who serves as a liaison between the health care facility and the media

hospital incident commander

Physician or administrator who assumes overall leadership for implementing the emergency plan

triage officer

Physician or nurse who rapidly evaluates each patient to determine priorities for treatment

medical command physician

Physician who decides the number, acuity, and resource needs of patients

unintentional injuries

Poisonings MVC Falls Drownings Fires Asphyxiation Burns

E: exposure

Remove all clothing for a complete physical assessment Prevent hypothermia (e.g., cover the patient with blankets, use heating devices, infuse warm solutions)

SBIRT

Screening Brief Intervention Referral to Treatment

trauma nursing core course

Trauma nursing priorities, interventions, diagnostic studies, injury management

injury prevention for staff

Use Standard Precautions at all times Anticipate hostile, violent patient, family, and/or visitor behavior Plan and practice options if violence occurs, including assistance from the security department

Level 1 Trauma Center

Usually located in large teaching hospitals in densely populated areas Provides a full continuum of trauma services for adult and/or pediatric patients Conducting research is a requirement for trauma center verification

Level 4 Trauma Center

Usually located in rural and remote areas Provides basic trauma patient stabilization and advanced life support within resource capabilities Arranges transfer to higher trauma center levels as necessary

certified emergency nurse

Validates core emergency nursing knowledge base

Arthropod Bite/Sting Prevention

Wear protective clothing, including gloves and shoes, when working in areas known to harbor venomous arthropods such as spiders, scorpions, bees, and wasps. Cover garbage cans. Bees and wasps are attracted to uncovered garbage. Use screens in windows and doors to prevent flying insects from entering buildings. Inspect clothing, shoes, and gear for insects before putting on these items. Shake out clothing and gear that have been on the ground to prevent arthropod "stowaways" and inadvertent bites and stings. Consult an exterminator to control arthropod populations in and around the home. Eliminating insects that are part of the arthropod's food source may also limit their presence. Identify nesting areas such as yard debris and rock piles; remove them whenever possible. Do not place unprotected hands where the eyes cannot see. Avoid handling insects and arthropods or keeping them as "pets." Do not swat insects, wasps, and Africanized bees because they can send chemical signals that alert others to attack. Carry a prescription epinephrine autoinjector and antihistamines if known to be allergic to bee and wasp stings. Ensure that at least one significant other person is also able to use the autoinjector.

patients who are most medically stable may be discharged early, including those who:

Were admitted for observation and are not bedridden Are having diagnostic evaluations and are not bedridden Are soon scheduled to be discharged or could be cared for at home with support from family or home health care services Have had no critical change in condition for the past 3 days Could be cared for in another health care facility such as rehabilitation or long-term care

mass casualty event

a situation affecting public health that is defined based on the resource availability of a particular community or hospital facility when the number of casualties exceeds the resource capabilities, a disaster situation is recognized to exist

moderate hypothermia interventions

active external and core (internal) rewarming methods applying external heat with heating blankets can promote core temperature "after-drop" by producing peripheral vasodilation After-drop is the continued decrease in core body temperature after the victim is removed from the cold environment; it is caused by the return of cold blood from the periphery to the central circulation. Therefore the patient's trunk should be actively rewarmed before the extremities core rewarming methods: administration of warm IV fluids; heated oxygen or inspired gas to prevent further heat loss via the respiratory tract; and heated peritoneal, pleural, gastric, or bladder lavage.

paramedics

advanced life support providers who can perform advanced techniques, which may include cardiac monitoring, advanced airway management and intubation, needle chest decompression, establishing IV or intraosseous access, and administering drugs en route to the ED

drowning hospital care

airway and cardiopulmonary support interventions begin, including oxygen administration, endotracheal intubation, CPR, and defibrillation, if necessary gastric decompression with a nasogastric or orogastric tube is needed to prevent aspiration of gastric contents and improve ventilatory function after a period of artificial ventilation by mask, the patient typically has a distended abdomen, which impairs movement of the diaphragm and decreases lung ventilation patients who experience drowning require complex care. the full spectrum of critical care technology may be needed to manage the pathophysiologic complications of drowning, including pulmonary edema, infection, acute respiratory distress syndrome (ARDS), and CNS impairment.

triage

an organized system for sorting or classifying patients into priority levels, depending on illness or injury severity

grade 3 frostbite

appears as small blisters that contain dark fluid and an affected body part that is cool, numb, blue, or red and does not blanch full-thickness and subcutaneous tissue necrosis occurs and requires débridement.

intentional injuries

assault, homicide, suicide

heat-related illness: prevention

avoid alcohol and caffeine prevent overexposure to sun, use 30 spf sunscreen rest frequently and take breaks from being in hot environment, plan to limit activity at the hottest time of day wear lightweight, light-colored, and loose-fitting clothing pay attention to personal physical limitations; modify activities accordingly and take the time necessary to properly acclimate to a hot environment (2 weeks) take cool baths or showers to help reduce body temperature stay indoors in air-conditioned buildings if possible ask a neighbor, friend, or family member to check on older adult at least 2x day during a heat wave

Heat Stoke Symptoms

body temp > 104 hot and dry skin; may or may not perspire mental status changes: acute confusion, bizarre behavior, anxiety, loss of coordination, hallucinations, agitation, seizures, coma VS: hypotension, tachycardia, tachypnea electrolyte imbalances: sodium and potassium oliguria, abnormal clotting, pulmonary edema (crackles)

severe hypothermia symptoms

bradycardia severe hypotension bradypnea cardiac dysrhythmias, possible vfib or asystole decreased neurologic reflexes to coma decreased pain responsiveness acid-base imbalance

Multicasualty event

can be managed by a hospital using local resources

common ED procedures

central line insertion chest tube insertion ETT and initiation of mechanical ventilation fracture management foreign body removal lumbar puncture paracentesis pelvic examination wound closure by suturing

SBIRT is performed on

clients with continued alcohol use problems

features of specialized areas to treat patients with psychiatric disorders

closed-circuit video monitoring access-control door locks solid ceilings- prevent climbing to ceilings secured area to retain patient belongings metal detectors panic alarms elimination of any items or room features the could pose a safety risk to self, other patients or staff

hypothermia

core body temperature below 95

acute stress disorder characteristics

dissociative symptoms numbing reduced awareness depersonalization derealization amnesia

forensic nurse examiners (RN-FNEs)

educated to obtain histories, collect forensic evidence, and offer counseling and follow up care for victims of rape, abuse, and domestic violence (intimate partner violence) provide information about developing a safety plan or how to escape a violent relationship document injuries and collect physical and photographic evidence may provide testimony in court as to what was observed during examination and information about type of care provided

Emergency preparedness goal

effectively meet the extraordinary need for resources such as hospital beds, staff, drugs, PPE, supplies, and medical devices

heat stroke intervention at the scene

ensure patent airway remove patient from hot environment into air-conditioning or into shade contact emergency medical services to transport patient to ED remove patient's clothing pour or spray cold water on the patient's body and scalp fan the patient place ice in cloth or bags and position in the packs on the patient's scalp, in the groin area, behind neck, and in armpits (if possible) if immediate immersion in cold water is possible; support the patient in the water for rapid cooling and protect airway (best method)

psychiatric nurse team

evaluates patients with emotional behaviors or mental illness and facilitates follow-up treatment plan, including possible admission to an appropriate facility interact with patients and families when sudden illness, serious injury, or death of a loved one may have precipitated a crisis

disaster

event in which illness or injuries exceed resource capabilities of a health care facility or community because of destruction and devastations

internal disaster

event occurring inside a health care facility or campus that could endanger the safety of patients or staff ex: fire, explosion, loss of critical utilities, violence outcome: maintain patient, staff and visitor safety

external disaster

event outside of the health care facility or campus, somewhere in the community that requires the activation of the facility's emergency management plan

expectant - black tag

expected and allowed to die massive head trauma, extensive full-thickness body burns, high cervical spinal cord injury necessitating mechanical ventilation

GCS

eye opening verbal response motor response

Prehospital care providers

first caregivers that patients see before transport to the ED by ambulance or helicopter key source for valuable patient data

PTSD characteristics

flashbacks avoidance less interest in previously enjoyable events detachment rapid heart rate insomia

heat exhaustion symptoms

flu-like symptoms with headache, weakness, N/V continue to perspire despite dehydration assess for orthostatic hypotension and tachycardia

heat stroke interventions at the hospital

give o2 by mask or NS; be prepared for ETT start at least one IV with a large-bore needle or cannula admin fluids as prescribed, using cooled solutions if available cooling blanket obtain baseline labs test: urinalysis, serum electrolytes, cardiac enzymes, liver enzymes, CBC DO NOT ADMIN ASPIRIN OR OTHER ANTIPYRETICS insert rectal probe to measure core body temp q15 min insert indwelling urinary drainage catheter monitor VS frequently assess ABGs admin muscle relaxants or benzodiazepines as prescribed if the patient begins to shiver measure and monitor urine output and specific gravity to determine fluid needs stop cooling interventions when core body temp is reduced to 102

active rewarming methods

heating blankets - monitor skin q15-30 min warm packs convective air heaters or warmers

frostbite risk factors

inadequate insulation against cold weather (i.e., the skin is exposed to the cold, or the person's clothing offers insufficient protection, which leads to injury) fatigue, poor nutrition, smokers/alcohol consumers, people with impaired peripheral circulation, previous hx

Emergency Management

includes actions or steps taken to decreased the potential loss during a disaster involves: mitigation, preparedness, response, and recovery

penetrating trauma

injury from sharp objects and projectiles. Examples are wounds from knives, ice picks, other comparable implements, and bullets (gunshot wounds [GSWs]) or pellets. Fragments of metal, glass, or other materials that become airborne in an explosion (shrapnel) can also produce this type of trauma

secondary survey and resuscitation

insertion of gastric tube for decompression of the GI tract to prevent vomiting and aspiration insertion of urinary catheter to allow careful measure of urine output and prep for diagnostic studies comprehensive head-to-toe assessment to identify other injuries or medical issues that need to be managed or that might affect the course of tx splints applies to fractures extremities, and temporary dressings placed over wounds

preparedness

involves active steps taken to prepare to handle an emergency

mitigation

involves preplanning for a disaster, analyzing risk and loss and putting processes in place to minimize impact

recovery

involves steps taken to return to normal after the event

response

involves the actions taken to rescue and care for those affected by a disaster

injury prevention for patients

keep rails up on stretcher keep stretcher in lowest position remind patient to use call light for assistance reorient the confused patient frequently if patient is confused, ask family member or significant other to remain with patient implement measures to protect skin integrity for patients at risk for skin breakdown

grade 2 frostbite

large, clear-to-milky, fluid-filled blisters develop with partial-thickness skin necrosis

drowning

leading cause of accidental death in the United States occurs when a person suffers primary respiratory impairment from submersion or immersion in a liquid medium (usually water)

Medical Reserve Corps (MRC)

made up of a group of volunteer medical and public health care professionals, including physicians, providers, and nurses They offer their services to health care facilities or to the community in a supportive or supplemental capacity during times of need such as a disaster or pandemic disease outbreak

heat stroke

medical emergency in which body temperature exceed 104 high mortality rate if not treated in a timely manner

Disaster Medical Assistance Team (DMAT)

medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours

trauma informed care

model of care the ensures patient safety through four key practices: realizing the widespread effect of trauma recognizing the signs and symptoms of trauma responding by fully integrating trauma knowledge into practices and procedures seeking to actively resist retraumatization"

heat exhaustion: clinical management

monitor VS rehydrate with IV solution if N/V persists draw blood for serum electrolyte analysis

moderate hypothermia symptoms

muscle weakness increased loss of coordination acute confusion apathy incoherence possible stupor decreased clotting

examples of appropriate identifiers

name, birthdate agency ID number home telephone number or address social security number

heat stroke first aid/prehospital care

no food or liquid by mouth because vomiting and aspiration are risks

mottling

normal finding in newborn, but may indicate poor peripheral perfusion and a shock state in an adult

nonexertional heat stroke (classic heat stoke)

occurs over a period of time as a result of chronic exposure to a hot, humid environment such as living in a home without air conditioning in the high heat of summer

frostbite

occurs when body tissue freezes and causes damage to tissue integrity

emergency medical technicians (EMTs)

offer basic life support (BLS) interventions such as oxygen, basic wound care, splinting, spinal immobilization, and monitoring of vital signs

heat-related illnesses: risk factors

older adults mental health/behavioral health conditions outside workers homeless individuals substance users outdoor sports athletes military members stationed in hot climates obesity, heart disease, fever, infection, strenuous exercise, seizures, all degrees of burns (even sunburn) drugs: lithium, neuroleptics, beta-adrenergic blockers, anticholinergics, angiotensin-converting enzyme inhibitors, diuretics

emergent - red tag

patient condition - life threatening chest pain with diaphoresis hemorrhage respiratory distress stoke vital sign instability

nonurgent - green tag

patient could wait several hours if needed without fear of deterioration fracture (simple) rashes strains and sprains urinary tract infection - uncomplicated

safety considerations

patient identification injury prevention for patients risk for errors and adverse events injury prevention for staff

urgent - yellow tag

patient needs quick treatment, but not immediately life threatening abdominal pain (Severe) fractures (displace or multiple) renal colic respiratory infection soft-tissue injuries

significant safety risk for all patients who enter the emergency care environment

potential for medical errors or adverse events

heat stroke hospital care

priority: ABCs followed by other interventions if shivering occurs during cooling process, midazolam or propofol may be prescribed (M= risk for delirium, P=risk for hypotension)

snake bite: critical rescue

priority: move victim to safe area away from snake and encourage rest to decrease venom circulation when in a safe area: remove clients jewelry and constricting clothing before swelling worsens call emergency assistance do not attempt to capture or skill snake - take photographs to aid in snake identification most significant risk: airway compromise and respiratory failure ensure patient has patent IV lines and emergency resuscitation equipment is at bedside

drowning first aid/emergency care

priority: potential rescuers assess own ability to swim once access is gained new priority is safe removal of victim from water spine stabilization with board or flotation device for people at high risk for spine trauma initiate airway clearance and ventilatory support measures do not attempt to get water out of victims lungs, respond by only giving abdominal or chest thrust ONLY if airway obstruction is suspected

moderate and severe hypothermia hospital care

protect patients from further heat loss and handle them gently to prevent ventricular fibrillation positioning the patient in the supine position prevents orthostatic changes in blood pressure from cardiovascular instability follow standard resuscitation efforts with special attention to maintenance of airway, breathing, and circulation

patient identification

provide ID bracelet for each patient use two unique identifiers if patient identity is unknown, use special ID system

professional and essential support staff

radiology and ultrasound techs RT lab techs social workers case managers nursing assistants clerical staff

frostbite hospital care

rapid rewarming in a water bath temp ranging from 99 to 102 admin analgesics, IV opiates, and IV rehydration as prescribed ibuprofen as prescribed after rewarming - handle injury gently and elevate above the level of the heart splits- immobilize extremities amputation may be needed for those with severe injuries or those who develop gangrene or severe compartment syndrome

emergency medicine physician

receive specialized education and training in emergency patient management

frostbite first aid/prehospital care

recognition of frostbite is essential to early, effective intervention and prevention of further damage to tissue integrity ask a significant other to frequently observe for early signs of frostbite such as a white, waxy appearance to exposed skin, especially on the nose, cheeks, and ears, is an effective strategy to identify the problem before it worsens in people with dark skin, skin becomes paler, waxy, and somewhat gray. In this case the best remedy is to have the person seek shelter from the wind and cold and attend to the affected body part superficial frostbite is easily managed using body heat to warm the affected area. teach patients to place their warm hands over the affected areas on their face or to place cold hands under the arms.

signs of human trafficking

recurrent STIs pregnancy tests and abortions physical signs: headaches, dizziness, back pain, missing patches of hair, burns, bruises, vaginal or rectal trauma, jaw problems, head injuries unusual tattooing or branding marks - signify ownership stress, paranoia, fear, suicidal ideation, depression, anxiety, shame, and self-loathing unable to identify home address, deny having finances, and defer to the controlling presence of an individual who has accompanied them to the ED

blunt trauma

results from impact forces such as those sustained in a MVC, fall or assault with fists, kicks, or baseball bat blast effect from exploding bomb

Impact of Event Scale (IES-R)

self-administered questionnaire that is used to detect PTSD or ASD score greater than 33 (possible 88) is indicative of probable PTSD high scores indicate a need for further eval and counseling: refer to mental health specialist

human trafficking

sexual exploitation - type of modern day slavery in which the victim is forced or coerced to provide sex to others in exchange for money or valuables that are given to the trafficker

mild hypothermia first aid/prehospital interventions

shelter from cold environment remove all wet clothing undergo passive or active rewarming non-complicated- drink warm high-carb liquids w/o alcohol and caffeine

mild hypothermia symptoms

shivering dysarthria --- slurred speech decreased muscle coordination impaired cognition diuresis

personal emergency preparedness plan

should outline the preplanned specific arrangements that are to be made for child care, pet care, and older adult care if the need arises, especially if the event prevents returning home for an extended period assemble a go bag, arrange for child and pet care, note who will be called when the plan is activated, note where a nurse is expected to report, collect names, addresses, and telephone numbers to be used if a crisis occurs

hand-off communication components

situation - reason for being in the ED and admitting diagnosis Pertinent medical HX, including implantable devices, and any hx of organ transplant assessment and diagnostic findings, particularly critical results transmission-based precautions and safety concerns (fall risk, allergies) interventions provided in the ED and response to those interventions

sexual assault nurse examiners (SANEs) or sexual assault forensic examiners (SAFEs)

specialize in helping victims of sexual assault

heat exhaustion interventions

stop physical activity immediately and move to a cool place cooling measures: cold pack on neck, chest, abdomen, and groin soak individual in cool water or fan whole spraying water on skin remove constrictive clothing provide sports drinks or oral rehydration-therapy - drinking plain water can worsen sodium deficit DO NOT GIVE SALT TABLETS if s/s persists call ambulance

exertional heat stroke

sudden onset and is often the result of strenuous physical activity (esp. when wearing too heavy clothing) in hot, humid conditions

drowning prevention

swim and are in or around water. do not swim alone. test the water depth before diving in head first; never dive into shallow water. avoid alcoholic beverages and substance use when swimming and boating and while in proximity to water. ensure that water rescue equipment such as life jackets, flotation devices, and rope is immediately available when around water.

heat exhaustion

syndrome resulting primarily from dehydration caused by heavy perspiration and inadequate fluid and electrolyte intake during heat exposure over hours to days if untreated can lead to heat stroke

primary survey and resuscitation

the ABCDEs of emergency care; once the problem(s) is identified, resuscitative action should begin immediately

grade 1 frostbite

the least severe type of frostbite, involves hyperemia (increased blood flow) of the involved area and edema formation.

grade 4 frostbite

the most severe form, there are blisters over the carpal or tarsal (instead of just the digit) the part is numb, cold, and bloodless. full-thickness necrosis extends into the muscle and bone at this stage, gangrene develops, which may require amputation of the affected part. Of note, except for frostnip, other degrees of frostbite may all have the same general appearance while the body part is frozen; the differentiating features of each degree of frostbite only become apparent after the part is thawed. Gangrene may evolve over days to weeks after injury.

frostnip

type of superficial cold injury that may produce pain, numbness, and pallor or a waxy appearance of the affected area but is easily relieved by applying warmth it does not cause impaired tissue integrity typically develops on areas such as the face, nose, finger, or toes. Untreated, it is a precursor to more severe forms of frostbite.

preventing ASD and PTSD following a mass casualty event

use available counseling encourage and support co-workers monitor each other's stress levels and performance take breaks when needed talk about feelings with staff and managers drink plenty of water and eat health snacks for energy keep in touch with family, friends, and significant others do not work more than 12 hours per day

severe hypothermia interventions

use extracorporeal rewarming methods such as cardiopulmonary bypass or hemodialysis cardiopulmonary bypass, which requires specialized personnel and resources, is the fastest core rewarming technique. However, this device is not available in all hospitals monitor for early signs of complications that can occur after rewarming such as fluid, electrolyte, and metabolic abnormalities; acute respiratory distress syndrome (ARDS); acute renal failure; and pneumonia.

disposition

where the patient should go AFTER being discharge from the ED