prefinal: care of clients in emergency situations

carbon monoxide poisoning

Carbon monoxide exerts its toxic effect by binding to circulating hemoglobin -> reducing the oxygen carrying capacity of the blood.

prevalence of choking

Choking is the fourth leading cause of unintentional injury death. Of the 3,000 people who died from choking in 2020, 1,430 were older than 74. Food is often responsible for choking incidents in the elderly. Living alone, and having dentures or difficulty swallowing can increase risk.-National Safety Council

causes of FBAO

Choking usually occurs while the person is eating or drinking and can be associated with muscle, neurological or cerebral impairment. Most deaths from choking are caused by food (87%), while small objects -a particular problem in children -are the cause of 13% of choking-related deaths (ONS, 2017).

damage control resuscitation: goal

Control and assist in stabilization of the trauma patient in hemorrhagic shock.

why trauma triad of death is so fatal

Trauma -> severe hemorrhage -> diminish oxygen delivery -> hypothermia -> further bleeding -> prevent blood from clotting -> bleeding will continue -> blood does not have much oxygen -> create energy anaerobically -> release of lactic acid -> metabolic acidosis -> damage tissues of body, muscles of heart -> decreased performance of heart -> decrease oxygen delivery

unintentional injury

accidental harm or damage to the body resulting from sudden, unplanned traumatic event ex. motor vehicle crashes, burns, drowning, exposure to poisons, falls, explosions, electrical accidents, or firearm injuries

adult choking algorithm

assess severity - severe - mild severe airway obstruction (ineffective cough) - unconscous -> start CPR - conscious -> 5 back blows, 5 abdominal thrusts mild airway obstruction (effective cough) - encourage cough -> continue to check for deterioration to ineffective cough or until obstruction relieved

primary survey: breathing

assess: - spontaneous breathing - respiration - chest wall integrity - life threatening conditions -intubate, mechanical ventilation -oxygen, pulse oximetry

moth ball breath odors indicate ___________

camphor

____________ substances include alkaline and acid agents that can cause tissue destruction after coming in contact with mucous membranes.

corrosive

bitter almond breath odor indicates _________ poisoning

cyanide

injury definition

damage to the body resulting from an exchange, usually acute, of mechanical, chemical, thermal, or other environmental energy that exceeds the body's tolerance

_______ and _________ are priority areas with which all health care providers must be actively involved with both public education and injury prevention

domestic violence and issues related to alcohol and substance abuse

critical care phase: goal

early detection and treatment of complications•

trauma definition

event and condition that occurs when an external force of energy impacts the body and causes structural or physiologic alterations or injuries

intentional injury

harm or damage to the body resulting from planned or premeditated injurious acts ex. assault, beatings, gunshot wounds, stab wounds, homicides, suicides

prehospital resuscitation: goal

immediate ID of life threatening injuries and transport (ground or air) to the closest appropriate medical facility

primary survey: airway

immobilize cervical spine look: - airway trauma - tachypnea - accessory muscle use - tracheal shift? listen - stridor - hyperresonance - dullness to percussion feel: - air exchange over the mouth - finger sweep secure: airway

penetrating trauma

injuries occur because of stabbings, firearms, or impalement -> penetrate the skin -> damage to internal structures

force formula

mass x velocity

oil of wintergreen breath odor indicated ____________ poisoning

methylsalicylate

trauma

multi-system phenomenon with immediate threat to life and long-term complications for the survivors of critical injury

_______ any substance that, when ingested, inhaled, absorbed, applied to the skin, or produced within the body injures the body by its chemical action

poison

____________ is the time following a traumatic injury when prompt medical treatment has the highest likelihood to prevent death

the golden hour

the branch of medicine that deals with the detection and treatment of poisons

toxicology

______________ a group of signs and symptoms (syndrome) associated with overdose or exposure to a particular category of drugs and toxins

toxidrome

common signs and symptoms of choking

•A cough •Struggling to breathe or talk •Cyanosis •Grasping or reaching for the throat •The patient may go silent and hold or point to their throat

Management of Poisoning: Stabilization

•Airway Patency •Breathing •Circulation •Cardiac Function •Acid-base balance and electrolyte homeostasis •Mentation •Injuries and disease processes •Vital signs

primary survey: circulation

•Assess pulse quality and rate •ECG monitoring •ACLS •Assess for life threatening conditions •Intravenous access •Blood samples •Fluid Replacement

Secondary Survey

•Full Set of Vital Signs; Five Interventions; Facilitate Family Presence •Give Comfort Measures •History taking •Head-to-toe Assessment •Inspect Posterior Surfaces

primary survey: disability

•GCS Score •Pupil size and reactivity •Posturing

nature of poisoning

•Homicidal •Suicidal •Accidental •Occupational

Management of Poisoning: Initial Decontamination

•Ocular Exposure -Irrigation for 15 minutes •Dermal Exposure -Flooding for 15 to 30 minutes •Inhalation Exposure -Fresh air •Ingestion Exposure -Dilution (Milk or Water)

primary survey: exposure/environment

•Remove clothing •Prevent hypothermia •Lacerations •Stab wounds •Gunshot wounds

Management of Poisoning: Gastrointestinal Decontamination

•Syrup of Ipecac •Gastric Lavage •Adsorbents •Cathartic •Whole-Bowel Irrigation

prehospital resuscitation: priorities

✓Airway ✓Bleeding and shock control ✓Immobilization

critical care phase: vital components

✓Critical care nurse must obtain report from referring area using SBAR method

damage control resuscitation: priorities

✓Definitive care ✓Operative phase

emergency department resuscitation: vital components

✓Detailed secondary survey ✓Initiation of most appropriate care

prehospital resuscitation: vital components

✓IV line ✓Pain management ✓Communicate information for triage to the receiving hospital

critical care phase: priorities

✓Ongoing repeated physical assessments ✓Monitoring laboratory and diagnostic test results ✓Observing patient's response to treatment ✓Preventing and reversing the lethal trauma triad.

damage control resuscitation: vital components

✓Permissive hypotension ✓Massive transfusion protocols ✓Damage control surgery

emergency department resuscitation: priorities

✓Rapid primary survey ✓Resuscitation of vital functions

Syrup of Ipecac

-induction of vomiting in poisoning contraindicated in - corrosive poisons - unconscious patients - seizures - shock - absent gag reflex

garlic breath odor indicates ___(2)____ poisoning

-organophosphate - arsenic

emergency department resuscitation: goal

Immediate identification of life threatening injuries and initial resuscitation through ATLS guidelines

dosage of ipecac for children up to 6 months of age

Ipecac must be given only under the direction of the doctor.

severity of airway obstruction: mild

Mild airway obstruction (effective cough): -patient is able to talk and has an effective cough Aggressive treatment with back blows and chest and abdominal thrusts at this stage is unnecessary-it may cause harm and could exacerbate the airway obstruction. These interventions should only be used if the patient shows signs of severe airway obstruction

Severity of airway obstruction: Severe

Severe airway obstruction (ineffective cough): typically, patient responds "yes" by nodding their head without speaking; unable to cougheffectively If the patient shows signs of severe airway obstruction: - Call for help/pull the emergency buzzer immediately and encourage the patient to cough - Stand at the patient's side, slightly behind them - Support the patient's chest with one hand and lean them forward -if this dislodges the foreign body, it will hopefully fall out of the mouth instead of slipping further down the airway - If symptoms continue, deliver up to five back blows (slaps) between the scapulae using the heel of the hand Following each back blow, check to see if the obstruction has been dislodged - If the back blows fail, proceed to abdominal thrusts - Stand behind the patient, placing both arms around the upper abdomen - Lean the patient forward;Place a clenched fist between the patient's umbilicus and the ribcage, and clasp it with the other hand - Deliver up to five sharp thrusts to the abdomen, inwards and upwards - Take care not to apply pressure to the xiphoid process or the lower ribcage as this may cause abdominal trauma - If the obstruction remains, alternate up to five back blows with up to five abdominal thrusts.

assessment for food poisoning

1. Suspected food be brought to the medical facility 2. Ask the patient about the following: Onset What was eaten Did anyone else become ill Vomiting, Diarrhea Neurologic Symptoms Fever 3. Weight, Fluids and Electrolytes

Emergency treatment is initiated with the following goals (4)

1. To remove or inactivate the poison before it is absorbed 2. To provide supportive care in maintaining vital organ function 3. To administer a specific antidote to neutralize a specific poison 4. To implement treatment that hastens the elimination of the absorbed poison

management of skin contamination (chemical burns) (2)

1. flush with water 2. standard burn treatment

management of CO poisoning (3)

1. fresh air 2. CPR 3. oxygen

top 5 causes of death in adolescents (WHO)

1. road traffic injuries 2. assault 3. pneumonia 4. heart disease and other lung diseases 5. tuberculosis

trimodal distribution of trauma deaths: third peak

20% time from injury: days to weeks location: critical care unit cause of death: - sepsis - multiple organ dysfunction syndrome (MODS)

trimodal distribution of trauma deaths: second peak

30% time from injury: minutes to few hours location: emergency department, OR cause of death: - subdural or epidural hematoma - hemo-pneumothorax - ruptured spleen - liver laceration - pelvic fracture - injuries associated with extensive blood loss

trimodal distribution of trauma deaths: first peak

50% time from injury: minutes location at scene, en route to medical facility cause of death: laceration of brain or brainstem, high spinal cord injury, injury to heart, aorta, or other large vessels

incidence and prevalence of trauma

- 4th leading cause of death for all ages in the US - leading cause of death for all age groups younger than 46 years old

key diagnostic investigations for poisoning

- Arterial Blood Gas - 12-Lead ECG - Blood and urine drug levels - Toxicology Screening

Red skin indicates ________(2)______ poisoning

- CO - boric acid

blunt trauma

- MVC types of impact/collision restraint system injuries - auto-pedestrian accidents - falls - blast injuries

moderate CO poisoning: 21-40%

- confusion - syncope - chest pain - dyspnea - weakness - tachycardia - tachypnea - rhabdomyolysis

blue skin indicates _____(2)_______ poisoning

- cyanosis - methemoglobinemia

trimodal/bimodal distribution of trauma death

- for the critically injured patient, the primary goal is to minimize the time from injury to definitive care - it is a nursing challenge to influence the quality of care the trauma patient receives in an attempt to "beat" the trimodal distribution of trauma deaths

types of car accidents

- head-on collisions - rear-end collisions - side-swipe collisions - left-turn collisions - t-bone collisions - merging collisions

mild CO poisoning: 15-20%

- headache - nausea - vomiting - dizziness - blurred vision

routes of poisoning

- inhalation - injection - ingestion - absorption

blunt trauma

- injuries occur due to forces sustained during a rapid change in velocity. - tissue damage occurs as a result of combo deceleration, acceleration, shearing, crushing, and compression forces

severe CO poisoning: 41-59%

- palpitations - dysrhythmias - hypotension - myocardial ischemia - cardiac arrest - respiratory arrest - non-cardiogenic pulmonary edema - seizures - coma

phases of trauma care

- prehospital resuscitation - emergency department resuscitation - definitive care and operative phase - critical care phase - intermediate care - rehabilitation

rotten egg breath odor indicates ___(2)_____ poisoning

- sulfur dioxide - hydrogen sulfide

diaphoretic skin indicates _____(3)______ poisoning

- sympathomimetics - organophosphates - salicylates

assessment for poisoning

- triage 1. is the patient's life in immediate danger? 2. is the patient's life in potential danger? - history - physical exam - lab studies

gunshot wounds

- type of gun - type of ammo - distance and angle fired

stab wounds

- type of object used - angle of insertion

adsorbent

-A solid substance that has the ability to attract and hold another substance to its surface -Activated Charcoal -Contraindicated in patients with intestinal obstruction -Administer if within 1 to 2 hours after ingestion; adsorption begins 1 minutes after administration

SBAR

Situation Background Assessment Recommendation

gastric lavage

-Fluid is introduced into the stomach through a large-bore orogastrictube and then drained in an attempt to reclaim part of the ingested agent before it is absorbed -36-to 40-French in Adults, 16-to 28-French in Children -Contraindicated in cases of ingestion of caustics or hydrocarbon with a high aspiration potential

whole bowel irrigation

-Large volume of polyethylene glycol with electrolyte solution (1 to 2L/hr) is given rapidly to flush the patient's bowel mechanically without creating electrolyte disturbances. -GoLYTELY, Colyte

cathartics

-Substance that causes or promotes bowel movements -Magnesium Citrate, 70% Sorbitol

trauma triad of death

-acidosis -coagulopathy -hypothermia

Antidotes: N-acetylcysteine (Mucomyst, Mucosil, Parvolex)

-for Acetaminophen Toxicity -avoid use with activated charcoal -don't give to semiconscious or unconscious patients -use cautiously in elderly or debilitated patients

Antidotes: Amyl nitrate

-for Cyanide -effective within 30 seconds, last only 3 to 5 minutes -ask the patient to inhale the vapour -monitor for orthostatic hypotension-may have headache after

Antidotes: Pralidoxime

-for organophosphate poisoning -most effective if started within 24 hours after exposure -don't give with carbaryl (Sevin)

Antidotes: Digoxin immune fab (Digibind)

-for potentially life threatening digoxin intoxication. -skin test -total serum digoxin levels may rise -monitor potassium levels

Antidotes: Naloxone (Narcan)

-for respiratory depression caused by Opioids -monitor respiratory rate and depth -overshoot effect -does not reverse respiratory depression caused by benzodiazepines

people at increased risk of FBAO (8)

1. Altered level of consciousness 2. Drug and/or alcohol intoxication 3. Neurological impairment, with reduced swallowing and cough reflexes (for example, stroke) 4. Respiratory disease 5. Mental impairment 6. Dementia 7. Poor dentition 8. Older age

management of food poisoning (3)

1. Closely monitor Respirations, BP, LOC CVP(if indicated), and muscular activity 2. Respiratory system support 3. Control nausea and vomiting

primary survey

Airway Breathing Circulation Disability Exposure/Environment

fatal CO poisoning: 60%

DEATH

fruity breath odor indicates ____(2)_____ poisoning

DKA, isopropranolol

____________ is a clinical emergency that may be life threatening. Nurses should be confident to assess the severity of airway obstruction, deliver interventions to relieve that obstruction and know when to call for assistance.

Foreign-body airway obstruction

dosage of ipecac for children 1-12 years old

The usual dose is 15 mL (1 tablespoonful). One-half to one full glass (120 to 240 mL) of water should be taken right before or right after the dose. The dose may be repeated one time after twenty to thirty minutes if vomiting does not occur.

dosage of ipecac for adults and teenagers

The usual dose is 15 to 30 milliliters (mL) (1 to 2 tablespoonfuls), followed immediately by one full glass (240 mL) of water. The dose may be repeated one time after twenty to thirty minutes if vomiting does not occur.

dosage of ipecac for children 6 months to 1 year of age

The usual dose is 5 to 10 mL (1 to 2 teaspoonfuls). One-half to one full glass (120 to 240 mL) of water should be taken right before or right after the dose. The dose may be repeated one time after twenty to thirty minutes if vomiting does not occur.