MedSurg Ch 16: Frist Aid. Emergency Care, and Disaster Management

-Try to determine the nature of the emergency (gun shot, car accident, fall)
-Look for any hazards to the victim and rescuer
-Assess ABC's
-Initiate CPR as needed
-Look for uncontrolled bleeding
-Systematically assess for injuries from the head to the feet, and immobilize spine and/or limbs
-Look for a medical alert tag

-Splint injured parts in the position they are found
-Prevent chilling, but do not add excessive heat
-Do not remove penetrating objects
-Do not try to give anything by mouth to an unconscious person
-Stay with the injured person until medical care or transportation arrives

-ABC's, watch for symmetric chest movement, respiratory effort, abnormal sounds, palpate carotid and peripheral pulses
-Assess for bleeding and shock
-Head to toe checking for obvious injury, bleeding, swelling, circulation, mobility, sensation, alignment
-LOC and comprehension
-Inspect eyes for pupil size, equality, and reaction to light
-Detect any areas of pain or tenderness

-Bleeding; cool, sweaty, pale skin; thready pulse; rapid respirations; decreasing alertness
-Internal bleeding may also have abdominal distention, pain, hematemesis (blood in vomit), dyspnea

-Direct, continuous pressure for external bleeding
-Use sterile or clean cloth over the wound
-Elevate(to decrease blood flow) and immobilize(prevent dislodging of clots) the injured part, unless fracture is suspected
-Reinforce the dressing but do not change it
-If direct pressure and elevation fail to control bleeding apply indirect pressure (tourniquet)

-Primary symptom is pain. Numbness and tingling may also be present. Deformity, swelling, discoloration and decreased function

-Immobilize (include the joints above and below the injury
-DO NOT STRAIGHTEN
-A cool pack may be applied to reduce swelling
-If severe bleeding is present with compound fracture, apply direct pressure to the artery above the injury

-Strain: injuries to muscles and tendons
-Sprain: injuries to ligaments
-Pain and swelling
-Immobilization, elevation, and cool pack

-Change in behavior
-Decreasing LOC
-Pupil dilation or constriction, inequality, and slow or no response to light
-Impaired sensory or motor function
-Decreasing pulse ad respiratory rate
-Projectile vomiting
-CSF draining form nose or ear (clear, colorless fluid)

-Do not move the victim
-Assess ABC's and begin resuscitation if needed

-Do not move
-Assess ABC's, victims movement and sensation
-A rolled towel or article of clothing can be rolled to support the neck
-Log-roll and keep the spine straight if need to move

-If embedded: remove by irrigation or by gently touching the object with the corner of a clean cloth, gauze pad, or moistened cotton tip
-Embedded foreign bodies should only be removed by a physician

-Immediately flush the eye for 30 minutes (sterile normal saline or water is ideal but tap water may be used)
-Direct irrigating fluid to flow from inner canthus to outer canthus

-Don not remove
-Limit the movement by covering it with a shield that does not touch the object
-Patch unaffected eye as well as this may stop movement of eyes

-Do not apply direct pressure as the globe may be injured as well and pressure could cause more damage
-Apply loose dressing and transport the victim for medical care

-Assessment: rate and character of respirations, skin color, pulse rate and rhythm, chest symmetry, any apparent injuries to chest
-S/Sx: dyspnea, tachycardia, restlessness, cyanosis, asymmetric or other abnormal chest wall movement, abnormal breathing sounds

-An open chest wound that penetrates the pleural cavity, allowing air to enter, which collapses the lung on affected side
-S/Sx: Dyspnea, asymmetric chest wall movement, "sucking" sound as air moves in and out of wound with respirations

-Apply vented dressing (sealed on 3 sides so air can escape but not enter
-Or apply airtight dressing. IF pts. condition worsens, suspect tension pneumothorax and loosen the dressing

--Several adjacent ribs are broken in more than 1 place, causing a loss of support in the affected section of the chest wall
-S/Sx: the affected section moves inward on inspiration and outward on expiration.

-Provide support for the injured area
-Use a pillow(or jacket or have victim lie on the affected side) to put pressure on the flail segment. Stabilization keeps it from moving in an opposite direction as the surrounding muscle and bone. If it doesn't move, it won't cause more damage to the heart, lungs and surrounding tissues

-Accumulation of blood in the pleural cavity which causes the lung or lungs to collapse
-S/Sx: increasing respiratory or circulatory failure

-Cannot be diagnosed directly or treated by the first aid care provider, and requires prompt tx in medical facility

-Presence of blood in the pericardial sac which decreases cardiac output
-S/Sx: Increasing respiratory and circulatory failure

-Cannot be diagnosed directly or treated by the first aid care provider, and requires prompt tx in medical facility

-Assess abdomen for abnormalities (distention, evisceration) noting any pain or tenderness
-Require medical evaluation
-Do not replace eviscerated organs (as this may cause more damage) cover them with a material to conserve moisture and warmth

-Reattachment is possible
-Clean wound surfaces with sterile water if available and place the tissue in normal position
-If it is completely detached, wrap in sterile gauze moister with saline and place in an airtight container such as a plastic bag
-Do not put on ice
-Extremities may be healthy enough for reattachment for 4-6 hours and digits may be viable up to 8 hours

-Immerse injured body part in cool water for 2-5 minutes
-Applying butter is contradicted
-Medical care is usually not required

-Topical preparations with benzocaine may be soothing. Many people believe that aloe vera is effective. Children and older adults with extensive sunburn may require hospitalization for dehydration

-Cover burns with a clean, dry dressing or cloth
-Do not apply medications or absorbent materials
-wrap fingers and toes separately to prevent sticking together
-Transport for medical immediately

-Remove contaminated clothing
-Thoroughly dust powdered chemicals from the skin and flush with water for 30 minutes (if the chemical is not completely removed before flushing, additional injury may result)
-Flush liquid chemicals from the skin with running water for 30 minutes
-Apply a dressing or covering and transport for medical care

-Caused by excessive fluid loss (which cause hypovolemia and electrolyte imbalances) when exposed to high environmental temperature and humidity
-Increased body temp and metallic rate increase O2 demand
-Cardiac output and HR first rise, the fall
-S/Sx: dizziness, headache, muscle cramps, nausea, vomiting, palor, damp skin

-Move person to cooler environment, loosen clothing, splash cool water on the skin
-If victim is alert offer fluids such as commercially prepared electrolyte drinks or water

-Body temp above 41.1*C (106*F)
-Temp mechanisms in the brain fail
-Heart, kidney, CNS are depressed
-Usually associated with strenuous activity in hot humid weather
-S/Sx: similar to heat exhaustion at first, as condition worsens skin becomes red, hot dry and no perspiration and victim may collapse and have seizures

-Cool the person quickly by moving to cooler environment (air conditioning, shade)
-Apply cool wed towels to trunk and the extremities and place ice packs on forehead and axillae
-Victim may be placed in a cool bath

-Temp below 35*C (95*F)
-S/Sx: shivering and impaired performance, progresses to decreasing HR, RR and BP
-Irregular HR and breathing patterns

-Mild: wrap in warm dry clothing and blankets
-Severe:Must be rewarmed aggressively but gradually because too much rapid rewarming sends lactic acid and cold blood to the heart possibly triggering a cardiac dysrhythmias
-Warm torso first, once retail temp reaches 35*C (95*F) then warm the extremities

-Frostnip mild tissue damage caused by cold
-Frostbite more serious
-Blood vessels in skin and extremities constrict when exposed to extreme cold and circulation decreases and blood clots form
-lack of O2 and nutrients causes cells to die
-Cheeks, fingers and toes are most often affected
-S/Sx: pain at first, then tingling, followed by numbness

-Rapid rewarming but do not rewarm tissue less warmth can be maintained
-Immerse in water at 37-40*C or (100-105*F)
-Handle affected areas very gently. Do not rub, massage or apply cold to the tissue
-As tissue warms it turns bright pike and blisters (very painful, analgesics will be ordered)
-After warming pat dry and wrap i sterile dressing
-Wrap ear finger and toe separately to prevent sticking
-Severe or deep frostbite must be surgically debrided

-Invisible, odorless gas emitted by car engines, gas stoves and furnaces
-Binds to hemoglobin more readily than O2 and prevents the transport of O2 to the cells (pt. becomes hypoxemic)
S/Sx headache, SOB, dizziness, nausea, vomiting, mental changes, cardiac and respiratory irregularities, may have cherry red skin but not always

-Remove victim and dake to fresh air
-CPR as needed
-Take to hospital
-May be placed in a hyperbaric chamber

-Assessment: name of drug or chemical involved, amount of substance, length of time since the substance, last food consumed (amount and time), other medications, drugs or alcohol ingested

-Call poison control center
-Some can be treated at home others require tx by physician
-Vomiting is specifically contradicted if the victim is already vomiting, unconscious, or having seizures
-Activated charcoal, total noel lavage and cathartics may be ordered at emergency facility

-Improper home canning
-Onset 18-36 hr after ingestion; nausea, vomiting, headache, dysphagia
-4-5 days later; descending paralysis affecting speech, breathing, and swallowing
-Can be fatal

-Gastric lavage, IV fluids, trivalent botulism antitoxin (ABE), mechanical ventilation if needed
-Discard food containers that are swollen or have broken seals
-Spores are not destroyed by boiling
-May not be a able to detect by smell or taste

-Poor hygiene of food handlers, inadequate refrigeration of food esp milk and mayo
-Onset 6h: weakness, nausea, vomiting, diarrhea, abdominal cramps
-Rarely fatal

-IV fluids, antiemetics, sedation
-Proper refrigeration of food
-Good hygiene

-Improper canning; inadequately cooked meat or poultry
-Onset 6-12 hrs after ingestion; abdominal cramps, diarrhea

-Antidiarrheals
-Thorough cooking

-Contaminated food and undercooked meat and eggs
-Abdominal cramps, diarrhea, nausea and vomiting

-Antidiarrheals, antiemetics, IV fluids

-Venom can be neurotoxic (affects the nervous system) and cause, vomiting, dizziness, tachycardia, muscle twitching, respiratory distress
-Local effects: discoloration, pain, mild to severe edema, usually leave 2 distinct fang marks

-Description of the snake (shape of head and color)
-To limit absorption of the venom, immobilize the bite area and keep below level of heart, wipe the wound, if available suction can be applies to aspirate the wound
-Antivenom may be given
-no longer recommended:(risks out weigh benefits) tourniquet, ice, incision an dsuction

-Local itching, edema, erythema
-Allergic reaction: urticaria (hives), dyspnea, hypovolemia, decreased BP

-Those severely allergic to insect venom should cary emergency epinephrine that can be given subq after a bite or sting to px anaphylaxis
-Only the honeybee leaves it stinger, which continues to inject venom; immediately remove with a scraping motion rather than grasping or pinching it as more venom may be injected
-Avoid perfumes, hair spray, and bright colors when outside as insects are drawn to strong scents and bright colors
-Use insect repellant containing VEET

-Mild reaction: Calamine lotion or paste of baking soda or meat tenderizer is soothing
-Severe reaction: epinephrine (subq), diphenhydramine chloride (Benadryl) aminophylline and hydrocortisone may be administered to px anaphylaxis

-Risk of wound infection and rabies
-Rabies is an infection of the CNS that is almost always fatal

-Clean wound thoroughly, apply bulky dressing
-Tetanus booster if immunizations are out of date
-ma be given a px rabies vaccine in 5 doses over a 1 month period

-Human bites a potentially very dangerous b/c risk of infection
-Most common sites are in the hand and fingers caused by hitting the person in the mouth

-Clean thoroughly and apply dressing
-Advise to seek medical tx for antibiotic therapy

-Can cary Lyme disease and Rock Mountain Spotted Fever

-Early stage: flu-like symptoms with or w/o a ring-shaped reddened area around the bite("bull's-eye lesion")
-Early disseminated stage: fatigue, anorexia, vomiting, neuro symptoms
-Late disseminated stage: joint and muscle involvement, progressive neuro symptoms

-Tell pt to notify the physician if flu-like symptoms or a bull's-eye lesion appear in the next 7-10 days
-Dx: skin biopsy to detect the causative organism (Borrelia burgdorferi); a blood ted can detect antibodies 2 months after the onset of the infection
-Lyme "arthritis" and neuro symptoms: penicillin, cephalosporin or chloramphenicol

-Appear 3-10 days ofter bite
-Chills, fever, headache, pain behind the eyes, joint and muscle pain, rash that begins at the wrists and ankles and spreads to the extremities and trunk
- May be fatal if untreated

-Tetracycline
-Chloramphenicol

-Venom is neurotoxic, causes pain, nausea and vomiting, fever, weakness, muscle cramps and headache
-More serious effects: respiratory distress, HTN, seizures, shock

-Antivenin is available
-NOT RECOMMENDED: Constricting bands

-Bite is not especially painful, area usually swells within a few hours. Initially a bluish ring appears around the bite and later it is surrounded by a white ring with a red "halo"
-Some people have nausea , vomiting, fever and joint pain
-Severe cardiac, renal and neuro reactions are uncommon
-In 3-5 days affected tissue becomes necrotic

-Medical attention should be sought
-There is no specific antivenin to counteract the venom
-Eventually the tissue sloughy off or needs to be debrided