Disaster Final

8/8/2019 Disaster Final

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The nurse may be asked to perform outside ofhis or her expertise and may take onresponsibility held by the physicians or

advanced nursing practice Ex.intubate, inserting chest tubes

Debridement, suturing

Nurse may serve as triage officer

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4

Forces overwhelm a

community. Services are compromised.

Outside assistance isrequired.


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Natural disaster

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10

estimates that as many as 26

nations possess chemical orbiological agents.

10 countries are believed to

possess biological agents asweapons


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Bubonic plaque

Botulism

Anthrax

Sars

H1N1

SMALL POX

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12

Attack can take many forms

Aerosolized agents


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Fire

Bioterrorism

Illegal logging

Nuclear attack or bombing

Etc.

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15

Pre-disaster W

arning Impact Emergency

isolation

rescue remedy

Recovery


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Validate what you hear

Perform a thoroughassessment

Assess for otherinjuries/illnesses evenwhen symptoms are absent


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DISASTERMANAGEMENTDISASTERMANAGEMENT

It is a collaborative activities that include

preparedness and rehabilitation

eR

esponsePeriod immediately after the disaster


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DISASTER CONTINUUM

DISASTERDISASTER

e Responsee Response

REHABILITATIONREHABILITATION

PREVENTIONPREVENTIONRECONSTRUCTIONRECONSTRUCTION

DEVELOPMENTDEVELOPMENT

PREPAREDNESSPREPAREDNESS

WARNINGWARNING

MITIGATIONMITIGATION


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MASS CASUALTY INCIDENT

Situation in which the number ofcasualties exceeds the number ofresources

INCIDENT COMMAND SYSTEM

Management tool for organizing

personnels, facilities, equipment,and communication


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DISASTER LEVELSDISASTER LEVELS

Level I - Local e Response personnel andorganization can manage the disaster

Level II Regional efforts and aid from othercommunities are sufficient to managethe effects of the disaster

Level III Local and Regional assets are over-whelmed; National assistance is needed


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First Priority

Second Priority Third Priority


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To afford the great number ofpeople the greatest chance of

survival.

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To properly triage a group ofpatient, you shared quality classify

each patient into one of fourgroups.

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CATEGORIES

1ST PRIORITY (IMMEDIATE)RED Injuries are life threatening butsurvivable with minimal intervention

2nd PRIORITY (DELAYED)YELLOW Injuries are significant and

require medical care but can wait hourswithout threat to life or limb


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UNSTABLE CHEST AND ABDOMINALWOUNDS

INCOMPLETE AMPUTATIONS

OPEN FRACTURE OF LONG BONES

2ND & 3RD DEGREE BURNSOF15-40%OFTOTAL BODY SURFACE AREA

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Stable Abdominal wounds with out evidenceof hemorrhage

Soft tissue injuries

Maxillofacial wounds with out airwaycompromise

Vascular injuries with adequate collateral

circulations

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Genito-urinary tract disruption

fractures requiring openreduction

Debridement and external

fixationMost eyes or CNS injuries

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3rd PRIORITY (MINIMAL)

GR

EEN Injuries are minor and treatmentcan be delayed hours to days; moved awayfrom the triage area

4th PRIORITY (EXPECTANT)BLACK Injuries are extensive and chancesof survival are unlikely even with definitive

care; separated but not abandoned


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Upper extremity fractures

Minor burns

Sprains Small lacerations without significant

bleeding

Behavioral disorders Psychological disturbances

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Seizures or vomiting with in 24 hour afterradiation exposure

profound shock with multiple injuries

Agonal respirations

No pulse

No BP

Pupils fixed and dilated

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ROLE OF NURSES IN DISASTERRESPONSE PLANS

Depends on the specific needs of thefacility at the time; Personal protective

Equipments:

component of preparednessand response; donned before contact witha contaminated patient.


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Prevent the disaster

Minimize casualties

Prevent further casualties

Rescue the victims

First aid

Evacuate

Medical care Reconstruction


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You are the triage nurse

at the receiving facilityfor casualties after thetornado. 5 patients arriveat the same time.

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An elderly man with arespiatory rate of 8 breathsper minute, color ashen,tense abdomen and only

carotid pulse present

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A 7 year old childwith ableeding scalp lacerationwho has a glasgow comascore of 8 and needs

intubation

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30 year old mother of achild, who is cryinghysterically, is walking andappears to have no pain or

visible injuries

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A 15 year-old girl whocomplains of pain in her leftleg , with obvious deformityof the calfbut good pulses in

the foot

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65-year-old woman whoarrives in a police carholding her right wristwhich is cool,

ecchymoticand painful, withgood pulses

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DECONTAMINATION

Process of removing accumulatedcontaminants

Step:1. Remove the patients clothing and

jewelry

2. Soap and water wash, then rinse


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Cell destruction of the layers

of the skin and the resultantdepletion of fluid andelectrolytes


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Thermal

e.g. caused by exposure toflames, hot liquids, steam or

hot objects


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Caused by tissue contact with

strong acids, alkalis or organiccompounds


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caused by heat generated by

an electrical energy as it passesthrough the body


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caused by exposure to

ultraviolet light, x-rays or aradioactive source


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1st degree- involves epidermis, reddish andpainful

2nd degree- involves the dermis, moist

surface, with vesicles, painful 3rd degree- involves subcutaneous layer,

pearly white, no pain

4th degree- involves the muscles and bones,

blackish or charred, no pain


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Head, Face, Neck = 9%

Anterior Trunk = 18%

Posterior Trunk = 18% Upper Extremities (each) = 9%

Lower Extremities (each) = 18%

Genital = 1%

TOTAL: 100%


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Stop the burning process

- immerse affected part in coldwater- advise client to roll on theground if clothing is on fire

- throw a blanket over the client tosmother the flame


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Promoting comfort:Relief of pain

- Morphine SO4- IV

- Bed cradle to relieve pressure fromtopsheet

- Avoid exposure to draft, exposed nerve

endings are senstive Prevention of infection

- Asepsis

- Reverse isolation

- Tetanus immunization- Sterile NSS to irrigate area


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Anti microbials

- Silver NO3 0.5%

- Silver sulfadiazene 1% (Silvadene)- Mafedine Acetate 10% (Sulfamylon)

*drug of choice because it can penetrate

eshar-Gentamycin SO4 (Geramysin)

-Providone-Iodine (Betadine)


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Hydrotherapy Debridement

Skin grafting

Promoting G.I. support

Rehabilitation


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An acute medical

emergency caused byfailure of the heat

regulating mechanismof the body


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CONDUCTION-the

transfer of heat fromone material to another

through direct contactEx.cup of coffee


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Carrying away of heat by

currents of air or wateror other gases or liquids

Ex. Spoon


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Sending out energy, such

as heat, in waves intothe space

Ex. The sun


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The change to liquid to

gas, when the bodyperspires or gets wet,


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evaporation of the

perspiration or otherliquid into the air has s

cooling effect on thebody


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Breathing, during

respiration body heat islost as warm air is

exhaled from the body


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People at risk thosenot acclimatized toheat, elderly & very

young


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CNS dysfunctions:Confusion, delirium,

bizarre behavior, comaTemp - 40.6 C / 105 F or

higherHot dry skin


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Anhidrosis ( absence of

sweating)Tachypnea,

hypotension,tachycardia


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Numbness or reduced

sense of touchStiff or rigid posture

Drowsiness


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Loss of motor

coordinationJoint muscle stiffness

Skin may appear red


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Reduce high temp asquickly as possible

Remove clothingCool sheets and towels or

continuous sponging withcool water


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Apply ice to neck, groin,chest & axillae, spray

with tepid waterCooling blankets

Iced saline lavage iftemp does not decrease


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Immersion of thepatient in a cold waterbath if possible

Use electric fan to blowair towards the client

Constant monitoring oftemperature


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Use caution to avoid

hypothermiaMonitor vital signs, ECG

Assess for seizures (ifrecurrent hyperthermia)

Give O2


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IV NSS or LR

I&O monitoring ( acutetubular necrosis may occur

as a complication of heatstroke)


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CBC

ELECTROLYTESABG

ECGU/A


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WATER CHILL- chilling

caused by conduction ofheat from the body

when the body orclothing is wet


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Chilling caused by

convection of heat fromthe body in The

presence of air currents


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Exposure to freezing Temp;actual freezing of intra &intercellular fluid,resulting to cellular &

vascular damage.Commonly affects the ears,

nose, hands & feet


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Affected part is hard,

cold and insensitive totouch may appear white

or mottled blue white


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Goal: restore normalbody temp

Constrictive clothing

are removed


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If lower ext areinvolved the patient

should not beallowed to ambulate


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Controlled yet rapidrewarming is done(extremity is placed in a37-40 C / 98.6- 104Fcirculating bath for 30-40

minute). Repeated untilcirculation is restored


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During rewarminganalgesics are given

(affected part may be verypainful during procedure)

Massage is contraindicated

( to avoid further injury)


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After rewarming procedureextremities are elevated &

protected fr.F

urther injurySterile gauze or cotton are

placed in between fingers


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Blebs w/c develop 1hour to few days after

rewarming are leftintact and not ruptured

especially ifhemorrhagic


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The core temperature is35C / 95F or less as a result

of exposure to coldUrban hypothermia has a

high mortality rate in theelderly & infants


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Alcohol ingestion

increases susceptibilityto hypothermia becauseit causes systemicvasodilation


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Trauma px are

susceptible esp. if coldfluids, unwarmedoxygen and coldexposure duringtreatment


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If patient has frostbite &

hypothermia(Hypothermia is thepriority )


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Core Temp of 35 or less

DysarthriaDrowsiness

Pulmonary edemaComa


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Continuous monitoring

Rewarming

Removal of wet clothing

insulation


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Cardiopulmonary bypassWarm IV fluid

Warm O2 by ventilatorWarmed peritoneal lavage

Warm blanketsOverbed heaters


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Monitor for Vfib as

px temp increasesfrom 31 to 32 C


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Defibrillation isineffective in px w/

temp of lower than31C; px must be

rewarmed 1st


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Nitrogen bubbles are

formed withinmuscles tendons or

within bloodvessels(embolus)

Assessment:


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Assessment:

Joint ext. painNumbness

Loss ofROM

Neurologic (similar tostroke)

Hx of diving or high altflying


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Management

Patent airway

100%O2 ( while in transit)

IV LR

Wet clothing is removed &px kept warm


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In the hospital hyperbarrictreatment is done

If air transport is neededlow altitude flight is

needed less than 1000 feet


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PENETRATING ABDOMINAL INJURY=(GUNSHOTWOUND, STABWOUNDS) ARESERIOUSAND REQUIRE SURGERY ANDR

ES

ULTS

IN HIGH INCIDENCEOF

INJUR

YTO HOLLOWORGANS


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BLUNT TRAUMA= MAY RESULTSFROMMOTORVEHICULAR CRASHES, FALLSBLOWSAND EXPLOSIONSAND IS COONLY

ASSO

CIATEDW

ITH EX

TR

A AB

DOM

INALINJURIES TO THE CHEST HEAD ANDEXTREMITIES.

ASSESSMENT:


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PHYSICAL

EXAMINATION: INSPECTION

AUSCULTATION PERCUSSION

PALPATION


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AUSCULTATIONOFBOWEL SOUNDSPROVIDESBASELINE DATA FROMWHICHCHANGES CAN BE NOTED

ABSENCEOFBOWEL SOUNDSMAY BE ANEARLY SIGNSOF INTA PERITONEALINVOLVEMENT

ALTHOUGH STRESS CAN ELIMINATE

BOWEL SOUNDS


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FURTHER ABDOMINAL ASSESSMENTMAYREVEAL PROGRESSIVE

ABDOMINAL DISTENTION

INVOLUNTARY GUARDING TENDERNESS, PAIN ,RIGIDITY

AND REBOUND TENDERNESS


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URINALYSIS

Hematocrit

WBC

Serum amylase

TO DETECTHEMATURIA(indicativ

e of urinary tract injury)

To evaluate trendsreflecting the absence orpresence of bleeding

To detect elevation(indicative of trauma)

Suggest pancreaticinjury


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Blood loss/ml

Blood loss % bloodvolume

PR

BP

Capillary refill

RR

UO

Mental status

Fluid replacement

CLASS1


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Blood loss/ml


PR

BP

Capillary refill

RR

UO

Mental status

Fluid replacement

CLASS 3

1500-2000

< 30-40%

>120

decreased

delayed

30

-40

5-15

anxious and confused

Crystalliod and blood


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Blood loss/ml


PR

BP

Capillary refill

RR

UO

Mental status

Fluid replacement

CLASS4

2000

>40%

140

decreased

delayed

>35

> 30

Confused, lethargic

Crystalliod and blood


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Secure or support a patent airway

Optimize breathing

Maintain circulation

Establish intravascular access Replace intravascular volume(blood products

or crystalliod

Manage bleeding by applying direct pressureon a compression site


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Abdominal scan

MRI

X-ray

Cbc

Blood typing and xcrossmatching

PT,PTT

ABG

HCG (If pregnant)

TREATMENT

Fluidresuscitation(LR,NSS)

CRYSTALLIOD

Vasopressors

Steroids

Na bicarbonate

Tetanus serum

Broad spectrumantibiotic

Blood transfusion(o-


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: fluid volume deficit r/t severe blood losslosses

Pain r/t trauma

Risk for infection related to blunt/penetratinginjury

Decrease cardiac output r/t to decreasecirculating blood volume


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Acute dental trauma is a serious injury to one

or more parts of your mouth. The word acute is

used to define problems that start suddenly,worsen quickly, and last a short time. Your

injury may include damage to any of your

teeth, the socket the tooth sits in, or your jaw.

You can also have injuries to the soft tissues of

your mouth. These include your tongue,


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Dental trauma can affect teeth that are

primary or permanent. Primary teeth are alsocalled baby or milk teeth. They fall out over

time and are replaced by permanent teeth,

also called adult teeth. There are 20 primary

teeth in children and 32 permanent teeth in


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What are the types ofacute dental trauma?


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yDamage to tooth: Your tooth or teeth

may get chipped, cracked, or fractured

(broken). The damage can be to the

crown or root of the tooth, or both. With a

very bad crown fracture, the dentin and

pulp of your tooth may be exposed


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Tender tooth:

Y

our tooth is firmly in itssocket and not damaged, but you have pain

in it when you chew. The force of the impact

can lead to swelling in the socket, which

causes the pain


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.Loose tooth: The structures that

hold your tooth in place can get

damaged. When this happens, your

tooth becomes loose but stays in its

socket.


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Loss of tooth: Your tooth may be

knocked completely out of its socket


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Dental trauma usually occurs with a

direct blow to your mouth area or jaw.

The greater the impact of blow you

receive, the more likely for you to have

worse problems. Trauma may be fromany of the following:


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Accidents. These include a badfall from a height, bicycle or

motor vehicle crashes, andpedestrian and playgroundaccidents. The highest number of

accidents with dental traumahappens in children at 2 to 3years of age.


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Sports injuries. These include injuries

from diving, gymnastics, ice hockey,

football, or horseback riding. Dental

trauma may be from contact with other

players or from getting hit by a hard object,

such as a hockey stick.


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Street fights or other physical

assaults.


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Brittle or loose teeth.

Dental caries (tooth decay).

Overbite. This is when your upper teethstick out past your lower teeth.

Periodontal (gum) disease.

Short upper lip or your teeth do not close

or come together in the front of yourmouth.


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Bleeding or bruising:

Bruises on your lips and face.

Bleeding gums or other soft tissuesinside your mouth.

Cuts on your lips, chin, or labial

frenulum (tissue that attaches yourlip to your gum).


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Facial fracture: You may have abroken bone, such as in the jaw orface.

You have a change in how yourface or jaw looks.

You are not be able to move yourjaw or close your mouth.


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Tooth discomfort or pain:

Toothache.

Tooth that is very sensitive to pressure,temperature (hot or cold), or tapping.You may also feel pain when eating or

drinking something sweet or sour.


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Tooth damage: You may have atooth that is cracked, chipped, loose,out of position, or missing.

You can feel a sharp or rough edgeon your tooth. This can rub againstthe inside of your mouth or yourtongue.

Missing tooth or teeth.


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yBleeding: Put pressure on areasthat are bleeding. Use a clean

hand or towel to do this.


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yKnocked out tooth: Put the toothback in the socket that it came out

of if you can.


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yApply ice: Use an ice pack to reduce

pain and swelling. An ice pack can be

crushed ice in a plastic bag or a bag

of frozen vegetables. Wrap the ice

pack in a thin towel to protect your

face from getting too cold.


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yBreathing:Make sure nothing isblocking your ability to breath. Thiscan include knocked out teeth orblood in your throat.


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Analgesics: These include different kinds of

medicines that help decrease pain, such as

acetaminophen. The kind of analgesic that may

be given to you will depend on how bad your

pain is. Some analgesics may also be used to

decrease swelling and fever (high body

tem erature .


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Antibiotics: This medicine is given to fight or

prevent an infection caused by bacteria. Always

take your antibiotics exactly as ordered by your

caregiver. Keep taking this medicine until it is

completely gone, even if you feel better. Stopping

antibiotics without your caregiver'sOK may makethe medicine unable to kill all of the germs. Never

"save" antibiotics or take leftover antibiotics that


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yRoot canal: This may be done if your

tooth crown is broken and the pulp is

damaged. A root canal, also called apulpectomy (pulp removal), may be done

if the pulp is badly damaged. It may also

be done to help the exposed pulp heal.This is a procedure where a filling is

placed inside your tooth and covered with

a cap.


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y Splinting of teeth: A splint may beplaced on your teeth for a period oftime. This helps support the position

of your damaged tooth while itssupporting tissues heal


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Tooth bonding: This isdone if a small part ofyour tooth chipped off.

A special glue will beused to put the piecesof tooth back together.

Tooth replantation: Atooth that completelycame out from its

socket may be put back.This should be donewithin five minutesafter the trauma or assoon as possible.


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Tooth reshaping: This isdone to make the sharp

edge of your brokentooth smoother.


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Have your injurychecked right away.Seeing a caregiver

right away may helpyou from havingdental or otherproblems later. These

include tooth loss ordental infections.

Avoid using yourdamaged tooth.Chewing food on

your damaged toothmay put too muchpressure and worsenyour injury.


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yLiquid diet:Avoid hot foods and stay on a

liquid diet if a splint was placed on your teeth.Liquid diet means you may not be able to eat

solid foods for a period of time. You can drink

anything that is a liquid such as soup, milk,

and smoothies.


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y Soft diet: Limit your diet to soft

foods for 1 to 2 weeks if you have aloose tooth. Soft foods includeapplesauce, baby food, bananas,

cooked cereal, cottage cheese, eggs,gelatin, pudding, and yogurt


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Keep your wounds clean. Soft tissuecuts and other wounds must be keptclean. Gargle using a salt water

solution. You can also clean yourwounds using hydrogen peroxideswabs. Ask your caregiver for more

information on how to clean yourwounds.


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WHEN THE VICTIMSRECOVERS

S

PO

NTANEO

US

LYOR

IS

SUCCESFULLY

RESUSCITATED(ATLEAST

TEMPORARILY)


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DEATH CAUSED BY

CHANGES IN THE LUNGS

R

ES

ULTING IN IMM

ERS

IO

N

OFWATER


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Persons struggles to keep afloat in the water

Gulps in large of air as he thrashes about

(when he can no longer keep afloat and startsto submerge


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He tries to take and hold one more deep breath

Water may enter the airway

(there is a series of coughing and swallowingactions


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This spasms seals the airway effectively that nomore than a small amount of water reaches thelungs

Unconsciousness soon results fromhypoxia(oxygen starvation)


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occ


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occurring when the entranceof water causes a

laryngospasm occluding theairway bringing aboutsuffocation.


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1. Laryngospasm

2. Asphyxiation

3. Hypoxia

4. Cardiac arrest


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in which water fills thelungs, stopping gas

exchange.


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FRESHWATER

Hypotonic

Hypervolemia Hemodilution

Hemolysis


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SALTWATER

Hypertonic

Hypovolemia Hemoconcentration

Crenation of RB

C


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Immediate quality CPR

Cold water

Clean water

Short immersion time


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Monitor patients AB C(cervical spineprecautions

Initiate CPR

Establish IV access


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Correct hypoxia

Correct acidosis

Correct hypotension

Transport victim to nearest hospital


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Monitor patients AB C(cervicalspine precautions)

Initiate monitoring(cardiac and

pulse oximeter


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Remove wet clothing; wrapin dry blanket

Provide aggressive re-warming effort


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Gently handle patient toprevent arrythmia

Anticipate profoundneurologic changes


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Provide re-warming therapy

Determine the duration ofsubmersion


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Monitor ICP

monitor hypoxic seizures


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When there are 2 rescuespresent, perform the head tiltchin support technique toprovide in-line stabilization of apatient in shallow water


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When you find a patientface down in shallow

water,position yourselfalong side the patient


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Extend the arms straightup alongside his head to

create a splint


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Begin to rotate the torsotoward you


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PO

ISO

NS


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y AKA (rust remover, metal polishSE: PAIN GI tract chemical burns

Lip burns, vomiting

Rx. Give milk or water, mlk ofmagnesia, egg white, prevent

aspiration. Transport patient insitting position, if possible


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Do not induce vomiting

Contact poison control for moreadvise


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AKA- Tylenol SE: There may be s/sx but

acetaminophen is toxic to the liverN/V, anorexia RUQ PAIN, pallorand diaphresis


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RX; ABCSO2 IV, EKG fluids forhypotension, activated charcoal50-100mg orally.

Mucomist may be given in ED

CAUTION:CONTACT POISON

CONROL


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SE: pain GI Tract chemical burnsLip burnns and vomiting

Rx: give milk or water, preventaspiration if possible trasportpatient in sitting position

Caution:

do not induce vomitingContact poison control


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Attacks occur while eating Most are caused by impacted food

Victim may clutch neck

The choking event is commonly witnessed!


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If victim demonstrates the universal chokingsign, quickly ask, Are you choking?


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M O S O


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M

ildO

bstruction In response to

question: victimspeaks & answersyes

Victim able to speak,cough, & breathe

S

evereO

bstruction In response to

question: victimunable to speak ornods

Victim unable tobreathe

Wheezing

Silent Cough

Unconscious victim

M O S O


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Mild

Obstruction

Encourage victim tocontinue coughing

Do NOT interfere

with patientsspontaneous efforts tocough & breathe

Do NOTHING else

Severe

Obstruction

INTERVENE!


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Apply abdominal thrusts in rapid successionuntil obstruction is relieved


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Stand behind victim & putboth hands around upperpart of abdomen

Lean victim forwards

Clench fist & place it thumbside against victimsabdomen between theumbilicus & xiphoid


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Grasp this hand with theother

Pull sharply inwards &upwards

Repeat until object isexpelled or victim becomesunresponsive


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If you find aCONSCIOUSchoking victimlying on the

ground, doabdominalthrusts in thesupine position


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If victim becomes unresponsive Carefully support patient to the ground

Activate EMS

Begin CPR

Initiate chest compressions even if pulse ispresent in the UNCONSCIOUSCHOKINGVICTIM


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Look for object in victims mouth each timeairway is opened

Use finger sweep if solid material is SEENobstructing airway of unresponsive patient

FBAO victims treated with abdominal thrustsshould be examined by a doctor

Can cause internal injuries


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S i D dl !


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Scorpions: Deadly! Not all scorpions are poisonous, but those that

are can be deadly. Scorpions are found mostlyin the Southwest and Western states.

Symptoms of a sting include pain, swelling,itching, vomiting, increased sweating, andvision problems. Get medical careimmediately.

T i b d b


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Toxins-substance produce byanimals or plants that arepoisonous to humans

Venom-is a term for a toxinproduced by some animals suchas snakes, and spiders

Al d f


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Altered state of awareness Noticeably stings or bites in the

skin Puncture marks

Blotchy skin

Localized pain or itching

Numbness in the limb/body

B i i h i


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Burning sensation at the site Redness

Swelling/blister at the siteWeakness/collapse

DOB

H/A, DIZZINESS

CHILLS


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CHILLS FEVER

N/V

MUSCLE CRAMPS

EXCESSIVE SALIVA

ANAPHYLAXIS

T t f h k


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Treat for shock Pull the stinger/venom sac-

avoid using tweezers

Remove jewelry

Contact poison control

R i i l b t ll


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Require special care but usuallynot life threatening

Snake bites takes several hoursto appear.


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Pit i ( ttl k


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Pit vipers-(rattle snakes,copperheads, water

mocassins

Coral snakes


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When youre feeling stressedWhen youre feeling stressed

and about to break down. Justand about to break down. Just

remember STRESSED is justremember STRESSED is just


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remember STRESSED is justremember STRESSED is justDESSERTS spelledDESSERTS spelled

backwards Its just a piece ofbackwards Its just a piece of

cake!cake!

Documents

Disaster Final