EMERGENCY AND

TRAUMA NURSING
PREPARED BY:
ROCHELL ANNE D. LIM, RN
 LEARNING OBJECTIVES
• Describe emergency care as a collaborative, holistic
Describe approach that includes the patient, the family, and
significant others.

• Discuss priority emergency measures instituted for the

Discuss patient with an emergency condition.

• Compare and contrast the emergency management of

Compare patients with heat stroke, frostbite, and hypothermia.

• Describe the significance of crisis intervention in the care

Describe of patients experiencing hemorrhage

• Discuss the emergency management of patients with

Discuss snake bites.
 EMERGENCY
NURSING
• According to the Emergency
Nursing Association (ENA),
emergency nursing “involves the
assessment, diagnosis and
treatment of perceived , actual or
potential, sudden or urgent,
physical or psychosocial
problems that are primarily
episodic or acute”.
 EMERGENCY NURSING

• Emergency Nursing is a nursing specialty in which nurses

care for patients in the emergency or critical phase of their
illness or injury.
• The key difference is that an emergency nurse is skilled at
dealing with people in the phase when a diagnosis has not
yet been made and the cause of the problem is not known.
 EMERGENCY
NURSING

• The term emergency

management
traditionally refers to
care given to
patients with urgent
and critical needs.
 The emergency nurse has specialized
education, training, experience, and
expertise in assessing and identifying
patients’ health care problems in crisis
situations.
SCOPE AND
PRACTICE OF
EMERGENCY The emergency nurse establishes priorities,
NURSING monitors and continuously assesses acutely
ill and injured patients, supports and
attends to families, supervises allied health
personnel, and teaches patients and
families within a time limited, high-
pressured care environment.
 Nursing interventions are accomplished
interdependently, in consultation with or
under the direction of a licensed
physician.

SCOPE AND Appropriate nursing and medical

PRACTICE OF interventions are anticipated based on
assessment data.
EMERGENCY
NURSING
The emergency health care staff members
work as a team in performing the highly
technical, hands-on skills required to care
for patients in an emergency situation.
 Patients in the ED have a wide
variety of actual or potential
problems, and their condition
may change constantly.
SCOPE AND
PRACTICE OF
EMERGENCY Although a patient may have
NURSING several diagnosis at a given
time, the focus is on the most
life-threatening ones.
 ISSUES IN EMERGENCY NURSING CARE

• Emergency nursing is demanding because

of the diversity of conditions and situations
which are unique in the ED.
• Issues include legal issues, occupational
health and safety risks for ED staff, and the
challenge of providing holistic care in the
context of a fast-paced, technology-driven
environment in which serious illness and
death are confronted on a daily basis.
ISSUES IN EMERGENCY NURSING CARE

Documentation of Limiting Exposure to

Consent and Privacy Health Risks

Violence in the
Providing holistic
Emergency
care
Department
 EMERGENCY INTERVENTIONS

Patient- Family-
Focused Focused
Interventions Interventions
 PATIENT-FOCUSED INTERVENTIONS

1) Clinicians caring for the patient should act

confidently and competently to relieve
anxiety and promote a sense of security.
2) Explanations should be given that the
patient can understand.
3) The unconscious patient should be treated
as if conscious.
 FAMILY-FOCUSED INTERVENTIONS

1) The family is kept informed about where

the patient is, how he or she is doing, and
the care that is being given.
2) Allowing family members to stay with the
patient, when possible, also helps allay
their anxieties.
3) In many facilities, family presence during
resuscitation is permitted to assist the
family to cope through this difficult time.
 STAGES OF CRISIS
Anxiety and Denial
• Family members are encouraged to recognize and talk about their feelings of anxiety.

Remorse and Guilt

• Family members start accusing themselves (or each other) of negligence or minor
omissions are urged to verbalize their feelings to help them cope appropriately.
Anger
• A way of handling anxiety and fear

Grief
• A complex emotional response to anticipated or actual loss.
• Letting them know that it is normal and acceptable for them to cry, feel pain, and
express loss.
 CORE COMPETENCIES
IN EMERGENCY
NURSING
1. Assessment
2. Priority Setting/Critical
Thinking Skills
3. Knowledge of Emergency
Care
4. Technical Skills
5. Communication
 Establishes priorities

Monitors and continuously assesses

acutely ill and injured patients.

ROLES OF THE
EMERGENCY Supports and attends to families
NURSE
Supervises allied health personnel

Teaches patients and families within a

limited, high pressure care environment
 1) Recent Outbreaks and Incidents (2019
TYPES OF Novel Coronavirus, Ebola)
EMERGENCIES 2) Natural Disasters and Severe Weather
(Floods, Hurricanes, Wildfires)
3) Radiation Emergencies (nuclear
power plant accident, nuclear
explosion or a dirty bomb)
4) Bioterrorism (Bacillus anthracis)
5) Chemical Emergencies (Chlorine,
Ammonia, Benzene)
6) Medical Emergencies
 PRINCIPLES OF Assess
Triage and
EMERGENCY CARE Intervene
 A process of assessing patients to determine
management priorities.

The word “triage” comes from the French word

“trier,” meaning “to sort.”
FIRST
PRINCIPLE:
Used to sort patients into groups based on the
TRIAGE severity of their health problems and the
immediacy with which these problems must be
treated.

A basic and widely used triage system that has been

in use for many years has three categories: emergent,
urgent, and nonurgent (Berner, 2005)
 THREE LEVELS OF TRIAGE SYSTEM

1. Emergent triage category

• Signifying life threatening or potentially life threatening injuries
or illness requiring immediate treatment.
2. Urgent triage category
• Signifying serious illness or injury that is not immediately life-
threatening.
3. Non-urgent triage category
• Signifying episodic or minor injury or illness in which treatment
may be delayed several hours or longer without increased
morbidity
 FIVE LEVELS OF
TRIAGE SYSTEM

1. Resuscitation
2. Emergent
3. Urgent
4. Non-urgent
5. Minor

*Currently used in the USA,

Australia, United Kingdom, and
Canada
1. Resuscitation
• Patients who are experiencing life-threatening conditions
• Patients needing immediate treatment to prevent death
2. Emergent
• Patients with conditions that may deteriorate rapidly and
develop a major life-threatening situation or require time-
sensitive treatment.
3. Urgent
• Patients who have non–life threatening conditions but require
two or more resources (such as catheterization, IV
medications, and diagnostic exams) to provide their care.
4. Non-urgent
• Patients who have non–life-threatening conditions
and likely need only one resource (such as
catheterization only or IV fluid therapy only) to
provide for their needs.
5. Minor
• Patients who have no life-threatening conditions
and likely require no resources to provide their
evaluation and management.
 START
(SIMPLE TRIAGE AND
RAPID TREATMENT)
 Developed to allow first responders to
triage multiple victims in 30 seconds or
less.

3 primary observations: Respirations,

SIMPLE Perfusion, Mental Status (RPM)
TRIAGE AND
RAPID Designed to assist rescuers to find the
TREATMENT most seriously injured patients

As more rescue personnel arrive on the

scene, the patients will be re-triaged for
further evaluation, treatment, stabilization,
and transportation.
 COLORS

• GREEN – MINOR (delayed care/can delay

up to 3 hours)
• YELLOW – DELAYED (urgent care/can delay
up to 1 hour)
THE FOUR • RED – IMMEDIATE (immediate care/life-
COLORS OF threatening)
• BLACK – DEAD / DECEASED / EXPECTANT
TRIAGE (victim is dead/no care required)

PURPOSE of triage tagging

• For easy recognition by other rescuers

arriving on the scene
 Tell all the people who can get up
and walk to move to a specific area.

If patients can get up and walk, they

FIRST STEP IN are probably not at risk of immediate
death.
START:
GET UP &
Patients who can walk are asked to move
WALK! away from the immediate rescue scene to
a specific designated safe area.

These patients are designated as

MINOR.
Move in an orderly and systematic manner through
the remaining patients, stopping at each person for a
quick assessment and tagging (should not take more
than one minute).
SECOND
STEP IN
Your main responsibility is to find and tag
START:
patients those who require immediate
attention.
BEGIN
WHERE YOU
STAND
Examine each patient, correct life-threatening
airways and breathing problems, tag the patient
with an “IMMEDIATE” tag and move on.
 HOW TO
EVALUATE
PATIENTS
USING RPM?

(RESPIRATION,
PULSE, MENTAL
STATUS)
 RESPIRATION / BREATHING

If the patient is breathing, note if it is more than 30cpm or less than

30cpm.

If the RR is more than 30cpm, tag with IMMEDIATE. It may be a primary

sign of shock and needs immediate care.

If RR is less than 30cpm, move on to perfusion and mental status criteria.

If the patient is not breathing and does not start to breathe with simple
airway maneuvers, the patient should be tagged DEAD.
 PERFUSION /
CIRCULATION

If the radial pulse is

Check the radial absent or irregular
pulse the patient is
tagged IMMEDIATE

If the radial pulse is

present, move to the
final observation of
the RPM series:
Mental Status
 MENTAL STATUS

Tell the patient “Open & close your eyes”,

“Squeeze my hand”.

Patients who can follow these simple

commands and have adequate breathing and
adequate circulation are tagged DELAYED.

A patient who is unresponsive or cannot follow

this type of simple command is tagged
IMMEDIATE.
 JUMPSTART
(PEDIATRIC MASS
CASUALTY INCIDENT
TRIAGE SYSTEM)
STEP 1:
• All children who are able to walk are designated
to the MINOR area where they will undergo a
secondary and more involved triage.
• Infants carried to this area or other non-
ambulatory children taken to this area must
undergo a complete medical and primary
evaluation.

JUMPSTART TRIAGE STEPS

STEP 2A:
• All remaining non-ambulatory
children are assessed for the
presence/absence of spontaneous
breathing. If present, assess for the
respiratory rate and move on to step 3.

JUMPSTART TRIAGE STEPS

STEP 2B:
• If spontaneous breathing is not present and is not
triggered by conventional positional techniques
to open the airway, palpate for a pulse
(preferably peripheral).
• If no pulse is present, patient is tagged
DECEASED / EXPECTANT and the triage officer
moves on.

JUMPSTART TRIAGE STEPS

STEP 2C:
• If there is a palpable pulse, the rescuer gives 5 breaths
(approximately 15 sec.) using mouth to mask barrier
technique.
• If the ventilatory trial fails to trigger spontaneous
respirations, the patient is tagged EXPECTANT /
DECEASED and the triage officer moves on.
• If respirations resume, the patient is tagged
IMMEDIATE

JUMPSTART TRIAGE STEPS

STEP 3:
• If the respiratory rate (RR) is 15-45/minute,
proceed to checking perfusion.
• If the respiratory rate is less than 15 (less
than 1/every 4 seconds) or faster than
45/minute or irregular, tag as IMMEDIATE
and move on.

JUMPSTART TRIAGE STEPS

STEP 4:
• Assess perfusion by palpating pulses on an
uninjured limb.
• If pulses are palpable, proceed to Step 5. If
there are no palpable pulses, the patient is
tagged IMMEDIATE and the triage officer
moves on.

JUMPSTART TRIAGE STEPS

STEP 5A: (At this point all patients have
“adequate” ABCs)
• Performs a rapid AVPU assessment of mental
status
• If the patient is Alert, responds to Voice, or
responds appropriately to Pain, the patient is
tagged DELAYED

JUMPSTART TRIAGE STEPS

STEP 5B: (At this point all patients
have “adequate” ABCs)
• If the patient does not respond to voice and
responds inappropriately to pain (moans or
moves in a non-localizing fashion) or is
Unresponsive, an IMMEDIATE tag is applied.

JUMPSTART TRIAGE STEPS

NOTE:
• All patients tagged
EXPECTANT/DECEASED, unless clearly
suffering from injuries incompatible with life,
should be reassessed once critical
interventions for IMMEDIATE and DELAYED
victims are completed.

JUMPSTART TRIAGE STEPS

 For patients in emergent or
urgent triage category, the
priority goals of care are:
SECOND
PRINCIPLE: • Stabilization
ASSESSMENT • Provision of critical treatments
& INTERVENE • Prompt transfer to the
appropriate setting (intensive
care unit, operating room,
general care unit)
 The

SECOND
nursing
assessment
• Primary
PRINCIPLE: process for
any client
Assessment
ASSESSMENT
& INTERVENE
entering
the ED is
• Secondary
divided Assessment
into:
 PRIMARY ASSESSMENT

The primary survey focuses on stabilizing life-

threatening conditions

The purpose is to immediately identify any client problem

that poses a threat, immediate or potential to his/her life

Utilizes the mnemonic, ABCD (Airway, Breathing,

Circulation, Disability)
 PRIMARY ASSESSMENT

A - establish a patent airway

B - provide adequate ventilation, employing resuscitation measures

when necessary

C - evaluate and restore cardiac output by controlling hemorrhage, preventing

and treating shock, and maintaining or restoring effective circulation

D - determine neurologic disability by assessing neurologic

function using the Glasgow Coma Scale
 SECONDARY ASSESSMENT

Insertion or
A complete application of
Diagnostic and monitoring
health history
laboratory devices such as
and head-to-toe ECG electrodes,
testing
assessment arterial lines, or
urinary catheters
 SECONDARY ASSESSMENT

Performance of
Cleansing, other necessary
Splinting of closure, and interventions
suspected dressing of based on the
fractures wounds patient’s
condition
AIRWAY OBSTRUCTION
 The airway is partially or completely
occluded, narrowed or blocked.

Permanent brain damage or death will

occur within 3-5 minutes.
AIRWAY
OBSTRUCTION Causes:
• Bronchoconstriction (narrowing of airway by
contraction of muscle fibers)
• Aspiration of foreign body
• Anaphylaxis
• Thick mucous secretions
• Certain diseases (Laryngeal edema, OSA,
peritonsillar abscess, infections)
 Labored Breathing

Use of Accessory Muscles

Cyanosis
CLINICAL
MANIFESTATIONS Confusion

Flaring Nostrils

Hypoxia

Loss of Consciousness
 If conscious, ask the person whether he or
she is choking and requires help.

ASSESSMENT
If unconscious, inspection of the oropharynx AND
may reveal the offending object.
DIAGNOSTIC
FINDINGS
Diagnostic Findings:
X-rays Laryngoscopy Bronchoscopy
 Establish Airway

• Abdominal Thrusts
MANAGEMENT • Head-Tilt/Chin-Lift Maneuver
OF PATIENTS • Jaw-Thrust Maneuver
WITH • Oropharyngeal Airway
OBSTRUCTIVE Insertion
AIRWAY • Endotracheal Intubation

Maintain Ventilation
 ABDOMINAL THRUSTS

Also known as the Heimlich Maneuver

Performing abdominal thrusts involves a rescuer standing behind a patient

and using their hands to exert pressure on the bottom of the diaphragm. This
compresses the lungs and exerts pressure on any object lodged in the trachea,
hopefully expelling it. This amounts to an artificial cough.
 Check Breathing

Opening the airway

Place patient in a supine position on a flat

HEAD-TILT/ surface
CHIN-LIFT
MANEUVER Place one hand in a patients forehead

Apply pressure to tilt the head back

Place the other hand under the bony part of

lower jaw near the chin and lifted up
 Position yourself at the patient’s head

Grasp the patient’s jaws using both hands

JAW-THRUST
MANEUVER
Slowly lift the jaws, displacing the
mandible forward

This is a safe approach to opening the airway of a

patient with suspected spinal cord injury because it
can be accomplished without extending the neck.
 It is a semicircular tube or tube-like plastic device
that is inserted over the back of the tongue into the
lower posterior pharynx in a patient who is
breathing spontaneously, but who is unconscious
OROPHARYNGEAL
AIRWAY It prevents the tongue from falling back
INSERTION against the posterior pharynx and obstructing
(GUEDEL AIRWAY) the airway

Allows suctioning of secretions

 ENDOTRACHEAL INTUBATION

It is the placement of a flexible plastic tube into the trachea to protect

the patient's airway and provide a means of mechanical ventilation.

Using a laryngoscope, an endotracheal tube is passed through the

mouth, larynx, and vocal cords, and into the trachea.

A bulb is then inflated near the distal tip of the tube to help secure it in
place and protect the airway from blood, vomit, and secretions.
 INDICATIONS

• Ventilation during anesthetic for

surgery
• Patient can’t protect their airway
ENDOTRACHEAL (e.g. if GCS <8, high aspiration
INTUBATION risk or given muscle relaxation)
• Potential airway obstruction
(airway burns, epiglottitis, neck
hematoma)
• Inadequate
ventilation/oxygenation (e.g.
COPD, head injury, ARDS)
HEMORRHAGE
HEMORRHAGE

Hemorrhage is defined
as a copious or heavy
discharge of blood from
the blood vessels.

Primary cause of shock

(hypovolemic shock).
 CLASSIFICATION (WHO)

Grade 0 - No bleeding

Grade 1 - Petechial bleeding;

Grade 2 - Mild blood loss (clinically significant);

Grade 3 - Gross blood loss, requires transfusion (severe);

Grade 4 - Debilitating blood loss, retinal or cerebral associated with fatality

 ACCORDING TO ORIGIN

Head: Intracranial,
Mouth: Cerebral,
Urinary tract:
Hematemesis, Intracerebral,
Hematuria
Hemoptysis Subarachnoid
hemorrhage

Gynecologic:
Vaginal bleeding, Gastrointestinal:
Lungs: Pulmonary
Postpartum Melena,
hemorrhage
hemorrhage, Hematochezia
Ovarian bleeding.
ACCORDING
TO SOURCE

Capillary

Venous

Arterial
MOST COMMON CAUSES OF HEMORRHAGE:

• Blood clotting disorders.

• Cancer.
• Complications from medical procedures, such as surgery or childbirth.
• Damage to an internal organ.
• Hereditary (inherited) disorders, such as hemophilia
• Injuries, such as cuts or puncture wounds, bone fracture or traumatic
brain injury.
• Violence, such as a gunshot or knife wound, or physical abuse.
• Viruses that attack the blood vessels, such as viral hemorrhagic fever.
 TYPES OF HEMORRHAGE

• EXTERNAL • INTERNAL
- blood loss outside of the -blood loss inside the
body. body
- happens when blood exits - occurs when blood leaks
through a break in the skin. out through a damaged
blood vessel or organ.
 SIGNS AND SYMPTOMS OF SHOCK

Cool, moist
skin
Decreasing Delayed Decreasing
(resulting Increasing
blood capillary urine
from poor heart rate
pressure refill volume
peripheral
perfusion)
 GOALS OF EMERGENCY MANAGEMENT

Control the bleeding

Maintain adequate circulating blood volume for tissue

oxygenation

Prevent shock
 NURSING INTERVENTIONS

Fluid Replacement: to maintain

adequate body circulation

Control of External Hemorrhage: direct,

firm pressure is applied over the
bleeding area or wound

Control of Internal Bleeding: blood

transfusions, surgery
 • It is a condition in which there is
loss of effective circulating
blood volume.
SHOCK
• Inadequate organ and tissue
perfusion follows, ultimately
resulting in cellular metabolic
derangements.
 HYPOVOLEMIC SHOCK

• It is a life-threatening emergency.

• Shock state resulting from decreased intravascular volume due

to fluid loss.

• It is an emergency condition in which severe blood or other fluid

loss makes the heart unable to pump enough blood to the body.
 • Traumatic Blood Loss

CAUSES OF
HYPOVOLEMIC • Severe Dehydration
SHOCK

• Ascites
 MANAGEMENT

Fluid and Blood Replacement

Modified Trendelenburg Position

Vasoactive Medications
WOUNDS
 • An injury to soft tissues can vary
from minor tears to severe
crushing injuries.
WOUNDS
• Main goal of treatment:
To restore the physical
integrity and function of the injured
tissue while minimizing scarring
and preventing infection.
 Pain
SYMPTOMS
OF WOUNDS
Swelling

Bleeding
 TYPES OF WOUNDS

Laceration Avulsion Abrasion

Skin tear with Tearing away of tissue Denuded skin
irregular edges and from supporting A rub or scrape on a
vein bridging structures rough surface
 TYPES OF WOUNDS

Ecchymosis/contusion Hematoma Stab

Blunt trauma causing Tumor like mass of Incision of the skin with well-
pressure damage to blood trapped under defined edges, usually caused by a
sharp instrument; a stab wound is
the skin and/or the skin or tissue.
typically deeper than long.
underlying tissues.
 MANAGEMENT

Primary
Wound
Closure
Cleansing
(Suture)

Delayed
Antibiotic
Primary
Agents
Closure

Tetanus
Prophylaxis
 TRAUMA
(INTRA-ABDOMINAL INJURIES)
 TRAUMA

Trauma is an unintentional or
intentional wound or injury
inflicted on the body from a
mechanism against which
the body cannot protect
itself.
 ABDOMINAL TRAUMA

Abdominal trauma is an injury to the abdomen.

Types of abdominal injuries

Open Closed

Closed or open wounds to the abdomen may

involve multiple organs and major blood vessels
(abdominal aorta and superior vena cava)
 CLINICAL MANIFESTATIONS OF
ABDOMINAL TRAUMA

Patient is in fetal position Distended abdomen

Nausea & vomiting of blood
Rapid, shallow breathing
Hematuria
Signs of shock
Abdominal pain
Evisceration (protruding of
Rigid abdominal muscles internal organs)
 PENETRATING ABDOMINAL INJURY

• Any penetrating injury that could have • Results in a high incidence of

entered the peritoneal cavity or injury to hollow organs,
retroperitoneum inflicting damage on
particularly the small bowel.
the abdominal contents.

• Injuries are serious and usually

require surgery. (i.e., gunshot
wounds, stab wounds)
 Hypotension (with or without abdominal
distention)

SIGNS AND Narrow pulse pressure.

SYMPTOMS
Tachycardia.

High or low respiratory rate.

Signs of inadequate end organ perfusion.

 BLUNT ABDOMINAL TRAUMA (BAT)

• Refers to road traffic injuries and

• It is commonly associated with extra-
injuries due to falls where impact or
abdominal injuries to the chest, head, or
countercoup wounds enter the
extremities
peritoneal cavity.

• This is especially true of blunt

• The incidence of delayed and trauma-
injuries involving the liver, kidneys,
related complications is greater than
spleen, or blood vessels, which can
for penetrating injuries
lead to massive blood loss into the
peritoneal cavity (ACS, 2013).
 Pain.

Tenderness.
SIGNS AND
SYMPTOMS
Gastrointestinal hemorrhage.

Hypovolemia.

Evidence of peritoneal irritation.

 EMERGENCY CARE OF ABDOMINAL
TRAUMA
Assess mental status and for spinal cord injury
Establish and maintain open airway
Provide oxygen
Control any external bleeding
Do not remove penetrating objects
Do not touch protruding organs
Apply large, moistened sterile dressings over organs and wound
HYPOTHERMIA /
HYPERTHERMIA
 HYPERTHERMIA

3 main types
Hyperthermia or of heat
high core body emergencies:
temperature
• Heat cramps
results when the
• Heat
body gains or exhaustion
produces more • Heat stroke
heat than it loses.
 HYPERTHERMIA

HEAT CRAMPS

• Affect people who sweat a lot during strenuous

activity in a warm environment
• Sweating leads to water and electrolyte loss that
leads to dehydration that causes muscle spasms
(usually in the shoulders, arms, abdomen, and
muscles at the back of the lower legs).
 HYPERTHERMIA

• Results from too much heat and dehydration

• Clinical manifestations:
• Increased temp (38.3-38.9C)) and fast HR
• Cool, pale, moist skin
HEAT • Muscle cramps
EXHAUSTION • Dizziness
• Heavy sweating and thirst
• Weakness and fatigue
• Headache
 HYPERTHERMIA

• Occurs when the body can no longer

regulate its temperature
• Clinical manifestations: (the same with heat
exhaustion)
HEAT • Altered mental status
STROKE • Dry, hot, flushed skin
• Shallow breathing
• Vision disturbances
• Fast HR initially then a slow HR
• Unresponsiveness
 MANAGEMENT

• Remove from hot environment and move to a cool location

• Give oxygen:
• If with available O2, give O2 via face mask at 15LPM
• If w/o available O2, assist breathing using mouth-to-
mask device
• Remove or loosen clothing and cool patient thru fanning
• Place in supine position and let the patient slowly drink
water (with SAP). If with altered mental status, do not give
fluids.
• VS and NVS monitoring (En route to the receiving facility)
• Fluid administration (IV access)
 HYPOTHERMIA

Hypothermia is a condition in
which the core (internal)
temperature is 35C (95F) or less
as a result of exposure to cold
or an inability to maintain body
temperature in the absence of
low ambient temperatures.
 CLINICAL MANIFESTATIONS

Temperature of 35C or below

Clumsiness or lack of coordination
Shivering
Drowsiness or very low energy
Slurred speech or mumbling
Confusion or memory loss
Slow, shallow breathing
Loss of consciousness
Weak pulse
 DIAGNOSTICS &
EMERGENCY MANAGEMENT

Monitoring Rewarming
• ABCs
• VS monitoring • Active Internal (Core)
• CVP monitoring • Passive or Active
• Strict I&O External
• ABG (Spontaneous)
• ECG
 REWARMING METHODS

Active Internal (Core)

• Used for moderate to severe

hypothermia (less than 28C to 32.2C
[82.5F to 90F])
• Cardiopulmonary Bypass
• Warm fluid administration
• Warm humidified oxygen by
ventilator
• Warmed peritoneal lavage
 REWARMING
METHODS

Passive or Active
External (Spontaneous)
• Used for mild
hypothermia (32.2C to
35C [90F to 95F])
• Uses over-the-bed
heaters to the
extremities
• Uses forced air warm
blankets
FROSTBITE
 FROSTBITE

• It is a trauma from exposure to freezing temperatures and

freezing of the intracellular fluid and fluids in the intercellular
spaces.
• Body parts most frequently affected by frostbite include the feet,
hands, nose, and ears.
• Frostbite ranges from first degree (redness and erythema) to
fourth degree (full-depth tissue destruction).
• It results in cellular and vascular damage.
• Frostbite can result in venous stasis and thrombosis
 SIGNS AND SYMPTOMS

• At first, cold skin and a prickling feeling

• Numbness
• Skin that looks red, white, bluish-white, grayish-yellow, purplish,
brown or ashen, depending on the severity of the condition and
usual skin color
• Hard or waxy-looking skin
• Clumsiness due to joint and muscle stiffness
• Blistering after rewarming, in severe cases
 MANAGEMENT

• Frozen extremities are usually placed in a 37°C to 40°C (98.6°F to

104°F) circulating bath for 30- to 40-minute spans.
• Pharmacological: Analgesics & Nonsteroidal anti-inflammatory
drugs (NSAIDs)
• Whirlpool bath for the affected body parts
• Escharotomy (incision through the eschar)
• Fasciotomy
• Encourage the patient to avoid tobacco, alcohol, and caffeine
ANAPHYLACTIC REACTION /
ANAPHYLAXIS
ANAPHYLACTIC REACTION / ANAPHYLAXIS

• It is a sudden and severe allergic reaction

that involves more than one body system.
• Causes the immune system to release a
flood of chemicals that can cause you to go
into shock — blood pressure drops
suddenly and the airways narrow, blocking
breathing.
• It's most often caused by an allergy to food,
insect bites, or certain medications.
 Itching

Red, raised, blotchy

skin

Wheezing or
shortness of breath

Congestion, a runny
nose, and sneezing
SIGNS AND SYMPTOMS Swollen tongue, lips, or
throat

Feeling of choking, or
hoarseness.

Rapid or slow
heartbeat

Low blood pressure

 MANAGEMENT

• Administration of epinephrine injection

• Cardiopulmonary resuscitation (CPR)
• High-flow oxygen therapy
• Intravenous antihistamines
• Intravenous corticosteroids
SNAKE BITES
 SNAKE BITES

Snakes bite to capture prey or

for self-defense

2 types of snake bites: dry bite

and venomous bite.

2 major groups of venomous

snakes: Elapids (cobra family)
and Viper.
 CLINICAL MANIFESTATIONS

Metallic taste
Edema Ecchymosis Fasciculations
in the mouth

Hemorrhagic Lymph node Hypotension Paresthesia

bullae tenderness

Nausea & Seizures Coma

Numbness
vomiting
 MANAGEMENT
(AT THE SITE OF SNAKE BITE)

Airway, breathing, and circulation are the priorities of care

Initial first aid at the site of the snake bite:

• Place patient on supine position
• Removing constrictive items such as rings
• Provide warmth
• Cleanse the wound
• Cover the wound with a light sterile dressing
• Immobilize the injured body part below the level of the heart
 Airway, breathing, and circulation
are the priorities of care

Administration of Antivenin
(Antitoxin)
MANAGEMENT
• Administered within 4 hours and no
(AT THE ED) greater than 12 hours after the snake bite
• Two antivenins are available: Antivenin
Polyvalent (ACP) and Crotalidae
Polyvalent Immune Fab Antivenin
(FabAV) (Auerbach, 2007).
• Dose depends on the type of snake and
the estimated severity of the bite
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