NCM 118: EMERGENCY NURSING

MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

-Ask pt. to squeeze their hands or raise their leg off the bed
HEAD AND NEUROLOGIC TRAUMA etc. simultaneous assessment of both sides of the pt. body,
where possible, is important..
Common forces involved: -The nurse should be aware of abnormal posturing which
 Blunt acceleration forces- injury by forceful impact/ indicate serious hypoxic brain injury.
struck by a dull object.  Decorticate/flexion (where pt arms are drawn rigidly
 Deceleration forces- when head is moving and strike up against their chest.
a stationary object.  Decebrate / extension (where the pt. arms turn
 Penetrating forces- object enters the head rigidly outwards against their sides of the body)

MISSED INJURIES ASSESMENT OF LEVEL OF VITAL SIGNS

Secondary neurologic injuries ( to the brain and brainstem) (Serious brain injury)
 complications often develop slowly, sometimes even  Hypertension (compensatory mechanism foo maintain
hrs or days after the initial trauma was sustained cerebral blood flow)
 w/ subtle and non-specific signs  cardiac dysrhythmia ( due to brainstem dysfunction)
 hyperthermia (as cerebral dysfunction a metabolism
TWO FUNDAMENTAL GOALS FOR increases)
NEUROLOGIC ASSESMENT A pt. / a severe late brain injury where there is significant
 To identify any obvious signs of head trauma and pressure will often on the brainstem, determine demonstrates
underlying neurological injury signs known as Cushing’s triad
 To provide baseline data which can be used to 1. Hypertension
identify developing neurologic injury 2. widening pulse pressure
3. Brady Cardia
NEUROLOGIC ASSESMENTS OF A PT. WITH
SUSPECTED OR ACTUAL HEAD TRAUMA

ASSESMENT OF LEVEL OF CONCIOUSNESS

-Using Glassgow Coma Scale

-assesses the functioning of a pt. CNS via their response to
verbal and/or painful stimuli
-when assessing the pt’s LOC, intoxication, sleepiness can
result to an inaccurate score
A COMPUTERIZED TOMOGRAPHY SCAN
ASSESSMENT OF PUPILLAR SIZE, EQUALITY AND
REACTIVITY TO LIGHT(using pen-torch) The National of the head Institute of Heath and Clinical
Excellence’s Head
-PERRLA = Pupils Equal, Round, Reactive to Light and
Injury : Assessment & Early Management CG176) Guideline
Accomodation
-a CT scan be undertaken if a pt. has a GCS of 13 on initial
-problems with PERRLA are often the first signs of an
presentation or a GCS of <15 2hrs after the injury
increased ICP due to, for example, an intracranial hemorrhage
 suspected skull fracture
or edema of the soft tissues of the brain.
 A post-traumatic seizure
 Any focal neurological deficit
ASSESMENT OF LEVEL OF CRANIAL NERVES
 more than 1 time vomiting.
-CN III (oculomotor), CN IV (trochlear), CN VI (abducens)
- these nerves exit the spinal cord around the area of the brain
stem
COMMON HEAD INJURY AND
-rapidly assessed by asking the pt. to follow finger through six MANAGEMENT
directions ( Six Cardinal Gaze ), sign of neurologic injuriry are:
 Disconjugate gaze= deviation of one eye
SCALP LACERATION
 Ptosis = drooping of eyelids
-Scalp is highly vascularised & scalp laceration often bleed
ASSESMENT OF LEVEL OF MOTOR SYMMETRY AND profusely
STRENGHT -Typically managed by direct pressure to control initial
-If pt is conscious hemorrhage, and subsequent wound repair using sutures,
staples or dips.

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

SKULL FRACTURE ✓ temporary amnesia

✓ minor confusion & disorientation
 Linear (the fracture is non-displaced, and there is no
minor neurological damage) ✓ headache
 depressed (one side of the fracture displaces below ✓ dizziness
the other, and there is moderate to severe neurologic ✓ drowsiness
damage ) ✓ irritability
Signs of suspected skull fracture ✓ visual disturbances
✓ hemotympanum (leakage of blood in ears)
✓ Raccoon eyes Care for pt with consussion involves regular observation to
✓ Leakage of CFS from ear or nose identify more serious brain injury and symptomatic
✓ Battle’s sign (bruising behind the ears) mastoid area management.
 Linear usually only requires supportive care
 Depressed = usually require surgical repair (plating)
DIFFUSED AXONAL INJURY
CONTUSION -a sever traumatic brain injury that results in shearing of the
-a bruise of on the scalp or on the surface of the brain arons, key structures w/in white matter of the brain
-When acceleration-deceleration forces are involved in the
injury, two contusions on the surface of the brain may result. Pt. w/ DAI typically present w/
 Coup = the initial site of impact ✓ extended loss of consciousness
 Contrecoup = the opposite side of the brain, as it ✓ flexion or extension posturing
rebounds inside the skull ✓ dysfunction of the autonomic nervous system
Pts w/ contusion are typically present with Management of pt with DAI involves supportive care, however
✓ an altered LOC their prognosis is often poor with patient rarely returning to their
✓nausea and/or vomiting full pre-injury neurologic function.
✓ visual disturbances
INCREASED INTRACRANIAL PRESSURE
✓ weakness
✓ difficulties w/ their speech Causes:
-Most contusions only require supportive care; however,  cerebral edema
severe contusions may require. Surgical evacuation, and the  Increased cerebral blood flow (e.g. hemorrhage)
removal flap of a of bone to relieve ICP whilst the brain tissue
heals. Pt. w/ ICP present w/
✓ decreased LOC
SUBDURAL OR EPIDURAL HEMATOMA ✓ changes in Vs (CT)
(bleeding beneath OR between the skull & one of the layers of ✓ pupillary dilation
the dura mater arachnoid matter) ✓ severe headache.
Pts w/ hematoma often present with ✓ nausea / vomiting.
 severe headache ✓ decrease in motor function
 Pupillary dilation on the same side of the body w/c
sustained the traumatic injury - Where ICP is very high, pressure in the brain stem may result
 hemiparesis (One sided weakness) on the opposite in brain death, where brain fx completely and irreversibly
side ceases
Small hematoma usually only require supportive care, through -Management of increased ICP involves managing its
larger ones may require surgical evacuation (craniotomy). underlying causes; medication & surgical therapy may be used.

CONCUSSION Focus Tx on:

 Treating the greatest threat to life first (management
(mild traumatic brain injury that involves a loss of
of airway, breathing & circulation)
consciousness w/ associated disruptions to neurological
functioning)  Effective managing pt pain (use small venous opioid)
but frequent doses
Presentations
✓nausea/ vomiting
✓visual disturbances

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

ORTHOPEDIC TRAUMA  CLOSED (Bone is broken but skin is intact)

 OPEN COMPOUND (where the bone is open and
Bones, surrounding soft tissue and associated neurovascular protrudes through skin
structures including nerves and blood vessels. ECCHYMOSIS - Bleeding w/ bruising

Common mechanism that causes orthopedic injuries: Patient Presents with

✓ Road Traffic Accidents  Obvious Deformity (x-ray)
✓ Falls From height  Pain
✓ Assaults  Swelling
✓ Sports & recreation  Ecchymosis in the affected region
Complications
✓ General accidents
 Broken bones may lacerate vital organs /arteries/
nerves
Orthopedic Injuries involving long bones may which may result
 Fractures of the large bones may result in
in hemorrhage, shock and severe pain may require immediate
hemorrhage
care.

MANAGEMENT
ASSESSMENT OF TRAUMATIC
ORTHOPEDIC INJURIES ✓Immobilization of the Fracture
-Assess ABC  Traction splint or an adjacent leg splint for fracture of
-Assess musculoskeletal system the femur
 Vacuum splint for all other long bone fractures.
1. Examine trauma site/s for obvious signs of injury.  Temporary casts may also be used
✓Obvious deformity ✓Minor fractures may be reduced (realigned) and fixed in the
✓Laceration emergency care setting
✓ Contusion ✓ More severe fractures require surgical intervention
✓Edema
DISLOCATIONS
✓ Abrasions
Occurs when a joint exceeds its normal ROM & the joint
✓ Pain
surfaces become disconnected
2. Do a Focused neurovascular assessment
✓ Colour SUBLUXATION - Term used to describe a dislocation if there
✓ Temperature is only partial or incomplete displacement of the joint surfaces.
✓ Pulses
✓ Sensation Common points of dislocation
✓ Motor function in the affected limbs Shoulder, Elbow, Finger, hip, knee / Patella, ankle & toe

Patients usually present with

INJURY RELATED TO ORTHOPEDIC
 Obvious deformity (confirmed by x-ray)
TRAUMA AND MANAGEMENT IN THE  Pain & Swelling
EMERGENCY CARE SETTING  Ecchymosis

SPRAIN AND STRAIN Minor Dislocation may be corrected in Emergency care setting
Involve minor damage to muscle, usually at its point OF via manipulation
attachment to a tendon Severe Dislocation require surgical intervention
 Doesn’t require urgent care
Encourage to TRAUMATIC AMPUTATION
 Support Removal of all or part of a digit, limb or other body structure
 Ice such as foot, hand, ear, nose, etc.
 Elevate affected Limb
 Manage Pain Using Oral Analgesia (Paracetamol & Management
 Ibuprofen) ✓Irrigating with normal saline
 Avoid weight bearing for 24-72 hours ✓Moist dressing
✓Elevation and prophylactic antibiotic administration
FRACTURES
-Any disruption or break in the bone

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

LIMB REPLANTATION - Until the wound is closed the area will be wrapped in a
A complex microsurgical procedure that allows patients to have dressing. The wound will be monitored & will visit OR
severe limbs reattached
- Hours after trauma ✓ the dressing removed.
- Not guaranteed ✓Dead tissue removed.
✓the wound cleaned
MUSCLE INJURIES
✓ Stitches tightened slowly close area down
-Including injuries to the rotator cuff (muscles in the shoulder)
✓New dressing applied
and meniscus (fibrocartilage in the knee)
Closure may take up to 2 weeks and skin graft may be needed
Patient should
Key to the emergency management of traumatic orthopedic
✓ Support & Ice
injury
✓ Use Oral Analgesia
✓ Management of patient's pain
✓ Avoid Use 24 to 72 hours
✓ Immobilization

CRUSH INJURY
Occur when part of the body typically a digit or limb, is crushed
SPINAL TRAUMA
for a prolonged period.

Damage to the Spinal cord can do

Patient Present
 Partial or complete paralysis
 Necrosis
 Blocs of motor ability
 Symptoms of “SYSTEMIC CRUSH SYNDROME"
 Loss of conscious function of body processes
1. Myoglubinuria
 Life threatening CNS dysfunction (problems with
2. Acidosis (release lactic acid)
ABC)
3. Renal Failure - free myoglobin are too big to
the glomerulus, resulting to plugging of holes
Causes of spinal injury
4. Cardiac Disruption - release potassium
systemically.  Road traffic accidents
 Falls from height
Management: Supportive care if worst med-surg intervention  Assault
 Sports & recreation accidents
COMPARTMENT SYNDROME  General accidents at work or in home
→ Occurs when excessive pressure builds up inside
→ usually develops bet 64 & hours after the primary Injury, Terms:
when the compartment pressure exceeds capillary pressure &  Tetraplegia ¾ of the body
becomes clinically evident when compartment pressure
 Quadriplegia four quadrants
exceeds venous pressure.
 Paraplegia lover part of the body
 Paralysis absence of sensation
5 P’s
Early signs
Spinal trauma assessment
 PAIN
 Assess ABC
 PARESTHESIA (tingling sensation)
 ASSESS OF THE SPINE & CNS
Late signs
 Inspection & Palpation of the spine
 PALLOR
 Ask about pain & altered sensation in
 PARALYSIS
regions of body
Last signs
 Assess pt. conscious motor pan & reflexes
 PUSELESSNESS  imaging (x-rays & CT scans)

FASCIOTOMY
SPINAL INJURIES AND COMPLICATIONS
-A surgery to relieve swelling & pressure in a compart op the
body INCOMPLETE SPINAL CORD INJURY
-Tissue that surrounds the area is out open to relieve pressure  Partial severing of spinal cord
- One incision will be made in the skin over the compartments  Incomplete Spinal injury 7 will experience impairments
- Loose stitching will be placed over the area but the wound will  There will always sensation of motor function below
remain open and will gradually close if swelling stops level of injury
NEUROGENIC SHOCK

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

 Occurs when spinal injury is complete and motor  HYPOVENTILATION

function bellow level of injury immediately ceases. Assessment of traumatic thoracic injuries
 Irreversible  Rate
 Patients should learn and immobilization techniques  Depth
to prevent further injury  Effort of the patient's breathing
 If injury is high it results problem with breathing  Auscultate breath sounds
unable to maintain circulation & thermoregulate and it  Integrity & symmetry of the chest wall
require emergency intervention  Assessment of cardiac function & continuous
monitoring of cardiac rhythm
AUTONOMIC DYSREFLEXIA
 Access patient circulation (capillary refill, skin color,
Complication of Spinal cord Injury which occurs above the level
temperature)
of 16 vertebrae
 Imaging studies (x-rays or CT scans)
It leads to a massive, uncontrolled cardiovascular response
Can trigger such as full bladder or bowel and can occur any
time after onset of spinal injury INJURIES RELATED TO THORACIC TRAUMA
RIB FRACTURES
Patient presents with May involve a single or multiple ribs most occur in 4th 10th rib
 Severe headache Management: Splinting
 HTN
 Bradycardia FLAIL INJURY
- A section of the rib cage independently from main ribcage
 Anxiety
during breathing
 Profuse sweating above & coldness below level of
- caused by severe rib fractures those involving eight or more
injury
ribs
Management: Splinting
Management of ABC & correction of the underlying causes are
crucial
PNEUMOTHORAX
- Accumulation of air in pleural space around the lungs
SECONDARY INJURIES TO THE SPINAL CORD
HEMOTHORAX - Blood fills in pleural space
 Involvement of vertebral fractures
Management: THORACENTHESIS - Drainage of Fluid in
 May develop over hours following initial injury
pleural space.
Manifestations
Patient typically presents with
 Hemorrhage
 Chest Pain
 Edema
 Dyspnea
 Hypo perfusion of the spinal cord
 Tachycardia
 Endogenous biochemical response
 Decreased or absence chest sounds.
Management of spinal injuries
 Tracheal deviation away from the side of
 Immobilization
pneumothorax
 Cervical Spine Immobilization done by paramedics for
suspected or actual head injury. CARDIAC TAMPONADE
 Spinal Board- used for patient with altered sensation - Occurs when there is accumulation of the blood in the
in their peripheries. pericardial sac.
 Psychosocial care - Social Support BECKS TRIAD
1. Hypotension
2. Muffled (or indistinct) heart sounds
THORACIC TRAUMA 3. Distended neck veins
If untreated it results to increasing dyspnea, decreased LOC &
Any traumatic injury affecting chest area death
Causes Management: PERICARDIOCENTHESIS - To drain fluid
 BUINT FORIES (Sudden deceleration, compression
or direct blows) MANAGEMENT OF TRAUMATIC THORACIC INJURIES
 PENETRATING INJURIES  Management with IV opioid analgesic
Patients with penetrating chest injuries tend to deteriorate more  Administer high-plow oxygen via non- rebreather
rapidly & dramatically than those with blunt injuries mask
Two main problems associated potential thoracic injuries  Reassurance
 HYPOXEMIA

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

ABDOMINAL AND GENITOURINARY  administration of supplemental oxygen (if airway

TRAUMA cannot be managed, sedation and insertion of an
TYPES: artificial airway may be required, usually
nasopharyngeal airway.
 Injuries to the solid organs (kidney, spleen, pancreas
 Inspection and subsequent palpation, following the
and liver)
administration of an appropriate level of analgesia of
 Injuries to the hollow organs (stomach, bladder,
the facial bones (indicator of fraction)
intestines)  Depressed irregularities in the bone
CAUSES
 Crepitus
 Penetrating forces  Imaging studies such as X-rays or CT scans to
 Falls from height formally diagnose internal injuries
 Blunt force trauma  If pt is conscious, ask about
 Assaults  Jaw pain
 Road traffic accidents  Ability to completely open jaw
 Extent to which their teeth meet normally
COMMON INJURIES AND THEIR  Assess visual acuity (count fingers)
MANAGEMENT  Assess peripheral vision
 Assess the facial nerve and its branches
LACERATION TO THE SOLID ORGANS Buccal nerve branch Wrinkle your nose
- liver and spleen are common sites of abdominal injuries. Mandibular nerve branch Purse your lips
- Liver injuries are significant because liver holds up to 25% of Temporal nerve branch Raise your eyebrow and
the body’s circulating blood at any given time, often resulting to wrinkle your forehead
major hemorrhage. Zygomatic nerve branch Squeeze your eye shut
Management: focus on maintaining hemodynamic stability
(aggressive fluid resuscitation) whilst preparing pt for corrective
COMMON MAXILLOFACIAL INJURIES AND
surgery.
MANAGEMENT
RENAL INJURIES
-majority are due to blunt force trauma SOFT TISSUES INJURY
Typical signs: - injuries to the skin, subcutaneous tissues, intraoral tissues,
 Ecchymosis of the flanks eye and ear.
 Palpable mass in the region of the kidney - although painful, these injuries do not usually require urgent
 Hematuria (blood in urine) care, however hemorrhage may result.
Management: focus on the use of direct pressure to confront
BLADDER INJURIES initial hemorrhage, and subsequent wound repair
- most common site of genitourinary injury -sometimes, urgent ophthalmologic surgery may be provided to
- bladder injuries or usually associated with pelvic injury. save patient sight
Nonspecific signs
 Gross hematuria FRACTURES
 Pain in the suprapubic area  the maxillary fracture
 Difficulty voiding  mandibular fracture
 Abdominal tenderness  the orbital region (eye socket)
- Only imaging studies can definitely diagnose a bladder injury Management:
Management: management of pain with opioid analgesic  management of pain with opioid analgesic
 administration of high flow oxygen via a non-
MAXILLO FACIAL rebreather mask
 psychosocial care (changes in physical appearance
TRAUMA may cause distress)
- involves injury of the bones, neurovascular structures, skin,
subcutaneous tissues, muscles and glands of the face and
upper neck RESPIRATORY
- traumas are quite distinct, have the potential to cause EMERGENCIES
significant problems and appearance

ASSESSMENT
 Ensure patency of the airway by checking possible
occlusion
 displacement of the mandible
 avulsed teeth
 naso-orbital hemorrhage
 swollen tongue
 suction to remove foreign objects
 control hemorrhage (by packing the nose and ASSESSMENT
applying ice across the cheeks  Assessment of airway, breathing, circulation
 A detailed assessment of pt’s respiratory system

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

 Measure the RR with the aim of identifying  Chest tightness

dyspnea  Distress
 Observe for other signs of dyspnea Treatment:
 Pallor or cyanosis  Administration of O2
 Tripod positioning (leaning forward on the  Inhalation of B2 agonist (vasodilator)
hands or elbows in attempt to open the Note: in severe cases, pt develop asthmaticus, a severe attack
chest) of asthma
 Nasal flaring
 Retractions
 Accessory muscle use CHRONIC OBSTRUCTIVE
 Grunting PULMONARY DISEASE
 Difficulty speaking in complete sentences - a progressive and irreversible disease, often associated with
 Tracheal tugging smoking
 Auscultating the pt lungs, listen for adventitious lung  Emphysema: enlargement of alveoli
sounds  Bronchitis: inflammation of bronchioles
 Rapid neurological assessment (GCS) S/SX
 Rapid head-to-toe assessment (complication with the  Severe dyspnea
respiratory system can have a variety of systemic
 Production of purulent sputum
effects)
 Pleuritic chest pain
 Barrel chest due to hyperventilation of the
lungs  Distress
 Clubbing of fingernails (sign of chronic
hypoxia)
 Chest X-ray or CT scan PULMONARY EMBOLISM
 CBC - are blood clot or atherosclerotic plaque that occludes a large
 ABG analysis vessel in the lungs
Non-specific symptoms
 Comprehensive health history
 Exposure to respiratory pathogen (influenza,  Worsening Dypspnea
tuberculosis)  Tachycardia
 Respiratory hazards (asbestos, bird  Cough
droppings, fumes, and dust)  Diaphoresis
 Smoking history  Anxiety

DIAGNOSTICS
 CT SCANS
 ABG analysis
 ECG
 Ultrasonography

MOST COMMON RESPI CONDITIONS AND TREATMENT

MANAGEMENT  Administration of Oxygen
 Bronchodilator Corticosteroids
PNUEMONIA  Anti-biotics
- an acute inflammation reaction in the lungs in response to the  Ventilatory/ ventilation
presence of pathogen, often bacteria
Signs and symptoms INHALATION INJURY
 Fever - Inhales substances produced by Fire ( asphyxiants: carbon
monoxide, smoke, drowning
 Fatigue
CHERRY RED LIPS = carbon monoxide inhalation hallmark
 Cough with hemoptysis
signs
 Dyspnea Non-Specific Symptoms
 Areas of consolidation
 Dyspnea
 Pleuritic chest pain
 Coughing
 Crackles
 Gagging
Treatment: urgent, aggressive administration of broad
 Choking
spectrum
 Tachypnea
ASTHMA  Pleuritic Chest pain
- Chronic obstructive disease of the lungs, characterized by Management
hyper-reactive inflammation and narrowing of the airways  Bronchodilators for wheezing/ bronchospasm
Signs and symptoms:  Epinephrine for stridor or retractions
 Severe dyspnea
 Coughing
 Wheezing

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

ACUTE RESPIRATORY DISTRESS SYNDROME MYOCARDIAL INFARCTION (MI)

(ASRD) One of the arteries of the heart becomes occluded and the
Hypoxemic Respiratory Failure distal areas of the cardiac muscle become acutely hypoxic.
 Oxygenation failure
 Caused by imbalance between ventilation and Classification
perfusion  ST-Segment MI (STEMI) - complete & prolonged
 Severe cases where blood leaves the heart without occlusion of an epicardial coronary blood vessel &
having participated in gas exchange. defined based on ECG criteria
 NON ST-segment MI (Non- STEMI) - severe coronary
Hypercapnic Respiratory Failure artery narrowing, transient occlusion or
 Ventilation failure microembolization of thrombus and atherosclerotic
 Imbalance between the supply of and demand for material
oxygen in the lungs Signs and symptoms
Management  Chest or radiating pain
 HIGH Flow o² via non-rebreather mask  Fatigue
 Blood Oxygen saturation (Sa 02) monitoring using  Nausea
pulse oximeter  Dyspnea
 Psychosocial care of pain  Diaphoresis
 Dizziness
CARDIOVASCULAR  Anxiety
EMERGENCIES WHAT TO DO WHEN SOMEBODY HAS HEART ATTACK
Mild, transient & Non- Specific Symptoms 1. Call 999/ 112 for emergency help (tell them you
suspect heart attack)
Without rapid intervention -> Late identification of illness 2. Tell them to sit down KNEES BENT
Poor management -> significant disability-> Death. 3. Give them aspirin 300 mg to chew

Assessment of a patient w/ cardiovascular illness DYSRHYTHMIA

 Assess ABC An abnormality in the normal rhythm of the heart
 Measure heart rate Categories
 Quality of peripheral puises & BP
 Signs of cardiac dysfunction - pallor and / or cyanosis,  Tachycardia (HR > 100 bpm including atrial flutter,
diaphoresis & dyspnea atrial ventricular fibrillation, and long QT Syndrome
 Ask feelings of dizziness, palpitations & nausea  Bradycardia (HR < 60 bpm, often caused by a
 Auscultate for adventitious heart sounds conduction block.
Assessment of chest pain Management: usually medications, but when cardiac arrest is
 O-Onset imminent, a defibrillator shock may be used
 P-Provocation & Palliation
 Q-Quality PERICARDITIS
 R- Region & Radiation - The fibrous sac surrounding the heart is inflamed due to
 S- Severity infection.
 T-Time - Pericarditis can lead to a range of significant complication,
Additional assessments to assist with Diagnosis including Mi & cardiac arrest
 Chest X-rays or CT scans
AORTIC ANEURYSM
 Blood Tests = Troponin released to blood after
- a dilated area of a Vessel often occur in a large, highly –
damage to the heart muscle; it is elevated (positive)
pressurized aorta which carries oxygenated blood from the
within a few hours of heart damage & remains
lungs/ heart to the rest of the body
elevated for up to 2 weeks
Management: Focus on resuscitating techniques in
 Ultrasound
preparation For emergency surgery to repair the rupture.
 ECG for electrical activity of heart
HYPERTENSIVE CRISIS
COMMON CARDIOVASCULAR - May be caused by kidney or endocrine
EMERGENCIES & MNGT - occurs when a patient BP high that they are risk of acute end-
organ damage
ANGINA PECTORIS Management: Medications are primary tx for hypertensive
Angina Pectoris - Arteries of the heart become partially crisis, close monitoring of pt is also important so that
occluded complications including renal or liver failure can be rapidly
Types identify and managed
 STABLE- Occurs in a pattern following a predictable
amount of exertion
 UNSTABLE- when chest pain may occur
unpredictably at any time including without exertion
They often present with acute exacerbations

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NCM 118: EMERGENCY NURSING
MAJOR TRAUMA
st
ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

BURNS EXTENT OF THE BURN

Nsg. Diagnosis : Impaired Skin Integrity & primary defenses 2 ways to measure extent of the buRN
 Lund Browder Chart
A burn occurs when the tissues of the body are injured by the  Rule of Nines.
ff:

HEAT=Thermal burns are caused by Flame, flesh, scale or

direct contact with a hot object

Common types
1. Smoke Inhalation the inhalation of hot air and noxious
chemicals produced by fire can damage the tissues of
respiratory tract.
THREE PRIMARY TYPES
→ Carbon Monoxide Poisoning
→ Inhalation injury abore epiglottis
→ Inhalation injury below the glottis

2. Chemical Burns are caused by contact with either an

acid, alkali, or an organic compound. LOCATION OF THE BURN
3. Electrical Burns are caused by the intense heat  Burns affecting the face and neck, and circumferential
generated by an electrical curnent passing through burns to the chest and back, are considered the most
body's tissue. severe as they are likely to interfere with respiratory
function.
THE SEVERITY OF AN ELECTRICAL BURN DEPENDS ON:  Face and neck burns also indicate the possibility of
 Amount of voltage in which the tissues were exposed inhalational injuries, and circumferential burns often
 Resistance of these tissues to the voltage. interfere with circulatory function
 the pathway the current took through the body
 the size of the body surface area in contact with the
current
 The length of the time the current flow was sustained

Exposure to extreme cold results to COLD BURNS OR

FROSTBITE
 Frostbite occurs when the tissues, particularly in the
peripheries, freeze when in prolonged contact with
cold ambient temperatures and / or snow and ice.
 Deep Frostbite involves acute peripheral
vasoconstriction the formation of ice crystal in the
intracellular spaces of the deep tissues and the
destruction of cell membranes

SEVERITY OF A BURN DEPENDS ON

 the temperature of the burning agent
 the duration of its contact time with the body tissues.
 type of tissue that is injured

ASSESSMENT AND CLASSIFICATION OF BURN INJURY

• The depth of the burn
• The extent of the burn
• The location of the burn
Depth of the Burn

Immediate Complications associated with Burn Injuries

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ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

NEUROLOGIC EMERGENCIES MENINGITIS

The inflammation of the meninges caused often by bacteria,
Migraine Headaches virus, or fungal pathogen
Neisseria Meningitides causative agent
Classified as:
 Vascular (caused by acute cerebral vasodilation) Presentations
 Muscular (skeletal muscle contraction in neck or  Fever
head)  Headache
 Photophobia
Triggers  Lethargy
 Nausea and vomiting
 Physiological triggers (dehydration, uremia, hepatic  Seizures
disorders, hypoglycemia, and allergic reaction.)  Petechial rash
 Environmental conditions (Stress, physical exertion, Management : Aggressive antibiotic therapy and antipyretic &
heat, bright light, certain foods.) anticonvulsants meds are recommended.
 Also occur spontaneously
INTOXICATION EMERGENCIES
Management: analgesics NSAIDS or opioids it is considered intoxicated if a substance they have taken is
impairing their capacity to act or reason.
Seizures
Caused by abnormal excessive electrical activity in the brain Causative substances
 Narcotics
Other causes  Stimulants
 Physiological disorders Epilepsy, Hypoglycemia,  Depressants
Acute Alcohol withdrawal  Hallucinogen
 CNS conditions: Meningitis, Tumor, Stroke il  Club drugs
 Inhalants
Treatment includes: Airway Patency, Use of O2, administer  Medications (Salicylates, Acetaminophen, OPIATES,
anti- epileptic meds, & management of underlying cause. benzodiazepines. CNS Stimulants)
Diagnostics: People may become intoxicated by substances
EEG by Wake or Asleep ( by inducing Benadryl)  Intentionally (Attempt to get high, or self-harm &
suicide)
STATUS EPILEPTICUS - severe seizure  Accidentally (Medication errors & unexpected drug
interactions)
MANAGING SEIZURES
1. Don’t put anything in mouth Management
2. Don’t Restrain Them
 Support ABC (resuscitative interventions)
3. Cushion their head
 Limiting the absorption of substance
4. Make person safe
5. Give person time to recover  Enhancing the elimination of the substance
6. Time the seizure Treatment:
7. Roll the person into recovery position after seizure  Gastric Lavage
has stopped  Administration of Activated Charcoal
8. Protect their dignity  Whole bowel irrigation
9. If seizure lasts more than 5 call an ambulance  Emergency dialysis

STROKE
Loss of neurological functioning resulting from an acute
disruption of blood flow & hypoxia in a section of the brain

Classified as:
 ISCHEMIC when a vessel becomes occluded
 HEMORRHAGIC- when a vessel in the brain ruptures
& bleed

Treatment:
 ISCHEMIC STROKE - Tissue Plasminogen Activator
(TPA) to dissolve clot
 HEMORRHAGIC STROKE- Treated w/ an implant to
control the bleed.

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MAJOR TRAUMA
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ST. PAUL UNIVERSITY SURIGAO 1 SEMESTER A.Y. 2023 – 2024

Common Drugs & Their Antidotes

Local anesthetics and
Drug Antidote possibly other cardiac
toxins (e.g., bupropion,
Acetaminophen/Tylenol/P calcium channel blockers,
aracetamol acetylcysteine (Mucomyst) cocaine, beta blockers, Fat emulsion (Intralipid ,
tricyclic antidepressants) Liposyn II , Liposyn III )
Anticholinergics,
diphenhydramine, lovenox protamine sulfate
dimenhydrinate Physostigmine
magnesium sulfate calcium gluconate
atrophine sulfate or
Anticholinesterase pralidoxime magnesium sulfate calcium gluconate

Antifreeze Fomepizole, Ethanol Methanol Folic acid

Arsenic, Copper, Lead, D-Penicillamine (Cuprimine Methotrexate Leucovorin calcium

Mercury )
Narcotics, morphine
Benzodiazepines Flumazenil sulfate naloxone (Narcan)

Beta-Blocking agents, Neuromuscular blockade

Calcium channel blockers, (paralytics) anticholinesterase agents
Hypoglycemia,
Hypoglycemic agents Glucagon, Epinephrine Opioid analgesics nalmefene or naloxone

Calcium Channel Blockers Calcium Chloride, Glucagon albuterol inhaler, insulin &
glucose, NaHCO3,
Coumadin/Warfarin Phytonadione or Vitamin K Potassium kayexalate

Amyl nitrite, sodium nitrite, Sodium channel blockers

Cyanide sodium thiosulfate (e.g. cyclic
antidepressants),
Cyclophosphamide Mesna salicylates Sodium Bicarbonate

Digibind or Digoxin Immune Sulfonylureas Octreotide (Sandostatin )

Digoxin Fab
Tricyclic antidepressants phyostigmine or NaHCO3
Dopamine phentolamie (Regitine)
Valproic acid L-Carnitine
Ethylene glycol fomepizole

ethyllene poisoning antizol

Extrapyramidal symptoms diphenhydramine

(EPS) (Benadryl)

Fluorouracil leucoverin calcium

Heparin protamine sulfate

Naloxone (Narcan) or
Heroin Nalmefene

Insulin reaction glucose (Dextrose 50%)

Iron Deferoxamine

Isoniazid, ethylene glycol Pyridoxine HCl (Vitamin B6)

dimercapol, edetate
Lead calcium, disodium,

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