Exam (elaborations)
EMERGENCY AND DISASTER NURSING
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EMERGENCY AND DISASTER NURSING
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lOMoAR cPSD| 30878495l
EMERGENCY AND
DISASTER NURSING
*WE DONT DECLARE THE DEATH OF PX! TYPES OF EMERGENCY NURSING
ONLY DOCTOR! Internal – hospital, structured. (+)
*In the hospital the doctor perform the CPR, the resources, focus is definitive care
nurse should assist the doctor by giving them External – pre-hospital, unstructured, (-)
epinephrine (check the EXPIRATION FIRST!! resources, focus is first aid
before i transfer sa syringe (lumalabas sa Board
Exam yan!!) and THE NURSE SHOULD TIME THE
DOCTOR WHILE DOING CPR!! GOALS OF EMERGENCY CARE
Prevent injury
when the doctor declares the death of the Preserve life
px you will left with the patient family, what
Promote recovery
will you do?
>If there is cardiac monitor we will see flat line as a PRINCIPLES of EMERGENCY care
prof that the px is dead
Ask for help first (team approach); outside -
>If theres no cardiac monitor, get ECG of Px.
ACTIVATE EMS or ERS
Because ECG is a prof that the px is dead
Intervene
(if you see on the ECG that is not flat line and u
see little wave and the px family insist that the px is
Do no harm –non-maleficence
still alive, tell them that the little wave that we see
in the ECG in the effect of the Epinephrine that we
Types of survey and assessment
gave to the patient) Primary: Rapid, establish the priority
problem.
*HINDI NURSE ANG MAGSASABI SA PX Disadvantage – incomplete.
RELATIVES NA PATAY NA ANG PASYENTE, Initial assessment, unstable client
KUNDI ANG DOCTOR LANG!!!
Secondary – complete and thorough.
*After the doctor tell the family that the Px is dead,
Disadvantage: Takes time.
we let the family grieve over px body
Done after stabilization.
*In muslim tradition the px body should be buried
24 hours after death (BOARD EXAM QUESTION!!)
PRIMARY SURVEY
*In saudi Arabia after the px death, the nurse
should turn the head/or change the position of Airway, Breathing, Circulation, Disability
stretcher of the patient to the EAST before ipunta (neurologic).
sa morge- because that is the center of muslim Primary check is LOC and responses.
religion (BOARd EXAM Q.!) Alert, Voice Response, Pain
EMERGENCY – serious, unexpected, and often response, Unresponsive.
dangerous situation requiring immediate action GCS is secondary.
DISASTER – sudden event, such as accident or Pulse checking: Adult/Child – carotid.
natural catastrophe, that causes great damage or Infant – Brachial.
loss of life
NOTE! CAB PRIORITIZATION – for cardiac arrest.
POSING RISK TO: VS are every 5 to 6 minutes.
Health
Environment SECONDARY SURVEY
Life Assess Cephalocaudal.
Property Baseline VS.
History of complaint.
Diagnostics and laboratory.
, lOMoAR cPSD| 30878495
EMERGENCY AND DISASTER NURSING
ETHICAL BASIC LIFE SUPPORT
PRINCIPLES INDICATIONS:
Respiratory Arrest
Non-maleficence = with pulse
Cardiac Arrest
Beneficence = w/o pulse
Autonomy – waived for emergency.
Paternalism – authority to decide for
another in emergency situations.
Justice – most important in triage and
disaster. Used in prioritization of care.
Fairness in allocation of limited
resources.
Utilitarianism – greater good for The NEW Chain of Survival
greatest number.
• Early access: immediate recognition and
activation
GOOD SAMARITAN LAW • Early CPR
• Early defibrillation
Legal immunity • Early advanced care
Cannot be sued or nullified • Integrated post-cardiac arrest care
Should be established that there is The First Link- Early Access
emergency
A well-informed lay person - key in the early
Nobody can render care at that time access link.
Should activate EMS Recognition of signs of heart attack and
respiratory failure
Voluntary action: bystander rescue Call for help immediately if needed
Activate the Emergency Medical System
EMERGENCY MANAGEMENT:
EARLY WARNING SIGNS OF HEART
Airway management- basic/advanced
ATTACK
Basic – easy to perform, BLS, jaw
thrust, head thrust, chin lift - prolonged compressing pain or unusual
Tubes discomfort in the center of the chest
- Oropharyngeal – - may radiate to shoulder, arm, neck or jaw,
contraindication if with (+) usually on the left side
gag, vomiting, aspiration risk, - may be accompanied by sweating, nausea,
(+) facial trauma. vomiting and shortness of breath
- Nasopharyngeal – contra (+)
CSF leakage
Advanced – longer tubes, direct to
the lungs.
- Laryngeal tube.
- Endotracheal tube.
- Tracheostomy – last resort.
2
, lOMoAR cPSD| 30878495
EMERGENCY AND DISASTER NURSING
EARLY WARNING SIGNS OF
RESPIRATORY FAILURE ATTACK
IF YOU WITNESS A CARDIAC
- Unable to speak, breath ARREST
or cough
- Clutches neck
(universal distress
signal)
- Bluish color of skin
and lips
Second Link - Early CPR
Lifesaving technique for cardiac &
respiratory arrest
Chest compressions +/- Rescue breathing
Lay persons and medical personnel
Why is early CPR important? NON-RESPONSIVE,
- CPR is the best treatment for cardiac arrest NO NORMAL BREATHING
until the arrival of ACLS care.
- prevents VF from deteriorating to asystole
- may increase the chance of defibrillation
- It significantly improves survival.
When will you do CPR?
PULSE CHECK
AS SOON AS POSSIBLE! Palpate for Carotid
Pulse within 10
Brain cells begin to die after 4-6 minutes without seconds
oxygen. (at the same time
CHECK FOR
BREATHING)
For trained healthcare
providers only
If with definite pulse but
no breathing
Do Mouth to
Mouth Breathing
Give one breath
every 5-6 secs
(about 12
breaths/min)
Recheck pulse
every 2 minutes
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