EMERGENCY NURSING  Take the family members

Roberto M. Salvador Jr. RN MD to a private place

 Talk to the family
Is a specialized education, together
training and experience to  Reassure the family that
gain expertise in assessing everything possible was
and identifying patients health done
care problems in crisis  Encourage family
situations. members to support
each other
Emergency nurse establish  Encourage the family to
priorities, monitors and view the body if they
continuously assesses acutely wish
ill and injured patient’s,
 Spend time with the
supports and attends to
family members,
families, supervise allied
listening to them and
health personnel and teaches
identifying any needs
the patient and families within
a time limited, high pressured  Avoid unnecessary
care environment. information
 Care given to clients with
urgent and critical needs
Issues in Emergency Nursing  Care must be rendered
Care without delay
1. Documentation of consent.
2. Limiting exposure to health
risk. Diversified situations
 Consent (unless
Providing holistic care unconscious and without
a. Patient focused S.O.)
intervention  Common clients (elderly,
b. Family focused stomach pain, chest
intervention pain, fever, drug related,
1. Anxiety and denial wound)
2. Remorse and guilt
3. Anger Disaster Nursing (terrorism)
4. grief Principle: TRIAGE

Helping family members cope Triage

 - a process use in sorting b. Cardiac arrest
victims into categories of c. Shock
priority for care and transport d. Stroke
based on severity of injuries e. Major Burns
and medical emergencies.

TRIAGE
French word “trier” to sort TRIAGE
Sorting of clients based on the II Urgent
severity of health problems • Threatening conditions
Hierarchy based on the • Not immediate
potential for life loss • Must be seen within 1
Advanced skills hour
a. Fever
Principles of tactical triage b. Minor Burns
1. Accomplish the greatest c. Lacerations
good for the greatest
number of casualties TRIAGE
2. Employ the most III Non-urgent
efficient use of available • Can be addressed within
resources 24 hours
3. Return personnel to duty • Chronic conditions
as soon as possible a. Dental problems
b. Missed Menses
TRIAGE
3 categories of TRIAGE 4th category
(Berner’s) Fast track – simple first aid
1. Emergent
2. Urgent TRIAGE
3. Non-urgent Assess and Intervene (Primary
survey)
TRIAGE A airway
I Emergent B breathing
• Highest priority C circulation
• Life threatening D disability
conditions, limbs E expose
• Must be treated
immediately QUICK ASSESSMENT
a. Airway compromise HEAD
MOUTH , LIPS & TEETH Localized pain
EYES 5
NOSE & EARS Withdraw
FACE 4
SPINE & TRUNK Flexion
LIMBS 3
Extension
GLASCOW COMA SCALE 2
None
Eye opening response 1
spontaneous
4 Secondary Survey
To voice done after the priorities has
3 been addressed.
To pain
2 a. Complete History and PE
None b. Diagnostic and
1 laboratory testing
c. ECG, Arterial lines,
urinary catheters
d. Splinting of suspected
fractures
e. Cleaning and dressing
Verbal response of wounds
oriented f. other necessary
5 interventions
Confused
4 WOUNDS
Inappropriate words Laceration – skin tear with
3 irregular edges
Incomprehensible Avulsion – tearing away from
2 supporting structure
None Abrasion – denuded skin
1 Ecchymosis/contusion – blood
trapped
Motor response Hematoma – tumorlike under
Obeys commands the skin mass of blood
6 trapped under the skin
Stab – incision with well  Fluid replacement &
defined edges Blood replacement
Stab wound with evisceration  Control of external
Gun shot wound hemorrhage:
Entry  Direct pressure
Exit a. Temporal
b. Facial
Management: c. Carotid
 wound cleansing d. Subclavian
 wound closure e. Brachial
 primary closure f. Radial & Ulnar
 delayed primary closure g. Femoral
 Tetanus prophylaxis h. Pressure dressing
 antibiotics i. Tourniquets (last resort)
 Wound closure
 Primary closure Control of Internal Bleeding
Delayed primary closure
Signs & Symptoms:
Hemorrhage  tachycardia
 Stopping bleeding is  Falling blood pressure
essential to the care and  Thirst
survival  Apprehension
 Primary cause of shock  Cool & moist skin
 Delayed capillary refill
Signs & Symptoms of Shock:
 Cool moist skin Management
 Falling blood pressure  Packed Red Blood Cell
 Increasing heart rate transfusion
 Delayed capillary refill  Surgery
 Decreasing urine volume  Pharmacologic therapy

Management:
fluid replacement
 control of external SHOCK
bleeding
 control of internal Signs and Symptoms
bleeding Early stage
 Restless, confusion
  increase pulse rate, RR  whole blood and blood
 cold, moist skin products
 decreased pulse  colloid solutions
pressure (albumin, plasma)
 pallor  plasma expanders
 thirst, dry mucous  crystalloids solution
membrane  Isotonic solutions plain
 diaphoresis LR
 oliguria 2. Assisting cardiac support
 modified trendelenburg
Late stage position
 shallow respiration  assisting with respiratory
 Dec. BP supports
 Oliguria, anuria  oxygen therapy
 Cool, clammy skin  mechanical ventilation
( hypovolemic,  suctioning
cardiogenic, septic)  deep breathing,coughing
 Cool, mottled skin exercise
( neurogenic, vasogenic)
 Lethargy 3. Assisting with renal support
 Cyanosis  monitor urine output
 Dilated pupils  bun, crea
4. assisting GI support
Nursing problems:  histamine blockers,
a. altered tissue perfusion antacids
related to failing  NGT
circulation 5. promoting safety
b. impaired gas exchange  restraints
related to ventilation-  strict asepsis technique
perfusion imbalance
c. decreased cardiac output Trauma
related to decreased  Unintentional or
circulating blood volume intentional wound or
injury
Management:  4th leading cause of
1. Promoting fluid balance and death in the US
cardiac output
  Leading cause of death
in children & young
adults < 44 years of age
 Injury prevention ( only
way to reduce incidence Assessment & Diagnostic
of trauma) Findings
a. Education  History & PE
b. Legislation  Lab studies:
c. Automatic protection  Urinalysis
 serial Hct. level
TRAUMA  WBC count
Stab Wound  Serum amylase analysis
1. Intra-abdominal injuries:
Internal Bleeding
Penetrating abdominal injuries  Inspection ( front of the
 Gunshot wound, Stab body, flanks & back)
wounds  Bluish discoloration,
 Serious & requires asymmetry, abrasion,
surgery contusion
 Liver ( most frequently  Abdominal CT Scan
injured solid organ)  Abdominal Ultrasound
 All abdominal gunshot  Left shoulder pain
wounds require surgical ( ruptured spleen)
exploration
 Right shoulder pain (liver
 Stab wounds may be laceration)
managed non-
operatively Intraperitoneal Injury
 Assess for tenderness,
Blunt Trauma
rebound tenderness,
Blunt Abdominal Injury
guarding, rigidity,
 Result from motor
 spasm, increasing
vehicle crashes, falls,
distention & pain
blows or explosions
 Referred pain
 Injuries may be hidden or
( intraperitoneal injury)
difficult to detect
 Involves the liver, Diagnosis:
kidneys, spleen, blood 1. abdominal ultrasound
vessel 2. abdominal CT scan
 3. Diagnostic peritoneal
lavage MINIMAL (GREEN TAG)
• 1 L LRS/ NSS  Also known as the
• 400 ml return “walking wounded”
• RBC > 100,000/mm3  Examples include but are
• WBC ct > 500/mm3 not limited to – small
• Bile, feces, food burns, lacerations,
abrasions, and small
Sinography ( detection of fractures.
peritoneal penetration)  These casualties have
• Purse string minor injuries and can
• Small catheter usually care for
themselves with self-aid
• Contrast agent
or “buddy aid”. These
X-ray
casualties should still be
employed for mission
Intraabdominal Injury
requirements (e.g.,
Management:
scene security).
 Resuscitation procedure
 Occlusion of chest wound DELAYED (YELLOW TAG)
 Direct pressure  The delayed category
 Intravenous fluid includes wounded
replacement casualties who may need
 Immobilization of the surgery, but whose
spine general condition
 Cervical spine permits a delay in
immobilization surgical treatment
 Tetanus prophylaxis without unduly
 Broad spectrum endangering life or limb.
antibiotics Medical treatment
(splinting, pain control,
Multiple Casualty Incident etc.) will be required but
it can wait.
MCI is defined as an event  Examples include but are
involving a number and/or not limited to –
severity of casualties,which is casualties with no
beyond the capabilities of evidence of shock who
available care teams and have large soft tissue
facilities. wounds, fractures of
 major bones, intra- neglected. They should
abdominal or thoracic receive comfort
wounds, or burns to less measures, pain
than 20% of total body medications, if possible,
surface area. and they deserve re-
triage as appropriate.
IMMEDIATE (RED TAG)  Examples include but are
 The immediate category not limited to –
includes casualties who casualties with
require immediate LSI penetrating or blunt
and/or surgery. Put head wounds and those
simply, if medical with absent radial pulses.
attention is not provided,
the patient will die. The TRIAGE TAGS
key to successful triage  Triage tags are designed
is to locate these to communicate the
individuals as quickly as triage category,
possible. treatment rendered, and
 Examples include but are other medical
not limited to – information. By
hemodynamically necessity, the
unstable casualties with information on the tag is
airway obstruction, chest brief. Triage tags are
or abdominal injuries, usually placed on the
massive external casualty by the triage
bleeding, or shock. officer although other
members of the team
EXPECTANT (BLACK TAG) may place or add
 Casualties in this information to the tags.
category have wounds
that are so extensive PURPOSE
that even if they were  To furnish the attending
the sole casualty and care provider during the
had the benefit of evacuation of a casualty
optimal medical with essential
resources, their survival information about the
would be highly unlikely. injury or disease and the
Even so, expectant treatment provided.
casualties should not be
  The sole or initial CLASSIFICATION OF
medical record for the FRACTURES
troops injured in BROAD CLASSIFICATION
combat. 1. Complete fracture
 Each triage tag is coded Involves a break across the
with a unique sequential entire cross-section of the
seven-character serial bone & is frequently displaced
number used for
identification and 2. Incomplete fracture (usually
tracking of the casualty. in adults)
The serial number is The break occurs through only
located on the top right a part of the cross-section of
and left diagonal tear- the bone
offs.
Break in the continuity of the
Management: bone cause:
Determine the extent of injury DISPLACEMENT OF
Establish priority of treatment FRAGMENT CAUSES:
Nursing management in DAMAGE TO THE SOFT PART
Sprain, Strain: CAUSES:
1. Immobilize extremity and
advise rest Clinical Features of Fractures:
2. Apply cold packs initially 1) pain and tenderness over
then heat packs the involved area
3. Compression bandage may 2) loss of function
be applied to relieve edema 3) deformity
4. Assist in cast application 4) attitude ( shortening)
5. Administer NSAIDS 5) abnormal mobility and
crepitus (a grating sensation
FRACTURE produced when bones rub
A fracture is a complete or each other)
incomplete break in the 6) neurovascular injury
continuity of bone. This will be ( localized swelling &
accompanied by varying discoloration of the skin)
degrees of injury to 7) radiographic findings
surrounding soft tissues.
 EMERGENCY “always IMMOBILIZE the
MANAGEMENT OF affected bone”
FRACTURE Principles of Fracture
1. Immobilize any suspected Treatment
fracture by splinting 1. Reduction of fracture
2. Support the extremity 2. Maintenance of
above and below when alignment
moving the affected part from 3. Promote callus formation
a vehicle 4. Restoration of function
3. Suggested temporary 5. Prevent complications
splints- hard board, stick,
rolled sheets ER Management
4. Apply sling if forearm 1. Assess
fracture is suspected or the 2. Immobilization
suspected fractured arm 3. A, B, C, D, E
maybe bandaged to the chest 4. Control bleeding
5. Open fracture is managed 5. TT, TIG and TAT
by covering a clean/sterile immunization
gauze to prevent 6. Wound care
contamination 7. Diagnostic and Lab
6. DO NOT attempt to reduce Procedures
( re-align) the fracture 8. Fracture Reduction
Compartment Syndrome
5 P’s in Fracture: - a condition in which the
P – pain circulation and function of
P – pallor tissues within a closed space
P - paresthesia are compromised by an
P - pulselessness increased pressure within that
P - Paralysis space
S/Sx: 4 Ps - Pain / Pallor /
Nursing Considerations Paralysis / Pulselessness
Assess * although none is
A airway pathognomonic, pain is the
B breathing most important
C circulation neurogenic * best indicator:
D disability tissue pressure measurement
E expose - a surgical emergency
(fasciotomy)
Whitesides Technique 5. Pulselessness, impaired
* for measuring capillary refill time and
intracompartmental pressure cyanotic skin
* results in permanent 6. Edema unrelieved by
neurovascular damage if not elevation
relieved in 4 to 6 hrs.
* the normal tissue
pressure within closed
compartments is
approximately 0 mmHg
> pressures of within Compartment syndrome
10 to 30mmHg of a patient’s Medical and Nursing
diastolic blood pressure - management
there will be inadequate 1. Assess frequently the
tissue perfusion and relative neurovascular status of the
ischemia casted extremity
> if the pressure within 2. Elevate the extremity
a compartment equals or above the level of the heart
exceeds the patient’s diastolic 3. Assist in cast removal and
blood pressure - there will be FASCIOTOMY
no effective tissue perfusion
Fat Embolism
Compartment Occurs usually in fractures of
syndrome the long bones
ASSESSMENT FINDINGS Fat globules may move into
1. Pain- Deep, throbbing the blood stream because the
and UNRELIEVED by opioids marrow pressure is greater
Pain is due to reduction in the than capillary pressure
size of the muscle Fat globules occlude the small
compartment by tight cast blood vessels of the lungs,
Pain is due to increased mass brain kidneys and other
in the compartment by organs
edema, swelling or
hemorrhage Onset of s/sx of fat embolism
2. Paresthesia- burning or is rapid, (within 24-72 hours)
tingling sensation
3. Numbness ASSESSMENT FINDINGS
4. Motor weakness 1. Sudden dyspnea and
respiratory distress
2. tachycardia Iced Saline Lavage
3. Chest pain Immersion in cold water bath
4. Crackles, wheezes and Massage ( promote
cough circulation)
5. Petechial rashes over the Pt monitoring ( VS, ECG, CVP)
chest, axilla and hard palate Oxygenation (100%)
IV infusion therapy
Nursing Management Monitor urine output
Support the respiratory Patient education
function
Respiratory failure is the most Frostbite
common cause of death Trauma from exposure to
Administer O2 in high freezing temperature
concentration Actual freezing of tissue fluids
Prepare for possible Results in cellular & vascular
intubation and ventilator damage
support Feet, hand, nose, ears

Environmental Emergencies Assessment:

History of exposure to cold
HEAT CRAMPS Frozen extremity, hard, cold ,
People at risk: insensitive to touch
Not acclimatized to heat
Elderly & very young Management:
Unable to care for themselves Restore normal body
With chronic & debilitating temperature
diseases Circulating back of 37 – 40 º C
Taking certain medications Sterile gauze or cotton in
Causes thermal injury at the between fingers & toes
cellular level ( heart, liver, Massage is contraindicated
kidney, blood coagulation) Whirlpool bath
Escharotomy
Fasciotomy
Management:
To reduce high temperature Hypothermia
ASAP The core (internal)
cool sheets & towels, TSB temperature is 35 º C or less
Ice pack
Cooling blankets Assessment and Findings:
Progressive deterioration Fresh water aspiration (loss of
Apathy surfactant)
Poor judgement Salt water aspiration
Ataxia (pulmonary edema)
Dysarthria
Drowsiness Management:
Pulmonary edema Maintain cerebral perfusion
Coagulopathy Adequate oxygenation
Immediate CPR
Management: Monitor temperature by rectal
Monitoring VS, CVP, UO, ABG, probe
Blood chem., ECG, Chest X- Rewarming procedures
ray ECG monitoring
Rewarming Indwelling urinary catheter
a. core rewarming method, CP NGT
bypass, warm fluid, warm .
humidified oxygen, warm Decompression Sickness
peritoneal lavage (DCS)
b. Passive external Also called “The Bends”
rewarming, warm blankets Diving, high altitude flying or
over the bed heaters flying in commercial aircraft
Supportive Care within 24 hours after diving
Results from nitrogen bubbles
Near – Drowning trapped in the body
Survival for at least 24 hours Musculoskeletal pain,
after submersion numbness/hypesthesia
Hypoxemia ( most common Nitrogen bubbles become air
consequence) emboli, stroke, paralysis,
Leading cause of death
unintentional death in children
younger than 14 years old

Factors: Assessment & Diagnosis:

Alcohol ingestion Detailed history
Inability to swim Rapid ascent, loss of air in the
Diving injuries tank, buddy breathing, recent
Hypothermia alcohol intake, lack of sleep or
Exhaustion flight within 24 hours
Management: Affects healthcare providers
Patent airway who uses this product
Adequate ventilation Management: Latex free
Oxygenation (100%) products
Hyperbaric chamber
. Injected Poisons: Stinging
Anaphylactic Reaction Insects
Acute systemic Venoms of the hymenoptera
hypersensitivity reaction (bees, hornets, yellow jackets,
Occurs within seconds or fire ants, wasps)
minutes after exposure to Venom allergy ( IgE mediated
certain foreign substances reaction)
Medications Stinging
Insect stings Clinical Manifestations:
Foods Generalized urticaria
Immunoglobulin E (IgE) Itching
Malaise
Diagnosis: Anxiety
Respiratory symptoms Bronchospasm
DOB Shock
Stridor secondary to laryngeal Death
edema
Fainting, itching, swelling of Management:
mucus membrane Stinger removal
Sudden drop in BP Wound care with soap & water
Ice application
Management: Oral Antihistamines &
Patent airway & ventilation analgesic
ET intubation Aqueous epinephrine SQ
Aqueous epinephrine Desensitization therapy
Crichothyroidotomy
Antihistamines Snake Bites
Aminophylines Affects ages 1- 9 years
Albuterol inhalers Pit vipers (most frequent
Isoproterenol or Dopamine poisonous snake in the US)
IV Benzodiazepines Cobra ( Philippines)
Upper extremity (most
Latex Allergy common site)
Envenomation (injection of a Too rapid infusion ( most
poisonous material by sting, common caused of allergic
spine, bite) reaction)

Medical emergency Common Household Poisons:

Management: First Aid Management
Have victim lie down
Remove constrictive items Absorbed Poisons - a poison
Provide warmth that enters the body through
Cleanse & cover the wound the skin.
Immobilize the injured part
below the level of the heart Injected Poisons - a poison
Ice & tourniquet is that enters the body through
contraindicated a bite, stings, or syringe
Corticosteroids are
contraindicated in the first 6-8 Ingested or Swallowed Poisons
hours after bite (Corrosive)
Observe for at least 6 hours Alkaline or acid agents caused
Administration of antivenin tissue destruction after in
within 12 hours after the bite contact with mucus
Children requires more membrane
antivenin than adults
Skin or eye test to detect Management:
allergy to antivenin Airway, ventilation,
Measurement of oxygenation
circumference of the affected Water or milk to drink for
part dilution
before administration of Syrup of Ipecac, Gastric
antivenin and every 15 lavage, Activated charcoal
minutes thereafter and Catharsis are all
After symptoms decrease, Contraindicated.
every 30-60 minutes for the Antidote as early as possible
next 48 hours Monitor VS, CVP, Fluid &
Done to detect compartment Electrolytes
syndrome (swelling, loss of Psychiatric consultation
pulse, increase pain,
paresthesia) Inhaled Poisons : Carbon
Diphenhydramine & Monoxide Poisoning
Cemetidine
Result of industrial or Botulism ( serious form of
household incidence or food poisoning)
attempted suicide Management:
Carbon monoxide exerts its Determine the source & type
toxic effect by binding to of food poisoning
circulating hemoglobin Food, gastric contents,
thereby reducing O2 carrying vomitus, serum, feces are
capacity of the blood examined
Fluid & electrolyte correction
Carboxyhemoglobin does not Antiemetic medication
transport oxygen Elicit information
Hgb has 200x more affinity How soon after eating did the
than oxygen symptom occurs
What was eaten and did the
Signs & Symptoms : food have an unusual smell
Headache Did anyone else become ill
Muscle weakness eating the same food
Palpitation Did vomiting or diarrhea
Dizziness occurs
Confusion Neurologic symptoms
Cyanosis What is the patient
Coma appearance

Management Substance Abuse

Reverse cerebral and Misused of specific substances
myocardial hypoxia and to to alter mood or behavior
hasten elimination of carbon Drug & alcohol
monoxide
Carry the patient to fresh air Acute Alcohol Intoxication
immediately and open all Affects young adults or people
windows and doors older than 60 years of age
Loosen all tight clothing It is a psychotropic drugs
Initiate CPR, 100% O2 Alcohol or ethanol is a direct
multisystem toxin & CNS
Food Poisoning depressant:
After ingestion of Drowsiness
contaminated food or drinks Incoordination
Slurring of speech
Sudden mood changes, 2.0.20% brain is
Aggression, belligerence, depressed, ataxia
grandiosity 3.May experience
Uninhibited behavior withdrawal symptoms if BAL is
high
Management: 2. Length of time drugs can
Detoxification of the acute be found in urine and blood
poisoning, recovery, varies with dosage and
rehabilitation metabolic properties of drug
Denial & defensiveness
Approach patient in a calm or Management:
non-judgemental manner Adequate sedation & support
Allow pt to rest and recover
Alcohol Withdrawal Place pt in a calm,
Syndrome/Delirium Tremens nonstressful environment
Acute toxic state that occurs Alcohol free environment
as a result as a cessation of Refer pt to self help groups
alcohol intake such as AA
Negative conditioning with
Signs & symptoms: Disulfiram(Antabuse)
Anxiety Naltrexone HCL (antidote)
Uncontrollable fear Drug Overdose
Tremor Nursing Diagnosis
Irritability Risk for Injury
Agitation 1. Determine disorientation,
Insomnia level of agitation, risk for
Incontinence suicide or harm to self or
Visual, tactile, auditory, others
olfactory hallucination 2. Protective environment,
frequent observation
Diagnostic Testing 3. Vital signs q 15 minutes:
1. Most commonly used feedback for symptoms of
tests include withdrawal
a. Urine Drug Screen (UDS) Ineffective Individual Coping
b. Blood Alcohol Level (BAL) 1. Limit setting; encourage
1.Legal intoxication is expression of feelings, fears
0.10% 2. Teach alternative ways
a. Clumsiness of dealing with stress
b. Impaired reaction time
Altered Nutrition: Less than
Body Requirements
1. Referral to dietician;
nutritional assessment ASSESSMENT
including blood work AIRWAY
2. Client modification of BREATHING
diet, goal setting for weight CIRCULATION
according to need DISABILITIES
Self-Esteem Disturbance EXPOSE
1. Acceptance of person
2. Focus on strength and Expose con’t
accomplishments A airway - check nose, face
and neck (priority) singed and
BURNS sooty hair of the nose
B breathing – rise and fall of
MAJORITY OF BURN CASES chest
ARE DUE TO NEGLIGENCE C circulation - if there is no
SO HAZARD PRECAUTIONS breathing and circulation start
MUST BE OBSERVED. CPR
“pinabayaan ng NANAY” D check for disability and
Carelessness with match manage accordingly
Scald from hot liquid E expose to determine extent
Defective electrical equipment of injury
Immersion in overheating
bath water Types of Burns
Use of chemicals Thermal – dry flames, moist
and heat
Safety Mechanical – friction or
Don’t panic abrasion
Drop to the floor Chemical – acid or alkali
Look for the exit Electrical – most fatal
Cover face with wet cloth Radiation – sunlight
Immerse into cool water or Classification of Burns
running water immediately if Burn classification as to depth
you get burned to prevent
further injury. Superficial Partial thickness
Extinguish any remaining fire (1st degree)
by dropping and rolling onto Outer layer of dermis
the floor. Erythema, pain up to 48 hrs
Healing 1-2 wks [sunburn] - cover with dry non-sticking
Burn classification as to depth sterile dressing
- treat victim for shock and
Deep Partial thickness keep warm
(2nd degree)
Epidermis & dermis involved Chemical Burns
Blisters & edema, frequently - remove the chemical by
quite painful flushing with water
Healing 14-21 days - flush for 20 min or longer
Burn classification as to depth - cover with dry dressing

Full thickness (3rd degree) Electrical Burns

Epidermis, dermis, - unplug or turn off power
subcutaneous fat are involved - check ABC
Dry, pearly white or charred in - treat for shock
appearance
Not painful INHALATION INJURIES
Eschar must be removed; may Heat Inhalation-
need grafting HOT AIR OR FLAMES
Systemic Toxins-
ENCLOSED FIRE-CO IS
INHALED
ABCDE assessment Smoke Inhalations-
Airway and fluid resuscitation FREQUENTLY HIDDEN BY
(priority) MORE VISIBLE INJURIES (60-
Give TIG or TAT and TT 80% FATALITIES)
Prophylactic antibiotic
Sterile dressing for wound Indications of inhalation injury
usually appears within 2-48
Thermal Burns hours after the burn occurred.
Management: Indications may include:
1st and 2nd degree The patient faints
- relieve pain by immersing in Fire or smoke present in a
cold water or applying cold closed area
cloth Evidence of respiratory
- Cover the burn with dry, distress or upper airway
non-sticking sterile dressing obstruction
Soot around the mouth or
3rd degree nose
Nasal hairs (SCORCHED HAIR), Posterior trunk- 18%
eyebrows, eyelashes have Upper arms- 18% ( 9%
been singed each x 2)
Burns around the face or neck Lower ext- 36%
Criteria for classification of ( 18% EACH X 2)
extent of burns Perineum- 1%

Minor Burn Fluid replacement

- 2nd degree burn <15% TBSA Consensus formula
in adults or <10% TBSA in LRS 2-4ml x BW (kg) x %TBSA
children Half given in 1st 8 hrs, then
- 3rd degree burns <2%TBSA half for 16 hrs
(not involving eyes, ears, face,
hands, feet, perineum, joints) Evan’s formula
Moderate uncomplicated Burn - colloid: 1ml x BW x TBSA
- 2nd degree 15-25% TBSA in - electrolytes 1ml x BW x
adults or 10-20% in childreb TBSA
- 3rd degree <10% - Glucose (D5W5%) 200ml for
IWL
Major Burn
- 2nd degree >25% TBSA in
adults or 20% in children
- all burns involving the Parkland Formula
critical areas (4ml x TBSA x BWkg)
1st 8H give ½,
Critical areas 2nd 8H give ¼
Face and for the
Hands 3rd 8H give the
Feet last part
Perineum
Chest Burn Management

ESTIMATION of BURNS 1.EMERGENT PHASE

Various methods are utilized Begins at the time of injury
for estimating the extent of and ends with the restoration
burn injury of the capillary permeability
1. The Rule of Nines in adults ( with 48-72 hours)
Head and Neck- 9% The GOAL is to PREVENT
Anterior trunk- 18% hypovolemic shock and
preserve the vital body organ near-normal and large fluid
function shifts have decreased
Emergency and pre-hospital The GOAL is to prevent shock
care by maintaining adequate
1st Phase circulating blood volume to
Fluid Accumulation maintain vital organ perfusion
IV to IT and IC
2nd Phase
most critical period Fluid Remobilization
36-48H post burn, FVD or IT and IC to IV
hypovolemia May last 48-60H
3rd fluid shift FVE (CHF)
edema on the injured area (IV Hypokalemia
to IT) Diuresis phase (oliguria may
fatal form is circumferential signifies RF)
edema from chest injury ISC – IVC
1st Phase Con’t Hemodilution
c. edema and p. edema (IV to 2nd Phase Con’t
IC) Hyponatremia due to fluid loss
hyponatremia (IV to outside from diuresis phase
from it) Infection may set in (isolation)
hyperkalemia (cell injury) Anemia may linger up to
1st Phase Con’t recovery period
↓BV – curling’s ulcer or Complications from immobility
paralytic ileus (dec. BV), NPO, may set in (Circulo-O-electric
NGT lavage, TPN bed)
Infection may set in (isolation) Anemia may linger
Fluid Resuscitation Burn Management
Blood Monitoring
ETT Insertiom 3.ACUTE PHASE
Pulse Carbon Monoxide Begins when the client is
Oximetry HEMODYNAMICALLY stable,
Arrhythmias Monitoring capillary permeability is
Burn Management restored and DIURESIS has
begun
2.RESUSCITATIVE PHASE Emphasis is placed on
Begins with the initiation of restorative therapy and the
fluids and ENDS when phase continues until wound
capillary integrity returns to closure is achieved
The FOCUS is on infection - minimal penetration to
control, wound care, wound eschar
closure, nutritional support, Silver Nitrate
pain management and - bacteriostatic and fungicidal
physical therapy - does not penetrate eschar
Mafenide acetate
3rd Phase to Recovery Period - Gram (-) and (+)
Infection may set in (isolation, -diffuses rapidly to eschar
Sulfadiazine application)
Healing process to scar Nursing Management
formation and contractures 1. Emergent phase (time of
Surgery (Reconstructive or injury)
Plastic) STSG auto-graft Remove person from source
3rd Phase Con’t of burn.
Debridement and 1) Thermal: smother burn
Escharotomy beginning with the head.
Diet: high caloric high CHON 2) Smoke inhalation: ensure
Psychological Aspect: dec. self patent airway.
esteem, stigma, perceived 3) Chemical: remove clothing
body changes, isolation, that contains chemical; lavage
depression, loss of identity area with copious amounts of
these are all related to water.
physical disfigurement. 4) Electrical: note victim
position, identify entry/exit
routes, maintain airway.

Burn Management Nursing Management

1. Emergent phase (time of
4.REHABILITATIVE PHASE injury)
The final phase of Burn care, Cool the burn for several
restoration of functions, minutes. DON’T USE ICE!!
cosmetic surgery Wrap in dry, clean sheet or
Goals of this phase – patient blanket to prevent further
independence and restoration contamination of wound and
of maximal function provide warmth and conserve
body heat.
Infection Prevention Assess how and when burn
Silver sulfadiazine occurred.
- bactericidal
Nursing Management a. Administer morphine
1. Emergent phase (time of sulfate IV and monitor vital
injury) signs closely.
Remove constricting clothes b. Administer
and jewelry analgesics/narcotics 30
Cover the wound with a sterile minutes before wound care.
dressing or clean, dry cloth c. Position burned areas in
Provide IV route only if proper alignment
possible
Transport immediately to a GENERAL NURSING
hospital or burn facility INTERVENTIONS IN THE
Nursing Management HOSPITAL
2. Resuscitative and Shock 2. Monitor alterations in fluid
phase (first 24—48 hours) and electrolyte balance.
Provide appropriate fluid a. Assess for fluid shifts and
resuscitation based on the electrolyte alterations
Parkland formula b. Monitor Foley catheter
4 mL Plain LR x %TBSA of output hourly (30 cc per hour
burns x kg body weight desired).
Nursing Management c. Weigh daily.
3. Fluid remobilization or d. Monitor circulation status
diuretic phase (2—5 days post regularly.
burn) e. Administer/monitor
Monitor and treat potential crystálloids/colloids
complications like acute renal
failure, paralytic ileus, GENERAL NURSING
Curling’s ulcer and INTERVENTIONS IN THE
hypokalemia HOSPITAL
Nursing Management 3. Promote maximal
4. Convalescent phase nutritional status.
a. Starts when diuresis is a. Monitor tube feedings if
completed and wound healing Peripheral Nutrition is
and coverage begin. ordered.
NPO immediately after
GENERAL NURSING injury!!! ONLY when oral
INTERVENTIONS IN THE intake permitted, provide
HOSPITAL high-calorie, high-protein,
1. Provide relief/control of high- carbohydrate diet with
pain.
vitamin and mineral
supplements. Rehabilitation
c. Serve small portions. Methods of coping and re-
d. Schedule wound care and socialization
other treatments at least 1 Ensure optimum nutrition
hour before meals. Initiate physical therapy to
GENERAL NURSING regain and maintain optimal
INTERVENTIONS IN THE range of motion and achieve
HOSPITAL wound coverage
4. Prevent wound infection. Provide psychosocial support
a. Place client in controlled to promote mental health
sterile environment.
b. Use hydrotherapy for no Rehabilitation
more than 30 minutes to Provide family-centered care
prevent electrolyte loss. to promote integrity of the
Observe wound for separation family as a unit
of eschar and cellulitis. Encourage post-discharge
GENERAL NURSING follow-up for several years
INTERVENTIONS IN THE Ensure appropriate referral to
HOSPITAL cosmetic surgeon,
5. Prevent GI complications. psychiatrist, occupational
a. Assess for signs and therapist, nutritionist and
symptoms of paralytic ileus. physical therapist
b. Assist with insertion of NG
tube to prevent/control Drugs for Burns
Curling’s/stress ulcer; monitor Mafenide (Sulfamylon)
patency/drainage. 1) Administer analgesics 30
GENERAL NURSING minutes before application.
INTERVENTIONS IN THE 2) Monitor acid-base status
HOSPITAL and renal function studies.
5. Prevent GI complications. SIDE EFFECT: LACTIC
c. Administer prophylactic ACIDOSIS
antacids through NG tube 3) Provide daily BATH for
and/or IV cimetidine removal of previously applied
(Tagamet) or ranitidine cream.
(Zantac) (to prevent stress
ulcer). Drugs for Burns
d. Monitor bowel sounds. Silver sulfadiazine (Silvadene)
e. Test stools for occult blood.
1) Administer analgesics 30
minutes before application. Skin grafting
2) Observe for and report Autograft
hypersensitivity reactions Homograft
(rash, itching) - from living or recently
3) Store drug away from heat deceased
4) Disadvantage: poor eschar Heterografts – from animals
penetration Biosynthetic – biobrane
Dermal substitute – integra,
Drugs for Burns alloderm
Silver nitrate Skin Grafting
1) Handle carefully; solution
leaves a gray or black stain on Don’ts in burns
skin, clothing, and utensils. DO NOT apply ointment,
2) Administer analgesic before butter, ice, medications, fluffy
application. cotton dressing, adhesive
3) Keep dressings wet with bandages, cream, oil spray, or
solution; dryness increases any household remedy to a
the concentration and causes burn. This can interfere with
precipitation of silver salts in proper healing.
the wound. DO NOT allow the burn to
become contaminated. Avoid
Drugs for Burns breathing or coughing on the
Povidone-iodine (Betadine) burned area.
Administer analgesics before DO NOT disturb blisters or
application. dead skin.
Assess for metabolic DO NOT apply cold
acidosis/renal function compresses and DO NOT
immerse a severe burn in cold
Gentamicin water. This can cause shock.
Assess vestibular/auditory and DO NOT place a pillow under
renal functions at regular the victim's head if there is an
intervals. airway burn and they are lying
down. This can close the
Cimetidine airway.
Given to prevent Curling’s
ulcer Violence, Abuse, Neglect
Wound debridement Family Violence, Abuse &
(ESCHAROTOMY) Neglect
Domestic violence is the phases of psychological
leading cause of death for reaction
young African American acute disorganization phase
Women ( shock, disbelief, fear, guilt,
Men & persons with humiliation, anger)
disabilities are also victims of Denial Phase: (anxiety, fear,
domestic violence flash backs, sleep
Elder abuse results physical, disturbances, hyperalertness
psychological abuse, neglect, & psychosomatic reactions)
vilations of personal rights & Phase of Reorganization:
financial abuse (Recovery)
Physical examination
Clinical Manifestation: Informed and written consent
Unexplained bruises, Focus on
laceration, abrasion, head External evidence of trauma
injuries & fractures Dried semen stains
Malnutrition & Dehydration Treat potential STD
(most common in neglect) Postcoital contraceptive
medication
Assessment: Ovral _ 12-24hrs not later
Early detection & Intervention than 72 hrs
Careful history
Management:
Management: Give sympathetic support
Primary concern safety & Reduce emotional trauma
welfare of the pt. Gather available evidence
Separation of the pt with the Respect patient privacy and
abuser sensitivity
Mandatory reporting laws Goal: have pt. regain control
over her/his life
Sexual Assault
Rape is force sexual act . Violence in the Emergency
Victims may either be male or Department
female Pts & families waiting for
assistance at the ED are
Crisis Intervention: sometimes dissatisfied
Assessment & diagnostic resulting in violence
findings Management:
rape trauma syndrome Safety is the first priority
 Use calm & noncritical
Psychiatric Emergencies approach
Is an urgent, serious Crisis intervention
disturbance of behavior, Sedative
affect, or thought that makes Restraint
the pt. unable to cope with life
situations & interpersonal Post Traumatic Stress
relationships Disorder (PTSD)
Concern: Determining . Development of
whether pt is at risk for characteristic symptoms after
injuring self or others a psychologically stressful
Aim: Maintain pt self esteem event
while providing care Symptoms include intrusive
. thoughts & dreams, phobic
Overactive Patients avoidance reaction,
Display disturbed, heightened vigilance,
uncooperative & paranoid exaggerated startle reaction,
behavior generalized anxiety, societal
Management: withdrawal
Reliable history about mental Assessment:
illness, hospitalization, Evaluation of the pts
injuries, illnesses, use of pretrauma history, the trauma
alcohol or drugs itself & post –trauma
Immediate goal: Gain control functioning
of the situation Management:
Restraint is used as the last Crisis intervention
resort Establish a trusting & sharing
Psychotropic agent : relationship
Chlorpromazine, (Thorazine), Education of the pt and family
Haloperidol (Haldol)
Underactive or Depressed
Violent Behavior Patient
Usually episodic Depression may be masked
Means of expressing feelings by anxiety & somatic
of anger, fear, or complaints
hopelessness Clinical manifestations:
Management: Sadness
Goal : bring the violence Apathy
under control Feeling of worthlessness
Self-blame systems and increasing
Suicidal thoughts thyroid hormone levels
Anorexia, Weight loss
Decrease interest in sex Diagnostic Tests
Sleeplessness a. Serum thyroid antibodies
Management: (TA): antibodies in
Ventilating personal feelings Hashimoto’s Thyroiditis
Suicidal precaution b. TSH test: (from pituitary)
Antidepressant & antianxiety elevated with primary
agents hypothyroidism
Psychiatric consultation c. T3 and T4: decreased for
diagnosis of hypothyroidism
Suicidal Patients d. T3 uptake test;
. Attempted suicide is an act decreased with
that stems from depression hypothyroidism
Viewed as a cry for help or RAI uptake test
intervention 1. Oral or intravenous dose
Weight loss of radioactive iodine (131I or
Sleep disturbances 123I) given to client
Somatic complaints 2. Thyroid scanned after 24
Suicidal preoccupation hours
Management: 3. Uptake decreased with
Treat the consequences of hypothyroidism
suicidal attempt & prevent 4. Size and shape of gland
further self injury revealed
Crisis intervention f. Serum cholesterol is
elevated
Myxedematous coma
1. Life-threatening DISORDERS OF the THYROID
complication of long-standing GLAND
and untreated hypothyroidism NURSING INTERVENTIONS
2. Hyponatremia, 1. Monitor VS especially HR
hypoglycemia, acidosis 2. Administer hormone
3. Precipitated by stressors, replacement: usually
failure to take thyroid Levothyroxine( Synthroid)-
replacement meds should be taken on an empty
4. Treatment includes stomach
restoring balance throughout DISORDERS OF the THYROID
GLAND
NURSING INTERVENTIONS the release of excessive
3. Instruct patient to eat LOW hormones in the blood
calorie, LOW cholesterol and DISORDERS OF the THYROID
LOW fat diet GLAND
4. Manage constipation
appropriately ASSESSMENT Findings for
5. Provide a WARM Thyroid Storm
environment 1. HIGH fever
DISORDERS OF the THYROID 2. Tachycardia and
GLAND Tachypnea
NURSING INTERVENTIONS 3. Systolic HYPERtension
6. Avoid sedatives and DISORDERS OF the THYROID
narcotics because of GLAND
increased sensitivity to these ASSESSMENT Findings for
medications Thyroid Storm
7. Instruct patient to report 4. Delirium and coma
chest pain promptly 5. Severe vomiting and
Nursing Diagnoses diarrhea
a. Decreased Cardiac 6. Restlessness, Agitation,
Output confusion and Seizures
b. Constipation DISORDERS OF the THYROID
c. Risk for Impaired Skin GLAND
Integrity: due to over all NURSING INTERVENTIONS
edema high risk for skin 1. Maintain PATENT airway
breakdown: preventative and adequate ventilation
interventions 2. Administer anti-thyroid
medications such as Lugol’s
DISORDERS OF the THYROID solution, Propranolol, and
GLAND Glucocorticoids
Thyroid storm
An acute LIFE-threatening
condition characterized by DISORDERS OF the THYROID
excessive thyroid hormone GLAND
DISORDERS OF the THYROID NURSING INTERVENTIONS
GLAND 3. Monitor VS
4. Monitor Cardiac rhythms
Thyroid storm 5. Administer PARACETAMOL (
CAUSE: Manipulation of the not Aspirin) for FEVER
thyroid during surgery causing
DISORDERS OF the THYROID DKA
GLAND Risk factors
NURSING INTERVENTIONS 1. infection or illness-
6. Manage Seizures as common
required. 2. stress
7. Provide a quiet 3. undiagnosed DM
environment 4. inadequate insulin, missed
dose of insulin
Diabetic Ketoacidosis DKA
This is cause by the absence ASSESSMENT FINDINGS
of insulin leading to fat 1. 3 P’s
breakdown and production of 2. Headache, blurred vision
ketone bodies and weakness
Three main clinical features: 3. Orthostatic hypotension
1. HYPERGLYCEMIA DKA
2. DEHYDRATION & electrolyte ASSESSMENT FINDINGS
loss 4. Nausea, vomiting and
3. ACIDOSIS abdominal pain
DKA 5. Acetone (fruity) breath
6. Hyperventilation or
PATHOPHYSIOLOGY KUSSMAUL’s breathing
No insulin reduced glucose HYPERGLYCEMIA
breakdown and increased Hyperglycemia
liver glucose production  DKA
Hyperglycemia LABORATORY FINDINGS
DKA 1. Blood glucose level of 300-
800 mg/dL
PATHOPHYSIOLOGY 2. Urinary ketones
Hyperglycemia kidney DKA
attempts to excrete glucose LABORATORY FINDINGS
 increased osmotic load  3. ABG result of metabolic
acidosis- LOW pH, LOW pCO2
diuresis  Dehydration
as a compensation, LOW
DKA
bicarbonate
4. Electrolyte imbalances-
PATHOPHYSIOLOGY
potassium levels may be HIGH
No glucose in the cell fat is
due to acidosis and
broken down for energy  dehydration
ketone bodies are produced DKA
Ketoacidosis
NURSING INTERVENTIONS Hyperglycemia osmotic
1. Assist in the correction of diuresis  loss of water and
dehydration electrolytes
Up to 6 liters of fluid may be HHNS
ordered for infusion, initially PATHOPHYSIOLOGY
NSS then D5W Insulin is too low to prevent
Monitor hydration status hyperglycemia but enough to
Monitor I and O prevent fat breakdown
Monitor for volume overload Occurs most commonly in
DKA type 2 DM, ages 50-70
NURSING INTERVENTIONS HHNS
2. Assist in restoring Precipitating factors
Electrolytes 1. Infection
Kidney function is FIRST 2. Stress
determined before giving 3. Surgery
potassium supplements! 4. Medication like thiazides
DKA 5. Treatment like dialysis
NURSING INTERVENTIONS HHNS
3. Reverse the Acidosis ASSESSMENT FINDINGS
REGULAR insulin injection is 1. Profound dehydration
ordered IV bolus 5-10 units 2. Hypotension
The insulin is followed by drip 3. Tachycardia
infusion in units per hour 4. Altered sensorium
BICARBONATE is not used! 5. Seizures and hemiparesis
HHNS
DIAGNOSTIC TESTS
HHNS 1. Blood glucose- 600 to 1,200
A serious condition in which mg/dL
hyperosmolarity and extreme 2. Blood osmolality- 350
hyperglycemia predominate mOsm/L
Ketosis is minimal 3. Electrolyte abnormalities
Onset is slow and takes hours HHNS
to days to develop NURSING INTERVENTIONS
HHNS Approach is similar to the DKA
PATHOPHYSIOLOGY 1. Correction of Dehydration
Lack of insulin action or by IVF
Insulin resistance  2. Correction of electrolyte
hyperglycemia imbalance by replacement
therapy
HHNS 5. Stress
NURSING INTERVENTIONS 6. Sedentary lifestyle
3. Administration of insulin Myocardial infarction
injection and drips PATHOPHYSIOLOGY
4. Continuous monitoring of Interrupted coronary blood
urine output flow myocardial ischemia
MACROVASCULAR CX anaerobic myocardial
Nursing management metabolism for several
1. Diet modification hours myocardial death 
2. Exercise depressed cardiac function 
MACROVASCULAR CX triggers autonomic nervous
Nursing management system response  further
3. Prevention and treatment imbalance of myocardial O2
of underlying conditions such demand and supply
as MI, CAD and stroke
4. Administration of Myocardial infarction
prescribed medications for ASSESSMENT
hypertension, hyperlipidemia findings
and obesity 1. CHEST PAIN
Chest pain is described as
Myocardial infarction severe, persistent, crushing
Death of myocardial tissue in substernal discomfort
regions of the heart with Radiates to the neck, arm, jaw
abrupt interruption of and back
coronary blood supply Myocardial infarction
Myocardial infarction ASSESSMENT
ETIOLOGY and Risk factors findings
1. CAD 1. CHEST PAIN
2. Coronary vasospasm Occurs without cause,
3. Coronary artery occlusion primarily early morning
by embolus and thrombus NOT relieved by rest or
4. Conditions that decrease nitroglycerin
perfusion- hemorrhage, shock Lasts 30 minutes or longer
Myocardial infarction Myocardial infarction
Risk factors Assessment findings
1. Hypercholesterolemia 2. Dyspnea
2. Smoking 3. Diaphoresis
3. Hypertension 4. cold clammy skin
4. Obesity 5. N/V
6. restlessness, sense of doom Provide a low-sodium, low
7. tachycardia or bradycardia cholesterol and low fat diet
8. hypotension 6. Minimize anxiety
9. S3 and dysrhythmias Reassure client and provide
Myocardial infarction information as needed
Laboratory Myocardial infarction
findings 7. Assist in treatment
1. ECG- the ST segment is modalities such as PTCA and
ELEVATED. T wave inversion, CABG
presence of Q wave 8. Monitor for complications of
2. Myocardial enzymes- MI- especially dysrhythmias,
elevated CK-MB, LDH and since ventricular tachycardia
Troponin levels can happen in the first few
3. CBC- may show elevated hours after MI
WBC count 9. Provide client teaching
4. Test after the acute stage- MI
Exercise tolerance test,
thallium scans, cardiac
catheterization
Myocardial infarction
Nursing
Interventions
1. Provide Oxygen at 2 lpm, Medical Management
Semi-fowler’s 1. ANALGESIC
2. Administer medications The choice is MORPHINE
Morphine to relieve pain It reduces pain and anxiety
nitrates, thrombolytics, Relaxes bronchioles to
aspirin and anticoagulants enhance oxygenation
Stool softener and MI
hypolipidemics Medical Management
3. Minimize patient anxiety 2. ACE
Provide information as to Prevents formation of
procedures and drug therapy angiotensin II
Myocardial infarction Limits the area of infarction
4. Provide adequate rest MI
periods Medical Management
5. Minimize metabolic 3. Thrombolytics
demands Streptokinase, Alteplase
Provide soft diet
Dissolve clots in the coronary >HR, oozing or bulging at the
artery allowing blood to flow site, change in LOC
Apply direct pressure
PURPOSE
Dfunctionissolve and lyze the Anticoagulant
thrombus (thrombolysis) Heparin
Allowing blood to flow again - prevents formation of
(reperfusion) thrombin
Minimizing the size of - monitor PTT
infarction - Protamine Sulfate
Preserving ventricular Warfarin
- Suppresses formation of
Absolute Contraindication prothrombin
Active bleeding - monitor PT
Known bleeding disorder - Vit K
History of hemorrhagic stroke Myocardial infarction
History of intracranial vessel
malformation NURSING INTERVENTIONS
Recent major surgery or AFTER ACUTE EPISODE
trauma 1. Maintain bed rest for the
Uncontrolled hypertension first 3 days
Pregnancy 2. Provide passive ROM
exercises
Nursing Consideration 3. Progress with dangling of
Minimize skin puncture the feet at side of bed
Avoid IM injection Myocardial infarction
Draw blood for laboratory NURSING INTERVENTIONS
test when starting IV line AFTER ACUTE EPISODE
Start Iv line prior to 4. Proceed with sitting out of
thrombolytic therapy bed, on the chair for 30
Monitor for dysrhythmias, minutes TID
hypotension, and allergic 5. Proceed with ambulation in
reaction the room toilet hallway
Monitor for reperfusion, TID
resolution of angina or acute Myocardial infarction
ST segment changes NURSING INTERVENTIONS
Check for signs and symptoms AFTER ACUTE EPISODE
of bleeding, < Hgb, Hct, < BP, Cardiac rehabilitation
To extend and improve quality each other like the links of a
of life chain
Physical conditioning
Patients who are able to walk HOW DOES CPR WORK?
3-4 mph are usually ready to All the living cells of our body
resume sexual activities need a steady supply of
Treatments for coronary oxygen to keep us alive
disease - angioplasty CPR works because you can
Coronary angioplasty involves breathe air into the victim’s
inserting a balloon into a lungs to provide oxygen into
diseased (blocked/narrowed) the blood. Then, when you
coronary artery through an press on the chest, you move
artery in the groin or arm. oxygen-carrying blood
Commonly a metal support through the body.
(stent) is inserted into the
artery to help keep it open. WHEN WILL YOU DO CPR?
A close up of a Stent. CPR must be started as soon
Angina Pectoris as possible when the carotid
NURSING pulse is not appreciated or if
MANAGEMENT breathing either stops or
1. Administer prescribed ineffective.
medications In case of doubt, do CPR. Any
Nitrates- to dilate the delay in starting CPR reduces
coronary arteries the chances of survival. In
Aspirin- to prevent thrombus addition, the brain cells begin
formation to die after four to six minutes
Beta-blockers- to reduce BP without oxygen.
and HR
Calcium-channel blockers- to
dilate coronary artery and
reduce vasospasm
Basic Life Support
This is a strategy which aims
to improve the outcome for
victims of Cardiopulmonary
arrest and is now being
adopted internationally
It involves a series of events
which are interconnected to