Chapter 69: Emergency, Terrorism, and Disasters

Question 1

Airway With Simultaneous Cervical Spine Stabilization and/or Immobilization

Answer 1

• Assess for respiratory distress.
• Assess airway for patency.
• Check for loose teeth or foreign bodies.
• Assess for bleeding, vomitus, or edema

• Open airway.
• Use jaw-thrust maneuver.
• Remove or suction any foreign bodies.
• Insert oropharyngeal or nasopharyngeal airway, endotracheal tube,
cricothyroidotomy.
• Immobilize cervical spine using rigid cervical collar and cervical immobilization
device. Secure forehead to backboard.

Question 2

Breathing

Answer 2

• Assess ventilation.
• Scan chest for signs of breathing.
• Look for paradoxic movement of the chest wall during
inspiration and expiration.
• Note use of accessory muscles or abdominal muscles.
• Observe and count respiratory rate.
• Note color of nail beds, mucous membranes, skin.
• Auscultate lungs.
• Assess for jugular venous distention and position of trachea.

• Give supplemental O2 via appropriate delivery system (e.g., non-rebreather
mask).
• Ventilate with bag-valve-mask with 100% O2 if respirations are inadequate or
absent.
• Prepare to intubate if severe respiratory distress (e.g., agonal breaths) or
arrest.
• Have suction available.
• If absent breath sounds, prepare for needle thoracostomy and chest tube
insertion.

Question 3

Circulation

Answer 3

• Check carotid or femoral pulse.
• Palpate pulse for quality and rate.
• Assess skin color, temperature, and moisture.
• Check capillary refill.
• Assess for external bleeding.
• Measure blood pressure.

• If absent pulse, initiate cardiopulmonary resuscitation and advanced
life-support measures.
• If shock symptoms or hypotensive, start two large-bore (14- to 16-gauge) IVs
and initiate infusions of normal saline or lactated Ringer’s solution.
• Control bleeding with direct pressure and pressure dressings, if appropriate.
• Administer blood products if ordered.
• Consider autotransfusion if isolated chest trauma.
• Consider use of a pneumatic antishock garment or pelvic splint in the
presence of pelvic fracture with hypotension.
• Obtain blood samples for type and crossmatch.

Question 4

primary survey

Answer 4

(Table 69-3) focuses on airway, breathing,
circulation (ABC), disability, and exposure or environmental
control.

Question 5

Determine the patient’s
response to verbal and/or painful stimuli to assess level of
consciousness.

Answer 5

A simple mnemonic to remember is AVPU:
A = alert, V = responsive to voice, P = responsive to pain,
and U = unresponsive.

Question 6

Primary Survey

Answer 6

A = Airway With Cervical Spine Stabilization and/or
Immobilization

B = Breathing

C = Circulation.

D = Disability

E = Exposure or Environmental Control.

Question 7

secondary survey

Answer 7

F = Full Set of Vital Signs, Focused Adjuncts, Facilitate
Family Presence

G = Give Comfort Measures.

H = History and Head-to-Toe Assessment.

I = Inspect Posterior Surfaces.

Question 8

The evaluation of airway patency and the

effectiveness of breathing will always

Answer 8

be the highest priority.
Monitor respiratory rate and rhythm, O2 saturation, and ABGs (if ordered) to evaluate the patient’s respiratory status.

Also, closely monitor the level of consciousness; vital signs; quality of peripheral pulses; urine output; and skin temperature, color, and moisture for key information about circulation and perfusion.

Question 9

rhabdomyolysis

heat stroke

Answer 9

(a serious
syndrome caused by the breakdown of skeletal muscle). The
muscle breakdown leads to myoglobinuria, which places
the kidneys at risk for acute kidney injury.

Question 10

The administration of… increases the elimination of poisons.

Answer 10

The administration of cathartics, whole-bowel irrigation,
hemodialysis, urine alkalinization, chelating agents, and antidotes
increases the elimination of poisons.

Question 11

Hemodialysis

Answer 11

Hemodialysis is reserved for patients who develop severe

acidosis from ingestion of toxic substances (e.g., aspirin).

Question 12

Skin and ocular decontamination

Answer 12

involves removal of toxins

from skin and eyes using copious amounts of water or saline

Question 13

Gastric lavage

Answer 13

involves oral insertion of
a large-diameter (36F to 42F) gastric tube for irrigation of
copious amounts of saline. Elevate the head of the bed or place
the patient on the side to prevent aspiration.