Disaster Prep Flashcards
Medical emergency
Need rapid response for extraordinary event that community resources HAS
Disaster
Goes beyond community resources, need outside help
Principle 1: Triage and Prioritization In non-disaster situations
health care workers assign highest priority and allocate most resources to the most critically ill patients.
Principle 1: Triage and Prioritization In disaster situations with large numbers of casualties
decisions are based on the likelihood of survival and the consumption of resources
Emergency Severity Index (ESI)*
•5 Level Triage system
What is the nurse looking at to determine?
- ESI-1: First the nurse assesses for threats to life
- Is the patient in imminent danger of dying?
- ESI-2: Or determines if the patient is high-risk and who should not wait to be seen
- ESI-3, ESI-4, or ESI-5: number of anticipated resources needed
ESI-1
1) Stability if ABC - UNSTABLE
2) life or organ threat- OBVIOUS
3) how soon to be seen- STAT
4) expected resources- HIGH
Ex: MI, OD, coding
ESI-2
1) Stability if ABC - THREATEN
2) life or organ threat- LIKEY BUT NOT ALWAYS
3) how soon to be seen- W/IN 10 MIN
4) expected resources- HIGH
EX: chest pain
ESI-3
1) Stability if ABC - STABLE
2) life or organ threat- UNLIKELY
3) how soon to be seen- 1 HR
4) expected resources- MEDIUM to HIGH
EX: abd pain, hip fracture
ESI-4
1) Stability if ABC - STABLE
2) life or organ threat- NO
3) how soon to be seen- CLULD BE DELAYED
4) expected resources-LOW, SINGLE TEST
EX: laceration
ESI-5
1) Stability if ABC - STABLE
2) life or organ threat- NO
3) how soon to be seen- COULD BE DELAYED
4) expected resources-LOW EXAM ONLY
EX: minor burn, RX refill
Principle 2: Primary Survey
- The purpose of the primary survey is to identify life-threatening conditions so that appropriate interventions can be started.
- Stat! A—-B—-C
- Unless uncontrolled external hemorrhage, then bleeding must be controlled first
Primary Survey Components
What to assess for?
ABCDEFG
- A: Airway and Alertness (patency, obstruction, resp. distress, bleeding, trauma, anaphylaxis ,LOC; cervical spine stabilization)
- B: Breathing (adequate ventilation, dyspnea, breath sounds, RR, trauma, O2 needs or intubation)
- C: Circulation (pulses, cap refill, skin color, hemorrhage, signs of shock, cardiac arrest; need venous access for IVF and blood products)
- D: Disability (Neurologic assessment, pupils-PERRLA, LOC, Responsiveness(voice, pain, unresponsive), Glasgow coma scale).
- E: Exposure and Environment Control (remove all clothing to perform complete physical assessment; prevent hypothermia).
- F: Facilitate adjuncts and Family (inform family and have present during resuscitation, caregiver support).
- G: Get resuscitation adjuncts (lab test, bld count/type, ECG monitoring, NGT, O2/monitoring, pain management—critical element in trauma care).
Principles 3, 4, and 5
•The final three principles of emergency nursing practice involve
- collecting additional assessment data
- providing and evaluating patient care
- making a decision regarding the patient’s next steps following emergency care.
Principle 3: Focused Assessment and Secondary Survey
1) Focused Health History & Head to Toe Assessment (SAMPLE)
- Symptoms
- Allergies
- Medications history
- Past medical history
- Last meal
- Events leading up
2) Secondary Survey: A brief systemic process to identify all injuries
- done after the ABC assessment and focused
- done to assess ALL other injuries
Principle 4: Patient Care and Evaluation
- Ongoing monitoring
* Patient response to interventions
Principle 5: Disposition
- Admission
- Transfer to specialty center
- Discharge home
Heat Related Emergencies
Brief exposure to intense heat
OR
Prolonged exposure to lower heat
- Thermoregulatory mechanisms cannot compensate
- Predisposing factors: excising in hot/humid environment, clothing that interferes with perspiration, and high fevers.
- Other risk factors: ETOH, age, environmental conditions, preexisting illness, Rx, and street drugs
Heat cramps
Sign?
Tx?
brief intense cramps after exercise.
S/S nausea, tachycardia, pallor, weakness, profuse diaphoresis.
Tx: rest, water and sodium replacement, elevation, gentle massage, analgesia, avoid the activity for the next 12 hrs.
Heat exhaustion
Signs? & Tx?
Prolonged exposure to heat over HOURS or DAYS
S/S: TEMP 99.6-105.8, fatigue nausea vomiting, extreme thirst, anxiety, hypotension, tachycardia, dilated pupils, mild confusion, ashen color, profuse diaphoresis
TX: Moist sheet to reduce core temp and fluid replacement
Heatstroke Signs?
medical emergency from failed thermoregulatory process
Temp over 105.8 F
initial increased sweating(eventually stop functioning)
vasodilation
tachypnea & tachycardia
weakness
alt. LOC
Coma, can lead to cerebral edema and hemorrhage; death dependent on amount of time the Patient’s temp is high
Heatstroke treatment
Stabilize ABC, 100% O2, continuous VS monitor, lower core temp with cool environment, cool water bath, auxiliary or growing ice packs
Control shivering (increases core temp) and monitor for RHANDOMYOLYSIS (muscle breakdown that releases a kidney damaging protein)
Cold-Related Emergencies
Two types?
Contributing factors?
1) Localized
- Frostbite
2) Systemic
- Hypothermia
- Contributing factors: Age, duration of exposure, environmental temperature, homelessness, preexisting conditions, drugs, and alcohol intoxication; smokers have increased risk
