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
Cold-Related Emergencies
Frostbite
What does it do to cells?
- Tissue freezing leads to ice crystals in tissues and cells
- Cold stress causes peripheral vasoconstriction that can lead to decreased blood flow and vascular stasis
- Organelles are damaged and cell membrane destroyed causing edema
Depth of frostbite depends on:
- Ambient temperature
- Length of exposure
- Type and condition (wet or dry) of clothing
- Contact with metal surfaces
- Other factors: skin color, lack of acclimation, previous episodes, exhaustion, and poor peripheral vascular status
Superficial frostbite
What body parts?
What does the skin look like?
What not to do ?
•Skin and subcutaneous tissue
- Ears, nose, fingers, and toes
•Skin appears waxy pale yellow to blue to mottled; feels crunchy and frozen
•Tingling, numbness, or burning
•NEVER squeeze, massage, or scrub the injured tissue
•Swelling will occur with thawing
- Remove clothing and jewelry
Superficial frostbite treatment
•Immerse affected area in circulating water that is 98.6° to 104° F
•Use warm soaks for facial areas
- Feels warm/ stinging as it thaws
- Blisters form w/in hours
•Debride and apply sterile dressing
•AVOID heavy blankets and clothing
•Rewarming is extremely painful
- Give analgesia and tetanus prophylaxis
•Evaluate for systemic hypothermiaDeep frostbite
- involves muscles, bone, tendon
- skin is white, hard, insensitive to touch
- mottling gradually progresses to gangrene
- immersed in a temperature controlled circulating water bath 98.6 to104 until flushing occurs distal to injured area
Deep frostbite
•After rewarming
- Elevate to decrease edema after rewarming; significant edema within 3 hours
- Blistering in 6 hours to days
- IV analgesia and NSAIDs
- Tetanus prophylaxis
- Evaluate for systemic hypothermia
- Amputation may be required
- Hospitalization may be indicated
Hypothermia
•Core temperature lower than 95° F
•Body heat produced less than body heat lost
- Most body heat is lost as radiant energy, especially from the head, thorax, and lungs
•Evaporative heat loss
- Increases to five times greater than normal with wet clothing
- Increases to 25 times greater than normal with immersion in cold water
•Heat is conserved and production by the body
- Peripheral vasoconstriction
- Shivering and movement
Hypothermia Predisposing factors
- Exposure to freezing temperatures
- Cold winds
- Wet terrain
- Physical exhaustion
- Inadequate clothing
- Inexperience
Hypothermia older adults
- Decreased body fat
- Decreased energy reserves
- Decreased metabolic rate
- Decreased shivering response
- Chronic medical conditions
- Drugs that alter body defenses
Mild hypothermia signs
T: 93-95 Shivering lethargic confusion rational to irrational behavior minor heart rate changes
Moderate hypothermia signs
T: 93° F •Rigidity •Bradycardia, bradypnea •BP obtainable ONLY by Doppler •Metabolic and respiratory acidosis •Hypovolemia •Shivering decreases or disappears at core temperatures of 86° F
Hypothermia assessment findings
- As core temperature decrease metabolic rate decreases
- Cold myocardium causes dysrhythmias
- Decreased renal blood flow causes decreased GFR and decreased water absorption, leading to dehydration
- Increased hematocrit causes decreased intravascular volume
•Cold blood is thick; acts as thrombus
- Risk of stroke, MI, PE, and renal failure
•Decreased blood flow leads to hypoxia, anaerobic metabolism, lactic acid accumulation, and metabolic acidosis
SEVERE hypothermia signs
- T: lower than 86° F
- Potential life-threatening situation
- Person appears dead
- Undetectable vital signs
- Absent reflexes; pupils fixed and dilated
- May see bradycardia, ventricular fibrillation, pulseless electrical activity (PEA)
- Every effort is made to warm patient to at least 86° F before they are pronounced dead
- Cause of death: refractory ventricular fibrillation
Treatment of hypothermia
- Remove from cold environment
- Manage and maintain ABCs
- Provide O2
- IV access for fluid resuscitation
- Rewarm patient
- Correct dehydration and acidosis
- 12-lead ECG and treat dysrhythmias
Mild hypothermia external rewarming procedures (low risk of dysrhythmia)
- Remove wet clothing and apply dry clothing and warm blankets; use radiant lights
- Fluid or air-filled warming blankets, warm water immersion
Moderate to severe hypothermia
•Active internal rewarming
- Heated, humidified oxygen
- Warmed IV fluids
- Peritoneal lavage with warmed fluids
- Extracorporeal circulation with
- Cardiopulmonary bypass
- Rapid fluid infuser
- Hemodialysis
Hypothermia care
• monitor core temp
- core b4 extremities
- ABCs, LOC, VS, O2, HR, electrolyte, glucose
• Risks of rewarming
- Afterdrop: further drop in core T
- Shock: hypotension and dysrhythmias
• Discontinue active rewarming once core temperature is 90° to 95°
- Injury or death from animal, spider, snake, and insect bites or stings
- Morbidity results from:
- Direct tissue damage
- Lethal toxins
- Tissue damage is a product of
- Animal size
- Characteristics of animal’s teeth
- Strength of jaw
Stings and Bites
•Tissue damage
- Lacerated, crushed, or chewed
•Toxins; local or system effects
- Released from teeth, fangs, stingers, spines, or tentacles
•Death associated with:
- Blood loss
- Allergic reactions
- Lethal toxins
Snake bite
- Snake venom can be neurotoxic, vascular toxic, or hemolytic, or a combo
- S/S: PAIN, swelling, discoloration, blistering, possible paresthesia, lymphadenopathy, N/V
- Tx: wound care, pain meds, tetanus prophylaxis, immobilization of extremity, remove restrictive clothing, monitor limb closely. In severe cases: fasciotomy and antivenom
Snake bite
Severe venom causes
Profound edema, tachycardia, blurred vision, headache, chills, paralysis, hypotension and muscle twitching, metallic taste in mouth
Progression -> pulmonary edema, Coagulopathy, thrombocytopenia, hemorrhage
Severe envenomation: treatment
•Closely monitor:
- ABCs, fluid resuscitation, respiratory support, labs
- Antivenom therapy
- Abnormal platelet and coagulation studies
- Limb circumference and advancing edema should be marked every 30 minutes
- Fasciotomy rarely needed
Poisonings: any chemical that harms the body
Severity depends on?
Management?
- Severity depends on type, concentration, and route of exposure
- Management consists of decreasing absorption, enhancing elimination, and implementation of toxin-specific interventions
Poisoning decontamination
- Decontamination takes priority over all interventions except life support measures
- Nurses must wear PPE for decontamination to prevent secondary exposure.
- Skin and ocular exposure require copious amounts of water/saline flushing.
- Brush dry substances off body or clothing before adding water.
Poisoning treatment
Contact Poison Control Center for Guidance! Binding agents to enhance elimination •Activated charcoal •Cathartics •Whole-bowel irrigation •Hemodialysis •Urine alkalinization •Chelating agents •Antidotes
Disasters/Casualty Events types
- Internal- I’m hospital (bomb, fire, power)
- External- earthquake, train crash, hurricane
- Multi- local
- Mass Casualty- needs gov help
Mass Casualty Triage Tags
🔴🟡🟢🔵
First responders must evaluate disaster victims within 15 seconds and give Triage Tags:
•Red-life threatening needing immediate intervention
•Yellow-urgent but not life threatening
•Green-minor injuries, will survive
•Blue/Black -expected to die/identifies the dead
Agents of terrorism:
Biologic weapons
Terrorism involving the intentional release or dissemination of biological agents (bacteria, viruses, insects, fungi, toxins in natural or modified form) to cause widespread illness, panic, and fear.
•“germ warfare”; anthrax, botulism, plague, smallpox, Ebola….
•Vaccines available for most agents
•May treat with antibiotics (anthrax, plague, tularemia)
Chemical weapons
Used for?
Examples?
Toxic chemicals used as weapons of mass destruction to demoralize, injure, and kill opposition.
tear gas, phosgene, chlorine, mustard gas, biotoxins, blood agents, caustics, metallic poisons, nerve agents, vomiting agents…
•Categorized by target organ or effect
steps in a Decontamination Process?
•The nurse must wear appropriate PPE; Standard Precautions up to Contact, Droplet, and Airborne Isolation Precautions
- Removal of patients clothing, jewelry; place in sealed hazard bag.
- Rinse the patient with water.
- Wash the patient with soap and water.
- Treat wounds and symptoms.
Dirty Bomb
- A mix of explosives like dynamite with radioactive powder that covers a few blocks to miles.
- Main danger comes from the explosion, not the radiation.
- Only ppl very close to the blast site would be exposed to enough radiation to cause serious immediate illness.
- Moderate to severe burns, flash blindness, injury, death.
Nuclear explosion
- “Mushroom clouds”
- Radiation is widespread causing moderate to severe burns, blast lung, tympanic rupture, abdominal and head injuries, eye damage, radiation sickness, cancer and death
- Radioactive fallout can contaminate water, agriculture, and animals and have detrimental effects on the environment.
Victims or persons close to the blast (dirty bomb or nuclear) must:
- Get inside the nearest building.
- Remove contaminated clothing and wipe off or wash unprotected skin.
- Stay inside and stay tuned to media with official information.
•Note that radiation cannot be seen, smelled, felt, or tasted
Radiation Sickness:
Is radiation dose related(bigger the exposure- more severe symptoms)
S/S include N/V, anorexia, headache, malaise, diarrhea, tachycardia, hair loss, skin ulcers, bone marrow depression, cancers, convulsion, tremor, ataxia, death
Tx: pain control, infection control, psych (PTSD); treat burns; optimal nutrition.
Radiation Decontamination
•Triage outside the hospital.
•Cover floor and use strict isolation precautions to prevent the tracking of contaminants.
•Air ducts and vent are sealed.
•Waste is double bagged and labeled “radiation waste.”
•Staff protection
***** PPE!! Water-resistant gowns, two pairs of gloves, caps, goggles, masks, and booties
•Nurses must wear dosimetry devices (radiation detection device).
•Patients are resurveyed and re-showered as necessary.
•Showering should be performed to not contaminate clean areas with runoff from the showering
