FINALS LEC (w/ antidotes) Flashcards
● Reducing potential disaster damages before a
disaster threatens
MITIGATION
PHASES OF DISASTER AND EMERGENCY
MPRR
Mitigation, Preparedness, Response, Recovery
Developing operational capabilities and facilitating an
effective response before an emergency occurs
PREPAREDNESS
Actions taken immediately before, during, or directly
after an emergency occurs
RESPONSE
Returns infrastructure systems to minimum operating
standards.
● Most difficult disaster phase
RECOVERY
A process for sorting injured people into groups based
on their need when resources are insufficient for all to
be treated
TRIAGE
are used in situations
in which triage is dynamic, occurs over many hours to days,
and only limited, austere, field, advanced life support
equipment is readily available.
START and SAVE triage techniques
Open fracture of femur with
● unstable V/S
● Severe burns
● Tension pneumothorax
● Open chest wound
● Upper airway obstruction
DISASTER TRIAGE TAGS
RED
Dislocations
Burns
Blunt trauma with stable v/s
Head injury with no
change in LOC
DISASTER TRIAGE TAGS
YELLOW
Simple fracture
Minor laceration
Hysterical reaction
DISASTER TRIAGE TAGS
GREEN
Triage system may have to be adapted to the situation
1. Red:
send to the hospital
Triage system may have to be adapted to the situation
YELLOW
send to an ambulatory site to either receive
meds or get vaccinated
Triage system may have to be adapted to the situation
GREEN
send home, are not at risk because are
immune
Triage system may have to be adapted to the situation
BLACk
susceptible or very ill, but do not
treat – send to where directed
Quick Circulatory Checks
(5P’s) pain, paresthesia, paralysis, pulses,
pallor
● Capillary Refill
● Obvious External
● Bleeding
● Electrocardiogram
particularly important in the patient with a
traumatic mechanism of injury where failure to identify
a second or third injury
Exposure
An intentional or unintentional wound or injury inflicted
on the body from a mechanism against which the
body cannot protect itself.
TRAUMA
any force that penetrates or fractures
the skull.
Direct Trauma
severe forces that may shake or
rotate the brain enough to cause permanent brain
damage.
Indirect Trauma
HISTORY: AMPLE
Allergies
● Medications
● Prior illnesses and operations
● Last meal
● Events and environment surrounding injury
an object entering the body or head due to an
object striking the body, or the body being placed in
motion and striking an object which then penetrates
the body.
PENETRATING TRAUMA
Do’s and Dont’s in Chest Impalement
Never try to remove an impaled object.
2. Expose the wound.
3. Control the bleeding.
4. Stabilize the impaled object.
referred pain at the tip of left shoulder and in left upper quadrant
Kehr’s sign
Lower abdominal rigidity with spasms
Appearance of blood in NGT
PERFORATED GASTROINTESTINAL TRACT
abnormal sound or murmur along middle or lower back
Bruit:
fixes area of dullness when left upper abdominal quadrant is percussed
Ballance’s
bluish color on blank
Turner’s
purplish color around umbilicus
Turner’s:
ecchymosis on scrotum and labia
Coopernail:
BITES AND STINGS NURSING MANAGEMENT
- Wash the wound gently with soap and water.
- Apply pressure if bleeding continuously.
- Apply sterile bandage to the wound.
SNAKE VENOM
Snake venom is highly modified saliva
MECHANISM OF TOXICITY
Cytotoxic effects on tissues
● Hemotoxic
● Neurotoxic
● Systemic effects
Local envenoming (swelling etc) with
bleeding/clotting disturbances
- VIPERIDAE
SYNDROME 1
Ptosis, external ophthalmoplegia, facial paralysis etc
and dark brown urine
- =Russell’s viper, Sri Lanka and South India
SYNDROME 2
Local envenoming (swelling etc) with paralysis
- =Cobra or king cobra
SYNDROME 3
Paralysis with minimal or no local envenoming
- Krait, Sea snake
SYNDROME 4
Paralysis with dark brown urine and renal failure:
Russle viper
SYNDROME 5
No evidence of envenomation
● Suspected snake bite
● Fang mark may be present
GRADE 0
Moderate envenomation
● Severe pain
● Edema spreading towards trunk
GRADE 2
Severe envenomation
● Within 12 hours edema spreads to the extremities and
part of the trunk
GRADE 3
Minimal envenomation
● Fang wound & moderate pain present
● 1-5 inches of edema or erythema
GRADE 1
Envenomation very severe
● Sudden pain rapidly
● Progressive swelling which leads to ecchymosis all
over trunk
GRADE 4
● Env
Blow up a blood pressure cuff to 80 mm Hg and leave
it on for 5 minutes.
● If a crop of purpuric spots appears below the cuff, the
test is positive.
HESS’ TEST
DON’TS in bites
● No Tourniquet
● No Suction apparatus to be used(Sawyers)
● Do not run
● No role of Ice application
begins at
the time of injury and concludes with restoration of
capillary permeability
Emergent Phase/Resuscitative Phase
when the person is hemodynamically
stable, capillary permeability has been restored and
diuresis has begun
Acute Phase
begins during the acute
hospital stay, after the patient is stable.
Rehabilitative Phase
individual fascicles of the
heart beat independently rather than the usual
coordinated, synchronized manner that produces
rhythmic heartbeat.
Ventricular Fibrillation
the heart has stopped beating
Cardiac Standstil
enters the body by passing through
the skin or membranes. No cut or tear is required for
them to enter a body
Absorbed Class
they are generally in the form of a
liquid, powder or syrup that has either no taste or a
pleasant taste
Ingestive Class
are airborne toxins that must be
introduced into the respiratory system in order for
them to work
Inhaled Class
these poisons have color,
once applied to a surface, they tend to fade into the
material they’re applied to, making them hard to
notice.
Insinuative/injective Class
the treatment of choice to
prevent absorption of the poison.
Activated charcoa
Within minutes of injury
- Due to major neurological or vascular injury
- Medical treatment can rarely improve outcome
FIRST PEAK
Occurs during the “golden hour”
- Due to intracranial hematoma, major thoracic or
abdominal injury
SECOND PEAK
Occurs after days or weeks
- Due to sepsis and multiple organ failure
THIRD PEAK
- No. of patients and the severity
of their injuries do not exceed the ability of the facility
to provide care.
Multiple Casualties
- The no. of patients and the
severity of their injuries exceed the ability of the
facility to provide care.
Mass Casualties
Segmental separation of chest wall causing inability to breath
and ventilate the lungs
SEVERE FLAIL CHEST
Does not begin until the primary survey is completed,
resuscitative efforts are established and patient is
demonstrating normalization of vital functions.
SECONDARY SURVEY
Rapid assessment of neurologic status to identify
life-threatening injury
● Pupil size and response
● Mental status (GCS)
● Motor and Sensory exam
DISABILITY OR DYSFUNCTION OF THE CNS
Head to toe examination of the patient for injury
● Pitfalls
- Maintenance of spine precautions
- Prevention of heat loss
EXPOSURE
RUQ PAIN
SIGNS OF HYPOVOLEMIC SHOCK
HX OF BLUNT OR PENETRATING ABDOMINAL TRAUMA
LACERATED OR FRACTURED LIVER
MUSCLE SPASM & RIGIDITY IN LUQ
KEHR’S SIGN
COMPLAINTS OF ABDOMINAL TENDERNESS, IF CONSCIOUS
S/SX OF HYPOVOLEMIC SHOCK
ENLARGED SPLEEN WITH MEDIAL DISPLACEMENT
RUPTURED SPLEEN
Signs of hypovolemic shock
Mild epigastric tenderness
Absence of bowel sounds
Involuntary abdominal muscle spasm
Possible elevated serum amylase
LACERATED OR FRACTURED PANCREAS
Lower abdominal rigidity with spasms
Appearance of blood in NGT
Epigastric tenderness
Hx of penetrating trauma to upper abdomen or lower thorax
PERFORATED GASTROINTESTINAL TRACT
Signs of hypovolemic shock but if pt has retroperitoneal hematoma, he may not have signs of shock
Hx of penetrating abdominal wound
LACERATED INFERIOR VENA CAVA
Abdominal tenderness and rigidity
Signs of hypovolemic shock
Hx of penetrating abdominal wound
LACERATED ABDOMINAL AORTA
Gross bleeding or dried blood at urethral orifice
Perineal ecchymosis
Suprapubic pain
Difficult urination, accompanied by distended bladder; urge to urinate
URETHRAL TRANSECTION
Signs of hypovolemic shock
Pain in abdomen and back, paralytic ileus
Absent or diminished bowel sounds, vomiting
hematuria
Hx of blunt abdominal/pelvic trauma
FRACTURED PELVIS
Pain in midback or flank
abdominal pain
Hematuria, oliguria or anuria
Local ecchymosis
Tenderness to touch
RENAL TRAUMA
Pain
Signs of hypovolemic shock
Difficulty with bowel movement
Hematuria
Ecchymosis
Large suprapubic mass
PERFORATED BLADDER
Radiograph Chest
Pneumothorax, Hemothorax, Fractured Ribs, Pulmonary Contusion, Tracheobronchial Injury, Great Vessel Injury
Pelvis
Extremeties
Angiogram
Fracture
Great vessel injury, renal injury, vascular injury of the extremities
Abdominal Injury, Retroperitoneal Injury, Thoracic Injury, Renal Injury, Pelvic Fracture
Computed Tomography
Duodenal Hematoma or Laceration
Upper GI Series
Intarvenous Pyelogram (IVP)
Renal Injury
Urethral Injury
Retrograde Urethrogram
Bladder Injury
Retrograde Cystogram
Paracetamol/Acetaminophen
Acetylcysteine or Mucomyst
Benzodiazepine
Flumazenil
Coumadin
Vitamin K
Curare
Endrophonium
Cyanide Poisoning
Methylene Blue
Digitalis
Digibind
Ethylene Glycol/ Methanol
Ethanol/Fomepizol
Heparin
Protamine Sulfate
Iron
Deferoxamine Mesylate (Desferal)
Lead
Edetate Disodium (EDTA), Dimercaprol (BAL), Succimer
Lovenox
Protamine Sulfate
Magnesium Sulfate
– Calcium Gluconate
Morphine Sulfate
Naloxone Hydrochloride
Methotrexate
Leucovorine
Mestinon
Atropine Sulfate
Neostigmine
Pralidoxime Chloride (PAM
Penicillin
Epinephrine
Isoniazid
Pyridoxine
Atropine
Physostigmine
Organophosphates
Atropine & Pralidoxime
