NCM 106 Emergency Management

8/10/2019 NCM 106 Emergency Management

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MS HASSEN ZABALA, RN, MANSEPT 2, 2013

Emergency Management


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EMERGENCY MANAGEMENT

HEMORRHAGE

HEAD/CHEST/ABDOMINAL TRAUMA

POISONING & OVERDOSE

SPINAL CORD INJURY


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HEMORRHAGE


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MANAGEMENT

Wash hands well before administering to

patient

Wear synthetic gloves

Make the victim lie down

Slightly elevate the legs

If possible keep the affected area

elevated


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Remove any obvious debris/particle

Apply direct pressure using cleancloth/bandage

Use hand if cloth is not available

Apply pressure continuously for at least

20 minutes

Do not remove the cloth to check thebleeding


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Hold the bandage in placeusing an adhesive tape

If bleeding seeps through

bandage, do not remove it Add extra bandage on top

of the first one

Apply direct pressure on

the artery if necessary


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Squeeze the artery keeping finger flat

Continue applying pressure on the

wound Once bleeding stops immobilize the

affected part

See a doctor


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SIGNS OF INTERNAL BLEEDING

Bleeding from body cavities

Vomiting or coughing up blood

Bruising on neck, chest, abdomen or side Wounds penetrating skull, chest or abdomen

Abdominal tenderness, possibly accompanied

by spasm of abdominal muscles Fractures

Shock, indicated by weakness, anxiety, thirst

or skin that's cool to the touch


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PLEASE AVOID.

Do not try to replace a displaced

organ

Just cover the wound with a cleancloth

Do not try to remove an embeddedobject


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HEAD/CHEST/ABDOMINALTRAUMA


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HEAD TRAUMA


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SIGNS & SYMPTOMS

Loss of consciousness - for short/long duration

Bleeding

Vomiting, Fluid discharge from nose Loss of hearing, vision, taste, smell

Speech-related problems

Irregular heart beat Seizures, Paralysis, Coma

Change in personality, Mental health-related

problems


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MANAGEMENT - MILD

Apply ice to injured area

The size of the bump is not related

to the severity of injury

Observe carefully for signs of

bleeding


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MANAGEMENTMODERATE TO

SEVERE

Check the patient's breathing pattern

If necessary do CPR

If bleeding, press area with a clean cloth If vomiting, turn on side and lower the head

To minimize spine injury - hold head, neck and

body in one line; Immobilize the patient If unconscious, treat it like a spinal injury

Keep the head in alignment with spine


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PLEASE AVOID

X shaking/moving one w/ head injuries

X washing wound/removing debris

Do not remove helmet in case of headinjury

Do not consume alcohol immediately

after a head injury

Do not pick up a fallen child with head

injury


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CHEST TRAUMA


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MANAGEMENT

1. Begin CPR, if Necessary

2. Cover an Open Wound

Use a cloth, pad, or whatever is at hand.

If possible, cover 2 inches beyond the edge of the wound. If blood bubbles up from the wound, tape cover down on

three sides to prevent air from building up in the chest.

Do not remove any objects that have penetrated the chest.

3. Stop Bleeding, if Necessary4. Position Person to Make Breathing Easier

If possible, place person on the injured side or sitting up.

5. Monitor Breathing


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ABDOMINAL TRAUMA


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SIGNS & SYMPTOMS - TRAUMA

Pain in the stomach

Feeling sick in the stomach

Nausea or vomiting

Pale cold skin

Evidence of bleeding or obviousinjury.


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SIGNS & SYMPTOMSNON-TRAUMA

RL abdominal pain, evidence of mild feverappendix;

RU abdominal paingallstones;

Referred back painkidneys;

Severe tearing mid/U abdominal pain - arterytear;

Severe R/L L abdominal pain in a femalecasualty - possible ectopic pregnancy;

Red flushed skin if infection present.


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MANAGEMENT

Control bleeding using direct pressure or

bandages.

Consider internal bleeding - pale, cold,clammy skin.

If in shock, lay them down and keep still

and warm. Flex knees, which may help reduce pain.

Do not allow VICTIM to eat or drink.


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Assist VICTIM into a comfortable

position.

If stomach contents are visible, coverwith plastic wrap, a non-stick dressing or

a wet dressing.

If an object is embedded in abdomen,pad around the object. Leave object in

place.


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POISONING & OVERDOSE


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SIGNS & SYMPTOMS

Abdominal pain Bluish lips

Chest pain, Heart

palpitations

Confusion

Cough, DOB

Diarrhea

Dizziness, Double vision

Drowsiness

Fever

Headache

Irritability

Loss of appetite

Loss of bladder control

Muscle twitching

n/v

Numbness or tingling

Seizures

Skin rash or burns

Stupor, Unconsciousness

Unusual breath odor

Weakness


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MANAGEMENT - ORAL

Check and monitor ABC. If necessary, do CPR.

If possible, identify the poison.

Do NOT make a person throw up unless told to do.

If the person vomits, clear airway.

With convulsions, give convulsion first aid.

The person should be rolled onto the left side, and

remain there while getting or waiting for medicalhelp.

If the poison has spilled on the person's clothes,

remove the clothing and flush the skin with water.


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MANAGEMENT - INHALATION

Call for emergency help.

If it is safe to do so, rescue. Open windows & doors.

Take several deep breaths of fresh air, and then hold

breath. Hold a wet cloth over nose and mouth.

Do not light a match or use a lighter.

After rescue, check & monitor ABC. If reqd, do CPR.

If necessary, perform first aid for eye injuries orconvulsions.

If the person vomits, clear the person's airway.

Even if perfectly fine, get medical help.


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PLEASE AVOID

Do NOT give an unconscious person anythingby mouth.

Do NOT induce vomiting unless you are told to

do so. Do NOT try to neutralize the poison with

lemon juice or vinegar, or any other

substance, unless you are told to do so. Do NOT use any "cure-all" type antidote.

Do NOT wait for symptoms to develop if yoususpect that someone has been poisoned.


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SYMPTOMS

N/V

Abdominal cramps, Diarrhoea

Dizziness, Loss of balance

Seizures (fitting)

Drowsiness, Confusion

Breathing difficulties Internal bleeding

Hallucination, Visual disturbances

Coma


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MANAGEMENT

Contact ambulance/help.

If unconscious, check v/s. If needed, begin CPR.

Check the airways and clear out (remove any pills, vomit, etc)

Once stable, place in recovery position (lying on their side)and wait for help.

Ask what happened & keep them as alert as possible.

DO NOT try to induce vomiting unless instructed to do so.

DO NOT give the person anything to eat or drink unlessinstructed

DO NOT leave the person alone

Try to figure out the time when the drug was taken and what

quantity was taken.


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SPINAL CORD INJURY


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Classification Description

AComplete: no motor or sensory function is preserved below

the level of injury, including the sacral segments S4-S5

B

Incomplete: sensory, but not motor, function is preserved

below the neurologic level and some sensation in the sacral

segments S4-S5

C

Incomplete: motor function is preserved below theneurologic level, however, more than half of key muscles

below the neurologic level have a muscle grade less than 3

(i.e., not strong enough to move against gravity)

DIncomplete: motor function is preserved below theneurologic level, and at least half of key muscles below the

neurologic level have a muscle grade of 3 or more (i.e., joints

can be moved against gravity)

E Normal: motor and sensory functions are normal


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SIGNS & SYMPTOMS

CERVICAL

Breathing probs, arms, legs & torso

THORACIC BP probs, abN sweating, trouble

maintaining N temp.

LUMBO-SACRAL Bladder & bowel control, lower extremities


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MANAGEMENT

Methylprednisolone

Rigid brace/ axial traction

Breathing mgt

Immobilization

Shock tx


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MANAGEMENT

Victim reports severe pain inneck or back.

Victim cannot or will not moveneck.

Victim has fallen on, or has

suffered trauma to the back,neck or head.

Head trauma with ongoingeffects on consciousness.

Loss of bladder or bowelcontrol.

Paralysis, weakness, ornumbness of limbs.

Neck or back is at an unnaturalangle.


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Do not move the victim

unless he is in

immediate danger offurther injury or you

need to open an airway

for them to breathe.


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Stabilize the victim to

prevent any movement

of the head, neck, orbody.

Do first aid without

moving the victim's

head or neck.


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If the victim must be moved. Pull them by their clothing. Grab a shirt collar and use your

forearms to support their head while pulling the body in astraight line. This is a preferred method as the victim's headis braced while moving.

Pull the victim with their feet or shoulders. Use both feet,both shoulders, or both arms pulled over the shoulders.

Keep the neck and torso of the body as straight aspossible, and pull the victim in a straight line. Do not pullthe body sideways!

Use at least two people if you must roll a victim over.Ifyou must roll a spinal injury victim over to prevent chokingon blood or vomit or other harm, use two people. Roll thevictim over in such a way that the neck, back, and torsomove as one unit. Do not allow the body to twist.

Documents

NCM 106 Emergency Management