3/20/2012

INDICATIONS: RESPIRATORY ARREST= with pulse present

CARDIAC ARREST = without pulse

Christian Paul S. Biluan, RN, USRN

Adult
10-12 breaths per min
1. 2. 3. 4. 5.

Recognition and Activation of EMS Early CPR Defibrillation ACLS Post Cardiac Arrest Care
CPB

Child / Infant
10-20 breaths per min

If with Advanced Airway

CPB

CPB

3/20/2012

Common cause is SUDDEN CARDIAC ARREST (SCA) Latest Update: 2010 C-A-B method

CPB

CPB

Adult / Child / Infant

P Power on A Attach Electrode A Analyze Rhythm S Shock if needed Resume CPR 1 cycle then repeat
CPB CPB

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From the French word trier which means to sort out or to choose. Triage is a process which places the RIGHT PATIENT in the RIGHT PLACE at the RIGHT TIME to receive the RIGHT LEVEL OF CARE. Principle: to do the GREATEST GOOD for the GREATEST NUMBER OF AFFLICTED.
CPB CPB

Triage is THE CLASSIFYING OF VICTIMS according to the severity of the injury, urgency of treatment and place of treatment Nurses who specialize in triaging are called as TRIAGE NURSE Triaging requires critical thinking and prioritizing skills
CPB

INTERNAL:
SICKEST PATIENTS ARE GIVEN PRIORITY. The highest intensity of care is provided to the most seriously ill patients, even if those patients have a low probability of survival.

EXTERNAL:
WISE ALLOCATION OF LIMITED RESOURCES. Treatment is directed towards the people who have high chances of survival with immediate care with the least use of resources or does not require extraordinary resources
CPB

3- tier
Emergent requires treatment immediately or within 15 to 30 minutes Urgent serious illness or injury that must be attended to within 2 hours Non-urgent can wait more than 2 hours
CPB

4-Tier Expectant victim is dead or expected to die Immediate Critical; life threatening compromised airway, shock, hemorrhage Delayed Minor illness or injury; requires treatment within 20 minutes to 2 hours Minimal/Fast-Track walking wounded; first aid treatment
CPB

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5-Tier DOA/DyOA Victim is dead or dying. Emergent life threatening injuries, needs immediate attention Urgent must be treated within 1-2 hours Non-Urgent Ambulatory, walkingwounded No Injury No treatment is necessary
CPB

Red Clients who have life threatening conditons Need IMMEDIATE CARE Yellow Clients who have cases that are not lifethreatening if treated promptly Care should be given within 1-2 hours Green Clients who have local injuries Black Clients who are dead or dying

CPB

You are a triage nurse responding to a mass casualty after an MRT bombing with estimated 1000 victims. Which of the following patients will you attend to first? a. 65yo with facial lacerations, crying intensely b. 40yo with arm bruises and unconscious c. 29yo unconscious, no pulse with pupils constricted d. 37yo with open fracture of femur

You are a triage nurse responding to a mass casualty after an MRT bombing with estimated 1000 victims. Which of the following patients will you attend to first? a. 65yo with facial lacerations, crying intensely b. 40yo with arm bruises and unconscious c. 29yo unconscious, no pulse with pupils constricted d. 37yo with open fracture of femur

CPB

CPB

After a sustained earthquake in the hospital, the west wing collapsed and the following patients were brought to the ED. As an Emergency Nurse who will you prioritize? a. 29yo unconscious, no pulse, irregular breathing b. 2yo with head laceration, projectile vomiting c. 40yo disoriented and confused d. 13yo with ear bleeding and facial bruises

After a sustained earthquake in the hospital, the west wing collapsed and the following patients were brought to the ED. As an Emergency Nurse who will you prioritize? a. 29yo unconscious, no pulse, irregular breathing b. 2yo with head laceration, projectile vomiting c. 40yo disoriented and confused d. 13yo with ear bleeding and facial bruises

CPB

CPB

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A 63 yo Pt with Chest pain A pt presenting sx of Bells palsy 3. An elderly with Pneumothorax 4. A MVA victim Open leg fractures 5. A sportsman with sprains 6. A beggar with Multiple abdominal injury 7. A burn victim with 20% TBSA affected 8. A child with penetrating eye injury 9. A lady with wrist fractures 10. A GSW victim unresponsive, no BP, pulse
1. 2.
CPB

FBAO Shock Hemothorax, pneumothorax, chest trauma Asphyxia Unstable chest and abdominal wounds Incomplete amputations Open fractures of long bones 2nd/3rd degree burns of 15 40% total body surface area.

CPB

Stable abdominal wounds without evidence of significant hemorrhage; soft tissue injuries; maxillofacial wounds without airway compromise; vascular injuries with adequate collateral circulation; genitourinary tract disruption; fractures requiring open reduction, dbridement, and external fixation; most eye and CNS injuries.

Upper extremity fractures minor burns Sprains small lacerations without significant bleeding behavioral disorders or psychological disturbances.
CPB CPB

Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple anatomical sites and organs, 2nd/3rd degree burns in excess of 60% of body surface area, seizures or vomiting within 24 hr after radiation exposure, profound shock with multiple injuries, agonal respirations; no pulse, no BP, pupils fixed and dilated.
CPB

Never move a casualty backward (against the flow). Never hold a critical patient for further care. Salvage life over limb. Triage providers do not stop to treat patients. Never move patients before triage except in cases of:
Risks due to bad weather. Impending darkness or darkness has fallen. A continued risk of injury. Medical facilities are immediately available.

CPB

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A disaster is any human-made or natural event that causes destruction and devastation that cannot be alleviated without assistance Types:
Internal within the health care agency External outside the health care agency

Natural Disasters typhoons, flashfloods, hurricanes, wildfires, thunderstorms, earthquake, blizzards, hailstorms, epidemics, droughts, landslide Human-made Disasters
Biological Warfare Chemical and Hazardous material (HAZMAT) Incidents Radiologic Disasters Terrorism Attacks War Transportation Accidents Structural Collapse and Fires

CPB

CPB

Disasters are often classified by the resultant anticipated necessary response: Level I: Local emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath. Level II: Regional efforts and aid from surrounding communities are sufficient to manage the effects of the disaster. Level III: Local and regional assets are overwhelmed; statewide or federal assistance is required. CPB CPB

1.

2. 3. 4. 5.

Mitigation action or measures that can prevent the occurrence of a disaster or reduce its effects Preparedness establishing disaster plans and disaster drills Response putting disaster plans into action; save lives and prevent damage Recovery actions taken to return to a normal situation Evaluation
CPB

CRITICAL INCIDENT STRESS MANAGEMENT

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Defusing is a process by which the individual receives education about recognition of stress reactions and management strategies for handling stress. 2. Debriefing is a more complicated intervention; it involves a 2- to 3- hour process during which participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing, and other psychological ramifications.
1.
CPB

Phases: Alert phase - during which staff remain at their regular positions, service provision is uninterrupted, and faculty and staff await further instructions from their supervisors Response phase - Response phase, during which designated staff report to supervisors or the command post for instructions, the response plan is activated, and nonessential services are suspended Expanded response phase - when additional personnel are required, off-duty staff are called in, and existing staff may be reassigned based on patient needs

CPB

Biologic Wafare Chemical Warfare Nuclear Radiation

VIRAL Smallpox SEPSIS BACTERIAL Anthrax Peumonia Plague Pneumonia Tularemia Pneumonia Botulism Respiratory Arrest
CPB CPB

1.

VESICANT Agents

3.

BLOOD Agents

Causes blister formation and burns Lewisite, Sulfur mustard, Nitrogen mustard

2.

NERVE Agents

Inhibits Aerobic Metabolism Cyanide Antidote: Na nitrite, Na thiocyanate, Amyl nitrite, hydroxycobalamin

Inhibits Cholinesterase Excessive Parasympathetic effects Sarin, Soman Organophosphates

4.
CPB

PULMONARY Agents

Separates alveoli and capillary membrane Phosgene, Chlorine

CPB

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Acute Radiation Syndrome Phases

Prodromal 48 to 72 hrs post exposure

Anorexia, NV, Diarrhea High doses Fever, Respiratory

distress
2.

Latent phase up to 3wks

3.

Ilness phase
Infection, bleeding, FE Imbalance, shock

CPB

CPB

4.

Death (or Recovery)

CPB

CPB

Ensure SAFETY of responders Don PPE Decontaminate Victims Triage and Treat Report to Authorities Philippines - NDCC
CPB

LEVEL A
Self Contained Breathing Apparatus (SCBA) Chemical-resistant suit, gloves, boots

LEVEL B
SCBA Chemical-resistant suit

LEVEL C
Air-purified Respirator (APR) Chemical-resistant suit, splash hood, gloves, boots

LEVEL D
Regular Uniform

CPB

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CPB

CPB

CPB

CPB

1. 2. 3. 4. 5. 6.

Go with the flow Dont go slow Life over limb Dont go limp Dont move patients before triage, except in cases of risks Triage first, dont make it worst
CPB CPB