Transcript emergency / trauma/ mass casualty/ bioterrorism

Demographic
Multiple specialties
Increasing visits to 123.8 million in 2011
Avg age of patient is 35.7 yrs old
75 + years old highest visit rate
Common reasons for healthcare
seeking:
A.
B.
C.
D.
CHART 66-1
Priority Emergency
Measures for
All Patients
Make safety the first priority
Preplan to ensure security and a safe
environment
Closely observe patient and family
members in the event that they
respond to stress with physical
violence
Assess the patient and family for
psychological function
Patient and family-focused
interventions
Relieve anxiety and provide a sense
of security
Allow family to stay with patient, if
possible, to alleviate anxiety
Provide explanations and information
Provide additional interventions
depending upon the stage of crisis
Technical Skills
Multitasking
Assist with:
Wound closure
Foreign body removal
Central line insertion
Transvenous pacemaker insertion
Lumbar puncture
Pelvic exam
Chest tube insertion
Lavage
Fracture management
http://www.youtube.com/watch?v=n5Zw4ZARvNg
Core Competencies
Triage
Means: to sort: ED triage differs from disaster
triage in that patients who are the most critically
ill receive the most resources, regardless of
potential outcome
1. Across-the-room assessment
starts with visual contact, general
appearance, work of breathing, skin color
2. Determine chief complaint
3. Focused assessment
(Subjective data) demographics, onset of
symptoms, past medical history, LMP, current
meds, allergies
(Objective data) inspection, palpation,
auscultation, obtain vital signs
Primary Survey
A: Airway
patency, stridor, inability to speak, rise
and fall of chest
B: Breathing
rate and depth, breath sounds, chest
expansion, skin color, spontaneous
breathing
C: Circulation
heart rate, pulses, blood pressure, skin,
cap refill
D: Disability Alertness, Responsive to Voice,
Responsive to pain, Unresponsiveness
E: Exposure
Remove clothing, keep pt warm
Priorities of Care for the
Patient With Multiple
Trauma
Use a team approach
Determine the extent of injuries and
establish priorities of treatment
Assume cervical spine injury-log roll
protect spine
Assign highest priority to injuries
interfering with vital physiologic
function
Trauma Nursing
By: Diana Blum RN MSN
Metropolitan Community College
Heat
Bites
Cold
Electrical
Altitude
Near drowning
Spinal
Head
Musculoskeletal
wounds
Stab/gunshot
rape
Acute Medical
Emergency
Failure of heat regulating
mechanisms
Elderly and young at risk
Exceptional heat
exhaustion
Stems from heavy
perspiration
Need to stay hydrated!
Causes thermal injury at
cellular level
may
Mental status…Seizure
occur
Monitor vitals frequently
Renal status
Monitor temp continuously
 EKG, Neuro status
Hypermetabolism due to
increased body temp
Increases 02 demand
Hyperthermia may
recur in 3 to 4 hours;
avoid hypothermia
Lower temp as quickly
as possible(102 and
lower) How can this be
done?
ABC’s
Give 02, Start large bore
IV
Insert foley
Labs:
Lytes, CBC, myoglobin.
Cardiac enzymes
 Exhaustion
 Stroke
 Caused by
dehydration
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Stems from heavy
perspiration
Poor electrolyte
consumption
 Signs/Symptoms
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Normal mental status
Flu like
Headache
Weakness
N/V
Orthostatic
hypotension
Tachycardia
 Treatment
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Outside hospital
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Stop activity
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Re-hydrate (water, sports
drinks)
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Move to cool place
Cold packs
Remove constrictive
clothing
If remains call 911
In hospital
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IV 0.9% saline
Frequent vitals
Draw serum electrolyte
level
 Leads to organ failure
and death
 Mortality rate up to 80%
 2 types:
 Exertional
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Sudden onset
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Occurs over period of time
Too heavy clothes
 Classic
Chronic exposure to heat
Example (no air conditioning)
Assessment
 Monitor mental status
 Monitor vitals
 Monitor renal status
Treatment
 At site
ensure patent airway 
Move to cool
environment
Pour water on scalp and
body
Fan the client
Ice the client
Call 911
At hospital
O2
Start IV
Administer normal saline
Use cooling blanket
DO NOT give ASA
Monitor rectal temp q15
minutes
Insert foley to monitor
I/Os closely and measure
specific gravity of urine
Check CBC, Cardiac
enzymes, serum
electrolytes, liver enzymes
ASAP
Assess ABGs
Monitor vitals q 15
minutes
Administer muscle
relaxants if the client
shivers
Slow interventions when
core temp is 102 degrees
or less
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Management of Patients With Heat
Stroke
 Remember ABCs (decrease temp
to 39° C as quickly as possible
 Cooling methods
 Cooling
blankets, cool sheets, towels,
or sponging with cool water
 Apply
ice to neck, groin, chest, and
axillae
 Iced lavage of the stomach or colon
 Immersion in cold water bath
 Monitor
temp, VS, ECG, CVP, LOC,
urine output
 Use IVs to replace fluid losses
–Hyperthermia may recur in 3 to 4
hours; avoid hypothermia
Ensure adequate fluid and
foods intake
Prevent overexposure to sun
Use sunscreen with at least
SPF 30
Rest frequently when in hot
environment
Gradually expose self to heat
Wear light weight, light
colored, loose clothing
Pay attention to personal
limitations: modify
accordingly
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HYPOTHERMIA
 Most common
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Hypothermia
Frostbite
 Synthetic clothing is best because it
wicks away moisture and dries fast
 “cotton kills” it holds moisture and
promotes frostbite
 A hat is essential to prevent heat loss
though head
 Keep water, extra clothing, and food in
car in case of break down
Hypothermia
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Internal core temperate is 35° C or less
Elderly, infants, persons with concurrent
illness, the homeless, and trauma victims
are at risk
Alcohol ingestion increases susceptibility
Hypothermia may be seen with frostbite;
treatment of hypothermia takes
precedence
Physiologic changes in all organ systems
Monitor continuously
 Apathy, drowsiness,
pulmonary edema,
coagulopathies
 Weak HR and BP
 Hypoxemia
 Continuous
temperature and EKG
 Watch for dysrhythmias
 Warm fluids, blankets
 Cardiopulmonary bypass
 Warm lavage
Frost Bite
 Inadequate insulation is the culprit
 3 stages
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Superficial (frost nip)
Mild
Severe
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1st degree- hyperemia, edema
2nd degree- fluid blisters with partial thick necrosis
3rd degree- dark fluid blisters, sub cutaneous necrosis
4th degree- no blisters, no edema, necrosis to muscle and
bone
 Frostnip produces mild pain,
numbness,pallor of affected skin
 Graded like burns-partial thick or full thick
 Most species non venomous and
harmless
 Poisonous snakes found in each
state except Maine, Alaska, and
Hawaii
Fatalities are few
 Children 1-9 yrs old victims during
daylight hours
 AWARENESS is KEY
2 main types in North America are
 1.
 2.
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 Pit Vipers
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Depression between eye and
nostril
Triangular head indicative of
venom
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Venom function is to immbolize, kill
and aid in digestion of prey
(systemic effects happen with in 8
hours of puncture)
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impairs blood clotting
Breaks down tissue protein
Alters membrane integrity
Necrosis of tissues
Swelling
Hypovolemic shock
Pulmonary edema, renal failure
DIC
2 retractable curved fangs with
canals
Rattlers have horny rings in tail
that vibrates as a warning
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Treatment
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At site
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Move person to safe area
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Remove jewelry and restrictive
clothing
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Encourage rest to decrease
venom circulation
Splint limb below level of heart
Be calm and reassuring
No alcohol or caffeine 2nd to
speed of venom absorption
Snake Bites
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At hospital
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Constrict extremity but not to tight
Do NOT incise or suck wound
Do NOT apply ice
Use Sawyer extractor if available if
used within 3 minutes of bite and
leave for 30 minutes in place
O2
2 large bore IV sites
Crystalloid fluids (NS or LR)
Continuous tele and bp monitoring
Opiod pain management
Tetanus shot
Broad spectrum antibx
Lab draw (coagulation studies, CBC,
creatinine kinase, T and C, UA)
ECG
Obtain history of wound and prehospital tx
measure circumference of bite
every 15-30 minutes
Possibly give antivenom if ordered
(see page 177)
Monitor for anaphylaxis
Notify poison control
 Coral Snakes
 Corals burrow in the ground
 Bands of black, red, yellow
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“red on yellow can kill a fellow”
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Enough in adult coral to kill human
“red on black venom lack”
 Are generally non aggressive
 Ability to inject venom is less efficient
 Maxillary fangs are small and fixed
 Use chewing motion to inject
 Venom is neurotoxic and myotoxic
 Action of venom
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Blocks binding of
acetylcholine at post synaptic
junction
 S/S
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pain mild and transient
Fang marks may be hard to
see
Effects may be delayed 12
hours but then act rapidly
after
N/V
Headache
Pallor, abd pain
Late stage: parathesias,
numbness, mental status
change, crainal and peripheral
nerve deficit , flaccid,
difficulty speaking,
swallowing, breathing
elevated creatinine kinase
 Coral
Treatment
 At site
 At Hospital
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Continuous tele
Continuous bp and
pulse ox
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Try to ID
snake
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Same as pit
viper without
concern of
necrosis
Provide airway
management (possible
ET tube)
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Provide antivenom
treatment as ordered
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Monitor for anaphylaxis
from antivenom
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Notify poison control
http://www.expotv.com/videos/reviews/19/169/Coghlan27sSnakeBiteKit/
156505
Avoid venomous snakes as pets
Be cautious in areas that harbour
snakes like tall grass, rock piles,
ledges, crevices, caaves, swamps
Don protective attire like boots, heavy
pants and leather gloves. Use a
walking stick
Inspect areas before placing hands or
feet in them
Do not harass snakes….striking
distance is the length of the snake
Snakes can bite even 20—60 minutes
after death due to bite reflex
Use caution when transporting snake
with victim to hospital…make sure it is
in a sealed container.
 Spiders: carnivorous
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Almost all are venomous
Most not harmful to
humans
Brown recluse, black
widow, and tarantula are
dangerous for example
 Scorpions: not in
Midwest or New
England
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Sting with tail
Bark scorpion is most
dangerous
 Bees and Wasps
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Wide range of reactions
African or killer bees
are very aggressive
found in southwest
states
http://www.videojug.com/film/how-to-treat-an-insect-bite
 Bites result in ulcerative
lesions
 Cytotoxic effect to tissue
 Medium in size
 Light brown color with dark
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brown fiddle shaped mark
from eyes
Shy in nature..hide in boxes,
closets, basements, sheds,
garages, luggage, shoes,
clothing, bedsheets, clothes
 Over 1-3 days lesion
becomes dark and
necrotic…eschar even
forms, and sloughs
 Surgery is often
needed
 Skin grafting
 Rare: Malaise, Joint
pain, Petechaie, N/V
Fever, Chills
 Pruritis
Erythema
 Extreme: hemolytic,
renal failure, death
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 Treatment
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At site
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Cold
compress
initially and
intermittentl
y over 4
days (may
limit
necrosis)
Rest
Elevation of
extremity
 At hospital
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NEVER use
heat
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Topical antiseptic
Sterile dressing
changes
Antibx
Dapsone:
polymorphonuclear
leukocyte inhibitor:
50mg twice/day
Monitor lab work
closely
Surgery consult
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Debridment and skin
grafting
 Found in every state but
Alaska
 Prefers cool, damp,
environment
 Black in color with red
hourglass pattern on abd
 Male are smaller and
lighter color that females
 Carry neurotoxic venom
 Bites to humans are
defensive in nature
 Main prey other bugs,
snakes, and lizards
 Bite is can be painful,
local reactions
 Systemic reactions can
happen in 1 hour and
involve the
neuromuscular system
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Causes lactrodectism
Venom causes neurotransmitters to release
from nerve terminals
s/s
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Abd pain
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Peritonitis like symptoms
N/V
Hypertension
Muscle rigidity
Muscle spasms
Facial edema
Pytosis
Diaphoresis
Weakness
Increased salavation
Priapism
Respiratory difficulty
Faciculations
parathesias
 At site
 Apply an ice
pack
 Monitor for
systemic
involvement
 ABCs
 At hospital
 Monitor vitals
 Pain meds
 Muscle relaxants
 Tentanus
 Monitor for seizures
 Antihypertensives
 Anti venom if
needed
 Call poison control
 Largest spider
 Found mostly in tropical and
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subtropical parts of USA
Some are in dry arid states
like New Mexico and Arizona
Can live 25 years
Venom paralyzes prey and
causes muscle necrosis
Most human bites have local
effects
Have urticating hairs in
dorsal abd area that can be
launched for a defensive
technique landing in skin
and causing an inflammatory
response
 USA trantulas don’t
produce systemic
reactions
 Worldly ones do
 S/S
 Pain at site
 Swelling
 Redness
 Numbness
 Lymphangitis
 Intense pruritis
 Severe ophthalmic
reactions if hairs come
in contact with eyes
 Treatment
 Pain meds
 Immobolize
extremity
 Elevate site
 Remove hairs with
sticky tape followed
by irrigation
 For eyes: irrigation
with saline
 Antihistamines and
steroids for pruritis
 Found in many states
 Not usual in midwest
or new england
unless pet, or
transported in
baggage
 Venom in stinger
located on the tail
 s/s
 Localized pain
 Inflammation
 Mild symptoms
 Treatment: pain
meds, wound care,
supportive
management
 Deadly
 Has a fatal sting
 Found
in tress, wood
piles, and around
debris
Humans stung when it
gets in clothing, shoes,
blankets, and items
left on ground
 Solid
yellow, brown, or
tan in color
 Have
thin pinchers,
thin tail, and a
tubercle
 Found
in Arizona, New
Mexico, Texas,
Nevada, and
California
 Has neurotoxic venom
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 s/s
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Involve cranial nerves
May be symptom free
Pain
Respiratory failure
Pancreatitis
Musculoskeletal
dysfunction
 Gentle
tap at possible
sting site while client
not looking greatly
increases pain, and is
confirmation of bite
Symptoms begin
immediately and
reach maximum
intensity in 5 hours
 Most
symptoms
resolve in 9- 30 hours
 Pain
and parathesia
can last 2 weeks
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 Treatment
 Monitor vitals
 May need intubation
 Supply O2
 IV Fluids
 Ice pack to sting site
 Pain meds and
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sedatives with caution
in non intubated client
Wound care
Call poison control
Atropine gtts to help
with hypersalavation
Antivenom if needed
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Stings cause wide array of reactions
S/S
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Anaphylaxis most severe
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Respiratory failure
Hypotension
Decrease in LOC
Dysrhythmias
Cardiac arrest
Pain
Local reaction
Swelling
N/V
Diarrhea
Pruritis
Urticaria
Lip swelling
 At site
 Remove
stinger
 Ice pack
 Epipen if
allergy to
bees
 Call 911 if
needed
 In hospital
 ABCs
 Check history for
allergy
 Epinephrine
 Antihistamine
 O2
 NS 0.9%
 corticosteroids
 Wear protective clothing
when working in areas with
known venomous athropods
(bees, scorpions, wasps)
Cover garbage cans
Use screens in windows and
doors
 Inspect clothing and, shoes
and gear before putting on
Shake out clothing and gear
that is on ground
 Exterminate the exterior
house
Do not place hands where
eyes can not see
 Do not keep insects as pets
 Epi pen if allergy to bee/wasp
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Year round problem
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Most common in summer
Caused by electrical charge in cloud
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Large energy with small duration
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Direct strike
 High voltage is 1000 volts
 Lighting is 1 million volts
Cloud to ground is most dangerous
Flash over phenomenon: force powerful
enough to blow off or damage the
victims clothing
Injury is by:
Spashing or side flash off of near by structure
Through the ground
 Best
remedy:
AVOIDANCE
 Education
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Observe forecasts
Seek shelter when your hear
thunder
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DO NOT stand under tree
DO NOT stand in an open area
Isolated sheds and caves are
dangerous
Leave water immediately
Avoid metal objects
If camping stay away from metal
tent poles and wet walls
Stay away from open doors,
windows, fireplaces
Turn off electrical equipment
Stay off of telephone
Move to valley area and huddle
in ball if in open area (this
minimizes target area)
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Most lethal effect is asystole or
Vfib
Most victims suffer cardiac injury
S/S
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Mottled skin
Cardiac arrest
Respiratory arrest
Decreased or absent peripheral
pulses
Temporary paralysis
Loss of Consciousness
Amnesia, confusion, disorientation
Photophobia
Seizures
Fatigue and PTSD
Ruptured tympanic membranes
Blindness, cataracts, retinal
detachment
Skin burns
Ferning marks: branching on the
skin
 Hospital care
 At site
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Spinal
immobilization
Monitor ABCs
CPR
Sterile
dressings for
burns
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ACLS
Telemetry
ABC support
Ventilator prn
Creatinine kinase level
to determine muscle
damage
Monitor for kidney
failure
Monitor for
rhabdomyolosis
(muscle destruction)
Burn precautions
Tetanus
Xfer to burn center
 High
altitude is
elevations above 5000
feet  most ski resorts
 As
altitude
increasesbarametric
pressure decrease
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This means less o2 the
higher you go
 Oxygen
is 21% of the
barametric pressure
 Acclimatizationthe
process of adapting to
high altitudes
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Increased RR
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Decrease in CO2
Respiratory alkalosis
Impaired REM
Excess bicarb excretion
through the kidneys
Cerebral blood flow
increases
3 most common altitude illnesses
 Acute Mountain Sickness (AMS)
Precursor for HACE/HAPE
Throbbing headache, anorexia, N/V
Chilled, irritable
Similar symptoms to alcohol hangover
VS variable
DOE or at rest
 High altitude cerebral edema (HACE)
Unable to perform ADLs
Ataxia w/o focal signs (decreased motor coordination)
Confusion, impaired judgment , seizures
Stupor, Coma, Death from brain swelling
Increased ICP over 1-3 days
 High altitude pulmonary edema (HAPE)
Most frequent cause of death
Poor exercise intolerance and recovery
Fatigue and weakness
Tachycardia and tachypnea, rales, pneumonia
Increased pulmonary artery pressure
Site
 Descent to lower altitude
 Monitor for symptom progression
 Rest
 O2 if available
Hospital
 Acetazolamide
Acts as bicarb diuretic
Sulfa drug
Take 24 hours beforest
ascent and take for 1 2
days of the trip
125mg-250mg po BID
or 500mg SR cap daily
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 Dexamethazone: 4mg –
Altitude Illness
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8mg po or IM initially
then 4mg q6hours during
descent
O2
Monitor airway
Lasix
Critical care
 Plan a slow descent
 Avoid overexertion
and over exposure to
cold
 Avoid alcohol and
sleeping pills
 Stay hydrated and
have adequate
nutrition
 If symptoms develop
descend immediately
 O2 if able
 Wear protective gear
 Wear sunscreen
 Each day in the United States, nine people drown.
 Drowning is the second leading cause of
accidental injury-related death among children
ages 1 to 14.
 Drowning is the leading cause of accidental
injury-related death among children ages 1 to 4.
 Male children have a drowning rate more than
two times that of female children. However,
females having a bathtub drowning rate twice
that of males.
 Among children ages 1 to 4 years, most
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drownings occur in residential swimming pools.
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More than half of drownings among infants (under age 1) occur in
bathtubs, buckets or toilets.
Nonfatal drownings can result in brain damage that may result in
long-term disabilities including memory problems, learning
disabilities, and permanent loss of basic functioning.
Nineteen percent of child drowning fatalities take place in public
pools with certified lifeguards on duty.
Roughly 5,000 children 14 and under go to the hospital because
of accidental drowning-related incidents each year; 15% die and
about 20% suffer from permanent neurological disability.
In nearly 9 out of 10 child-drowning deaths, a parent or caregiver
claimed to be watching the child.
Participation in formal swimming lessons can reduce the risk of
drowning by 88% among children ages 1-4.
2011 Drowning Statistic
Between Memorial Day June 28, 2011, there were 48 drownings
and 75 near-drowning events in 35 states and territories.
Causes
Leaving small children
unattended around
bathtubs and pools
Drinking alcohol while
boating or swimming
Inability to swim or
panic while swimming
Falling through thin ice
Blows to the head or
seizures while in the
water
Attempted suicide





Symptoms
but
Symptoms can vary,
may include:
Abdominal distention
face,
Bluish skin of the
especially
around the lips
Cold skin and pale
appearance
Confusion
Cough with pink,
frothy sputum
Irritability
Lethargy
No breathing
Restlessness
Shallow or gasping
respirations
Chest pain
Unconsciousness
Vomiting











 First Aid
 When someone is drowning:
 Extend
a long pole or branch to the person, or use a
throw rope attached to a buoyant object, such as a life






ring or life jacket. Toss it to the person, then pull him or
her to shore.
People who have fallen through ice may not be able to
grasp objects within their reach or hold on while being
pulled to safety.
Do not place yourself in danger.
Do NOT get into the water or go out onto ice unless your
are absolutely sure it is safe.
If you are trained in rescuing people, do so immediately
if you are absolutely sure it will not cause you harm.
If the victim's breathing has stopped, begin rescue
breaths as soon as you can. This often means starting the
breathing process while still in the water.
Continue to breathe for the person every few seconds
while moving them to dry land. Once on land, give CPR if
needed. For step-by-step instructions on rescue
breathing, see the article on CPR.
Always use caution when moving a drowning victim.
 Assume that the person may have a neck or spine injury, and
avoid turning or bending the neck.
Keep the head and neck very still during CPR and while moving
the person.
You can tape the head to a backboard or stretcher, or secure the
neck by placing rolled towels or other objects around it.
Follow these additional steps:
Keep the person calm and still. Seek medical help immediately.
Remove any cold, wet clothes from the person and cover with
something warm, if possible. This will help prevent hypothermia.
Give first aid for any other serious injuries.
The person may cough and have difficulty breathing once breathing restarts. Reassure the person until you get medical help.







DO NOT
DO NOT go out on the ice to rescue a drowning person that you can
reach with your arm or an extended object.
DO NOT attempt a swimming rescue yourself unless you are
trained in water rescue.
DO NOT go into rough or turbulent water that may endanger you.
When to Contact a Medical Professional
If you cannot rescue the drowning person without endangering
yourself, call for emergency medical assistance immediately. If you
are trained and able to rescue the person, do so and then call for
medical help.
All near-drowning victims should be checked by a doctor. Even
though victims may revive quickly at the scene, lung complications
are common.
 Prevention
 Avoid drinking alcohol whenever swimming or boating.
 Observe water safety rules.
 Take a water safety course.
 Never allow children to swim alone or unsupervised
regardless of their ability to swim.
 Never leave children alone for any period of time, or let
them leave your line of sight around any pool or body of
water.
 Drowning can occur in any container of water. Do not
leave any standing water (in empty basins, buckets, ice
chests, kiddy pools, or bathtubs). Secure the toilet seat
cover with a child safety device.
 Fence all pools and spas. Secure all the doors to the
outside, and install pool and door alarms.
 If your child is missing, check the pool immediately.
 Primary





Hyperflexion (moved forward excessively)
Hyperextension (MVA)
Axial loading (blow at top of head causes
shattering)
Excessive rotation (turning beyond normal
range)
Penetrating (knife, bullet)





Neurogenic shock
Vascular insult
Hemorrhage
Ischemia
Electrolyte imbalance
 Secondary
 1st assess respiratory status

ET tube may be necessary if
compromised
 2nd assess for intra
abdominal hemorrhage
(hypotension, tachycardia,
weak and thready pulse)
3rd assess motor function







C4-5 apply downward pressure
while the client shrugs
C5-6 apply resistance while client
pulls up arms
C7 apply resistance while pt
straightens flexed arms
C8 check hand grasp
L2-4 apply resistance while the
client lifts legs from bed
L5 apply resistance while client
dorsiflexes feet
S1 apply resistance while client
plantar flexes feet
 Observe for signs of
autonomic dysreflexia

Sever HTN, bradycardia, sever
headache, nasal stuffiness, and
flushing

Caused by noxious stimuli like
distended bladder or constipation
 Immediate interventions








Place in sitting position
Call doctor
Loosen tight clothes
Check foley tubing if present
Check for impaction
Check room temp
Monitor BP q10-15 minutes
Give nitrates or hydralazine per
md order
 Immobilize fx
 Proper body alignment
 Traction is possible
 Monitor vs q4 hours or more
 Neuro
checks q4 hours or
more
 Monitor
for neurogenic shock
(hypotension and


bradycardia)
Prepare for possible surgery
Teach skin care, ADLs, wound
prevention techniques, bowel
and bladder training,
medications, and sexuality


Brain Injuries (TBI)
Open- skull fx or when skull is pierced by penetrating object
Linear fx- simple clean break
Depressed fx- bone pressed in towards tissue
Open fx-lacerated scalp that creates opening to brain tissue
Comminuted fx- bone fragments and depresses into brain tissue
Basilar- unique fx at base of skull with CSF leaking though the ear
or nose
Closed- blunt trauma
Mild concussion-brief LOC
Diffuse axonal injury- usually from MVA
May go into coma
Contusion-bruising of brain
Site of impact (coupe)
Opposite side of impact (contrecoupe)
Laceration-tearing of cortical surface vessels that leads to
hemorrhage edema and inflammation












 Always assume c-spine
injury
 ABC highest priority
 Control bleeding right
away
 Frontal


Front of car stops and driver
keeps going
Injuries: Seatbelt, Steering
wheel, TBI, cspine, flail chest,
myocardial contusion
 Side

Injuries: Cspine, flail chest,
pneumothorax
 Rear

Hyperextension, cspine

Multiple injuries
 Rollover
Figure 74.2
Unrestrained frontal
impact.
 Motorcyle
 Tib/fib, chest, abd, TBI,
cspine, femur
 Pedestrian
 Femur, chest, lower
extremities
 Falls
 Calcaneous, compression,
wrist, TBI
 Battles sign
 Raccoon eyes
 Flail chest
 Tension Pneumothorax
 Hemothorax
 Acceleration-caused by
external force
contacting head
 Deceleration- when
head suddenly stops or
hits a stationary object
 Normal ICP is 1015mmHg
 Normal increases occur


with coughing, sneezing,
defecation
Leading cause of death
for head trauma
As ICP increases cerebral
perfusion decreases
causing tissue hypoxia,
decrease serum pH, and
increase in CO2
 3 types of edema
 Vasogenic: increase in
brain tissue volume
 Cytotoxic: result of
hypoxia
 Interstitial: occurs with
brain swelling
 Epidural- bleed b/w
dura and inner table
 Subdural-bleed below
dura and above arachoid
 Intracerebral-
accumulation of blood in
brain tissue
 48-72 hours after injury





hematoma forms at break site
Area of bone necrosis forms
secondary to diminished
blood flow
Fibroblasts and osteoblasts
come to site
Fibrocartilage forms =new
foundation
Callus forms 2-6 weeks after
initial break
3 weeks to 6 months later new
bone is formed
 Age
 Severity of trauma
 Bone injured
 Inadequate
immobilization
 Infection
 Avascular necrosis
Musculoskeletal assessment












Assess for life threatening
complications
Skin color and temp
Movement
Sensation
Pulses especially distal to the injury
Cap refill
Pain
Listen for crepitation-grating sound
Look for ecchymosis
Assess for subcutaneous
emphysema-bubbles under skin
(like bubble wrap when pushed)
Assess clients feeling of situation
Some fractures can causes internal
injury-hemorrhage
 No special lab tests
except maybe DDimer for clots
 H/H could be low due
to bleeding
 CT
 Bone scan
 MRI
 X-rays
 Affected extremity
 Inspect fx site
 Palpate area lightly
 Assess motor function
 Immobilize extremity
 Realignment
 Cast
 Traction
 Surgery
 open reduction with internal
fixation
 Provide education regarding





medication
Instruct the client on s/s of
infection (foul discharge,
purulent drainage, fever,
lethargy, etc)
Instruct on dressing changes
and importance of them
Instruct about pressure ulcer
prevention
Instruct on use of crutches or
walker if needed
Instruct about HHC and other
available resources
 Fx of clavicle usually from a fall
 Fx of scapula not common and caused by direct impact
 Fx of humerus common in older adult
 Fx of olecrenon usually from fall directly onto elbow
 Fx of radius and ulna usually Fx together
 Fx of wrist and hand most common site is the carpal





scaphoid bone in young adult men..one of the most
misdiagnosed Fx b/c of poor visibility on x-ray
Fx of hip caused by falls
Fx of femur caused from trauma
Fx of patella result from direct impact
Fx of tibia and fibula usually break together
Fx of ankle and foot difficult to heal because of instability of
ankle bone
 Fx of ribs and sternum caused by chest trauma
and potentially can puncture lungs, heart and
arteries
 Fx of pelvis can also cause major internal
damage because of the vascular structure
present
 Compression Fx of the spine usually caused by
osteoporosis. This causes pain, deformity,
neurologic compromise
 High incidence of hemmorage
 Femur fx-cast, brace, splint, traction
 Fat embolism: fat from bone released into blood and
into heart, lungs, etc
 Pelvic- girdle, assess for stability
 Large amount of force
 Rectal exam
Femur
and Pelvic
Fractures
Figure 56.10
Vascular anatomy of
the pelvis.
 Painful
 Needs to be reduced
ASAP
 Can cause nerve
damage
 Avascular Necrosis
 Dislocation occludes
blood supply
 Vertebroplasty
 Kyphoplasty
 Both are minimally
invasive
 Both use a bone cement
to provide immediate
relief of pain










complications
Acute compartment syndrome: increase pressure compromises circulation to are. Most
common in lower leg and forearm.
Fat embolism: fat from bone released into blood and into heart, lungs, etc. Most common with
long bone fx
DVT
PE
INFECTION: from break or from implanted hardware..bone infection most common with open fx
Fracture blisters: associated with twisting injury..fluid moves into vacant spaces..leads to
infection
Ischemic necrosis: blood flow to bone is disrupted
Delayed union: unhealed after 6 months
Nonunion:never completely heal
Malunion: heal incorrectly



amputations
Removal of part of the body
Types


Traumatic- example digit
Levels



Surgical-example digit
Lower extremity: digits, bka, aka,
midfoot
Upper extremity: hands, fingers,
arms
Complications



Hemorrhage


Immobility

Infection
Phantom limb pain: perceive pain in
the amputated limb
Neuroma: sensitive tumor
consisting of nerve cells found at
several nerve endings
Contractures
assessments
 Skin color
 Temp
 Sensation
 Pulses
 Cap refill
 Assess feelings r/t amputation
 Young: bitter, hostile, uncooperative, loss of job, loss of

hobbies, altered self concept, feeling a loss of
independence
Assess families perceptions also
 Routine preop xrays done
 BP done in all extremities
 Angiography to look at layout of vessels

CRUSH SYNDROME
CAUSES




Wringer type injuries
Natural disasters
Work related injuries
Drug or alcohol overdose



Acute compartment syndrome
Hyperkalemia
Rhabdomyolosis – myoglobin released into blood

Hypovolemia, hyperkalemia, compartment syndrome

IVF, diuretics, low dose dopamine, sodium bicarb, kayexelate,
hemodialysis is possible.
 CHARACTERISTICS
 S/S
 TX
Complex regional pain syndrome
 s/s: debilitating pain, atrophy, autonomic dysfunction
(excessive sweating, vascular changes), and motor
impairment (muscle paresis)
 Caused by hyperactive sympathetic nervous system
 Results from trauma
 Common in feet and hands
 3 stages:



1: lasts 1-3 months; local severe burning pain, edema,
vasospasm, muscle spasms
2: 3-6 months; pain, edema, muscle atrophy, spotty
osteoporosis
3: marked muscle atrophy, intractable pain, severely limited
mobility, contractures, osteoporosis
 Pain control
 PT
 OT
 ROM
 Gentle skin care
 Support groups, etc
Sports related injuries
 Tears
 Lock knee
 Torn ACL
 Tendon rupture
 Dislocation
 Subluxation
 Strains
 Sprains
 Torn rotator cuff
Casts
Braces
Splints
Traction
Surgery
Reduction (realignment)
 4 types of wounds
 Incised = Sharp cut like injuries
(knives, glass)
 Slash wounds= more longer than
deep
 Stab wound= depth longer than
length
 Defense wound= warding
wounds (like on hand)
 Defense Wound
 Stab Wound w/ single
edge blade
 4 types
 Close contact= illustrates



a patternized abrasion
around the wound
Contact= barrel has
contacted the skin and
the gases have passed
into SQ tissues faint
abrasion ring and sone
grey/black discoloration
Intermediate wound=
powder tatooing
Exit wound= slit like exit
wound…no powder or
soot
Wound Care Treatment (at Site)
 Bleeding can usually be stopped by applying direct pressure
to the wound.
 Very large foreign objects stuck in a wound should be
stabilized. Do not remove them.
 All wounds require immediate thorough cleansing with fresh
tap water.
 Gently scrub the wound with soap and water to remove
foreign material.
 Remove dead tissue from the wound with a sterile scissors or
scalpel.
 After cleaning the wound, a topical antibiotic ointment
(bacitracin) should be applied 3 times per day.
 Wounded extremities should be immobilized and elevated.
 Puncture wounds are usually not sutured (stitched) unless
they involve the face.


If the wound is clean, the edges can be drawn together
with tape.
 (Do
not cover wounds inflicted by animals or
that occurred in seawater with tape.)
Oral antibiotics are usually recommended to prevent
infection.
 Ifleast
infection develops, continue antibiotics for at
5 days after all signs of infection have



cleared.
Inform the doctor of any drug allergy prior to
starting any antibiotic. The doctor will
prescribe the appropriate antibiotic. Some may
cause sensitivity to the sun, so sunscreen (at
least SPF 15) is mandatory while taking these
antibiotics.
Pain may be relieved with 1-2 acetaminophen (Tylenol)
every 4 hours, 1-2 ibuprofen (Motrin, Advil) every 6-8
hours, or both.
Call 911 or get to ER immediately if stab or gunshot
wound.
In Hospital Treatment
•Stay Safe. Utilize universal precautions and wear personal protective equipment if
available.
•Control bleeding before anything else. Putting pressure directly on the puncture
wound while holding it above the level of the heart for 15 minutes should be enough
to stop bleeding.
• If not, try using pressure points. Tourniquets should be avoided unless medical
care will be delayed for several hours.
•Holes in the chest can lead to collapsed lungs.
• Deep puncture wounds to the chest should be immediately sealed by hand or
with a dressing that does not allow air o flow. Victims may complain of shortness
of breath. If the victim gets worse after sealing the chest puncture wound, unseal
it.
•Once bleeding has been controlled, wash the puncture wound with warm water and
mild soap . If bleeding starts again, repeat step two.
Sexual abuse (also referred to as molestation)
is defined as the forcing of undesired sexual acts
by one person to another. The term incest is
defined as sexual abuse between family
members, and the euphemism "bad touch" is
sometimes used to describe such abuse.
(Renvoizé 1982)
Different types of sexual abuse involve:

Non-consensual, forced physical sexual behavior such
as rape or sexual assault
Psychological forms of abuse, such as verbal sexual
behavior or stalking.
The use of a position of trust for sexual purposes.
Acquaintance rape - forced sexual intercourse
between individuals who know each other - is a
crime that is widespread on many college and
university campuses.
 Usually, both parties involved in acquaintance rape
have been drinking - often to excess.
Research has not yet explained how and why
alcohol is related to aggression in general or to
acquaintance rape in particular
http://www.youtube.com/watch?v=PvXxzZUuIn
0











Signs of sexual abuse
Unexplained injuries (especially to
parts of the female body that can be
covered by a two-piece swimsuit)
Torn or stained clothing or
underwear
Pregnancy
Sexually transmitted diseases
(STDs)
Unexplained behavioral problems
Depression
Self abuse and/or suicidal behavior
Drug and/or alcohol abuse
Sudden loss of interest in sexual
activity
Sudden increase of sexual behavior
 The doctor in the emergency room will
examine the victim for injuries and collect
evidence.

The attacker may have left behind pieces of evidence such as
clothing fibers, hairs, saliva or semen that may help identify him.

In most hospitals, a "rape kit" is used to help collect evidence.
A rape kit is a standard kit with little boxes, microscope slides
and plastic bags for collecting and storing evidence. Samples
of evidence may be used in court.

Next, the doctor will need to do a blood test. Women will be
checked for pregnancy and all rape victims are tested for
diseases that can be passed through sex.
 Cultures of the cervix may be sent to a lab to check for
disease, too. The results of these tests will come back in
several days or a few weeks.

It's important for the client to see their own doctor in 1 or 2 weeks
to review the results of these tests. If any of the tests are positive,
the victim will need to talk with your doctor about treatment.

treatments.
The emergency room doctor can tell the victim about different
pregnancy
If a birth control pill or intrauterine device (IUD)
is small.
the chance of
prevention
If no birth control is taken the victim may consider pregnancy
treatment.
first
Pregnancy prevention consists of taking 2 estrogen pills when you
get to the hospital and 2 more pills 12 hours later. This treatment
reduces the risk of pregnancy by 60% to 90%. (The treatment may
make you feel sick to your stomach.)
about
The risk of getting a sexually transmitted disease during a rape is
5% to 10%. Your doctor can prescribe medicine for chlamydia,
gonorrhea and syphilis when the victim first gets to the hospital.
vaccination
If not already vaccinated for hepatitis B, the victim should get that
when you first see the emergency room doctor. Then
they’ll get another vaccination in 1 month and a third in 6 months.
infection.
The doctor will also discuss human immunodeficiency virus (HIV)
Your chance of getting HIV from a rape is less than 1%, but if
you want preventive treatment, you can take 2 medicines-- zidovudine
(brand name: Retrovir) and lamivudine (brand name: Epivir) -- for 4
weeks.


Classified as assault

Difficult to prosecute b/c of lack of
evidence


Primary cause is an aggressive
desire to dominate according to
experts
Statistics



Women by men: 90-91% most frequent
Male by male: 9-10% less common
Little to no research on women offenders
Definition

Intercourse , is attempted or happens
without consent of one of the parties
involved (penetration with penis or
objects etc)
 Gang

Multiple offenders, one
victim
 Date
 Custodial
 Serial
 Marital
 Prison
 Acquaintance
 Wartime
 Statuatory
 Unpredictable emotions




Feeling numb and detached

Relive the rape over and
over
Memory problems
Avoidance of things
anxiety
 PTSD can occur
 Disturbed sleeping
patterns
 Eating habits affected
 If reported to police
50% chance an arrest
will be made
 If arrest made, 80%
chance of prosecution
 If prosecuted, 58%
chance of felony
conviction
 If felony conviction,
69% chance of jail
time
 If abuse suspected
 Child
 Domestic
 Any type
Mass Casualty
Classified disaster earthquake,
tornado, accident, Terrorist attack
Notify by radio/pager
Utilize telephone tree to call staff in
INCIDENT COMMAND CENTER
initiated
Commander
Triage officer
Medical command physician
Critical Incident Stress Debriefing
2 types
Critical Incident Stress
Management
Post Traumatic Stress
Disorder
Administrative Review
Psychological Effects After a
Disaster
 Provide active listening and emotional support
 Provide information as appropriate
 Refer to therapist or other resources
 Discourage repeated exposure to media regarding the
event
 Encourage return to normal activities and social roles
Incident Command
Incident Commander
Public Information
Officer
Liaison Officer
Medical or Technical Officer
Safety and
Security
Officer
Operations
Planning
Finance
Logistics
Triage
Description
Color
Immediate
Respirations are present,
very serious injury that can
be fixed quick with out a
lot of resources
RED
Delayed
Can wait to be treated for
hours to days, dislocations,
minor fractures
YELLO
W
Minor
“walking Wounded”, cuts,
minor wounds
GREEN
Expectant/
Deceased
Not breathing, Massive
Head trauma, would take
massive resources away
from many others to save
one
BLACK
DISASTER and
BIOTERRORISM NURSING
Disrupt Daily Life & Cause Terror
and Panic
FBI – “the unlawful use of force or
violence against person’s or
property to intimidate or coerce a
government, the civilian
population, or any segment
thereof, in furtherance of political
or social objectives”
International al Qaeda, Irish Republic Army
Domestic Klux Klux Klan, Greenpeace, and
Individuals like Timothy McVeigh
Anything & Anywhere that
causes large scale disruption
Large crowds/gatherings of
people
Nuclear/Chemical Plants
Federal Systems
Controversial businesses
(Abortion Clinics)
Isolation Precautions for
Biological Terrorism Agents

Due to modern travel, spread of infection may occur
in areas thousands of miles apart

Health care providers need to be aware of potential
signs of biological weapon s

signs and symptoms are similar to those of common
disease process



Isolation practices depend upon the infecting agent

Terminal disinfection and disposal of wastes
depends on the infecting agent
Always use Standard Precautions
Some agents require Transmission-Based
Precautions
Disaster Planning
Assumptions versus Observations
 Assumptions

Dispatchers will send emergency
response units once notified

Trained Emergency personnel
will carry out field search and
rescue

Trained EMS personnel will carry
out triage, first aid, medically
stabilize and decontaminate
before transport



Casualties will be transported via
ambulance to the appropriate
facility or hospital in an
appropriate amount that the
facility or hospital can
accommodate
Hospitals will be properly notified
Most serious casualties will arrive
first
 Observations






Emergency Response Units will self
dispatch (local and distant)
Initial search and rescue is carried out by
the survivors themselves
Casualties are likely to bypass on-the-site
triage, first aid and decontamination
stations and go directly to hospitals
Most casualties are not transported by
ambulance. Most go by private vehicles,
police vehicles, buses or on foot. Most
casualties will go to the nearest hospital or
the most familiar hospital.
Hospitals most often are notified by
arriving victims and/or by news media
The least serious casualties often arrive
first
•
•
•
•
Weapons of Mass Destruction (WMD)
•
Because they cause massive destruction and injury
CBRNE (Department of Justice) – Chemical,
Biological, Radiological, Nuclear and
Explosive (includes Fire-causing)
Delivery of agent – spraying devices,
packages, contaminating water and food,
animals and the wind
Identifying an event –
–
–
–
–
Biological – Delayed onset, epidemiology,
public health
Chemical – symptoms suggestive of chemical
agent used
Radiological – clustering of symptoms
resembling radiological exposure (could be
delayed)
Explosive – boom! Trauma causalities
BIOLOGICAL AGENTS
 Bacteria - Anthrax, Brucellosis


(Black Death),
Cholera, Glanders, Plague, Q Fever,
Rickettsia, Tularemia,
Typhus
Viruses - Dengue Fever, Ebola, Rift
Valley
Fever,
Small Pox, Venezuelan
Equine, Encephalitis (VEE)
Virus,
Viral
Hemorrhagic Fever (VHF)
Toxins - Botulinum, Ricin,
Saxitoxin,
Staphylococcal Enterotoxin B
(SEB),
Trichothecene Mycotoxinx
BIOLOGICAL AGENTS
Bacteria: Anthrax, Brucellosis,
Plague, Q Fever, Tularemia
Viral: Small Pox, Venezuelan equine
encephalitis (VEE), Viral
hemorrhagic fevers
Toxins: Botulinim, Staphylococcal
enterotoxin B (SEB), Ricin,
Trichothecene (T-2) mycotoxins
 3 categories



A: high priority



easy to spread person to person
High death rate
Require special action
(anthrax, botulism, plague, smallpox,
hemorrhagic fever, tularemia)
B: second highest priority



Moderately easy to spread
Moderate illness
Low death
(Salmonella, e coli, Q fever, Ricin toxin,
etc)
C: third highest priority



Easy available
Easy produced
Potential for high death and major
health impact
(hantavirus)
http://www.bt.cdc.gov/bioterrorism/factsheets.asp
Isolation Precautions for
Biological Terrorism

Due to modern travel, spread of infection
may occur in areas thousands of miles apart

Health care providers need to be aware of
potential signs of biological weapons

signs and symptoms are similar to those
of the disease

Isolation practices depend upon the
infecting agent


Always use Standard Precautions

Terminal disinfection and disposal of wastes
depends on the infecting agent
Some agents require Transmission-Based
Precautions
Chemical Weapons




Chemical substances that quickly cause
injury and/or death and cause panic
and social disruption
Agents:
 Nerve agents
 Blood agents
 Vesicants
 Pulmonary agents
Agents vary in toxicity
Limitation of exposure is essential with
evacuation and decontamination as
soon possible and as close to the scene
of the incident as possible

Types













Biotoxins ( poison from plant or animal)
Blister agents (lewisite, sulfar mustard,
nitrogen mustard, etc)
Blood agents (hydrogen cyanide, cyanide
chloride)
Caustics (acid)
Choking agents (chlorine, phosgene, etc)
Incapacitating agents
Long acting anticoagulants
Metals
Nerve agents (VG, VM, sarin, soman, etc)
Organic solvents
Riot control agents (tear gas)
Toxic alcohols
Vomitting agents
http://usmilitary.about.com/library/milinfo/blchemical.htm
Nerve Agents
 Inhibit cholinesterase-causing
cholinergic symptoms
 Decontaminate with copious
amounts of soap and water or
saline for at least 20 minutes
 Blot; do not wipe off
 Plastic equipment will absorb
sarin gas
•
•
•
•
•
NERVE AGENTS
Signs and Symptoms
SLUDGEM: salivation, lacrimation,
urination, defecation, gastric upset,
emesis, and miosis
Dim vision
Cardiac dysrhythmias, confusion
and convulsions, along with
unconsciousness
Runny nose and shortness of
breath
Pinpoint pupils and muscle
fasciculations (muscle twitching)
 Oxime reversal agents: Protopam
chloride (2-PAM chloride)
 MARK I kit: atropine and protopam
 Diazepam (Convulsions and muscle
twitching)
 Full decontamination of body and
clothing
 Hydration: electrolyte and fluid
replacement as needed
 Reassure patient, to decrease anxiety
and promote rest
 Do not induce vomiting if ingested
Vesicants
 Lewisite, sulfur mustard, nitrogen
mustard, and phosgene
 Respiratory effects can be serious
and cause death
 Are blistering agents that
cause burning, conjunctivitis,
bronchitis, pneumonia,
hematopoietic (stem cell)
suppression and death.
 Inhalation, Topical (skin
damage irreversible but
seldom fatal)
VESICANT AGENTS
Signs and symptoms








Eyes: irritation, conjunctivitis, corneal burns,
blindness
Skin: erythema, itching, areas of increased
pigmentation, blisters
Mucosal sloughing and airway obstruction
Bone marrow suppression
Respiratory effects: irritation/burning of
nares, sinus pain or irritation, nosebleeds,
and irritation of the pharynx, dyspnea and
increased sputum production
Damage to the trachea and upper airways,
laryngitis
Headache, nausea, vomiting, and diarrhea
Blood-stained emesis and feces

Supportive







Treat skin – wound
care, burn care
Treat respiratory –
O2 support, Airway
support, mechanical
ventilation if
necessary
Support bone
marrow and immune
response
Antibacterial for
secondary infections
Treat symptoms
Decontaminate with
soap and water
Eye irrigations
BLOOD AGENTS
Gases:
Hydrogen cyanide
Cyanogen chloride
Crystals:
Sodium Cyanide
Potassium Cyanide
BLOOD AGENTS
Signs and Symptoms
 Initial transient rapid respiratory
rate
 Apprehension, anxiety, agitation,
and vertigo
 Feeling of general weakness,
nausea with or without vomiting,
and muscular trembling
 Slowing respirations, loss of
consciousness, convulsions, and
apnea with cardiac standstill
BLOOD AGENTS
Treatment
CHOKING AGENTS
 Destroys the pulmonary
membrane that
separates the alveolus
from the capillary bed
 Results in fluid filled
alveoli
 Inhaled
Ammonia
Chlorine
Phosgene
CHOKING AGENTS
Signs and Symptoms
 Irritation of the nasopharynx,




causing sneezing, pain, and
erythema
Dysphagia, cough
Hoarseness, stridor, and
coarse rhonchi, lacrimation
and rhinorrhea, swelling of the
throat and bronchi
Pulmonary edema - large
amounts of white to pink frothy
sputum
Chemical pneumonitis and
lung hemorrhage
IRRITANTS
 Commonly known as – “riot controlling agents”
 Produces transient discomfort – to render an
opponent incapable of resistance or fighting back
 Examples
 Mace
 Tear gas
 Pepper spray
 Signs and symptoms
 Pain, eye and nasal burning, lacrimation, or discomfort
on exposure to mucous membranes
 Treatment is fresh air, washing away the irritant


RADIOLOGIC AGENTS
Nuclear explosion –



Trauma from the blast
thermal burns from the heat and light
acute radiation syndrome from exposure to the nuclear radiation
Exposure to radiation Is affected by time, distance, and shielding
RADIOLOGIC AGENTS


Nonionizing - low energy and non-harmful
Ionizing – Alpha, Beta and Gamma
Alpha – poorly penetrates skin, travel 12 inches, very harmful to kidneys lungs
and skeletal system if introduced
through broken skin or ingested



Beta – can penetrate skin at short
distances causing burns, travels up to
10 ft., can be harmful if ingested or
inhaled


Blocked by clothing or paper
Blocked by heavy clothing, walls, or thin
metals
Gamma – emitted during nuclear
detonation and are present in fall out,
travel several 100 ft., are penetrating
through tissue to deep organs.

Blocked by dense materials – lead,
concrete, and steel
 An acute illness that occurs
when the entire body (or most
of it) receives or is exposed to
a high dose of radiation.
 Generates highly reactive free
radicals, damages messenger
RNA (mRNA) and DNA and
interferes with cell growth, or
even causes cell death.
 Severity varies with the
amount of exposure, age and
overall heath of an individual
Radiation Decontamination
 Triage outside the hospital
 Cover floor and use strict isolation
precautions to prevent the tracking of
contaminants
 Seal air ducts and vents
 Waste is double bagged and put in a
container labeled radiation waste
 Staff protection
 Water-resistant gowns, 2 pairs of
gloves, caps, goggles, masks, and
booties
http://www.remm.nlm.gov/radtriage.htm#start
Decontamination
EXPLOSIVE AGENTS
 High Order Explosive
(nitroglycerin) and Low
Order Explosives
(pyrotechnics,
gunpowder)
 High Order Explosive
Injuries are classified into
Primary, Secondary and
Tertiary.
Blast Injuries from High Order
Explosives

Nail Bomb or Jar Bomb



Primary – Impact of the
overpressurization wave
with body surfaces –
lungs, ears, GI,
TBI (most)
Secondary – Flying debris
and bomb
fragments
Tertiary – Injuries incurred
from
being
thrown by the blast.
Quaternary – explosion
related
injuries that are
complication of the
previous
injuries
Psychological Effects After a
Disaster




Provide active listening and emotional support

Encourage return to normal activities and social
roles
Provide information as appropriate
Refer to therapist or other resources
Discourage repeated exposure to media
regarding the event
 Strategic National Stock Pile






Push Packs-shipped within 12
hours of the decision to deploy
4% of the stockpile
Antibiotic agents
IV/IM medications
Bulk Supplies-First Aid
Analgesics
Other Emergency Medications
DMAT/DMORTS
Disaster Management Assistance Teams/Disaster
Management Mortuary Teams
 Health care providers, nurses, EMT’s, Technical Staff, and
other health care professionals.
 DMORTS – management and identification of the dead
The point is
to save as
many as you
can