Emergency Nursing Lec Poisoning & Burns PDF

NCM 112 LEC- FINALS Common examples of inhaled poisons include: POISONING ​ Carbon monoxide: A colorless, odorless...

NCM 112 LEC- FINALS Common examples of inhaled poisons include: POISONING ​ Carbon monoxide: A colorless, odorless gas that can interfere with the body's ability POISONING to carry oxygen. ​ A poison is any chemical substance that is ​ Chlorine gas: A toxic gas often associated harmful or lethal to living organisms. with industrial settings or chemical spills. ​ Poisoning occurs when a person is exposed ​ Ammonia fumes: Common in cleaning to a harmful substance, which can be products or industrial environments. ingested, inhaled, absorbed through the ​ Smoke inhalation: Caused by exposure to skin, or injected burning materials, such as during fires. ​ It life-threatening conditions, depending on ​ Pesticide vapors: Harmful chemicals used the type of substance, dose, and route of in agriculture that can be inhaled during exposure. Immediate medical intervention is spraying or application. often necessary, as poisoning can lead to organ damage, metabolic disturbances, or MANAGEMENT death. 1.​ Remove the Person from the Source of Exposure. TYPES OF POISONING: ​ Move the victim to fresh air A.​ Ingested Poisons: immediately to prevent further 1.​ Household chemicals: Cleaning inhalation of the toxic substance. agents, detergents, pesticides, and ​ If the exposure occurred indoors, alcohol. open windows and doors to ventilate 2.​ Medications: Overdose of prescription the area if it's safe to do so. or over-the-counter drugs (e.g., ​ Avoid self-exposure—ensure that you painkillers, sedatives, antidepressants). are not inhaling the poison yourself 3.​ Food and beverages: Contaminated while helping the victim. food, spoiled or improperly stored food, and certain plants or mushrooms (e.g., 2.​ Call​ for help immediately especially if the poisoning from toxic berries or person is experiencing difficulty breathing, mushrooms). chest pain, confusion, or unconsciousness. 4.​ Alcohol poisoning: Acute intoxication ​ Provide information about the from excessive alcohol consumption can substance involved, if known, as this cause confusion, respiratory depression, will help emergency responders and potentially coma. prepare for treatment. B.​ Inhaled poisoning 3.​ Monitor the Victim’s Airway and Breathing. inhaled poisoning occurs when a toxic Check the victim's airway to ensure it's clear. substance is breathed into the lungs, leading Provide rescue breathing or CPR if the to harmful effects on the body. These person is not breathing or if their heart has poisons can be gases, vapors, fumes, or stopped, following appropriate guidelines. particles that interfere with normal respiratory and other bodily functions. 4.​ Administer Oxygen therapy Inhaled poisons can cause damage to the ​ Carbon monoxide poisoning: respiratory system, nervous system, and Administering pure oxygen or using other organs depending on the nature and hyperbaric oxygen therapy (in severe concentration of the substance. cases). Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment HYPERBARIC OXYGEN THERAPY ​ Protective Equipment: Use masks, Other conditions treated with hyperbaric oxygen respirators, and other protective gear when therapy include: handling toxic chemicals. ​ Serious infections. ​ Carbon Monoxide Detectors: Install ​ Bubbles of air in blood vessels. detectors in homes and workplaces to detect ​ Wounds that may not heal because of harmful levels of CO diabetes or radiation injury. ​ Fire Safety: Ensure smoke alarms are working and take precautions during ​ In a hyperbaric oxygen therapy chamber, fire-related activities. the air pressure is increased 2 to 3 times ​ Inhaled poisoning can be life-threatening, so higher than normal air pressure. Under swift action is essential for preventing these conditions, your lungs can gather severe outcomes. much more oxygen than would be possible breathing pure oxygen at normal air C.​ Absorbed poisoning pressure. Absorbed poisoning occurs when a toxic ​ This extra oxygen helps fight bacteria. It substance enters the body through the skin also triggers the release of substances called or mucous membranes, leading to harmful growth factors and stem cells, which effects. Poisons that cause absorbed promote healing. poisoning can be chemicals, drugs, or toxins that come into contact with the skin or are absorbed through the eyes, mouth, or other mucosal surfaces. Once absorbed, the poison can enter the bloodstream and affect various organs in the body, often leading to systemic toxicity. Common Causes of Absorbed Poisoning ​ Pesticides: Many pesticides contain chemicals that can be absorbed through the https://www.youtube.com/watch?v=DWg6S9yDO skin during application or by handling _w contaminated items. ​ Industrial Chemicals: Solvents, acids, 5.​ Specific Antidotes or Treatments (if alkalis, or other hazardous chemicals used in applicable). In some cases, specific manufacturing or cleaning processes can treatments or antidotes may be available, cause poisoning if they come in contact with such as the skin. ​ Oxygen therapy for carbon monoxide ​ Herbicides: Chemicals used in agriculture poisoning. or landscaping to control unwanted plants ​ Methylene blue for certain cases of can cause poisoning if absorbed through the methemoglobinemia (which can result skin. from inhaling certain chemicals). ​ Heavy Metals: Toxic metals such as ​ Bronchodilators for chemical mercury, lead, or arsenic can be absorbed inhalations that affect the airways. These through the skin, leading to poisoning, treatments are usually administered by particularly in industrial settings. healthcare professionals. ​ Drug overdoses: Intravenous or subcutaneous injection of illicit drugs (e.g., PREVENTION heroin, methamphetamine) can cause ​ Ventilation: Ensure that spaces where immediate toxicity. harmful substances are used are ​ Venomous animal bites: Poison from well-ventilated. snakes, spiders, scorpions, or marine creatures can cause local reactions or  systemic effects. substances are disposed of correctly, following local regulations to avoid Symptoms of Absorbed Poisoning environmental contamination. ​ The symptoms of poisoning depend on the type of poison, the amount ingested, and ​ Source: Contaminated water, lead-based the route of exposure. Common signs and paint, industrial exposures. symptoms include: ​ Symptoms: Fatigue, headaches, abdominal ​ Nausea and vomiting pain, vomiting, tremors, and neurological ​ Abdominal pain or cramping changes. ​ Diarrhea ​ Treatment: Chelation therapy (e.g., ​ Dizziness, confusion, or altered mental dimercaprol or EDTA) to bind and remove status the metal from the body. ​ Headache ​ EDTA-Ethylenediaminetetraacetic acid ​ Difficulty breathing or shortness of breath which is a chemical compound used in ​ Chest pain or irregular heartbeat chelation therapy to treat heavy metal ​ Burning or tingling sensations in the mouth, poisoning. It is a powerful agent that binds throat, or skin to metals like lead, mercury, arsenic, and ​ Sweating or clammy skin calcium in the bloodstream and facilitates ​ Seizures their removal from the body, typically ​ Unconsciousness through the kidneys and urinary system. ​ Cyanosis (bluish skin color) or paleness due to lack of oxygen (especially in cases of ENVIRONMENTAL INJURIES carbon monoxide poisoning) ENVIRONMENTAL INJURIES Common Poisons and Their Effects: ​ Injuries or illnesses caused by exposure to ​ Carbon Monoxide (CO): environmental factors, such as extreme MANAGEMENT temperatures, hazardous substances, or ​ Source: Faulty heating systems, car natural disasters. These injuries can range exhausts, and fires. from mild discomfort to life-threatening ​ Symptoms: Headache, dizziness, conditions, and the severity often depends weakness, confusion, chest pain, and in on the type of exposure, the duration, and severe cases, unconsciousness or death. the individual’s health condition. ​ Treatment: Administer 100% oxygen via Environmental injuries are common in both mask, or hyperbaric oxygen therapy in outdoor and occupational settings and severe cases. require specific prevention and treatment ​ Cyanide strategies. Prevention of Absorbed Poisoning Types of Environmental Injuries ​ Use protective equipment: Wear gloves, 1.​ Thermal Injuries/Heat Injuries: goggles, and protective clothing when a.​ Heat Exhaustion: Occurs when the handling chemicals, pesticides, or other body is unable to cool itself potentially toxic substances. adequately, leading to symptoms ​ Proper handling and storage: Store such as heavy sweating, weakness, chemicals and poisonous substances in dizziness, nausea, and headache. It secure, labeled containers, and use them in often happens during intense physical well-ventilated areas. activity in hot, humid environments. ​ Read labels and safety instructions: b.​ Heatstroke: A more severe form of Always follow the manufacturer's guidelines heat injury where the body’s and safety protocols when using hazardous temperature regulation system fails, materials. causing the body temperature to rise ​ Proper disposal: Ensure that toxic to dangerous levels (over 104°F or  40°C). Barotrauma is a condition caused by changes in Symptoms: confusion, hot, dry skin, pressure that affect the body, particularly the rapid pulse, and loss of air-filled spaces such as the ears, sinuses, lungs, consciousness. This is a medical and gastrointestinal tract. emergency. It typically occurs when there is a discrepancy c.​ Sunburn: Skin damage from between the external air pressure and the prolonged exposure to ultraviolet pressure inside the body, leading to injury of (UV) radiation. Symptoms include tissues in the affected areas. redness, pain, and peeling of the Barotrauma can occur in various settings, skin. including diving, air travel, mountain climbing, or hyperbaric oxygen therapy. MANAGEMENT FOR HEAT INJURIES ​ Move the person to a cool area, hydrate, Types of Barotrauma and use cooling techniques such as fans or ​ Ear Barotrauma (Most Common)The middle cool compresses. ear is the most common site of barotrauma ​ For heatstroke, seek immediate medical due to pressure changes. It often occurs attention. during airplane travel, scuba diving, or mountain climbing. 2.​ Cold Injuries ​ Cause: The pressure between the outer ear a.​ Frostbite: Freezing of body tissues, and middle ear becomes unequal, typically typically fingers, toes, ears, and nose, due because of the inability to equalize pressure to prolonged exposure to extreme cold. It (e.g., when the Eustachian tube doesn't can lead to tissue damage and, if function properly). untreated, gangrene and loss of body parts. MANAGEMENT FOR COLD INJURIES b.​ Hypothermia: Occurs when the body’s a.​ Frostbite: Gradually warm the affected core temperature drops below 95°F area using lukewarm water (never direct (35°C). It can cause confusion, shivering, heat), and seek medical care for severe slurred speech, and, if untreated, can frostbite. lead to unconsciousness or death. b.​ Hypothermia: Warm the person gradually with blankets or warm fluids and seek SIGNS AND SYMPTOMS: emergency medical care. Hypothermia: ​ Shivering, confusion, slurred speech 3.​ Chemical Injuries: ​ Loss of coordination ​ Exposure to harmful chemicals in the ​ Weak pulse, slow breathing environment can cause a range of injuries, ​ Unconsciousness or coma in severe cases such as burns, respiratory problems, or poisoning. Common causes Hyperthermia/Heat Stroke: ​ Pesticides and herbicides in agricultural ​ Hot, dry skin (in heat stroke) settings ​ Rapid, shallow breathing ​ Industrial chemicals: such as solvents, acids, ​ Increased heart rate and gases like chlorine or ammonia. ​ Altered mental status, confusion, agitation ​ Air pollution (e.g., smog, ozone, carbon ​ Seizures, unconsciousness monoxide) can cause respiratory injuries and exacerbate conditions like asthma. Barotrauma/Decompression Sickness: ​ Ear pain or difficulty equalizing pressure Management for Chemical burns: ​ Chest pain, difficulty breathing ​ Rinse the skin or eyes with copious amounts ​ Dizziness, nausea of water, remove contaminated clothing, and seek medical attention. 4.​ Electric Shock: Occurs when the body A.​ Snake bites: Can inject venom that may becomes a conduit for electrical current, cause local tissue damage or systemic leading to burns, cardiac arrhythmias, nerve symptoms such as bleeding, shock, or organ damage, and potentially death. failure. ​ Electrocution: Exposure to electricity, 1.​ Immediate First Aid particularly in stormy weather or work a.​ Stay Calm: The first step is to remain as environments involving high-voltage calm as possible. Anxiety and panic can equipment, can cause burns, cardiac increase heart rate and speed up the arrest, and nerve damage. spread of venom. ​ Lightning Strike: A form of electrical b.​ Call for help injury from lightning, which can cause c.​ Try to identify the snake (without putting burns, cardiac arrest, neurological yourself at risk). Knowing whether the damage, and respiratory failure. snake is venomous or non-venomous can ​ An electric shock is the physical effect or help with treatment. sensation caused when an individual d.​ Immobilize the Affected Limb with a splint comes into contact with an electrical or by having the victim remain still. Avoid current. It can range from a mild tingling using a tourniquet, as it can worsen the to a painful jolt. Electrocution refers to situation. death or serious injury resulting from e.​ Remove Tight Clothing or Jewelry: exposure to a lethal dose of electric Avoid Certain Actions: current. ​ Do not try to suck out the venom or cut the wound. 5.​ Radiation Injuries: ​ Do not apply ice or cold packs to the ​ Exposure to excessive ionizing radiation bite site, as it can cause further (such as from nuclear accidents, x-rays, damage to tissues. or radioactive materials) can cause skin ​ Do not administer alcohol or caffeine, burns, radiation sickness, and increase as they can speed up the spread of the risk of cancer.Sunlight (UV radiation), venom by increasing heart rate. while necessary for vitamin D production, can also cause skin cancer, eye damage, 2.​ Transport to a Medical Facility Once and premature skin aging. emergency services arrive or the victim is being transported to a medical facility, try to 6.​ Drowning and Near-Drowning: keep the patient calm and still. Monitor the ​ Drowning is caused by submersion in victim's breathing and heart rate during water, leading to breathing difficulties transport, and be prepared to administer and suffocation. It can occur in CPR if the victim stops breathing. swimming pools, rivers, oceans, or even bathtubs. Hospital Management ​ Near-drowning refers to incidents where The following steps may be taken based on the a person survives a drowning event, but type and severity of the snake bite: suffers from complications like hypoxia a.​ Antivenom Administration: Antivenom (lack of oxygen), brain injury, or (or antivenin) is the specific treatment for infections. venomous snake bites. It works by neutralizing the snake’s venom. 7.​ Bites and Stings: ​ The type of antivenom used depends on the ​ Insects, animals, and marine life can species of snake that inflicted the bite. cause injuries through bites or stings, Identification of the snake is crucial in leading to: selecting the correct antivenom. ​ Insect bites: Can cause allergic reactions, Administering antivenom as early as possible infections, or the transmission of diseases significantly improves outcomes, especially like malaria or Lyme disease in cases of severe envenomation. Monitoring and Supportive Care: Freshwater may cause the nematocysts to ​ Monitor V/S. Vital signs such as heart rate, discharge more venom, worsening the pain. blood pressure, and respiratory function will be closely monitored. Injuries Due to Natural Disasters: ​ IV Fluids. IV fluids may be given to prevent ​ Earthquakes, hurricanes, floods, wildfires, dehydration, stabilize blood pressure, and and tornadoes can cause environmental treat shock. injuries through: ​ Oxygen therapy. Oxygen therapy may be ​ Trauma from falling debris, collapsing used if the patient has breathing difficulties. buildings, or exposure to high winds. ​ Pain management. Pain management will be ​ Burns from fire or chemicals released during administered for bite site pain or generalized the disaster. discomfort. ​ Infections from water contamination ​ Wound Care: The wound will be cleaned following flooding. and assessed for infection. Any swelling will ​ Psychological injuries like post-traumatic be managed with elevation and cold stress disorder (PTSD). compresses (NOT on the bite directly). ​ Provide first aid, stop any bleeding, ​ Blood Tests: Bleeding time , clotting time and seek immediate medical care if there is severe injury or shock. B.​ Animal bites (e.g., dogs or cats): Can A.​ Altitude Sickness: cause infections like rabies or tetanus if not ​ Acute Mountain Sickness (AMS) occurs properly treated. when people ascend to high altitudes MANAGEMENT: (typically above 8,000 feet/2,400 meters) ​ Clean the wound,, and seek medical too quickly. Symptoms include headache, attention, particularly for snake bites nausea, dizziness, and fatigue. or severe allergic reactions. ​ More severe forms include high-altitude pulmonary edema (HAPE) and C.​ Marine stings (e.g., from jellyfish or high-altitude cerebral edema (HACE), stingrays) can cause severe pain, skin which can be life-threatening. damage, or systemic symptoms like allergic ​ high altitudes, the air pressure and reactions. oxygen concentration decrease, leading to hypoxia (a lack of oxygen). This reduced Immediate First Aid for Jellyfish Stings: oxygen level triggers the body to react in various ways, one of which is pulmonary 1.​ Remove the person from the water vasoconstriction (narrowing of the Safety first: Get the person out of the blood vessels in the lungs) to attempt to water to prevent further stings or drowning, redirect blood to more oxygenated areas especially if they are still in the area where of the lungs. jellyfish may be present. HIGH ALTITUDE PULMONARY EDEMA 2.​ Rinse with Vinegar or Saltwater ​ HAPE is a condition characterized by the Vinegar: White vinegar or acetic acid can accumulation of fluid in the lungs due to help neutralize toxins from the sting and increased pressure in the pulmonary prevent the nematocysts (stinging cells) circulation, leading to impaired gas from releasing more venom. Vinegar is exchange and respiratory distress. especially helpful for stings from box jellyfish or certain other species. ​ Hypoxia → pulmonary constriction → How to use: Pour or soak the affected area increased pulmonary pressure → pulmonary with vinegar for at least 30 seconds. hypertension → pulmonary edema Saltwater: If vinegar is unavailable, rinse ​ Because of pressure and fluid build up → the sting with seawater (not freshwater). respiratory failure.  ​ Hypoxia (Low Oxygen Levels): At high 2.​ Oxygen: If available, supplemental oxygen altitudes, the air pressure and oxygen can help alleviate symptoms by improving concentration decrease, leading to hypoxia oxygenation at high altitudes. (a lack of oxygen). This reduced oxygen 3.​ Medications: Acetazolamide (Diamox): A level triggers the body to react in various carbonic anhydrase inhibitor that helps ways, one of which is pulmonary accelerate acclimatization by improving vasoconstriction (narrowing of the blood oxygen absorption. It is commonly vessels in the lungs) to attempt to redirect prescribed for preventing or treating mild blood to more oxygenated areas of the AMS symptoms. The typical dose is 125-250 lungs. mg twice a day, starting 24-48 hours before ​ Exaggerated Pulmonary ascent. Vasoconstriction: leading to increased ​ Ibuprofen or Paracetamol: For pulmonary artery pressure (pulmonary headache and body aches, these hypertension). This high pressure causes over-the-counter pain medications fluid to leak from the blood vessels into the may help relieve discomfort. alveoli (air sacs) of the lungs, leading to pulmonary edema (fluid accumulation in the CARDIOPULMONARY RESUSCITATION lungs). Prevention and Treatment: 1.​ Preventing Rapid Ascent: 2.​ Gradual ascent to high altitudes (no more than 300-500 meters/day) allows the body to acclimatize. ​ Rest Days: Taking regular rest days to allow for acclimatization (typically every 2-3 days during ascent) helps reduce the risk of both https://www.youtube.com/watch?v=dGMSxrT3VL HAPE and HACE. 4 ​ Oxygen Therapy: Supplemental oxygen can help alleviate symptoms and prevent Basic Life Support- CPR: complications in the early stages of both Cardiopulmonary Arrest and Cardiopulmonary conditions. Resuscitation ​ Descend if Necessary: The primary treatment for both HAPE and HACE is KNOWLEDGE OBJECTIVES: immediate descent to a lower altitude, After completing this session, participants will be which is the most effective way to stop the able to - progression of these life-threatening 1.​ Identify the four links of Chain of Survival. conditions. 2.​ Describe cardiac arrest. ​ Medications: Drugs like acetazolamide, 3.​ Enumerate the three conditions of cardiac dexamethasone, and nifedipine can be arrest. used to manage symptoms and reduce 4.​ Enumerate the criteria for not starting CPR severity of edema and when to STOP CPR. Immediate Actions: CHAIN OF SURVIVAL: 1.​ Rest and Hydration: FOUR LINKS ​ Ensure the person is well-rested. Avoid 1.​ The First Link: EARLY ACCESS further ascent until symptoms improve. It is the event initiated after the patient’s ​ Encourage drinking plenty of water to stay collapse until the arrival of Emergency hydrated, as dehydration can worsen Medical Services personnel prepared to symptoms. provide care.  2.​ The Second Link: EARLY CPR independently rather than the coordinated, It is most effective when started synchronized manner that produces immediately after the victim’s collapse. The rhythmic heartbeat. probability of survival approximately doubles when it is initiated before the arrival of EMS. 3.​ Cardiac Standstill. It means that the heart has stopped beating. 3.​ The Third Link: EARLY DEFIBRILLATION Automated External Defibrillator (AED) It is most likely to improve survival. It is the key intervention to increase the chances of survival of patients with “out-of-hospital” cardiac arrest. 4.​ The Fourth Link: EARLY ACLS If provided by highly trained personnel like paramedics, provision of advanced care outside the hospital would be possible. THE FIRST GOLDEN MINUTES An Automated External Defibrillator (AED) is a portable medical device used to deliver an electric shock (defibrillation) to the heart in cases of cardiac arrest, specifically when the heart is in a life-threatening arrhythmia (such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)). An AED is designed to be used by laypersons and medical professionals alike, as it guides the user through the steps with clear verbal prompts. WHEN TO START A CPR It is the responsibility of the rescuer to start CPR in CARDIAC ARREST virtually all patients who are in cardiac arrest. Is the condition in which circulation ceases and There are two general exceptions to the rule. vital organs are deprived of oxygen. 1.​ You should not start CPR if the patient has obvious signs of irreversible or biological CARDIOPULMONARY RESUSCITATION death. This is a combination of chest compressions and ○​ Rigor mortis, or stiffening of the body rescue breathing. These must be combined for after death effective resuscitation of the victim of cardiac ○​ Dependent lividity (livor mortis), a arrest. discoloration of the skin due to pooling of blood THREE CONDITIONS OF CARDIAC ARREST ○​ Putrefaction or decomposition of the body 1.​ Cardiovascular Collapse. The heart is still ○​ Evidence of nonsurvivable injury, such beating but its action is so weak that blood as decapitation. is not being circulated through the vascular 2.​ You should not start CPR if the patient and system to the brain body tissues. his or her physician have previously agreed upon DNR (do not resuscitate) or no-CPR 2.​ Ventricular Fibrillation. Occurs when the orders individual fascicles of the heart beat DO A PRIMARY SURVEY OF THE VICTIM DO A SECONDARY SURVEY OF THE VICTIM ​ Check for Consciousness It is a systematic method of gathering additional ​ Check for Airway information about injuries or conditions that may ​ Check for Breathing need care. ​ Check for Circulation 1.​ Interview the victim. 2.​ Check vital signs. 3.​ Perform head-to-toe examination CARDIOPULMONARY RESUSCITATION FOR ADULT ADULT BLS ALGORITHM RECOVERY POSITION Signs and Symptoms: 1.​ Tachycardia (increased heart rate) 2.​ Hypotension (low blood pressure) 3.​ Pale, cool, clammy skin 4.​ Weak, rapid pulse 5.​ Decreased urine output 6.​ Restlessness or confusion MANAGEMENT: A.​ Fluid Resuscitation: Administer IV fluids (crystalloids like normal saline or WHEN TO STOP CPR lactated Ringer's) to restore blood It is generally accepted that once CPR has been volume. started, it should be continued until one of the B.​ Blood Transfusion: In cases of severe following situation occurs: blood loss, a blood transfusion may be necessary. 1.​ The victim develops visible signs of C.​ Oxygen Therapy: Ensure adequate circulation, a definite pulse, or begins to oxygenation to vital organs. breathe by him/herself. D.​ Control Bleeding: Apply direct 2.​ Another trained rescuer takes over. pressure to wounds, elevate the legs, 3.​ EMS personnel arrive to provide emergency and consider surgical intervention if medical services. needed. 4.​ The rescuer becomes too exhausted to continue. 2.​ CARDIOGENIC SHOCK 5.​ It is unsafe to continue. Cause: Occurs when the heart's ability to 6.​ A medical doctor directs the rescuer to stop. pump blood effectively is impaired, 7.​ A written “Do Not Resuscitate” order is commonly due to a heart attack (myocardial presented. infarction), congestive heart failure, or arrhythmias. SHOCK AND MODS Signs and Symptoms: ​ Chest pain SHOCK AND MODS ​ Tachycardia or MULTIPLE ORGAN FAILURE OR MULTIPLE ORGAN DYSFUNCTION SYNDROME ​ Bradycardia ​ Hypotension SHOCK ​ Cool, pale skin ​ Shock is a critical condition that requires ​ Shortness of breath immediate intervention. It occurs when the ​ Reduced consciousness or confusion circulatory system fails to deliver enough oxygen and nutrients to the body's tissues MANAGEMENT: and organs, Shock can result from various A.​ Oxygen Therapy: Administer oxygen to causes, and nurses play a key role in quickly support cardiac function and oxygen identifying and managing it. delivery. B.​ Medications: Use medications like TYPES OF SHOCK inotropes (e.g., dopamine or 1.​ Hypovolemic Shock dobutamine) to help improve heart Cause: Results from a significant loss of contractility. blood or fluids, such as in cases of trauma, C.​ Cardiac Monitoring: Monitor heart severe bleeding (hemorrhage), burns, or rhythm and blood pressure. dehydration D.​ Mechanical Support: In some cases, devices like an intra-aortic balloon pump (IABP) may be used to assist the heart's  pumping ability. Signs and Symptoms: ​ Warm, flushed skin (except in neurogenic 3.​ DISTRIBUTIVE SHOCK OR shock, where skin may be dry) VASODILATORY SHOCK ​ Hypotension 3.Tachycardia is a medical emergency where the body ​ Confusion or altered mental status can't get enough blood to your heart, brain ​ Respiratory distress (in septic shock or and kidneys. anaphylactic shock) Cause: when blood vessels are extremely dilated (flaccid or relaxed), which brings MANAGEMENT: down your blood pressure and cuts down on ​ Septic Shock: Administer IV antibiotics, how much blood can get to your organs. fluids, and vasopressors (e.g., norepinephrine) to restore blood pressure. ​ Anaphylactic Shock: Administer epinephrine immediately, along with antihistamines and steroids. ​ Neurogenic Shock: Provide spinal cord injury care, including stabilizing the spine and giving IV fluids and vasopressors ​ Oxygen Therapy: To support tissue oxygenation in all forms of distributive shock. MODS (Multiple Organ Failure/Multiple Organ Dysfunction Syndrome) is a serious and often life-threatening condition where multiple organs in the body progressively fail. It usually occurs in critically ill patients, often 3.1.​ Distributive Shock as a result of sepsis, trauma, or severe systemic Cause: Characterized by widespread inflammation, and it represents the final common vasodilation (widening of blood vessels), pathway of severe illness or injury. which leads to inadequate blood flow to organs and tissues despite adequate Causes of Multiple Organ Failure: blood volume. This can be caused by 1.​ Trauma 1.​ Septic shock (due to infection) 2.​ Hemorrhagic shock 2.​ Anaphylactic shock (severe allergic 3.​ Sepsis reaction) 4.​ Drug overdose 3.​ Neurogenic shock (due to spinal cord 5.​ Severe burns injury) 6.​ Liver failure ​ Shock is a medical emergency that requires 7.​ Renal failure immediate identification and management. 8.​ Acute pancreatitis Nurses in emergency settings are crucial in 9.​ Toxins and poison the early recognition, stabilization, and 10.​ Exposure to chemicals treatment of shock through prompt assessment, resuscitation, and monitoring. ​ Trauma: Severe injuries, especially those ​ The specific management approach depends involving significant blood loss or damage to on the type of shock and its underlying multiple body systems (e.g., head trauma, cause, but the goal is to restore blood flow blunt abdominal trauma, burns). to tissues, support vital organ function, and ​ Hemorrhagic Shock: Loss of a significant prevent irreversible damage. amount of blood or fluids leading to inadequate perfusion of organs.  ○​ Shock: Different types of shock (e.g., resulting from poor brain perfusion and septic shock, hypovolemic shock, systemic toxicity. cardiogenic shock, distributive shock) can lead to insufficient blood flow and 6.​ Gastrointestinal Symptoms: Abdominal oxygen supply to organs, causing distension, ileus, GI bleeding, or vomiting, them to fail. often due to ischemia of the gut. ​ Sepsis: A widespread infection that causes an overwhelming inflammatory response, Management of Multiple Organ Failure: leading to widespread organ damage. ​ Early detection and aggressive treatment ​ Drug Overdose: Some toxins or are critical for improving outcomes medications can directly damage multiple 1.​ Mechanical Ventilation organ systems, including the liver, kidneys, 2.​ IV Fluids and heart. 3.​ Vasopressors: Medications like ​ Severe Burns: Extensive burns can lead to norepinephrine or dopamine may be systemic inflammatory responses, shock, used to raise blood pressure and improve and organ failure. organ perfusion. ​ Liver Failure: Advanced liver disease or 4.​ Hemodialysis or continuous renal acute liver injury can lead to metabolic replacement therapy (CRRT) disturbances, coagulation problems, and 5.​ Nutrition- TPN affect other organs. ​ Renal Failure: Severe kidney dysfunction, Mechanical Ventilation: If respiratory failure such as from acute kidney injury (AKI), can occurs, oxygen therapy or mechanical ventilation lead to the accumulation of toxins in the may be needed. body, contributing to multi-organ Fluid Resuscitation: For patients in shock, IV dysfunction. fluids (e.g., crystalloids, colloids) are used to ​ Acute Pancreatitis: Severe inflammation restore blood volume and improve perfusion. of the pancreas that can lead to the release Vasopressors: Medications like norepinephrine or of enzymes into the bloodstream, damaging dopamine may be used to raise blood pressure and multiple organs. improve organ perfusion. ​ Toxins and Poisons: Exposure to certain Dialysis: If kidney failure occurs, hemodialysis or chemicals or drugs (e.g., alcohol, carbon continuous renal replacement therapy (CRRT) may monoxide) can damage multiple organs be needed to filter waste products and restore fluid simultaneously. balance. Nutritional Support: Patients may need enteral Signs and Symptoms of Multiple Organ (tube feeding) or parenteral (IV) nutrition to Failure: provide adequate calories and proteins for recovery. 1.​ Respiratory: SOB, hypoxemia BURNS 2.​ Cardiovascular: chest pain, hypotension, tachycardia, arrhythmias Burns are injuries to the skin or other tissues caused by heat, chemicals, electricity, radiation, or 3.​ Renal Failure: oliguria , increased friction. Burns are classified based on their severity creatinine/urea levels in the blood, fluid and depth, and proper emergency care is critical to overload. prevent complications and promote recovery. 4.​ Hepatic Failure: Jaundice coagulopathy, and altered liver enzymes. 5.​ Neurological Symptoms: Confusion, delirium, altered mental status, coma, Types of Burns Management: 1.​ Thermal Burns: ​ Cool the burn with cool (not cold) Caused by heat sources such as fire, steam, water. hot liquids, or hot objects. ​ Apply aloe vera gel or over-the-counter creams for pain relief. ​ Pain relievers like acetaminophen or ibuprofen. ​ Heal within a few days without scarring. 2.​ Chemical Burns: Occur when the skin or eyes come into II.​ Second-Degree Burns contact with corrosive chemicals (e.g., acids, (Partial-Thickness Burns): alkalis). ​ Affects both the epidermis and dermis (deeper layer of the skin). Symptoms: Blisters, intense pain, redness, swelling, and moist or weeping skin. 3.​ Electrical Burns: Management: Result from contact with electrical currents, ​ Cool the burn with running water. which can cause both external and internal ​ Do not pop blisters (to prevent damage. infection). ​ Apply antibiotic ointment to prevent infection. ​ Dress the burn with a sterile bandage. ​ Pain management with NSAIDs and possibly prescription pain medications. ​ May leave scars, depending on severity III.​ Third-Degree Burns (Full-Thickness Burns): ​ Affects the epidermis, dermis, and subcutaneous tissue (fat). Symptoms: White, charred, or leathery skin; no pain at the site due to nerve destruction, but surrounding areas may still Classification of Burns (based on depth and be painful. severity): Management: I.​ First-Degree Burns (Superficial Burns) ​ Emergency care is critical. Cover the ​ Affects only the epidermis (outer burn with a clean cloth preferably layer of the skin). sterile. ​ Do not remove burned clothing Symptoms: Redness, pain, swelling, and unless it is smoldering. peeling of the skin. Usually no blisters. ​ Do not apply ice or ointments to extensive burns.  ​ Fluid resuscitation is often necessary Management: due to fluid loss. ​ Requires immediate advanced care, ​ Pain management with strong including surgical intervention for medications, and IV antibiotics to debridement and possible prevent infection. amputations. ​ Surgical intervention may be required ​ Intensive care to manage fluid for skin grafts. balance, infections, and organ ​ Long-term rehabilitation (physical function. therapy, reconstructive surgery. ​ Prolonged rehabilitation and possible ​ Smoldering is the process of burning prosthetics. slowly with smoke but no flame. Umuusok. Burn Severity and Area of Injury ​ The severity of a burn is also determined by how much of the body is affected. ​ The Rule of Nines is a common method for estimating the total body surface area (TBSA) burned in an adult: ○​ Head and Neck: 9% ○​ Each Arm: 9% (18% for both arms) ○​ Each Leg: 18% (36% for both legs) ○​ Front of Torso: 18% ○​ Back of Torso: 18% ○​ Genital Area: 1% [Visual and chemical characteristics of smouldering and flaming fires] RULE OF NINE IV.​ Fourth-Degree Burns: Lund-Browder – The Lund-Browder chart ​ Extends through the skin and (figure 2) is the most accurate method for subcutaneous tissues into muscles, estimating TBSA for both adults and children. tendons, and even bones. Children have proportionally larger heads and ​ Often caused by very severe thermal smaller lower extremities, so the percentage TBSA or electrical injuries. is more accurately estimated using the Lund-Browder chart. LUND AND BROWDER CHART EMERGENT BURN CARE: Initial Assessment: ​ Airway: Ensure the airway is clear, especially in cases of inhalation injury or burns to the face or neck. ​ Breathing: Check for signs of respiratory distress, which may indicate smoke inhalation or airway compromise. ​ Circulation: Assess circulation and perfusion. Monitor vital signs and check for shock. ​ Burn Size and Depth: Quickly assess the extent of burns (TBSA) and depth (first, second, third, or fourth degree). ​ Fluid Resuscitation: Parkland Formula: A common method to calculate fluid requirements for burn patients: ​ 4 mL x % TBSA burned x body weight (kg). ​ Half of the fluid is given in the first 8 hours, Example of Burn Estimation Using the Lund and the rest over the next 16 hours. and Browder Chart: ​ IV fluids (usually lactated Ringer's) are ​ For a 5-year-old child who has burns on the crucial to replace lost fluids and prevent head, front of the torso, and one leg, you shock. might estimate: ○​ Head and Neck: 15% Wound Care: ○​ Front of the Torso: 18% ​ Cover the burn: Use a clean, sterile cloth ○​ One Leg: 14% or burn dressing. ○​ Total= 15% + 18% + 14% = 47% of ​ Pain management: Administer analgesics, TBSA affected. including opioids if necessary, for pain ​ This total is then used to guide further control. treatment, such as fluid resuscitation (based ​ Prevent infection: Apply antibiotic on the Parkland Formula or other protocols). ointments like silver sulfadiazine and keep the wound sterile. ​ Palm method– Small or patchy burns can ​ Debridement: In severe cases, dead tissue be approximated by using the surface area may need to be surgically removed. of the patient's palm. The palm of the patient's hand, excluding the fingers, is Inhalation Injury: approximately 0.5 percent of total body ​ Signs: Facial burns, singed nasal hair, soot surface area, and the entire palmar surface in the mouth or nose, hoarseness, and including fingers is 1 percent in children respiratory distress. and adults ​ Management: Administer oxygen, monitor for signs of airway obstruction, and consider intubation if necessary. ​ Monitoring: ○​ Vital signs: Continuous monitoring of heart rate, blood pressure, and respiratory status. ○​ Urine output: Monitor closely to  assess kidney function, especially in management, pain control, and cases of severe burns where fluid loss psychological support. is significant. ​ Understanding the severity and appropriate management of burns can significantly Wound Healing: improve patient outcomes. ​ Wounds may require skin grafts for third- and fourth-degree burns. 4. Radiation Burns: ​ Dressings are changed frequently, and Caused by prolonged exposure to ultraviolet (UV) wound care is vital to prevent infection. light (sunburns) or ionizing radiation (e.g., from ​ Scar formation: Burns can result in nuclear exposure). significant scarring, which may require plastic surgery. 5. Friction Burns: Occur due to the skin rubbing against a rough Rehabilitation: surface, causing abrasions and heat buildup ​ Physical therapy to prevent contractures (common in road rash). (tightening of the skin and muscles). ​ Psychosocial support to help with emotional and psychological trauma due to disfigurement and prolonged recovery. ​ Nutritional support to assist healing and recovery, as burn victims often require more calories and protein. Long-term Monitoring: ​ Patients with extensive burns require ongoing medical monitoring for complications like infections, kidney failure, and metabolic imbalances. PREVENTION OF BURNS: ​ Fire safety: Educate on the proper use of fire extinguishers, smoke detectors, and safe cooking practices. ​ Protective equipment: Use gloves, goggles, and appropriate clothing when handling chemicals or working in hazardous environments. ​ Sun safety: Avoid prolonged sun exposure and use sunscreen to prevent UV radiation burns. ​ Burns are serious injuries that require immediate and proper medical attention. ​ Early intervention in the emergency setting is critical to minimize damage, prevent complications, and optimize recovery. ​ Burns may require long-term rehabilitation and follow-up care, including wound