Medical Emergency Procedures - Unit 3 PDF

**Unit 3** 1. **Heat stroke** \[worse than heat exhaustion\] a. Patho: an acute medical emergency caused by failure of the heat-regulating mechanisms of the body b. S/s: confusion/altered menstrual status, hot dry skin, cerebral edema (seizures, delirium, coma), anhidro...

**Unit 3** 1. **Heat stroke** \[worse than heat exhaustion\] a. Patho: an acute medical emergency caused by failure of the heat-regulating mechanisms of the body b. S/s: confusion/altered menstrual status, hot dry skin, cerebral edema (seizures, delirium, coma), anhidrosis c. **HCP orders:** i. **IV access & fluids, need to be cooled off slowly, (\< 102 F w/in 1 hour),** remove clothing, ice packs in axilla or groin, CBC, CMP, PT/PTT, UA, cold bath, cooling blankets, continuous core temp monitoring, strict I&O, 12 lead EKG (monitor cardiac rhythm), frequent reassessment of LOC and VS 1. **Due to hyponatremia and hypokalemia**: **ORAL replacement of Na & K** d. ABC first e. **Priority**: remove clothing, apply cooling blankets, apply ice packs in the axilla, tepid bathes, potentially use cold IV fluids f. **Monitor:** neuro status, UOP, cardiac status 2. **Frostbite** g. **Patho:** ​​Frostbite is trauma from exposure to freezing temperatures and freezing of the intracellular fluid and fluids in the intercellular spaces h. ABCs first i. **S/s:** Frozen extremity may be hard, cold, and insensitive to touch and may appear white or mottled blue-white ii. **Commonly on hands, feet, noses, ears, and cheeks** j. **RF:** occupational or recreational exposure (skiing), Homeless, Mental Health Disorders, Alcoholics, Smokers, mobility issues k. **Intervention:** controlled yet rapid rewarming is instituted for 30-40 mins, during rewarming you may give analgesic for pain iii. Once warmed, the part is protected from further injury and is elevated to control swelling, hourly active motion of an affected digits is encouraged to promote maximal reposition of function to prevent contractures iv. **Management:** 2. **Do not run under hot water, massage it, or put wet gauze on your hands.** 3. Remove restrictive jewelry & clothing & draw potassium lab a. **K+ lab BECAUSE they could be susceptible to hyperkalemia due to the release of K in the damaged cells** 4. **Discharge:** Educate pts to avoid caffeine, alcohol, & tobacco (b/c they are vasoconstrictors) v. Complication: metabolic acidosis (NOT IN BOOK) 3. **Ingestion of poison** l. **Syrup of ipecac is no longer used** vi. **Never used due to the risk of aspiration and should NEVER be used with with corrosive poisoning** m. Clinical manifestations: vii. **If ingested, they may experience oral pain, vomiting, ulceration, drooling, abdominal pain, and dysphagia** n. Tx for each type (like alkaline and acidotic??? And is this is it??): viii. **Corrosive agent: dilute with milk or water** 5. If swallowed something that is corrosive, **do not try to make them throw up** 6. Will burn going down & up ix. Gastric lavage for the patient who is obtunded is only usefully within 1 hour of ingestion x. Activated charcoal administration if the poison is one that is absorbed by charcoal; given orally or by NG tube. **It is effective in small intermittent doses to decrease vomiting.** It absorbs commonly ingested positions xi. Cathartics are rarely indicated b/c they can result in severe electrolyte imbalances, diarrhea, and hypovolemia xii. If unknown, call local poison control center xiii. **Monitor:** VS F/E status, and CVP o. **POC:** xiv. **Priorities: Remove or inactivate \[limit exposure\]** 7. Control of the airway, ventilation, and O2 is essential 8. Antidote administration if possible 9. Supportive care to decrease damage to organs 10. Treat to quickly eliminate absorbed poison p. **Management**: **ABCs, neuro status, renal function, shock, VS, EKG, insertion of indwelling catheter** 4. **Overdose** q. **Opioids -- Heroin, Opium, Morphine** xv. s/sx: **pinpoint pupils,** dyspnea (resp. depression), dizzy, N/V, bradycardia, hypotensive, altered LOC, pulmonary edema xvi. **Antidote → Narcan (Naloxone)** r. **Benzos -- diazepam (Valium), lorazepam (Ativan), midazolam (Versed)** xvii. s/sx: Decreased LOC, drowsiness, confusion, mimics being drunk, slurred speech xviii. **Antidote → flumazenil (Romazicon)** s. **Acetaminophen -- Tylenol** xix. S/sx: **Hepatic failure (RUQ pain)**, coagulopathies, lethargy, encephalopathy, diaphoresis, hepatomegaly, hypoglycemia, GI upset, and metabolic acidosis (pg. 5805) xx. **Antidote → Acetylcysteine (Mucomyst)** 5. **Snake bites:** t. Most commonly occur in **daylight hours and early evening in the summer months** u. **Most common site:** upper extremities and result in envenomation v. **S/sx**: edema, ecchymosis, hemorrhagic bullae leading to necrosis at the site of envenomation. w. **Plan of care:** xxi. Remove constrictive items (ex: rings), provide warmth, cleanse the wound, light sterile dressing, **immobilizing the injury BELOW heart level** (book) xxii. Tetanus and analgesia should be given if necessary xxiii. The patient is NEVER left unattended xxiv. Labs: CBC, UA, and coagulation studies (PT/PTT) xxv. Education on serum sickness: 11. **S/sx of serum sickness:** fever; rash starting on the chest and spreading to the back; arthralgia; gastrointestinal \[GI\] disturbances \[e.g., nausea, vomiting, diarrhea, abdominal pain x. **Provider orders:** xxvi. **Measure the circumference of extremity** 12. **Need to remeasure every 30-60 mins for 48 hours** to monitor for compartment syndrome 13. **Contraindications: corticosteroids** in the first 6 to 8 hours after bite b/c they may depress antibody production and hind the action of antivenin xxvii. **Tx:** **antivenin** is an immunoglobulin that can disable the toxin, most effective within 4 hours and NO greater than 12 hours after the snakebite 6. **Anthrax** y. **S/s:** three main methods of infection (skin contact, GI ingestion, and inhalation) z. **Precautions:** xxviii. **Standard precautions**, does not spread person to person 14. After death, cremation is recommended because the spores can survive for decades and represent a threat to morticians a. **Provider orders/POC:** xxix. **Treatment** (w/in 24 hours of exposure) 15. **Ciprofloxacin, Levofloxacin, Penicillin, Doxycycline** b. **Treat for 60 days** 16. **No s/sx/asymptomatic but exposed, OR cutaneous anthrax → Cipro/Doxy for 60 days** 17. In mass casualty: tx with doxy and cipro is recommended 7. **Triage** b. Determines severity of illness from resuscitation to minor, ranks from level 1 (most urgent/resuscitation) to level 5 (least urgent/minor) c. **ER**: Most critically ill pts get seen first xxx. **Emergency Severity Index, pg. 5753** used for triage and sorts patients into the 5 categories below 18. **1 -- Resuscitation:** continuous nursing surveillance 19. **2 -- Emergent:** reassessed Q15 min 20. if left untreated, could result in death 21. **3 -- Urgent:** reassessed Q30 mins 22. serious but not gonna be dying soon 23. **4 -- Non-urgent:** reassessed Q60 mins 24. **5 -- Minor/fast track**: reassessed q120mins d. **Disaster:** do the most good for the most people in disaster triage, utilitarian xxxi. **Red**/Immediate -- Life threatening but survivable with minimal intervention (priority \#1) 25. Ex: Sucking chest wound, airway obstruction secondary to mechanical cause, shock, hemothorax, tension pneumothorax, 15-40% burns on body surface (book) xxxii. **Yellow**/delayed -- Injuries are significant and require medical care but can wait hours without threat to life or limb (priority \#2) 26. Ex: soft tissue injuries, fractures requiring open reduction, débridement, and external fixation (book). xxxiii. **Green**/minimal -- Injuries are minor and treatment can be delayed hours to days (priority \#3) 27. Ex: Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding (book) xxxiv. **Black** (deceased/expectant) -- Injuries are extensive, and chances of survival are unlikely even with definitive care (book) 28. Ex: Patients who are unresponsive with penetrating head wounds, high spinal cord injuries, no pulse, cardiac arrest**,** 60% burns on body surface (book) xxxv. **White**/Involved -- no obvious injuries