EMERGENCY CARE Teresa Hunt RN BSN University of

EMERGENCY CARE Teresa Hunt RN, BSN University of Central Florida For University of Rhode Island : NUR 433

GROWTH AND DEVELOPMENT ISSUES Infant: § Cry = stress parents, many indications § Very little tolerance for physical or emotional pain or discomfort § Parent – infant bond Toddler: § Aware of self = autonomous and distinct beings § Restraining and securing = vulnerability Preschooler: § Fear and fantasy = reduce lag time § Increasing independence = reduced separation anxiety School-Age: § Risk-taking behavior § Adequate coping and understanding Adolescent: § Own unique identity § Believe of being invisible, age of extremes

TRIAGE & ASSESSMENT Primary ABCDEs § Airway § Breathing § Circulation § LOC (Disability) § Exposure Secondary Full set of Vital Signs Family presence Give Comfort Measures Head-to-toe assessment § SAMPLE Complete medical history Inspection of the back

CARDIOPULMONARY RESUSCITATION Infant: § 30: 2 one rescuer § 15: 2 two rescuers § Two fingers/thumbs encircling chest Child: § Same as infant § Heel of one hand or two hands Adults: § 30: 2 one or two rescuers § Heel of two hands http: //www. bhf. org. u k/heart-health/lifesaving-skills/handsonly-cpr. aspx § (adult) http: //youtu. be/Ff_k al. DZfz. U § (Kids)

HYPOVOLEMIC SHOCK Most common causes: § Hemorrhage, burns and dehydration Compensation § Increase peripheral vascular resistance, stroke volume, and heart rate. The body also redistributes the blood flow to the vital organs. If untreated: § Altered sensorium, oliguria, lethargy, confusion, dry mucus membranes, depressed fontanel, cold/clammy skin, poor skin turgor, delayed cap refill, tissue and organ damage (can be irreversible), death. Treament: § IV crystalloid infusion of warm saline or LR, blood transfusion, Albumin (if needed after bolus)

DISTRIBUTIVE SHOCK Abnormality in the distribution of blood flow or inability of the body to maintain vascular tone through vasoconstriction. Signs and Symptoms § Early: Vasodilation, Extremities are warm to touch, Tachycardia, Tachypenia. § Late: Rapid/Thready pulse, cyanosis, cold/clammy skin, purpuric skin lesions, narrow pulse pressure, oliguria or anuria Most common cause: § Sepsis (bacteria, viruses, fungi or rickettsiae), Anaphylaxis, central nervous system or spinal injury, and drug intoxication. Treatment: § IV antibiotics, Steroids, Hypoglycemic and electrolyte correction, vasoconstrictors, blood products, stabilize nervous system/spinal injury.

CARDIOGENIC SHOCK Myocardial function is impaired and cardiac output is not sufficient to meet the body’s metabolic demands. Signs & Symptoms: § Low cardiac output, cyanosis, respiratory distress, differentiated extremity blood pressures, poor tissue perfusion, and poor response to fluid resuscitation. Causes: § Structural abnormalities, cardiomyopathies, intractable arrhythmias, trauma, ischemia, metabolic abnormalities, drug intoxication, and impaired cardiac function after intracardiac surgical repair Treatment: § Identify the cause. Then treat with Dopampine, Dobutamine, milrinone, furosemide (Lasix) 1 mg/kg, Extracorporeal life support (ECLS), oxygen supply

TRAUMA: BLUNT AND PENETRATING Blunt Force: § Motor Vehicle Accident § Pedestrian Injury Penetrating Force: § Stabbing, firearms, blasting and impaling. § 20% of pediatric injuries.

MANAGE TRAUMA PATIENT Motorcycle accident, trauma eval. § http: //youtu. be/k. Oaez U-TAQs

OVERDOSE & INGESTION Can cause Permanente damage. Do not place chemicals in drinking bottles. 90% occur in the home. Over half occur in children <6 yrs old.

COMMON OVERDOSES IN KIDS Tylenol/Acetaminophen Signs and Symptoms § 1 st : (24 hrs) Nausea, vomiting, sweating, pallor, weakness § 2 nd : (24 -48 h) Increase in liver enzymes and bilirubin, RUQ pain, prolonged PTT § 3 rd : (3 -7 D) Jaundice, liver necrosis, hepatic failure § 4 th : (5 -7 D) recovery or progression to death. Treatment § IV fluids, Mucomyst (Nacetylcysteine), 1 -2 hrs activated charcoal Aspirin/Salicylates Signs and Symptoms § 1 st : stimulation of respiratory center, leading to repirstory alkalosis. § 2 nd : decreased K+, Increase metabolic rate, accumilation of ketones leading to metabolic acidosis, hypokalemia and dehydration, increased PTT, decreased platelet leves Treatment: § Activated charcoal, IV fluids, Sodium Bicarbonate, Postassium replacement, Vitamin K, Glucose, Hemodialysis

OVERDOSE IN KIDS Carbon Monoxide Signs and Symptoms § Headache, visual disturbances, altered LOC, cherry red lips and cheeks, N/V Treatment § 100% oxygen by rebreather mask, Serum carboxyhemoglobin levels, Hypebaric chamber (PRN) Lead Signs and Symptoms § Dependent on exposure and length of exposure Treatment § Based on exposure.

NEAR DROWNING (SUBMERSION) Submersion that results in asphyxia and death within 24 hrs. 2 nd & 3 rd unintentional deaths in children 1 -4 yrs old. Can happen in any body of water including toilets, tubs, ponds, rivers, ect. Prognosis base on: § Age, submersion time, water temperature, elapsed time before CPR started, neurological status.

BITES (HUMAN & ANIMALS) Human bites higher incidence of infection. Spider bites are the brown recluse spider and the black widow: cause skin necrosis. Most animal bites are from dogs. Snakes: poisonous were Crotalids/Pit Vipers and Elapids

BITES: TREATMENT Treatment § Depends on origin of the bit such as human, snake, spider or animal. § Animal: irrigation and debridement. Extremity in the dependent position to reduce circulation issues. Identification of creature for antivenin, Possible antibiotics, hypothermic treatment reduce spread

HEAT EXHAUSTION Nursing Education Consultants, INC. (2007 b). Heat exhaustion. Retrieved from http: //www. sy mptomsofexha ustion. net

HEAT STROKE Nursing Education Consultants, INC. (2007 a). Heat stroke. Retrieved from www. doctorsha ndout. com/pho to/heat-stroke

REFERENCES Daily Mail Reporter. (2011). Boy, three, left with horrific facial injuries as Labrador savages him while his mother strokes puppy. Retrieved from http: //www. dailymail. co. uk/news/article-2003849/Boy-3 -lefthorrific-facial-injuries-Labrador-savages-Poole-Harbour. html Forsythe, M. (2014). Blunt trauma. Retrieved from http: //www. slideshare. net/Profdr. Elghamry/blunt-trauma Mishra, B. (2008). Abdominothoracic trauma due to impalement by an iron bar. Retrieve from http: //www. trauma. org/index. php/main/image/754/C 13 Nursing Education Consultants, INC. (2007 a). Heat stroke. Retrieved from www. doctorshandout. com/photo/heat-stroke Nursing Education Consultants, INC. (2007 b). Heat exhaustion. Retrieved from http: //www. symptomsofexhaustion. net