EMERGENCY STEPS ON HOW TO EARLY REPORTING: CHANT

CASE
NURSING HELP
ADDRESS
INCIDENT COMMANDER
 Handles the situation in a disaster operation NAME OF CALLER
 Controls throughout the duration of the TELEPHONE NUMBER OF CALLER
disaster operation.

USES OF AN AMBULANCE:
AMBULANCE MUST-KNOWS:
 Transports a patient to hospital and home and
1) DRIVER
vice versa
 MUST NOT LEAVE the ambulance
 Rescues trauma patients from an accident
 TEAM LEADER: sat beside the driver
 Serves as a standby rescue vehicle during big
(passenger seat)
gatherings and events
2) BEACONS
 DOES NOT bring recovered bodies to funeral
a) Lights
homes for proper identification
b) Sirens
c) is in front (In order
to convey the vehicle in front that it is
EMERGENCY PRINCIPLES an ambulance by using its side mirror)
1) 90-5-5 3) PATIENT POSITION: Head of patient must be
 90% = Safety of yourself the first to enter the ambulance
 5% = Safety of patient 4) NUMBER OF CREW (Philippine setting)
 5% = Safety of bystander a) Team Leader (passenger seat)
2) BSI (Body Substance Isolation) ✓ Delegator
 Before contact, isolate yourself from b) Driver
infectious conditions ✓ Never leave the ambulance
 Hand hygiene first before in contact c) Documentator (fills in patient’s
with the patient information and the run sheet)
3) RESCUE the patient FIRST d) Vital signs taker
4) DO NOT TREAT at the impact site e) Treat Man
5) Ask for help ✓ Treats the patient
6) COMMON sense
7) Calmness
8) Patience

STAR OF LIFE
1) Early Detection
2) Early Reporting
3) Early Response
4) On-Scene Care
5) Care In Transit
6) Transfer To
Definitive Care
CRAMPS CONCUSSION
 Unpleasant muscle contraction  Jarring (Na-alog) of the brain
 CAUSES:  CAUSES:
a) Excessive Exercise a) Blows to the head that does not injure
b) Prolonged Compression the skull (e.g. Coup-contra coup or
c) Forced ROM Whiplash)
 MANAGEMENT:
a) Stretch out muscle
b) Use WARM compress

SPRAIN vs. STRAIN

SPRAIN STRAIN
DEFINITION Ligament Muscle
fibers
CAUSES Pulling or Excessive
Twisting use of body  COMPLICATIONS
mechanics a) Confusion
S/SX a) Inflammation a) Pain b) Temporary loss of consciousness
b) Redness b) Bluish
c) Pain
c) Pain red
d) Warmth c) Warmth d) Possible seizures
NURSING a) Check PMS  MANAGEMENT:
MANAGEMENT  Pulse a) Monitor LOC
 Motor Movements
 Sensory Sensation
b) Remove jewelries
c) COLD compress
CONTUSION
 Bruising of brain tissue, possible accompanied
by hemorrhage (Na-untog)
 CAUSES:
DISLOCATION vs. FRACTURE a) Direct blows and deep impact to the
head
DISLOCATION FRACTURE
 MANAGEMENT:
DEFINITION Misaligned bone Damage to
from original bone b) Administer CPR if pulseless and
position integrity breathless
NURSING a) DO NOT replace/stretch c) Treat the bleeding
MANAGEMENT the bone (IMMOBILIZE) d) Apply COLD pack
 Treat the Fx (fracture)
e) Transport to nearest hospital
the way you fx
b) COLD packs
c) SPLINT
 If fx is along the bone:
BANDAGE it from
JOINT to JOINT
 If fx is along the joint:
BANAGE it from BONE
to BONE.
d) PMS before and after
splinting.
 If (-) PMS after
splinting, it is too tight.
 HYPOTHERMIA FROSTBITE
STAGES Core Axillary Sigs &  Localized destruction of tissue due to
Temp. Temp. Symptoms exposure to freezing temperatures
MILD 32- 30.5- a) Alert a) Constriction of capillaries on to the distal
(Normal) 35°C 35°C b) Vigorous parts of the body, causing lack of blood
shivering
supply.
MODERATE 30- 28.5- a) Reduced LOC
32°C 32°C b) Shivering  SIGNS & SYMPTOMS:
diminishes a) Numbness
c) Loss of fine b) Waxy appearance (INITIAL SIGN)
motor control c) Black appearance (LATE SIGN)
d) Loss of  MANAGEMENT:
coordination a) Soak in WARM water (100°F)
e) Blue lips-
✓ ONLY APPLICABLE on the initial sign
cyanosis
28- 26.5- a) Shivering b) Transport to nearest hospital
30°C 30°C stops
b) Fixed dilated
pupils HEAT EMERGENCIES
SEVERE 25- 23.5- a) Unconscious
I. HEAT CRAMPS
28°C 28°C b) Shivering has
stopped  Painful severe cramps
c) Rigid muscles  Typically occurs on the calves, abdomen,
d) Appears dead back and arms
e) Potential  EARLIEST sign of heat illness
arrhythmias  CAUSES:
20- 18.5- a) Cardiac a) Due to excessive water/electrolyte
25°C 25°C Arrest
loss
PROFOUND <20°C <18.5°C a) NO detectable
V/S b) Excessive performing activities
without hydration
A. MILD HYPOTHERMIA  SIGNS & SYMPTOMS:
 NORMAL a) Painful muscle spasms
 Shivering b) Heavy sweating
 OKAY to give warm drinks  MANAGEMENT:
B. MODERATE HYPOTHERMIA a) Hydration ORALLY
 NO MORE shivering II. HEAT EXHAUSTION
 FIRST: give blanket  If not immediately treated prior from
 NOT OKAY to give warm drinks heat cramps, it can lead to heat exhaustion
✓ Swallowing reflex might be lost  SIGNS & SYMPTOMS:
prior to no more shivering reflex a) Body Temp: 38.8-102°C
✓ Risk of aspiration b) Headache
C. SEVERE HYPOTHERMIA c) Fatigue & Weakness
 Possible seizures d) Moist skin/Sweating
 PRIORITY: Safety Precautions e) Orthostatic hypotension
D. PROFOUND HYPOTHERMIA f) Tachycardia
 Possible death g) Anxiety-Confusion
 MANAGEMENT:
a) Salt & Water replacement
b) Rest
III. HEAT STROKE
  If not immediately treated prior from  INITIAL ACTIONS AFTER THE STING:
heat exhaustion, it can lead to heat stroke a) Swipe the stinger with a card
 SIGNS & SYMPTOMS: b) Wash the site with soap and water
a) Body Temp: 40.6-105°C c) Prioritize airway or watch out for
b) Sodium and Potassium depletion airway problems
c) Listlessness  ACTIONS “MINUTES” AFTER THE STING
d) Weakness (if prominent swelling is indicated):
e) Hot & dry skin a) Use curved tweezers
f) Impaired sweating  It can lead to:
g) Tachypnea a) ALLERGY
h) Tachycardia ✓ Increased temperature
i) Anxiety-Confusion ✓ Itchiness
 COMPLICATIONS: ✓ Mottled appearance
a) Cerebral Edema: (pantal-pantal sa balat)
✓ Seizures b) ANAPHYLAXIS
✓ Delirium ✓ Allergy S/Sx
✓ Coma ✓ Difficulty of breathing
 MANAGEMENT:  FACTS:
a) Cooling a) When bee stings, it cannot pull the
b) Rest stinger back out. It leaves behind
c) Fluid & Electrolyte Support not only the stinger but also part of
IV. FAINTING its digestive tract, plus muscles
 Temporary loss of blood in the brain and nerves. This massive
 CAUSES: abdominal rupture and bleeding is
a) Excitement what kills the bee.
b) Lack of rest
c) Low or high temperatures
d) Did not eat meals
e) Overwork
f) Weak
g) No air (lead to asphyxiation)
 WARNING SIGNS OF A FAINTING SPELL:
a) Dizziness & Nausea
b) Turning pale
c) Tinnitus
d) Blurry vision or tunnel vision
e) Feeling faint or light-headed
f) Suddenly feeling warm and sweaty
 MANAGEMENT:
a) Assess AVPU/LOC
✓ Alertness
✓ Verbal commands
✓ Pain stimulus
✓ Unconsciousness/LOC
b) If FACE is RED: RAISE Head
c) If FACE is PALE: RAISE tail (legs)
d) SUPINE if necessary FIRE/BURNS
V. BEE STING  Elements of FIRE (FIRE TETRAHEDRON)
 TYPES OF FIRE
EXTINGUISHERS

 OBJECTIVES:
a) RACE/ARCE
RACE ARCE

(WITH patient) (WITHOUT

patient)

Rescue Alarm
Alarm Rescue
Contain/Confine Contain/Confine
Extinguish & Evacuate Extinguish &
Evacuate

b) Airway (ABCs): PRIORITY

✓ Equipment: face mask/non-
rebreather mask on O2
c) NEVER REMOVE clothes
d) 3 Magic Words:
✓ STOP
✓ DROP STEPS IN OPERATING A FIRE
✓ ROLL
e) Medications via IV EXTINGUISHER
1) Position yourself to exit
2) Twist pin
3) Pull pin
4) Aim nozzle
5) Squeeze handle
6) Swing nozzle
 DEGREES OF BURNS RULE OF NINES (ADULT)
Nomenclature Traditional Depth Findings FRONT BACK (%) FRONT-BACK
Nomenclature (%) (%)
SUPERFICIAL 1ST DEGREE Epidermis  Erythema HEAD- 4.5 4.5 9
 (-) blisters NECK
 (-) scar CHEST- 18 18 36
 (+) Pain ABDOMEN
SUPERFICIAL 2ND DEGREE Between  (+) blisters & WHOLE (R) 4.5 4.5 9
PARTIAL epidermis weeps ARM
THICKNESS and dermis  Clear fluid
WHOLE (L) 4.5 4.5 9
 (+) Pain
 (+) scar ARM
 Do not WHOLE (R) 9 9 18
require LEG-THIGH
surgery WHOLE (L) 9 9 18
 Increase LEG-THIGH
depth: GENITAL 1
increase risk AREA
of infection or
scarring
PARTIAL 2ND DEGREE Full dermis  (+) blisters &
THICKNESS/ weeps
DEEP
PARTIAL
 Whitish
appearance
RULE OF NINES (PEDIA)
 Requires TBSA (%)
surgery
 Forms more HEAD-NECK 21
scars
 LESS painful CHEST-ABDOMEN 13
 Increase
depth:
BACK 13
increase risk
of infection or
scarring WHOLE (R) ARM 10
FULL 3RD DEGREE Underlying  Hard,
THICKNESS tissues leathery, dry WHOLE (L) ARM 10
eschar
 Insensate to WHOLE (R) LEG- 13.5
light touch THIGH
and pin prick WHOLE (L) LEG- 13.5
 (-) Pain THIGH
 Large areas
GENITAL AREA 1
require skin
grafting
 Small areas BUTTOCKS 5
will heal with
minimal scar
or
contracture
 High risk of
infection RULE OF PALM
4TH DEGREE Muscle or  Loss of  If there is an isolated burn wound/mark
bone burned part
that is BIGGER or the SAME AS THE SIZE of
his/her palm, consider it as 1%.
 PHASES BURN RHABDOMYOLOSIS
EMERGENT CARE  24-48 hours post burn  Products of muscle breakdown in urine of
 PARKLAND FORMULA: major burn victim
✓ 4 cc X kg X %TBSA  GOOD sign: KIDNEYS are still functioning!
of Lactated Ringer’s
Solution
✓ This is for the
amount of fluids to
ELECTROCUTION
be given for the  Electricity above tolerable current passes
first 24 hours upon or enters through body
admission  CAUSES:
ACUTE CARE  72 hour (maintenance
nd
1) Spaghetti wiring
techniques) 2) Octopus wiring
REHABILITATIVE  Therapy techniques  NURSING MANAGEMENT
CARE
1) DO NOT TOUCH patient
2) Look for the SOURCE, SWITCH,
FLUIDS OLIGURIC DIURETIC
FUSE BOX
Intravascular to Interstitial to 3) CPR
interstitial intravascular 4) NPO until fully recovered
MI/HEART CARDIAC
HEMATOCRIT INCREASED DECREASED ATTACK ARREST
Pumping
URINE
POTASSIUM
DECREASED
INCREASED
INCREASED
DECREASED Of Heart
Muscles
✓ X
SODIUM DECREASED DECREASED Blood
PROTEIN DECREASED DECREASED Supply To
The Heart
X ✓
pH METABOLIC METABOLIC
ACIDOSIS ACIDOSIS
MANAGEMENT EMERGENT ACUTE CARE
CARE
WOUNDS (CLOSE/OPEN)
 Is a break in the continuity of a tissue of the
body, either internal or external.
GOAL OF BURNS CLOSED WOUND OPEN WOUND
1) RETURN TO NORMAL OF ABCs  It involves the  It is a break in the
2) IV: Lactated Ringer’s Solution (LRS) underlying tissue skin or mucous
3) Whirlpool Therapy without break/ membrane; or the
 To promote debridement of eschar damage in the skin protective barrier
4) ANALGESICS Before whirlpool therapy and or mucous skin layer is
membrane. damaged.
exercises
NURSING MANAGEMENT
5) Antibiotics
1) ICE application (to
6) Check temperature for fever promote
7) Check WEIGHT (indicator for fluid retention) vasoconstriction and
decrease bleeding)
2) Compression
3) Splinting
KINDS OF BLEEDING (OPEN WOUND)
1) ARTERIAL BLEEDING
INGESTED POISONING
 Irregular spurting of blood  ASSESSMENT:
2) VENOUS BLEEDING 1) Identify FIRST if CORROSIVE or NOT
 Even flow of blood CORROSIVE
3) CAPILLARY BLEEDING  CHECK the label of the poison
 Capillary oozing CORROSIVE NOT
CORROSIVE
CLASSIFICATION OF OPEN WOUND DO NOT INDUCE INDUCE vomiting
1) PUNCTURE vomiting
2) ABRASION LEFT position LEFT position
3) LACERATION TRANSPORT TRANSPORT
4) AVULSION
 AVOID RIGHT position!
5) INCISION
✓ The poison can easily
pass through the
FIRST AID MANAGEMENT
duodenum and
1) CONTROL the bleeding absorbed by the portal
 Put pressure on the wound vein via the liver.
2) COVER the wound with dressing and secure
with bandage
3) CARE for shock JELLYFISH STING
 Proper positioning of the affected part  MANAGEMENT:
4) CONSULT or refer to physician 1) Rinse the affected area with
seawater to help gets rid of loose
stingers. AVOID freshwater which
WOUNDS WITH SEVERE BLEEDING may irritate the wound by activating
1) CONTROL the bleeding by: additional nematocysts.
✓ AVOID drying the site with tower
 DIRECT pressure or getting sand in it which it will
➢ EXCEPT: add to the irritation.
a) Eye injury 2) Carefully scrape the remaining
b) Wound with embedded stingers out of your skin using an ID or
object credit card.
c) Possible skull fracture 3) Apply plain vinegar to the site or a
paste of baking soda and seawater
2) ELEVATION which may deactivate nematocysts
3) PRESSURE POINT bleeding control and reduce the reaction
4) Rinse the area under hot water not
 Brachial artery
to exceed 113 degrees F or apply ice
 Femoral artery packs. Choose the method that seems
to offer you the most relief.
5) Apply calamine lotion and take a
pain reliever or anti-inflammatory
medication to help reduce swelling
and irritation
6) Rest and monitor the site. See a
doctor if a rash develops or you start to
have DOB.
 SNAKE BITE a) Bleeding
b) Fang marks
 ASSESSMENT: c) Discoloration
1) ASSESS the bite mark FIRST if it is d) Burning sensation
VENOMOUS or NON-VENOMOUS e) Swelling
2) WASH the affected area 8) GASTRIC
3) KEEP the patient still a) Nausea
4) DO NOT USE TOURNIQUET b) Vomiting
✓ Yes, it can suppress the toxin on 9) INTESTINAL
the distal area of the affect a) Diarrhea
extremity. 10) OTHER SKIN SITES
✓ THE PROBLEM IS: after removing, a) Bleeding spots
the toxin will circulate in a b) Numbness
“BOLUS-TYPE” fashion, leading c) Tingling
to abrupt death to the patient. d) Sweating
VENOMOUS NON-
BITE VENOMOUS
BITE BASIC LIFE SUPPORT (AMERICAN
BITE MARK TWO bite marks MULTIPLE bite
marks (Horseshoe-
HEART ASSOCIATION GUIDELINES,
shaped) 2019)
EYES VERICAL pupils ROUNDED/OVAL
pupils
HEAD ARROW-typed ROUNDED
IHCA & OHCA Chains of Survival
 SIGNS & SYMPTOMS:
IHCA (Intra-Hospital Cardiac Arrest)
1) CNS
a) PRIMARY PROVIDERS
a) Dizziness
 Surveillance & Prevention
b) Fainting
 Recognition And Activation Of The
c) Increased thirst
Emergency Response System
d) Headache
 Immediate High-Quality CPR
2) VISION
b) CODE TEAMS
a) Blurriness
 Rapid Defibrillation
3) SYSTEMIC
c) CATH LAB
a) Fever
d) ICU
b) Sever pain
 Advanced Life Support & Post-Arrest
4) HEART & VESSELS
Care
a) Rapid pulse
b) Low BP
OHCA (Outside Hospital Cardiac Arrest)
c) Sever shock
a) LAY RESCUERS
5) RESPIRATORY
 Recognition And Activation Of The
a) DOB
Emergency Response System
6) MUSCULAR
 Immediate High-Quality CPR
a) Convulsions
 Rapid Defibrillation
b) Loss of coordination
b) EMS
c) Weakness
 Basic & Advanced Emergency Medical
Services

7) WOUND SITE
 c) ED
 Advanced Life Support & Post-Arrest ADULT, CHILD & INFANT CPR:
Care
d) CATH LAB 30 compressions
 Advanced Life Support & Post-Arrest 2 ventilations
Care 5 times
e) ICU 2 minutes
 Advanced Life Support & Post-Arrest
Care LAY RESCUERS or NO training
(Badger County):
OVERVIEW of BLS Steps
1) HAZARD (90-5-5)
200 compressions in 2 minutes
 Survey the scene if it is safe
2) HELLO
 Introduce yourself
 Ask: Sir/Ma’am, can you hear me?/can ADULT CHILD INFANT
If patient has: 2 HANDS 1 HAND 2 FINGERS

(-) PULSE 1.5-2 INCHES 1-1.5 INCHES 0.5-1 INCH

(-) BREATHING
WAYS TO VENTILATE THE LUNGS
→ PERFORM CPR IMMEDIATELY
1) Mouth-to-Mouth
2) Mouth-to-Nose
you get up?
3) Mouth-to-Mouth and Nose
3) HELP 4) Mouth-to-Stoma
 Instruct bystander to call EMS
4) CIRCULATION If patient has:

 Check circulation on the carotid artery

(+) PULSE
for 10 seconds (ADULT)
 Check circulation on the brachial
artery for 10 seconds (INFANT) (+) BREATHING
5) AIRWAY
→ PLACE RECOVERY POSITION (to
 Perform head tilt chin-lift maneuver in prevent aspiration)
adults
 Lay the infant on a FLAT SUPINE
position
6) BREATHING
WHEN NOT TO PERFORM CPR
1) DNR (Do Not Resuscitate Order) or AND (Allow
Natural Death Order)
2) Dependent lividity
3) Obvious death
 6) AFTER CHECKING BREATHING:
NORMAL 1) STAY with patient until
BREATHING assistance arrives
AND PULSE
(-) 1) 30 compressions and 2
BREATHING respirations using bag
(-) PULSE valve mask device
(ambu bag) or
continuous compression
until AED arrives
(-) 1) Provide respirations for
BREATHING 5-6 seconds using bag
(+) PULSE valve mask device with
filter and tight seal
7) AED ARRIVES:
SHOCKABLE 1) Give 1 shock and
resume CPR until
instructions from AED
tells you to stop or:
a) AED goes to
rhythm check
b) Until patients
starts to move
NON 1) Do CPR until instructions
SHOCKABLE from AED tells you to
stop or:
a) AED goes to
rhythm check
b) Until patients
WHEN TO STOP CPR starts to move
1) Signs of Life
2) Turnover to ambulance
3) Operator is exhausted FOREIGN BODY AIRWAY OBSTRUCTION
4) Physician takes over (CHOKING)
5) Scene is unsafe  NURSING MANAGEMENT:
1) DO NOT ASK if he is choking
2) DO NOT RAPPORT
3) ASK him if he can cough
BASIC LIFE SUPPORT AND 4) If (+) Cough, Encourage to cough
COVID-19 5) If (-) Cough:
a) Perform back blows (5x)
1) Don PPE
b) Perform Heimlich maneuver (5x)
2) Limit personnel/bystanders 6) Repeat a & b.
3) Check for responsiveness
4) If unresponsive:
a) Ask for help
b) Call medical assistance
c) Get AED
5) Check breathing and pulse for 10 seconds
 ALONE AND CHOKING

TRIAGING
 MCI = Mass Casualty Index
✓ xMeet = SUPPLY = DEMAND
 the process by which patients classified
according to the type and urgency of their
conditions to get the RIGHT PATIENT to the
RIGHT PLACE at the RIGHT TIME with the
RIGHT CARE PROVIDER.
FIRST: follow START Protocol (Simple
Triage And Rapid Treatment)
PREGNANT/OBESE CHOKING ✓ to quickly classify victims during a mass
 NURSING MANAGEMENT: casualty incident (MCI) based on the
1) DO NOT HEIMLICH maneuver severity of their injury (e.g. using tags).
2) DO CHEST TRUSTS! TRIAGE
GREEN NON-  walking-
URGENT wounded
 HOME first aid
INFANT CHOKING RED EMERGENT  Injury of VITAL
organs
 SHOCK
 ABCs problems
 Amputations
 Spinal cord
injury
YELLOW URGENT  Injury of the
extremities
 NO SHOCK
 ABCs are GOOD
BLACK EXPECTANT  Expected to die
  Decapitated  Drought
 Earthquakes

DISASTER NURSING
b) Emergency diseases (Pandemic)
 Extreme heat
 Floods
 Hail
DISASTER
➢ A sudden event that causes great damage or loss MAN-MADE TYPES OF DISASTER
of life a) HAZMAT spills (Hazardous Materials)
1) PREPAREDNESS b) Power Disruption & Blackout
✓ activities PRIOR TO a disaster c) Nuclear Power Plant And Nuclear Blast
✓ EXAMPLES: d) Chemical Threat And Biological Weapons
a) Preparedness Plans e) Cyber Attacks
b) Emergency Exercises/Trainings f) Explosion
c) Warning Systems g) Civil Unrest (Political Problems)
2) RESPONSE h) Terrorism
✓ activities DURING a disaster
✓ EXAMPLES: TROPICAL CYCLONE
a) Public Warning Systems CLASSIFICATIONS
b) Emergency Operations CATEGORY INTENSITY (wind
c) Search & Rescue (Living) speed)
d) Search & Retrieval/Recovery TROPICAL 61 kph or less
(Deceased) DEPRESSION (td)
3) RECOVERY TROPICAL STORM (ts) 62-88 kph
SEVERE TROPICAL 89-117 kph
✓ activities FOLLOWING a disaster
STORM (sts)
✓ EXAMPLES: TYPHOON (ty) 118-220 kph
a) Temporary Housing SUPER TYPHOON (sty) More than 220 kph
b) Claims Processing And Grants
c) Long-Term Medical Care And SAFETY MEASURES:
Counseling (Psychological First- a) Safety
Aid) b) Relocation Sites
4) MITIGATION c) Resettlement
✓ Activities that REDUCE THE EFFECTS d) Evacuation Site
of a disaster e) Empowerment
✓ EXAMPLES: f) Disease Detection
a) Building Codes And Zoning g) Reverse Triage
b) Vulnerability Analyses  In order to accommodate a greater
c) Public Education number of the new critical patients,
WHO DECLARES A DISASTER? the existing patients may be triaged,
a) Mayor and those who will not need
b) Governor immediate care can be discharged.
c) President

TYPES OF DISASTER
a) Natural
b) Man-Made
NATURAL TYPES OF DISASTER
a) Agricultural diseases & pests