to sort
triage means what?
life, limb, or vision
Rapid assessment to determine treatment priorities.
�Priority to those with threats to what?
�Require immediate, life-saving intervention?
�Is this a patient who shouldn't wait?
�How many resources will this patient need?
�What are the patient's vital signs?
what is the Emergency severity Index?
Primary: airway, breathing,
circulation, disability
Secondary: Systematic exam to identify all other injuries. (E-I) Expose, full set of vitals, give comfort measures, history and head to toe, inspect. ongoing monitoring
Primary & Secondary Surveys?
�Check central pulses; periphery may be compromised
�Check skin for color, temperature, capillary refill, note mental status
�Observe for bleeding
what do you check for to see if patient has good circulation?
� Stop bleeding
� Venous access
� Two large-bore IVs
� Intraosseous access
� Central line may be needed
treatment of hypovolemia
10 units and patients total blood volume
Massive fluid resucition is administration greater than ..... units of packed RBC in 24 hrs or replacemnt of ......... in 24 hrs?
� Restores oxygen transport to tissues
� Stops progress of shock
� Prevents complications
� Monitor for electrolyte imbalances
massive fluid resuscitation does what?
Disability
Measured by patient's level of consciousness
AVPU
A= alert
v = response to VOICE
p= response to PAIN
U = unresponsive
Pupils: size, shape, responsive to light, equality
how do you determine someone's Disability by LOC?
Glasgow Coma Scale
Assess arousal aspect of patient's consciousness (3-15) 3 being the worst
poisoning and submersion
more common injuries in children?
� Fatigue
� Lightheadedness
� GI-N/V/D
� > pulse and > resp
� Mild confusion, <executive function
� Profuse diaphoresis � IF LEFT UNTREATED
� Hypothalmic thermoregulatory failure
� Dehydration
� Cerebral edema or hemorrhage
� Temp > 99.6-104 F
heat injury symptoms?
� Cool down with fluids, remove clothing
� Fluid/electolytes replacement
HEAT STROKE-
� More aggressive cooling methods
� ABCs
� Chlorpromazine to < shivering
heat injury treatment?
elderly, certain drugs, alcohol; diabetes
Cold Issues/Injuries: those at risk?
93.2-96.8F
� Shivering
� Lethargy
� Confusion/irrational
mild hypothermia? symptoms?
86-93.2 F
� Symptoms as in mild, plus bradycardia, slow shallow respirations
� Severe Metabolic/respiratory acidosis
mod hypothermia and symptoms?
78-82.4F
hypothermia that can cause coma and death?
Dependent on degree: Warm patient- warm fluids, warming blanket, warm lavage�gastric or colonic
-Correct dehydration/acidosis/cardiac arrhythmias
they arent dead until they are warm and dead.. warm to atleast 86F
Management of hypothermia
� "Dry"- life threatening bronchospasm/airway obstruction
� Aspiration�pulmonary edema, respiratory distress syndrome. Type of fluid aspirated is significant.
� Immersion syndrome�hypothermia�potential fatal arrhythmias, death.
3 types of submersion injuries?
� Mechanical ventilation, PEEP to improve gas exchange
� Lasix and mannitol to decrease free water and cerebral edema.
Treatment of submersion injuries?
Hymennoptera
(bees, wasps)local reaction or anaphylaxis?
� The more stings, the more severe the reaction
� Remove stinger if present
� Treat allergic response�Epi pens-ED
� Comfort measures.
flu like symptoms typically in 3 days, may have a rash and can progress to arthritic and neurologic symptoms
lime disease symptoms?
Rocky Mountain Spotted Fever
most serious rickettsial disease with possible fatal outcome
� Symptoms may appear 2-14days, rash on palms, soles, wrists, fever, chills, headache
� Remove tick and clean wound, give antibiotics
symptoms of RMSF? tx?
Clean with copious irrigation, debridement, tetanus prophylaxis, and analgesics as needed
� Prophylactic antibiotics for bites at risk for infection: Wounds over joints, Wounds less than 6-12 hours old, Puncture wounds, Bites on hand or foot
animal and human bite tx? human bite is high risk for infection and hepatitis
� Determine if poisonous
� Observe, measure, manage symptoms
� Rarely antivenom
� Tourniquet is not useful
snake bite tx?
Days 0, 3, 7, 14, and 28
Series of five injections of human diploid cell vaccine:?
Gastric lavage
� Intubate before lavage if altered level of consciousness or diminished gag reflex.
� Perform lavage within _2_ hours of ingestion of most poisons
Activated charcoal
� Most effective intervention: Administer orally or via gastric tube with
poisoning treatment and decreasing absorption?
Cathartics (e.g., sorbitol)
Give with first dose of charcoal to stimulate intestinal motility/increase elimination
Decontaminiation
For dermal or eye poisoning what takes priority over all interventions except basic life support?
Black - deceased or cannot save
Red - in need of advanced care immediately to save life
Yellow - serious injury but can wait for treatment
Green - able to speak, walk and follow commands
Use color-coded labels or tags for mass casualty situations?