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MSIII - Ch. 8-10, Trauma and Triage
Terms in this set (36)
What are the two families of poisonous snakes in North America?
Pit vipers, which include various
What is a helpful way to determine if a coral snake is venemous?
-Red on yellow can kill a fellow: If red band touches yellow band, snake is venomous
-Red on black, venom lack: If black band lies between red and yellow bands, snake is usually nonvenomous
These sayings only applies to coral snakes in the U.S.
What are some ways to prevent snakebites?
-Do not keep venomous snakes as pets
-Be extremely careful in locations where snakes may hide: Tall grass, rock piles, ledges and crevices, woodpiles, brush, boxes, and cabinets. Snakes are most active on warm nights.
-Don protective attire: Boots, heavy pants, leather gloves. When walking or hiking, use a walking stick or trekking poles
-Inspect suspicious areas before placing hands and feet in them
-Do not harass any snakes you may encounter. Striking distance can be up to 2/3 the length of the snake. Even young snakes pose a threat; they are capable of envenomation from birth.
-Be aware that newly dead or decapitated snakes can inflict a bite for up to an hr after death because of persistence of the bite reflex
-Do not transport the snake with the victim to the medical facility for identification purposes; instead, take a digital photo of the snake at a safe distance if possible
What are some first aid/prehospital cares right after a snake bite from a pit viper?
-Priority: Remove person to a safe area away from the snake
-Encourage rest to decrease venom circulation
-Remove jewelry and constrictive clothing before swelling worsens
-Call for STAT emergency assistance
-Immobilize affected extremity in positon of function: Maintain at lvl of heart
-Keep pt warm, provide calm environment
-Do not incise or suck wound, apply ice, or use a tourniquet
What are some interprofessional collaborative cares for a snake bite from a pit viper?
-Give supplemental O2
-Insert 2 lg-bore IV lines
-Infuse NS or LR
-Provide opioids to decrease pain
-Mark, measure, and record circumference of bitten extremity Q15-30 min
What are some assessment findings to look for after a pit viper bite?
-Pain, swelling, redness, and/or bruising around bite(s)
-Pt identification of
minty, rubbery, or metallic taste
-Tingling or paresthesias on scalp, face, and lips
-Muscle twitching, weakness
What is a first aid/prehospital care right after a snake bite from a coral snake?
Encircle affected extremity with an elastic bandage or roller gauze dressing (do not wrap so tightly that arterial flow is impeded); then splint. Leave on until pt is treated at an acute care facility.
What are some interprofessional collaborative cares for a snake bite from a coral snake?
-If snake is not able to be identified, treat as if venom were injected
-Be aware that toxic effects of venom may be delayed up to 13 hrs and then produce rapid clinical deterioration
-Provide interventions to decrease risk for aspiration
-Coral snake antivenom is not manufactured in the U.S. Supportive care is recommended
-Contact regional poison control for specific advice on pt management
What are some assessment findings to look for after a coral snake bite?
-Weakness, cranial nerve deficits (ptosis, diplopia, swallowing difficulty), altered LOC, and resp. paralysis
-Pain at the site, which may be described as mild and transient
What are some first aid/pre-hospital cares for a bee or wasp sting?
-Quickly remove stinger with tweezers or by gently scraping or brushing it off with the edge of a knife blade, credit card, or needles (if present) and apply ice pack
-Ensure ABCs are maintained
-Give epi STAT if pt is ALRG. Follow with antihistamine and go to the hospital.
What are some S/S of frostbite?
-White, waxy appearance to exposed skin
-People with darker skin: Skin becomes paler, waxy and somewhat grey
What are some prehospital/first aid cares for frostbite?
-Shelter from wind and cold
-Superficial frostbite is easily managed using body heat to warm the affected area: Place warm hands over affected areas of face or place cold hands under the arms
What are some hospital cares for frostbite?
-For all degrees of partial-thickness-to-full-thickness frostbite (second through third degree), rapid rewarming in a water bath at a temp. range of 104°F to 108°F is indicated to thaw the frozen part: Pt experience severe pain, so do in a medical facility
-Elevate extremity gently above heart lvl after rewarming process completed to decrease edema
-Analgesics: IV opiates
-PO ibuprofen Q8HRS to decrease thromboxane production in the inflammatory cascade and may reduce secondary tissue injury in frostbite
-Assess at least QHR for development of compartment syndrome
What are some first aid/prehospital cares for hypothermia?
-Shelter from the cold environment
-Remove all wet clothing
-Undergo passive rewarming: Applying warm clothing or blankets
-Undergo active rewarming: Heating blankets, warm packs, convective air heaters or warmers to speed rewarming
-Drink warm high-carb liquids that do not contain ETOH or caffeine
What are some hospital cares for hypothermia?
-Active external and core (internal) rewarming methods
-Avoid external rewarming with heating devices as it can cause rapid vasodilation and cardiac arrest
-Tx of choice: Cardiopulmonary bypass or hemodialysis
Moderate and severe hypothermia
-Position pt supine r/t orthostatic changes: Handle them gently to prevent V-fib
What are some core rewarming methods for hypothermia?
-Warm IV fluids
-Heated O2 or inspired gas
-Heated peritoneal, pleural, gastric, or bladder lavage
Explain after-drop in hypothermia.
The continued decrease in core body temp after pt is removed from the cold environment; caused by return of cold blood from periphery to central circulation
-Actively rewarm pt's trunk before extremities
What are some early S/S of complications that can occur after rewarming a patient who has severe hypothermia?
-Fluid, electrolyte, metabolic abnormalities
-Acute renal failure
A patient with mild hypothermia is using a heating blanket. How often should his skin be monitored?
At least Q15-30 min to reduce risk for burn injury
What conditions increase the risk for heat-related illnesses?
-mental health disorders
-All degrees of burns (even sunburn)
What are some interventions for a patient with heat stroke at the scene?
-Ensure patent airway
-Remove pt from hot environment (into air-conditioning or into the shade)
-Remove pt's clothing
-Pour or spray cold water on pt's body and scalp
-Fan the pt (not only the person providing care, but all surrounding people should fan the pt with newspapers or whatever is available)
-If ice is available, place ice in cloth or bags and position the packs on the pt's scalp, groin, behind the neck, and armpits
-Contact emergency medical services to transport pt to ED
-NPO: Vomiting and aspiration can occur
What are some cares for a patient in heat stroke at the hospital setting?
-Give O2 by mask or NC; be prepared for ET intubation
-Start at least one IV with lg-bore needle or cannula
-Administer NS as prescribed, using cooling solutions if available
-Use a cooling blanket along with other external cooling methods (ice packs, etc)
-Possible internal cooling methods: Iced gastric and bladder lavage
No ASA or other antipyretics
-Insert rectal probe to measure core body temp continuously or use a rectal thermometer and assess temp Q15 min
-Insert indwelling urinary drainage cath
-Monitor VS frequently as clinically indicted
-Baseline labs: Serum electrolytes, cardiac enzymes, liver enzymes, CBC, and ABGs
Administer muscle relaxants (BZs) if pt begins to shiver IV
-Measure urine output and sp. gr to determine fluid needs
-Stop cooling interventions when core body temp is reduced to 102°F (39°C)
-Obtain UA and monitor urine output
What are some first aid/prehospital cares for a patient who has HACE?
-Most important: Descent to a lower altitude
-Mild HACE: Allow pt to rest and acclimate at the current altitude
-Do not ascend to a higher altitude, esp. for sleep, util S/S lessen. If S/S persist or worsen, move to a lower altitude STAT
-O2 if available
What does HACE stand for?
High altitude cerebral edema
What are some interventions for a person who has AMS?
-PO acetazolamide for prevention and tx: Rids body of excess fluid and induces metabolic acidosis - take 24 hrs before ascent and continue for first 2 days of trip
-Dexamethasone for moderate to severe AMS: Does not speed acclimation, but reduces S/S
What is important to note about acetazolamide?
It is a sulfa drug, so ask about ALRGs
What are some interventions for HACE?
-Early recognition of ataxia or change in LOC: Prompts a rapid descent
-Give supplemental O2 and dexamethasone PO during descent or parenteral if airway and mental status impaired
What are some ways to prevent lightning strikes?
-Observe weather forecasts when planning to be outside
-Seek shelter when you hear thunder
-Leave water STAT (including indoor shower or bathtub) and move away from any open bodies of water
-Avoid metal objects such as chairs or bleachers; put down tools, fishing rods, garden equipment, golf clubs, and umbrellas; stand clear of fences, exposed pipes, motorcycles, bikes, tractors, golf carts
-If camping in a tent, stay way from tent poles and wet walls
-Turn off electrical equipment, including computers, TVs and stereos
-Stay off a hard-wired telephone
What are some considerations for shelters to prevent lightning strikes?
-Do not stand under an isolated tall tree or structure in an open area such as a field or hilltop: Ski lift, flagpole, boat mast, power line - lighting seeks the highest point
-A stand of dense trees offers better protection than other high points, but still try and stand away from tall trees
-Inside the nearest building or an enclosed vehicle
-Once inside a building, stay away from open doors, windows, fireplaces, metal fixtures, and plumbing
-Isolated sheds and entrances to caves are dangerous!
-If caught out in the open and cannot seek shelter, attempt to move to lower ground (ex. ravine or valley) and place insulating material between you and the ground (ex. sleeping pad, rain parka, life jacket)
What are some signs that a lightning strike is imminent? What should you do?
-Signs: Hair stands on end, you see blue halos around objects, and hear high-pitched or crackling noises
-If you cannot move from area STAT, crouch on balls of feet and tuck head down to minimize target size
-Do not have hands in contact with the ground
What are some assessment findings after a lighting strike?
-Classic finding: An immediate but temporary paralysis (AKA keraunoparalysis) - usually resolves in several hrs
-Mottled skin and decreased to absent peripheral pulses: Typically resolves spontaneously in several hrs
-Cardiopulmonary arrest: Treat these S/S first
-Tympanic membrane rupture
-Burns: Most are superficial and heal without incident
-Lichtenberg figures or keraunographic markings: Tree-like branching or ferning marks on skin - not considered burns
What are some watery safety interventions to prevent drowning?
-Constantly observe people who cannot swim and are in or around water
-Do not swim alone
-Test water depth before diving in head first; never dive in shallow water
-Avoid ETOH when swimming and boating and while in proximity to water
-Ensure water rescue equipment such as life jackets, floatation devices, and rope is STAT available when around water
What are some first aid/emergency cares after a drowning?
-Priority: Get victim out of the water safely
-Spine stabilization with a board or floation device should be considered ONLY for victims who are at high risk for spine trauma (ex. hx of diving, use of a water slide, signs of injury or ETOH intoxication), as opposed to all drowning victims
-If hypothermia is a concern, handle victim gently to prevent V-fib
NOTE: Do not attempt abdominal or chest thrusts to try and get water out of lungs. Only do this if airway obstruction is suspected.
What are some hospital cares for drowning?
-ABCs: ET intubation, CPR, defibrillation, O2
-Gastric decompression with a NG or orogastric tube is needed to prevent aspiration of gastric contents and improve ventilatory function
What are some basic supplies for personal preparedness?
3-day supply on Table 10-3 on page 156
-Clean, durable weather-appropriate clothing; sturdy footwear
-Portable water: At least 1 gallon per person per day for at least 3 days
-Food: Nonperishble, no cooking required
-Personal ID with emergency contacts and phone numbers, ALRGs, medical information; lists of credit card numbers and bank accounts (Keep in a watertight container)
-Towel and washcloth; towelette, soap, hand sanitizer
-Sunglasses/protective and/or corrective eyewear
-Emergency blanket and/or sleeping bag or pillow
-Personal first aid kit with OTC and prescription meds
-Plastic garbage bags and ties, resealable plastic bag
-Household liquid bleach for disinfection
What are some ways to prevent PTSD in staff during a mass casualty?
-Use available counseling
-Encourage and support co-workers
-Monitor each other's stress lvl and performance
-Take breaks when needed
-Talk about feelings with staff and managers
-Drink plenty of water and eat healthy snacks for energy
-Keep in touch with family, friends, and significant others
-Do not work for more than 12 hrs per day
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