EMERGENCY NURSING

Learning Outcomes

1. Discuss priority emergency measures.

2. Identify Priorities of care for patients who are critical and
has multiple injuries.
 QUESTIONS
• What is Emergency Nursing?

• What are it’s concepts?

• What are your expectations as a future nurse?

EMERGENCY NURSING
 GOLDEN RULES IN EMERGENCY NURSING
A. Emergency is always an emergency.
B. Injuries either minor or major injuries shall be given attention.
C. Introduce your self and communicate to your patient/casualty.
D. Study and learn to be a competent nurse especially in handling
critical cases.
E. If the patient is in 50-50 situation do something through intense
collaboration with other medical workers.
F. When caring for children toys and distractions are essential.
G. Familiarize with the equipments around you.
H. Common things are common but can kill or compromise the
patient’s life.
 ASSESSMENT
• Do a rapid to toe visual scan of the patient.
TAKE NOTE OF THE FOLLOWING:
a. RR
b. pallor
c. positioning
d. perfusion
e. hemorrhage
f. signs of distress- physical and psychological
Take note!
• Teamwork in the
emergency department is
essential to provide
successful emergency
care.
• Emergency nurses and
doctors should work with
individual patients to
develop care plans
towards the patient’s
suvival and well being.
• Emergency care roles
should also promote injury
prevention through first aid
and health teaching
towards the casualty and
their families.
• Infection prevention is also
necessary as part of
precaution especially in
handling patient with
infectious disease.
 Triage
• Determining the urgency of care
 The key processes of triage are:

• rapid assessment;
• identifying life- or limb-threatening problems;
• initiation of investigations;
• providing analgesia;
• controlling patient flow
 TRIAGE SCALE
CATEGORY DESCRIPTION TIME FRAME
RED IMMEDIATE IMMEDIATELY
ORANGE VERY URGENT WITHIN 10 MINS OF ARRIVAL
YELLOW URGENT WITHIN 1H OF ARRIVAL
GREEN STANDARD WITHIN 2H OF ARRIVAL
BLUE NON URGENT WITHIN 4H OF ARRIVAL
 TRAUMA

ASSESSMENT
Control of Airway Circulation
catastroph Breathing
with C- with Disability Exposure
ic and
spine hemorrhag
hemorrha ventilation
protection e control
ge
Control of catastrophic hemorrhage
Airway with C-spine protection
 Breathing and ventilation Assessment

Look, listen and feel

R Respiratory rate What is the respiratory rate

What can you see on the chest (e,g. wounds, bruising,

I Inspection
Breathing and symmetry)
ventilation
P Palpation What can you feel? ( crepitus, does this elicit pain ?)

P Percussion What can you hear? ( normal resonance, dull, hyper resonant )

Can you hear breath sounds ?they may be present reduced or

A Auscultation
absent

S Saturation What is the peripheral oxygen saturation

 Common bleeding sites in the trauma
patient

“On the floor and for more “

Circulation with Floor Is there blood on the floor or at the scene ?

hemorrhage control
is there blood in the chest (massive hemothorax )?clues include
Chest
shock dull note on percussion absent air entry (to affected side )
Is there blood in the abdomen ?
Abdomen
clues include shock, bruised, tender or distended abdomen
Is there blood in the pelvis ?
Pelvis
clues include bruise, deformed, painful pelvis
Is there blood in the long bones (femur, humerus)?
Long bones
Clues include bruise, deformed, swollen painful limb
Disability
Exposure
Steps of
Emergency
Management
Prevention
• Actions taken to avoid an incident. Stopping an incident
from occurring. Deterrence operations and surveillance.
Mitigation
• Refers to measures that prevent an emergency, reduce
the chance of an emergency happening, or reduce the
damaging effects of unavoidable emergencies.
•
Preparedness
• Activities increase a community's ability to respond when
a disaster occurs.
Response
• Actions carried out immediately before, during, and
immediately after a hazard impact, which are aimed at
saving lives, reducing economic losses, and alleviating
suffering.
• Recovery
• Actions taken to return a community to normal or near-
normal conditions, including the restoration of basic
services and the repair of physical, social and
economic damages.
PRIMARY
SURVEY
• The primary survey is designed to assess and treat life-
threatening injuries rapidly

• It should be completed very rapidly.

• The main causes of death in a trauma patient are airway

obstruction, respiratory failure, massive hemorrhage,
and brain injuries.
 Examples of Injuries to be assessed in the Primary
Survey
 Airway obstruction
 Tension pneumothorax
 Massive internal or external hemorrhage
 Open pneumothorax
 Flail chest
 Cardiac tamponade
 Intracranial bleed
 Increased intracranial pressure
The common acronym for performing the primary
trauma survey is ABCDE

Airway
Breathing
Circulation
Disability
Exposure and Environmental Control
 A: Airway with cervical spine precautions /or
protection.
Assessement:
a. Can the patient speak/responsive or cough?
b.Perform a head tilt chin lift or jaw thrust maneuver if
there are obstructions present.
c. Foreign bodies, secretions, facial fractures, or airway
lacerations are also sought out.
d. If there are other causes of obstruction, a definitive
airway should be established, whether through intubation or
the creation of a surgical airway such as
cricothyroidotomy.
e. cervical spine is immobilized and maintained in line.
f. This means one provider maintains the in-line
immobilization, and the other manages the airway. Once the
patient is stabilized in this scenario, their neck should be
secured with a cervical collar.
 B: Breathing and Ventilation
• This assessment is performed first by inspection.
• The practitioner should look for tracheal deviation, an
open pneumothorax or significant chest wounds, flail
chest, paradoxical chest movement, or asymmetric
chest wall excursion.
• Then, auscultation of both lungs should be conducted to
identify decreased or asymmetric lung sounds.
Decreased lung sounds can be a sign of
pneumothorax or hemothorax.
• Open chest wounds should be covered immediately with
a bandage taped on three sides to prevent the entry of
atmospheric air into the chest.
• Note that, in general, all trauma patients should receive
supplemental oxygen
 Circulation with hemorrhage control
• Adequate circulation is required for oxygenation to the
brain and other vital organs. Blood loss is the most
common cause of shock in trauma patients.
• Evaluated by assessing the level of responsiveness,
obvious hemorrhage, skin color, and pulse (presence,
quality, and rate)
• The level of responsiveness can be quickly assessed by
the mnemonic AVPU, as follows:

• (A) Alert
• (V) Respond to Verbal stimuli
• (P) Respond to Painful stimuli
• (U) Unresponsive to any stimuli.
• Any obvious hemorrhaging should be controlled by direct
pressure if possible and, if needed, by applying
tourniquets to the extremities.

• Pale or ashen extremities or facial skin is a warning sign

of hypovolemia.

• Rapid, thready pulses in the carotids or femoral arteries

are also of concern for hypovolemia.
•Secondary
Survey
 What is Secondary Survey
• The secondary survey is performed once the patient has
been resuscitated and stabilised.

• A more thorough head-to-toe examination.

• The aim is to detect other significant but not immediately

life-threatening injuries.
 4 STEPS IN SECONDARY SURVEY
• 1. History ​

• 2. Assess and record vital signs ​

• 3. Head to toe Assessment ​

• 4. Give first aid for injuries and illnesses found.​

 1. History
• Symptoms​
• Allergies ​
• Medications ​
• Medical History ​
• Last Meal ​
• Events leading to incident​
MEDICAL EMERGENCIES
 HEMORRHAGE
• Bleeding
• Blood escaping from the
circulatory system from
damaged blood vessels.
• Bleeding can occur internally, or
externally either through a
natural opening such as the
mouth, nose, ear, urethra,
vagina or anus, or through a
wound in the skin.
 Hemorrhage

Causes
• Traumatic injury, Medical
condition
Types of Bleeding
• Arterial bleeding
• Venous bleeding
• Capillary bleeding
Diagnostics
• CBC, RBC count, hemoglobin,
blood typing and crossmatching
 Hemorrhage

Goals of Emergency Management in

Bleeding
• Control bleeding
• Maintain adequate circulating blood
volume for tissue oxygenation
• Fluid replacement
• Blood transfusion
• Prevent shock
 external bleeding

External Bleeding
• occurs with open wounds where there is a break in the skin
Assessment
• Wounds
• A wound is an injury to the tissue caused by a cut, blow, or other
impact, typically one in which the skin is cut or broken.
External bleeding
EXTERNAL BLEEDING
 external bleeding

Goals of Wound Treatment

• 1. Prevent infection
• Wound cleansing
• 2. Restore physical integrity
and function of the injured
tissue
• Primary closure
• Delayed primary closure
 external bleeding

Management
1. Direct Pressure: Place a dressing over the injured area. If no
dressing is available, use gloves to put direct pressure.
• Use bare hands only if no barrier is available then wash hands
immediately.
• Do not put pressure on an object in a wound.
• Do not put pressure on the scalp if the skull may be injured.
• Do not use tourniquet to stop the bleeding except as an extreme
last resort.
 external bleeding

Management
3. Elevation: Lift the injured extremity above the heart level
4. Pressure Points: This procedure is used only if after a direct
pressure and elevation has failed. Pressure is applied at common
pressure sites like brachial artery pressure point and femoral artery
pressure point (indirect pressure).
5. Splints: For immobilization preventing further injury.
external bleeding
 external bleeding

Management
6. Tourniquet:
• Locate the site of tourniquet application. This should be between
the wound and the patient’s heart, as close to the wound as
possible. The safest location is 1 – 2 inches from the wound.
• Place a tourniquet pad on the site you have selected, over the
artery. Pad can be a roll of dressing, a folded handkerchief or a
piece of cloth.
 external bleeding

Management
• Use flat belt, necktie, stocking or a long dressing material.
Carefully slip the tourniquet around the patient’s limb and tie a
half knot. Place a device such as metal rod, stick or a wooden
dowel over the half knot then tie a full knot over. Turn the device
until bleeding has stopped.
• Attach a note to the patient stating that a tourniquet has been
applied and the time it was applied.
• Provide care for shock.
• Complications: risk of loss of the extremity
external bleeding
 Hemorrhage

Complications
• Hypovolemic Shock
 MEDICAL MANAGEMENT

Vitamin K

Tranexamic acid (TXA)-

antifibrinolytic drug that promotes blood clotting by preventing blood

clots from breaking down.
Type of medicine An antifibrinolytic medicine

Used for To prevent or treat heavy bleeding

Also called Cyklokapron®; Cyklo-f® Heavy Period Relief

Available as Tablets and injection

Tranexamic acid side-effects What can I do if I experience this?

Feeling sick (nausea) or being Stick to simple meals - avoid rich and spicy food. If you are not
sick (vomiting) already doing so, try taking the tablets after meals

Diarrhea Drink plenty of water to replace the lost fluids

Eyesight problems (such as Let your doctor know about this as soon as possible as your
problems with your colour treatment will need to be reviewed
vision)
 STROKE
- also called brain attack, occurs
when blood flow to the brain is
disrupted.
- It is caused when either a
blood clot blocks one of the vital
blood vessels in the brain
(ischemic stroke),

- when a blood vessel in the

brain bursts, spilling blood into
surrounding tissues
(hemorrhagic stroke).
 Symptoms may be sudden and include:

• weakness or numbness of the face, arm, or leg,

especially on one side of the body
• confusion or difficulty speaking or understanding
• problems with vision such as dimness or loss of vision in
one or both eyes
• dizziness or problems with balance or coordination
• problems with movement or walking
• severe headaches with no other known cause
• Aphasia inability to speak
 less common, symptoms of stroke

• Sudden nausea, vomiting, or fever not caused by a viral

illness

• Brief loss or change of consciousness such as fainting,

confusion, seizures, or coma

• transient ischemic attack (TIA), or "mini-stroke"

Management for stroke
1. Call for Emergency help
2.Note the first sympotms of stroke and also the signs.
3. Perform CPR Immediately if the patient’s breathing and
pulse is not present.
4. NPO
 Medical Management
• rapid initial evaluation for airway, breathing and circulation
• neurological examination to assess severity of stroke.
• acute phase should include heart rate and rhythm,
blood pressure, temperature, oxygen saturation,
hydration status, and presence of seizure activity.
• Blood Tests (CBC, Electrolytes, Coagulation, Creatinine)\
• Seizure Assessment
• Neurovascular (Brain and Vascular) Imaging
Thoracic emergency
TRAUMA
 FLAIL CHEST

What is Flail Chest?

CAUSES:

1. severe blunt trauma, such as a serious fall or car accident

2. bone disease or deterioration in older patients
Symptoms of Flail Chest
- at least three ribs close together broken in two or more places
- Paradoxical movement
- Chest pain and Difficulty drawing breath
 Management
The goal of emergency room personnel is to:
1. stabilize the chest wall, followed by identification and treatment
of all injuries in and around the chest.

2. Mechanical Ventilation to stabilize the chest cavity

Other managements:

3. Corrective Surgery

4. Analgesics/Pain medication.
 pneumothorax

a collapsed lung.

A pneumothorax occurs when

air leaks into the space
between your lung and chest wall.
This air pushes on the
outside of your lung and
makes it collapse
Symptoms

The main symptoms of a pneumothorax

are sudden chest pain and shortness of breath

example: Diminished Breath sounds.

.
Medical Management
 Trauma-Informed Care
• What is Trauma?
 There are three main types of trauma:

Acute trauma

Chronic trauma

Complex
Trauma Care
Anaphylaxis and Inhalation Injury
INHALATION INJURY
 Classifications
• Upper airway injury
• Tracheobronchial injury
• Parenchymal injury
• Systemic toxicity (inhalation of toxic substances
example: Carbon monoxide poisoning, Cyanide)
 Emergency Medical Management

1. Intubation
2. Monitoring of ABC
3. Oxygen therapy for patients who are not intubated.
 Monitor the following:
• Pneumonia
• ARDS
• Fluid Overload
• Malnutrition
 Medications:

- Bronchodilators
- Mucolytic agents (N-acetylcysteine (NAC))
-
Example treatment protocol for nonintubated patients

• itrate humidified high-flow oxygen to maintain oxygen

saturation >90 percent

• Supervise the patient performing coughing and deep

breathing exercises every two hours

• Turn the patient side to side every two hours

• Administer chest physiotherapy every two hours

• Provide nebulizer treatments every two hours alternating
aerosolized NAC / bronchodilator (if wheezing) as one
treatment and aerosolized heparin/saline as the other

• Perform nasotracheal suctioning as needed

• Encourage early ambulation

• Educate the patient and family about the disease process

and prognosis
 Other management
• TRACHEOSTOMY
ANAPHYLAXIS
 Symptoms
• Skin reactions, including hives and itching and flushed or
pale skin
• Low blood pressure (hypotension)
• Constriction of the airways and a swollen tongue or
throat, which can cause wheezing and trouble breathing
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting
 CAUSES
• Certain medications, including antibiotics, aspirin and
other pain relievers available without a prescription, and
the intravenous (IV) contrast used in some imaging tests

• Stings from bees

• Latex
 Risk factors
• Previous anaphylaxis

• Allergies or asthma

• Certain other conditions

 Prevention

• The best way to prevent anaphylaxis is to stay away from

substances that cause this severe reaction.
 ENVIRONMENTAL
EMERGENCIES
• These are Injuries that result
from the exposure of
external factors, forces and
agents occurring in any
setting – wilderness, rural,
suburban, and urban areas.
• Temperature related
illnesses
• Water related injuries
• Toxin and poison exposure
 Heat related emergencies

Heat Stroke
• It is a severe condition caused by
impairment of the body’s temperature-
regulating abilities, resulting from prolonged
exposure to excessive heat and
characterized by severe headache, high
fever, hot dry skin, and in serious cases
collapse and coma.
• It is the most serious form of heat stress and
is considered a medical emergency.
 Heat stroke

Causes
• Prolonged exposure to
extreme temperature
• Lack of acclimatization
• Physical exertion especially
during hot weather
 HEAT STROKE

Assessment
• Headache • Increased dizziness and weakness
• Temperature: 40 degrees • Decreased urine output
Celsius and above • Initially, constricted pupils the later
• Hot, reddish skin becoming, dilated
• Hypotension • Convulsions, sudden collapse and
• Tachycardia possible loss of consciousness
• Altered mental status (ranging from
confusion to coma)
 HEAT STROKE

Management
• Remove the patient when possible from the source of heat,
establish an airway and administer high concentration oxygen
• Place patient in a cool environment
• Establish IV access for fluid administration
• Monitoring to avoid hypothermia and prevent hyperthermia,
which may recur spontaneously within 3 to 4 hours.
• Monitoring of patient’s status: vital signs, ECG findings for
ischemia, infarction or dysrhythmias, and level of
responsiveness.
 HEAT STROKE

Management
Initiate rapid cooling measures
• Remove patient’s clothing
• Ice applied to the neck, groin, chest
and axilla while sponging
continuously with cool water
• Place wet sheets over patient and
place in front of fan
• Cooling blankets
• Cool water bath
 cold related emergencies

Frostbite
• damage to tissues and blood vessels as
a result of prolonged exposure to cold
• described as “true tissue freezing”
which results in the formation of ice
crystals in the tissues, cells,
intracellular fluids and fluids in the
intercellular spaces
• results in cellular and vascular damage.
• can result in venous stasis and
thrombosis.
 FROSTBITE

Causes
• Prolonged exposure to cold (-6.7 degrees
Celsius or lower)
• Prolonged submersion to cold water
• Inadequate clothing for environmental
temperature
• High altitudes
 FROSTBITE

Assessment
• Low body temperature • Blue, white or frozen extremities
• Shivering (necrosis and gangrene may develop
in severe cases)
• Numbness
• Blistering (occurs once the patient is
• Hypoventilation in a warm environment)
• Hypotension • Areflexia
• Pale, cyanotic skin • Arrythmias
• Altered mental status • Fixed dilated pupils
 FROSTBITE

Stages
• 1. Frostnip – affects tips of fingers,
earlobes, tip of the nose, chin and toes
• 2. Superficial – affects the skin and the
tissues beneath the skin; skin is firm
and waxy and the tissues beneath are
soft and numb; turn violet after thawing
• 3. Deep – involves the entire tissue
under the skin which becomes solid
and waxy white with purplish tinge in
color
 FROSTBITE

Management
• Remove the patient from the cold environment
• Wet clothing is removed as rapidly as possible.
• Manage and maintain ABC’s
• If the lower extremities are involved, the patient should not be
allowed to ambulate. To avoid further mechanical injury, the body
part is not handled. Massage is contraindicated.
• Protect the injured from friction of pressure; remove any
constricting clothing or jewelry; if clothing is frozen to the skin,
leave it
 FROSTBITE

Management
• Rewarm the affected part rapidly and
continuously with warm water (37 to
40 degrees Celsius) for 15 – 20
minutes or until skin flushing occurs.
• Once rewarmed, the part is protected
from further injury and is elevated to
help control swelling. Sterile gauze or
cotton is placed between affected
fingers or toes to prevent
maceration.
 FROSTBITE

Management
• After rewarming, hourly active
motion of any affected digits is
encouraged to promote
maximal restoration of function
and to prevent contractures.
• Do not debride blisters.
• Leave area exposed initially for
continued assessment, and then
apply sterile bulky dressings as
prescribed to provide protection
 FROSTBITE

Other ways of rewarming

• Passive: remove wet clothing, put on dry clothing and apply warm
blankets and then administer warm oral fluids
• Active external: use body to body contact, apply heating devices
or radiant lights
• Active core warming (internal): administer warmed IV fluids,
heated humidified oxygen, peritoneal, gastric or colonic lavage
with warm fluids
 Near drowning

• It is the survival of at least 24

hours after submersion in a fluid
medium that caused a respiratory
arrest.
• This is also known as Submersion
Injury or Submersion Incident.
The most common consequence
is hypoxemia.
 Near drowning

Causes
• Inability to swim or exhaustion while swimming
• Hypothermia
• Entrapment of entanglement with objects in water
• Loss of ability to move due to trauma, stroke, hypothermia, acute
MI
• Poor judgement due to alcohol or drugs
• Seizure while in water
• Diving accidents
 Near drowning

Types
• Wet drowning and Dry drowning
 Near drowning

Assessment B. Cardiac
A. Pulmonary • Arrhythmias
• Dyspnea (tachycardia/bradycardia)
• Crackles, rhonchi • Hypotension
• Cough with pink, frothy • Arrest
sputum
C. Others
• Cyanosis
• Exhaustion
• Respiratory distress and
arrest • Coma
• Core temperature slightly elevated or
below normal
Near drowning
 Near drowning

Management
• Establish an airway and initiate ventilation
• Remove the patient from the water as quickly as you can by any
method that is safe as possible, unless suspecting neck or spinal
injuries
• If there is no pulse, begin CPR (do not initiate CPR if you have
palpated the carotid pulse within 60 seconds)
• Administer high-flow supplemental oxygen; suction as needed
 Near drowning

Management
• Once the patient is breathing and has a pulse, assess for
hemorrhage; control any serious bleeding if there is any
• Remove wet clothing and cover with warm blankets. Prescribed
warming procedures are started during resuscitation.
• Arterial blood gases are monitored to evaluate oxygen, carbon
dioxide, bicarbonate levels, and blood pH.
 poisoning

• Ingested poison
• Inhaled poison
• Absorbed poison
• Injected poison
 poisoning

Goals of emergency treatment

• To remove or inactivate the poison before it is absorbed
• To provide supportive care in maintaining vital organ function
• To administer a specific antidote to neutralize a specific poison
• To implement treatment that hastens the elimination of the
absorbed poison
 INGESTED POISONS

• poisons taken through the mouth

Causes
• Overdosage of medications
• Taking drugs with alcohol
• Putting cleansing products and/or other
chemicals in unlabeled food containers
• Eating food with bacteria or toxins
• Carelessness
 INGESTED POISONS

Examples of poisons around the

house
• Cosmetics, hair preparations
• Gasoline, kerosene and other
petroleum products
• Paint
• Strong detergent, bleaches and
cleaning solutions
• Ammonia and acids
 INGESTED POISONS

History taking
• Determine what substance was ingested
• Determine when was the substance was taken
• Ask if the patient or a bystander made an attempt to induce
vomiting and/or if an antidote was given
• Check if the patient has a psychiatric history
• Check if the patient has an underlying medical illness, allergy or
chronic drug addiction
 INGESTED POISONS

Assessment
• Observe patient’s skin for pallor or cyanosis
• Smell the patient’s breath
• Assess for the level of consciousness
• Assess pupillary reaction
• Assess BP, pulse and respirations
• Assess the appearance and odor of any vomitus or diarrhea
 INGESTED POISONS

Check for
• Dilated or constricted pupils
• Nausea, retching, vomiting or
diarrhea
• Severe abdominal pain
• Slowed or abnormal respiration or
circulation
• Excessive salivation or foaming at
the mouth
 INGESTED POISONS

Check for
• Excessive sweating and tear
formation
• Burns or stains around the
mouth, pain in the mouth or
throat, pain upon swallowing
• Unusual breath or body odors,
characteristic, chemical odor on
the breath
 INGESTED POISONS

Management
• Maintain a clear airway, ventilation and
oxygenation
• Induce vomiting
• Have the patient drink water, juice or
carbonated beverages
• Adult: 8 – 16 ounces
• Child: 8 ounces
• Administer Ipecac
• Adult: 2 tablespoons or 30 ml
• Child: 1 tablespoon or 15 ml
 INGESTED POISONS

Management
• If the patient begins to get stuporous after ipecac syrup has been
given, take all necessary measures to protect the airway and
prevent aspiration
• Have the patient sit and lean forward to prevent aspiration
• Place the infant or child on his stomach with the head lower than
the rest of the body
 INGESTED POISONS

Management
• Do not delay transport for
lavage while waiting for the
patient to vomit (if ipecac syrup
was given)
• Transport the patient quickly so
that the physician can perform
gastric lavage.
 INGESTED POISONS

Management
• If the patient stops from
vomiting from ipecac, give
activated charcoal.
• Save a part of the vomitus so it
can be evaluated by a
toxicologist
• Place the patient on NPO an
hour following emesis
• Never allow the patient to sleep
in supine position after
vomiting
 INGESTED POISONS

Management
• ECG, vital signs, and neurologic status are monitored closely for
changes.
• If poisoning was determined to be a suicide or self-harm attempt,
a psychiatric consultation should be requested before the patient
is discharged.
When NOT to induce vomiting
• Significant vomiting has already occurred
• The patient has swallowed a substance that may reduce his level
of consciousness
 INGESTED POISONS

When NOT to induce vomiting

• The patient has swallowed a sharp object such as nail, pin, razor
blade or broken glass
• The patient is younger than 6 months of age
• The patient is in coma or stuporous
• The patient is in active seizure or had a seizure
• The patient shows sign and symptoms of MI
• The patient has ingested corrosives, strong acids or strong
alkaline substances
• The patient is pregnant or lactating
 inhaled POISONS

• a poison breathed into the lungs

Causes
• Carbon monoxide
• Carbon dioxide from industrial sites,
sewers and wells
• Chlorine gas
• Ammonia
• Sulfur dioxide
• Solvents used in dry cleaning,
degreasing agents
• Hydrogen sulfide
 inhaled POISONS

Assessment
• Severe headache
• Nausea and vomiting
• Cough, stridor, wheezing or
rales
• Chest pain or tightness
• Facial burns
• Signs of respiratory tract burns,
burning sensation on the throat
or the chest.
• Confusion, dizziness, varying
levels of consciousness
 inhaled POISONS

Management
• Loosen all tight-fitting clothing
• Carry the patient to fresh air;
open all doors and windows
• If the patient is not breathing,
start artificial ventilation and CPR
• If the patient’s breathing is noisy,
consider laryngeal edema
• Administer 100% humidified
oxygen
• Prevent chilling; wrap the patient
in blankets
ABSORBED POISONS

• corrosives or irritants that

injure the skin and are taken
into the body tissues
Causes
• Insecticides
• Garden chemicals
• Plants (e.g. Poison Ivy)
 ABSORBED POISONS

Assessment
• Skin reaction (itchiness, redness)
• Eye irritation
• Blisters (papulovesicular lesions)
 ABSORBED POISONS

Management
• Move the patient away from the source of the poison
• Flush the affected area with large amounts of cool water (if the
poison is a powder, brush off excessive amounts with dry cloth
before flushing)
• Remove the patient’s clothing that has come in contact with the
poison
• Carefully check hidden areas such as the nail beds, skin creases
between fingers and the toes
• Apply calamine lotion to relieve discomfort
• Use of topical or oral corticosteroids
 injected POISONS

• poison that enters the body

through a bite, sting or a
syringe (envenomation)
Causes
• Snake bites
• Stings
• Animal or Human bites
 injected POISONS

Assessment
Insect stings
• Generalized urticaria and
itching
• Body malaise
• Laryngeal edema and
bronchospasm
 injected POISONS

Assessment
Snake bites
It may affect multiple organ systems, especially
neurologic, cardiovascular, and respiratory
• Swelling, discoloration and ecchymosis
• Numbness at the bite site
• Necrosis at the bite site
• Sweating and chills
• Nausea and vomiting
• Breathing may be affected
 injected POISONS

Management
Insect stings
• Removal of the stinger if the
sting is from a bee
• Wound care with soap and water
• Avoid scratching
• Ice application reduces swelling
and venom absorption
• Antihistamines and analgesics
are administered as prescribed
 injected POISONS

Management
Snake bites
• Have the victim lie down and remove constrictive items
• Examine the wound to see extent of injury
• If there is bleeding, allow moderate bleeding of the wound
• Apply pressure if necessary
• Wash the wound with antiseptic soap or detergent
• Make sure to immobilize the bitten limb with a splint or a sling
 injected POISONS

Management
Snake bites
• Avoid any interference with the bite wound (incisions, rubbing,
vigorous cleaning, massage, application of herbs or chemicals) as
this may introduce infection, increase absorption of the venom,
and increase local bleeding
• Keep the patient still to slow down the absorption of poison and
keep the bitten area below the level of the heart
• Transport patient to the hospital. Anti-venom or anti-venin is the
only effective antidote.
injected POISONS