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12-01-2024 MS (Labonete)

Dec 01, 202429 min read5651 words

Emergency Nursing as discussed by Sir Tom Labonete RN-EMT, LPT, Italian Model, Rockstar on 12-01-2024

Emergency Principles

  1. Common sense: a lot of individuals feel pressure and anxiety at the scene. Attempt to maintain the intuition held by an emergency responder. Do not forget the basic principles.
  2. Calmness and Patience: maintain a calm demeanor. Patients can pick up feelings of anxiety especially if displayed by the emergency responder.
  3. The 90-5-5 Principle: 90% of the focus of the emergency response is delegated to the safety of the responder. 5% is for the patient, and 5% is for the bystanders. There is no point in rescuing a victim if the responder themself is put in danger, and may become a victim as well.
  4. Body Substance Isolation, Handwashing: always minimize the potential for contamination.
  5. Do not treat at the site. The site of danger is almost never a safe place to perform treatment at. Attempt to make a distance of 50 meters or 100 paces.
  6. Rescue the patient first. This is a prerequisite for treatment, as mentioned in the previous principle.
  7. CHANT Method: when asking for help, include the:
    • (a) Case, the accident or disaster being reported with the pertinent details of victim count, etc.
    • (b) Help, expected required responses e.g. the need for fire trucks, a bomb squad, multiple ambulances
    • (c) Address: the location as specific as possible, or important landmarks.
    • (d) Name: name of the caller.
    • (e) Telephone: the number of the caller for follow-up calls.
  8. Assess dysfunction related to the injury: the affected body parts are

Star of Life

The Star of Life is a universal symbol for medical identification of emergency and first aid personnel. Specifically, its symbolism represents the six main tasks executed by rescuers all through the emergency chain.

  1. Early Detection: the use of the senses to determine the presence of an emergency or potential hazard.
  2. Early Reporting: calling for professional help with the CHANT method; dispatch is connected with victims.
  3. Early Response: if appropriate, the initiation of first aid response and immediate care to the extent of the first rescuers’ capabilities.
  4. On-scene Care: care provided by the EMS personnel arriving at the scene.
  5. Care in Transit: transportation of the patient to a hospital for specialized care. Medical care is given during transportation, especially for the ABCs of life.
  6. Transfer to Definitive Care: appropriate specialized care is provided at the hospital.

Star of Life

ABCDE

ABC is done within a hospital setting. The use of ABCDE is done outside of the hospital. The inclusions include deformity/disability and exposure/environment

Ambulance

The following are must-knows about ambulances and their operation.

  1. Driver: the driver must not leave the ambulance. They must be ready to initiate transport at a moment’s notice.
  2. Beacons: the beacon is a marker. These are the lights, sirens, and text of an ambulance that marks the presence and location of an ambulance.
  3. Patient Position: the patient is placed on a backboard and secured with spider straps. When applied with a c-lock and (head strap thing), it becomes a spine board.
  4. Number of Crew: the standard team is composed of one driver and two crew members.

Ambulances are categorized between two types:

  1. Type I: ambulances capable of providing Basic Life Support (BLS). This involves CPR, bandaging, wound management, oxygen delivery via cannula.
  2. Type II: ambulances capable of providing Advanced Life Support (ALS). This includes tracheostomies, intubations, and other invasive procedures.

Bone Injuries

These take the form of dislocations, the removal of a joint from its anatomical position, and fractures, the breakage of the continuity of a bone.

Nursing Considerations

  1. Immobilize the injury. Do not re-place or stretch the bone. Treat the fracture the way you found the fracture.
  2. Use an ice pack: cold therapy reduces swelling by inducing vasoconstriction.
  3. Pulse, motor, and sensory assessment before and after splinting. The presence of a pulse indicates that vascular damage is not present. Pulse is checked distal to the injury. Motor ability is checked by asking the patient to move the digits distal to the injury, and sensory assessment is done by checking for sensation.
  4. Splinting: the placement of an immobilizing object; anything hard enough to support an injury.
    • Joint fracture: bandage from bone-to-bone proximal and distal to the injury.
    • Bone fracture: bandage from joint-to-joint proximal and distal to the injury.

Hypothermia

DegreeManifestationsManagement
MildShivering reflexWarm the patient with warm food and fluids.
ModerateNo shivering, the hypothalamus fails to induce the shivering reflex.Hypothermia blanket, as food may be aspirated.
SevereSeizuresSeizure precautions for safety (side-lying), and hypothermia blanket, food may still be aspirated.
ProfoundDead or DyingTransport to the nearest hospital.

Frostbite

Localized destruction of tissue due to freezing temperatures. The most common areas to be frostbitten are the ears, nose, lips, fingers, and toes. This results in tissue taking a waxy appearance (white/pale yellow) initially before becoming blackened and necrotic (dry gangrene) if unmanaged. The nurse’s management is to soak the frostbitten tissue in warm water until the tissue appears pink or red.

Fainting

Fainting is caused by a temporary loss of blood in the brain. This may be caused by:

  1. Excitement: extreme excitement can cause fainting. This involves both positive and negative emotions.
  2. Lack of rest
  3. Extremes of temperature: vasoconstriction and vasodilation will reduce blood flow to the brain.
  4. Lack of sustenance (eating)

Warning Signs of Fainting

The warning signs of fainting includes nausea, dizziness, turning pale, ringing in the ears (tinnitus), blurry vision or tunnel vision, sudden feelings of warm and sweat, and feeling faint or light-headed.

Management

  1. Alert, Verbal, Pain, and Unresponsive (AVPU) and Level of Consciousness (LOC):
    • Check for consciousness (alertness) by asking the patient if they are able to hear the patient.
    • Next, check response to verbal commands by asking the patient to squeeze the fingers by asking the patient to do so.
    • Induce pain (noxious stimuli) on the breastbone, traps, or (muscle between the thumb and index) to attempt to incite a response.
  2. If the face is red, raise the head to allow blood to circulate away from the head.
  3. If the face is pale, raise the tail to allow blood to circulate to the head.
  4. Place the patient on supine if necessary. This equalizes blood pressure and promotes blood flow to the head.

Bee Stings

Bees are normally peaceful insects that can become aggressive upon agitation of the bee hive or queen bee. They sting their pray at the cost of their own life as the stinger, parts of the digestive tract, muscles, and nerves are left behind after they sting their pray. Pain, swelling, allergy, or even anaphylaxis may occur.

Management

Initially after the sting, management is:

  1. Swipe with a card to safely remove the stinger embedded within the skin. Do not press or pull on the stinger.
  2. Wash the site to clean the puncture site and reduce risk for infection.
  3. Monitor the airway in case of an anaphylactic reaction that constricts the airway. The patient experiences heat and rashes due to an allergic reaction.

Within minutes,

  1. Obtain curved tweezers to remove the stinger if the initial removal with a card is not done. The tweezers are curved avoid squeezing the end of the stinger where toxins may reside.

Burns

Fire is dangerous because of its heat and the toxic fumes produced by burning materials. For a fire to form, the fire triad (or tetrahedron) is required:

  1. Heat: sufficient heat is required for a heat to sustain its chain reaction.
  2. Oxygen: oxygen is essential for the chemical reaction of a fire. Oxygen is a flammable gas.
  3. Fuel: fuel is continuously consumed in fire
  4. Chain Reaction/Combustion

Objectives

  1. RACE/ARCE: RACE is used when patients are inside a burning room, as rescue is more urgent than sounding the alarm.
    • Alarm: (2:14) sound the alarm; fire alarm if present, or call for help if relevant.
    • Rescue: rescue any persons or patients in the vicinity.
    • Contain/Confine: remove fuel from the room if possible (burnable objects) and close doors to burning rooms, if possible.
    • Extinguish/Evacuate: use a fire extinguisher if present and/or evacuate the building.
  2. Airway: many burn injuries are related to inhalation of toxic gases or burning of the airway, inside or out.
  3. Never Remove Clothes: burning clothes may adhere to the skin, and its removal may cause the skin to also be removed.
  4. Three Magic Words: Stop, Drop, Roll
  5. Medication via IV: burns will impair gastrointestinal functioning, making oral medications ineffective.

Therapeutic Goal

  1. ABCs of Life (as usual)
  2. LRS via IV: the infusion of Lactate Ringer’s Solution using Parkland’s Formula.

Parkland's Formula

This is given to replace fluid and electrolyte loss from burns from leakage and from direct loss within the first 24 hours. In infusion,

  • The first 50% of fluids to infuse is completed within 8 hours,
  • the following 25% is infused in 8 hours,
  • the final 25% is also infused in 8 hours.
  1. Analgesia: as pain is difficult
  2. Antibiotics: due to the risk for infection
  3. Temperature: to determine the presence of a fever
  4. Monitor Weight: to monitor fluid status

Burn Rhabdomyolosis

A burn patient will have muscle breakdown. This may be excreted in the urine, giving it a bright red appearance, which is a good outcome. This signifies that the kidney is excreting waste, which includes breakdown products of muscle. In other cases, this may also be another cause of complication in patients, such as in kidney failure.

Poisoning

Corrosive PoisoningNon-corrosive Poisoning
1. Identify the poison1. Identify the poison
2. Do NOT induce vomiting2. Induce vomiting
3. Position on the left side3. Position on the left side
4. Transport the patient4. Transport the patient

Management

A nasogastric tube is used to perform gastric lavage.

Jellyfish Stings

Jellyfish stings can cause rapid death in large doses in some species of jellyfish, or only pain. It also varies in the number of stingers that comes in contact with an individual.

Management

  1. Pour sea water on the sting rather than freshwater and urine.
  2. Scrape the tentacles using a card (remember bee stings?)
  3. Vinegar/Baking Soda
  4. Calamine Lotion: anti-pruritic lotion
  5. Transport the patient

Snake Bites

The intervention is to, first, assess the bite mark. Afterwards, wash the site and keep the patient still to reduce the spread of venom, if present. Do NOT use a tourniquet, as this often causes more harm than good, as the venom forms potential boluses that are released upon the release of the tourniquet.

Tourniquet

Tourniquets are only good for two hours. These are used for amputations and severe bleeding only.

VenomousNon-Venomous
Bite MarkFangsMultiple teeth
EyesOval/Slit-eyedRound
HeadTriangularRound

Management

Management is symptomatic. Different toxins present different symptoms, causing pain, affecting the heart, clotting the blood, etc. These symptoms are managed as they appear. The only actual treatment for the venom is an antitoxin from the specific snake venom.

  1. Chemotoxic: destruction of tissue
  2. Hemotoxic: causes coagulopathies
  3. Cardiotoxic: affects heart functioning
  4. Neurotoxic: causes extreme pain

Q&A

EMT responsibility:

  1. Find and manage emergencies
  2. Recognize and eliminate emergencies
  3. Recognize and familiarize with emergencies

Basic requirement before performing first aid:

  1. Training
  2. Medical background
  3. Common sense

In an ambulance,

  1. You can load via GCash
  2. You can load a dead body
  3. You can load a dying patient

The most common type of prehospital injury:

  1. Heart attack
  2. Bleeding
  3. Ghosting by a boyfriend
  4. Infection

In an motor vehicular collision, who is more likely to survive?

  1. A driver struck at the front of the car
  2. A driver struck at the door
  3. A car hit from above by a boulder

Who are seated in the front of the ambulance?

  1. Driver and Witness
  2. Driver and Patient
  3. Driver and 2 EMT
  4. Driver and 1 EMT

Who is less likely to survive?

  1. A driver struck at the door
  2. A driver struck at the front of the car

What does the latin term “primos auxilium” stand for?

  1. Primary Survey
  2. Prime Axillary
  3. First Aid

In the safety ratio, what does 90% of the rescuer’s focus get dedicated to?

  1. Victim
  2. Bystanders
  3. Rescuer

In the 2005 AHA update, how are the ABCs of life organized?

  1. CAB
  2. BAC
  3. ABC
  4. CBA

The French term “cravat” is synonymous to:

  1. Croissant
  2. Cadaver
  3. Neckerchief

What is the meaning of “hyphema”?

  1. Bleeding in the Nose
  2. Bleeding in the Ears
  3. Bleeding in the Eyes

A vehicle that will extinguish fire and is being operated by fire fighters is called:

  1. Fire Hydrant
  2. Penetrator
  3. Fire Truck
  4. Fire Engine

What does ABCDE stand for?

  1. Airway, Breathing, Circulation, Deformity, Exposure
  2. Airway, Breathing, Circulation, Disaster, Emergency
  3. Airway, Breathing, Circulation, Danger, Environment

Philippine Red Cross is a:

  1. Public Organization
  2. Private Organization
  3. Government Agency
  4. Branch of the Department of Health

The antidote for spinal anesthesia is:

  1. Morphine
  2. Nitroglycerin
  3. Epinephrine
  4. Caffeine

A late symptom of compartment syndrome is:

  1. Pedal Edema
  2. Paresthesia
  3. Paralysis
  4. Pain

A patient with hyphema is first assessed for:

  1. Stroke
  2. Vision
  3. Pain
  4. Movement of the eyeball

An ambulance going to an impact site utilizes:

  1. Sirens only
  2. Lights only
  3. Lights and sirens

A patient is loaded into the ambulance:

  1. Love first
  2. Head first
  3. Injured part first
  4. Feet first

Rescuer attire is colored:

  1. Green
  2. Pink
  3. Blue
  4. Orange

A patient on an ambulance stretcher/gurney going down the stairs is transported:

  1. Stretcher first followed by the patient
  2. Feet first
  3. Head first

The RN inserts an IV NSS inside a Type I ambulance. Is this appropriate?

  1. Yes, in any scenario
  2. Yes, unless the vehicle is moving
  3. No

Paralysis in the later stages of compartment syndrome is caused by:

  1. Inflammation
  2. Lack of blood
  3. Bone damage
  4. Pain

Which are two important rescue contents of a fire engine?

  1. Axe and ladder
  2. Hose and ladder
  3. Hose and water

If the patient has no heartbeat:

  1. Love the patient
  2. Check for responsiveness
  3. Perform CPR
  4. Perform defibrillation

In the CHANT mnemonic, what does H stand for?

  1. Help
  2. Handicapped
  3. Harm
  4. Hypothermia

In the 2010 AHA update, how are the ABCs prioritized?

  1. BAC
  2. ABC
  3. CBA
  4. CAB

In mild hypothermia, what is the nurse to give?

  1. Jacket
  2. Hot chocolate
  3. Epinephrine
  4. Blanket

In a sprain, what tissue is broken?

  1. Muscle
  2. Promises
  3. Ligaments
  4. Tendon

How does a monophasic defibrillator work?

  1. Sends an impulse to all nerves of the body
  2. Sends an impulse to the brain
  3. Sends an impulse from the ventricles to the atria then atria to the ventricles
  4. Sends an impulse from the ventricles to the atria

No ratio

In a hypothermic patient who is not shivering, the nurse gives:

  1. New clothes
  2. Blanket
  3. A hug
  4. Warm fluids

In a client with a gunshot wound to the chest, what intervention may be expected?

  1. Use of a portable x-ray
  2. Chest tube thoracotomy
  3. Anticoagulant therapy
  4. Tracheostomy

A high-oxygen flames tend to emit what color glow?

  1. Red
  2. Yellow
  3. White
  4. Blue

A patient who has been shot experiences what feeling?

  1. No sensation
  2. Warm sensation
  3. Wet sensation
  4. Cold sensation

In a search and rescue, the rescue team searches for:

  1. Retrieving a dead person
  2. Searching for high-value items
  3. Searching for a living person

In a patient rescued from a frozen lake, all wet, conscious, the first intervention to keep him warm is:

  1. Undress the patient
  2. Give the client a cup of boiling water.
  3. Provide a blanket
  4. Load the patient inside the ambulance

A monophasic type defibrillator will deliver how many joules?

  1. 50V
  2. 110V
  3. 200J
  4. 360J

What is more dangerous?

  1. Dropping a major subject in nursing
  2. Dropping a lit match on gasoline
  3. Dropping a lit cigarette on gasoline

An EMT’s most important must-have equipment is:

  1. Bandage
  2. Stethoscope
  3. Tourniquet

Is the hair a conductor of electricity?

  1. No
  2. Yes, but only when the hair is very dry
  3. Depends on if the patient is bald
  4. Yes

An example of a superficial burn is a sunburn. This is also known as a:

  1. Micro burn
  2. Wind burn
  3. Flash burn
  4. Sunscreen burn

Upon arriving at the ER entrance, the personnel meeting the crew is the:

  1. Security officer
  2. Physician
  3. Nurse
  4. Orderly

An injured individual who experiences multiple trauma feels cold before dying because of:

  1. Bradycardia
  2. Loss of Blood
  3. Delirium
  4. Weather

The PPE that can be used multiple times while attending to one patient is an:

  1. Gown
  2. Mask
  3. Eye shield
  4. Gloves

In the prehospital setting, who is more capable?

  1. All individuals are capable in an emergency
  2. A trained personnel
  3. A certified personnel

The biphasic defibrillator delivers 200 joules in both directions.

  1. Its advantage is because of less risk for burn injury
  2. Its advantage is because of its higher success rate
  3. Its advantage is because of its lower current delivery

While performing CPR, an earthquake occurs. The rescuer:

  1. Protects the patient
  2. Stops and hides
  3. Apologizes and leaves the patient

In gymnastics, a performer loses balance. What is the safest action to take?

  1. Tuck and roll
  2. Perform a sign of the cross
  3. Land on bended knees

A patient enters the ER reporting domestic abuse. The nurse initially:

  1. Reports to the Head Nurse
  2. Reports to the Police
  3. Confirms with the family
  4. Refers the patient to a social worker

A patient is choking. First:

  1. Establish rapport
  2. Place the patient supine
  3. Ask the patient what object they are choking on
  4. Encourage coughing

IV Fluid needed in burn resuscitation:

  1. Whole Blood
  2. NSS
  3. D5050
  4. LRS

Common Anatomical Airway Obstruction:

  1. Base of the tongue
  2. Saliva
  3. Dentures
  4. Tooth fillings

A client reports to the ER after being stung by a bee. The first nursing action is to:

  1. Remove the patient’s rings in case of swelling
  2. Prepare an EpiPen
  3. Count the number of stings
  4. Open airway

A patient is electrocuted after coming into contact to a live wire at a light switch. The priority is the:

  1. Patient
  2. Environment
  3. Light switch
  4. Finding help

The patient becomes unconscious during the Heimlich maneuver. The nurse:

  1. Lies the patient down and performs ventilations
  2. Keeps the patient upright and continues the Heimlich maneuver
  3. Lies the patient down and performs CPR

Who is the priority in the following cases?

  1. A classmate with no ballpen
  2. Elderly patient with chest pain
  3. Dehydrated infant
  4. Vomiting adult

A harmful substance that can be absorbed, inhaled, and ingested:

  1. Drugs
  2. Toxins
  3. Venom
  4. Poison

Calling the authorities immediately if domestic abuse is suspected is done because:

  1. Patient’s latest memory of the incident must be documented.
  2. Fastest time to arrest the abuser
  3. The latest physical evidence must be collected

A bee sting occurs. The nurse prioritizes the:

  1. Card
  2. EpiPen
  3. Airway
  4. Killing the Bee

A patient with an inhalation injury must use a:

  1. Oxygen tent
  2. Nasal cannula
  3. Non-rebreather mask

What is more dangerous?

  1. Heat from an explosion
  2. Projectiles from an explosion
  3. Radiation burn from an explosion

In ACLS, a patient with bradycardia can be given:

  1. Atropine
  2. Vicks Vapor Rub
  3. Amiodarone
  4. Diltiazem

Which is used in muscle cramps?

  1. Liniment
  2. Warm compress
  3. Cold compress
  4. Petrissage

When is the usual onset of a thrombotic stroke?

  1. During exercise
  2. In the shower
  3. During their sleep
  4. During winter

What is decontamination?

  1. Where patients proceed from exposed to unexposed
  2. Where patients proceed from dirty to clean
  3. When patients proceed from susceptible to immune
  4. When patients proceed from ill to healthy

Avoid giving oxygen masks to:

  1. Any children
  2. Patients with trisomy
  3. Patients with claustrophobia
  4. Pregnant patients

If an ambulance is heading towards you on the highway:

  1. The sirens sound low-pitched
  2. The sirens sound high-pitched

A patient with an exposed fracture must be:

  1. Treated for the bleeding first
  2. Given an anticoagulant first
  3. Treated for the fracture first
  4. Have their bones realigned first

How many percent of the atmosphere is made up on oxygen?

  1. 21%
  2. 95%
  3. 5%
  4. 78%

Common disorders of retired EMTs or rescuers include:

  1. Schizophrenia
  2. Depression
  3. Operational exhaustion
  4. Dementia

In a patient whose fracture has been splinted, no sensation is assessed on the area of injury. The nurse:

  1. Proceeds, as this is normal after splinting
  2. Immediately transfers the patient to the hospital
  3. Removes the splint and reapplies it
  4. Assesses again for sensation in 60 seconds

A patient is drowning on the beach. Which complication arises?

  1. Dehydration
  2. Edema

What does MCI stand for?

  1. Any event that causes great damage and loss of life
  2. Any incident the exceeds the responder’s capability to treat and transport

In an explosion, what vehicle is placed in front of the rescue convoy?

  1. Fire engine followed by the ambulance
  2. Ambulance followed by the fire engine

PTSD, previously known as operational exhaustion, happens to prehospital personnel because of:

  1. Too many failed attempts at CPR
  2. Too much love will kill you
  3. Too much time spent on service
  4. Too many injuries seen during responses

Patient is drowning in a river. The complication expected is:

  1. Edema
  2. Dehydration

Every liter of O₂ is equivalent to 4% FiO₂, the how many percent of oxygen is given if we administer 1 L/min. via cannula to the patient?

  1. 21%
  2. 25%
  3. 4%

An EMT’s most important assessment skill to use is the use of his:

  1. Nose
  2. Ears
  3. Lips
  4. Eyes

In CPR, the rescuer becomes exhausted. The action to do is:

  1. Stop immediately
  2. Finish the five cycles and stop

In a rape patient who wishes to take a bath, the nurse:

  1. Give the patient a bath
  2. Tell the patient that they should not bathe
  3. Accompanies the patient in the bath

Verapamil is given to patients with:

  1. Bradycardia
  2. Asystole
  3. Arrhythmia
  4. Tachycardia

In rescuing a patient who is drowning, the rescuer swims:

  1. From the front of the patient
  2. From the back of the patient

The patient is receiving 15 L/min of O2 via a non-rebreather mask. What is the FiO2 being delivered?

  1. 91%
  2. 81%
  3. 21%

During CPR, what accessory can hinder the rescuer from performing compressions?

  1. Ring
  2. Mask
  3. Watch
  4. Belt

In a person drowning in a pool, the priority is:

  1. Pulse
  2. Safety
  3. Airway
  4. Looking for other drowning persons

A patient who drowned is being managed. Which is appropriate?

  1. Compression only
  2. Mouth-to-mouth only
  3. Compressions and two mouth-to-mouth for five cycles

Before the term “ambulance”, they were called in war as:

  1. Moving clinics
  2. Mobile sanitariums
  3. Field hospitals

In an unconscious patient who has been rescued from electrocution, the nurse:

  1. Performs CPR
  2. Avoids touching the patient

In a patient with a fractured femur, they are tagged in triage as:

  1. Red
  2. Black
  3. Green
  4. Yellow

A patient is thirsty after electrocution. The nurse:

  1. Places them on NPO status
  2. Allows them to drink water
  3. Only allow ice chips

A pulseless patient with minimal wounds after electrocution:

  1. Ignore the wounds and perform CPR
  2. Treat the wounds then perform CPR

The Latin term “fercuium” in english refers to:

  1. Stretcher
  2. Carriage
  3. First aid

which of the following is more dangerous?

  1. Liquefied petroleum gas and fire
  2. Gasoline and cigarettes
  3. Oxygen tank and fire

A child has ingested non-corrosive materials.

  1. Induce vomiting
  2. Do not induce vomiting
  3. Lay the client on their right side
  4. Place the client on Trendelenburg’s position

Which comes first in using a fire extinguisher?

  1. Swing
  2. Push
  3. Squeeze
  4. Aim

An ambulance transporting a stable patient will have:

  1. Lights on
  2. Sirens on
  3. Lights and sirens on

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