1 / 57

Module 5 Emergency Procedures

Module 5 Emergency Procedures . Dr. Laney Nelson . Abdominal Emergencies. Quadrants Check for tension (bloated) Pain with peritonitits Cramp like “colicky pain” Rigidity with low pulse Left lateral side position of shock Nothing to eat or drink. Nausea and Vomitting.

annick
Download Presentation

Module 5 Emergency Procedures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Module 5 Emergency Procedures Dr. Laney Nelson

  2. Abdominal Emergencies • Quadrants • Check for tension (bloated) • Pain with peritonitits • Cramp like “colicky pain” • Rigidity with low pulse • Left lateral side position of shock • Nothing to eat or drink

  3. Nausea and Vomitting • Lie down on left side, if not illness then clear fluids • Water, clear broth, flat soda • Apple, Cranberry juice • Keep fluids down then small amounts of carbohydrates, bread rice, • No dairy for 48 hours • No solid food until carbs and fluid down for 48 hours.

  4. Diarrhea • Most common cause is • Infection • Food poison • Best to let it runs it’s course • Dehydration is most concerning. • Especially the elderly and young • 8 – 10 glasses of water a day • Clear broth rules • BRAT diet: bananas, rice, applesauce, toast

  5. Ruptured Esophageal Varcies • Alcohol drinkers • Victims of liver disease • Chronic liver dysfunction • Enlarged liver, jaundice • Vomiting of profuse amounts of bright red blood • Blood welling up in back of throat • Absence of tenderness in stomach • Respiratory distress • Treat: protect airway, lay face down, treat shock

  6. Abdominal Aortic Aneurysm • Sudden, severe, constatn pain in abdomen or back • PAIN RADIATES TO: flank and groin • Pale color of legs • Possible nauseam, • Absent pulses in groin and foot • Hard and rigid abdomen

  7. Seizures • Irritation or Overactive brain cells • Alterations in chemical metabolic balance • Head trauma, fever, hypoglycemia • http://www.youtube.com/watch?v=j2MUnByfSUQ&feature=fvwrel • http://www.youtube.com/watch?v=MRZY2a2jnuw

  8. Causes of Seizures • Toxic • Allergies to drugs, chemicals • Drug withdrawal • Metabolic • Trauma: • scar formation • Vascular • Reduced blood flow • Infection • Inflamationof brain • Febrile • Children 6 months 3 years • Rate of temperature increase • Idiopathic • Degenerative • MS, Dementias, seizures • Congenital defects • Infants and young children • Brain Tumor • Often first sign of tunor • Swelling of brain

  9. Seizures vs. Epilepsy • An involuntary sudden change in sensation, behavior, muscle activity or level of consciousness caused by irritation or overactive brain cells. • A chronic brain disorder characterized by recurrent seizures not caused by acute problems, with or without loss of consciousness.

  10. Status Epileptics • A single seizure lasting for several minutes. • Can b e a series of seizures that occur without the victims regaining consciousness. • This is a medical emergency • O2 to brain, cardiac, respiratory and kidney systems

  11. Symptoms of Seizures • Premonition “aura” can be numbness • Unexplained motor activity: turning head and eyes, weird taste on tongue, peculiar sound • Loss of consciousness, high pitched cry sound, • Skeletal muscles spasm of various groups, tongue bitten off • Convulsion lead to deep sleep and recovery to a transient confusion

  12. First Air • Airway is critical, position for drainage and suction • Protect the victim for further arm • No restraint unless hurt themselves • Keep victim from being a spectacle • Reassure and reorient the victim following the seizure • Never force anything between the teeth • Lay on left side, face pointing downward • If unconscious protect airway

  13. Fainting • Vertigo - dizziness • TIA – Central Vertigo • NO nausea, vomiting, hearing loss • Vestibular cochlear Vertigo • Nausea and vomiting • Whirling sensation • Syncope • Treat: • Head between the legs • Elevate legs above heart • Cool head

  14. Emergency Childbirth • Perineum • Crowning • Rim of fire • Crowning • “blood show” • Opening of the cervix • Expulsion of mucous plug– first stage of labor • Presenting part • Miscarriage • http://www.youtube.com/watch?v=4pOSNcEOaTI

  15. Three stages of Labor • Stage 1: First uterine contraction to dilation of cervix • Stage 2: Birth of Baby • Stage 3 Delivery of placenta • http://www.youtube.com/watch?v=tDnoCO1xJxA&feature=related

  16. Supplies you will need…… • Surgical scissors • Cord clamp – shoelaces, dental floss • Umbilical tape • Bulb syringe • Five towels • 2 X 10 sponge gauze • Sterile gloves • Receiving blanket • T-3 sanitary napkins • Two plastic bags • Hand sanitizer, foiled germicidal wipes

  17. Childbirth – “rim of fire”

  18. Care of Newborn • Lay baby on mothers belly • Immediately dry the infant • Use your shirt • Suction mouth and nose • Lay on belly of mother • Clockwise sympathetic massage on back • Flick the bottom of feet

  19. Resuscitating a Newborn • 1 breath to every 1 – 1½ second • Shallow, slow gasping respiration • HR below 100 bpm • HR below 60 bpm begin chest compressions

  20. Multiple Births • 1/3 of time the second twin is breech • Usually happens 10 minutes after the first baby • After baby contractions continue to be strong • Watch for Meconium • Feces in amniotic sac • Aspiration pneumonia

  21. Meconium vs. VernixCaseosa • If it is brown and no bulb • Place mouth over mouth and nose • Suck and spit • If the covering is white • It is alright to wipe it off

  22. Placenta Delivery

  23. Predelivery Emergencies Cramp like abdominal pain Moderate to serve vaginal bleeding Passage of tissue Inability to feel the uterus Uterus below the woman’s naval Watch out for Seizures

  24. Spontaneous Aborption

  25. Prolapsed Cord Compromised O2 • Prolapsed Cord • This is an emergency • Lay mother upside down • Take pressure off cord • Look for blood pressure within cord • Push baby head it to free up cord, • Get mother to “pant” try to stop labor until help arrives

  26. Management of a perineal tear

  27. Breech Birth • Buttock emerges first • If head not delivered in 10 minutes • Place hand in vagina with palm towards baby face • Make a “V” on either side of the babies nose • Foot presentation • Pant until EMS arrives • Hand in an fold for turn

  28. Ectopic Pregnancy • Sudden sharp abdominal pain “localized on one side” • Missed menstrual period • Pain under diaphragm • Pain radiating to one or both shoulders • Tender abdomen • Palpable mass in abdomen • Light headed • Increased pulse • shock

  29. Do not be confused……. Rectocele Rectocele

  30. Preeclampsia / Eclampsia • 1 in 20 women • Toxemia of pregnancy • Poisoning of blood during pregnancy • Last three months of term • Usually affects women in 20’s • First pregancies • High blood pressure • Swelling extremities • Face, fingers, legs or feet • Sudden weight gain • >2 pounds • Blurred vision • Persistent headache • Mental confusion • Abdominal pain

  31. Assessing the Child • Small frame - under developed temperature control system • Skin looks molted, not vascular disease • Little chest little heart • Faster rate • Little blood • Easier to bleed to death – from a minor wound • Easier to develop shock • Dehydrate easily • A little blood, shortness of breath to a child • Big problem

  32. Child in Distress, Parents are in distress • Blame & Shame, Tears & Fears • No vocabulary to describe problem • ABpCDE • Always address respiration in more detail • Blood a little is a lot • Pressure act fast • Consciounress • Look sick, in shock, extreme pain, • Disfigured always save the obvious for last

  33. General Rules For Peds • Prepare yourself psychologically – think clear • Children are taught not to go to strangers • Get on eye level • Speak in childlike terms • Involve parents as much as possible • Be honest, it will hurt when I touch you leg • Reduce pain, do not restrain unless you have to • Save the most painful for last

  34. Vital Signs • Respiration (hand on stomach) • 40 / minute for an infant • 25 for 8 year old • Pulse (slow is a concern) • Radial in child • Brachial in an infant • Temperature (warning sign) • Change quickly • Neurological Assessment • Watch movement

  35. Fact: Children have head injures • Heads are larger • Increased angular & rotational velocity • Therefore if unsconscious or shoulder innjury • Think cervical spine

  36. Fact: Child abdominal injuries • Liver and spleen are larger in proportion of abdomincal cavity • Susceptible to blunt traunma • Not well protected

  37. Fact: Environmental Factors • Skin surface area is large compared to bodymass • Children susceptible to hypothermia, hyperthermia • Dehydration

  38. Fact: Children Airways • Tongues are larger • Relaxed tongue can block airway easily • Large stomachs which can press on diaghrapm making respiration difficult • Smaller air passages • Less air reserve capacity

  39. URTI • Croup - Viral • Epiglottis – bacterial • Asthma – allergens • All have challenged airways • Allow the child to situp • Do not lie down position of greatest comfort

  40. Cardiac Arrest • Unresponsive • Seizure – due to hypoxia, lay on side do not let tongue block airway • Gasping sounds • No chest movement • Pale or blue skin • Absent pulse • EMS – begin chest compressions

  41. Shock • Major cause if blood loss, acute infection, heart failure and loss of body heat? • Babies cannot shiver or warm themselves by moving around • Large surface area • Cold moist skin • Low blood pressure • Lack of vitality • Extreme anxiety • Rapid thready pulse

  42. SIDS • #1 cause of death between 1 month and1 year old child • Almost always while sleeping • Usually healthy, premature, • Usually between 4 weeks and 7 months • Always act appropriate • DDX: alterations in brain activity suppressing respiratory control, inadequate amounts of O2 in the blood several weeks before onset

  43. Child Abuse and Neglect: Physical Signs • Old and new bruises • Odd shape bruises • Cluster brusing • Trunk and buttock bruising • Donute shape burns • Both feet and hands scalding burns • Rope burns • Spinal fractures • Altered limb appearance

  44. Child Abuse….

  45. Look for things out of the normal…

  46. Cervical spine , shoulder injuries

  47. What constitutes child abuse? I know it when I see it…….

  48. What are you going to do….. • Inform the authorities • Prepare to have an emotional day • Do not assume…… • Be positive with speech • Be very confidential

  49. Child Abuse and Neglect Behavioral signs • Wary of adult contact • Parents always with children • Withdrawn • Get scared when other kids cry • Afraid to go home • Frightened of parents • Injures were several days before you were called

  50. Conditions that mimic child abuse

More Related