05-19-2024 FEDN

Triage

ED	Disaster/Field
Emergent	Immediate	Minutes; Highest priority due to immediately life-threatening conditions.
Urgent	Delayed	1 hour; Not life threatening
Non-urgent	Minimal	24 hours; no developing potential morbidity.
---	Expectant	No time constrain
Fast-Track	---	First Aid

Emergent, Immediate (Red)

1. Sucking Chest Wound
2. Airway Obstruction secondary to mechanical cause
3. Shock
4. Hemo/Tension Pneumothorax
5. Asphyxia
6. Open fractures of the long bone: femur fracture may result in fat embolism syndrome.
7. 2nd to 3rd Degree Burns with 15% to 40% TBSA

Urgent, Delayed (Yellow)

1. Fracture requiring open reduction
2. Genitourinary (GUT) disruptions
3. Eye and CNS Injuries
4. Maxillofacial injuries without Airway Compromisation

Non-Urgent, Minimal, Minor (Green)

1. Behavioral Disorders
2. Extremity Fractures
3. Minor Burns
4. Sprains

Expectant (Black)

1. Profound Shock with Multiple Injuries
2. Unresponsive Patients with Penetrating Head Wounds
3. Seizures/Vomiting within 24 hours after radiation exposure
4. High Spinal Cord Injury: cervical area
5. Agonal respiration, no blood pressure, no pulse, and fixed pupils
6. 2nd to 3rd degree burns in excess of 60% TBSA

Primary Survey

Conscious, trauma

1. Airway
2. Breathing
3. Circulation
4. Disability

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Disaster Nursing

A disaster is a destructive event that disrupts the normal function of the community. This may both be ecological (nature) or emergent.

• Natural Disaster: an ecological disruption or threat.
• Man-made Disasters: fire, explosions, armed conflicts, acts of war, transportation accidents, radiologic events, chemical spills

Phases of Disaster Management Program

1. Preparedeness: proactive planning, planning for potential vulnerabilities, and warnings (e.g., a Staging Warning for Typhoon).
2. Mitigation: measures to reduce the harmful effects of a disaster by attempting to limit its impact.
3. Response: the actual implementation of the disaster plan, reaction to the disaster process, relief provision, and rescue responses.
4. Recovery: returning to pre-disaster state, rebuilding, repairing, rehabilitation
5. Evaluation: evaluate, and plan for the future.

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Burns

Electrical Burns

Due to the nature of electrical burns, they are automatically classified as third-degree burns. They also have an entrance and exit wound from where the electricity enters and exits the body.

Depth of Burn Injury

1. 1st Degree (Superficial-Partial Thickness): burns of the epidermis, and possibly a portion of the dermis
   • Reddened, blanches with pressure
   • ex. Sunburn
   • Nursing Diagnosis: Pain. Cooling soothes the pain.
2. 2nd Degree (Deep Partial Thickness): burns of the epidermis and dermis.
   • Blistered, weeping surface
   • Recovery takes up to 4 weeks.
   • Nursing Diagnosis: Pain.
   • ex. scalding, flash flame
3. 3rd Degree (Full Thickness): burns reach the muscle or even bone. Pain is not felt due to the nerves being damaged.
   • Pale-white and painless burn wound.
   • Nursing Diagnosis: Hypovolemic Shock; Fluid Volume Deficit. Apply or insert fluids. Plain LR is preferable due to its electrolytes. PNSS can be used if unavailable.
   • ex. electrical burn, chemical burn.

Extent of Burn Injury

1. Head: 9%
2. Torso: 36% (Chest and Abdomen are 9% each)
3. Arms: 9%
4. Legs: 18%
5. Perineum: 1%

Phases of Burn Management

Nursing interventions in trauma patients are Airway, Breathing, Circulation, Disability (ABCD)

1. Emergent or Resuscitative Phase: from the onset of injury to completion. There is generalized dehydration in burns, as the capillaries are damaged and plasma leaks from circulation. Intravascular fluid shifts to interstitial or extracellular spaces. This also results in hemoconcentration. Cell damage results in hyperkalemia and loss of plasma results in hyponatremia. Hyperkalemia can result in acute kidney injury, manifesting as Kussmaul breathing. Hyperglycemia also occurs from stress.
   • First Aid
   • Fluid Resuscitation: PLR
   • Ensure Airway Patency from inhalation of smoke and burning of the airway
2. Acute or Intermediate Phase:
   • Prevent and treatment of infection.
   • Nutritional support and wound closure.
   • Hydrotherapy
3. Rehabilitation Phase:
   • Prevention of scars and contractures.
   • Physical and occupational rehabilitation.
   • Cosmetic reconstruction.
   • Psychosocial counselling.

Medical Management

1. Pain is managed with opioids (Tramadol, Demerol, Morphine), NSAIDs, and anxiolytics.
2. Wound Cleaning
3. Hydrotherapy: provides active exercise and cleaning the body.
4. Antimicrobial Therapy:
   • Silver sulfadiazine (Silvadene) 1%.
   • Mafenide acetate (Sulfamylon), Acticoat: effective against gram positive and negative bacteria
5. Fluid Requirement: $\text{2 to 4 ml/kg/\% TBSA}$ given 50% within the first 8 hours, then 25% within the next two hours.
   • e.g. A burn patient has a 50% TBSA burn. 2 * 50 * 50 = 5000 ml over 24 hours = 2,500 mL in the first 8 hours, 1,250 hours for the two 8-hour periods after.

Example Questions

1. The term given to category of triage that refers to life threatening requiring immediate treatment A.) Non-urgent B.) Emergent C.) Urgent D.) Minimal
2. Which of the following will fall under a green tag in triage? A.) Has significant injuries, can wait hours B.) Injuries that are life threatening but survival is good C.) Extensive injuries, change of survival is unlikely D.) Minor injuries, treatment can be delayed from hours to days.
3. Which is the most important goal of triage? A.) Assigning each client to most appropriate treatment area B.) Giving priority of care to the most critically ill C.) Providing thorough assessment D.) Obtaining appropriate monitoring
4. A 47 year old male with history of vehicular accident is admitted. The nurse determines that a patient has a patent airway. The next assessment of the nurse would be? A.) Check consciousness B.) Observe breathing effort C.) Examine the patient for bleeding D.) Assess pulses
5. The other name for delayed triage category: A.) Minor B.) Non-urgent C.) Minimal D.) Urgent
6. Mitigating phase includes measures to reduce harmful effects. The following fall under this type, except: A.) Establishing standards B.) Education and training C.) Requirement for building permit D.) Fire exit
7. Which phase of disaster management is undertaken to handle a disaster when it strikes? A.) Preparedness B.) Evaluation C.) Response D.) Mitigation
8. Which phase of disaster management is done during the actual disaster? A.) Preparedness B.) Evaluation C.) Response D.) Mitigation