13.3 Miscellaneous Emergency Situations

Question 1

Heat Stroke

Answer 1

• Caused by failure of heat regulation systems

Non Exertional
- Prolonged exposure to temperatures greater than 39.2 (102.5)

Exertional
- Caused by strenuous activity in hot environments

Risk Factors
- People not acclimated to heat
- Very young or old people
- Ill people
- Medications

Manifestations
- CNS dysfunction
- Elevated temperature (105+)
- Hot dry skin
- Anhidrosis (no sweating)
- Tachypnea/Tachycardia
- Hypotension

Management
- ABC’s and reduce temperature to 102 ASAP
- Cool sheets, sponging with cool water,
- Ice to neck, groin, chest, and axillae
- Cooling blankets
- Immersion in cold bath water

Nursing Care
- Monitor VS, ECG, CVP, LOC, I&O
- IV Fluids

Medications
- Anticonvulsants
- Potassium
- Sodium Bicarbonate
- Benzodiazepines

Question 2

Frost Bite

Answer 2

• Trauma from exposure to freezing temperatures and freezing of fluid in the intracellular spaces.

Nursing Care
- Controlled rapid rewarming to 37-40C circulating bath for 30-40 min intervals.
- Analgesics for pain
- DO NOT MASSAGE and DO NOT WALK if feet are involved.

Manifestations
- Hard, Cold, Insensitive to touch
- White/Mottled
- May turn red and painful when rewarmed

Question 3

Hypothermia

Answer 3

• Internal core temperature less than 35C (95F)

Risk Factors
- Patients with illness, homeless
- Alcohol
- Treatment of hypothermia takes precedence over frostbite

Management
- ABC’s
- Remove wet clothing
- Supportive care

Re-warming
- Active core rewarming
- Cardiopulmonary bypass, warm fluids, warm humidified oxygen, warm peritoneal lavage.
- Warm blankets

WARNING
- COLD BLOOD RETURNING FROM EXTREMITIES HAS HIGH LEVELS OF LACTIC ACID THAT CAN CAUSE CARDIAC DYSRYHTMIAS AND ELETROLYTE IMBALANCES.

Question 4

Poisoning

Answer 4

Treatment Goals
- Remove or inactivate poison before it is absorbed
- Supportive care to vital organs
- Administer antidotes

Management
- ABCs
- VS, LOC, ECG, UO
- Labs
- Determine what, when and how much poison was ingested

Care
- Emetics (induces vomiting)
- Gastric lavage
- Activated charcoal
- Cathartic’s (purging drugs)
- Antagonist drugs (antidotes)
- Diuresis/Dialysis/Hemoperfusion

• DO NOT INDUCE VOMITING WITH ACIDS/ALKALINE POISONING BECAUSE THEY ARE CORRUSIVE AND CAN CAUSE TISSUE DAMAGE

Question 5

Drug Overdose

Answer 5

Treatment Goals
- Support respiratory/cardiovascular function
- Enhance clearance of agent

• IV drugs are high risk for HIV, Hep B/C, and Tetanus

Question 6

Substance Abuse

Answer 6

Alcohol is a multisystem toxin
- Maintain airway and observe CNS depression and hypotension
- Rule out other potential causes
- Be non-judgmental and calm
- May need sedation if belligerent
- Examine for withdrawal delirium, injuries, and evidence of other disorders.

Question 7

Sexual Assault

Answer 7

Goals
- Provide support
- Reduce emotional trauma
- Gather evidence for legal proceedings

Care
- Physical
- Specimen collection
- Treating STI’s and pregnancy
- Encourage follow-up care

Question 8

Human Trafficking

Answer 8

• The use of force, fraud, or coercion for the purpose of subjection into involuntary servitude.
• These people have limited access to healthcare.

Signs of Victims
- May present to ED with injuries with boyfriend or travel partner
- History of running away, homelessness, self-mutilation.
- Might be frightened, agitated, and defer questions to the person accompanying them.
- May have poor healing, dizzy, rashes, or sores.

Behaviors
- Addiction
- Panic Attacks
- Impulse control
- Suicide
- Hostile
- Suicidal

Nursing Care
- Offer opportunities to speak alone with the patient without companion
- Use Targeted Questions
(Are you in control of your money?)
(Are you able to come and go as you please?)
(Who is the person accompanying you)

Question 9

Overactive Patients

Answer 9

• People with disturbed, uncooperative, and paranoid behavior due to psychiatric disorders, stress or alcohol.
• IMMEDIATE GOAL IS TO GAIN SAFETY AND CONTROL FOR THE PATIENT AND OTHER PATIENTS
• Call security if patient is violent
• Restraints as a last resort with providers order.

Nursing Care
- Assess precipitating events that lead to the crisis
- Maintain safety for all patients
- Determine if patient is at risk for harming themselves.
- Maintain persons self esteem

Question 10

Emergency Decontamination

Answer 10

• Physical process of immediately reducing contamination of individuals in potentially life threatening situations.
• NOT A CONTROLLED SITUATION
• Establish area of refuge ASAP
• Establish gross decon area using some form of water
• Provide emergency care

Flush-Strip-Flush

Chemical Exposure (serious)
- Rapid decontamination and treatment

Possible Liquid Exposure (moderate)
- Delayed decontamination and treatment

Vapor Exposure (minimal)
- Delayed decontamination and treatment

No signs/symptoms
- Psychological Decontamination

Question 11

Decontamination

Answer 11

• Removing contaminants or rendering them harmless

1st Step
- Remove clothing and jewelry and rinse the patient

2nd Step
- Soap and water rinse

• Decontamination should ALL BE COMPLETE within the hot zone to prevent secondary contamination
• Wastewater is collected in special areas.

Gross Decontamination
- Removing surface contaminants (the big stuff)

Secondary Decontamination
- Remove contaminants to a safe level