Emergency/Disaster Preparedness - PowerPoint PPT Presentation

Loading...

PPT – Emergency/Disaster Preparedness PowerPoint presentation | free to view - id: 4534a1-MjNjO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Emergency/Disaster Preparedness

Description:

... Manmade or natural event or disaster that overwhelms community s ... Volcanoes Wildfires Winter weather Level-1 DMAT - disaster medical assistance teams ... – PowerPoint PPT presentation

Number of Views:1322
Avg rating:3.0/5.0
Slides: 85
Provided by: lran9
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Emergency/Disaster Preparedness


1
Emergency/DisasterPreparedness
  • Lisa Randall, RN, MSN, ACNS-BC
  • RNSG 2432

2
Objectives
  • Compare and contrast interdisciplinary roles and
    responsibilities associated with emergency and
    disaster situations.
  • Compare and contrast risk factors associated with
    need for emergency care.
  • Analyze etiology, pathophysiology, and
    signs/symptoms of bioterrorism, chemical and
    radiation exposure, and other emergencies.
  • Discuss nursing care and diagnoses associated
    with emergency care.

3
Definitions
  • Emergency
  • MCI
  • Bioterrorism
  • Chemical and radiation exposure
  • Primary survey
  • Secondary survey

4
Emergency and Mass Casualty Incident
Preparedness
  • Emergency
  • Any extraordinary event that requires a rapid
    and skilled response and can be managed by a
    communitys existing resources
  • Mass casualty incident (MCI)
  • Manmade or natural event or disaster that
    overwhelms communitys ability to respond with
    existing resources

5
Emergency and Mass Casualty Incident Preparedness
  • Total number of casualties a hospital can expect
    is estimated by doubling number of casualties
    that arrive in first hour
  • 30 admission to hospital
  • half will need surgery within 8 hours

6
Emergency and Mass Casualty Incident Preparedness
  • All health care providers have a role in
    emergency and MCI preparedness
  • Know hospitals emergency response plan
  • Participation in emergency/MCI preparedness
    drills is required

7
Emergency and Mass Casualty Incident Preparedness
  • Response to MCIs often requires the aid of a
    federal agency such as the National Disaster
    Medical System (NDMS)
  • U.S. Department of Homeland Security
  • responsible for the coordination of the federal
    medical response to MCIs

8
Bioterrorism
  • Anthrax
  • Botulism
  • Plague
  • Tularemia
  • Smallpox
  • Typhoid fever
  • Hemorrhagic fever

9
Anthrax
  • Bacillus anthracis
  • Infected animals
  • Skin, ingestion, inhalation
  • Pulmonary
  • Cutaneous
  • GI
  • Antibiotics
  • Oral Fluoroquinolones
  • Prevention
  • Vaccination limited

10
Botulism
  • Clostridium botulinum
  • Ingestion (12-36), inhalation (24-72)
  • Neuropathies
  • Blurred vision
  • Weakness
  • Respiratory dysfunction
  • Vaccine investigational

11
Plague
  • Yersinia pestis
  • Infected fleas (2-8d), aerosol (1-3)
  • Lymphatic (bubonic)
  • Blood (septicemia)
  • Airborne
  • Pulmonary variant
  • Fever
  • Cough
  • Hemoptysis
  • Antibiotics
  • Doxycycline
  • Vaccine
  • Bubonic

12
Smallpox
  • Variola virus
  • Airborne
  • 7-17d incubation
  • Flu-like symptoms
  • Rash
  • Vaccine

13
Chemical Exposure
  • A-Z
  • Biotoxins
  • Blood agents
  • Caustics (acids)
  • Incapacitating agents
  • Metals
  • Nerve agents
  • Pulmonary agents
  • Riot control agents
  • Toxic alcohols
  • Vesicants

14
Chemical Exposure
  • Categorized by target organ or effect
  • Sarin
  • Neurotoxin
  • Death within minutes of exposure
  • Enters body through eyes and skin
  • Paralyzes respiratory muscles
  • Antidotes
  • Atropine
  • Pralidoxime chloride (2-PAM, Protopam given IV)

15
Chemical Exposure
  • Phosgene
  • Colorless gas normally used in chemical
    manufacturing
  • Severe respiratory distress, pulmonary edema, and
    death
  • Mustard gas
  • Yellow to brown in color with garlic-like odor
  • Eyes
  • Skin burns/blisters

16
Radiation Exposure
  • Ionizing radiation
  • Nuclear bomb
  • Radioactive material
  • Serious threat to safety of casualties and
    environment
  • MASS CASUALTY
  • Decontamination procedures
  • Acute radiation syndrome
  • Substantial exposure
  • Predictable pattern

17
Acute Radiation Syndrome
18
Management Radiation Exposure
  • Exposure dependent
  • 10-12 Gy fatal
  • Vomiting
  • Lymphopenia
  • Cerebrovascular changes
  • Fluid replacement
  • Cytokines
  • G-CSF, GM-CSF, filgrastim
  • Antiobiotics
  • Burns, wounds
  • Abdominal trauma
  • Thyroid protection
  • KI
  • OR
  • Within 36hr or after 6wks

19
Explosion
  • Radiologic dispersal devices (RDDs)
  • Mix of explosives and radioactive material
  • Scatters radioactive dust, smoke, and other
    material into environment
  • Main danger from RDDs Explosion

20
Explosive Devices as Agents
of Terrorism
  • Blast, crush, or penetrating
  • Blast injuries
  • Supersonic overpressurization shock wave that
    results from explosion
  • Lungs
  • Ear
  • GI
  • Fracture, lacerations, burns, blindness

21
Other Emergencies/Disasters
  • Earthquakes
  • Floods
  • Hurricanes
  • Landslide/mudslide
  • Tornadoes
  • Tsunamis
  • Volcanoes
  • Wildfires
  • Winter weather

22
Emergency and Mass Casualty Incident Preparedness
  • Level-1 DMAT - disaster medical assistance teams
  • Deployed within 8 hours
  • Self-sufficient for 72 hours with enough food,
    water, shelter, and medical supplies to treat
    about 250 patients per day
  • Level-2 DMAT
  • Replaces a Level-1 team
  • Supplements the equipment left on site

23
Emergency and Mass Casualty Incident Preparedness
  • HAZMAT
  • NRP
  • First responders
  • Police
  • Emergency Medical Personnel
  • Triage of casualties differs from usual ED triage
    and is conducted in lt15 seconds

24
Emergency and Mass Casualty Incident Preparedness
  • Colored tags
  • Green
  • minor injury
  • walking wounded
  • Yellow
  • non-critical injury
  • RPM
  • R-resp. P-pulse M- mental status/response/comma
    nds
  • Red
  • life-threatening injury
  • immediate intervention
  • Black
  • dead or expected to die
  • catastrophically injured

25
RPM assessment
  • Step 1. Respiration (breathing)A. None, open
    airway, still no breathing, tag deceased -
    blackB. Respirations greater than 30/min. or
    less than 10/min. tag Red.C. Respiration between
    10-30 per minute. Go on to Step 2.Step 2.
    Perfusion check (radial pulse) or use a capillary
    blanch testA. Squeeze nail bed, palm of hand or
    pad of finger.B. If color regains in greater
    than two seconds, tag Red.C. If the color
    returns in less than two seconds go onto Step 3
    Mental status.D. In poor lighting, attempt to
    find the radial pulse. If radial pulse is present
    proceed to Step 3.Step 3. Mental statusA.
    Altered mental status is the inability to follow
    simple commands, tag Red.B. Able to follow
    simple commands, tag Yellow.C. Example of simple
    commands can you squeeze my hands? Can you
    open and close your eyes? D. All steps have
    been passed for patient to be tagged Yellow.

26
Nursing concerns
  • Triage
  • Assessment
  • Interventions
  • Drug therapy
  • Diet therapy
  • Hypermetabolic states
  • Surgical/medical interventions

27
Triage Emergency Severity Index
  • Short term hospital resource and staffing needs
  • Illness severity
  • Hospital resources
  • 5 level
  • ESI-1 highest priority
  • Triage algorithm

28
Definition ESI-1 ESI-2 ESI-3 ESI-4 ESI-5
Stability of vital functions Unstable Threatened Stable Stable Stable
Life /organ threat Obvious Likely but not always obvious Unlikely but possible No No
How soon patient should be seen by physician Immediately Minutes Up to 1 hour Could be delayed Could be delayed
Expected resource intensity High staff at bedside continuously mobilization of team response High multiple, complex diagnostic studies frequent consultation cont monitoring Medium/high multiple diagnostic studies or brief observation or complex procedure Low 1 simple diagnostic study or simple procedure Low examination only
29
ESI Triage Algorithm
30
ESI-1
  • Cardiac arrest.
  • Respiratory arrest.
  • Severe respiratory distress.
  • SpO2 lt 90.
  • Critically injured trauma patient who presents
    unresponsive.
  • Overdose with a respiratory rate of 6.
  • Severe respiratory distress with agonal or
    gasping-type respirations.
  • Severe bradycardia or tachycardia with signs of
    hypoperfusion.
  • Hypotension with signs of hypoperfusion.
  • Trauma patient who requires immediate crystalloid
    and colloid resuscitation.
  • Chest pain, pale, diaphoretic, blood pressure
    70/palp.
  • Weak and dizzy, heart rate 30.
  • Anaphylactic reaction.
  • Baby that is flaccid.
  • Unresponsive with strong odor of ETOH.
  • Hypoglycemia with a change in mental status.

31
Triage
  • ISOLATION PRECAUTIONS
  • Basic triage principles
  • 1. life threatening injuries
  • 2. decontaminate
  • 3. decongest area

32
Triage the following (ESI)
  • A 6 yo w T 103.2
  • A 22 yo w asthma in acute resp distress
  • An infant who has been vomiting for 2 days
  • A 50 yo man w LBP/spasms
  • A 32 yo woman unconcious following an MVA
  • A 40 yo woman w rhinitis and cough
  • A 58 yo man w midsternal chest pain
  • A teenager w an angulated FA from sports

33
Primary Survey
  • Maintain airway
  • Suction and/or remove foreign body
  • Insert nasopharyngeal/oropharyngeal airway
  • Endotracheal intubation
  • Cricothyroidotomy or tracheostomy

34
Primary Survey
  • Stabilize/immobilize cervical spine
  • Collar
  • Spinal precautions
  • Flat bedrest
  • Log roll

35
Primary Survey
  • Breathing
  • Assessment
  • Administer high-flow O2 via a nonrebreather mask
  • Bag-valve-mask (BVM) ventilation with 100 O2 and
    intubation for life-threatening conditions
  • Monitor patient response

36
Primary Survey
  • Circulation
  • Check central pulse
  • Assess skin for color, temperature, moisture
  • Assess mental status and capillary refill
  • Aggressive fluid resuscitation
  • Insert two large-bore IV catheters
  • NS or LR

37
Primary Survey
  • Disability
  • LOC
  • AVPU
  • A alert
  • V responsive to voice
  • P responsive to pain
  • U unresponsive
  • GCS
  • Pupils

38
(No Transcript)
39
Secondary Survey
  • Exposure/Environmental control
  • Remove clothing
  • Provide temperature controlavoid hypothermia

40
HPI
  • Obtain history
  • Location
  • Duration
  • Activity
  • Occupation
  • affected

41
Secondary Survey
  • VS
  • BP
  • HR
  • RR
  • Temperature

42
Secondary Survey
  • Head-to-toe assessment
  • Head and spine
  • Chest
  • Listen to abdomen first
  • Pelvis
  • Perineum
  • Limbs reduce fractures

43
Assessment
  • S/S nonspecific
  • VS
  • LOC
  • Neuro
  • GI
  • Skin

44
Secondary Survey
  • Five interventions
  • ECG
  • Pulse oximetry
  • Catheterize
  • NGT
  • Labs

45
Labs
  • Serial CBC
  • Blood cultures
  • Chromosomal aberration
  • 24 hr urine/stool

46
Drug therapy
  • Volume expanders
  • Inotropes
  • Vasopressors
  • Opiods
  • Vasocnstrictors
  • Immunizations, vaccines, immune globulin
  • Antibiotics and antivirals
  • Antidotes such as atropine

47
Nursing Diagnosis
  • Ineffective airway
  • Ineffective tissue perfusion
  • Risk for infection
  • Impaired physical mobility
  • Spiritual distress
  • Risk for post-trauma syndrome

48
Emergency and Mass Casualty Incident Preparedness
  • Many hospitals and DMATs have a Critical Incident
    Stress Management unit
  • Group discussions
  • Facilitates psychologic recovery

49
Question
  • The nurse performing a primary survey in the ED
    is assessing
  • a. the acuity of the patients condition to
    determine priority of care
  • b. the status of airway, breathing, circulation,
    or presence of deformity.
  • c. whether the patient is responsive enough to
    provide needed information
  • d. whether the resources of the ED are adequate
    to treat the patient.

50
Question
  • A homeless man is brought to the ED in profound
    hypothermia with a temperature of 85 degrees F.
    On initial assessment, the nurse would expect to
    find
  • a. shivering and lethargy
  • b. fixed and dilated pupils
  • c. respirations of 6-8 per minute
  • d. BP obtainable only by doppler

51
Question
  • A victim of a sublethal dose of whole-body
    ionizing radiation exposure is admitted to the ED
    several hours after exposure. On assessment the
    nurse would expect the patient to report
  • a. hair loss.
  • b. nausea and vomiting.
  • c. bleeding from the gums and nose.
  • d. bruises on skin not covered by clothing.

52
Heat StrokePathophysiology
  • Definition
  • Failure of the hypothalamic regulatory process
  • Increased diopherisis
  • Vasodilatation
  • Increased RR
  • Sweat glands stop working
  • Core temp rises
  • Circulatory collapse

53
Heat Stroke
  • Development is directly related to
  • Amount of time the body temperature is elevated
  • What are some common causes?

54
Heat Stroke
  • Strenuous activity in hot/humid environment
  • High fevers
  • Clothing that interferes with perspiration
  • Working in closed areas/prolonged exposure to
    heat
  • Drinking alcohol in hot environment

55
Heat StrokeManifestations Complications
  • Core temp gt 104F
  • AMS
  • No perspiration
  • Skin hot, ashen, dry
  • Dec. BP
  • Inc. HR
  • S/S of what?

56
Heat StrokePrognosis
  • Related to
  • Age
  • Length of exposure
  • Baseline health status
  • Number of co-morbidities
  • Which co-morbidities would predispose your
    patient to heat related emergencies?

57
Heat StrokeTreatment Interventions
  • Monitor for s/s of rhabdomyolysis
  • What is this?
  • How would you monitor for this?
  • Monitor for s/s disseminated intravascular
    coagulation (DIC)
  • What is this?
  • How would you monitor for this?

58
HypothermiaPathophysiology
  • Definition
  • Core temperature less than 95F (35C)
  • Core temp lt86F - severe hypothermia
  • Core temp lt78F - death
  • Heat produced by the body cannot compensate for
    cold temps of environment
  • 55-60 of all body heat is lost as radiant
    energy
  • Head, thorax, lungs
  • Dec body temp ? peripheral vasoconstriction ?
    shivering movement ? coma results lt78F

59
HypothermiaCauses
  • Exposure to cold temperatures
  • Inadequate clothing, inexperience
  • Physical exhaustion
  • Wet clothes in cold temperatures
  • Immersion in cold water/near drowning
  • Age/current health status predispose
  • What health issues would predispose a patient to
    hypothermia?

60
HypothermiaManifestations Complications
  • Vary dependent upon core temp
  • Mild (93.2F - 96.8F)
  • Lethargy, confusion, behavior changes, minor HR
    changes, vasoconstriction
  • Moderate (86F 93.2F)
  • Rigidity, dec HR, dec RR, dec BP, hypovolemia,
    metabolic resp acidosis, profound
    vasoconstriction, rhabdomyolysis
  • Shivering usually disappears at 92F
  • Profound/(Severe) (lt86F)
  • Person appears dead attempt to re-warm to 90F
  • Reflexes vitals very slow
  • Profound bradycardia, asystole 64.4F, or Vfib
    71.6F

61
HypothermiaTreatment Interventions
  • Goal
  • Rewarming to temp of _____F
  • Correction of dehydration acidosis
  • Treat cardiac dysrhythmias
  • Attainment
  • Passive active external rewarming
  • Active core rewarming

62
Submersion InjuryCauses Incidence
  • 8000 submersion injuries
  • per year
  • 40 children under 5yrs
  • Categorized as
  • Drowning
  • Near drowning
  • Immersion syndrome
  • Risk factors
  • Inability to swim entanglement with objects in
    water
  • ETOH or drug use
  • Trauma
  • Seizures
  • Stroke

63
Submersion Injury Pathophysiology
  • Definition
  • Drowning
  • Death from suffocation after submersion in water
    or other fluid medium
  • Near Drowning
  • Survival from potential drowning
  • Immersion syndrome
  • Immersion in cold water ? stimulation of vagus
    nerve potentially fatal dysrhythmias
    (bradycardia)

64
Submersion Injury Pathophysiology
  • Death is caused by hypoxia
  • secondary to aspiration swallowing of fluid
  • Victims that aspirate
  • Fluid aspirated into pulmonary tree ? PULMONARY
    EDEMA - HYPOXIA
  • Victims that do not aspirate
  • Bronchospasm airway obstruction ? dry
    drowning - HYPOXIA

65
Submersion Injury
  • http//www.youtube.com/watch?vroFGBt8xEisfeature
    relateddrowning

66
Poisoning
  • 1-800-POISON1
  • Treatments
  • Activated charcoal, gastric lavage, eye/skin
    irrigation, hemodialysis, hemoperfusion, urine
    alkalinization, chelating agents and antidotes
    acetylcysteine (Mucomyst)
  • Contraindicated (charcoal gastric lavage)
  • AMS, ileus, diminished bowel sounds, ingestion of
    substance poorly absorbed by charcoal (alkali,
    lithium, cyanide)

67
Bites StingsPathophysiolgy
  • Direct tissue damage is a product of
  • Animal size
  • Characteristics of animals teeth
  • Strength of jaw
  • Toxins released
  • Death is due to
  • Blood loss
  • Allergic reactions
  • Lethal toxins

68
Bites Stings
  • Hymenopteran stings
  • Bees, yellow jackets, hornets, wasps, fire ants
  • Mild to Anaphylactic
  • What are some manifestations of each?
  • What interventions would you implement to treat
    these manifestations?
  • Treatment
  • Remove stinger with scraping motion
  • Tweezers why or why not?
  • Maintain ABCs
  • What meds might you give?

69
Bites Stings
  • Spider bites
  • Black widow
  • Venom is neurotoxic to humans
  • Symptoms progress over time 15mins 3hrs
  • Can cause systemic issues
  • Treatment
  • Cool area to slow movement of toxins
  • Antivenin used in special at risk population
  • Brown recluse
  • Venom is cytotoxic to humans
  • Symptoms progress over 6hrs 2weeks
  • Can cause systemic issues
  • Treatment
  • Clean area, treat pain, antibiotics (why?)
  • Surgical debridement with grafting may be
    necessary

70
Black Widow
Brown Recluse
71
Bites Stings
  • Snakebites
  • Pit viper, rattlesnakes, copperheads, water
    moccasins, coral snakes
  • Pit viper hemolytic, coral neurotoxic
  • Can cause systemic reaction
  • Necrosis can occur
  • Treatment
  • IV access, fluids, labs (which ones?), analgesics
    as needed, circumference of site q30mins, tetanus
    prophylaxis
  • Ice tourniquets not recommended
  • Caffeine, alcohol smoking not recommended
  • Remember "red on yellow kill a fellow"

72
Question
  • The priority of management of the near-drowning
    patient is
  • a. correction of hypoxia
  • b. correction of acidosis
  • c. maintenance of fluid balance
  • d. prevention of cerebral edema

73
Question
  • As a member of a volunteer disaster medical
    assistance team, the nurse would be expected to
  • a. triage casualties of a tornado that hit the
    local community.
  • b. assist with implementing the hospitals
    response plan.
  • c. train citizens of communities how to respond
    to mass casualty incidents.
  • d. deploy to local or other communities with
    disasters to provide medical assistance.

74
Cardiopulmonary Resuscitation
75
CPR
  • http//www.hulu.com/watch/21873/saturday-night-liv
    e-cpr-class

76
Case Study
  • Mr. M., 72yo, was taking a short break from
    nailing new shingles on his roof during the
    summer when he lost conciousness and collapsed in
    his yard. Accompanied by his wife, he was brought
    by ambulance to the emergency department.

77
Case Study
  • Subjective Data
  • Wife states he has been working all week on the
    roof even though he has not felt well the last
    day or two
  • Objective Data
  • VS T 106 HR 124 and weak and thready RR 36 and
    shallow BP 8240
  • Skin hot, dry, and pale

78
Case Study continued
  • 1. What factors in Mr. Ms history place him at
    risk for heat stroke?
  • Advanced age and prolonged exposure to heat over
    several days

79
Case Study continued
  • 2. What laboratory tests would the nurse
    anticipate to be ordered, and what alterations in
    these tests would be indications of heat stroke?
  • ABGsdecreased PaO2
  • Electolytesdecreased Na, Cl-, K
  • CBChemoconcentration with elevated HH, BUN/Cr,
    Glu
  • PT/INRincreased
  • LFTelevated
  • UAelevated sp. Gr., protein, possible hematuria

80
Case Study continued
  • 3. How would cooling for Mr. M. be carried out?
  • Clothing would be removed, fans, tepid mist, ice
    water bath
  • Cold water peritoneal dialysis

81
Case Study continued
  • 4. What supportive treatment is indicated for Mr.
    M.?
  • 100 O2, with intubation and mechanical
    ventilation
  • IV crystalloid with CVC or PA catheter
  • Cooling methods
  • Indwelling catheter, IO
  • Thorazine (shivering)

82
Case Study continued
  • 5. What should Mrs. M. be told about Mr. Ms
    condition?
  • Mrs. M. should be told that Mr. M. is very
    seriously ill and that there is a chance he might
    not recover
  • High morbidity and mortality rate
  • She should be kept informed of the treatment he
    is receiving and his response to treatment
  • Emotional support

83
Case Study continued
  • 6. Based on the assessment data presented, write
    one or more appropriate nursing diagnoses. Are
    there any collaborative problems?
  • Hyperthermia r/t environmental exposure
  • Decreased CO r/t hypermetabolic process
  • Deficient fluid volume r/t fluid loss excessive
    to intake
  • Altered protection r/t ams
  • Risk for injury r/t seizure activity
  • Risk for impaired skin integrity r/t immobility
  • Collaborative hypovolemic shock cerebral edema
    seizures hypoxia electrolyte imbalance renal
    failure

84
References
  • Lewis, S., Heitkemper, M., OBrien, P., Bucher,
    L. (2007). Medical-Surgical Nursin.g Assessment
    of Management of Medical Problems. Mosby
    Elsevier, St. Louis, Missouri.
  • Emergency Preparedness and Response. Centers for
    disease control and prevention. Retrieved
    2/21/2011, from http//www.bt.cdc.gov.
About PowerShow.com