Emergency/Disaster by: MR:GEBRIELLE HIPOLITO RN, USRN, MAN RN (Registered Nurse)

- Initial Assessment
Emergency Nursing Protocols - Unstable Clients
- Discharge Teaching/ Health Teaching
PRIMARY SURVEY LPN (Licensed Practical Nurse)
- Conduction of rapid observation to address clients immediate - Stable client
problem. - Medication (except IV route)
1. General Impression UAP/CNA (Unlicensed Assistive Personnel/ Certified Nurse Assistant)
 Chief Complaint - Routine procedures on stable clients
2. Responsiveness
 Alert BASIC HOSPITAL COLOR CODE
 Verbal Response BLUE : Need immediate Resuscitation
 Classify as unresponsive ORANGE: Hazardous Spills(Chemical or Radioactive)
3. Airway RED : Fire Emergency (RACE)-Rescue, Alarm, Confine, Extinguished
4. Breathing GRAY : Combative Person
5. Circulation SILVER : Armed Combatived Person
6. Classify/Sort the client BLACK : Bomb Threat
PINK : Infant/ Child Abduction
TRIAGE SYSTEM BROWN : Severe Weather
RED – Emergent Cases GREEN : Mass Evacuation
- life threatening cases, needs immediate medical attention. CLEAR : Code is lifted
YELLOW – Urgent Cases
- Medical attention with in 6 hours Right Sided Heart Failure(Systemic) Left Sided Heart Failure(Pulomary)
GREEN – Non- Urgent Cases  Anasarca  Anxiety
- Walking Wounded  Bloated  Breath Sounds(Crackles/Rales)
- Care can be delayed by up to 24 hours  Cardiomegaly  Cardiomegaly
BLACK – Expectant  Distended Jugular Vein  Dyspnea
- Expected to die  Edema (Peripheral)  Edema (Pulmonary)
- Expires with or without medical intervention  Face (Puffiness/Swollen)  Fink (Pink)Frothy Sputum
- Poor chance of prognosis  Gallop (S₃)  Gallop (S₃)
A B C D E F G
SECONDARY SURVEY
- Focused observation to determine the root cause of clients THROMBO ANGITIS OBLITERANS (BUERGERS DISEASE)
condition. Cause: Unknown
1. Signs & Symptoms Risk #1: SMOKING
2. Allergies Vasoconstriction- low oxygen(tissues)
3. Medications Taken  Pain(worst when walking) Intermittent Claudication
4. Past and present Medical History
5. Last Oral Intake
6. Events that lead to current problem
Mgt: STAGES
1. Stop Smoking I. Invasive Stage: ↑V/S, Hypersalivation, Apprehensiveness,
2. ↑ambulation and ↑ Collateral Circulation Cramping/Photosensitivity
3. Medication: Pentoxyfilline (Vasodilator) II. Excitation Stage: Muscle Spasm, Bronchospasm(feeling of
chooking or drowning), Hydrophobia, Skin is painful to touch
FLAIL CHEST- affected area into the lungs (Aerophobia 24-48 hours)
Therapeutic PEEP(Positive End Expiratory Pressure) III. Paralysis Stage: Nerve Tissue death(spasm stop, paralysis sets
N: 5-20mmHg in, followed by death)
Diagnostic Test
CONVERSION: Screening: Observe Animal for 10 days
1 gr= 60 mg (+) If nimal dies or changes behaviour.
1 dram=1770 mg Confirmation: Brain Autopsy (NEGRI BODIES-Optional)
1 pint =480 ml Use FAT(Flourescent Anti Body Test), If Brain is not plausible
1 quart = 2 pints -Far away from nursing station.
1 gallon = 4 quarts
ACTIVE IMMUNIZATION -via IM (Deltoid, Vastus Lateralis)
PARKLAND FORMULA
=4 x wt(kg)x % TBSA Day 0 -1 dose or 2 doses ID.
Day 7 -1 dose or 2 doses ID
ADULT: Day 21-1 dose or 2 doses ID
Right Arm 9 % A.Trunk 18% Day 28- 1 dose or 2 doses ID
Left Arm 9 % P.Trunk 18%
Head 9 % Right Leg 18% 1. Verorab: Purified Vero – Cell Vaccine(Dose: 0.5 ml per injection)
Left Lleg 18% 2. Rabipur: Purified Chick – Embryo Vaccine (Dose: 1 ml per injection)
PEDIA: 3. Lyssavac: Purified Duck – Embryo Vaccine (Dose: 1 ml per injection)
Right Arm 9 % A.Trunk 18%
Left Arm 9 % P.Trunk 18% PASSIVE IMMUNIZATION
Head 18 % Right Leg 14% - Effective/immediately
Left Lleg 14% - Single Injection
- Dose depends on weight : site: buttocks
COMMUNICABLE DISEASE - A should be given with in 7 days of biten or incident
-Refers to any illness that’s caused by a microorganism or parasite that can
be transmitted directly or indirectly to man. 1. Equine Rabies Immunoglobulin (ERIG): HyperRab
CAUSE: never IDIOPATHIC Dose: 40 IU/kg or 0.2 ml/kg
SKIN TEST IS NECESSARY
RABIES 2. Human Rabies Immunoglobulin (HRIG): Imogan/Raburan
Agent: Rhabdovirus Dose: 20 IU/kg
M.O.T.: Direct Inoculation
Incubation Period: Varies
(Nearer to head-shorter incubation)
SYPHILIS HEPATITIS B SEROLOGY
Agent: Treponema Pallidum
Incubation: 3-21 days 1. Hepatitis B Serum Antigen(HBsAg)
(+) Current Hepatitis B Infection
STAGES 2. Hepatitis B Serum Antibody (ABsAb)(Anti-Hbs)
Primary (+) Immunity to Hepatitis B
 Lesions: Chancre, painless, moist, ulcer resolves on its. 3. Hepatitis B Core Antibody (HBCab)(Anti-HBc)
Secondary (+) History of Past Hepatitis B Infection
 Lesions: Condyloma Lata, hard, wart-like lesion throughout body, 4. Igm- anti HBC (Immunoglobulin ntibody to Hepatitis B Core Antigen)
cause hair loss. (+) Hepatitis B for ≤6 mons (ACUTE)
Latency
 s/sx subside but client remains contagious CASE 1 2 3 4 5
HBsAg ─ + + ─ ─
Tertiary/ Neurosyphilis HBsAb ─ ─ ─ + +
 CNS damage HBcAb ─ ─ ─ + ─
 Gait/balance problems IgM anti ─ + ─ ─ ─
 Blindness /Deafness HBC
 Psychosis RESULT Vulnerable Acute Chronic Immune Immune
 Lesions: GUMMA (painful lesions that reach deep tissues Hep B. Hep. B due to due to
past Vaccination
Diagnostic Test: Darkfield Exam (Blood) Infection
Treatment: PENICILLIN(orally, IM Buttocks, IV critical)
 Kills bacteria
 Dead bacteria releases toxins(Toxins attract cytokines) ADULT DOSING: VARICELLA VACCINE
Cytokines- Inflammatory - Starts at 13 years old and above 2 doses of 0.5. ml (subcutaneous)
last for <24 hours - 2nd dose is given 28 days after 1st dose.
fever
rashes Histoplasma Capsulatum
diaphoresis Treatment: IV Ampotherecin B/ Traconazole
tachycardia
Reaction: Jarisch – Herxheimer
Management:
1. Paracetamol for pain and fever
2. Corticosteroids
TB: Kochs Disease 2. Intended Peripheral neuritis
Mgt: Change Contraceptives/ take Vit. B6(Pyridoxine)
ACTIVE TB PRIMARY INFECTION TB A/E: Intra- Cerebral Damge (Seizures)
+ S/Sx ─ 3. PYRAZINAMIDE: P.O: 2000 mg
yes Contagious no S/E: Purine-based: Hypercalcemia
+ X-Ray (─) but with consolidation Mgt: ↑Fluid Intake
+ Mantoux Test + A/E: Progressive Liver Failure
+ Sputum ─ Check Liver Enzymes
Most hepatotoxic TB Drug
 People with primary TB infection/ are not contagious but can 4. ETHAMBUTOL P.O.: 1100 mg
progress to ACTIVE TB if there immunity is comprimesd. S/E: EYES:Optic Neuritis :Diplopia
 Primary Infection TB- Children most risk. Mgt: Check Visual Acuity (Snellen Chart)
A/E: EYES: Blindness
Agent: Mycobacterium TB (+)tunnel vision
M.O.T: Airborne or Droplet Nuclei (+)halos around lights
Incubation: 2-10 weeks 5. STREPTOMYCIN :IM: DELTOID 1000 mg
Communicability: Contagious until S/E: Severe pain at site
1. Sputum is negative for 3 instances Mgt: Massage the site/analgesics
2. 2 weeks of continuous antibiotics A/E: Sensorineural hearing loss (stop if + tinnitus)
S/Sx:
 Low grade fever TB CATEGORY INTENSIVE MAINTENANCE
 Productive Cough I-Any newly HR-Rifampicin and
 Anorexia diagnosed TB or Isoniazid
 Wt. loss EPTB(Extra 4 mons.
 Night sweats Pulmonary TB) HRZE for 2 months
 Dyspnea Ia- Any newly HR-progressed to
 Hemoptysis diagnosed EPTB 10 mons.
Dx: clients but if EPTB is
X-RAY- for locating infection on Bone or CNS/
Mantoux Test- for exposure joint,
Sputum Exam- Confirmatory Test II-Former TB/EPTB HRE
Treatment- Antibiotics Clients(Returning HRZES for 2 mons 5 mons
HRZES/RIPES patients) +
1. RIFAMPICIN: P.O. 600mg IIa- Former EPTB HRZE for 1 mons HRE
S/E : Red-Orange Tinged Urine Clients , If EPTB is on 9 mons
Mgt: Teach client that change are temporary that is NORMAL Bones, CNS, or Joints
A/E: Reduce RBC/ Platelets
2. ISONIAZID: INH: P.O. 450 mg
S/E: 1. Increases failure rate of oral contraceptives
MDR- TB(Multiple Drug Resistant TB) Diagnostic Test: Specimen(Blood)
- Strain that is resistant to both Rifampicin & Isoniazid Antibody Detection
Via: ELISA(Enzyme-Linked Immunosorbent Assay) Confirmatory Test
Treatment: IV Route : ZkmlfxPtoCs Mgt: Airway- Mechanical Ventilation
Z- Pyrazinamide Bronchodilator
Km-Kanamycin Corticosteroid
Lfx-Levofloxacin Drug- for SARS only (antiviral: Ribavirin and Oseltamivir)
Pto-Prothionamide
Cs- Cycloserine HIV T- LYMPHOTROPIC VIRUS III
- Retrovirus
MODERN TB Therapy - Single Strand Rna
BEDAQUILLINE: P.O.(24 weeks) - Human Immunodeficiency Virus
1ST – 2nd weeks: 400 mg/day, 4-10 mg/tabs ORIGINS: CONGO
3rd – 24th weeks: 600 mg/week, 200 mg/tabs Affects: CD4, T Cells
M.O.T. Sexually active age (15-35)
CORONA VIRUS: COV Blood/needle pricks
Mother to Child
SARS MERS  Oral Sex poses very little risk < 1% unless mouth sores are
(China) (Middle East) present
Guangdong, China Origin Jeddah Incubation: 3-6 mons
2-10 days incubation 3-13 days
x vector Camel, Bats Stages of Infection
Airborne/ Droplet Nuclei M.O.T. Airborned (prolonged) 1. Acute Retroviral Syndrome
Notes:  Relapsing fever
- Both can lead to pheumonia  Oral Thrush
- Both considered epidemics  Rashes
- SARS was a pandemic  Bacterial Outgrowth
- SARS is deadlier and more contagious  Lingua Villosa (Hairy Tongue)
- SARS can be managed by antivirals. 2. Latency – Asymptomatic/ Less Contagious(lifespan-2 yrs)
3. Acquired Immune Deficiency Syndrome
S/Sx: + AIDS if CD4 T cell is < 200/mm, if 199 below-AIDS
- High Grade Fever *NORMAL T-CELLS- 500-100,000/mm3
- Sore Throat Mortality
- Non- productive Cough(initially) Most common- worldwide
- Myalgia  Pneumocystis Carinii Pneumonia(fungal) ex. Cp or gloves
- Dyspnea Most Common- Filipino
- Crackles  TB-Death
- Acute Respiratory Distress Syndrome Most common- Malignancy
 Kaposis Sarcoma
HIV: Dx TEST: SCREENING:ELISA: -3 drugs/ weekly
If (+):confirmatory test – Western Blot - Prevention-Abstinence, Be Monogamous, Condom

AIDS: Dx TEST :Confirmation DENGUE FEVER

CD4 T-Cell Count -Breakdown or Dandy Fever

Mgt: HAART-Highly Active Anti-Retro Viral Therapy Agent: Flavivirus-type 1234

Slows disease: progression 1- gives cross immunity (temporary)
A/E: Hepatotoxic, Aplastic Anemia 234- gives permanent immunity a person needs to have Dengue
twice….
ENZYME BLOCKERS
A. Protease Inhibitor VECTORS
 Indinavir(Crixivan) BIOLOGICAL: Aedes Aegypti
 Saquinavir MECHANICAL: culex fatigans
 Ritonavir  Aedes Habits
 Lopinavir  Day Biting
B. Integrase Inhibitor  Low Flying
 Dolutegravir  Stagnant to Water
 Raltegravir  Urban Area
 Eltegravir Dengue FEVER: Missing 1 or more hall mark signs
C. Fusion/ Entry Inhibitor Dengue Hemorrhagic Fever : All 4 defining criteria re present
 Mariviroc Incubation: 3-7 days
 Enfuvirtide DHF: ALL 4 criteria should be present
D. NRTI-Nucleoside Reverse Transcriptase 1. High Grade Fever
 It prevents RNA-DNA conversion by damaging the DNA before it 2. Bleeding
forms 3. Low platelet Count
1. Retrovir/Zidovudine/Aeidothymidine 4. Fluid Shifting(Hct: discrepancy of 20 %)
2. Didanosine
3. Lamivudine DENGUE SHOCK SYNDROME
4. Abacavir 1. DHF + Circulatory Failure(Hypotachytachy)
5. Tenofovir Grade I DHF: ↑CAPILLARY fragility
E. Non-Necleoside Reverse Transcriptase Inhibitors  Fever
-Blocks RNA-DNA Conversion by stopping RNA Coupling  Bone and joint paint
(Combinations)  Petechiae
1. Etravirine  Herman’s Sign (Skin Flushing)
2. Nevirapine  Pain- abdomen, neck, periorbital.legs(distal)
3. Rilpivirene Grade II: S/Sx of Gr I + Bleeding
4. Efavirenz Grade III: S/Sx of Gr II + Circulatory Failure(cool and clammy skin)
5. Delavirdine Grade IV: S/Sx of Ciculatory Failure + Hypovolemic Shock
 Cyanosis Skin BIRD FLU
 Palpatory BP <50bpm
 ↓ urine output Highly Pathogenic (HP)Avian Influenz(Bird Eaters)
Diagnostic Test: Suspected(Screening) Agent: Virus
(+) S/Sx - H5N1
(+) Tourniquet Test: Petechiae - HPAIH5N1
(+) if 10 or more possible (laboratory screening) - HPAIH7N9
 WBC-↑ M.O.T.: Airborne
 PLT- ↓ - Droplet
 HCT-↑ but goes down when in later stages of shock - Direct Contact- Handling/ Consumption (eat)
*Normal hct : M: 42%-52% - Low Transmission chance if person to person
F: 35%-47% Incubation: 4-8 days
Positive confirmed dengue (ELISA) s/sx:
1. Mac Igm MAC ELISA - High Grade Fever
2. Platelia NS1 Antigen Test - Sore Throat
Management: - Diarrhea (if ingested)
 Minimal IV Fluids –PNSS - Orbital pain
 Just enough to correct imbalance - Myalgia
 Use oral route if tolerated - Dyspnea
- Respiratory Distress
 NSAID Of choice : Paracetamol
- Diffused Infection – Liver- Jaundices, Kidney- ARF
 To avoid masking of bleeding
- Multiple Organ Dysfunction Syndro,e Failure
 No dark colored foods
Dx Test: Blood: ELISA
Ex. Chocolate, coffee, Dark green leafy Vegetables
Tx: Anti Virals
 Blood Transfusion
1. Oseltamivir – Tamiflu
1. Whole Blood
2. Peramivir- nephrotoxic,…..
2. Platelet Transfussion
3. Fresh Frozen Plasma
PREVENTION OF DENGUE
 Wear light – colored clothes
 Zooprophylaxis- divert bites to animals with higher heat/ CO2
Emissions.
 Planting Neem/ Eucalyptus Trees
AUGUST 17, 2019……