MEDICAL – SURGICAL MEDICAL – SURGICAL EMERGENCIESEMERGENCIES

Michelle Theresa C Jimenez, RN, MDMichelle Theresa C Jimenez, RN, MD

EMERGENCYEMERGENCY

Any situation that Any situation that warrants immediate warrants immediate medical attention.medical attention.

TRAUMATRAUMA

WoundsWounds FracturesFractures AmputationAmputation

AbrasionAbrasion – denuded skin – denuded skin

LacerationLaceration – skin tear – skin tear with with irregular edgesirregular edges

AvulsionAvulsion – tearing away from – tearing away from supportive structuressupportive structures

ContusionContusion – blood trapped under the – blood trapped under the skin surface; results from a blunt forceskin surface; results from a blunt force

Hematoma Hematoma – tumor – like mass of – tumor – like mass of blood trapped under the skinblood trapped under the skin

StabStab – incision with well – defined edges, – incision with well – defined edges, caused by a sharp, pointed instrumentcaused by a sharp, pointed instrument

CutCut – incision with well – defined margins, – incision with well – defined margins, usually long than deepusually long than deep

MANAGEMENTMANAGEMENT

Wound cleansingWound cleansing Use Normal Saline solution if availableUse Normal Saline solution if available Avoid Betadine & Hydrogen PeroxideAvoid Betadine & Hydrogen Peroxide SuturingSuturing

FRACTURESFRACTURES

Break in the Break in the continuity of a bonecontinuity of a bone

Usually occurs Usually occurs when the bone is when the bone is subjected to a subjected to a much greater force much greater force than it usually than it usually carries carries

MANAGEMENTMANAGEMENT

Check for open woundsCheck for open wounds SplintingSplinting ImmobilizationImmobilization ReductionReduction

CRUSH INJURIESCRUSH INJURIES

When a person is When a person is caught between caught between objects, run over by objects, run over by a moving vehicle, or a moving vehicle, or compressed by compressed by machinerymachinery

AmputationAmputation

HEMORRHAGEHEMORRHAGE

Excessive bleedingExcessive bleeding Usually arterialUsually arterial May lead to May lead to

hypovolemic shockhypovolemic shock

Manifestation of Manifestation of Hypovolemic ShockHypovolemic Shock

HypotensionHypotension TachycardiaTachycardia TachypneaTachypnea Cold, clammy skinCold, clammy skin Delayed CRTDelayed CRT PallorPallor

ThirstThirst DiaphoresisDiaphoresis OliguriaOliguria Metabolic AcidosisMetabolic Acidosis Changes in Changes in

SensoriumSensorium

Goals of TreatmentGoals of Treatment

Control bleedingControl bleeding Maintain adequate circulating blood Maintain adequate circulating blood

volumevolume Prevent shockPrevent shock

ManagementManagement

Control of External HemorrhageControl of External Hemorrhage Identify area/s of injuryIdentify area/s of injury Apply direct pressureApply direct pressure Elevate injured partElevate injured part

Tourniquet should be a lost resort when Tourniquet should be a lost resort when hemorrhage cannot be controlledhemorrhage cannot be controlled

ManagementManagement

Fluid ReplacementFluid Replacement Double line with NSS or Lactated Double line with NSS or Lactated

Ringer’s SolutionRinger’s Solution Blood Transfusion ASAPBlood Transfusion ASAP

POISONINGPOISONING

Ingestion, inhalation, or absorption of Ingestion, inhalation, or absorption of any substance or material that may any substance or material that may injure the body because of its chemical injure the body because of its chemical reactionsreactions

May be intentional or May be intentional or unintentionalunintentional

SIGNS & SYMPTOMSSIGNS & SYMPTOMS

– Cardiovascular : Bradycardia, hypotension– Respiratory: Rhinorrhea, bronchorrhea,

bronchospasm, cough, severe respiratory distress

– Gastrointestinal: Hypersalivation, nausea and vomiting, abdominal pain, diarrhea, fecal incontinence

– Genitourinary: Incontinence– Ocular: Blurred vision, miosis– Glands: Increased lacrimation,

diaphoresis

Goals of TreatmentGoals of Treatment

Remove or inactivate poison before it Remove or inactivate poison before it is absorbedis absorbed

Provide supportive care in maintaining Provide supportive care in maintaining vital organ system functionvital organ system function

Administer a specific antidote to Administer a specific antidote to neutralize a specific poisonneutralize a specific poison

MANAGEMENTMANAGEMENT

AirwayAirway OxygenationOxygenation DecontaminateDecontaminate Eye irrigationEye irrigation Atropine & Atropine &

DiazepamDiazepam

MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION

Inadequate Inadequate oxygenation of the oxygenation of the myocardium caused myocardium caused by blockage in the by blockage in the coronary arteriescoronary arteries

SIGNS & SYMPTOMSSIGNS & SYMPTOMS

Chest painChest pain Radiating pain to Radiating pain to

neck, arms, jaw neck, arms, jaw and backand back

DyspneaDyspnea LightheadednessLightheadedness AnxietyAnxiety

MANAGEMENTMANAGEMENT

AssessmentAssessment Activate EMSActivate EMS OxygenationOxygenation IV accessIV access NitroglycerinNitroglycerin

THE ENDTHE END

THANK YOU!THANK YOU!