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The Golden Hour
Emergency Medical Care at the Trackside for Non Medical Personnel
BASIC AIRWAY MANAGEMENT
Ineffective Tissue Perfusion Nursing care plan
Learn About urosepsis
Vital sign

Posted: 01 Jan 2011 07:41 AM PST

The first 60 minutes following a serious injury is known as the “Golden Hour”. Seriously injured casualties correctly resuscitated and treatment begun in a definitive care facility during this vital time will be given the best chance of survival with minimum long term disability.

Of those victims of major trauma who die, 2/3 will have suffered major head or other central nervous system injuries about which little could have been done that would have altered the inevitable outcome. However, 2/3 of the remaining fatalities would be preventable if the casualty were to receive appropriate medical management in this “Golden Hour”.

The majority of preventable deaths at the scene occur as a result of inadequate airway management. The rest occur as a result of inadequate management of ineffective breathing or inadequately treated shock following haemorrhage.
source http://www.haworth21.karoo.net/The%20Golden%20Hour.htm

Emergency Medical Care at the Trackside for Non Medical Personnel

Posted: 01 Jan 2011 07:38 AM PST

Priorities of Care

* Personal safety
* Recognise and treat immediately life threatening injuries
* Do no further harm
* Call for medical assistance early

Rescue unit response times

Theory – 90secs. To arrival on scene

Practically – including making the decision, waking up the crew etc. 3-5mins.

Personal safety

* Venture onto the track only when it is safe to do so
* All incidents must be covered by appropriate flag signals
* Race stop if necessary to ensure personal safety
* Fire hazards etc. Must be dealt with before approaching the casualty

What will happen to a driver who is not breathing

3 – 4 mins. Brain damage likely

4 – 5 mins. Brain damage inevitable, death likely

5 – 6 mins. Death inevitable

Priorities in Medical Treatment

* A
* irway with cervical spine control B
* reathing C
irculation

Cervical Spine Control

* Always possibility of neck injury in high speed impact or roll
* Immobilise neck manually
* Do not attempt to remove crash helmet unless it is necessary to gain access to the airway
* Do not attempt to right an overturned car unless it is necessary to gain immediate access to a trapped driver

When Should We Attempt to Right an Overturned Car?

* If unable to gain access to the driver by any other means AND
* He is unconscious AND
* He is not breathing

On Approaching the Casualty

* Approach from the front.
* Talk to him. If he responds appropriately in a normal voice his airway is clear and circulation adequate
* Do nothing other than reassure him and stabilise his neck
* Do NOT remove a crash helmet

If Casualty Does Not Respond

* Lift helmet visor if necessary
* Check breathing. LOOK

LISTEN

FEEL

* If the casualty is breathing adequately do nothing other than stabilise the neck
* Do NOT remove a crash helmet

If Casualty Is Not Breathing Adequately

Call for medical assistance

* Remove crash helmet whilst the neck is stabilised by someone else
* Reassess breathing. Removing the helmet may cure the problem

Signs of Inadequate Breathing

* Unable to feel or hear air movement
* Abnormal or no chest movement
* Unconsciousness
* Abnormal noises from the airway
* Blue lips/fingertips

Clear the Airway

Jaw thrust

Chin lift

Clear debris

Once the Airway Is Clear

* Maintain neck immobilisation
* Check breathing again
LOOK
LISTEN
FEEL

If Breathing Is Still Inadequate

* Begin artificial respiration with the neck still immobilised
* 2 breaths then recheck breathing

If Breathing Remains Inadequate

* Continue artificial respiration at a rate of 10 to 15 breaths per min.
* By this time, hopefully, a Rescue Unit will have arrived to render expert assistance

source http://www.haworth21.karoo.net/Emergency%20Medical%20Care%20at%20the%20Trackside%20for%20Non%20Medical%20Personnel.htm

BASIC AIRWAY MANAGEMENT

Posted: 01 Jan 2011 07:35 AM PST

BASIC AIRWAY MANAGEMENT

Airway obstruction

* The majority of preventable deaths following trauma occur as a result of airway obstruction.
* Obstruction may occur at any point within the airway, from the upper airways to the bronchi deep within the chest.

Common causes of airway obstruction

Upper Airway

* tongue (due to unconsciousness)
* soft tissue swelling
* blood, vomit
* direct injury

Larynx (voice box)

* foreign material, direct injury, soft tissue swelling

Lower Airway

* secretions, oedema, blood
* bronchospasm
* aspiration of gastric contents

Recognition of airway obstruction

* LOOK for chest/abdominal movement
* LISTEN at mouth and nose for breath sounds and abnormal noises
* FEEL at mouth and nose for expired air

Abnormal sounds in airway obstruction

* Snoring – due to obstruction of upper airway by the tongue
* Gurgling – due to obstruction of upper airway by liquids (blood, vomit)
* Wheezing – due to narrowing of the lower airways

Complete airway obstruction is silent.

Opening the airway

* Remove crash helmet with manual in-line stabilisation of the c-spine
* Head tilt (NOT if c-spine injury)
* Chin lift with manual in-line stabilisation of the c-spine
* Jaw thrust with manual in-line stabilisation of the c-spine
* Suction with manual in-line stabilisation of the c-spine

Oral airways

* Will stimulate vomiting and movement in conscious or semi-conscious casualties
* This may result in;
worsening airway problems
cervical spine compromise

Sizing an oropharyngeal airway

Oropharyngeal airway insertion
Nasal airways

* Will cause bleeding from the nose in a large number of cases.
* This will result in worsening airway problems so use only as a last resort.
source BASIC AIRWAY MANAGEMENT http://www.haworth21.karoo.net BASIC%20AIRWAY%20MANAGEMENT.htm

Ineffective Tissue Perfusion Nursing care plan

Posted: 01 Jan 2011 07:28 AM PST

Since the body of the newborn is unable to compensate to the imbalances of the inflammatory response related to his condition the body tends to "hyperdrive" causing an inadequate oxygen in the tissues or capillary membrane leading to poor perfusion.

Assessment

Nursing Diagnosis

Planning

Intervention

Rationale

Expected Outcome

Subjective: Objective:
The patient may manifest one or more of the following:

-skin or temperature changes

-Weak pulses

-Edema

-Inadequate urine output

Ineffective tissue perfusion related to impaired transport of oxygen across alveolar and on capillary membrane

Short-term:After 3 hours of nursing intervention the patient will demonstrate increased perfusion as evidenced by warm and dry skin, strong peripheral pulses, normal vital signs, adequate urine output and absence of edema

Long Term:

After 3 days of NI, pt will maintain adequate perfusion AEB stable VS, warm and dry skin, absence of edema, adequate urine output and strong peripheral pulses.

Independent

1. Monitor neonate's condition.

2. Monitor Vital signs

3. Note quality and strength of peripheral pulses

4. Assess respiratory rate, depth, and quality

5. Assess skin for changes in color, temperature and moisture

6. Elevate Head of Bead

7. Elevate affected extremities with edema once in a while

Interdependent

8. Provide a quiet, restful atmosphere

Dependent

9. Administer oxygen as ordered

1. To determine the need for intervention and the effectiveness of therapy.2. To have a baseline data

3. To asses pulse that may become weak or thready, because of sustained hypoxemia

4. To note for an increased respiration that occurs in response to direct effects of endotoxins on the respiratory center in the brain, as well as developing hypoxia, stress. Respirations can become shallow as respiratory insufficiency develops creating risk of acute respiratory failure.

5. To assess for compensatory mechanisms of vasodilation

6. To promote circulation /venous drainage

7. To reduce edema

8. Conserves energy and lowers O2 demand

9. To maximize O₂ availability for cellular uptake

The patient shall demonstrate increased perfusion as evidenced by warm and dry skin, strong peripheral pulses, normal vital signs, adequate urine output and absence of edema

source : http://nurseslabs.com/nursing-care-plans/neonatal-sepsis-nursing-care-plans/