Triage
French word that means "to sort." Triage involves sorting patients out depending on their needs and
what is required for their care. In other words, we are determining who has the highest priority for care.
Ex: Someone who arrives to the ER with chest pain is treated as a higher priority than someone who
arrives to the ER with cold/flu symptoms.
Emergent
Those coming in with LIFE THREATENING CONDITIONS. It is a LIFE AND DEATH SITUATION.
Examples: Stroke, Acute Stemi, Shock, Cardiac Arrest. These are HIGH PRIORITY!
Urgent
Patient has a serious health problem but it is not immediately life threatening.
Examples: Fractures, appendicitis
Non Urgent
Patient has a non-life-threatening condition.
Fast Track
The fast track is designed to quickly treat patients with mild ailments, like cuts and colds, without
interfering with the treatment of seriously ill patients.
Good Samaritan Act
An act that states that a person cannot be held liable for assisting someone in need during an
emergency situation. There is no law that requires you to stop and help. However, if you do stop to
help, you are obligated to stay with the person until appropriate help arrives. You are not held liable.
Basic Individual Rights
States that everyone has the right to emergency care (including those without insurance, criminals, and
illegal immigrants)
Consent to Treat
Hospital will treat the patient in an emergency unless there are specific orders (ex: DNR/advanced
directive) that state not to.
Informed Consent
Active shared decision making process between HCP and recipient of care (patient). Must meet the
following: the diagnosis, nature and purpose of the proposed treatment, risks involved with treatment,
alternative options for the treatment, and prognosis if treatment is not done. Nurses are only
considered a witness to the consent.
EMTALA (Emergency Medical Treatment and Active Labor Act)
Federal Law that requires all hospitals that receive Medicare and Medicaid funding to provide
emergency evaluation and treatment to stabilize the patient. Once stable, patient may be transferred to
another facility if certain care is not available in that facility. If EMTALA is violated, there are penalties
and fines.
A triage nurse should possess the following skills:
- Experienced at rapid assessment
- Excellent interview/communication skills
- Skilled in time management and critical thinking
- Interpret assessment data while providing compassion
- Be non judgmental
Primary Survey: ABCDE
Primary Survey is the initial assessment and management of a trauma patient.
A: Airway - establish the airway. If c-spine stabilization is necessary, use jaw thrust only instead of head
tilt chin lift.
B: Breathing - note the quality (rate/depth of respirations), lung sounds, chest symmetry.
C: Circulation - check all peripheral pulses.
D: Neurologic Disability - LOC, GCS, Pupils
E: Exposure - Remove all clothing from patient
Secondary Survey: FGHIJ
Secondary Survey is a rapid but thorough head-to-toe examination assessment to identify all potential
injuries in a trauma patient. It is performed after the patient has been resuscitated or stabilized.
Full Set of Vital Signs, health history, head to toe assessment, provide Family support
Get diagnostics and laboratory testing
Help - assess specific wounds & first aid
Inspect posterior, insert lines and other devices as needed.
Jump back & reassess
TRAUMA SURVEY (AMPLE)
Trauma survey is usually done after initial assessment.
A: Allergies
M: Medications
P: Past medical history
L: Last meal (Important in case patient needs emergency surgery)
E: Events surrounding injury (what happened?)
Causes of Airway Obstruction
- Foreign body
- Aspiration
- Anaphylaxis
- Serious infection (like laryngitis)
- Trauma
- Reactive airway disease
- Medications
- Laryngeal spasms due to post extubation or in patients with critical hypocalcemia.
Manifestations of Airway Obstruction
- Difficulty breathing
- Signs of choking
- Stridor
- Patient is apprehensive
- Use of accessory muscles while breathing
- Flaring of nares
Management of Airway Obstruction
- Suspicion of foreign body would require the Heimlich Maneuver.
- Monitor oxygen saturation and if they need it you can start oxygen.
- Establish oral airway if needed with intubation
- Be mindful of cervical spine - if cervical spine is suspected to be fractured, use jaw thrust.
Hemorrhage Causes
Can be external or internal. Can be venous or arterial. Can be overt (visible) or covert (not visible)
Manifestations of Hemorrhage
- Signs of shock, specifically hypovolemic
shock
- Altered mental status (restlessness, agitation,
confusion)
- Tachycardia
- Decreased BP
- Cool, clammy skin
- Pallor
- Decreased urine output
Management of Hemorrhage
- Patient has to be supine with feet up
(trendelenburg position)
- Oxygenation should be supported (intubation if needed.)
- Start IV and give IV fluids. Patient may also need blood. REPLACING FLUIDS IS PRIORITY IN THESE
PATIENTS!
- If patient is bleeding from wound, may use tourniquette above the wound to decrease bleeding.
What is essential to prevent Carbon Monoxide Poisoning?
Install carbon monoxide detectors and make sure batteries are functioning.
What are 3 types of Heat Related Emergencies?
1. Heat Cramps
2. Heat Exhaustion
3. Heat Stroke
Children & the elderly are more susceptible to these conditions.
Signs & Symptoms of Heat Cramps
- Muscle cramps
- Thirst
Signs & Symptoms of Heat Exhaustion
- Pale, ashen skin
- Weakness, fatigue
- Profuse sweating
- Extreme thirst
- Altered mental status: anxiety
- Low BP
- Weak, thready pulse
- Tachycardia
- Temperature up to 105 degrees
- Most likely to occur in people doing exercise
in hot/humid weather.
Treat with: Rapid cooling, IV fluids (cold
saline)
Signs & Symptoms of Heat Stroke
HEAT STROKE IS A MEDICAL EMERGENCY!!
Patient will experience:
- Altered mental status (confusion/coma)
- Temp >105
- HOT, dry skin
- Weakness
- Can lead to cerebral edema or intracranial
hemorrhage.
Interventions to treat HEAT CRAMPS, HEAT EXHAUSTION, & HEAT STROKE:
- ABC's
- Establish IV access for rapid fluid administration (cold saline)
- Cool environment (use fan, lower the temp of the room)
- Can give Meperidine Hydrochloride to prevent shivering. (Shivering increases the demand for oxygen)
- Rapid cooling for heat stroke with hypothermia blankets
- Make sure patient is hooked up to 12 lead EKG and monitor for any arrhythmias.
- Blood work: hemoglobin and hematocrit may be elevated because of dehydration
- Make sure they have an indwelling catheter
- Continue ongoing monitoring
Hypothermia
Hypothermia occurs when the core body temperature is below 95 degrees (35 degrees Celsius)
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Confusion
Shivering
Lack of Coordination
Urge to urinate
Cold body
Frostbite
True tissue freezing resulting in the formation of ice crystals in the tissues. Initial response to cold
is vasoconstriction leading to decreased blood supply. Severity of frost bite depends on outside
temperature, duration of exposure, type and condition of clothing (wet or dry), & skin color (dark
skinned people are more prone to frostbite.) There are 2 types - superficial and deep frostbite.
Superficial Frostbite
- Involves mainly the ears, nose, fingers, and toes.
- Patient will experience numbness/tingling in the affected area.
- Affected area may appear waxy pale to blue, mottled, and may form blisters.
- Skin will feel dry & crunchy.
Deep Frostbite
- Involves muscles, bones, and tendons.
- The skin is white, hard, and insensitive to touch.
- Skin can appear mottled to gangrenous.
Interventions/Treatment for Frostbite
- Remove clothing & jewelry
- Do not squeeze, massage, or scrub the tissue
- Soak the area in a warm controlled circulating water
- Provide warming blankets
- Manage pain
- Surgical Intervention may be needed
- Tetanus Toxoid may be used to help treat deep frostbite
NOTE: Rewarming the patient can be very painful. Rewarm them slowly. No more than 1 degree increase
in temperature PER HOUR.
What is trauma?
Any bodily injury caused by violence or force. Can affect any system of the body.
What are examples of blunt trauma?
Fist fights
Being hit with baseball bat
What are examples of penetrating trauma?
Gunshot wounds
Stab wounds
Risk Factors for Trauma
Age: teenagers and elderly are at increased risk
Gender: More common in men than women as men are known to be "risk takers"
Alcohol/drug use
Poor socioeconomic area (high crime rates)
Lack of access to services
Traumatic Brain Injuries can be caused by:
1. Sport injuries
2. MVA's
3. Falls
Secondary issues that may occur due to traumatic brain injury?
1. Increased ICP (normal is 5-15)
2. Intracranial bleed
3. Impaired auto-regulation
Treatment for TBI's:
- Good neuro assessment
- CT/MRI/SPINAL TAP
- Surgery
- Meds
- Nursing interventions to lower ICP
The most important tool for evaluating TBI:
Neurologic Assessment
Degrees of Injury
GCS Score of 13-15 = Mild brain injury
GCS Score of 9-12 = Moderate brain injury
GCS Score <8 = Severe brain injury
Glasgow Coma Scale
Assesses motor, verbal, and eye opening response from patient.
15 = best score
3 = worst score
< 8 = patient is in a coma
3 classes of brain injuries:
1. Skull Fracture
2. Concussion
3. Contusion
Basilar Skull Fracture
Signs & Symptoms:
- Battle sign
- Raccoon eyes
- Rhinorrhea
- Otorrhea
- Halo sign: suggestive of CSF leak
These patients are at an increased risk for INFECTION!
Collaborative Care:
- NOTHING IN EARS OR NOSE: No NG tubes, no tympanic temperatures, no nasal suctioning, no blowing
the nose!
- Prevent infection with antibiotics.
- Keep HOB elevated
- Patient might require surgery.
Concussion
Primary closed head injury causing a transient change in neurological function.
Best treatment: PHYSICAL REST & COGNITIVE REST - do not mentally stimulate these patients. They
shouldn't go back to work or school and should avoid sports.
Educate patient and family to notify the HCP of any changes in LOC or speech - patients with conussion
are usually sent home after being evaluated in the ED as long as there are no bleeds. These patients
should also be woken up q 2 hours at home just to make sure they are OK.
Patient may have POST CONCUSSIVE SYNDROME: a loss of recent memories.
ImPACT Quick Test
A test performed on those who have had a concussion that helps
to determine whether the patient should stop certain activities
(such as going to work, school, or playing sports).
Contusion
Primary closed head injury that is characterized by bruising of the
brain at the impact site.
Epidural Hematoma
MEDICAL EMERGENCY. Bleed occurs above the dura. Accumulation of blood occurs rapidly. Usually an
arterial bleed. Period of lucidity is hallmark sign.
Treatment: Burr Holes
Subdural Hematoma
Accumulation of blood below the dura. Generally a venous bleed that occurs slowly. Can be acute,
subacute, or chronic. Usually caused by a blow to the head or seen in elderly people on some type of
oral anticoagulation.
Acute: Symptoms present 24-48 hours later.
Subacute: Symptoms present 48 hours to 2 weeks later.
Chronic: Symptoms present weeks to months later.
Symptoms: decreased LOC, decreased pupil reactiveness, and possible hemiparesis.
Treatment: Burr Holes
Intracerebral Hemorrhage
A bleed that occurs within the brain as the result of a ruptured blood vessel.
Monroe Kellie Hypothesis
The head is a closed box composed of the Brain (80%), Blood (10%), & CSF (10%). A change in one causes
a change in the other - can lead to increased ICP.
Normal CPP & How to Calculate CPP
Normal CPP: 70-100
CPP < 50 = compromised cerebral blood flow.
CPP < 30 = incompatible with life
CPP = MAP - ICP
MAP = 2 x the diatolic bp + the systolic bp / 3
ICP Monitoring
Normal ICP is 5-15 mm Hg.
With ICP monitoring there is a major risk for infection.
This is done for patients that come in with severe head trauma or intracranial hemorrhage. The device
(screw, bolt, or EVD) is inserted through Burr Hole in skull. It allows for continuous monitoring of ICP.
There is a high risk for infection since there is a direct line to the brain. Done at bedside.
Advantages:
- Pressure can be recognized and treated before clinical
manifestations appear
- Allows drainage of CSF via 3 way stopcock (EVD)
- CPP can be calculated and treatment can be adjusted
- Effect of nursing interventions on ICP can be monitored
-To ensure brain is being adequately perfused, we want the blood
pressure to be:
-Slightly elevated - 140's to 160's
Symptoms of Increased ICP
- Altered LOC
- Headache
- Assess speech
- Assess pupils/extraocular movements
- Assess GCS
- Patient may have altered breathing such as Cheyne-Stokes
- CUSHING'S TRIAD: Elevated systolic BP, bradycardia, bradypnea, widened pulse pressure, hyperthermia
"A Wave" / "Plateu Waves" on ICP Monitor
Indicates decreased CPP due to increased ICP (>20). May result in neuronal death. Drain off CSF to lower
ICP.
Complete Spinal Cord Injury
Loss of sensory and motor functions below the level of injury.
Will result in tetraplegia or paraplegia.
Incomplete Spinal Cord Injury
injury in which a person has some function below the level of the
injury, even though that function isn't normal
Brown Sequard Syndrome
An incomplete spinal cord injury - A rare neurological condition
characterized by a lesion in the spinal cord which results in weakness or
paralysis on one side of the body and a loss of sensation on the opposite
side.
On the same side as the injury, patient will experience loss of motor
function. On the opposite side as the injury, patient will experience loss
of sensation to pain, temperatures, and touch.
Cauda Equina Syndrome
An incomplete spinal cord injury - A condition that occurs when the bundle of nerves below the end of
the spinal cord (lumbar and sacral nerves) known as the cauda equina is damaged.
Symptoms:
- Asymmetrical patchy loss of motor and sensory functions
- Flaccid motor weakness below level of injury
- Loss of sensation in "saddle" area (area between buttocks and inner thighs)
- Severe radicular pain
- Loss of bowel and bladder function
Mechanism of Spinal Cord Injury
Hyperextension
Hyperflexion
Compression
Penetrating Wounds
Ex: Gunshot wounds/stab wounds
Tetraplegia
Also called "quadriplegia". It involves paralysis of everything from the neck
down.
Paraplegia
Paralysis of legs and lower body (from the waist down) due to spinal cord injury.
Neurogenic Shock
Usually caused by a spinal cord injury. Involves loss of vasomotor tone and impairment of autonomic
function. Patient will be hypotensive, bradycardic, and have warm + dry skin.
Spinal Shock
- Flaccid paralysis
- Loss of spinal reflexes (DTRs)
- Loss of bowel/bladder function
Autonomic Dysreflexia
A medical emergency that results from exaggerated autonomic responses
to stimuli. Usually occurs after spinal shock. Seen in patients with a spinal
cord injury at or about T6 or higher.
Could be triggered by restrictive clothing, full bladder/UTI, or fecal impaction.
Patient will experience extreme vasodilation above the level of injury. Will see the following signs &
symptoms:
- Severe hypertension
- Bradycardia
- Severe throbbing headache
- Profuse sweating (above level of injury)
- Flushed skin (above level of injury)
Patient will experience extreme vasoconstriction below level of injury. Will see the following signs and
symptoms:
- Pallor (below level of injury)
- Cool skin (below level of injury)
- No sweating (below level of injury)
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How do we treat Autonomic Dysreflexia as the nurse?
- FIRST PRIORITY ACTION: Place the patient in a sitting position. Raise HOB to 45-90 degree angle (High
Fowler's)
- Notify the HCP
- Assess for the cause: retention of urine, fecal impaction, kinks in catheter tubing (causing bladder
distention)
- Monitor vital signs
- Give Nifedipine or nitrate as prescribed
- Alpha blockers (ending in -osin) may be given as prophylactic treatment for recurrent dysreflexia.
Cardiothoracic Trauma:
Myocardial Contusion
Associated with motor vehicle accidents - usually seen when steering wheel hits person's chest. Patient
must be monitored for 24-48 hours before sending them home as the patient may have dysrhythmias.
Organs Involved in Abdominal Trauma: Solid Organs & Hollow Organs
Solid Organs: spleen, liver, kidney
Hollow Organs: intestines, bladder
What is the major problem with abdominal trauma? (ex: stab/gunshot wounds in the abdomen)
BLEEDING!
Abdominal Trauma Assessment, Diagnostics, & Interventions
- Major problem is bleeding
- Patient may have positive KEHR sign: the occurrence of acute pain in the tip of the shoulder due to the
presence of blood or other irritants in the peritoneal cavity.
- Monitor vital signs
- Watch for abdominal distention
- Monitor for shock
- Diagnosed with DPL (Diagnostic Peritoneal Lavage)
- Surgery may be needed for treatment
DPL (Diagnostic Peritoneal Lavage)
Saline is injected into peritoneal cavity and then aspirated to assess what the return looks like. If it's
bloody, it indicates blood within the peritoneal cavity (likely indicates spleen or liver tear.) Return of fecal
material/foul smelling substance indicates perforation of colon or intestine. If spleen is torn, patient may
require splenectomy. After splenectomy, patient should receive pneumococcal vaccine.
Pelvic Trauma
- Pelvic trauma can include a fracture of the pelvis
- These patients are highly at risk for internal bleeding
- Ask patient if they are experiencing rectal/vaginal bleeding
- Assess urine for blood (hematuria)
- Anticipate X-Rays, CT Scans, and IVP
- During assessment, look for deformity/shortening of extremities
- Want to perform neurovascular assessment on lower extremities (6 P's - pallor, pain, pulselessness,
poikilothermia, paresthesia, paralysis)
Stable Pelvic Injury VS Unstable Pelvic Injury
Stable: No further pathologic displacement of pelvis can occur with turning or moving the patient.
Unstable: Further pathologic displacement may occur when turning or moving the patients.
Organs involved in pelvic trauma:
- Bladder
- Ureters
- Rectum
- Kidney
- Vagina
Musculoskeletal Trauma
Can be associated with contusions, lacerations, or fractures. It is most likely to be associated with crush
injuries: occurs when force or pressure is put on a body part. (Examples: Compartment Syndrome, AKI)
Fat Embolism Syndrome
- Can be caused by long bone fractures
- S/S appear within 24-48 hours
- Can lead to hemorrhagic interstitial pneumonitis
- Will see signs similar to ARDS
Compartment Syndrome
A condition in which swelling causes increased pressure within the muscle
compartment. The fascia surrounding the muscle does not stretch, leading to
compromise in circulation and nerve damage. Usually involves the leg but can
occur in any muscle. Can also occur in the abdomen. This condition is almost
always associated with trauma, fractures, or crush injuries. Can be caused by
tight splints or casts. The swelling can obstruct circulation, eventually leading
to ischemia.
Early recognition of compartment syndrome is important - perform frequent
neurovascular assessments on patients with fractures in order to detect it
early (6 P's)
DO NOT elevate the extremity or apply cold compresses.
Treatment: Fasciotomy
Fasciotomy
A surgical incision through the fascia to relieve tension or pressure
Renal Trauma
Renal Trauma can lead to massive bleeding and may be easily missed due to retroperitoneal bleeding.
One should suspect renal trauma if there is a flank injury, either blunt or penetrating. Kidneys can be
contused or lacerated. Monitor vital signs frequently! Increasing HR, decreasing BP, and pallor should
concern you! Patient may complain of collicky pain, gross hematuria/microscopic, flank bruising.
Management: IV fluids, transfusion of blood products, and surgical intervention depending on level of
trauma.
Complications of Multiple Injuries
SIRS
SEPSIS/SEPTIC SHOCK
MODS
DIC
Causes of Death in Trauma
Minutes from injury: brain, spinal cord, cardiac, or arterial injuries
Within hours of injury: Subdural/epidural hematomas, ruptured spleen or liver
Days to weeks after injury: Sepsis, MODS, DIC
Disasters can be:
Natural or Manmade
Internal or External
Mass Casualty Incident
A situation in which the number of casualties exceeds the available resources.
Terrorism
A man made disaster - deploying or dispensing nuclear, biologic, or chemical agent as weapons of mass
destruction - intention is to cause panic and harm to the public - it is done intentionally.
Triage System & Tags: Red
Indicates high priority treatment or transfer. EMERGENT!
Ex: massive hemorrhage, tension pneumothorax
Triage System & Tags: Yellow
Signals medium priority. Urgent, but not immediately life threatening.
Ex: Isolated simple femur fracture
Triage System & Tags: Green
Used for ambulatory patients. Non Urgent.
Ex: isolated abrasions, contusions, or sprains.
Triage System & Tags: Black
Used for those who are deceased or those with minimal chance of survival.
Ex: massive head injuries, 95% coverage with 3rd degree burns
START
Simple Triage and Rapid Treatment
SALT
Sort, Assess, Lifesaving
Treatment/Transport
Elements of Emergency Disaster
Preparedness Plan
- Establishing communication strategies
- Plan for managing resources
- Managing security & safety (one entrance & one exit)
- Defining staff roles & responsibilities**
Triage in an Emergency VS Triage in Disaster
In nondisaster situations, health care workers assign a high priority and allocate the most resources to
those who are the most critically ill. However, in a disaster, when health care providers are faced with a
large number of casualties, the fundamental principle guiding resource allocation is to do the greatest
good for the greatest number of people. Decisions are based on the likelihood of survival and
consumption of available resources. Therefore, patients with conditions associated with a high
mortality rate would be assigned a low triage priority in a disaster situation, even if the person is
conscious. Although this may sound uncaring, from an ethical standpoint, the expenditure of limited
resources on people with a low chance of survival, and denial of those resources to others with serious
but treatable conditions, cannot be justified.
The Nurse's Role in Disaster
This role can vary - nurse may be asked to perform duties outside his or her area of expertise and may
take on responsibilities normally held by physicians or APNs. Although the exact role of a nurse in
disaster management depends on the specific needs of the facility at the time, it should be clear which
nurse or physician is in charge of a given patient care area and which procedures each individual nurse
may or may not perform.
Agents of Terrorism
-Chemical Agents
- Chlorine, mustard gas
-Radiologic/Nuclear
-Explosive Devices
Biologic Agents
- Anthrax, smallpox.
Chemical Agents: Nerve Agents
The most toxic agents in existance are the nerve agents.
Examples: Sarin, Vx, Soman, Organophosphates
These chemical agents increase acetylcholine level by blocking inactivation of cholinesterase. Cholinergic
crisis develops.
Signs & Symptoms of Cholinergic Crisis:
- Bronchospasm
- Increased secretions (will hear crackles)
- Increased GI motility (diarrhea)
- Constricted pupils
- Twitching
Collab Care:
- Decontamination (rinse with soap and water for 8-20 min to prevent further absorption of chemical)
- Atropine/Pralidoxime
- Supportive Care
Chemical Agents: OTHERS such as CHLORINE, MUSTARD GAS, PHOSGENE, & CYANIDE
Signs & symptoms depend on type of agent.
Collaborative Care:
- Decontamination
- Agent specific treatment
- Supportive Care
Decontamination
The process of removing accumulated contaminants - It is critical for the health and safety of health care
providers. It prevents secondary contamination.
Effective decontamination includes 2 steps:
1st step: removal of the patient's clothing & jewelry and then rinsing the patient with water. This step
alone can remove a large amount of contamination and decrease secondary contamination.
2nd step: Thorough soap & water wash and rinse. Bleach may be used if indicated based on the
contaminant.
When patients arrive at the hospital, it should not be assumed that they have been thoroughly
decontaminated.
Every ER has a decontamination room!
Bioterrorism: Anthrax
- Most likely weaponized
- Spore forming gram positive rod - naturally occurring in the soil; easily available.
- Spread by contact with animals or inhalation of spores. There is no known human to human spread.
- Incubation period is up to 7 days
- S/S: starts as a cold; progresses to severe respiratory failure and even death; may also see skin lesions.
- Treatment: Supportive care; patient may also need ventilator support; antibiotics for long term use
(ciprofloxacin is antibiotic of choice)
Bioterrorism: Small Pox
- Has been eradicated; only 2 countries have this virus in their "stock pile": US & Russia.
- It is a variola virus and is highly contagious
- Spread by direct contact and by droplets of saliva.
- Incubation period is 10-12 days.
- S/S: high fevers, characteristic rash - starts as red maculo-papular rash which evolves on the face,
mouth, and pharynx. Lesions fill with pus and eventually heal with a scar.
- Treatment: Supportive care - no specific treatment. Patient should be placed
on AIRBORNE precautions.
- Prevention: Vaccination
If patient comes in with rash, always ask if they have traveled anywhere outside of the country.
Death in the Emergency Department
- Patient may have been treated in the ED without success or patient may have been pronounced dead
on arrival.
- Maintain belongings with patient!
- Notify next of kin (ask them to come to the hospital, do not give information over the phone)
- Organ donation: sharing network must be notified within 1 HR of death)
Discuss Autopsies
If cause of death is known, autopsy is not required (example: MI that leads to cardiac arrest)
Family may request an autopsy but they will need to pay (about 4 to 5 thousand dollars); If the medical
examiner feels the autopsy is not needed, insurance will not cover it.
Family cannot refuse an autopsy if it is indicated for medical-legal purposes (ex: suspected shooting, foul
play, MVA)
Corrosive Poisons
Swallowed poisons may be corrosive. Corrosive poisons include alkaline and acid agents that can cause
tissue destruction after coming into contact with mucous membranes. Alkaline products include: lye,
drain cleaners, toilet bowl cleaners, bleach, nonphosphate detergents, oven cleaners, and button
batteries. Acid products include toilet bowl cleaners, pool cleaners, metal cleaners, rust removers,
battery acid.
Treatment:
- Control airway, ventilation, and oxygenation
- Measures are instituted to remove the toxin or decrease it's absorption. Consultation with a poison
control center is strongly recommended for definitive antidote and continued monitoring. The patient
who has ingested a corrosive poison is either given water or milk to drink for dilution. However, dilution
is not attempted if the patient has acute airway edema or obstruction of the airway, or if there is clinical
evidence of esophageal, gastric, intestinal burns or perforation. The following gastric emptying
procedures may be prescribed:
- Gastric lavage for obtunded patient; gastric aspirate is saved and sent to the lab for toxicology screens.
- Activated charcoal if poison is one that is absorbed by charcoal.
- Cathartic, when appropriate.
NEVER induce vomiting with corrosive poisons. (Syrup of ipecac induces vomiting)
Levels of Triage In Order
Immediate (I—red): Patients have life-threatening injuries that probably are survivable with immediate
treatment.
Delayed (II—yellow): Patients require definitive treatment, but no immediate threat to life exists.
Patients can wait for treatment without jeopardy.
Minimal (III—green): Patients have minimal injuries, are ambulatory, and can self-treat or seek
alternative medical attention independently.
Expectant (0—black): Patients have lethal injuries and usually will die despite treatment.
Airway management technique for patients with suspected spine/neck injury:
We want to use Jaw Thrust for those with suspected spine/neck injuries.
AVOID HEAD TILT CHIN LIFT for those with suspected spine/neck injuries.
Jaw Thrust
Head Tilt Chin Lift