EDN DAY 1

Safety and immediate, delay-free action

main priority in emergency nursing

triage

process of sorting based on severity and immediacy to prioritize treatment

French word “trier” which means “to sort

origin of the word “triage”

Emergent, Urgent, Non-Urgent

three levels of triage based on urgency

Sickest and worst first

What principle governs routine triage?

Utilitarianism

What principle governs field triage?

Mass casualty, NATO, START, military

Give examples of field triage situations.

ESI Level 1 (RED)

Immediate life-saving intervention needed; see patient now.

Acuity and resource needs

What is ESI based on?

ESI Level 2 (Orange)

High-risk situations; see patient within 10 minutes

ESI Level 3 (Yellow)

Multiple resources needed, vital signs normal; see patient within 30 minutes.

ESI Level 4 (Green)

One resource only; see patient within 60 minutes

ESI Level 5 (Blue)

No resources needed; see patient within 2 hours

Back of the tongue.

Where is the oropharyngeal airway (OPA) placed?

For unconscious patients breathing spontaneously

When is OPA indicated?

Conscious or semi-conscious patients.

What is the contraindication for OPA?

Insert upside down, then rotate 180°.

How is an OPA inserted?

Nares.

Where is the nasopharyngeal airway (NPA) placed?

Similar to OPA but tolerated in semi-conscious patients.

When is NPA indicated?

Facial trauma, basilar skull fracture.

What contraindicates NPA?

Absent ventilation, persistent hypoxia

What is the indication for endotracheal intubation?

Through the vocal cords into the trachea

Where is the endotracheal tube inserted?

Check bilateral breath sounds

How do you assess artificial airway placement?

Pneumothorax or dislodgement.

What complication should you watch for with artificial airways?

Stabilize the patient

goal of the primary survey

Jaw thrust.

What technique is used to open the airway in spinal injury?

C3–C5.

In spinal trauma, what vertebrae affect breathing?

Direct pressure, immobilization, elevation

What techniques are used to control bleeding?

Alert, Verbal, Pain, Unresponsive – used for LOC assessment.

What is AVPU and what does it assess?

≤ 8.

What GCS score indicates need for intubation?

Deformities, Contusion, Abrasion, Penetration/Puncture, Burns, Tenderness, Laceration, Swelling.

What does DCAP-BTLS stand for?

Apply 3-sided occlusive dressing.

How are chest injuries managed to prevent tension pneumothorax?

Full set of VS, family presence

What does F stand for in the secondary survey?

Get monitoring devices, give comfort (analgesic).

What does G stand for?

History taking – ask mechanism of injury.

What does H stand for?

Input diagnostics and lab studies.

What does I stand for?

Prevent tetanus.

goal of wound management

clinical death

No pulse, no breath

respiratory arrest

With pulse, no breath.

cardiac arrest

No pulse, with or without breath.

4–6 minutes

critical time frame after arrest before brain damage

Chest compressions, rescue breaths, defibrillation.

key components of Basic Life Support (BLS)

BLS + intubation, epinephrine, equipment (e.g., mechanical vent)

components of Advanced Cardiac Life Support (ACLS)

Danger – check the scene for safety

first step in Basic Life Support

Use the shout-tap-shout technique and ask: “Are you okay?”

How do you assess a patient’s level of consciousness (LOC)?

Movement and breathing.

What signs indicate life in a patient during BLS assessment?

• Activate the Emergency Response System (Call 911).

What should you do after assessing responsiveness in BLS?

• Compression, Airway, Breathing.

What does CAB stand for in BLS?

Lower half of the sternum, avoiding the xiphoid process.

Where should chest compressions be given?

Adults: 2 inches; Children (1-8 yrs): 2 inches

recommended depth of chest compressions in adults and children

1.5 inches (using 2 fingers).

recommended compression depth for infants?

Carotid pulse on one side

Where do you check the pulse in adults and children?

Brachial or femoral pulse

Where do you check the pulse in infants?

100–120 bpm.

What is the compression rate in BLS?

10–12 breaths per minute.

What is the ventilation rate in BLS?

Monophasic (360J), Biphasic (120–200J).

two types of AED shocks

Right pad: upper chest above the nipple; Left pad: below the left breast (sandwich the heart).

Where should AED pads be placed?

1. Defibrillation, then resume CPR.

What is the next step after identifying a shockable rhythm like VFib or pulseless VTach?

disaster

A sudden/unexpected event that interrupts normal community functioning.

Prevention/To reduce the likelihood and impact of disasters.

goal of the mitigation phase in disaster management?

training of drills/To enhance the ability to respond to disasters.

goal of the preparedness phase

DILG (Department of the Interior and Local Government).

What agencies are involved in preparedness?

To provide emergency assistance for short-term needs.

goal of the response phase

DSWD (Department of Social Welfare and Development)

Which agency leads the disaster response phase?

To return or rebuild normalcy (long-term needs).

What is the goal of the recovery phase?

RA 10121 – Philippine DRRM Act of 2010.

What law governs disaster risk reduction in the Philippines?

Utilitarianism – the greatest good for the greatest number.

main principle of NATO triage classification

RED

Immediate care needed – life-threatening but survivable with minimal intervention.

YELLOW

Delayed care – serious injuries but can wait for treatment.

GREEN

Minimal injuries – walking wounded.

BLACK

Expectant – fatal injuries, unlikely to survive.

Children under 8 years old.

What age group is JUMP START triage used for?

Children under 8 years old.

purpose of a secondary assessment in triage

To evaluate ongoing needs during extended catastrophic events.

purpose of a secondary assessment in triage

layer of skin is affected in first-degree burns

Epidermis (superficial)

Redness, intact skin, painful.

characteristics of a first-degree burn?

Moist with blisters, painful, weeping.

characteristics of second-degree burns

Thermal, Chemical, Electrical, Radiation.

four causes of burns

Spinal cord injuries and arrhythmias.

complications are priorities in electrical burns

Green

what color tag is given to someone who can walk

Black

what color tag is assigned if the patient is not breathing after repositioning the airway?

Red

If a patient’s respiratory rate is above 30 or capillary refill is over 2 seconds, what is their triage category?

Yellow (delayed).

In START triage, what does inability to follow commands indicate?

a 3rd-degree burn

Full-thickness burn involving subcutaneous tissue; appears pearly white or yellow and is painless

4th-degree burn

Deep full thickness burn that extends to muscles and bones; appears black, charcoal, or leathery, and is painless due to nerve damage.

3rd and 4th-degree burns

Nerve damage resulting in a loss of sensation.

Eschar is crusty, rigid dead tissue that can limit circulation and requires debridement.

What is eschar and why is it a concern in burn injuries?

• Compartment syndrome (extremities)

• Airway obstruction (neck and chest burns)

What are the two major complications of circumferential burns?

Escharotomy or fasciotomy to relieve pressure

medical intervention for circumferential eschar

Acute Tubular Necrosis (ATN) in the ccute Tubular Necrosis (ATN)

occurs due to muscle breakdown, increasing myoglobin, leading to tubular obstruction and acute kidney injury (AKI).

Stop the burning process

first priority in burn first aid

• Do: Stop, drop, roll

• Throw: Wet blanket

• Remove: Clothing and jewelry

actions should be taken if active flames are present

Immerse in cool water (not ice); do not apply ice directly.

What should be done when there is no flame, but the skin is burned?

Flush with water for more than 15 minutes.

immediate intervention for a chemical burn

• Rescue the patient

• Activate the fire alarm

• Confine the fire

• Extinguish the fire

priorities during a fire in order

• Pull the pin

• Aim at the base of the fire

• Squeeze the handle

• Sweep side to side

What does the PASS method stand for in using a fire extinguisher?

Emergent (resuscitative) phase; occurs within the first 48 hours.

first phase of burn management called and when does it occur

Airway, Breathing, Circulation (ABC).

main priority during the emergent phase

• Fluid shifts from intravascular to interstitial space, causing edema.

• Fluid volume decreases → hypovolemia → burn shock.

What are the fluid shifts during the emergent phase of burns?