Triage and Agents
injuries are life threatening but survivable with minimal intervention
examples: give me one
What is Immediate Triage?
sucking chest wound
airway obstruction
shock
patient reported have small blisters on the hands and arms a few days ago. The blisters have subsided and now a ulcer has remained with a dark center.
1. issue?
2. transmission- port of entry?
what is cutaneous anthrax?
what is breakage of skin?
effects of Botulinum toxin on the acetylcholine receptor?
what symptoms?
acts on neuromuscular junction, binds to presynaptic cholinergic terminal and inhibits release of acetylcholine.
causes functional denervation leading to weakness, atrophy and ultimately paralysis
bubonic
travels through lymph system to the nearest lymph node. y pestis replicate. the lymph node swells and becomes a bubo. vey painfulbites from animals, insects or stings
medications to avoid giving children or teenagers under the age of 18 presenting with flu or other viral illness
Aspirin (acetylsalicylic acid) or any salicylate containing products (e.g. Pepto Bismol)
injuries are minimal and treatment can wait hours or even days
example:
Minimal
1. upper extremity fractures
2. minor burns
3. sprains
signs and symptoms associated with inhalation anthrax?
what is the mortality rate?
10 to 15% without treatment or 55% with treatment. most deadly
rules about antibiotics?
1. vent support
2. Baby BIG- immunoglobulin
3. visual stimulation should be performed during paralysis to maintain development.
antibiotics- can rapidly progress paralysis- be ready to intubate and vent
Tell me about Reyes Syndrome
Reye's syndrome appears over the course of several hours. OCCURS WITH MANY VIRAL ILLNESSES!
Symptoms include: vomiting, irritability and aggressiveness. Children may become confused and lethargic. They may have seizures or fall into a coma.
There is no cure for Reye’s syndrome.
Treatment is supportive.
Steroids can help reduce swelling in the brain.
Can be fatal or cause permanent brain damage.
patient presents with possible c4-c5 vertebrae fracture and is currently unresponsive. EMT reports the client has been unconscious for 1 hour. triage category
what is Expectant
transmission of Gastrointestinal anthrax and big s/s
what might those big s/s cause far as other signs and symptoms
through the consumption of eating raw or undercooked meat from an infected animal
s/s- n/v with bloody vomit, diarrhea (possibly bloody).
subsequent s/s- swelling of neck gland, sore throat, painful swallowing, hoarseness, flushing, red eyes
medications contraindicated in botulism?
why?
aminoglycosides and clindamycin
exacerbate neuromuscular blockage
nerve agents mechanism of work
lead to cholinergic crisis characterized by musanaric and nicotinic overstimulation
inhibit cholinesterase, causing cholinergic symptoms progressing to loss of consciousness, seizures, copious secretions, apnea, and death.
who should avoid getting the flu shot?
egg allergies
hx of gullain barre
present fever/infection
patient presents with a facial laceration after being in a ten car pile up. the patients vitals are 120/68, HR 88, Temp 98.7, and RR 14. which triage category
what is delayed?
What is usually recommended for handling of a body that has been contaminated with anthrax.
what happens to the clothes of a person?
what is burning or boiling?
5 sources of botulinum exposure
1. honey
2. soil3. syrup
4. canned food5. fish
meds and interventions for nerve agents
atropine- to block acetylcholine receptors to halt crisis
benzos- stops seizures and agitation
pralidoxime-antidote for nicotinic overstimulation
interventions-decontaminate with large amounts of soap and water or saline. blot; don't wipe. plastic equipment absorbs sarin gas.
Oseltamivir (Tamiflu)
§Recommended for high risk patients
§Pregnant women and infants okay to use this drug
§Should start treatment within 48 hours of symptom onset
§Typically, 5 day course of treatment
§Still contagious while on this medication
Category A biological Agents-name 3?
which are transferred by human to human contact?
what is?
Anthrax, Small pox, botulinum toxin, Ebola, plague
what is?
pneumonic plague, small pox
patho of inhalation anthrax
starts primarily in the lymph nodes in the chest before spreading through rest of the body, ultimately causing severe breathing problems and shock.
descending paralysis, constipation, generalized weakness, loss of head control, respiratory failure
radiation event interventions
triage outside hospital, cover floor and strict isolations, air ducts/vents sealed, waste is double bagged and labeled radiation waste.
staff protection- water resistant gowns, two pairs of gloves, caps, goggles, masks, and booties.
patients surveyed for radiation, showered and resurveyed. all patient belongings will be collected and contained.
cervical cancer-secondary prevention
PAP smears