NEO Nursing Terrorism Lecture

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Presentation Description

For Nursing Students at NEO A&M College

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Presentation Transcript

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In crisis... people do best at what they do daily…

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Decontamination in an NBC MCI Majority of victims are decontaminate at the hospital. Bystanders triage victims to the hospital. Victims triage themselves to the hospital.

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Decontamination in an NBC MCI Inherent delays in setting up decontamination area. 18.5% of HAZMAT victims are treated at the scene.

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Decontamination in an NBC MCI Majority of the victims will be exposed to vapor or aerosol.

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NBC/MCI Decontamination Challenges How many victims should hospitals be prepared to treat? Who should be trained? What level of PPE should be provided? How do you handle personal items and maintain privacy? How will decontamination runoff be contained? Decontamination is important!

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Bomb Blasts Instantaneous chain of events in which an explosive material is rapidly converted into a gas under extremely high temperature and pressure.

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Blast Mechanics A solid surface acts as a reflective force Low-energy explosives-react slower than the speed of sound (gunpowder pipe bomb) High-energy explosives-detonate faster than the speed of sound (TNT, diesel fuel and fertilizer)

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Explosive Properties The larger the explosive charge, the greater the shock wave. Mechanism of injury Direct exposure to the blast wave. Reflective blast waves. Acceleration-deceleration forces. Penetrating and non-penetrating wounds. Burns and inhalation of toxic gases. Building collapse.

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Mechanism of Injury Primary Blast Injury Direct damage from the blast wave. Secondary Blast Injury From flying debris. Tertiary Blast Injury From being thrown against a stationary object. Misc. Blast Effects Burns, crush injuries, inhalation of toxic gases, neuropsychiatric conditions.

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Injury Patterns Most survivors suffer secondary and tertiary blast effects. Primary blast injury is infrequent in survivors. 15% of survivors require hospital admission. The remaining are treated and released from the emergency department.

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General Management ABC’s Patients at risk for air embolism and pneumothorax. Extensive surgical debridement of penetrating foreign bodies with delayed wound closure. Tetanus toxoid and antibiotics.

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Bomb Blast Triage Minimal-- Walk and talk. Alert and oriented. Intact hearing. Immediate— Decreased or loss of hearing Monitor 6-12 hrs at least. Short of breath. Change in mental status. Penetrating and traumatic injuries.

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Special Considerations Bombs may be contaminated with NBC materials. Contaminated clothing and retained foreign bodies become evidence. Chain of evidence must be maintained. Items should be labeled and secured. Assign one individual to the task. Document for future identification.

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Special Considerations Contaminated clothing should be bagged. Paper bags for explosives only. Paper bags placed in plastic for chemical. Removed foreign bodies. Chemical and biological-place in 5% hypochlorite solution. Radiologic-place in lead-lined container. Irrigate wound and apply sterile dressing. Ensure self-protection.

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Acute Crush Syndrome Produced by prolonged and continuous pressure on extremities. Skeletal muscle death releases cellular toxins. Results in renal failure, lethal cardiac arrhythmias, and sudden death. Clinical presentation depends upon length of time extremity has been crushed.

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Acute Crush Syndrome Management Large volumes of IV normal saline before and after victim is freed. 1-2 liter bolus (20cc/kg). Maintains renal blood flow and excretion of toxic substances. (Rhabdomyolisis) Mannitol Bicarbonate Treat elevated potassium levels.

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