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TERRORISM DISASTER AND MASS CASUALTY FALL UPON California

1. The terrorism agent used was smallpox, a biological agent, potentially infecting 2000 people.
2. In addition, several large blasts occurred in downtown san Francisco and san Diego causing building destruction and about 200 citizens wounded with possible fatalities as well. Many of these injured sustained partial and full thickness burns as well as smoke inhalation.
3. ED staff at Kindred Hospital will be responsible for triaging individuals flooding into the ED. In addition to the individuals directly affected by the terrorism event, many other patients arrive to the ER not directly impacted by the event. ED staff will be involved in treatment and transport to the local trauma and burn center, Scripps Mercy Hospital. These patients will include the following:
   1. Two elderly patients ages 78 and 86 years old from the neighboring LTC center arrive with respiratory distress
   2. Male patient who is 54 years old having an anterior wall MI and appears to be going into cardiogenic shock
   3. Female patient who is 72 years old is having an ischemic stroke with a history of rapid atrial fibrillation
   4. Male patient who is 24 years old and having an acute psychotic mental health crisis and possible overdose
   5. Male elder patient age 82 having heat stroke and found with a possible cervical injury
   6. Preschooler age 4 rescued by parents after an apparent freshwater submersion incident
   7. Hiker age 28 found lost at Mt Baker suffering from frostbite and severe hypothermia

Assignment:

This team will be the trauma and burn specialists at Scripps Mercy Hospital and will receive those patients who were transferred to their facility from Kindred ED.

1.Describe the triaging through this hospital and transferring to the special trauma and burns ICUs. Include all preparations for receiving these patients. Collaborate with another TEAM for these exact numbers and types of patients.

2.Continue to describe treatment plans (in the form of a concept map or algorithm) for these patients. Include various health care team members and describe their role in the treatment process.

3. Get creative and discuss the progress, success or lack of recovery for any of these patients as you describe their treatment process. Include pertinent pathophysiology of burns and its treatment.

Answer 1

TRIAGE

Triage is the process of determinig the priority of the patients treatment based on the severity of their condition.

RED -IMMEDIATE

YELLOW-DELAYED

GREEN-MINOR

BLACK-DECEASED

1. TRAUMA ICU

Red -Male patient who is 54 years old having an anterior wall MI and appears to be going into cardiogenic shock

Female patient who is 72 years old is having an ischemic stroke with a history of rapid atrial fibrillation

Male patient who is 54 years old having an anterior wall MI and appears to be going into cardiogenic shock

these patient needs immediate care so they should keep in red code area.

Yellow -Two elderly patients ages 78 and 86 years old from the neighboring LTC center arrive with respiratory distress

Preschooler age 4 rescued by parents after an apparent freshwater submersion incident

  Male patient who is 24 years old and having an acute psychotic mental health crisis and possible overdose

Hiker age 28 found lost at Mt Baker suffering from frostbite and severe hypothermia

BURNS ICU

RED- Male elder patient age 82 having heat stroke and found with a possible cervical injury

According to triage we can seperate the patient on the above ways

Registration

The registration process is important for two reasons: it is important for getting the information for the patient record

and we have to obtain there consent for treatment. Both are necessary to order diagnostic tests to enable the physician

determine the best treatment option for them. Patient Access Specialists can conduct bedside registration for patients who

have been taken directly to a treatment room.

PREPARATION OF HEALTHCARE TEAMS

• The staff includes physicians, nurses and other healthcare professionals who follow specific procedures include the wardsstaffs, lab people,technicians, so that you can get the care you need as quickly as possible.
• prepare all the beds for recieving the patients
• prepare all the emergency articles and the emergency medicines.

Depending on the condition, a registered nurse may start an intravenous (IV) line. The IV line will allow the nursing staff to quickly administer medications or fluids that may be ordered by a physician. A nurse or technician may also take blood or urine samples, or they may send the patient for an X-ray or other imaging test before a physician sees them. Physicians may also order blood tests on an urgent basis. Test results help emergency medicine physicians assess their  condition. The results could be available within one to two hours, while they are in the ED. However, some test results may require a longer wait.

2 TREATMENT PLAN

FOR RESPIRATORY DISTRESS PATIENT

Assessment Repisalony distus 02 298% in patient responding to a continue to via mast if not start cpap investigation ABG/CXR/ culture start antibiotin & u fluids. Review ABG, after Thous Fio improved Worsening motore Symptom continue Niv Poon respectory Goo Respiratory 100 righ fro. reduced too, continue Venlilation extubation Only Niv

ANTERIORWALL MI

Assessment 12 Lead Echt Lab - Cardiac biomacks. • Supplymental Oxygen. Nitroglycerm Morphim Aspirin 162-325mg B-blocken. Angiotensin convertizing Enzymes • Evaluate for the Indication of Reperfation Therapy

ISCHEMIC STROKE

Therapy Rapid Evaluation Exact time of onset important history Neurology Evaluation •STAT T & Labs. tundsrags- confiem the cuteria fullfilling thromboly tie therapy for Ishemic stroke Onset L3 hrs IN-APA Treatma onset 3-bhes. A thrombolyti therapy.

FROST BITE

아 Aim: To restore normal temperature → Remove all constructine clothing, Jewellasy items If lower Extamities involved not allow the patient to ambulate Frozen Extrimity placed in 37°C to 40°c this treatment Continue until circulation restored thon is Analgesics for pain sterile gauze / cotton is placed on affected area to prevent contact with. beddothes

FRESHWATER SUBMERSION

check for response Answer: Pulmonary Auscultation Abnormal Normal with cough. Shock Normal ВР Graden Grade 3 Advanced medical attentin Administer O₂ by face maske/ Intubation Start infusion evaluate for use of vasopressor

HEAT STROKE

Assess for ataxia, coma Confusion, stability. Seizure. Address CAB " Entrate EMS Remove pt from heat Begin cooling to core temp38c - Labtest 1 Monitor renal tuntem

PSYCHOTIC MENTAL HEALTH CRISIS

assess/ keep the patient calm/supportive care/ prevent for further absorption/administration of antidots/prevention of re exposure

HEALTHCARE PROFESSIONALS AND THEIR ROLES

TRIAGE TEAM

The members in triage team should seperate the patient according to the priority of the condition without fail

DOCTORS

Assess the patient immediately and identify the problem

start the medical management process according to the condition

advise immedeate investigations

NURSES

Keep the patient calm

keep all the necessasary iv lines and the monitors for the vital parameters

check the vitals immediately after the admission of the patient

follow the doctors orders and inform all the technicians necessary

3 with the advanced treatment and immediate measures the 90% of success will get for all the patient, and the combinrd effort of all the health care professional helps the treatment 100% succesful if they are treating the patient without any time delay

PATHOPHYSIOLOGY OF BURNS

fleat Skin causes coagulation necrosis of and subcutaneous tessu , Release vasoactive peptide bride Altered capillary pamcadility Loss of fluid - severe hypovolen Decreased cardia output oliguria. Ls Altered pulmonary resistance causin Clems. infection MODS Multi Organ Dysfunction Syndrome

TREATMENT

• Water-based treatments.  use techniques such as ultrasound mist therapy to clean and stimulate the wound tissue.
• Fluids to prevent dehydration.  need intravenous (IV) fluids to prevent dehydration and organ failure.
• Pain and anxiety medications. Healing burns can be incredibly painful. morphine and anti-anxiety medications — particularly for dressing changes.
• Burn creams and ointments.  topical products for wound healing, such as bacitracin and silver sulfadiazine (Silvadene). These help prevent infection and prepare the wound to close.
• Dressings wound dressings to prepare the wound to heal. wound will likely be covered in dry gauze only.
• Drugs that fight infection. If develop any infection, may need IV antibiotics.
• Tetanus shot.  doctor might recommend a tetanus shot after a burn injury.