4307 FM.qxd 3/17/05 5:13 AM Page i Rapid Response to Everyday Emergencies ➤ A NURSE’S GUIDE 4307 FM.qxd 3/17/05 5:13 AM Page ii 4307 FM.qxd 3/17/05 5:13 AM Page iii Rapid Response to Everyday Emergencies ➤A NURSE’S GUIDE 2007.12.3 9:52 PM STAFF Executive Publisher Judith A Schilling McCann, RN, MSN Editorial Director H Nancy Holmes Clinical Director Joan M Robinson, RN, MSN Senior Art Director Arlene Putterman Editorial Project Manager William Welsh Clinical Project Manager Mary Perrong, RN, CRNP, MSN, APRN,BC Editor Elizabeth Jacqueline Mills Clinical Editors Karen A Hamel, RN, BSN; Tamara Kear, RN, MSN, CNN; Jana L Sciarra, RN, CRNP, MSN Copy Editors Kimberly Bilotta (supervisor), Amy Furman, Kelly Pavlovsky, Lisa Stockslager, Pamela Wingrod Designer Jan Greenberg (project manager) Digital Composition Services Diane Paluba (manager), Joyce Rossi Biletz, Donna S Morris Manufacturing Patricia K Dorshaw (director), Beth J Welsh Editorial Assistants Megan L Aldinger, Karen J Kirk, Linda K Ruhf Indexer Barbara Hodgson Page iv The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical, and legal authorities To the best of our knowledge, these procedures reflect currently accepted practice Nevertheless, they can’t be considered absolute and universal recommendations For individual applications, all recommendations must be considered in light of the patient’s clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert information The authors and publisher disclaim any responsibility for any adverse effects resulting from the suggested procedures, from any undetected errors, or from the reader’s misunderstanding of the text © 2006 by Lippincott Williams & Wilkins All rights reserved This book is protected by copyright No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means — electronic, mechanical, photocopy, recording, or otherwise — without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook Printed in China For information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756 RPDRSPONS010505—030509 Library of Congress Cataloging-in-Publication Data Rapid response to everyday emergencies: a nurse's guide p ; cm Includes bibliographical references and index Emergency nursing — Handbooks, manuals, etc I Lippincott Williams & Wilkins [DNLM: Nursing Care — methods — Handbooks Emergency Nursing — methods — Handbooks WY 49 R218 2006] RT120.E4R37 2006 610.73'6 — dc22 ISBN13: 978-1-58255-430-3 ISBN10: 1-58255-430-7 (alk paper) 2005002797 RRS0904 125039_P000iv 4307 FM.qxd 3/17/05 5:13 AM Page v Contents Contributors and consultants Foreword 10 11 12 13 14 15 vii ix Emergency essentials Cardiovascular emergencies 67 Respiratory emergencies 110 Gastrointestinal emergencies 137 Neurologic emergencies 191 Musculoskeletal emergencies Endocrine and metabolic emergencies 218 259 Obstetric and gynecologic emergencies 279 Genitourinary emergencies 297 Hematologic emergencies Eye, ear, nose, and throat emergencies 315 340 Dermatologic emergencies 352 Environmental emergencies Emergencies due to drug toxicity and overdose 406 Psychiatric emergencies Emergency cardiac drugs 430 Normal and abnormal serum drug levels Bioterrorism readiness Selected references Art credits Index 391 436 439 448 450 451 v 4307 FM.qxd 3/17/05 5:13 AM Page vi 4307 FM.qxd 3/17/05 5:13 AM Page vii Contributors and consultants Haralee Abramo, RN, MSN Sharon Lee, RN, MS, BSN, FNP, CCRN Director of Education Los Robles Hospital and Medical Center Thousand Oaks, Calif Family Nurse Practitioner, Emergency RN Bryan LGH Medical Center Lincoln, Nebr Karen Balich-Reitz, RN, MS Elizabeth Molle, RN, MS Quality Facilitator MacNeal Hospital Berwyn, Ill Nurse Educator Middlesex Hospital Middletown, Conn Anne L Bateman, RN, EdD, APRN,BC, PMH Ruthie Robinson, RN, MSN, CCRN, CEN, CNS Assistant Professor, Nursing and Psychiatry University of Massachusetts Worcester Director, Magnet Program and Clinical Research Christus St Elizabeth Hospital Beaumont, Tex Laura M Criddle, RN, MS, CEN, CCNS, Belinda L Spencer, RN, MSN, CCRN, CNRN APRN,BC Doctoral Student Oregon Health and Science University Portland Chief Nurse Army Trauma Training Center Ryder Trauma Center Miami Cynthia L Dakin, RN, PhD Warren Stewart, RN, BSN, CEN Assistant Professor Northeastern University Boston Staff Nurse Irwin Army Community Hospital Ft Riley, Kans Laura Favand, RN, BSN, MS Robin Walsh, RN, BSN, CEN Chief Nurse Education and Training Army Trauma Training Center Ryder Trauma Center Miami Clinical Nurse Supervisor University Health Services at the University of Massachusetts Amherst Rita M Wick, RN, BSN Education Specialist Berkshire Health Systems Pittsfield, Mass vii 4307 FM.qxd 3/17/05 5:13 AM Page viii 4307 FM.qxd 3/17/05 5:13 AM Page ix Foreword As a nursing student, I longed to work in an exciting, high-acuity practice setting After graduation, as I began my career in the real world of professional nursing, I quickly learned that true emergencies can be terrifying events, especially to a novice An interesting dichotomy emerged: Despite my initial desire to work in an action-packed setting, I suddenly wanted all of my patients to be absolutely stable Each new crisis challenged my ability to respond competently and effectively cope with the aftermath of my actions I would replay each scenario in my mind and wonder if I could have done anything differently It was a frustrating experience I eventually learned my lessons, but it wasn’t easy In those days, emergency care algorithms and protocols weren’t widely available or even taught to most nurses We were expected to adapt — and because of that, the stress and strain of learning how to rapidly respond weighed upon me heavily Luckily for you, Rapid Response to Everyday Emergencies: A Nurse’s Guide is an all-new title specifically designed to demystify emergency situations by providing vital emergency-response information in a quickscan format This user-friendly handbook gives students and experienced nurses alike a practical need-to-know clinical reference that offers prioritized, highly bulleted guidance for instant crisis management The book’s concise yet highly detailed structure is just one of many innovations that make it such a valuable reference It begins with a chapter on emergency essentials, which includes an overview of how to conduct primary and secondary surveys — tools that, if used properly, rapidly identify life-threatening emergencies and enable you to prioritize your care This chapter also discusses triage and basic life-support guidelines, which are two aspects of nursing care that every nurse should occasionally brush up on The rest of the book is broken down into chapters by either body system or trauma type, and the disorders in each chapter are listed in alphabetical order to facilitate its quick-access format Forget about paging through this book to find what you need Rapid Response to Everyday Emergencies: A Nurse’s Guide allows you to locate information in a flash Once you’re at the entry, the book speeds you along even faster Crucial information pertinent to each emergency is presented up-front for easy access; pathophysiology and other background content follows Just ix 4307 FM.qxd 3/17/05 5:13 AM Page x x Foreword the right amount of supplemental information allows for a critique of the event and a discussion of clinical issues surrounding the emergency In addition to the core text, Rapid Response to Everyday Emergencies: A Nurse’s Guide emphasizes key points in a variety of ways Sidebars filled with insightful information abound, and eye-catching logos draw attention to some of the most important clinical points In Action presents case studies of actual emergencies and provides in-depth analysis on how to best manage them Complications highlights warning signs and symptoms to monitor for and the actions to take should they develop Alert details crucial points in the management of crisis situations The inclusion of appendices on emergency cardiac drugs and normal and abnormal serum drug levels enhance the book’s overall utility In my experience, knowledge, focus, and anticipation are essential in emergency management Knowledge involves recognition of the situation through assessment and critical thinking, as well as prioritizing actions Focus is necessary to block out extraneous information and concentrate on critical aspects of care Anticipation is vital to stay one step ahead, be prepared for complications that may arise, and to plan for ways to prevent the emergency altogether Rapid Response to Everyday Emergencies: A Nurse’s Guide illustrates this approach like no other book on the market It’s a part of my reference library, and I highly recommend that it become a part of yours Linda Laskowski-Jones, RN, MS, APRN,BC, CCRN, CEN Director, Trauma, Emergency & Aeromedical Services Christiana Care Health System – Christiana Hospital Newark, Del 4307_index.qxd 3/17/05 4:57 AM Page 456 456 Index Esophageal balloon tamponade, follow-up actions for, 119, 121 Esophageal varices rupture, 116-119, 121 acute upper gastrointestinal bleed as complication of, 120 treatment modalities for, 119 Ethylene glycol, antidote for, 105t Evisceration, 135-136, 136i Ewald tube, 118i External pacing, 28i Extrapyramidal effects, antipsychotic drugs and, 425 Extravaginal torsion, 296, 296i See also Testicular torsion Eye covering, protective, 330i Eye emergencies, 315-319, 324-332, 336-339 Eye irrigation methods, 316i F Facial fractures, 324-326 airway obstruction in, 325, 326 spinal injury and, 325 Factor VIII concentrates as hemophilia treatment, 306 Factor VIII deficiency, hemophilia and, 305 Factor IX concentrate as hemophilia treatment, 306 Factor IX deficiency, hemophilia and, 305 Factor replacement products, 306 Failure to capture as pacemaker malfunction, 52i Failure to pace as pacemaker malfunction, 52i Failure to sense intrinsic beats as pacemaker malfunction, 53i Falls in facility, Family, facilitating presence of, 4-5 Fasciotomy for compartment syndrome, 192i Fasting hypoglycemia, 242 See also Hypoglycemia i refers to an illustration; t refers to a table Fat embolism, 203 Femur fracture, 195-200 Fetal distress as abruptio placentae complication, 263 Fibrinolytic therapy, indications for, 186 First-degree burn, 352, 358, 358i See also Burns Flail chest, 85 Flesh-eating bacteria See Necrotizing fasciitis Fluid overload, indications of, 119 Fluid replacement precautions, 234, 246 Flumazenil, administration precautions for, 104, 105t Fondaparinux, action of, 298t Fractures See also specific type of fracture as cause of hypercalcemia, 226 classifying, 201 Freshwater aspiration, 383 See also Near drowning G Gastric lavage, 118i Gastric tubes, types of, 118i Gastrointestinal emergencies, 110-136 Gastrointestinal radiation toxicity, 385 See also Radiation exposure Generalized seizures, 176-177 Generalized tonic-clonic seizures, 177 Genitourinary emergencies, 279-296 Glaucoma, acute angle-closure, 326-329 pathophysiology in, 327i, 328-329 Grandiose delusions, 412 See also Delusional disorders Gynecologic emergencies, 259-278 4307_index.qxd 3/17/05 4:57 AM Page 457 Index H Head injury, closed, 146-148 Head-tilt, chin-lift maneuver, 76i Head-to-toe assessment in secondary survey, 4, 5-6 Heart attack See Myocardial infarction Heart failure, 37-40 left-sided, 38, 40i pulmonary edema as complication of, 39 right-sided, 38, 40i Heat cramps, 371 See also Hyperthermia Heat exhaustion, 371 See also Hyperthermia Heatstroke, 371 See also Hyperthermia Heat syndrome See Hyperthermia Hematologic emergencies, 297-314 Hemolytic streptococcal gangrene See Necrotizing fasciitis Hemophilia, 305-309 factor replacement products for, 306 helping parents manage, 308-309 managing, during surgery, 306 Hemorrhagic stroke, 188t See also Stroke Hemothorax, 86-87 Heparin, antidote for, 105t Heparin derivatives, actions of, 298t Herniated disk, 205-208 pathophysiology of, 208, 208i Herniated nucleus pulposus See Herniated disk HHNS See Hyperosmolar hyperglycemic nonketotic syndrome Hip fracture, 195-200 managing, 196-197 preventing complications of, in elderly patients, 199 Hip replacement, 198i Hives, 348-351 i refers to an illustration; t refers to a table Hormone replacement therapy, 253 Hunt-Hess classifications for subarachnoid hemorrhage, 141 Hydronephrosis as renal calculi complication, 293 Hyperaldosteronism, 223-224 Hypercalcemia, 224-226 serum calcium level in, 224 Hyperemesis gravidarum, 266-267 Hyperglycemia, 226-228 blood glucose level in, 226 Hyperkalemia, 230-233 clinical effects of, 232t in hypothermia, 372 insulin therapy precautions in, 231 potassium level in, 230 Hypernatremia, 233-235 sodium level in, 233 Hyperosmolar hyperglycemic nonketotic syndrome, 228-230 comparing, with diabetic ketoacidosis, 229i Hyperparathyroidism as cause of hypercalcemia, 226 Hypertensive crisis, 40-42 pathophysiology of, 41i, 42 Hyperthermia, 369-371 temperature reduction in, 370 Hyperthyroidism as cause of hypercalcemia, 226 Hypervolemia, 235-237 Hypervolemic hyponatremia, 247 See also Hyponatremia Hypocalcemia, 238-241 calcium level in, 238 safe administration of I.V calcium in, 239 signs and symptoms of, 127 testing for, 238i Hypoglycemia, 241-242 blood glucose level in, 241 457 4307_index.qxd 3/17/05 4:57 AM Page 458 458 Index Hypokalemia, 243-245 as burn complication, 356 clinical effects of, 232t digoxin therapy and, 243 I.V potassium administration guidelines in, 244 potassium level in, 243 signs and symptoms of, 127 Hypomagnesemia, signs and symptoms of, 127 Hyponatremia, 245-247 sodium level in, 245 Hypophosphatemia as cause of hypercalcemia, 226 Hypothermia, 371-373 cardiopulmonary resuscitation and, 372 core body temperature in, 371 hyperkalemia and, 372 Hypovolemic hyponatremia, 247 See also Hyponatremia Hypovolemic shock, 59-61 development of, 60i, 61 Hypoxemia as hallmark of acute respiratory distress syndrome, 67 I Idiopathic thrombocytopenic purpura, 299-300 Implantable cardioverterdefibrillator, 18i Infectious arthritis, 210-212 Informed consent form, 111 Inguinal hernia, incarcerated, 290-292 Insect stings, 373-375 Insulin, antidote for, 105t Interventions in secondary survey, Intestinal obstruction, 121-123 detecting in large bowel, 122 in small bowel, 121-122 progression of, 123i i refers to an illustration; t refers to a table Intracerebral hematoma, 154-157, 154i Intracranial abscess, 137-139 Intracranial pressure, increased as cerebral aneurysm complication, 143-144 signs of, 138, 143 Ipecac syrup for poisoning, 394t Iron, antidote for, 105t Ischemic stroke, 188t See also Stroke Isovolemic hyponatremia, 247 See also Hyponatremia I.V bag and tubing for eye irrigation, 316i I.V calcium, safe administration of, 239 I.V potassium, administration guidelines for, 244 J Jaw-thrust maneuver, 76i Jealous delusions, 412 See also Delusional disorders K Kernig’s sign, 159i Kidney stones See Renal calculi L Lacunar stroke, 188t See also Stroke Large-bowel obstruction, detecting, 122 See also Intestinal obstruction Laryngeal edema as angioedema complication, 350 Lasègue test, 206 Latex allergy reaction, managing, 79 Lead, antidote for, 105t Leg fractures See Long bone fractures Less urgent condition, triage level for, Levacuator tube, 118i 4307_index.qxd 3/17/05 4:57 AM Page 459 Index Level of consciousness, establishing baseline for, 117 Lightning strike, managing, 367-368 See also Electric shock Lithium, therapeutic range of, 409 Long bone fractures, 200-204 fat embolism as complication of, 203 Loss of consciousness, potential causes of, Lund-Browder chart for estimating burn extent, 355i Lung, collapsed See Tension pneumothorax M Magnesium sulfate, adverse effects of, in premature labor, 273 Major depression, 413-417 suicide as complication of, 417 Mallory-Weiss syndrome, 124-125, 124i Mallory-Weiss tear, 124-125, 124i Mammal bites, 375-379 rabies as complication of, 377-378 tetanus prophylaxis for, 376t Meningitis, 157-160 Metabolic acidosis, 247-249 arterial blood gas results in, 247 Metabolic alkalosis, 249-251 arterial blood gas results in, 249 Methanol, antidote for, 105t Methylene blue as cyanide poisoning antidote, 393t MI See Myocardial infarction Monoamine oxidase inhibitors, toxicity risk associated with, 416 Monophasic defibrillators, 27i Morgan lens for eye irrigation, 316i Multiple organ dysfunction syndrome as disseminated intravascular coagulation complication, 304 i refers to an illustration; t refers to a table Muscle-tendon rupture, 215 Musculoskeletal emergencies, 191-217 Myocardial contusion, 43-44 Myocardial infarction, 44-49 cardinal symptom of, 44-45 chest pain in, 14-15t ventricular aneurysm as complication of, 47 Myocarditis, 49-50 Myoclonic seizures, 177 Myringotomy, 333 Myxedema coma, 251-253 facial signs of, 252i N Naloxone administration precautions for, 104, 105t as opioid antidote, 393t Narrow-angle glaucoma See Glaucoma, acute angleclosure Nasal packing, types of, 321-322i Nasogastric tube inserting, 114i types of, 118i Near drowning, 379-383 drug metabolism in, 380 physiologic changes in, 382i positive end-expiratory pressure for, 380 Necrotizing fasciitis, 342-344 signs and symptoms of complications of, 343 Neurogenic shock, 160-161 Neuroleptic malignant syndrome, 162-163, 426 rhabdomyolysis as complication of, 163 Neurologic emergencies, 137-190 Neurologic examination, rapid, 149, 150 Neurologic status, primary assessment of, 2, 3t, N.I.H Stroke Scale, 180-181t 459 4307_index.qxd 3/17/05 4:57 AM Page 460 460 Index Nikolsky’s sign, 344 Nitroprusside, thiocyanate toxicity and, 42 Noninvasive pacing, 28i Nonurgent condition, triage level for, Nosebleed See Epistaxis Nose emergencies, 320-326 O Obstetric emergencies, 259-278 Ocular trauma, penetrating, 329-331 protective eye covering for, 330i Olanzapine, 425 Older adults, pneumonia in, 88 Open pneumothorax, 91-93 Opioid agonist-antagonists, 402 Opioid agonists, 402 Opioid antagonists, 402 Opioid toxicity, 400-402 naloxone as antidote for, 105t, 393t, 401 Opisthotonos, 158 Orbital cellulitis, 331-332 Orchitis as epididymitis complication, 289 Organophosphate poisoning, 383-385 pralidoxime as antidote for, 105t, 394t protection against physical contact in, 384 Orthostatic hypotension neuroleptic drugs and, 425 spinal cord injury and, 169 Osteomyelitis, acute, 208-210 Otitis media, acute, 332-335 treatment for, 333 Ovarian cyst, ruptured, 267-268 Oxygen therapy, possible adverse effects of, 107 P Pacemaker, transcutaneous, 28i i refers to an illustration; t refers to a table Pacemaker malfunction, 50-51, 52-53i Pancreatitis, acute, 126-128 Ranson’s criteria for, 126 Panic disorder, 418-419 Papillary muscle rupture, 52-54 Paralysis as late sign of ischemia, Paralytic ileus as peritonitis complication, 132 as spinal cord injury complication, 169 Parkland formula for fluid replacement after burn, 356 Paroxysmal supraventricular tachycardia, 20-21t Partial seizures, 176 Patient history, obtaining, 5-6 Patient’s fears, calming, Pediatric patient, ear characteristics of, 334i Pelvic fracture, 204-205 Pemphigus vulgaris, 344-345 lesions of, 344, 345i Peptic ulcer, perforated, 128-131 dumping syndrome as complication of, 130 pathophysiology of, 128, 129i, 131 Percutaneous transluminal coronary angioplasty, 46i Pericardiocentesis, 30-31 Pericarditis, 54-56 chest pain in, 14-15t hemodynamic pressures in, 55 Periorbital ecchymoses, recognizing, 165i Peritonitis, 131-133 paralytic ileus as complication of, 132 Permanent pacemaker malfunction, 50-51 Persecutory delusions, 412 See also Delusional disorders Pharmacologic hypoglycemia, 242 See also Hypoglycemia 4307_index.qxd 3/17/05 4:57 AM Page 461 Index Pheochromocytoma, 253-255 ensuring reliable test results in, 254 Placenta accrete, 268 Placental abruption See Abruptio placentae Placenta previa, 268-270 types of, 270i Pneumonia, 87-88 in older adults, 88 Pneumothorax, chest pain in, 14-15t See also specific type Positive end-expiratory pressure for near drowning, 380 Postconcussion syndrome, 148 Posterior nasal packing, 321-322i Posttraumatic stress disorder, 419-420 Potassium imbalance, clinical effects of, 232t Pralidoxime as antidote, 394t Preeclampsia, 270, 271 Pregnancy-induced hypertension, 270-272 Prehospital care information, obtaining, Premature labor, 272-274 Premature rupture of the membranes, 275-277 prolapsed cord as complication of, 276 Pressure-equalizing tubes, 333 Preterm labor, 272-274 Primary survey, 2, 3t, Prone positioning to improve oxygenation and pulmonary function, 69 Pseudomembranous enterocolitis, 134-135 Psychiatric emergencies, 406-427 Pulmonary edema, 93-96 as heart failure complication, 39 reexpansion form of, 93, 94-95 Pulmonary embolism, 96-98 chest pain in, 14-15t risk factors for, 98 i refers to an illustration; t refers to a table Pulseless ventricular tachycardia, defibrillation for, 17 Pulse oximetry, 68 carbon dioxide levels and, 99 Pump failure See Cardiogenic shock Pyelonephritis acute, 280-282 chronic, 282 Q Quetiapine, 425 R Rabies as mammal bite complication, 377-378 Raccoon eyes, identifying, 165i Radiation exposure, 385-387 Ranson’s criteria for pancreatitis, 126 Rape trauma syndrome, 420-422 child as victim in, 421 Rapid gastric emptying, 130 Reactive hypoglycemia, 241, 242 See also Hypoglycemia Reduction for dislocation and subluxation, 195 of fracture, 201, 202 Reexpansion pulmonary edema, 93, 94-95 Renal calculi, 292-294 hydronephrosis as complication of, 293 Renal vein thrombosis, 294-295 Respiratory acidosis, 98-100 arterial blood gas results in, 98, 99t Respiratory alkalosis, 100-101 arterial blood gas results in, 100, 101t Respiratory arrest, 101-103 as stage of respiratory compromise, 101 Respiratory collapse, abrupt cessation of wheezing and, 82 461 4307_index.qxd 3/17/05 4:57 AM Page 462 462 Index Respiratory depression, 103-105 antidotes for drugs and toxins involved in, 104, 105t Respiratory distress in hospitalized patient, 7-8 Respiratory emergencies, 67-109 Respiratory syncytial virus, 105-107 Resuscitation, triage level for, Retinal detachment, 336-339 pathophysiology of, 337i, 339 scleral buckling for, 338i Retrograde amnesia, 147 Rewarming methods, 372 Rhabdomyolysis, 163 Rib fractures, flail chest and, 85 RICE protocol, 213 Risperidone, 425 Rule of Nines for estimating burn extent, 354i Ruptured disk See Herniated disk S Salicylate overdose, 402-404 activated charcoal as antidote for, 392t Saltwater aspiration, 383 See also Near drowning SAMPLE mnemonic, Scalded skin syndrome, 347-348 Schizophrenia, 423-424, 426 phases of, 423 Scleral buckling procedure, 338i Second-degree burn, 352, 358-359, 358i See also Burns Seizures, types of, 176-177 See also Status epilepticus Selective factor XA inhibitor, action of, 298t Septic arthritis, 210-212 Septic shock, 61-64 development of, 63, 64i Serum potassium level in hyperkalemia, 230 verifying results of, 231 Shock See specific type i refers to an illustration; t refers to a table SIADH See Syndrome of inappropriate antidiuretic hormone Sickle cell crisis, 308-312 autosplenectomy in, 309-310 managing, 312 pathophysiology of, 310i, 312 Sinus bradycardia, 22-23t Skin bends, 365 See also Decompression sickness Skull fracture, 164-167 cerebrospinal fluid leakage in, 165 treatment of, 166 types of, 164 Slipped disk See Herniated disk Small-bowel obstruction, detecting, 121-122 See also Intestinal obstruction Somatic delusions, 412 See also Delusional disorders Somatization disorder, 426-427 Sphenoidal skull fracture, 164 See also Skull fracture Spider bites, 387-390 Spinal cord injury, 168-174 autonomic dysreflexia as complication of, 169, 174 managing, 172-173 mechanisms involved with, 173-174 orthostatic hypotension in, 169 paralytic ileus as complication of, 169 types of, 170-171i Spontaneous pneumothorax, 89-90 Sprains, 212-213 Status asthmaticus, 107-109 Status epilepticus, 174-177 Stevens-Johnson syndrome, 346-347 Straight-leg–raising test, 206 Strains, 214-215 Stroke, 177-188 assessment findings in, 178-179t, 179 4307_index.qxd 3/17/05 4:57 AM Page 463 Index Stroke (continued) Cincinnati prehospital scale for, 182i fibrinolytic therapy for, 186 N.I.H Scale for, 180-181t suspected, treatment algorithm for, 184-185i types of, 177t Subarachnoid hemorrhage, 139-144 Hunt-Hess classifications for, 141 Subdural hematoma, 188-190 Subluxations, 193-195 treatment of, 195 Sucking chest wound, 91-93 Suicide attempted, managing, 415-416 as depression complication, 417 Superficial thrombophlebitis, 64-66 Suppurative fasciitis See Necrotizing fasciitis Syndrome of inappropriate antidiuretic hormone, 255-257 pathophysiology of, 256i, 257 Synergistic necrotizing cellulitis See Necrotizing fasciitis Systemic inflammatory response syndrome, 304 T Temperature reduction in hyperthermia, 370 Temporal skull fracture, 164 See also Skull fracture Temporary pacemaker malfunction, 50-51, 52-53i Tension pneumothorax, 90-91 pathophysiology of, 91, 91i Testicular torsion, 295-296 Tetanus prophylaxis, 376t The bends, 365 See also Decompression sickness Thermal burns, 358 See also Burns i refers to an illustration; t refers to a table Thiocyanate toxicity, signs and symptoms of, 42 Third-degree atrioventricular block, 22-23t Third-degree burn, 353, 358i, 359 See also Burns Thrombin inhibitors, action of, 298t Thrombophlebitis, 64-66 Thrombotic stroke, 188t See also Stroke Thrombus formation, 48i Thyroid storm, 257-258 Thyrotoxic crisis, 257-258 Total hip replacement, 198i Toxic epidermal necrolysis, 347-348 Toxic shock syndrome, 277-278 pathophysiology of, 278, 278i Transcutaneous pacemaker, 28i Transfusion reaction early signs of, 286 hemolytic, 312-314 Transient ischemic attacks, 187 Trauma patient primary survey of, 2, 3t, secondary survey of, 4-6 Traumatic amputation, 215-217 caring for body part in, 216i Traumatic pneumothorax, 91-93 Triage, guidelines for establishing, 6-7 Tricyclic antidepressants, antidote for, 105t Trousseau’s sign, 238i Turner’s sign, 127 Tympanic membrane, ruptured, 335-336 Tympanoplasty ventilating tubes, 333 U Umbilical cord prolapse as premature rupture of membranes complication, 276 463 4307_index.qxd 3/17/05 4:57 AM Page 464 464 Index Undersensing as pacemaker malfunction, 53i Upper gastrointestinal bleeding, acute, 120 Urgent condition, triage level for, Urticaria, 348-351 V Vascular compromise, signs of, 194 Vasopressin, adverse effects of, 220 Ventricular aneurysm as myocardial infarction complication, 47 Ventricular fibrillation, 24-25t defibrillation for, 17 Ventricular tachycardia, 24-25t Viral pneumonia, 88 See also Pneumonia Vital signs, assessing, WXYZ Warfarin, action of, 298t Warfarin toxicity, 404-405 Wasp stings, 373-375 Wheezing, abrupt cessation of, 82 Whole body irradiation, effects of, 386t Wound dehiscence, 135-136, 136i i refers to an illustration; t refers to a table 4307_index.qxd 3/17/05 4:57 AM Page 465 NOTES 4307_index.qxd 3/17/05 4:57 AM Page 466 NOTES 4307_index.qxd 3/17/05 4:57 AM Page 467 NOTES 4307_index.qxd 3/17/05 4:57 AM Page 468 NOTES 4307_index.qxd 3/17/05 4:57 AM Page 469 NOTES 4307_index.qxd 3/17/05 4:57 AM Page 470 RRS0904 NOTES ... sensation, location, radiation, duration, and precipitating and alleviating factors (See Understanding chest pain.) Assess for associated symptoms, such as dyspnea, tachycardia, palpitations, nausea,... AM Page 18 18 Cardiovascular emergencies ➤ IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR REVIEW An implantable cardioverter-defibrillator (ICD) has a programmable pulse generator and lead system that... pumped to the brain or other vital organs Circulatory and respiratory collapse occurs and, without prompt treatment, death ensues ➤ Cardiac arrhythmias Cardiac arrhythmias, also called cardiac dysrhythmias,