The Case of Triage after a Disaster - Research Paper Example

Running Head: TRIAGE AFTER A DISASTER The Case of Triage after a Disaster Kern County follows a reverse triage pattern in disaster situations involving greater than 100 victims. Using this system, how would you triage the above victims? Lisa is in critical condition and requires urgent attention. Her blood pressure is extremely low and she is unconscious. She is still losing blood and her pupils are unresponsive and her condition may deteriorate to death. She should be the first person to be attended to. She needs critical attention in the intensive care unit. Jason’s condition is relatively stable compared to Lisa. However, his blood pressure is running low. He is still bleeding, and it is evident that he is experiencing arterial bleeding from the bright red colour of blood oozing from his bandaged wounds. He also needs critical care and should be the second person to attend to avoid losing too much blood. Jason should be assessed for injuries on internal organs as the lacerations on the chest are quite deep (Lee, 2010). Mr. Campbell is suffering from high blood pressure and needs urgent attention as he has already began experiencing respiratory distress and chest pain. Owing to his medical history of cardiac disease, it may turn out to be fatal in a short while. He should be the third person to attend to. It is important to help him restore his normal blood pressure. Jane needs further medical evaluation to determine her mental and physiological state. Her condition requires nursing diagnosis as it is not clear what she is suffering from but it is evident that she has a problem. She should the fourth patient to attend to. Blake is suffering from relatively mild conditions. He suffered a fractured leg that has already been stabilised. Painkillers can be administered to him to relief his discomfort. He will be the fifth person to attend to if there is no other acute case that will emerge as he can wait longer but not too long to cause him a lot of suffering (Koenig et al. 2006). 2. What physical assessment should be performed with Janet to get a clearer picture of her status? Physical assessment on Janet will begin with neurological evaluation considering factors such as changes in the consciousness level of the patient, anxiety, lethargy, confusion and incomprehension. It is also necessary to seek for the patient’s neurological health history to determine if she had previous experiences of anaesthesia and sensory disturbance among others. The intensity of these neurological aspects will be used to determine if there are functional disorders or indications of a medical problem. These assessments will help to understand if she is traumatised as a result of the disaster and the thought of ‘near death’ situation. If her condition is as a result of shock, she will be out of danger and it will be easy to resuscitate her. The somatic, emotional, and intellectual responses of the body are essential in understanding the condition of the nervous system. It is also important to assess the respiratory system for aspects such as dyspnea, hyperventilation and choking (Iserson & Moskop, 2007). Respiratory problems might also be as a result of the nervous system. The cardiovascular system of the patient should also be assessed for rapid, uneven or slow pulse rate. Other signs such as a slowdown of some or all body systems should also be observed. Gastrointestinal assessment reveals symptoms such as nausea and abdominal pains. Head or neck injuries are commonly characterised by nausea and vomiting. It can also signify shock or traumatic brain injury, neck injury, broken ribs and organ damage among other injuries that might have occurred in an accident but are not easily noticeable (Frykberg, 2002). 3. You notice that she is becoming more lethargic, and starts to vomit. You log roll her towards you and attempt to sweep the vomit from her mouth. She is unable to cough, what is your main concern at this point? Nursing diagnosis? The priority nursing diagnosis for Janet will be risk of injury. She might have sustained blunt stomach trauma, neck damage or broken ribs among other non-visible injuries when the bookshelf collapsed on her. It is important to perform ultrasonography concentrated on the abdomen due to the high risk of intra-abdominal haemorrhage (Noji, 2008). Janet is unable to cough when she vomits. This is an indication of chocking and her life is in danger as she may become unconscious in a short while. It is important to perform a ‘Heimlich Maneuver’ that involves holding her by the waist and placing one clamped fist directly above the navel and beneath the rib cage. This will be followed by grasping the clenched fist with the other hand and pulling it sharply and directly backwards and upwards beneath the rib cage several times swiftly until she is able to breath and cough (Holt, 2013). 4. As you are trying to help Janet by clearing her airway, you look up to see masses of kids and teachers coming toward the triage area. It is obvious that a new area of the school has been evacuated, and these are fresh victims from the demolished school. What are your actions at this point? The severity of injuries on the fresh victims that are approaching is unknown. It is important to prepare for a new round of reverse triage depending on the new conditions (Noji, 2008). However, Janet’s air way must be cleared before attending to any other patient. Leaving her in such a condition will only result in deterioration of her condition as new cases might generate greater tasks such that there may be no time to get back to Janet. After her normal breathing is restored, results on her risk of injury assessment will be analysed and the next cause of action determined. If the risk of injury is low, Blake’s leg should be plastered to ensure that his agony does not persist when new patients begin being attended to while he continues waiting. He might be affected psychologically and think that no one cares about him. If there are severe cases among the new arrivals that need to be attended to before Blake, he should be made to understand that it is not out of malice that the first priority is not accorded to him but rather to save the lives of his colleagues (Kahn et al. 2009). 5. You realize that your gloves are soiled, and you have blood and body fluids on your clothing. What is your appropriate next action? The most appropriate action is to change the clothes and gloves immediately. Soiled gloves, blood and body fluids on clothing is a recipe for disaster. They may result in hospital acquired infections by the nurse as well as transmission of diseases from one patient to another. It is important that each patient is handled with a clean pair of gloves to avoid exposing them to pathogens from other patients. The gloves should also be water proof to avoid contact between the nurse and the body fluids of patients. Blood and fluids on the clothing do not reflect hygiene and may cause anxiety among the patients. It is important to change the cloths to keep the nurse comfortable and focused on the patients (Maurer & Smith, 2013). References Frykberg, E.R. (2002), Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 53(2), 201-212. Holt, L. (2013), E. Coli and the Heimlich Maneuver: World Lighthouse Tour, New York NY: CreateSpace Independent Publishing Platform. Iserson, K.V, & Moskop, J.C. (2007), Triage in medicine, part I: concept, history, and types. Ann Emerg Med. 49(3), 275-281. Kahn, C. A., Schultz, C.H., Miller, K.T., & Anderson, C.L. (2009), Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 54(3), 424-430. Koenig, K.L., Cone, D.C., Burstein, J.L., & Camargo, C.A. (2006), Surging to the right standard of care. Acad Emerg Med. 13(2), 195-198. Lee, C. H. (2010), Disaster and Mass Casualty Triage, Ann Emerg Med. 12(6), 466-470. Maurer, F. A., & Smith, C.M. (2013). Community/Public Health Nursing Practice, 5th ed. New York, NY: Sounders. Noji, E.K. (2008), The Public Health Consequences of Disasters. New York, NY: Oxford University Press. Read More