Nclex Review

Front 1

What is meant by Internal Disaster?

Back 1

when the buildings actually started emploding [collapsing upon themselves] killing and/or trapping thousands of people inside.

Front 2

What do you do? You are the head of the INTERNAL DISASTER MANAGEMENT TEAM.

Back 2

help the people that are least hurt first. The reason being, so that they can possible help you, with the other survivors or you have very little time and you know you can move the victim and they have a chance to survive. In an INTERNAL DISASTER help and survival are KEY.

Front 3

EXTERNAL DISASTER

Back 3

is a disaster away from a medical center and it is "man made". [ie: Plan crash, train wreck or casualties of war].

Front 4

NATURAL DISASTER

Back 4

say the San Diago Bridge collapses or there is a giant volcano ect. Still use the same rule as in the 2001 ect above. Help the people off the bridge [the least wounded] before the bridge collapses. The goal here is to save lives. You can not do anything about the people whose cars have already fallen into the ocean or for the people to whom the fire has already engulfed.

Front 5

T-R-I-A-G-E.

Back 5

Trauma, R=respiratory, Intracranial pressure & mental status, An infection, GI-upper, Elimination-lower.

Front 6

METTAG SYSTEM

Back 6

• Green is the lowest priority and is used for walking wounded or
patients who may not need to go to the hospital. Patients in this
category may have minor musculoskeletal or soft tissue injures. They
can wait for treatment and/or transport until all other patients have
been removed from the scene.
• Moving up the tag, yellow is the next category and is used for
patients who definitely need to go to a hospital, but not
immediately. These patients have injuries that are serious but not
life-threatening, such as burns without airway problems, major or
multiple bone or joint injuries, and back injuries without spinal
cord damage. These patients will be treated and transported after the
critical (or red-tagged) patients have been taken to trauma centers
or hospitals.
• The highest priority is red, and it is used for critically-injured patients with treatable life-threatening injuries or illnesses. This
might include airway and breathing difficulties, decreased mental
status, and uncontrolled bleeding. These patients will be treated and
transported from the scene first.
• The final category is black and it is used for dead and
unsalvageable patients such as someone in cardiac arrest. These
victims will be removed from the scene, but only after all of the
living/salvageable patients.

Front 7

How to start categorizing disaster victims?

Back 7

The first (and easiest) thing you must do is separate the walking
wounded from the other victims with more severe injuries. This can be
done by shouting slowly and clearly or using a bullhorn. Designate an
area for walking wounded and instruct anyone who can walk to get up
and move to that area. (Note: Some victims may be unwilling to leave
their friends or family members who are ill or injured; permit them
to stay as they can help you with managing the patient.) The theory
here is that if a person can walk, he does not need immediate medical
care. Green-tagged patients will not be ignored. Rather, they will be
further assessed and treated when all of the red and yellow patients
have been treated and/or transported and resources become available
to take care of them.

Front 8

R = Respirations

Back 8

The first assessment is for presence and rate of respiration (RPM).
If the rate is above 30
breaths-per-minute, the patient is critical and requires immediate
care. (Remember from your EMT-B class that a respiratory rate above
30 and below eight breaths-per-minute (BPM) is not adequate to meet
the body's needs and may quickly progress to cellular death.)
If the patient requires simple airway maintenance (e.g. manual head
positioning), you will need to assign someone to this task. If no
emergency service personnel are available, remember that you have a
pool of human resources in the green tag area. If no one there is
available, you will need to improvise by placing something under the
patient's head/neck to keep the airway open.

Front 9

P = Perfusion

Back 9

The next step is to assess for Perfusion (RPM). As you may remember
from your EMT-B course or core refresher, perfusion is the
circulation of blood within an organ or tissue in adequate amounts to
meet the cells' current needs. If the body lacks adequate
perfusion
or circulation, cells, tissues, and organs will die.
Check for the
presence of radial pulses.
If the patient has no radial pulses,
he is critical and in immediate need of care.
the presence of a radial pulse correlates to a systolic
blood pressure of at least 80 to 90 mmHg.

Front 10

M = Mentation

Back 10

The third and final assessment is for Mentation (RPM) or mental
status. A patient who is either unconscious, or conscious but unable
to follow directions, is critical and requires immediate care.

Front 11

green tag

Back 11

Anyone who gets up and walks to the designated area
(may not even require hospital care)

Front 12

black tag

Back 12

Anyone who is not breathing
(dead/non-
salvageable)

Front 13

red tag

Back 13

Anyone who fails one of the RPM assessments
(critical/immediate).

Front 14

yellow tag

Back 14

Anyone who cannot walk but passes all of the assessments
(delayed).

Front 15

In an INTERNAL DISASTER help and survival are KEY.
How does this differ from a disaster from which they are now coming to your hospital?

Back 15

Once they are at their destination of medical care, the gear shifts, you help the more tramatized patient first to ensure their chances of survival.