Emergency Care in Nursing

Compiled By: Mr. Ashish Roy

1. EMERGENCY CARE IN NURSING COMPILED BY - Mr. Ashish Henjali Roy B.Sc Nursing(Nursing Tutor) Savitri Hospital And Paramedical Institute,Gorakhpur,UttarPradesh.

2. Definition Emergency care can be defined as the episodic and crisis-oriented care provided to patients with serious or potentially life-threatening injuries or illnesses.

3. Concept Of Emergency Nursing The term E mergency is used for those patients who require immediate action to prevent further deteriorations or stabilizing the condition till the availability of the services close to the patients.

4. Scope and Practice of Emergency Nursing Emergency management traditionally refers to urgent and critical care needs. The emergency nurse has special training, education, experience, and expertise in assessing and identifying health care problems in crisis situations. Nursing interventions are accomplished interdependently in consultation with or under the direction of a physician or nurse practitioner. The emergency room staff works as a team.

5. Principles of emergency Nursing Establish a patent airway and provide adequate ventilation. Control hemorrhage, prevent and manage shock. Maintain and restore effective circulation. Evaluate the neurological status of the client. Carry out a rapid initial and ongoing physical assessment. Start cardiac monitoring. Protect and clean wounds. Identify significant medical history and allergies. Document the findings in medical records.

6. Principles of Emergency management and emergency medical services Early detection Early reporting Early response Good on scene care Care during transportation Transport to definitive care

7. General principles of emergency medical care Triage :- Emergent, Urgent, Non-Urgent Primary survey using ABCD approach - Airway, Breathing, Circulation and Disability Secondary survey using EFGHI approach - Exposure to environment - Full set of vitals - Give comfort measures - Hemorrhage - Inspect the posterior surface

8. CONTD… Secondary survey using AMPLE approach - A llergy - M edication history - P ast health history - L ast meal - E vents/Environment preceding illness or injury

9. Priority Emergency Measures for All Patients Make safety the first priority Preplan to ensure security and a safe environment Closely observe patient and family members in the event that they respond to stress with physical violence Assess the patient and family for psychological function

10. Contd … Patient and family-focused interventions Relieve anxiety and provide a sense of security Allow family to stay with patient, if possible, to alleviate anxiety Provide explanations and information Provide additional interventions depending upon the stage of crisis

11. EMERGENCY ASSESSMENT A systematic approach to the assessment of an emergency patient is essential. Usually, the most dramatic injury is not the most serious. The primary and secondary surveys provide the emergency nurse with a methodical approach to help identify and prioritize patient needs. Primary Assessment- The initial, rapid, ABCD (airway, breathing, and circulation , as well as neurologic disability resulting from spinal cord or head injuries)

12. Secondary Assessment:- The secondary assessment is a brief, but thorough, systematic assessment designed to identify all injuries. The steps: Full set of vital signs/Five interventions/Facilitate family presence, and Give comfort measures. Full set of vital signs/five interventions/facilitate family presence: Obtain a full set of vital signs including blood pressure, heart rate, respiratory rate, and temperature. As stated previously, obtain blood pressure in both arms if chest trauma is suspected. Five interventions: Pulse oximetry to measure the oxygen saturation Indwelling urinary catheter (do not insert if you note blood at the meatus, blood in the scrotum, or if you suspect a pelvic fracture) Gastric tube (if there is evidence of facial fractures, insert the tube orally)

13. Contd … Laboratory studies frequently include type and cross matching, hemoglobin and hematocrit, urine drug screen, blood alcohol, electrolytes, prothrombin time (PT) and partial thromboplastic time, and pregnancy test if applicable Facilitate family presence: It is important to assess the family's needs. If any member of the family wishes to be present during the resuscitation, it is imperative to assign a staff member to that person to explain what is being done and offer support. Give comfort measures: These include verbal reassurances as well as pain management as appropriate. Do not forget to give comfort measures to the family during the resuscitation process .

14. Triage Triage (“to sort”) sorts patients by hierarchy based on the severity of health problems and the immediacy with which these problems must be treated Emergent, urgent, non-urgent. The triage nurse collects data and classifies the illnesses and injuries to ensure that the patients most in need of care do not needlessly wait. Protocols may be initiated in the triage area. Emergency triage differs from disaster triage in that patients who are the most critically ill receive the most resources, regardless of potential outcome.

15. Cont.… Triage Level I: Resuscitation Conditions requiring immediate nursing and physician assessment. Any delay in treatment is potentially life- or limb-threatening. Includes conditions such as: Airway compromise. Cardiac arrest. Severe shock. Cervical spine injury. Multisystem trauma. Altered level of consciousness (LOC) (unconsciousness).

16. Triage Level II: Emergent Conditions requiring nursing assessment and physician assessment within 15 minutes of arrival. Conditions include: Head injuries. Severe trauma. Lethargy or agitation. Conscious overdose. Severe allergic reaction. Chemical exposure to the eyes. Chest pain. Back pain

17. Cont.… GI bleed with unstable vital signs. Stroke with deficit. Severe asthma. Abdominal pain in patients older than age 50. Vomiting and diarrhea with dehydration. Fever in infants younger than 3 months. Acute psychotic episode Severe headache. Any pain greater than 7 on a scale of 10. Any sexual assault. Any neonate age 7 days or younger.

18. Triage Level III: Urgent Conditions requiring nursing and physician assessment within 30 minutes of arrival. Conditions include: Alert head injury with vomiting. Mild to moderate asthma. Moderate trauma. Abuse or neglect. GI bleed with stable vital signs. History of seizure, alert on arrival.

19. Cont.… Triage Level IV: Less Urgent Conditions requiring nursing and physician assessment within one hour. Conditions include: Alert head injury without vomiting. Minor trauma. Vomiting and diarrhea in patient older than age 2 without evidence of dehydration. Earache. Minor allergic reaction. Corneal foreign body. Chronic back pain.

20. Cont … Triage Level V: Non-urgent Conditions requiring nursing and physician assessment within two hours. Conditions include: Minor trauma, not acute. Sore throat. Minor symptoms. Chronic abdominal pain.

21. Common Emergencies # Airway- Obstruction:- Partial airway obstruction Complete airway obstruction Causes may include aspiration of foreign bodies or food, anaphylaxis, infection, trauma, sedative meds, neurologic dysfunction Management Establish an airway! Abdominal thrusts Head tilt, chin lift maneuver/jaw thrust maneuver (if cervical spin injury suspected) Oro-pharyngeal airway Endotracheal intubation Crico -thyroidectomy Maintain ventilation

22. Cont … # Hemorrhage:- Management Fluid replacement Blood, crystalloids, colloids If large volume rapid infusion, need to warm fluids to prevent hypothermia Control of external hemorrhage, via direct pressure; tourniquet used as a last resort Control of internal hemorrhage, usually via emergent surgery; administer PRBCs while awaiting surgery

23. Cont.… # . Trauma :- An unintentional or intentional wound or injury inflicted on the body from a mechanism against which the body cannot protect itself Collection of forensic evidence A critical role of the nurse! Documentation may be used in legal proceedings If criminal activity suspected, bag clothes and belongings and give to law enforcement; document the name of officer If suicide or homicide, must notify medical examiner Multiple trauma Priority managements

24. Cont.… # . Hypovolemic Shock:- Patent airway and ventilation Restoration of circulating fluid volume Central Venous Pressure Blood component therapy # . Wounds:- Restore physical integrity and function of injured tissue, with minimal scarring and without infection Wound cleansing Primary closure Delayed primary closure

25. Cont.… # . Intra- Abdominal Injuries:- Blunt trauma or penetrating injuries Abdominal trauma can cause massive life-threatening blood loss into abdominal cavity Assessment Obtain history Perform abdominal assessment and assess other body systems for injuries that frequently accompany abdominal injuries Assess for referred pain that may indicate spleen, liver, or intra-peritoneal injury Perform laboratory studies, CT scan, abdominal ultrasound and diagnostic peritoneal lavage Assess stab wound via ultra- sonography .

26. Cont.… Intra- abdominal injuries Ensure airway, breathing, and circulation Continually monitor the patient Document all wounds If viscera are protruding, cover with a sterile, moist saline dressing Hold oral fluids NG to aspirate stomach contents Provide tetanus and antibiotic prophylaxis Provide rapid transport to surgery if indicated

27. Cont.… # . Patient with Multiple Trauma:- Use a team approach Determine the extent of injuries and establish priorities of treatment Assume cervical spine injury Assign highest priority to injuries interfering with vital physiologic function

28. Patient with Multiple Trauma-

29. Cont.… # . Heat- Stroke:- A failure of heat regulating mechanisms Types Exertional : occurs in healthy individuals during exertion in extreme heat and humidity Hyperthermia: the result of inadequate heat loss Elderly, very young, ill, or debilitated—and persons on some medications—are at high risk Can cause death Manifestations: CNS dysfunction, elevated temperature, hot dry skin, tachypnea, hypotension, and tachycardia

30. Cont.… Heat- stroke Use ABCs and reduce temperature to 39° C as quickly as possible Cooling methods Cool sheets, towels, or sponging with cool water Apply ice to neck, groin, chest, and axillae Cooling blankets Iced lavage of the stomach or colon Immersion in cold water bath Monitor temperature, VS, ECG, CVP, LOC, urine output Use IVs to replace fluid losses Hyperthermia may recur in 3 to 4 hours; avoid hypothermia

31. Cont.… # . Psychiatric Emergencies:- Overactive , underactive, violent, and depressed or suicidal patients Management Maintain the safety of all persons and gain control of the situation Determine if the patient is at risk for injuring himself or others Maintain the person’s self-esteem while providing care Determine if the person has a psychiatric history or is currently under care to contact the therapist Crisis intervention Interventions specific to each of the conditions

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