emergency nursing (management in emergency) ppt

complete information about the emergency care provided to the
patients, in emergency ward, after accident, in life and death condition this contain definition, process, system nursing management, medical management, research.

1. Emergency nursing
Submitted to –Mrs Mamtatoppo
subject coordinator
medical surgical nursing
Submitted By –Nushratpraveen
Roll no –16
3
rd
year basic Bscnursing
college of nursing rims ranchi

2. Contents
Introduction
Definition
Principles of emergency nursing
Concepts of emergency nursing
Ethical aspect of emergency nursing
Role of emergency nurse
Emergency trolley
Triage
Some of emergency event and its management
Emergency drugs
Summary
Research work done
Reference
Bibliography

3. Introduction
Emergency nursing is a specialty within
the field of professional nursing focusing
on care of patients who requires prompt
medical attention to avoid long term
disability or death.

4. Definition
Nursing emergency is nursing speciality in
which nurses care for patients in the
emergency or critical phase of the illness
and injury .

5. Principles of emergency
nursing
Establish a patent airway and provide adequate
ventilation
Control heamorrhageprevent and manage
shock.
Maintain and restore effective circulation .
Evaluate the neurological status of the client .
Carry out rapid initial and on going physical
assesssment.
Start cardiac monitoring
Protect and clean wounds
Identify significant medical history and allergies
Documents the findings in medical records .

6. Concept
The term emergency nursing is used for
those patients who require immediate
action to prevent further detoriationsor
stabilizing the condition till the availability
of the services close to the patients.
The nurse as a team member plays a
significant role in the early asssessment,
intervention either in the form of care or
transferring the patient safely to the
health services

7. Ethical aspects of emergency
nursing
Ethics are involved as the boundary of what is acceptable
and what is not yet acceptable .five key of ethical principle
are
Respect for individual –the need to ensure confidentiality
and privacy
Respect for the autonomy of the individual –the need to
ensure appropriate consent is given by the patient or
relatives.
Beneficence / nonmalfeasance–the need to ensure that
division regarding treatment for individual patient are
designed to be of benefit to the patient not merely to
avoid harm
Honesty –individual patient and family are given honest
information regarding progress and prognosis
Justice –equity of access rather than post code services

8. ROLE OF EMERGENCY NURSE
Role of emergency nurse involves
Accept without prior warning any person requiring
health care with undifferentiated and undiagnosed
problem originated from social psychological
,spiritual or cultural factors .
Leads , initiates and coordinates patient care
Rapid patient assementand assimilation of
information often beyond the presenting problem .
Allocation of priority for care .
Intervention based on the assessment
Ongoingevaluation
Discharge or referral to other sources of care
undertaken independently by the nurse within
guideline

9. Emergency trolley

10. Emergency trolley
A crash card or code card is a set of trays /drawers /shelves on
wheels used in hospitals for transportation and dispensing of
emergency medication / equipment at site of medical surgical
emergency for life support protocols to potentially save someone’s
life.
This are the drugs and equipment present in the trolley
Monitor / defibrillators , suction devices, and bag valve masks of
different size
Advanced cardiac support drugs such as epinephrine , atropine ,
amiodarone, lidocaine, sodium bicarbonate , dopamine ,and
vasopressin
First line drugs for treatment of common problem such as
adenosine , dextrose , diazepam or midazolam , naloxone ,
nitroglycerinand other .
Drugs for rapid sequence intubation
Succinylcholine or another paralytic and a sedative such as
etomidateor midazolam endotracheal tube and other intubation
equipments
Drugs for central and peripheral assess

11. Triage ( category of severity )
Triage
Black
Expectant
Green
Wait
Yellow
observation
Red
Immediate

12. Definition
It is the process by which patient is classified according to
the type and urgency of their condition to get the right
patient to right place at right time with the right case
provider .
Goal of triage
Early patient assessment
Priority rating
Assignment of correct area of case and infection control
Control of patient flow
Initiation of diagnostic measure
Initiation of emergency care
Patient education

13. BLACK /EXPECTANT
Last priority –Dead person
RED / IMMEDIATE
First priority –cannot wait
YELLOW / OBSERVATIO
Second priority
There condition is stable for the movement but need
observation
green / wait
Third priority
Need observation of doctors
white / dismiss
Forth priorty
Needs no observation

14. Triage system
Standardized five level triage system is as follow
TRIAGE LEVEL 1 –immediately life threating or
resuscitation egmultisystem trauma altered level of
consciousness eclampsia
TRIAGE LEVEL 2-Imminently life threating or emergent
eghead injury , severe trauma , lethargy , or
agitation
TRIAGE LEVEL 3 –potentially life threatening time
critical or urgent egalert head injury with vomiting ,
mild to moderate asthma , gastrointestinal bleeding .
TRIAGE LEVEL 4 –potentially /situational urgency or
semi –urgent egalert head injury with vomiting ,
minor truamadehydration , minor alergicreaction .
TRIAGE LEVEL 5 –less /nonurgentegminor trauma ,
not acute , sore throat , chronic abdominal pain .

15. Some of the emergency event
Trauma
shock
Injected poisoning
Snake bite
Clinical burn
Heat stroke
Asphyxia
Hanging
strangulation

16. TRAUMA
It refers to ‘’a body wound or shock
produced by sudden physical injury , as
from violence or accident
It can also describe as ‘’a physical wound
or injury , such as a fracture or blow

17. Classification
Poly trauma
Head trauma
Chest trauma
Surface trauma
Abdominal trauma
Facial trauma
Spinal cord trauma
Blunt trauma
Penetrating trauma

18. Abdominal trauma
Penetrating abdominal trauma causes an
open wound , such as from the gunshot or
stabbing . The solid organs can bleed
profusely when injured .the hollow organ
generally don’t bleed significantly and are
likely to cause peritonitis damage
Blunt abdominal trauma –a force to the
abdominal that doesn’t leave an open
wound ,commonly occurs with motor
vehicle crashes or falls . Compression is a
example

19. Clinical findings
Catheterization and urine analysis , serial
hemoglobinand hematocrit.
CBC serum analysis ,
CT scan Chest and abdominal X-ray
FAST –for blunt abdominal trauma .

20. Management
Immobilize body part and keep the patient on
supine position with adequate cervical
stabilization .
Observe signs of fracture –pain , swelling ,
tenderness , ecchymosis ,crepitation
Cover open fracture with sterile dressing to
prevent infection
Immobilize any suspected fractures by splinting the
joint above and below the injury
perform neurovascular check of area distal to
fracture

21. Nurse role in case of patient
with trauma / injury
Primary assessment and resuscitation
ABC
Examine for swelling , deformities neck
wounds
deviation of trachea of one side
Assess airway
check airway and assess breathing
If respiration is absent , start artificial
respiration

22. Give oxygen via non –rebreathe mask with oxygen
open chest wound,flail chest etc
penetrating object should be left in position
a filial segment should be stabilized
Circulation case with haemorrhage
control
look for the major bleeding
check for the sign of shock
management
keep the patient flat
keep warm and resource
commence intravenous(IV) fluid

23. DISABILITY
briefly assess patients neurological status
A: Alert, V: Respond to verbal command
R: Respond to pain, U : Irresponsible
assess public response
maintain patient warmness and the environment
hypothermia may lead to shock.

24. SHOCK
Shock is an abnormal physiological state where an
imbalance between the circulating blood volume
and the size of the vascular bed results in
circulatory failure and oxygen and nutrient
deprivation of tissue
Classification
hypovolemic shock
Cardiogenic shock
Septic shock
Neurological shock
Anaphylactic shock

25. Sign and symptoms
Skin
Symptoms and sign of hypovolemic
shock(pale , cool and moist skin ) and
cardiogenic shock
warm , dry ,pink in septic shock and
neurological shock .
Pulse-trachycardia, weak and thread
Respiration –rapid and shallow due to tissue
anorexia and excessive amount of CO2
Alert level of consciousness , restlessness , and
apprehensive

26. MANAGEMENT
MEDICAL MANAGEMENT
Fluid and electrolyte balance
Antibiotic treatment-for treating septic shock
Inotropic agent –to improve cardiac output eg
dopamine and dobutamine
Norepinephrine –to improve cardiac output
Corticosteroid –to treat septic shock , it will
protect all membranes and decrease the
inflammatory response

27. Nursing management
Maintain patent airway and adequate ventilation
Establish and maintain airway
Administer oxygen as order
Monitor respiratory status as ordered
Promote restoration of blood volume
Administering blood and fluid
Crystalloid solution are preferred normal saline and
ringes lactate
Blood product –whole blood or packed red blood
cell , fresh frozen plasma
administer drug as ordered

28. Minimizes factors contributing shock
Elevate lower extremities to 45 to promote venous return
Avoid trendelenburgsposition , it will increase respiratory
impairment
Promote rest by using energy conservation measure
Relief pain by administering analgesics
Maintain continuous assessment of the
patient
Check vitals frequently ,monitor urine output
Obscene colorand temperature of skin
Monitor central venous return and
electrocardiogram
Monitor cardiac parameters –arterial blood pressure
,pulmonary artery pressure , pulmonary artery wedge
pressure cardiac output.

29. Injected poisoning
Insect bite or stings
Sting do not usually attack and unless
they are provoked . Insect bite are
puncture wounds caused by insects.
Insects release saliva that can cause
inflammation , blisters and irritation on skin
.

30. Types
Horse flies –it is very painful , symptoms includes urticaria, weals,
dizziness , weakness ,.
Bedbugs
Not usually painful
May develop intense irritation wealsor lumps.
Blandfordfly
Usually painfully
produresever localized reaction edema, blistering and high
temprature.
Ticks
Not usually painful
Cause swelling , itching , blistering and bruising
Mito
Very itchy lumps appear on the skin , blisters

31. Treatment
Local application of cold compress
Wash with soap and water
apply ointment locally
antihistamines to reduce itching
Analgesic if pain is severe
Observer for anaphylactic reaction

32. SNAKE BITE
Snake bite is a common problem in rural area of
India , common snake seen in India are . Vipers ,
russellsviper , saw –scaled viper , cobra .
Clinical feature
Local symptoms
Two clear cut fang marks
Pain and swelling
Painful regional lymph node
Nausea vomiting ,headache , fainting , and
abdominal pain
Paralysis , respiratory failure , arrhythmias .

33. Management
Pre hospital management
All patient with suspected envenomation should be
observed for upto12 hours
Immobilize the bitten area or limb.
Hospital management
Gather information
do quick assessment for local reaction and systemic
reaction .
Create IV access and start IV fluid administration
Send blood for investigation
Monitoring vital signs, cardiac rhythm, and neurology
function

34. Supportive therapy
Analgesic to reduce pain
Ttprophylaxis
Respiratory support
antibiotics
Aspirin should not be used
Specific measure
Anti snake venom
Anticholinesterase –to manage neuoroparalytic
symptoms ( neostigmine 50 -100g /kg )
Furosemide to manage acute renal failure

35. Clinical Burn
Strong chemicals can burn skin on contact .
Sometimes burns develop slowly .acid alkalis , liquids
and solids can cause burns
Acid substances cause coagulation necrosis and
alkali produce liquefaction necrosis .
FIRST AID MEASURE
Move victim to avoid fumes
Brush off dry chemical from skin
Remove clothing and jewelryfrom burn area while
flushing water
Flush entire area quickly with large amount of running
water .
If eye is exposed , wash with water and tilt victim head .

36. Management
Hospital care
IV fluids to maintain hydration
Analgesic /narcotics to reduce pain
Silver sulfadiazine
Use of decontaminants to minimise their
caustic effect
Observe affected area for deep injury
and extending tissue necrosis .
Monitor for complication

37. Heat stroke
Heat stroke is an emergency condition
where the body ‘s core temperature is
markedly elevated (104’f and 40’c) in
adults after being expose to high
temperature combined with neurological
symptoms and loss of body thermal
autoregulation.

38. Sign and symptoms
Muscle cramps , exhaustion and profuse
sweating
Tachycardia , tachypnea, headache
Hot and dry skin
Confusion hallucination ,and seizure .
Coma and death .

39. Management
Rapid cooling by spraying cool water and by
covering them with cold water shocked sheets
Additional cooling by placing ice pack under
armpit , head , neck , groin area .
Initiation of IV access and administration of fluids
If patient is conscious administer fluid orally .
Monitor vital sign and urine output
Administer calcium carbonate if muscular cramps
are severe
Constantly observe the client for neurological and
internal complication.

40. asphyxia
Near drowning
Drowning is an unexpected submersion
injury in which a previous healthy person
are exposed to sever cerebral hypoxia ,
aspiration , academia and suffers
permanent brain damage

41. Clinical feature
Semiconscious and unconscious
Awake , restless apprehension .
Headache , vomiting , cough , dyspnea
Chest pain
Hypoxia , hypercapniaand metabolic
acidosis
Usually client recover within 48 to 72 hours

42. management
Frist aid
Retrieve or remove the victim from the
water and stabilize his her neck
Maintain ABC
If the patient is unconscious keep the oral
cavity patent to intubate
Remove any foreign material present on
face and mouth .

43. Hospital management
Establish IV access , administer IV fluid
Establish patient airway intubate if
needed
Collect sample to check ABG value
Provide blanket to manage hypoxia
administer supplement oxygen .

44. Hanging and strangulation
Hanging –hanging is a form of asphyxia
produce by suspension of the body by a
ligature around the neck which constrict
the neck by the weight of the body .
Strangulation is also a form of asphyxia
similar to hanging cause by constriction of
neck by ligature without suspending the
body .

45. Clinical feature
Ligature marked around the neck
Presence of abrasions, ecchymosis , and
redness around the ligation mark
Dribbling or drooling of saliva
Sign of asphaxia

46. Management
Pre hospital
cut down the ligation and remove it
Make the patient flat and cervical spine supported
Loosen all cloths
If the person is unresponsive call for help.
In hospital
Administer o2
Administer IV fluid
Insert ET tube and provide ambubag support to maintain
respiration.
Apply sucking intermittently to remove secretion
Monitor vital sign and respiratory distress
Administer mannitolto reduce ICP .
Complete medico legal formalities .


47. EMERGENCY DRUGS
DRUG DOSE
Fentanyl(50 mcg /ml ),
analgesic , sedative
anesthesia
1mcg /kg
Hydralazine(20 mg /ml
)hypertension by
vasodilation
0.1 to 0.5mg/kg
Lorazepam(2 mg /ml )
sedation seizures
0.05 0.1 mg /kg
Morphine(1mg /ml ), pain
sedation
0.050.1 mg /kg

48. RESEARCH WORK

53. Summary
Emergency nursing is the specialty within the
field of professional nursing focuses on the
care of patient who requires prompt medical
attention to avoid long term disability and
death . the principle of emergency nursing ,
ethical aspect of emergency nursing I,e
respect for individual , respect for autonomy ,
honesty and justices . triage and and
categorising the disease on the basis of
severity . Some of common events and its
management .

54. Evaluation
Define the term emergency nursing
What is triage?
What are the classification of triage?
What are the basic nursing procedure which
perform in emergency ward?
What is trauma ?
What are management of trauma
What is the difference between hanging and
strangulation
What the instant drug used in snake bite ?

55. Reference
Book
Internet
Discussion with teacher

56. Bibliography
Javedansari‘’a text book of medical
surgical nursing 2 ‘’PV
publication page 305 to 307
BT Basavan‘’Textbook of medical surgical
nursing ‘’ third edition , jaypee
publication page no 765 to 768
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