EMERGENCY AND DISASTER Acute Coronary Syndrome nausea / dizziness (lightheadedness) squeezing pain in chest radiating to shoulders call

all for help , transport, ED, treatment 160-325 mg of uncoated aspirin before help arrive Assessment, care, hospital preparation AED automatic external defibrillator obtain 12 lead ECG O2 below 94% NTG: 3 doses w/ interval of 3-5 min Right Ventricular Infarction - presents as inferior wall STEMI - obtain R-sided lead if RV infarction present, NITRATES are contraindicated if RV infarction is suspected, use NITRATES w/ extreme caution 30 minutes of arrival FIBRINOLYTICS 50 minutes - XRAY STEMI patient Adjunctive treatments NTG infusion unfractionated/ low molecular wt. heparin B- blockers clopidogrel glycoprotein inhibitors PCI Percutaneous Coronary Intervention - helps re-establish blood flow to the heart - opens block artery - give INFORMED CONSENT before proc. EMERGENCY NURSING Deals with human responses to any trauma or sudden illness that requires intermediate intervention to prepare and prevent imminent, severe damage and death Care is provided in any setting to persons of all ages with actual and perceived alterations in physical and emotional health Initially, patients may not have a medical diagnosis Care is episodic when patients return frequency primary when it is initial option for help and health or preventive care and acute when patients needs Emergency Nursing is a specialty area of the nursing profession like no other. ENURSES must be ready to hear a wide variety of illness and injury situations, ranging from a sore throat to heart attack. Historical Development Florence Nightingale was the first emergency nurse, providing care to the wounded in the Crimean War. EDNA Emergency Department Nurses Association A competency based examination, first administered in 1980, provides certification in EN, certification is valid for 4 years EDNA developed standards of EN Practice, published in 1983 In 1985, Association name was changed into EN Association ( ENA) , recognizing the practice of EN as roles specific rather than site specific The hospital care by emergency medical services (EMS), emergency medical techniques/ technicians, and paramedics. All international phone number for emergency. ER expanded to ED ( Emergency Department)

TRIAGE
(French word = CLASSIFYING) Triage classifies emergency patients for assessment and treatment priorities. ( 150 seconds assessment) Triage decision: require gathering objective and subjective data rapidly and effectively to determine the type of priority situation present EMERGENT SIT Potentially life threatening, includes respiratory distress or arrest, cardiac arrest, severe chest pain, seizure, hemorrhage, severe trauma resulting in open chest and abdominal wounds, shock, poisoning, drug overdose, temp over 105 F (40C) emergency childbirth and delivery complications URGENT SIT Serious but not life threatening if treatment is obeyed briefly, they include such conditions as chest pain post respiratory distress, major procedures, burns, decrease level of consciousness, back injuries, nausea and vomiting, severe abdominal pain, temp bet 102-105 F (58.9-40C) bleeding from any orifice, acute panic and anxiety

NON EMERGENCY Not acute and are considered minor and moderately severe; includes chronic backache, other symptoms, moderate headache, minor burns, sprains, URTI, UTI, Dead on arrival patient

Types of Emergency
1. Acc. to DANGERS Medical emergencies Heart attacks, strokes, trauma Dangers to Health : emergencies that are not immediately tx. Natural disasters Tornadoes, hurricanes, floods, mudslides Danger to Property: Fire, Flood, Volcanic eruptions Dangers to Environment: Forest Fires, Marine oil spills 2. Acc. to CAUSE of BIOLOGICAL Ex Diseases as biologic agents that may be used to terrorism Anthrax, avian influenza, botulism, plague, small pox Chemical Ex: ammonia, chlorine, cyandies, newe agents, ricin Radiologic Ex: dirty bombs, potassium iodide Weather and Home Emergencies: Carbon Monoxide, Portable Power Generators, Cold weather, Hot weather, Hurricane, Lightning, Flood

Roles of Emergency Nurse

CARE PROVIDER Provides comprehensive direct care to the patient and family EDUCATOR Provides patient and family education based on their learning needs and allows the patient to assume more responsibility for meeting HC needs MANAGER Coordinates activities in the team to achieve the specific goal of emergency care ADVOCATE Ensures protection of the patients right

Functions of the Emergency Nurse

To determine priorities based on assessment and anticipation of the patients needs. Provides direct measures to resuscitate, if necessary Provides preliminary care before the patient is transferred to the primary care area Provides education Supervises patient

Legal Issues in Emergency

Negligence Malpractice Good Samaritan Law (these statures may protect private Citizens but usually do not apply to emergency personnel on duty or in Nursing Emergency situations) Informed Consent Implied Consent Duty to report suspected crimes to the police Duty to gather evidence in criminal investigation to be aware of hospital policy and state laws for evidence collection Advanced directives including durable power of attorney and living wills

Qualifications of ER Nurse
RN Undergo special education Exam and certified in emergency nursing Specialization ACLS, BLS; Burns