NUR 3552 DISASTER & EMERGENCY NURSING

EMERGENCY CARE

DEFINITION
EMERGENCY A sudden and unexpected occurrence which requires urgent attention. Emergency is a sudden and unexpected happening that makes it necessary to act quickly especially in saving a persons life during being in critical condition

EMERGENCY CARE Delivery of urgent treatment, either as a temporary measure until full investigation and treatment is practical, or as a lifesaving measure. Medical or other health treatment, services, products or accomodations provided to an injured or ill person for a sudden onset of a medical condition of such nature that failure to render immediate care would reasonably result in deterioration of the injured person's medical condition

The emergency department (ED) is an area of the hospital that is truly different each and every day and can quickly shift from the quietest to the most hectic department in the hospital in literally a matter of minutes. The types of patients that come to the emergency department for care as well as the numbers of patients that show up in hospital emergency departments often depend on things

EMERGENCY NURSING

ED nurses can expect to care for patients of all ages; heart attack, stroke, and asthma victims; and the occasional pregnant woman whose delivery is progressing faster than she anticipated. Emergency room nurses arent limited to working in hospitals. Nurses with experience in emergency nursing might be found in EMS and pre-hospital transport, flight nursing in medical transport helicopters, the military, poison control centers, administrative and managerial positions, educators in

Emergency care nursing sounds exciting, ED nurse should have.

Good listening, interpersonal and customer service skills? The ability to think and act decisively on your feet? The ability to perform many tasks simultaneously? Stamina?

The ability to shift gears, refocus and reprioritize quickly? Good coping skills? The ability to remain calm in tense, highly stressful situations? A sense of humor (laughter is a great way to deal with difficult situations)?

EMERGENCY NURSE
Background Emergency nurses specialize in rapid assessment and treatment when every second counts, particularly during the initial phase of acute illness and trauma. Emergency nurses must tackle diverse tasks with professionalism, efficiency, and above allcaring. Emergency nursing is a specialty area of the nursing profession like no other. To provide quality patient care for people of all ages, emergency nurses must possess both general and specific knowledge about health care to provide

ED NURSES ROLES
Patient Care - Emergency nurses care for patients and families in hospital emergency departments, ambulances, helicopters, urgent care centers, cruise ships, sports arenas, industry, government, and anywhere someone may have a medical emergency or where medical advances or injury prevention is a concern.

 Education - Emergency nurses provide education to the public through programs to promote wellness and prevent injuries, such as alcohol awareness, child passenger safety, gun safety, bicycle and helmet safety, and domestic violence prevention. Leadership and Research - Emergency nurses also may work as administrators, managers, and researchers who work to improve emergency health care.

PRIMARY SURVEY
Focuses on airway, breathing, circulation and disability and serves to identify life threatening conditions so that appropriate interventions could be initiated

The primary survey is a process carried out to detect and treatlifethreatening conditions. As these conditions are detected, lifesaving measures are taken immediately, and early transport may be initiated. The primary survey is a treat-asyou-go process. As each major problem is detected, it is treated immediately, before moving on to the next. Duringtheprimary survey, should

A status decision is a judgment about the severity of the patients condition and whether the patient requires immediate transport to a medical facility without a secondary survey at the scene. Ideally, the ABCDE steps, status, and transport decision should be completed within 10 minutes of your arrival on the scene.

A=Airway - An obstructed airway may quickly lead to respiratory arrest and death - Assess responsiveness and, if necessary, open the airway B=Breathing - Respiratory arrest will quickly lead to cardiac arrest - Assess breathing and if necessary, provide rescue breathing. - Look for and treat conditions that may compromise breathing, such as penetrating trauma to the chest

AIRWAY
Airway with cervical spine stabilization and /or immobilization Airway obstruction of saliva, bloody secretions, vomitus, sputum, laryngeal trauma, facial trauma, fractures, and the tongue. __________________________________ __________________________________ Primary signs and symptoms Dyspnea, inability to vocalize, in patient with a compromised presence of foreign body in airway the airway, and trauma to the face or neck. __________________________________ __________________________________ Treatment a)Opening the airway using the jawthrust maneuver (avoiding hyperextension of the neck). b)Suctioning and removal of foreign body. c)Endotracheal intubation (ETT).

BREATHING
Breathing to ensure adequate Breathing alterations are ventilation to the upper and caused by many conditions lower airway such as fractured ribs, pneumothorax, penetrating injury, allergic reaction, pulmonary emboli, and asthma __________________________________ attack. Patients with these conditions __________________________________ may experience a variety of Dyspnea (due to pulmonary signs and symptoms emboli), paradoxic or asymmetric chest wall movement (flail chest), decreased or absent breath sounds on the affected site __________________________________ (pneumothorax), visible wound Treatment to chest wall (penetrating injury), cyanosis (due to asthma), tachycardia and hypotension. __________________________________

C=Circulation Ifthepatientshearthasstopp ed, bloodand oxygenarenotbeingsent tothebrain. - Irreversiblechanges willbegintooccurinthe brainin4to 6minutes;celldeathwillusuall y occurwithin10minutes. - Assess circulation andifnecessary, provide CPR

CIRCULATION
Circulation is to ensure an effective Uncontrolled internal or external circulatory system including the bleeding places a person at risk for heart, intact blood vessels, and hemorrhagic shock. adequate blood volume __________________________________ __________________________________ Sign and symptoms should be A central pulse (carotid) and assessed for circulation peripheral pulses should be palpated, assess skin for color, temperature and moisture, delayed capillary refill (longer than 3 seconds) and mental status are the __________________________________ most significant signs of shock. Intervention __________________________________ Intravenous lines are inserted into veins in a massive fracture or an injury that affects limb circulation. Blood samples are obtained to determine ABO and Rh group. Typespecific packed red blood cells should be administered if needed. In an emergency situation, uncrossmatched blood may be

D=Disability - Serious centralnervoussystem injuriescan lead todeath - Assessthe patientslevelofconsciousness and, ifyoususpectaheadorneckinj ury, applyarigidneckcollar - Observe

DISABILITY
Disability is indicated with a brief neurologic examination (is measured by the patients level of consciousness) __________________________________ A simple mnemonic to remember Determining the patients response to verbal and/or painful stimuli to assess the level of consciousness. __________________________________ A : Alert V : Responsive to Voice P : Responsive to Pain U : Unresponsive __________________________________ Glasgow Coma Scale (GCS) is used to further assess the patients consciousness. Pupils should also be assessed for size, shape, equality and response to light.

__________________________________ Intervention

E= Expose Youcannottreatconditionsyouha ve not discovered.Removeclothing especiallyif thepatient isnotalertor communicatingor anylifethreatening injuries. - Protectthepatients privacyandkeepthe

SECONDARY SURVEY
After each step of the primary survey is addressed and any lifesaving interventions are initiated, the secondary survey begins. The secondary survey is a brief, systematic process that is aimed at identifying all injuries.

When the primary survey is completed, resuscitation efforts are well established, and the vital signs are normalizing, the secondary survey can begin. The secondary survey is a head-to-toe evaluation of the trauma patient, including a complete history and physical examination, including the reassessment of all vital signs. Each region of the body must be fully examined. X-rays indicated by examination are obtained. If at any time during the secondary

PARAMETER Exposure and Environment Control Full Set of Vital Signs Five Interventions

ASSESSMENT Remove clothing for adequate examination. Keep patient warm with blankets, warmed IV fluids, overhead lights. Obtain vital signs: temperature, BP, respiratory rate, HR. Heart rhythm, 0 saturation, insertion of urinary catheter, insertion of gastric tube, blood for laboratory test. Determine family's desire to be present during invasive procedures or cardiopulmonary resuscitation. Detail of the incidence, medication history, allergies, note general appearances (head, neck, face), chest (observe rate, depth, breathing pattern, breathing sound, obtain ECG), abdomen and flanks (sign of injury, bruising, bleeding, abrasions, lacerations, punctures, abdomen distention, assess for bowel sounds), pelvis and perineum (assess genitalia for blood, ecchymosis, rectal bleeding, etc), extremities (sign of external

Facilitate Family Presence

Give Comfort Measures Level of pain, anxiety. History and HeadtoToe Assessment

PLANNING
Emergency Care Planning Definition: A process that includes all activities, tools and policies/procedures used to assist clinicians during attending patients on what actions to take if a medical problem or change in condition occurs An emergency care plan ensures that you have a back up plan in place if you are suddenly unable to provide care. An emergency care plan ensures there is written documentation nominating who provides care, how to provide care and

NURSING ACTIONS
Giving care to patient Emergency nurses care for patients & families anywhere, to someone who have a medical emergency or where medical advances or injury prevention is a concern. Provide education Emergency nurses provide education to the public through programs to promote wellness and prevent injuries, such as alcohol awareness, child

 Involved in leadership and research Emergency nurses also may work as administrators, managers, and researchers who work to improve emergency health care.

Documentation in Emergency Department (ED) is important, as it improves patient care and providing effective risk management Proper Emergency Nursing Documentation is essential for continuity of care, patient safety and for hospital ED reimbursement, by determining and documenting the ED level of care. ED Nursing Documentation teaches the critical patient documentation skills which are necessary from a clinical,

DOCUMENTATION

This is divided between good clinical care and proper nurse documentation It also emphasizes the importance of good nursing documentation for patient care, risk management and proper facility reimbursement