EMERGENCY NURSING What is Emergency?

A situation, often dangerous, which arises suddenly and calls for prompt action TRIAGE I Emergent Highest priority Life threatening conditions ust !e treated immediately Airway compromise "ardiac arrest #hoc$ #tro$e a%or &urns II Urgent Threatening conditions 'ot immediate ust !e seen within ( hour )e*er inor &urns Lacerations III Non-urgent "an !e addressed within +, hours "hronic conditions -ental pro!lems issed enses A Triage Tag is a .uic$ and easy way to communicate a patients priority to others "olor/coded flagging tape can !e used to mar$ patients in a triage situation #I 0LE TRIAGE BLACK / EXPECTANT #e*erely in%ured They will die of their in%uries, possi!ly hours or days E1ample2 Large/!ody !urns #e*ere trauma Lethal radiation dose "ardiac arrest #hoc$ They should !e ta$en in the holding area and gi*en pain$illers to ease their passing RED/ IMMEDIATE )irst priority "annot wait !ut are li$ely to sur*i*e with immediate treatment Re.uire immediate surgery3 life sa*ing measures E1amples2 Airway o!struction -rowning

assi*e e1ternal !leeding

YELLOW/ OBSER ATION "ondition is sta!le for the moment Re.uires watching of a trained persons 'eeds fre.uent re/triage, will need hospital care would recei*e immediate priority care under 4normal4 circumstances E1amples2 5pen chest wound 6 w3o respiratory distress7 A!dominal wounds 6 w3o shoc$7

GREEN! WAIT Re.uires a doctor8s care in se*eral hours or days !ut not immediately ay wait for a num!er of hours or !e told to go home and come !ac$ the ne1t day 6e9g !ro$en !ones without compound fractures, many soft tissue in%uries79

W"ITE/ DISMISS #WALKING WOUNDED$ Ha*e minor in%uries: first aid and home care are sufficient A doctor8s care is not re.uired In%uries are along the lines of cuts and scrapes, or minor !urns9

AD ANCED TRIAGE -octors may decide that some seriously in%ured people should not recei*e ad*anced care !ecause they are unli$ely to sur*i*e Ad*anced care will !e used on patients with less se*ere in%uries9 &ecause treatment is intentionally withheld from patients with certain in%uries9 ;sed to di*ert scarce resources away from patients with little chance of sur*i*al in order to increase the chances of sur*i*al of others who are more li$ely to sur*i*e RE ERSE TRIAGE Less wounded are treated in preference to the more se*erely wounded9 E<A 0LE2 -uring war When significant num!er of personnel8s are affected

COMMON EMERGENCY CONDITIONS AIR WAY OBSTRUCTION Life/threatening medical emergency9 Airway may !e partially or completely occluded9 If the airway is completely o!structed, permanent !rain damage or death will occur within = to > minutes secondary to hypo1ia CAUSES% Aspiration of foreign !odies Anaphyla1is ?iral or !acterial infection

 Trauma Inhalation or chemical !urns

ASSESSMENT% "ho$ing 0atient may clutch the nec$ !etween the thum! and fingers 6 universal distress signal ). Apprehensi*e appearance Inspiratory and e1piratory stridor La!ored !reathing, ;se of accessory muscles 6suprasternal and intercostal retraction7, )laring nostrils Increasing an1iety, restlessness, and confusion9 "yanosis and loss of consciousness DIAGNOSTIC &INDINGS% As$ the patient if she is cho$ing If the person is unconscious, inspection of the oropharyn1 may re*eal the offending o!%ect9 </rays, Laryngoscopy, &ronchoscopy MANAGEMENT% 0erform heimlich maneu*er Encourage to cough forcefully 6 if partial o!struction7 0erform finger sweep 6 if unconscious lying7 Esta!lishing an airway !y2 Head/tilt/chin lift maneu*er 6 if cer*ical spine is not in%ured7 @aw/thrust maneu*er 6 if nec$ in%ury suspected7 Endotracheal intu!ations "rycothyroidotomy

HEA-/TILT/"HI' LI)T @AW/THR;#T A'E;?ER !e sure to assess *ictimAs pulse B respirations: perform "0R if re.uired

BLEEDING Estimated !lood loss se*erity in2 A-;LT2 (CCCcc "HIL-RE'2 >CCcc I')A'T2 (CC/+CC cc of !lood T'(e) o* B+ee,-ng Arter-.+ /+ee,-ng 0 /r-g1t re,! )(urt-ng enou) /+ee,-ng 0 ,.r2 (ur(+-)1//+u-)1! )te.,' *+o3 C.(-++.r' /+ee,-ng - ,.r2 re,! oo4-ng M.n.gement o* /+ee,-ng

D-re5t (re))ure E+e6.t-on Pre))ure (o-nt) #)u((+'-ng .rter'$ S(+-nt) #-mmo/-+-4.t-on$ Con)tr-5t-ng /.n,) #e7ert) (re))ure to (ro6-,e .n e7tr. me.)ure o* /+ee,-ng 5ontro+$ Tourn-8uet) 0 +.)t re)ort 31en .++ reme,-e) 1.6e *.-+e,9

POISONING 0oison is any su!stance that enters the !ody and causes in%ury and death9 It can !e in a form of li.uid, solid, gas3 fumes #WAL5WE- 05I#5'# #trong acids #trong al$ali 0etroleum 5*erdose of medicines M.n.gement "hec$ airway, *entilation and o1ygenation 0lace patient on the left side onitor E"G, ?#, 'eurologic status6 seiDure management7 Insert indwelling )oley catheter and monitor urine output &lood specimens are o!tained to test for concentration of drug or poison9 -etermine what su!stance was ta$en easures are instituted to remo*e the to1in or decrease its a!sorption !y2 The patient who has ingested a corrosi*e poison is gi*en water or mil$ to drin$ for dilution or egg whites The following gastric emptying procedures may !e used as prescri!ed2 #yrup of ipecac to induce *omiting in the alert patient9 Gastric la*age for the o!tunded patient Gastric aspirate is sa*ed and sent to the la!oratory for testing 6to1icology screens7 Acti*ated charcoal 6 in/ effecti*e in metals e9g sodium, potassium, lithium, alcohols, glycols, petroleum7 "athartics -ialysis Gi*e antidotes

C.r/on Mono7-,e (o-)on-ng Hemoglo!in !inds with "ar!on mono1ide decreasing o1ygen !inding +CC1 affinity to Hemoglo!in than 51ygen #3#1 ay appear into1icated Headache uscle wea$ness 0alpitations -iDDiness

 "onfusion #$in color/ pin$ or cherry red, pale or cyanotic MANAGEMENT% "arry the patient to fresh air immediately: open all doors and windows9 Loosen all tight clothing9 Initiate cardiopulmonary resuscitation if re.uired: administer o1ygen9 (CC E 5+ 0re*ent chilling: wrap the patient in !lan$ets9 Feep the patient as .uiet as possi!le9 -o not gi*e alcohol in any form9 NEAR DROWNING 'ear/drowning is sur*i*al for at least +, hours after su!mersion9 The most common conse.uence is hypo1emia Leading causes of unintentional death in children younger (, years &.5tor) .))o5-.te, 3-t1 ,ro3n-ng .n, ne.r-,ro3n-ng -n5+u,e% Alcohol ingestion Ina!ility to swim, -i*ing in%uries, Hypothermia, E1haustion9 0R5&LE # WITH 'EAR -R5W'I'G Hypo1ia and acidosis Loss of surfactant 6fresh water aspiration7 0ulmonary edema 6 salt water76 osmotic effects7 MANAGEMENT% The treatment goal, pre*ention of hypo1ia Ensure ade.uate airway B *entilation onitor A&G of the patient Endotracheal intu!ation is necessary if the patient does not !reathe spontaneously 'GT for decompression Feep the patient warm onitor E"G onitor urine output 6 insertion of indwelling )oley catheter7

BURN PATIENT Types of &urns Thermal G dry flames, moist and heat echanical G friction or a!rasion "hemical G acid or al$ali Electrical G most fatal Radiation G sunlight "lassification of &urns P.rt-.+ T1-52ne)) Burn) :)t ,egree /urn) superficial Epidermis "ommon cause is thermal !urn 6H7 erythema 6/7 !listers

-iscomfort lasts a!out ,I hrs: healing occurs in a!out =/J days ;n, ,egree /urn) ,ee( "ommon cause is chemical 6H7 Erythema 6H7 !listers 6H7 *ery painful heals in = G K w$s "lassification of &urn &u++ T1-52ne)) Burn) <r,-=t1 ,egree /urn) Affect all layers of s$in, muscle and !ones "ommon cause is electrical !urns 'ot painfull -ry, thic$, leathery te1ture, appears deep red, !lac$, white, yellow or !rown healing ta$es wee$s to months THIR- -EGREE &;R' St.ge) o* /urn) (st ,I hours 6 fluid accumulation phase7 s3s12 GeneraliDed dehydration Hypo*olemia 5liguria Inc9 hematocrit eta!olic acidosis Hyper$alemia +nd ,I hours 6 fluid remo!iliDation phase7 s3s12 Hyper*olemia -iuresis -ec9 hematocrit hypo$alemia "ont9 Third stage2 reco*ery stage Healing phase BURN MANAGEMENT Emergen5' Room A&"-E assessment 6 how??7 Airway and fluid resuscitation 6priority7 "hec$ for arrythmia 6 chec$ E"G7 "hec$ for $idney function6 !ec9myoglo!in 7 Gi*e TT 0rophylactic anti!iotic #terile dressing for wound A&"-E A--r3.' / chec$ nose, face and nec$ 6priority7 singed and sooty hair of the nose B-re.t1-ng G rise and fall of chest

C--r5u+.t-on / if there is no !reathing and circulation start "0R D--)./-+-t' chec$ and manage accordingly E-7(o)e to determine e1tent of in%ury ETT Insertion "ont9 To chec$ other in%uries -etermine T&#A Rule of 'ines L&er$er )ormulaM 0ar$land )ormula 6,ml 1 T&#A 1 &W$g7 o (st IH gi*e N, o +nd IH gi*e O and for the o =rd IH gi*e the last part Repeat A&"-E assessment R;LE 5) 'I'E anagement of &urns &-r)t-,egree /urn) Feeping the s$in clean and dry Se5on,-,egree /urn) Remo*al of !listers9 Anti!iotic ointment application 6 sil*er sulfadiaDine7 or 6 mafenide7 then dressing9 de!ridement T1-r,-,egree /urn) E1cision of the eschar and split/thic$ness s$in grafting RE E &ER2 0ractice asepsisPPP 0rotect the patient from infection #$in Grafting

S"OCK Inade.uate !lood flow to the tissues CLASSI&ICATIONS2 HQ05?5LE I" G dec &? "AR-I5GE'I" G dec "5 "IR";LAT5RQ3-I#TRI&;TI?E G massi*e *asodilation 'E;R5GE'I" G loss of *asomotor tone #E0TI" G endoto1in, systemic infection A'A0HQLA"TI" G inc capillary permea!ility, histamine and !rady$inin leads to *asodilation SIGNS AND SYMPTOMS Early and compensatory An1iety Restlessness Irrita!ility 0ale "ool s$in -ecreased in !ody temp Late symptoms "onfusion #lowed speech

A!sent refle1es -ecreased &0 Irregular wea$ pulse "lammy s$in

5ther signs Thirst -ilated pupils "yanosis

M.n.gement o* S1o52 Nur)-ng Inter6ent-on) M.n.gement -n .++ t'(e) .n, (1.)e) o* )1o52 -n5+u,e) t1e *o++o3-ng% Basic life support Fluid replacement Vasoactive medications Nutritional support aintain patent airway and ade.uate *entilation9 6 5+ or intu!ation7 onitor ?#, hemodynamic status of pt9 0romote restoration of !lood *olume: administer fluid and !lood replacement as ordered Administer drugs as ordered inimiDe factors contri!uting to shoc$9 aintain continuous assessment of the client9 0osition the patient in modified trendelen!urg E-# )5R #H5"F '#/ 6 ,Ccc3$g repeat 0R'7 6 ?5L; E E<0A'#I5'7/ !e careful with cardiogenic shoc$ 6 >cc3$g then reassess7 "olloids2 al!umin , !lood 6 *olume e1panders7 Ionotropes 6dopamine, do!utamine, epinephrine7 )5R #E0TI" #H5"F ?asopressin #teroids Acti*ated protein c 6 <igris7 6 to pre*ent -I"7 6 Antiinflammatory7

T"E END>