Emergency and disaster nursing

Prepared by: Michael Magpantay

EMERGENCY NURSING

- practice of episodic, primary, critical and acute nursing care of all ages who experience physical,emotional or psychological alterations in health.

Care of the Client presenting to an Emergency Department :

1. Triage classification of all clients presenting to the emergency department. Purpose: to prioritize treatment.

Triage Rating Systems: 3 Categories

a. Emergent conditions requiring IMMEDIATE CARE and intervention because of increased risk of mortality or threat to life, limb or vision.

B-burns C-chest pain-cardiac arrest R-respiratory distress H-hemorrhage sec. to ectopic pregnancy M-major blunt or penetrating trauma

b. Urgent conditions that require care ASAP and generally within 1 hour because the condition has the potential for causing the deterioration of health state if not treated ASAP. These clients will have stable V/S but have acute illness and must be treated to prevent morbidity.

F-fever A-abd.pain S-stable fracture H-HA L-lacerations with controlled bleeding D-DHN

c. Non-urgent- require routine care that can be delayed for more than 2 hours without the possibility of deterioration; clients presenting with non-urgent conditions frequently utilize the emergency dept. because they do not have a primary care physician.

C-colds S-sore throat T-tooth ache A-abrasions R-rashes

2. Disaster Management Plan a community wide, hospital wide or emergency department plan to handle mass casualty incidents that may occur at any time.

Assessment:
a.Primary Assessment rapid initial assessment of the symptoms to determine life threatening conditions while simultaneously intervening.

Airway- with C spine immobilization, patent airway, ability to speak, foreign body, chest expansion. Tx: chin-lift / jaw thrust, suctioning, intubation, cricothyroidectomy, tracheostomy, cervical spine neutral position. Breathing- effectiveness of breathing and ventilation ability. Abnormal : apnea, weak, shallow/labored respiration diminished /absent breath sounds unequal chest expansion retractions/ paroxysmal chest wall movement tracheal deviation NVE Open chest wound Sx of chest trauma Subcutaneous emphysema

Tx:
1. Oxygen therapy 2. Chest tube insertion, intubation 3. Pressure dressing on a flail segment of the ribs Circulation- adequate circulation to maintain cellular tissue perfusion. Abnormal : bradycardia or tachycardia cool, pale and diaphoresis obvious uncontrolled external bleeding decrease LOC Sx of hypovolemia, pericardial tamponade, cardiac arrest

Tx: 1. direct pressure to control external bleeding 2.IV access 3. CPR 4. Pericardiocentesis-aspiration of blood from pericardial sac 5. Autotransfusion BT of one s own blood.

Disability complete a brief neurological assessment to determine baseline functioning, potential life threatening complications, LOC.

Abnormal: Unresponsive altered pupils : fixed pupils, papillary response abnormalities.

Expose- remove all clothing from the client to facilitate a thorough complete secondary assessment examination.

Secondary Assessment- a brief, systematic head to toe assessment that identifies all injuries. Tx: cervical immobilization is maintained at all times as well as continual assessment of hemodynamic and oxygen status. Fahrenheit-provide measures to prevent body heat loss at this time through the use of warmed IVF, warmed blankets or healing lamps.

Get V/S other assessment aids : cardiac monitor, pulse oxi,urinary catheter, NGT, lab. studies: CBC, electrolytes, Fibrin degradation products (coagulation), amylase, lactate; renal studies ; blood type and crossmatch; toxicology studies. History- head to toe assessment : HPI / PMH / FH /Meds

Common Problems Seen in Emergency Settings :

1. Airway obstruction- partial or complete obstruction of the airway. 2. Tension pneumothorax- occurs when air enters the pleural space through a tear during inspiration and accumulates because it cannot escape during expiration. 3. Flail chest the force of impact to the chest wall during injury causes the fracture of 3 or more continguous ribs\ in 2 or more places resulting in a floating segment.

4. Uncontrolled hemorrhage- uncontrolled bleeding. 5. Motor Vehicle Accidents *MVA- blunt and multiple trauma. Acceleration/deceleration forces increased velocity of a moving object followed by a reduction in velocity e.g. speed of a vehicle. Compression forces- body parts are pressed against immobile objects due to explosive injury to air filled organs *liver and spleen Shearing forces- a rotational force exerted around a fixed site. Blunt trauma- fractures, lacerations, contusions, rupture or tearing of solid and hollow organs and major blood vessels.

6. Penetrating injuries - stab wounds/GSW : knives, pencils, forks; high velocity /high energy missiles: guns,rifles,high pressure injection devices.
7. Hypothermia a condition where the core body temp. is 36 C ( 96.8 F ) or less. Tx : ABC, faster rewarming, Cordarone, D50-50 IV

8. Frostbite injury caused by exposure to cold environment and conditions.

Tx : Remove from the cold envt. before thawing. Area not be rubbed mechanical friction can cause tissue damage; Aloe vera topical inhibits platelet aggregation : thromboxane inhibiting effect. Tetanus prophylaxis Topical and parenteral antibiotics Oral and parenteral analgesics

9. Heat exhaustion- vasomotor collapse sustained from prolonged exposure to heat. Tx : Rest in cool, shaded area TSB, direct fans toward patient F/E replacement

10.Heat stroke an extremely elevated core body temperature caused by a failure of the hypothalamus-perspiration regulating mechanism; carries 70% mortality rate. Tx : Aggressive cooling measures to institute Full body exposure and cooling by evaporation Prevent shivering Cardiac monitor Ice water gastric and peritoneal lavage Prevent over correction , hypothermia and cerebral edema IV NSS, do not use LR because liver is unable to metabolize lactate. U.O. / ABCs Meds: Thorazine 10-25mg prevent shivering Mannitol Solu-Medrol

11. Drowning and Near drowning drowning is death caused by asphyxia and aspiration after submersion in water; near drowning is risk of death occurring within 24 hours. Tx : ABC CBC, ABG Fresh water drowning electrolytes decreased Salt water drowning electrolytes increased XRay bilateral infiltrate Cardiac monitor ET intubation Correct hypoxia and cyanosis, I and O Antibiotics,Epinephrine,Lidocaine,At SO4, Bronchodilators,NaHCO3,Steroids

12. Bites dog,cat, rodent, human, insect/bee, spider, tick, snake; a break in the continuity of the skin caused by a bite from an animal, insect or human. Tx : Meticulous wound care Devitalized tissue should be debrided and topical antibiotic ointment. IV antibiotics severe human and animal bite Rabies prophylaxis-animal bite Carnivores-rabies positive : raccoons, bats, wild animals Herbivorous rabies negative : mice, rodents Venomous bites black widow spiders, poisonous snakes Anti venom tx: constricting band/ice to slow the circulation and spread of venom to circulation. *Wound should be left open and a bulky dressing is applied-dry sterile dressing. *ABC,V/S,LOC Muscle relaxants Animal control

13. Poisonings substances that are harmful : inhaled, ingested *food, drug, overdose or acquired by contact *insecticides Carbon monoxide inhalation Food poisoning Drug overdose: ASA overstimulation of resp. center and metabolic acidosis- hyperventilation, hyperthermia,hyperglycemias Insecticide surface absorption Tx : ABC,IV access Narcan-Naloxone antagonist for resp. depression due to narcotic overdose Flumazanil-for Benzodiazepine ingestion Gastric lavage-NGT Vomiting is C/I Antidotes: Ipecac, activated charcoal

14. Electrocution injury sustained by electric current Tx : ABC, Spine immobility,Local wound care Meds : NaHCO 3 , Mannitol, Tetanus, Lidocaine, Amiodarone and Epinephrine

End of Emergency Nursing