Emergency and disaster nursing <ul><li>Prepared by: </li></ul><ul><li>Michael Magpantay </li></ul>
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: <ul><li>Primary Assessment – rapid initial assessment of the </li></ul><ul><li>symptoms to determine life threatening conditions while </li></ul><ul><li>simultaneously intervening. </li></ul>
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
<ul><li>Tx: </li></ul><ul><ul><ul><li>1. direct pressure to control external bleeding </li></ul></ul></ul><ul><ul><ul><li>2.IV access </li></ul></ul></ul><ul><ul><ul><li>3. CPR </li></ul></ul></ul><ul><ul><ul><li>4. Pericardiocentesis-aspiration of blood from </li></ul></ul></ul><ul><ul><ul><li>pericardial sac </li></ul></ul></ul><ul><ul><ul><li>5. Autotransfusion – BT of one s own blood. </li></ul></ul></ul>
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 : <ul><li>Airway obstruction - partial or complete obstruction of </li></ul><ul><li>the airway. </li></ul><ul><li>2. Tension pneumothorax - occurs when air enters the </li></ul><ul><li>pleural space through a tear during inspiration and </li></ul><ul><li>accumulates because it cannot escape during expiration. </li></ul><ul><li>3. Flail chest – the force of impact to the chest wall during </li></ul><ul><li>injury causes the fracture of 3 or more continguous ribs </li></ul><ul><li>in 2 or more places resulting in a floating segment. </li></ul>
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
<ul><li>13. Poisonings – substances that are harmful : inhaled, ingested </li></ul><ul><li>*food, drug, overdose or acquired by contact *insecticides </li></ul><ul><ul><li>Carbon monoxide inhalation </li></ul></ul><ul><ul><li>Food poisoning </li></ul></ul><ul><li>Drug overdose: ASA –overstimulation of resp. center and metabolic </li></ul><ul><li>acidosis- hyperventilation, hyperthermia,hyperglycemias </li></ul><ul><li>Insecticide surface absorption </li></ul><ul><li>Tx : ABC,IV access </li></ul><ul><li>Narcan-Naloxone –antagonist for resp. depression due to </li></ul><ul><li>narcotic overdose </li></ul><ul><li>Flumazanil-for Benzodiazepine ingestion </li></ul><ul><li>Gastric lavage-NGT </li></ul><ul><li>Vomiting is C/I </li></ul><ul><li>Antidotes: Ipecac, activated charcoal </li></ul>
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