The document provides information on common emergency room procedures and the nursing responsibilities associated with each. It discusses procedures like laceration repair, splinting, intraosseous access, abscess drainage, lumbar puncture, chest tubes, NG/OG tubes, intubation, foley catheter placement, paracentesis, and nasal packing. For each procedure, it outlines the nursing responsibilities which include obtaining consent, preparing equipment, assisting physicians, monitoring vital signs, providing education and aftercare, and documenting. The overall document serves as a guide for nurses on their roles and responsibilities when assisting with various emergency room procedures.

1. Emergency Room

2. Introduction
• Emergency department of a hospital is responsible for the provision
of medical and surgical care to patients arriving at the hospital in
need of immediate care.

3. • GOAL : Understand the process inside the
emergency room and medical services done in
the emergency room
• OBJECTIVES
• To understand the function of ER Nurse
• To Classify life threatening condition in
emergency department and to know how to
Prioritize action according to the needs of the
situation
• Provide effective emergency care for patients
with medical &surgical emergencies

4. Emergency room (ER) nurses
• Emergency rooms are often the first line of
defense for accidents, allergic reactions, and any
number of urgent medical care.

5. • They work as part of a team with physicians, other nurses and
healthcare professionals to provide care, monitor health conditions,
plan long-term care needs, administer medicine, use medical
equipment, perform minor medical operations, and advise patients
and their families on illness, care and continued care after a hospital
stay.

6. Nursing Responsibility
• Perform Emergency Care Procedures
• Explaining Emergency Interventions to the Client
• Evaluating and Documenting the Client's Response to Emergency
Interventions

7. Triage System

8. Mass casualty situations

9. When to Perform resuscitation
• NO PULSE
• NOT BREATHING
• Unconsciousness
• Electrocution Injuries
• Drowning

10. Procedures in ED
Procedures that most ER physicians would expect a Nurse to be
familiar with
Splinting
is indicated for orthopedic injuries and at other times when the
integrity of the extremity is compromised or otherwise should have
limited mobility (fractures, soft-tissue trauma, gout, etc.)

11. Nursing Responsibility
• Assess the patients behavior if there is a need for
restraint
• If needed get a written order and obtain consent as per hospital
policy
• Must communicate with patients family member and explain to the
patient and family member the reason for restrain
• prepare the necessary equipment
• Assist the physician during the procedure
• Health education

12. Laceration Repair
• Laceration repair can be accomplished in a few different
ways. Sutures, staples, and strips are a few options that
are available. Depending on the size, complexity,
location, and reparative needs of the wound,
1.Laceration Repair
Laceration repair can be accomplished in a few different ways. Sutures, staples, and Dermabond are a few options that are available. Depending on the size, compl

13. Nursing Responsibilities
• Control bleeding
• Explain the procedure
• Secure AC and Consent
• Prepare equipment
• Clean the wound using sterile technique
• Assist the Physician during the procedure
• Health teaching

14. Intraosseous Access (IO)
• Intraosseous access (IO) is often obtained when a peripheral line is
unable to be obtained on a critical patient or during a code/peri-
code situation. IO access can be established in various locations
(depending on the age of the patient) and is found to be more
successful than peripheral IV access.

15. Nursing responsibilities
• Educate the Family
• Sign the consent
• Prepare equipment
Needle
drill
dressing
lidocaine
IV line
• Assist the physician during the procedure

16. Abscess Incision and Drainage (I&D
• Abscess Incision and Drainage (I&D) is a procedure that is
performed for areas of cellulitis which have become infected.
Utilizing a scalpel, an incision is made in the abscess and the
contents are drained.

17. Nursing responsibilities
• Educate the patient and Family member about the procedure
• Let the family member Sign the consent
• Secure AC
• Prepare the equipment
 universal precaution materials (gown, gloves, protective
eyewear)
 Sterile draping towels and sterile gloves
 Local anesthetic
 10-cc syringe and 25- to 30-gauge needle
 Skin prep material (chlorhexidine or iodine swabs)
 No. 11 or 15 blade and scalpel
 Scissors
 Dressing (4- × 4-inch gauze pads and tape

18. Lumbar Puncture
• Lumbar puncture (LP)/spinal tap is a procedure where a spinal
needle is inserted between vertebra into the spinal canal to obtain a
sample of cerebrospinal fluid for laboratory testing.
• Lumbar punctures can be used to rule out conditions or
differentiate between disease pathologies that are similar. Some of
the reasons that a LP may be performed are to test for meningitis,
underlying disease processes in migraine sufferers, or other
neurologic conditions.

19. Nursing Responsibility
• Educate the family about the procedure
• Secure consent
• Secure AC
• Prepare the equipment
• Assist the AP during the procedure
• Monitor the vital sign
• Instruct to remain still and Hold the patient

20. After the procedure
• Apply brief pressure to the puncture site.
• Monitor vital signs, neurologic status, and intake and output
• Monitor the puncture site for signs of CSF leakage and drainage
of blood
leakage includes positional headaches, nausea and vomiting,
neck stiffness, photophobia
• Encourage increased fluid intake.
• Label and number the specimen tube correctly.

21. Chest Tubes
• Chest tubes are placed to drain blood, air, or other fluid from the
pleural cavity. This is often an emergent procedure that is
performed on a critical patient in the emergency room. Trauma,
infection, cancer, or a spontaneous pneumothorax are some of the
indications for the insertion of chest tube

22. Nursing Responsibility
• Secure consent
• Gather supplies
• Assist the Physician during the procedure
• Monitor Vital signs including SpO2 • Rate, depth and ease of
respirations
• Documentation

23. Nursing Responsibility
Nurses have the responsibility to care for their patients’ chest tubes after they have been
properly inserted so that the pleural drainage system remains clear and intact.
The following are steps to care for chest tubes.
• Wash hands thoroughly with soap and warm water and don sterile gloves before
coming in contact with the patient.
• The chest tube should contain approximately 6 feet of tubing that connects to a
collection device located several feet below the patient’s chest. Instruct the patient
not to rest the body on the tubing.
• The nurse should take this time to check the patient’s tubing for twists and kinks in
the tubing line.
• The nurse should also tape the tubing connections to prevent air from leaking out of
the tube.

24. • The drainage system has a water seal that operates as a one-way valve. The nurse
must add the required amount of saline into the patient’s separate water chamber
while ensuring the end of the patient’s tubing remains in the fluid.
• Add suctioning to the chest drainage system if necessary, but remember that the
amount of suctioning depends of the saline solution’s depth.
• The nurse should make a note of the level of drainage at the end of his or her shift.
Also, document the color and amount of the drainage in the patient’s notes.
• The respiratory status of the patient requires frequent assessment to maintain the
patient’s health. Nurses should also make note of decreased breathing sounds near
the side of the patient’s chest tube.
• To maintain the care of the chest tube, nurses should encourage the patient to
perform deep-breathing exercises or coughing.

25. NG/OG Tubes
• Nasogastric/Orogastric (NG/OG) tube insertion is a tube that is
placed through the nose (naso-) or mouth (oro-) into the stomach to
drain fluid (suction), administer medication, or food.
Naso/orogastric tubes can also be used to take a sample of gastric
contents for laboratory testing (for example, in the case of
gastrointestinal (GI) bleeding).

26. Nursing Responsibility
• Educate the patient and family members
• Secure consent
• Prepare equipments
• Assist the physician

27. Intubation
• Intubation is a procedure that is performed when the airway, airway
reflexes, or the gag reflex is compromised.

28. Nursing Responsibility
• Make sure that the physician educate the patient family members
• Secure consent
• Prepare equipments
• Assist the physician
• Secure the tube
• Inform RT
• Document

29. Foley Catheter Placement
• Foley catheter placement is a procedure that is performed in order
to relieve the urinary bladder. A catheter is placed via the urethra
and is passed into the urinary bladder. These devices are often
placed to measure urinary output or relieve urinary retention.

30. Nursing Responsibility
• Educate the family member
• Secure consent
• Prepare materials
• Help the physician during the procedure
• Secure it properly
• Make sure there is urine output
• Document

31. Paracentesis
• Paracentesis is a procedure that is performed to remove fluids from
a body cavity, similar to how a chest tube allows fluid or blood to be
removed from the chest cavity. An example of this procedure would
be to relieve ascites (fluid collection in the abdomen) that results in
a distended abdomen

32. Abdominal Paracentesis Purpose
• For relieving pressure in peritoneal cavity,
• For drainage fluid from abdominal cavity in Ascites condition.
• For pressure relieving on the organs of chest and abdomen,
• Cirrhosis of liver with Ascites,
• For lab diagnosis (Histopathology e.g, cancer, Biochemistry values
e.g. Albumin),

33. Nursing Responsibilities
• Check for the physician’s order, and Explain to procedure to patient
• Take written consent from patient or relatives,
• Skin prep and Record vital sign
• Provide privacy, and Maintain I. V, line
• Paint abdomen with Betadine,
• Assist to Doctor, during the procedure
• Needle should be inserted z-track technique,
• Monitor patient, Observe for fluid color,
• Measure fluid quantity, Send test tube for diagnostic tests,
• seal the punctured wound with sterile dressing,
• Fasten the abdominal binder tightly, from the top to bottom

34. • After care of the patient:-
• Provide any hot tea if indicated,
• Monitor patient vitals continuously,
• monitor input and out put chart,
• Watch for any reaction for 24 hours

35. Nasal Packing
• Nasal packing is performed for uncontrolled epistaxis (nose bleed).
Nasal packing is often performed using a commercial device that is
used to place compact cotton in a posterior direction in order to
control bleeding.

36. Nursing Responsibility
• Monitor o2 sat.
• Administer supplementary 02 as ordered.. •
• monitor vital signs and respiratory rate or pattern.
• Inspect the mouth and oropharynx. Notify the physician if the packing is
seen in the oropharynx.Misplacement of nasal packing can obstruct the
upper airway
• Elevate the head of the bed. facilitates ventilation.
• Encourage deep, slow breathing through the mouth..
• Check for blood at the back of the throat and frequent swallowing. Visible
blood or frequent swallowing could indicate posterior bleeding.
• Report hematemesis.. Hematemesis may indicate continued bleeding. •
Apply cold compresses to nose,
• • Provide for rest. Rest reduces the metabolic demands and oxygen
consumption.
• • Ensure adequate oral fluid intake.

37. Thoracentesis
• is a procedure in which a needle is inserted into the pleural space
between the lungs and the chest wall. This procedure is done to
remove excess fluid, known as a pleural effusion, from the pleural
space to help you breathe easier.

38. Purpose of Performing Thoracentesis
• This procedure is performed on clients with
various clinical problems. The procedure can
either be diagnostically or therapeutically for
the:
• Removal of fluid and air from the pleural cavity
• Diagnostic aspiration of pleural fluid
• Pleural biopsy
• Instillation of medication into the pleural space

39. Nursing Responsibility
BEFORE The Procedure
• Secured consent
• Assess client for known allergies, especially to local anesthetic.
• Place patient on the proper position. Proper positioning stretches
the chest or back and allows easier access to the intercostal spaces.
The nurse can position the client in one either of the following:
• Assist the patient to straddle on a chair with his or her arms and
head resting on the back of the chair
• If the client is unable to assume a sitting position, assist him or her
to lie on the unaffected side. Then elevate the head of bed to 30 to
45 degrees

40. • DURING The Procedure
• Inform the client of the cold sensation to be felt when antiseptic skin
solution is applied to the puncture site. stinging sensation is felt
during the injection of the local anesthesia.
• Instruct to refrain from coughing, breathing deeply or moving during
the procedure to avoid injury to the lung.

41. • AFTER The Procedure
• After the needle is withdrawn, apply pressure over the puncture site
and a small, sterile dressing is fixed in place.
• Place the client on bed rest.
• Obtain post-procedure chest x-ray results. The x-ray verifies that
there is no pneumothorax.
• Record total amount of fluid withdrawn, nature of fluid and its color
and viscosity.
• If ordered, prepare samples for laboratory evaluation. A specimen
container with formalin may be needed if a pleural biopsy is to be
obtained.
• Evaluate the patient at intervals for increased respiration rate,
asymmetric lung movement, vertigo, tightness in the chest area,
uncontrolled cough with blood-tinged mucus, rapid pulse and signs
of hypoxemia.