KEY POINTS TO INTERNAL POLICIES AND PROCEDURES IN ER

1. 14 - September - 2012 Prepared By Dr Gamal Soliman 1
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
ER POLICYER POLICY
DEAD ON
ARRIVAL
MANAGEMENT OF
SHOCK

2. 14 - September - 2012 Prepared By Dr Gamal Soliman 2
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
A person brought to a hospital lifeless
and confirmed dead after
the physician legally pronounced it.

3. 14 - September - 2012 Prepared By Dr Gamal Soliman 3
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To examine and confirm death.
2. To give immediate resuscitative measures
before confirming death.
3. To inform police department.

4. 14 - September - 2012 Prepared By Dr Gamal Soliman 4
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. "Dead- on- Arrival" patients must be examined and
resuscitative measures must be given before
confirming death.
2. Police department must be informed by information
personnel.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. All emergency resuscitative measures will be
carried out to save the patient's life.
4. Vital signs are obtained and monitored
continuously.

6. 14 - September - 2012 Prepared By Dr Gamal Soliman 6
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. When all resuscitation efforts
have been exhausted,
the physician will
examine and confirm the death.

7. 14 - September - 2012 Prepared By Dr Gamal Soliman 7
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MANAGEMENT OF
SHOCK

8. 14 - September - 2012 Prepared By Dr Gamal Soliman 8
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
Shock is a complex life-threatening condition (or
syndrome) characterized by inadequate blood flow to the
tissues and cells of the body.
OBJECTIVE
1. To ensure rapid recognition and prompt intervention to
increase the chance of survival.
2. To initiate priorities in the assessment for all types of
shock.

9. 14 - September - 2012 Prepared By Dr Gamal Soliman 9
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. To restore and maintain tissue
perfusion
4. To correct physiological
abnormalities
5. To restore the patient to a
stable physical condition.

10. 14 - September - 2012 Prepared By Dr Gamal Soliman 10
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. The nurse must have the knowledge of the classification of shock and comparisons.
Hypovolemic results in reduced circulating vascular volume, water, plasma or whole
blood.
Cardiogenic when the heart muscles lose its contractive power or when cardiac
output is insufficient to meet the metabolic demands of the body, resulting in
inadequate tissue perfusion.
Septic results of bacteria and their products circulating in the blood.

11. 14 - September - 2012 Prepared By Dr Gamal Soliman 11
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Spinal Shock
Neurogenic
shock
Anaphylactic
shock
Hypoglycemic
shock

12. 14 - September - 2012 Prepared By Dr Gamal Soliman 12
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
The initial priorities in the assessment are the
same for all types of shock.
Is the airway open
Is the patient breathing
Is there a circulation problem

13. 14 - September - 2012 Prepared By Dr Gamal Soliman 13
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENT
1. Crash cart – Emergency drugs
Emergency equipments
Suction machine
Oxygen
Cardiac monitor
BP cuff and stethoscope
3. Intravenous equipment plus fluid
4. Urinary catheter equipment
5. Emergency room flow sheet

14. 14 - September - 2012 Prepared By Dr Gamal Soliman 14
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
INITIAL MANAGEMENT
OF SHOCK

15. 14 - September - 2012 Prepared By Dr Gamal Soliman 15
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1. Assess level or consciousness:
1.1Confusion
1.2 Irritability
1.3 Anxiety
1.4 Agitation 1. Important indicator of shock
because it reflects cerebral
perfusion.
1.5 Inability to concentrate
1.6 Increased lethargy, progressing to coma, indicating
progression of shock.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Draw blood samples for investigations.
2. As data baseline.
3. Monitor arterial blood pressure.
3. The blood pressure may
initially rise approximately
20%. If the patient is
compensating for shock.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4. Assess urinary output. 4.
Urine output should be 50
ml/hour. An output less
than 25 ml./hour may
indicate shock

18. 14 - September - 2012 Prepared By Dr Gamal Soliman 18
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. Administer 02 to maintain
the Pa02 at 80-100 Torr.
5. This will augment oxygen-
carrying capacity of arterial
blood.
5.1 100% oxygen by non-
breather face mask.

19. 14 - September - 2012 Prepared By Dr Gamal Soliman 19
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.2 Intubation if the patient is
unable
to manage or is
ventilating poorly.
5.3 If intubated, the
patient may be
hyperventilated to
help control
acidosis.

20. 14 - September - 2012 Prepared By Dr Gamal Soliman 20
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6. Initiate I.V. fluid therapy
6.1 Two large-bore I.V. lines
should
be established.6. To
restore intravascular
volume. To improve cardiac
and tissue oxygenation.

21. 14 - September - 2012 Prepared By Dr Gamal Soliman 21
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.3 Fresh whole blood is
infused when
there is
massive blood loss.
6.3 Rate of flow
depends on
severity of loss and
clinical
evidence of
hypovolemia.