• Emergency is defined as any

situation posing an immediate risk

to health, life, property or
environment.

• Emergency Nurse is a professional

nurse applying the critical thinking
and the nursing process in the
provision of care to emergency
situations.
• Emergency Department is a special area in the
hospital where emergency cases are rushed in.
This is where the Emergency nurse applies the
principles of emergency care.

• Patients are temporarily rushed in to the ED for

immediate care and may be transferred to the
other departments of the hospital for continuous
management or maybe sent home as an out-
patient.
 Major Goals of
Emergency Medical
Treatment

 To preserve life
 To prevent deterioration
 Restore the patient to useful living
 Principles of
Emergency
Management

 Maintain a patent airway

 Control hemorrhage & its consequences

 Evaluate & restore cardiac output
 Prevent & treat shock;
maintain/restore effective
circulation
 Carry out a rapid initial & ongoing
physical examination.

Assess whether or not the patient can

follow commands; evaluate the size &
reactivity of the pupils & motor
responses.
Start ECG monitoring if appropriate.

Splint suspected fractures

Protect wounds

Check for medic-alert tag

Documentation
EMERGENCY ACTION
PRINCIPLE
A – ask for help
I – intervene
D – Do no further
harm
2 types of Emergency Survey

 PRIMARY SURVEY FOR

LIFE – THREATENING
CONDITIONS
SECONDARY SURVEY FOR
NONEMERGENCY
CONDITIONS.
PRIMARY SURVEY :
(ABCD)

A- AIRWAY
B- BREATHING
C- CIRCULATION
D- DISABILITY
STEPS IN SECONDARY SURVEY:

(ABC)

A- Assessment (PA)
B- Baseline Data
C- Chief Complaint
 CPR
Cardiopulmonary
Resuscitation

INDICATIONS:
RESPIRATORY ARREST= with pulse present
CARDIAC ARREST = without pulse
ASSESSMENT/ACTIONS

1) DETERMINE UNRESPONSIVENESS
2) ESTABLISH AIRWAY
3) DETERMINE BREATHLESSNESS
4) GIVE TWO RESCUE BREATHS
5) DETERMINE PULSELESSNESS
6) IF PULSELESS, BEGIN CHEST
COMPRESSION
7) REASSESSMENT
CPR
Adult
30 compressions : 2 breaths
5 cycles / 2 mins
Child / Infant
30 compressions : 2 breaths
10 cycles / 2 mins
RESCUE BREATHING
Adult 24 cycles / 2 mins

Child / 40 cycles / 2 mins

Infant
SHOCK & INTERNAL INJURIES

SHOCK

ABDOMINAL INJURIES

MULTIPLE INJURIES
 SHOCK

HYPOVOLEMIC SHOCK CARDIOGENIC SHOCK

SEPTIC SHOCK SPINAL SHOCK

NEUROGENIC SHOCK ANPHYLACTIC SHOCK

HYPOGLYCEMIC SHOCK
 SHOCK
general intervention

• Priority: fluid resuscitation

•Oxygenation
•Close monitoring of BP and LOC changes
• Treatment of probable cause is secondary
when the patient is stabilized
 SHOCK
general intervention
maintain normothermia

pharmaclogic intervention

Inotropes

isoproterenol (isuprel) dobutamine (dobutrex)

digoxin (lanoxin)

vasopressors

dobutamine (intropin)
NE (levophed) metaraminol (aramine)

antibiotics
 Abdominal Injuries
primary assessment & intervention

• ABCD
• Initiate resuscitation as indicated
• Control bleeding
• If there is an impaled object in the abdomen,
leave it there. Stabilize the object in place with
bulky dressings along the sides of the object.
 Abdominal Injuries
General interventions
• Keep patient quiet & on the stretcher
• Cut the clothing away from the wound
• Count the # of wounds
• Look for entrance and exit of wounds
• If comatose, suspect cervical injuries & treat
accordingly
• Apply compression to external bleeding
wounds & occlusion of chest wounds
 ADDOMINAL INJURIES
General interventions
• Cover protruding abdominal viscera
• Cover open wounds with dry dressings
• Insert two large-bore IV lines, NGT
• Pharmacologic interventions
• Prepare for surgery
• Prepare the patient for diagnostic procedures
 Multiple Injuries
primary assessment & interventions
AIRWAY

1. Clear airway of obstruction

2. Oxygenation
3. Suction as necessary
4. Prepare for possible intubation
 Multiple Injuries
primary assessment & interventions
BREATHING
Note the character of chest wall motion
Auscultate lungs & note for tracheal deviation
Ask for difficulty of breathing & chest pain
Suspect serious intrathoracic injuries if respiratory distress
Continues after adequate airway has been established.
Assess the overall effectiveness of ventilation
 Multiple Injuries
CIRCULATION

 Assess cardiac function & threat

cardiac arrest
 Control hemorrhage
 Palpate carotid pulse & note its rate &
quality
 Prevent & treat hypovolemic shock
 Note presence or absence of pulses in
fractured extremities
 Multiple Injuries
NEURLOGIC

•Assess level of responsiveness, pupil size

& reactivity, motor power & reflexes
• Determine GLASCOW COMA SCORE
• ICP monitoring may be instituted
INJURIES TO
HEAD, SPINE, &
FACE
 Head Injuries
ASSUME A CERVICAL SPINE FRACTURE FOR ANY PATIENT WITH A
SIGNIFICANT HEAD INJURY, UNTIL PROVEN OTHERWISE

PRIMARY ASSESSMENT

AIRWAY: assess for vomitus, bleeding, & foreign object

BREATHING: assess for abnormally slow or shallow
respirations. An elevated PCO2 can worsen
cerebral edema
CIRCULATION:
asses pulse & bleeding
 Head Injuries
primary interventions

Open Airway ( jaw-thrust technique without head tilt)

Administer high-flow Oxygen

Control bleeding

Initiate an intravenous (IV) line to run at KVO

 Head Injuries
secondary assessment

History LOC V/S

Unequal or unresponsive pupils
Confusion or personality changes
Impaired vision
Seizure activity
 Head Injuries
general intervention
1. Keep the neck in neutral position
2. Hyperventilation
3. Establish IV line
4. Be prepared to manage seizures
5. Maintain normothemia
6. Pharmacologic intervention
Cervical Spine Injuries
PRIMARY ASSESSMENT
Immobilization

Airway

Breathing intercostal paralysis with diaphragmatic breathing

indicates cervical spinal cord injury

Circulation
 PRIMARY INTERVENTIONS

Immobilize cervical spine

Open the airway using jaw-thrust
Intubate as indicated
Assist with bag-valve mask if respirations are
shallow
 SECONDARY ASSESSMENT

Assess the position of patient when found

Spinal shock
Neck/ Back pain/ extremity pain or burning sensation
Hx of unconsciousness
Total sensory loss & motor paralysis below level of injury
Loss of bowel & bladder control
Loss of sweating & vasomotor tone below cord lesion
Priapism, Hypothermia, Loss of rectal tone
 General Intervention

Monitor blood gas values serially

Prepare for nasotracheal intubation

Initiate IV access
Insert indwelling urinary catheter
 General Intervention

Monitor hypotension, hypothermia, & bradycardia

Neurocheck
Manage seizures
INJURIES TO
SOFT TISSUE,
BONES, & JOINTS
SOFT TISSUE INJURIES
Closed Wound

• contusion • hematoma

Open Wound

• abrasion • puncture
• laceration • avulsion
• amputation hematoma
SOFT TISSUE INJURIES
Primary Assessment

ABC
Bleeding
Arterial blood or venous bleeding
 SOFT TISSUE INJURIES
Primary Interventions

Wounds that result in severe arterial bleeding should be considered

life threatening and treatment is second only to CPR.

direct pressure
elevation

pressure points
 Secondary Assessment
• expose the wound
• assess for the presence of concomitant injuries
• assess vascular status distal to injury, and compare it to the
uninjured extremity
• neurologic test
• determine tetanus immunization status
• history of injury, including when and how the wound
occurred
• allergies to local anesthesia, epinephrine, and antibiotics
 General Interventions
wound preparation

wound closure

wound dressing

pharmacologic interventions

patient education
INJURIES TO BONES & JOINTS
Primary Assessment
• ABC

Estimated blood loss from closed fractures

Tibia – 1.5L Femur – 2L

Pelvis – 6L Humerus – 2L
INJURIES TO BONES &
JOINTS
PRIMARY INTERVENTION

• support airway, breathing, circulation if compromised

• initiate IV line and treat for shock if evident
• protect injured part from movement or further trauma
INJURIES TO BONES &
JOINTS
Secondary Assessment
• seek information in the mechanism of injury
• assess for the presence of concomitant injuries
• perform neurovascular assessment to include area above
and below injury
• examine the bones & joints adjacent to the injury
• S/Sx of fractures, dislocations, sprains, strains
• closely monitor vital signs
 General Interventions
• initiate an IV line & start volume replacement
• immobilize the injury
• prepare the patient for the O.R. for open/close
reduction, internal fixation & or wound care
• antibiotic
BITES AND STINGS
I. Snakebite
Characteristics of Poisonous snakes:
• Large fangs
• Vertical pupils (elliptical pupils)
• Triangular head is larger than the neck

• Types of snake bites:

• Horseshoe-shaped bite = non-
poisonous
• Two distinct fang marks = Poisonous
Signs and symptoms:
• Severe burning pain
• Swelling around the fang marks
• Purplish discoloration
• Numbness
• Nausea, Vomiting
• Signs of Anaphylaxis
First Aid care fir Snake bite:
• Move the victim away from the snake
• Discourage walking
• Clean the bite with soap and water
• Splint and Immobilize
• Lower the site below the level of the heart
• Refer immediate medical treatment
• Antivenin must be given within 4hours

NEVER:
• Cut skin - causes infection
• Use tourniquet – can result to loss of limb
• Apply ice – causes more rapid absorption
• Electric shock – causes severe injury
II. Bee Stings
Management:
• If the stinger is still present, remove it by gently
scraping against it with the edge of a creditcard
or a knife
• Wash with soap solution
• Never scrub
• Lower the site below the level of the heart
• Cold compress to relieve pain and swelling
• Apply a paste of baking soda and water for bee
stings
• Use vinegar or lemon juice to relieve pain of a
wasp stings
• Limit physical activity
• Refer immediately if there are signs of
anaphylaxis
III. Marine Bites
• Management:
• Move the victim away to a dry area
• Stings by Stingray, spiny fish, sea urchin =
flush the site with water, immobilize, soak
in hot water for 30 minutes.
• Stings by Jellyfish, coral, anemone=
carefully remove dried tentacles, pour
vinegar on the affected area or soak to
denature the toxin, never rinse the site
with ammonia or fresh water (can
aggravate the stinging sensation)
THE
END