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EMERGENCY NURSING Refer to care given to patient with urgent and critical needs.

Goals of Emergency Medical Treatment 1. To preserve life 2. To prevent deterioration 3. To restore the patient to useful living Principles of Emergency Nursing 1. Triage ± a process of prioritizing patients based on the severity of their condition. y Emergency situations ± greatest risk receives priority y Major disasters ± highly specialized cares are given minimal care; based on principles to benefit largest number; minimal care are treated first to be available to help.

A ± athropine sulfate ± Anticholinergic L ± lidocane ± anesthesia/ anti-rythmic agents M ± magnesium sulfate ± antiseizure D ± dopamine ± increase cardiac output D ± dobutamine ± increase cardiac output CPR Cardiopulmonary resuscitation ± process of externally supporting the circulation and respiration of a person who has had a cardiac arrest. Indications: y Respiratory arrest ± with pulse present y Cardiac arrest ± without pulse Crucial time: CPR is instituted within 4-6 minutes after the arrest to prevent brain death ( need to establish a circulation and perspiration) Two types of CPR: y Basic Life Support (BLS) ± involves the use of hands, mouth and the sincere desire to give the person a second chance for life. y Advanced cardiac life support ± involves BLS and the use of equipment ( defibrulator), emergency drugs and fluids to monitor the client and stabilize his condition. CPR INVOLVES THE ABCD OF LIFE SUPPORT A ± open airway B ± restore breathing C ± restore circulation D ± provide definitive treatment (ACLC) Defibrillation: restoring the heart beat ASSESSMENT/ACTIONS 1. DETERMINE UNRESPPONSIVENESS 2. POSITION VICTIM SUPPINE ON A FIRM SURFACE 3. ESTABLISH ARIWAY y Use head tilt, chin lift maneuver y Place ear over nose and mouth ( for 3-5 seconds) o Look to see if chest is moving o Listen for escape of air o Feel for movement of air against face o If no respiration, proceed to #4 4. GIVE 2 RESCUE BREATHS y Mouth to mouth ventilation y Mouth to nose ventilation y Mouth to stoma ventilation y Mouth to barrier ventilation

*NOTE: give 2 initial breaths lasting for 1 ½ to 2 seconds. If no rise and fall of the chest is observed, consider airway obstruction. 5. DETERMINE PULSELESSNESS/ ASSESS CIRCULATION 6. IF PULSELESS, BBEGIN CHEST COMPRESSION y Proper placement of hands: Adult: lower half of the sternum/ 2 fingerbreaths from the xiphoid process Infant: midsternum *used heel of both hands for adult, heel of one hand for child, 2 fingers for infant y Depth compressions: Adult: 1 ½ - 2 inches Child: 1 ± 1 ½ inches Infant: ½ - 1 inches y 30 compression per with 2 ventilation 7. REASSESSMENT y Reassess after 4 cycles, if pulse is absent, continue CPR y Recheck pulse every 3-4 minutes thereafter TERMINATION OF CPR y Successful resuscitation y Transfer of emergency vehicle y Pronounced dead by physician y Exhaustion of rescuer COMMON COMPLICATION OF CPR y Fracture of ribs y Puncturesd internal organ- liver ADVANCED CARDIAC SUPPIRT Refers to a set of clinical interventions for the treatment of cardiac arrest and other life threatening emergencies. CARDIOPULMONARY ARREST ± result of a cardiac dysrhythmias. ( 2 clinical signs: unconscious, lack of major pulse) DEFIBRILLATION ± treatment of choice for ventricular fibrillation. *nursing intervention: y Place the client in a flat, firm surface y Apply interface material to the paddles y Grasp the paddles only by the insulated handles to prevent electrocution y Give command for personnel to stand clear of the client and bedd

Triage Category: o Emergent ± highest priority ( airway compromise, cardiac arrest, severe shock, cervical spine injury, multisystem trauma, altered LOC, eclampsia) o Urgent ± serious health problem but not immediate life threatening ( fever, minor burns, minor musculoskeletal injuries, dizziness, lacerations) o Non-urgent ± can wait for several hours; local injuries ( sprains, missed menses, low back pain) o Fast-track ± requires simple first aid / can manage themselves ( simple bruises) 2. Assessment and interventions y Primary Survey A ± airway B ± breathing C ± Circulation D ± disability E ± exposure y Secondary Survey C ± chief complaint H ± history E ± exact location C ± compare K ± keep checking EMERGENCY DRUGS B ± bicarbonate ± antacid E ± epinephrine ± increase myocardial contractility/ produce bronchospasm C ± calcium carbonate ± for gastric acidity

back and extremeties y Splint fractures y Carry out a more thoroughly and ongoing examination and assessment . respiratory ³rapid & shallow. fifth ICS Push the discharge buttons in both paddles simultaneously Defibrillation releases 200-360 joules 3. PRIORITY 2 (DELAYED) YELLOW ± injuries are significant and require medical care but can wait hours w/out threat to life. 3. y Transverse ± fracture that is across the bone shaft. asphyxia. debridement and external fixation. lack of perfusion. also called an open fracture. seizures or vomiting with 24 hours after exposure to radiation. 4. pulse. GUT disruption. cry or breath: y Give up to 5 back blows y Give up to 5 chest thrusts y Repeat SHOCK Life threatening condition that occurs when the body is not getting enough blood flow. MAJOR CLASSES OF SHOCK: 1. abdomen. hypoxia y Progressive ± bp can no longer compensate. profound shock with multiple injuries. shock. low blood volume. Anaphylactic shock ± life threatening type of allergic reaction. TYPES OF FRACTURES y Comminuted ± bone has splintered into several fragments y Compound ± damage involves skin or mucous membranes. tachypnea. between imbilicus and xiphoia process y Grasp fist with other hand and pross fist into victim¶s abdomen with upward thrust y Repeat thrusts until object expelled from victim¶s airway o Victim lying down y Place victim supine y Kneel astride victim¶s thighs and place heel of one hand against victim¶s abdomen y Place other hand on top of first y Press into abdomen with quick upward thrust 2. HEIMLICH MANEUVER o Victim standing / sitting y Make fist with one hand y Place thumb side of fist against victim abdomen. 7 PRIORITY MANAGEMENT y Establish airway and ventilation y Control of hemorrhage y Prevent and treat Hypovolemic shock. Cardiogenic shock ± unable to supply enough blood to the organs of the body. This type of shock can cause many organs to stop working. *Unresponsive patients with penetrating head wounds. minor burns. MULTIPLE INJURIES Caused by simple catastrophic event that causes life threatening injuries to at least 2 distinct organ system. tension pneumothorax.y y y Apply the chest paddles as follows: one at the right of the sternum. PRIORITY 4 (EXPECTANT) BLACK ± injuries are extensive and chances of survival are unlikely even with definitive care. vascular injuries w/ adequate callteral circulation. renal effects. 2. pallor. CONSCIOUS INFANT ± if the infant is conscious and cannot cough. y Assess for head and neck injuries. fractures requiring open reduction. high spinal cord injuries. agonal respirations. hepatic effects y Irreversible / refractory stage EXTERNAL FLUID LOSS y Trauma y Surgery y Vomiting y Dieresis y Diarrhea y Diabetes insipidus INTERNAL FLUID SHIFTS y Hemorrhage y Burns y Ascites y Peritonitis y Dehydration CRASH INJURIES ± occur when a person is caught bet. no bp. third ICS. Septic shock ± overwhelming infection leads to life threatening low blood pressure. *Stable abdominal wounds w/out evidence of significant hemorrhage. Multiple organ dysfunction STAGES: y Compensatory ± tachycardia. w/ no disruption of the skin integrity. y Re-assess for head and neck. MANAGEMENT: 1. FINGER SWEEP ± used only in the unconscious adult patient. Individuals to this group should moved away from the main triage area. most eye and CNS injuries. pupils fixed and dilated. increase capillary permeability. and the other one on the left midaxillary.the placement of a flexible plastic tube into the trachea to protect the patients airway and provide a means of mechanical ventilation. * Sucking chest wound. Hypovolemic shock ± severe blood and fluid loss makes the heart unable to pump enough blood to the body. CHEST THRUST ± used only in the patient stages of pregnancy or in the markedly obese person. maxillofacial wounds w/out airway compromise. 5. soft tissue injuries. Nuerogenic shock ± caused by damage to the CNS 6. Circulatory shock 7. hemothorax. run over by a moving vehicle or compressed by machinery. PRIORITY 3 (MINIMAL) GREEN ± injuries are minor and treatment can be delayed hours to days. sprains. 4. small lacerations w/out significant bleeding. open fractures for long bones and 2nd/3 rd burns 15 to 40% total body surface area. *Upper extremity fractures. paralysis PRIORITY 1 (IMMEDIATE) RED ± injuries are life threatening but survival with minimal intervention. y Spiral ± fracture that twist around the shaft of the bone. pale/ cool skin. This action draws the tongue away from the back of the throat and away from the foreign body that may be lodged there. airway obstruction 2nd to mechanical cause. behavioral disorders or psychological disturbance. 2nd/3 rd degrees burns in excess of 60 of the body surface area. no pulse. y Simple / close ± fracture that remains contained. hypotension. y Diagonal y Oblique Signs and symptoms: Paresthesia. Monitor urine output. Objects. chest. pain. INTUBATION . unstable chest and abdominal wound. constriction of peripheral circulation.