4 Emergency and Mass Casualty Nursing

Monday, 10 October 2022

9:59 PM
Emergency Nursing
Is a specialized education, training and experience to gain expertise in assessing and identifying
patients health care problems in crisis situations.
 
Scope of Emergency Nursing
 Encompasses management of clients across the lifespan
 All health conditions that prompt an individual to seek emergency care
 
Principles of Management
1. Remain calm and think before acting—examine the signs (fruity breath, bite marks)
2. Identify oneself as a nurse to victim and bystanders — "Good Samaritan Law" limits
liability and offer legal immunity for people who help in emergency, provided they give the
best possible care under the conditions of emergency.
3. Do rapid assessment for priority data, check for patent airway; stop bleeding
4. Carry out life saving measures as indicated the priority assessment
5. Do a head-to-toe assessment before initiating general first aid measures
6. Keep victims lying down or in the position, in which he or she is found, protect from
dampness or cold
7. If victim is conscious explain what is occurring. Assure that help will be given
8. Avoid unnecessary handling or moving of the victim. Move only if danger is present.
9. Do not give fluid if there is a possibility of abdominal injury and appropriate transportation
is available
10. Protect the wounds and allay anxiety
 
Core Competency of Emergency Nurse
Assessment
 Discern normal from abnormal
 Significance of pre-existing diseases or comorbidities
Priority Setting
 Triage Process
 Generally gained through hands on clinical ED nursing experience
Knowledge of Emergency Care
 Common and less common medical surgical disease entities
 Extends to recognition, management and legal implications of societal problems
 Interdisciplinary protocols to expedite lifesaving interventions
Technical Skills
 Proficiency with equipment
 Assist physician with certain procedures
 Procedural set ups, client preparation, teaching, and post procedural set up
Common ED procedures
1. Simple and complex wound suturing
2. Foreign body removal
3. Central line insertion
 4. Endotracheal intubation
5. Lumbar puncture
6. Pelvic examination
7. Chest tube insertion
8. Peritoneal lavage
9. Fracture management
 
Triage
 From the French word "trier" means "to sort"
 Classifying patients into priority levels depending on illness or injury severity
 ED patients with highest acuity needs receive the quickest evaluation, treatment, and
prioritized resource utilization
Three-tiered Model Triage Scheme
1. Emergent triage
 Condition that poses n immediate threat to life or limb
2. Urgent triage
 Client should be treated quickly but an immediate threat to life does not exist at the
moment
3. Non—urgent
 Can generally tolerate waiting several hours for health care services without
significant risk for deterioration
 
Emergency Scene
When an emergency occurs or on arriving at the emergency scene. it is important to assess the
situation and the environment before initiating actions
 
1. Priority Assessment
2. Head to Toe Assessment
 
Assessment
PRIMARY ASSESSMENT
 Responsiveness
 CAB
SECONDARY ASSESSMENT
 History
 Inspection / Observation
 Palpation
 Testing (special testing)
RAPID TRAUMA
 Deformity
 Contusion
 Abrasion
 Puncture
 Burn
 Tenderness
 Laceration
  Swelling
HISTORY
 Signs and symptoms
 Allergies
 Medications
 Pertinent/ past illnesses
 Last meal
 Events/ environment prior to injury
 
The primary survey and resuscitation interventions:
 ABC's of emergency care
 
Airway/Cervical Spine
 Highest priority
 Even minute without adequate oxygen supply can cause cerebral injury
 Cervical spine must be protected in any trauma client
 Supplemental oxygen is required for patients who require resuscitation
 BVM for clients who need ventilatory assistance
 Endotracheal intubation for patients with decreased LOC (CCS lower than 8)
Breathing
 Next priority to assess whether ventilatory efforts are effective. Not only whether the client
is breathing or not
 Auscultation, evaluation of chest expansion, respiratory effort and chest trauma
 BVM until ET intubation is performed
 Needle thoracostomy and tube thoracostomy for pneumothorax
Circulation
 Adequacy of heart rate. BP and overall perfusion
 External hemorrhage versus internal hemorrhage
 BP is assessed by using sphygmomanometer or palpation of pulses
o Radial pulse at least 80 mmHg
o Femoral pulse at least 70 mmHg
o Carotid pulse at least 60 mmHg
 
Disability
 Rapid baseline of neurological status
 Alert, responsive to voice, responsive to pain, unresponsive
 Glasgow coma scale
Exposure
 All clothing is removed to allow for thorough assessment
 Observe evidence preservation policies for medico legal patients
 Prevent hypothermia
 
 
Triage
Emergent
 Highest priority
 Life threatening conditions, limbs must be treated immediately
o Airway compromise
o Cardiac arrest
o Shock
o Stroke
o Major Burns
Urgent
 Threatening conditions
 Not immediate
 Must be seen within 1 hour
o Fever
o Minor Burns
o Lacerations
Non-urgent
 Can be addressed within 24 hours
o Chronic conditions
o Dental problems
o Missed Menses
4th category
Fast track - simple first aid
 
Role of the Nurse
 May perform beyond his expertise
 Example: Insertion of ET and CT, debridement and suturing
 TRIAGE officer
 May provide shelter in housing area, bereavement support
 Nonmedical personnel may be utilized
 EMERGENCY RESCUE AND TRANSPORT
 
Triage
START - Simple Triage And Rapid Treatment
 Quick assessment of respiration, perfusion, mental status
SAVE - Secondary Assessment of Victim Endpoint
 Identifies who may benefit from care available
 
Triage Categories
RED YELLOW GREEN BLACK
Most 2nd Urgent/Delayed Non-urgent/Minimal Death/Expectant
urgent/immediat
e
Life-threatening Injuries with systemic Localized injuries No distinction
shock, hypoxia effects but not yet life- without immediate between clinical
  threatening systemic implication and biological death
2nd - 3rd degree      
burns Soft tissue injury Minor burns, UE fx Example:
Hemothorax unresponsive px
 
Wounds
1. Laceration - skin tear with irregular edges
2. Avulsion - tearing away from supporting structure
3. Abrasion - denuded skin
4. Ecchymosis/contusion - blood trapped
5. Hematoma - tumor-like under the skin mass of blood trapped under the skin
6. Stab - incision with well-defined edges
7. Stab wound with evisceration
8. Gunshot wound - entry and exit
 
Gunshot Wounds and Acute Hemorrhage
 Penetrating trauma is one of the leading causes of hemorrhage
 Leading cause of penetrating trauma
 Cone-shaped path leading to damaged tissues
 Entry and exit wounds
 Damages depends on the gun's caliber type of bullet proximity, pressured path
Management
 1. Secure or support patient airway
2. Optimize breathing
3. Maintain circulation
4. Establish IV access
5. Replace intravascular volume
6. Manage bleeding
7. Management of hypovolemic Shock
8. Prepare client for possible surgery
 
Hemorrhage
 Stopping bleeding is essential to the care and survival
 primary cause of shock
 Signs Symptoms of Shock:
 Cool moist skin
 Falling pressure
 Increasing heart rate
 Delayed capillary refill
 Decreasing urine
Management
 Fluid Blood replacement
 Control of external hemorrhage:
 Direct pressure
 Temporal
 Facial
 Carotid
 Subclavian
 Brachial
 Radial and Ulnar
 Femoral
 Pressure Dressing
 Tourniquets (last resort)
Control of Internal Bleeding
 Signs & Symptoms:
 tachycardia
 Falling blood pressure
 Thirst
 Apprehension
 Cool & moist skin
 Delayed capillary refill
 Packed Red Blood Cell transfusion
 Surgery
 Pharmacologic therapy