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NUR 3552 DISASTER & EMERGENCY NURSING

EMERGENCY CARE

DEFINITION
EMERGENCY A sudden and unexpected occurrence which requires urgent attention. Emergency is a sudden and unexpected happening that makes it necessary to act quickly especially in saving a person’s life during being in critical condition

EMERGENCY CARE Delivery of urgent treatment, either as a temporary measure until full investigation and treatment is practical, or as a lifesaving measure. Medical or other health treatment, services, products or accomodations provided to an injured or ill person for a sudden onset of a medical condition of such nature that failure to render immediate care would reasonably result in deterioration of the injured person's medical condition

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The types of patients that come to the emergency department for care as well as the numbers of patients that show up in hospital emergency departments often depend on things EMERGENCY NURSING .The emergency department (ED) is an area of the hospital that is truly different each and every day and can quickly shift from the quietest to the most hectic department in the hospital in literally a matter of minutes.

and asthma victims. and the occasional pregnant woman whose delivery is progressing faster than she anticipated. administrative and managerial positions. Emergency room nurses aren’t limited to working in hospitals. heart attack. Nurses with experience in emergency nursing might be found in EMS and pre-hospital transport.ED nurses can expect to care for patients of all ages. educators in . stroke. flight nursing in medical transport helicopters. the military. poison control centers.

Emergency care nursing sounds exciting. ED nurse should have…. interpersonal and customer service skills? The ability to think and act decisively on your feet? The ability to perform many tasks simultaneously? Stamina? . Good listening.

The ability to shift gears. refocus and reprioritize quickly? Good coping skills? The ability to remain calm in tense. highly stressful situations? A sense of humor (laughter is a great way to deal with difficult situations)? .

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Emergency nurses must tackle diverse tasks with professionalism.  Emergency nursing is a specialty area of the nursing profession like no other. emergency nurses must possess both general and specific knowledge about health care to provide . efficiency. particularly during the initial phase of acute illness and trauma. and above all—caring.EMERGENCY NURSE Background  Emergency nurses specialize in rapid assessment and treatment when every second counts. To provide quality patient care for people of all ages.

government. cruise ships.ED NURSES’ ROLES • Patient Care . and anywhere someone may have a medical emergency or where medical advances or injury prevention is a concern. . industry. helicopters. ambulances.Emergency nurses care for patients and families in hospital emergency departments. urgent care centers. sports arenas.

Emergency nurses also may work as administrators. . bicycle and helmet safety. and domestic violence prevention.• Education . • Leadership and Research . gun safety. such as alcohol awareness. managers. child passenger safety.Emergency nurses provide education to the public through programs to promote wellness and prevent injuries. and researchers who work to improve emergency health care.

PRIMARY SURVEY • Focuses on airway. breathing. circulation and disability and serves to identify life threatening conditions so that appropriate interventions could be initiated .

During the primary survey.      As   these   conditions   are   detected.   The primary survey is a “treat-asyou-go” process. it is treated immediately. As each major problem is detected.The primary survey is a process carried out to detect and treat lifethreatening conditions. and early transport may be initiated. should . lifesaving measures are taken immediately. before moving on to the next.

. Ideally. the ABCDE steps. status. and transport decision should be completed within 10 minutes of your arrival on the scene.A status decision is a judgment about the severity of the patient’s condition and whether the patient requires immediate transport to a medical facility without a secondary survey at the scene.

A=Airway . provide rescue breathing. . such as penetrating trauma to the chest .Assess responsiveness and.An obstructed airway may quickly lead to respiratory arrest and death .Look for and treat conditions that may compromise breathing.Assess breathing and if necessary. if necessary.Respiratory arrest will quickly lead to cardiac arrest . open the airway B=Breathing .

fractures. vomitus. . in patient with a compromised presence of foreign body in airway the airway. b)Suctioning and removal of foreign body. facial trauma. __________________________________ __________________________________ Treatment a)Opening the airway using the jaw–thrust maneuver (avoiding hyperextension of the neck). and trauma to the face or neck. __________________________________ __________________________________ Primary signs and symptoms Dyspnea. laryngeal trauma. bloody secretions. inability to vocalize. c)Endotracheal intubation (ETT). and the tongue. sputum.AIRWAY Airway with cervical spine stabilization and /or immobilization Airway obstruction of saliva.

cyanosis (due to asthma). penetrating injury. allergic reaction. visible wound Treatment to chest wall (penetrating injury). paradoxic or asymmetric chest wall movement (flail chest). pneumothorax.BREATHING Breathing to ensure adequate Breathing alterations are ventilation to the upper and caused by many conditions lower airway such as fractured ribs. __________________________________ . tachycardia and hypotension. pulmonary emboli. decreased or absent breath sounds on the affected site __________________________________ (pneumothorax). and asthma __________________________________ attack. Patients with these conditions __________________________________ may experience a variety of Dyspnea (due to pulmonary signs and symptoms emboli).

  cell  death  will  usuall y occur  within  10  minutes.Assess circulation and if necessary. . .C=Circulation If  the  patient’s  heart  has  stopp ed. blood and  oxygen are not being sent to  the  brain.Irreversible changes will begin to occur in the  brain in 4 to 6  minutes. provide CPR .

intact blood vessels. In an emergency situation. assess skin for color. and hemorrhagic shock. Intervention __________________________________ Intravenous lines are inserted into veins in a massive fracture or an injury that affects limb circulation. uncrossmatched blood may be .CIRCULATION Circulation is to ensure an effective Uncontrolled internal or external circulatory system including the bleeding places a person at risk for heart. adequate blood volume __________________________________ __________________________________ Sign and symptoms should be A central pulse (carotid) and assessed for circulation peripheral pulses should be palpated. temperature and moisture. delayed capillary refill (longer than 3 seconds) and mental status are the __________________________________ most significant signs of shock. Blood samples are obtained to determine ABO and Rh group. Type–specific packed red blood cells should be administered if needed.

Serious central nervous system injuries can  lead to death .Observe .D=Disability . apply  a  rigid  neck  collar .Assess the patient’s level of consciousness  and. if you suspect a head or neck inj ury.

Pupils should also be assessed for size. __________________________________ Intervention .DISABILITY Disability is indicated with a brief neurologic examination (is measured by the patient’s level of consciousness) __________________________________ A simple mnemonic to remember Determining the patient’s response to verbal and/or painful stimuli to assess the level of consciousness. shape. equality and response to light. __________________________________ A : Alert V : Responsive to Voice P : Responsive to Pain U : Unresponsive __________________________________ Glasgow Coma Scale (GCS) is used to further assess the patient’s consciousness.

E= Expose You cannot treat conditions you ha ve not   discovered. .Protect the patient’s privacy and  keep  the . Remove clothing especially if  the patient is not alert or communicating or any lifethreatening injuries.

SECONDARY SURVEY • After each step of the primary survey is addressed and any lifesaving interventions are initiated. • The secondary survey is a brief. . the secondary survey begins. systematic process that is aimed at identifying all injuries.

The secondary survey is a head-to-toe evaluation of the trauma patient. If at any time during the secondary . X-rays indicated by examination are obtained. resuscitation efforts are well established. Each region of the body must be fully examined. and the vital signs are normalizing. including a complete history and physical examination. the secondary survey can begin. including the reassessment of all vital signs.When the primary survey is completed.

Determine family's desire to be present during invasive procedures or cardiopulmonary resuscitation. History and Head−to−Toe Assessment . HR. extremities (sign of external Facilitate Family Presence Give Comfort Measures Level of pain. chest (observe rate. bleeding. blood for laboratory test. anxiety. Keep patient warm with blankets. rectal bleeding. respiratory rate. breathing pattern. allergies. pelvis and perineum (assess genitalia for blood. abrasions. 0₂ saturation. breathing sound. bruising. Heart rhythm. insertion of gastric tube. note general appearances (head. lacerations. neck. overhead lights. depth. Obtain vital signs: temperature. punctures. assess for bowel sounds). BP. etc). warmed IV fluids. abdomen distention. ecchymosis. abdomen and flanks (sign of injury. Detail of the incidence.PARAMETER Exposure and Environment Control Full Set of Vital Signs Five Interventions ASSESSMENT Remove clothing for adequate examination. insertion of urinary catheter. face). medication history. obtain ECG).

An emergency care plan ensures there is written documentation nominating who provides care.PLANNING Emergency Care Planning • Definition: A process that includes all activities. how to provide care and . tools and policies/procedures used to assist clinicians during attending patients on what actions to take if a medical problem or change in condition occurs • An emergency care plan ensures that you have a back up plan in place if you are suddenly unable to provide care.

NURSING ACTIONS • Giving care to patient —Emergency nurses care for patients & families anywhere. child . to someone who have a medical emergency or where medical advances or injury prevention is a concern. such as alcohol awareness. • Provide education —Emergency nurses provide education to the public through programs to promote wellness and prevent injuries.

. managers. and researchers who work to improve emergency health care.• Involved in leadership and research —Emergency nurses also may work as administrators.

patient safety and for hospital ED reimbursement. by determining and documenting the ED level of care. as it improves patient care and providing effective risk management  Proper Emergency Nursing Documentation is essential for continuity of care.  ED Nursing Documentation teaches the critical patient documentation skills which are necessary from a clinical. DOCUMENTATION .Documentation in Emergency Department (ED) is important.

risk management and proper facility reimbursement .This is divided between good clinical care and proper nurse documentation  It also emphasizes the importance of good nursing documentation for patient care.

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