Emergency NursingEmergency Nursing

Emergency NursingEmergency Nursing is a nursing is a nursing specialty in which nurses care for specialty in which nurses care for patients in the emergency or critical patients in the emergency or critical phase of their illness or injury phase of their illness or injury

the key difference is that an emergency the key difference is that an emergency nurse is skilled at dealing with people in nurse is skilled at dealing with people in the phase when a diagnosis has not yet the phase when a diagnosis has not yet been made and the cause of the problem been made and the cause of the problem is not known. is not known.

E-CART- CRASH CARTE-CART- CRASH CART A A crash cartcrash cart or or code cartcode cart ( (crash trolleycrash trolley in UK medical jargon) in UK medical jargon)

is a set of trays/drawers/shelves on wheels used in hospital is a set of trays/drawers/shelves on wheels used in hospital emergency roomsemergency rooms for transportation and dispensing of for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency medication/equipment at site of medical/surgical emergency for life support protocols emergency for life support protocols (ACLS/ALS)(ACLS/ALS) to potentially to potentially save someone's life.save someone's life.

A crash cart typically contains a A crash cart typically contains a defibrillatordefibrillator and intravenous and intravenous medicationsmedications (such as (such as epinephrineepinephrine and and atropine)atropine), plus a , plus a variety of medical supplies such as variety of medical supplies such as latex gloveslatex gloves, , endotracheal endotracheal tubes, Ambu bags, cannulaetubes, Ambu bags, cannulae..

Hospitals typically have internal intercom codes used for Hospitals typically have internal intercom codes used for situations when someone has suffered a cardiac arrest or a situations when someone has suffered a cardiac arrest or a similar potentially fatal condition outside of the emergency room similar potentially fatal condition outside of the emergency room (where such conditions already happen frequently and do not (where such conditions already happen frequently and do not require special announcements). When such codes are given, require special announcements). When such codes are given, hospital staff and volunteers are expected to clear the corridors, hospital staff and volunteers are expected to clear the corridors, and to direct visitors to stand aside as the crash cart and a and to direct visitors to stand aside as the crash cart and a team of physicians and nurses may come through at any team of physicians and nurses may come through at any momentmoment

TOP DRAWERTOP DRAWER

2nd drawer – adult intubation supplies2nd drawer – adult intubation supplies

3rd drawer – peds intubation supplies3rd drawer – peds intubation supplies

4th drawer – peds miscellaneous supplies4th drawer – peds miscellaneous supplies

5th drawer – IV and blood draw supplies5th drawer – IV and blood draw supplies

6th drawer – IV solution and tubing6th drawer – IV solution and tubing

7th drawer – procedure trays and miscellaneous 7th drawer – procedure trays and miscellaneous suppliessupplies

Scope and practice of Scope and practice of Emergency nursing Emergency nursing

Specialized educationSpecialized education Expertise in assessing and identifying Expertise in assessing and identifying

patients health care problemspatients health care problems Establishes priorities, monitors acutely ill Establishes priorities, monitors acutely ill

and injured pts.and injured pts. Nursing interventions are accomplished Nursing interventions are accomplished

independentlyindependently

Categories of TriageCategories of Triage

Emergent- highest priority, condition is Emergent- highest priority, condition is life threatening and must be attended life threatening and must be attended immediatelyimmediately

Urgent serious health problems but not Urgent serious health problems but not immediately life threatening ; must be immediately life threatening ; must be seen in one hourseen in one hour

Non- Urgent- episodic illness that must Non- Urgent- episodic illness that must be seen w/n 24 hours without increased be seen w/n 24 hours without increased morbiditymorbidity

Use of colors for Use of colors for segregationsegregation

RED- emergent(bleeding patients RED- emergent(bleeding patients attended to as soon as possible)attended to as soon as possible)

YELLOW- delayed (patient can wait for YELLOW- delayed (patient can wait for one hour to be treated)one hour to be treated)

GREEN- ambulatory injured GREEN- ambulatory injured patients(non-urgent)patients(non-urgent)

BLACK- death BLACK- death imminent/expectant(minimal chance of imminent/expectant(minimal chance of survival)survival)

ALLERGIC REACTIONSALLERGIC REACTIONS

GeneralGeneral Signs of allergic reactions include Signs of allergic reactions include

difficulty breathing (wheezing); difficulty breathing (wheezing); swollen lips, face, and tongue; swollen lips, face, and tongue; possible hives and skin redness, possible hives and skin redness, swelling, or itching.swelling, or itching.

TreatmentTreatment Contact your EMS system immediately.Contact your EMS system immediately. Keep the person quiet in whatever position is Keep the person quiet in whatever position is

most comfortable for him or her.most comfortable for him or her. If the person stops breathing, give artificial If the person stops breathing, give artificial

ventilation.ventilation. Some individuals who have had previous severe Some individuals who have had previous severe

allergic reactions may carry adrenalin injection allergic reactions may carry adrenalin injection kits prescribed by their doctor. The individual may kits prescribed by their doctor. The individual may be able to inject himself or herself. If the person be able to inject himself or herself. If the person cannot do so, read the directions in the in the kit cannot do so, read the directions in the in the kit to administer the injection.to administer the injection.

BITES and STINGSBITES and STINGS

TreatmentTreatment Wash the bite or sting with soap and water, if available.Wash the bite or sting with soap and water, if available. For all types of bites and stings:For all types of bites and stings:

Do not attempt to suck out the venom with your Do not attempt to suck out the venom with your mouth.mouth.

Do not apply a tourniquet.Do not apply a tourniquet. Do not place ice directly on the bite or sting.Do not place ice directly on the bite or sting. Do not administer unproven treatments, such as Do not administer unproven treatments, such as

electric shocks or folk/herbal remedies.electric shocks or folk/herbal remedies. Do not administer alcohol, stimulants, or aspirinDo not administer alcohol, stimulants, or aspirin

Bee StingsBee Stings Do not remove the stinger with tweezers Do not remove the stinger with tweezers

or any instrument that squeezes the or any instrument that squeezes the stinger.stinger.

If the person shows signs of difficulty If the person shows signs of difficulty breathing; swollen lips, face, or tongue; breathing; swollen lips, face, or tongue; or hives and skin swelling, treat for an or hives and skin swelling, treat for an allergic reaction.allergic reaction.

Spider Bites/Scorpion StingsSpider Bites/Scorpion Stings Keep the bitten area immobilized and Keep the bitten area immobilized and

lower than the person’s heart.lower than the person’s heart. Place a cold pack on the bite. DO NOT Place a cold pack on the bite. DO NOT

place ice directly on bite. If you don’t place ice directly on bite. If you don’t have a cold pack, use a plastic bag filled have a cold pack, use a plastic bag filled with water and ice.with water and ice.

If a negative – pressure venom extractor If a negative – pressure venom extractor device is available, use it as soon as device is available, use it as soon as possible.possible.

Venomous SnakebiteVenomous Snakebite Have the person lie down and minimize activity. Keep Have the person lie down and minimize activity. Keep

the bitten area immobilized and lower than the the bitten area immobilized and lower than the person’s heart.person’s heart.

Call an ambulance or take the person to be nearest Call an ambulance or take the person to be nearest hospital ER immediately. Do nothing that might hospital ER immediately. Do nothing that might injure the person or delay getting the person to the injure the person or delay getting the person to the hospital.hospital.

Do not cut across fang marks. If a negative pressure Do not cut across fang marks. If a negative pressure venom extractor is available, use it as soon as venom extractor is available, use it as soon as possible.possible.

Do not apply tourniquet. Many doctors recommend a Do not apply tourniquet. Many doctors recommend a lightly constrictive band on the arm or leg above the lightly constrictive band on the arm or leg above the bite, however. If placed, this band should not be so bite, however. If placed, this band should not be so tight that it cuts off the circulation; you should be tight that it cuts off the circulation; you should be able to comfortably insert a finger underneath the able to comfortably insert a finger underneath the band.band.

..

Remove jewelry or tight – fitting clothes Remove jewelry or tight – fitting clothes in case swelling becomes severe.in case swelling becomes severe.

If swelling or redness appears, mark the If swelling or redness appears, mark the border of the swelling or redness with a border of the swelling or redness with a pen every 15 minutes, and note the time pen every 15 minutes, and note the time of each mark.of each mark.

Do not attempt to capture the snake Do not attempt to capture the snake unless you have special training in snake unless you have special training in snake handling. Snakes that are motionless handling. Snakes that are motionless after being struck may not be deadafter being struck may not be dead

BLEEDINGBLEEDING GeneralGeneral Heavy bleeding is a medical emergency. Prompt Heavy bleeding is a medical emergency. Prompt

first aid to control the bleeding is essential.first aid to control the bleeding is essential. TreatmentTreatment

Have someone call a doctor or the EMS system.Have someone call a doctor or the EMS system. Keeps the person lying down.Keeps the person lying down. Place a pad directly over the wound. If possible, wear Place a pad directly over the wound. If possible, wear

gloves to protect yourself from exposure to blood.gloves to protect yourself from exposure to blood. Press firmly with one or both hands, applying Press firmly with one or both hands, applying

pressure directly over the wound.pressure directly over the wound.

Hold the pad firmly in place with a strong Hold the pad firmly in place with a strong bandage.bandage.

If possible, elevate a bleeding arm or leg higher If possible, elevate a bleeding arm or leg higher than the level of the person’s heart.than the level of the person’s heart.

A tourniquet around an arm or leg should be used A tourniquet around an arm or leg should be used only as a last resort when bleeding is only as a last resort when bleeding is uncontrollable, and should generally be used only uncontrollable, and should generally be used only by trained persons.by trained persons.

Once the bleeding has been controlled:Once the bleeding has been controlled: Keep the person warm by covering him or Keep the person warm by covering him or

her with blankets or a coat.her with blankets or a coat. If you suspect the person could have a spine, If you suspect the person could have a spine,

neck or head injury, do not move the person. neck or head injury, do not move the person. If no such injury is suspected, put newspaper If no such injury is suspected, put newspaper or something under the person if he or she is or something under the person if he or she is on a cold or damp surface.on a cold or damp surface.

If possible, keep the wound uncovered and If possible, keep the wound uncovered and in view.in view.

If the person is conscious and asks for If the person is conscious and asks for water, moisten his or her lips and tongue.water, moisten his or her lips and tongue.

If the person is unconscious or if an If the person is unconscious or if an abdominal injury is suspected, do not give abdominal injury is suspected, do not give fluids.fluids.

Do not give the person alcoholic beverages.Do not give the person alcoholic beverages.

BURNSBURNS GeneralGeneral

Burns can result from heat (thermal burn) or chemicals Burns can result from heat (thermal burn) or chemicals (chemical burn).(chemical burn).

The object of first aid for burns is to prevent shock and The object of first aid for burns is to prevent shock and contamination and to control pain. Every burn can be contamination and to control pain. Every burn can be complicated by shock. A person with “burn shock” may complicated by shock. A person with “burn shock” may die unless he or she receives immediate first aid.die unless he or she receives immediate first aid.

““Burn shock” is characterized by cold, clammy skin with Burn shock” is characterized by cold, clammy skin with beads of perspiration on the forehead and palms; pale beads of perspiration on the forehead and palms; pale skin color; a cold feeling or shaking chills; nausea; skin color; a cold feeling or shaking chills; nausea; vomiting; or shallow, rapid breathing.vomiting; or shallow, rapid breathing.

All burns, except where the skin is reddened in All burns, except where the skin is reddened in only a small area, should be seen by a doctor.only a small area, should be seen by a doctor.

Do not apply ointments, sprays, antiseptics, home Do not apply ointments, sprays, antiseptics, home remedies such as butter or margarine, baking remedies such as butter or margarine, baking soda, or other substances to burns.soda, or other substances to burns.

TreatmentTreatment Extensive Thermal BurnsExtensive Thermal Burns

Cool the burned area quickly with cold water.Cool the burned area quickly with cold water. Place a clean cloth over all burned areas to Place a clean cloth over all burned areas to

protect these areas from air.protect these areas from air. Keep the person lying down.Keep the person lying down. Give no fluids by mouth. Give no fluids by mouth. Elevate the person’s legs if possible.Elevate the person’s legs if possible. Call the EMS system.Call the EMS system.

Small Thermal BurnsSmall Thermal Burns Do not disturb or open blisters.Do not disturb or open blisters. If the skin is not broken, immerse the If the skin is not broken, immerse the

burned part in clean, cold water or apply burned part in clean, cold water or apply a cold pack to relieve pain.a cold pack to relieve pain.

Place a pad over the burn and bandage Place a pad over the burn and bandage loosely.loosely.

Chemical BurnsChemical Burns Brush away any powdered chemicals from the skin, Brush away any powdered chemicals from the skin,

being careful not to get the chemical on you.being careful not to get the chemical on you. Immediately flush the area with plenty of water – not just Immediately flush the area with plenty of water – not just

a rinse. Speed in washing off the chemical is critical to a rinse. Speed in washing off the chemical is critical to reduce the extent of the injury. Use a shower, hose, or reduce the extent of the injury. Use a shower, hose, or any available water faucet. Continue to apply a stream of any available water faucet. Continue to apply a stream of water while removing clothing from the burned area.water while removing clothing from the burned area.

Continue flushing the area with large quantities of water Continue flushing the area with large quantities of water for at least 5 minutes.for at least 5 minutes.

Place a clean cloth over the burn.Place a clean cloth over the burn. Call the EMS system immediately.Call the EMS system immediately. Burns from certain chemicals require specific first – aid Burns from certain chemicals require specific first – aid

treatment. These techniques should be learned by treatment. These techniques should be learned by anyone working in areas where the chemicals are used.anyone working in areas where the chemicals are used.

Bring any containers or available identifying information Bring any containers or available identifying information about the chemicals to the hospital emergency about the chemicals to the hospital emergency department.department.

EYE CONTAMINATIONEYE CONTAMINATION(Chemical or other foreign material in eye)(Chemical or other foreign material in eye)

GeneralGeneral Prompt first – aid treatment is essential. Prompt first – aid treatment is essential.

Delay greatly increases the extent of injury.Delay greatly increases the extent of injury. TreatmentTreatment

Immediately rinse the eyes with a gentle stream Immediately rinse the eyes with a gentle stream of room – temperature water from a faucet, of room – temperature water from a faucet, shower, hose, or pitcher while holding the shower, hose, or pitcher while holding the person’s eyes open. Do not use an eye cup.person’s eyes open. Do not use an eye cup.

Continue rinsing for at least 15 minutes.Continue rinsing for at least 15 minutes. Do not use boric acid or eye drops, drugs, Do not use boric acid or eye drops, drugs,

or ointments. Such substances may or ointments. Such substances may increase the injuryincrease the injury

Take the person to the nearest hospital emergency department Take the person to the nearest hospital emergency department immediately.immediately.

Ask the person if he or she is wearing contact lenses. Remove Ask the person if he or she is wearing contact lenses. Remove them if the person cannot do it, medical help is unavailable, and them if the person cannot do it, medical help is unavailable, and you know how. Often, running a gentle stream of water over the you know how. Often, running a gentle stream of water over the eyes will dislodge the lenses.eyes will dislodge the lenses.

Do not remove a contact lens if the colored area of the Do not remove a contact lens if the colored area of the person’s eye is not visible on opening his or her eyelids.person’s eye is not visible on opening his or her eyelids.

Never try to pry a contact lens loose with fingernails, Never try to pry a contact lens loose with fingernails, matches, pencils, toothpicks, swabs, or similar objects.matches, pencils, toothpicks, swabs, or similar objects.

Do not use force. If you see the lens but can’t remove it, Do not use force. If you see the lens but can’t remove it, use the eyelids to gently slide it onto white of eye. The lens use the eyelids to gently slide it onto white of eye. The lens can stay there until medical help arrives.can stay there until medical help arrives.

You can remove contact lenses with the person standing, You can remove contact lenses with the person standing, sitting, or lying on his or her back.sitting, or lying on his or her back.

After removing contact lenses, put them in their container. After removing contact lenses, put them in their container. If the lens container is not available, place the lenses in If the lens container is not available, place the lenses in bottles with a little water and identify the eye from which bottles with a little water and identify the eye from which the lenses were removed.the lenses were removed.

NOSEBLEEDSNOSEBLEEDS

TreatmentTreatment Have the person sit and lean forward.Have the person sit and lean forward. Pinch the soft portion of the nose (below the Pinch the soft portion of the nose (below the

nasal bone) between the thumb and index finger nasal bone) between the thumb and index finger for 10 minutes continuously.for 10 minutes continuously.

If bleeding does not stop, put a small, clean pad If bleeding does not stop, put a small, clean pad of gauze into one or both nostrils and pinch of gauze into one or both nostrils and pinch your nose with your thumb and index finger.your nose with your thumb and index finger.

Apply cold compresses or a cold pack to the Apply cold compresses or a cold pack to the bridge of the nose and face.bridge of the nose and face.

If bleeding continues, call for medical help.If bleeding continues, call for medical help.

POISONINGPOISONINGGeneralGeneral Symptoms of poisoning include:Symptoms of poisoning include: Sudden onset of unconsciousness, seizures, Sudden onset of unconsciousness, seizures,

confusion, or illness when access to poisons is confusion, or illness when access to poisons is possible.possible.

Bottles or packages of drugs or poisonous Bottles or packages of drugs or poisonous chemicals found open in the presence of children.chemicals found open in the presence of children.

Evidence in the mouth of eating wild berries or Evidence in the mouth of eating wild berries or leaves.leaves.

Pain or burning sensation in the throat.Pain or burning sensation in the throat. Unusual odor on the breath.Unusual odor on the breath. Vomiting.Vomiting.

Swallowed poisonsSwallowed poisons Important: Do not induce vomiting if the person has Important: Do not induce vomiting if the person has

swallowed a petroleum product or a corrosive swallowed a petroleum product or a corrosive product.product.

Petroleum products – kerosene, gasoline, lighter Petroleum products – kerosene, gasoline, lighter fluid, furniture polish, and others may be identified fluid, furniture polish, and others may be identified by their odors on the person’s breath.by their odors on the person’s breath.

Corrosive products – acids such as rust removers; Corrosive products – acids such as rust removers; toilet bowl cleaners; other acids for cleaning; and toilet bowl cleaners; other acids for cleaning; and alkalies such as lye, bleaches, and ammonia will alkalies such as lye, bleaches, and ammonia will cause burns on the mouth or lips or a pain or cause burns on the mouth or lips or a pain or burning sensation in the mouth or throat.burning sensation in the mouth or throat.

Other swallowed poisons include wild mushrooms, Other swallowed poisons include wild mushrooms, plants, and berries; household and lawn and garden plants, and berries; household and lawn and garden chemicals; hair and cosmetic products; and over-chemicals; hair and cosmetic products; and over-the-counter and prescription medications.the-counter and prescription medications.

TreatmentTreatment For severe poisonings, call an ambulance For severe poisonings, call an ambulance

immediately. For other poisonings, call poison immediately. For other poisonings, call poison control center or a doctor.control center or a doctor.

Do not induce vomiting unless instructed to do Do not induce vomiting unless instructed to do so by the poison control center or medical so by the poison control center or medical personnel. Do not induce vomiting if the victim personnel. Do not induce vomiting if the victim is unconscious or is having convulsions.is unconscious or is having convulsions.

Give the poison container with its intact label Give the poison container with its intact label and any remaining contents to the doctor, and any remaining contents to the doctor, paramedic, or hospital personnel. The type of paramedic, or hospital personnel. The type of the poison determines the treatment.the poison determines the treatment.

Convulsions from poisoningConvulsions from poisoning

Call an ambulance immediately.Call an ambulance immediately. If the person is having convulsions:If the person is having convulsions:

Maintain an open airway.Maintain an open airway. If the person stops breathing, begin If the person stops breathing, begin

artificial ventilationartificial ventilation Position the person so that he or she will Position the person so that he or she will

not injure himself or herself (usually lying not injure himself or herself (usually lying on is or her back) and away from walls or on is or her back) and away from walls or heavy furniture. Do not restrain the personheavy furniture. Do not restrain the person

Loosen tight clothing.Loosen tight clothing. Do not force a hard object or finger between the person’s Do not force a hard object or finger between the person’s

teeth.teeth. After the convulsion, turn the person on his or her side in After the convulsion, turn the person on his or her side in

case of vomiting.case of vomiting. Inhaled poisons (smoke or chemical gas fumes)Inhaled poisons (smoke or chemical gas fumes)

Do not become a victim yourself by exposure to the same poison.Do not become a victim yourself by exposure to the same poison. Call an ambulance.Call an ambulance. Do not attempt the rescue alone.Do not attempt the rescue alone. If there is minimal risk of injury to yourself, move the person to If there is minimal risk of injury to yourself, move the person to

fresh air as soon as possible.fresh air as soon as possible. Start artificial ventilation immediately if breathing has stopped.Start artificial ventilation immediately if breathing has stopped. Keep the person warm.Keep the person warm. Keep the person as quiet as possible.Keep the person as quiet as possible.

Never give the person alcoholic beverages. Give Never give the person alcoholic beverages. Give nonalcoholic liquids only if the person is consciousnonalcoholic liquids only if the person is conscious

SEIZURE or CONVULSIONSEIZURE or CONVULSION

GeneralGeneral A seizure is a medical emergency, except for A seizure is a medical emergency, except for

persons with epilepsy who have a history of persons with epilepsy who have a history of frequent seizures.frequent seizures.

TreatmentTreatment Call an ambulance immediately for any seizures in a person Call an ambulance immediately for any seizures in a person

who is not known to have epilepsy or in a person with who is not known to have epilepsy or in a person with epilepsy who has a seizure lasting 15 minutes or longer.epilepsy who has a seizure lasting 15 minutes or longer.

Remove objects that might injure a person as he or she Remove objects that might injure a person as he or she moves involuntarily.moves involuntarily.

Do not restrain.Do not restrain. Do not slap.Do not slap. Do not douse with water.Do not douse with water.

Do not place anything in his or her mouth.Do not place anything in his or her mouth.

SHOCKSHOCK GeneralGeneral

Shock is characterized by cold, clammy skin with Shock is characterized by cold, clammy skin with beads of perspiration on the forehead and palms; beads of perspiration on the forehead and palms; pale skin color; a cold feeling or shaking chills; pale skin color; a cold feeling or shaking chills; nausea; vomiting; or shallow, rapid breathing.nausea; vomiting; or shallow, rapid breathing.

Shock usually accompanies severe injury, illness, Shock usually accompanies severe injury, illness, or severe emotional upset.or severe emotional upset.

Shock may follow other conditions discussed Shock may follow other conditions discussed in thisin this

TreatmentTreatment Call an ambulance.Call an ambulance. Correct the cause of the shock if possible Correct the cause of the shock if possible

(eg. control bleeding).(eg. control bleeding). Keep the person’s airway open.Keep the person’s airway open. If the person vomits, turn his or her head If the person vomits, turn his or her head

to the side so the vomitus will not be to the side so the vomitus will not be swallowed. If a neck injury is suspected, swallowed. If a neck injury is suspected, maintain alignment of the person’s head, maintain alignment of the person’s head, neck, and body while turning.neck, and body while turning.

Elevate the person’s legs if there are no Elevate the person’s legs if there are no broken bones.broken bones.

Keep the person’s head lower than the trunk if Keep the person’s head lower than the trunk if possible.possible.

Keep the person comfortable and warm.Keep the person comfortable and warm. Give water only if the person is conscious and Give water only if the person is conscious and

able to swallow, and if medical help will be able to swallow, and if medical help will be delayed for more than 1 hour.delayed for more than 1 hour.

Do not give fluids to unconscious or Do not give fluids to unconscious or semiconscious persons.semiconscious persons.

Do not give fluids if an abdominal injury is Do not give fluids if an abdominal injury is suspected.suspected.

Never give alcoholic beverages.Never give alcoholic beverages. Reassure the person.Reassure the person.