Emergency and disaster Emergency and disaster nursingnursing

Prepared by:Prepared by:

Michael MagpantayMichael Magpantay

EMERGENCY NURSING - practice of episodic, primary, critical and acute nursing care of all ages who experience physical,emotional or psychological alterations in health.

Care of the Client presenting to an Emergency Department :

1. Triage – classification of all clients presenting to the emergency department.

Purpose: to prioritize treatment.

Triage Rating Systems: 3 Categories

a. Emergent – conditions requiring IMMEDIATE CARE and intervention because of increased risk of mortality or threat to life, limb or vision.

B-burnsC-chest pain-cardiac arrest

R-respiratory distressH-hemorrhage sec. to ectopic pregnancy

M-major blunt or penetrating trauma

b. Urgent – conditions that require care ASAP and generally within 1 hour because the condition has the potential for causing the deterioration of health state if not treated ASAP. These clients will have stable V/S but have acute illness and must be treated to prevent morbidity.

F-feverA-abd.pain

S-stable fractureH-HA

L-lacerations with controlled bleedingD-DHN

c. Non-urgent- require routine care that can be delayed for more than 2 hours without the possibility of deterioration; clients presenting with non-urgent conditions frequently utilize the emergency dept. because they do not have a primary care physician.

C-coldsS-sore throatT-tooth acheA-abrasions

R-rashes

2. Disaster Management Plan – a community wide, hospital –wide or emergency department plan to handle mass casualty incidents that may occur at any time.

Assessment:

a.Primary Assessment – rapid initial assessment of the symptoms to determine life threatening conditions while simultaneously intervening.

Airway- with C spine immobilization, patent airway, ability to speak,

foreign body, chest expansion.Tx: chin-lift / jaw thrust, suctioning, intubation,

cricothyroidectomy, tracheostomy, cervical spine neutral position.

Breathing- effectiveness of breathing and ventilation ability.Abnormal : apnea, weak, shallow/labored respiration

diminished /absent breath sounds unequal chest expansion

retractions/ paroxysmal chest wall movement tracheal deviation

NVE Open chest wound

Sx of chest trauma Subcutaneous emphysema

Tx: 1. Oxygen therapy 2. Chest tube insertion, intubation 3. Pressure dressing on a flail segment of the ribs

Circulation- adequate circulation to maintain cellular tissue perfusion.Abnormal : bradycardia or tachycardia

cool, pale and diaphoresis obvious uncontrolled external bleeding

decrease LOC Sx of hypovolemia, pericardial

tamponade, cardiac arrest

Tx:1. direct pressure to control external bleeding2.IV access3. CPR4. Pericardiocentesis-aspiration of blood from

pericardial sac5. Autotransfusion – BT of one s own blood.

Disability – complete a brief neurological assessment to determine baseline functioning, potential life threatening complications, LOC. Abnormal: Unresponsive –altered pupils : fixed pupils, papillary response abnormalities.

Expose- remove all clothing from the client to facilitate a thorough complete secondary assessment examination.

Secondary Assessment- a brief, systematic head to toe assessment that identifies all injuries.

Tx: cervical immobilization is maintained at all times as well as continual assessment of hemodynamic and oxygen status.

Fahrenheit-provide measures to prevent body heat loss at this time through the use of warmed IVF, warmed blankets or healing lamps.

Get V/S –other assessment aids : cardiac monitor, pulse oxi,urinary catheter, NGT, lab. studies: CBC, electrolytes, Fibrin degradation products (coagulation), amylase, lactate; renal studies ; blood type and crossmatch; toxicology studies.

History- head to toe assessment : HPI / PMH / FH /Meds

Common Problems Seen in Emergency Settings :

1. Airway obstruction- partial or complete obstruction of the airway.2. Tension pneumothorax- occurs when air enters the pleural space through a tear during inspiration and accumulates because it cannot escape during expiration.3. Flail chest – the force of impact to the chest wall during injury causes the fracture of 3 or more continguous ribs\ in 2 or more places resulting in a floating segment.

4. Uncontrolled hemorrhage- uncontrolled bleeding.5. Motor Vehicle Accidents *MVA- blunt and multiple trauma.

Acceleration/deceleration forces – increased velocity of a moving object followed by a reduction in velocity e.g. speed of a vehicle.

Compression forces- body parts are pressed against immobile objects due to explosive injury to air filled organs *liver and spleen

Shearing forces- a rotational force exerted around a fixed site.

Blunt trauma- fractures, lacerations, contusions, rupture or tearing of solid and hollow organs and major blood vessels.

6. Penetrating injuries - stab wounds/GSW : knives, pencils, forks; high velocity /high energy missiles: guns,rifles,high pressure injection devices.

7. Hypothermia – a condition where the core body temp. is 36 C ( 96.8 F ) or less.

Tx : ABC, faster rewarming, Cordarone, D50-50 IV

8. Frostbite – injury caused by exposure to cold environment and conditions.

Tx : Remove from the cold envt. before thawing. Area not be rubbed –mechanical friction can cause tissue

damage; Aloe vera topical – inhibits platelet aggregation :

thromboxane inhibiting effect.Tetanus prophylaxisTopical and parenteral antibioticsOral and parenteral analgesics

9. Heat exhaustion- vasomotor collapse sustained from prolonged exposure to heat.

Tx : Rest in cool, shaded area TSB, direct fans toward patient F/E replacement

10.Heat stroke – an extremely elevated core body temperature caused by a failure of the hypothalamus-perspiration regulating mechanism; carries 70% mortality rate.Tx : Aggressive cooling measures to institute Full body exposure and cooling by evaporation Prevent shivering Cardiac monitor Ice water gastric and peritoneal lavage Prevent over correction , hypothermia and cerebral edema IV NSS, do not use LR because liver is unable to metabolize lactate. U.O. / ABCs Meds: Thorazine 10-25mg – prevent shivering Mannitol Solu-Medrol

11. Drowning and Near drowning – drowning is death caused by asphyxia and aspiration after submersion in water; near drowning is risk of death occurring within

24 hours. Tx : ABC CBC, ABG Fresh water drowning – electrolytes decreased Salt water drowning – electrolytes increased XRay – bilateral infiltrate Cardiac monitor ET intubation Correct hypoxia and cyanosis, I and O

Antibiotics,Epinephrine,Lidocaine,At SO4,Bronchodilators,NaHCO3,Steroids

12. Bites – dog,cat, rodent, human, insect/bee, spider, tick, snake; a break in the continuity of the skin caused by a bite from an animal, insect or human.Tx : Meticulous wound care Devitalized tissue should be debrided and topical antibiotic ointment. IV antibiotics –severe human and animal bite Rabies prophylaxis-animal bite Carnivores-rabies positive : raccoons, bats, wild animals Herbivorous – rabies negative : mice, rodents Venomous bites – black widow spiders, poisonous snakes Anti venom tx: constricting band/ice to slow the circulation and spread of venom to circulation.*Wound should be left open and a bulky dressing is applied-dry sterile dressing.*ABC,V/S,LOC Muscle relaxants Animal control

13. Poisonings – substances that are harmful : inhaled, ingested *food, drug, overdose or acquired by contact *insecticides

Carbon monoxide inhalation Food poisoning

Drug overdose: ASA –overstimulation of resp. center and metabolic acidosis- hyperventilation, hyperthermia,hyperglycemiasInsecticide surface absorptionTx : ABC,IV access Narcan-Naloxone –antagonist for resp. depression due to narcotic overdose Flumazanil-for Benzodiazepine ingestion Gastric lavage-NGT Vomiting is C/I Antidotes: Ipecac, activated charcoal

14. Electrocution – injury sustained by electric current Tx : ABC, Spine immobility,Local wound care

Meds : NaHCO 3 , Mannitol, Tetanus, Lidocaine, Amiodarone and Epinephrine

End of Emergency Nursing