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11/11/20131 Emergency Nursing & Mass Casualty Priorities Keith Rischer RN, MA, CEN.

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Presentation on theme: "11/11/20131 Emergency Nursing & Mass Casualty Priorities Keith Rischer RN, MA, CEN."— Presentation transcript:

1 11/11/20131 Emergency Nursing & Mass Casualty Priorities Keith Rischer RN, MA, CEN

2 11/11/20132 Todays Objectives Identify the core competencies needed to function in emergency setting Explain the different roles of the interdisciplinary team Describe the triage process Triage different clients into emergent, urgent, and nonurgent categories Identify nursing assessment red flagsregarding chief complaint Identify the role of the primary & secondary survey Contrast triage process under usual ED context w/triage in mass casualty

3 11/11/20133 Emergency Department Environment Characterized by: Rapid change Med errors Multispecialty care Crowded, noisy conditions Hostile behavior Staff safety Crucial communications EMS Complex age and demographic range of clients

4 11/11/20134 Frequent Fliers…Problem ED visits increased 26% to 114,000,000 annually in US FF represent small %, consume disproportionate amt. of health care dollars Contributes to overcrowding 5% of all ED pts. 1/3 ED visits non-urgent-could be provided in other settings

5 11/11/20135 Frequent Fliers…Demographics 35 yr old Caucasian female Single, unemployed Has primary MD and public/private health insurance Chronic medical conditions w/pain of same type the most common CC Non-narcotic approaches to pain utilized ED visits decr. From 19 to 7 annually

6 Interdisciplinary Team Members 11/11/20136 Prehospital care providers Paramedic Emergency Medical Technician (EMT) Emergency medicine physician Registered Nurse BLS ACLS PALS TNCC Certification in Emergency Nursing (CEN) Support staff Emergency Tech Unit Support Sexual assault nurse examiners Psychiatric Crisis Inpatient nursing staff

7 11/11/20137 Triage Brief clinical assessment to determine time, order, and sequence clients are seen Quickly identify emergent/life threatening conditions as well as SUBTLE manifestations highest acuity needs receive the soonest evaluation, treatment, and prioritized resource utilization Triage nurse in the emergency care system performs rapid assessment to determine triage priority by category: Emergent triage Urgent triage Nonurgent triage

8 11/11/20138 Triage Interview Assess carefully What brought you to the ER today? Use all senses Visual Smell Auditory Tactile/touch Intuition

9 11/11/20139 ED Assessment: Airway/Breathing Red Flags Obvious resp. distress Tachypnea O2 sats <90% Hx of COPD, asthma or croup Recent surgery or immobility Drooling-SOB Stridor or barky cough

10 11/11/ ED Assessment:Chest Pain Red Flags Male >30 yrs…>35 yrs female or post menopause High risk factors…hx CAD, DM, high cholesterol, HTN Chest pain Cardiac Quality Radiation Severity timing Non-cardiac Quality Radiation Severity timing

11 11/11/ ED Assessment : Women & CAD #1 killer of women…more than #2-14 combined Develop 10 yrs later than men on avg. Protective effects estrogen Atypical presentations Mortality rate 2x higher than men Unrecognized sx/atypical presentation Less likely to be dx w/AMI Do not receive early & aggressive tx

12 11/11/ ED Assessment: Headache Red Flags Sudden onset-severe Syncopal or neuro deficits present HA w/fever Recent head trauma Coumadin Distinctly different from previous hx worst headache Ive ever had

13 11/11/ ED Assessment:Abdominal Pain Red Flags Blood in emesis or stool Persistent N&V &D >18 hours older than 6 yrs >12 hours if less than 6 yrs Sudden AAA Bowel obstruction Renal calculi Chole/pancreatitis Gradual Appe Constipation UTI Palpation or any body movement worsens

14 11/11/ ED Assessment: Pearls Across the Lifespan Trauma MECHANISM OF INJURY Pediatric Child abuse Larger tongue/smaller trachea Dehydration-lips/mucous membranes/no tears Temp >100.4 in child <12 weeks Elderly Elder abuse/neglect Use other family members to clarify CC Slow down to sort out Hypothermia-sepsis Atypical CP

15 11/11/ Triage How do you classify & prioritize the following? 28 yr male w/laceration-bleeding controlled 22 yr female w/lower abd pain & heavy vaginal bleeding 22 yr female w/lower gradual abd pain 8/10 only 45yr female w/CP last 2 hours-hx DMII 20 yr male w/CP-worsens w/deep insp. 78 yr female w/HA & brief syncopal episode 82 yr male w/abd pain-distended 10/10

16 11/11/ Primary & Secondary Survey Primary (A) Airway/cervical spine (B) Breathing (C) Circulation (D) Disability Glascow coma scale AVPU…LOC assessment (E) Exposure Secondary

17 11/11/ Care of the Emergency Department Client Nursing assessment Triage Chief complaint VS PMH Primary RN once in room Primary/secondary assessment Initiate standing orders Delegate to ED tech prn Physician assessment Disposition Client and family health teaching

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