1. Emergency By Diana Blum MSN Metropolitan Community College

2. Environment of Care Rapid change Noisy Unpredictable

3. Demographic Multiple specialties Increasing visits to 107.5 million in 2001 Avg age of patient is 35.7 yrs old 75 + years old highest visit rate Common reasons for healthcare seeking: Chest pain Abd pain Headache fever

4. Team Members ER nurse EMTs Paramedics Physcians Ancillary members: admissions, radiology, etc. Special teams: forensic nurse, psychiatric team

5. Client Safety All patients have ID number and if unconscious they are named John or Jane Doe If unconscious the nurse plays detective Prevent falls and breakdown Get med list if available Always ask allergies if able Look for medic alert bracelets, necklaces Standard precaution always Recognize volatile situations (plan escape route)

6. Priority Emergency Measures for All Patients Make safety the first priority Preplan to ensure security and a safe environment Closely observe patient and family members in the event that they respond to stress with physical violence Assess the patient and family for psychological function

7. Patient and family-focused interventions – Relieve anxiety and provide a sense of security – Allow family to stay with patient, if possible, to alleviate anxiety – Provide explanations and information – Provide additional interventions depending upon the stage of crisis

8. ER Nursing 6 months to 1 year acute care/ICU training Some ERs will hire new grads using intern program

9. Technical Skills Multitasking Assist with: Wound closure Foreign body removal Central line insertion Transvenous pacemaker insertion Lumbar puncture Pelvic exam Chest tube insertion Lavage Fracture management http://www.youtube.com/watch?v=n5Zw4ZARvNg

10. Core Competencies

11. Knowledge of ER Care Broad based Multi disease process/insects/snakes/animals Mandatory reporting for sexual assault, abuse BLS, ACLS, PALS

12. Assessment Rapid recognition of abnormal findings Must be aware of comorbidites Act Quickly

13. Communication Complex barriers Use professional language Protect HIPPA related information

14. Principles

15. Triage Means: to sort : ED triage differs from disaster triage in that patients who are the most critically ill receive the most resources, regardless of potential outcome 1. Across-the-room assessment starts with visual contact, general appearance, work of breathing, skin color 2. Determine chief complaint 3. Focused assessment (Subjective data) demographics, onset of symptoms, past medical history, LMP, current meds, allergies (Objective data) inspection, palpation, auscultation, obtain vital signs

16. Basic Elements Assign acuity level Emergent: immediate threat to life or limb CODE, Respiratory Failure, Chest pain, hemorrhage Urgent: treat quickly but life no immediate threat present at this time Pneumonia, abd pain, fractures Non-Urgent: can wait for several hours if needed Strains, sprains, toothaches, cold, some rashes

17. 5 Level Triage Level 1- immediate life saving interventions, many resources Level 2- high risk, many resources Level 3- urgent, two or more resources, wait 30 min Level 4- non-urgent one resource, wait up to 1 hour Level 5-no resources, wait up to 2 hours

18. Resources LabsIV fluids XRAYConsults EKGSimple procedure CT/MRIComplex procedure IV/IM medications

19. Examples Level 1- CPR, intubation required Level 2- chest pain, dyspnea, suicidal with plan or attempt, stroke, pregnant with active bleeding Level 3-abdominal pain, closed fractures, dislocations Level 4- sore throat, strains, sprains, URI, Level 5- suture removal, medication refill, certain rashes

20. Primary Survey A: A irway patency, watch for tripod, stridor, inability to speak, rise and fall of chest B: B reathing rate and depth, breath sounds, chest expansion, skin color, spontaneous breathing C: C irculation heart rate, pulses, blood pressure, skin, cap refill D: Disability  Alertness, Responsive to Voice, Responsive to pain, Unresponsiveness E: Exposure Remove clothing, keep pt warm

21. 2 nd ary Survey Identifies other injuries or medical issues that needs to be managed

22. Secondary Survey Before beginning Secondary survey – Attach EKG leads, Pulse ox, C02 device to ETT, foley cath if not contraindicated, NG, radiographs -Full set of vital signs/Focused interventions FAST scan-focused assessment -Give comfort measures -History/Head to toe assessment Pre-hospital info AMPLE

23. Priorities of Care for the Patient With Multiple Trauma Use a team approach Determine the extent of injuries and establish priorities of treatment Assume cervical spine injury Assign highest priority to injuries interfering with vital physiologic function

24. Care of Client Place client in hospital gown Ensure privacy Med administration as ordered Assist with procedures Reprioritize and reassess as needed

25. Disposition Admitted or discharged is the question What is the nurses role?

26. Case Management Nurse case managers intervene when necessary to assist in making follow up and referral arrangements especially with elderly and homeless, and abused clients

27. Teaching review D/C instructions Reinforce safety (sealtbelt wearing) Discuss home safety (detectors, fall prevention) teach new procedures that will continue at home

28. Priority Setting Triaging client care Critical thinker Go to Prioritization PPT