Chapter 33 Emergency Nursing

2 Emergency Care Area  Requirements  Central location  Easy access  Dedicated “crash table”  Basic necessary equipment  Oxygen source  Suction unit  Surgical lighting  Multiple electrical outlets

3 Crash Cart  Organize and prioritize drawers according to the ABC’s  A=airway  B=breathing  Thoracocentesis materials for emergency respiratory patient  Venous access (C=circulation)  Venous access drawer  Various size and length catheters

4 Emergency Drugs  Well organized and labelled  Current dose chart  Syringes and saline flush nearby

5 Laboratory Equipment  Minimum database “QATS”  Lactate testing  Additional point of care testing  Blood gases  Coagulation testing  Commercial test kits  Ethylene glycol

6 Fluid Therapy  Goals and objectives  Maintaining hydration  Replacing fluid losses  Treatment of shock  Treatment of hypoproteinemia  Increase urine output  Correcting acid–base or electrolyte disturbances  Providing nutritional support

7 Fluid Therapy in Shock  To correct poor perfusion, replace deficits rapidly  Goal: expand and maintain the intravascular space  Shock fluid rates  Combination of therapy crystalloids and colloids

8 Principles of Triage  Set protocols for a consistent, thorough response  CRASH PLAN  Be well-organized  Expect the unexpected

9 Respiratory Emergencies  Goals  Provide oxygen in the least stressful route  Keep patient calm  Obtain patient history  Complete physical examination  Baseline lab data IF possible

10 Routes of Oxygen Administration  Oxygen cage  Oxygen hood  Flow-by oxygen  Face mask  Nasal oxygen  Endotracheal oxygen

11 Assessing Respiratory Function  Respiratory effort  Respiratory pattern  Mucous membrane color  Pulse quality and rhythm  Heart rate  Auscultation

12 Respiratory Emergencies  Insufficiencies resulting from trauma  Upper airway trauma/rupture  Pneumothorax  Hemothorax  Pulmonary contusions  Diaphragmatic hernia  Flail chest

13 Respiratory Emergencies  Rapid recognition imperative  Clinical signs of:  Upper airway trauma  Bloody respiratory discharge  Increased respiratory effort  Subcutaneous emphysema  Increased upper airway noise

14 Respiratory Emergencies  Pneumothorax and hemothorax  Rapid shallow breathing  Poor or restrictive chest expansion  Respiratory distress  Flail chest  Independently moveable segment of the chest wall  Paradoxical motion during respirations

15 Respiratory Emergencies  Stabilization techniques and diagnostics  Oxygen therapy  Thoracocentesis  Thoracic drain placement  Diagnostics  Thoracic radiographs pulse oximetry  Arterial blood gas analysis

16 Cardiovascular Triage  Physical examination techniques  MM color  Capillary refill time  Pulse quality  Heart rate  Jugular vein evaluation  Cardiac auscultation

17 Cardiovascular Triage  Monitoring  ECG  Blood pressure  Baseline laboratory values

18 Hemorrhage Protocols  Pressure bandage techniques  Minimum laboratory database  Peripheral serial PCV/TS  Diagnostic procedures  Thoracocentesis  Abdominocentesis  PCV/TS of collected fluid

19 Neurological Emergencies  Protocols for stabilization  Assess respiratory function  Assess cardiac function  Assess mentation  Dull mentation may signal head trauma

20 Head Trauma  Clinical signs  Poor mentation  Anisocoria  Nystagmus  Abnormal pupillary light response (PLR)  Head tilt or turn  Abnormal gait

21 Head Trauma  Treatment  Oxygen therapy  Fluid therapy to maintain perfusion  Pharmaceuticals  Mannitol  Lasix

22 Spinal and Orthopedic Injuries  Goals  Maintain perfusion  Fluids  Pain medications  Supportive bandaging  Wound care