EMERGENCY NURSING

Emergency Care
episodic and crisis-oriented care provided to patients with serious or potentially life-
threatening injuries or illnesses.
Philosophy : an EMERGENCY is whatever the patient or family considers it to
be.
Emergency Assessment
systematic approach
Usually, the most dramatic injury is not the most serious.
The primary and secondary surveys provide the emergency nurse with a methodical
approach to help identify and prioritize patient needs.
Primary Assessment
A Airway
! !reathing
" "irculation
# #isa$ility
A%PU &cale
Secondary Assessment
$rief, thorough, systematic assessment designed to identify all injuries.
The steps include :
'(pose)environmental control
*ull set of vital signs
*ive interventions
*acilitate family presence, and
+ive comfort measures.
,ursing process in 'mergency &ituation
- logical framewor. for pro$lem-solving in limited time / pressured
environment
ER Nurse has :
e(pertise in assessing / identifying patient0s health care pro$lem in crisis situation
esta$lishment of priorities
monitoring an acutely ill and injured patient
supporting and attending to family
supervising allied health personnel / teaching patients and their families
Approach to Patients
assessment of psychological functioning includes evaluation of emotional e(pression,
degree of an(iety / cognitive functioning
1apid physical assessment
Approach to Famiy
they are told of the patient0s location and interventions $eing given

Guideines in heping the !amiy dea "ith sudden death in the ER :
Ta.e the family to a private place / tal. to the family together
Assure the family that every possi$le intervention was done
Avoid using euphemism, show family of your concern thru touch.
Allow family to tal. a$out the deceased and what they meant to them2 this permits
ventilation of feelings
'ncourage family mem$ers to support each other and freely e(press their emotions
Avoid giving sedation to family mem$ers as this may mas. or delay the grieving
process.
'ncourage the family to view the $ody if they wish to do so. "over the mutilated
areas $efore the family sees the $ody.
&pend a few minutes with the family, listening to them
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#istory
3 3echanism of injury
4 4njuries sustained ) suspected
% %ital &igns
T - Treatment
#ead to $oe Assessment
5ead / *ace
"hest
A$domen ) *lan.s
Pelvis ) Perineum
'(tremities
Posterior surface
PRI%RI$IES & PRINCIP'ES %F EMERGENCY MANAGEMEN$
Priorities ( Ma)or Goas
To preserve life
To prevent deterioration $efore more de6nitive treatment can $e given.
To restore the patient to useful living
---injuries to face, nec. and chest that impairs respiration are the highest priorities

PRINCIP'ES
maintain patent airway / provide ade7uate ventilation employing resuscitation
measures when necessary
control haemorrhage / its conse7uences
evaluate and restore cardiac output
prevent and treat shoc., maintain or restore e8ective circulation
carry out a rapid initial and ongoing physical e(amination
assess whether or not the patient can follow commands, evaluate the size /
reactivity of pupils
start '"+ monitoring if appropriate
splint suspected fractures including cervical spines in patients with head injuries
protect wounds with sterile dressings
start a 9ow sheet of patient0s vital sign, neurological state, to guide in decision
ma.ing
$RIAGE
comes from the *rench word trier
to sort:
characteristic of a hierarchy $ased on the potential for loss of life
advanced s.ill
Emergent patients
have the highest priority;their conditions
are life threatening, and they must $e seen immediately.
Urgent Patients
patients have serious health pro$lems, $ut not immediately life-threatening ones2
they must $e seen within < hour.
Non*urgent Patients
patients have episodic illnesses that can $e addressed within => hours without
increased mor$idity ?!erner, =@@<A.
2
+Fast*$rac,- Patients
increasingly used class
These patients re7uire simple 6rst aid or $asic primary care.
They may $e treated in the '# or safely referred to a clinic or physician0s oBce.
Cardiopumonary Resuscitation
techni7ue of $asic life support
Purpose : Oxygenating the brain and heart until appropriate, defnitive medical
treatment can restore normal heart and ventillatory action.
Indications
"ardiac arrest
1espiratory arrest
Assessment
4mmediate loss of consciousness
A$sence of $reath sounds or air movement through nose or mouth
A$sence of palpa$le carotid or femoral pulse2 pulselessness in large arteries
Compications
Post-resuscitation distress syndrome ?secondary derangements in multiple organsA
,eurologic impairment, $rain damage
Air"ay %.struction
Acute upper airway o$struction is a life-threatening medical emergency.
Partial or "omplete
Pathophysioogy
Upper airway o$struction causes
Aspiration of foreign $odies
Anaphyla(is
viral or $acterial infection
Trauma
inhalation or chemical $urns
4n adults, aspiration of a $olus of meat is the most common cause of airway
o$struction.
4n children, small toys, $uttons, coins, and other o$jects are commonly
aspirated in addition to food.
Cinica Mani!estations
"ho.ing
apprehensive appearance
inspiratory and e(piratory stridor
la$ored $reathing
use of accessory muscles ?suprasternal and intercostal retractionA
9aring nostrils
increasing an(iety
1estlessness
confusion.
"yanosis and loss of consciousness develop as hypo(ia worsens.
Assessment & diagnostic Findings
as.ing the person whether he or she is cho.ing and re7uires help
unconscious, inspection of the oropharyn( may reveal the o8ending o$ject.
C-rays, laryngoscopy, or $ronchoscopy also may $e performed.
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Management
'sta$lishing an airway may $e as simple as repositioning the patient0s head to
prevent the tongue from o$structing the pharyn(.
#EA/ IN0URY
fractures to the s.ull and face, direct injuries to the $rain ?as from a $ulletA, and
indirect injuries to the $rain ?such as a concussion, contusion, or intracranial
hemorrhageA.
5ead injuries commonly occur from motor vehicle accidents, assaults, or falls.
Concussion
A temporary loss of consciousness that results from a transient interruption of
the $rainDs normal functioning.
Contusion
A $ruising of the $rain tissue. Actual small amounts of $leeding into the $rain
tissue.
Intracrania hemorrhage:
&igni6cant $leeding into a space or a potential space $etween the s.ull and the $rain.
serious complication of a head injury with a high mortality due a rising intracranial
pressure ?4"PA and the potential for $rain herniation.
"lassi6ed as epidural hematomas, su$dural hematomas, or su$arachnoid
hemorrhages, depending on the site of $leeding.
Primary Assessment
Air"ay
assess for vomitus, $leeding, and foreign o$jects
'nsure cervical spine immo$ilization
1reathing
assess for a$normally slow or shallow respirations
An elevated car$on dio(ide partial pressure can worsen cere$ral edema
Circuation
Assess pulse and $leeding.
/isa.iity
assess the patientDs neurologic status.
Primary Inter2ention
Epen the airway using the jaw-thrust techni7ue without head tilt. 3a.e sure that you
do not stimulate the gag re9e( as this can cause increases in 4"P.
Administer high-9ow E=: the most common cause of death from head injury is
cere$ral ano(ia.
Assist inade7uate respirations with a $ag-valve mas. as necessary.
"ontrol $leeding do not apply pressure to the injury site. Apply a $ul.y, loose
dressing.
4nitiate two 4.%. lines.
#EM%RR#AGE
results in the reduction of circulating $lood volume is a primary cause of shoc..
The goals of emergency management are
to control the $leeding, maintain an ade7uately circulating $lood volume for
tissue o(ygenation,
prevent shoc..
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Patients who hemorrhage are at ris. for cardiac arrest caused $y hypovolemia with
secondary ano(ia.
Management
*luid replacement to maintain circulation.
1eplacement 9uids may include isotonic electrolyte solutions ?lactated 1inger0s,
normal salineA, colloid, and $lood component therapy.
!lood transfusion ?F': cases 1h- to women, 1hG in menA
#YP%3%'EMIC S#%C4
&hoc. is a condition in which there is loss of e8ective circulating $lood volume.
4nade7uate organ and tissue perfusion follow, ultimately resulting in cellular
meta$olic derangements.
The underlying cause of shoc. ?hypovolemic, cardiogenic, neurogenic, or septicA must
$e determined.
5ypovolemia is the most common cause
Altered tissue perfusion related to
failing circulation,
impaired gas e(change related to a ventilationperfusion im$alance,
decreased cardiac output related to decreased circulating $lood volume
The goals of treatment are to restore and maintain tissue perfusion and to correct
physiologic a$normalities.
Cinica Mani!estations
#ecreasing arterial pressure
4ncreasing pulse rate
"old, moist s.in
#elayed capillary re6ll
Pallor
Thirst
#iaphoresis
Altered sensorium
Eliguria
3eta$olic acidosis
5yperpnea
Management
'nsure a patent airway and maintain $reathing
%entillatory assistance
rapid physical e(amination
rapid 9uid and $lood replacement
!lood component therapy
4ntravenous 9uids are infused at a rapid rate
4nfusion of lactated 1inger0s solution is useful initially
it appro(imates plasma electrolyte composition and osmolality,
allows time for $lood typing and screening,
1estores circulation,
&erves as an adjunct to $lood component therapy.
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