Emergency

Room and
Disaster
Nursing
S-tatement of privacy policy

I-nvasives

T-ransfer
 D-iseases
2. Limiting EXPOSURE O-rganisms
to Health Risk
C- hemicals (gases,
radiation)

*fitted with_____________ masks

to use when treating patients with
airborne diseases
• VIOLENT SITUATIONS
encountered

• INJURIES or other
emergencies

• SUBSTANCE abuse

• EMOTIONS
Precautions!!! • Hand or ankle restraint
(handcuff) is ____________
• Mask
• Physical restraints
• Distance
• Grabbed items
• Escape route
• Objects not left within
reach
• Safety Course
• Silent Code
4. HOLISTIC Care

STAGES of CRISIS
1.Anxiety & Denial
2. Remorse & Guilt
3. Anger
4. Grief
5. Reconciliation
 Ramon died at 10:00 PM. His father cried
much and refused to move Ramon’s body.
What is the APPROPRIATE approach of the
nurse?
A. Talk about the reality of death
B. Leave the mother and the child for the
last time
C. Silence to allow the mother to grieve.
D. Cry with the mother as you remember
your own experience of death in family.
Mr. Rey, who is on an end-stage of life has an order
of “Do Not Resuscitate” and past away in your shift.
He was declared dead by his physician at 8:30 AM. What
should be your PRIORITY nursing action in this
situation.
A. Prepare the death certificate for the physician to sign
B. Request your nurse attendant to all the funeral parlor at
once.
C. Allow the family to have private moments with the deceased.
D. Clean the body and remove all the IV lines, tubes and other
appliances.
 • Recognize
• Verbalize
• Questions

• Ego-defense
Don’t prolong
Prepare for Reality
 Stage II.
accuse themselves
REMORSE and or others
GUILT
VERBALIZATION
 Remember 3A’s

•ALLOW
expression

•ASSIST to identify
 Stage IV
GRIEF Remember H-A-S
-complex emotional response to anticipated or actual
loss

• H-elp work through

grief
• A-cceptable and
normal
• S-upport coping
Stage V
RECONCILIATION
 Ramon died at 10:00 PM. His father cried
much and refused to move Ramon’s body.
What is the APPROPRIATE approach of the
nurse?
A. Talk about the reality of death
B. Leave the mother and the child for the
last time
C. Silence to allow the mother to grieve.
D. Cry with the mother as you remember
your own experience of death in family.
Mr. Rey, who is on an end-stage of life has an order
of “Do Not Resuscitate” and past away in your shift.
He was declared dead by his physician at 8:30 AM. What
should be your PRIORITY nursing action in this
situation.
A. Prepare the death certificate for the physician to sign
B. Request your nurse attendant to all the funeral parlor at
once.
C. Allow the family to have private moments with the deceased.
D. Clean the body and remove all the IV lines, tubes and other
appliances.
Helping Family in Coping
with SUDDEN DEATH
PRIVATE
PLACE
COMMUNICATION
REASSURANCE
 AVOID
EUPHEMISM
CARE
SUPPORT
 NO
SEDATION
 VIEW the
BODY

“Go with the family and do not leave them alone”

TOUCH
SPEND
TIME
WITH
FAMILY
 SUDDEN DEATH

PRIVATE PLACE COMMUNICATION REASSURANCE

AVOID
CARE
EUPHEMISMS
 SUDDEN DEATH

NO
SUPPORT VIEWING
SEDATIONS

TOUCH TIME
When human needs are taken away or not
met for some reason, a person
experiences loss. Using Maslow’s
hierarchy of needs, which one of the
following will the nurse consider a
loss in case of death?
a.Loss of security and a sense of
belonginess.
b.Loss related to self-actualization
c.Physiologic and safety loss
d.Loss of self-esteem
Which of the following gives cues to
the nurse that the patient may be
grieving for a loss?
a.Thoughts, feelings, behavior, and
physiologic complaints.
b.Hallucination, panic level of
anxiety, sense of impending doom.
c.Sad affect, anger, anxiety and sudden
change of mood
d.Complaints of abdominal pain,
diarrhea, loss of appetite
 E-
MOST
COMMON
D-
Sentinel
Event in
ED nurse staffing patterns,
patient volume, and
specialty unavailability
COMPASSION ________________
FATIGUE
1. E-XPOSURE
suffering and injury

2. E-NERGY
expended everyday
 CISM 3 STEPS
Critical Incident Stress Management
to critique individual and group performance and to facilitate healthy coping

1.Defusing- immediately

2.Debriefing- 1-10 days

3.Further Follow-up-
persistent negative sx
EMERGENCY CARE-
care rendered without delay
 3 CATEGORIES
1. Emergent -highest priority

2. Urgent -serious but not immediately life-threatening

3. Non-urgent -episodic illnesses

EMERGENCY Severity index
CTAS System’s 5 Levels
 TEAM TRIAGE (TT)
(Provider in Triage [PIT])

• triage nurse works with the physician

• diagnostics and possibly discharge

without full admission to ED

• decreased waiting times

• maintain flow for EMS agencies, (and be

available for true emergencies)
ED vs FIELD triage
ROUTINE triage
Routine - directs resources
to most critically ill
(regardless of potential
outcome)
ROUTINE triage
FIELD triage
(or hospital triage during a
disaster)
-scarceresources must
be used to benefit the
most people possible
FIELD triage
 Remember!!!
• T-errorism
• T-oxic Substance Spills “TT – Ng- C-O-W”

• N-atural Disaster

• C-rashes
• O-utbreaks
• W-arfare
1. C-hain of Command
2. A-ctivating response plan
3. R-ole Remember
“C-A-R”
Utilitarianism
survival
resources
There are divergent triage systems in the world, but there is no general and
universal agreement on how patients and injured people should be triaged
IMMEDIATE
Life-
threatening
Survivable
Minimal
intervention
S-
A-
SASHA-LAB-U
S-
H-
A-
L-
A-
B-
U-
DELAYED
SIGNIFICANT injuries

NO life or limb threat

Can wait for HOURS

SAW “SAW My-Friends
MF Enjoying Vacation,
E Going So Far”
V
G
S
F
MINIMAL

Minor injuries

Hours to Days
F FBI and Police
B should be removed from the main triage area

P
EXPECTANT

Extensive injuries
Survival unlikely
H “HUMAN
U For Morgue Ba Sya?”
M
A
N
F
M
B
S
START, Homebush triage Standard, Sieve, CareFlight, STM, Military, CESIRA Protocol, MASS,
Revers, CBRN Triage, Burn Triage, META Triage, Mass Gathering Triage, SwiFT Triage, MPTT,
TEWS Triage, Medical Triage, SALT, mSTART, ASAV. JUMP START, PTT, SAVE, SORT
S
A
L
T
 START Triage
most commonly used triage system in the United States

S
T
A
R
T
PRIORITY: Fewer damages and
Minor injuries

resources limited

return people ASAP and helping other people

•T (Treatment) codes :T1, T2, T3, T4 and
dead

•P (Priority) codes: P1, P2, P3 and P-

hold.
M
A
S
S
PRIMARY SURVEY
PRIMARY SURVEY
A

E
AIRWAY
OBSTRUCTION
AIRWAY OBSTRUCTION
I. Partial Obstruction - progressive
hypoxia, hypercarbia, respiratory and
cardiac arrest

II. Complete Obstruction- permanent

brain injury or death within
_____________secondary to hypoxia
CAUSES
 aspiration
 infection
 inflammation
 trauma
 medications
 motor coordination
diseases
 mental dysfunction
 FOREIGN BODY AIRWAY
OBSTRUCTION
• cannot speak, breathe, or cough
• universal distress signal of choking
• apprehensive,refusing to lie flat
• stridor
• labored breathing
• accessory muscles use
• anxiety, restlessness, confusion
• _____________________-late signs
MANAGEMENT
Partial Obstruction: patient
can breathe and cough
spontaneously

*The victim is encouraged

to ________________.
Complete Airway
Obstruction: weak,
ineffective cough, high-
pitched noise while inhaling,
increased respiratory
difficulty, or cyanosis
 MANAGEMENT
1. Reposition
Head
*head-tilt/chin-lift maneuver
*jaw-thrust maneuver
• the cervical spine must be
protected from injury
*Look listen feel
2. Insertion of Specialized
Equipment Sounds like
Oropharyngeal Airway “EMPIRE”
1.M
2.P
3.O
4. I
5. R
ALTERNATIVE: hold tongue
with tongue blade and
insert directly, no rotation
Quality and Safety
Nursing Alert !!!
In the case of potential facial
trauma or basal skull fracture,
the nasopharyngeal airway
should not be used
because________________.
Endotracheal Intubation
CRICOTHYROIDOTOMY
• opening of the
cricothyroid membrane
• ETT not possible or
contraindicated
• replaced with a formal
tracheostomy
MAINTAINING VENTILATION
ASSESS: A_B_C_D

• Absent Breath sounds (or

diminished)
• Chest wound (open)
• Difficulty delivering artificial
breaths
MANAGEMENT
•chest tube
•occlusion of the sucking
wound
• airway or ventilatory
assistance
HYPOVOLEMIC SHOCK
SHOCK-

Types:
1. C
2. H
3. D
ASSESSMENT
•cool, moist skin
•hypotension
•tachycardia
•delayed CRT
• decreasing UO
MANAGEMENT of
Hemorrhage
1. FLUID
REPLACEMENT
•Large-gauge IV
catheters
•Blood sample
•Replacement fluids
Nurse Sophie checks the gauge of
the patient’s intravenous
catheter. Which is the smallest
gauge catheter that the nurse can
use to administer blood?
A. 22-gauge
B. 18-gauge
C. 20-guage
D. 24-guage
page 1423 Kozier and Erb 11th edition (2021)
Quality and Safety Nursing Alert
• The infusion rate is determined by
__________________and clinical
evidence of hypovolemia

• BT should be given via

__________________

• Administration of large amounts of

blood that has been refrigerated has
C____________ that may lead to
C______________ and
C________________.
2. Control of EXTERNAL
HEMORRHAGE
•P
•I
•E

• Last resort: __________

Definitive: Surgery
Control of INTERNAL BLEEDING
S/SX: no external signs of bleeding
tachycardia, HPN, thirst, apprehension, cool and
moist skin, or delayed CRT

Mngt:
• PPP
• drugs
• Supine and monitored closely
• Definitive: SURGERY
Glasgow Coma Scale + motor and sensory evaluation of the spine
GCS
AVPU
Undress the patient quickly but gently so that any wounds or
areas of injury are identified (American College of Surgeons [ACS], 2013)
Complete health history
Head-to-Toe assessment
 Diagnostic and Laboratory testing
Monitoring Devices
Splinting
Wound Management
injury to soft tissues
MAIN GOALS
• restore physical integrity
• restore function
• minimize scar
• prevent infection
• documentation
• wound history
Management
Cleansing:
• Hair ____________
• cleansed with ______________ or a
___________agent

• ________________should not be allowed

to get deep into the wound without
thorough rinsing

for the initial cleansing because it

____________exposed and healthy tissues
 Collection of
Forensic Evidence
LET US PLAY!!! G?
Remove all tubes and
lines before
investigation
The patient’s hands must
be covered with paper
bags
It is not right to photographs
of wounds or clothing
Better to cut through tears, holes, blood
stains, or dirt present on the clothing
Clothing should be given to families
Each piece of clothing should
placed in an individual plastic
bag
unintentional or intentional wound or injury inflicted on the
body
INFECTION PREDISPOSITION
 exposure to exogenous
bacteria from the environment
at the time of injury
 aspiration of vomitus
 diagnostic and therapeutic
procedures

• MNGT: Tetanus prophylaxis

and broad-spectrum
antibiotics , continuous
monitoring
FOR OR
• shock, blood loss, free air under the
diaphragm, evisceration, hematuria,
severe head injury, musculoskeletal
injury, or suspected or known
abdominal injury

• The goal for the management of all

patients who have experienced
trauma is to________________.
Multiple Trauma
-caused by a single catastrophic event that causes life-
threatening injuries to at least two distinct organs or organ
systems
ASSESSMENT

evidence of assumed to
trauma may be have a spinal
sparse or absent cord injury
a.BLUNT TRAUMA
-commonly associated with
extra-abdominal injuries to the
chest, head, or extremities
1. ABC
2. Stretcher
3. Cervical spine
immobilization
4. logrolling
b. ABDOMINAL PENETRATING
TRAUMA
1. Evisceration-
covered with
sterile, moist saline
dressings.
2. NPO
3. Decompress
stomach
c.CRUSH INJURIES
• caught between opposing forces (e.g., run over by a
moving vehicle, crushed between two cars, crushed
under a collapsed building)
MANAGEMENT
•Primary Survey
•Assess for AKI and ATN
CLASSIC TRIAD OF
RHABDOMYOLYSIS
1. M-
2. C-
3. D-

DX:
MANAGEMENT
Splint
Elevate
Fasciotomy
Anxiolytics
Debridement/ fracture repair
Hyperbaric oxygen chamber
INDICATION OF SUCCESSFUL
RESUSCITATION
_________________= < 2.5 mmol/L
This Photo by Unknown Author is licensed under CC BY-SA-NC
Quality and Safety
Nursing Alert!!!
Left shoulder pain is common in a
patient with ___________

Right shoulder pain can result from

laceration of the_________