EMERGENCY NURSING Refer to care given to patient with urgent and critical needs.

Goals of Emergency Medical Treatment 1. To preserve life 2. To prevent deterioration 3. To restore the patient to useful living Principles of Emergency Nursing 1. Triage a process of prioritizing patients based on the severity of their condition. y Emergency situations greatest risk receives priority y Major disasters highly specialized cares are given minimal care; based on principles to benefit largest number; minimal care are treated first to be available to help.

A athropine sulfate Anticholinergic L lidocane anesthesia/ anti-rythmic agents M magnesium sulfate antiseizure D dopamine increase cardiac output D dobutamine increase cardiac output CPR Cardiopulmonary resuscitation process of externally supporting the circulation and respiration of a person who has had a cardiac arrest. Indications: y Respiratory arrest with pulse present y Cardiac arrest without pulse Crucial time: CPR is instituted within 4-6 minutes after the arrest to prevent brain death ( need to establish a circulation and perspiration) Two types of CPR: y Basic Life Support (BLS) involves the use of hands, mouth and the sincere desire to give the person a second chance for life. y Advanced cardiac life support involves BLS and the use of equipment ( defibrulator), emergency drugs and fluids to monitor the client and stabilize his condition. CPR INVOLVES THE ABCD OF LIFE SUPPORT A open airway B restore breathing C restore circulation D provide definitive treatment (ACLC) Defibrillation: restoring the heart beat ASSESSMENT/ACTIONS 1. DETERMINE UNRESPPONSIVENESS 2. POSITION VICTIM SUPPINE ON A FIRM SURFACE 3. EST ABLISH ARIWAY y Use head tilt, chin lift maneuver y Place ear over nose and mouth ( for 3-5 seconds) o Look to see if chest is moving o Listen for escape of air o Feel for movement of air against face o If no respiration, proceed to #4 4. GIVE 2 RESCUE BRE ATHS y Mouth to mouth ventilation y Mouth to nose ventilation y Mouth to stoma ventilation y Mouth to barrier ventilation

*NOTE: give 2 initial breaths lasting for 1 to 2 seconds. If no rise and fall of the chest is observed, consider airway obstruction. 5. DETERMINE PULSELESSNESS/ ASSESS CIRCUL ATION 6. IF PULSELESS, BBEGIN CHEST COMPRESSION y Proper placement of hands: Adult: lower half of the sternum/ 2 fingerbreaths from the xiphoid process Infant: midsternum *used heel of both hands for adult, heel of one hand for child, 2 fingers for infant y Depth compressions: Adult: 1 - 2 inches Child: 1 1 inches Infant: - 1 inches y 30 compression per with 2 ventilation 7. REASSESSMENT y Reassess after 4 cycles, if pulse is absent, continue CPR y Recheck pulse every 3-4 minutes thereafter TERMINATION OF CPR y Successful resuscitation y Transfer of emergency vehicle y Pronounced dead by physician y Exhaustion of rescuer COMMON COMPLICATION OF CPR y Fracture of ribs y Puncturesd internal organ- liver ADVANCED C ARDI AC SUPPIRT Refers to a set of clinical interventions for the treatment of cardiac arrest and other life threatening emergencies. CARDIOPULMONARY ARREST result of a cardiac dysrhythmias. ( 2 clinical signs: unconscious, lack of major pulse) DEFIBRILL ATION treatment of choice for ventricular fibrillation. *nursing intervention: y Place the client in a flat, firm surface y Apply interface material to the paddles y Grasp the paddles only by the insulated handles to prevent electrocution y Give command for personnel to stand clear of the client and bedd

Triage Category: o Emergent highest priority ( airway compromise, cardiac arrest, severe shock, cervical spine injury, multisystem trauma, altered LOC, eclampsia) o Urgent serious health problem but not immediate life threatening ( fever, minor burns, minor musculoskeletal injuries, dizziness, lacerations) o Non-urgent can wait for several hours; local injuries ( sprains, missed menses, low back pain) o Fast-track requires simple first aid / can manage themselves ( simple bruises) 2. Assessment and interventions y Primary Survey A airway B breathing C Circulation D disability E exposure y Secondary Survey C chief complaint H history E exact location C compare K keep checking EMERGENCY DRUGS B bicarbonate antacid E epinephrine increase myocardial contractility/ produce bronchospasm C calcium carbonate for gastric acidity

y y

Apply the chest paddles as follows: one at the right of the sternum, third ICS, and the other one on the left midaxillary, fifth ICS Push the discharge buttons in both paddles simultaneously Defibrillation releases 200-360 joules

3. Anaphylactic shock life threatening type of allergic reaction. 4. Septic shock overwhelming infection leads to life threatening low blood pressure. 5. Nuerogenic shock caused by damage to the CNS 6. Circulatory shock 7. Multiple organ dysfunction ST AGES: y Compensatory tachycardia, tachypnea, constriction of peripheral circulation, pale/ cool skin, lack of perfusion, low blood volume, hypoxia y Progressive bp can no longer compensate, hypotension, increase capillary permeability, respiratory rapid & shallow, renal effects, hepatic effects y Irreversible / refractory stage EXTERN AL FLUID LOSS y Trauma y Surgery y Vomiting y Dieresis y Diarrhea y Diabetes insipidus INTERN AL FLUID SHIFTS y Hemorrhage y Burns y Ascites y Peritonitis y Dehydration

CRASH INJURIES occur when a person is caught bet. Objects, run over by a moving vehicle or compressed by machinery. TYPES OF FR ACTURES y Comminuted bone has splintered into several fragments y Compound damage involves skin or mucous membranes; also called an open fracture. y Spiral fracture that twist around the shaft of the bone. y Simple / close fracture that remains contained; w/ no disruption of the skin integrity. y Transverse fracture that is across the bone shaft. y Diagonal y Oblique Signs and symptoms: Paresthesia, pulse, pain, pallor, paralysis PRIORITY 1 (IMMEDIATE) RED injuries are life threatening but survival with minimal intervention, * Sucking chest wound, airway obstruction 2nd to mechanical cause, shock, hemothorax, tension pneumothorax, asphyxia, unstable chest and abdominal wound, open fractures for long bones and 2nd/3 rd burns 15 to 40% total body surface area. PRIORITY 2 (DELAYED) YELLOW injuries are significant and require medical care but can wait hours w/out threat to life. *Stable abdominal wounds w/out evidence of significant hemorrhage, soft tissue injuries, maxillofacial wounds w/out airway compromise, vascular injuries w/ adequate callteral circulation, GUT disruption, fractures requiring open reduction, debridement and external fixation, most eye and CNS injuries. PRIORITY 3 (MINIMAL) GREEN injuries are minor and treatment can be delayed hours to days. Individuals to this group should moved away from the main triage area. *Upper extremity fractures, minor burns, sprains, small lacerations w/out significant bleeding, behavioral disorders or psychological disturbance. PRIORITY 4 (EXPECT ANT) BL ACK injuries are extensive and chances of survival are unlikely even with definitive care. *Unresponsive patients with penetrating head wounds, high spinal cord injuries, 2nd/3 rd degrees burns in excess of 60 of the body surface area, seizures or vomiting with 24 hours after exposure to radiation, profound shock with multiple injuries, agonal respirations, no pulse, no bp, pupils fixed and dilated.

INTUB ATION - the placement of a flexible plastic tube into the trachea to protect the patients airway and provide a means of mechanical ventilation. MAN AGEMENT: 1. HEIMLICH MANEUVER o Victim standing / sitting y Make fist with one hand y Place thumb side of fist against victim abdomen, between imbilicus and xiphoia process y Grasp fist with other hand and pross fist into victims abdomen with upward thrust y Repeat thrusts until object expelled from victims airway o Victim lying down y Place victim supine y Kneel astride victims thighs and place heel of one hand against victims abdomen y Place other hand on top of first y Press into abdomen with quick upward thrust 2. FINGER SWEEP used only in the unconscious adult patient. This action draws the tongue away from the back of the throat and away from the foreign body that may be lodged there. 3. CHEST THRUST used only in the patient stages of pregnancy or in the markedly obese person. 4. CONSCIOUS IN FANT if the infant is conscious and cannot cough, cry or breath: y Give up to 5 back blows y Give up to 5 chest thrusts y Repeat SHOCK Life threatening condition that occurs when the body is not getting enough blood flow. MAJOR CL ASSES OF SHOCK: 1. Cardiogenic shock unable to supply enough blood to the organs of the body. 2. Hypovolemic shock severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.

MULTIPLE INJURIES Caused by simple catastrophic event that causes life threatening injuries to at least 2 distinct organ system. 7 PRIORITY M AN AGEMENT y Establish airway and ventilation y Control of hemorrhage y Prevent and treat Hypovolemic shock. Monitor urine output. y Assess for head and neck injuries. y Re-assess for head and neck, chest, abdomen, back and extremeties y Splint fractures y Carry out a more thoroughly and ongoing examination and assessment