1.

EMERGENCY

Emergencies are life-threatening illnesses, condition or accidents which require immediate,

intensive treatment.

2. EMERGENCY WORK FLOW

PATIENT ARRIVED TO ER ( AMBULATORY, EMS )

TRIAGE ROOM

PRIMARY TREATMENT BASED ON THE TRIAGE LEVEL ( DIAGNOSTIC TEST,

MEDICAL THERAPY )

Keep the patient based on the triage level, we will give treatment as per doctor order.

 ADMIT TO THE HOSPITAL ( INPATIENT DEPARTMENT )

 DISCHARGE OR TRANSFER TO OUTPATIENT DEPARTMENT
 DIE
After all treatment/ intervention will be decided patient for admission or discharge ( or
die ) or consult to any speciality

3. TRIAGE
Triage is the processes of sorting and organization. Triage is utilized in the
healthcare community to categorize patients based on the severity of their injuries and,
by extension, the order in which multiple patients require care and monitoring
TRIAGE CLASSIFICATION :
LEVEL 1 ( RESUCITATION )
Patients need to be seen by a physician immediately 98% of the time. Requires
resuscitation and includes conditions that are threats to life or imminent risk of
deterioration, requiring immediate aggressive interventions (for example cardiac
arrest, major trauma or shock states).
LEVEL 2 ( EMERGENT )
Patients need to be seen by a physician within 15 minutes 95% of the time. Requires
emergent care and includes conditions that are a potential threat to life or limb
function, requiring rapid medical intervention or delegated acts (for example head
injury, chest pain or internal bleeding).
LEVEL 3 ( URGENT )
Patients need to be seen by a physician within 30 minutes 90% of the time. Requires
urgent care and includes conditions that could potentially progress to a serious
problem requiring emergency intervention, such as mild to moderate asthma,
moderate trauma or vomiting and diarrhea in patients younger than 2 years.
LEVEL 4 ( LESS URGENT )
Patients need to be seen by a physician within 60 minutes 85% of the time. Requires
less-urgent care and includes conditions related to patient age, distress or potential for
deterioration or complications that would benefit from intervention, such as urinary
symptoms, mild abdominal pain or earache.
LEVEL 5 ( NON URGENT )
 Patients need to be seen by a physician within 120 minutes 80 % of the time. Requires
non-urgent care and includes conditions in which investigations or interventions could
be delayed or referred to other areas of the hospital or health care system, such as
sore throat, conditions related to chronic problems or psychiatric complaints with no
suicidal ideation or attempts.

4. ASESSEMENT DURING TRIAGE

a. Complaint.
What happen to you ?. What do you feel ?. What is your complaint ?
b. Allergy.
Do you have allergies ? what is that ?
What allergy do you have ?
c. Past medical history.
Do you have past medical history before ?. What is that ?
Have you ever had pas medical history ?
d. Last medication.
Do you take any medicine before ?. What is that ?
Have you ever took any medicine before ?
e. Family history.
Does anyone in our family have a chronic disease?
f. History of surgery
Have you ever had surgery before ?. What is that ?
g. Last food
Do you take any food before ?
h. Body Weight
i. Rapid Head to Toe for trauma case
j. LMP ( Last Menstrual Period )
k. Vital Signs

5. DRUG HANDLING
HOW TO HANDLE MEDICINE IN ER ?
ER drug kept separately based on the drug classification.
For narcotic and semi narcotic medicine usually will be kept in a different box with 2
keys and handled by 2 registered nurse.
For drug dilution, we have to put label on the fluid.
Be carefull with Look Alike Sound Alike ( LASA ) : Example : Ephedrine and
ephineprine.
For antibiotic automatically will be STOP ORDER after 3 days. If the doctor still want to
continue the antibiotic, need any culture ( blood, urine C&S ) result.

6. INFECTION CONTROL
PPE is Personal Protective Equipment ( hair cap, face mask, google, gloves, gown,
boat ).
Five moment hand hygiene :
- Before touching patient.
- Before a procedure. 
- After a procedure or body fluid exposure risk.
- After touching a patient.
- After touching a patient's surroundings.

7. BASIC LIFE SUPPORT

 - Check respons
- If no response, Call for help :
Announce code blue : code blue code blue, location ( which floor ), adult/ child
- Check carotid pulse for 10 seconds ( thousand 1, thousand 2, thousand 3,
thousand 4, ...... thousand 10 )
Do head tilt chin lift, check the airway ( any obstruction or not ). Do look, listen and
feel
Look the chest rise, listen the breath sound, Feel the air flow.
IF no pulse, no breathing then continue with CPR
- CPR ( 30 compression followed with 2 ventilation ) for 2 minutes and 5 cycles
The location is in the low part of sternum.
High Quality CPR :
 Frequency : 100-120/minute
 The depth : 5-6 cm
 Minimal Interruption
 Allow chest recoil
 Early Defibrillation
- After 2 minutes check CAB again
- The second helper arrived, “ AED arrived “, switch on the machine. Put the pad in
the right mid clavicula and left mid axile line.
- “Rhythm analyse”. Stop CPR,
- “ shock advise “, continue CPR, “charging”,
- “ shock ready “, stop CPR, “ i will give shock, i am clear, you’re clear, everybody
clear, “CLEAR “”
- “ shock delivered “, continoue CPR
- If “ no shock advise “, continous CPR
- After 2 minutes, check CAB
- If there is pulse, no breathing, continue with rescue breathing 10-12 minutes/
minute
- 1 breating, thousand 1, thousand 2, thousand 3..... 5.
- After 2 minutes, check CAB
- If there is pulse and breathing, put in recovery position.

IPSG ( International Patient Safety Goals )

1. Identify patient correctly with full name and hospital number.
2. Improve effective communication with write down, read back, confirm. When we
receive an order. And using SBAR while informing/ reporting order.
3. Improve the safety of high alert medications. Keep medicine separately and give
labels.
4. Ensure safe surgery. Should be correct patient, correct site, correct procedure. Apply
site marking.
We have to give endorsement to OT nurse ( Time in Time Out ) :
a. Patient name.
b. Patient diagnose
c. Patient procedure.
d. Last food
e. Informed consent
f. Last vital signs
g. Jewelery
h. Make up
i. Artificial denture
 j. Past history.
k. Last medication
5. Reduce the risk of health care associated infections with hand hygine. Five moment
hand hygiene.
6. Reduce the risk of patient of harm resulting from the falls. Keep side rails up. Give
label for patient with high risk of fall ( children, geriatric, patient with decreased of
LOC)

Six rights of medication :

1. Right patient
2. Right time
3. Right route
4. Right medication
5. Right dose
6. Right documentation

The specialities
1. Dentist
2. Dermatologist
3. Neurosurgeon
4. Urologist
5. Gynecologist
6. Pediatrician
7. Neurologist
8. Urologist
9. Internist
10. Pulmonologist
11. Surgeon
12. ENTs
13. Opthalmologist
14. Cardiologist
15. Orthopedist
16. Nephrologist

As general what is your intervention for a patient :

- Patient asessement
- Vital signs
- Comfort position ( fowler, semifowler )
- Apply oxygen
- Doing ECG
- Imobilization ( trauma case )
- Apply cervical collar ( trauma case )
- Apply splint and bandage ( trauma case )
- Administer medication ( pain medication/ nebulization/ injection as per doctor order

Labour is process of giving birth to a baby.

FOUR stages of labour :

 First stage : dilation of the cervix

Early labor ( cervix dilated to 3-6 cm ), active labor ( cervix dilated to 3- 7 cm ).
Transition phase ( cervix dilated to 10 cm )
 Second stage : the birth of the baby
 Third stage : delivery of placenta
 Four stage : first two hours after birth

Caesarian section is an surgical procedure by one/more babies are delivered through an

incision in the mother abdomen.

Dilation and curettage ( D and C ) is a procedure to remove tissue from inside your uterus,
to treat certain uterine conditions ( such as heavy bleeding ) or to clear the uterie lining after
miscarriage or abortion.

What is intervention for patient with heavy vaginal bleeding ?