EMERGENCY NURSING

DEFINITION
• A nursing specialty in which nurses care for patients in the emergency or
critical phase of their illness or injury.

• While this is common to many nursing specialities, the key difference is

that an emergency nurse is skilled at dealing with people in the phase when
a diagnosis has not yet been made and the cause of the problem is not
known. Emergency nurses also deal with non-emergent populations that
present to the Emergency Department may range from birth to geriatric.
 CONCEPT
• The term emergency is used for those patients who require
immediate action to prevent further detoriations or stabilizing
the condition till the availability of the services close to the
patients.

• The nurse as a team member plays significant role in the early

assessment, intervention either in the form of care or
transferring the patients safely to the health services
 PRINCIPLES OF EMERGENCY
NURSING
• Establish a patent airway and provide adequate ventilation
• Evaluate and restore cardiac output by controlling haemorrhage and
its consequences, preventing and treating shock and maintaining or
restoring effecting circulation
• Determine the patient’s ability to follow commands and evaluate
motor skills and papillary size and reactivity
• Carry out a rapid initial and ongoing physical examination
• Start cardiac monitoring
• Protect and clean wounds – apply sterile dressing
• Identify allergies and medical history that is significant
• Document on the medical record the patient’s vital
signs, blood pressure, neurologic status and intake and
output to guide decision making.
 SCOPE OF EMERGENCY NURSING

•Treats a wide variety of illnesses

or injury situations, ranging from
a sore throat to a heart attack
 ROLE OF NURSES

• Patient care

• Education

• Leadership and Research

 MEDICAL EMERGENCIES

•Is an injury or illness that is

acute and poses an immediate
risk to a person’s life.
 PRINCIPLES OF EMERGENCY
• TRIAGE
CARE
is “to sort” in the daily routine of the emergency department.
It is used to sort the patient in the following categories:
EMERGENT: Highest priority of care
URGENT : Higher priority of care
NON-URGENT: Priority of care
- assess and intervenes
primary survey
secondary survey
TRIAGE
 DIFFERENCES
Primary Secondary

• A – airway • E – exposure to environment

• B – breathing • F – full set of vital signs
• C – circulation • G – give comfort
• D - disability • H – history
• I - inspection
TRAUMA
 DEFINITION
•Refers to a “body wound or shock
produced by sudden physical injury, as
from violence or accident

•It can also be described as “a physical

wound or injury, such as fracture or blow”
 CLASSIFICATION
•Poly trauma •Orthopaedic trauma
•Head trauma •Genitourinary trauma
•Chest trauma •Psychological trauma
•Surface trauma •Blunt trauma
•Abdominal trauma •Penetrating trauma
•Facial trauma
•Spinal cord injury
 CAUSES
• Motor vehicle accidents
• Fall

Diagnostic Evaluations:

- Physical examination
- Imaging (e.g. X-ray, MRI, CT-Scan)
 ABDOMINAL TRAUMA
• Penetrating abdominal trauma – causes an open wound, such
as from gunshot or stabbing. The solid organs can bleed
profusely when injured. The hollow organs generally don’t
bleed significantly but are likely to cause peritonitis if
damaged.
• Blunt Force Trauma – a force to the abdomen that doesn’t
leave an open wound, commonly occurs with motor vehicle
crashes or falls.
EMERGENCY
MANAGEMENT OF
POISONING
 PREHOSPITAL MANAGEMENT

• The emergency management of poisoning starts from the scene of the

event, where early induction of vomiting can remove a significant
portion of the ingested poison. It is not clear, however, whether early or
late induction of vomiting influences the outcome.

In countries where poisons information centres are accessible to the

public, people are advised to keep some ipecacuanha (Ipecac Syrup USP
or Paediatric Ipecacuanha Emetic Mixture BP) at home.
 ON-SITE TREATMENT OF
POISONING
• irrigate external chemical burns with plenty of water;

• If corrosives have been ingested, to drink a cup of water

or milk, which may dilute the corrosive and reduce
tissue damage, provided the patient can protect his or
her airway
 TREATMENT INDICATIONS
• Gastric lavage should not be considered unless a patient
has ingested a potentially life-threatening amount of a
poison and the procedure can be undertaken within 60
minutes of ingestion.

• Activated charcoal may be considered if a patient has

ingested a potentially toxic amount of a poison (known to be
absorbed by charcoal) up to 1 hour previously; there are
insufficient data to support or exclude its use after 1 hour of
ingestion.
• Ipecacaunha its routine administration in the emergency department
should be abandoned; there are insufficient data to support or exclude
its administration soon after ingestion of poison.
• Whole-bowl irrigation may be considered for potentially toxic
ingestion of sustained-release or enteric-coated drugs; there are
insufficient data to support or exclude the use of whole-bowl irrigation
for potentially toxic ingestion of iron, lead, zinc, or packets of illicit
drugs.
• Cathartics the administration of cathartic alone has no role in the
treatment of poisoned patient and is not recommended as method of
gut decomposition.
 POISON AND IT’S ANTIDOTES
• Insecticide – atropine; pralidoxime mesylate

• Arsenic, mercury, lead, gold – Dimercaprol

• Benzodiazepines – flumazenil

• Cyanide – Hydroxocobalamine

• Paracetamol - Acetylcysteine

• Opioids – Naloxone hydrochloride

 EMERGENCY MANAGEMENT FOR PAEDIATRIC
POISONING
• Stabilize the child. Assess ABCs (airway, breathing,
circulation).
- Provide ventilator and oxygen support.

• Perform a rapid physical examination, start an IV infusion,

draw blood for toxicology screen, and apply a cardiac monitor.

• Obtain a history of the ingestion, including substance

ingested, where child was found, by whom, position, when,
how long unsupervised, history of depression or suicide,
allergies, and any other medical problems.
• Reverse or eliminate the toxic substance using the appropriate method:

a. Antidotes and agonists

- mucomyst (for acetaminophen poisoning)
- narcan (opioid overdose)
- romaxicon (benzodiazepine overdose)
b. Gastric lavage
- a gastric tube is inserted through the mouth.
- Normal saline solution is instilled and aspirated until the return is clear. Considered a less
effective method of vomiting. Reserved for children with central nervous system depression, diminished or
absent gag reflex, or unwillingness to cooperate with other measures.
- contraindicated in children who have ingested alkaline corrosive substances, as insertion of the tube
may cause esophageal perforation.
• Used in children who have ingested acids to decrease continued
damage and potential perforation of stomach and intestines.
• Activated charcoal
- Given to absorb and remove any remaining particles of toxic
substances.
- Usual dosage administration is 1 g/kg of body weight.
- A commercial preparation of activated charcoal is administered
orally or through a gastric tube.
- Available as a ready-to-drink solution in an opaque container.
- May be mixed with apple juice or soda if protocol allows to
encourage consumption.
• Activated charcoal is administered only after the child has stopped vomiting, because aspiration of
charcoal is damaging to lung tissue.
• Cathartics
- Hasten excretion of a toxic substance and minimize absorption.
- Most commonly used cathartic is magnesium sulphate.
- Note: Syrup of Ipecac is no longer recommended because it may not remove all poison
and can be harmful in some situations.
 END

THANK YOU