EMERGENCY

NURSING
By: Keverne Jhay P. Colas
Emergency Nursing
• A specialty field in nursing practice that focuses in
treating diseases that needs immediate attention, be it
medical or surgical intervention. Usually when a
condition threatens the life of a client emergency
nursing will be initiated.
Emergency Nursing
• emergency nursing care is to some extent limitless. It includes
all demographics and pathophysiology which may include the
following:
• Life and death situations.
• Behavioral health to infectious illness.
• Chronic disease to sudden health collapse.
• Intermittent crises to progressive decline in health.
Emergency Nursing
• Emergency nursing can be defined through its character which
is the anticipation of abruptly acting on an unplanned emergent
care, in an environment that is potentially stressful or chaotic.
Emergency management
• Traditionally refers to urgent and critical care needs.
• However, the ED has increasingly been used for non-urgent
problems, and emergency management has broadened to include
the concept that an emergency is whatever the patient or family
considers it to be.
Scope & Practice of Emergency Nursing
1. Triage and prioritization.
2. Stabilization and resuscitation.
3. Quick ADPIE.
4. Provisions of care in uncontrolled and/or unpredictable situations.
5. Crisis interventions to meet the needs of unique patient situations.
6. Emergency operations preparedness.
Scope & Practice of Emergency Nursing
7. Community health education to facilitate attainment of an optimal
level of wellness, including disease and injury prevention.
8. Research.
9. Management.
10.Education and mentorship & Advanced practice.
11.Forensic nursing.
Common areas of employment
emergency departments
pre-hospital setting
military settings
Ambulance care settings
Qualifications of an Emergency Nurse
Has special training.
Education.
Experience.
Expertise in assessing and identifying health care problems
in crisis situations.
Tasks of an Emergency Nurse
1. Establishes priorities.
2. Monitors & continuously assesses acutely ill and injured
patients.
3. Supports and attends to families.
4. Supervises allied health personnel.
5. Teaches patients and families within a time-limited, high
pressured environment.
Focus of Emergency Nursing
1. Preserve life.
2. Prevent deterioration before definitive treatment can be
given.
3. Restore the patient to optimal function.
Focus of Emergency Nursing
injuries of the face, neck, and chest that impair
respiration are given the highest priorities
Principles of Emergency Care
1. Establish a patent airway.
2. Evaluate and restore cardiac output by controlling hemorrhage
and its consequences.
3. Determine the patient’s ability to follow commands and
evaluate motor skills and pupillary size.
4. Carry out a rapid initial and on going physical exam.
5. Start cardiac monitoring if appropriate.
6. Splint suspected fracture.
Principles of Emergency Care
7. Protect and clean wounds and apply sterile dressing.
8. Identify allergies and medical history that is significant – such as
but not limited to DM, seizure.
9. Document v/s; neuro status; I and O to guide decision-making.
Nursing Considerations
1. Data collection.
2. Infection control.
3. Make safety the first priority.
Preplan to ensure security and a safe environment.
4. Closely observe patient and family members in the event that they
respond to stress with physical violence.
5. Discharge planning.
Triage
To sort patients by hierarchy based on the severity of
health problems and the immediacy with which these
problems must be treated.
It is used to determine those patients in need of
immediate treatment and those who can safely wait.
Triage
3 main categories of triage
1. Emergent – life-threatening or potentially life-threatening
injury or illness requiring immediate treatment
2. Immediate – non-acute, non-life-threatening injury or illness
3. Urgent – minor illness or injury needing first-aid level
treatment
- can be referred to a primary physician’s office or clinic
Common Practice in Emergency Nursing
I. Establishing an airway
II. Controlling hemorrhage
fluid replacement
III. Controlling hypovolemic shock
Shock – condition in which there is loss of effective circulating
blood volume.
Management:
1. Ensure a patent airway and maintain effective breathing.
2. Restoration of the circulating blood volume which is accomplished by
rapid fluid and blood replacement as ordered.
Common Practice in Emergency Nursing
3. CVP line
4. BT
5. IFC
6. on-going nursing surveillance of the patient is maintained.
7. BP, RR, HR, skin temp, color, pulse oxymetry, neuro status,
CVP, ABGs, ECG, Hct, Hgb, etc
Common Practice in Emergency Nursing
IV. Wounds
 vary from tears to severe crushing injuries.
Management:
1. Shave/clip hair around wound.
2. Clean with NSS/ betadine/ H2O2.
3. Do not get deep into the wound without thorough rinsing.
Irrigate copiously with sterile NSS.
4. If needed, the area is infiltrated with anesthesia before
cleaning.
Common Practice in Emergency Nursing
V. Traumas
Priorities of Care for the Patient With Multiple Trauma
• Use a team approach.
• Determine the extent of injuries and establish priorities of
treatment.
• Assume cervical spine injury.
• Assign highest priority to injuries interfering with vital
physiologic function.
Common Practice in Emergency Nursing
VI. Intra-abdominal injuries
penetrating vs. blunt

“Abdominal trauma can cause massive life-threatening blood

loss into abdominal cavity.”

Assessment:
• Obtain history .
• Perform abdominal assessment and assess other body
systems for injuries that frequently accompany abdominal
injuries.
Common Practice in Emergency Nursing
Assessment:
• Assess for referred pain that may indicate spleen, liver, or
intraperitoneal injury.
• Perform
laboratory studies,
CT scan,
abdominal ultrasound (FAST) especially stab wound,
diagnostic peritoneal lavage.
Common Practice in Emergency Nursing
Management of Patients With Intra-Abdominal Injuries
• Continually monitor the patient.
• Immobilize cervical spine.
• Document all wounds.
• If viscera are protruding, cover with a sterile, moist saline
dressing.
Common Practice in Emergency Nursing
Management of Patients With Intra-Abdominal Injuries
• Hold oral fluids.
• NG to aspirate stomach contents.
• Ensure airway, breathing, and circulation.
• Provide tetanus and antibiotic prophylaxis.
• Provide rapid transport to surgery if indicated.
Common Practice in Emergency Nursing
VII.Crushing injuries
Assessment:
Observe for the following:
1. hypovolemic shock.
2. paralysis of the body.
3. erythema and blistering of the skin.
4. damaged body part appearing swollen, tense, and hard.
5. renal dysfunction.
Common Practice in Emergency Nursing
VIII.Multi or multiple injuries.
Nursing responsibilities:
1. Assess and monitor patient.
2. Ensure IV access.
3. Administer prescribed meds.
4. Collect laboratory specimen.
5. Document activities and patient’s response.
Common Practice in Emergency Nursing
IX. Fractures
Management:
1. Assessment for ABCs including pulses in the extremities.
2. Evaluate for neuro and abdominal injuries before the
extremities are treated unless a pulseless extremity is
detected.
Common Emergencies
Heat Stroke
• The failure of heat regulating mechanisms in the body.
• Types:
 Exertional: occurs in healthy individuals during exertion in
extreme heat and humidity.
 Hyperthermia: the result of inadequate heat loss.
Heat Stroke
• Elderly, very young, ill, or debilitated—and persons on some
medications—are at high risk.
• Can cause death.
• Manifestations: CNS dysfunction, elevated temperature, hot dry
skin, anhydrosis, tachypnea, hypotension, and tachycardia.
Heat Stroke Management
• Use ABCs and reduce temperature to 39° C as quickly as
possible.
• Cooling methods:
 Cool sheets, towels, or sponging with cool water.
 Apply ice to neck, groin, chest, and axillae.
 Cooling blankets.
 Iced lavage of the stomach or colon.
 Immersion in cold water bath.
Heat Stroke Management
• Monitor temperature, VS, ECG, CVP, LOC, urine output.
• Use IVs to replace fluid losses.
• Hyperthermia may recur in 3 to 4 hours.
• Avoid hypothermia.
Frostbite
• Trauma from freezing temperature and actual freezing of fluid
in the intracellular and intercellular spaces.
• Manifestations: hard, cold, and insensitive to touch; may appear
white or mottled; and may turn red and painful as rewarmed.
• The extent of injury is not always initially known.
Frostbite
• Controlled but rapid rewarming; 37° to 40° C circulating bath
for 30- to 40-minute intervals.
• Administer analgesics for pain.
• Do not massage or handle; if feet are involved, do not allow
patient to walk.
Hypothermia
• Internal core temperate is 35° C or less.
• Elderly, infants, persons with concurrent illness, the homeless,
and trauma victims are at risk.
• Alcohol ingestion increases susceptibility.
Hypothermia
• Hypothermia may be seen with frostbite; treatment of
hypothermia takes precedence.
• Physiologic changes in all organ systems.
• Monitor continuously.
Hypothermia Management
• Use ABCs, remove wet clothing, and rewarm.
 Active core rewarming: Cardiopulmonary bypass, warm
fluid administration, warm humidified oxygen, and warm
peritoneal lavage.
 Passive external rewarming: Warm blankets and over-the-
bed heaters.
• Cold blood returning from the extremities has high levels of
lactic acid and can cause potential cardiac dysrhythmias and
electrolyte disturbances
Poisoning
• Is any substance: solid, liquid or gas, that tends to impair health or
cause death through chemical reaction which occurs when
introduced into the body or into the skin surface. Poisoning can be
life threatening.
• Ways poison can enter
Ingestion
Inhalation
Injection
absorption
Poisoning Management
• Treatment goals:
 Remove or inactivate the poison before it is absorbed.
 Provide supportive care in maintaining vital organ systems.
 Administer specific antidotes.
 Implement treatment to hasten the elimination of the
poison.
Poisoning Management
Inhaled poison:
Maintain ABCs.
Monitor VS, LOC, ECG, and UO.
Send laboratory specimens STAT.
Determine what, when, and how much substance was
ingested.
Assess signs and symptoms of poisoning and tissue damage.
Assess health history.
Determine age and weight.
Poisoning Management
Ingested poison:
Measures to remove the toxin or decrease its absorption
 Use of emetics.
 Gastric lavage.
 Activated charcoal.
 Cathartic when appropriate.
 Administration of specific antagonist as early as possible.
 Other measures may include diuresis, dialysis.
Poisoning Management
Ingested poison:
• Corrosive agents such as acids and alkalis cause destruction of
tissues by contact

• do not induce vomiting with corrosive agents

Poisoning Management
Food poisoning:
• A sudden illness due to the ingestion of contaminated food or
drink.
• Food poisoning, such as botulism or fish poisoning, may result
in respiratory paralysis and death.
Poisoning Management
Food poisoning:
• ABCs and supportive measures.
• Treat fluid and electrolyte imbalances.
• Control nausea and vomiting.
• Provide clear liquid diet and progression of diet after nausea and
vomiting subside.
Poisoning Management
Substance abuse:
• A sudden illness due to the excessive ingestion of substances or Acute alcohol
intoxication: a multisystem toxin.
 Alcohol poisoning may result in death
 Maintain airway and observe for CNS depression and hypotension
 Rule out other potential causes of the behaviors before it is assumed the patient is intoxicated
 Use a nonjudgmental, calm manner
 Patient may need sedation if noisy or belligerent
 Examine for withdrawal delirium, injuries, and evidence of other disorders

• Commonly abused substances: see attached pdf file.

Poisoning Management
Management Patients With Carbon Monoxide Poisoning
• Inhaled carbon monoxide binds to hemoglobin as carboxyhemoglobin, which
does not transport oxygen
Manifestations: CNS symptoms predominantly.
 NOTE: Skin color is not a reliable sign and pulse oximetry is not valid.
Treatment:
 Get to fresh air immediately
 Perform CPR as necessary
 Administer oxygen: 100%
 Monitor patient continuously
Burns
• Is an injury involving the skin, including muscles,
bones, nerves and blood vessels. This results from heat,
chemicals, electricity or solar or other forms of
radiation.
Burns
• Severity of the injury depends upon the mechanism of action
of the substance, the penetrating strength and concentration,
and the amount of skin exposed to the agent.
• Severity can also determined by:
1. Depth & Location.
2. Percentage of skin surface burned.
3. Age and comorbidities.
Burns
1. Immediately flush the skin with running water from a
shower, hose, or faucet.
 Lye or white phosphorus must be brushed off the skin dry.

2. Protect health care personnel from the substance.

3. Determine the substance.

Burns
4. Some substances may require prolonged flushing/irrigation.

5. Follow-up care includes reexamination of the area at 24

hours, 72 hours, and 7 days.
Shock
• Is a depressed condition of many body functions due to
the failure of enough blood to circulate throughout the
body following serious injury.
• Shock may lead to:
Infection
Amputation
Death
Shock
Etiology:
• P – Pain (excessive & chronic)
• R – Rough Handling
• I – Improper Handling
• C – Continuous Bleeding
• E – Exposure to extreme cold & Excessive heat.
• F – Fatigue
Shock
Types:
1. Anaphylactic – caused by severe allergic reaction.
2. Hemorrhagic – due to excessive blood loss.
3. Neurogenic – severed neurogenic pathways.
4. Hypovolemic – disproportionate fluid loss, mainly by excessive output.
5. Metabolic – as a consequence of metabolic problems.
6. Cardiogenic – the result when the heart is too tired to function.
7. Septic – caused by systemic infection.
Shock
Signs & Symptoms: [Early]
• Face – pale or cyanotic in color.
• Skin – cold and clammy.
• Breathing – irregular.
• Pulse – rapid and weak.
• Nausea and vomiting
• Weakness
• Thirst
Shock
Signs & Symptoms: [Late]
• If the condition deteriorates, victim may become apathetic or relatively
unresponsive.
• Eyes will be sunken with vacant expression.
• Pupils are dilated.
• Blood vessels may be congested producing mottled appearances.
• Blood pressure may decrease to a very low level.
• Unconsciousness may occur, body temperature falls.
Shock
Management:
• Maintain on proper position: Supine with lower extremities
elevated above the heart of the patient.
• If it is necessary to move the patient, then move as one unit
and maintain body alignment.
• Make sure that core body temperature is within normal range.
• Treat shock symptomatically.
Crisis management for rape
• How the patient is received and treated in the ED is important to his or
her psychological well-being.
• Crisis intervention begins as soon as the patient enters the facility; the
patient should be seen immediately.
• Goals are to provide support, reduce emotional trauma, and gather
evidence for possible legal proceedings.
• Patient reaction; rape trauma syndrome.
• History taking and documentation.
• Physical examination and collection of forensic evidence.
• Role of the sexual assault nurse examiner (SANE).
Psychiatric Emergencies
• Overactive, underactive, violent, and depressed or suicidal patients are
treated as emergencies.
• Management:
 Maintain the safety of all persons and gain control of the situation.
 Determine if the patient is at risk for injuring himself or others.
 Maintain the person’s self-esteem while providing care.
 Determine if the person has a psychiatric history or is currently under care to
contact the therapist.
• Crisis intervention.
• Interventions specific to each of the conditions.