EMERGENCY CARE IN

NURSING
COMPILED BY -
Mr. Ashish Henjali Roy
B.Sc Nursing(Nursing Tutor)
Savitri Hospital And Paramedical Institute,Gorakhpur,UttarPradesh.
 Definition
Emergency care can be defined as the episodic and
crisis-oriented care provided to patients with serious or
potentially life-threatening injuries or illnesses.
Concept Of Emergency Nursing
The term Emergency is used for those patients
who require immediate action to prevent
further deteriorations or stabilizing the
condition till the availability of the services
close to the patients.
 Scope and Practice of Emergency Nursing
• Emergency management traditionally refers to urgent
and critical care needs.
• The emergency nurse has special training, education,
experience, and expertise in assessing and identifying
health care problems in crisis situations.

• Nursing interventions are accomplished interdependently

in consultation with or under the direction of a physician
or nurse practitioner.

• The emergency room staff works as a team.

 Principles of emergency Nursing
• Establish a patent airway and provide adequate
ventilation.
• Control hemorrhage, prevent and manage shock.
• Maintain and restore effective circulation.
• Evaluate the neurological status of the client.
• Carry out a rapid initial and ongoing physical
assessment.
• Start cardiac monitoring.
• Protect and clean wounds.
• Identify significant medical history and allergies.
• Document the findings in medical records.
Principles of Emergency management
and emergency medical services
 Early detection
 Early reporting
 Early response
 Good on scene care
 Care during transportation
 Transport to definitive care
 General principles of emergency medical care
• Triage :- Emergent, Urgent, Non-Urgent
• Primary survey using ABCD approach
- Airway, Breathing, Circulation and Disability
• Secondary survey using EFGHI approach
- Exposure to environment
- Full set of vitals
- Give comfort measures
- Hemorrhage
- Inspect the posterior surface
 CONTD…
• Secondary survey using AMPLE approach
- Allergy
- Medication history
- Past health history
- Last meal
- Events/Environment preceding illness or
injury
 Priority Emergency Measures for
All Patients
• Make safety the first priority
• Preplan to ensure security and a safe environment
• Closely observe patient and family members in the event
that they respond to stress with physical violence
• Assess the patient and family for psychological function
 Contd…
• Patient and family-focused interventions
– Relieve anxiety and provide a sense of
security
– Allow family to stay with patient, if possible,
to alleviate anxiety
– Provide explanations and information
– Provide additional interventions depending
upon the stage of crisis
 EMERGENCY ASSESSMENT
• A systematic approach to the assessment of an emergency
patient is essential. Usually, the most dramatic injury is not
the most serious. The primary and secondary surveys
provide the emergency nurse with a methodical approach to
help identify and prioritize patient needs.

• Primary Assessment-
• The initial, rapid, ABCD (airway, breathing, and
circulation, as well as neurologic disability resulting from
spinal cord or head injuries)
 Secondary Assessment:-
The secondary assessment is a brief, but thorough, systematic assessment designed to identify all injuries.
The steps: Full set of vital signs/Five interventions/Facilitate family presence, and Give comfort
measures.
• Full set of vital signs/five interventions/facilitate family presence:
– Obtain a full set of vital signs including blood pressure, heart rate, respiratory rate, and
temperature. As stated previously, obtain blood pressure in both arms if chest trauma is
suspected.
– Five interventions:
• Pulse oximetry to measure the oxygen saturation
• Indwelling urinary catheter (do not insert if you note blood at the meatus, blood in
the scrotum, or if you suspect a pelvic fracture)
• Gastric tube (if there is evidence of facial fractures, insert the tube orally)
 Contd…

• Laboratory studies frequently include type and cross matching,

hemoglobin and hematocrit, urine drug screen, blood alcohol,
electrolytes, prothrombin time (PT) and partial thromboplastic
time, and pregnancy test if applicable
• Facilitate family presence: It is important to assess the family's
needs. If any member of the family wishes to be present during
the resuscitation, it is imperative to assign a staff member to that
person to explain what is being done and offer support.
• Give comfort measures: These include verbal reassurances as well as pain
management as appropriate. Do not forget to give comfort measures to the
family during the resuscitation process.
 Triage
• Triage (“to sort”) sorts patients by hierarchy based on the severity of health
problems and the immediacy with which these problems must be treated
• Emergent, urgent, non-urgent.

• The triage nurse collects data and classifies the illnesses and injuries to ensure that
the patients most in need of care do not needlessly wait.
• Protocols may be initiated in the triage area.
• Emergency triage differs from disaster triage in that patients who are the most
critically ill receive the most resources, regardless of potential outcome.
 Cont.…
• Triage Level I: Resuscitation
Conditions requiring immediate nursing and physician
assessment. Any delay in treatment is potentially life- or limb-
threatening.
Includes conditions such as:
– Airway compromise.
– Cardiac arrest.
– Severe shock.
– Cervical spine injury.
– Multisystem trauma.
– Altered level of consciousness (LOC) (unconsciousness).
  Triage Level II: Emergent

• Conditions requiring nursing assessment and physician

assessment within 15 minutes of arrival.
• Conditions include:
– Head injuries.
– Severe trauma.
– Lethargy or agitation.
– Conscious overdose.
– Severe allergic reaction.
– Chemical exposure to the eyes.
– Chest pain.
– Back pain
 Cont.…
– GI bleed with unstable vital signs.
– Stroke with deficit.
– Severe asthma.
– Abdominal pain in patients older than age 50.
– Vomiting and diarrhea with dehydration.
– Fever in infants younger than 3 months.
– Acute psychotic episode
– Severe headache.
– Any pain greater than 7 on a scale of 10.
– Any sexual assault.
– Any neonate age 7 days or younger.
Triage Level III: Urgent
• Conditions requiring nursing and physician
assessment within 30 minutes of arrival.
• Conditions include:
– Alert head injury with vomiting.
– Mild to moderate asthma.
– Moderate trauma.
– Abuse or neglect.
– GI bleed with stable vital signs.
– History of seizure, alert on arrival.
 Cont.…
• Triage Level IV: Less Urgent
• Conditions requiring nursing and physician assessment
within one hour.
• Conditions include:
– Alert head injury without vomiting.
– Minor trauma.
– Vomiting and diarrhea in patient older than age 2
without evidence of dehydration.
– Earache.
– Minor allergic reaction.
– Corneal foreign body.
– Chronic back pain.
 Cont…
Triage Level V: Non-urgent
• Conditions requiring nursing and physician
assessment within two hours.
• Conditions include:
– Minor trauma, not acute.
– Sore throat.
– Minor symptoms.
– Chronic abdominal pain.
 Common Emergencies
#Airway- Obstruction:-
• Partial airway obstruction
• Complete airway obstruction
• Causes may include aspiration of foreign bodies or food,
anaphylaxis, infection, trauma, sedative meds, neurologic
dysfunction
• Management
• Establish an airway!
• Abdominal thrusts
• Head tilt, chin lift maneuver/jaw thrust maneuver (if
cervical spin injury suspected)
• Oro-pharyngeal airway
• Endotracheal intubation
• Crico-thyroidectomy
• Maintain ventilation
 Cont…
#Hemorrhage:-
• Management
• Fluid replacement
• Blood, crystalloids, colloids
• If large volume rapid infusion, need to warm fluids
to prevent hypothermia
• Control of external hemorrhage, via direct
pressure; tourniquet used as a last resort
• Control of internal hemorrhage, usually via
emergent surgery; administer PRBCs while
awaiting surgery
 Cont.…
#. Trauma:-
• An unintentional or intentional wound or injury
inflicted on the body from a mechanism against which
the body cannot protect itself
• Collection of forensic evidence
– A critical role of the nurse!
– Documentation may be used in legal proceedings
– If criminal activity suspected, bag clothes and belongings
and give to law enforcement; document the name of
officer
– If suicide or homicide, must notify medical examiner

• Multiple trauma
– Priority managements
 Cont.…
#. Hypovolemic Shock:-
• Patent airway and ventilation
• Restoration of circulating fluid volume
• Central Venous Pressure
• Blood component therapy
#. Wounds:-
• Restore physical integrity and function of injured
tissue, with minimal scarring and without infection
• Wound cleansing
• Primary closure
• Delayed primary closure
 Cont.…
#. Intra- Abdominal Injuries:-
• Blunt trauma or penetrating injuries
• 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
– Assess for referred pain that may indicate spleen,
liver, or intra-peritoneal injury
– Perform laboratory studies, CT scan, abdominal
ultrasound and diagnostic peritoneal lavage
– Assess stab wound via ultra-sonography.
 Cont.…
Intra- abdominal injuries
• Ensure airway, breathing, and circulation
• Continually monitor the patient
• Document all wounds
• If viscera are protruding, cover with a sterile, moist
saline dressing
• Hold oral fluids
• NG to aspirate stomach contents
• Provide tetanus and antibiotic prophylaxis
• Provide rapid transport to surgery if indicated
 Cont.…
#. 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
Patient with Multiple Trauma-
 Cont.…
#. Heat- Stroke:-
• A failure of heat regulating mechanisms
• Types
– Exertional: occurs in healthy individuals during
exertion in extreme heat and humidity
– Hyperthermia: the result of inadequate heat loss
• 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, tachypnea, hypotension,
and tachycardia
 Cont.…
• Use ABCs and reduce Heat- stroke
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
• Monitor temperature, VS, ECG, CVP, LOC, urine output
• Use IVs to replace fluid losses
– Hyperthermia may recur in 3 to 4 hours; avoid
hypothermia
 Cont.…
#. Psychiatric Emergencies:-
• Overactive, underactive, violent, and depressed or
suicidal patients
• 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
;) THANKYOU SO MUCH FOR YOUR CAREFULL LISTENING AND
KIND ATTENTION !!! ;)