Chapter 33

Emergency Nursing

2Emergency Care Area

Requirements Central location

Easy access

Dedicated “crash table”

Basic necessary equipment Oxygen source

Suction unit

Surgical lighting

Multiple electrical outlets

3Crash Cart

Organize and prioritize drawers according to the ABC’s A=airway

B=breathing

Thoracocentesis materials for emergency respiratory patient

Venous access (C=circulation)

Venous access drawer

Various size and length catheters

4Emergency Drugs

Well organized and labelled

Current dose chart

Syringes and saline flush nearby

5Laboratory Equipment

Minimum database “QATS”

Lactate testing

Additional point of care testing Blood gases

Coagulation testing

Commercial test kits Ethylene glycol

6Fluid Therapy

Goals and objectives Maintaining hydration

Replacing fluid losses

Treatment of shock

Treatment of hypoproteinemia

Increase urine output

Correcting acid–base or electrolyte disturbances

Providing nutritional support

7Fluid Therapy in Shock

To correct poor perfusion, replace deficits rapidly

Goal: expand and maintain the intravascular space

Shock fluid rates

Combination of therapy crystalloids and colloids

8Principles of Triage

Set protocols for a consistent, thorough response

CRASH PLAN

Be well-organized

Expect the unexpected

9Respiratory Emergencies

Goals Provide oxygen in the least stressful route

Keep patient calm

Obtain patient history

Complete physical examination

Baseline lab data IF possible

10Routes of Oxygen Administration Oxygen cage

Oxygen hood

Flow-by oxygen

Face mask

Nasal oxygen

Endotracheal oxygen

11Assessing Respiratory Function Respiratory effort

Respiratory pattern

Mucous membrane color

Pulse quality and rhythm

Heart rate

Auscultation

12Respiratory Emergencies

Insufficiencies resulting from trauma Upper airway trauma/rupture

Pneumothorax

Hemothorax

Pulmonary contusions

Diaphragmatic hernia

Flail chest

13Respiratory Emergencies

Rapid recognition imperative

Clinical signs of: Upper airway trauma

Bloody respiratory discharge

Increased respiratory effort

Subcutaneous emphysema

Increased upper airway noise

14Respiratory Emergencies

Pneumothorax and hemothorax Rapid shallow breathing

Poor or restrictive chest expansion

Respiratory distress

Flail chest Independently moveable segment of the chest wall

Paradoxical motion during respirations

15Respiratory Emergencies

Stabilization techniques and diagnostics Oxygen therapy

Thoracocentesis

Thoracic drain placement

Diagnostics Thoracic radiographs pulse oximetry

Arterial blood gas analysis

16Cardiovascular Triage

Physical examination techniques MM color

Capillary refill time

Pulse quality

Heart rate

Jugular vein evaluation

Cardiac auscultation

17Cardiovascular Triage

Monitoring ECG

Blood pressure

Baseline laboratory values

18Hemorrhage Protocols

Pressure bandage techniques

Minimum laboratory database

Peripheral serial PCV/TS

Diagnostic procedures Thoracocentesis

Abdominocentesis

PCV/TS of collected fluid

19Neurological Emergencies

Protocols for stabilization Assess respiratory function

Assess cardiac function

Assess mentation

Dull mentation may signal head trauma

20Head Trauma

Clinical signs Poor mentation

Anisocoria

Nystagmus

Abnormal pupillary light response (PLR)

Head tilt or turn

Abnormal gait

21Head Trauma

Treatment Oxygen therapy

Fluid therapy to maintain perfusion

Pharmaceuticals

Mannitol

Lasix

22Spinal and Orthopedic Injuries Goals

Maintain perfusion

Fluids

Pain medications

Supportive bandaging

Wound care