- time is of essence Emergency- any sudden illness or injury which is perceived by the significant others and/or patient as requiring immediate medical attention Emergency Nursing care given to situations needing immediate medical interventions care of individuals of all ages with perceived or actual physical or emotional alterations of health that are undiagnosed or that require further interventions It is episodic (at any time, not constant, primary (immediate, !" restorative or rehabilitative and usually acute (patients are wheeled out after care is given Scope of Emergency Nursing #$ %sessment &$ iagnosis '$ reatment ($ valuation (for as long as the patient is stable Principle of Emergency Medical Treatment )* +ommunicating in +risis ,rinciple )-.patients need to know that their feelings are accepted and acknowledged by the (/ personnel /ole of nurses- )* 0ive verbal and nonverbal 1* Inform patients (what and why is it to be done ,hysician.s responsibility$ () obtain informed consent, (1 e2plains any invasive procedures to patient 3* 4e aware of one.s own feelings (self$assessment 5* 'alk with patients 6* (ncourage patients to discuss opinions (e*g* delivery of care 7* 8elp patients verbali9e frustrations :* "ffer realistic hope ;* 4e honest 1* ,atient #ssessment, /eporting and &ocumentation ,rinciple 1- <rapid, accurate initial patient assessment and precise reporting and documentation, whether in the pre$hospital or hospital settings are keys to effective patient care. /ole of nurses** )* =erify that the scene is safe and secure 1* 4e an astute observer 3* Information gathered must be communicated 5* /ecord other pertinent information of the patient 6* ,rovide e2planation for omissions of care (for purposes of law suits* 7* /ecord detailed triage notes 'riage notes> 8ow the patient was brought to the hospital (ambulatory, brought by private vehicle, conscious Interventions initiated by (?'$Basics ?edications given by the (?'$Paramedics (advanced cardiac life support (?'$Intermediate (performs basic life support and some interventions in advanced cardiac life support 3* ,atient and @amily (ducation ,rinciple 3-.patient and family education is the responsibility of every (/ nurse. /ole of nurses- )* ,rovide effective, individuali9ed instruction re> home care 1* Identify learning needs 3* (stablish realistic goals 5* #llow for learning time 6* (valuate the results 7* &ocument the instruction "ther 4asic ,rinciples in (mergency care )* ,rovide for basic survival needs and comfort 1* 8elp survivors achieve restful and restorative sleep 3* ,rovide privacy 5* ,rovide non$intrusive ordinary social contact 6* #ddress immediate physical problem 7* #ssist in locating and verifying the personal safety of separated loved ones and friends :* 8elp survivors take practical steps to resume ordinary day to day life Basic Legal Issues #* +onsent (permission to care to treatment )* (2pressed (verbal or/and writing$freely and voluntary given 1* Implied$presumed consent 3* Involuntary$patient refuses care and an individual gives consent (e*g* %" 5* Informed$given provided that proper e2planation has been done 3 (ssential components of Informed +onsent> 'he physician must &escribe the procedure to be performed (2plain the alternatives available to the procedure &etail the risks of the procedure Ahen does an informed consent become validB Cegal age D ); ?entally stable Information communicated in the language known to the consente Emergency Doctrine (implied consent - Implies that the client would have consented to treatment if able, because the alternative would have been death or disability - ,rovides and e2emption to obtaining informed consent before a procedure is to be done Consent Dilemmas )* ?inors (mancipated minors (economically independent, married 1* /efusal to consent based on religious conviction 0eneral rule$patient can refuse care on the ground of religious convictions (2ceptions$ () social circumstances, (1 court order e*g child who needs blood transfusion of whom both parents are Eehova.s witness, the court must have the final say 3* /efusal of treatment leaving against medical advice Patient self-determination Act (!!" - ,rovides hospitali9ed patients with the ability to decide regarding their wishes for termination or continuation of life support (*g* a* &urable ,ower of #ttorney #ttorney$in$fact (could be %" - 'hings to be done are the ones specified in the document signed by a conscious patient b* Civing wills - a written statement/document detailing the patient.s desires regarding their medical treatment in circumstances in which they are no longer able to e2press informed consent* c* &o not resuscitate order (&!/ - Cegal document signed by the patient and his physician, which states that the patient has terminal illness and does not wish to prolong life through resuscitative efforts - #lso called an advance directive #$at are good %amaritan la&s' - Caws which are passed in order to encourage lay persons or all persons present in emergency situations without fear of liability with regard to care given - (*g 4roken ribs caused by inappropriate performance of +,/ by a nursing studentFgood %amaritan laws cannot be invoked - (*g patient has incurred bruises (as long as it is !"' a ma(or complicationsFgood %amaritan law can be invoked - (ffect of help should not be graver than the condition of the patient Patient Transfer Issues (mergency ?edical 'reatment and #ctive Cabor #ct ((?'#C# (Before" +onsolidated "mnibus 4udget /econciliation #ct (+"4/# Caws governing patient with regarding to dumping or transferring to one hospital to another because of inability to pay EMTALA )ig$lig$ts )* #ll individuals 1* 'o determine the e2istence of an emergency medical condition, there must be> threat to life or limb, or severe pain, or active labor - &uty to provide #?% (#ppropriate ?edical screening$ whether patient is on an emergency situation 3* 8ospitali9ed with speciali9ed capabilities must accept transfers if with capacity to treat 5* 'ransfers require> consent of patient accepting physician accepting facility appropriate vehicle appropriate equipment qualified personnel records must accompany the patient Principle of Confidentiality not entitled to spread/share information to persons not directly involve to the care of patient (2emptions> - ,ublic interest is at stake - +riminal cases - +onsent of patient to reveal information - %ued for damages (content of patient.s chart is the very thing in issue G +ase of support is not a criminal case* More of legal issues &ocumentation /eportable conditions Dreport crimes to appropriate agencies, conditions mandated by laws, doctors and nurses has e*ual responsibility !ote> report the condition even if you don.t have consent from the doctor &ischarge instructions$ written and oral ,hysical evidence and chain of custody - 4ullets - 4lood specimens/blood samples !ote> patient should not be force to undergo blood e2aminations (forcing would mean assaultH e2emptionsI principle of confidentiality "rgan donation$brain death has been pronounced by the doctorH signed a legal consent +oles in Emergency ,ursing )* 'riage !urse 1* 'elephone #dvice !urse 3* ,oison +ontrol %pecialist 5* 'ransport !urses 6* 'rauma !urse +oordinator 7* ,ediatric (& !urse :* +ase ?anager ;* (?% Ciason J* !urse ,ractitioner )K* +linical !urse %pecialist -eneral +esponsi.ilities of Emergency ,urses )* Aorks in an area staffed and equipped for the reception and treatment of persons with conditions requiring immediate medical care, serious illness and trauma 1* (fficiently do #$,$I$( +esponsi.ility During Deat$ and Dying )* ,rovide ample opportunity to the patient and family to be together 1* #llow presence of family members during resuscitation 3* ,rovides religious support 5* +ommunicate honestly about the patient.s condition 6* (ncourage viewing the body in instances of sudden death or trauma 7* 4ecause preservation of legal evidence is often important in sudden death, %" are advised beforehand of the various tubes and devices present* :* &etermine client.s wishes re> organ donation ;* ?ay provide a follow$up telephone call to %" not present re> their questions or concerns J* ?ake referrals to support groups Disaster Nursing &isaster$ any situation, natural or manmade that produces an immediate patient load greater than the normal (& can handle Mass Casualty Incident - #ny time an incident or disease occurs that leaves many people ill or injured - +an be caused by natural ( i*e* earthquakes, floods or accidental or intentional disasters (terrorist attacks, sarin gas release Classification of MCI )* Cevel I$ involves more than )KK patients 1* Cevel II$ involves greater than 6K but not more than )KK patients 3* Cevel III$ greater than 16 but not more than 6K 5* Cevel I=$greater than )K but not more than 16 6* Cevel =$an incident involving no more than )K patients 7* MCI (contamination - an ?+I of any level, which includes or has the potential for biological, chemical or radiological contamination ,ote/ +ommon on all levels> $8aving a great impact on the emergency department and going beyond the capacity to treat Categories of Disaster/ )* +lass # (all require response by hospital disaster teamH bigger impact - !atural disasters> earthquakes, floods, tornadoes - (2ternal disasters/medical emergencies> chemical e2posure, epidemic of disease, nuclear fall$out 1* +lass 4 - Internal disasters/medical emergencies that may require response by hospital disaster team or specially created crisis team - &eath of key personnel (pope, president, large scale poisoning, death of religious personnel 3* +lass + - Internal disasters/non$medical emergencies - ?ay require response by hospital disaster team or specially created crisis team - 4omb threats, strikes, criminal activity (rape, kidnapping, shooting P$ases 0%tages of Disaster )* ,re$impact/preparedness - "ccurs prior to the onset of the disaster - !ot all type of disasters has the pre$ impact phase 1* Impact/response - &isaster occurs, continuing to immediately following disaster (brief or lasing to few hours - Inventory and rescue period - Assessment of the e2tent of the losses, planning on how to use the resources left and how to rescue the victims 3* ,ost$impact/recovery - ?ajority of rescue operations - /emedy and recovery period - Cengthy phase and may last for years )* 8oneymoon phase$feelings of euphoria 1* &isillusionment$anger, disappointment 3* /econstruction phase$acceptance of loss, coping stress, rebuilding DISASTER PLAN # predefined set of instructions for a community.s emergency responders @eatures of a good disaster plan )* Aritten 1* Aell$publici9ed 3* /ealistic 5* /ehearsed 1ey components of Disaster Plan )* ,atient care %ystem on how to receive and distribute patients whether incoming/evacuated patients 'riage procedure ,rovides care for the greatest number (,2T applicable in non$disaster triage #void treating ambulatory patients as dependent patients ,re$assignment with regard to responsibillity 1* +ommunication Internal> within personnel (2ternal> one hospital facility to another 3* /esources$staff &isaster team must know how to contact the resource staff 5* %ecurity/ %afety Densure the scene is safe 6* +oordination with ,ublic #gencies 7* &ocumentation :* ,ublic relations$ officials ;* +ritical Incident %tress &ebriefing - ,2T a form of psychotherapy - &one to mitigate (lessen the occurrences of ,'%& - 0roup process involving persons who are victims/ survivors of an overwhelming event or trauma including those who may have been impacted by the trauma - #ims to prevent the subsequent development of ,'%& - ,rovides avenue for the patient to e2press feelings, coping mechanisms, lessons learned Disaster Management Principles )* ,revent occurrence 1* ?inimi9e casualties 3* ,revent further casualties 5* /escue the injured 6* ,rovide first aid 7* (valuate the injury :* ,rovide definitive care ;* @acilitate reconstruction and recovery 'he responsibility of nursing care 3ary (depends on situation or available resources ?ay include triage, patient care, equipment, directing others, recording, transportation #$at are t$e psyc$ological and emotional responses to emergency and disaster' Immediate reactions (an2iety, frustration, anger, physical symptoms &elayed reactions (feelings of loss, grief and guilt, flashbacks, nightmares !ursing Interventions> #* @or immediate stress reaction )* 6 minutes break at least every hour 1* ?onitor for shaking, trembling, loss of coordination 3* ,rovide rest area 5* /otate frontline personnel 4* @or delayed reaction )* 1 mandatory debriefing sessions 1* (ncourage liberal leave policy 3* 4egin stress management class Triage System - trier to sort Triage Nursing $ care given to patients to ensure that those requiring immediate attention for life threatening emergencies receive it $ first used during !apoleonic war Primary goal of an efective triage: $ +APID identification of patients with urgent, life threatening conditions Comlementary goals of an efective triage: )* ,rioriti9ing care needs for all patients 1* /egulating patient flow through (& 3* &etermining the most appropriate area for treatment$ the (& or an outside primary care area Note: 'he triage models in disaster those patients who are severely injured and are unlikely to survive despite medical attention would receive the lowest priority triage* (greatest good for the greatest number 'he triage model in emergency nursing ,riority is those patients who are in severe condition Triage Models Triage tags D refers to color coding, identification to each injured patientH for priority, save time A! Non-"isaster Triage mo"els $i*e* models for individual triage> traffic directorH spot checkH comprehensive ,urpose> to provide best care for each individual patient* A44 Models for indi3idual triage a!#!#! Tra$c "irector categories> emergent (life$threatening and major illness L non-urgent (treatment can be delayed sometimes done by unlicensed person assessment consist of chief complaints disadvantage> emergent patients are disregards due to mi2ed with nonemergent patients sort to acute care or waiting room no further evaluation by triage (re$ triage when used )* low daily census 1* no waiting period for patients to see licensed health care professional a!#!%! Sot C&ec' categories> emergent (life threatening, urgent (major illness, delayed (patient may be treated or treatment may be delayed for more than 1K hours assessment by /! or ?& no planned reevaluation when used )* high patient census 1* waiting period is anticipated a!#!(! Comre&ensive Triage categories> life-sa3ing (multiple traumaH assessment is continuousH sta.le .ut urgent (sickle$cell, fracturesH every )6 minH sta.le .ut non-urgent (small lacerationH every 3K minH stable, may wait indefinitely for care (abrasion, impetigoH every 7K min assessment done by /! patients who remain in the waiting room are re$assessed every )6$ 7Kmin depending on severity of illness or injury when used )* high patient census 1* treatment space limited )! *ulti-casualty+Disaster Triage *o"el ,urposes> to provide the most effective care for the greatest number of patients %ample models for ?ulti$casualty/disaster triage model ,!#!#! Simle categories> immediate care (multiple traumas, inhalation injuriesH delayed care (e2tremity fractures, minor burns ,!#!%! *ilitary 6 level triage system +ategories 4 Immediate (I" triage tag> red life$threatening injuries that probably survivable with immediate treatment i*e* tension pneumothora2, respiratory distress, airway injuries, shock 54 Delayed (II" triage tag> yellow treatment may be postponed without loss of life i*e* minor e2tremity fractures, lacerations with hemorrhages controlled 64 Minimal triage tag> green little or no professional care required ambulatory, can self$treat or seek alternative medical attention independently i*e* minor lacerations, abrasions 74 E8pectant (9" triage tag> black have lethal injuries and will die despite treatment i*e* devastating head injuries, destruction of all vital organs :4 ,o apparent in(uries triage tag> white ,!#!(! Disaster --. level triage// G +ategories 4 Emergent triage tag> red critical life threateningH patient is e2pected to liveH shockH airway problems 1* urgent triage tag> yellow major illness/injuries should be treated within 1Kmin D 1 hoursH i*e* open fractures, chest wounds 3* non-urgent triage tag> green minor injuries, usually ambulatoryH are maybe delayed for more than 1 hoursH i*e*, closed fractures, sprains 5* Dead or &it$ impending deat$ D 'riage tag> black slim to no chance of survivalH shouldn.t take priority over salvageable patientH i*e*, massive trauma, e2tensive 3 rd degree burns 0t&er Triage *o"els #!/ START -(simle triage an" rai" treatment)/ can be performed by lightly trained lay L emergency personnel in emergencies physiologic parameters> /,? / D respiration , D pulse ? D mental Categories/ 4 Priority (9" tagged as blackH patients not breathing and have no pulse evacuation> leave where they fell attempt to open airway to assess respiration and pulse 54 Priority (" ; immediate tagged as redH patients who have / $ M 3K cpm , D absent radial pulse ? D altered used in evacuation> by ?(&(=#+ or ambulance 64 Priority (5" delayed tagged as yellow / N 3K cpm , D have radial pulses present ? D alert evacuation> delayed until all immediate persons have been transported 74 Priority (6" ; minor tagged as green walking wounded evacuation> not evacuated until all immediate L delayed persons have been evacuated %!/ A"vance" triage-similar to military $ implemented by skilled nurses G +ategories> )* E8pectant (.lac<" severely injured with life threatening medical crisis unlikely to survive given with care available should be taken to a holding area and given pain killers cardiac arrestH septic shock not used in (/ #dvance cardiac life support 1* Immediate (red" immediate surgery, cannot wait but likely to survive (i*e* tension pneumothora2 3* 2.ser3ation (yello&" stable for the moment but requires watching and frequent re$triage (i*e* laceration with controlled hemorrhage 5* #ait (green" walking wounded required doctors care in several hours or days but not immediately, maybe told to go home and come back home within the ne2t day i*e* broken bones without compound fractures, soft tissue injuries 6* Dismiss (&$ite" walking wounded with minor injury, do not require doctor.s care i*e* small cuts, scrapes STEPS IN TRIA1E )* ,rimary survey consist of #4+ consist of #4+& proposed by (!# A D #irway B D 4reathing C D +irculation D D &isability (neurologic assessment status E D (2posure or environment (coldness or hotness A=P> (a very practical use A D alert = D voice P D pain (response > D unconscious/unresponsive 1* %econdary survey follows primary survey and is very brief use %#?,C( (% D signs and symptomsH A D allergiesH M D medicationsH P D pertinent past historyH L D last oral intake, E D events leading to problem $ #?,C( $ a crash plan A D airway/breathing C D cardiovascular + D respiratory A D abdominal % D spinal ) D head L ((!' P D pelvis L D legs A D arteries (pulses , D nerves $ head to toe assessment > !9 seconds G @ocused #ssessment $ diagnostic procedures )* (+0 1* lab studies 3* radiology CARDI0P2L*0NAR3 ARREST $ with patients heart, circulation, and respiration suddenly cease +auses> a* ?etabolic a*)* hypoglycemia a*1* hyperkalemia b* &rug$induced c* ,ulmonary d* !eurologic e* 8ypovolemic f* "ther cardiac causes a! *eta,olic causes a44 $ypoglycemia s0s/ unconsciousness, tachydysrhythmias, sei9ures, aspiration, weakness mgt/ 6KO de2trose a454 $yper<alemia s0s/ (+0 (prolonged P$' intervalH peaked ' waveH wide P/% comple2es mgt/ calcium chlorideH sodium bicarbonate , D atrial contraction P/% D ventricles contract to pump out blood %' D time when the ventricles end of contraction and beginning of the ' wave ' D time of repolari9ation ,! Drug- In"uce" .44 TCA?s (e4g4 amitryptyline" s0s/ tachydsyrhythmias mgt/ sodium bicarbonate D alkylating agent .454 ,arcotics s0s/ bradydysrhythmiasH heart blocks mgt/ nalo2one (!arcan .464 Propanolol s0s/ cardiac> bradydysrhythmiasH respiratory> bronchospasmH metab> hypoglycemia mgt/ for bradydysrhythmias> Isuprel, #tropine for bronchospasm> aminophylline for hypoglycemia> 6KOde2trose c! Pulmonary c44 ast$ma s0s/ severe bronchospasm, tachydysrhythmias mgt/ endotracheal intubation and ventilatory support c45 pulmonary em.olus s0s/ pleuritic chest pain, %"4, tachydsyrhythmias mgt/ good ventilatory support c464 Tension pneumot$ora8 s0s/ distended neck veins, tracheal deviation, asymmetric chest e2pansion mgt/ needle thoracotomy, chest tube "! Neurogenic d44 increased ICP from any causes s0s/ dilated pupils, decerebrate$ decorticate posturing, dysrhythmias mgt/ steroids, diuretic agents, surgery i*e ?annitol> ?I" monitoringH soluset used, risk for cardiopulmonary edema e! 4yovolemia e4 anyt$ing t$at causes 3olume loss of .lood s0s/ tachycardia, decreasing bp, cool clammy skin mgt/ I= fluids, ,#%0 (,neumatic anti$shock garment, shock position ,#%0 is contraindicated in the ff> +ardiopulmonary edema %evere chest injuries even patient is in shock ,regnant woman> do not cuff abdomen f! 0t&er car"iac causes f4 Pericardial tamponade s0s/ distended neck veins, decrease 4,, bradydysrhythmias, widening pulse pressure mgt/ I= fluids, atropine, Isuprel, thoracotomy C&ain of survival )* (arly access 1* (arly +,/ 3* (arly defibrillation 5* (arly advance care )asic Life suort %urvey the scene (%cene is safe, crowd controlled Introduce self #ctivate the (?% (Emergency Medical %ervices $+all the ambulance +heck for consciousness L-ook L-isten @$eel 8ey, hey are you okB 0ive 1 initial breaths* +ontinue on LL@4 +heck pulse* 4rachial$infantH carotid$adult If pulse and respiration is absent, do 3K cycles of chest compressions> 1 breaths Aait for the automated e2ternal defibrillator #(&
+heck if shockable +heck if not shockable =entricular tachycardia, #systole also called ventricular defibrillation 3entricular stand stillA pulseless electrical activity (no blood to be pumped &eliver ) shock using #(&* +annot perform defibrillation* +$C$($#$/* $!obody is touching the patient* /epeat +,/ for 6 $,o metallic objects* cycles until #+C% $,ot on wet ground* arrives* /epeat +,/ for 6 cycles %hockable Drefers to dysrhythmias which can be subjected to defibrillation (electrical activity of the heart is present 4C% can operate automated e2ternal defibrillator =entricular tachycardiaM )KK bpm !itroglycerine patches$dilates the vessel to encourage blood to stay in the venous system $less cardiac rate Qse gloved hand in detaching the plastic to pre3ent $eadac$e4 It will burst due to the electrical activity being delivered ,osition of patches> #nterolateral position$most common #nterior and posterior Advanced Cardiac Life Support (ACLS)
,ulseless$no respiration &eliver o2ygen ?onitor using (+0 )1 $lead #(& If s$oc<a.le #dminister ) shock (#(& /epeat +,/ for 6 cycles If s$oc<a.le Wait AED CPR (5 cycles) AED (1 shock) CPR (5 Cycles) Administer Epinephrine (1 mg/I) asopressin (!" I# I) $ I$ epinephrine is not the choice If not s$oc<a.le 0ive +,/ for 6 cycles #dministration of the ff> )* (pinephrine () mg/I= 3$6 minutes 1* =asopressin 5K IQ/I= 3* #tropine ) mg/I= in 3 doses If s$oc<a.le CPR (5 cycles)
AED (1 shock)
CPR (5 Cycles)
Administer the $$ antiarrhythmic dr%gs Amiodarone &idocaine 'agnesi%m If not s$oc<a.le 0ive +,/ for 6 cycles #dministration of the ff> )* (pinephrine () mg/I= 3$6 minutes 1* =asopressin 5K IQ/I= 3* #tropine ) mg/I= in 3 doses Difference .et&een BL% and ACL% - administration of drugs K$5 min brain damage not likely 5$7 min brain damage is probable 7$)K min irreversible brain damage is possible ?ore than )K min irreversible brain damage is certain Contraindication in Defi.rillation )* Cess than ) year old (infant.s heart is normal, therefore the electrical activity is normalI respiratory problems brought about by @oreign A Body 2bstruction and drowning are common causes among this age 1* If electrical activity is normal, no defibrillation should be given* 3* ,atients with severe traumatic chest injuries 5* 8ypothermic$no to defibrillation, warm the patient first before applying defibrillation Car"ioversion %ynchronous electrical countershock timed to coincide with the P/% !ot delivered on the ' (repolari9ation wave (compromised delivery of energy Differences/ +ardioversion &efibrillation $set in synchronous mode $sedate patient if conscious $hemodynamically unstable $set in unsynchronous mode $patient is hemodynamically stable ,ursing +esponsi.ility for Cardio3ersion/ )* ?onitor =/%, C"+ and cardiac rhythm frequently until patient is hemodynamically stable and returns to pre$orientation C"+ Complications of Cardio3ersion/ #systole ,=+.s (,remature ventricular contractions =entricular tachycardia =entricular fibrillation /eturn to atrial fibrillation or atrial flutter Drugs Commonly 2se" in Car"ioulmonary Resuscitation Drugs Classifications )* #denosine (#denocard 1* #tropine 3* 4retylium (bretylol 5* (pinephrine #ntiarrhythmias #nticholinergicH parasympathomimetic +ategory 3 antidysrhythmias (adrenalin 6* Isoproterenol (Isuprel 7* Cidocaine (2ylocaine :* ,rocainamide (pronestyl ;* %odium 4icarbonate J* =erapamil (+alan, isoptin %ympathomimetic drugs %ympathomimetic drugs +ategory )4 antidysrhythmias +ategory )# antidysrhythmias (lectrolyte , alkylating agent in metabolic acidosis +alcium channel blocker, category 5 antidysrhythmias Commonly 2se" Parental 5asoactive Drug Drugs Classifications )* (smolol (brevibloc 1* +alcium chloride 3* &ia9o2ide (hyperstat 5* &iltia9em (cardi9em 6* &obutamine (dobutre2 7* &opamine (Intropin, &opastat #ntidysrhythmias, #+( inhibitors (lectrolytes #ntihypertensive drug +alcium channel blocker %ympathomimetic drugs %ympathomimetic drugs 0t&er Drugs in Car"iac Emergencies Drugs Classifications )* (nalapril (=asotec 1* Cabetalol (!ormodyne 3* !itroglycerine ('ridil 5* !itroprusside (!ipride 6* !orepinephrine (levophed 7* ,ropanolol (Inderal #+( inhibitor #lpha$adrenergic blocker =asodilator =asodilatorH antihypertensives =asopressorH adrenergic 4eta blockers ?orphine sulfate> emergency drug of ?I $reduces the preload thus decreasing the myocardial o2ygen demandH relieves pain P$ases of MI/ A4 Ischemic phase$ myocardial repolari9ation is altered and delayed causing the T &a3e to in3ert B4 Injury phase$causes %T segment c$anges -%T segment rises at least ) mm measuring K*K; seconds* If the myocardial injury is on the endocardial surface, the %T segment is depressed ) mm or more at least K*K; seconds C4 Infarction$abnormal P wave is K*K5 seconds or longer (%melt9er L 4are, 1KK5, p* :17 s&oc' $state of inadequate perfusion and o2ygenation to vital organs and tissues throughout the body =ital 2rgans Affected .y s$oc</ 4rain 8eart Ridneys Civer 7 %tages of %$oc</ )* Initial Dcellular level $ increase anaero.ic meta.olismH decrease aero.ic meta.olism $ Increase lactic acid productionF pain $ &ecrease cardiac output 1* +ompensatory a* /enin$angiotension system b* %ympathetic $ /elease epinephrine (vasoconstriction c* /elease of #&8 (posterior pituitary gland d* Intracellular fluid shifts 3* ,rogressive 5* /efractory (Irreversible Types of %$oc</ )* 8ypovolemic shock $caused by a decrease in circulating volume greater than )6 O $s0s/ initial stage> pain, tachycardia, skin dry and slightly moist, #40.s normal +ompensatory stage> an2ious, hypotension, cool, clammy skin, may have metabolic acidosis ,rogressive> confused, restless, agitated, profound hypotension, cardiac dysrhythmias, skin pale, no purposeful movement Irreversible> severe hypotension, tachypnea with shallow depth, profound metabolic acidosis, comatose 1* +ardiogenic $+aused by abnormal cardiac functioning or pump failure $s0s> restless, agitated, hypotension, tachycardia with weak thread pulse, decreased pulse pressure, skin cool and moist, E=& 3* "bstructive $results from the inability of the ventricles of the heart to fill or empty appropriately because of an obstruction in the blood flow from the heart $s0s/ an2iety, hypotension, E=&, pallor, diminished or absent breath sounds, tracheal deviation 5* &istributive a* #naphylactic shock$results from an overwhelming immune response to the presence of an allergen or antigen s0s/ marked restlessness, difficulty swallowing or severe itching, hypotension tachycardia b* %eptic shock$associated with endoto2ic release of gram negative bacteria in the blood stream s0s/ decreased 4,, or normal 4, with widened pulse pressure, tachycardia, hyperventilation, positive cultures c* !eurogenic shock$occurs as a result of decreased sympathetic control of vasomotor responses s0s/ hypotension, bradycardia followed by tachycardia, pallor, decreased to absent urinary output* Emergency Care %teps @or %$oc</ )* ?aintain an open airway and assess respirate 1* If with adequate breathing> apply high concentration o2ygen by nonrebreather mask* 3* #ssist ventilation or perform +,/ if necessary 5* +ontrol bleeding 6* #pply and inflate the ,#%0 7* If with possibility of spine injury> elevate the legs ;$)1 inches :* %plint any suspected bone injuries or joint injuries en route to the hospital* If in shock, place the body on a spine board* ;* ,revent loss of body heat J* 'ransport patient immediately* )K* If patient is conscious, speak calmly, and reassuringly throughout the assessment, care and transport -eneral Treatment Measures of %$oc</ )* @ollow #4+ guidelines 1* %upine position with spinal alignment maintained 3* #irway should be secured, protected and supplemental o2ygen should be initiated through the appropriate delivery device dependent on the client.s overall assessment* 5* Initiate an I= access 6* Initiate continuous cardiac and %a "1 monitoring and prepare doe frequent, repetitive vital sign assessments 7* ?aintain stabili9ation of all deformities and prevent hypothermia :* ,lace an indwelling cath ;* #dminister sympathomimetic drugs as ordered