EMERGENCY AND DISASTER NURSING EMERGENCY NURSING practice of episodic, primary, critical and acute nursing care of all

ages who experience physical,emotional or psychological alterations in health. Care of the Client presenting to an Emergency Department :

1. Triage
classification of all clients presenting to the emergency department. Purpose: to prioritize treatment. Triage Rating Systems: 3 Categories

a. Emergent
conditions requiring IMMEDIATE CARE and intervention because of increased risk of mortality or threat to life, limb or vision. B-burns C-chest pain-cardiac arrest R-respiratory distress H-hemorrhage sec. to ectopic pregnancy M-major blunt or penetrating trauma

b. Urgent
conditions that require care ASAP and generally within 1 hour because the condition has the potential for causing the deterioration of health state if not treated ASAP. These clients will have stable V/S but have acute illness and must be treated to prevent morbidity. F-fever A-abd.pain S-stable fracture H-HA L-lacerations with controlled bleeding D-DHN

c. Non-urgent
require routine care that can be delayed for more than 2 hours without the possibility of deterioration; clients presenting with non-urgent conditions frequently utilize the emergency dept. because they do not have a primary care physician.

C-colds S-sore throat T-tooth ache A-abrasions R-rashes Disaster Management Plan a community wide, hospital wide or emergency department plan to handle mass casualty incidents that may occur at any time. Assessment: Primary Assessment rapid initial assessment of the symptoms to determine life threatening conditions while simultaneously intervening. Airway with C spine immobilization, patent airway, ability to speak, foreign body, chest expansion. Tx: chin-lift / jaw thrust, suctioning, intubation, cricothyroidectomy, tracheostomy, cervical spine neutral position. Breathing effectiveness of breathing and ventilation ability. Abnormal : apnea, weak, shallow/labored respiration diminished /absent breath sounds unequal chest expansion retractions/ paroxysmal chest wall movement tracheal deviation NVE Open chest wound Sx of chest trauma Subcutaneous emphysema

Tx:

1. Oxygen therapy 2. Chest tube insertion, intubation 3. Pressure dressing on a flail segment of the ribs Circulation- adequate circulation to
maintain cellular tissue perfusion.

Abnormal : bradycardia or tachycardia cool, pale and diaphoresis obvious uncontrolled external bleeding decrease LOC Sx of hypovolemia, pericardial tamponade, cardiac arrest Tx: 1. direct pressure to control external bleeding 2.IV access 3. CPR 4. Pericardiocentesis-aspiration of blood from pericardial sac 5. Autotransfusion BT of one s own blood. Disability complete a brief neurological assessment to determine baseline functioning, potential life threatening complications, LOC. Abnormal: Unresponsive altered pupils : fixed pupils, papillary response abnormalities. Expose remove all clothing from the client to facilitate a thorough complete secondary assessment examination. Secondary Assessment a brief, systematic head to toe assessment that identifies all injuries. Tx:

cervical immobilization is maintained at all times as well as continual assessment of hemodynamic and oxygen status.

Fahrenheit provide measures to prevent body heat loss at this time through the use of warmed IVF, warmed blankets or healing lamps. Get V/S: other assessment aids : cardiac monitor, pulse oxi,urinary catheter, NGT, lab. studies: CBC, electrolytes, Fibrin degradation products (coagulation), amylase, lactate; renal studies ; blood type and crossmatch; toxicology studies. History head to toe assessment : HPI / PMH / FH /Meds Common Problems Seen in Emergency Settings : 1. Airway obstruction partial or complete obstruction of the airway. 2. Tension pneumothorax occurs when air enters the pleural space through a tear during inspiration and accumulates because it cannot escape during expiration. 3. Flail chest the force of impact to the chest wall during injury causes the fracture of 3 or more continguous ribs\ in 2 or more places resulting in a floating segment. 4. Uncontrolled hemorrhage uncontrolled bleeding.

5. Motor Vehicle Accidents *MVA

blunt and multiple trauma. Acceleration/deceleration forces increased velocity of a moving object followed by a reduction in velocity ex. speed of a vehicle.

Compression forces body parts are pressed against immobile objects due to explosive injury to air filled organs *liver and spleen

Shearing forces a rotational force exerted around a fixed site. Blunt trauma fractures, lacerations, contusions, rupture or tearing of solid and hollow organs and major blood vessels. 6. Penetrating injuries stab wounds/GSW : knives, pencils, forks; high velocity /high energy missiles: guns,rifles,high pressure injection devices. 7. Hypothermia a condition where the core body temp. is 36 C ( 96.8 F ) or less. Tx : ABC, faster rewarming, Cordarone, D50-50 IV

8. Frostbite injury caused by exposure to cold environment and conditions. Tx : Remove from the cold envt. before thawing. Area not be rubbed mechanical friction can cause tissue damage; Aloe vera topical inhibits platelet aggregation : thromboxane inhibiting effect. Tetanus prophylaxis Topical and parenteral antibiotics Oral and parenteral analgesics 9. Heat exhaustion vasomotor collapse sustained from prolonged exposure to heat.

Tx : Rest in cool, shaded area TSB, direct fans toward patient F/E replacement

10.Heat stroke an extremely elevated core body temperature caused by a failure of the hypothalamusperspiration regulating mechanism; carries 70% mortality rate. Tx : Aggressive cooling measures to institute Full body exposure and cooling by evaporation Prevent shivering Cardiac monitor Ice water gastric and peritoneal lavage Prevent over correction , hypothermia and cerebral edema IV NSS, do not use LR because liver is unable to metabolize lactate. U.O. / ABCs Meds: Thorazine 10-25mg prevent shivering Mannitol Solu-Medrol 11. Drowning and Near drowning drowning is death caused by asphyxia and aspiration after submersion in water; near drowning is risk of death occurring within 24 hours. Tx : ABC CBC, ABG Fresh water drowning electrolytes decreased Salt water drowning electrolytes increased XRay bilateral infiltrate Cardiac monitor ET intubation Correct hypoxia and cyanosis, I and O Antibiotics,Epinephrine,Lidocaine,At SO4, Bronchodilators,NaHCO3,Steroids 12. Bites

dog,cat, rodent, human, insect/bee, spider, tick, snake; a break in the continuity of the skin caused by a bite from an animal, insect or human Tx : Meticulous wound care Devitalized tissue should be debrided and topical antibiotic ointment. IV antibiotics severe human and animal bite Rabies prophylaxis-animal bite

Carnivores-rabies positive : raccoons, bats, wild animals Herbivorous rabies negative : mice, rodents Venomous bites black widow spiders, poisonous snakes Anti venom tx: constricting band/ice to slow the circulation and spread of venom to circulation. *Wound should be left open and a bulky dressing is applied-dry sterile dressing. *ABC,V/S,LOC Muscle relaxants Animal control 13. Poisonings substances that are harmful : inhaled, ingested *food, drug, overdose or acquired by contact *insecticides Carbon monoxide inhalation Food poisoning Drug overdose: ASA overstimulation of resp. center and metabolic hyperthermia,hyperglycemias Insecticide surface absorption Tx : ABC,IV access Narcan-Naloxone antagonist for resp. depression due to narcotic overdose Flumazanil-for Benzodiazepine ingestion Gastric lavage-NGT Vomiting is C/I Antidotes: Ipecac, activated charcoal 14. Electrocution injury sustained by electric current acidosishyperventilation,

Tx : ABC, Spine immobility ,Local wound care Meds : NaHCO 3 , Mannitol, Tetanus, Lidocaine, Amiodarone Epinephrine