Download Emergency - Metropolitan Community College

EMERGENCY
By: Diana Blum MSN
Metropolitan Community College
Environment of Care
Rapid change
Noisy
Unpredictable
Demographic
Multiple specialties
Increasing visits to 123.8 million in 2011
Avg age of patient is 35.7 yrs old
75 + years old highest visit rate
Common reasons for healthcare seeking:
Chest pain
Abd pain
Headache
fever
Team Members
ER nurse
EMTs
Paramedics
Physcians
Ancillary members: admissions, radiology, etc.
Special teams: forensic nurse, psychiatric team
Client Safety
All patients have ID number and if unconscious they
are named John or Jane Doe
If unconscious the nurse plays detective
Prevent falls and breakdown
Get med list if available
Always ask allergies if able
Look for medic alert bracelets, necklaces
Standard precaution always
Recognize volatile situations (plan escape route)
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
• 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
ER Nursing
6 months to 1 year acute care/ICU training
Some ERs will hire new grads using intern program
Technical Skills
Multitasking
Assist with:
Wound closure
Foreign body removal
Central line insertion
Transvenous pacemaker insertion
Lumbar puncture
Pelvic exam
Chest tube insertion
Lavage
Fracture management
http://www.youtube.com/watch?v=n5Zw4ZARvNg
Core Competencies
Knowledge of ER Care
Broad based
Multi disease process/insects/snakes/animals
Mandatory reporting for sexual assault, abuse
BLS, ACLS, PALS
Assessment
Rapid recognition of abnormal findings
Must be aware of comorbidites
Act Quickly
Communication
Complex barriers
Use professional language
Protect HIPPA related information
Triage
Means: to sort: ED triage differs from disaster triage in that
patients who are the most critically ill receive the most
resources, regardless of potential outcome
1.Across-the-room assessment
starts with visual contact, general appearance, work of
breathing, skin color
2.Determine chief complaint
3. Focused assessment
(Subjective data) demographics, onset of symptoms, past medical
history, LMP, current meds, allergies
(Objective data) inspection, palpation, auscultation, obtain vital
signs
Basic Elements
Assign acuity level
Emergent: immediate threat to life or limb
CODE, Respiratory Failure, Chest pain, hemorrhage
Urgent: treat quickly but life no immediate threat present at this time
Pneumonia, abd pain, fractures
Non-Urgent: can wait for several hours if needed
Strains, sprains, toothaches, cold, some rashes
5 Level Triage
Level 1- immediate life saving interventions, many
resources
Level 2- high risk, many resources
Level 3- urgent, two or more resources, wait 30 min
Level 4- non-urgent one resource, wait up to 1 hour
Level 5-no resources, wait up to 2 hours
Examples
Level 1- CPR, intubation required
Level 2- chest pain, dyspnea, suicidal with plan or
attempt, stroke, pregnant with active bleeding
Level 3-abdominal pain, closed fractures, dislocations
Level 4- sore throat, strains, sprains, URI,
Level 5- suture removal, medication refill, certain rashes
Resources
Labs
XRAY
EKG
CT/MRI
IV/IM medications
IV fluids
Consults
Simple procedure
Complex procedure
Primary Survey
A: Airway
patency, watch for tripod, stridor, inability to speak, rise and fall
of chest
B: Breathing
rate and depth, breath sounds, chest expansion, skin color,
spontaneous breathing
C: Circulation
heart rate, pulses, blood pressure, skin, cap refill
D: DisabilityAlertness, Responsive to Voice, Responsive to pain,
Unresponsiveness
E: Exposure
Remove clothing, keep pt warm
2nd ary Survey
Identifies other injuries or medical issues that needs to be
managed
Secondary Survey
• Before beginning Secondary survey
• Attach EKG leads, Pulse ox, C02 device to ETT, foley cath if not
contraindicated, NG, radiographs
-Full set of vital signs/Focused interventions
FAST scan-focused assessment
-Give comfort measures
-History/Head to toe assessment
Pre-hospital info AMPLE
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-log roll protect spine
• Assign highest priority to injuries interfering with vital
physiologic function
Hemorrhage Control
Care of Client
Place client in hospital gown
Ensure privacy
Med administration as ordered
Assist with procedures
Reprioritize and reassess as needed
Disposition
Admitted or discharged is the question
What is the nurses role?
Case Management
Nurse case managers intervene when necessary to assist in
making follow up and referral arrangements especially with
elderly and homeless, and abused clients
Teaching
review D/C instructions
Reinforce safety (sealtbelt wearing)
Discuss home safety (detectors, fall prevention)
teach new procedures that will continue at home
Priority Setting
Triaging client care
Critical thinker
Go to Prioritization PPT