PREPARED BY: BRIAN JAY E.

CALIBOT, RN
 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
• 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
• 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)
•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.
• 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
– 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.
• 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.
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
#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
 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
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
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.
 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
#. 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-
#. 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
 HEAT STROKE
• Use ABCs and reduce 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
#. 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 S O M U C H F O R YO U R
C A R E F U L L LISTENING AND
KIND ATTENTION !!! ;)