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• First aid and emergency care knowledge can be life-saving.
• Nurses must be ready to act in emergencies not only in hospitals but also at homes and public places.
• Prompt intervention is crucial to improve patient prognosis.

General Principles of Emergency Care

• In emergencies, victims and observers may feel anxious or scared.
• Victims respond to emergencies in various ways, from shock to hysteria.
• As a nurse, your priority is to save lives and reduce injury effects, while reassuring the people involved.
• Follow these steps: Survey the scene, conduct primary and secondary surveys, and gather health history.

Surveying the Scene

• Check if the area is safe before helping.
• See how many people are hurt and how.
• Ask for help, and get consent to give care and call 911.
• To prevent harm to the rescuer and additional harm to the victim, dangers must be recognized.

Primary and Secondary Surveys

• A primary survey identifies life-threatening injuries and includes checking:

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
  • Facilitating the family

• If needed, intervene in this specific order:

  • Open the airway and protect the neck.
  • Start CPR or rescue breaths (Use the “jaw thrust” if the patient is unconscious).
  • Stop any severe bleeding by pressing on the wound.
  • Find out how conscious they are.
  • Look for injuries by taking off clothing.
  • Allow family nearby.
  • Search for a medical alert tag, usually as a necklace or bracelet.

• After the primary survey, a secondary survey involves a complete head-to-toe exam to find any missed changes or findings.

First Aid Treatment Guidelines

• Maintain a clear airway.
• Splint injuries where they are found.
• Keep warm, but avoid overheating.
• Never remove objects that have pierced the body.
• Do not give anything orally to unconscious or severely injured individuals.
• Stay with the injured until medical help comes.

Nursing Assessment

• Patient emergencies can occur in every setting, nurses must observe and assess quickly to provide appropriate care.

Health History

• If possible, collect a brief health history including the chief complaint, treatments given, and relevant medical history.
• Use the acronym SAMPLE to remember what to ask:
  • Symptoms
  • Allergies
  • Medications
  • Past Illnesses/Pregnancy
  • Last oral intake
  • Events related to injury
• Identify why, what the signs and symptoms are, and the circumstances. Note how long they have been unconscious.
• See if any treatment has been given. Check for a medical alert tag. Determine present meds, known allergies and drug use.

Physical Examination

• Check if responsive, prioritize ABCDE:
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
• Watch and listen for breathing.
• Check pulses.
• Control bleeding and shock, assess consciousness, pupils, and function.
• Expose the body to check for injuries.
• If no bleeding/shock, do a systematic head-to-toe exam, noting:
  • Injury
  • Bleeding
  • Swelling
  • Bruising
  • Drainage
  • Circulation
  • Mobility
  • Sensation
  • Symmetry
  • Alignment
• Keep checking skin as well.

Specific Emergencies

• Focused assessments and quick interventions are required.

Cardiopulmonary Arrest

• Cardiac arrest means the heart stops beating.
• Respiratory arrest means breathing stops.
• Both systems rely on each other so when one fails, the other does too.
• The brain is susceptible to hypoxia [low oxygen]. Without circulation and oxygenation, brain damage begins after 4 minutes.
• CPR can maintain oxygen to the brain until advanced life support is here.
• Nurses should know how to use an automated external defibrillator (AED), which is available in public places.

Causes of Cardiopulmonary Arrest

• Myocardial infarction
• Heart failure
• Electrocution
• Drowning
• Drug overdose
• Anaphylaxis
• Asphyxiation

Signs and Symptoms of Cardiopulmonary Arrest

• Victims collapse
• Quickly lose consciousness
• Lack a pulse/respiration

Interventions for Cardiopulmonary Arrest

• Goals: Provide oxygen until heartbeat and breathing return.
• Improve skin color/pulse and have spontaneous respiration, effective ventilation and improving skin color.
• Follow latest CPR guidelines.

Choking/Airway Obstruction

• Airway obstruction will occur due to a foreign body that restricts airflow.

Mild Airway Obstruction

• Good air exchange
• Responsive
• Forceful coughing
• Do not interfere. Encourage them to breathe/cough. Call 911 if symptoms continue.

Severe Airway Obstruction

• Poor/no air exchange
• Poor or no cough
• Stridor [high-pitched noise]
• Respiratory distress
• Cyanosis
• Inability to speak/move air
• Clutching neck [universal sign]

Interventions for Choking

• Achieve a clear airway, normal breathing, audible normal respirations, improving the following:
  • Skin color
  • Decreased coughing
  • Anxiety and normal pulse
• Perform abdominal thrusts properly [Heimlich] for the conscious/unconscious victim and for obese or pregnant individuals.

Complications From Abdominal Thrusts

• Damage can occur to internal organs. Any individual who undergone abdominal thrusts should be looked at by a medical provider later.

Prevention of Death From Choking

• Cut food into small pieces
• Eat slowly
• Chew food thoroughly
• Avoid laughing/talking while swallowing
• Abdominal thrusts when in distress

Shock

• Circulatory failure is caused by inadequate blood volume, heart failure, infection, allergic reactions, pain, or fear.

Hemorrhage

• A hemorrhage is a large blood loss.
• Losing 1 liter can cause hypovolemic shock which can lead to death.
• Bleeding can be external or internal. Suspect internal bleeding if patient displays symptoms of shock, but there is no evident external bleeding.

Focused Assessment for Hemorrhage

• Assess for signs/symptoms, including;
  • Obvious bleeding
  • Cool, pale, sweaty skin
  • Weak, thready pulse
  • Rapid respirations
  • Decreasing alertness
• With internal bleeding the patient may also have:
  • Abdominal distention
  • Pain
  • Hematemesis
  • Dyspnea
• Ask patient if they have a bleeding disorder or uses any blood-thinning medications/supplements.

Interventions for Hemorrhage

• Goal: Increase cardiac output, have pulse and blood pressure normalization, warm/dry skin & absence of visible bleeding. Patient needs to relax and have anxiety reduced if possible as well.
• Direct/continuous pressure should be applied [with/without gauze]. Use a sterile dressing. If unavailable, use a clean cloth.
• Lay patient supine, stabilize, and immobilize by raising feet 6"-12".
• Dress the wound with available supplies and reinforce the dressing, careful to not change it.
• If direct pressure and elevation doesn't work, apply indirect pressure and utilize pressure to the main artery serving the area

Tourniquets for Hemorrhage Control

• An option when controlling severe bleeding.
• Tourniquets can cause amputations due to inappropriate placement/prolonged wear.
• Only be used by individuals with advanced training.
• Utilize a pneumatic tourniquet [blood pressure cuff]. Inflate cuff above the victim's systolic blood pressure.

Epistaxis (Nosebleed)

• Apply pressure by pinching nostrils for at least 10 minutes while patient sits and leans head forward to prevent aspiration of blood. Don't blow or pick the nose afterwards.

Traumatic Injury

• Results from various situations from sports, MVC's or violence.

Fractures

• Break in a bone can be simple/compound, open/closed, complete/incomplete:.

• Simple fracture = closed/does not break the skin

• Compound fracture = open/pierces through the skin

• Complete fracture = broken ends are separated

• Incomplete = bone ends are not separated

Focused Assessment for Fractures

• Check for signs/symptoms: primary, objective signs, numbness/tingling, deformity, etc.

interventions:

• Goal: Reduce risk for trauma and ensure that damage is minimal. Stabilize the bone to fixate tissue damage. Stabilize injury by immobilizing above/below joints. Boards, sticks, magazines will aid with splinting. Apply cool pack to prevent swelling. Severe bleeding requires direct pressure

Strains and Sprains

• Strains are injuries to muscles/tendons, sprains are ligament injuries. Immobilization, elevation, and cool packs should be applied.

Head Injury

• Not always immediate after the accident, especially with MVC or fall. Worsening can increase intracranial pressure [ICP], resulting in bleeding/swelling from the trauma, progressively impairing brain function and breathing.
• The older adult is more likely to have sensory/circulatory issues that can lead to head injuries. They may be overlooked if their confusion is attributed to old age.

Focused Assessment for Head Injury

• Perform inspection/palpation of head. Look for signs of pressure:

  • Change in behavior
  • Agitation or confusion
  • Decreased LOC
  • Pupil dilation/constriction
  • Sensory and motor function decline
  • Pressure increase while rates decrease = project vomiting.
  • Leakage from Basilar Skull Fractures [CSF]
  • Halo Effect

• The yellow "halo" is one data piece used for assessing CSF leakage.

Goals and Outcome Criteria for Head Injury

• Adequate oxygenation
• Decreased injury potential & Continuous Spinal Immobility
• Physician assessment is critical. Neck should be immobilized + alignment. Use the jaw thrust method to open air. Check movement and sensations on the extremities

Neck and Spinal Injuries

Suspect an injury if patient had head injury with diving or MVC. Improper movement puts the patient for paralysis. With injury from diving- immobilize the neck/back and ensure neck/back area is covered

Eye Injury

• Immediate attention is required in certain cases. Eye lids, redness, foreign bodies, penetrating objects, chemical irritant exposure can be involved. Irrigation: from inner to outer 20 minutes using saline or water

Interventions for Eye Injury

• Prevent injury and minimize the risks. Take time to remove foreign particles/ protect from chemical/ protect body while obtaining medical help. Use loose dressing if there is excessive bleeding

Ear Trauma

• High risk for avulsion [tearing loose]. Assess the extent of injury and tissue damage using pressure to control bleeding. Integrity must be restored during the procedure

Chest Injuries

• Can impair normal respiratory function. The injuries are either open/closed. Pneumothorax, Flail Chest, Hemothorax and cardiac tamponade can occur. Perform respiratory assessment for chest injuries: rate/character respirations, asymmetry, pain, symptoms

Focused Assessment to Determine Chest Injuries

• Observe the general rate + rhythm, skin color, and symptoms (e.g. dyspnea/ cyanosis)

Interventions for Chest Injuries

• Secure injuries and administer emergency management

Abdominal Injury

• Assess extent of injury. In addition to asking the patient about abdominal symptoms, inspect the abdomen for abnor- malities. Suspect internal injuries while preparing for transport and keep incision closed for the duration of transport/

Traumatic Amputation

• Body tissue separation can require immediate medical procedures. Clean broken surfaces utilizing water/saline, put the tissue back. Wrap with plastic, keep cool/frozen for the duration of transport and to protect bodily components

Burns

• Can require a detailed summary of measures if patient needs urgent burn care.

Interventions for Burns

• For any severe injuries, treatment of burn includes:
  • stopping the burning process.
  • ensuring a patent airway (burns/chemicals can impair function of airway)
  • oxygen administered and arterial blood gases analyzed
  • rescue breathing

Heat And Cold Exposure

• Body temperature variations will have local/systemic components. With either situation, several mechanisms will fail and extremes, placing children and older- adults at higher risks for injury

Hyerthermia

• If mild, the treatments consist of going to a cooling place. Sports drinks are recommended. Heat stroke is more serious and the patient should be immediately transported

Patient Teaching: Prevention of Heat Exhaustion

• To preventing heat stroke, ensure patients take routine breaks. Increase fluids, while increasing rest in hot humid heat

Hypothermia

• Decreased body core temperature- requires gradual rewarming. Hypothermia: 3 stages; all lead to cardiopulmonary arrest if not medically addressed.

Poisoning

• Can be an innocuous substance that is ingested, inhaled, or injected that are capable of causing harm to the body

Carbon Monoxide Poisoning Prevention:

• Gas and wood burners should have proper ventilation. Never let an engine run in a closed area and utilize CO alarm/testers

Management:

• Check for mental status/CO poisoning. Move to fresh air followed by rescue and notify EMS, giving oxygen.

Drug or Chemical Poisoning

• Causes vary from drug interactions to inappropriate substance ingestion. History is significant with drug use: what chemical/ name drug used, signs + vitals and approximate weight.

Prevention:

• If any ingestion occurs, contact PCC, local center- medical care can be administered and they have further instructions

Food Poisoning

Bacteria, Chemicals and Toxins can contaminate common foods. The common symptoms are nausea and diarrhea

Action for Food Poisoning

• Determine the exact substance and contact medical professional and test for any poisoning by checking rates (respiratory rate of 12-20 per minute and pain). Administer antiemetics, fluids within limits

Bites and Stings

Can cause serious harm and anaphylactic shock occurs.

Focused Assessment for Bites/Stings/ Action

• Type of bite, characteristics/changes in skin. For any local reactions, use Benadryl, Baking Soda

Actions

• Reduce risks, clean the wound, medical treatment and vaccines are available to counter venom with allergies. Epi-pens can prevent anaphylaxis.

Acts of Bioterrorism

• Includes anthrax, botulism, plague, smallpox and requires the health provider to be properly informed.

Disaster Planning

• Preparedness is key for nurses to stay informed, notify CDC or other response

Legal Aspects of Emergency Care

• Nurses are protected under Good Samaritan code. They must show proficiency in skill in the event of accidents