Emergency Nursing and Healthcare Teams

Module 1: Emergency Nursing & Healthcare Team

• An inclusive attitude is essential for equitable emergency care.
• Social, political, and historical contexts influence the approach to care.
• Ethical considerations impact communication, collaboration, and teamwork.
• Awareness of personal values and biases enhances patient interactions.
• Recognizing patients' lived experiences aids in understanding ED access and care perception.

Unique Qualities of Emergency Nursing

• The ED environment is fast-paced and unpredictable.
• Rapid assessment and decision-making are critical.
• Triage relies on the Canadian Triage and Acuity Scale (CTAS).
• Emergency nursing involves high emotional and ethical demands.

Roles of the Emergency Department (ED) Team

• Nurses perform initial assessments, triage, and interventions.
• Physicians are responsible for diagnosis and treatment.
• Respiratory Therapists (RTs) manage airways and provide oxygen therapy.
• Paramedics (EHS) deliver pre-hospital care and stabilization.
• LPNs assist in patient care delivery.

Socio-Political Factors Affecting EDs

• Overcrowding is due to limited primary care access.
• Healthcare funding and resource allocation affect wait times.
• The mental health crisis puts a strain on ED resources.

Module 2: Abdominal Emergencies & Emergency Nursing Assessment Framework

• Primary Assessment (C-G) requires immediate completion.
• Secondary Assessments provide deeper insights.
• The Level of Urgency (LOU) is determined by initial findings.
• Focus on stable and potentially unstable patients early in training.
• Clinical reasoning should justify interventions, such as ECGs for dizziness, not only ankle injuries.

Common Causes of Abdominal Pain

• Right Upper Quadrant (RUQ) Pain: Cholecystitis, hepatitis.
• Right Lower Quadrant (RLQ) Pain: Appendicitis, ovarian torsion.
• Left Upper Quadrant (LUQ) Pain: Splenic injury, gastritis.
• Left Lower Quadrant (LLQ) Pain: Diverticulitis.
• Diffuse Pain: Peritonitis, ischemic bowel.

Level of Urgency in ED Nursing

• CTAS determines urgency during triage.
• LOU (Level of Urgency) involves continuous reassessment based on symptoms.

Documentation Best Practices

• Documentation must be clear, concise, and objective.
• Include subjective findings (patient complaints) and objective assessments (physical exam, vitals).

Module 3: Respiratory Emergencies & Oxygen Supply & Demand Framework

• The Oxygen Supply & Demand Framework guides assessment and interventions.
• Example: Shortness of breath requires oxygen therapy to increase supply.
• Example: Fever requires Acetaminophen to reduce demand (HR, RR, metabolic load).
• Example Application includes case studies such as McDermott (abdominal pain) and Lara (SOB).

Primary Assessment Approach

• Focus on Airway, Breathing, Circulation (ABCs).
• Utilize oxygen therapy and mechanical ventilation, if necessary.

Arterial Blood Gas (ABG) Interpretation

• Normal pH: 7.35-7.45
• Normal PaCO2: 35-45 mmHg (respiratory function)
• Normal HCO3: 18-24 mmHg (metabolic Function)

Respiratory Conditions & Risk Factors

• Risk Factors for Community-Acquired Pneumonia (CAP) include smoking, age > 65, and chronic disease.
• Asthma involves wheezing and hyperinflation.
• COPD has clubbing and CO2 retention.

Module 4: Cardiac Emergencies

• Sympathetic Stimulation increases HR and contractility.
• Parasympathetic Stimulation decreases HR.
• Cardiac Output (CO) is calculated as HR × Stroke Volume (SV).

Cardiac Assessment & Red Flags

• For chest pain, rule out MI, PE, and aortic dissection.
• Signs of Decreased CO include cool skin, weak pulses, and hypotension.
• Red Flags: Tachycardia, hypotension, and altered LOC.

Cardiac Medications

• ACE Inhibitors cause vasodilation and may lead to a cough.
• Beta Blockers (Metoprolol) decrease HR & contractility.
• Diuretics reduce preload (Lasix).
• Nitrates cause vasodilation and reduce chest pain, but avoid use in hypotension.

Module 5: Neurological Emergencies & Triage

• Rapid prioritization is necessary due to limited information.
• Atypical presentations can result in delayed appropriate care.
• ED triage prioritizes the sickest first, whereas disaster triage prioritizes the greatest number of lives saved.
• Apply Primary (C–G) and Secondary Assessments to neuro patients.

Assessment

• Subjective signs include headaches, dizziness, and vision issues.
• Objective signs include GCS score, pupil reactivity, and limb strength/posturing.

Stroke Management: Clinical Pathways

• FAST: Facial droop, Arm weakness, Speech difficulty, Time.
• Ischemic stroke: Administer thrombolytics within 4.5 hours.
• Hemorrhagic stroke: Manage ICP and BP; do not use thrombolytics.
• CT scans and rapid diagnostics are essential.

Neurovascular Anatomy & Physiology

• The brain depends on oxygen, glucose, and blood flow.
• Cerebellum: Coordination and balance.
• Brainstem: Controls vital functions.
• RAS (Reticular Activating System): Arousal and consciousness.

Increased Intracranial Pressure (ICP)

• Causes of Increased Intracranial Pressure (ICP) include trauma, hemorrhage, infection, and tumors.
• Early signs: Headache, nausea, and restlessness.
• Late signs: Cushing’s Triad which includes hypertension, bradycardia, and irregular respirations.
• Evaluation includes GCS, pupillary checks, and posture changes.

Clinical Reasoning in Neuro Presentations

• Assessment findings should be combined to hypothesize causes.
• Fever + neck stiffness suggests meningitis.
• Trauma + LOC change suggests intracranial bleed.
• Guide interventions, imaging, and urgency level.

Module 6: SIRS, GU Disorders & Rural vs. Urban EDs

• This is an inflammatory and immune response continuum.

SIRS Criteria

• Temperature >38°C or {