Med Surg 1

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Questions and Answers

What is a primary challenge faced by emergency nurses regarding patient consent?

Consent is usually clear without ambiguity.

Patients often have altered levels of consciousness. (correct)

Patients have no prior medical history.

Patients frequently refuse treatment.

Which of the following is considered the number one priority in emergency nursing?

Staff satisfaction

Cost management

Patient education

Safety (correct)

What is the purpose of the Emergency Medical Treatment and Active Labor Act (EMTALA)?

To ensure all patients receive a medical screening examination upon arrival. (correct)

To provide funding for emergency departments.

To limit emergency service utilization by patients with insurance.

To increase triage staffing in emergency departments.

What is meant by 'sentinel events' in the context of emergency nursing?

Unanticipated events causing significant patient harm. Signup and view all the answers

Which skill is NOT explicitly identified as essential for being an effective emergency nurse?

Legal expertise Signup and view all the answers

How does having insurance affect patient behavior in emergency services?

Patients with insurance are more likely to abuse emergency services. Signup and view all the answers

What is the main goal of triage in emergency nursing?

To sort patients according to the severity of their illness or injury. Signup and view all the answers

Which of these family interventions is NOT recommended in emergency nursing?

Encouraging the family to avoid viewing the patient's body post-mortem. Signup and view all the answers

What is the primary treatment for compartment syndrome?

Escharotomy and fasciotomy Signup and view all the answers

Which of the following conditions can increase the risk of hypothermia?

Hypothyroidism Signup and view all the answers

At what core temperature do shivering and cardiac dysrhythmias typically occur?

Below 90 degrees F Signup and view all the answers

What initial step is recommended for managing a patient with hypothermia?

Remove wet clothing Signup and view all the answers

Which of the following injuries has the highest risk of infection?

Human bites Signup and view all the answers

What intervention might be necessary for a hypothermic patient with metabolic acidosis?

Sodium bicarbonate administration Signup and view all the answers

Which method is NOT suitable for rewarming mild hypothermia?

Cold fluid administration Signup and view all the answers

What is the protocol for rabies prophylaxis following a bite from an unlocatable animal?

Administer rabies prophylaxis if vaccination is verified Signup and view all the answers

What action taken by an EMT could potentially increase the risk of hypothermia in a patient?

Removing clothes and applying non-warm oxygen Signup and view all the answers

Which organ is most commonly injured in cases of intra-abdominal trauma?

Liver Signup and view all the answers

What lab work is needed to assess for bleeding in intra-abdominal injuries?

Complete blood count (CBC) Signup and view all the answers

Which symptom is NOT typically associated with heat stroke?

Muscle rigidity Signup and view all the answers

What is the primary management strategy for a patient suffering from heat stroke?

Cooling the patient slowly to below 102 F within 1 hour Signup and view all the answers

Which of the following individuals is at the highest risk for developing heat stroke?

An elderly person with chronic health issues Signup and view all the answers

In the assessment of abdominal injuries, what should be assessed first?

Airway, Breathing, Circulation (A/B/C) Signup and view all the answers

What lab values are essential to check for in patients potentially suffering from heat stroke?

Low sodium and potassium levels Signup and view all the answers

What is the appropriate initial action for a human bite on the arm?

Clean with soap and water, administer a tetanus shot, and provide antibiotics Signup and view all the answers

What are common symptoms of a snake bite?

Edema, ecchymosis, and metallic taste in the mouth Signup and view all the answers

When measuring the circumference of an extremity after a snake bite, how often should it be done?

Every 30-60 minutes for 48 hours Signup and view all the answers

What is the primary contraindication for corticosteroid use after a snake bite?

Suppression of antibody production Signup and view all the answers

What should be avoided when treating a patient with corrosive poisoning?

Administering syrup of ipecac Signup and view all the answers

What educational information should be provided regarding serum sickness after snake antivenom administration?

Symptoms include fever and lymphadenopathy Signup and view all the answers

What is the most effective timeframe for administering antivenom after a snake bite?

Between 4 to 12 hours Signup and view all the answers

Which of the following is a typical management step for ingested poisons?

Control the airway and provide ventilation Signup and view all the answers

What should you do if you suspect someone has ingested a corrosive agent?

Dilute with milk or water and seek medical help Signup and view all the answers

Which items should be removed during management of a snake bite?

Constrictive items like rings Signup and view all the answers

What is the primary effect of administering activated charcoal in small doses?

Decreases vomiting. Signup and view all the answers

Which of the following symptoms is NOT typically associated with carbon monoxide poisoning?

Severe abdominal pain. Signup and view all the answers

What should be done immediately in the management of a patient with suspected carbon monoxide poisoning?

Move the patient to fresh air. Signup and view all the answers

Which method is NOT recommended for managing chemical burns?

Using hand sanitizer immediately. Signup and view all the answers

Which factor is NOT considered when assessing the severity of chemical burns?

The temperature of the surrounding environment. Signup and view all the answers

In the context of carbon monoxide poisoning, which monitoring parameter is critical?

Carboxyhemoglobin levels less than 5%. Signup and view all the answers

What is one of the main reasons pulse oximetry is unreliable in cases of carbon monoxide poisoning?

It cannot differentiate between oxyhemoglobin and carboxyhemoglobin. Signup and view all the answers

What is the recommended first step for managing a patient who has experienced a chemical burn from a wet chemical?

Flushing the skin with copious amounts of water. Signup and view all the answers

For patients with food poisoning, which assessment detail can help determine the source of the poisoning?

What other people ate. Signup and view all the answers

What is often a misconception regarding the signs of carbon monoxide poisoning related to skin color?

Skin color is a reliable indicator of poisoning severity. Signup and view all the answers

What is a common reason for the risk of hypothermia in emergency medical services?

Removing clothes and applying non-warm oxygen Signup and view all the answers

Which organ is most commonly injured in intra-abdominal trauma?

Liver Signup and view all the answers

What is the best diagnostic imaging method for assessing intra-abdominal injuries?

CT scan Signup and view all the answers

Which of the following symptoms is indicative of heat stroke?

Altered mental status Signup and view all the answers

In cases of heat stroke, what is a critical part of the management plan?

Cooling off slowly to below 102 F within 1 hour Signup and view all the answers

Which laboratory test is necessary to assess for infections related to intra-abdominal injuries?

Complete blood count (CBC) Signup and view all the answers

Which vital sign change is commonly seen in heat stroke?

Tachypnea Signup and view all the answers

What is the immediate action required after someone experiences prolonged exposure to high temperatures?

Remove clothing and cool the body gradually Signup and view all the answers

What immediate action should be taken to manage an airway obstruction?

Establish an airway Signup and view all the answers

Which of the following is the leading cause of airway obstruction in adults?

Bolus of meat Signup and view all the answers

What sign indicates severe airway obstruction?

Choking and clutching the neck Signup and view all the answers

What is the primary management step for hemorrhage leading to hypovolemic shock?

Stop the bleeding and replace fluids Signup and view all the answers

Which of the following is a common symptom of hypovolemic shock?

Decreased level of consciousness Signup and view all the answers

Which intervention is appropriate when treating a patient with an airway obstruction who is conscious?

Encourage the patient to cough forcefully Signup and view all the answers

In the case of a severe airway obstruction, which method is used if the patient becomes unconscious?

Oropharyngeal airway placement Signup and view all the answers

Which physiological change occurs due to airway obstruction that can lead to serious outcomes?

Rapid decrease in blood oxygen levels Signup and view all the answers

What is the primary reason for prioritizing the treatment of hypothermia if frostbite is also present?

Hypothermia leads to life-threatening conditions. Signup and view all the answers

Which management strategy is most effective for correcting metabolic acidosis in hypothermic patients?

Administering sodium bicarbonate. Signup and view all the answers

Why is it important to monitor central venous pressure (CVP) in patients with hypothermia?

It provides information on cardiac output and function. Signup and view all the answers

Which of the following is a critical consideration when managing a patient with a dog bite?

The human mouth is known for a higher bacterial count than other animals. Signup and view all the answers

What are the common symptoms associated with generalized hypothermia?

Shivering and low blood pressure. Signup and view all the answers

What is the most appropriate initial action upon receiving a patient with suspected hypothermia?

Remove any wet clothing and begin rewarming. Signup and view all the answers

Which of the following factors increases the risk for hypothermia?

Certain medications, including phenothiazines. Signup and view all the answers

Which method is effective for active internal rewarming in hypothermic patients?

Warmed humidified oxygen by ventilator. Signup and view all the answers

What is a primary goal in managing wounds?

Restore physical integrity and function Signup and view all the answers

What should a nurse avoid doing when assessing a trauma patient’s clothing for possible criminal evidence?

Cut through blood stains Signup and view all the answers

When managing a wound with a high potential for infection, what method is appropriate?

Delayed primary closure if tissue is lost Signup and view all the answers

In the context of traumatic injuries, what does 'multiple trauma' refer to?

A single catastrophic event affecting at least two organ systems Signup and view all the answers

Which position should a patient experiencing internal hemorrhage be kept in?

Supine Signup and view all the answers

What is the primary action to take if a patient has a severe leg injury with exposed bone?

Cover wounds with damp sterile gauze Signup and view all the answers

What should be documented when assessing a trauma patient's injury?

The patient's description of the incident in their own words Signup and view all the answers

What is a significant risk factor for mortality in trauma cases?

Involvement of multiple organ systems Signup and view all the answers

What is essential to maintain in a trauma patient’s care?

Maintain warmth and assess vital signs Signup and view all the answers

What should be done if a trauma patient dies at the scene?

Notify the medical examiner and leave tubes in place Signup and view all the answers

What is the main reason activated charcoal is effective in treating poisoning?

It binds to ingested poisons in the gastrointestinal tract. Signup and view all the answers

What is a crucial first step in managing a patient with carbon monoxide poisoning?

Move the patient to fresh air. Signup and view all the answers

Which of these complications is associated with long-term exposure to carbon monoxide?

Seizures. Signup and view all the answers

Why are cathartics rarely indicated in the management of poisonings?

They can cause severe electrolyte imbalances. Signup and view all the answers

Which skin color change is NOT a reliable sign of carbon monoxide poisoning?

Jaundiced skin. Signup and view all the answers

In the treatment of chemical burns, which action should be prioritized for a wet chemical?

Remove the chemical using copious amounts of water. Signup and view all the answers

When monitoring a patient for carbon monoxide levels, which value indicates safe levels?

Less than 5%. Signup and view all the answers

What should not be used for washing hands in the case of chemical exposure?

Liquid hand sanitizer. Signup and view all the answers

What is an important assessment step in managing food poisoning?

Inquire about the food consumption timeline. Signup and view all the answers

What symptom is typically associated with carbon monoxide poisoning?

Increased respiratory rate. Signup and view all the answers

Study Notes

Emergency Nursing

Emergency nursing involves providing care in a high-pressure environment where patients present with various urgent issues.
Challenges in the field include legal issues, staffing shortages, safety risks for staff, and the need to provide holistic care in a fast-paced setting.
Technology, such as electronic health records, can sometimes hinder efficient documentation and care delivery.
A significant challenge is obtaining informed consent from patients, particularly those with altered levels of consciousness or children.
Emergency departments face the ongoing struggle of managing patient capacity, which is often the greatest challenge.
Emergency departments typically operate under bundled payment models.

Essential Qualities of an Emergency Nurse

Effective emergency nurses possess essential qualities such as time management skills, strong assessment abilities, critical thinking, and sound clinical judgment.
They remain calm and collected under pressure, demonstrating assertiveness, resilience, and resourcefulness.

EMTALA

The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates that all emergency departments with Medicare provider agreements must perform a medical screening examination on every patient arriving with an emergency medical complaint.
This applies if the patient's condition could lead to serious injury or death without immediate treatment.
Historically, emergency departments have been considered financial "losers" due to the nature of the services provided.

Common Emergency Department Visits

The most frequent visits to emergency departments are for complaints of abdominal pain, chest pain, cough, and fever.
Individuals with health insurance are more likely to utilize emergency department services compared to uninsured patients.

Safety in Emergency Nursing

The top priority in emergency nursing is patient safety.
Sentinel events are unexpected occurrences that result in patient harm.
The most common sentinel events in emergency departments are delays in care and medication errors.
Root causes for sentinel events often include nurse staffing patterns, patient volume, and the availability of specialists.

Family Interventions in Emergency Settings

Keeping families informed about their loved one's location, condition, and care is crucial in an emergency setting.
Strategies for supporting families include promoting privacy, communicating with them collectively, reassuring them about the care provided, avoiding euphemisms, encouraging viewing of the body, and avoiding unnecessary information disclosure.
Family involvement in emergency care, such as being present during resuscitation, is encouraged to enhance understanding and support.

Triage

Triage is the process of determining the severity of illness or injury, classifying patients into different levels of urgency based on the severity of their condition.
The triage nurse collects vital signs, pain assessment information, history of the event, past medical history, neurological assessment findings, weight, allergies, and pertinent diagnostic data.
EMT procedures, such as removing clothing and applying non-warm oxygen, can increase the risk of hypothermia in patients.

Intra-abdominal Injuries

The abdomen should be assessed thoroughly for signs of injury, including blunt force trauma or penetrating wounds.
Impalement injuries often present with the object still in place.
The liver is the most commonly injured organ due to its size and position in the right upper quadrant.
Laboratory tests, such as urinalysis (UA), CBC (hemoglobin and hematocrit), amylase/lipase, and complete blood count (CBC) are crucial for assessing intra-abdominal injuries.
Blunt force trauma typically affects the chest, head, and extremities, and identifying injuries can be challenging in the presence of distracting injuries.
Symptoms of abdominal pain, rigidity, auscultation of bowel sounds, abdominal distention, involuntary guarding, rebound tenderness, and muscular rigidity can indicate internal injuries.
Diagnostic imaging, including CT scans and ultrasounds, are essential for diagnosing intra-abdominal injuries.
Opioids, in small doses, can be administered to manage pain.

Management of Intra-abdominal Injuries

Patients should be placed on nothing by mouth (NPO) and may require a nasogastric (NG) tube for decompression.
Tetanus prophylaxis and broad-spectrum antibiotics are typically administered.
Open wounds should be addressed and the patient must be closely monitored for signs and symptoms of shock.

Environmental Emergencies: Heat Stroke

Heat stroke is a serious medical emergency that occurs when the body's heat-regulating mechanisms fail.
This leads to coagulopathies and damage to the heart, liver, and kidneys.
Individuals at risk for heat stroke include the elderly, very young, those with chronic conditions, and those taking medications like beta blockers and diuretics.
The primary cause of heat stroke is non-exertional, prolonged exposure to high environmental temperatures.
Symptoms of heat stroke include altered mental status (confusion), hot and dry skin, cerebral edema (leading to seizures, delirium, coma), low sodium and potassium levels, high body temperature, rapid breathing, and rapid heart rate.
Treatment for heat stroke requires gradual cooling down, ideally lowering the patient's temperature to below 102 degrees Fahrenheit within the first hour.

Management of Heat Stroke

Management strategies for heat stroke include removing clothing, applying ice packs to the armpits and groin, establishing intravenous (IV) access for fluid administration, administering a cold bath or cooling blankets, continuously monitoring core temperature, ensuring strict intake and output (I&O) monitoring, observing cardiac rhythm, and frequent reassessment of mental status and vital signs.
Low sodium and potassium levels require replacement.
Ambulation is contraindicated if the lower extremities are affected.
Additional measures, such as whirlpool baths, escharotomy, and fasciotomy, may be necessary to treat compartment syndrome.

Environmental Emergencies: Hypothermia

Hypothermia occurs when the core body temperature falls to 95 degrees Fahrenheit or lower due to cold exposure or the body's inability to maintain temperature.
Hypothermia takes precedence if frostbite is also present.
Trauma increases the risk of hypothermia in all individuals.
Factors contributing to hypothermia include alcohol use, medication use, medical conditions, fatigue, and sleep deprivation.
Generalized hypothermia is a serious condition with symptoms including shivering, low blood pressure (BP) and heart rate, and progressive mental deterioration.
In advanced hypothermia, shivering may cease, BP and HR may become undetectable, and cardiac dysrhythmias can occur..
It's important to monitor central venous pressure (CVP), arterial blood gases (ABGs), complete metabolic panel (CMP), electrocardiogram (ECG), urine output (UOP), and chest x-ray.

Management of Hypothermia

Treatment for hypothermia involves removing wet clothing, gradually rewarming the patient, continuous monitoring, and supportive care.
Active internal rewarming methods, such as cardiopulmonary bypass, warm intravenous (IV) fluid administration, warmed humidified oxygen delivered via mechanical ventilation, and warmed peritoneal lavage, are used.
Passive or active external rewarming methods, such as over-the-bed heaters and forced-air warming blankets, are used for mild hypothermia.
Sodium bicarbonate may be administered to correct metabolic acidosis if necessary.
An indwelling catheter might be inserted to monitor urine output.

Animal and Human Bites

Cat bites are associated with a higher risk of infection compared to bites from other animals.
Human bites carry a significant risk of infection due to the high bacterial load in human mouths.
The majority of bite injuries are caused by dogs.
Immediate wound care with mild soap and water is recommended.
Tetanus vaccination should be administered if appropriate.
If the biting animal cannot be located or rabies vaccination status is unclear, rabies prophylaxis for the person bitten is necessary.
Human bites, often associated with assault, should be documented with photographs for legal purposes.
For an arm wound resulting from a human bite, the nurse should clean it with soap and water, administer a tetanus shot, prescribe antibiotics, and take pictures of the wound for legal documentation.

Snake Bites

Snake bites are most common during daylight hours and early evenings during summer months.
The most common sites of snake bites are the upper extremities, resulting in envenomation (injection of venom).
Symptoms include edema, ecchymosis, hemorrhagic bullae leading to necrosis, lymph node tenderness, nausea and vomiting, numbness, and a metallic taste in the mouth.
Snake bites can impact neurological, cardiovascular, and respiratory systems.
Management of snake bites involves removing constricting objects like rings, providing warmth, cleansing the wound, applying a light sterile dressing, and keeping the affected limb lower than the heart.
Tetanus prophylaxis and analgesia should be given if needed.
Essential lab tests include CBC, urinalysis, and coagulation studies.
The circumference of the affected extremity should be measured every 30-60 minutes for 48 hours to monitor for compartment syndrome.
Corticosteroids are contraindicated within the first 6 to 8 hours after a snakebite because they can suppress antibody production and hinder the effectiveness of antivenom.

Treatment Options for Snake Bites

Antivenom is an immunoglobulin used to neutralize the venom.
It is most effective within 4 hours, but no later than 12 hours after a snakebite.
Common antivenoms include CroFab or FabAV.
Educate patients about serum sickness, recognizing its symptoms, and the use of pre-medications like IV Benadryl and Cimetidine to potentially prevent it.

Poisoning

Inhaled or ingested poisons are considered medical emergencies.
Ingested poisons can cause oral pain and vomiting.
The primary goals in managing poisoning are to remove or inactivate the poison (limiting exposure), control the airway, ventilation and oxygenation, administer antidotes when available, provide supportive care to minimize organ damage, and promptly eliminate absorbed poison.

Management of Ingested Poison

Corrosive poisons, including alkaline and acidic agents, damage mucus membranes.
Alkaline agents examples: lye, drain cleaners, toilet bowl cleaners, bleach, non-phosphate detergents, oven cleaners, and button batteries.
Acidic agents examples: toilet bowl cleaners, pool cleaners, metal cleaners, rust removers, and battery acid.
Assessment for ingested poison involves reviewing the patient's health and incident history.
Management involves addressing ABCs, evaluating neurological status, assessing renal function, monitoring for shock, measuring vital signs, performing an EKG, and inserting an indwelling catheter.

Measures to Remove or Reduce Poison Absorption

Corrosive agents should be diluted with milk or water, but do not induce vomiting; this can worsen burns.
Syrup of ipecac is no longer used for poison management due to the increased risk of aspiration, and it is contraindicated for corrosive poisoning.
Gastric lavage may be considered within the first hour of ingestion for obtunded patients.
Activated charcoal is administered orally or via NG tube if the ingested poison is absorbed by charcoal, and it can help reduce vomiting.
Sorbitol, an active ingredient in activated charcoal, can cause diarrhea.
Cathartics are rarely used due to possible severe electrolyte imbalances, diarrhea, and hypovolemia.
If the type of ingested poison is unknown, contact the local poison control center.
Continuous monitoring of vital signs, fluid and electrolyte status, and central venous pressure is critical.

Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning occurs when CO binds to hemoglobin, reducing oxygen-carrying capacity, leading to asphyxiation.
Causes of CO poisoning can include industrial or household incidents or suicide attempts.
Prevalent symptoms include CNS manifestations such as confusion, headache, muscle weakness, palpitations, dizziness, chest pain, blurred vision, nausea, shortness of breath, and flu-like symptoms.
The brain and heart are most vulnerable to CO damage.
Skin may appear pink to cherry red, or pale and cyanotic, but skin color alone is not a reliable indicator.
Prolonged exposure can lead to loss of consciousness (LOC), seizures, cardiac arrhythmias, and death.
Pulse oximetry readings are unreliable in CO poisoning because CO has a higher affinity for hemoglobin than oxygen.

Management of Carbon Monoxide Poisoning

Immediate treatment is crucial for CO poisoning.
Move the patient to fresh air, open windows and doors, loosen restrictive clothing, initiate cardiopulmonary resuscitation (CPR) if needed, wrap the patient in blankets, and keep them as quiet as possible.
Address ABCs, perform CPR if necessary, and provide 100% oxygen for short-term duration to flush out the CO.
Monitor carboxyhemoglobin levels continuously, aiming for a level below 5%.
Frequent carboxyhemoglobin levels should be drawn every hour.
Discontinue oxygen when carboxyhemoglobin levels are below 5%.
Intravenous fluid administration and pressors may be used if needed.

Complications of Carbon Monoxide Poisoning

Complications include seizures (dantrolene or benzodiazepines may be required), hypotension, arrhythmias, significant acidosis, and potential long-term neurologic deficits.
If neurological symptoms persist after resuscitation efforts, they may indicate permanent brain damage.
Neurologic deficits associated with CO poisoning include psychoses, spastic paralysis, ataxia, visual disturbances, and deterioration of mental status.

Patients with Chemical Burns

The severity of a chemical burn is determined by the mechanism of action, penetrating strength and concentration, and duration of exposure.
Management of chemical burns involves removing the chemical agent first, followed by rinsing with copious amounts of water for wet chemicals, or gently brushing off dry chemicals.
Thorough flushing of the skin with a continuous stream of cool water is required while removing clothing.
Prolonged lavage with generous amounts of tepid water is critical.
A decontamination shower (deluge) may be employed.
If the eyes are affected, flush them from the inner to outer canthus.
Wash hands thoroughly with soap and water (not hand sanitizer) to avoid introducing alcohol.
Appropriate personal protective equipment (PPE) should be worn if necessary.

Standard Treatment for Chemical Burns

Standard treatment includes antimicrobial agents, tetanus prophylaxis, wound debridement, and antidotes (when available).
Plastic surgery may be considered for further wound management.
Regularly re-evaluate the burned area at 24-72 hours and then again a week later.

Food Poisoning

The key to managing food poisoning is identifying the source and type of organism involved.
Assessment includes addressing ABCs and inquiring about the onset of symptoms, specific foods consumed, whether others are sick, the presence of vomiting and diarrhea, and fever.

Airway Obstruction

Airway obstruction is life-threatening and requires immediate attention as it can lead to brain death quickly.
The most common cause of airway obstruction in adults is a bolus of meat.
Symptoms include: inability to speak, breathe, or cough; choking; refusing to lie flat; inspiratory and expiratory stridor; labored breathing; flaring nostrils; increased anxiety; accessory muscle use; restlessness; retractions; confusion; cyanosis; and the universal distress signal (patient clutches the neck between the thumb and fingers).
Management focuses on establishing an airway, which may involve forceful coughing, head tilt with chin lift, oropharyngeal airway placement, rescue breathing, ET tube insertion, and mechanical ventilation.

Hemorrhage

Hemorrhage is a significant cause of shock due to hypovolemia.
The priority in managing hemorrhage is controlling the bleeding and replacing fluids.
Direct pressure on the artery above the bleeding site or direct pressure on the bleeding site is crucial.
Management includes: two large bore IVs, oxygen, crystalloids, pressors, packed red blood cells (for significant bleeds), clotting factors, blood analysis, typing, and cross-matching.
Patients may require massive transfusions of warm blood to prevent hypothermia.
Symptoms of hypovolemic shock include: tachycardia, low blood pressure, cool and moist skin, rigid abdomen, decreased level of consciousness, delayed capillary refill, and decreased urine output

Wounds

Wound management aims to restore physical integrity, minimize scarring, and prevent infection.
Documentation of wound details, including the cause and time of the injury, is crucial.
Aseptic technique is essential during wound care, and sensory, motor, and vascular changes should be monitored.
Management includes: preparation (clipping or shaving hair, cleaning with normal saline or polymer agents), debridement, suturing, or stapling.
Immediate action for an exposed tibia should include covering the wound with damp sterile gauze and stabilizing the limb.
Tetanus prophylaxis is administered as prescribed.

Trauma

All trauma patients require a primary survey (ABCDE survey) and stabilization of ABCs upon arrival.
Nurses are responsible for assessing, managing, and monitoring vital signs, drawing labs, establishing IV access, maintaining warmth, and documenting patient care.
Documentation should include the patient's own words about the incident, the mechanism of injury, the time of the event, and whether a criminal event was involved.
Multiple trauma involves life-threatening injuries to at least two organ systems, increasing mortality depending on the systems affected.
Management priorities include airway/breathing/ventilation control, hemorrhage control, prevention and treatment of hypovolemic shock, rapid trauma assessment (including head and neck injuries), splinting, and immobilization.
When removing clothing from a trauma patient, nurses should be cautious not to cut through or disrupt any tears, holes, or blood stains on the clothing if criminal activity is suspected.
All trauma patient deaths must be reported to the medical examiner.
If a trauma patient dies, leave all tubes in place, clean and prepare the body for the family, and bag the hands.

Intra-Abdominal Injuries

Assessment of intra-abdominal injuries includes assessing the abdomen for blunt force or penetrating trauma.
The liver is the most commonly injured organ due to its size and location in the RUQ.
Essential lab work includes urinalysis (GU injury), CBC (bleeding), amylase/lipase (liver injury), and WBC (infection).
Symptoms include abdominal pain, rigidity, auscultation of bowel sounds, abdominal distention, involuntary guarding, pain, muscular rigidity, and rebound tenderness.
Imaging studies may include CT or ultrasound.
Management includes: NPO status, NG tube insertion for decompression, tetanus prophylaxis, broad-spectrum antibiotics, covering open wounds, and monitoring for signs and symptoms of shock.

Environmental Emergencies - Heat Stroke

Heat stroke is a medical emergency caused by the failure of the body's heat-regulating mechanisms.
The pathophysiology of heat stroke includes heat-induced coagulopathies and damage to the liver, heart, and kidneys.
Risk factors include: elderly or very young age, chronic conditions, and certain medications (beta blockers, diuretics).
Most cases are nonexertional, stemming from prolonged exposure to high temperatures.
Symptoms include: confusion/altered mental status, hot, dry skin, cerebral edema (seizures, delirium, coma), low sodium and potassium levels, high body temperature, tachypnea, tachycardia.
Management focuses on slow cooling (below 102°F within one hour) and includes: removal of clothing, ice packs in the axilla or groin, IV access and fluids, cold baths, cooling blankets, continuous core temperature monitoring, strict intake and output, cardiac rhythm monitoring, and frequent reassessment of LOC and vital signs.

Environmental Emergencies - Hypothermia

Hypothermia occurs when the core temperature drops to 95°F or below due to cold exposure or the inability to regulate body temperature.
Hypothermia takes priority over frostbite if both are present.
Trauma increases the risk of hypothermia in all individuals.
Causes include: alcohol consumption, medications (phenothiazines), medical conditions (hypothyroidism, spinal cord injury), fatigue, and sleep deprivation.
Severe generalized hypothermia can lead to a cessation of shivering at 90°F and cardiac dysrhythmias.
Symptoms include: shivering, low blood pressure, low heart rate (may not be detectable), and progressive mental deterioration.
Monitoring includes: central venous pressure (CVP), arterial blood gas (ABG), complete metabolic panel (BUN, creatinine, glucose, electrolytes), electrocardiogram (ECG), urine output (UOP), and chest X-ray.
Management involves removing wet clothing, slowly rewarming, continuous monitoring, and supportive care.
Rewarming methods may include active internal rewarming (cardiopulmonary bypass, warmed fluid administration, warmed humidified oxygen via ventilation, warmed peritoneal lavage) and active or passive external rewarming (over-the-bed heaters, forced-air warming blankets).
Sodium bicarbonate may be administered to correct metabolic acidosis if needed.
An indwelling catheter may be inserted to monitor urine output.