Emergency Patient Care

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• Apply pressure directly over the wound when a patient has an open femur fracture.
• Hypovolemic shock is a sign of prolonged vomiting
• Anuria indicates an irreversible stage of hypovolemic shock.
• Hyperkalemia and hyponatremia should be assessed for electrolyte imbalances during the first 24 hours after a thermal injury.
• Ventricular depolarization is represented by the QRS complex on an ECG reading.
• The SA node is the element that a pacemaker serves to perform in clients with dysrhythmia.
• During cardiac arrest, the arrest team must consider the amount of time the client has been anoxic.
• Ventricular fibrillation is the most common cause of cardiac arrest in adults.
• Circulatory compromise is a clinical problem that can lead to compartment syndrome.
• Vasoconstriction and increased systemic blood pressure are the drug actions expected when administering epinephrine.
• In prioritizing emergency management of a burn client, the order should be: Remove the client from the burn source, establish and maintain an airway, establish an IV line with a large-gauge needle, and assess for associated injuries
• Log rolling on the grass/ground is the most effective way to extinguish flames with as little further damage as possible.
• Assess the client's breathing after a flame has been extinguished.
• Start an intravenous line after checking the airway patency of a client with burns.
• The nurse anchors a Foley Catheter in a client with burns to accurately measure urine output.
• A client with deep partial- and full-thickness burns on the right anterior lower extremity and abdomen has 27% of burns.
• Lactated Ringer's solution is the intravenous solution to prepare during fluid resuscitation of a client with burns in the emergent phase.
• A deep partial thickness burn is understood by a nurse when both the epidermis and dermis are damaged.
• In the RACE protocol during a fire, R stands for Rescue.
• A nurse's first response to a code red (fire) is to remove clients in danger from the fire.
• Removing all clothing containing the chemical is the priority intervention in the emergency management of a client with chemical burns.
• Maintaining airway, breathing, and circulation are the top treatment priorities during the emergent phase of care for a client sustained a chemical burn.
• Wound healing is the primary therapeutic goal during the acute phase of burns.
• The best approach for preventing hypovolemic shock in a client with severe burns is to infuse IV fluids.
• A client who sustained deep partial thickness and full thickness burns of the face, whole anterior chest and both upper extremities that begins to exhibit extreme restlessness most likely indicates cerebral hypoxia.
• A restless client is an early indication that one's oxygenation status is compromised.
• A pulse oximetry reading of 100% in a client with carbon monoxide poisoning is not a reliable sign to rule out carbon monoxide poisoning, and further assessment is required.
• The nurse should first cover the wound with a petroleum-impregnated dressing for a client with a sucking stab wound in the chest wall.
• The Heimlich maneuver is administered on a suspected choking client when the client cannot speak owing to airway obstruction.
• Respiratory status should be assessed first in a client admitted to the nursing unit with a C4 spinal cord injury.

Other Emergency Cases

• An analgesic is given during passive external rewarming from hypothermia
• Body temperature in heat stroke is >40C

Heat Stroke Interventions

• Reduce the high temperature ASAP
• Removing clothing
• Sponging of cool water
• applying ice
• Saline lavage
• Cooling blankets

Snakebites Treatment

• Lie down
• Remove constrictive items
• Warm compress
• Immobilize (dependent position)
• Monitor ABC
• Bring patient to the ER

Snakebites to avoid

• Ice
• Tourniquet
• Heparin

Insect Sting Treatment

• Stinger (sac) - one quick scrape
• Scratching is avoided
• Apply ice
• Antihistamine, steroids, and SQ epinephrine can be administered

Jellyfish Sting Treatment

• Acetic acid or salt water is used

Poisoning Treatment

• Removing clothing and washing patient if Poison was ingested or swallowed
• Open the airway / provide ventilation.
• Call up poison center (5218450)
• Non-corrosive poisons require ipecac syrup

Corrosive poisoning

• Milk & activated charcoal are used
• Gastric lavage, cathartics and dialysis are used

Antidotes

• Paracetamol is treated with N-acetylcysteine
• Narcotics are treated with Naloxone
• Benzodiazepines are treated with Flumazenil
• Thrombolytics are treated with Aminocaproic acid
• INH is treated with Pyridoxine
• Organophosphate is treated with Atropine SO4
• Lye poisoning is treated with Acetic Acid
• Digitalis is treated with Digi-bind

Cerebrovascular Disorders

• Involves disruption of blood supply to the brain

Types of Cerebrovascular Disorders:

• Transient ischemic attack (TIA): neurological deficit resolved within 24 hours
• Cerebrovascular accident (CVA): middle cerebral artery
• thrombotic - obstruction
• embolic - obstruction
• hemorrhagic - bleeding
• NM: monitor the Glasgow Coma Scale score
• normal - 15
• coma - <7
• lowest - 3
• Motor response: 6 - Obeys simple response
• 5 - Localize pain
• 4 - Withdraws to pain
• 3 - Decorticate posturing
• 2 - Decerebrate posturing
• 1 - No motor response
• Verbal response: 5 - Oriented
• 4 - Confused
• 3 - Verbalize
• 2 - Vocalize
• 1 - No verbal response
• Eye Opening : 4 - Spontaneous
• 3 - Respond to sound
• 2 - Respond to pain
• 1 - No respond

Monitor Signs of Increased ICP

• decreasing in LOC
• disorientation & restlessness, lethargy, stupor and coma
• headache, vomiting, increase temperature
• Cheyne-stokes respiration
• Cushing's triad
• anisocoria, normal size is 2-6 mm
• NM: Decrease ICP and BP
• Fowler's position and hyperoxygenate
• Diuretics (mannitol), dexamethasone

Seizure Disorders

• Refers to paroxysmal, uncontrolled, excessive firing of hyper excitable neurons in the brain

Types

• Grand Mal and Petit Mal (Absence)
• Status Epilepticus: seizure activity > 30 mins

Etiology of Seizures:

• Idiopathic, CVA, fever
• trauma - birth and head
• Brain tumor (glioma)
• Meningitis, encephalitis, abscess
• Hypoglycemia

Signs and Symptoms

• Prodrome of uneasy feeling (aura)
• Loss of consciousness
• Convulsions, muscle twitching
• Excessive salivation
• Stupor (post-ictal)

Nursing management

• Seizure precautions: elevate & pad all side rails, keep bed low position, pillow under the head, loosen clothing, standby suction machine/02
• During seizure activity: don't restrain, don't put anything against a clenched teeth, record the duration/movements
• After seizure activity: side lying position, suction PRN & 02, re-orient clients
• Education: don't withdraw maintenance drugs (Dilantin) w/o doctor's order

Coronary Artery Disease (CAD)

• A focal narrowing of coronary arteries due to intimal plaque formation, which deprives the coronary blood flow.

Presentations:

• Angina Pectoris
• Stable angina
• Unstable angina
• Prinzmetal's angina
• Myocardial Infarction
• Sudden cardiac death
• Manifestations: retrosternal chest pain typically described as burning or squeezing that may radiate to the arm, jaw, neck and shoulder.
• Non-cardiogenic pulmonary edema is a sign of Adult respiratory distress syndrome

Cause of ARDS

• Injury of the alveolar capillary membrane (shock and sepsis)

Characteristics of ARDS

• white lung on CXR

Symptoms of ARDS

• crackles/signs of respiratory distress
• progressive hypoxemia PO2 (<60) - unresponsive to 02 therapy

Treatment for ARDS

a. steroids and diuretics b. intubation c. mechanical ventilation (PEEP) to keep alveoli distended. positive - end - expiatory- pressure

Pulmonary Embolism

• Obstruction of pulmonary arteries from the venous system or right side of the heart
• This result to all ventilation perfusion ratio
• Pulmonary Embolism Etiology: a. Thrombus/b. Fat/c. Air/d. Amniotic fluid
• Sudden, sharp, substernal or chest pain, DOB, tachycardia, restlessness, cyanosis and a sense of impending doom are S/S of pulmonary embolism
• Trendelenburg, high back rest and 02 are nursing interventions to treat pulmonary embolism
• Emphysema (pink puffers) - permanent over distention of air spaces
• Chronic bronchitis (blue bloaters) - hypersecretion of goblet cells - cor pulmonale → RSHF
• Medications - bronchodilators (salbutamol & terbutaline), corticosteroids (hydrocortisone, prednisone) adrenergics (epinephrine SQ) are nursing interventions to treat asthma

Causes of Epiglottitis

• High fever, stridor, Nasopharynx, sore throat, hoarseness are signs caused and are treated with NPO and oxygen
• Obeys simple response indicates spinal cord injury and the following assessments should then first be performed: a. Take the temperature, b. Assess extremity muscle strength, c. Observe for spinal shock, d. Assessment of respiratory status
• Spontaneous pneumothorax and closed fractures may lead to flail chest in rib fracture

Hypovolemic Shock Characteristics:

• hypotension, tachycardia, weak thready pulse, cool, pale, moist skin, decreased CO, increased SVR
• First Aid: B - Barrier, L- Locate and Examine, E- External Direct Pressure, E - Elevate, D - Dressing