NCM-118-Prelims-transes.pdf

NCM 118 – DISASTER & EMERGENCY NURSING Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: BASIC APPROACH TO EMERGENCY CARE 2. Airc...

NCM 118 – DISASTER & EMERGENCY NURSING Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: BASIC APPROACH TO EMERGENCY CARE 2. Aircraft Crashes DEFINITION OF EMERGENCY  Small private planes and charter aircraft EMERGENCY are common in the air space. An unforeseen combination of circumstances or the resulting state that calls for immediate action. C. HUMAN CAUSED Something dangerous or serious, such as an accident, 1. National Emergency (War, Terrorism) that happens suddenly or unexpectedly and needs  There is a chance that a certain fast action in order to avoid harmful results place/country could be affected either directly or indirectly by a major war or EMERGENCY NURSING terrorism incident.  Traditionally referred to Urgent and Critical Care 2. Civil Disorder needs  Planned or unplanned demonstrations Has been increasingly used for non-urgent problems, may become large and uncontrollable. the emergency management has broadened to In some cases, participants could include the concept that emergency is whatever the become violent. patient or family considers it to be. 3. Active Shooter Nursing interventions are accomplished  An active shooter would place the interdependently in consultation with or under the campus community at risk by either direction of a physician or nurse practitioner targeting specific individuals or mass The emergency room staff works as a team groups. The emergency nurse has special training, education, experience, and expertise in assessing and identifying PERSONAL PROTECTIVE EQUIPMENT health care problems in crisis situations - When an emergency event occurs or a disaster strikes, first responders and recovery workers are often the TYPES OF EMERGENCIES first ones to arrive on-site. A. NATURAL - First responders may need personal protective Severe Weather (Tornadoes, Thunderstorms, equipment (PPE) to keep them safe during natural Hail) disasters, biological hazards, accidental releases, and B. TECHNOLOGICAL terrorism events Fire Hazardous Materials Accidents Fuel and chemical spills are the most widespread materials likely to create accidents. Chemicals used in laboratories, water treatment are also sources of possible hazardous incidents. 1. Chemical/Biological/Radiological (CBR) Emergencies  When properly stored and handled, CBR materials pose no extreme threat. They are commonly present in academic buildings housing scientific experiments - Emergency response-type PPE is classified into four and research. However, during times of levels, ranging from the most protective (Level A) to natural or human-caused disasters, the least protective (Level D). Workers must be these materials become a special hazard trained on the conditions that require PPE and the to the campus and to emergency personnel. 1|P L S D O N O T S H A R E T H E F I L E NCM 118 – DISASTER & EMERGENCY NURSING Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 1: BASIC APPROACH TO EMERGENCY CARE procedures to prevent and reduce exposure, including 4. Manager/ Researcher/ Collaborator/ Leader – decontamination and proper disposal procedures. emergency nurses also work on these different roles who work to improve emergency health care. They LEVEL DESCRIPTION find time to provide excellent care for patients. Level A Highest level of respiratory, skin, and eye ISSUES IN EMERGENCY NURSING protection LEGAL ISSUES Level B Highest level of Any client who presents to an ED seeking treatment respiratory protection must be rendered aid regardless of financial ability to with a lower level of skin pay for services. protection Requiring ED personnel to stabilize any client Level C Same level of skin considered medically unstable before transfer to protection as level B, with another health care facility. a lower level of respiratory protection PROFESSIONAL & ETHICAL ISSUES Level D No respiratory protection Documentation of consent - patient must consent to and only minimal skin invasive procedures unless unconscious or in critical protection condition. If unconscious and without family or friends, this fact NURSE’S ROLE IN EMERGENCY should be documented. Emergency nursing is a specialty area of the nursing After treatment, notations are made on the record profession like no other. about the patient’s condition on discharge or transfer To provide quality patient care for people of all ages, and about instructions given to the patient and family emergency nurses must possess both general and for follow-up care. specific knowledge about health care to provide quality patient care for people of all ages. LIMITING EXPOSURE TO HEALTH RISK Health care providers are at increased risk for exposure to communicable diseases through blood or other body fluids. This risk is further compounded in the ED because of the common use of invasive treatments. All emergency health care providers should adhere strictly to standard precautions for minimizing exposure. 1. Care Provider—Emergency nurses care for patients PROVIDING HOLISTIC CARE and families in hospital emergency departments Sudden illness or trauma is a stress to physiologic and 2. Educator- provide education to the public through psychological homeostasis that requires physiological programs to promote wellness and prevent injuries, and psychological healing. such as alcohol awareness, child passenger safety, gun Patients and families experience real and terrifying safety, bicycle and helmet safety, and domestic fear of death, mutilation, immobilization, and other violence prevention. assaults on their personal identity and body integrity. 3. Advocate- emergency nurses defend or plead a cause or issue on behalf of another. Has legal and ethical obligation to safeguard the patient’s interests and rights. 2|P L S D O N O T S H A R E T H E F I L E NCM 118 – DISASTER & EMERGENCY NURSING Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 2: EMERGENCY ASSESSMENT  A patient’s condition may improve or deteriorate PRIORITY EMERGENCY MEASURES FOR ALL PATIENTS during the waiting time for treatment. Make safety the first priority  Triage is aimed to get the Preplan to ensure security and a safe environment o Right patient to the Closely observe patient and family members in the o Right place at the event that they respond to stress with physical o Right time with the violence o Right care provider Assess the patient and family for psychological function  Primary Goal: Patient and family-focused interventions o “Do the greatest goal for the greatest Relieve anxiety and provide a sense of number”: Maximize Survival! security  Secondary Goals: Allow family to stay with patient, if possible, o Relief of suffering to alleviate anxiety o Efficient resource allocation Provide explanations and information Provide additional interventions depending upon the stage of crisis “START” TRIAGE PRINCIPLES OF EMERGENCY CARE Assess and intervene CATEGORIES o Primary survey Categories Description Triage  ABCDE Tag o Secondary Survey Color Triage Immediate - Highest priority o Emergent (emergent) - Life threatening o Urgent - Requires immediate care o Non-urgent  Victim can be helped by immediate intervention TRIAGE and transport.  The word triage is derived from a French word trier  Requires medical attention that means “to sort.” within minutes for survival  In emergency care, triage is a process that is used to (up to 60). determine the severity of a patient’s illness or injury.  Includes compromises to  Performed in both the pre-hospital and hospital patient’s Airway, Breathing, environments. Circulation.  A process based on the number of patients, the amount of resources available, and the care that is (Sucking wounds, Pneumothorax, available. Incomplete amputation, Unstable  An important component of emergency nursing abdominal wound) practice as patient census continue to increase and Delayed - Serious health problems more has to be provided with less (urgent) but not life-threatening  involves the sorting of patients in emergency care - Can be delayed for minutes settings according to their level of acuity to 1 hour  It ensure that all patients receive access to care in an  Victim’s transport can be organized and timely manner based on the urgency of delayed. their clinical needs.  Includes serious and  Triage is a dynamic process and is usually done more potentially life-threatening than once. 3|P L S D O N O T S H A R E T H E F I L E NCM 118 – DISASTER & EMERGENCY NURSING Lecture / 4th year / 1st sem / Prelims this file is not intended for sharing UNIT 2: EMERGENCY ASSESSMENT injuries, but status not Breathing ALL WALKING expected to deteriorate RESPIRATIONS Minor WOUNDED significantly over several NO YES hour. POSITION AIRWAY Under Over 30/Min. 30/Min. (Stable abdominal wound without NO YES PERFUSION Immediate evidence of hemorrhage, Fracture Morgue Immediate requiring open reduction,  Cannot breathe on own after airway opened = BLACK Debridement & external fixation)  Breathing rapidly = RED Minor - Episodic illnesses  Breathing regularly = go to next step in flow chart (non- - Able to wait for hours urgent) - Can delay for 3 hrs Perfusion  Victim with relatively minor PERFUSION injuries. Radial Pulse Absent  OR Status unlikely to Capillary Refill deteriorate over days. Nail Bed Press  May be able to assist in Over Under 2 Seconds 2 Seconds own care: “Walking Control Bleeding Wounded”. Immediate (Minor burns, Sprains, Small  If NO radial pulse go to “Mental Status” lacerations)  If no radial pulse, check capillary refill Deceased - Mortally wounded  If refill >2 secs = RED - No care required  If refill 105° F (40.5° C) Management: Dry or moist, flushed skin. Stop activity and move to a cool location Confusion, dizziness. Drink sports drink or juice, or water if the Slurred speech. others are not available. Seizures. Gently stretch and massage muscles. Severe headache. Increased breathing and pulse. Heat Exhaustion Unresponsiveness. Develops when you ignore early signs of heat-related emergency or illness. Management Condition can worsen quickly Rapidly reduce temperature Can be either by water depletion or sodium Administer oxygen to meet increased metabolic depletion, but often is characterized by combination demands of both Institute seizure precautions Manifestations: Headache Nausea Vomiting Malaise Dizziness Muscle cramps Signs and Symptoms of dehydration Temperature may be normal or elevated (