ER NURSING.pdf

Introduction to Emergency Nursing by ROVZ CAPILI  Emergency · Any trauma or sudden illness that requires immediate intervention to prevent imminent severe damage or death. rovzcapili@NEU2024 Emergency Emergency Nursing Ø is a fast-paced and demanding specialty that re...

Introduction to Emergency Nursing by ROVZ CAPILI  Emergency · Any trauma or sudden illness that requires immediate intervention to prevent imminent severe damage or death. rovzcapili@NEU2024 Emergency Emergency Nursing Ø is a fast-paced and demanding specialty that requires critical thinking, clinical expertise, and emotional resilience. rovzcapili@NEU2024 I  Emergency Medical Services § Responsible for establishing, regulating, coordinating, and monitoring the components involved in the provision of emergency care. rovzcapili@NEU2024  Team of healthcare providers that provides emergency care. 1. Emergency Medical Technician (EMT) § Also known as an ambulance technician, is a health professional that provides emergency medical services. § EMTs are most commonly found working in ambulances. They are also the most common type of providers in all of EMS. rovzcapili@NEU2024  Team of healthcare providers that provides emergency care. 2. Emergency Medical Technician Intermediates (EMTI). § EMTIs are next to EMTs. § Intermediates maintain a critical skill set that can often be life-saving to those involved in accidents, emergencies, and complicated procedures. rovzcapili@NEU2024 Team of healthcare providers that provides emergency care. 3. Emergency Medical Technician Paramedics (EMTP). § EMTPs are the highest level of EMTs. § Paramedics are advanced providers of emergency medical care and are highly educated in anatomy and physiology, cardiology, medications, and medical procedures. rovzcapili@NEU2024  Emergency Nursing Ø involves rapidly assessing and treating patients experiencing life-threatening conditions. Ø Nurses must perform a primary survey assessing airway, breathing, circulation, disability, and exposure (ABCDE) to identify and address critical issues within 10 minutes of arrival. Ø After I initial resuscitation, nurses conduct a secondary survey with a full physical exam and testing to identify all injuries.  Emergency Nursing Ø is a nursing specialty that focuses on the care of patients who require prompt medical attention to avoid long-term disability or death. Ø It involves the assessment, diagnosis, and treatment of perceived, actual or potential, sudden or urgent, physical or psychosocial problems that areI primarily episodic or acute. rovzcapili@NEU2024 Emergency Nurses Ø Emergency nurses care for patients of all ages with a wide range of illnesses and injuries, providing immediate life-saving care and stabilization. I Emergency Nurses Ø must have strong clinical skills, work well under pressure, and provide compassionate care for patients of all ages experiencing medical emergencies or trauma. Roles and Responsibilities of Emergency Nurses 1 Rapid Assessment 2 Vital Sign Monitoring Emergency nurses quickly They monitor vital signs, assess patients' conditions, administer medications, and prioritizing care based on the perform procedures to severity of their needs. stabilize patients' conditions. 3 Communication & 4 Patient Advocacy Collaboration They advocate for their They communicate effectively patients' needs and ensure with other healthcare they receive the appropriate professionals, including care and resources. physicians, paramedics, and family members.  Four Basic Steps for Emergencies 1. Know your facility Ø It is important to know what emergency resources are available in each location and the equipment’s placement, such as overhead sprinkler systems, fire extinguishers, and defibrillators. Ø Healthcare providers, especially nurses, should know where the E-carts and E-kits are placed in the hospital setting. They need to be available to providers very easily.  Four Basic Steps for Emergencies 2. Know the proper scope of your emergency care Ø The NURSE should know their role, accountability, and responsibility when dealing with emergencies. Ø The NURSE is responsible for the following: ü Deciding when to call the doctor ü Coordinating care ü Assisting with other emergency procedures ü Performing emergency assessment and interventions  Four Basic Steps for Emergencies 3. Know your patients. Ø NURSES are responsible for identifying if the patient is in an emergency and recognizing patients’ symptoms, taking measures within their scope of practice to administer medications, providing other measures for symptom alleviation, and collaborating with other professionals to optimize patients’ comfort and families’ understanding and adaptation.  Four Basic Steps for Emergencies 4. Stay prepared. Ø Preparing for unexpected occurrences is only part of the equation. Ø Being fast, ready, and accurate for an emergency also involves practicing good mental health strategies that can develop one’s level of competency in the event of a crisis. Primary and Secondary Assessment · Primary Assessment Ø allows for the recognition of potentially life threatening conditions and the correct management to be implemented. Ø The acronym ABCDE provides the basis of the primary assessment and it is an easy way to remember the correct order for assessing patients presenting to the emergency department. ·  Primary Assessment Airway Breathing. Circulation. Disability. Exposure. rovzcapili@NEU2024  Primary Assessment Airway ü Clear airway: Chin lift, finger sweep ü Protect airway ü Surgical airway rovzcapili@NEU2024  Primary Assessment Breathing ü Ventilate with 100% O2 ü Check thorax and neck ü Deviated trachea ü Tension pneumothorax ü Chest wounds ü Sucking chest wounds ü Multiple broken rib, sternum ü Listen for breath sounds rovzcapili@NEU2024 Primary Assessment Circulation. Look: Color, LOC, Monitor: Pulse; BP Capillary refill, external Control external bleeding (significant hemorrhage with direct blood loss) pressure Feel: Peripheral Pulse Ensure adequate IV access Carotid- SBP= >60 Use isotonic crystalloid Femoral SBP = >80 (Normal Saline, Lactated Radial SBP = >80 Ringers) Dorsalis Pedis SBP = 90 Emergent treatment is based on underlying injury.  Primary Assessment Disability. ü Brief Neuro exam ü Pupil size and reactivity ü Limb movement ü Glasgow Coma Scale (GCS) rovzcapili@NEU2024  Primary Assessment Exposure. ENVIRONMENT/EXPOSURE ü Remove all clothing/coverings ü Avoid hypothermia ü Complete head to toe exam ü Don’t forget back of head or neck rovzcapili@NEU2024  · Airway. The most important component to be established and maintained to prevent hypoxia and ultimately death. · Breathing. Assessed after the airway. During times of acute injury and stress, the respiratory system can be compromised. · Circulation. Adequate circulation is needed to maintain tissue perfusion and cellular oxygenation. This system involves the heart, vessels, and blood volume. · Disability. A neurological assessment to assess for motor or sensory deficits is vital as a decrease in level of consciousness can affect ABC. · Exposure. Once the patient is exposed for full body assessment, their privacy needs to be respected by providing a gown and blanket. rovzcapili@NEU2024 · Secondary Assessment § When all life threatening conditions have been found and corrected, the secondary assessment is undertaken. § The main focus of the secondary assessment is to explore specific medical conditions the patient may have. § The components of the secondary are continuous with the primary assessment A,B,C,D,E,F,G,H,I.  · Secondary Assessment § Full set of vital signs. Vital signs such as temperature, respiration rate, heart rate, blood pressure, and pain should be assessed. § Give comfort. For many patients in the emergency department, levels of pain may be quite high. rovzcapili@NEU2024 · Secondary Assessment § History. Understanding the complexity and processes involved in history taking allows nurses to gain a better understanding of patients’ problems. The mnemonic AMPLE is a useful tool to guide history taking. Allergies Medications Past medical history Last meal Events surrounding injury  · Secondary Assessment § Inspect posterior surfaces. ENVIRONMENT/EXPOSURE § Remove all clothing/coverings § Avoid hypothermia § Complete head to toe exam § Don’t forget back of head or neck rovzcapili@NEU2024 Triage and Patient Assessment 1 Triage Patients are prioritized based on the severity of their condition, ensuring those with the most urgent needs receive immediate attention. 2 Patient Assessment A thorough assessment is conducted to gather information about the patient's medical history, symptoms, and current condition. 3 Diagnostic Testing Emergency nurses may order and interpret diagnostic tests, such as blood work, imaging scans, and electrocardiograms. 4 Treatment Plan Based on the assessment, the emergency nurse collaborates with the physician to develop a treatment plan. Emergency Procedures and Treatments Cardiopulmonary Medication Resuscitation (CPR) Administration Emergency nurses are trained They administer medications, to perform CPR, a life-saving including analgesics, anti- technique used to restore emetics, and antibiotics, to heartbeat and breathing. alleviate symptoms and stabilize patients. Wound Care Intubation and Ventilation Emergency nurses provide wound care, including In critical situations, cleaning, dressing, and emergency nurses may assist suturing wounds to prevent with intubation, a procedure infection. to insert a breathing tube to help patients breathe. Ethical and Legal Considerations in Emergency Nursing Patient Confidentiality Emergency nurses must maintain patient confidentiality, protecting sensitive medical information. Informed Consent Emergency nurses ensure that patients are informed about their medical conditions and treatment options before procedures. Legal Documentation Accurate and thorough documentation is crucial for legal purposes, providing a record of patient care. Golden Rules of Emergency Care · Obtain consent whenever possible · Be as calm and as direct as possible · Care for the most serious injuries first · Keep onlookers away from the injured person · Handle victim to a minimum · Loosen tight clothing · Do not leave the victim alone · Do not assume that the obvious injuries are the only ones · Don’t give false reassurance · Do not require the victim to make decision rovzcapili@NEU2024 q Trier in French, battlefield screening, to sort out, to categorize, to classify. q The prioritization of patient care based on the severity of injury/illness, prognosis, and availability of resources. Purpose: · To sort or classify all patients · Set priorities of care rovzcapili@NEU2024  Emergency Department Triage System (Three-Tier System) EMERGENT (RED) Priority 1 o Injuries are life threatening q Needs immediate attention and continuous evalution q Severe head injury or comatose state q Active seizures q Sustain chemical splashes to the eye q Severe respiratory distress or cardiac arrest  Emergency Department Triage System (Three-Tier System) EMERGENT (RED) Priority 1 o Chest pain with acute dyspnea or cyanosis o Trauma o Severe chest or abdominal wound o Limb amputation o Severe shock o Excessively high temperature (40.6 °C) rovzcapili@NEU2024  Emergency Department Triage System (Three-Tier System) URGENT (YELLOW) Priority 2 Injuries have complications that are not life threatening § Needs to be treated within 1 to 2 hours (evaluation 30-60 minutes thereafter) § Asthma without respiratory distress § Persistent nausea and vomiting and/or diarrhea § Hypertension § Other types of severe pain § Simple fracture § Abdominal pain § Client with renal stone § Fever above 38.9 °C rovzcapili@NEU2024  Emergency Department Triage System (Three-Tier System) NONURGENT (GREEN) Priority 3 Injuries do not have immediate complications § Can wait for several hours for medical treatment (evaluation every 1-2 hours) § Mild headache § Cold symptoms § Minor laceration § Sprain § Strains Emergency Department Triage System (Three-Tier System) NO CATEGORY or BLACK CATEGORY § Includes dead or even catastrophically injured patients who have a minimal chance for survival despite optimal medical care. rovzcapili@NEU2024 Descriptions of a few Emergency Nurse roles: Triage Nurse · An emergency nurse is assigned to triage patients as they arrive in the emergency department, and as such, is the first professional patients will see. · This emergency nurse must be skilled at rapid, accurate physical examination and early recognition of life-threatening conditions. Descriptions of a few Emergency Nurse roles: ED Charge Nurse § An experienced emergency nurse is put in the role of charge nurse or team leader. § This nurse is responsible for the overall flow of the department. § He/she assigns nurses to patients, assures patients are being transported to and from tests outside the ED, addresses patient complaints and concerns, communicates with the house supervisor, takes phone calls, and assures nurses get their breaks. Descriptions of a few Emergency Nurse roles: Trauma Nurse § Trauma Nurses work in Trauma Centers and run the show when trauma patients come in by ambulance, helicopter, or personal vehicle. § This role requires specialized training and usually two years of experience. rovzcapili@NEU2024 Descriptions of a few Emergency Nurse roles: Code Nurse Code Nurses run the Code Rooms where the sickest of the sick patients go in the ED. No pulse, not breathing? No problem! The Code Nurse will run the ACLS-based codes and provide emergency care for these critically ill patients. rovzcapili@NEU2024  Trauma Care and Management Primary Survey Secondary Survey Trauma Stabilization The primary survey is a rapid A more thorough assessment to Emergency nurses provide immediate assessment to identify and address identify and address other injuries and care to stabilize trauma patients, life-threatening conditions, including conditions, including head-to-toe including controlling bleeding, airway, breathing, and circulation. examination, vital sign monitoring, and immobilizing fractures, and managing diagnostic testing. pain. rovzcapili@NEU2024 Ø Patients with isolated injuries, such as a mild/moderate head injury or a broken leg, may go to specific wards, such as neurosurgical or orthopaedic wards. rovzcapili@NEU2024 Ø Other stable patients with multiple trauma injuries are usually admitted to a trauma ward. Ø Most MTCs will have a team of trauma nurse coordinators to ensure support for the patients and families, as well as to coordinate the multidisciplinary team involved in treating the patient. rovzcapili@NEU2024 Disaster Response and Preparedness Mass Casualty Incident Triage and Prioritization Disaster Planning (MCI) During MCIs, nurses prioritize Emergency nurses participate Emergency nurses are care based on the severity of in disaster planning drills to prepared to respond to MCIs, injuries, ensuring the most enhance their skills and such as natural disasters or critical patients receive readiness to respond mass shootings. immediate treatment. effectively in critical situations. Continuing Education and Professional Development Continuing Education Professional Conferences Courses They attend conferences to learn Emergency nurses engage in ongoing from experts, network with education to stay current with colleagues, and gain new insights advancements in emergency into emergency nursing practices. medicine. Certification Programs Research and Innovation Emergency nurses may pursue They contribute to research and certification to demonstrate their innovation to improve emergency specialized knowledge and skills in nursing practice and patient care. emergency care. rovzcapili@NEU2024