emergency and disaster nursing:
DESCRIPTION
Emergency and Disaster Nursing:. A Systematic Approach to Providing Care. The Challenges of ED Care. Statistics 5/2012. http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf. - PowerPoint PPT PresentationTRANSCRIPT
Emergency and Disaster Nursing:A Systematic Approach to Providing Care
The Challenges of ED Care
http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf Statistics 5/2012
http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf Statistics 5/2012
http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf Statistics 5/2012
Primary Survey
Airway
• Assessed while maintaining Cervical Spine
• Signs and symptoms of compromised airway
• Jaw Thrust Maneuver
Breathing• Causes
• Assessment
• Treatment
Circulation
• Central Pulse is Checked
• Color, Temperature, Moisture
• AMS and delayed capillary refill are the most significant signs of shock
• 2 large bore IV’s with NS or LR
Disabilities
• Level of Consciousness
• Glasgow Coma Scale
• Pupil Size
Secondary Survey
Secondary
Expose – remove all clothing (special consideration for forensics)
Full Set of Vital Signs
Family Presence
Give Comfort
History and Head to Toe Assessment
Forensics Trauma victims
are often victims or perpetrators of crime
Work collaboratively with law enforcement
Maintain the chain of evidence
Diagnostic Tests• Blood type and cross• Blood alcohol level• Urine drug screen• Pregnancy test
• What others can you think of?
Diagnostic Tests cont.• X-Ray, CT, MRI
• Diagnostic Peritoneal Lavage (DPL)
• Abdominal Ultrasound -
Focused Assessment with Sonography for Trauma (FAST)
MedicationsBlood, crystalloids –NS or LR, volume expanders
- HespanInotropic drugs after IV fluids
Dopamine, dobutamine, isoproterenol
Vasopressorsdopamine, epinephrine
Opioids - pain controlTetanus prophylaxisAntibioticsMannitol
Death in the ER
Gerontologic Populations
• Atypical presentations
• Cognitive Impairment
• Co-morbidities
• Polypharmacy – Coumadin,Beta-blockers, Anti-hypertensives
Hwang, U., Richardson, L.D., Sonuyi, T.O., & Morrison, R.S. (2006). The Effect of emergency department crowding on the management of pain in older adult with hip fracture. Journal of the American Geriatric Society. 54, 270-275.
Poisonings
1-800-222-1222 Humans1-888-426-4435 Pets – ASPCA $65
Activated charcoal, gastric lavage, eye/skin irrigation, hemodialysis, hemoperfusion, urine alkalinization, chelating agents and antidotes - acetylcysteine
Contraindicated in AMS, ileus, diminished bowel sounds, ingestion of substance poorly absorbed by charcoal
Violence Crosses all socioeconomic and sociocultural
barriers
1.5 million women and 834,000 men treated at ED’s have been battered by persons known to them
Make referrals, provide emotional support, inform victims about their options, ensure patient safety
Suspected abuse of elders, persons with disabilities and children MUST be reported by law. It is not an option to assume the social worker or doctor will report.
It is OUR RESPONSIBILITY to inquire and offer options even if the options are a social worker or phone numbers.
5 ESI Level Triage• Level One: Resuscitation – patients require immediate
evaluation and management
• Level Two: Emergent – patients require evaluation within 15 minutes for potential threats to life or limb
• Level Three: Urgent – patients have conditions that cause significant discomfort and should be evaluated within 30-60 minutes
• Level Four: Less Urgent – patients do not require rapid intervention, but should be evaluated within 60 minutes
• Level Five: Non-urgent – patients may be seen in a delayed fashion and could be referred to other areas of the health care systemPrah Ruger, J., Lewis, L.M., & Richter, C.J. (2007). Identifying high-risk patients for triage and resource
allocation in the ED. AmericanJournal of Emergency Medicine. 25, 794-798.
5 ESI Level Triage
Chemical Emergencies• Release of a
hazardous chemical that has the potential for harm• Biotoxins• Blood agents• Pulmonary agents• Nerve agents
• Treatment depends on the chemical - some have no treatment
Radiation Emergencies• Can be incurred from
handling of or exposure to radioactive materials
• Radiological technicians/First Responders, ED personnel
• Weapons of Mass Destruction –everyone is exposed
Mass Casualty Incident
Assessments conducted in less than 15 seconds…
System of colored tags to determine seriousness of injury and likelihood of survival
Total number of casualties a hospital can expect is estimated by doubling the number of casualties that arrive in the first hour.
NDMS, DMAT & CERT• National Disaster
Medical System
• Disaster Medical Assistance Teams
• Community Emergency Response Teams
Reverse Triage• Injury identification-rapid assessment at
scene• Penetrating injuries to abdomen, pelvis, chest,
neck or head• Spinal cord with deficit• Crushing injury to head, chest or abdomen• Major burns
• Critical interventions• providing life support, immobilizing the cervical
spine, managing the airway, and treating hemorrhage and shock
• Rapid transport-ASAP to regional trauma center
Triage Tag• Patient Information• Triage Status• Chief Complaint• Transportation• Peel - off Bar Codes• Transport Record• Vital Signs • History• Treatment
MIEMSS
HOSP NOTIFIED Maryland Emergency Medical Services
TRIAGE TAG
A V P U
A V P U
A V P U
Inflated at _______________PASG
Gauge
Tourniquet @ _______
Extremity Splint
Gross Decon. Final Decon.
Maryland Department of Transportation
Chief Complaint Section• Major obvious injuries or illness can be circled• Indicate injuries on the human figure• Additional information is added on the comments
line
Pre-Hospital Care• Paramedics
communicate with ED• Brief report about client
with ETA
• Severity of condition determines ED response
• Champion Revised Trauma Scoring System
Nursing Diagnosis• Ineffective airway clearance• Altered tissue perfusion• Impaired gas exchange• Risk for infection• Impaired physical mobility• Spiritual distress• Risk for post-trauma syndrome
PTSD / Compassion Fatigue• Risk for patients and
caregivers• Emotions range from fear,
anger denial and shock.• May experience flashbacks
and nightmares
Implications for Nursing• Recognition of our own values and perceptions
• Need for evidenced based practice
• Continuing education through in-services and online training
• Department specific policies – no more than 8 hours in triage
• Use of a different triage ranking system such as ESI where specific complaints are automatic level assignments