Slide 1 :
|| Emergency and disaster nursing
Slide 2 :
|| EMERGENCY NURSING
- practice of episodic, primary, critical and acute nursing care
of all ages who experience physical,emotional or
psychological alterations in health.
Slide 3 :
|| Care of the Client presenting to an Emergency
Department : 1. Triage – classification of all clients presenting to the
Purpose: to prioritize treatment.
Slide 4 :
|| Triage Rating Systems: 3 Categories
a. Emergent – conditions requiring IMMEDIATE CARE and intervention
because of increased risk of mortality or threat to life,
limb or vision. B-burns
C-chest pain-cardiac arrest
H-hemorrhage sec. to ectopic pregnancy
M-major blunt or penetrating trauma
Slide 5 :
|| b. Urgent – conditions that require care ASAP and generally
within 1 hour because the condition has the
potential for causing the deterioration of health
state if not treated ASAP. These clients will have
stable V/S but have acute illness and must be
treated to prevent morbidity. F-fever
L-lacerations with controlled bleeding
Slide 6 :
|| c. Non-urgent- require routine care that can be delayed for
more than 2 hours without the possibility of deterioration;
clients presenting with non-urgent conditions frequently
utilize the emergency dept. because they do not have a
primary care physician. C-colds
Slide 7 :
|| 2. Disaster Management Plan – a community wide, hospital
–wide or emergency department plan to handle mass
casualty incidents that may occur at any time. Assessment: Primary Assessment – rapid initial assessment of the
symptoms to determine life threatening conditions while
Slide 8 :
|| Airway- with C spine immobilization, patent airway, ability to speak,
foreign body, chest expansion.
Tx: chin-lift / jaw thrust, suctioning, intubation, cricothyroidectomy,
tracheostomy, cervical spine neutral position.
Breathing- effectiveness of breathing and ventilation ability.
Abnormal : apnea, weak, shallow/labored respiration
diminished /absent breath sounds
unequal chest expansion
retractions/ paroxysmal chest wall movement
Open chest wound
Sx of chest trauma
Slide 9 :
1. Oxygen therapy
2. Chest tube insertion, intubation
3. Pressure dressing on a flail segment of the ribs
Circulation- adequate circulation to maintain
cellular tissue perfusion.
Abnormal : bradycardia or tachycardia
cool, pale and diaphoresis
obvious uncontrolled external bleeding
Sx of hypovolemia, pericardial tamponade,
Slide 10 :
1. direct pressure to control external bleeding
4. Pericardiocentesis-aspiration of blood from
5. Autotransfusion – BT of one s own blood.
Slide 11 :
|| Disability – complete a brief neurological assessment to
determine baseline functioning, potential life
threatening complications, LOC.
Abnormal: Unresponsive –altered pupils : fixed pupils,
papillary response abnormalities.
Expose- remove all clothing from the client to facilitate a
thorough complete secondary assessment examination.
Slide 12 :
|| Secondary Assessment- a brief, systematic head to toe
assessment that identifies all injuries.
cervical immobilization is maintained at all times as well
as continual assessment of hemodynamic and oxygen status.
Fahrenheit-provide measures to prevent body heat loss at this
time through the use of warmed IVF, warmed
blankets or healing lamps.
Slide 13 :
|| Get V/S –other assessment aids : cardiac monitor, pulse
oxi,urinary catheter, NGT, lab. studies: CBC,
electrolytes, Fibrin degradation products
(coagulation), amylase, lactate; renal studies ;
blood type and crossmatch; toxicology studies.
History- head to toe assessment : HPI / PMH / FH /Meds
Slide 14 :
|| Common Problems Seen in Emergency Settings : Airway obstruction- partial or complete obstruction of
2. Tension pneumothorax- occurs when air enters the
pleural space through a tear during inspiration and
accumulates because it cannot escape during expiration.
3. Flail chest – the force of impact to the chest wall during
injury causes the fracture of 3 or more continguous ribs\
in 2 or more places resulting in a floating segment.
Slide 15 :
|| 4. Uncontrolled hemorrhage- uncontrolled bleeding.
5. Motor Vehicle Accidents *MVA- blunt and multiple
Acceleration/deceleration forces – increased velocity
of a moving object followed by a reduction in velocity
e.g. speed of a vehicle.
Compression forces- body parts are pressed against
immobile objects due to explosive injury to air filled
organs *liver and spleen
Shearing forces- a rotational force exerted around a
Blunt trauma- fractures, lacerations, contusions, rupture
or tearing of solid and hollow organs and major blood
Slide 16 :
|| 6. Penetrating injuries - stab wounds/GSW : knives,
pencils, forks; high velocity /high energy missiles:
guns,rifles,high pressure injection devices.
7. Hypothermia – a condition where the core body temp.
is 36 C ( 96.8 F ) or less.
Tx : ABC, faster rewarming, Cordarone, D50-50 IV
Slide 17 :
|| 8. Frostbite – injury caused by exposure to cold environment and
Tx : Remove from the cold envt. before thawing.
Area not be rubbed –mechanical friction can cause tissue
Aloe vera topical – inhibits platelet aggregation : thromboxane
Topical and parenteral antibiotics
Oral and parenteral analgesics
Slide 18 :
|| 9. Heat exhaustion- vasomotor collapse sustained from
prolonged exposure to heat.
Tx : Rest in cool, shaded area
TSB, direct fans toward patient
Slide 19 :
|| 10.Heat stroke – an extremely elevated core body temperature
caused by a failure of the hypothalamus-perspiration
regulating mechanism; carries 70% mortality rate.
Tx : Aggressive cooling measures to institute
Full body exposure and cooling by evaporation
Ice water gastric and peritoneal lavage
Prevent over correction , hypothermia and cerebral edema
IV NSS, do not use LR because liver is unable to
U.O. / ABCs
Meds: Thorazine 10-25mg – prevent shivering
Slide 20 :
|| 11. Drowning and Near drowning – drowning is death
caused by asphyxia and aspiration after submersion in
water; near drowning is risk of death occurring within 24
Tx : ABC
Fresh water drowning – electrolytes decreased
Salt water drowning – electrolytes increased
XRay – bilateral infiltrate
Correct hypoxia and cyanosis, I and O
Slide 21 :
|| 12. Bites – dog,cat, rodent, human, insect/bee, spider, tick, snake; a break
in the continuity of the skin caused by a bite from an animal,
insect or human.
Tx : Meticulous wound care
Devitalized tissue should be debrided and topical antibiotic ointment.
IV antibiotics –severe human and animal bite
Rabies prophylaxis-animal bite
Carnivores-rabies positive : raccoons, bats, wild animals
Herbivorous – rabies negative : mice, rodents
Venomous bites – black widow spiders, poisonous snakes
Anti venom tx: constricting band/ice to slow the circulation
and spread of venom to circulation.
*Wound should be left open and a bulky dressing is applied-dry sterile
Slide 22 :
|| 13. Poisonings – substances that are harmful : inhaled, ingested
*food, drug, overdose or acquired by contact *insecticides
Carbon monoxide inhalation
Drug overdose: ASA –overstimulation of resp. center and metabolic
acidosis- hyperventilation, hyperthermia,hyperglycemias
Insecticide surface absorption
Tx : ABC,IV access
Narcan-Naloxone –antagonist for resp. depression due to
Flumazanil-for Benzodiazepine ingestion
Vomiting is C/I
Antidotes: Ipecac, activated charcoal
Slide 23 :
|| 14. Electrocution – injury sustained by electric current
Tx : ABC, Spine immobility,Local wound care
Meds : NaHCO 3 , Mannitol, Tetanus, Lidocaine,
Amiodarone and Epinephrine
End of Emergency Nursing