EMERGENCY NURSING A – athropine sulfate – Anticholinergic *NOTE: give 2 initial breaths lasting for 1 ½ to 2 seconds.

If no
Refer to care given to patient with urgent and critical L – lidocane – anesthesia/ anti-rythmic agents rise and fall of the chest is observed, consider airway
needs. M – magnesium sulfate – antiseizure obstruction.
D – dopamine – increase cardiac output
Goals of Emergency Medical Treatment D – dobutamine – increase cardiac output 5. DETERMINE PULSELESSNESS/ ASSESS
1. To preserve life CIRCULATION
2. To prevent deterioration CPR 6. IF PULSELESS, BBEGIN CHEST COMPRESSION
3. To restore the patient to useful living Cardiopulmonary resuscitation – process of externally  Proper placement of hands:
supporting the circulation and respiration of a person Adult: lower half of the sternum/ 2 fingerbreaths
Principles of Emergency Nursing who has had a cardiac arrest. from the xiphoid process
1. Triage – a process of prioritizing patients based on the Infant: midsternum
severity of their condition. Indications: *used heel of both hands for adult, heel of one hand
 Emergency situations – greatest risk receives  Respiratory arrest – with pulse present for child, 2 fingers for infant
priority  Cardiac arrest – without pulse  Depth compressions:
 Major disasters – highly specialized cares are given Adult: 1 ½ - 2 inches
minimal care; based on principles to benefit largest Crucial time: CPR is instituted within 4-6 minutes after the Child: 1 – 1 ½ inches
number; minimal care are treated first to be arrest to prevent brain death ( need to establish a circulation Infant: ½ - 1 inches
available to help. and perspiration)  30 compression per with 2 ventilation
7. REASSESSMENT
Triage Category: Two types of CPR:  Reassess after 4 cycles, if pulse is absent, continue
o Emergent – highest priority ( airway compromise,  Basic Life Support (BLS) – involves the use of hands, CPR
cardiac arrest, severe shock, cervical spine injury, mouth and the sincere desire to give the person a  Recheck pulse every 3-4 minutes thereafter
multisystem trauma, altered LOC, eclampsia) second chance for life.
o Urgent – serious health problem but not immediate  Advanced cardiac life support – involves BLS and the use TERMINATION OF CPR
life threatening ( fever, minor burns, minor of equipment ( defibrulator), emergency drugs and  Successful resuscitation
musculoskeletal injuries, dizziness, lacerations) fluids to monitor the client and stabilize his  Transfer of emergency vehicle
o Non-urgent – can wait for several hours; local condition.  Pronounced dead by physician
injuries ( sprains, missed menses, low back pain)  Exhaustion of rescuer
o Fast-track – requires simple first aid / can manage CPR INVOLVES THE ABCD OF LIFE SUPPORT
A – open airway COMMON COMPLICATION OF CPR
themselves ( simple bruises)
B – restore breathing  Fracture of ribs
C – restore circulation  Puncturesd internal organ- liver
2. Assessment and interventions
D – provide definitive treatment (ACLC)
 Primary Survey
Defibrillation: restoring the heart beat ADVANCED CARDIAC SUPPIRT
A – airway
B – breathing Refers to a set of clinical interventions for the treatment of
ASSESSMENT/ACTIONS cardiac arrest and other life threatening emergencies.
C – Circulation
1. DETERMINE UNRESPPONSIVENESS
D – disability
2. POSITION VICTIM SUPPINE ON A FIRM SURFACE CARDIOPULMONARY ARREST – result of a cardiac
E – exposure
3. ESTABLISH ARIWAY dysrhythmias. ( 2 clinical signs: unconscious, lack of major
 Secondary Survey
 Use head tilt, chin lift maneuver pulse)
C – chief complaint
 Place ear over nose and mouth ( for 3-5 seconds)
H – history
o Look to see if chest is moving DEFIBRILLATION – treatment of choice for ventricular
E – exact location
C – compare o Listen for escape of air fibrillation.
K – keep checking o Feel for movement of air against face *nursing intervention:
o If no respiration, proceed to #4  Place the client in a flat, firm surface
EMERGENCY DRUGS 4. GIVE 2 RESCUE BREATHS  Apply interface material to the paddles
B – bicarbonate – antacid  Mouth to mouth ventilation  Grasp the paddles only by the insulated handles to
E – epinephrine – increase myocardial contractility/  Mouth to nose ventilation prevent electrocution
produce bronchospasm  Mouth to stoma ventilation  Give command for personnel to stand clear of the
C – calcium carbonate – for gastric acidity  Mouth to barrier ventilation client and bedd
  Apply the chest paddles as follows: one at the right
of the sternum, third ICS, and the other one on the
left midaxillary, fifth ICS
 Push the discharge buttons in both paddles
simultaneously
 Defibrillation releases 200-360 joules
INTUBATION - the placement of a flexible plastic tube into
the trachea to protect the patients airway and provide a means
of mechanical ventilation.
MANAGEMENT:
1. HEIMLICH MANEUVER
o Victim standing / sitting
 Make fist with one hand
 Place thumb side of fist against victim
abdomen, between imbilicus and xiphoia
process
 Grasp fist with other hand and pross fist into
victim’s abdomen with upward thrust
 Repeat thrusts until object expelled from
victim’s airway
o Victim lying down
 Place victim supine
 Kneel astride victim’s thighs and place heel of
one hand against victim’s abdomen
 Place other hand on top of first
 Press into abdomen with quick upward thrust
2. FINGER SWEEP – used only in the unconscious adult
patient. This action draws the tongue away from the back
of the throat and away from the foreign body that may be
lodged there.
3. CHEST THRUST – used only in the patient stages of
pregnancy or in the markedly obese person.
4. CONSCIOUS INFANT – if the infant is conscious and
cannot cough, cry or breath:
 Give up to 5 back blows
 Give up to 5 chest thrusts
 Repeat
SHOCK
Life threatening condition that occurs when the body is not
getting enough blood flow.
MAJOR CLASSES OF SHOCK:
1. Cardiogenic shock – unable to supply enough blood to the
organs of the body.
2. Hypovolemic shock – severe blood and fluid loss makes
the heart unable to pump enough blood to the body. This
type of shock can cause many organs to stop working.
3. Anaphylactic shock – life threatening type of allergic CRASH INJURIES – occur when a person is caught bet.
reaction. Objects, run over by a moving vehicle or compressed by
4. Septic shock – overwhelming infection leads to life machinery.
threatening low blood pressure.
5. Nuerogenic shock – caused by damage to the CNS TYPES OF FRACTURES
6. Circulatory shock  Comminuted – bone has splintered into several fragments
7. Multiple organ dysfunction  Compound – damage involves skin or mucous
membranes; also called an open fracture.
STAGES:  Spiral – fracture that twist around the shaft of the bone.
 Compensatory – tachycardia, tachypnea, constriction of  Simple / close – fracture that remains contained; w/ no
peripheral circulation, pale/ cool skin, lack of perfusion, disruption of the skin integrity.
low blood volume, hypoxia  Transverse – fracture that is across the bone shaft.
 Progressive – bp can no longer compensate, hypotension,  Diagonal
increase capillary permeability, respiratory “rapid &  Oblique
shallow, renal effects, hepatic effects
 Irreversible / refractory stage Signs and symptoms:
Paresthesia, pulse, pain, pallor, paralysis
EXTERNAL FLUID LOSS
 Trauma PRIORITY 1 (IMMEDIATE) RED – injuries are life
 Surgery threatening but survival with minimal intervention,
 Vomiting * Sucking chest wound, airway obstruction 2 nd to mechanical
 Dieresis cause, shock, hemothorax, tension pneumothorax, asphyxia,
 Diarrhea unstable chest and abdominal wound, open fractures for long
 Diabetes insipidus bones and 2nd/3rd burns 15 to 40% total body surface area.
INTERNAL FLUID SHIFTS
 Hemorrhage PRIORITY 2 (DELAYED) YELLOW – injuries are significant
 Burns and require medical care but can wait hours w/out threat to
 Ascites life.
 Peritonitis *Stable abdominal wounds w/out evidence of significant
 Dehydration hemorrhage, soft tissue injuries, maxillofacial wounds w/out
airway compromise, vascular injuries w/ adequate callteral
circulation, GUT disruption, fractures requiring open
reduction, debridement and external fixation, most eye and
MULTIPLE INJURIES
CNS injuries.
Caused by simple catastrophic event that causes life
threatening injuries to at least 2 distinct organ system.
PRIORITY 3 (MINIMAL) GREEN – injuries are minor and
treatment can be delayed hours to days. Individuals to this
7 PRIORITY MANAGEMENT
group should moved away from the main triage area.
 Establish airway and ventilation
*Upper extremity fractures, minor burns, sprains, small
 Control of hemorrhage
lacerations w/out significant bleeding, behavioral disorders or
 Prevent and treat Hypovolemic shock. Monitor urine psychological disturbance.
output.
 Assess for head and neck injuries. PRIORITY 4 (EXPECTANT) BLACK – injuries are extensive
 Re-assess for head and neck, chest, abdomen, back and and chances of survival are unlikely even with definitive care.
extremeties *Unresponsive patients with penetrating head wounds, high
 Splint fractures spinal cord injuries, 2nd/3rd degrees burns in excess of 60 of the
 Carry out a more thoroughly and ongoing examination body surface area, seizures or vomiting with 24 hours after
and assessment exposure to radiation, profound shock with multiple injuries,
agonal respirations, no pulse, no bp, pupils fixed and dilated.