Emergency Nursing

Emergency Nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known.

E-CART- CRASH CART

A crash cart or code cart (crash trolley in UK medical jargon) is a set of trays/drawers/shelves on wheels used in hospital emergency rooms for transportation and dispensing of emergency medication/equipment at site of medical/surgical emergency for life support protocols (ACLS/ALS) to potentially save someone's life. A crash cart typically contains a defibrillator and intravenous medications (such as epinephrine and atropine), plus a variety of medical supplies such as latex gloves, endotracheal tubes, Ambu bags, cannulae. Hospitals typically have internal intercom codes used for situations when someone has suffered a cardiac arrest or a similar potentially fatal condition outside of the emergency room (where such conditions already happen frequently and do not require special announcements). When such codes are given, hospital staff and volunteers are expected to clear the corridors, and to direct visitors to stand aside as the crash cart and a team of physicians and nurses may come through at any moment

TOP DRAWER

2nd drawer adult intubation supplies

3rd drawer peds intubation supplies

4th drawer peds miscellaneous supplies

5th drawer IV and blood draw supplies

6th drawer IV solution and tubing

7th drawer procedure trays and miscellaneous supplies

Scope and practice of Emergency nursing

Specialized education Expertise in assessing and identifying patients health care problems Establishes priorities, monitors acutely ill and injured pts. Nursing interventions are accomplished independently

Categories of Triage
Emergent- highest priority, condition is life threatening and must be attended immediately Urgent serious health problems but not immediately life threatening ; must be seen in one hour Non- Urgent- episodic illness that must be seen w/n 24 hours without increased morbidity

Use of colors for segregation

RED- emergent(bleeding patients attended to as soon as possible) YELLOW- delayed (patient can wait for one hour to be treated) GREEN- ambulatory injured patients(non-urgent) BLACK- death imminent/expectant(minimal chance of survival)

ALLERGIC REACTIONS
General Signs of allergic reactions include difficulty breathing (wheezing); swollen lips, face, and tongue; possible hives and skin redness, swelling, or itching.

 Treatment
Contact your EMS system immediately. Keep the person quiet in whatever position is most comfortable for him or her. If the person stops breathing, give artificial ventilation. Some individuals who have had previous severe allergic reactions may carry adrenalin injection kits prescribed by their doctor. The individual may be able to inject himself or herself. If the person cannot do so, read the directions in the in the kit to administer the injection.

BITES and STINGS

Treatment
Wash the bite or sting with soap and water, if available. For all types of bites and stings:

Do not attempt to suck out the venom with your mouth. Do not apply a tourniquet. Do not place ice directly on the bite or sting. Do not administer unproven treatments, such as electric shocks or folk/herbal remedies. Do not administer alcohol, stimulants, or aspirin

 Bee Stings
Do not remove the stinger with tweezers or any instrument that squeezes the stinger. If the person shows signs of difficulty breathing; swollen lips, face, or tongue; or hives and skin swelling, treat for an allergic reaction.

 Spider Bites/Scorpion Stings

Keep the bitten area immobilized and lower than the persons heart. Place a cold pack on the bite. DO NOT place ice directly on bite. If you dont have a cold pack, use a plastic bag filled with water and ice. If a negative pressure venom extractor device is available, use it as soon as possible.

 Venomous Snakebite Have the person lie down and minimize activity. Keep the bitten area immobilized and lower than the persons heart. Call an ambulance or take the person to be nearest hospital ER immediately. Do nothing that might injure the person or delay getting the person to the hospital. Do not cut across fang marks. If a negative pressure venom extractor is available, use it as soon as possible. Do not apply tourniquet. Many doctors recommend a lightly constrictive band on the arm or leg above the bite, however. If placed, this band should not be so tight that it cuts off the circulation; you should be able to comfortably insert a finger underneath the band. .

 Remove jewelry or tight fitting clothes in case swelling becomes severe. If swelling or redness appears, mark the border of the swelling or redness with a pen every 15 minutes, and note the time of each mark. Do not attempt to capture the snake unless you have special training in snake handling. Snakes that are motionless after being struck may not be dead

BLEEDING General Heavy bleeding is a medical emergency. Prompt first aid to control the bleeding is essential. Treatment
Have someone call a doctor or the EMS system. Keeps the person lying down. Place a pad directly over the wound. If possible, wear gloves to protect yourself from exposure to blood. Press firmly with one or both hands, applying pressure directly over the wound.

 Hold the pad firmly in place with a strong bandage. If possible, elevate a bleeding arm or leg higher than the level of the persons heart. A tourniquet around an arm or leg should be used only as a last resort when bleeding is uncontrollable, and should generally be used only by trained persons. Once the bleeding has been controlled:

Keep the person warm by covering him or her with blankets or a coat. If you suspect the person could have a spine, neck or head injury, do not move the person. If no such injury is suspected, put newspaper or something under the person if he or she is on a cold or damp surface.

 If possible, keep the wound uncovered and in view. If the person is conscious and asks for water, moisten his or her lips and tongue. If the person is unconscious or if an abdominal injury is suspected, do not give fluids. Do not give the person alcoholic beverages.

BURNS
General
Burns can result from heat (thermal burn) or chemicals (chemical burn). The object of first aid for burns is to prevent shock and contamination and to control pain. Every burn can be complicated by shock. A person with burn shock may die unless he or she receives immediate first aid. Burn shock is characterized by cold, clammy skin with beads of perspiration on the forehead and palms; pale skin color; a cold feeling or shaking chills; nausea; vomiting; or shallow, rapid breathing.

 All burns, except where the skin is reddened in only a small area, should be seen by a doctor. Do not apply ointments, sprays, antiseptics, home remedies such as butter or margarine, baking soda, or other substances to burns.

Treatment Extensive Thermal Burns

Cool the burned area quickly with cold water. Place a clean cloth over all burned areas to protect these areas from air. Keep the person lying down. Give no fluids by mouth. Elevate the persons legs if possible. Call the EMS system.

 Small Thermal Burns

Do not disturb or open blisters. If the skin is not broken, immerse the burned part in clean, cold water or apply a cold pack to relieve pain. Place a pad over the burn and bandage loosely.

 Chemical Burns
Brush away any powdered chemicals from the skin, being careful not to get the chemical on you. Immediately flush the area with plenty of water not just a rinse. Speed in washing off the chemical is critical to reduce the extent of the injury. Use a shower, hose, or any available water faucet. Continue to apply a stream of water while removing clothing from the burned area. Continue flushing the area with large quantities of water for at least 5 minutes. Place a clean cloth over the burn. Call the EMS system immediately. Burns from certain chemicals require specific first aid treatment. These techniques should be learned by anyone working in areas where the chemicals are used. Bring any containers or available identifying information about the chemicals to the hospital emergency department.

EYE CONTAMINATION (Chemical or other foreign material in eye)

General Prompt first aid treatment is essential. Delay greatly increases the extent of injury. Treatment
Immediately rinse the eyes with a gentle stream of room temperature water from a faucet, shower, hose, or pitcher while holding the persons eyes open. Do not use an eye cup. Continue rinsing for at least 15 minutes.

Do not use boric acid or eye drops, drugs, or ointments. Such substances may increase the injury

 Take the person to the nearest hospital emergency department immediately. Ask the person if he or she is wearing contact lenses. Remove them if the person cannot do it, medical help is unavailable, and you know how. Often, running a gentle stream of water over the eyes will dislodge the lenses.

Do not remove a contact lens if the colored area of the persons eye is not visible on opening his or her eyelids. Never try to pry a contact lens loose with fingernails, matches, pencils, toothpicks, swabs, or similar objects. Do not use force. If you see the lens but cant remove it, use the eyelids to gently slide it onto white of eye. The lens can stay there until medical help arrives. You can remove contact lenses with the person standing, sitting, or lying on his or her back. After removing contact lenses, put them in their container. If the lens container is not available, place the lenses in bottles with a little water and identify the eye from which the lenses were removed.

NOSEBLEEDS
Treatment
Have the person sit and lean forward. Pinch the soft portion of the nose (below the nasal bone) between the thumb and index finger for 10 minutes continuously. If bleeding does not stop, put a small, clean pad of gauze into one or both nostrils and pinch your nose with your thumb and index finger. Apply cold compresses or a cold pack to the bridge of the nose and face. If bleeding continues, call for medical help.

POISONING
General Symptoms of poisoning include: Sudden onset of unconsciousness, seizures, confusion, or illness when access to poisons is possible. Bottles or packages of drugs or poisonous chemicals found open in the presence of children. Evidence in the mouth of eating wild berries or leaves. Pain or burning sensation in the throat. Unusual odor on the breath. Vomiting.

Swallowed poisons
Important: Do not induce vomiting if the person has swallowed a petroleum product or a corrosive product. Petroleum products kerosene, gasoline, lighter fluid, furniture polish, and others may be identified by their odors on the persons breath. Corrosive products acids such as rust removers; toilet bowl cleaners; other acids for cleaning; and alkalies such as lye, bleaches, and ammonia will cause burns on the mouth or lips or a pain or burning sensation in the mouth or throat. Other swallowed poisons include wild mushrooms, plants, and berries; household and lawn and garden chemicals; hair and cosmetic products; and over-the-counter and prescription

 Treatment
For severe poisonings, call an ambulance immediately. For other poisonings, call poison control center or a doctor. Do not induce vomiting unless instructed to do so by the poison control center or medical personnel. Do not induce vomiting if the victim is unconscious or is having convulsions. Give the poison container with its intact label and any remaining contents to the doctor, paramedic, or hospital personnel. The type of the poison determines the treatment.

Convulsions from poisoning

Call an ambulance immediately. If the person is having convulsions:

Maintain an open airway. If the person stops breathing, begin artificial ventilation Position the person so that he or she will not injure himself or herself (usually lying on is or her back) and away from walls or heavy furniture. Do not restrain the person

 Loosen tight clothing. Do not force a hard object or finger between the persons teeth. After the convulsion, turn the person on his or her side in case of vomiting. Inhaled poisons (smoke or chemical gas fumes)
Do not become a victim yourself by exposure to the same poison. Call an ambulance. Do not attempt the rescue alone. If there is minimal risk of injury to yourself, move the person to fresh air as soon as possible. Start artificial ventilation immediately if breathing has stopped. Keep the person warm. Keep the person as quiet as possible.

Never give the person alcoholic beverages. Give nonalcoholic liquids only if the person is conscious

SEIZURE or CONVULSION
General A seizure is a medical emergency, except for persons with epilepsy who have a history of frequent seizures. Treatment
Call an ambulance immediately for any seizures in a person who is not known to have epilepsy or in a person with epilepsy who has a seizure lasting 15 minutes or longer. Remove objects that might injure a person as he or she moves involuntarily. Do not restrain. Do not slap. Do not douse with water.
Do not place anything in his or her mouth.

SHOCK General
Shock is characterized by cold, clammy skin with beads of perspiration on the forehead and palms; pale skin color; a cold feeling or shaking chills; nausea; vomiting; or shallow, rapid breathing. Shock usually accompanies severe injury, illness, or severe emotional upset.

Shock may follow other conditions discussed in this

 Treatment
Call an ambulance. Correct the cause of the shock if possible (eg. control bleeding). Keep the persons airway open. If the person vomits, turn his or her head to the side so the vomitus will not be swallowed. If a neck injury is suspected, maintain alignment of the persons head, neck, and body while turning.

 Elevate the persons legs if there are no broken bones. Keep the persons head lower than the trunk if possible. Keep the person comfortable and warm. Give water only if the person is conscious and able to swallow, and if medical help will be delayed for more than 1 hour. Do not give fluids to unconscious or semiconscious persons. Do not give fluids if an abdominal injury is suspected. Never give alcoholic beverages. Reassure the person.