52 emergencies

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matthewd
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52 emergencies
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2011-11-22 08:37:16
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  1. defined as a medical or surgical condition requiring immediate or timely intervention to prevent permananet disability or death
    emergency
  2. advancement in emergency care is attributed/influenced by the ______-
    military
  3. group responsible for developing a ststematic method of treating and responding to trauma
    military
  4. wound or injury =
    trauma
  5. # 1 killer of those younger than 43 is ________
    trauma
  6. trauma is the _____ leading cause of death
    4th
  7. care of clients who require emergency intervention
    emergency nursing
  8. what must an emergency room nurse be capable of?
    rapid assessment & health taking

    Immediate intervention
  9. situation or event of greater magnitude than an emergency that has an unforsen, serious, or immediate threat to public health
    disaster
  10. disasters are natural events such as?
    • earthquakes
    • floods
    • fires
    • hurricane
    • tornadoes
    • war
    • terrorism
    • environmental contamination
  11. to prepare for emergencies or disasters it is improtant to identify ______?
    who needs to know how to do what
  12. 3 general approaches to emergency care
    • hospital triage
    • disaster triage
    • emergency medical services
  13. how to care for an emergent client
    one must determine the severity of illness
  14. refers to the classification of clients to determine priority of need and proper place of treatement

    and

    is typically used to establish priorities and levels of care needed by the client
    triage
  15. golden rules of emergency care
    • 1. establish the safety of the scene
    • 2. remove he client from danger
    • 3. establish ABC's
    • 4. manage shock
    • 5. attend to eye injuries
    • 6. treat skin injuries
    • 7. call for help
  16. simplest method for triaging clients
    AHA principles: ABC's
  17. what must be doen if any of the ABC's are not functioning
    heimlich or CPR
  18. commonly used triage classifications
    • emergent
    • urgent
    • nonurgent
  19. triage classifications for clinets that require immediate care in order to sustain life or limb ex. foreign bodies in eye, cardiopulmonary arrest, SOB, birth
    emergent
  20. triage classification that requires care within 1-2 hours to prevent worsening of condition ex. abdominal pain or compound fracture
    urgent
  21. triage classification for clients that can be delayed without the risk for permanent consequences ex. contusions or sprains
    nonurgent
  22. charaaterized as, when there are more vicitms than health care providers
    mass caulaty incidence
  23. similiar hospital triage system established by the incident command systems during an MCI or diaster where victims are rapidly color coded based on respiration, perfusion, mental status
    • START system
    • (SIMPLE TRIAGE RAPID TREATMENT)
  24. ____ tag for:
    • shock
    • severe head injury
    • risk for death
  25. ____ tag for:

    serious injuries, but respirations < 30/min, cap refill <2/sec, and can follow simple commands

    *can get delayed treatment
    yellow
  26. ___ tag:

    minor injuries

    Tx?
    green

    reassurance & transportation
  27. ___ tag:

    deceased
    or going to be deceased
    navy
  28. Aka EMT-B (basic) / First Responder

    Trained to provide basic lifesaving
    measures prior to arrival at hospital
    Emergency medical technician (EMT)
  29. Emergency Medical Service that is More specialized

    Trained to provide advanced life support to client requiring emergency interventions prior to arrival at hospital
    Paramedic –EMT-P
  30. ( body's inabilty to meet tissue demand for oxygen) Condition of profound hemodynamic and metabolic disturbance characterized by inadequate tissue perfusion
    shock
  31. shock can be a result of:
    • trauma
    • injury
    • insult
  32. what should be done during shock that is critical to a clients survival
    recognize and treat immediately
  33. Major types of shock:
    Hypovolemic

    Distributive = Septic, anaphylactic, and neurogenic

    Obstructive

    Cardiogenic
  34. type of shock that is easily recognized and results from severe fluid volume depletion through vomiting, dehydration, diarrhea, or blood loss
    Hypovolemic – loss of fluid volume
  35. most common cardiogenic shock
    acute MI (heart attack)
  36. type of shock that can be caused by several different heart conditions that esult in loss of the contractile property of the heart muscle
    Cardiogenic – loss of heart contractility
  37. type of shock that results from vasodilation and abnormal fluid distribution within circulatory system
    Distributive – loss of adequate circulatory system = Septic, anaphylactic, neurogenic
  38. type of shock usally caused by overwhelming infection which results in circulatory system collapse

    ex. urogenic, gram negative, toxic shock
    septic shock
  39. type of shock caused by a severe allergic reaction to toxin such as insect bites or medication
    anaphylactic shock
  40. type of shock caused by body's response to extreme pain or trauma to the spinal cord results from inadequete supply of oxygen or electrolytes
    neurogenic shock
  41. type of shock that results from indirect pump failure that leads to decreased cardiac function and reduced circulation results from pulmonary embolism, pulmonary HTN, arterial stenosis, cardiac tamponade
    Obstructive
  42. Tx for hypovolemic shock
    Restore volume
  43. Tx for cardiogenic shock
    Improve myocardial function (maintain ABC's)
  44. Tx for septic shock
    Give IV antibiotics and fluids
  45. Tx for neurogenic shock
    Give medications for hypotension
  46. Tx for anaphylactic shock
    Identify cause
  47. Tx for obstructive shock
    Identify and treat cause
  48. early stage s/s of shock
    no clinical evidence

    may have incresed HR, restlessness, sense of impending doom
  49. S/S of compensatory stage of shock
    • hyperglycemia
    • increased RR/HR
    • decrease urine ouput
    • weak pulse
    • hypoactive bowels
    • cold clammy skin
  50. s/s of progressive stage of shock
    • rapid pulse
    • BP < 80
    • peripheral edema
    • crackles/wheezing
    • unresponsiveness
    • metabolic acidotic
  51. s/s of refractory stage of shock
    cell death adn tissue damage from lack of oxygen

    multiple organ failure resulting in death
  52. immediate medical priority of shock
    maintain ABC's then stop bleeding
  53. pharmacological priority of shock
    • Oxygen
    • IV
    • epinephrine - improve circulation
  54. nursing mgnt focus
    identify shock and intervene
  55. Emergencies that jeopardize function of heart and lungs

    May result from trauma or illness
    Cardiopulmonary Emergency
  56. near drowning episodes occur more during ______ and injuries for drowning include _____&_____ injuries
    summer

    head & spinal cord
  57. foreign body obstruction of the airway most commonly occurs in _____ area
    larger right main bronchus
  58. most common source of airway obstruction is?
    the tongue
  59. type of injuries that puncture the chest such as knife or gunshot wound
    penetrating
  60. _____ trauma is more likely caused by falls or forceful trauma by an object such as bat or steering wheel
    blunt
  61. with cardiopulmonary emergencies what is one of the most complained of s/s in the ED
    chest pain
  62. medical management of cardiopulmonary emergency
    • maintain ABC's
    • Intubate as needed
    • Establish IV line for lifesaving meds
  63. medication of choice for clients with cardiopulmonary emergency who is experiencig pain and anxiety
    morphine - decreases pain and anxiety = improved breathing
  64. defined as instability of the chest caused by fracture of 3 or more ribs in 2 or more places. segments move inward during inspiration and outward during expiration (paradoxical breathing)
    flail chest
  65. during near drowning episodes what type of meds are usually given for fluid overload
    mannitol or lasix
  66. ____ may occur as a result of deep breathing from pain
    hypoventilation
  67. encourage ____ in clients with cardio problems to prevent pneumonia
    turning and deep breathing
  68. activity for cardiopulmonary emergency clients
    bedrest with log rolls if necessary
  69. common type of neurological trauma most often associated with MVC and vary from minor to major
    head injuries
  70. called strokes or brain strokes that occur in different areas of the brain when starved for oxygen or hypoxic
    cerbrovascular accident
  71. ischemc sroke is caused by?
    blood clot
  72. hemorrhagic stroke is caused by?
    bleeding blood vessel
  73. s/s of stroke
    • mild confusion
    • fascial droop
    • unresponsiveness
  74. altered level of consciousness (LOC) need to be evaluated quickly, exact time of onset should also be established if possible bc it can be caused by?
    • stroke
    • hypoglycemia
    • drug overdose
    • electrolyte imbalance
    • carbon monoxide poisoning
    • drug overdose
  75. _____ should be done for hypoglycemics to protect the brain from more insult
    prompt restoration of blood glucose

    supplemental oxygen PRN
  76. trauma mgnt is aimed at?
    maintaing ABC's
  77. if client with neurological emergency does not have spontaneous respirations or is nor independently breathing what can be expected
    injury in C4 or above
  78. neuro clients are frequently monitored for HA, widened pulse, emesis w/out warning, dilated pupils, ominous sign of HICCUPS bc this can indicate?
    ICP (increased intracranial pressure)
  79. neuro screening test that measures a clients best verbal and motor and eye response to stimuli
    glasgow coma scale
  80. Pharm mgmt for ICP
    give oxygen immediately
  81. neuro client activity level with head injuries
    semi fowlers to decrease ICP and edema
  82. nursing mgmt for neuro emergency clients
    • give oxygen
    • monitor vitals
    • maintain semi fowlers position
    • assess with coma scale
  83. head injuris with clear fluid coming from the nares or ears can indicate?
    cerebrospinal leak
  84. Range from simple contusion and brusing, to ruptured
    spleen or illnesses from gastroenteritis to GI bleeding
    abdominal emergency
  85. intial mgmt for abdominal emergency
    • IV access
    • oxygen
    • ABCs
    • blood products
    • NG tube
    • x-ray and labs
  86. presence of blood in abdominal emergencies indicate?
    immediate surgical intervention (internal bleeding)
  87. if loops of intestines are exposed to outside air ____ should be done
    cover with saline soaked gauze
  88. Forceful, threatening sexual penetration with nonconsenting person inclusive to persons who are intoxicated or have mental illness.

    called alleged sexual assault for surviviors
    rape
  89. for GU emergencies with blood seen at the external urethral meatus ______ should be suspected and _____ should be avoided
    urethral tear

    catherization
  90. ____ is prescibed for rape victims to avoid STI, and ____ should be avoided before specimen collection
    antibiotics, blood & pregnancy test, morning after pill

    douching/bathing
  91. when should rape clients resume sexual activity?
    when they are ready
  92. When client falls while straddling object
    straddle injury
  93. Foreign bodies, impaled objects, and avulsed eyeballs
    ocular emergency
  94. primary goal of ocular emergency
    Restore health of eye
  95. leading cause of accidental blindness
    retinal detachment
  96. why is it necessary to patch both eyes in ocular emergencies while protecting and waiting for definitive treatment
    bc both eyes move together, decreased movement will help to prevent and heal better
  97. prophylactic measures for all eye trauma
    antibiotic eye meds
  98. diet for ocular emergency
    NPO PRN otherwise no change in diet
  99. activity for ocular injury
    semi fowler to prevent intracular edema
  100. Overstretching of muscle
    muscle strain
  101. Twisting of joint and partial rupture of ligaments often in wrist or ankle
    sprain
  102. Bone displacement from joint often in fingers and toes
    dislocation
  103. care is given to cardiopulmonary system for long bone fracture bc?
    fat emboli devlops and can cause severe respiratory problems
  104. initial Tx for sprains
    • RICE
    • (rest, ice, compression, elevation)
  105. ___ is given for any client with an open musculoskeletal injury
    tetanus toxoid
  106. pharm mgmt for sprains and strains
    • advil
    • motrin
    • NSAIDS
  107. to reduce atrophying in muscles when casted ___ should be encouraged
    contracting and releasing muscle area
  108. Break in continuity of bon
    fracture
  109. Minor abrasions, lacerations, puncture wounds, contusions, bites of all varieties, and burns
    soft tissue emergency
  110. with soft tissue emergencies why do cleints seek medical attention
    fear
  111. protocal for all skin emergencies
    cleaning & debridement
  112. type of dressing for burns after debridement
    silvadene
  113. best intervention to prevent rapid spread of venom for snake bites
    rubber band above site
  114. any substance that causes harm to bodyand may be tasteless, odorless, colorless and can be accidental or intentional and must be treated as an emergency
    poisoning
  115. common type of poisoning
    ingested
  116. most important aspect of safe effective poisoning Tx is
    accurate identification of substance
  117. best source for antidote info
    poison control
  118. during poisoning client should immediately _______
    call poison control
  119. poison control hotline
    1800-222-1222
  120. pharmalogical protocol
    activated charcoal
  121. #1 priority for poisoning
    ABCs
  122. imperitive intervention for hypothermic or frost biten client
    rewarming
  123. heat stroke vitals taken where
    rectal core temp
  124. heat stroke sysptoms
    • red
    • flushed
    • hot dry skin
    • no sweating
  125. hypothermic clients:

    core temp should be at least at
    34.4 c / 94 f
  126. heat injuries _____ is imperitve
    reducing body temp

    • oxygen
    • pour cool water
    • cold IV's
    • fanning
  127. cleint with 8 gray radiation measurement
    would die
  128. Extreme heat can decrease body’s ability to ____
    cool
  129. •Injury sustained in more than one body system

    •Blunt injuries and penetrating trauma

    •Treatment:

    –Immediately manage ABCs, control
    bleeding, remove clothing to visualize injuries, start IV line, administer
    tetanus, and obtain labs and x-rays
    multiple system trauma
  130. “Dirty bombs” and attacks on nuclear facilities

    Effects would be severe and widespread

    Amount of radiation absorbed determines effects on client

    Causes hematopoietic, GI, cerebrovascular, and skin symptoms
    nuclear terrorism
  131. Nerve, pulmonary, cyanide, vesicant, and
    incapacitating agents

    All clients exposed to chemical agents
    must be decontaminated

    Treatment determined by type of agent
    used
    chemical terrorism
  132. Deliberate releasing of pathogenic microorganisms into community: E.g., viruses, bacteria, fungi, toxins

    CDC’s categories for agents: A, B, and C

    Treatment determined by type of agent used
    bioterrosim
  133. ______ provide protection against malpractice to people who stop at scene of accident and render safe and appropriate care
    Good Samaritan laws
  134. Medical personnel may care for clients without obtaining informed consent in emergencies

    T/F
    true

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