Emergency Care

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Author:
ashlynn4787
ID:
290213
Filename:
Emergency Care
Updated:
2014-11-29 14:19:04
Tags:
Emergency Care Nursing
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Description:
Trauma, environmental injuries, poisoning
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  1. Triage (ESI)
    ESI-1: Resuscitative

    ESI-2: Emergent

    ESI-3: Urgent

    ESI-4: Non-urgent

    ESI-5: Minor
  2. ESI-1
    • Resuscitative
    • Life-threatening condition
    • Needs immediate treatment
    • Unstable vitals
  3. ESI-2
    • Emergent
    • not immediately life threatening but potential to deteriorate rapidly
    • condition requires time sensitive treatment- seen in minutes
    • unstable vitals or compensating
  4. ESI-3
    • Ask yourselfs: Can I walk away?
    • Urgent
    • Non life-threatening condition: yet!
    • seen within 1hour: stable vitals
    • requires 2 or more sources to provide care
  5. ESI-4
    • Non-urgent
    • non life-threatening
    • treatment can be delayed
    • requires one source to provide care
    • ex: fracture
  6. ESI-5
    • minor
    • exam only
    • should of went to doctor
  7. Primary Survey
    • ABCDEs
    • A-Airway
    • B-Breathing
    • C-Circulation
    • D-Disability (neuro)
    • E-Environment/Exposure
  8. Secondary Survey
    • Reassess
    • H&P (ample)
    • diagnostic and lab testing
    • insertion of monitoring devices
    • other pt interventions: splinting of suspected fractures & cleaning and dressing wound
  9. AMPLE
    • H&P (Clues)
    • A-Allergies
    • M-Medications
    • P-Past medical HX
    • L-Last meal
    • E-Events: what led to them coming in
  10. Acute Airway Obstruction
    • foreign body
    • anaphylaxis
    • trauma
    • inhalation injury
  11. Altered Breathing Patterns
    • Trauma (chest, head, spinal cord, abdominal)
    • cardiopulmonary arrest
    • toxicity (OD on drugs)
  12. Circulation
    • cardiopulmonary arrest
    • shock (all types)
    • hemorrhage
  13. Managing Hemorrhage
    • Fluid replacement:
    • rapid infusion of isotonic solutions (NS or LR)
    • volume expander (dextran)
    • blood components

    • Control of External Hemorrhage:
    • apply direct pressure to area
    • If uncontrolled apply pressure to artery proximally
    • use tourniquet as last resort
    • venous or capillary bleeding try pressure dressing

    • Control of Internal bleeding:
    • look for s/s of internal bleeding
    • -Tachy, BP difficult to maintain, thirst, cool/moist skin, fear (feel doomed)
    • Rapid infusion of fluids and packed RBCs
    • Prepare for surgery or procedure
  14. Disability
    • Neruo and neurovascular deficits
    • Strokes
    • decrease in LOC. unequal pupils
    • AVPU
  15. AVPU
    • A-alert
    • V-voice
    • P-pain
    • U-unresponsive
  16. Exposure/Environment
    • frostbite
    • burns
    • hypothermia
    • ED environment
  17. Abdominal Trauma
    Primary Survey
    • Blunt Trauma:
    • Caused by a direct force to the abdomen
    • ex- MVA, Falls, Punch
    • Ruptured Diaphragm: respiratory distress, surgical emergency, mechanical ventilation
    • Internal bleeding: Assess and mange hypovolemic shock

    • Pentrating Trauma:
    • causes by a foreign object that leaves an opening
    • ex- stab wound, GSW
    • Consider multiple wounds
    • External bleeding: direct pressure, stablize object (do not remove), Cover protruding viscera with saline soaked gauze
  18. Abdominal Trauma
    Secondary Survey
    • Inspect: assess front, flank and back for...
    • bluish discoloration, asymmetry, abrasions & contusions
    • Cullen's sign: bluish discoloration around umbilicus
    • Turner's Sign: ecchymosis in the flank (usually kidneys)

    • Auscultate: bowel sounds and location
    • absent bowel sounds may indicate intreperiotoneal injury or stress

    • Palpate: pain, rebound tenderness
    • Left shoulder: ruptured slpeen
    • Right Shoulder: lacerated liver

    Rectal/vaginal examination
  19. Cullen's sign
    bluish discoloration around umbilicus
  20. Turner's sign
    ecchymosis in the flank (kidneys)
  21. Left shoulder pain
    ruptured spleen
  22. Right shoulder pain
    lacerated liver
  23. Aortic tear
    • S/S
    • exsanguination (bleeding out) into chest
    • skin above nipple line is normal
    • skin below nipple line is cool, clammy and pale
    • radial and carotid pulse stronger than femoral

    • TX
    • surgical repair
  24. Beck's triad
    • decreased BP
    • Decreasd heart sounds
    • distended jugular veins

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