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Chapter 33

Chapter 33. Emergency Nursing. Emergency Care Area. Requirements Central location Easy access Dedicated “crash table ” Basic necessary equipment Oxygen source Suction unit Surgical lighting Multiple electrical outlets. Crash Cart.

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Chapter 33

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  1. Chapter 33 Emergency Nursing

  2. Emergency Care Area Requirements Central location Easy access Dedicated “crash table” Basic necessary equipment Oxygen source Suction unit Surgical lighting Multiple electrical outlets

  3. Crash Cart • Organize and prioritize drawers according to the ABC’s • A=airway • B=breathing • Thoracocentesis materials for emergency respiratory patient • Venous access (C=circulation) • Venous access drawer • Various size and length catheters

  4. Emergency Drugs Well organized and labelled Current dose chart Syringes and saline flush nearby

  5. Laboratory Equipment Minimum database “QATS” Lactate testing Additional point of care testing Blood gases Coagulation testing Commercial test kits Ethylene glycol

  6. Fluid Therapy • Goals and objectives • Maintaining hydration • Replacing fluid losses • Treatment of shock • Treatment of hypoproteinemia • Increase urine output • Correcting acid–base or electrolyte disturbances • Providing nutritional support

  7. Fluid Therapy in Shock To correct poor perfusion, replace deficits rapidly Goal: expand and maintain the intravascular space Shock fluid rates Combination of therapy crystalloids and colloids

  8. Principles of Triage Set protocols for a consistent, thorough response CRASH PLAN Be well-organized Expect the unexpected

  9. Respiratory Emergencies Goals Provide oxygen in the least stressful route Keep patient calm Obtain patient history Complete physical examination Baseline lab data IF possible

  10. Routes of Oxygen Administration Oxygen cage Oxygen hood Flow-by oxygen Face mask Nasal oxygen Endotracheal oxygen

  11. Assessing Respiratory Function Respiratory effort Respiratory pattern Mucous membrane color Pulse quality and rhythm Heart rate Auscultation

  12. Respiratory Emergencies Insufficiencies resulting from trauma Upper airway trauma/rupture Pneumothorax Hemothorax Pulmonary contusions Diaphragmatic hernia Flail chest

  13. Respiratory Emergencies Rapid recognition imperative Clinical signs of: Upper airway trauma Bloody respiratory discharge Increased respiratory effort Subcutaneous emphysema Increased upper airway noise

  14. Respiratory Emergencies Pneumothorax and hemothorax Rapid shallow breathing Poor or restrictive chest expansion Respiratory distress Flail chest Independently moveable segment of the chest wall Paradoxical motion during respirations

  15. Respiratory Emergencies Stabilization techniques and diagnostics Oxygen therapy Thoracocentesis Thoracic drain placement Diagnostics Thoracic radiographs pulse oximetry Arterial blood gas analysis

  16. Cardiovascular Triage Physical examination techniques MM color Capillary refill time Pulse quality Heart rate Jugular vein evaluation Cardiac auscultation

  17. Cardiovascular Triage Monitoring ECG Blood pressure Baseline laboratory values

  18. Hemorrhage Protocols • Pressure bandage techniques • Minimum laboratory database • Peripheral serial PCV/TS • Diagnostic procedures • Thoracocentesis • Abdominocentesis • PCV/TS of collected fluid

  19. Neurological Emergencies Protocols for stabilization Assess respiratory function Assess cardiac function Assess mentation Dull mentation may signal head trauma

  20. Head Trauma Clinical signs Poor mentation Anisocoria Nystagmus Abnormal pupillary light response (PLR) Head tilt or turn Abnormal gait

  21. Head Trauma Treatment Oxygen therapy Fluid therapy to maintain perfusion Pharmaceuticals Mannitol Lasix

  22. Spinal and Orthopedic Injuries Goals Maintain perfusion Fluids Pain medications Supportive bandaging Wound care

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