Emergency Nursing

prevention of heat related illness..

Avoid alcohol and caffeine. Prevent overexposure to the sun; use a sunscreen with an SPF of at least 30 with UVA and UVB protection. Rest frequently, and take breaks from being in a hot environment. Plan to limit activity at the hottest time of day. Wear clothing suited to the environment. Lightweight, light-colored, and loose-fitting clothing is best. Pay attention to your personal physical limitations; modify activities accordingly. take cool baths or showers to reduce body temp Stay indoors in air-conditioned buildings, if possible. Ask a neighbor, friend, or family member to check on the older adult at least twice a day during a heat wave. SPF, Sun protection factor; UVA, ultraviolet A; UVB, ultraviolet B.

diagnosing botulism

some of these tests are: Brain scan Spinal fluid examination Nerve and muscle function tests (nerve conduction study [NCS] and electromyography [EMG]) Tensilon test for myasthenia gravis

what does the secondary survey consist of?

(F) Fahrenheit - prevent heat loss - use of warmed IV solutions and blankets (G) Get vital signs, cardiac monitor, pulse oximetry, urinary catheter, NG tube, labs, and diagnostics (H) History and Head-to-toe assessment - checking for any obvious injuries, hidden deformities, impaled objects, bruises, bleeding, and any complaints of pain. 1. Head and face 2. Neck 3. Chest 4. Abdomen and flanks 5. Pelvis and perineum 6. Extremities 7. Posterior surface

Primary survey: Exposure

1. Remove all clothing to facilitate a thorough examination; use caution when preserving evidence; care to prevent hypothermia 2. Assess for any hazardous chemicals/impaled objects, gun shots

management of poisonings

A-B-C's take priority IV access naloxone for respiratory depression resulting from Opiods Prepare 0.4 mg in 10 mL NSS - administer 0.5 mL every 2 mins as needed flumazenil for benzodiazepine ingestion Administer 0.2 mg IV, repeating 0.3 mg every 30 seconds - max 3mg Decrease the ingestion of drug by inducing vomiting (contraindicated with altered LOC), administering activated charcoal, and cathartics to evacuate the bowel Continuous vs, neurologic & cardiac monitoring: treat life threatening dysrhythmias

Paramedics---EMT-P

Advanced Life Support providers Perform advanced techniques such as cardiac monitoring, airway management and intubation, establishing intravenous access, administration of medications en route to the ED

The primary survey... Airway/Cervical Spine

Airway/cervical spine immobilization 1. Assess airway and maintain patency 2. Interventions - chin lift/jaw thrust; suction; oro- or naso- pharengeal intubation; cricothyroidotomy; tracheostomy

s/s of tularemia

All forms are accompanied by fever, which can be as high as 104 °F. Main forms of this disease are listed below: Ulceroglandular This is the most common form of tularemia and usually occurs following a tick or deer fly bite or after handing of an infected animal. A skin ulcer appears at the site where the bacteria entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin. Glandular Similar to ulceroglandular tularemia but without an ulcer. Also generally acquired through the bite of an infected tick or deer fly or from handling sick or dead animals. Oculoglandular This form occurs when the bacteria enter through the eye. This can occur when a person is butchering an infected animal and touches his or her eyes. Symptoms include irritation and inflammation of the eye and swelling of lymph glands in front of the ear. Oropharyngeal This form results from eating or drinking contaminated food or water. Patients with orophyangeal tularemia may have sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck. Pneumonic This is the most serious form of tularemia. Symptoms include cough, chest pain, and difficulty breathing. This form results from breathing dusts or aerosols containing the organism. It can also occur when other forms of tularemia (e.g. ulceroglandular) are left untreated and the bacteria spread through the bloodstream to the lungs. Typhoidal This form is characterized by any combination of the general symptoms (without the localizing symptoms of other syndromes)

Bioterrorism agents

Anthrax - spread through air Plague - spread through fleas Smallpox - vaccine incubated in eggs; Contact spread. Small pox was eradicated in the 1970's and the discontinuation of worldwide vaccination, have opened the door for this virus to be used as a weapon Botulism - most lethal substance known to man; Contact spread; Very toxic in contained areas or through a food vector Viral Hemorrhagic Fever (Ebola) - internal and external bleeding; do not occur naturally in the united states; close contact with infected individuals or bites from infected animals; Spread easily through contact with body fluids or droplet spread Tularemia - infected by bites from blood sucking insect, handling meat and skins of infected animals, contaminated food or water, breathing in the bacteria. Occurs naturally and can be purchased from commercial sources. Most commonly spread by air or water/food

primary survey: Disability

Assess with a brief neurologic exam A: Alert V: Responsive to verbal stimuli P: Responsive to pain U: Unresponsive Glasgow Coma Scale 2. Interventions - continual reassessment while identifying causes - metabolic abnormalities, hypoxia, neuro injuries

Primary Survey-- Circulation/Control Hemmorage

Assess for presence of adequate circulation Presence of radial pulse: BP at least 80 mm Hg Presence of femoral pulse: BP at least 70 mm Hg Presence of carotid pulse: BP at least 60 mm Hg External hemorrhage vs. internal hemorrhage - presents with shock 2. Interventions - direct pressure to control bleeding, IV access 16 gauge AC, fluid volume replacement with warmed RL or normal saline, blood or blood products, CPR, pericardiocentesis, autotransfusion

core nursing competencies in ED

Assessment - rapidly and accurately assess according to client acuity and age Priority setting/Critical thinking skills - depends on accurate assessment Knowledge of emergency care - broad base of medical-surgical diseases emergency care principles of recognition, management, and legal implications of societal problems

chest pain in the ED

Assume pain is cardiac until you prove otherwise - always triage as Emergent Angina: chest pain or discomfort d/t myocardial ischemia.

management for heat stroke

At the scene: airway, remove from environment, remove clothes, poor cool water over body, fan patient (EVERYONE AROUND), place ice on them if available, contact ED. At hopsital: O2, prepare endotrach, start at least one large bore needle, admin 0.9% NS, cooling blanket, DO NOT GIVE ASPIRIN, insert cath, monitor VS, obtain baseline lab tests, assess ABGs, administer relaxants, measure uo

Primary Survey-- Breathing

Auscultate breath sounds; evaluate chest excursion, respiratory effort, evidence of chest wall trauma; observe for distended neck veins, retractions, tracheal deviation, subcutaneous emphysema 2. Interventions - oxygen, BVM ventilation, chest tube insertion, cover open chest wound, needle thoracostomy, pressure dressing for flail chest

EMTs

Basic Life Support providers Administer oxygen, provide basic wound care, spinal immobilization, vital sign monitoring, may be authorized to use EpiPen or Nitroglycerine

anthropod bites and stings

Bites from brown recluse spiders result in ulcerative lesions. Central bite appears as a bleb or vesicle. Use cold compress (never heat). dapsone may be given orally. Debridement and skin grafting may assist wound healing

Tension Pneumothorax

Blunt penetrating trauma, fractured ribs, barotraumas, injured tracheobronchial tree, infection Results in hyperinflation, lung collapse on injured side, mediastinal shift unaffected side => compressed vena cava, ↓cardiac output

lightning injuries

Both the cardiopulmonary and the CNS are profoundly affected by lightning injuries. Most lethal initial effect on the cardiopulmonary system is asystole or ventricular fibrillation. Treatment includes immediate CPR. Rescuer is in no danger of electrical charge from contact with the victim

management of Airway Obstruction

Chin-lift, jaw thrust maneuver, endotracheal intubation, cricothoracotomy, tracheostomy Anticipate antibiotics, bronchodilators, and sedation for intubation

Head Trauma nursing interventions

Control the pt. Environment, decrease stimuli. Maintain airway needs & provide O2 Continuous assessment of neurologic status, changes, VS, and increased ICP. Mental status: check arousal, language, memory LOC Cranial Nerve assessment Motor status: spontaneous movement, muscle strength, tone. Sensory: sensation to stimuli Respiratory: check respiratory pattern and rate

what is a secondary survey?

Comprehensive head-to-toe assessment to identify other injuries or medical issues that need to be managed or that impact the course of treatment

No scabs ..small pox

Contagious? No. Four weeks after the rash appears, all scabs should have fallen off. Once all scabs have fallen off, the person is no longer contagious.

assessment for uncontrolled hemm

Cool, clammy, pale skin and extremities, delayed cap refill, weak, thready pulses, hypotension, tachypnea, ↓ LOC, cardiac dysrhythmias, ↓ urinary output

Debriefing

Critical Incident Stress Management program should be implemented -Addresses pre-crisis through post-crisis interventions for all involved -PTSD can lead to multiple characteristic psychological and physical effects. Administrative review functions to analyze the response effort while it is still in the` forefront of concern by those who participated

uncontrolled hemmorage

Decreased tissue perfusion results in hypoxia, vasoconstriction, and blood shunting Metabolic acidosis, multi-organ system failure, respiratory failure and cardiac arrest can result

drug overdose assessment

Depends upon substance ingested - nausea, vomiting, CNS depression or agitation, altered papillary response, altered respiration and temperature control, seizures, cardiac arrest

Snake Bites

Determine whether envenomation from a North American pit viper. Keep bitten extremity below the heart. Obtain hospital acute care as soon as possible. crotalidae polyvalent immune fab (Crofab)therapy treats bites of all North American and South American crotalids. Coral snake bite requires continuous monitoring

client and family health teaching in the ED

Discharge teaching Community health teaching Injury prevention - including seat belt use, smoke and CO2 detectors, fall prevention, disease specific education

assessment of flail chest

Dyspnea, poor air movement, chest wall pain, ecchymosis, splinting respirations, hypoxia, pain on inspiration, paradoxical chest wall movement, subcutaneous emphysema

mass casualty principles:

ED personnel undergo hazardous material training and recognition of patterns of illness that could be indicative of biologic terrorism agents.

Mandatory reporting

Each hospital has a list of reportable incidents that are mandated by law to report, including: Child abuse Spousal abuse Client abuse in hospitals/nursing homes Attempted suicide Animal bites Illegal abortions Reportable illnesses - HIV, tuberculosis, syphilis, bioterrorism

Patient edu and COLD environments

Educate people how to prepare for cold environments, including proper clothing (no cotton) and avoidance of wind and wet weather

Scorpion Sting

Effects of a sting that injects venom from a scorpion are typically self-limiting and best treated by analgesics, supportive management, and basic wound care. One species of scorpion can inflict a sting associated with a severe, potentially fatal systemic response.

presentation of heat STROKE

Elevated body temperature > 105 degrees F or 40.5 degrees C Mental status changes, anxiety, and confusion Hypotension Tachycardia Tachypnea Severe renal impairment and disseminated intravascular coagulation

altitude related illnesses

Elevations > 5000 ft can produce physiologic consequences as a result of lowered levels of available oxygen. Hypoxia can result in AMS, ACE, and HAPE. Relocate the victim to a safer, lower altitude; oxygen should be administered

Burns: emergent phase and goals

Emergent phase of burn injury First phase continues for 48 hours. Goals of management include-- Secure airway Fluid replacement Prevent infection Maintain body temp Provide emotional support

Black widow spider bite treatment

Envenomation produces latrodectism, severe abdominal pain, muscle rigidity and spasm, hypertension, and nausea and vomiting. Other symptoms include facial edema, ptosis, diaphoresis, weakness, increased salivation, priapism, respiratory difficulty, increased respiratory secretions, fasciculations, and paresthesias. Treat with ice pack and transfer to a medical facility as soon as possible

Airway obstruction: etiology and assessment

Etiology-- Facial & Neck Trauma Mechanical Obstruction Allergic Reactions, infection, exposure to chemical irritants Medical and Neurologic conditions Assessment: Inabilities to cough, breathe, or speak Stridor, wheezing, choking, gagging Late manifestations - cyanosis, SOB, altered LOC, bradycardia, hypotension, cardiopulmonary arrest

HYPOTHERMIA or FROSTBITE

Exposure to cold results in loss of body heat and vasoconstriction to preserve core body Heat

management of penetrating injury

Extent of organ and tissue damage determines management Anticipate tetanus immunization, antibiotics and analgesics

nursing assessment for traumatic amputation

Extremity assessment Q1-2 hours, comparing affected to unaffected extremity Affected extremity should remain elevated and cooled to promote venous return and minimize edema. Turning and positioning the immobilized pt. is essential to prevent skin breakdown. Antibiotic therapy to prevent infection Ongoing Cardiovascular assessments, VS, neurologic evaluations, pulse ox and fluid volume status are a must for any traumatic musculoskeletal injury

Case management in the ED

Facilitate referrals to PCP, disease management programs, working with homeless and victims of domestic violence

kinds of botulism

Foodborne botulism can happen by eating foods that have been contaminated with botulinum toxin. Common sources of foodborne botulism are homemade foods that have been improperly canned, preserved, or fermented. Though uncommon, store-bought foods also can be contaminated with botulinum toxin. Wound botulism can happen if the spores of the bacteria get into a wound and make a toxin. People who inject drugs have a greater chance of getting wound botulism. Wound botulism has also occurred in people after a traumatic injury, such as a motorcycle accident, or surgery. Infant botulism can happen if the spores of the bacteria get into an infant's intestines. The spores grow and produce the toxin which causes illness. Adult intestinal toxemia (also known as adult intestinal toxemia) botulism is a very rare kind of botulism that can happen if the spores of the bacteria get into an adult's intestines, grow, and produce the toxin (similar to infant botulism). Although we don't know why people get this kind of botulism, people who have serious health conditions that affect the gut may be more likely to get sick. Iatrogenic botulism can happen if too much botulinum toxin is injected for cosmetic reasons, such as for wrinkles, or medical reasons, such as for migraine headaches.

Frost bite def and interventions

Frostbite is accompanied by initial pain, loss of sensation and paresthesia; area may be edematous, red, blistered, white, hard and cold t touch, or necrotic pallor of affected area. Remove from cold and immerse the areas in warm water Do not rub the affected area - it can cause more tissue damage Deep frostbite requires aggressive management in a medical facility Newly thawed area will be very painful Anticipate tetanus prophylaxis, topical and parenteral antibiotics, and analgesics

management of near drowning event

Handle the pt. gently, a cold heart can cause ventricular fibrillation with rough handling if core body temp below 32*C (90*F). Continuous temperature monitoring with rectal probe, intrabladder catheter, or esophageal probe \ Recovery after submersion Safe rescue of the victim After removal from the water, airway and cardiopulmonary support interventions, including CPR if necessary Establish patent airway - intubation and mechanical ventilation IV access - LR for salt water submersion; NSS for freshwater drowning Anticipate epinephrine, amiodarone, atropine for cardiac arrest; sodium bicarbonate for acidosis. Steroids, bronchodilators, and isoproteronel for edema and bronchospasm; antibiotic

heat related illnesses

Heat exhaustion is a syndrome primarily caused by dehydration, stemming from heavy perspiration and inadequate fluid and electrolyte consumption during heat exposure over a period of hours to days. Treatment involves immediate termination of physical activity and transfer to a cool place

heat stroke

Heat stroke is a true medical emergency, with a mortality rate that can approach 80% for individuals not effectively treated in a timely manner. Sudden onset of external heat stroke is typically due to strenuous physical activity in hot, humid conditions. Classic heat stroke occurs over a period of time as a result of chronic exposure to a hot, humid environment. High rate of mortality and complications

emergency preparedness personal roles..

Hospital incident commander - assumes overall leadership for implementing Medical command physician - determines the number, acuity, and medical resource needs of the victims Triage officer - rapidly evaluates each victim, re-evaluating acuity Hospital staff - alter routine roles based upon the institutional plan Event resolution deactivates the emergency response plan

hypothermia

Hypothermia causes ↓ clotting and impairment of the immune system Occurs at core body temperature of < 95 degrees F (35 degrees C) Stabilize airway, breathing, administer oxygen Re-warming methods include blankets, packs, and heaters; heated and humidified oxygen, heated gastric lavage, heated peritoneal lavage, and heated pleural irrigation through chest tube. IF CPR & Defibrillation unsuccessful - retry after re-warmed

MVA--Blunt and multiple trauma

Hypovolemia - tachycardia, mental status changes, pale, cool skin, hypotension Respiratory distress, pneumothroax or hemothorax Blunt trauma to head - altered LOC, decreased motor ability d/t spinal fracture or damage CNS Fractures, pain swelling to extremities

post resuscitation management

Identification of medical conditions or injury that may have precipitated the event Anticipate pneumonitis & pulmonary edema May need to administer corticosteriods, PCN, furosemide Anticipate profound neurologic depression May need to administer diuretics, barbiturates; intraventricular monitoring Anticipate hemolysis, DIC, renal insufficiency

Spinal Cord immobilization

Initial treatment of suspected spinal injuries include: ABCs of resuscitation, spinal immobilization, prevention of further injury, transport to ER. Perform a complete sensory & motor neurologic examination. Maintaining spinal immobilizing devices until x-ray studies are confirmed is a must to prevent further spinal cord damage

penetrating or perforating ocular injuries

Injuries to the ocular structures are a major cause of vision loss. Failure of aggressive management of lacerations of the cornea and sclera will likely result in visual loss Major responsibility of the nurse to the client with an ocular injury includes: Monitor for signs of infection Further vision loss Increasing pain Hemorrhage or other complications These need reported to the PCP immediately!!!

psychiatric crisis nurse team

Interact with clients and families in crisis Evaluates clients with psychiatric complaints or disorders Facilitates follow-up of admission to psychiatric facility

the first aspect of EMTALA is to define what applies...

It applies when someone has come to the facility with an EMC. According to the CMS, EMTALA applies when someone is on hospital property and: 1. Requests an exam or treatment for a medical condition. 2. Has such a request made on his/her behalf. 3. A prudent layperson would believe, based on the individual's appearance and behavior, that the individual needs examination or treatment

assessment for a pneumothorax

Labored respirations, dyspnea, tachypnea, hypoxia, decreased or absent lung sounds, tracheal deviation away from injured side, ↓cardiac output

mass casualty incident is defined as...

Mass casualty incident or disaster is commonly defined based on the resource availability of a specified community or hospital facility. When the number of casualties exceeds resource capabilities, a disaster situation is declared

traumatic amputations

Massive blood loss can lead to hypovolemic shock and death if not treated quickly. This type of injury requires priority interventions to restore cardiovascular stability. Emergency measures include direct pressure & pressure dressings to the amputation site. Soft tissue edema at amputated site can cause sluggish venous return, causing increased muscle compartment volume, resulting in neurovascular compromise

assessment for poisonings CO

Mild - nausea, vomiting, headache, flu-like symptoms Moderate - dyspnea, dizziness, confusion Severe - coma, respiratory arrest, hypotension, dysrhythmia

transmission of anthrax

NOT CONTAGIOUS can get by working with infected animals, eating under cooked meat, injecting heroin

assessment of food poisoning

Nausea, vomiting, diarrhea, abdominal cramps, fever, chills, dehydration, HA

assessment of insecticide surface absorption

Nausea, vomiting, diarrhea, headache, dizziness, weakness or tremors, respiratory distress, slurred speech, seizures, cardiopulmonary arrest

nursing assessment in the emergency department

Nursing Assessment Follow established protocols Maintain privacy, dignity, and confidentiality Implement physician orders Re-assess and re-prioritize as neede

disposition in the ED

OR, interventional radiology, inpatient (Admit, observation), LTC, Home with VNA, transfer tertiary (higher level) care

education for preventing lightning strikes

Observe weather forecasts when planning to be outside Seek shelter when you hear thunder. Leave the water immediately (including an indoor shower or bathtub), and move away from any open bodies of water Avoid metal objects Once inside a building, stay away from open doors, windows, fireplaces, metal fixtures, and plumbing Turn off electrical equipment Stay off the telephone If you are caught out in the open and cannot seek shelter, attempt to move to lower ground such as a ravine or valley; place insulating material between you and the ground (e.g., sleeping pad, rain parka, life jacket). A lightning strike is imminent if your hair stands on end, you see blue halos around objects, and hear high-pitched or crackling noises. If you cannot move away from the area immediately, crouch on the balls of your feet and tuck your head down to minimize the target size

Near Drowning Event

Obtain a thorough pre-hospital history of the event, including length of submersion, treatments, and client progress. Etiology Asphyxia can be caused by laryngotracheal spasm, water filled lungs, emesis Water in lungs => removal or displacement of surfactant and increased alveolar surface tension, decreasing oxygen perfusion Chlorinated swimming pool water => a chemical pneumonitis Salt water => pulmonary edema resulting from fluid shift from vascular space to alveolar space

forensic nurse examiners

Obtain histories Collect forensic evidence Offer counseling and follow-up care for rape, child abuse and domestic violence

spinal cord evalulation

Ongoing assessment Airway & ventilation functioning. S & Urine output Further degenerative losses of movement, sensation, muscle spasms and contractures are essential for immediate interventions, including surgery or transport to a higher-level facility

management of a pneumothorax

Oxygen, needle thoracostomy, chest tube Monitor for signs of hypoxia - restlessness, anxiety, and mental status change Anticipate analgesics

patient safety in the ED

Patient Safety Client identification - focal point of care in ED Client safe from falls and skin breakdown Risk for medication errors and adverse events resulting from episodic and chaotic nature or ED management, including hospital acquired infections Vulnerable Populations: Homeless, poor, elderly

support staff in ED

Professional and ancillary staff including x-ray and ultrasound technicians, respiratory therapists, laboratory technicians, social workers

bees and wasps

Potential for anaphylactic reaction Emergency care to remove stinger and apply an ice pack Advanced emergency care in a hospital to ensure that the airway, breathing, and circulation are maintained "EpiPen" administration of epinephrine with the click of a button, which is especially valuable for allergic clients Carry a prescription epinephrine autoinjector and antihistamines if known to be allergic to bee and wasp stings. Ensure at least one family member is also able to use the autoinjector

Interdisciplinary team members: pre hopsital care providers

Pre-hospital Care Providers First caregivers encountered by client Local protocols define skill level of EMS responders

Staff safety in ED

Precautions to protect the personal safety of emergency department staff Transmission based precautions - Standard precautions Security Measures - guards, metal detectors, panic buttons, staff controlled entry, canine Recognizing volatile situations

rules of physical evidence and chain of custody in the ED

Preservation of evidence: Collecting and documenting: Recognize & preserve evidence by: Observations Collection-handling Labeling Proper storage of any materials/lab collections Photographs need to be taken prior to any treatment if possible

Respiratory emergencies in the ED

Priority nursing interventions : Establishing an open airway Airway positioning Airway foreign object removal: Heimlich Oral/nasal airway insertion ER department intubation practices The nurse will be assisting in airway management Supplemental oxygen

definition of emergency nursing

Rapid Change is the Rule" Provide care for clients across the lifespan Acuity from minor to life-threatening Most common reason clients seek ED care is pain Chest pain, abdominal pain, breathing difficulties, injuries, headache, fever Average age of person entering ED is 35.7 years Clients 75 and over generate highest ED visit rate Crowded, noisy conditions

prevention of the plague

Reduce rodent habitat around your home, work place, and recreational areas. Remove brush, rock piles, junk, cluttered firewood, and possible rodent food supplies, such as pet and wild animal food. Make your home and outbuildings rodent-proof. Wear gloves if you are handling or skinning potentially infected animals to prevent contact between your skin and the plague bacteria. Contact your local health department if you have questions about disposal of dead animals. Use repellent if you think you could be exposed to rodent fleas during activities such as camping, hiking, or working outdoors. Products containing DEET can be applied to the skin as well as clothing and products containing permethrin can be applied to clothing (always follow instructions on the label). Keep fleas off of your pets by applying flea control products. Animals that roam freely are more likely to come in contact with plague infected animals or fleas and could bring them into homes. If your pet becomes sick, seek care from a veterinarian as soon as possible. Do not allow dogs or cats that roam free in endemic areas to sleep on your bed.

Level III trauma center

Smaller, rural hospitals, serve areas will low population densities Primary focus is stabilization and patient transfer (typically with ALS ambulance or helicopter and critical care transport team)

flail chest

Result of blunt force trauma to chest

SBATIR

SBATIR Situation Brief Medical History Assessment and diagnostic findings Transmission based precautions Intervention Response to interventions

management of MVA

Serial assessment of VS, LOC, pain Treat shock with modified Trendelenburg Control obvious bleeding Two large bore IV lines with RL or NSS Nasogastric tube, urinary catheterization Closed fractures - positioning, splinting, ice, and elevation Immobilize cervical spine with cervical collar Anticipate fluid resuscitation with LR or NSS, tetanus immunizations, antibiotics, analgesics, vasopressors

organ donation

Should be considered with severe brain assault: A major head injury due to trauma A nontraumatic event from a severe stroke or ruptured aneurysm An extended anoxic event such as a near-drowning Early intervention with the family is crucial

What is triage?

Sorting or classifying clients into priority levels depends on illness or injury severity. Triage must be performed by a registered nurse, physician, or physician's assistant Clients who present to the ED with the highest acuity needs receive the soonest evaluation, treatment, and prioritized resource utilization.

Emergency medicine physicians

Specialized education and training in emergency client management - board certification

penetrating injuries

Stab wounds/Gunshot wounds Low-velocity missiles with low kinetic energy results in little dissipation as it enters the body High-velocity missiles with high kinetic energy results in much damage to tissue directly affected by the missile and those tissues affected by cavitations, shock wave, and heat of the missile

management for uncontrolled hemmorage

Stop obvious bleeding - direct pressure or surgical intervention Warmed IV fluids - RL of NSS Blood replacement - T&C Monitor cardiac rhythm, vital signs, CVP, mental status, urinary output Anticipate crystalloids and blood products, sodium bicarbonate to correct acidosis, vasopressors

management of flail chest

Supplemental oxygen to maintain oxygen saturation >90%, IV access to avoid over hydration, pain management to avoid splinting, hypoventilation and atelectasis ***Anticipate pain management with opiods, intercostals nerve blocks, epidural

Technical Skills needed in the ED

Technical skills - multitasking in a stressful, high pressure environment - assisting physician with: Suturing Foreign body removal Central line insertion Endotracheal intubation and initiation of mechanical ventilation Transvenous pacemaker insertion Lumbar puncture Pelvic examination Chest tube insertion Paracentesis Fracture management Communication Certification - BCLS, ACLS, ENPC, PALS, CEN

EMTALA

The Emergency Medical Treatment and Active Labor Act is the federal law governing patient transfers. The core of EMTALA is the statement which says that everyone presenting on hospital property requesting emergency medical treatment gets a medical screening exam (MSE) and stabilizing treatment, and that this exam is not based on anyone's ability to pay.

Tarantula bites

Urticating hairs can produce an inflammatory response in skin and mucous membranes consisting of edematous papules and intense pruritus that can last for several weeks. Treat with supportive management and analgesics. Remove hairs from skin with sticky tape followed by thorough irrigation

early rash of small pox

This stage lasts about 4 days. Contagious? Yes. At this time, the person is most contagious. A rash starts as small red spots on the tongue and in the mouth. These spots change into sores that break open and spread large amounts of the virus into the mouth and throat. The person continues to have a fever. Once the sores in the mouth start breaking down, a rash appears on the skin, starting on the face and spreading to the arms and legs, and then to the hands and feet. Usually, it spreads to all parts of the body within 24 hours. As this rash appears, the fever begins to decline, and the person may start to feel better. By the fourth day, the skin sores fill with a thick, opaque fluid and often have a dent in the center. Once the skin sores fill with fluid, the fever may rise again and remain high until scabs form over the bumps.

s/s of small pox initail

This stage lasts anywhere from 2 to 4 days. Contagious? Sometimes. Smallpox may be contagious during this phase, but is most contagious during the next 2 stages (early rash and pustular rash and scabs). The first symptoms include: High fever Head and body aches Sometimes vomiting At this time, people are usually too sick to carry on their normal activities.

a level one trauma center consists of...

Total Collaborative Care from prevention through rehabilitation Professional and community education programs, conduct research Usually located in large teaching hospital

level 2 trauma center consists of..

Usually located in community hospitals Capable of providing care to vast majority of injured patients Usually transfer patients in need of complex injury management (advanced surgery)

prevention of tularemia

When hiking, camping or working outdoors: Use insect repellents containing 20% to 30% DEET (N,N-diethyl-meta-toluamide), picaridin or IR3535. EPA provides information on the proper use of repellents. Wear long pants, long sleeves, and long socks to keep ticks and deer flies off your skin. Remove attached ticks promptly with fine-tipped tweezers. Don't drink untreated surface water. When mowing or landscaping: Don't mow over sick or dead animals. When possible, check the area for carcasses prior to mowing. Use of masks during mowing and other landscaping activities may reduce your risk of inhaling the bacteria, but this has not been studied. If you hunt, trap or skin animals: Use gloves when handling animals, especially rabbits, muskrats, prairie dogs, and other rodents. Cook game meat thoroughly before eating.

Emergency Doctrine

When the client is unconscious or unable to give consent, treatment can proceed under the doctrine, which implies consent. This frees the nurse from liability for violation of the common law. Implied consent means the client would have consented to the treatment required to maintain health when the alternative could be death or serious disability

anthrax --definition

a serious infectious disease caused by gram-positive, rod-shaped bacteria known as Bacillus anthracis. Although it is rare, people can get sick with anthrax if they come in contact with infected animals or contaminated animal products.

treatment for botulism

antitoxins*** The toxin attacks the body's nerves, and the antitoxin prevents it from causing any more harm. It does not heal the damage the toxin has already done. Depending on how severe your symptoms are, you may need to stay in the hospital for weeks or even months before you are well enough to go home. If your disease is severe, you may have breathing problems and even respiratory (breathing) failure if the toxin paralyzes the muscles involved in breathing. If that happens, your doctor may put you on a breathing machine (ventilator) until you are able to breathe on your own.

treatments for anthrax exposure

antitoxins, antibiotics, mech vent, and fluids

s/s of the plague

bubonic plague: sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form usually results from the bite of an infected flea. If the patient is not treated with the appropriate antibiotics, the bacteria can spread to other parts of the body. Septicemic plague: fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal. Pneumonic plague: fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous.

Triage functions are preformed for mass casualty using...

by mass casualty teams using tags, numbers, bracelets, labels. Class I or Emergent (red tag) immediate threat to life Class II or Urgent (yellow tag) major injuries requiring immediate treatment Class III or Nonurgent (green tag) minor injuries "Walking Wounded" Class IV or Expectant (black tag) expected or allowed to die

diagnosis of the plague

diagnosis for people who are sick and live in, or have recently traveled to, the western United States or any other plague-endemic area. The most common sign of bubonic plague is the rapid development of a swollen and painful lymph gland called a bubo

tuleremia def

disease of animals and humans caused by the bacterium Francisella tularensis. Rabbits, hares, and rodents are especially susceptible and often die in large numbers during outbreaks. Humans can become infected through several routes, including: Tick and deer fly bites Skin contact with infected animals Ingestion of contaminated water Inhalation of contaminated aerosols or agricultural dusts Laboratory exposure

signs and symptoms of botulism

double vision blurred vision drooping eyelids slurred speech difficulty swallowing a thick-feeling tongue dry mouth muscle weakness. Infants with botulism: appear lethargic feed poorly are constipated have a weak cry have poor muscle tone (appear "floppy")

plague def

ease that affects humans and other mammals. It is caused by the bacterium, Yersinia pestis. Humans usually get plague after being bitten by a rodent flea that is carrying the plague bacterium or by handling an animal infected with plague.

d(x) and t(x) of tulaeremia

emia can be difficult to diagnose. It is a rare disease, and the symptoms can be mistaken for other, more common, illnesses. For this reason, it is important to share with your health care provider any likely exposures, such as tick and deer fly bites, or contact with sick or dead animals. Blood tests and cultures can help confirm the diagnosis. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for several weeks, most patients completely recove

small pox vaccine

ere is no proven treatment for smallpox disease, but some antiviral drugs may help treat it or prevent it from getting worse. Smallpox Vaccine Smallpox can be prevented by the smallpox vaccine. If you get the vaccine: Before contact with the virus, the vaccine can protect you from getting sick. Within 3 days of being exposed to the virus, the vaccine might protect you from getting the disease. If you still get the disease, you might get much less sick than an unvaccinated person would. Within 4 to 7 days of being exposed to the virus, the vaccine likely gives you some protection from the disease. If you still get the disease, you might not get as sick as an unvaccinated person would

s/s of inhalation anthrax

ever and chills Chest Discomfort Shortness of breath Confusion or dizziness Cough Nausea, vomiting, or stomach pains Headache Sweats (often drenching) Extreme tiredness Body aches

d(x) anthrax exposure

f inhalation anthrax is suspected, chest X-rays or CT scans can confirm if the patient has mediastinal widening or pleural effusion, which are X-ray findings typically seen in patients with inhalation anthrax. The only ways to confirm an Anthrax diagnosis are: To measure antibodies or toxin in blood To test directly for Bacillus anthracis in a sample blood skin lesion swab spinal fluid respiratory secretions Samples must be taken before the patient begins taking antibiotics for treatment.

consent of treatment...

failure to obtain consent for treatment will subject the professional to a lawsuit. OBTAIN INFORMED CONSENT

s/s of cutaneous anthrax

group of small blisters or bumps that may itch Swelling can occur around the sore A painless skin sore (ulcer) with a black center that appears after the small blisters or bumps Most often the sore will be on the face, neck, arms, or hands

s/s of small pox--incubation prd

his stage can last anywhere from 7 to 19 days (although the average length is 10 to 14 days). Contagious? No The incubation period is the length of time the virus is in a person's body before they look or feel sick. During this period, a person usually has no symptoms and may feel fine

pustular rash and scabs for small pox

his stage lasts about 10 days. Contagious? Yes The sores become pustules (sharply raised, usually round and firm to the touch, like peas under the skin). After about 5 days, the pustules begin to form a crust and then scab. By the end of the second week after the rash appears, most of the sores have scabbed over.

scabs fall off.. small pox

his stage lasts about 6 days. Contagious? Yes The scabs begin to fall off, leaving marks on the skin. Three weeks after the rash appears, most scabs will have fallen off.

poisonings

inhaled, ingested, or acquired by contact Carbon Monoxide inhalation - tissue hypoxia and metabolic acidosis Food Poisoning - Staphylococcus aureus, Salmonella, E-coli, Clostridium perfringens, or Bacillus ceruns Drug Overdose - depends on type and amount of drug ingested and speed of medical intervention Insecticide surface absorption - result in cholinergic crisis

assessment for penetrating wounds

look for open wound and monitor for shock

transmission of small pox

mainly spread by direct and fairly prolonged face-to-face contact between people. Smallpox patients became contagious once the first sores appeared in their mouth and throat (early rash stage). They spread the virus when they coughed or sneezed and droplets from their nose or mouth spread to other people. They remained contagious until their last smallpox scab fell off

transmission of the plague

maintain their existence in a cycle involving rodents and their fleas. In urban areas or places with dense rat infestations, the plague bacteria can cycle between rats and their fleas.

the triage nurse performs triage by using what 3 triage models...

performs rapid interview and assessment to determine triage priority by 3 tier model: Emergent triage - implies the condition poses an immediate threat to life, limb, or vision; requires immediate care and intervention Urgent triage - Require care within 1 hour because condition has potential for causing deterioration of health state if not treated asap; no immediate threat to life at this moment Non-urgent triage - routine care; conditions where treatment delays greater than 2 hours will not result in client deterioration

Botulism def

serious illness caused by a toxin that attacks the body's nerves and causes difficulty breathing, muscle paralysis, and even death. This toxin is made by Clostridium botulinum

what is small pox

serious infectious disease caused by the variola virus. It was contagious—meaning, it spread from one person to another. People who had smallpox had a fever and a distinctive, progressive skin rash.

prevention of botulism

store home canned food for only time on can, throw away open cans, use bleach to clean up food spills

treatment of plague

very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery