chapter 33 emergency nursing. 2 emergency care area requirements central location easy access ...
TRANSCRIPT
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Chapter 33
Emergency Nursing
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2Emergency Care Area
Requirements Central location
Easy access
Dedicated “crash table”
Basic necessary equipment Oxygen source
Suction unit
Surgical lighting
Multiple electrical outlets
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3Crash 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
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4Emergency Drugs
Well organized and labelled
Current dose chart
Syringes and saline flush nearby
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5Laboratory Equipment
Minimum database “QATS”
Lactate testing
Additional point of care testing Blood gases
Coagulation testing
Commercial test kits Ethylene glycol
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6Fluid 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
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7Fluid 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
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8Principles of Triage
Set protocols for a consistent, thorough response
CRASH PLAN
Be well-organized
Expect the unexpected
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9Respiratory Emergencies
Goals Provide oxygen in the least stressful route
Keep patient calm
Obtain patient history
Complete physical examination
Baseline lab data IF possible
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10Routes of Oxygen Administration Oxygen cage
Oxygen hood
Flow-by oxygen
Face mask
Nasal oxygen
Endotracheal oxygen
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11Assessing Respiratory Function Respiratory effort
Respiratory pattern
Mucous membrane color
Pulse quality and rhythm
Heart rate
Auscultation
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12Respiratory Emergencies
Insufficiencies resulting from trauma Upper airway trauma/rupture
Pneumothorax
Hemothorax
Pulmonary contusions
Diaphragmatic hernia
Flail chest
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13Respiratory Emergencies
Rapid recognition imperative
Clinical signs of: Upper airway trauma
Bloody respiratory discharge
Increased respiratory effort
Subcutaneous emphysema
Increased upper airway noise
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14Respiratory 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
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15Respiratory Emergencies
Stabilization techniques and diagnostics Oxygen therapy
Thoracocentesis
Thoracic drain placement
Diagnostics Thoracic radiographs pulse oximetry
Arterial blood gas analysis
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16Cardiovascular Triage
Physical examination techniques MM color
Capillary refill time
Pulse quality
Heart rate
Jugular vein evaluation
Cardiac auscultation
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17Cardiovascular Triage
Monitoring ECG
Blood pressure
Baseline laboratory values
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18Hemorrhage Protocols
Pressure bandage techniques
Minimum laboratory database
Peripheral serial PCV/TS
Diagnostic procedures Thoracocentesis
Abdominocentesis
PCV/TS of collected fluid
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19Neurological Emergencies
Protocols for stabilization Assess respiratory function
Assess cardiac function
Assess mentation
Dull mentation may signal head trauma
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20Head Trauma
Clinical signs Poor mentation
Anisocoria
Nystagmus
Abnormal pupillary light response (PLR)
Head tilt or turn
Abnormal gait
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21Head Trauma
Treatment Oxygen therapy
Fluid therapy to maintain perfusion
Pharmaceuticals
Mannitol
Lasix
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22Spinal and Orthopedic Injuries Goals
Maintain perfusion
Fluids
Pain medications
Supportive bandaging
Wound care