Patients in emergency nursing
Life-threatening
Potentially life-threatening
Urgent problems enter hospital through emergency department
... [Show More] (ED)
Annual visits to ED
- how many visit ED annually
- # increasing why (6)
Over 136 million people visit EDs annually.
This number is increasing bc
(1) the inability to see a primary care provider
(2) an aging population
(3) shorter hospital stays resulting in frequent readmissions
(4) acute mental health crises
(5) ED closures
(6) lack of or inadequate health insurance or a primary care provider
Triage
- means
- process of
- represents
- does what to patients
"To sort"
Process of rapidly determining patient acuity
Represents a critical assessment skill
Categorizes patients so most critical are treated first
After initial focused assessment to determine actual or potential threats to life...
- what kind of approach
- what is used for all trauma patients
- what is used for nontrauma patients
...proceed with more detailed assessment
systematic approach to this assessment decreases the time needed to identify potential threats to life and limits the risk of overlooking a life-threatening condition.
A primary and secondary survey is the approach used for all trauma patients.
For nontrauma patients, the primary survey is followed by a focused assessment
Primary Survey: ABCDEFGH
Alertness and airway
Breathing
Circulation (becomes #1 if there is uncontrolled hemorrage)
Disability
Exposure and environmental control
Facilitate adjuncts and family
Get resuscitation adjuncts
History and head-to-toe assessment
If uncontrolled external hemorrhage is noted
usual ABC assessment format may be reprioritized to ABC for hemorrhage control.
The stands for catastrophic hemorrhage and, if present, needs to be controlled first.
Apply direct pressure with a sterile dressing followed by a pressure dressing to any obvious bleeding sites.
Primary survey
- aim
- If life-threatening conditions related to ABCs are identified during primary survey
primary survey aims to identify life-threatening conditions so that appropriate interventions can be started.
interventions are started immediately and before proceeding to the next step of survey
Primary Survey: Alertness and airway (1)
- what is alertness level important for
- AVPU
alertness level of the patient can be an important factor for selecting appropriate airway interventions.
Determine LOC by assessing the patient's response to verbal and/or painful stimuli.
AVPU
A=alert
V=responsive to voice
P=responsive to pain
U=unresponsive
Airway obstruction
- cause of what
- what can obstruct the airway (8)
Cause of nearly all immediate trauma deaths
Saliva, bloody secretions, vomitus, laryngeal trauma, dentures, facial trauma, fractures, and the tongue can obstruct the airway
Patients at risk for airway compromise (5)
Seizures
Drowned
Anaphylaxis (swelling of airway)
Foreign body obstruction
Cardiopulmonary arrest (MI)
Signs and symptoms of a compromised airway (5)
Dyspnea
Inability to speak
Gasping (agonal) breaths
- ineffective breaths
Foreign body in airway
Trauma to face or neck
Tx of a compromised airway (4)
- how to progress
progress rapidly from the least to the most invasive method.
Open airway using jaw-thrust maneuver
Suction and/or remove foreign body
Insert nasopharyngeal or oropharyngeal airway
- in unconscious pt. only
Endotracheal intubation
Tx of a compromised airway
- what if intubation is impossible because of airway obstruction
- what is done before intubation
If intubation is impossible because of airway obstruction, an emergency cricothyroidotomy or tracheotomy is performed.
Ventilate patients with 100% O2 using a bag-valve-mask (BVM) device before intubation or cricothyroidotomy.
Jaw-Thrust Maneuver
- recommended for
- pt. and rescuer position
- rescure position of hands and elbos
- what is done to head
- avoid what
recommended procedure for opening the airway of an unconscious patient with a possible neck or spinal injury.
The patient should be lying supine with the rescuer kneeling at the top of the head.
The rescuer places one hand on each side of the patient's head, resting his or her elbows on the surface.
The rescuer grasps the angles of the patient's lower jaw and lifts the jaw forward with both hands without tilting the head.
Avoid hyperextending neck
Suspect cervical spine trauma in any patient with (2)
Face, head, or neck trauma
Significant upper chest injuries
Tx for suspected cervical spine trauma (3)
Stabilize the cervical spine (head maintained in a neutral position) and/or immobilize during assessment of the airway w/ cervical collar or cervical immobilization device (CID)
secure patient's forehead to the backboard.
Do not use sandbags because the weight of the bags could move the head if the patient is logrolled.
Primary survey: breathing
- assess for (7)
Assess for dyspnea, cyanosis paradoxic/asymmetric chest wall movement, decreased/absent breath sounds, visible wound to chest wall, tachycardia, hypotension
Tx for breathing (1)
- For life-threatening conditions (flail chest, pneumothorax) (4)
Administer high-flow O2 via a nonrebreather mask
For life-threatening conditions (flail chest, pneumothorax)
- Bag-valve-mask (BVM) ventilation with 100% O2
- Needle decompression
- Intubation
- Treatment of underlying cause [Show Less]