Principles of Emergency Nursing

- Vital signs

Normal vital sign ranges for the average healthy adult while resting are:

 Blood pressure: 90/60 mm Hg to 120/80 mm Hg.

 Breathing: 12 to 18/20 breaths per minute.
 Pulse: 60 to 100 beats per minute.
 Temperature: 97.8°F to 99.1°F (36.5°C to 37.3°C); average 98.6°F (37°C)

IV Fluids, /What is IV fluid used for?

ECG- electrocardiogram (ECG) is a simple test that can be used to check
your heart's rhythm and electrical activity. Sensors attached to the skin are Intravenous fluids (usually shortened to 'IV' fluids) are liquids given to
used to detect the electrical signals produced by your heart each time it replace water, sugar and salt that you might need if you are ill or having an
beats. An ECG can help detect problems with your heart rate or heart operation, and can't eat or drink as you would normally. IV fluids are given
rhythm. It can help doctors tell if you're having a heart attack or if you've straight into a vein through a drip.
had a heart attack in the past. An ECG is usually one of the first heart tests
you will have.
Glasgow Coma Scale
 Each small square represents 0.04 seconds

 Each large square represents 0.2 seconds

 5 large squares = 1 second

 300 large squares = 1 minute

parenteral drug administration (IM, ID, IV, SQ)

Electrodes - How to operate ECG machine/ Steps for the correct placement of
electrodes:
 An ECG electrode is a conductive pad that is attached to the skin
to record electrical activity. Prepare the skin
 The data gathered from these electrodes allows the 12 leads of Before placing your electrodes, it is very important to prepare the subject's
the ECG to be calculated (e.g. lead I is calculated using data skin by wiping the chest area thoroughly with skin cleansing (alcohol)
from the electrodes on both the right and left arm). swabs. This removes any oil that may be on the skin and which can cause
 The electrodes used to generate a 12 lead ECG are described drift in your ECG/EKG signals.
below.
 Chest electrodes  Once the skin is clean, find and mark the placements for the electrodes...

There are six chest electrodes: Find and mark the placements for the electrodes:

 V1:4th intercostal space at the right sternal edge

 V2:4th intercostal space at the left sternal edge
 V3:midway between the V2 and V4 electrodes
 V4:5th intercostal space in the midclavicular line
 V5:left anterior axillary line at the same horizontal level as V4
 V6:left mid-axillary line at the same horizontal level as V4 and V5
glucometer -A small device called a glucose meter or glucometer measures
how much sugar is in the blood sample. This measures your blood sugar
after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL
or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and
126 mg/dL or higher indicates you have diabetes.

infusion pump- An infusion pump is a medical device that delivers fluids,
such as nutrients and medications, into a patient's body in controlled
amounts.  Such as insulin or other hormones, antibiotics, chemotherapy
drugs, and pain relievers.

pulse oximeter- measures your blood oxygen levels and pulse. It can
rapidly detect even small changes in oxygen levels. These levels show how
efficiently blood is carrying oxygen to the extremities furthest from your
heart, including your arms and legs.

cardiac monitor- A cardiac event monitor is a device that you control to

record the electrical activity of your heart (ECG). This device is about the
size of a pager. It records your heart rate and rhythm. Cardiac event General Pre Operative Preparations
monitors are used when you need long-term monitoring of symptoms that
occur less than daily. Preparing for Surgery

Doppler- A Doppler test is used to detect blood flow. It shows whether a Preparations for surgery depend on your diagnosis. Your physician will
pulse is present and whether there is blood flow to a limb. It can diagnose discuss with you how to prepare for your surgery. However, if you will
or help to manage conditions such as peripheral arterial disease (PAD) or undergo general anesthesia, you may be asked to do the following:
diabetic foot ulcer A Doppler ultrasound is a noninvasive test that can be
used to estimate the blood flow through your blood vessels by bouncing  Stop drinking and eating for a certain period of time before the
high-frequency sound waves (ultrasound) off circulating red blood cells. A time of surgery
regular ultrasound uses sound waves to produce images, but can't show
blood flow..  Bathe or clean, and possibly shave the area to be operated on

Nebulizer- Many people with chronic lung diseases such as COPD or  Undergo various blood tests, X-rays, electrocardiograms, or other
asthma use a nebulizer to take their medication in the form of a mist that is procedures necessary for surgery
inhaled into the lungs. Some of the common medicines used in nebulizers
include: Albuterol. Budesonide. Cromolyn sodium. Nebulizer treatment  Sometimes a patient may be asked to take an enema the
relaxes the breathing muscles and permits air to flow more easily in and out evening before surgery, to empty the bowels. Please check with
of the lungs. It also helps to loosen mucous in the lungs. Both of these your physician.
benefits of nebulizer treatment help to decrease and prevent wheezing,
shortness of breath, coughing, and tightness in the chest.  Do not wear makeup the day of surgery

 Do not wear nail polish

- Code Blue
 Do not wear your eye contacts
Cardiac or respiratory arrest or medical. emergency that cannot be moved.
“Blue code” is generally used to indicate a patient requiring resuscitation or  Leave valuables and jewelry at home
otherwise in need of immediate medical attention, most often as the result
of a respiratory or cardiac arrest. Person has stopped breathing. Person  Advise the medical staff of dentures or other prosthetic devices
has no pulse. Unable to determine if the person has a pulse or if they are you may be wearing
breathing, and is unresponsive.
Often, to make their experience more comfortable and efficient, patients
CPR Cardiopulmonary resuscitation is an emergency procedure consisting are advised to bring the following:
of chest compressions often combined with artificial ventilation in an effort
to manually preserve intact brain function until further measures are taken  Loose-fitting clothes to wear
to restore spontaneous blood circulation and breathing in a person who is
in cardiac arrest  Social Security card number

Leopold's Maneuver  Insurance information

The Leopold maneuvers are used to palpate the gravid uterus  Medicare or Medicaid card
systematically. This method of abdominal palpation is of low cost, easy to
perform, and non-invasive. It is used to determine the position,
presentation, and engagement of the fetus in utero. - Emergency drugs - epinephrine, atropine, amiodarone, hydrocortisone,
nicardipine, dopamine

Epinephrine- Epinephrine is both a neurotransmitter and a hormone, but it

acts mainly as a hormone. Epinephrine, also known as adrenaline, plays an
important role in your body's fight-or-flight response. It's also used as a
medication to treat many life-threatening conditions. Epinephrine is part of situations when the heart beats too slowly, as an antidote to for example
your sympathetic nervous system, which is part of your body’s emergency organophosphate insecticide or nerve gas poisoning and in mushroom
response system to danger — the “fight-or-flight” response. Medically, the poisoning. It can be used as part of the premedication before general
anaesthesia. The use of atropine in cardiovascular disorders is mainly in
flight-or-flight response is known as the acute stress response.
the management of patients with bradycardia. Atropine increases the heart
Epinephrine is also called a catecholamine, as are norepinephrine and
rate and improves the atrioventricular conduction by blocking the
dopamine.
parasympathetic influences on the heart.
During the fight-or-flight response, you (your brain) perceive
Toxicity
danger. Next, nerves in an area of your brain called the hypothalamus send
a signal down your spinal cord, then out to your body. The neurotransmitter High doses of atropine may cause palpitation, dilated pupils,
that transmits your brain’s nervous system message of what to do is difficulty swallowing, hot dry skin, thirst, dizziness, restlessness, tremor,
norepinephrine (noradrenaline). fatigue and ataxia. Toxic doses of atropine lead to restlessness and
excitement, hallucinations, delirium and coma.8 In cases of severe
 Eyes: Pupils dilate to let more light in to better see more of your intoxication, atropine can cause a circulatory collapse, leading to a decline
surroundings. in blood pressure and respiratory failure that may ensue in death following
paralysis and coma.
 Skin: Skin turns pale as blood vessels receive a signal to divert
blood to areas more in need of your blood’s oxygen, such as your Amiodarone is used to treat and prevent certain types of
muscles, so you can fight or run away. serious, life-threatening ventricular arrhythmias (a certain type
of abnormal heart rhythm when other medications did not
 Heart: Heart pumps harder and faster to deliver more oxygenated
help or could not be tolerated. Amiodarone is in a class of
blood to areas most in need, like your muscles. Blood pressure
medications called antiarrhythmics.
also increases.
What is the main side effect of amiodarone?
 Muscles: Muscles receive more blood flow and oxygen so they
can react with greater strength and speed. This medicine can cause changes in your heart
rhythm, such as a condition called QT prolongation. It may
 Liver: Stored glycogen in your liver is converted to glucose to cause fainting or serious side effects in some patients.
provide more energy.
What does amiodarone do to BP?
 Airways: Breathing is deeper and faster. Your airways open up so
more oxygen is delivered to the blood, which goes to your
muscles.

How is epinephrine used as a medication?

When used as a medication, synthetic epinephrine is used to treat:

1. Cardiac arrest/cardiopulmonary resuscitation (CPR): Epinephrine

stimulates your heart.
2. Eye surgery: Epinephrine helps keep your pupils dilated. Does amiodarone affect the blood pressure? Amiodarone can
3. Septic shock: Epinephrine increases your blood pressure. also decrease blood pressure, slow heart rate, and—at higher doses or
4. Asthma: Epinephrine opens airways and decreases airway with long-term use—even cause arrhythmias of its own. This becomes
spasms. more prominent when given in combination with medications used to treat
5. Anaphylaxis: Epinephrine relaxes airway muscles. It’s the first- hypertension and cardiac disorders. It works by slowing down overactive
response treatment for this severe, life-threatening allergic electric signals in the heart, which stabilizes your heart rhythm. It belongs
reaction. to a group of medications called antiarrhythmics.
What health conditions result from high levels of epinephrine?Health Hydrocortisone is a steroid (corticosteroid) medicine. It works by calming
conditions that result from high levels of epinephrine include: down your body's immune response to reduce pain, itching and swelling
(inflammation). It can also be used as hormone replacement for people
1. High blood pressure (hypertension).
who do not have enough of the natural stress hormone, cortisol.
2. Rapid or irregular heartbeat.
3. Excessive sweating. 1. Hydrocortisone oral tablet is available as a brand-name drug and
4. Cold or pale skin. in a generic form. Brand name: Cortef.
5. Severe headaches.
6. Nervous feeling, jitters. 2. Hydrocortisone comes in many forms. These include a tablet you
7. Epinephrine overdose, which can lead to high blood pressure, take by mouth, and an injectable form.
stroke and death.
8. Pheochromocytoma, which is an adrenal gland tumor. 3. Hydrocortisone oral tablet is used to treat adrenocortical
deficiency, and swelling and inflammation. It’s also used to slow
Atropine down your immune system.
Atropine/diphenoxylate is an antimotility agent that can be useful in the Important warnings
treatment of diarrhea as second-line therapy by allowing the central acting
opioid effect of diphenoxylate and capitalization on its anticholinergic side  Infection risk warning: Hydrocortisone can weaken your body’s
effect of constipation to slow motility. It is used in emergency response to infection because the drug weakens your immune
 system. Using this medication may also make it harder for you to What is Dopamine and how is it used?
know that you have an infection.

 Vaccine warning: Due to hydrocortisone weakening your immune

system, you shouldn’t be given a live vaccine, such as the
chickenpox vaccine, when taking high doses of hydrocortisone or
if you’ve taken hydrocortisone for a long time. Instead, you may
be given killed or inactivated vaccines. However, the vaccine may
not work as well.

 Warning for stopping this drug: If you’ve been taking

hydrocortisone for a long time, don’t stop taking it suddenly. This
can cause withdrawal that can last a long time. Symptoms of
withdrawal may include fever, muscle and joint pain, and overall
discomfort. To prevent withdrawal, your doctor will slowly lower Dopamine is a prescription medicine used to treat the
your dosage of hydrocortisone over time or have you take it less symptoms of low blood pressure, and low cardiac output and
often. improves blood flow to the kidneys. Dopamine may be used
alone or with other medications.
Hydrocortisone side effects
 Dopamine belongs to a class of drugs called Inotropic Agents.
Hydrocortisone oral tablet doesn’t cause drowsiness
 The most common side effects of Dopamine include:
More common side effects  headache,anxiety,nausea,vomiting,chills and,
goosebumps
 The more common side effects of hydrocortisone include:
 headaches
 muscle weakness
 skin problems such as acne or thin, shiny skin

Nicardipine Nicardipine (Cardene)

is used to treat high blood pressure and to control angina (chest pain).
Nicardipine is in a class of medications called calcium channel blockers. It
lowers blood pressure by relaxing the blood vessels so the heart does not
have to pump as hard.

Nicardipine is indicated for the treatment of

hypertension, including hypertensive urgency and
hypertensive emergency. Adverse Effects: Hypotension,
headache, and tachycardia may occur. In patients who are
taking beta-blocking agents, Nicardipine may precipitate or
exacerbate heart failure. For oral nicardipine it can treat
Chest pain caused by low blood flow to the heart (stable
angina) - oral capsules onl

Why is nicardipine used in hypertensive emergency?

Nicardipine belongs to the dihydropyridine class of calcium channel

blockers. Because nicardipine acts quickly and safely, it is often used to
treat hypertensive emergencies and postoperative hypertension.
Nicardipine mainly induces arterial relaxation, resulting in decreased blood
pressure.