ER Lec1

Emergency
Nursing
Video clips (Introduction)
• Coming to the ER
Scope and Practice of
Emergency Nursing
• Emergency management traditionally
refers to urgent and critical care
needs.
• The ED has increasingly been used for
non-urgent problems
• Emergency management has
broadened to include the
concept that an emergency is
whatever the patient or family
considers it to be.
• The emergency room staff works as a
team.
The Emergency Nurse
The emergency nurse has had specialized
education, training, experience, and
expertise in assessing and identifying
patients’ health care problems in crisis
situations.
Nursing interventions are accomplished
interdependently in consultation or
under the direction of a physician or
nurse practitioner.
Priority Emergency Measures
for all Patients
• Safety is the first priority
• Preplanning to assure security and a safe
environment
• Close observation of patient and family
members in event that they respond to
stress with physical violence
• Assessment of patient and family
psychological function
• Patient and family focused interventions
o Actions to relieve anxiety and provide a sense of security
o Allow family to stay with patient, if possible, to alleviate anxiety
o Provide explanations and information
o Additional interventions are provided depending upon the stage
of crisis
Assess and Intervene
Check for ABCs of life
• A – Airway
• B – Breathing
• C - Circulation
6 DaRRaN
Team Members
• Rescuer
• Emergency Medical Technician
• Paramedics
• Emergency Medicine Physicians
• Incident Commander
• Support Staff
• Inpatient Unit Staff
7 DaRRaN
Emergency Action
Principle
I. Survey the Scene
• Is the Scene Safe?
• What Happened?
• Are there any bystanders
who can help?
• Identify as a trained first
aider!
8 DaRRaN
II. Do a Primary Survey
- organization of approach
so that immediate threats to
life are rapidly identified
and effectively manage.
Primary Survey
A - Airway/Cervical Spine
- Establish Patent Airway
- Maintain Alignment
- GCS ≤ 8 = Prepare Intubation
DaRRaN 9
10 DaRRaN
Video clips
• Tracheostomy 3D
• How to perform an emergent cricothyroidectomy

B – Breathing
- Assess Breath Sounds
- Observe for Chest Wall Trauma
- Prepare for chest decompression
C – Circulation
- Monitor VS
- Maintain Vascular Access
- Direct Pressure
12 DaRRaN
Estimated Blood Pressure
SITE SBP
Radial ≥ 80
Femoral ≥ 70
Carotid ≥ 60
DaRRaN 13
Control of Hemorrhage
14 DaRRaN
Video clips
• Treat severe bleeding
D – Disability
- Evaluate LOC
- Re-evaluate clients LOC
- Use AVPU mnemonics
E – Exposure
- Remove clothing
- Maintain Privacy
- Prevent Hypothermia
16 DaRRaN
video
• ABCDE assessment
III. Activate Medical Assistance
o Information to be Relayed:
- What Happened?
- Number of Persons
Injured
- Extent of Injury and First
Aid given
- Telephone number from
where you’re calling
19 DaRRaN
IV. Do Secondary Survey
• Interview the Patient
S – Symptoms
A – Allergies
M – Medication
P – Previous/Present Illness
L – Last Meal Taken
E – Events Prior to Accident
• Check Vital Signs
20 DaRRaN
Triage
• Triage
– sorts patients
– based on the severity of health problems
– Takes in account the immediacy with which these problems must be treated
–
• The triage nurse collects data and classifies the

illnesses and injuries to ensure that the patients most in
need of care do not needlessly wait.
• Protocols may be initiated in the triage area.

Triage Categories
• Three levels
• Emergent
o Highest priority
o Life threatening conditions
o Must be seen immediately
• Urgent
o Serious problems
o Not immediately life threatening
Triaging Contd.
• Nonurgent
oEpisodic illnesses
oAddress within 24hrs,
• “fast track”
oSimple first aid/primary care
oCan be referred
Triage
• Five level system
oResuscitation
oEmergent
oUrgent
oNonurgent
oMinor
Triaging Contd.
• The obvious first-priority patients are those with

multiple trauma:
• Gunshot or stab wounds
• Persons involved in motor vehicle accidents
• Persons with obvious CVA
• Persons with severe chest pain/heart attack
• Patients in shock or who have unstable vital signs
.Persons presenting with respiratory symptoms
Video clips
• Typical ER triage
• Triage emergency mgt

• Primary survey
• Secondary survey
Principles of Emergency Care
• Assess and Intervene
oA, B, C
oNeuro
oHealth history
oHead-to-toe assessment
Principles of Emergency Care (cont’d)
•Diagnostic and lab testing
•Insertion of monitoring devices
•Splinting
•Wounds
•ACTIVITY:

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Emergency

• How to perform an emergent cricothyroidectomy

• The triage nurse collects data and classifies the

• Protocols may be initiated in the triage area.

• The obvious first-priority patients are those with

• Triage emergency mgt

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