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Emergency and Disaster Nursing:

Emergency and Disaster Nursing:. A Systematic Approach to Providing Care. The Challenges of ED Care. Statistics 5/2012. http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf.

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Emergency and Disaster Nursing:

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  1. Emergency and Disaster Nursing: A Systematic Approach to Providing Care

  2. The Challenges of ED Care

  3. Statistics 5/2012 http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf

  4. http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdfhttp://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf Statistics 5/2012

  5. http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdfhttp://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf Statistics 5/2012

  6. Primary Survey

  7. Airway • Assessed while maintaining Cervical Spine • Signs and symptoms of compromised airway • Jaw Thrust Maneuver

  8. Breathing • Causes • Assessment • Treatment

  9. Circulation • Central Pulse is Checked • Color, Temperature, Moisture • AMS and delayed capillary refill are the most significant signs of shock • 2 large bore IV’s with NS or LR

  10. Disabilities • Level of Consciousness • Glasgow Coma Scale • Pupil Size

  11. Secondary Survey

  12. Secondary Expose – remove all clothing (special consideration for forensics) Full Set of Vital Signs Family Presence Give Comfort History and Head to Toe Assessment

  13. Forensics • Trauma victims are often victims or perpetrators of crime • Work collaboratively with law enforcement • Maintain the chain of evidence

  14. Diagnostic Tests • Blood type and cross • Blood alcohol level • Urine drug screen • Pregnancy test • What others can you think of?

  15. Diagnostic Tests cont. • X-Ray, CT, MRI • Diagnostic Peritoneal Lavage (DPL) • Abdominal Ultrasound - Focused Assessment with Sonography for Trauma (FAST)

  16. Medications Blood, crystalloids –NS or LR, volume expanders - Hespan Inotropic drugs after IV fluids Dopamine, dobutamine, isoproterenol Vasopressors dopamine, epinephrine Opioids - pain control Tetanus prophylaxis Antibiotics Mannitol

  17. Death in the ER

  18. Gerontologic Populations • Atypical presentations • Cognitive Impairment • Co-morbidities • Polypharmacy – Coumadin, • Beta-blockers, Anti-hypertensives Hwang, U., Richardson, L.D., Sonuyi, T.O., & Morrison, R.S. (2006). The Effect of emergency department crowding on the management of pain in older adult with hip fracture. Journal of the American Geriatric Society. 54, 270-275.

  19. Poisonings • 1-800-222-1222 Humans • 1-888-426-4435 Pets – ASPCA $65 • Activated charcoal, gastric lavage, eye/skin irrigation, hemodialysis, hemoperfusion, urine alkalinization, chelating agents and antidotes - acetylcysteine • Contraindicated in AMS, ileus, diminished bowel sounds, ingestion of substance poorly absorbed by charcoal

  20. Violence • Crosses all socioeconomic and sociocultural barriers • 1.5 million women and 834,000 men treated at ED’s have been battered by persons known to them • Make referrals, provide emotional support, inform victims about their options, ensure patient safety • Suspected abuse of elders, persons with disabilities and children MUST be reported by law. It is not an option to assume the social worker or doctor will report. • It is OUR RESPONSIBILITY to inquire and offer options even if the options are a social worker or phone numbers.

  21. 5 ESI Level Triage • Level One: Resuscitation – patients require immediate evaluation and management • Level Two: Emergent – patients require evaluation within 15 minutes for potential threats to life or limb • Level Three: Urgent – patients have conditions that cause significant discomfort and should be evaluated within 30-60 minutes • Level Four: Less Urgent – patients do not require rapid intervention, but should be evaluated within 60 minutes • Level Five: Non-urgent – patients may be seen in a delayed fashion and could be referred to other areas of the health care system Prah Ruger, J., Lewis, L.M., & Richter, C.J. (2007). Identifying high-risk patients for triage and resource allocation in the ED. AmericanJournal of Emergency Medicine. 25, 794-798.

  22. 5 ESI Level Triage

  23. Chemical Emergencies • Release of a hazardous chemical that has the potential for harm • Biotoxins • Blood agents • Pulmonary agents • Nerve agents • Treatment depends on the chemical - some have no treatment

  24. Radiation Emergencies • Can be incurred from handling of or exposure to radioactive materials • Radiological technicians/First Responders, ED personnel • Weapons of Mass Destruction –everyone is exposed

  25. Mass Casualty Incident • Assessments conducted in less than 15 seconds… • System of colored tags to determine seriousness of injury and likelihood of survival • Total number of casualties a hospital can expect is estimated by doubling the number of casualties that arrive in the first hour.

  26. NDMS, DMAT & CERT • National Disaster Medical System • Disaster Medical Assistance Teams • Community Emergency Response Teams

  27. Reverse Triage • Injury identification-rapid assessment at scene • Penetrating injuries to abdomen, pelvis, chest, neck or head • Spinal cord with deficit • Crushing injury to head, chest or abdomen • Major burns • Critical interventions • providing life support, immobilizing the cervical spine, managing the airway, and treating hemorrhage and shock • Rapid transport-ASAP to regional trauma center

  28. MIEMSS A V P U A V P U A V P U Tourniquet @ _______ Extremity Splint Gauge PASG Inflated at _______________ Gross Decon. Final Decon. TRIAGE TAG Maryland Emergency Medical Services Maryland Department of Transportation HOSP NOTIFIED Triage Tag • Patient Information • Triage Status • Chief Complaint • Transportation • Peel - off Bar Codes • Transport Record • Vital Signs • History • Treatment

  29. Chief Complaint Section Major obvious injuries or illness can be circled Indicate injuries on the human figure Additional information is added on the comments line

  30. Pre-Hospital Care • Paramedics communicate with ED • Brief report about client with ETA • Severity of condition determines ED response • Champion Revised Trauma Scoring System

  31. Nursing Diagnosis • Ineffective airway clearance • Altered tissue perfusion • Impaired gas exchange • Risk for infection • Impaired physical mobility • Spiritual distress • Risk for post-trauma syndrome

  32. PTSD / Compassion Fatigue • Risk for patients and caregivers • Emotions range from fear, anger denial and shock. • May experience flashbacks and nightmares

  33. Implications for Nursing • Recognition of our own values and perceptions • Need for evidenced based practice • Continuing education through in-services and online training • Department specific policies – no more than 8 hours in triage • Use of a different triage ranking system such as ESI where specific complaints are automatic level assignments

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