Lewis: Medical-Surgical Nursing, 8th Edition
Chapter 69: Nursing Management: Emergency, Terrorism, and Disaster Nursing
Key Points – Printable
CARE OF EMERGENCY PATIENT
Triage refers to the process of rapidly determining the acuity of the patient’s problem. It works on the premise that patients who have a threat to life must be treated before other patients. *
The Emergency Severity Index (ESI) is a five-level triage system that incorporates concepts of illness severity and resource utilization to determine who should be treated first. *
After the initial assessment to determine the presence of actual or potential threats to life, appropriate interventions are initiated for the patient’s condition. * The primary survey focuses on airway, breathing, circulation (ABCs), disability, and exposure/environmental control. It serves to identify life-threatening conditions so that appropriate interventions can be initiated immediately. * The secondary survey is a brief, systematic process that is aimed at identifying all injuries.
Ongoing patient monitoring and evaluation of interventions are critical, and the nurse is responsible for providing appropriate interventions and assessing the patient’s response.
Depending on the patient’s injuries and/or illness, the patient may be transported for diagnostic tests or directly to the operating room; admitted to a general unit, telemetry, or intensive care unit; or transferred to another facility. *
* Post-Cardiac Arrest Hypothermia
* Patients with nontraumatic, out-of-hospital cardiac arrest benefit from a combination of good chest compressions, rapid defibrillation, therapeutic hypothermia, and supportive care postarrest. * Therapeutic hypothermia involves the three phases: induction, maintenance, and rewarming. *
* Death in the Emergency Department
The emergency nurse should recognize the importance of certain hospital rituals in preparing the bereaved to grieve, such as collecting the belongings, arranging for an autopsy, viewing the body, and making mortuary arrangements.
Many patients who die in the emergency department (ED) could be a candidate for non–heart beating donation; certain tissues and organs can be harvested from patients after death.
GERONTOLOGIC CONSIDERATIONS: EMERGENCY CARE
Elderly people are at high risk for injury, primarily from falls.
The three most common causes of falls in the elderly are generalized weakness, environmental hazards, and orthostatic hypotension.
When assessing a patient who has experienced a fall, it is important to determine whether the physical findings may have actually caused the fall or may be due to the fall itself.
* Brief exposure to intense heat or prolonged exposure to less intense heat leads to heat stress. Effects can be mild (e.g., heat rash) or severe (e.g., heatstroke). * Heat cramps are severe cramps in large muscle groups fatigued by heavy work. * Prolonged exposure to heat over hours or days leads to heat exhaustion, a clinical syndrome characterized by fatigue, nausea, vomiting, extreme thirst, hypotension, elevated body temperature, and feelings of anxiety. *
Heatstroke is a medical emergency resulting from failure of the hypothalamic thermoregulatory processes.
Increased sweating, vasodilation, and increased respiratory rate deplete fluids and electrolytes, specifically sodium, and core temperature rises rapidly.
Treatment focuses on stabilizing the patient’s ABCs and rapidly reducing the temperature through various cooling methods. *
* COLD-RELATED EMERGENCIES
* Frostbite is true tissue freezing, which results in the formation of ice crystals in the tissues and cells. * Superficial frostbite involves skin and subcutaneous tissue, usually the ears, nose, fingers, and toes. Deep frostbite involves muscle, bone,...
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