ED Nursing Flashcards
1
Q
Primary Assessment
A
Airway Breathing Circulation Disability (neuro/LOC) Exposure/environment control
2
Q
Secondary Survey
A
- Only done after the Primary Survey*
- Full set of Vital Signs
- Hx/Family
- Head to toe assessment
- Inspection
3
Q
Sections of the secondary assessment
A
Head: ears, eyes, mouth, neck, veins Chest: Lungs Abd Pelvis Extremities
4
Q
Unconscious patient= unknown etiology
A
A: Alcohol E: Epilepsy I: Insulin (Hypoglycemia) O: OD U: Uremia T: Trauma/Tumor I: Infection P: Psych S: Stroke/Shock
5
Q
Drug Overdose or Poisoning- Essentials of care
A
S: Stabilize the pt I: Identify the substance R: Reverse the effect E: Eliminate from body S: Support the pt/significant other
6
Q
Drug OD and Poisoning
A
Assessment Gastric Lavage Activated Charcoal Hemodialysis Specific Antidotes
7
Q
Caveat when giving reversal agents
A
Reversal agents often times have a shorter half life than the drug it reverses
8
Q
Oxycodon 1/2 life
A
3-5 hrs
9
Q
Naloxone 1/2 life
A
60-90 minutes
10
Q
Benzo 1/2 life
A
1-4 hrs: Midazolam
20-50hrs: Diazepam
11
Q
Flumazenil (Romazicon) 1/2 life
A
approx 1 hr
12
Q
Most common Poisonings and Overdoses
A
*Most common= most accessible* Acetaminophen ASA NSAID Antidepressant Alcohol stimulants Opioids Cannabis Hallucinogens Inhalants
13
Q
Stimulants
A
Amphetamines
Cocaine
14
Q
S/sx toxicity of stimulants
A
Palpitations Tachycardia Increased BP Dysrhythmias Myocardial Ischemia Hallucinations Paranoia
15
Q
Opioid OD sx
A
Drowsiness Miosis: Pinpoint pupils Slowed breathing Cyanosis LOC
- *Administer Narcan
- Support breathing
16
Q
Musculoskeletal Trauma
A
- Sprains/Strians
- Dislocations
- Fractures: Open/compound or comminuted
17
Q
Open compound and comminuted fx are highest emergency for MS trauma
A
Do x-ray
Note: Cast/splint is NOT a resource. Cane/crutches are NOT resources.
18
Q
Clinical Manifestations of MS trauma
A
Edema Pain Muscle Spasm Deformity Ecchymosis Loss of function
19
Q
MS Basic Tx
A
RICE R: rest I: Ice C: Compress E: Elevate
20
Q
Complications of Trauma and Fractures
A
Infection Venous Thrombosis Compartment Syndrome Fat Embolism Rhabdomyolysis
21
Q
Fat Embolism
A
Confusion and Agitation
Petechial Rash
22
Q
Petechiae
A
small reddish dots
Look for in long bone injuries- fat embolism
Note: Will also see in bacterial meningitis
Note: Rash is typically on the chest but can be anywhere.
23
Q
Rhabdomyolysis
A
Muscle pain
Muscle weakness
Dark red/brown (tea colored) or decreased urine
24
Q
Rhabdo notes
A
Direct or indirect muscle injury
Pts that have been lying on the floor for the past few days
Can happen to those who don’t shift their weight/extreme pressure for extended periods of time.
Orthopedic surgeries
Myoglovin in muscles is a big molecule and the kidneys often cant filter out because its too big.
25
Priority of Tx
- Check Circulation, motion and sensation (CMS)
- Stabilize the fx/injury - C-Spine injuries: immobilize and consider respiratory depression
-VS
-Secondary assessment/additional injuries
xrays
26
Environmental Emergencies: Heat Related
Heat cramps
Heat exhaustion
Heat stroke
- Apply cold compresses
- Use a fan to lower temperature
- Elevate feet
- Give fluids
- Have the person lie down.
27
Heat stroke s/sx
```
Core temp> 105.8 (rectal)
AMS
Absence of perspiration
Skin is hot and dry
Circulatory collapse
cerebral edema and hemorrhage may occur
```
28
Heat Stroke Tx
```
ABCs
Rapidly reduce core temp
100% O2
Cool, wet sheets/ice packs
Large fan
Fluid bolus
Monitor for rhabdo
```
29
Large complication of heat stroke
Rhabdo!
30
Submersion Injuries
Near drownings and drownings
31
Pathophys of submersion injuries
Leads to:
Non-cardiogenic pulmonary edema
ARDS
32
Patho of Aspiration of Freshwater
- Water rapidly leaks to capillary bed and circulation
- Surfactant destruction
- destruction of alveolar-capillary membrane
- Non-cardiogenic pulmonary edema
- ARDS
33
Patho of Aspiration of saltwater
- Saltwater draws fluid into alveoli
- Surfactant destruction
- destruction of alveolar-capillary membrane
- Non-cardiogenic pulmonary edema
- ARDS
34
Burns
```
Classification
Severity
Depth
Extent
Special Considerations
```
35
Depth: Superficial
```
1st degree
Ie: Sunburn
Epidermis only
Local pain and erythema
No blisters
Heals spontaneously without scarring
Systemic response minimal
```
36
Depth: Partial-thickness
2nd degree
37
Depth: Full thickness
3rd degree
```
Involves all layers of the skin
Variable color: white, waxy, red, brown
Destroys elasticity, dry
Painless
Does not heal
```
38
Partial Thickness burn
Epidermis and Dermis
Moist appearance
Blister formation
Tactile and pain sensors in tact
39
Rule of 9s
Anything over 10-12% will be transferred to a burn center for more focused care
40
Head and Neck
9%
41
Arms
9% each
42
Ant trunk
18%
43
Posterior trunk
18%
44
Legs
18% each
45
Perineum
1%
46
Special Considerations: Burn
Location of burn
47
Face
Airway
| Self Image
48
Circumferential chest
respiratory function
49
Hands, feet, eyes, joints
Difficulty with self care and future function
50
Ears, nose, perineum
Infection
51
Pt Burn Risk Factors
```
Healing slower with older patients
Cardiac Dz
Respiratory Dz
Renal Dz
DM
Alcoholism
Drug Abuse
Concurrent trauma
```
52
Do 3rd degree burns heal themselves?
No- they need skin grafts
53
Airway management
```
Early nasotracheal or endotracheal intubation
- extubate after 3-6 days
- HIGH fowlers
100%O2
Bronchodilators
```
54
Goals of Emergency Care
Rapid Stabilization
Prevention of complications
Early recovery
55
Triage meaning
"to sort" or "to choose"
56
Level 1
Immediate: Conditions that are immediately life threatening or those that will cause serious physical impairment if not treated immediately.
57
Level 2
Emergent: Conditions that require immediate care.
58
Level 3
Urgent: Conditions that require prompt, but not immediate care and two or more resources might be needed.
59
Level 4
Semi-Urgent: Conditions that need evaluation and treatment, but time is not a critical factor. It’s anticipated that one resource might be needed.
60
Level 5
Non-Urgent: Conditions that need evaluation and treatment, but time is not a critical factor. Does not need any resources.
61
Level 1 examples
- Airway obstructed or partially obstructed
- Acute mental status change – OD, Hypoglycemia, Stroke
- Apneic
- Intubated pre-hospital
- Severe respiratory distress
- Pulseless or abnormal rate/rhythm/quality with poor perfusion
- Chest pain with signs of acute MI
- Hemodynamic instability with need for immediate meds or fluid resuscitation
62
ESI Level 1 – What are life-saving interventions?
- CPR
- Intubation
- Surgical airway
- Emergent CPAP/BiPAP
- BVM/Oral or nasal airway
- Defibrillation
- External Pacing
- Significant IV fluid resuscitation
- Rapid blood administration
- Control of major bleeding
- Chest needle decompression
- Acute-onset ICH/CVA interventions
63
NOT Life saving interventions
```
Diagnostic Tests:
EKG
Lab studies
Oxygen administration
Nasal cannula
Non- rebreather mask
Cardiac monitor
IV access
Medications
Aspirin
Nitroglycerin
Pain medication
Antibiotics
Heparin
```
64
Level 2 Categories
High risk OR confused/lethargic/disoriented OR severe distress
Included neonates (under 3 mo) with a fever
65
ESI Level 2 Examples
- Episode of chest pain has a known cardiac history
- Rule out PE
- Newborn with a fever
- Rule out ectopic pregnancy
- Neutropenia with a fever
- Suicidal/homicidal
- New onset of confusion or disorientation
- Adolescent found confused and disoriented
- Patients in SEVERE pain
- Sexual assault patient
- Syncope
- Hyper or hypoglycemia without ALOC
- Epistaxis, on blood thinner or with hypertension
- Seizure
- Chemical splash to eye-immediate eye flush
66
Examples of severe pain for a level 2
```
~A patient with 10/10 flank pain, writhing in pain
~Abdominal pain with nausea and vomiting in the elderly
~An oncology patient with severe pain
~A sickle cell crisis
~Any full or partial thickness burns
~Possible dislocations
~Compartment syndrome
~Urinary retention
```
67
Resources level 3:
2 or more
68
Resources level 4
1 resource
69
Resource level 5
0 resources
70
ESI Resources
1. Labs (blood, urine)
2. ECG, Xrays, CT, MRI, US< angiography
3. IV fluids
4. IV, IM< or neb meds
5. Speciality consult
6. Simple procedure (lac repair, foley cath) =1
7. Complex procedure = 2 like conscious sedation
71
NOT resources
```
H&P
POC
Saline or heplock
PO meds
Tetanus
RX refill
Phone call to PCP
Simple wound care: dressings/recheck
Crutches/splints, slings
```
72
Danger VS <3mo
HR >180
RR>50
Level 2
73
Danger VS 3m-3yr
HR>160
| RR>40
74
Danger VS 3-8yr
HR >140
| RR>30
75
Danger VS >8yr
HR >100
RR>20
Spo2<92
76
Peds fever criteria
1-28y/o: T>38 (100.4) = level 2
1-3mo temp >38 (100.4) = consider level 2
3mo-3ys temp> 39 (102.2) consider level 3
