Emergency Care Flashcards
What is emergency management?
Care given to patients with URGENT and CRITICAL needs
- severe conditions affecting their ABCs
- concept has evolved from mgmt of life-threatening conditions to managing emergencies as whatever the patient or family considers it to be
What is emergency nursing?
Field of nursing that requires specialized education, training, and expertise in assessing and identifying pt’s healthcare problems in crisis situations
What are the functions of an ER nurse?
[EMC-2S-EWPAN]
- Establishes priorities
- Monitors
- Continuously assesses pts who are acutely ill and injured
- Supports and attends to families
- Supervises allied health personnel
- Educates patients and families within a time-limited, high-pressured environment
- Works with a team
- Performs highly technical, hands-on skills (for ER pts
- Accomplishes interventions independently or in consultation w/ MD or NP
- Nursing area specialty
RE: Functions of ER Nurse
In terms of supervising allied health personnel, the nurse acts as a team leader in:
- Code Management
- Staff Supervision
RE: Functions of an ER Nurse
What are the different certifications for ER Nursing?
- BCLS/BLS : Basic Cardiac Life Support; noninvasive assessment and mgmt for ABCs; no pharma
- ACLS : Advanced Cardiac Life Support; Invasive airway mgmt skills; involves pharma (e.g. if epi is given at a certain point); with AED
- PALS : Neonatal and pedia resuscitation
- CERN : Certified Emergency Registered Nurse
- CCRN : Certified Critical Care Registered Nurse
Challenges in emergency care include? (Subtopics only)
- Diversity of Conditions and Situation
- Ethical and Legal Issues
- Occupational Health and Safety Risks
- Holistic Care in the Context of Fast-Paced Technology-Driven Environment
- Disaster Nursing
Under Ethical and Legal Issues:
What is Negligence?
Not performing necessary actions = damage or death to pt
Under Ethical and Legal Issues:
What is Malpractice?
Gives substandard practice with ill intention to harm
Under Ethical and Legal Issues:
What is the “Good Samaritan Law”?
- Gives legal protection to those who help accident victims via emergency medical care within the golden hour
- Usually do not apply to emergency personnel on duty; medicolegal cases are handled by that dept
Under Ethical and Legal Issues:
What is informed VS. implied consent?
Informed : Before receiving the pt, inform them about procedures to be done to get their agreement (e.g. inform na ure going to auscultate)
Implied : No verbal consent, but no signs of disagreeing; other party didn’t impose
Under Ethical and Legal Issues:
What are the 2 duties nurses have?
- Duty to report suspected crimes to the police
- Will be handled by medicolegal team - Duty to gather evidence in criminal investigations
- Be aware of hospi policy + state laws; whatever u do / remove = evidence, must be documented
Under Ethical and Legal Issues:
What are the 2 kinds of advance directives?
- Durable power of attorney: designates a person to make decisions on your behalf
- Living will regarding health matter AKA advance healthcare directive: specified medical treatments you do or do not wish to receive
Under Ethical and Legal Issues:
What is the order of proxies to provide consent for the pt?
Spouse → Children → Parent/s → Sibling/s
Under Ethical and Legal Issues:
What is loco parentis?
Doctor takes control of the situation and makes decision on behalf of pt to perform life saving procedures
Under Ethical and Legal Issues:
What are the exemptions in obtaining consent to examine and to treat?
NOTE: ALL 3 MUST BE PRESEN
- Unconscious / in critical conditions
- Unable to make decisions
- Without family and friends (of legal age)
IF ALL 3 PRESENT: we get to make the decision
Under Ethical and Legal Issues:
Data Privacy Act of 2012 is RA __________?
10173
Under Ethical and Legal Issues:
Before gathering evidence, it is imperative to:
Ask pt first if they will file for medico-legal. All pieces of evidence should be taken into consideration and properly documented
Under Occupation Health and Safety Risks:
What are the reasons HCW have this risk?
- Non-comprehensive medical history
- Infections, hazards
- Physical Threats (also verbal abuse)
Under Occupation Health and Safety Risks:
What are non-restraint techniques?
Talking, decreasing stimuli, distancing yourself
Under Holistic Care:
What are the 2 kinds of interventions?
- Patient-focused
- human contact, reassuring words; individualized care - Family-focused
- family kept informed + with patients as much as possible; verbalization encouraged
What is compassion fatigue?
Combi of physical, emotional, and spiritual depletion assoc with caring for pts in significant emotional pain and physical distress
TLDR: too much care affects u
What is the function of the Critical Incident Stress Management team?
They allow ppl the chance to cope with the stressful event they experienced via 3 steps
What are the 3 steps to cope in CISM?
- Defusing: rendered immediately after
- Debriefing: after 1-10 days
- Follow-up: after 10 days; could also be after months
During these sessions, HCW expresses their feelings about the incident they experienced
In discharge planning, METHODS stands for?
- Medications
- Exercise
- Treatment
- Hygiene
- Out-patient
- Diet
- Sleep, Sexuality, Spirituality
What’s the difference between EMTs and Paramedics?
EMT: Emergency Medical Technicians; BLS certified, 200h training, prereq to paramed
PARAMEDICS: ACLS certified; >1k hrs training, includes ET insertion
Assessment + Intervention should be done rapidly in less than ?
5 minutes
Primary Survey involves?
- Airway / Cervical Spine
- Breathing
- Circulation
- Disability
- Exposure
If GCS < 8, what does it mean and what should we do?
- Severe condition
- ET intubation, mech vent
Note: GCS 3 = coma
What size of catheters are used to facilitate fluid resuscitation or blood transfusion?
g20 or g18
For bolus of fluids or blood transfusion
AVPU is?
- Alert
- Verbal
- Pain (does pt respond to painful stimuli ONLY?)
- Unresponsive (to all stimuli? Incl. pain?
How do you prevent hypothermia?
- Blankets
- Heat lamps
- Infusion warm IVF
Meaning of “SAMPLE” history mnemonic?
- S/sx
- Allergies
- Medications
- Past med history
- Last food/liquid
- Events
Triage Acuity System includes:
- Emergent - continuous assessment
- Urgent - q30m
- Non urgent - q1-2h
What are the ESI levels:
1: x immediate life saving intervention
2: high risk, disoriented, severe pain, vitals in danger zone
3: requires multiple resources to stabilize pt, but vitals are not in danger zone
4: one resource needed to stabilize pt
5: doesn’t require any resources to be stabilized
Canadian Triage and Acuity Scale levels:
- Resuscitation: immediate, continuous nursing surveillance
- Emergent: q<15mins
- Urgent: q<30mins
- Less urgent: q<60 mins
- Nonurgent: q<120 mins
4-tiered hospital model triage (Berber, 2005) includes:
- Emergent: seen + treated agad; threat to life/limb
- Urgent: threat doesn’t exist atm; treated w/i 30 mins to 1 hour
- Nonurgent: no threat; doesnt req immediate treatment; treated w/i 2-24 hrs
- Fast track: simple first aid; can be referred to clinic
Disaster Triage
Emergent (Class I / Red Tag): Airway compromised
Urgent (Class II / Yellow Tag): Needs tx w/i 30 mins. to 2 hrs.
Non-urgent (Class III / Green Tag): tx delayed > 2 hours
Expectant (Class IV / Black Tag): Expected and allowed to die; dead
Mass Evacuation order?
Ambulatory > Wheelchair > bed bound > unit manager
Code blue?
Reqs RRT
Code Gray?
Dangerous person present, missing person, criminal activity
Code red?
Fire, deactivated by head of security ONLY
Code black?
Bioterrorism, bomb threat
Code pink?
Missing child, deactivated only by head of security and dept unit manager
