emergency preparedness Flashcards
principles for care of the emergency patient
Recognize life threatening illness or injury.
Institute interventions to reverse or prevent crisis.
Triage ( French word to sort )
Process to determine patient acuity.
Most important assessment skill.
System identifies and categorizes patients so most critical are treated first. Use Emergency Severity Index (ESI). Is 5 level triage system.
ESI Five-Level Severity System
System measures stability of vital functions (ABC’s).
Measures life threat or organ threat.
Measures how soon the patient should be seen by a physician.
Measures expected resource intensity.
Examples:
ESI-1: Cardiac arrest, intubated trauma patient, severe overdose, SIDS
ESI-5: Cold symptoms, minor burn, recheck
primary nursing survey for emergency patient
Focuses on airway, breathing, circulation and disability.
Serves to identify life-threatening conditions so appropriate interventions can be started.
Then interventions can be started immediately.
airway for emergency patient
Nearly all immediate trauma deaths occur because of airway obstruction.
High risk patients include those with seizures, near drowning, anaphylaxis, foreign airway obstruction, cardiac arrest, cervical spine injury.
If airway is not maintained, hypoxia, acidosis, and death can occur.
circulatory for emergency patient
Need effective heart, intact blood vessels, and adequate blood volume.
Any uncontrolled internal or external bleeding places a person at risk for hemorrhagic shock.
Assess central pulse for quality and rate, mental status, capillary refill, and skin color. Check vital signs for signs of shock.
Large bore IV lines are started in the upper extremities. Pneumatic anti-shock garment may be used . Transfusions and fluids may be given.
breathing for emergency patient
Need effective heart, intact blood vessels, and adequate blood volume.
Any uncontrolled internal or external bleeding places a person at risk for hemorrhagic shock.
Assess central pulse for quality and rate, mental status, capillary refill, and skin color. Check vital signs for signs of shock.
Large bore IV lines are started in the upper extremities. Pneumatic anti-shock garment may be used . Transfusions and fluids may be given.
breathing for the emergency patient
Causes of breathing problems could be fractured ribs, pneumothorax, penetrating injuries, allergic reaction, pulmonary emboli and asthma attack.
Any critically injured or ill patient with increased metabolic demand should have supplemental oxygen
disability for emergency patient
Brief neurological exam completes the primary survey.
Look at level of consciousness to determine degree of disability.
Determine response to verbal/painful stimuli.
Use AVPU
A- alert
V- response to voice
P- response to pain
U- unresponsive
May use glascow coma scale
Check pupils for size, shape, response to light and equality.
Inspect extremitie s for deformity. Determine ROM and strength.
Do a brief pain assessment.
Examples of conditions causing disability: Head injury and stroke.
secondary survey of emergency patient
Occurs after each step of the primary survey is addressed and any life-threatening interventions are initiated.
Purpose is to identify all injuries.
Components:
Exposure and environmental control
Full set of vital signs
5 interventions: ECG, o2 sat, foley cath, gastric tube, obtain blood for lab studies.
Facilitate family presence
Give comfort measures
History and head-to-toe assessment.interventions / evaluations of emergency patient
Record findings
Determine tetanus prophylaxis
Need ongoing patient monitoing
Death in the emergency department
Need to deal with feelings about sudden death in order to help families and significant others begin the grieving process.
Role in hospital rituals:
Prepare bereaved to grieve. Collect belongings
Arrange for autopsy if indicated.
Allow family to view body.
Make mortuary arrangements.
Non-heart beating tissue donation (NHBD)
reverse triage of emergency patient
Used in disaster situations.
Goal: Do the greatest good for the greatest number with limited resources.
Save the least hurt people first.
The key difference between emergencies and disasters is that emergencies are controlled.
disaster nursing
Disaster- is an uncontrolled event that leads to major loss.
a. American Red Cross says it is an occurrence such as
a hurricane, tornado, storm, flood, tidal wave,
earthquake, pestilence, famine ,building collapse,
commercial transportation wreck, etc.
b. Anything that causes human suffering or creates
human needs that victims cannot get without
substantial assistnce.
disaster nursing continued
Emergency- any extraordinary event that requires a rapid and skilled response that can be managed by a community’s existing resources. Is controlled.
Mass Casualty Incident (MCI)- is a man made (biologic or natural human ) event or disaster that over-whelms a community’s ability to respond with existing resources. Involves large number of casualties, physical & emotional suffering and permanent changes within a community. Always requires outside assistance and resources.
When Disaster/MCI occurs
First responders dispatched to scene ( police, emergency medical personnel.
Triage differs from ER Triage-may use reverse triage system with colored flags designating seriousness of the injuries and likelihood of survival.
Triage conducted fast. Casualties treated and stabilized. If suspected contamination, decontamination procedures are instituted at the scene. After this, transport to the hospitals
community services in disaster
CERTs- Community Emergency Response Teams
a. Recognized by FEMA. CERT training helps citizens to understand their personal responsibility in preparing for a disaster.
b. Taught how to safely help themselves, their family,
and neighbors. Training includes lifesaving skills
with emphasis on decision making and rescuer safety.
c. Considered extension of first responders
d. . Are able to offer immediate help to casualties and
organize untrained volunteers to assist until
professional services arrive.
Hospital health care providers have to have knowledge of hospital’s emergency plan and their role and responsibilities in it. Need drills to assess level of preparedness,
federal involvement (disaster)
National Disaster Medical System (NDMS) section within US Dept. of Homeland Security.
Coordinates federal medical response to MCI
Works with local emergency response personnel
Organizes & trains Disaster Medical Assistance Teams (DMATs). Composed of members with a variety of medical skills. Categorized according to ability to respond to MCI
role of nursing (disaster)
Nurses function outside usual practice setting and assume many roles. Must be able to perform under stressful and physically dangerous conditions.
May function in triage of casualties
May provide direct care to casualties.
Short term goal- provide emergency medical assistance with special attention to vulnerable groups.
Long term goals-provide assistance with resettlement programs, psychological needs, economic needs, legal needs. May partner with other agencies for assistance
agencies nurses work with (disaster)
National Disaster Medical System (NDMS)
Local services ( police, EMS)
International Medical/Surgical Response Teams (IMSURTs)
Deployable Rapid Assembly Shelter Hospitals (DRASHs)
Medical Reserve Corps- part of USA Freedom Corp.
American Red Cross
Commission Corps Readiness Force
nursing responsibilites (disaster)
Responsibility to the public to be knowledgeable about disaster preparedness and response
Should have personal and family plan as part of their disaster preparedness.
Nurses who are prepared for disasters will be better able to help themselves, their families and their community
stress management (disaster)
Critical Incident Stress Management Unit
Helps with psychological stress to those involved immediately with the disaster. Many hospitals and DMATs use this.
Unit arranges group discussions to allow participants to verbalize and validate their feelings and emotions about the experience which is important for emotional recovery.
