Test 1 Flashcards
Disaster`
Any time there is an increase in injuries or illness that are greater than available resources in hospital or community
Keys: injuries or illness greater than available resources in hospital or community
Internal Disaster
Fire
Violence
Staffing Issues
Flooding
Power OUtage
External Disaster
Natural Disaster
Plane Crash
Terrorism (nuclear, biological, chemical)
Pandemics (reduces resources)
Hospital Incident Command System
Chain of hierarchy during disasters
Emergency Officer Command: ER Physician
Nurse Superviser
ER Charge Nurse
Disaster Teams
Role Emergency Officer Command
Role of the ER physician - based on title, NOT name
Takes on responsibility of hospital activity
ER Nurse Supervisor Role during Disaster
Controls all patients moving in hospital
Calls all charge nurses and tells them the floor needs to come pick up a patient
Communicates alongside ER charge nurse and physician
ER Charge Nurse Role during Disaster
Controls patients moving within ER
Tells someone to go down list and start calling people in
Takes on responsibility of triage
Disaster Team A`
Disaster just hit or is impending, immediate responders
Disaster Team B
24 to 36 hours post disaster
Care for anyone who came in during disaster
Disaster Team C
72-hours post disaster
Recovery Team
After disaster is over, they are the ones who put everything back in order
The Join Commission Disaster Prep Rules
Require hospitals to perform 2 mock drills per year - 1 city wide, 1 hospital wide
Mass Casualty
Overwhelms community or hospital
Requires more than 1 community or hospital involvement
Greater severity of injuries/events
Mass Casualty Triage
Makes decisions baed on greater good within the field
Patients tagged Red, yellow, green or black
Mass Casualty: Red Patient
Emergent, immediate care is needed or death will result
Mass Casualty: Yellow Patient
Urgent, if not fixed within 30 minutes to an hour then they will likely become red
i.e. gunshot wound walking around, wound in arm but eventually may lose too much blood despite being okay now
Mass Casualty: Green
Walking wounded
Typically can wait 4 to 6 hours before intervention
Mass Casualty: Black
We expect you to die and will allow you to die
Emergency Severity Index
Triage occurs within the hospital
Placement is dependent on VITAL SIGNS
ALWAYS LOOK AT VITALS
Emergency Severity Index: Level 1
Red/black status
Emergent - life, limb, or eyesight
If you came in during a code then you are automatically level 1 or am I about to have to code you?
Examples: Open femur fracture with unstable vital signs
Emergency Severity Index: Level II
Yellow
Urgent, VS are abnormal, but can still talk
Patients can still wait 30 minutes, if intervention does not occur then they usually turn into life, limb eyesight
Possibly septic
Needs to see specialist
Ex) Open femur fracture with stable VS, closed humorous fracture w/ unstable VS, newborn with fever, immunocompromised patients, unstable stroke with abnormal VS
Emergency Severity Index: Level III
Green, walking wounded but can wait 5 to 6 hours
ex) chest pain with normal ECG/VS, abdominal pain (from last 2-3 days), pelvic pain, closed humorous fracture with stable VS, stable stroke with normal VS (normal since lat night)
Ask: How many resources are needed - xray, blood, meds
Emergency Severity Index: Level IV
Blue, non-urgent
Only 1 resource needed (urine sample OR something else)
ex) sore throat, earaches, sprained ankles, UTI (uncomplicated),
Emergency Severity Index: Level V
Pink, no resources needed
Patients with medication refill, work release, splinter in finger, stubbed toe, stable remover
Multi Casualty
Same amount of injuries, but many minor injuries (cuts, bruises), only handful, requiring surgery or major injuries
Very few must go to hospital
Handled within 1 hospital or community
ER Characteristics
Short-term
Trauma
4:1 or 5:1 ratio
Range of acuity levels
CEN, TNCC or CCRN certification
Vulnerable population - homeless, elderly, kids, uninsured due to lack of access to resources/funding
4 Phases of Disaster Prep
Mitigation
Preparedness
Response
Recovery
ICU Characteristics
Long-term care
higher patient acuity
2:1 ratio
CCRN
Characteristics ICU and ER Share
Teamwork
High Acuity
ACLS/BLS Certified
Sound Clinical Judgment Outcomes
Improves pt outcomes
Decreases LOS
Decreases Readmission Rates
Poor Clinical Judgment Outcomes
Failure to Rescue
Death
Failure to Rescue (FTR)
Occurs when we don’t notice a decline in status, must call rapid response team (RRT)
When do patients start to exhibit signs of death? What is a common contributing factor?
There were usually signs/symptoms 1 to 3 days earlier of declining status
Typically multisystem organ system failure dysfunction (MODS) may contribute
Where are patient death reports sent?
AHRG, CNS, TJC to perform root cause analysis (RCA)
Early Warning Signs/Patient Safety Indicators
BP, respirations, - increase/decrease (different from baseline)
LOC - change in status
UOP, O2 Sats - decrease
Crackles in Lungs
Dysrhythmias
Pain
Fever
Seizure (if no known history)
Who is on the rapid response team (RRT)?
Respiratory Therapist
Critical Care RN (ICU/ER)
Intensivist (board certified doctor) - only work in ICU
Emergency MD - board certified and only works in ER
When do we call rapid response team?
patient is ALIVE
Change in status
EWS present
More resources needed or education
If family/pt wants them to come
What does the rapid response team do?
Assess ABCs
Intervene - ACLS, lifesaving drugs protocols without orders, establish IV access or EKG, rapid sequence intubation (RSI), educate, start labs quickly w/out dr orders
Code Team
Different from rapid response team
EVERYONE responds, 12-14 people
Called when someone is dead
EMTALA Laws/Emergency Medical Treatment and Labor Act
Emergency medical treatment and labor act
If in active labor or experiencing medical emergency, hospital cannot turn you away
Pt must be examined 1st or stabilized before releasing
If no resources to deal with case, send to next best equipped location
Triage
“To Sort”
Rapidly determines patient acuity and categorizes patients so most critical are treated first
Represents critical assessment skill
ABCDEFGH
Alertness and airway
Breathing
Circulation
Disability
Exposure and environmental control
Facilitate adjuncts and family
Get resuscitation adjuncts
history and head to toe1
Primary Survey
Focus is on ABCDE
Initial Assessment
Addressed before moving on to next steps
If hemorrhaging, then priority shifts to CAB…
Primary Survey: Uncontrolled External Hemorrhage
Reprioritized to CAB
Apply direct pressure and apply pressure dressing
Alertness and Airway
Determines LOC
Assess patient response to verbal and/or painful stimuli
AVPU - alert, voice, pain, unresponsive
Signs/Symptoms of Compromised Airway
Dyspnea
Inability to speak
gasping/agonal breath
Foreign body in airway
trauma to face/neck
Treatment of Compromised Airway
Open airway using jaw-thrust maneuver - do not hyperextend neck
Suction/remove foreign body
Insert NG or OG tube unconscious patient
Endotracheal intubation
Rapid Sequence Intubation
Preferred procedure for unprotected airway
Involves sedation or anesthesia and paralysis
When do we suspect cervical spine trauma?
Face, head or neck trauma
Significant upper chest injury
Treatment:
- Cervical collar
- cervical immobilization device (CID)
Primary Survey: Breathing Interventions
High-flow O2 via nonrebreather mask
Primary survey: Breathing Interventions for Life Threatening Conditions
Bag-valve-mask with 100% O2
Needle decompression
intubation
treat underlying cuase
Primary survey: Circulation Assessment
Check for central pulse - peripheral may be absent
Assess quality and rate
Assess skin color, temp, moisture
Assess for signs of chock
Signs of shock
Change in mental status
delayed cap refill
Cirulation Intervention
Insert 2 large-bore IV catheters
Initiate aggressive fluid resuscitation using normal saline or LR
Disability Assessment
Measured by LOC
Glasgow Coma Scale
Pupils
What to do in cases of exposure and environmental control?
Remove clothing to perform physical assessment
Do NOT remove impaled object
Prevent heat loss
maintain privacy
Secondary Survey
Brief, systematic process to identify all injuries - history, head, neck and face; chest, abdomen and flanks, pelvis and perineum, extremities, posterior surfaces
Includes FGH of ABCDEFG
Resuscitation Adjuncts: LMNOP
Laboratory Studies
Monitor ECG
Nasogastric tube or orogastric tube
Oxygenation and ventilation assessment
Pain Management
Secondary Survey: SAMPLE
Symptoms
Allergies
Medication History
Past Health History
Last meal/oral intake
Events or environmental factors leading to illness/injury
Pulseless Extremity
time-critical emergency
Compartment Syndrome
Limb-threatening complication causing severe vascular impairment
Early Signs:
Increase in Pain
Paresthesias (numbness, painful tingling)
