NUR 265 Exam 4 Study Guide (NUR 265)

EMERGENCY CARE - Main reasons people seek emergency care include: Pain (main reason), Abdominal Pain, Chest pain, h/a, Difficulty breathing, fever, Injury (especially in elderly population) - EMTs can provide basic life support interventions such as AEDs, O2 - Paramedics can provide advanced life support interventions such as cardiac monitoring, advanced airway management (intubation) IV access - Staff and pt safety are major concerns in ER/ED setting a. Staff: Disease transmission and physical safety when dealing with agitated or aggressive pts.  always use standard precautions. De-escalate situations if able, notify security, know exit routes. b. Patient: 1. Identification: use identifiers such as ID bracelet. Two unique identifiers (name/DOB/SSN etc) unknown pts use unique identification system such as Jane/John Doe. 2. Safety: Early identification of falls risk. Older adults should always have all side rails up, bed should be in lowest position and call light w/in reach. Teach them to call out if they need assistance. Reorient pt as needed. 3.Skin integrity: Take measures that maintain skin integrity. -Death in ER: 1. Medical examiner required if: a. Trauma b. Suspected homicide or abuse DO NOT clean skin, leave all IV lines & tubing in place. The body can be covered with linen. The face may be exposed for viewing. - Triage: Emergent (life threatening) Urgent (needs quick but not immediate treatment) Non urgent (can wait a few hours) Resp distress, active bleeding, chest pain w/ diaphoresis, stroke, unstable VS Severe abdominal pain, fractures (displaced/closed or multiple) new onset of resp. infections Simple fractures, skin rash, colds. -Primary Survey and Resuscitation Interventions (ABCDE) (A) Airway/cervical Spine. Spontaneously breathing: Non-rebreather mask Vent Assistance needed: Bag valve mask + 100% Oxygen. ***if GCS 8 then mechanically vent*** Manually align neck + spine to neutral position, use jaw thrust method. (B) Breathing Assess Resp status (lung sounds, resp effort, chest expansion etc) If CPR is needed d/c vent and bag pt manually (C) Circulation Assess cardiac status Ensure IV access (16 gauge in AC usually best) RL or NS usual. External hemorrhage: apply direct pressure, if direct pressure fails, a tourniquet should be considered (D) Disability Rapid Assessment of neuro status GCS is common, is pt Alert, responsive to voice, responsive to pain or unresponsive? (E) Exposure Expose and examine for any bleeding. Always remove clothing w/ scissors cutting away (burns, or when moving limbs can cause injury) Cover any viscera w/ moist sterile dressing/gauze Prevent hypothermia by covering pt with blankets, use of heating devices or by infusing warm solutions. -Secondary Survey and resuscitation interventions are used to identify other injuries or medical issues that may be managed or that might affect the course of treatment. It usually involves a head to toe assessment and placement of gastric tubes, catheters and diagnostic studies. This study resource was shared via CourseH MASS CASUALTIES Red Tag (class I) Yellow Tag (class II) Green Tag (class III)