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EMERGENCY NURSING1TRIAGINGMethod of PRIORITIZING patient care according to:type of illness or injury and urgency of the patient condition

TRIER meaning to sort.2TRIAGINGLevel 1ResuscitationNeed of immediate nursing and medical attentionLevel 2EmergentNeed immediate nursing assessment and rapid treatmentLevel 3UrgentNON-LIFE THREATENINGCan wait for 30 minutesLevel 4Less urgentCan wait for 1 hourLevel 5Non-urgentCan wait for 2 hoursFAST-TRACK: first aid or basic primary care in the ED or a clinic or physician's office

3TRIAGINGLevel 1Need of immediate nursing and medical attentionCardiopulmonary arrestMajor traumaSeizuresLevel 2Need immediate nursing assessment and rapid treatmentHead injuriesChest pain, strokeAsthma, sexual assaultLevel 3Can wait for 30 minutesSigns of infection, mild distress and moderate painLevel 4Can wait for 1 hourEarache, chronic back pain, upper respiratory symptoms, mild headacheLevel 5Can wait for 2 hoursSore throat, menstrual cramps4TRIAGINGLEVEL 3: requires two or more resources (Moderate sedation) LEVEL 4: one resource only (FBC)RESOURCESimaging studiesmedications administered by intravenous (IV) intramuscular (IM) routesinvasive procedures5TRIAGINGNOTES:If you cant decide which TRIAGE level is BEST for the patient: assign in the HIGHER LEVEL MAINTAIN COMMUNICATION: patient status may change

6TRIAGING7TRIAGINGTRIAGE CATEGORYPRIORITYCOLORTYPICAL CONDITIONSIMMEDIATE: life-threatening but survivable with minimal intervention. can progress rapidly to expectant 1RedSucking chest wound, airway obstruction, shock, hemothorax, 2nd/3rd degree burns of 15%40% total body surface areaDELAYEDrequire medical care, but can wait hours 2YellowStable abdominal wounds without evidence of significant hemorrhage; MINIMAL: minor and treatment can be delayed hours to days. 3Greenminor burns, sprains, small behavioral disorders or psychological disturbances.EXPECTANT: survival unlikely 4BlackUnresponsive patients with penetrating head wounds, high spinal cord injuries, 8DISASTER LEVELSLEVEL I: LOCAL emergency response personnel and organizations can contain and effectively manage the disaster and its aftermath.LEVEL II: REGIONAL efforts and aid from surrounding communities are sufficient to manage the effects of the disaster.Level III: Local and regional assets are overwhelmed; national assistance is required.

9DECONTAMINATIONprocess of REMOVING ACCUMULATED CONTAMINANTSSTEPS:Removal of the patient's clothing and jewelry and then rinsing the patient with water.Thorough soap-and-water wash and rinse.

10TYPES OF WEAPONS OF TERROR:11CHEMICALCHARACTERISTICS: VOLATILITY (tendency for a chemical to become a vapor)PERSISTENCE (likelihood to vaporize and disperse)TOXICITY (potential of an agent to cause injury to the body)LATENCY (time from absorption to the appearance of symptoms)12RADIOLOGICTYPES OF RADIATIONTYPEEFFECTREMARKSAlpha particles Cannot penetrate the skinLocalized damage Beta particles Moderately penetrate the skinSkin damage if prolonged

Gamma-radiation(X-rays an example )PenetratingDifficult to shield13RADIOLOGICTYPES OF INJURYTYPEEXPOSUREREMARKSExternal irradiation all or part of the body not radioactiveContaminationexternally or internallyimmediate medical management Incorporation actual uptake of radioactive material Vital organs involved 14RADIOLOGICPHASES OF EFFECTS OF RADIATION EXPOSUREProdromal phase (4872 hr after exposure)GI UPSET; fatigue (High-dose radiation) fever, respiratory distress, and increased excitability Decreasing lymphocytes, leukocytes, thrombocytes, red blood cellsLatent phase (last up to 3 week)Decreasing lymphocytes, leukocytes, thrombocytes, red blood cells (symptom-free )Illness phaseInfection, fluid and electrolyte imbalance, bleeding, diarrhea, shock, and altered level of consciousnessRecovery phaseCan take weeks to months for full recoveryDeathIncreased intracranial pressure is a sign of impending death15RADIOLOGIC

SURVIVALPROBABLE (no initial symptoms or only minimal symptoms does not persist)POSSIBLE (with nausea and vomiting that persists for 24 to 48 hours. lymphocyte count is less than 1200/mm3) IMPROBABLE (received more than 800 rad of total body penetrating irradiation)PERSONAL PROTECTION: ESSENTIAL 16NEGLIGENCE

an act of omission or commission 4DSDuty for nurseDereliction (breach of duty)Damages as resultDirect result (injury, harm or death)AN ACT TO PROMOTE DONATIONS IN GOOD FAITH OF MEDICINES, FOOD PRODUCTS OR SUPPLIES BY ESTABLISHMENTS AND OTHER ENTITIES, INCLUDING INDIVIDUALS BY EXEMPTING THEM FROM ANY FORM OF LIABILITY ARISING THEREFROMGood Samaritan Law

protects private citizen provides aid without undue fear of litigation protects EMT from civil charges doesnt protects EMT from gross negligenceSenate Bill No. 1917Consentprinciple: AUTONOMY/Self Determination consent not possible; - disoriented- minors with no parents available - mentally handicapped Two types: a. Expressed/Informed b. Implied **emancipation as an exemption

Refusal of Treatment & TransportChallenges.. each person has the right to refuse (competent) has the right to withdraw treatment issue is false imprisonment issue on Assault & Battery

Interventions..explain consequences & alternatives try to convince victim to accept care transport sign: refusal treatment release form use best judgement whether victim has mental incompetence

Other issuesAbandonment EMT leave victim without giving opportunity for continued care EMT must prove patient refused charges possible of patient refusing is incompetent

Intoxicated, Irrational & Emotionally disturbed.. high legal risk two solutions; a. protective custody b. forcible removal

**High Legal risk - held against wishes **PROTECTIVE CUSTODY violent/suicidal patients ** FORCIBLE REMOVAL soft restraints, precise documentation21Other issuesResuscitation Issue;Proxies Extended Transport - If patient dies during transportAmbulance must stopInform coroner

Donor & Organ Harvest; advance directives - divers license -separate donor card- Communicate info w/ medical director

Proxies DNR orders, advance directives, healthcare proxy(SPAMEDICAL INSIGNIA bracelet/ necklacesCrimes scene don not cut thru the holes in clothing22COMMUNICATION

One of the most important role in EMS - receives the call for help - dispatches 1st responder & EMS- coordinate emergency response- relay information from prehospital to hospital

COMMUNICATION

Characteristics: AccurateConfidentialUse of systemic approach to collect informationAbility to calm peopleAbility to express empathy & care

COMMUNICATION

Types:Radio via repeater Base station radioMobile two-way radios Hand-held/portable radiosBiotelemetryCellular phones

COMMUNICATION

Process:Receive call for helpDispatch appropriate unitsProvide updates/clarificationDispatch additional resource as neededProvide pre-arrival information

COMMUNICATION

When to communicatewhen call receivedwhen unit begins responseOn arrival at sceneWhen leaving the sceneOn arrival at hospital When leaving the hospitalWhen return to station or postWhen unit available for next assignment

Fast Facts: Victim & Family InterventionPatientallow patient to express feelingsdo not contradict if patient indicates death imminent do not offer false assurancelisten empathically provide respect, privacy, dignity, sense of controlallow DABDA to run its course

Family

assess knowledge constantly inform allow family to travel with patient If family refuses treatment, inform the medical director

DEMOBILIZATION re moving victim from the scene of critical event DEFUSING: (1) Introduction; (2) Exploration; (3) Information

28DOCUMENTATION

DOCUMENTATION

Pre-hospital Care Report (PRC) Valuable part of patient recordDocuments all aspects of callImportant part of legal record

DOCUMENTATION

Run (dispatch) data Date, time of call (military time)Crew respondingType of callSequential time of responseRoute, cross streets, major thoroughfares Nature of problem stated in call

DOCUMENTATION

b. Patient dataBasic informationIf become unconscious PRC data becomes main information sourcec. Assessment dataCritical signs & symptomsChief complainsVital signsMental status Skin assessment Objective & subjective findings

DOCUMENTATION

d. Treatment dataTreatment with time relationshipTreatment rendered before arrivalTransport methodHospital notificationType of receiving facility e. Patient DispositionReceiving hospitalSpecial transport methodFinal disposition of patient at hospitalSignature of EMT, receiving nurse/physician

DOCUMENTATION

Death;Irreversible or obvious deathClinical declaration neededRecord factors of deathGeneral statements such as DOA not acceptableTime of deathDNR order notedDying statement: EMS becomes sole witnessHomicide & Suicide;Do not disturb crime sceneDo not move bodyReport criminal act to police

ANTE MORTEM STATEMENTS34Up nextBody mechanics