Health

1. NIMCO MAHAMED HUSSIEN
RAHMAABDIRAHAN
SUAD SAID MAHAMED
SAYNAB MOHAMEDABDI
SAHRAAHMED CISMAN
GROUP 3

2. EMERGENCY
NURSING

3. CONTENTS
Introduction
Definition
Principles of emergency nursing
Ethical aspect of emergency nursing
Role of emergency nurse
Some of emergency event and its management
Emergency drugs

4. INTRODUCTION
•Emergency nursing is a specialty within the field of
professional nursing focusing on care of patients
who requires prompt medical attention to avoid long
term disability or death

5. DEFINITION
•nursing emergency is nursing specialty in which
nurses care for patients in the emergency or critical
phase of the illness and injury.

6. PRINCIPLES OF EMERGENCY NURSING
1. Establish a patent airway and provide adequate ventilation
2. Control haemorrhage prevent and manage shock
3. Maintain and restore effective circulation
4. Evaluate the neurological status of the client
5. Carry out rapid initial and on going physical assessment
6. Start cardiac monitoring
7. Protect and clean wounds
8. Identify significant medical history and allergies
9. Documents the findings in medical records

7. CONCEPT
The term emergency nursing is used for those patients
who require immediate action to prevent further
detoriations or stabilizing the condition till the availability
of the services close to the patients
The nurse as a team member plays a significant role in the
early assessment intervention either in the form of care or
transferring the patient safely to the heath serices

8. ETHICAL ASPECTS OF EMERGENCY
NURSING
Ethics are involved as the boundary of what is acceptable and what is not yet acceptable.
Five key of ethical principle
1. Respect for individual- the need to sure confidentially and privacy
2. Respect for the autonomy of the individual- the need to ensure appropriate consent is
given by the patients and relatives.
3. Beneficence- the need to ensure that division regarding treatment for individual patient are
designed to be benefit to the patient not merely to avoid harm
4. Honesty- individual patient and family are given honest information regarding progress and
prognosis
5. Justice- equity of access rather than post code services

9. ROLE OF EMERGENCY NURSE
 Role of emergency nurse involves
 Accept with out prior warning any person requiring health care with undifferentiated and
undiagnosed problem originated from social psychological spiritual or cultural factors leads,
initiates, and coordinates patient care
 Rapid patient assement and assimilation of information often beyond the presenting problem.
 Allocation of priority for care
 Intervention based on the assessment
 Ongoing or referral to other sources of care undertaken independently by the nurse within
guideline

10. EMERGENCY TROLLEY
• A crash card or code cards is a set of trays /drawers/shelves on wheels used in
hospitals for transportation and dispensing of emergency medication/
equipment at side of medical surgical emergency for life support protocols to
potentially save someone’s life
• This are the drugs and equipment present in the trolley
• Monitor/defibrillators, suction devices and bag valve masks of different size
• Advanced cardiac support drugs such as epinephrine, atropine lidocaine
sodium bicarbonate dopamine and vasopressin
• First line drugs for treatment of common problem such as adenosine dextrose
diazepam

11. SOME OF THE EMERGENCY EVENT
1. Trauma
2. Shock
3. Injected poisoning
4. Snake bite
5. Clinical burn
6. Heart stroke

12. TRAUMA
It refers to a body wound or shock produced by sudden physical
injury as from violence or accident
It can also describe as a physical wound or injury, such as a
fracture

13. CLASSIFICATION
Poly trauma
Head trauma
Chest trauma
Surface trauma
Abdominal trauma
Facial trauma
Spinal cord trauma
Blunt trauma
Penetrating trauma

14. ABDOMINAL TRAUMA
Penetrating abdominal trauma causes an open wound, such as from the
gunshot or stabbing. The solid organs can bleed profusely when injured. The
hollow organ generally do not bleed significantly and are likely to cause
peritonitis damage
Blunt abdominal trauma- a force to the abdominal that does not leave an open
wound commonly occurs with motor vehicle crashes or falls compression is a

15. CLINICAL FINDINGS
Catheterization and urine analysis, serial hemoglobin and
hematocrit
CBC serum analysis
CT scan chest and abdominal x –ray
Fast- for blunt abdominal trauma

16. MANAGEMENT
oImmobilize body part and keep the patient on supine position with adequate
cervical stabilization
oObserve sings of fracture- pain swelling tenderness
oCover open fracture with sterile dressing to prevent infection
oImmobilize any suspected fractures by splinting the joint above and below the
injury
o

17. NURSE ROLE IN CASE OF PATIENT WITH
TRAUMA/ INJURY
Primary assessment and resuscitation ABC
Examine for swelling, deformities neck wounds
Deviation of trachea of one side assess airway check airway and
assess breathing if respiration is absent, start artificial respiration

18. CON,,,
• GIVE OXYGEN VIA NON – rebreathe mask with oxygen open chest wound flail chest ets
• Penetrating object should be left in position
• A filial segment should be stabilized
Circulation case with haemorrhage control
• Look for the major bleeding
• Check for the sign of shock
Management
 Keep the patient flat
 Keep warm and resource
 Commence intravenous IV fluid

19. DISABILITY
• Briefly assess patients neurological status
• A=alert v= respond to verbal command
• R=respond to pain U= irresponsible assess public response
• Maintain patient warmness and the environment hypothermia may lead to
shock.

20. Shock
• Shock is an abnormal physiological state where an imbalance between the
circulating blood volume and the size of the vascular bed results in circulatory
failure and oxygen and nutrient
Classification
Hypovolemic shock
Cardiogenic shock
Neurological shock
Anaphylactic shock

21. SIGN AND SYMPTOMS
• Skin
• Symptoms and sign of hypovolemic shock [pale, cool and moist skin] and
cardiogenic shock
• Warm dry pink in septic shock and neurological shock .
• Pulse- tachycardia weak and thread
• Respiration- rapid and shallow due to tissue anorexia and excessive amount of
co2
• Alert level of consciousness, restlessness and apprehensive

22. MANAGEMENT
MEDICAL MANAGEMENT
Fluid and electrolyte balance
Antibiotic treatment – for treating septic shock
Inotropic agent – to improve cardiac output eg dopamine and dobutamine
Norepinephrine- to improve cardiac output
Corticosteroid- to treat septic shock it will protect all membranes and decrease
the inflammatory response

23. NURSING MANAGEMENT
Maintain patent airway and adequate ventilation
Establish maintain airway
Administer oxygen as order
Monitor respiratory status as ordered
Promote restoration of blood volume
Administering blood and fluid
Crystalloid solution are preferred normal saline and ringe lactate
Blood product- whole blood or packed red blood cell, fresh frozen plasma
Administer drug as ordered

24. INJECTED POISONING
•Insect bite or stings
• Insects bite are puncture wounds caused by insect.
Insects release saliva that can cause inflammation
blisters and irritation on skin

25. TYPES
Horse flies- it is very painful symptoms includes dizziness
weakness
Bedbugs
Not usually painful
May develop intense irritation
Cause swealing itching
Very itchy lumps appear on the skin

26. TREATMENT
Wash with soap and water
Antihistamines to reduce itching
Analgesic if pain is severe
Observer for anaphylactic

27. SNAKE BITE
Snake bite is a common problem in rural area of somaliya
Clinical feature
1. Local symptoms
2. Two clear cut fang marks
3. Pain and swealing
4. Painful regional lymph node
5. Nausea vomiting headache fainting and abdominal pain

28. MANAGEMENT
a. Pre hospital management
b. Immobilize the bitten area
c. Gather information
d. Do quick assessment for local reaction and systemic reaction
e. Create IV access and star IV fluid administration
f. Send blood for investigation
g. Monitoring vital sign cardiac rhythm and neurology function

29. Con,,,
H. supportive therapy
I. Analgesic to reduce pain
J. Anti snake venom
K. Antibiotics

30. Clinical burn
 strong chemicals can burn skin on contact.
some times burns develops slowly acid alkalis liquids and solids can cause
burns
Acid substances cause coagulation necrosis and alkali produce liquefaction
necrosis
FIRST AID MEASURE
• Move victim to avoid fumes
• Brush off dry chemical from skin
• Remove clothing and jewelry from burn area while flushing water

31. MANAGEMENT
A. Hospital care
B. IV fluids to maintain hydration
C. Analgesic narcotics to reduce pain
D. Silver sulfadiazine
E. use of decontaminants to minimize their caustic effect
F. Observe affect area for deep injury and extending tissue necrosis
G. Monitor for complication

32. HEAT STROKE
•Heat stroke is an emergency condition where the body's
core temperature is markedly elevated 40ć in adults after
being expose to Hight temperature combined with
neurological symptoms and loss of body thermal
autoregulation

33. SIGN AND SYMPTOMS
1. Muscle crams exhaustion and profuse swealing
2. Tachycardia, headache
3. Hot and dry skin
4. Confusion hallucination and seizure
5. Coma and death

34. MANAGEMENT
•Rapid cooling by spraying cool water and by covering
them with cold water shocked sheets
•Additional cooling by placing ice pack under armpit, head,
neck, groin, area
•IV fluid
•If patient is conscious administer fluid orally
•Monitor vital sign and urine output

35. ASPHYXIA
• Near drowning
• Drowning is an unexpected submersion injury in which a previous
heath person are exposed to sever cerebral hypoxia aspiration,
academia and suffers permanent brain damage

36. CLINICAL FEATURE
Semiconscious and unconscious
Awake, restless apprehension
Headache, vomiting, cough, dyspnea
Chest pain
Hypoxia
Usually client recover within 48 to 72 hours

37. MANAGEMENT
I. First aid
II. Remove the victim from the water and stabilize his her
neck
III. Maintain ABC
IV.If the patient is unconscious keep the oral cavity patent
to intubate
V. Remove any foreign material present on face and mouth

38. HOSPITAL MANAGEMENT
1. Establish IV access, administer IV fluid
2. Establish patient airway intubate if needed
3. Collect sample to check ABG value
4. Provide blanket to manage hypoxia
5. Administer supplement oxygen

39. EMERGENCY DRUGS
DRUGS DOSE
Fentanyl [50mcg /ml]
Analgesic, sedative anesthesia
1mcg/kg
Hydralazine [20mg/ml]
Hypertension by vasodilation
0.1 to 0.5mg/kg
Lorazepam [2mg/ml]
Sedation seizures
0.005.1mg/kg
Morphine [1mg/ml] pain sedation 0.05.1mg/kg