Responding to emergencies

Bleeding

apply direct pressure; elevate; pack deep wounds

Seizure

keep person safe from emergency; lie pt on side; ensure clear airway; time the event; cushion head

Hypotension

trendelenburg, ensure safe space, provide o2 if needed

Chest pain

ECG monitoring, oxygen therapy

Wound dehiscence

notify physician, pt low fowlers, cover the wound

Wound evisceration

low fowlers, cover organs with moist sterile dressing never push organ back in, reassure pt, call MD

Vomiting

if unconscious, turn on side to prevent choking, offer calm reassuring presence, eliminate strong odors, provide oral care, encourage rest and rehydration

Hemtemesis

assess ABCs, large bore IV, fluid resuscitation, place pt on cardiac/oxygen monitoring, obtain labs, prepare or emergency endoscopy

Giving the wrong med

assses pt condition, honest and transparent communication, report the error, take steps to present recurrence

Fluid overload

admin diuretics, restrict sodium/ fluid intake, elevate HOB, strict I&Os, monitor daily weight

Aspiration

stop feeding, position them upright, clear the airway with suction if trained, provide oxygen, monitor vitals, call MD

pulmonary edema

ABCs, administer oxygen, CPAP or BiPAP for support, intubation and mechanical vent, diuretics, vasodilators, inotropes, morphine PRN

Low urine output

bladder scan, VS, focus on pt hx, potential obstruction, potential cath, diuretics

Hypo/hyperglycemia (HYPO)

15-20 g fast acting carbs then recheck in 15 mins or D50 IV or glucagon for extreme emergencies

HYPERglycemia

prepare to admin insulin, encourage sugar free drinks, recheck BG

Hyperkalemia

tele, assess vitals and I&Os, stop K intake, kayexalate, calcium gluconate, educate on low K diet (avoid bananas and potatoes)

Pt falls

assess pt status and safety, ABCS, rapid head to toe check, notify provider, document incidient

Acute change in mental status

rapid assessment, ensure safety, stabilize ABCs, reduce stimuli, chart, alert provider

Recognizing a change in pt condition that should be report

call MD immediately, chart, VS before calling MD

What to do if pt wants to read med record

allow access by providing digital/ paper copies within 30 days

Sign out of AMA

assess capacity, educate on the risks, notify provider, have them sign AMA document, document entire conversation, risks explained, focus on empathy and well being 

Get off floor

ensure pt safety, asks pt why, see hospital policy, let staff member (nurse, sitter, volunteer, MD) can accompany them 

Arrhythmias (VT, VF, rapid AF, very slow bradycardia): 

• VT (pulse): shock; VT (pulseless): CPR and defib

• VF: CPR, debib, epi, amiodarone

• rapid AF: admin BBs, valsalva manuever, cold water, deep breathing, rest

• very slow bradicardia: atropine