Emergency and Disaster Nursing Study Notes

Emergency/Disaster Nursing

Overview of Emergency Nursing

  • Definition and Scope
      - Traditionally refers to urgent and critical care needs.
      - Care rendered without delay.
      - Increasingly applied to non-urgent problems.

Principles of Emergency Care

  • Triage
      - The process of sorting patients based on the severity of their health problems and the immediacy of treatment required.
        - Categories include:
          - Emergent
          - Urgent
          - Nonurgent
      - Uses a level system (Emergency Severity Index - ESI) to classify patients from Level 1 (most urgent) to Level 5 (least urgent).

Triage Process

  • Baseline Information Required
      - Vital signs, history of current event & past medical history, allergies, and diagnostic data.
      - May initiate protocol-based treatments and basic first aid.
      - Different from triage in disasters; in emergencies, patients may receive an urgent or higher triage category.

  • Priorities in Care
      - Stabilization, provision of critical treatments, and transfer to an appropriate setting.

Emergency Assessment and Treatment

  • Primary Survey
      - ABCDE Method - Focus on stabilizing life-threatening conditions:
        - Airway: Establish a patent airway, ensuring cervical spine stabilization.
        - Breathing: Provide adequate ventilation; evaluate breathing presence and effectiveness.
        - Circulation: Restore cardiac output; maintain and restore circulation through assessment of heart rate, blood pressure, peripheral pulses, and capillary refill.
        - Disability: Determine neurologic disability; assess level of consciousness using the Glasgow Coma Scale.
          - Quick neurologic assessment using AVPU: Alert, Verbal, Pain response, Unresponsive.
        - Exposure: Undress patient to assess wounds and areas of injury.

  • Secondary Survey
      - Collection of health history including present illness and head-to-toe examination.
      - Diagnostic and lab testing, application of monitoring devices.
      - Interventions such as splinting of suspected fractures and wound management (cleansing, closure, dressing).

Types of Emergencies

  • Airway Obstruction
      - Causes: foreign body, anaphylaxis, viral/bacterial infection, trauma, inhalation or chemical burns.
      - Assessment: Ask if the individual is choking and requires help.
      - Management: Establish airway through intubation or cricothyroidotomy and maintain ventilation.

  • Hemorrhage Management
      - Control bleeding; assess for shock.
      - Management Strategies:
        - Fluid replacement.
        - Control of external and internal hemorrhage.

  • Wound Classification and Management
      - Types of Wounds:
        - Abrasions
        - Avulsions: tearing away of tissue from supporting structures.
        - Cuts: Incisions with well-defined edges, often longer than deep.
        - Ecchymosis/contusion: blood trapped under the surface of the skin.
        - Hematomas: tumor-like mass of blood trapped beneath the skin.
        - Lacerations: skin tears with irregular edges.
        - Patterned wounds: representing the outline of the object causing the wound.
        - Stabs.
      - Documentation:
        - Characteristics of wound with pictures.
        - Details on how and when the injury occurred.
        - Inspection for extent of damage, presence of foreign body, and alterations in sensory, motor, or vascular function.
        - Wound cleansing, debridement, cauterization, primary closure (suture or staples), and delayed primary closure (high potential for infection).

Traumatic Injury Management

  • Trauma Statistics
      - 4th leading cause of death in children and adults under 44 years old.
      - Importance of documentation: mechanisms of injury, timing, evidence collection when necessary; death due to trauma is reportable to the medical examiner.

  • Multiple Trauma
      - Defined as a single catastrophic event causing life-threatening injuries to distinct organ systems.
      - Team role in trauma centers consists of a surgeon, nurse, x-ray tech, and nursing assistant.
      - Intra-abdominal Injuries:
        - Can result from penetrating injuries (e.g., gunshot or stab wounds).
        - High incidence of injury to hollow organs (e.g., liver).
        - Blunt injuries can arise from motor vehicle collisions, falls, blows, or explosions, often associated with extra-abdominal injuries.

  • Diagnosis and Assessment of Fractures
      - Assessment: ABCDE method; identify all injuries through inspection of the fractured body part (look for lacerations, swelling, and deformities such as angulation, shortening, rotation, and asymmetry).
      - Peripheral pulses assessment including observation for coolness, blanching, and decreased sensation.

Heat-Related Illnesses

  • Heat Exhaustion and Heat Stroke
      - Symptoms: confusion, delirium, bizarre behavior, coma, seizures, elevated body temperature, hot dry skin, absence of sweating (anhidrosis), tachypnea, hypotension, tachycardia.
      - Management Goals: Reduce body temperature through various cooling interventions (cool sheets, towels, cooling blankets, immersion).
      - Importance of constant monitoring (temperature, vital signs, electrocardiogram, and level of consciousness).
      - Monitoring of urine output is critical.

  • Frostbite
      - Definition: Freezing of intracellular fluids posing risk of damage; can occur from ice packs.
      - Areas affected: mainly extremities (feet, hands, nose, ears).
      - Classification by degree:
        - First Degree: Frostnip - mild irritation with no permanent damage.
        - Second Degree: Superficial frostbite - bubbles and peeling skin.
        - Third Degree: Deep frostbite - numbness and formation of large blisters.
        - Fourth Degree: Tissue death with necrosis.
      - Management involves restoration of normal body temperature, removal of constrictive items, controlled rewarming, and pain control.

Hypothermia

  • Definition: Core temperature at or below 35°C (95°F) or inability to maintain it in absence of low ambient temperature affecting all organ systems.

  • Management:
      - ABCs, vital signs monitoring (core temperature, urine output, blood chemistry).
      - Strategies for rewarming including active cardiopulmonary bypass, warmed IV fluids, warmed humidified oxygen by ventilator, and warmed peritoneal lavage, along with passive methods (warming blankets, over bed heaters).

Nonfatal Drowning and Poisoning

  • Poisoning Management:
      - Ingestion of corrosives (e.g., drain cleaner).
      - Apply ABCs, assess for antidotes, and consider dilution or gastric lavage with activated charcoal.

  • Carbon Monoxide Poisoning:
      - Hemoglobin absorbs carbon monoxide 200 times more readily than oxygen, leading to CNS symptoms.
      - Management: Move to fresh air, monitor carboxyhemoglobin levels, administer 100% oxygen or use a hyperbaric chamber.

Substance Use Disorders

  • Management of acute alcohol intoxication and alcohol withdrawal syndrome, as well as overdose treatment for pharmaceuticals or substance abuse.

Basic Life Support and Advanced Cardiac Life Support

  • BLS/ACLS Techniques:
      - Adult Basic Life Support Algorithm:
        - Verify scene safety and check for responsiveness; shout for help if needed.
        - Activate the emergency response system; check for breathing and pulse.
      - Techniques vary based on CPR quality; use an AED as soon as available. Epinephrine and drugs like amiodarone may also be indicated.

Special Cases of Cardiac Arrest

  • Cardiac Arrest in Pregnancy:
      - High-quality CPR and defibrillation methods.
      - Maternal interventions, airway management, provision of oxygen, and potential for perimortem cesarean delivery.

Disaster Nursing: Overview

  • Definition: Sudden disruptions or events interrupting a community’s functioning.
      - Types: Mass casualty incidents, terrorism, natural disasters (earthquakes, floods), outbreaks, biological, chemical, or nuclear incidents.

Disaster Response Strategies

  • Components of Effective Response:
      - Ensuring appropriate resources and trained staff are available.
      - Coordination among various agencies (e.g., Department of Health, American Red Cross, CDC).

  • Incident Command System:
      - Federally mandated structure for managing emergency incidents.

Disaster Preparedness Plans

  • Plans should include communication strategies, patient care coordination, security measures, resource identification, and mass casualty incident planning.

Ethical and Practical Considerations

  • Ethical Conflicts in Disaster Nursing:
      - Issues around confidentiality, consent, duty, futile therapy, and rationing care.

  • Natural Disaster Management:
      - Understanding patient inflow (e.g., minimally injured arriving on their own; severely injured being rescued).
      - Challenges in documentation and client identification during multiple casualty incidents.

  • Outbreaks, Epidemics, and Pandemics:
      - Managed through public health surveillance; containment strategies necessary until new cases drop below normal levels.

Weapons of Terror and Nuclear Radiation Exposure

  • Terrorism Types:
      - Blast injuries, biological weapons, chemical agents, and nuclear exposure considerations.
      - Acute radiation syndrome characterized by distinct phases (prodromal, latent), requiring specific management approaches in disaster scenarios.