Emergency and Disaster Nursing Notes

Emergency and Disaster Nursing Overview

• Emergency nursing is a unique specialty that requires preparedness for various unexpected situations as patients with a wide range of conditions enter the emergency department (ED).
• Important elements include:
  • Triage Process: A crucial skill used to rapidly assess patient acuity, identifying life-threatening issues before others.
  • Patient Care: This encompasses comprehensive care for emergency patients, with emphasis on conditions such as terrorism and mass casualties.

Key Statistics and Trends

• Over 130 million patients visit the ED annually, resulting in overcrowding and long wait times.
• The patient profile is shifting, with more older and sicker patients having complex health needs.
• Growth of alternative care options, such as retail clinics and telehealth for non-emergency problems is noted.

Emergency Nursing Entities

• Emergency Nurses Association (ENA):
  • A specialty organization focused on the advancement of emergency nursing practice.
  • Provides standards of care and certification processes for certified emergency nurses (CENs).

Goals and Competencies in Emergency Nursing

• The primary goal is the identification of life-threatening conditions, enabling timely interventions prior to diagnosis.
• Essential competencies include:
  • Prompt identification of patients needing immediate treatment.
  • Determining suitable interventions based on patient assessment.

Triage System

• Emergency Severity Index (ESI):
  • A five-level triage system that prioritizes patients based on illness severity and resource needs.
  • Details of the levels:
  • ESI-1: Immediate danger of dying.
  • ESI-2: High-risk patients requiring urgent attention.
  • ESI-3, ESI-4, ESI-5: Assess based on the expected resources required and stability of vital signs.

Primary Survey Components

• The primary survey focuses on rapid assessments using the ABCDEFG approach:
  • A - Airway
  • B - Breathing
  • C - Circulation
  • D - Disability
  • E - Exposure
  • F - Full set of vitals and Family presence
  • G - Get monitoring devices and Give comfort

Specific Steps

1. Airway Management (A):
   • Identify obstructions like saliva, vomitus, or foreign bodies.
   • Recognize at-risk patients: seizures, drowning, anaphylaxis, etc.
2. Breathing Assessment (B):
   • Look for respiratory changes and provide supplemental oxygen as needed.
3. Circulation Control (C):
   • Monitor for hemorrhagic shock and control bleeding with IV access for fluid resuscitation.
4. Disability Evaluation (D):
   • Assess neurologic status with the Glasgow Coma Scale (GCS).
5. Exposure (E):
   • Control environmental exposure and maintain data privacy during assessments.
6. Full Vitals (F):
   • Collect comprehensive vital data including family presence during assessments.
7. Get Monitoring Devices (G):
   • Implement necessary monitoring and comfort measures early in the care process.

Secondary Survey

• Conducted after the primary survey to identify all injuries.
• Utilize a head-to-toe assessment to evaluate neurological, cardiovascular, and trauma damage.
• Key indicators such as MIST (Mechanism of injury, Injuries, Signs and symptoms, Treatment prior to arrival) and SAMPLE (Symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to injury) are invaluable.

Special Considerations for Older Adults

• Adults over 60 make up 20% of ED visits.
• Focus on identifying falls, which are often caused by environmental hazards or syncope due to underlying health conditions.

Environmental Emergencies

• Increased outdoor activity leads to more environmental emergencies, including heat-related illnesses and bites/stings.
• Heat Cramps: Severe muscle cramps; requires fluid and sodium replacement.
• Heat Exhaustion: Symptoms include fatigue and hypotension; need rehydration and monitoring.
• Heat Stroke: Medical emergency with severe symptoms, immediate cooling is required.

Conclusion

• Agility in response, knowledge of triage systems, and comprehensive assessment skills are crucial for effective emergency nursing.
• Continuous education and training on procedures related to environmental emergencies, special populations like the elderly, and trauma care are important for improving patient health outcomes.