CM

Emergency and Disaster Nursing Notes

Overview of Emergency and Disaster Nursing

  • Emergency nursing is a challenging and unique specialty where nurses must be prepared for a wide variety of patient conditions due to unpredictable patient presentations in the emergency department (ED).
  • Important topics covered include:
    • Triage process overview
    • Care of emergency patients
    • Response methods for terrorism and mass casualty incidents.

Current Trends in Emergency Departments

  • Over 130 million patients visit the ED annually, leading to overcrowding and increased wait times.
  • The demographic shift shows an increase in older and sicker patients with complex medical needs.
  • Growth noted in retail clinics and telehealth services as alternative care sources for nonemergent issues.

Specialization in Emergency Nursing

  • Some EDs focus on specific patient populations (e.g., pediatric or trauma).
  • Emergency Nurses Association (ENA) is the specialty organization supporting emergency nursing practice, offering:
    • Standards of care for ED nurses.
    • Certification process for Certified Emergency Nurses (CENs).

Care Goals in Emergency Nursing

  • A primary goal is the early recognition of life-threatening conditions, with immediate intervention often exceeding formal medical diagnosis.
  • Competencies required include rapid identification of treatment needs and determination of appropriate interventions.

Triage Process

  • Defines the method of rapidly assessing patient acuity to ensure critically ill patients receive timely care.
  • Emergency Severity Index (ESI):
    • A five-level triage system used to prioritize treatment based on illness severity and resource needs.
    • Levels are:
    • ESI-1: Life threat, immediate intervention required.
    • ESI-2: High risk, cannot wait to be seen (abnormal vital signs).
    • ESI-3: Requires moderate resources (normal vital signs).
    • ESI-4 & ESI-5: Stable conditions needing minimal resources.

Patient Assessment Protocols

Primary Survey - ABCDE
  • Systematic approach focusing on:
    • Airway: Ensure no obstructions.
    • Breathing: Assess ventilation adequacy.
    • Circulation: Control hemorrhage and ensure adequate blood flow.
    • Disability: Evaluate neurologic status via the Glasgow Coma Scale (GCS).
    • Exposure: Remove clothing for thorough assessment while maintaining patient modesty and preventing hypothermia.
Secondary Survey
  • Conducted after addressing immediate life threats.
  • Involves a comprehensive head-to-toe assessment to identify all injuries.
  • History techniques such as MIST and SAMPLE help gather relevant patient information for targeted interventions.

Responding to Environmental Emergencies

  • Environmental emergencies include heat-related illnesses (heat cramps, exhaustion, heatstroke), cold-related conditions (frostbite, hypothermia), and drowning incidents.
  • Effective management involves rapid assessment, stabilization of vital functions, and restoration of normal body temperature.

Trauma and Violence in EDs

  • Penetrating trauma (gunshot and stab wounds) is common in EDs and requires swift action to stabilize the patient.
  • Emergency care includes immediate evaluation of airway and circulation and addressing any serious arterial injuries.
  • Violence directed towards healthcare workers is a growing concern; measures for safety include staffing security and implementing prevention strategies.

Disaster Preparedness and Response

  • Emergency and mass casualty incidents (MCIs) require a coordinated response beyond usual community resources, involving triage protocols for rapid evaluation and treatment.
  • High stress for all involved necessitates mental health support and psychological first aid for both victims and responders.