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MedSurgII-ER, Terrorism & Disaster Nursing (ppt)

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cdunbar4's version from 2017-04-13 14:50

ED in Hospitals

Question Answer
Reasons for ER visits(1) the inability to see a primary care provider, (2) an aging population, (3) shorter hospital stays resulting in frequent readmissions, (4) acute mental health crises, and (5) lack of health insurance or a primary care provider. These factors result in chronic overcrowding and long wait times in many EDs.
Triage works on what premisepatients who have a threat to life must be treated before other pts. Rapid assessment of pt acuity
Primary Survey *NTKABCDE focus (Airway, Breathing, Circulation, Disability, Exposure). ID's life-threatening conditions and if apparent interventions are started asap before 2nd step of survey
Nearly all immediate trauma deaths occur bc of airway obstruction: s/s of pt with compromised airwaydyspnea, inability to vocalize, presence of foreign body in airway, trauma to face/neck
Pts at risk for airway compromiseseizures, near-drowning, anaphylaxis, foreign body obstruction, or cardiopulmonary arrest.
Maintain airway using least to most invasive methodsJaw-thrust maneuver→suction/remove foreign body→insert naso/oropharyngeal airway→endotracheal intubation→ER cricothyroidotomy or trach is last resort
jaw-thrust maneuver The patient should be lying supine with the rescuer kneeling at the top of the head. The rescuer places one hand on each side of the patient’s head, resting his or her elbows on the surface. The rescuer grasps the angles of the patient’s lower jaw and lifts the jaw forward with both hands without tilting the head.
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Primary Survey

Question Answer
Rapid-sequence intubationPreferred procedure for unprotected airway; Involves sedation or anesthesia and paralysis
Stabilize/immobilize cervical spine Face, head, or neck trauma and/or significant upper torso injuries
BreathingAssess for dyspnea, cyanosis paradoxic/asymmetric chest wall movement, decreased/absent breath sounds, tachycardia, hypotension
Types of mask to assist with breathing/ventilationHigh-flow O2 via non-rebreather mask; Bag-valve-mask ventilation with 100% O2 & intubation if life-threatening; monitor pt. response
Circulation: central pulse check (peripheral pulses may be absent d/t injury or vasoconsrtictionInsert two large bore IV catheters; aggressive IV fluid resuscitation w NS or LR
Cold environments due what to circulation checksdelays cap refill, altered mental status and cap refill are most sig. signs of shock
Disability: Measured by patient' LOC --> Glasgow, Pupils & AVPU<-- what does this stand for?Alert, responsive to Voice, responsive to Pain, Unresponsive
Exposure/environmental controlit is important to limit heat loss, prevent hypothermia, and maintain privacy by using warming blankets, overhead warmers, and warmed IV fluids.
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Secondary Survey

Question Answer
Basic secondary surveybrief, systematic process to ID all injuries
Need to determine whether to take full set of vitals or perform _____________.interventions
What kinds of things might need to be initiated aside from a set of vitals?ECG monitoring; pulse oximetry; indwelling catheter; orogastric/nasogastric tube ; Collect blood for laboratory studies
Family presencePatients report that caregivers comfort them, serve as an advocate for them, and help to remind the health care team of their “personhood.”
Give comfort measuresverbal reassurance, listening, reducing stimuli (e.g., dimming lights), and developing a trusting relationship with the patient and caregiver should be provided to all patients in the ED.
History & head-to-toe assessment. Can use AMPLEAllergies. Medications. Past HH. Last meal. Events/Environment leading to illness.
Inspect posterior surfaces via logroll method (stabilize c-spine) *NTKlook for ecchymosis, abrasions, puncture wounds, cuts & obvious deformities; palpate entire spine for misalignment, deformity & pain
Prepare totransport pt. for diagnostic tests; admit to general unit, telemetry,, or ICU. Pt. may have to transfer to another facility
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Poisonings

Question Answer
Death in ER departmentmust recognize importance of hospital rituals so bereaved can grieve (collecting belongings, viewing the body); determine if pt. can be a candidate for non-heart beating donations)
Gerontologic considerations in ERHigh risk for injury from falls. Due to: generalized weakness, envt'l hazards, ortho hypoTN, need to determine if physical findings may have caused fall or due to fall.
Poisoningsseverity depends on type, concentration & route of exposure
Poisoning managementdecrease absorption; enhance elimination; implement toxin-specific interventions per poison control center
Administration of the following to increase elimination of poisons.cathartics, whole-bowel irrigation, hemodialysis, urine alkalinization, chelating agents, and antidotes
What can be done to decrease absorptionGastric lavage: perform w/in 2hrs of ingested poison; intubate b4 lavage if altered LOC or diminished gag reflex
Gastric lavage contraindicationsCaustic agents; Coingested sharp objects; Ingested nontoxic substances
Activated charcoalMost effective intervention: administer orally or via gastric tube within 60 minutes of poison ingestion
Contraindications of Activated charcoalDiminished bowel sounds; Paralytic ileus; Ingestion of substance poorly absorbed by charcoal. Charcoal can absorb and neutralize antidotes: do not give immediately before, with, or shortly after charcoal
Dermal cleansing/eye irrigationflush with water or saline (unless it is mustard gas bc water mixes with mustard gas and creates chlorine gas)
Hemodialysis is reserved for which patients?pts who develop acidosis from ingestion of toxic substances (e.g. aspirin)
Sodium Bicarbonateraises the pH (>7.5), which is particularly effective for phenobarbital and salicylate poisoning.
Vitamin Cadded to IV fluids to enhance excretion of amphetamines and quinidine.
chelation therapyis considered for heavy metal poisoning (e.g., edetate calcium disodium [Calcium EDTA] for lead poisoning).
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Bioterrorism

Question Answer
terrorism involves overt actions for the expressed purpose of causing harm via disease pathogens, chemical agents, radiologic/nuclear, explosive devices
BioterrorismAnthrax, plague, and tularemia: treated with antibiotics assuming sufficient supplies and nonresistant organisms. Smallpox can be prevented or ameliorated by vaccination even when first given after exposure
Chemical agents of terrorism are categorized by target organ or effectSarin: toxic nerve gas that can cause death w/in minutes of exposure, enters body via eyes/skin and acts by paralyzing respiratory muscles.
Antidotes for nerve agents: atropine, pralidoxime chloride
Phosgenecolorless gas normally used in chemical manufacturing - resp. distress, pulm edema, death
Mustard gas: yellow-brown in color with garlic-like odorirritates eyes & causes skin burns/blisters *do not flush with water or saline
Radiologic dispersal devices (RRDs) (“dirty bombs”): mix of explosives and radioactive material When detonated, blast scatters radioactive dust, smoke, and other material into environment, resulting in radioactive contamination Main danger from RRDs: explosion
Radiologic/Nuclear agents Initiate decontamination procedures immediately if external radioactive contaminants are present. Acute radiation syndrome develops after a substantial exposure to ionizing radiation and follows a predictable pattern.
Explosive Devices results in blast, crush or penetrating injuries Crush injuries (i.e., blunt trauma) often result from explosions that occur in confined spaces and result from structural collapse (e.g., falling debris). Some explosive devices contain materials that are projected during the explosion (e.g., shrapnel), leading to penetrating injuries.
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Mass Casualty Incident Protocols

Question Answer
Mass Casualty Incident (MCI) Preparedness Will need all of community's resources and usually involve large numbers of victims, physical and emotional suffering, and permanent changes within a community
Green tag injury *NTKminor
Yellow tag injury *NTKnon-life threatening / non-critical injury
Red tag injury *NTKlife-threatening injury
Blue tag injury *NTKindicates those who are expected to die
Black tag *NTKyou dead
Triage of victims must be rapid *NTKNeeds to be done in <15 seconds. 2/3 of victims will be tagged green or yellow. Remaining red, blue, black
Hospitals can estimate number of casualties bydoubling the number of casualties that arrive in first hour
CERTS (extension of 1st responder services)community emergency response teams:partners in emergency preparedness, and training helps citizens to understand their personal responsibility in preparing for natural/manmade disaster
All health care providers have a role in emergency and MCI preparednessKnowledge of the hospital’s emergency response plan. Participation in emergency/MCI preparedness drills is required
National Incident Management System (NIMS)Section within the U.S. Department of Homeland Security that is responsible for the coordination of the federal medical response to MCIs
Disaster Medical System: organizes and trains volunteer DMATS:Disaster Medical Assistance Teams which are categorized according to ability to respond to an MCI
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