EMERGENCY NURSING

 

EMERGENCY NURSING:

Emergency is a life-threatening situations or conditions that requires immediate medical or surgical attention.

List and classification of medical emergencies

A. Trauma:

Fractures

Sprains / strains

Wound

Dislocations

Burns and scalds

Intestinal obstruction

Ruptured spleen

B. Infection:

Severe malaria

Rabies

Typhoid perforation

Meningitis

C. Respiration:

Asthma

Pneumothorax

Haemothorax

D. Unconsciousness and fits

E. Foreign bodies on nose, ear, throat and eyes

F. Poisoning:

Food

Drugs and chemical

Gas

Insects (Bee and wasp) and scorpion stings

Dog and snake bites

Sequence of treating injuries

Some injuries are more serious than others and in general, they should always be treated in this order.

A. Airway -Casualties with airway problems

B. Breathing – casualties with difficulty in breathing or whose breathing has stopped

C. Circulation -Casualties with bleed wounds or are in shock

 D. Disability -Casualties with other injuries e.g. Breaks and burns

Responding to Emergency

By recognizing an emergency situation and prioritizing your actions, you will be able to respond effectively in an emergency situation. These are three steps you should take in emergency and these include

A. Check the scene and victim

B. Call the emergency medical system

C. Care for the victim by giving care to the level of his or her training

Treatment of Emergency Priorities

Treat the most urgent condition first as follows,

1. Interference with breathing:

Foreign objects are removed from mouth and throat e.g. denture, food.

Mouth-to-mouth breathing is commenced. Ambulance attendants will bring airways, Ambu bags and Oxygen equipment.

2. Severe bleeding:

Pressure is applied hard over the wound with the fingers. If there is any delay in proper treatment, a thick pad and firm bandage are applied over the wound. When the bleeding is from a limb, the limb is raised but the head and trunk are kept flat. It is useful to keep a check on the pulse below the bleeding wound.

3. Unconsciousness:

The patient is immediately placed in the left lateral position with the face directed to slightly downwards so that secretions or vomit may flow out of his backwards in the pharynx. A pillow is placed behind the patient to maintain his position. This maintains an open airway.

Do not leave the airway. Care is necessary when lifting this patient. His head. body and legs must be lift together and at the same level.

THINGS TO DO BEFORE GIVING CARE

Before rendering first aid help to casualties, there are legal implications and considerations that must be observed.

1. Obtaining consent

Before giving care to a casualty, permission must be sought before giving care. A conscious victim has the right to know who you are, your level of training and the care you would like to you. If the casualty is unconscious, implied consent is used. Implied concerns means that you can assume that if client was well, he would have agreed to be taken care of.

2. Good Samaritan laws

These laws give legal protection to people who willingly provide emergency care. Good Samaritan laws were enacted to encourage people to help others in emergency. These laws assume that an individual would do his or her best to save life and prevent further injury. The Good Samaritan law was primarily developed for first aid purposes. It is a legal principle or doctrine that serves to protect rescuers who have voluntarily assisted a victim in distress from being sued for wrong doing.

Main purpose of the Good Samaritan law

The law is to discourage people from being reluctant to help a stranger(s) in emergency situations for fear of legal implications or repercussions.

However, the law is not applicable in situations where the care rendered is uncalled-for. For instance, a rescuer cannot benefit from the law if the assistance or care is reckless or grossly negligent. That is the care must be reasonable before the law can protect a rescuer.

Circumstances under which the Good Samaritan law can be successfully supported

a. The initial emergency or injury was not caused by the person given the assistance

b. The emergency care was not given in a grossly negligent or reckless manner.

c. Aid was given with permission whenever possible to obtain it.

d. The care rendered is not in expectation of any reward or benefit.

e. The care rendered was as a result of an emergency.

It is however worth knowing that every country has its own adaptation of the Good Samaritan Law even though the crucial points are about the same. In certain areas, it covers only medically trained rescuers while other areas extend protection to the general public.

The best way a rescuer can prevent possible liability when helping others, is to always act on behalf of the victim. That may sound obvious, but if your motivation is to be a hero and not to help out a fellow human, then you risk making the types of mistakes not covered by Good Samaritan Laws.

Ways to avoid going to the court because of breach of patient care law

1. Take a CPR and first aid class.

2. Follow your training.

3. Use common sense.

4. Don’t practice anything you’re not trained to do.

 

5. Get professional help for the victim.

6. Do not accept gifts or reward.

Resuscitation

The body requires an adequate supply of oxygen to enter the lungs and be transferred to the cells in the body through the bloodstream to sustain life. A constant supply of oxygen must be maintained and delivered to the brain and other vital organs by circulating blood. Without oxygen, the casualty will lose consciousness, the heartbeat and breathing will cease and death will result.

The ABC of Resuscitation

Three elements are involved in getting oxygen to the brain. The air passage or Airway, must be open so that oxygen can enter the body; Breathing must take place so that oxygen can enter the bloodstream via the lungs; and the blood must travel around the body (the Circulation), taking the oxygen to all the tissues and vital organs.

Restoring Breathing and Circulation

The blood is oxygenated by breathing and it is circulated around the body by the beating of the heart. If the body’s natural mechanisms of breathing stops, the patient is given artificial ventilation.

If the body’s natural mechanisms of heartbeat stop, the patient is given chest compression. This restores supply of oxygen to the brain. The sequence of techniques used to sustain life in the absence of spontaneous breathing and heat beat is known as Cardio-Pulmonary Resuscitation.

Artificial Ventilation

When breathing stops, blowing air into the lungs can give enough oxygen to keep a person alive. In mouth to mouth ventilation, pinch the nose so that air can not escape, the heart must be beating to circulate the oxygenated blood. If the heart is not beating, give chest compression.

Chest Compression

If the heart stops beating, blood does not circulate and the brain is starved of Oxygen, so the heart needs mechanical help. By pressing down rhythmically at about 100 compressions per minute, on the lower half of the sternum, blood is driven from the heart. When pressure is released, the chest returns to normal position and blood refills the heart. To Oxygenate blood, this must be done with artificial ventilation.

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation is defined as an emergency procedure which is attempted to return life to a person in cardiac arrest. It is mostly done to casualties who are unresponsive with no breathing or those gasping for air. CPR involves chest compression at the rate of at least 100 per minute in an effort to activate artificial circulation by manually pumping blood through the heart. In addition, the rescuer (first aider) may provide breaths by either exhaling air or ventilation which is called artificial ventilation. CPR can also be defined as an emergency technique which combines RESCUE BREATHING and CHEST COMPRESSION. Rescue breathing serves to get oxygen into the victim’s lungs while chest compression is to pump oxygenated blood to vital organs. If CPR is performed promptly and properly, it increases the casualty’s chances of survival and also prevents potential disabilities.

NOTE:

1. CPR does not guarantee the survival but it only offers the casualty chances to survive when otherwise there would have been none.

2. If CPR is not performed in a proper manner, it only takes the casualty about 3-4 minutes to become brain dead.

3. By performing CPR, the casualty is provided with the needed oxygen and circulating blood to keep the vital organs functioning while the first aider waits for medical help.

INDICATIONS FOR PERFORMING CPR

1. Absence of pulse and respiration.

2. Unconsciousness.

3.Gasping

Situations That Require CARDIO-PULMONARY RESCUSCITATION(CPR)

1. Heart attac

2. Unresponsiveness

3. Drowning victims

4. Inhalation of poisonous gases

5. Drug overdose

6. Suffocation.

Aims of providing CARDIO-PULMONARY RESCUSCITATION(CPR)

1. To establish and maintain an open airway.

2. To restore and ensure proper functioning of the heart.

3.To ensure adequate supply of oxygenated blood to vital organs.

Resuscitation Sequence

1. Check response

2. Open airway

3. Breath for casualty

4. Assess circulation

5. Commence CPR

How Cardiopulmonary Resuscitation is Performed

1. Assess the scene of incident for any danger

2. Call for medical aid, that is, ambulance crew and other agencies. E.g., fire services

3. Check for response by using the following procedures.

By asking questions or by gentle tapping or shaking the shoulders of the casualty, pinch the ear, tilt the head back to open the airway, remove any obvious obstruction. Also check the mouth to see if the tongue is not misplaced or the tongue is not falling back to block the airway.

Open the eye and try to throw light on it and see if the casualty will react or not.

Check whether the casualty is breathing or not by using available, Check for carotid pulse just 2cm away from the mouth. Check for signs of circulation for not more than ten seconds. Alternate thirty chest compressions with two rescues breathe before interlacing your two hands and placed it in the mid-sternum or just in between the two breast bone and press it down at 4-5cm down at rate of 100 / minute. Continue the exercise until casualty begins to cough or move a part.

Note

In case the casualty is a child, use only two fingers to do the chest compression first, then two rescue breath, thirty chest compressions. Also, for a near drown child, give five rescue breath, thirty chest compression first then two rescue breaths, thirty chest compressions. If a casualty recovers from unconsciousness, try and put casualty in a recovery position.

Techniques to Rescue Breathing

* Mouth to mouth

* Mouth to stoma

* Mouth to nose

* Mouth to barrier (ambu-bag)

When Does CPR Ends

When the first aider feels too tired to continue the process. When help arrives or another first aider arrives. When the casualty starts coughing. When the casualty starts moving a part; example chest expansion.

How to Put a Casualty into A Recovery Position

Introduce yourself and assure him or her. Lay the casualty flat on the ground. Make sure both legs are straight. Place the arms neatly to you at right angle to the casualty’s body with the elbow bent and palm facing upwards. Bring the arm that is farthest from you across the casualty’s chest and hold the back of his or her hand against the cheek nearest to you with the other hand. Grasp the leg above the knee and pull it up keeping the feet flat on the ground. Keeping the casualty’s hand pressed against her cheek. Pull on the far leg and roll the casualty towards you and unto his or her side. Adjust the upper leg that both the hip and the knee are bent at right angles and tilt the casualty’s head back so that the airway remains open. Call for medical aid and transport the casualty to the hospital.

What to Do After Casualty Recovers

When a casualty recovers during cardiopulmonary resuscitation (CPR)before the arrival of medical help, do the following:

Continue to monitor casualty’s signs closely to determine his or her condition. If there is any deviation from normal, then intervene as necessary.

Always be prepared to start CPR in case casualty stops breathing or becomes unresponsive. Always remain with casualty until medical help arrives. Talk reassuringly to casualty if he or she regains consciousness. Gather and record details of the casualty’s injury or illness, your Interventions and limitations. These will serve as a guide when medical help arrives.

The Recovery Position

The Supine position is the best position for a casualty who is semiconscious or unconscious but still breathing. It permits fluids to drain freely from the nose and throat, so they are not breathed in to the lungs to prevent choking and regurgitation. When gastric contents enter the lungs, their acidic component irritates and inflames the inner lining causing aspiration pneumonia.

Importance of the recovery position

1. It ensures a stable position that prevents casualty from rolling.

2. It ensures patent airway that enhances adequate breathing.

3. It prevents the casualty’s tongue from falling back and blocking the airway (especially if left in the supine position).

4. It promotes free drainage of such fluids as blood or vomitus, from casualty’s mouth to prevent aspiration

5. It keeps the casualty in a safe position if they have to be left alone.

6. It offers easy access for close monitoring of the airway.

NOTE:

The recovery position ensures that physical obstructions (caused by a fallen tongue) is cleared by gravity and also provides a patent route through which fluid (especially vomitus) can drain freely from the airway.

Indications of the Recovery Position

1. Drowning.

2. Fainting.

3. Adverse drug reaction or anaphylaxis

4. Asphyxia.

5. Unconsciousness

6. Fume inhalation.

Complications of CPR

1. Fracture of the sternum or ribs.

2. Bruising of chest skin.

3. Disruption of normal heart rhythm when performed on a healthy Person