EMERGENCY NURSING CONCEPT 1

PROF. LESLIE LAZARO, PhD, MBA, MAN, RN

_________________________________________________________________________________________________________________________________________________________________________________________________________________

11. If death has already occurred, ask if the significant

EMERGENCY NURSING: PART 1 others are coming to the emergency department, or
where they would like to see their loved one
 The nursing care of individuals and their families / 12. At the end of your call, repeat your name and phone
significant others with sudden or unexpected, actual or number. If death has occurred, encourage significant
potential life / limb threatening conditions in an others to call with any concerns
uncontrolled environment. It involves the nursing
diagnosis and management of responses of clients / CHRONOLOGY OF INFORMATION
significant others to the sudden change in health 1 Onset
status. 2 Location of occurrence
 This could happen anywhere 3 Pre-hospital treatment (home remedy first before
bringing to hospital)
INFLUENCING FACTORS that affect e-care service: 4 Treatment efforts rendered in the ER
 Limited time 5 Person’s response to treatment
 Urgency measures
 Clinical setting/equipment ANTICIPATORY GRIEF
 Limited information
 Roles and resources

The following points help ensure that necessary

information is given and obtained when giving the news
of a person’s death or critical condition over the phone:

1. Use the same term consistently during your

conversation with the significant others
2. Pre-established a standardized format or protocol
when making telephone notation
3. Take a few moments to deal with your own feelings
before making the call
4. State your name, position, work area, and give TRIAGE
institutional information
5. Do not give the bad news first; rather present facts  The system for identifying people at greatest risk.
chronologically
6. Clarify the person’s condition if, in fact, it appears
that survival is likely
7. Notify significant others as soon as possible so they
can begin anticipatory grieving
8. Present information in a factual way asking for
periodic feedback to make sure you are being
understood
9. Prevent reckless driving by significant others on their
way to the hospital
10. Ask if you should notify anyone else to serve as
support

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

Assessment findings implying a high priority for care: 5. Splint fractures / dislocations
1. Significant alteration in vital signs 6. Identify sources of blood loss
2. Altered level of consciousness 7. Decompress stomach, catheterize bladder
3. Chest pain, especially in person age 35+ (left-side HF) 8. Hematocrit, blood crossmatch, urinalysis, arterial
4. Severe pain (<1 hr, must be lowered) blood gases
5. Bleeding not controlled by direct pressure 9. Antibiotics, tetanus prophylaxis
 Profuse bleeding = Hemaconcentration
 All is elevated TYPES OF INJURIES
6. Conditions that will worsen from delay in treatment
7. Sudden vision loss (Anticipate flushing = Isotonic) BLUNT TRAUMA
8. Dangerous, aberrant, or disruptive behavior (Restraint)  No break in the skin
9. Psychologically devastating conditions  More life-threatening as not as obvious and diagnosis
10. Elderly or very young person is more difficult
11. Symptomatology that is vague but causes the triageur  Types include acceleration, deceleration, shearing,
(emergency assessor) concern crushing, comprehensive injuries
 Big blow, concussion, contusion
Priorities in initial management of severely injured  Size of vehicle and occupant as well as position.
person:  Compressions cause:
 Maximum priorities (life-saving measures)  Gastric lavage Lavage = inward; Gavage =
1 Immobilize cervical spine (para/hemi/resis/plegia) outward)
2 assure airway patency PENETRATING TRAUMA
3 maintain adequate ventilation  Wounds caused by impalement or an object passing
4 control external hemorrhage through tissue
5 restore thoracic mechanical problems  Severity is due to organ or tissue damage
 High-velocity vs. Low-velocity weapons
 High-velocity: High-powered rifle
 Low-velocity: Ski pole, Knife stab wound

RAPE
 The term victim of alleged sexual assault is used to
describe an individual who has allegedly been a victim
of the crime of rape. (Rape Trauma Syndrome)
 Provide artificial. Respirations (ventilations) to deliver
oxygen into the blood in an attempt to prevent cell
anoxia.
ASSESSMENT FINDINGS:
1. Massive trauma with loss of consciousness
2. Ecchymotic areas especially of face or neck; trauma to
High Priorities (Triage Decision Making) larynx and/or fracture of mandible; Multiple
1. Flow sheet of vital signs, fluid balance contusions and lacerations
2. Brief history from emergency medical technicians 3. Clothing may be stained, torn, or disheveled
(ROS) 4. Affect varies; do not assume that lack of concern or
3. Rapid complete examination relative calm means that assault did not occur or
4. Lateral cervical spine roentgenogram (blunt trauma) victim is handling it well

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

serology
TYPES OF SEXUAL ASSAULT 10. Provide person with opportunity to bathe after
examination
SEXUAL HARASSMENT 11. CD prophylaxis
 Verbal or non-verbal unwanted sexual contact
SEXUAL EXPLOITATION
 Using another person without caring about how it
affects them
RAPE / ATTEMPTED RAPE
 Forced sex against a person’s will
SEXUAL ABUSE Deaths reported to the medical examiner’s office:
 Adult or older child forces, tricks, or bribes a child into 1. Suspected suicides or homicides
sexual activity 2. Deaths in which the deceased has not been attended by
a physician within 24 hours prior to death
INTERVENTIONS: 3. Deaths in suspicious circumstances
1. ABC 4. Deaths due to accidents
1 AIRWAY 5. Deaths following surgery
6. Deaths associated with firearms or other weapons
7. Deaths occurring as a result of crime
8. Stillbirths
9. Deaths resulting from drugs
10. Deaths possibly associated with hazard to public safety
2 BREATHING
3 CIRCULATION Reportable Conditions
1 Gunshot
2 Stab wounds
3 Assault
2. Psychological support 4 Automobile accidents
3. Place person in private exam room; have someone stay 5 Actual or attempted homicide / suicide
with her 6 Venereal diseases
4. Explain not to wash, gargle, douche, and so forth until 7 Contagious diseases
necessary specimens have been obtained 8 Food borne illnesses
5. Encourage reporting assault to authorities if 9 Suspected child abuse / neglect
unreported 10 Elder / vulnerable adult abuse / neglect
6. Contact sexual assault counselor(s) if available if not
already done; obtain person’s permission for this EMERGENCY NURSING: PART 2
7. Clothes may be used as court evidence; handle them
carefully RADIATION EMERGENCIES
8. Obtain detailed history and physical exam after  Non-routine situations or events that require a prompt
explaining need for detail action to mitigate a radio-nuclear hazard or its adverse
9. Laboratory data: cultures for gonorrhea; hanging drop consequences for human life, health, property or the
dead analysis and smears for presence of sperm and environment.
their motility; acid phosphatase of vaginal secretions;  May result from misuse of radioactive sources during
foreign pubic hairs analyze by police laboratory; industrial, medical or research applications, accidental

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

exposure to uncontrolled (abandoned, lost or stolen) explosions, poisoning and environmental

radiation sources, accidents during transport of contamination. This insight will focus primarily on the
radioactive materials, but also can be combined with human health and environmental
conventional emergencies (a fire or a release of  SANITATION PERMIT = Waste Management
chemical substances), natural disasters, military  SEWAGE TREATMENT = Water treatment in
conflicts, or malicious acts involving radiation facilities (release of toxins)
sources.
 Could be intentional CLOGS DRAINAGE (FOG):
 Sabotage (Saboteur); Explosions (dirty bomb)  Fats
 Can be accidental  Oils
 Ecological; Misuse of Chemicals; TNT  Grease
 For protection/radioactive protectors: RISKS:
 Concrete walls and SOIL  Explosions
 Safest: at the middle, in the hallway, underground  Poisoning
 Environmental Contaminations
TRIANGULAR PROTECTORS:
1 Time - main catalyst BIOTERRORISM
2 Proximity  Deliberate release of viruses, bacteria, toxins, or other
3 Apparel harmful agents to cause illness or death in people,
 Lead suit animals, or plants. These agents are typically found in
nature, but could be mutated or altered to increase their
RADIOACTIVE ACCIDENTS/SITUATIONS: ability to cause disease, make them resistant to current
1 Medical - Radioactive implant; Time/exposure medicines, or to increase their ability to be spread into
2 Research - Radioactive implant; Time/exposure the environment.
3 Industrial - Lack of quality control  Spread through air, water, or in food
 Germ theory
NUCLEAR EMERGENCIES  Penicillin, tetracysteine, fluoroquinolones
 Involve release of the energy resulting from a nuclear  Black Death - affect lungs and spread to lung stream
chain reaction or from the decay of the products of  Pneumonic (lungs)
chain reaction (e.g. nuclear power plant accidents such  Septicemic (blood)
as Chernobyl and Fukushima accidents).  Bubonic (lymph node)
 Radiological emergencies are situations involving
radiation exposure from a radioactive source. When According to WHO, COMPLETELY ERADICATED:
referring to an emergency situation regardless of its  Rinderpest - buffalo infection (does not affect
type, “radiation emergency” term is often used. humans)
 Smallpox - affect humans
CHEMICAL EMERGENCIES
 Involves the discharge or release of hazardous liquids, BIOLOGICAL AGENTS
gases, or solids. It can happen as a result of an  Can be spread through the air, water, or in food.
industrial accident, failed infrastructure or an Biological agents are attractive to terrorists because
intentional attack. Anywhere hazardous products are they are extremely difficult to detect and do not cause
manufactured, transported or stored can potentially be illness for several hours to several days. Some
the site of a chemical release. bioterrorism agents, like the smallpox virus, can be
 The risks associated with a chemical release include spread from person to person and some, like anthrax,

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

cannot.  Bubonic (lymph node)

3. Varicella = Syphilis
 Small pox = Blisters (itchy
= scars); Cause body
dysfigurement
4. Francisella Tularensis
 Cysteine (Amino acid)
 Found in Soil and Water
 Cause the people to be
immunocompromised
5. Anthropods and Arachnids
Category B 1. Brucellosis (Brucella)
 From unpasteurized milk
 Hepatomegaly
 Salmonella - food-borne disease  Spleenomegaly (Spleen =
 Chemotrophs - requires oxidation and reduction Scavenger of our blood)
process in order to survive  Lymphaginitis
 Affect gastrointestinal 2. Salmonellosis (Salmonella)
 Parathyroid fever septocaine  Found by Daniel Salmon
 Flagella - very motile, can transfer easily  Chemotrophs = Requires
 Chitin - shellfish (crabs, shrimps, etc) oxidation and reduction
 Viremia - bloodstream infection process in order to survive
 Insect bites  Affects Gastrointestinal
 Tuberculosis tract & lining
 Affect lungs, brain, spine (gibbus), kidney  Parathyroid fever
 Bacteria due to poor sanitation 3. Escherichia coli (E. coli)
 Easily spread (double for next 24 hours until  Flagella (Very motile,
treated) transfers easily)
 Hantal virus  Causes dysentery (bloody
 H1N1, HIV, SarsCov 1 and 2 (Covid-19), stool)
influenza 4. Vibrio Cholerae
 Emerging illnesses  Cholera
 Thrives in water (Marine
CATEGORIES BIOLOGICAL AGENTS organisms)
Category A 1. Bacillus Anthracis (Anthrax)  From chitin (shellfish)
 Transpired through GERM  Caused by seafoods
theory  Caused by improperly
2. Yersinia Pestis fermented foods (Buro =
 By Alexander Yersinia Food preservation; Pickled
 Scarlet Fever = From foods)
oriental rat flea 5. Alpha viruses
 Black death  Causes Viremia
 Pneumonic (lungs) (Bloodstream infection)
 Septicemic (blood)  Drink prophylaxis

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

Category C - Blood thiving (vector bites)  R & R (Roles and Resources)

1. Mycobacterium tuberculosis
 TB bacillus (oxygen
thriving but once entered
bloodstream, it spreads)
 Affects lung, brain, spine,
and kidney
2. Nipah Viruses
 From fruit bats
 Typical virus
 Travellers are the most
affected
3. Hanta Viruses
 Emerging viruses
 HIV, SarsCov
 Influenza

SIMPLE TRIAGE AND RAPID

TREATMENT (START) SYSTEM

 Was developed to allow first responders to triage

multiple victims in 30 seconds or less, based on three
primary observations (RPM):
1 Respiration
2 Perfusion = Pulse (<30 mins); Determine location
of bleeding
3 Mental Status = Level of consciousness /
responsiveness
 The START system is designed to assist rescuers to  Black = Deceased
find the most seriously injured patients. As more  Red = Most priority
rescue personnel arrive on the scene, the patients will  Yellow = Wounded (Can wait for < 30 mins)
be re-triaged for further evaluation, treatment,  Green = Walking wounded ( Can wait for > 30 mins)
stabilization, and transportation.
 This system allows first responders to open blocked  Check for identification cards or dental records
airways and stop severe bleeding quickly.
 Check LOC or OR mostly if the patient is not CASUALTY TRIAGE
responsive  The categorization of casualties for the priority of
SALT treatment and evacuation.
 Sorting = Start triage technique  Triage is one of the most important tasks in casualty
 Assessment (cephalocaudal, review of system) care. It requires the most informed judgment,
 Life Saving Intervention (ABC, CAB - all medications knowledge, and courage. Triage is a continuing
are administered through IV) process and the individual assigned should be the most
 Transport and Treatment (equipped) capable and experienced health care provider

TAN, L. M.
EMERGENCY NURSING CONCEPT 1
PROF. LESLIE LAZARO, PhD, MBA, MAN, RN
_________________________________________________________________________________________________________________________________________________________________________________________________________________

available.  Improve employee productivity and efficiency

 Good Samaritan law by the virtue of ACT IN YOUR

BEST JUDGMENT: Judgment, knowledge, courage

PRINCIPLES
1 Accomplish the greatest good for the greatest
number of casualties
2 Employ the most efficient use of available
resources
3 Return personnel to duty as soon as possible

 Dead bodies are either:

1. Transferred immediately to funeraries
2. Put to refrigerators

PERSONAL PROTECTIVE EQUIPMENT

(PPE)

 Refers to protective clothing for the eyes, head, ears,

hands, respiratory system, body, and feet.
 It is utilized to protect individuals from the risks of
injury and infection while minimizing exposure to
chemical, biological, and physical hazards. PPE serves
as the final line of defense when engineering and
administrative controls are insufficient in reducing or
eliminating risks.
 According to the hierarchy of controls by the National
Institute for Occupational Safety and Health (NIOSH),
PPE (sometimes also referred to as PPE equipment)—
is recommended to be the last level of defense to
prevent occupational injuries, illnesses, and fatalities,
but some businesses combined it with other control
measures to ensure a safe and healthy environment for
their workers.

BENEFITS OF USING PPE:

 Prevent unnecessary injury in the workplace
 Protect employees from excessive chemical exposure
 Prevent the spread of germs and infectious diseases
including COVID-19
 Help businesses comply with regulatory
requirements(e.g., The Personal Protective Equipment
at Work Regulations 1992)

TAN, L. M.