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N450 Emergency & Disaster Nursing (1)
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N450 Emergency & Disaster Nursing (1)
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N450 Emergency & Disaster NursingTriage - ANS-French "to sort" Works on the premise that pts who have threat to life must be
treated before other pts.
Emergency Severity Index (ESI) - ANS-A five-level triage system that incorporates concepts of
illness severity and resource utilization to determine who should be treated first.
The four categories to sort pts. on the Emergency Severity Index (ESI) - ANS-1) ABCs
(unstable, threatened, stable)
2) Life threat or organ threat (obvious, likely but not always obvious, unlikely but possible, No)
3) How soon pt should be seen by HCP (immediate, 10 min, up to 1 hr, could be delayed)
4) Expected resource intensity (EKG, Labs, Xray, IV Fluids)
What surveys are used for all trauma pts - ANS-Primary & Secondary Survey
What surveys are used for non-trauma pts - ANS-Primary survey followed by focused
assessment
Primary survey - ANS-Focuses on airway, breathing, circulation, disability,
exposure/environment control.
It serves to identify life threatening condition so that the appropriate interventions can be
initiated
At any point during this time if you find life threatening conditions START INTERVENTIONS
IMMEDIATELY.
External hemorrhage during primary survey - ANS-In this case, <C> stands for catastrophic
hemorrhage. Must be controlled first. Apply direct pressure w/ sterile dressing.
Primary survey: What is A? - ANS-Alertness & Airway: Determine LOC by pt's response &/or
painful stimuli.
AVPU: Alert, Responsive to Voice, Responsive to Pain, Unresponsive.
Patients at risk for airway compromise - ANS-drowning, seizures, anaphylaxis, foreign body
obstruction, cardiopulmonary arrest
S&S of a compromised airway - ANS-Dyspnea, inability to speak, gasping (agonal) breaths,
foreign body in airway, trauma to face/neck.
, Ways to open airway - ANS-Head tilt-chin lift and jaw thrust, suctioning, removal of foreign body,
insertion of nasopharyngeal or oropharyngeal airway, intubation, emergency cricothyroidotomy
or tracheotomy.
Ventilate pt w/ 100 O2, bag-valve-mask (BVM), before tracheotomy.
What survey: What is B? - ANS-Breathing: Adequate airflow through upper airway DOES NOT
ensure adequate ventilation.
S/S of dyspnea - ANS-paradoxic or asymmetric chest wall movement, decreased or absent
breath sounds on the affected side, visible wound to the chest wall, cyanosis, tachycardia,
hypotension.
Conditions that affect breathing - ANS-Fractured ribs, pneumothorax, penetrating injury, allergic
reactions, pulmonary emboli, asthma attacks.
Primary survey: What is C? - ANS-Circulation: Effective circulatory system includes the heart,
intact blood vessels, & adequate blood volume.
Check CENTRAL pulse (e.g., carotid) because peripheral pulses may be absent d/t
injury/vasoconstriction.
Assess skin for color, temp & moisture.
**Altered mental status & cap refill >3 seconds - common sign of shock
Uncrossed blood: Use O-
Primary survey: What is D? - ANS-Disability: Conduct brief neuro exam. Assess LOC using
Glasgow Coma Scale (GCS) (not for intubated or aphasic pts). Check pupils for size, shape,
equality & reactivity.
Glascow Coma Scale (GCS) - ANS-
Primary survey: What is E? - ANS-Exposure & Environmental Control: Remove clothing to do
assessment (may have to cut off clothing).
Do not remove impaled objects.
Use warming blankets, overhead warmers, warmed IV fluids to limit heat loss, prevent
hypothermia & maintain privacy.
Primary survey: What is F? - ANS-Facilitate Adjuncts & Family: Obtain full vitals after pt is
exposed.
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