Laceration Laceration is segmental or involves the hilar vessels and devascularization of more than 25% of the spleen. II Hematoma A non-expanding subcapsular hematoma covers 10% to 50% of the surface and is less than 2 cm deep.
NOTES
ENA: EMERGENCY NURSING ORIENTATION
Lesson Notebook: Behavioral Health Emergencies
LESSON OUTLINE
Behavioral Health and Emergency Care
Patient Management
Behavioral Health Disorders
Assess for signs of suicide risk, such as talking about suicide, seeking lethal means to commit suicide, hopelessness, social withdrawal, anger, substance abuse, and insomnia. Watch for signs of escalating behavior that could lead to violence, such as a louder voice, fidgeting or verbal noises, and building up energy.
PRECEPTOR EXERCISES
Emergency Care Psychiatric Clinical Framework
Agitation and Restraints
Risk of Suicide
Violent and Homicidal Behavior
Escalating Violence
Lesson Notebook: Burns
Etiology
Pathophysiology
Burn Assessment
Smoke Inhalation
If the patient develops neuropathic pain, treat with low-dose tricyclic antidepressants or sodium channel blockers. To minimize heat loss, keep the patient covered, administer warmed intravenous fluids, and increase the room temperature.
KEY RESOURCES
Rule of Nines
Lund-Browder Chart
4 mL/kg/% TBSA of lactated Ringer's solution plus 50 mEq sodium bicarbonate (180 mEq sodium)/L for the first 8 hours.
Assessment Tools for Burns
Burn Centers and Protocols
Management of Carbon Monoxide Poisoning
Cyanide Antidote Kits
Lesson Notebook: Cardiovascular Emergencies, Part 1
Anatomy and Physiology Review
Dysrhythmias
In a normal sinus rhythm, the rate is 60 to 100 beats per minute (in an adult) and the rhythm is regular. Wandering atrial pacemaker causes a rate of 50 to 100 beats per minute and a regular or slightly irregular rhythm.
Therapeutic Electrical Interventions
Cardiac Rhythm Documentation
Defibrillation
Synchronized Cardioversion
Pacing
Lesson Notebook: Cardiovascular Emergencies, Part 2
Cardiac Arrest
Vasodilators, such as nitroglycerin (Nitrostat) or nitroprusside (Nitropress), to reduce cardiac workload by reducing preload and afterload.
Acute Coronary Syndrome
Heart Failure
Pericarditis
Aortic Aneurysm
Hypertensive Crisis
Vasoactive Agents Commonly Used During Cardiovascular Emergencies
Vasoactive Agents Commonly Used During Cardiovascular Emergencies (Continued)
Be aware that nitroprusside can cause hypotension, ischemic chest pain, increased intracranial pressure, and seizures.
Handling a Cardiac Arrest
Therapeutic Hypothermia after Cardiac Arrest
Chest Pain Protocols
Care of the Patient with Acute Myocardial Infarction
Electrocardiography
Cardiac Monitoring in the Emergency Department
Medications in Acute Myocardial Infarction
Cardiac Protocols
Heart Failure Protocol
Emergency Blood Protocols
Lesson Notebook: Child and Elder Maltreatment and Intimate Partner Violence
Child Maltreatment
Emotional abuse is a repeated pattern of harmful interactions between the caregiver(s) and the child that becomes characteristic of the relationship. Medical records may be required in cases of child abuse and the health professional who examined the child may be called to testify.
Intimate Partner Violence
Because child maltreatment is a complex problem that requires the expertise of various professionals, many facilities take a multidisciplinary approach.
Elder and Dependent Adult Maltreatment
Child Maltreatment Policy
Reporting Child Maltreatment
Sexual Abuse Advocacy
Specimen Collection and Documentation
Child Death Review Team
Victim Screening and Support
Screening
Reporting Elder Abuse
Lesson Notebook: Communicable Diseases
Anatomy and Physiology
Infection Prevention in Acute Care
Hepatitis A
Hepatitis B
Hepatitis B virus can cause acute illness or subclinical infection followed by acute recovery or chronic hepatitis.
Hepatitis C
Hepatitis D
Hepatitis E
Human Immunodeficiency Virus (HIV) Infection
Methicillin-resistant Staphylococcus Aureus (MRSA) Infection
Tuberculosis (TB)
Types and Characteristics of Viral Hepatitis
Stages of HIV Infection and Common Clinical Syndromes
Reducing the Risk of Bloodborne Exposures
Postexposure Prophylaxis
MRSA Infection
MRSA Precautions
Tuberculosis
Lesson Notebook: Dental, Ear, Nose, Throat, and Facial Emergencies
The bony structures of the face include the vomer, mandible and six pairs of bones. Four pairs of sinuses (air-filled sacs) are the ethmoid, frontal, maxillary and sphenoid sinuses.
Patient Assessment
Dental Emergencies
Each ear is divided into three parts: the outer ear (auricle, auditory canal, and eardrum), the middle ear (ossicles, round and oval windows, and the Eustachian tube), and the inner ear (bony labyrinth). The nose is a mostly cartilaginous structure that warms, filters, and humidifies inhaled air, provides the sense of smell, and is the primary passageway for air to the lungs. Ludwig's angina is the spread of an existing dental infection or cellulitis into the three mandibular spaces.
Ear Emergencies
This causes swelling in the neck and submandibular tissue (which displaces the tongue superiorly), pain, trismus, muffled voice, dysphagia, drooling, fever or chills, and dyspnea. Priorities in the emergency department include maintaining the airway, breathing and circulation; relief of pain; and.
Nasal Emergencies
Throat Emergencies
Facial Emergencies
Managing Dental Emergencies
Ear Irrigation
Nasal Packing
Lesson Notebook: Disaster Preparedness
Historic Events
Disaster Management
Evolution of Disaster Management
National Incident Management System
Incident Command System
Communication
Triage
Disaster Triage
Standards of Care
Credentialing Disaster Responders
Personal Preparedness
Homeland Security Mission Areas
Homeland Security Mission Area 1: Prevention
Consider a plan where family members call or email the same friend or relative (preferably in a different location) when a disaster strikes. Keep a copy at home and one in an alternate location that you can access in the event of a disaster. Plan for housing, food, water and related materials for personnel who must remain on duty.
Homeland Security Mission Area 2: Protection
Get involved with a response team now, such as a disaster medical assistance team, Medical Reserve Corps or hospital response team. Check with your state health department or state board of nursing for rules and regulations pertaining to interstate licensure requirements to ensure proper.
Homeland Security Mission Area 3: Response
Homeland Security Mission Area 4: Recovery
Internal and External Communication
Preparation for a Disaster
Evacuation
Lesson Notebook: Drug Calculations
Six Rights of Medication Administration
Basic Drug Calculations
Metric System
Apothecary System
In the pharmacy system, the basic unit of measurement for weight is the grain (gr), and the basic unit of measurement for volume is the minimum. The major units of measurement in this system are the dram (dr) and the ounce (oz).
Household System
Critical Care and Pediatric Medications
Safe Dosage Range
The dimensional analysis method uses factor labeling to calculate the dose of medication to be administered. The three factors used to calculate drug doses are the drug label factor, the conversion factor, and the drug order factor. The conversion factor allows you to build into the mathematical equation the conversions you need to calculate the correct dose of the drug.
Medication Administration Safety
Lesson Notebook: Endocrine Emergencies
The adrenal cortex produces corticosteroids, such as cortisol and hydrocortisone, and mineralocorticoids, such as aldosterone.
Diabetic Emergencies
Alcoholic Ketoacidosis
Pituitary Disorders
Later findings include headache, blurred vision, confusion, decreased level of consciousness, convulsions, coma, tachycardia, dysrhythmias, and hypotension. Treatment requires correction of hypokalemia and hypercalcemia, discontinuation of causative drugs, administration of thiazide diuretics, and restriction of salt intake. Other findings include weakness, nausea, vomiting, diarrhea, abdominal and muscle cramps, sudden weight gain without edema, headache, fatigue, and severe neurological changes.
Thyroid Emergencies
Syndrome of inappropriate antidiuretic hormone (SIADH) causes the pituitary gland to release excess antidiuretic hormone.
Adrenal Disorders
Comparison of Hyperosmolar Hyperglycemic State and Diabetic Ketoacidosis
Diabetic Ketoacidosis
Hypoglycemia Protocol
Lesson Notebook: Environmental Emergencies
Heat-related Emergencies
Cold-related Emergencies
Drowning
Diving Emergencies
Bites and Stings
Treatment requires immediate removal of the sting followed by the application of ice and antihistamines for mild reactions or epinephrine (Adrenaline), diphenhydramine (Benadryl), methylprednisolone (Solu-Medrol), and histamine2 blockers for severe reactions.
Patient Cooling
Rewarming Strategies
Hyperbaric Oxygen Chamber
Antivenin
Lesson Notebook: Fluid and Electrolyte Imbalances and Vascular Access
Anatomy and Physiology Review: Water
Anatomy and Physiology Review: Electrolytes
Fluid Imbalances
Electrolyte Imbalances
Hypocalcemia is easily managed with intravenous calcium, but requires careful monitoring of calcium levels, heart rate, and blood pressure. Treatment of hypercalcemia depends on the cause, but usually includes intravenous hydration, diuretics, and possibly glucocorticoids. Hypermagnesemia can be treated with intravenous calcium chloride, diuresis with saline and furosemide, and possibly hemodialysis.
Vascular Access
Composition of Various Body Fluids
Serum Electrolyte Values
Calculate the patient's basal fluid requirements based on his or her size, expressed as body surface area (BSA). In children: Intravenous bolus of normal saline or Ringer's solution at 20 ml/kg In adult surgical patients: Intravenous bolus of Ringer's lactate solution at 200 to 300 ml In adult medical patients: Intravenous bolus of 200 to 300 ml normal saline Replacement with colloids .
Blood Product Administration
Hypertonic Saline Infusion
Peripheral Venous Access
Central Lines
What are our institution's access and access procedures for tunnelless, tunneled, and implanted venous access devices?
Intraosseous Access
Lesson Notebook: Forensic Nursing in the Emergency Department
Definition of Forensic Nursing
History of Forensic Nursing
Emergency Nurse Roles and Responsibilities
Semen can be collected from adult patients many days after an assault and can extend the time for collection of deoxyribonucleic acid (DNA) evidence up to 1 week, depending on the jurisdiction. Air dry the swab, wrap it in a clean envelope, write the appearance and location of the stain on the envelope and initials above the tape. Next, photograph the patient's injury one-third the distance (4 feet away) and finally take a close-up one-third the distance (2 feet away) with and without a scale, such as a ruler or penny.
Documenting Evidence
Collecting Physical Evidence
Chain of Custody
Evidence Photography
Lesson Notebook: Gastrointestinal Emergencies
The small intestine absorbs nutrients and other products of digestion and transports residue to the large intestine, which absorbs water and electrolytes and forms and stores stool.
Assessment
Specific Gastrointestinal Emergencies
Upper gastrointestinal bleeding can be spasmodic (usually due to portal hypertension) or variceal bleeding (usually due to erosion of the esophagus or duodenum). Other manifestations may include low body temperature, tachycardia, nausea, vomiting, flatulence, jaundice, and weight loss. Interventions may include administration of crystalloids, antiemetics, opioids, and antibiotics; insertion of a nasogastric tube; and monitoring vital signs and fluid intake and output.
Abdominal Assessment
Upper Gastrointestinal Bleeding
Lesson Notebook: Gynecologic Emergencies
In the female reproductive system, the external genitalia include the mons pubis, the labia majora and minora, the clitoris, the vestibular glands, the hymen, the vaginal opening, the mouth of the urethra, and the ducts of Bartholin's and Skene's glands. If the egg is not fertilized, the endometrium sheds its inner lining during menstruation.
Specific Gynecologic Emergencies
Infection changes the amount, color and smell of the discharge and causes itching, burning or irritation. Pelvic inflammatory disease is an infection of the upper reproductive tract, usually as a result of an increasing sexually transmitted infection. The secondary phase produces a dull symmetrical rash on the palms and soles, fever, chills, lethargy, patchy alopecia, lymphadenopathy, loss of the lateral third of the eyebrows, and nonspecific findings.
Abnormal Vaginal Bleeding
Based on the patient population our emergency department typically serves, do we use any culturally specific interventions for women presenting with gynecologic emergencies.
Pelvic Pain
Chlamydial Infection and Gonorrhea
Patient Teaching
Lesson Notebook: Head Trauma
Hematomas can occur in these areas because the middle meningeal artery is in the epidural space and the bridging veins span the subdural space. Watch for early signs of increased intracranial pressure, such as increasing headache or motor delays, behavioral changes, nausea, vomiting, speech or visual disturbances, and sluggish or ovoid pupils. Be alert for late signs of increased intracranial pressure, such as decreased responsiveness, impaired brainstem reflexes, decerebrate or decorticate posture, irregular respirations, fixed and dilated pupils, arrhythmias, and Cushing's triad (systolic hypertension, widening of pulse pressure, and bradycardia).
Specific Head Injuries
Primary brain injury occurs at the time of trauma, when the structure of the brain is damaged. Brain Trauma Foundation guidelines recommend intracranial pressure monitoring for all patients with a post-resuscitation Glasgow Coma Scale score of 8 or less and an abnormal computed tomography of the brain. Before discharging the patient, be sure to teach the patient and family key information, such as when to return to the emergency department and how to prevent brain injury.
Cranial Nerves and Their Functions
Glasgow Coma Scale
Cranial Nerve Examination
Ask patient to stick out tongue to midline and move it from side to side.
Extraocular Eye Movements
Advantages, Disadvantages, and Nursing Considerations of Intracranial Pressure Monitoring Techniques
Administer sedatives or analgesics as appropriate to reduce the risk of catheter dislodgement due to patient movements. Administer sedatives or analgesics as appropriate to reduce the risk of catheter dislodgement or injury from patient movements. It can be placed in the subdural or subarachnoid space, in the ventricle or directly in the brain tissue.
Cross-Cultural Communications
Brain Death Evaluation
Tests of Cerebrospinal Fluid
Mild Traumatic Brain Injury
Primary Brain Injury
Airway Management
Fluid Resuscitation
Blood Product
Intracranial Pressure Monitoring
Intracranial Pressure Management
Mannitol
Burr Holes
Cerebral Perfusion Pressure Management
Lesson Notebook: Hematologic and Oncologic Emergencies
Blood is a suspension of erythrocytes (red blood cells), leukocytes (white blood cells), platelets (thrombocytes) and other particles in an aqueous colloidal solution. There are six types of leukocytes in the blood: neutrophils, eosinophils, basophils, monocytes, lymphocytes and plasma cells. Also assess for changes in other systems, such as joint deformities or limited movement in the musculoskeletal system.
Hematologic Emergencies
Leukemia is a malignant disorder of the blood and blood-forming organs characterized by excessive, abnormal growth of leukocyte precursors in the bone marrow. Thrombocytopenia is an abnormally low platelet count that can be caused by sepsis, tumors, severe bleeding, and other causes. Specific treatments include oxygen; intravenous fluids; transfusion of fresh frozen plasma, packed red blood cells, cryoprecipitate and platelets.
Oncologic Emergencies
Depending on the type of hemophilia, treatment may require fresh frozen plasma, cryoprecipitate, and clotting factors. Treatment depends on the cause, but may include chemotherapy - or removal of vascular access and fibrinolytic and anticoagulant administration. Symptomatic spinal cord compression is an emergency because irreversible neurological damage can occur in hours.
Cellular Components of Blood
Coagulation Factors
Components of the Complete Blood Count
Pain Management in a Vaso-occlusive Crisis
Factor Replacement
Infection Protection
Lesson Notebook: Influenza: Seasonal, Asian, and Pandemic
Types of Influenza
Twentieth-Century Pandemics
Recent Pandemic Flu Scares
Seasonal Influenza
Adaptability and Mutation
Preparedness Planning
Impact of a Pandemic
Influenza Vaccination
Pandemic Response
Surveillance and Reporting
Prevention and Control in Health Care Facilities
Isolation Precautions
Lesson Notebook: Management of the Critical Care Patient in the Emergency Department
Mechanical Ventilation
Invasive Monitoring
Sepsis
Minute ventilation The volume of air that moves in and out of the lungs in 1 minute. A therapy used in mechanical ventilation to ensure constant end-expiratory airway pressure and to increase the volume of gas in the lungs at the end of exhalation (residual functional capacity). Ideally, it increases the surface area of the alveoli to reduce the movement of blood through the lungs and improve gas exchange.
Cardiac Parameters
6 to 12 mm Hg Ventricular preload and volume at end diastole (used in fluid assessment) Systemic vascular. The resistance, impedance, or pressure that the right ventricle must overcome to eject the volume of blood in it.
Endotracheal Intubation
Arterial Blood Pressure Monitoring
Central Venous Pressure Monitoring
Pulmonary Artery Catheters
As an emergency nurse, what is my role in assisting with the insertion and maintenance of the intracranial pressure monitoring device.
Sepsis Management
Obtaining Samples for Cultures
Lesson Notebook: Maxillofacial Emergencies
Perform a focused assessment of the face, including soft tissues, bones, symmetry, mouth, teeth, jaws, eyes, ears, nose, and associated cranial nerves.
Soft Tissue Trauma
