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Emergency Nursing

- fast, quick, rapid


- time is of essence
Emergency- any sudden illness or injury which
is perceived by the significant others and/or patient
as requiring immediate medical attention
Emergency Nursing
care given to situations needing immediate
medical interventions
care of individuals of all ages with
perceived or actual physical or emotional
alterations of health that are undiagnosed
or that require further interventions
It is episodic (at any time, not constant,
primary (immediate, !" restorative or
rehabilitative and usually acute (patients
are wheeled out after care is given
Scope of Emergency Nursing
#$ %sessment
&$ iagnosis
'$ reatment
($ valuation (for as long as the patient is
stable
Principle of Emergency Medical Treatment
)* +ommunicating in +risis
,rinciple )-.patients need to know that their
feelings are accepted and acknowledged by the
(/ personnel
/ole of nurses-
)* 0ive verbal and nonverbal
1* Inform patients (what and why is
it to be done
,hysician.s responsibility$ ()
obtain informed consent, (1
e2plains any invasive procedures
to patient
3* 4e aware of one.s own feelings
(self$assessment
5* 'alk with patients
6* (ncourage patients to discuss
opinions (e*g* delivery of care
7* 8elp patients verbali9e
frustrations
:* "ffer realistic hope
;* 4e honest
1* ,atient #ssessment, /eporting and
&ocumentation
,rinciple 1- <rapid, accurate initial patient
assessment and precise reporting and
documentation, whether in the pre$hospital or
hospital settings are keys to effective patient
care.
/ole of nurses**
)* =erify that the scene is safe and
secure
1* 4e an astute observer
3* Information gathered must be
communicated
5* /ecord other pertinent
information of the patient
6* ,rovide e2planation for omissions of
care (for purposes of law suits*
7* /ecord detailed triage notes
'riage notes>
8ow the patient was brought
to the hospital (ambulatory,
brought by private vehicle,
conscious
Interventions initiated by
(?'$Basics
?edications given by the
(?'$Paramedics (advanced
cardiac life support
(?'$Intermediate
(performs basic life
support and some
interventions in
advanced cardiac life
support
3* ,atient and @amily (ducation
,rinciple 3-.patient and family education is the
responsibility of every (/ nurse.
/ole of nurses-
)* ,rovide effective, individuali9ed
instruction re> home care
1* Identify learning needs
3* (stablish realistic goals
5* #llow for learning time
6* (valuate the results
7* &ocument the instruction
"ther 4asic ,rinciples in (mergency care
)* ,rovide for basic survival needs and
comfort
1* 8elp survivors achieve restful and
restorative sleep
3* ,rovide privacy
5* ,rovide non$intrusive ordinary social
contact
6* #ddress immediate physical problem
7* #ssist in locating and verifying the
personal safety of separated loved ones
and friends
:* 8elp survivors take practical steps to
resume ordinary day to day life
Basic Legal Issues
#* +onsent (permission to care to treatment
)* (2pressed (verbal or/and writing$freely
and voluntary given
1* Implied$presumed consent
3* Involuntary$patient refuses care and an
individual gives consent (e*g* %"
5* Informed$given provided that proper
e2planation has been done
3 (ssential components of Informed
+onsent>
'he physician must
&escribe the procedure
to be performed
(2plain the alternatives
available to the
procedure
&etail the risks of the
procedure
Ahen does an informed consent become validB
Cegal age D );
?entally stable
Information communicated in the
language known to the consente
Emergency Doctrine (implied consent
- Implies that the client would have
consented to treatment if able, because
the alternative would have been death or
disability
- ,rovides and e2emption to obtaining
informed consent before a procedure is to
be done
Consent Dilemmas
)* ?inors
(mancipated minors (economically
independent, married
1* /efusal to consent based on religious
conviction
0eneral rule$patient can refuse care on
the ground of religious convictions
(2ceptions$ () social circumstances, (1
court order e*g child who needs blood
transfusion of whom both parents are
Eehova.s witness, the court must have
the final say
3* /efusal of treatment leaving against medical
advice
Patient self-determination Act (!!"
- ,rovides hospitali9ed patients with the ability to
decide regarding their wishes for termination or
continuation of life support
(*g*
a* &urable ,ower of #ttorney
#ttorney$in$fact (could be %"
- 'hings to be done are
the ones specified in
the document signed
by a conscious patient
b* Civing wills
- a written
statement/document
detailing the patient.s
desires regarding their
medical treatment in
circumstances in which
they are no longer able
to e2press informed
consent*
c* &o not resuscitate order (&!/
- Cegal document signed
by the patient and his
physician, which states
that the patient has
terminal illness and
does not wish to prolong
life through
resuscitative efforts
- #lso called an advance
directive
#$at are good %amaritan la&s'
- Caws which are passed in order to
encourage lay persons or all persons
present in emergency situations without
fear of liability with regard to care given
- (*g 4roken ribs caused by inappropriate
performance of +,/ by a nursing
studentFgood %amaritan laws cannot be
invoked
- (*g patient has incurred bruises (as long
as it is !"' a ma(or
complicationsFgood %amaritan law can
be invoked
- (ffect of help should not be graver than
the condition of the patient
Patient Transfer Issues
(mergency ?edical 'reatment and #ctive
Cabor #ct ((?'#C#
(Before" +onsolidated "mnibus
4udget /econciliation #ct (+"4/#
Caws governing patient with
regarding to dumping or transferring
to one hospital to another because of
inability to pay
EMTALA )ig$lig$ts
)* #ll individuals
1* 'o determine the e2istence of an
emergency medical condition, there
must be> threat to life or limb, or
severe pain, or active labor
- &uty to provide #?%
(#ppropriate ?edical screening$
whether patient is on an
emergency situation
3* 8ospitali9ed with speciali9ed
capabilities must accept transfers if
with capacity to treat
5* 'ransfers require>
consent of patient
accepting physician
accepting facility
appropriate vehicle
appropriate equipment
qualified personnel
records must accompany the
patient
Principle of Confidentiality
not entitled to spread/share
information to persons not
directly involve to the care of
patient
(2emptions>
- ,ublic interest is at stake
- +riminal cases
- +onsent of patient to reveal
information
- %ued for damages (content
of patient.s chart is the very
thing in issue
G +ase of support is not a
criminal case*
More of legal issues
&ocumentation
/eportable conditions Dreport crimes to
appropriate agencies, conditions
mandated by laws, doctors and nurses
has e*ual responsibility
!ote> report the condition even if you
don.t have consent from the doctor
&ischarge instructions$ written and oral
,hysical evidence and chain of custody
- 4ullets
- 4lood specimens/blood samples
!ote> patient should not be force to
undergo blood e2aminations (forcing
would mean assaultH e2emptionsI
principle of confidentiality
"rgan donation$brain death has been
pronounced by the doctorH signed a
legal consent
+oles in Emergency ,ursing
)* 'riage !urse
1* 'elephone #dvice !urse
3* ,oison +ontrol %pecialist
5* 'ransport !urses
6* 'rauma !urse +oordinator
7* ,ediatric (& !urse
:* +ase ?anager
;* (?% Ciason
J* !urse ,ractitioner
)K* +linical !urse %pecialist
-eneral +esponsi.ilities of Emergency ,urses
)* Aorks in an area staffed and equipped for
the reception and treatment of persons
with conditions requiring immediate
medical care, serious illness and trauma
1* (fficiently do #$,$I$(
+esponsi.ility During Deat$ and Dying
)* ,rovide ample opportunity to the patient and
family to be together
1* #llow presence of family members during
resuscitation
3* ,rovides religious support
5* +ommunicate honestly about the patient.s
condition
6* (ncourage viewing the body in instances of
sudden death or trauma
7* 4ecause preservation of legal evidence is often
important in sudden death, %" are advised
beforehand of the various tubes and devices
present*
:* &etermine client.s wishes re> organ donation
;* ?ay provide a follow$up telephone call to %" not
present re> their questions or concerns
J* ?ake referrals to support groups
Disaster Nursing
&isaster$ any situation, natural or manmade
that produces an immediate patient load
greater than the normal (& can handle
Mass Casualty Incident
- #ny time an incident or disease occurs
that leaves many people ill or injured
- +an be caused by natural ( i*e*
earthquakes, floods or accidental or
intentional disasters (terrorist attacks,
sarin gas release
Classification of MCI
)* Cevel I$ involves more than )KK
patients
1* Cevel II$ involves greater than 6K but
not more than )KK patients
3* Cevel III$ greater than 16 but not
more than 6K
5* Cevel I=$greater than )K but not more
than 16
6* Cevel =$an incident involving no more
than )K patients
7* MCI (contamination
- an ?+I of any level, which includes
or has the potential for biological,
chemical or radiological
contamination
,ote/
+ommon on all levels>
$8aving a great impact on
the emergency department and going
beyond the capacity to treat
Categories of Disaster/
)* +lass # (all require response by hospital
disaster teamH bigger impact
- !atural disasters> earthquakes, floods,
tornadoes
- (2ternal disasters/medical emergencies>
chemical e2posure, epidemic of disease,
nuclear fall$out
1* +lass 4
- Internal disasters/medical emergencies
that may require response by hospital
disaster team or specially created crisis
team
- &eath of key personnel (pope, president,
large scale poisoning, death of religious
personnel
3* +lass +
- Internal disasters/non$medical
emergencies
- ?ay require response by hospital disaster
team or specially created crisis team
- 4omb threats, strikes, criminal activity
(rape, kidnapping, shooting
P$ases 0%tages of Disaster
)* ,re$impact/preparedness
- "ccurs prior to the onset of the disaster
- !ot all type of disasters has the pre$
impact phase
1* Impact/response
- &isaster occurs, continuing to
immediately following disaster (brief or
lasing to few hours
- Inventory and rescue period
- Assessment of the e2tent of the losses,
planning on how to use the resources left
and how to rescue the victims
3* ,ost$impact/recovery
- ?ajority of rescue operations
- /emedy and recovery period
- Cengthy phase and may last for years
)* 8oneymoon phase$feelings of
euphoria
1* &isillusionment$anger,
disappointment
3* /econstruction phase$acceptance of
loss, coping stress, rebuilding
DISASTER PLAN
# predefined set of instructions
for a community.s emergency
responders
@eatures of a good disaster plan
)* Aritten
1* Aell$publici9ed
3* /ealistic
5* /ehearsed
1ey components of Disaster Plan
)* ,atient care
%ystem on how to receive
and distribute patients
whether incoming/evacuated
patients
'riage procedure
,rovides care for the
greatest number (,2T
applicable in non$disaster
triage
#void treating ambulatory
patients as dependent
patients
,re$assignment with regard
to responsibillity
1* +ommunication
Internal> within personnel
(2ternal> one hospital facility
to another
3* /esources$staff
&isaster team must know
how to contact the resource
staff
5* %ecurity/ %afety Densure the
scene is safe
6* +oordination with ,ublic #gencies
7* &ocumentation
:* ,ublic relations$ officials
;* +ritical Incident %tress &ebriefing
- ,2T a form of
psychotherapy
- &one to mitigate
(lessen the
occurrences of ,'%&
- 0roup process
involving persons who
are victims/ survivors
of an overwhelming
event or trauma
including those who
may have been
impacted by the
trauma
- #ims to prevent the
subsequent
development of ,'%&
- ,rovides avenue for
the patient to e2press
feelings, coping
mechanisms, lessons
learned
Disaster Management Principles
)* ,revent occurrence
1* ?inimi9e casualties
3* ,revent further casualties
5* /escue the injured
6* ,rovide first aid
7* (valuate the injury
:* ,rovide definitive care
;* @acilitate reconstruction and recovery
'he responsibility of nursing care
3ary (depends on situation or
available resources
?ay include triage, patient care,
equipment, directing others,
recording, transportation
#$at are t$e psyc$ological and emotional
responses to emergency and disaster'
Immediate reactions (an2iety, frustration,
anger, physical symptoms
&elayed reactions (feelings of loss, grief and
guilt, flashbacks, nightmares
!ursing Interventions>
#* @or immediate stress reaction
)* 6 minutes break at least every hour
1* ?onitor for shaking, trembling, loss
of coordination
3* ,rovide rest area
5* /otate frontline personnel
4* @or delayed reaction
)* 1 mandatory debriefing sessions
1* (ncourage liberal leave policy
3* 4egin stress management class
Triage System
- trier to sort
Triage Nursing
$ care given to patients to ensure that those
requiring immediate attention for life
threatening emergencies receive it
$ first used during !apoleonic war
Primary goal of an efective triage:
$ +APID identification of patients with urgent,
life threatening conditions
Comlementary goals of an efective
triage:
)* ,rioriti9ing care needs for all patients
1* /egulating patient flow through (&
3* &etermining the most appropriate area for
treatment$ the (& or an outside primary care
area
Note:
'he triage models in disaster
those patients who are severely injured and are
unlikely to survive despite medical attention
would receive the lowest priority triage*
(greatest good for the greatest number
'he triage model in emergency nursing
,riority is those patients who are in severe
condition
Triage Models
Triage tags D refers to color coding, identification to
each injured patientH for priority, save time
A! Non-"isaster Triage mo"els
$i*e* models for individual triage> traffic
directorH spot checkH comprehensive
,urpose> to provide best care for each individual
patient*
A44 Models for indi3idual triage
a!#!#! Tra$c "irector
categories> emergent (life$threatening
and major illness L non-urgent
(treatment can be delayed
sometimes done by unlicensed person
assessment consist of chief complaints
disadvantage> emergent patients are
disregards due to mi2ed with
nonemergent patients
sort to acute care or waiting room
no further evaluation by triage (re$
triage
when used
)* low daily census
1* no waiting period for patients to
see licensed health care
professional
a!#!%! Sot C&ec'
categories> emergent (life
threatening, urgent (major illness,
delayed (patient may be treated or
treatment may be delayed for more
than 1K hours
assessment by /! or ?&
no planned reevaluation
when used
)* high patient census
1* waiting period is anticipated
a!#!(! Comre&ensive Triage
categories> life-sa3ing (multiple
traumaH assessment is continuousH
sta.le .ut urgent (sickle$cell,
fracturesH every )6 minH sta.le .ut
non-urgent (small lacerationH every
3K minH stable, may wait indefinitely
for care (abrasion, impetigoH every
7K min
assessment done by /!
patients who remain in the waiting
room are re$assessed every )6$
7Kmin depending on severity of
illness or injury
when used
)* high patient census
1* treatment space limited
)! *ulti-casualty+Disaster Triage *o"el
,urposes> to provide the most effective care for the
greatest number of patients
%ample models for ?ulti$casualty/disaster triage model
,!#!#! Simle
categories> immediate care
(multiple traumas, inhalation
injuriesH delayed care (e2tremity
fractures, minor burns
,!#!%! *ilitary
6 level triage system
+ategories
4 Immediate (I"
triage tag> red
life$threatening injuries that
probably survivable with
immediate treatment
i*e* tension pneumothora2,
respiratory distress, airway
injuries, shock
54 Delayed (II"
triage tag> yellow
treatment may be postponed
without loss of life
i*e* minor e2tremity fractures,
lacerations with hemorrhages
controlled
64 Minimal
triage tag> green
little or no professional care
required
ambulatory, can self$treat or
seek alternative medical
attention independently
i*e* minor lacerations, abrasions
74 E8pectant (9"
triage tag> black
have lethal injuries and will die
despite treatment
i*e* devastating head injuries,
destruction of all vital organs
:4 ,o apparent in(uries
triage tag> white
,!#!(! Disaster --. level triage//
G +ategories
4 Emergent
triage tag> red
critical life threateningH patient is
e2pected to liveH shockH airway
problems
1* urgent
triage tag> yellow
major illness/injuries should be
treated within 1Kmin D 1 hoursH
i*e* open fractures, chest wounds
3* non-urgent
triage tag> green
minor injuries, usually
ambulatoryH are maybe delayed
for more than 1 hoursH i*e*,
closed fractures, sprains
5* Dead or &it$ impending deat$ D
'riage tag> black
slim to no chance of survivalH
shouldn.t take priority over
salvageable patientH i*e*, massive
trauma, e2tensive 3
rd
degree
burns
0t&er Triage *o"els
#!/ START -(simle triage an" rai"
treatment)/
can be performed by lightly trained
lay L emergency personnel in
emergencies
physiologic parameters> /,?
/ D respiration
, D pulse
? D mental
Categories/
4 Priority (9"
tagged as blackH patients not
breathing and have no pulse
evacuation> leave where they fell
attempt to open airway to assess
respiration and pulse
54 Priority (" ; immediate
tagged as redH patients who have
/ $ M 3K cpm
, D absent radial pulse
? D altered
used in evacuation> by ?(&(=#+ or
ambulance
64 Priority (5" delayed
tagged as yellow
/ N 3K cpm
, D have radial pulses present
? D alert
evacuation> delayed until all
immediate persons have been
transported
74 Priority (6" ; minor
tagged as green
walking wounded
evacuation> not evacuated until all
immediate L delayed persons have
been evacuated
%!/ A"vance" triage-similar to
military
$ implemented by skilled nurses
G +ategories>
)* E8pectant (.lac<"
severely injured with life threatening
medical crisis unlikely to survive
given with care available
should be taken to a holding area
and given pain killers
cardiac arrestH septic shock
not used in (/
#dvance cardiac life support
1* Immediate (red"
immediate surgery, cannot wait but
likely to survive (i*e* tension
pneumothora2
3* 2.ser3ation (yello&"
stable for the moment but requires
watching and frequent re$triage (i*e*
laceration with controlled
hemorrhage
5* #ait (green"
walking wounded
required doctors care in several
hours or days but not immediately,
maybe told to go home and come
back home within the ne2t day
i*e* broken bones without compound
fractures, soft tissue injuries
6* Dismiss (&$ite"
walking wounded with minor injury,
do not require doctor.s care
i*e* small cuts, scrapes
STEPS IN TRIA1E
)* ,rimary survey
consist of #4+
consist of #4+& proposed by (!#
A D #irway
B D 4reathing
C D +irculation
D D &isability (neurologic assessment status
E D (2posure or environment (coldness or hotness
A=P> (a very practical use
A D alert
= D voice
P D pain (response
> D unconscious/unresponsive
1* %econdary survey
follows primary survey and is very brief
use %#?,C( (% D signs and symptomsH
A D allergiesH M D medicationsH P D
pertinent past historyH L D last oral
intake, E D events leading to problem
$ #?,C(
$ a crash plan
A D airway/breathing
C D cardiovascular
+ D respiratory
A D abdominal
% D spinal
) D head L ((!'
P D pelvis
L D legs
A D arteries (pulses
, D nerves
$ head to toe assessment > !9 seconds
G @ocused #ssessment
$ diagnostic procedures
)* (+0
1* lab studies
3* radiology
CARDI0P2L*0NAR3
ARREST
$ with patients heart, circulation, and respiration
suddenly cease
+auses>
a* ?etabolic
a*)* hypoglycemia
a*1* hyperkalemia
b* &rug$induced
c* ,ulmonary
d* !eurologic
e* 8ypovolemic
f* "ther cardiac causes
a! *eta,olic causes
a44 $ypoglycemia
s0s/ unconsciousness,
tachydysrhythmias, sei9ures,
aspiration, weakness
mgt/ 6KO de2trose
a454 $yper<alemia
s0s/ (+0 (prolonged P$' intervalH
peaked ' waveH wide P/% comple2es
mgt/ calcium chlorideH sodium
bicarbonate
, D atrial contraction
P/% D ventricles contract to pump out blood
%' D time when the ventricles end of
contraction and beginning of the ' wave
' D time of repolari9ation
,! Drug- In"uce"
.44 TCA?s (e4g4 amitryptyline"
s0s/ tachydsyrhythmias
mgt/ sodium bicarbonate D alkylating
agent
.454 ,arcotics
s0s/ bradydysrhythmiasH heart blocks
mgt/ nalo2one (!arcan
.464 Propanolol
s0s/ cardiac> bradydysrhythmiasH
respiratory> bronchospasmH metab>
hypoglycemia
mgt/ for bradydysrhythmias> Isuprel,
#tropine
for bronchospasm> aminophylline
for hypoglycemia> 6KOde2trose
c! Pulmonary
c44 ast$ma
s0s/ severe bronchospasm,
tachydysrhythmias
mgt/ endotracheal intubation and
ventilatory support
c45 pulmonary em.olus
s0s/ pleuritic chest pain, %"4,
tachydsyrhythmias
mgt/ good ventilatory support
c464 Tension pneumot$ora8
s0s/ distended neck veins, tracheal
deviation, asymmetric chest
e2pansion
mgt/ needle thoracotomy, chest tube
"! Neurogenic
d44 increased ICP from any causes
s0s/ dilated pupils, decerebrate$
decorticate posturing, dysrhythmias
mgt/ steroids, diuretic agents,
surgery
i*e ?annitol> ?I" monitoringH soluset
used, risk for cardiopulmonary edema
e! 4yovolemia
e4 anyt$ing t$at causes 3olume loss of
.lood
s0s/ tachycardia, decreasing bp, cool
clammy skin
mgt/ I= fluids, ,#%0 (,neumatic
anti$shock garment, shock position
,#%0 is contraindicated in the ff>
+ardiopulmonary edema
%evere chest injuries even
patient is in shock
,regnant woman> do not
cuff abdomen
f! 0t&er car"iac causes
f4 Pericardial tamponade
s0s/ distended neck veins, decrease 4,,
bradydysrhythmias, widening pulse pressure
mgt/ I= fluids, atropine, Isuprel, thoracotomy
C&ain of survival
)* (arly access
1* (arly +,/
3* (arly defibrillation
5* (arly advance care
)asic Life suort
%urvey the scene
(%cene is safe, crowd controlled
Introduce self
#ctivate the (?% (Emergency Medical %ervices
$+all the ambulance
+heck for consciousness
L-ook
L-isten
@$eel
8ey, hey are you okB
0ive 1 initial breaths* +ontinue on LL@4
+heck pulse* 4rachial$infantH carotid$adult
If pulse and respiration is absent, do 3K cycles of chest
compressions> 1 breaths
Aait for the automated e2ternal defibrillator
#(&

+heck if shockable +heck if not
shockable
=entricular tachycardia, #systole also called
ventricular defibrillation 3entricular stand stillA
pulseless electrical
activity (no blood to be
pumped
&eliver ) shock using #(&* +annot perform
defibrillation*
+$C$($#$/*
$!obody is touching the patient* /epeat +,/ for 6
$,o metallic objects* cycles until #+C%
$,ot on wet ground* arrives*
/epeat +,/ for 6 cycles
%hockable Drefers to dysrhythmias which can
be subjected to defibrillation (electrical activity
of the heart is present
4C% can operate automated e2ternal
defibrillator
=entricular tachycardiaM )KK bpm
!itroglycerine patches$dilates the vessel to encourage
blood to stay in the venous system
$less cardiac rate
Qse gloved hand in detaching the plastic to pre3ent
$eadac$e4
It will burst due to the electrical
activity being delivered
,osition of patches>
#nterolateral position$most common
#nterior and posterior
Advanced Cardiac Life Support (ACLS)

,ulseless$no respiration
&eliver o2ygen
?onitor using (+0 )1 $lead
#(&
If s$oc<a.le
#dminister
) shock
(#(&
/epeat +,/
for 6 cycles
If s$oc<a.le
Wait AED
CPR (5 cycles)
AED (1 shock)
CPR (5 Cycles)
Administer
Epinephrine (1 mg/I)
asopressin (!" I# I)
$ I$ epinephrine is
not the choice
If not s$oc<a.le
0ive +,/ for 6 cycles
#dministration of the ff>
)* (pinephrine ()
mg/I= 3$6 minutes
1* =asopressin 5K
IQ/I=
3* #tropine ) mg/I= in
3 doses
If
s$oc<a.le
CPR (5 cycles)

AED (1 shock)

CPR (5 Cycles)

Administer the $$
antiarrhythmic dr%gs
Amiodarone
&idocaine
'agnesi%m
If not s$oc<a.le
0ive +,/ for 6 cycles
#dministration of the ff>
)* (pinephrine ()
mg/I= 3$6 minutes
1* =asopressin 5K
IQ/I=
3* #tropine ) mg/I= in
3 doses
Difference .et&een BL% and ACL%
- administration of drugs
K$5 min brain damage not likely
5$7 min brain damage is probable
7$)K min irreversible brain damage is possible
?ore than )K min irreversible brain damage is certain
Contraindication in Defi.rillation
)* Cess than ) year old (infant.s heart is normal,
therefore the electrical activity is normalI
respiratory problems brought about by @oreign
A Body 2bstruction and drowning are common
causes among this age
1* If electrical activity is normal, no defibrillation
should be given*
3* ,atients with severe traumatic chest injuries
5* 8ypothermic$no to defibrillation, warm the
patient first before applying defibrillation
Car"ioversion
%ynchronous electrical countershock timed to
coincide with the P/%
!ot delivered on the ' (repolari9ation wave
(compromised delivery of energy
Differences/
+ardioversion &efibrillation
$set in synchronous
mode
$sedate patient if
conscious
$hemodynamically
unstable
$set in
unsynchronous
mode
$patient is
hemodynamically
stable
,ursing +esponsi.ility for Cardio3ersion/
)* ?onitor =/%, C"+ and cardiac rhythm frequently
until patient is hemodynamically stable and
returns to pre$orientation C"+
Complications of Cardio3ersion/
#systole
,=+.s (,remature ventricular contractions
=entricular tachycardia
=entricular fibrillation
/eturn to atrial fibrillation or atrial flutter
Drugs Commonly 2se" in
Car"ioulmonary Resuscitation
Drugs Classifications
)* #denosine
(#denocard
1* #tropine
3* 4retylium (bretylol
5* (pinephrine
#ntiarrhythmias
#nticholinergicH
parasympathomimetic
+ategory 3
antidysrhythmias
(adrenalin
6* Isoproterenol
(Isuprel
7* Cidocaine
(2ylocaine
:* ,rocainamide
(pronestyl
;* %odium 4icarbonate
J* =erapamil (+alan,
isoptin
%ympathomimetic drugs
%ympathomimetic drugs
+ategory )4
antidysrhythmias
+ategory )#
antidysrhythmias
(lectrolyte , alkylating
agent in metabolic
acidosis
+alcium channel blocker,
category 5
antidysrhythmias
Commonly 2se" Parental 5asoactive
Drug
Drugs Classifications
)* (smolol
(brevibloc
1* +alcium chloride
3* &ia9o2ide
(hyperstat
5* &iltia9em
(cardi9em
6* &obutamine
(dobutre2
7* &opamine
(Intropin,
&opastat
#ntidysrhythmias,
#+( inhibitors
(lectrolytes
#ntihypertensive drug
+alcium channel
blocker
%ympathomimetic
drugs
%ympathomimetic
drugs
0t&er Drugs in Car"iac Emergencies
Drugs Classifications
)* (nalapril
(=asotec
1* Cabetalol
(!ormodyne
3* !itroglycerine
('ridil
5* !itroprusside
(!ipride
6* !orepinephrine
(levophed
7* ,ropanolol
(Inderal
#+( inhibitor
#lpha$adrenergic
blocker
=asodilator
=asodilatorH
antihypertensives
=asopressorH
adrenergic
4eta blockers
?orphine sulfate> emergency drug of ?I
$reduces the preload thus decreasing the
myocardial o2ygen demandH relieves pain
P$ases of MI/
A4 Ischemic phase$ myocardial repolari9ation is
altered and delayed causing the T &a3e to
in3ert
B4 Injury phase$causes %T segment c$anges
-%T segment rises at least ) mm
measuring K*K; seconds* If the myocardial
injury is on the endocardial surface, the %T
segment is depressed ) mm or more at least
K*K; seconds
C4 Infarction$abnormal P wave is K*K5 seconds or
longer
(%melt9er L 4are, 1KK5, p* :17
s&oc'
$state of inadequate perfusion and o2ygenation to vital
organs and tissues throughout the body
=ital 2rgans Affected .y s$oc</
4rain
8eart
Ridneys
Civer
7 %tages of %$oc</
)* Initial Dcellular level
$ increase anaero.ic meta.olismH
decrease aero.ic meta.olism
$ Increase lactic acid productionF pain
$ &ecrease cardiac output
1* +ompensatory
a* /enin$angiotension system
b* %ympathetic
$ /elease epinephrine (vasoconstriction
c* /elease of #&8 (posterior pituitary gland
d* Intracellular fluid shifts
3* ,rogressive
5* /efractory (Irreversible
Types of %$oc</
)* 8ypovolemic shock
$caused by a decrease in circulating volume
greater than )6 O
$s0s/ initial stage> pain, tachycardia, skin dry
and slightly moist, #40.s normal
+ompensatory stage> an2ious,
hypotension, cool, clammy skin, may
have metabolic acidosis
,rogressive> confused, restless, agitated,
profound hypotension, cardiac
dysrhythmias, skin pale, no purposeful
movement
Irreversible> severe hypotension,
tachypnea with shallow depth, profound
metabolic acidosis, comatose
1* +ardiogenic
$+aused by abnormal cardiac functioning or
pump failure
$s0s> restless, agitated, hypotension,
tachycardia with weak thread pulse, decreased
pulse pressure, skin cool and moist, E=&
3* "bstructive
$results from the inability of the ventricles of
the heart to fill or empty appropriately because
of an obstruction in the blood flow from the
heart
$s0s/ an2iety, hypotension, E=&, pallor,
diminished or absent breath sounds, tracheal
deviation
5* &istributive
a* #naphylactic shock$results from an
overwhelming immune response to the
presence of an allergen or antigen
s0s/ marked restlessness, difficulty
swallowing or severe itching, hypotension
tachycardia
b* %eptic shock$associated with endoto2ic
release of gram negative bacteria in the
blood stream
s0s/ decreased 4,, or normal 4, with
widened pulse pressure, tachycardia,
hyperventilation, positive cultures
c* !eurogenic shock$occurs as a result of
decreased sympathetic control of
vasomotor responses
s0s/ hypotension, bradycardia followed by
tachycardia, pallor, decreased to absent
urinary output*
Emergency Care %teps @or %$oc</
)* ?aintain an open airway and assess respirate
1* If with adequate breathing> apply high
concentration o2ygen by nonrebreather mask*
3* #ssist ventilation or perform +,/ if necessary
5* +ontrol bleeding
6* #pply and inflate the ,#%0
7* If with possibility of spine injury> elevate the legs
;$)1 inches
:* %plint any suspected bone injuries or joint injuries
en route to the hospital* If in shock, place the body
on a spine board*
;* ,revent loss of body heat
J* 'ransport patient immediately*
)K* If patient is conscious, speak calmly, and
reassuringly throughout the assessment, care and
transport
-eneral Treatment Measures of %$oc</
)* @ollow #4+ guidelines
1* %upine position with spinal alignment
maintained
3* #irway should be secured, protected and
supplemental o2ygen should be initiated
through the appropriate delivery device
dependent on the client.s overall assessment*
5* Initiate an I= access
6* Initiate continuous cardiac and %a "1
monitoring and prepare doe frequent, repetitive
vital sign assessments
7* ?aintain stabili9ation of all deformities and
prevent hypothermia
:* ,lace an indwelling cath
;* #dminister sympathomimetic drugs as ordered