emergency in nursing

1. Clinical emergencies-
Medical Surgical Nursing
Mrs.Puvaneswari. K
Assoc.Professor
NHCON

2. MEDICAL AND SURGICAL CONDITIONS
CONSIDERED AS EMERGENCY
Acute abdomen
Shock
Respiratory emergencies
Cardiac emergencies
Neurologic emergencies
Trauma
Poisoning

3. Acute abdomen
Abdominal pain is a symptom of many
different types of tissue injury and can arise
from damage to abdominal or pelvic organs
and blood vessels.

4. Abdominal emergency- Conditions
Minutes -
Perforated ulcer or diverticulum,
ruptured AAA, testicular or ovarian torsion, ectopic
pregnancy, pancreatitis, mesenteric infarct
Hours-
Biliary disease, appendicitis, diverticulitis, SBO
Days -
Inflammatory bowel disease, malignant obstruction

5. Assessment of acute abdomen
 History
 Assess for Pain
 Nausea, vomitting,
 Diarrhoea, Constipation,
Flatulence
 Fatigue, Fever,
 Increase abdominal
girth.
 Board like abdomen
Diagnostic tests.
Abdominal X-ray
CBC
Urine analysis.
Ultra sound
CT scan

7. NURSING - Physical assessment
Vital
Signs
• Tachycardia - volume loss ( Shock)
• Rapid shallow breathing- Peritonitis
Bowel
sounds
• Auscultate before palpating
• Absent sounds- possible peritonitis,
shock
• High pitched tinkling sounds - Possible
bowel obstruction
Position and
general
appearance
• Still refusing to move - inflammation or
Peritonitis
• Extremely restless - obstruction

8. Medical and Nursing Management
Oxygen administration
IV of Lactated Ringers or Normal Saline Solution
Keep patient warm
Monitor vital signs
Monitor EKG
Insert Ryles tube for aspiration if needed
Treat pain as per protocols (some believe that
masking/treating pain is wrong)
Administer anti emetics

9. Perioperative care
Prepare the patient for emergency surgery.
Keep the client on NPO.
Post operatively keep low suction NG tube
Maintain intake output chart.
Routine mouth care and nasal care is essential.
Check for abdominal distension- (Early ambulation )
Drainage care.
Follow aseptic procedures.

10. SHOCK
Shock is a condition characterised by
decreased tissue perfusion and impaired
cellular metabolism

11. SurgicalMedical
Causes of Shock
Post op bleeding
GI bleeding
Aortic dissection
Ruptured Ectopic
pregnancy
Ruptured organ or
vessel
MI
Dehydration
Sepsis
Diabetes Insipidus
Addisonian crisis
Trauma
Fracture

12. Assessment And Diagnostic tests
 Nurses can Assess for
Restlessness, Rapid and thready pulse,
Hypotension, Cool and Clammy skin, cyanosis,
Decreased LOC, Nausea and vomitting.
Perform Emergency
ECG
Cardiac monitoring,
Pulse oxymetry.
ABG, Haemodynamic monitoring and CT scan

13. Medical and nursing management
Initiate patent airway
Administer high flow oxygen
Anticipate need for intubation and mechanical
ventillation
Establish IV access and administer NS and
crystalloids
Assess for life threatening injuries
Consider vasopressor therapy only after the
hypovolemia is corrected
Treat dysarrythmias.

14. Cardiac emergencies
Myocardial
infarction
Cardiac
tamponade
Cardiogenic
shock
Pulmonary
embolism
Sudden
cardiac
death

15. GENERAL ASSESSMENT
Observe overall appearance of the patient, age,
body position
Assess for LOC, pain , edema, Nausea,
vomiting, fatigue, headache , palpitations ,
Pale skin and cyanosis
AIRWAY AND BREATHING
Evaluate the patient’s ventilatory status for rate
, depth of breathing, respiratory effort, and tidal
volume.
Assess lung sounds - crackles or rales.
CIRCULATION
Evaluate distal pulse rate, quality (strength),
and rhythm, temperature,
Look for any external bleeding

16. NURSING ASSESSMENT AND
INVESTIGATIONS
History - Previous associated problems ( HT,DM)
Detailed Physical examination
ECG and Echocardiography
X-ray and Cardiac enzymes
Arterial Blood Gases (ABG)
Ventilation Perfusion Lung Scan (VQ scan)
CT , Pulmonary Angiography

17. Medical And Nursing management
Maintain an open airway, remove secretions,
vomitus
Initiate CPR with supplemental high
concentration of oxygen.
Place the patient in a position of comfort
Open IV access , Connect to ECG, Pulse oxymetry
Defibrillation if needed.
Mechanical Ventilator- Assisted ventilation or
CPAP is often helpful

18. Medical And Nursing management
Monitor vital signs.
Fluid restriction if needed
Maintenance of intake and output chart.
Foot end elevation in Hypotension.
Do not give NTG if the BP is low. Administer
NTG if BP is high
Administer Emergency Cardiac drugs –
Inotropes, Diuretics, Cardiac glycosides,
Narcotics, Atropine, Adrenaline etc

19. Respiratory emergencies
Pneumothorax
Airway obstruction
Status asthmaticus
Acute pulmonary edema
Respiratory distress

20. Nursing assessment
• Onset
• Provocation
• Quality
• Radiation
• Severity
• Time
•Initial Exam
•Body position , Skin signs and color, Respiratory
rate and effort, Mental status , Pulse (rate &
character)
Focused Exam (S)
Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call

21. Diagnostic tests
Physical examination
Pulse oxymetry
ABG
X-ray
PFT
CT/MRI

22. Tension
Pneumo
thorax
 Needle decompression
 Place Flutter valve
 Prepare for chest tube
insertion.
 Surgical management –
Thoracotomy

23. Open
Pnuemo-
thorax
 Observe for the development of tension
pneumothorax
 Cover the wound with an 3 sided occlusive
dressing
 Asherman
Chest seal

24. Airway
obstruction
 Simultaneous protection of the C-spine .
 ETT or Nasotracheal tube intubation
 Tracheostomy and Cricothyrotomy
 Epinephrine administration
 Cardiopulmonary resuscitation (CPR)
Status
Asthmatics
• Correct Hypovolemia and mechanical
ventillation
• Administer Short acting Inhaled B2 agonists
• Nebulisation with anti cholinergics
• IV corticosteroids
• Oxygen therapy

25. Neurologic emergencies
Stroke
Altered Consciousness and Coma
Status epilepticus
Haemorrhage
Spinal shock

26. Nursing Assessment and Diagnostic
Aids
History and Physical examination
Four domains to examine:
Pupillary responses
Extraoccular movements
Respiratory pattern
Motor responses
Glasgow coma scale (GCS)
Emergency CT scan with Contrast, EEG

27. Medical and nursing management
ABCs - insure adequate oxygenation and blood
pressure before proceeding
Blood glucose to be maintained normal.
 Airway control and prevention of hypercapnea
are crucial - ventillator
When intubating patients with elevated ICP use
thiopental, etomidate, or intravenous lidocaine.

28. Medical and nursing management
ICP monitoring
Avoid jugular vein compression , Head
should be in neutral position , Cervical collars should
not be too tight
Pharmacologic options
 Mannitol 0.25 gm/kg q4h
 Hypertonic saline, , Steroids.
 Lorazepam (Ativan) IV 0.1 mg/kg
 Propofol , Phenobarbital IV 20 mg/kg ,
 Valproate IV 20 - 30 mg/kg

29. Medical and nursing management
Immediate IV access to be established
Check metabolic panel, drug screen
 Follow aseptic techniques.
CVP, ETT, Surgical Drains
Fluid and electrolyte management.

30. Trauma
Head injury.
Chest lnjury
Abdominal injury
Vascular injury

31. Primary Survey
Secondary Survey
Assessment
ABCDEs of trauma care
A - Airway
B - Breathing
C - Circulation
D - Disability
E – Exposure
AMPLE history
Physical exam
Reassessment of
vitals
Diagnostic studies

32. Nursing- Assessment
Breathing
Unlaboured No breathingLaboured
Beware
Chest injury
Pneumothorax
Contusion
Flial chest
Head injury
Spinal injury

33. Investigations
Standard trauma labs
ABG , CBC, Electrolytes
PTT, Blood Glucose
 CT/ MRI
Chest radiographs
ECG and ECHO
FAST scans
TEE
Aortography

34. Medical and nursing management
Assess ABC, Vitals.
Provide cervical collar.
CPR
Clear the airway, Administer High flow oxygen
Assess for internal bleeding. Control External
bleeding
Keep the client in NPO.
Position the client . Avoid unnecssary movement.
Open IV access .Administer Fluids

35. Poisoning
Any substance that can cause injury, illness or
death when introduced into the body.
Inhaled poison
Ingested poison
Absorbed poison
• Injection

36. The signals of poisoning include
• Trouble breathing.
• Nausea or vomiting.
Chest or abdominal
pain
Changes in
consciousness.
Seizures.
Headache.
Dizziness.
Irregular pupil size.
Burning or tearing
eyes.
Sweating.
Abnormal skin color.

37. Assessment
Assessment, including evaluation of airway,
breathing, and circulation (the ABCs).
History and Physical examination
Obtain laboratory tests- Toxin level
ECG
Imaging studies ( X-ray)

38. Nursing care of the poisoned
patient
Stabilize the ABCs.
Use the coma cocktail —DONT (dextrose,
oxygen, naloxone, and thiamine)
Perform gastric decontamination, if indicated.
Consider enhanced elimination techniques.
Use an antidote, if indicated, and/or deliver
specific care or symptomatic/supportive care.

39. Nursing management – NANDA
Diagnosis
Acute pain
Decreased cardiac output
Inability to sustain spontaneous ventilation
Ineffective breathing pattern
Impaired gas exchange
Impaired tissue perfusion
Deficient Fluid volume