Emergency, Terrorism, and Disaster Nursing free essay sample

Ongoing patient monitoring and evaluation of interventions are critical, and the nurse is responsible for providing appropriate interventions and assessing the patient’s response. Depending on the patient’s injuries and/or illness, the patient may be transported for diagnostic tests or directly to the operating room; admitted to a general unit, telemetry, or intensive care unit; or transferred to another facility. * * Post-Cardiac Arrest Hypothermia * Patients with nontraumatic, out-of-hospital cardiac arrest benefit from a combination of good chest compressions, rapid defibrillation, therapeutic hypothermia, and supportive care postarrest. Therapeutic hypothermia involves the three phases: induction, maintenance, and rewarming. * * Death in the Emergency Department The emergency nurse should recognize the importance of certain hospital rituals in preparing the bereaved to grieve, such as collecting the belongings, arranging for an autopsy, viewing the body, and making mortuary arrangements. Many patients who die in the emergency department (ED) could be a candidate for non–heart beating donation; certain tissues and organs can be harvested from patients after death. GERONTOLOGIC CONSIDERATIONS: EMERGENCY CARE Elderly people are at high risk for injury, primarily from falls. The three most common causes of falls in the elderly are generalized weakness, environmental hazards, and orthostatic hypotension. When assessing a patient who has experienced a fall, it is important to determine whether the physical findings may have actually caused the fall or may be due to the fall itself. ENVIRONMENTAL EMERGENCIES HEAT-RELATED EMERGENCIES * Brief exposure to intense heat or prolonged exposure to less intense heat leads to heat stress. Effects can be mild (e. g. , heat rash) or severe (e. g. heatstroke). * Heat cramps are severe cramps in large muscle groups fatigued by heavy work. * Prolonged exposure to heat over hours or days leads to heat exhaustion, a clinical syndrome characterized by fatigue, nausea, vomiting, extreme thirst, hypotension, elevated body temperature, and feelings of anxiety. * * Heatstroke Heatstroke is a medical emergency resulting from failure of the hypothalamic thermoregula tory processes. Increased sweating, vasodilation, and increased respiratory rate deplete fluids and electrolytes, specifically sodium, and core temperature rises rapidly. Treatment focuses on stabilizing the patient’s ABCs and rapidly reducing the temperature through various cooling methods. * * COLD-RELATED EMERGENCIES * Frostbite * Frostbite is true tissue freezing, which results in the formation of ice crystals in the tissues and cells. * Superficial frostbite involves skin and subcutaneous tissue, usually the ears, nose, fingers, and toes. Deep frostbite involves muscle, bone, and tendon. * Rewarming is painful and requires analgesia. The patient is monitored for complications. * * Hypothermia Hypothermia is defined as a core temperature lt;95? F (35? C). * Patients with mild hypothermia (93. 2? F-96. 8? F [34? C-36? C]) have shivering, lethargy, confusion, rational to irrational behavior, and minor heart rate changes. * Moderate hypothermia (86? F-93. 2? F [30? C-34? C]) causes rigidity, bradycardia, slowed respiratory rate, blood pressure only by Doppler, metabolic and respiratory acidosis, and hypovolemia. Shivering diminishes or disappears at temperatures ? 86? F (30? C). * Severe hypothermia (lt;86? F [30? C]) is a severe and potentially life-threatening situation that makes the person appear dead. Profound bradycardia, ventricular fibrillation, or asystole may be present. Every effort is made to warm the patient to at least 86? F (30? C) before the person is pronounced dead. The cause of death is usually refractory ventricular fibrillation. Treatment of hypothermia focuses on managing and maintaining ABCs, rewarming the patient, correcting dehydration and acidosis, and treating cardiac dysrhythmias. * * SUBMERSION INJURIES Submersion injury results when a person becomes hypoxic because of submersion in a substance, usually water. Drowning is death from suffocation after submersion in water or other fluid. Near-drowning is defined as survival from potential drowning. Immersion syndrome occurs with immersion in cold water that leads to stimulation of the vagus nerve and potentially fatal dysrhythmias. * Treatment of submersion injuries focuses on correcting hypoxia, acid-base imbalances, and fluid imbalances; supporting basic physiologic functions; and rewarming when hypothermia is present. * Secondary drowning refers to pulmonary complications that can develop in patients who are free of symptoms immediately after the near-drowning episode. * STINGS AND BITES Animals, spiders, snakes, and insects cause injury and even death by biting or stinging. Morbidity is a result of either direct tissue damage or lethal toxins. Death associated with animal bites is usually due to blood loss, allergic reactions, or lethal toxins. Stings can cause mild discomfort or life-threatening anaphylaxis. Venom may be cytotoxic, hemolytic, allergenic, or vasoactive. The most significant problems associated with bites are infection and mechanical destruction of the skin, muscle, tendons, blood vessels, and bone. Initial treatment for animal and human bites includes cleaning with copious irrigation, debridement, tetanus prophylaxis, analgesics, and prophylactic antibiotics as needed. * * POISONINGS A poison is any chemical that harms the body. Poisoning can be accidental, occupational, recreational, or intentional. Severity of the poisoning depends on type, concentration, and route of exposure. Specific management of toxins involves decreasing absorption, enhancing elimination, and implementation of toxin-specific interventions per the local poison control center. Options for decreasing absorption of poisons include activated charcoal, dermal cleansing, eye irrigation, and, less frequently, gastric lavage. * Skin and ocular decontamination involves removal of toxins from skin and eyes using copious amounts of water or saline. Most toxins can be safely removed with water or saline. * Elimination of poisons is increased through administration of cathartics, whole-bowel irrigation, hemodialysis, urine alkalinization, chelating agents, and antidotes. VIOLENCE * Violence is the acting out of the emotions of fear or anger to cause harm to someone or something. Violence can take place in a variety of settings, including the home, community, and workplace. EDs have been identified as high-risk areas for workplace violence. * Family and intimate partner violence is a pattern of coercive behavior in a relationship that involves fear, humiliation, intimidation, neglect; and/or intentional physical, emotional, financial, or sexual injury. * Screening for family and intimate partner violence is required for any patient who is found or suspected to be a victim of abuse. Appropriate interventions should be initiated, including making referrals, providing emotional support, and informing victims about their options. * AGENTS OF TERRORISM * Terrorism involves overt actions such as the dispensing of nuclear, biologic, or chemical (NBC) agents as weapons for the expressed purpose of causing harm. * The biologic agents most likely to be used in a terrorist attack are anthrax, smallpox, botulism, plague, tularemia, and hemorrhagic fever. * Chemicals used as agents of terrorism are categorized according to their target organ or effect. These agents include sarin, phosgene, and mustard gas. * Radiologic dispersal devices (RRDs), also known as â€Å"dirty bombs,† consist of a mix of explosives and radioactive material. * Ionizing radiation (e. g. , nuclear bomb, damage to a nuclear reactor) represents a serious threat to the safety of the victims and the environment. * Explosive devices used as agents of terrorism result in one or more of the following types of injuries: blast, crush, or penetrating. * * EMERGENCY AND MASS CASUALTY INCIDENT PREPAREDNESS The term emergency usually refers to any extraordinary event that requires a rapid and skilled response and that can be managed by a community’s existing resources. An emergency is differentiated from a mass casualty incident (MCI) in that an MCI is a manmade (e. g. , involving NBC agents) or natural (e. g. , hurricane) event or disaster that overwhelms a community’s ability to respond with existing resources. When an emergency or MCI occurs, first responders (e. g. , police, emergency medical personnel) are dispatched to the scene. Triage of victims of an emergency or MCI differs from the usual triage that occurs in the ED and must be conducted in less than 15 seconds. * If there is known or suspected contamination, decontamination is performed at the scene and before transport to hospitals. * Many victims will arrive at hospitals on their own; the total number of victims a hospital can expect is estimated by doubling the number of victims that arrive in the first hour . All health care providers have a role in emergency and MCI preparedness. This involves knowledge of the hospital’s emergency response plan and participation in emergency/MCI preparedness drills on a regular basis. Many communities have initiated programs to develop community emergency response teams (CERTs). Citizens are taught what to expect following a disaster and how to safely help themselves, their family, and their neighbors. Many hospitals and disaster medical assistance teams have a critical incident stress management unit that arranges group discussions to allow participants to verbalize and validate their feelings and emotions about the experience to facilitate emotional recovery.