Chapter 67: Emergency Nursing

A foundational principle is triage, the systematic process of sorting patients based on the severity and immediacy of their health concerns, utilizing validated systems like the Emergency Severity Index (ESI). The structured approach to life-saving interventions begins with the primary survey, which employs the mnemonic ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) to stabilize life-threatening conditions, immediately followed by the secondary survey, a comprehensive head-to-toe assessment and history collection. Essential primary interventions include establishing a patent airway, sometimes requiring maneuvers or devices like the King Tube or cricothyroidotomy; managing hemorrhage through direct pressure, tourniquets, and fluid resuscitation with isotonic solutions or blood products; and anticipating and treating hypovolemic shock. Specialized care is detailed for trauma victims, especially those with multiple trauma, who are monitored for the life-threatening "triad of death": hypothermia, acidosis, and coagulopathy. Nurses are responsible for careful forensic evidence collection, maintaining a formal chain of custody, especially in cases of suspected criminal activity. Environmental emergencies require distinct management strategies, such as aggressive, rapid cooling for heat stroke to reduce core temperature, compared to controlled, slow rewarming for hypothermia and frostbite. The chapter reviews nonfatal drowning management, which prioritizes correction of hypoxia and acidosis, often through ventilatory support, and covers decompression sickness requiring hyperbaric therapy. Management of poisoning varies greatly, from external decontamination of chemical burns and specific interventions for carbon monoxide poisoning (100% oxygen), to the treatment of bites, including pit viper envenomation using antivenin (FabAV), and prompt antibiotic intervention for tick-borne diseases like Lyme disease. Treatment for ingested corrosive poisons strictly avoids inducing vomiting. Cases involving Substance Use Disorder (SUD) and acute alcohol intoxication mandate routine screening (SBIRT) and managing complex issues like delirium tremens with benzodiazepines and supportive care. The chapter concludes by addressing violence, abuse, neglect, and sexual assault (including Intimate Partner Violence and Human Trafficking), emphasizing mandatory reporting for vulnerable patients. For psychiatric emergencies, the priority is determining safety risks, differentiating between violent/overactive and depressed/suicidal patients, and employing strategies like Critical Incident Stress Management (CISM) to support emergency personnel continuously exposed to high-stress events.