Welcome to the ERWelcome to the ER

Meet Your Team:

•Trauma Surgeon

•ER Physician

•Flight Crew

•EMS Crew

•ER Nurses

•ER Technicians

•Radiology Techs

•Phlebotomists

•Medical Secretary

Three ways of entrance…

•Flight

•Ambulance

•Walk-In

TRIAGE…

The most common method of triage is a numeric classification system in which a number is given

based on the services needed. Examples of services include IV’s, labs, x-rays, scans, small

procedures, etc.

Class 1 (most severe) TO

Class 5 (least severe, least services)

Class 5: Will need no services

Class 4: Will possibly need 1 service

Class 3: Will most likely need 2 or more services

Class 2: Will need services quickly

Class 1: Will need services immediately

Let’s Practice…• A patient arrives at triage complaining of a minor toothache. He denies any fever. His vital signs are stable and has no previous medical conditions.

•A patient arrives at triage complaining of burning and frequency when she urinates. She states she has had a low grade fever. Her vital signs are stable. Her only past medical history is hypertension.

•A patient arrives at triage complaining of nausea and vomiting for 2 days. His blood pressure is elevated at 170/95 with no previous history of hypertension. His only past medical history is an ACL repair 2 years ago.

• A patient arrives at triage with a family member. The family member explains that the patient will not eat or drink and has very little urine output. The patient is pale with tenting skin turgor. The patient’s mucous membranes are dry. The vital signs show an increased heart rate. The patient is 8 months old that was born prematurely.

• A patient arrives at triage with a family member. The family member explains that they were eating breakfast 45 minutes ago and she became very confused. She lost use of her right arm and had difficulty walking. Her vital signs show increased heart rate and blood pressure. Her history is that 1 year ago she had a heart attack.

Now it’s your turn… Find a partner, Review the Case Studies, and Decide what Triage

Category the patient falls into.

If you only have one open bed, who do you take to the back first?

SECONDARY NURSING ASSESSMENT

• Research the issues further• Prepare the patient for treatment• Get equipment that will be needed, if possible• Start treatment protocols• Educate the Patient (especially of wait times) • Notify the proper personnel

Beyond the

curtain

Important Lab Values:

Complete Blood Count (CBC):

Includes: WBC, RBC, Hemoglobin (Hgb), Hematocrit (Hct) and PlateletsPurpose:•to identify an infection •to diagnose anemia •to identify acute and chronic illness, bleeding tendencies, and white blood cell disorders such as leukemia

Coagulation Panel:

Includes: PT, PTT, INR

Purpose:

These identify coagulation defects, based on time required for blood to clot.

Important Lab Values:

Chemistry Panel:

Includes: Glucose, Calcium, Sodium, Potassium, Chloride, CO2, BUN & Creatinine, ALT/AST, Total Protein

Purpose:

Gives you important information about the current status of your kidneys, liver, electrolyte, and acid/base balance as well as of your blood sugar and blood proteins.

TESTS/PROCEDURES…

• EKG• X-Ray• CAT Scan• MRI• Chest Tube• Central Line• Arterial Line

Common Equipment Used…

• Defibrillator• Laryngoscope• Ventilator• Rapid Infuser• IV pump• Backboard• C-collar• IV Kits• Pyxis or Omnicell for drugs• Splints• Casting Materials• Obstetrics

COMMON DIAGNOSIS:

• Heart Attack (MI)• Stroke (CVA)• Seizure• Headaches (HA)• Ground Level Fall• Nausea/vomiting (N & V)• Abdominal pain• Urinary Tract Infection (UTI)• Fever• Dehydration• Kidney Stones• Behavioral Health• Miscarriage (Ab)

TRAUMA

Diagnosis:• MVA• Gun Shot Wound• High Level Fall• Violence

Equipment:• Let’s discuss

Procedures:• Let’s discuss

Fast Track (minor injuries):

• Small Lacerations

• Sprains

• Minor Fractures

• Minor Pain

• Tooth Aches

Can you think of any more???

A look at real trauma!

Decision Time

•Admit to hospital•Transfer to a more appropriate facility•Discharge back to where the patient came from

What do you think are some potential problems or concerns of the

Emergency Department?