Overview
This lecture covers emergency and mass casualty nursing, with a focus on triage priorities, emergency interventions, and key concepts in managing specific urgent conditions.
Triage Nursing: Goals and Roles
- The main goal of triage is to prioritize care for the most critically ill or injured clients.
- Triage nurses perform rapid assessments to determine who needs immediate care.
- Thorough assessments and psychological support are not the primary role of triage nurses.
Emergency and Mass Casualty Triage
- Emergency triage prioritizes the sickest patients for fastest evaluation and treatment.
- Mass casualty triage aims for the greatest good for the greatest number, treating those most likely to survive first.
- Difference: Emergency triage = sickest first; mass casualty = most likely to live first.
Key Emergency Interventions
- Initial action for trauma: always assess airway first (Airway, Breathing, Circulation – ABCs).
- In heat exhaustion, after airway: remove the client from the heat and place in a cool area.
- For snake bites (North American pit viper): immobilize the affected limb below heart level, do not apply ice or suck venom.
- For black widow spider bites: apply ice to inhibit neurotoxin action.
Prioritizing in Specific Cases
- Three-tier triage: Emergent (life/limb threat), Urgent (needs quick attention, not immediately life-threatening), Non-Urgent (can wait hours).
- Example: Chest pain with unstable vitals is "emergent."
- Risk factors for hypothermia include alcohol/tobacco use, malnourishment, shock, cold exposure, and immersion in cold water.
Condition-Specific Notes
- Post-traumatic stress disorder (PTSD) can show physical (e.g., tachycardia, insomnia) and psychological symptoms.
- After lightning strike, expect elevated CK (muscle damage), elevated creatinine and BUN (kidney injury), and hyperkalemia.
- Least effective rewarming for hypothermia is using only warm blankets (surface rewarming); core rewarming is superior.
- Near-drowning in salt water: causes osmotic gradient that draws water into alveoli (hypertonic effect).
Key Terms & Definitions
- Triage — the process of prioritizing patients based on severity of condition.
- Emergent — needs immediate attention, life/limb threat.
- Urgent — should be seen quickly, but not immediate threat to life.
- Non-Urgent — can wait hours for evaluation or treatment.
- Mass casualty — incident involving large numbers where resources may be overwhelmed.
- PTSD — post-traumatic stress disorder; includes physical and psychological symptoms.
- CK (Creatine Kinase) — enzyme elevated with muscle damage.
- Hyperkalemia — elevated potassium in blood, often from cell/muscle breakdown.
Action Items / Next Steps
- Review triage classifications and ABCs.
- Study the differences between emergency and mass casualty triage logic.
- Memorize key risk factors for hypothermia and initial interventions in specific emergencies.