Principles of Emergency Care: Assessment and Intervention

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Emergency-CareFor the critically ill/injured patient classified as resuscitation, emergent and urgent in the triage category, prompt transfer, stabilization, and provision of critical treatment modalities are the main priorities of emergency care management.  Although treatment is initially started in the emergency department, the ongoing and more definitive care and treatment of the identified underlying problem is usually provided in specialized settings such as the operating room and intensive care unit. Generally, the main objective of emergency personnel assigned in a hospital’s ED is stabilizing the patient’s vital signs and quickly transfer to a specialized area for further management.

A systematic approach to efficiently establish and manage health priorities in individuals seeking emergency care is using the primary assessment and secondary survey approach. The primary survey concentrates on stabilizing life-threatening conditions first before anything else. Normally, ED personnel and staff follow the ABCD (airway, breathing, circulation, disability) method of effectively evaluating a patient’s status upon entry in the ED.

The process is normally done by:

  1. Establishing an open and patent airway.
  2. Providing adequate ventilation, utilizing basic and advance resuscitation methods when necessary. Trauma patients must have the cervical spine protected and stabilized and chest injuries evaluated first before the other systems.
  3. Assess and maintain sufficient cardiac output by controlling active bleeding, preventing and treating shock, and restoring and maintaining adequate circulation. This also curtails prevention and management of hypothermia.
  4. Determine and assess any suspected neurologic disability by examining neurologic function (routine tests include Glasgow coma scale).

Following the above mentioned priorities having been addressed, the emergency medical team proceeds with the secondary assessment which includes the following:

  1. A complete health history including a head-to-toe assessment.
  2. Laboratory and diagnostic examinations.
  3. Application of monitoring instruments such as ECG (electrocardiogram) electrodes, urinary catheters and IV lines.
  4. Splinting and stabilizing suspected fractures.
  5. Wound care and suturing of deep open wounds.
  6. Performing other pertinent interventions based on the patient’s immediate needs.

Once the patient has been given a complete initial admitting diagnostic work-up is established and initial essential treatment is initiated, the specific member of the health team, nurses are usually tasked to provide provisional care to the patient as well as to his/her significant others aside from the existing health problem. One of the most important roles ED nurses are tasked with the care for critically ill individuals is an effective pain management as well as emotional support. Effective pain management must be started early and should include rapid-acting medications that result in minimal sedation in order for the individual who is cared for to maintain consciousness for continued interaction and assessment members of the health care team.

Ideally, emergency care should not only be patient centered but should also focus in holistically safeguarding the safety and security of the patient’s significant others and other members of the emergency department. Family crisis intervention is currently being employed and practiced by EDs of various health institutions. Even if the individual’s condition is not emergent, the patient’s significant others might perceive it as such. Therefore every family needs attention and support since a visit to the ED is a powerful stressor one experiences in his/her lifetime.

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