Introduction to Emergency Nursing Concepts Final

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b Introduction to trauma care By Mrs. Pascaline David Martis Associate Professor, V.S.P.M’S College Of Nursing, And RC , Nagpur .

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Terminology :

Terminology Trauma A serious injury or shock to the body, as from violence or an accident. Trauma An injury [ as a wound] to living tissue, caused by an extrinsic agent.

Cont…:

Cont … Emergency An emergency is, any sudden illness or injury, that is, perceived to be a crisis , threatening to physical or psychological wellbeing of a person or group. Triage Triage is used to sort patients, into groups, based on the severity, of their health problems, and the immediacy, with which, theses problems must be treated.

Epidemiology:

Epidemiology Injury is a leading cause of death and disability and, thus, a major health care problem for society. Leading cause of death in the first 4 decades. 150,000 deaths annually in the US. Permanent disability 3 times the mortality rate.

Cont…:

Cont … India is experiencing an increasing trend in injuries, particularly due to, road traffic accidents, at an alarming annual rate of 3 per cent. The World Report on Road Traffic Injury Prevention, indicates that, by 2020, road traffic injuries, will be a major killer accounting for, half a million deaths and 15 million disability .

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Blunt Penetrating MVA Sports Falls Crush injuries Gunshot Stabbing

Trimodal Distribution of Death:

Trimodal Distribution of Death First peak- seconds to minutes from time of injury to death— severe injuries: lacerations of the brain, brainstem, high spinal cord, heart, aorta, large blood vessels. Second peak- minutes to several hours: subdural, epidurdal hematomas, hemopneumothorax, ruptured spleen, lacerated liver, pelvic fractures, other injuries associated with major blood loss.

Cont…:

Cont … Third peak-occurs several days to weeks after the initial injury: most often the result of sepsis and multiple organ failure. At this stage, outcomes are affected by care previously provided.

Need of the injured patient:

Need of the injured patient Life threatening injuries are appropriately treated, promptly and in accordance with appropriate priorities , to maximize the likelihood of survival.

Cont…:

Cont … Potentially disabling injuries are treated appropriately, so as to minimize functional impairment and maximize the return to independence . Pain and psychological suffering are minimized.

Trauma care:

Trauma care Trauma care provided by the health sector includes, all activities, from the time of occurrence of injury , till the injured returns to optimum functioning and is a continuum of activities.

Historical perspective of trauma care:

Historical perspective of trauma care Beginning of the 1960’s , a major effort, by surgeons, scientist, government agencies and professional and charitable organizations, has sought to define, the need for a trauma network, of highly skilled hospital centers, manned by specialists, knowledgeable to trauma care.

Cont…:

Cont … Studies have documented the, improved patient outcome, associated with a system approach to trauma care, using the basic categorization design promulgated by the American trauma society has resulted in, effort to improve both pre hospital care and the care of trauma victim receives within the first hour after admission to the emergency department.

Cont…:

Cont … Increased medical societal and legal pressures, have demanded that, those institutions that, purport to deliver emergency care, in fact are staffed and equipped to do so .

Cont…:

Cont … Private hospitals also emphasizes on, special care, to be given to trauma patients, within the first few hours, by providing mobile ambulance services and sign boards are put up in the prime areas of the cities.

Cont…:

Cont … In India [1996] ---the number of annual deaths from injuries -- range from 130,000 to 650,000. About 15 percent of all hospital beds, are occupied by injury victims. Over 10,000 deaths and one million disabling injuries annually, are attributed to burns in India.

Cont…:

Cont … In 1992 , the government of India reported more than 57,000 deaths from traffic injuries in the country. At least 8 persons are injured [ or] [will be] every minute ratio of injured to dead is 6:1. 2000 onwards, the Indian government focused ,on trauma care, as a special unit in all the government hospitals.

Cont…:

Cont … In most advanced countries, treatment of general and orthopedic trauma situations, follows definite principles and protocols, which are well established. The aim of trauma care is to, incorporate advantages offered by, new technologies in the farmework of which, was successful in the past and to develop a winning system for tomorrow.

Concept of trauma care:

Concept of trauma care Treat the greatest threat to life first. The lack of a definitive diagnosis, should never impede, the application of an indicated treatment. A detailed history is not essential, to begin the evaluation.

Cont…:

Cont … ABCDE approach Airway and spine protection. Breathing and ventilation. Circulation with hemorrhage control. Disability/ neurological status. Exposure/ environmental control

Goals of good trauma care:

Goals of good trauma care To prevent deaths among those surviving the initial impact. Reduce complications and disabilities among those hospitalized . Return the injured to their optimum levels of functioning after an injury .

Principles :

Principles Obtain a correct and detailed history of the incident either from the patient or anyone who witnessed the situation. The affected person may be examined thoroughly, taking a note of every complaint and symptoms. Only then diagnosis should be made.

Cont…:

Cont … With the help of diagnosis treat the casualty until he/she is transferred to his /her needed care centre. It is better to shift the client as soon as possible, to his/her needed care centre, ward or emergency room, until then emergency care should be continued.

Systems Approach to Trauma:

Systems Approach to Trauma An organized approach to trauma care that includes. Prevention, access, acute hospital care, rehabilitation, and research.

Elements of Effective Trauma Care System:

Elements of Effective Trauma Care System Pre hospital care Call & control centre Ambulances Trained staff Sensitized & trained public Hospita l Equipment Evidence - based guidelines Triage Trained staff Referral System Transport Guidelines Training Specialised diagnosis Specialist care Rehabilitaion System Appropriate appliances Occupational therapy Physiotherapy Work & Home support Outcomes

Emergency nursing:

Emergency nursing

Emergency Nursing:

Emergency Nursing The assessment , diagnosis, and treatment of perceived, actual or potential, sudden or urgent, physical or psychological problems, that are primarily episodic or acute, these may require minimal care or life support measures, education of client and significant other, appreciate referral and knowledge of legal implications. Emergency nursing association.

Roles and responsibilities of emergency nurse:

Roles and responsibilities of emergency nurse Collaborator :- A nurse collaborator, collaborates between physicians and nurses in the care of emergency patients. Their education and experience should enable them to triage, prioritize, stabilize, resuscitate and apply principles of the nursing process while attending to patients of all ages and underlying conditions.

Cont…:

Cont … Co-coordinator :- One of the important roles of emergency nurses to coordinate the services of physicians, nurses, support service staff and other ancillary staff in order to deliver timely efficient and high quality emergency care.

Cont…:

Cont … Educator:- An emergency nurses as educator, mentors staff nurses, particularly in planning and implementation of the educational program in emergency nursing , contribution to professional literature, develops client teaching, prepares patients for discharge and plans follow up materials.

Cont…:

Cont … Consultant :- An emergency nurses, as consultant, leases between clients, other members of the emergency care team, health professionals, organizations and other concerned authorities with respect to complex clinical situations and issues relating to emergency care.

Cont…:

Cont … Researcher:- An emergency nurses as a researcher assists, directs or conducts clinical research in the emergency care setting and disseminates current research findings, this is in order to bring the necessary changes with a view to improving clinical emergency nursing practice.

Cont…:

Cont … Administrator:- An emergency nurses as an administrator should supervise subordinate staff and demonstrate a leadership role in developing and reviewing the policies and procedures of the emergency nursing services in the department or institution and bring any necessary changes to improves and maintain the standard of nursing practice in the emergency department.

Cont…:

Cont … Quality assurance:- An emergency nurses as a quality assurer maintains the standards of patient care set by the department or institution.

Cont…:

Cont … Communicator :- The emergency nurse should always keep herself well informed regarding information unique to the department . She should promote and maintain effective communication between management and staff and the patients relatives which is the fundamental basis for the successful management of an emergency department.

Conclusion:

Conclusion Timely referral to trauma centers, equipped with proper facilities to deal with serious injuries, results in reduction of mortality among victims.

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