Page 604 - ACCCN's Critical Care Nursing

Emergency Presentations 22

David Johnson
Mark Wilson

additional common presentations to the Emergency
Learning objectives Department (ED): trauma and resuscitation emergencies,
respectively.
After reading this chapter, you should be able to: The chapter initially describes the organisational systems
l describe the uniqueness of the emergency care and processes of care in an ED environment, including
environment triage, extended practice nursing roles, multiple casualties/
l outline the development of Australasian triage models disaster management and transport/retrieval of critically
l discuss the process of initial patient assessment and triage ill patients. A select group of the most common emer-
nursing practice gency presentations and conditions related to critical care
l integrate emergency nursing principles and practice in practice are then described, particularly topics not dis-
initial patient care cussed in other chapters: acute abdominal pain, overdose
l describe the various roles of extended nursing practice in and poisoning, envenomation, near-drowning, hypother-
the emergency setting mia and heat illness. The initial clinical assessment and
l describe the principles and practice of patient preparation incidence of these common presentations is discussed,
for retrievals or transfers and the likely diagnoses associated with these presenta-
l discuss the principles for the management of disaster tions and their initial management in the ED are also
victims in the emergency department outlined. Ongoing management of these selected condi-
l discuss the initial nursing management of common tions are discussed in the relevant chapters in Section II
presentations to the ED, including chest pain, abdominal of this text.
pain, neurological, respiratory, poisoning, envenomation, Emergency nursing practice is the holistic care of indi-
submersion and heat illness. viduals of all ages who present with perceived or actual
physical and/or emotional alterations. These presenta-
tions are often undiagnosed and require a range of
prompt symptomatic and definitive interventions. Emer-
Key words gency clinical practice is usually unscheduled, episodic
and acute in its nature, and is therefore unlike any other
triage type of nursing in the demands it places on nursing
1,2
extended practice staff. In many instances the emergency nurse is the first
poisoning healthcare professional to be in contact with an acutely
ill or injured patient. Patient presentations include a full
retrieval range of acuity across the spectrum of possible illnesses,
disaster management injuries and ages.
envenomation
near-drowning BACKGROUND
heat illnesses
hypothermia Emergency nursing is unique, in that it involves the care
of patients with health problems that are often undiag-
nosed on presentation but are perceived as sufficiently
INTRODUCTION acute by the individual to warrant seeking emergency care
in the hospital setting. As patients present with signs and
Emergency nursing practice covers an enormous range of symptoms rather than medical diagnoses, refined assess-
clinical presentations. As the focus of this book is critical ment skills are paramount. Many skills required by
care, this chapter discusses conditions at the critical end emergency nurses are based on a broad foundation of
of the practice spectrum. Please read in conjunction with knowledge that serves as a guide in collecting informa-
Chapters 23 and 24, which describe the management of tion, making observations and evaluating data, and to 581