1. Welcome to the ER

2. Meet Your Team: Trauma Surgeon ER Physician Flight Crew EMS Crew ER Nurses ER Technicians Radiology Techs Phlebotomists Medical Secretary

3. Three ways of entrance… Flight Ambulance Walk-In

4. 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)

5. 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

6. 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.

7. 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.

8. 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?

9. 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

10. Important Lab Values: Complete Blood Count (CBC): Includes: WBC, RBC, Hemoglobin (Hgb), Hematocrit (Hct) and Platelets Purpose: 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.

11. Important Lab Values: Chemistry Panel: Includes: Glucose, Calcium, Sodium, Potassium, Chloride, CO 2, 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.

12. TESTS/PROCEDURES… EKG X-Ray CAT Scan MRI Chest Tube Central Line Arterial Line

13. Common Equipment Used… Defibrillator Laryngoscope Ventilator Rapid Infuser IV pump Backboard C-collar IV Kits Pyxis or Omnicell for drugs Splints Casting Materials Obstetrics

14. 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)

15. TRAUMATRAUMA Diagnosis: MVA Gun Shot Wound High Level Fall Violence Equipment: Let’s discuss Procedures: Let’s discuss

16. Fast Track (minor injuries): Small Lacerations Sprains Minor Fractures Minor Pain Tooth Aches Can you think of any more???

17. A look at real trauma!

18. Decision Time Admit to hospital Transfer to a more appropriate facility Discharge back to where the patient came from

19. What do you think are some potential problems or concerns of the Emergency Department?