Med-Surg · chapter 33 · Emergency Care
Types of Emergency Care
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
ED handoff preparation
Before arriving at the hospital, emergency medical services (EMS) call ahead to inform the ED staff about the patient’s initial condition and any life-threatening injuries. The ED nurse then works with the health-care team to anticipate the patient’s needs by setting up any equipment, gathering supplies, and preparing the patient’s room.
Transfer for specialty care
After the patient is stabilized, the nurse performs a secondary, more comprehensive assessment. If additional diagnostic testing is indicated, it is performed at this stage as well.
Crush injury circulation assessment
Upon initial assessment, the nurse should assess the patient’s skin color, especially the area distal to where the crush injury occurred. The nurse should observe the skin for signs of cyanosis and palpate pulses distal to the area of injury.
Neurovascular deterioration response
Nurses should perform neurovascular checks frequently on patients with crush injuries. If there are any notable deviations, this may indicate a worsening of the patient’s condition.
Rhabdomyolysis warning signs
Nurses will assess for early symptoms of this condition, which include pain, muscle weakness, and tea- or dark red–colored urine (myoglobinuria). The hallmark sign of rhabdomyolysis is significantly elevated CPK levels in the blood.
Compartment syndrome consequences
Pressure increases within the muscle compartments to the point that circulation and oxygenation are restricted, and this results in muscle anoxia and necrosis. Permanent functions could be lost if this condition persists for longer than six hours (Torlincasi et al., 2023).
Crush injury urgent care
It is vital that the nurse recognizes that rapid fluid resuscitation is key to improved outcomes. Recognizing cues for decline in status, prioritizing care, and taking swift action are the keys to providing competent, quality patient care.
Poisoning routes and forms
Poisoning can occur through inhalation, ingestion, or absorption through the skin. It can happen through any form of a substance, whether a solid, liquid, or gas.
Poison Control notification
Toxicology screening and urine samples may also be ordered to identify the substance. When a patient enters the emergency department with suspected or confirmed poisoning, the nurse is obligated to notify Poison Control (Mukherji et al., 2023).
Poisoning reversal agents
For opioid overdoses, naloxone is administered, and for benzodiazepines, flumazenil. N-acetylcysteine (NAC) is another common reversal agent, and it is used for salicylate or acetaminophen poisoning (Chacko Peter, 2019).
Poisoning assessment priorities
Nurses use the ABCDE triage assessment for assessing patients with potential or confirmed poisoning. Depending on the severity of the poisoning and the status of the patient, mechanical ventilation, supplemental oxygen, and/or medical sedation may be necessary.
Mandatory abuse reporting
Nurses are legal mandatory reporters of abuse (Einboden et al., 2019). Every practicing nurse should follow their state and federal guidelines on reporting abuse.
Child abuse suspicion cues
Abuse should be suspected when there are unexplained injuries or injuries that do not match the described situation. For example, a spiral fracture of a child’s wrist may indicate they were forcefully grabbed.
Psychiatric emergency safety
First, the nurse must make safety a priority for themselves, the patient, and the other members of the health-care team. The nurse should remove any unnecessary items from the patient’s surroundings and have the patient change into a gown, if possible.
Terms to know
- crush injury
- A crush injury occurs from prolonged pressure to an area of the body.
- rhabdomyolysis
- One potential complication of crush injuries is rhabdomyolysis, the breakdown of skeletal muscle tissue that is often the result of sustained pressure or crushing of the muscles.
- poisoning
- In the emergency department, nurses are required to stay up to date on current poisoning protocols, as well as be responsible for understanding diagnostic testing related to poisoning, which refers to exposure to substances, drugs, or chemicals.
- maltreatment
- The term maltreatment refers to the poor quality of care an individual receives.
- abuse
- The term abuse means harming another person physically, sexually, or emotionally.
- neglect
- The term neglect means failing to supply a person with basic needs, such as food, shelter, or clothing.
- psychiatric emergency
- A psychiatric emergency occurs when a patient’s behavior is or can become harmful to themselves or others.
- psychiatric hold
- A psychiatric hold is when a patient is involuntarily admitted to a health-care facility under law.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 1400, a patient arrives in the emergency department with suspected poisoning. Toxicology results are pending. Before completing the initial nursing note, which communication action should the nurse take and document?
- Notify Poison Control that the patient has suspected poisoning.
- Include a request in the shift handoff for the next nurse to contact Poison Control.
- Defer contacting Poison Control until toxicology results identify the substance.
- Notify the health-care provider and contact Poison Control only if the patient's condition worsens.
Answer: Notify Poison Control that the patient has suspected poisoning.
The section requires Poison Control notification for suspected as well as confirmed poisoning, so pending results do not justify waiting. Waiting for deterioration or the next shift also delays the required notification; notifying the provider does not replace it.
At 0300, a nurse caring for a patient with a crush injury has assessed and documented distal skin color, pulses, and capillary refill. Which additional assessments should the nurse perform and document to complete the neurovascular check? Select all that apply.
- Assess the patient's ability to move the affected extremity, if possible.
- Review the patient's intake and output.
- Review the patient's latest CPK level.
- Assess what the patient feels when sensation is applied to the affected area.
- Check the patient's urine for tea or dark red coloration.
Answer: Assess the patient's ability to move the affected extremity, if possible., Assess what the patient feels when sensation is applied to the affected area.
The documented findings address circulation; movement and sensation are the remaining components of the neurovascular assessment. Urine color, CPK, and intake/output are relevant to monitoring a patient with a crush injury, but they do not complete the missing neurovascular components.
At 1800, an ED nurse identifies unexplained bruising on a child and suspects abuse. While preparing the encounter note, the nurse considers the next step. Which action should the nurse take and then document?
- Report the suspicion immediately through the appropriate state and health-care organization channels.
- Record the bruising and wait for the caregiver to explain it before deciding whether to report.
- Include the concern in the shift handoff and leave reporting to the receiving nurse.
- Request a provider assessment and defer reporting until abuse is confirmed.
Answer: Report the suspicion immediately through the appropriate state and health-care organization channels.
The section directs nurses to report suspicions of abuse immediately through the proper channels; confirmation is not required before reporting. Waiting for a caregiver's explanation or provider confirmation delays that step, and mentioning the concern in handoff does not substitute for reporting.
Where every quote comes from
Section 33.2 Types of Emergency Care of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.