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Welcome to Emergency Care and Disaster Planning. The emergency room is a fast-paced and often chaotic environment where rapid changes are very common. The nurses that work in the IDI are typically drawn to that kind of environment and usually dislike routines on a regular basis.
One of the most important aspects of IDI nursing includes the recognition of life-threatening illnesses or injury before a diagnosis can be made. Recognition of dangerous clinical signs and symptoms with the initiation of interventions to reverse or prevent a crisis is essential. The IDI nurse is usually confronted with multiple patients who have a variety of problems. Prompt identification of these patients who require immediate treatment and determination of the appropriate treatment is essential for a busy emergency room.
Special populations that are found in the ER are clients who often lack health care and use the emergency room as their primary care provider. These include the underinsured or non-insured clients. Health care reform and health care costs and the complexity of the overall health care system creates a difficult system for the clients to navigate. That is why they tend to use the IDI as their primary care provider.
You will also find special nursing teams in the emergency area. Forensic nurse examiners are responsible for collecting evidence from victims of crime as well as testifying in court as expert witnesses. They are there to not only examine but also support and help victims of violence or sexual abuse. They can work with adults or children and are usually trained specifically for whichever group they focus on helping. They have advanced knowledge of evidence collection, preservation, and documentation, all of which are extremely important for the prosecution if it goes to trial. They understand the legal proceedings that will follow and what is necessary to effectively prosecute the perpetrators. They are also trained in sensitivity. Previously, victims of any violent crime were most likely in an ER or examined by a medical professional who was not trained in sensitivity or in collecting evidence. This results in not only a higher likelihood of the perpetrator walking free but can also leave the victim feeling further victimized, vulnerable, and can make victims less likely to seek help when they need it.
The psychiatric crisis team. More people are using emergency rooms and crisis units for help with pressing emotional problems. Part of this is due to the shift in psychiatric care from large state hospitals to the community-based treatment programs. Fewer patients are kept in psychiatric hospitals now for any length of time, and these people are treated rapidly and discharged to community facilities for follow-up care. During periods of increased stress that leads to decompensation, these patients may turn to the emergency room for medication, rehospitalization, or other resources, including food and shelter. Suicide attempts and threatened suicide are among the most common psychiatric emergencies seen in nursing situations. Stressors connected with illness that may lead to depression and suicide include the threat of surgery with an unknown outcome, death of a loved one, the agony of chronic pain with little relief, the prospect of chronic illness and incapacitation, and disfigurement from a radical burn or operation.
In addition to treating acutely suicidal patients, professionals also treat patients who show chronic patterns of self-destructive behavior. A professional who is responsible for the care of a patient in a psychiatric emergency emphasizes and attempts to understand how the patient feels at the time of the crisis. Professionals must be aware that an individual in a crisis is highly anxious. The patient also feels many other highly charged emotions along with the anxiety. A primary feeling of the lack of trust for those around them is typical of the patient in a psychiatric emergency. Feelings of fear, doom, lack of hope, anger, hostility, loss of control, disorganization, and decreased perceptual ability are common symptoms in a psychiatric crisis.
During a psychiatric emergency, a patient usually experiences physiological changes as well. These changes may include altered appetite, thirst, sweating, dehydration, and an increase or decrease in blood pressure, pulse, respirations, and temperature. Changes in all the above can lead to electrolyte imbalances, leaving the patient exhausted and susceptible to other medical problems. Accurate and comprehensive diagnosis and assessment are necessary before intervention and appropriate treatment can be given to these patients in crisis.
Examples of some of the interdisciplinary team members include the EMS, the IDI nurses, physicians, case managers, respiratory therapy, clergy, dietician, etc. Examples of the interdisciplinary team members include the EMF, EB nurses, physicians, case managers, respiratory therapy, clergy, dietitians, and others.
The EMTs are part of the pre-hospital care providers, and they respond to emergency calls. They perform certain medical procedures and transport patients to hunt to the hospital in accordance with protocols and guidelines established by physician medical directors. They may work in an ambulance service. They could be paid or voluntary. They could work as a member of technical rescue teams or squad or as a part of an allied service such as a fire or police department. EMTs, emergency medical technicians, are trained to assess a patient's condition and to perform such emergency medical procedures as are needed to maintain a patent airway with adequate breathing and cardiovascular circulation until the patient can be transferred to an appropriate destination for advanced medical care. Interventions include cardiopulmonary resuscitation, defibrillation, controlling severe external bleeding, preventing shock, body and mobilization to prevent spinal damage, and splinting of bone fractures.
The EMT Basic is the entry level of EMS. The procedures and skills allowed at this level are generally non-invasive, such as bleeding control, positive pressure ventilation, which is PPV with a bag valve mask, oropharyngeal airway, nasopharyngeal airway, supplemental oxygen administration, and splinting, including a full spinal immobilization. Splinting a femur fracture may involve used traction splint, which will reduce the fracture. Some medications, for example, epi for anaphylactic shock or a severe allergic reaction, is administered through an auto-injection device such as an EpiPen and can only be administered or assisted to a patient with a prior prescription. Training requirements and treatment protocols vary from area to area.
EMT intermediate are the levels of training between the basic EMT-B and the paramedic EMT-P and is a level of training that will typically allow several more invasive procedures than are allowed at the basic level, and that could include IV therapy, the use of multi-lumen airway devices, and possibly even endotracheal intubation in some states and provides for enhancement or enhanced assessment skills such as cardiac monitoring and the administration of additional pharmaceutical intervention.
The EMT paramedics, who are commonly referred to as usually just paramedics, represents the highest level of the EMT and in general the highest level of pre-hospital medical provider, though some areas utilize physicians as providers on air ambulances or as a ground provider. Paramedics perform a variety of medical procedures such as fluid resuscitation, pharmaceutical administration, obtaining IV access, cardiac monitoring, and by that I mean continuous and twelve-lead and sometimes 18-lead, and other advanced procedures and assessment.
The emergency physician is a specialist in advanced cardiac life support, macare such as fractures and soft tissue injuries, and management of other life-threatening situations. The IDI physician is specially trained to practice in the emergency department. The IDI physician typically manages the treatment and the overall care of the patients in the EB.
Support staff and inpatient unit staff are also important care providers associated with the EB. Support staff and ancillary staff includes radiology, lab, social workers, respiratory therapists; they're all part of this support staff in the ER. These professionals work in conjunction with the IDI nurse to obtain specimens, order necessary tests, provide direct assistance with patient care, such as vent support, and also assist in the discharge planning process of clients when they're discharged from the IDI. The inpatient staff units work in conjunction with the IDI to appropriately admit clients to the acute care setting. Effective communication is very important during this transition of care. Report should include a description of the situation, a history, assessment, diagnostic and lab findings, interventions completed, and the response experienced due to those interventions.
Standard precautions are guidelines recommended by the CDC, which is the Centers for Disease Control and Prevention, and standard precautions are for reducing the risk of transmission of blood-borne and other pathogens in the hospitals. The standard precautions synthesized the major features of universal precautions and BSI, which is body substance isolation. Universal precautions were designed to reduce the risk of transmission of blood-borne pathogens, and BSI, or body substance isolation, was designed to reduce the risk of pathogens from moist body substances. The unit B standard precautions synthesizes both the universal precautions and body substance isolation and applies them to all patients receiving care in the hospital, regardless of their diagnosis or their presumed infection status.
Standard precautions include a group of infection prevention practices that apply to all patients, regardless if they've been confirmed with an infection or just suspected of an infection, in any setting where healthcare is delivered. These include hand hygiene, use of gloves, gowns, masks, eye protection or face shield, depending on the anticipated exposure, and safe injection practices. Standard precautions apply to blood, all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood, non-intact skin, and mucous membranes. The precautions are designed to reduce the risk of transmission of microorganisms from both the recognized and the unrecognized sources of infection in hospitals.
Universal precautions were the infection control techniques that were recommended following the AIDS outbreak in the 1980s. Universal precautions are defined as work practices that help prevent contact with blood and a number of other body fluids visibly contaminated with blood. These precautions take the guesswork out of self-protection by extending the practices to all people and all blood-borne pathogens. Universal precautions are precautions designed in preventing the transmission of blood-borne diseases such as HIV, which is human immunodeficiency virus, hepatitis B, and other blood-borne pathogens. When first aid or healthcare is provided for the patient's blood and certain body fluids of all patients are considered potentially infectious. The precautions include specific recommendations for the use of gloves, gowns, masks, and protective eyewear when contact with blood or body secretions containing blood is anticipated.
Although the objective is the same, standard precautions widen the spectrum of potentially dangerous body substances. They combine the major components of universal precautions and BSI, which reduces the chances of transmitting those pathogens from moist body substances. The probably biggest difference between universal precautions and standard precautions lies in the addition of body fluids regardless of visible blood. Standard precautions include work practices to avoid contamination by blood, body fluids, secretions, excretions with the exception of sweat, non-intact skin, mucous membranes, dried blood, and other body substances, including saliva.
All emergency medicine personnel need to be aware of the signs and symptoms of potential violence. Any patient can become violent, but patients with organic disorders such as dementia, delirium, and chemical intoxication have a high incidence of violence, as do functional disorders such as mania and schizophrenia. The following includes some of the early warning signs of violence, such as if a patient exhibits or threatens violence; if a patient makes the IDI staff anxious or fearful; if their behavior alternates between shouting and dozing and between cooperation and belligerent, somewhere back and forth along that continuum; if the patient expresses fear of losing control; if the patient is uncooperative, hostile, agitated, and unable to sit still, showing anxiety; if the patient is intoxicated with alcohol or other chemicals or withdrawing from drugs; if the patient has a past history of violence or if they are a frequent flyer, which means they come in frequently to the ER; if they're known to police or the IDI staff for violence or impulsive behavior; if the patient has tensed, rigid posture, is easily startled, and just looks suspicious; if the patient has suggested some type of a relationship to a violent organization or gang. Any of these warning signs should be taken seriously, and when recognized, they should be discussed among the staff in order to protect the patient and the staff from harm.
The method of talking a patient down includes avoiding eye contact with the patient, not allowing anybody to block the exit from the room. You want to leave the door to the room open and always put yourself between the open door and the patient so you can make an exit if quickly if you need to. You want to maintain distance from the potentially violent patient. Do not invade the patient's space or what they perceive as their personal space. You want to adopt a passive, non-confrontational posture and attitude and allow the patient to ventilate their feelings. You want to develop a therapeutic alliance with the patient and treat the patient as you expect him to behave. Offer them food or drink. Do not make challenging, provocative, or belligerent remarks. And if the patient acts out, tell the patient directly, "Your behavior is frightening others, and we cannot allow such behavior." Do not turn your back on a potentially violent patient, and never, never underestimate the potential for violence.