EMERGENCY NURSING

- “Fast”, “Quick”, “Rapid” PRINCIPLES OF TRIAGE

-time is of essence
TRIAGE-comes from the French word
EMERGENCY-any sudden illness or trier, which means “to sort”, a method
injury which is perceived by the to quickly evaluate and categorize the
significant others and/or patient as patients requiring the most emergent
requiring immediate medical attention medical attention.

EMERGENCY MANAGEMENT- GOALS OF TRIAGE

traditionally refers to care given to ✓ Timely assessment and treatment of
patients with urgent and critical the ill and injured.
needs. ✓ The assignment of each patient a
triage category reflecting the urgency
 Has broadened to include the with which care is required.
concept that an emergency is ✓ The appropriate decision-making to
whatever the patient or the provide immediate and other needs of
family considers it to be. the client.
✓ To determine which accident victims
The emergency nurse has: need the services of a trauma center
 Special training, education, and which can be cared for at a local
experience, and expertise in facility.
assessing and identifying health ✓ To regulate the flow of patients.
care problems in crisis
situations TRIAGE ASSESSMENT
 Nursing interventions are C → Chief Complaint
accomplished interdependently O → Onset of symptoms
in consultation with or under the L → Location of the problem
direction of a physician or nurse D → Duration of the symptoms
practitioner C → Characteristics of the symptoms
 The emergency room staff A → Aggravating Factors
works as a team R → Relieving Factors
T → Treatment administered
Issues in Emergency Nursing Care:
 Documentation of consent and S → Skin
Privacy A → Activity
 Limiting exposure to health V → Ventilation
risks E → Eye contact
 Violence in the emergency A → Abuse
department C → Cry
 Providing holistic care (patient- H → Heat
focused interventions and I → Immunization
family focused-intervention) L → Level of consciousness
 Sentinel events D → Dehydration
(unanticipated events
that result in patient Determination of Priority in ER
harm) in the ED include Triage: classified based on principle
delays to care and to benefit the largest number of
medication errors. people
 family presence during Determination of Priority in Field
resuscitation is permitted Triage: critical patients are given
to assist the family to lowest priority
cope through difficult
time. ER TRIAGE (three-tier system)
 Relieve anxiety and -daily triage
provide a sense of
security EMERGENT- (immediate) patients in
 PTSD is less likely to this category have the highest priority;
occur if the family must be seen immediately; Injuries are
member is present during life-threatening; If treatment is not
resuscitation.
given at the soonest possible time, the NON-URGENT- (minor)- patients have
life of the client is in great danger. episodic illnesses
 EMERGENT CATEGORY  Moderate headache
✓ Airway and breathing ✓ Minor fracture
difficulty (respiratory distress) ✓ Minor lacerations or cut
✓ Active seizures ✓ Cold symptoms
✓ Cardiac arrest (Myocardial ✓ Chronic pain
Infarction)
✓ Cervical spine compromise Emergency Severity Index (ESI)
✓ Chest pain (with acute -Assigns patient into 5 levels based on
dyspnea and cyanosis); severe both their acuity and their anticipated
pain resources needs.
✓ Uncontrolled or unsuspected
severe bleeding (severe shock)
✓ Severe head injuries
✓ Severe medical problems,
such as poisoning, drug
overdose, and complications of
long-standing debilitating
illnesses
✓ Severe chest or abdominal
wounds
✓ Sustained chemical splashes
to the eye
✓ Emergency childbirth;
complications of pregnancy
(toxemia).
✓ Excessively high temperature
(40.60C)
✓ Limb amputation

URGENT- (delayed) patients have

serious health problems but not
immediately life-threatening ones;
Their condition is currently stable and
they are not in immediate danger of
death; Needs to be treated within 1 to
2 hours; Evaluation must be
performed 30-60 minutes thereafter
 URGENT CATEGORY
✓ Dulled or obtunded level of
consciousness ✓ Chest pain that
is associated to an Upper
Respiratory Tract Infection
(URTI)
✓ Client with renal stone
✓ Hypertension
✓ Acute Panic states
✓ Acute asthma attack without
respiratory distress
✓ Abdominal pain
✓ Major multiple fractures
✓ Persistent vomiting and
diarrhea
✓ Simple fracture
✓ Temperature of 39.90C
✓ Back injuries with or without
spinal cord injuries
✓ Other types of severe pain
(migraine headache)
 met by a rescuer at the first possible
opportunity.”

 MINOR- able to walk alone

(presumed to have well
compensated physiology);
must be immediately
reassessed in secondary
triage

 EXPECTANT- Dead or dying;

not breathing after jaw
thrust

 URGENT- R<30; P<2sec; M-

obeys commands

 EMERGENT-R>30; P>2sec;
Canadian Triage and Acuity Scale
M-does not obey commands
(CTAS)
-CTAS system’s five levels include time
parameters that guide how frequently
patients must be reassessed by either
a nurse or provider.

RESUSCITATION-patient must receive

continuous nursing surveillance
EMERGENT- must be reassessed at
least every 15 minutes
URGENT-reassessed every 30 minutes
LESS URGENT-every 60 minutes
NON-URGENT- every 120 minutes
EMERGENCY CART
DISASTER TRIAGE -An emergency cart or most commonly
known
START TRIAGE as “crash cart” is a wheeled cabinet or
5 basic parameters: (RPM- respiration, chest of drawers
perfusion, mental status) which contains all of the equipment
a. Ability to walk necessary for emergency resuscitation
b. Presence or absence of , from latex gloves to a defibrillator.
respirations -are conveniently positioned
c. Respiratory rate throughout hospitals and some other
d. Assessment of perfusion medical facilities so that they can be
e. Mental status quickly accessed in an emergency.

The first action upon entering the Contents of E-cart are tailored
scene (after identifying and starting according to specific policies,
mitigation of ongoing hazards) is to guidelines, and needs of each
make an announcement stating, healthcare institution.
“anyone who can hear my voice
should get up and walk to a
designated point, where they will be
EMERGENCY CART CONTENTS FOR catheter; urine collection bag;
A LEVEL 2 HOSPITAL ACCORDING waterproof aprons
TO DOH
 Medication: Assessment and Intervention in
adenosine6mg/2ml vial, the ER:
amiodarone 150mg/3ml PRIMARY SURVEY: ABCDE Method
ampule, anti-tetanus serum, (rapid assessment)
aspirin USP grade  Airway
(325mg/tablet), atropine sulfate  Is the airway open?
1mg/1ml ampule, B-adrenergic  Is there any obstruction?
agonists (salbutamol 2mg/ml),  Note whether the patient
benzodiazepine (diazepam can speak. if he can, he
10mg/2ml or midazolam-placed has patent airway.
in high alert box), calcium  Unresponsive but no
gluconate 10% 10ml, trauma? Head-tilt chin-lift
clopidogrel 75mg tablet, D5W maneuver
250cc, D50% 50ml, digoxin (contraindicated in a
0.5mg/2ml ampule, suspected c-spine injury)
diphenhydramine 50mg/ml  Unresponsive with
ampule, dobutamine250mg/5ml trauma? Jaw thrust
ampule, dopamine 200mg/5ml maneuver
ampule, epinephrine 1mg/1ml  Insert nasopharyngeal
ampule, furosemide 20mg/2ml airway or oral airway if
ampule, haloperidol 50mg/ml necessary (unconscious
ampule, hydrocortisone patient)
250mg/2ml vial, lidocaine 10%  intubation
in 50ml spray, lidocaine 2%  Breathing
solution, nitroglycerin injection  Assess for spontaneous
10mg/10ml ampule or respiration (assess lung
isosorbide dinitrate 5mg SL sounds, respiratory effort,
tablet or 10mg/10ml ampule, rhythm, rate, and depth)
magnesium sulfate 1g/2ml  Obtain oxygen saturation
ampule, morphine sulfate  Is the patient using
10mg/mL (in high alert box), accessory muscles to
noradrenaline 2mg/2ml ampule, breathe? Do you hear
paracetamol 300mg/ampule, breath sounds bilaterally?
phenobarbital 120mg/ml Any tracheal deviation?
ampule IV or 30mg tablet-in Jugular vein distention?
high alert box, phenytoin  VENTILATE patient using
100mg/capsule or 100mg/2ml a bag valve mask
ampule, Plain LRS 1L/bottle;  Circulation
Plain NSS 1L/bottle; KCL  Check for the presence of
40mEq/20ml vial-in high alert peripheral pulse
box; Sodium bicarbonate  Blood pressure
50mEq/50ml ampule; verapamil  Capillary refill
5mg/2ml ampule  Skin color
 Equipment/supplies: airway  Skin temperature
adjuncts; intubation kit with  Diaphoresis
stylet and bag valve masks;  Obvious bleeding
alcohol disinfectant; aseptic  Assess the need for a two
bulb syringe; calculator; large-bore IV Lines (all
capillary blood glucose (CBG) major trauma patients)
kit; cardiac board; ETT Tubes all  Fluid warmer may be
sizes; penlights; sterile and non- used
sterile gloves; laryngoscope  Assess for hemorrhage-
with different sizes of blades; Apply direct pressure on
nasal cannula; protective face the site if there is
shield or mask or goggles; external bleeding
standard face mask; sterile  No pulse? CPR.
gauze; syringes; urethral  Disability (LOC)
  Perform a neurologic  Insert urinary catheter (don’t
assessment (Glasgow insert urinary catheter if there’s
coma scale) blood at the urinary meatus)
 Maintain cervical spine  Insert NGT for stomach
immobilization until X-ray decompression.
confirm that there’s no (contraindicated in patient with
injury facial fracture)
 Assess for level of  Obtain laboratory studies
consciousness
 A-Alert
Patient is awake,
alert, responsive to MEDICAL EMERGENCIES
voice and is
oriented to person, FOREIGN BODY OBSTRUCTION/
time, and place AIRWAY OBSTRUCTION
 V-responsive to  - An acute upper airway obstruction
Voice is a blockage of the upper airway,
Pt responds to which can be in the trachea,
voice but is not laryngeal (voice box), or bronchi
fully oriented to areas
person, time, or
place -patient is partially able or not able to
 P-pain take in oxygen through inhalation
Patient does not which will result into hypoxemia.
respond to voice
but does respond Causes:
to painful stimulus  Anaphylaxis
 U-unresponsive  Aspiration of foreign object
Patient does not  Burns to the head, face or neck
respond to voice or area
painful stimulus  Cerebral disorders
 What if the patient has ALOC?  Croup
Check pupils (size,  Epiglottitis
equality, and reactivity to  Laryngospasms
light)  In adults, aspiration of a bolus
 Exposure and environment of meat is the most common
 Expose patient to cause.
perform thorough  In children, small toys, buttons,
assessment coins, and other objects
 Assess for injuries Clinical manifestations:
 If the patient has bullet 1. Choking
holes or knife tears 2. Apprehensive appearance
through his clothing don’t 3. Inspiratory & expiratory stridor
cut through these areas. Labored breathing
 Save any evidence 4. Flaring of nostrils
(bullets, drugs, or 5. Use of accessory muscles
bleeding clothes) (suprasternal & intercostal
 Assess for signs of retractions)
hypothermia 6. ñ anxiety, restlessness, confusion
7. Cyanosis & loss of consciousness
 Cover the patient with develops as hypoxia worsens.
warm blankets Assessment and diagnostics:
 Involves simply asking whether the
SECONDARY SURVEY: detailed patient is choking & requires help
Head-to-toe assessment  If unconscious, inspection of the
 Full set of vital signs; BP on both oropharynx may reveal the object.
arms if suspected chest trauma  X-rays, laryngoscopy, or
 Initiate cardiac monitoring bronchoscopy may also be
 Obtain continuous pulse performed.
oximetry readings  For elderly patients, sedatives &
hypnotic medications, diseases
 affecting motor coordination, & 5. To facilitate removal of
mental dysfunction are risk factors tracheobronchial secretions
for asphyxiation of food.
 Victims cannot speak, breath or Cricothyroidotomy
cough.  Used in the following emergencies
 If victim can breathe in w/c ET intubation is
spontaneously, partial obstruction contraindicated:
should be suspected; the victim is 1. Extensive maxillofacial
encouraged to cough it out. trauma
 If the patient has a weak cough, 2. Cervical spine injuries
stridor, DOB & cyanosis, do the 3. Laryngospasm
Heimlich. 4. Laryngeal edema
 After the obstruction is removed, 5. Hemorrhage into neck tissue
rescue breathing is initiated; if the 6. Laryngeal obstruction
patient has no pulse, start cardiac
compressions. Nursing Diagnoses For Airway
Obstruction
Head-Tilt-Chin-Lift Maneuver 1. Ineffective airway clearance due to
1. Place the patient on a firm, flat obstruction of the tongue, object,
surface. or fluids (blood, saliva)
2. Open the airway by placing one 2. Ineffective breathing pattern due to
hand on the victim’s forehead, obstruction or injury
and apply firm backward
pressure with the palm to tilt Hemorrhage
the head back.
3. Place the fingers of the other  Bleeding that may be external,
hand under the bony part of the internal or both
lower jaw near the chin and lift  External: Laceration, avulsion,
up. GSW, stab wound
4. Bring the chin and teeth forward  Internal: Bleeding in body cavities
to support the jaw. and internal organs

Jaw-Thrust Maneuver Assessment

1. Place the patient on a firm, flat  Results in reduction of
surface. circulating blood vol., w/c is the
2. Open the airway by placing one principal cause of shock
hand on each side of the  Signs and symptoms of shock:
victim’s jaw, followed by 1. Cool, moist skin
grasping and lifting the angles, 2. Hypotension
thus displacing the mandible 3. Tachycardia
forward. 4. Delayed capillary refill
5. Oliguria
Oropharyngeal Airway Insertion
A semicircular tube or tube-like plastic Management
device inserted over the back of the  Fluid Replacement
tongue into the lower pharynx  Two large-bore intravenous
Used in a patient who is breathing cannulae are inserted to provide a
spontaneously but unconscious. means for fluid and blood
replacement, and blood samples
ET Intubation: Indications are obtained for analysis, typing, &
1. To establish an airway for cross-matching.
patients who cannot be  Replacement fluids may include
adequately intubated with an isotonic solutions (LRS, NSS),
oropharyngeal airway. colloid, and blood component
2. To bypass an upper airway therapy.
obstruction • Packed RBCs are infused when
3. To prevent aspiration there is massive hemorrhage
4. To permit connection of the • In emergencies, O(-) blood is used
patient to a resuscitation bag or for women of child-bearing age.
mech. ventilator • O(+) blood is used for men and
postmenopausal women.
• Additional platelets and clotting 1. Massive external or internal
factors are give when large bleeding
amounts of blood is needed. 2. Traumatic, vascular, GI and
pregnancy related
Control of External Hemorrhage 3. Burns
 Physical assessment is done to
identify area of the hemorrhage. Nursing Diagnoses for
 Direct, firm pressure is applied over Hypovolemic Shock
the bleeding area or the involved 1. Altered tissue perfusion related
artery. to failing circulation
 A firm pressure dressing is applied, 2. Impaired gas exchange related
and the injured part is elevated to to a V-P imbalance
stop venous & capillary bleeding if 3. Decreased cardiac output
possible. related to decreased circulating
 If the injured area is an extremity, blood volume
it is immobilized to control blood
loss. Clinical Manifestations
1. Weakness, lightheadedness,
Control of Bleeding: Tourniquets and confusion
 Applied only as a last resort just 2. Tachycardia
proximal to the wound and tied 3. Tachypnea
tightly enough to control arterial 4. Decrease in pulse pressure
blood flow; tag the client with a “T” 5. Cool clammy skin
stating the location and the time 6. Delayed capillary refill
applied
 Loosened periodically to prevent Hypovolemic Shock: Management
irreparable vascular on neuro 1. Rapid blood and fluid replacement;
damage blood component therapy
 If still with arterial bleeding, optimizes cardiac preload, correct
remove tourniquet and apply hypotension, & maintain tissue
pressure dressing perfusion
 If traumatically amputated, the 2. Large-bore intravenous needles or
tourniquet remains in place until catheters are inserted into
the OR. peripheral vv.
3. A central venous pressure catheter
Control of Internal Bleeding may also be inserted in or near the
 Watch out for tachycardia, RA.
hypotension, thirst, apprehension, 4. LRS approximates plasma
cool and moist skin, or delayed electrolyte composition and
capillary refill. osmolarity
 Packed RBC are administered at a 5. A Foley catheter is inserted to
rapid rate, and the patient is record urinary output every hour;
prepped for OR. urine volume indicates adequacy of
 Arterial blood is obtained to kidney perfusion
evaluate pulmonary perfusion & to 6. Ongoing nursing surveillance of the
establish baseline hemodynamic total patient is maintained to
parameters assess the patient’s response to
 Patient is maintained in a supine treatment; a flow sheet is used to
position and closely monitored. document parameters
7. Lactic acidosis is a common side
effect & causes poor cardiac
performance

Hypovolemic Shock Wounds

 A condition where there is loss of  A type of physical trauma wherein

effective circulating blood volume the skin is torn, cut or punctured
due to rapid fluid loss that can (open wound), or where blunt force
result to multi-organ failure trauma causes a contusion (closed
 Causes wound).
 Specifically refers to a sharp injury  Caused by a great or extreme
which damages the dermis of the amount of force applied over a long
skin. period of time
 Types of Wounds Patterned Wound: Wound
1. Open (Incised wound, representing the outline of the object
Laceration, Abrasion, Puncture (e.g. steering wheel) causing the
wound, Gunshot wound) wound
2. Closed (Contusion, Hematoma,
Crushing injury)
Management: Wound Cleansing
1 . Hair around wound may be shaved.
2 . NSS is used to irrigate the wound.
Incised Wound 3 . Betadine & hydrogen peroxide are
 A clean cut by a sharp-edged only used for initial cleaning &
object such as glass or metal. aren’t allowed to get deep into the
 As the blood vessels at the wound wound without thorough rinsing.
edges are cut straight across, there 4 . Use local or regional block
may be profuse bleeding anesthetics if indicated.

Laceration Wound Management

 Ripping forces or rough brushing 1 . Use of antibiotics depends on how
against a surface which can cause the injury occurred, the age of the
rough tears in the skin or wound, & the risk for
lacerations. contamination
 Laceration wounds are usually 2 . Site is immobilized & elevated to
bigger and can cause more tissue limit accumulation of fluid
damage due to the size of the 3 . Tetanus prophylaxis is administered
wound. based on the condition of the
wound and the immunization
Abrasion status
 Superficial wounds that occur at
the surface of the skin. Wound Healing: By First Intention
 Friction burns and slides can cause  Occurs when tissue is cleanly
abrasion incised and re-approximated and
 Characteristic in the way that only healing occurs without
the top most layer of the skin is complications.
scrapped off.  The incisional defect re-epithelizes
 Bleeding is not profuse though rapidly and matrix deposition seals
wounds the defect.

Puncture Wound Wound Healing: By Second

 Small entry site Intention
 Though not large in surface area,  Healing occurs in open wounds.
wounds are deep and can cause  When the wound edges are not
great internal damage. approximated and it heals with
formation of granulation tissue,
Gunshot Wound (GSW) contraction and eventual
 Caused by firing bullets or any spontaneous migration of epithelial
other small arms. cells.
 Have a clean entry site but a large
and ragged exit site. Wound Healing: By Third
Intention
Contusion a.k.a. bruise: Caused by  Occurs when a wound is allowed to
blunt force trauma that damages heal open for a few days and then
tissue under the skin closed as if primarily.
Such wounds are left open initially
Hematoma: Also called a blood because of gross contamination
tumor
 Caused by damage to a blood TRAUMA
vessel that in turn causes blood to
collect under the skin
 The unintentional or intentional 2. Auscultation of bowel sounds
wound or injury inflicted on the 3. Watch out for signs of
body from a mechanism against peritoneal irritation like
w/c the body cannot protect itself distention, involuntary
 Leading cause of death in children guarding, tenderness, pain,
and in adults younger than 44 y/o muscular rigidity, or rebound
 Alcohol & drug abuse are tenderness together with absent
implicated in both blunt & BS.
penetrating trauma
 Collection of Forensic Evidence: Trauma: Diagnostic Findings
Included in documentation are the 1. Urinalysis to detect hematuria
ff: 2. Serial hematocrit to detect
1. Descriptions of all wounds presence or absence of bleeding
2. Mechanism of injury 3. WBC count to detect elevation
3. Time of events associated with trauma
4. Collection of evidence 4. Serum amylase to detect
5. Statements made by the patient pancreatic or GIT injury

 If suicide or homicide is suspected PE for Internal Bleeding

in a deceased patient, the medical  Inspect body for bluish
examiner will examine the body on discoloration, asymmetry,
site or have it moved to the abrasion, & contusion
medico-legal office for autopsy.  FAST (Focused Assessment for
 All tubes & lines are left in place. Sonographic Examination of the
 Patient’s hands are covered with Trauma Patient) exam through
paper bags to protect evidence. CT scan to assess
hemodynamically unstable
Injury Prevention Components patients and detect
1. Education: Provide information intraperitoneal bleeding
and materials to help prevent  Pain in the left shoulder is
violence, and to maintain safety common in a patient with
at home and in vehicles. bleeding from a ruptured
2. Legislation: Provide universal spleen.
safety measures without  Pain in the right shoulder can
infringing on rights (Seatbelt result from a laceration of the
Law). liver.
3. Automatic Protection:  Administration of opioids is
Provide safety without requiring avoided during the observation
personal intervention (Airbags, period.
seatbelts).
High incidence of injury Trauma: Genitourinary Injury
to hollow organs,  A rectal or vaginal exam is done to
particularly the small determine any injury to the pelvis,
intestines bladder, and intestinal wall.
The liver is the most frequently  To decompress the bladder &
injured solid organ. monitor urine output, a Foley
High velocity missiles create catheter is inserted AFTER DRE.
extensive tissue damage.  A high-riding prostate gland
indicates a potential urethral injury.
Intra-abdominal Injuries: Blunt
(MVA, falls, blows) Trauma: Management of Intra-
Associated with extra-abdominal abdominal Injuries
injuries to chest, head, extremity 1. A patent airway is maintained.
Incidence of delayed & trauma-related 2. Bleeding is controlled by applying
complications is higher direct pressure to any external
Leads to massive blood loss into the bleeding wounds & by occlusion of
peritoneal cavity any chest wounds.
Trauma: Assessment 3. Circulating blood vol. is maintained
1. Inspection of abdomen for with intravenous fluid replacement
signs of injury (bruises, including blood component therapy.
abrasions)
4. In blunt trauma, cervical spine  Requires a team approach with one
immobilization is maintained until person responsible for coordinating
cervical x-rays have been obtained the treatment
& injury is ruled out.  Immediately after injury, the body
5. All wounds are located, counted & is hypermetabolic,
documented. hypercoagulable, and severely
6. If abdominal viscera protrude, the stressed.
area is covered with sterile, moist  Mortality is related to the severity
saline dressing to prevent drying. & the number of systems involved.
7. Oral fluids are withheld and
stomach contents are aspirated Multiple Injuries: Nursing
with an NGT in anticipation of Responsibilities
surgery. 1. Assessing & monitoring the patient
Tetanus and broad-spectrum 2. Ensuring venous access
antibiotics are given as prescribed. 3. Administering prescribed meds
8. If still with evidence of shock, 4. Collecting laboratory specimens
blood loss, free air under the 5. Documenting activities and the
diaphragm, evisceration, hematuria patient’s response
or suspected abdominal injury, 6. Gross evidence may be slight or
transport to OR. absent; the injury regarded as the
least significant may be the most
Trauma: Crushing Injuries lethal.
 Occur when a person is caught 7. Determine the extent of injuries &
between objects, run over by a establish priorities of treatment
moving vehicle, or compressed by (ABC’s)
machinery 8. Establish airway & ventilation.
 Watch out for hypovolemic shock 9. Control hemorrhage.
from extravasation of blood & 10.Prevent & treat hypovolemic shock
plasma into injured tissues after & monitor intake & output.
compression has been released. 11.Assess for head & neck injuries.
12.Evaluate for other injuries –
Crushing Injuries: Assessment reassess head & neck, chest;
 Watch out for paralysis of a body assess abdomen, back &
part, erythema & blistering of skin, extremities.
damaged part appearing swollen, 13.Splint fractures.
tense & hard. 14.Carry out a more thorough and
 Renal dysfunction is secondary to ongoing examination &
prolonged hypotension. assessment.
 Myoglobinuria is secondary to
muscle damage causing ARF. FRACTURES
 In conjunction with ABC’s, the
patient is observed for acute renal  When a client is being examined
insufficiency for a fracture, the body part is
 Major soft tissue injuries are handled gently & as little as
splinted early to control bleeding possible.
and pain.  Clothing is cut off to visualize the
 A ò serum lactic acid body & assessment is done for pain
concentration to <2.5 mmol/L over or near a bone, swelling, &
indicates successful resuscitation. circulatory disturbance,
 If an extremity is involved, it is ecchymosis, tenderness &
elevated to relieve swelling & crepitation.
pressure.
 A fasciotomy is done to restore Management of Fractures
neurovascular function.  ABCD Method & evaluation for
 Medications for pain & anxiety are abdominal injuries is performed
given as prescribed, and the BEFORE an extremity is treated
patient is transported to the OR for unless a pulseless extremity is
debridement & fracture repair seen.
 If the extremity is pulseless,
Trauma: Multiple Injuries repositioning of the extremity to
proper alignment is required.
Pulseless Extremities
 If the pulseless extremity involves
a fractured hip or femur, a Hare
traction may be applied to assist w/
alignment.
 If repositioning is ineffective in
restoring the pulse, a rapid total
body assessment is completed,
followed by a transfer to the
operating room for arteriography
and possible arterial repair.

Management of Fractures
 After the 1° survey, the 2° survey
is done using a head-to-toe
approach.
 Observe for lacerations, swelling &
deformities including angulation,
shortening, rotation, & symmetry.
 Palpate all peripheral pulses.
 Assess extremity for coolness,
blanching, decreased sensation &
motor function.

Splinting of Extremities
 Before moving the patient, a splint
is applied to immobilize the joint
above & below the fracture
 Relieves pain, restores circulation,
prevents further tissue injury

 Procedure:
1. One hand is placed distal to the
fracture & some traction is
applied while the other hand is
placed beneath the fracture for
support.
2. The splint should extend beyond
the joints adjacent to the
fracture.
3. Upper extremities must be
splinted in a functional position.
4. If a fracture is open, moist,
sterile dressing is applied.
5. Check the vascular status by
assessing color, temperature,
pulse, and blanching of the nail
bed.
6. If there is neurovascular
compromise, the splint is
removed and reapplied.
Investigate complaints of pain or
pressure