Emergency Procedures - question

  1. Hi there

    I am finally on my last assignment for this degree!!! which is a case study for my elective (emergency nursing). I have a scenario where I'm a nurse in E.D. - rural hospital and I receive a call from the ambulance saying they are bringing in a 35yr old woman with burns to all areas of her body, and she is smelling of petrol. I have to write a case study on how to prepare for her arrival and then the assessment and emergency care required and also debriefing of staff. I would like to know if Rural E.D. hospital procedures differ from those in the city, and what manuals are in place there. Is there a manual of practice specific for Australian E.D.? or any helpful books/resources at all, any input would be appreciated.

    Cheers
    Tracy

    P.S. I do my prac for this elective later in the year so have no idea what i'm doing!!!!
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  2. 7 Comments

  3. by   UK2USA
    A good resource for you may be the Broomfield Hospital, Chelmsford, UK. This is a hospital with recognition as a centre of excellence for burns management. I am afraid that I don't know their contact details.... but they may be worth a try. Good luck with the assessment.
  4. by   Richo
    Thanks heaps for that, I will look them up.

    Cheers
    Tracy
  5. by   gwenith
    Tracy haven't you checked out both the burns forum and the rural nursing forums - lots of links put there by yours truly
  6. by   Richo
    LOL I was just looking in there as you posted a reply to me!! Thankyou your resources are very good, just have to find one that relates to my scenario.

    Thanks again
    Tracy
  7. by   gwenith
    Preparation:
    1) Intubation gear checked and on hand Resus trolley checked non- rebreather mask for 100% O2
    2) Fluid and lots of hanging ready
    3) space blanket /switch off air conditioning
    4) look around desperately for whatever you can use to cover the burns at least until they can be transported - believe me - there may not be much and whatever you use make sure it has no fibres that can adhere - you would be better off with gladwrap than cotton wool.
    5) make sure you have a clean pair of undies on ( )

    Tracy - when thinking of emergency burns management especially rural you HAVE to think of ABC - Airway/ Breathing/Circulation and for that you have to consider two things

    1) was she in a confined space (increased risk of inhalation of CO and other toxins) and 2) Is the face and especially the nose hairs burnt?? (probable respiratory burns)

    They may not be distressed initially but believe me they soon will be if there is respiratory burns

    Circulation - get that IV in as soon as - don't delay!!! This is a number 1 priority ESPECIALLY if you are remote/rural as you may not have access to central lines and indeed you might not have anyone with required expertise to put a central line in!!!

    Pain relief!!!! and reasses breathing at each pain relief administration

    Warm them - do not allow them to become cold - hence the space blanket - you probably will not have anything else (can you tell I am thinking small rural here). You will definitely need some kind of warming if they are to be shipped by air.

    IDC - absolutely essential to guide your fluid management (if you have one - use hourly measure if not make do.) Remember you will not have access to central venous pressures so urinary output might be your only guide of fluid replacement requirements

    Assess peripheral circulation (the books will say do a full assessment first but in reality you will be assessing as you get in the IV and set up for intubation) Are there any circumferential full thickness burns that might restrict blood supply?? Can you read pulse Ox on the fingers or are they too badly burnt?? Remember with pulse oximetry in burns you are often better off placing an ear probe across the nasal septum to get a reading - everything else might be too burnt.



    All of this is aimed at UNTIL

    Rural hospitals in QLD should NOT hang onto burns patients they should be shipped as soon as possible to one of the Tertiary centres and a 35% burns will either go to RBH or PAH so your emphasis is to care for the patient UNTIL the careflight arrives.

    This was off the top of my head - hope it helps!!

    Oh and if you are having to keep the patient longer than 3-4 hours start NG feeds!!!
    Last edit by gwenith on May 11, '04
  8. by   Richo
    How long have you been nursing? forgive me, but I am a little overwhelmed. How on earth do you ever get to a point where you 'pluck that from the top of your head'? I am totally amazed at this, I will print this off if I can and go through bit by bit to understand it all! I can not say thankyou enough for what you have given me and will go away to try and absorb some of it. I must say, I am absolutely terrified that I have chosen emergency nursing as my elective. I have no idea how I will survive the four weeks in E.D. Do they provide you with some on the job training? or will I be expected to "know" how to do it all because I have studied the theory side of things. I have soooo much more learning ahead of me yet, though hopefully hands on will sink in a lot better than the theory. Thanks so much for your time and help, it is very much appreciated Gwenith.

    Tracy
    Quote from gwenith
    Preparation:
    1) Intubation gear checked and on hand Resus trolley checked non- rebreather mask for 100% O2
    2) Fluid and lots of hanging ready
    3) space blanket /switch off air conditioning
    4) look around desperately for whatever you can use to cover the burns at least until they can be transported - believe me - there may not be much and whatever you use make sure it has no fibres that can adhere - you would be better off with gladwrap than cotton wool.
    5) make sure you have a clean pair of undies on ( )

    Tracy - when thinking of emergency burns management especially rural you HAVE to think of ABC - Airway/ Breathing/Circulation and for that you have to consider two things

    1) was she in a confined space (increased risk of inhalation of CO and other toxins) and 2) Is the face and especially the nose hairs burnt?? (probable respiratory burns)

    They may not be distressed initially but believe me they soon will be if there is respiratory burns

    Circulation - get that IV in as soon as - don't delay!!! This is a number 1 priority ESPECIALLY if you are remote/rural as you may not have access to central lines and indeed you might not have anyone with required expertise to put a central line in!!!

    Pain relief!!!! and reasses breathing at each pain relief administration

    Warm them - do not allow them to become cold - hence the space blanket - you probably will not have anything else (can you tell I am thinking small rural here). You will definitely need some kind of warming if they are to be shipped by air.

    IDC - absolutely essential to guide your fluid management (if you have one - use hourly measure if not make do.) Remember you will not have access to central venous pressures so urinary output might be your only guide of fluid replacement requirements

    Assess peripheral circulation (the books will say do a full assessment first but in reality you will be assessing as you get in the IV and set up for intubation) Are there any circumferential full thickness burns that might restrict blood supply?? Can you read pulse Ox on the fingers or are they too badly burnt?? Remember with pulse oximetry in burns you are often better off placing an ear probe across the nasal septum to get a reading - everything else might be too burnt.



    All of this is aimed at UNTIL

    Rural hospitals in QLD should NOT hang onto burns patients they should be shipped as soon as possible to one of the Tertiary centres and a 35% burns will either go to RBH or PAH so your emphasis is to care for the patient UNTIL the careflight arrives.

    This was off the top of my head - hope it helps!!

    Oh and if you are having to keep the patient longer than 3-4 hours start NG feeds!!!
  9. by   RNin92
    Quote from Richo
    How long have you been nursing? forgive me, but I am a little overwhelmed. How on earth do you ever get to a point where you 'pluck that from the top of your head'? I am totally amazed at this, I will print this off if I can and go through bit by bit to understand it all! I can not say thankyou enough for what you have given me and will go away to try and absorb some of it. I must say, I am absolutely terrified that I have chosen emergency nursing as my elective. I have no idea how I will survive the four weeks in E.D. Do they provide you with some on the job training? or will I be expected to "know" how to do it all because I have studied the theory side of things. I have soooo much more learning ahead of me yet, though hopefully hands on will sink in a lot better than the theory. Thanks so much for your time and help, it is very much appreciated Gwenith.

    Tracy
    Good luck in your ED rotation.
    You will love it!
    Don't be overwhelmed...NO ONE knows it all.
    We are always learning...that's one of the joys of nursing.

    Remember to ask lots of questions...don't ever "fake it"

    At my hospital our new grads have a 6 month orientation to the ED.

    And don't sweat out the traumas...you are NEVER alone.
    And once you do one, you will be amazed at what you remember for the next time!

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