Emergency Assessment

A. Assessment

i. The initial assessment is performed by the triage nurses on each patient every time that enter the emergency department. It includes a rapid assessment of the patient's airway, breathing, circulation and disability problems. It also includes evaluation of the patient's level of consciousness by using the A.V.P.U. scale. The purpose of the initial assessment is to prioritize the patients according to their needs and hence ensure that the proper care is given to the patients to facilitate a faster period of recovery. The initial assessment is also designed in such a way so that emergency nurses can identify life-threatening situations or injuries and initiate treatment in a rapid efficient manner. This assessment is used also to evaluate if care can be given at the institution or if the patient will need to be transferred out to another facility so that the required care can be given. Proper initial assessment reduces time wastage. Furthermore, the triage nurses are the first people that the patients meet and hence it is their job to ensure that an accurate initial assessment is obtained.

ii. The secondary assessment is immediately after the primary assessment. It is a more thorough assessment and is designed to provide information that is used to form a baseline by which progress or deterioration can be measured. The emergency nurse begins by obtaining a full set of vitals such that the patient's response to the injury can be measured. She then starts cardiac monitoring to evaluate the heart, the pulse oximeter is placed in an area with sufficient blood supply in order for accurate reading to be obtained, a urinary catheter is inserted to monitor output, if needed a nasogastric tube is inserted to monitor for frank bleeding and initial labs are drawn. It is very important in this assessment for the emergency nurse to provide comfort to the patient. The patient will be frightened and disoriented by what is going on. It is the job of the emergency nurse to reassure and calm the patient so that treatment can be initiated and be beneficial to the patient. The emergency nurse conducts a head to toe assessment so that each area of the body is examined for injuries and any injuries found is graded and categorized.

B. Triage

i. The purpose of categorizing patients in the emergency department by the emergency nurse is to identify potential nonurgent patients from the resuscitative patients. In the emergency department, the nurse uses five levels to categorize patients with level 5 being the less urgent and level 1 being life-threatening injuries or situations. The main reason for categorizing patients is so that the emergency nurse can rapidly identify which patients need immediate attention. With use of classifying patients, there is a constant flow of patients in the emergency department such that levels 1and 2 patients are seen instantly whilst the lower levels can stay until attention can be given to them. Another important reason why emergency nurses categorize patients is to decide which of these patients do not need to be seen in the main emergency department and can be seen in the minor trauma areas in emergency departments. For example, for level 4 and 5 patients, the emergency nurse will send them to the minor trauma areas since their injuries are not life-threatening and they can wait until attention can be given to them.

ii. In order for the emergency nurse to categorize patients correctly, she needs to ask some important questions to aid in her decisions. Firstly, she must ask herself, "Does this patient require immediate life-saving intervention?" If her answer is yes, then this patient is a level 1 patient and needs immediate attention. However, if her answer is no, then she must ask herself, "Is this a patient who should not wait?" If her answer to this question is yes, then the patient is a level 2. One the other hand, if both previous questions were no then she needs to ask herself, "How many resources will the patient need?" If the patient needs many resources, he automatically becomes a level 3. However, when performing the vital signs, which another question the emergency nurse ask, and depending on the reading, the patient may remain a level 3 or promoted to a level 2. Patients who need one or no resources are level 4 and 5 respectively. Therefore, it can be concluded that in order for emergency nurses to categorize patients accurately, she needs to ask herself certain questions and depending on the answer, she can then make the appropriate decisions for patient care.

C. Intervention

i. Airway management is the first priority in caring for the critically ill patient. The priority of care begins with oxygenation and ventilation of the patient. The emergency nurse ensures that throughout the management of the patient, that the patient has a patent airway. The main goal of airway management is to oxygenate and ventilate the patient and not to place a device. The emergency nurse main goal is to manage the patient's airway to ensure patency, adequate ventilation and oxygenation. Proper use of devices such as oral or nasal airways and at times the chin lift or jaw thrust can open or salvage airway but only if done properly. These artificial airways can be used for short or long term airway management. Tracheotomy may be used when prolonged artificial airway is anticipated and it provides the patient with greater opportunity regarding speech and communication, feeding and nutrition. However, the emergency nurse must understand that to maintain a patent airway in patients with tracheotomy tube,