Emergency principles
ABCDE
• A: Airway
◦Responsive and Alert VS. Lethargic, stuporous, obtunded, unarousable, unresopnsive
◦Airway trauma d/t: Trauma; Tracheal narrowing; Obstruction; etc.
◦Abnormal Findings:
‣ Stridor
‣ Muffled voice/ Voice change
‣ Drooling/ Unable to handle secretions/ pooling of secretions
‣ Weak or absent gag reflex
‣ Trauma/ Surgery/ Interventions to face or throat
‣ Excessive bleeding
‣ Foreign object present
◦Airway Interventions:
‣ Remove pillows
‣ Elevate HOB
‣ C-collar
‣ Head-tilt-chin
‣ Jaw-thrust (If suspected SPINAL TRAUMA)
‣ Airway adjunct:
• NPA (YES ✅ GAG reflex; contraindicated in facial fractures)
• OPA (DO NOT ❌ use with GAG reflex)
• Intubation
• B: Breathing
◦Normal breathing:
‣ Respiratory Rate: 12-20
‣ PaC02: 80-100
‣ C02: 35-45
‣ Sp02: >95%
◦Breathing Interventions:
‣ Elevate HOB
‣ Nasal Cannula → 24-44% at 1-6L/min
‣ Face mask → 40-60% at 5-8L/min
‣ Partial rebreather → 40-60% at 6-11L/min (w/ reservoir bag no valve)
‣ Nonrebreather → 80-80% at 10-15L/min (highest O2 possible)
‣ Venturi (most precise)
‣ Endotracheal tube
• Xray confirms placement
‣ Manual ventilation (Positive pressure force air into alveoli )
• Alarms:
◦LOW pressure → low exhaled volume d/t disconnection, cuff leak, tube displacement
◦HIGH pressure → excess secretions d/t client biting tube, kinks, coughing, pulmonary edema, bronchospasm,
pneumothorax
◦Apnea → no respiration detected
• CPAP
◦One continuous positive pressure during inhale + exhale
◦Preset rate and tidal volume
◦Indications: Sleep apnea
◦Risks: Volutrauma, ↓ CO, ↓ ICP
• BiPAP
◦Two different levels of pressure; HIGH pressure on inhale + LOWER pressure on exhale
◦Indications: Severe respiratory issue ex. ARDS & COPD
‣ Other treatments:
• Chest physiotherapy; Deep breathe & cough; Incentive spirometer; Nebulizer; Inhaler
◦Chest Trauma:
‣ Pneumothorax & Hemothorax: Lung collapsed with seeping into pleural space
• S/S for both: Uneven chest rise; diminished/absent breathe sounds on affected side
Tension (emergency) → Tracheal deviation; JVD
• Diagnostic: Thoracentesis
◦Assist pt to edge of bed and to lean over bedside table
◦Educate to remain still during procedure
◦Assess q4hr + position HIGH fowler 90°
• Intervention:
◦Chest tube
◦Needle decompression (temporary alleviation of pressure to prepare for chest tube)
, ‣ Flail Chest: Fracture of ribs in atleast 2 different places
• S/S: Paradoxical breathing (inhale ribs suck inside, exhale ribs push out); very Painful in affected area that increases with
movement
• Interventions:
◦Splinting or Direct pressure
◦Positive pressure mechanical ventilation
◦IV fluids
◦Pain management
◦Physiotherapy and Hygiene
◦Chest tube:
‣ Water seal: Tidaling with occasional (intermittent) bubbles ✅
• If NO tidaling check for kinks, listen to lung sounds
• If CONTINUOUS bubbling, check for leaks
‣ Assess site for: Infection; Leaks → Subcutaneous emphysema
‣ IF S/S of Tension pneumo (tracheal deviation, absent breath sound on one side) → assess for kinks or clamps
‣ Clean with Chlorhexidine & dressing is covered with tape
‣ Keep drainage system BELOW level of heart/chest and upright at all times. Cough & deep breath q2hr
‣ IF system becomes unattached → cover with sterile gauze, tape 3 sides, call provider
‣ Before removal:
• Confirm bilateral breath sounds; CXray; Premedicate (pain); Cover site with occlusive dressing
• Educate patient as doctor removes chest tube have patient BARE DOWN (Valsalva)
• C: Circulation
◦Pump (Heart)
‣ Issues: Lethal Dysrhythmias (VTach & VFib); Congestive HF; Cardiogenic/ Obstructive shock; Cardiac arrest
‣ For Cardiac arrest causes refer to chart below
◦Distribution (Vessels)
‣ Occlusion
‣ MI:
‣ Loss of pulse to extremity
◦Volume
‣ Bleeding internal VS external
‣ S/S: ↑HR; if bleeding in the abdomen → rigid boardlike abdomen & bruising
‣ Intervention:
• IV fluids (isotonic & colloids)
• for external bleed: Direct pressure; Tourniquets
to
• D: Disability
◦Perform neurological assessment for LOC
◦Assess motor & sensations for weakness, numbness, tingling
◦HIGH alert if trauma to head, neck, back
◦If GSC is <8 we INTUBATE
• E: Exposure
◦Remove cause of injury (chemical/thermal burn)
◦Remove all clothing (save for evidence)
◦Inspect the back (use log-roll method)
◦Prevent hypothermia
ABCDE
• A: Airway
◦Responsive and Alert VS. Lethargic, stuporous, obtunded, unarousable, unresopnsive
◦Airway trauma d/t: Trauma; Tracheal narrowing; Obstruction; etc.
◦Abnormal Findings:
‣ Stridor
‣ Muffled voice/ Voice change
‣ Drooling/ Unable to handle secretions/ pooling of secretions
‣ Weak or absent gag reflex
‣ Trauma/ Surgery/ Interventions to face or throat
‣ Excessive bleeding
‣ Foreign object present
◦Airway Interventions:
‣ Remove pillows
‣ Elevate HOB
‣ C-collar
‣ Head-tilt-chin
‣ Jaw-thrust (If suspected SPINAL TRAUMA)
‣ Airway adjunct:
• NPA (YES ✅ GAG reflex; contraindicated in facial fractures)
• OPA (DO NOT ❌ use with GAG reflex)
• Intubation
• B: Breathing
◦Normal breathing:
‣ Respiratory Rate: 12-20
‣ PaC02: 80-100
‣ C02: 35-45
‣ Sp02: >95%
◦Breathing Interventions:
‣ Elevate HOB
‣ Nasal Cannula → 24-44% at 1-6L/min
‣ Face mask → 40-60% at 5-8L/min
‣ Partial rebreather → 40-60% at 6-11L/min (w/ reservoir bag no valve)
‣ Nonrebreather → 80-80% at 10-15L/min (highest O2 possible)
‣ Venturi (most precise)
‣ Endotracheal tube
• Xray confirms placement
‣ Manual ventilation (Positive pressure force air into alveoli )
• Alarms:
◦LOW pressure → low exhaled volume d/t disconnection, cuff leak, tube displacement
◦HIGH pressure → excess secretions d/t client biting tube, kinks, coughing, pulmonary edema, bronchospasm,
pneumothorax
◦Apnea → no respiration detected
• CPAP
◦One continuous positive pressure during inhale + exhale
◦Preset rate and tidal volume
◦Indications: Sleep apnea
◦Risks: Volutrauma, ↓ CO, ↓ ICP
• BiPAP
◦Two different levels of pressure; HIGH pressure on inhale + LOWER pressure on exhale
◦Indications: Severe respiratory issue ex. ARDS & COPD
‣ Other treatments:
• Chest physiotherapy; Deep breathe & cough; Incentive spirometer; Nebulizer; Inhaler
◦Chest Trauma:
‣ Pneumothorax & Hemothorax: Lung collapsed with seeping into pleural space
• S/S for both: Uneven chest rise; diminished/absent breathe sounds on affected side
Tension (emergency) → Tracheal deviation; JVD
• Diagnostic: Thoracentesis
◦Assist pt to edge of bed and to lean over bedside table
◦Educate to remain still during procedure
◦Assess q4hr + position HIGH fowler 90°
• Intervention:
◦Chest tube
◦Needle decompression (temporary alleviation of pressure to prepare for chest tube)
, ‣ Flail Chest: Fracture of ribs in atleast 2 different places
• S/S: Paradoxical breathing (inhale ribs suck inside, exhale ribs push out); very Painful in affected area that increases with
movement
• Interventions:
◦Splinting or Direct pressure
◦Positive pressure mechanical ventilation
◦IV fluids
◦Pain management
◦Physiotherapy and Hygiene
◦Chest tube:
‣ Water seal: Tidaling with occasional (intermittent) bubbles ✅
• If NO tidaling check for kinks, listen to lung sounds
• If CONTINUOUS bubbling, check for leaks
‣ Assess site for: Infection; Leaks → Subcutaneous emphysema
‣ IF S/S of Tension pneumo (tracheal deviation, absent breath sound on one side) → assess for kinks or clamps
‣ Clean with Chlorhexidine & dressing is covered with tape
‣ Keep drainage system BELOW level of heart/chest and upright at all times. Cough & deep breath q2hr
‣ IF system becomes unattached → cover with sterile gauze, tape 3 sides, call provider
‣ Before removal:
• Confirm bilateral breath sounds; CXray; Premedicate (pain); Cover site with occlusive dressing
• Educate patient as doctor removes chest tube have patient BARE DOWN (Valsalva)
• C: Circulation
◦Pump (Heart)
‣ Issues: Lethal Dysrhythmias (VTach & VFib); Congestive HF; Cardiogenic/ Obstructive shock; Cardiac arrest
‣ For Cardiac arrest causes refer to chart below
◦Distribution (Vessels)
‣ Occlusion
‣ MI:
‣ Loss of pulse to extremity
◦Volume
‣ Bleeding internal VS external
‣ S/S: ↑HR; if bleeding in the abdomen → rigid boardlike abdomen & bruising
‣ Intervention:
• IV fluids (isotonic & colloids)
• for external bleed: Direct pressure; Tourniquets
to
• D: Disability
◦Perform neurological assessment for LOC
◦Assess motor & sensations for weakness, numbness, tingling
◦HIGH alert if trauma to head, neck, back
◦If GSC is <8 we INTUBATE
• E: Exposure
◦Remove cause of injury (chemical/thermal burn)
◦Remove all clothing (save for evidence)
◦Inspect the back (use log-roll method)
◦Prevent hypothermia
