Medical Emergencies: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of medical emergencies in order to:
- Apply knowledge of pathophysiology when caring for a client experiencing a medical emergency
- Apply knowledge of nursing procedures and psychomotor skills when caring for a client experiencing a medical emergency
- Explain emergency interventions to a client
- Notify primary health care provider about client unexpected response/emergency situation
- Perform emergency care procedures (e.g., cardio-pulmonary resuscitation, respiratory support, automated external defibrillator)
- Provide emergency care for wound disruption (e.g., evisceration, dehiscence)
- Evaluate and document the client's response to emergency interventions (e.g., restoration of breathing, pulse)
Applying a Knowledge of Client Pathophysiology When Caring for a Client Experiencing a Medical Emergency
One of the most challenging things that nurses do is applying a knowledge of client pathophysiology when a medical emergency occurs.
Life threatening emergencies focus on the here and now as the client's condition often changes in a rapid and sometimes unpredictable manner. Of the many ways that nurses can somewhat predict the possibility of a medical emergency is knowing all they can know about the client, their medical history and their current physical status, understanding the pathophysiology of their current condition or situation and applying this knowledge to the possible complications and adverse responses to not only their health related problem but also to the treatments and procedures that may be currently placing them in jeopardy for a medical emergency.
The nurse must readily identify and respond to all medical emergencies when they occur and they must also be able to rapidly and knowledgably apply priority setting and critical thinking skills during a time when needs, priorities and the client condition are rapidly changing. This is the time for short term minute to minute simultaneous client care planning and interventions.
As previously discussed in the "Integrated Process: The Nursing Process" and the section entitled "Setting and Establishing Client Priorities", priorities of care are established using a number of methods and frameworks including the ABCs, Maslow's Hierarchy of Needs, and the ABCs combined with the MAAUAR method of priority setting. The ABCs method of priority setting identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order; Maslow's Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others, and the self-actualization needs in that order of priority from the highest priority to the lowest priority; and the ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest priorities which is then followed with the 2nd and 3rd priority level needs of the MAAUAR method of priority setting, as previously detailed in the previous section of this NCLEX RN review.
Applying a Knowledge of Nursing Procedures and Psychomotor Skills When Caring for a Client Experiencing a Medical Emergency
Cardiopulmonary arrest is the sudden loss of cardiac function, the cessation of breathing and the client's complete loss of consciousness, as the result of a significant disturbance of the heart' electrical impulses, such as ventricular tachycardia and asystole, as discussed previously in the sections entitled "Hemodynamics: Identifying Cardiac Rhythm Abnormalities" and "Intervening to Improve the Client's Cardiovascular Status".
The immediate treatment for sudden cardiac arrest is cardiopulmonary resuscitation (CPR) and defibrillation, as indicated by the client's condition.
Airway obstructions can be partial or complete. A complete airway obstruction is signalled with the lack of any cough or other noises from the patient. The airway must be opened using the techniques you have learned when you took your Basic Life Support course. Intubation, when necessary, is also done.
A partial airway obstruction can be determined by listening to the patient's cough and other respiratory noises. A cough that is not efficient indicates a more severe airway obstruction than a cough that is effective in terms of clearing the airway of secretions and/or foreign bodies. The patient who is coughing should be encouraged and prompted to continue to cough. Visible foreign bodies that can be removed and should only be removed if there is no chance of pushing the foreign body further into the airway.
The look, listen and feel assessment for breathing to determine whether or not the patient is spontaneously breathing on their own includes looking at the chest to see if it rises and falls, listening for any breath sounds from the nose or mouth, and feeling the chest and upper abdomen to see if there is any movement present. Rescue breathing is done when the patient is not breathing and the airway is open.
Chest compressions are done, as you learned in your Basic Life Support course, on all patients who are unconscious, unresponsive, not breathing and pulse less.
Defibrillation gives an electric shock to the heart. There are standard external defibrillators which are typically found in hospitals and other healthcare facilities and used by nurses, transvenous defibrillators, implantable cardioverter defibrillators, and automated external defibrillators.
Automated external defibrillations are most often found in the community and outside of healthcare facilities. Automated external defibrillations are simple to use and there is no need to be able to recognize cardiac arrhythmias or interpret cardiac rhythm strips. Automated external defibrillations are intended to be used by the general public without any healthcare or nursing knowledge of experience.
The steps for using an automated external defibrillation is turn the machine on, put the pads on the patient's chest as shown on the machine, and then listen to and follow the automated instructions of the automated external defibrillation.
In addition to the most severe of all medical emergencies, there are many other conditions that can lead to a life threatening medical emergency and these conditions can be classified as:
- Cardiovascular system medical emergencies
- Gastrointestinal medical emergencies
- Respiratory medical emergencies
- Renal medical emergencies
- Central and peripheral nervous system medical emergencies
- Musculoskeletal system medical emergencies
- Obstetrical and gynecological medical emergencies
- Medical emergencies affecting the ear, nose and eyes
- Medical emergencies affecting the mouth and dental structures
The immediate medical care and interventions, in addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, for a number of cardiovascular emergencies, in addition to the previously discussed cardiac arrest, include the following:
Heart Failure
Brief Description: Heart failure occurs when the heart can no longer pump the ample amount of oxygenated blood that the body needs and demands to sustain life and to maintain the necessary bodily functions. Although left sided heart failure and left ventricular malfunctioning is more common than right sided heart failure and right ventricular malfunctioning, heart failure can be both right sided and left sided.
Signs and Symptoms: The signs and symptoms associated with heart failure include tachycardia, hypotension, lethargy, an intolerance of activity, dyspnea, related anxiety, the retention of excessive bodily fluid and skin pallor.
Interventions and Treatments: ACE inhibitors, angiotensin II receptor antagonists, beta blockers, diuretics, a sodium restricted diet, an implanted cardioverter and or pacemaker and a physician approved exercise regimen may be indicated for the client, as based on their current cardiac status.
Complications: Virtually, all bodily systems and tissues can be jeopardized and compromised with heart failure; these systems and tissues can include the renal system, the client's hemodynamic stability, and the pulmonary system. Respiratory and cardiac arrest can occur when treatment is not successfully rendered to the affected client.
Cardiac Tamponade
Brief Description: Cardiac tamponade causes the heart to not fill, contract and pump in the normal manner because an abnormal accumulation of fluid is present in the pericardial sac around the heart.
Signs and Symptoms: The signs and symptoms of cardiac tamponade include high central venous pressure, scant urinary output, severe hypotension, impaired peripheral perfusion, impaired peripheral pulses, narrowing of the pulse pressure, tachycardia, tachypnea, dyspnea, a loss of consciousness, and jugular vein distention.
Interventions and Treatments: Emergency measures to correct hypotension, oxygen supplementation, and a pericardiocentesis may be indicated for the client.
Complications: Cardiac arrest.
Hypertensive Crisis
Brief Description: Hypertensive crisis is a sudden, significant rise in the client's blood pressure that typically occurs unpredictably and without warning.
Signs and Symptoms: The signs and symptoms can include chest pain, the signs and symptoms of heart failure and/or a myocardial infarction, an altered level of consciousness, headache, cardiovascular compromise, oliguria, renal compromise, and renal failure.
Interventions and Treatments: Immediate treatment with emergency intravenous antihypertensive medications such as nitroprusside in combination with an ACE inhibitor or a beta blocker which should decrease the blood pressure by about 30 percent in one half an hour.
Complications: Renal failure, myocardial infarction, heart failure, and cardiac arrest.
Superior Vena Cava Syndrome
Brief Description: Superior vena cava syndrome is the compression of the vena cava which prevents the normal return of the body's circulating blood to the heart.
Signs and Symptoms: Tachypnea, dyspnea, venous stasis, a loss of consciousness, edema, seizures, respiratory and/or cardiac arrest.
Interventions and Treatments: Mechanical ventilation, oxygen supplementation, and seizure precautions.
Complications: Respiratory arrest and cardiac arrest
Septic Shock
Brief Description: Massive systemic infection that leads to massive vasodilation throughout the entire body
Signs and Symptoms: Massive hypotension, adventitious breath sounds, decrease cardiac output, microemboli, peripheral vasoconstriction, a widened pulse pressure, metabolic acidosis and respiratory alkalosis
Interventions and Treatments: Fluid replacement, mechanical ventilation, oxygen supplementation, treatment of the underlying cause, the correction of metabolic acidosis and respiratory alkalosis, and at times, dialysis
Complications: Multisystem failure and death.
Hypovolemic Shock
Brief Description: The depletion of bodily fluids secondary to a number of different causes such as hemorrhage and severe dehydration
Signs and Symptoms: Decreased cardiac output, progressive and severe dehydration, and metabolic acidosis
Interventions and Treatments: Fluid replacement with lactated Ringers, blood, blood components and plasma expanders, and placing the client in the Trendelenburg position.
Complications: Multisystem failure and shutdown.
Acute Coronary Syndrome
Brief Description: A sudden, abrupt and serious reduction of the circulation to the heart
Signs and Symptoms: The signs and symptoms of acute coronary syndrome are similar to those of a myocardial infarction and they can include referred pain, chest pain, angina pain, dyspnea, diaphoresis, and nausea and vomiting.
Interventions and Treatments: The administration of nitroglycerin, angiotensin-converting enzymes, (ACE) inhibitors, angiotensin receptor blockers beta-blockers, calcium channel blockers, aspirin, thrombolytics, statin therapy drugs, and anticoagulant medications, surgical interventions such as a stent, coronary bypass surgery or angioplasty, particularly when the client has an acute ST-segment elevation MI (STEMI), may be indicated as based on the client's physical staus and compromise.
Complications: Myocardial infarction and death
Myocardial Infarction
Brief Description: Ischemia of the heart muscle secondary to the lack of oxygenated blood flow through the coronary arteries.
Signs and Symptoms: Some are "silent" and asymptomatic; others can present intermittent or constant diaphoresis, severe chest pain, shortness of breath, nausea and vomiting.
Interventions and Treatments: Oxygen supplementation, unfractionated heparin, intravenous fluids, nitroglycerin, pain management, aspirin, clopidogrel, anticoagulant therapy; and, at times, a percutaneous coronary intervention or a coronary artery bypass graft is indicated.
Complications: Life threatening cardiac arrhythmias, cerebrovascular accidents, emboli formation, and a weakened heart muscle.
Aneurysm Dissection and Rupture
Brief Description: Bulging of an artery that can lead to rupture and hemorrhage, particularly those aneurysms that are affecting the aorta which is the major artery in the body.
Signs and Symptoms: Asymptomatic until it dissects or ruptures and then it leads to massive hemorrhage and hypovolemic shock with the signs and symptoms described above for hypovolemic shock in addition to abdominal pain, tachycardia, clammy skin, nausea and vomiting when the abdominal aorta is affected. Thoracic aorta rupture and dissections can present with symptoms that can include shortness of breath, dysphagia, dyspnea, coughing, and pain in the chest, arms, jaw, neck, and/or back.
Interventions and Treatments: Endovascular repair of the aneurysm or an open abdominal repair, antihypertensive medications when there is a rupture and antihypertensive medications to prevent a rupture from occurring.
Deep Vein Thrombosis
Brief Description: Embolus formation
Signs and Symptoms: Can be asymptomatic or symptomatic. Some of the symptoms can include redness and discoloration of the skin proximate to the site of the thrombosis, pain, tenderness, swelling and warm skin at the site.
Interventions and Treatments: Interventions vary from the application of heat, the application of compression hose or a sequential compression device, the elevation of the affected extremity, the administration of anti-inflammatory NSAIDs, anticoagulants, thrombin inhibitors, and thrombolytics. At times a vena cava filter is surgically implanted.
Complications: Pulmonary embolus and death.
Cardiogenic Shock
Brief Description: The lack of adequate cardiac functioning that impedes sufficient cardiac output and systemic circulation as the result of some major ventricular malfunctioning and myocardial muscle damage
Signs and Symptoms: The signs and symptoms of cerebral and/or cardiac perfusion, tachycardia, a thready pulse, hypotension, tacypnea, chest pain, diaphoresis, cool and/or pale skin, confusion, agitation, shortness of breath, oliguria, anuria, and changes in the client's level of consciousness.
Interventions and Treatments: Medications such as dopamine, epinephrine, norepinephrine, and dobutamine can be administered to increase the client's blood pressure and cardiac output, oxygen supplementation, a temporary emergency pacemaker, pain relief, defibrillation, cardioversion and surgical procedures such as angioplasty, a coronary artery bypass, the implantation of a permanent pacemaker, as well as cardiopulmonary resuscitation and ACLS protocols as indicated.
Complications: Cardiac arrest, renal, cerebral and/or hepatic damage and failure, deadly cardiac arrhythmias and death.
Anaphylactic Shock
Brief Description: Massive, systemic circulation collapse and relaxation secondary to the body's impaired immune response to an allergen such as occurs with an allergic response to a drug such as penicillin, a food or an insect bite, for example
Signs and Symptoms: Severe and significant hypotension, laryngeal edema, respiratory distress, a lowered cardiac output, venous pooling and venous stasis, tachycardia, and a bounding pulse
Interventions and Treatments: If the cause of the anaphylaxis is an IV antibiotic the IV must be immediately removed. The immediate injection of epinephrine, rRespiratory support, cardiopulmonary resuscitation, and ACLS protocols as indicated.
Complications: Respiratory and cardiac arrest
Neurogenic Shock
Brief Description: The massive relaxation and collapse of the venules and arterioles of the circulatory system which most often occurs as the result of a spinal cord injury, including but not limited to, a traumatic spinal injury or one that results from the administration of spinal anesthesia
Signs and Symptoms: Fainting, syncope, hypotension and bradycardia
Interventions and Treatments: Medications to stimulate the sympathetic nervous system such as metarminol or atropine
Complications: Massive circulatory collapse and death
Obstructive Shock
Brief Description: A sudden obstruction of circulatory flow to the heart that occurs with the obstruction of a major vessel which can occur secondary to such disorders as cardiac tamponade, an embolus, aortic stenosis, and a pneumothorax
Signs and Symptoms: Hypotension, clammy, cool and pale skin, tachycardia, a thready pulse, hypothermia, distended neck veins, a change in the level of consciousness, shallow respirations, oral dryness, confusion, restlessness, anxiety, and cyanosis
Interventions and Treatments: The treatment of the underlying cause with a pericardiocentesis for cardiac tamponade or chest tube insertion and drainage for a pneumothorax, for example, in addition to fluid replacements and the management of the complications, signs and symptoms such as hypothermia and respiratory support for respiratory compromise.
Complications: Multisystem organ failure and death
Disseminated Intravascular Coagulation
Brief Description: Disseminated intravascular coagulation (DIC) is an acquired clotting factor abnormality that always occurs as the result of an underlying disorder or disease and not as a primary disorder
Signs and Symptoms: Blood clotting, hemorrhage, peripheral thrombosis, peripheral cyanosis, hypotension, hypothermia, tachycardia, hypoxia, cyanosis, acidosis, changes in terms of the client's level of consciousness, headaches, and affective behavioral changes
Interventions and Treatments: Fluid replacement, the administration of human activated protein C, blood and blood products such as fresh frozen plasma, packed red blood cells, and clotting factors and intravenous fluids.
Complications: Severely impaired organ perfusion, multisystem failure and death.
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of gastrointestinal medical emergencies include the following.
Intussusception
Brief Description: The loss of perfusion to an area of the intestine because the affected part of the intestine slides into another part of the intestine near the affected area
Signs and Symptoms: Knee to chest posturing, abdominal pain, bloody stool, fever, constipation, vomiting and diarrhea.
Interventions and Treatments: Decompression of the bowel with a nasogastric tube to suction, intravenous fluid replacements, and a surgical repair of the affected part of the intestine
Complications: Peritonitis, sepsis, shock and death when left untreated
Appendicitis
Brief Description: An acute infection and inflammation of the appendix which is attached to the cecum of the gastrointestinal tract.
Signs and Symptoms: Constant or intermittent classical McBurney's point pain in the lower right quadrant of the abdomen, a tense and rigid abdomen, rebound tenderness, a temperature, projectile vomiting, anorexia, malaise, lethargy and nausea
Interventions and Treatments: Antibiotics and an emergency appendectomy
Complications: A ruptured appendix, gangrene, peritonitis, sepsis, and death
Peritonitis
Brief Description: A massive inflammation and infection of the peritoneum which can result from a number of causes such as a perforated gastrointestinal ulcer and a ruptured appendix when the gastrointestinal contents, including E coli, enter the peritoneal space
Signs and Symptoms: The presence of severe and the abrupt onset of abdominal pain accompanied with abdominal guarding, rebound tenderness, decreased or absent bowel sounds, nausea and vomiting, abdominal distention, a fever, malaise, tachypnea, tachycardia, oliguria, anuria, and the other signs and symptoms of shock.
Interventions and Treatments: Pain management, the administration of antibiotics, intestinal decompression, and emergency surgical interventions to correct the underlying cause
Complications: Massive sepsis, shock and death
Gastrointestinal Hemorrhage
Brief Description: Massive bleeding in the gastrointestinal tract; this bleeding can originate at any point of the upper gastrointestinal tract and the lower gastrointestinal tract.
Signs and Symptoms: Changes in the color of the stools that can vary from a black and tarry looking stool, to a burgundy color stool, to a coffee grounds color stool, to a bright red stool with or without evidence of blood clots depending on the section of the gastrointestinal tract that is adversely affected. Some of the other signs and symptoms can be vomiting, hypotension, vomiting blood, skin pallor, weakness, shortness of breath and the signs and symptoms of hypovolemic shock, as previously discussed in this section of the NCLEX RN review.
Interventions and Treatments: Gastric lavage and suctioning, the administration of blood and blood products, intravenous fluid replacement and medications to support the client's cardiovascular functioning
Complications: Hypovolemic shock and death
Esophageal Varices
Brief Description: The pathophysiological enlargement of the veins of the lower esophagus that most often result from hepatic failure and portal hypertension
Signs and Symptoms: They are asymptomatic until they rupture and lead to hemorrhage, shock, vomiting of bright red blood and black stools
Interventions and Treatments: The administration of medications to decrease the portal hypertension, surgical interventions such as banding off the bleeding vessels, and measures to correct the hypovolemic shock if it has occurred as the result of this medical emergency.
Complications: Hypovolemic shock and death
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of respiratory medical emergencies include the following:
Obstructions of the Respiratory Tract
Brief Description: A partial or complete obstruction and closure of the respiratory tract can occur secondary to a number of different causes including aspiration of a foreign body or a bodily substance such as respiratory secretions and vomitus, chemical inhalation and ingestion, anaphylactic reactions, pneumonia, croup, an abscess, a tumor and epiglottitis, among other causes
Signs and Symptoms: A partial airway or respiratory tract obstruction is accompanied with coughing, panic, restlessness, anxiety, air hunger, wheezing and other unusual respiratory sounds; and complete airway obstructions are characterized with apnea, cyanosis, the loss of consciousness, and cyanosis in addition to the other signs and symptoms associated with hypoxia.
Interventions and Treatments: The Heimlich maneuver, the removal of the source of the obstruction, oxygen administration, the placement of an endotracheal or nasotracheal tube and mechanical ventilation when the condition is severe and otherwise not corrected.
Complications: Aspiration pneumonia, respiratory distress and respiratory arrest and death.
Chronic Obstructive Pulmonary Disease
Brief Description: Chronic obstructive pulmonary disease, which consists of chronic bronchitis and emphysema, entails the thickening of the mucus production and the lung lining, and the loss of elasticity and thickening of the alveoli, respectively.
Signs and Symptoms: These physiological changes lead to respiratory difficulty, hypoxia, cyanosis and other symptoms associated with impaired oxygen and gas exchanges in the lungs.
Interventions and Treatments: Emergency treatments and interventions include oxygen supplementation, corticosteroid administration, the administration of an anticholinergic drug and a B2 agonist medication, intubation and mechanical ventilation when indicated
Complications: Hypoxia, respiratory arrest and death.
Aspiration
Brief Description: The abnormal entry of bodily fluids, food or another foreign body into the respiratory tract.
Signs and Symptoms: Coughing, chocking, and the signs and symptoms of a respiratory obstruction, as discussed above.
Interventions and Treatments: Correction of the obstruction, prophylactic antibiotic therapy to prevent aspiration pneumonia, oxygen supplementation, intubation and mechanical ventilation
Complications: Aspiration pneumonia, airway obstruction, respiratory distress, respiratory arrest and death
Inhalation Lung Injuries
Brief Description: Injuries that occur from the inhalation of toxic substances as occurs from household cleaning products and dangerous combinations of the same, ammonia, smoke, chlorine and acts of terror.
Signs and Symptoms: The signs and symptoms differ according to the substance and they can include respiratory distress, dyspnea, airway obstruction, bronchospasm, pulmonary edema, and hemorrhage when the inhaled agent is corrosive.
Interventions and Treatments: Oxygen supplementation, corticosteroids, bronchodilators, and mechanical ventilator support when indicated
Complications: Lung scar tissue formation, respiratory arrest and death
Pleural Effusion
Brief Description: The abnormal collection of fluid around the lung(s) in the pleural space as the result of an abnormal decrease in the absorption of this fluid and/or the overproduction of this fluid
Signs and Symptoms: Shortness of breath, dyspnea, coughing, chest pain and a possible fever
Interventions and Treatments: In addition to treating any underlying causes, the emergency interventions for this potentially life threatening disorder include supplemental oxygen, a thoracentesis, chest tube placement and drainage, and other measures to correct any of the signs and symptoms
Complications: Respiratory distress, respiratory failure and respiratory arrest which can lead to death when this medical emergency is not promptly and effectively treated.
Pneumothorax
Brief Description: The complete or partial collapse of the lung because air has entered the pleural space and created positive pressure on the lung and eliminated the normal negative pressure of the pleural space which is necessary for the expansion of the lung during the respiratory cycle.
Signs and Symptoms: An increase in the work of breathing, shortness of breath, dyspnea, the use of the accessory muscles of breathing, hypoxia, tachycardia, tachypnea, hypotension, chest pain, the shifting of the trachea and the mediastinum to the side opposite of the tension pneumothorax, hyperextension of the chest, and circulatory collapse
Interventions and Treatments: The insertion of and maintenance of a chest tube to drainage, the aspiration of the abnormal air collection in the pleural space, a surgical repair of the injured lung area, and respiratory support such as oxygen supplementation
Complications: Respiratory distress, hypoxia and respiratory arrest
Acute Respiratory Distress Syndrome
Brief Description: The sudden onset of life threatening respiratory distress and hypoxia that can result from a number of causes such as sepsis, trauma, chemical inhalation, aspiration and pneumonia.
Signs and Symptoms: An increase in the work of breathing, dyspnea, shortness of breath, adventitious breath sounds, fatigue, cyanosis, tachypnea, hypotension, hypoxia, and hypotension.
Interventions and Treatments: Intubation, mechanical ventilation, oxygen supplementation, and the treatment of the underlying cause
Complications: Respiratory distress, hypoxia, multisystem failure and respiratory arrest
Atelectasis
Brief Description: The collapse of the lung as the result of one of many causes such as aspiration, the poor placement of an endotracheal tube, pleural effusion and a pneumothorax
Signs and Symptoms: Decreased lung volumes, chest pain, dyspnea and the signs and symptoms of hypoxia when severe
Interventions and Treatments: Coughing, deep breathing and any respiratory support that is indicated by the severity of the atelectasis
Complications: Respiratory distress, hypoxia, multisystem failure and respiratory arrest
Flail Chest
Brief Description: An instability of the chest wall and a decrease in the expansion of the chest wall as the result of some trauma such as fractured ribs
Signs and Symptoms: Evidence of chest trauma, palpable rib fractures, the presence of subcutaneous air at the site of the injury, inspiratory chest wall retraction, and paradoxical chest wall movement.
Interventions and Treatments: Pain management, gentle pressure over the affected area, fixation of the fractured ribs, oxygen supplementation, chest tube insertion to prevent a pneumothorax, and mechanical ventilation when indicated
Complications: Pneumothorax, pneumonia, respiratory distress, respiratory failure, hypoxia and death
Hemothorax
Brief Description: The complete or partial collapse of the lung because blood has entered the pleural space and created positive pressure on the lung and eliminated the normal negative pressure of the pleural space which is necessary for the expansion of the lung during the respiratory cycle
Signs and Symptoms: The same signs and symptoms as discussed immediately above under "Pneumothorax"
Interventions and Treatments: The interventions and treatments as discussed immediately above under "Pneumothorax"
Complications: The same complications as discussed immediately above under "Pneumothorax"
Respiratory Syncytial Virus (RSV)
Brief Description: A highly infectious communicable upper respiratory infection that commonly causes bronchiolitis
Signs and Symptoms: Thick mucus production, the accumulation of excessive respiratory secretions in the bronchioles, wheezing, tachypnea, cyanosis, coughing, respiratory stridor, listlessness, pharyngitis, hypercapnia and episodes of apnea
Interventions and Treatments: Symptomatic and supportive care, intravenous fluid replacements, supplemental oxygen administration, and other respiratory interventions, such as intubation and mechanical ventilation, when it is indicated
Complications: Respiratory failure and respiratory arrest
Fat Emboli
Brief Description: The entry and presence of fat globule emboli from the marrow of the bone into the circulatory system. This life threatening emergency can occur as the result of a skeletal fracture, severe burns, blunt trauma to the liver and some severe infections.
Signs and Symptoms: Restlessness, a headache, a decreased level of consciousness and/or cognition, seizures, dilation of the pupils, pulmonary infiltration, hypoxia, right sided heart failure, a petechial rash, venous and capillary stasis, a low hematocrit level, fever, tachycardia, diminished urinary output, anuria, and evidence of fat globules in the urine.
Interventions and Treatments: Symptomatic and supportive care including supplemental oxygen administration, and other respiratory interventions, such as intubation and mechanical ventilation, when it is indicated
Pulmonary Emboli
Brief Description: The formation of and the travelling of an embolus into the lungs.
Signs and Symptoms: Increased work of breathing, shortness of breath, tachypnea, tachycardia, hypoxia, cyanosis, dyspnea, chest pain, coughing, anxiety and panic.
Interventions and Treatments: Respiratory support, the administration of streptokinase or a tissue plasminogen activator, anticoagulation therapy and oxygen supplementation are often indicated
Complications: Respiratory distress, respiratory arrest and death
Pulmonary Edema
Brief Description: The filling of the alveoli with fluid that leads to the poor gas exchanges of oxygen and carbon dioxide
Signs and Symptoms: Adventitious breath sounds, fatigue, cyanosis, dyspnea, shortness of breath, tachypnea and hypoxia
Interventions and Treatments: The administration of diuretics, suctioning, intubation, oxygen supplementation and mechanical ventilation as indicated by the client's respiratory status
Complications: Respiratory distress, severe hypoxia, respiratory arrest and death
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of renal medical emergencies include the following:
Renal Calculi
Brief Description: Renal calculi, often referred to as kidney stones, are small, hard mineral and acidic salt deposits that abnormally form in the kidney
Signs and Symptoms: Asymptomatic until these calculi begin to move into the ureter at which time the presenting signs and symptoms can include intermittent or constant and severe pain located in the side and back below their ribs, pain spreading to the lower abdomen and groin, dysuria, pink, red, or brown urine, cloudy, foul smelling urine, urinary frequency, urinary urgency, nausea, vomiting and the signs of infection such as a temperature and chills when this medical emergency is accompanied with an infection.
Interventions and Treatments: Increased oral fluid intake, pain management, the administration of an alpha blocker, extracorporeal shock wave lithotripsy, and a surgical percutaneous nephrolithotomy
Complications: Hemorrhage, chronic urinary tract infections, renal damage and renal failure
Pyelonephritis
Brief Description: Pyelonephritis is a kidney infection that originates in the urethra or bladder and then spreads to the kidneys. Immediate medical attention is required, and if not treated or not treated effectively, this infection can permanently damage renal function and sepsis can occur.
Signs and Symptoms: Upper back and flank pain, a high fever, urinary frequency, urinary urgency, chills, nausea, vomiting, pus in the urine, hematuria, and burning while urinating.
Interventions and Treatments: The administration of antimicrobial therapy, often coupled with the need for hospitalization and intravenous antibiotic therapy
Complications: Renal damage, massive sepsis, shock and renal failure
Renal Failure: Acute and Chronic
Brief Description: Renal failure can be acute or chronic. Acute renal failure can be possibly result from a number of different causes including poor renal perfusion, infection, poisoning, hemorrhage, dehydration, obstructions, hypertension, and some medications like gentamicin, streptomycin, naproxen and ACE inhibitors
Signs and Symptoms: Nausea, vomiting, confusion, oliguria, anuria, edema, anorexia, anxiety and flank pain
Interventions and Treatments: Hemodialysis, peritoneal dialysis, kidney transplantation, fluid restrictions, and the administration of medication such as phosphate binders, ferrous sulfate for the treatment of anemia, erythropoietin, and blood transfusions when indicated.
Complications: Renal shutdown and death
Sickle Cell Anemia Crisis
Brief Description: Sickle cell anemia, an autosomal recessive genetic disorder, can lead to the hemolysis and rupture of the abnormally sickled red blood cells which in turn adversely affects the haemoglobin and all bodily systems during sickle cell anemia crisis.
Signs and Symptoms: Splenic sequestration, anemia, cardiac and pulmonary system damage, pain, extreme fatigue, leg ulcerations, ocular damage, bone infarcts and aseptic necrosis, hand and feet swelling which is referred to as dactylitis
Interventions and Treatments: Symptomatic treatment with analgesics, fluids, rest, oxygen supplementation, the administration of hyroxyurea to stimulate the production of haemoglobin and the administration of blood and blood components.
Complications: Multisystem failure and shutdown which can lead to death with inadequate treatment
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of central and peripheral nervous system medical emergencies include the following.
Cerebrovascular Accidents
Brief Description: An insult to the brain that can lead to permanent disability and even death. Cerebrovascular accidents, also referred to as strokes, can result from ischemia secondary to atherosclerosis, vasculitis, emboli, cerebral hypoperfusion and also as the result of a cerebral hemorrhage secondary to hypertension, a brain tumor, a ruptured cerebral aneurysm, and cerebral vascular abnormalities.
Signs and Symptoms: The signs and symptoms of a cerebrovascular accident vary according to the severity of the cerebrovascular accident and the region of the brain that is adversely affected with the cerebrovascular accident. Dysphagia, impaired vision, personality changes, unilateral neglect and impaired urinary elimination can occur as the result of a cerebrovascular accident that adversely affects the anterior region of the brain; and ataxia, vertigo, nystagmus, diplopia, visual disturbances, and bilateral or unilateral sensory and motor deficits can occur as the result of a cerebrovascular accidents that adversely affect the anterior region of the brain; and, brain stem cerebrovascular accidents are usually accompanied with altered level of consciousness, severe respiratory compromise, hypoxia, and respiratory arrest.
Interventions and Treatments: Complications are prevented with the administration of thrombolytic medications within 3 or 4 hours after the symptoms appear when the client has had a thrombolytic stroke, oxygen supplementation, the control of hypertension with antihypertensive drugs, anticonvulsant medications such as phenytoin, intubation, and possible mechanical ventilation when the client indicates the need for these treatments
Complications: Seizures, increased intracranial pressure, post ischemic inflammatory encephalitis and death.
Guillain Barré Syndrome
Brief Description: Guillain Barré syndrome is an acquired inflammatory condition which most often occurs as the result of campylobacter jejuni infection; this life threatening disorder leads to peripheral nerve demyelination.
Signs and Symptoms: The signs and symptoms of Guillain Barré syndrome are pain, paresthesia, numbness, diaphoresis, the lack of the autonomic nervous system's sweating reflex, bilateral and ascending paralysis, absent deep tendon reflexes, high levels of protein in the cerebrospinal fluid, as well as blood pressure and heart rate changes.
Interventions and Treatments: The prevention of respiratory failure and respiratory arrest, the ABCs, ACLS protocols, intubation, oxygen supplementation, mechanical ventilation and long term restorative and rehabilitative care are often indicated.
Complications: Respiratory distress, respiratory arrest, coma and death.
Meningitis
Brief Description: This life threatening infection leads to the inflammation of the pia layers of the meninges and the cerebrospinal fluid. There are a number of pathogens that can cause meningitis including viruses, fungi and bacteria such as neisseria meningitis, haemophilius influenzae, streptococcus pneumoniae, group B streptococcus, and gram negative pathogens such as Escherichia coli, serratia and enterobacter
Signs and Symptoms: Classical nuchal rigidity, a decrease in terms of the clients mental status, a positive Brudzinski sign, a positive Kernig's sign, a fever, headache, a purpural or petechial skin rash, arching of the back and neck, seizures, photophobia, and bulging fontanels when an infant is affected with meningitis prior to the closing of these fontanels.
Interventions and Treatments: Seizure precautions, the frequent monitoring of the client's neurological signs, maintaining a quiet environment, medications such as antipyretics, antibiotics and intravenous fluids as ordered and the close monitoring of the client's neurological and vital signs.
Complications: Permanent and irreversible cerebral damage and death
Encephalitis
Brief Description: Encephalitis, which is somewhat similar to meningitis, is an inflammation of cerebral tissue as the result of a virus such as the West Nile virus, herpes simplex, and toxoplasma and, at times, as the result of post ischemic inflammatory encephalitis after a cerebrovascular accident.
Signs and Symptoms: Nausea, vomiting, fever, headache, altered neurological functioning, motor weakness, disorientation, seizures and unusual behavioral changes.
Interventions and Treatments: Seizure precautions, the frequent monitoring of the client's neurological signs, maintaining a quiet environment, bed rest, increased fluid intake, medications such as antipyretics and antiviral drugs such as ganciclovir, foscarnet and acyclovir, intravenous fluid replacements as ordered and monitoring of the client's vital signs.
Complications: Long lasting or permanent changes in terms of the client's personality, muscular weakness, a lack of fine and/or gross motor coordination, paralysis, fatigue, impaired memory, impaired hearing, visual deficits, impaired speech, coma and death.
Brain Herniation
Brief Description: The abnormal protrusion and herniation of the brain stem through the foramen magnum at the base of the skull; this life threatening emergency is typically the result of increased intracranial pressure which was fully described and discussed in the previous section entitled "Assisting the Client in Receiving Appropriate End of Life Physical Symptom Management".
Signs and Symptoms: Cushing's reflex, Cheyne Stokes respirations, decorticate or decerebrate posturing, hypoxia, apnea, and respiratory failure.
Interventions and Treatments: The preservation of life if this is possible, the administration of anticonvulsant medications to prevent seizure activity, intravenous osmotic diuretics, like mannitol, to decrease the increased intracranial pressure, corticosteroids to decrease cerebral edema, anticonvulsant medications to prevent seizures, a planned barbiturate come to decrease the client's metabolic demands, intubation and mechanical ventilation as indicated
Complications: Permanent brain damage, seizures, coma, respiratory arrest and death.
Traumatic Head Injury
Brief Description: A traumatic injury to the skull and brain. A primary brain injury is one that occurs immediately after a trauma; the physical movement and displacement of the anatomical structures of the brain, contusions, vascular damage and widespread axonal shearing and tearing of the axons of the cerebral neurons occur and the damage is done immediately upon impact. Secondary traumatic brain injuries, unlike primary brain injuries, is not due to any type of traumatic physical or mechanical force, but instead, it occurs gradually and progressively over a period of time and not immediately after a trauma.
Signs and Symptoms: The signs and symptoms of a traumatic closed head injury include increased intracranial pressure, cerebral swelling and movement, cerebral ischemia, cerebral hypoxia, and impaired respiratory functioning in addition to hypotension, acidosis, hypocapnea, pupil dilation, decerebrate or decorticate posturing, seizures, and major changes in terms of the client's level of consciousness and awareness.
Interventions and Treatments: Treatments include medications such as mannitol which is a cerebral osmotic diuretic that decreases the fluid buildup, anticonvulsant medications to decrease the risk of seizure activity, the relief of cerebral edema using corticosteroids, oxygenation, mechanical ventilation, intravenous fluid replacement, blood pressure maintenance and the correction of any accompanying signs and symptoms in order to sustain life.
Complications: Increased intracranial pressure, permanent life altering brain damage, seizures, coma and death
Subarachnoid Hemorrhage
Brief Description: Hemorrhage and bleeding in the subarachnoid space which is the space between the brain and the meninges which are the thin tissues surrounding and covering the brain. This medical emergency occurs as the result of head trauma, a serious bleeding disorder and a bleeding cerebral aneurysm.
Signs and Symptoms: This medical emergency can be asymptomatic as well as symptomatic and presenting with signs and symptoms such as a severe, crushing headache which is often referred to as a thunder clap headache, a sensation of popping in the head, a decreased level of consciousness, nausea, vomiting, photophobia, a postcoital headache, confusion, irritability, numbness, a stiff neck and/or back, visual changes such as the development of blind spots, double vision and/or the loss of vision in one eye, seizures, muscular pain, unequal pupils, and drooped eyelids.
Interventions and Treatments: Bed rest, constipation prevention, the control of hypertension, the administration of nimodipine to prevent vasospasm, and the correction of the underlying cause such as the treatment of an aneurysm with a bypass, clip or endovascular coils.
Complications: Chemical meningitis, hydrocephalus, brain edema, vasospasm, coma and death.
Epidural Hematoma
Brief Description: A hematoma and bleeding into the region of the skull between the skull and the brain and into the dura mater. This emergency medical crisis is usually caused by head trauma and skull fractures.
Signs and Symptoms: Loss of consciousness, confusion, unilateral pupil dilation, a severe and crushing headache, nausea, vomiting, seizures, and lethargy
Interventions and Treatments: All interventions to preserve life, to prevent possible complications and to control the symptoms. Some interventions can include Burr holes in the skull to decrease the intracranial pressure, a craniotomy, the administration of anticonvulsant medications such as phenytoin and the administration of hyperosmotic agents such as hypertonic saline, mannitol and glycerol to reduce the brain swelling.
Complications: Permanent brain damage, brain herniation, paralysis, coma and death
Spinal Cord Injuries
Brief Description: A traumatic injury of the spinal cord which is part of the central nervous system. The American Spinal Injury Association (ASIA) classifies these injuries from A to E, as based on the severity of the sensory and motor losses that are sustained by the client.
A grade A spinal cord injury is the most severe of all; all sensory and motor function is lost. In contrast to the A grade spinal cord injury, grades B, C and D are incomplete injuries. Grade B spinal cord injuries consists of the loss of motor function at and below the level of the injury but some sensory functioning, including anal sensation, is preserved; a grade C spinal cord injury reflects the preservation of some muscular function below the level of the spinal cord injury; a grade D spinal cord injury is characterized with the preservation of more than 50% of muscular movement at and below the level of the injury; and a grade E spinal cord injury preserves normal sensory and motor function.
Spinal cord injuries can also categorized as tetraplegia and paraplegia injuries, which are the loss of or the impairment of the client's sensory and/or motor function originating at the cervical portion of the spinal cord which leads to poor or absent functioning of the legs, pelvic organs, arms and trunk and the pelvic organs and legs and the loss or impairment of, sensory and/or motor function originating at the thoracic, sacral or lumbar region of the spinal cord.
Lastly, spinal cord injuries are also categorized according to the type of force that was exerted to produce it and as penetrating and non penetrating. These forces include flexion, extension, compression and rotation. Penetrating spinal cord injuries, such as those that occur as the result of a gun shot wound, are serious and unstable because the cerebral neural tissue is lacerated and torn.
Signs and Symptoms: This medical emergency, in addition to the sensory and motor losses discussed immediately above, these injuries present with different signs and symptoms depending on the level of the injury and the completeness of the injury; the diaphragm, intercostal muscles and accessory breathing muscles may be impaired, the arterial blood gases are impaired, respiratory secretions can accumulate, aspiration, pain, nausea, vomiting, impaired urinary function, paralytic ileus, and hypothermia can also occur.
Interventions and Treatments: All interventions to preserve life and to prevent any possible complications such as further spinal cord damage are done. The ABCs, ACLS protocols, intubation, mechanical ventilation, immobilization and stabilization of the spinal cord using sand bags, head restraints and a Kendrick Extrication Device (KED) in the field, pain management, a nasogastric tube to suction and/or antiemetic medication can be used for nausea and vomiting and to avoid distention and aspiration, the administration of stool softeners and laxatives to prevent autonomic dysreflexia secondary to constipation and the correction of any hypothermia.
Complications: Spinal neurogenic shock, respiratory distress, respiratory arrest, poikilothermia which is the body's loss of ability to control and regulate the body temperature, autonomic dysreflexia which is a life threatening disorder that occurs most often with an over distention of the bowel or bladder, life threatening hypertension, compensatory bradycardia, all the hazards of immobility, fear and anxiety, permanent brain damage, seizures, coma and death
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of musculoskeletal system medical emergencies include the following.
Skeletal Fractures
Brief Description: The breakage of a bone as the result of some trauma. As discussed in the previous section entitled "Applying, Maintaining and Removing Orthopedic Devices", some of the several types of fractures are a greenstick fracture, an avulsion fracture, a comminuted fracture, a transverse fracture, an oblique fracture, a spiral fracture, an impacted fracture, a compression fracture, an open fracture and a depressed fracture such as that which may occur when the skull bones are pushed into the cranial space. Other types of fractures include a stress fracture which occurs among athletes, stable fractures, unstable fracture which are displaced thereby necessitating reduction, a closed fracture which is not accompanied with a breakage of the skin at the site, an incomplete fracture which affects only part of the bone, a complete fracture which adversely affects the entire cross section of the bone, and a pathological fracture which can occur as the result of a pre existing disease or disorder such as cancer.
Signs and Symptoms: Abnormal rotation such as occurs when the hip is fractured and the leg on the affected side externally rotates, shortening of the limb, muscular spasms, crepitus at the site, deforming angulation, pain, impaired neurological functioning such as cool skin proximate to the affected area, swelling, ecchymosis at the site, limited or absent muscular movement, impaired skin integrity and bleeding as may occur with an open fracture, impaired circulation, skin cyanosis and skin pallor such as occurs when the venous and/or arterial blood flow to the site is impaired and the area is deprived of adequate perfusion, distal ischemia which is assessed with the 5 Ps of pallor, paresthesia, pain, polar skin coolness and paralysis, impaired distal pulses, swelling, edema, thrills, bruits, and poor capillary refill times.
Interventions and Treatments: Pain management, immobilization of the affected limb, elevation of the affected limb, the application of cold to decrease the swelling, edema, and associated pain, internal or external fixation, casting, splinting and traction.
Complications: Deformity, compartment syndrome after a casting of a limb, a fat embolism, neurological and vascular impairments, osteomyelitis with an open compound fracture, and, at times, lifelong deformity and disability.
Dislocations and Subluxations
Brief Description: Dislocations and subluxations occur as the result of a traumatic injury; a dislocation occurs when the joints, or their articular surfaces of the bones are completely separated and are no longer articulated and connected with each other; and a subluxation is only a partial, rather than a complete, displacement and separation of the joints or articular surfaces.
Signs and Symptoms: Intense and severe pain, limitations in terms of the movement and mobility of the affected joint, changes in terms of the alignment and length of the affected limb, possible neurological and circulatory impairments, swelling, and abnormal limb rotation
Interventions and Treatments: Reduction with, for example, the Kocher method, the traction-counter traction and the Stimson method, or hanging arm technique, for a shoulder dislocation, immobilization after reduction, and analgesia
Complications: Fractures like a Bankart lesion or a Hill-Sachs lesion, neurological impairment, vascular impairments, circulatory and perfusion impairments, recurrent dislocations and residual joint stiffness.
Traumatic Amputation
Brief Description: The traumatic loss of a limb or a part of it. Traumatic amputations are classified as avulsion amputations, crush amputations, and guillotine amputations.
Signs and Symptoms: Pain, bleeding, haemorrhage, and the signs and symptoms of hypovolemic shock
Interventions and Treatments: The ABCs, ACLS protocols, the maintenance of the client's hemodynamics, the preservation and care of the amputated body part by keeping it dry and cool after it is cleaned with sterile saline and placed in a sealed plastic bag in the field and in the emergency department until surgical interventions are planned and done, the administration of broad scope antibiotics, surgical reattachment when possible,
Complications: The permanent loss of the limb, infection, neurological and circulatory compromise, disability, hypovolemic shock, and death
Mangled Limb
Brief Description: The traumatic mangling of an extremity that is classified according to a scale such as the Mangled Extremity Severity Score (MESS), the Mangled Extremity Syndrome Index (MESI), the Hannover Fracture Scale, the Predictive Salvage Index, and/or the Limb Salvage Index. These scoring scales guide decision making in terms of whether or not the limb can be saved or the need to amputate the affected limb is necessary.
Signs and Symptoms: Pain, fear, anxiety, and altered neurological and circulatory perfusion to the affected limb
Interventions and Treatments: The salvage, reconstruction and restoration of the limb when possible, pain management, the prevention of infection, measures to correct any hemorrhage and hypovolemic shock, immobilization, and the administration of broad scope antibiotics and the tetanus vaccine.
Complications: The loss of the mangled limb because restoration and reconstruction were not possible, infections, a planned surgical amputation, disability and possible impaired neurological and circulatory perfusion to the affected limb
Traumatic Blast Injuries
Brief Description: An explosion that leads to Injuries to the musculoskeletal and internal organs and one that can occur with an act of terrorism as occurred with the Boston Marathon massacre or an accident such as an explosion of a gas or a mining accident. Traumatic blasts carry debris, nails, glass, rocks and other projectiles in addition to the external application of undue pressure on the body and bodily parts.
Traumatic blasts can be primary, secondary and tertiary in terms of their classification. Primary traumatic blast injuries occur as the direct result of a blast and the amount of pressure it exerts on the body; secondary traumatic blast injuries occur as the result of flying debris and other projectiles that originated with the blast; and tertiary traumatic blast injuries occur as the result of blunt force trauma from the blast.
Signs and Symptoms: The stretching, shearing, tearing, and/or lacerations, a possible traumatic limb amputation, rupture damage and pressure to internal organs, particularly those like the colon and lungs that contain air or another gas, tissue and organ ischemia and necrosis, hemorrhage, ischemia and impaired perfusion, and a peppered appearance of the skin as the result of fragments and projectiles.
Interventions and Treatments: Some treatments, according to the nature and severity of this traumatic injury, can include a colon repair, an ostomy, a splenectomy, colon repair, a temporary or permanent colostomy, a nephrectomy, prophylactic antibiotics, the administration of the tetanus vaccine, wound care, the surgical removal of fragments and debris, incision and drainage, the ligation and clamping of major vessels that have been adversely affected, and possible amputations.
Complications: Infection, sepsis, hemorrhage, hypovolemic shock, failures of bodily organs that were affected, disability, limb loss, coma and death
Obstetrical and Gynecological Conditions
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of different obstetrical and gynecological medical emergencies include the following.
Some of the obstetrical medical emergencies that can adversely affect the pregnant woman and/or the developing fetus are:
- Maternal collapse and cardiopulmonary arrest which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Pulmonary embolus which was previously discussed and detailed in this section
- Ectopic pregnancy which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Preeclampsia and eclampsia which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Toxic shock syndrome which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Endometritis which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Salpingitis which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Tubo-Ovarian abscesses which was previously discussed and detailed in the section entitled "Assessing the Maternal Client For Antepartal Complications"
- Amniotic fluid embolism which is discussed below
- Vaginal bleeding which is discussed below
- Pelvic inflammatory disease which is discussed below
- Ovarian hyperstimulation syndrome which is discussed below
Amniotic Fluid Embolism
Brief Description: This obstetrical disorder, although rare in terms of incidence, is a leading cause of death among pregnant women. This disorder occurs when amniotic fluid enters into the maternal circulatory system and it usually occurs as the result of the labor process and some invasive procedures during pregnancy.
Signs and Symptoms: The onset of the signs and symptoms of an amniotic fluid embolus is rapid and abrupt and these signs and symptoms can include pulmonary hypertension, hypoxia, and respiratory distress during the first phase of this disorder; and hemorrhage and uterine atony in addition the onset of some of the complications of this disorder during the second phase of this life threatening obstetrical medical emergency. Other signs and symptoms include finger numbness and tingling, panic, hypotension, coagulopathy, nausea, vomiting, and chest pain.
Treatments and Interventions: The goal of treatment is to sustain the life of the mother and that of the fetus. Interventions can include oxygen supplementation, intravenous fluids, intubation, mechanical ventilation, the treatment of the hypotension and hypovolemia, the treatment of coagulopathy with fresh frozen plasma, cryoprecipitate, platelets, or a whole-blood, the administration of corticosteroids, continuous fetal monitoring, and an emergency caesarean section including a post maternal mortem caesarean section when indicated for the preservation of life.
Complications: Myocardial damage, left sided heart failure, disseminated intravascular coagulation (DIC), consumptive coagulopathy, cardiopulmonary arrest, fetal demise and maternal death.
Vaginal Bleeding
Brief Description: Abnormal vaginal bleeding can affect women of all ages. The types of vaginal bleeding include primary dysmenorrhagia, dysfunctional uterine bleeding, and abnormal uterine bleeding
Signs and Symptoms: The signs and symptoms of primary dysmenorrhagia are cramping and pain during menstruation; the signs and symptoms of dysfunctional uterine bleeding are an irregular menstrual cycle and heavy bleeding during menstruation; and the sign and symptom of abnormal uterine bleeding is vaginal bleeding that occurs at times other than that which is expected during the normal menstrual cycle such as after sexual intercourse.
Interventions and Treatments: Primary dysmenorrhagia is treated with an oral contraceptive, a non-steroidal anti-inflammatory drugs, the application of a heating pad, exercise, acupuncture, hypnosis, message and/or using transcutaneous electrical nerve stimulation (TENS); dysfunctional uterine bleeding can be treated, according to its cause, with the administration of oral contraceptives, estrogen, progestins and desmopressin when the client has a coagulation disorder, a hysterectomy, and an endometrial ablation.
Complications: Sterility with a hysterectomy, hemorrhage, and hypovolemic shock
Pelvic Inflammatory Disease
Brief Description: Pelvic inflammatory disease includes the presence of salpingitis, pelvic peritonitis, a tubo ovarian abscess and/or endometritis caused mostly by the Neisseria gonorrhoeae and Chlamydia trachomatis pathogens.
Signs and Symptoms: Acute pelvic pain, a fever, abdominal pain, guarding and/or rebound tenderness, abnormal vaginal bleeding and an elevated white blood cell count.
Interventions and Treatments: Hospitalization for pregnant women and those affected with a tubo ovarian abscess, the administration of an appropriate antimicrobial drug such as ceftriaxone, azithromycin, metronidazole and doxycycline.
Complications: Pelvic inflammatory disease can lead to serious and permanent scarring of the fallopian tubes and infertility, proneness for future ectopic pregnancies, sepsis, septic shock and death when left untreated.
Ovarian Hyperstimulation Syndrome
Brief Description: Ovarian hyperstimulation syndrome, which is another life threatening medical emergency, typically follows in vitro fertilization.
Signs and Symptoms: Decreased urinary output, anuria, intense abdominal pain, shortness of breath, diarrhea, and thirstiness
Interventions and Treatments: Depending on the severity of this disorder, the treatments and interventions can include hospitalization, the administration of anticoagulating medications, the administration of intravenous fluids, a paracentesis for ascites, respiratory support, analgesia, and increasing the daily fluid intake to about 3 liters per day
Complications: Respiratory distress, pleural effusion, ascites, pericardial effusion, coagulopathy, edema, hemoconcentration, and death
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of ear, nose and eye medical emergencies include the following:
Mastoiditis
Brief Description: A serious middle ear infection that adversely affects the mastoid bone
Signs and Symptoms: Tenderness, swelling and redness around the mastoid bone which lies behind the ear, irritability, severe ear pain, a temperature, pus and other ear drainage, and a displaced pinna which has been pushed away from the side of the head
Interventions and Treatments: Intravenous antibiotics, a myringotomy, and a mastoidectomy
Complications: The spread of this infection to the brain which can, like meningitis, can be life threatening, abscess formation, necrosis and permanent hearing loss
Ruptured Tympanic Membrane
Brief Description: A ruptured tympanic membrane occurs as the result of some middle ear pressure that can result from trauma, an infection, being slapped over the ear, using a Q tip to clean the ear, an explosive blast, in addition to a non penetrating trauma to the ear such as a significant change in altitude, sky diving and scuba diving.
Signs and Symptoms: Ear drainage which may be bloody, ear pain that may decrease when the pressure within the ear is relieved with the tympanic membrane rupture, and hearing loss
Interventions and Treatments: Antibiotics to treat an ear infection, the removal of a foreign body in the ear when that is the cause of the ruptured tympanic membrane, and pain management
Complications: Hearing loss which can be permanent and debilitating
Foreign Bodies in the Ear
Brief Description: The placement of a foreign body in the ear such as a piece of a broken toy or a bead. Children are at greatest risk for this ear injury and trauma.
Signs and Symptoms: Itching, ear discharge, the signs and symptoms of a ruptured tympanic membrane when the foreign body has affected this membrane, and visualization of the foreign body using an auroscope
Interventions and Treatments: Removal of the foreign body using an auroscope or, when necessary, using crocodile forceps when the foreign body is too large to remove with the auroscope as often occurs when organic matter such as a vegetable swells and expands after being placed in the ear
Complications: Ruptured tympanic membrane and hearing loss
Epistaxis
Brief Description: Epistaxis is a nasal hemorrhage that can occur as the result of picking the nose, trauma, the insertion of a foreign body into the nose, multiple traumas, nasal dryness and the use of anticoagulant medications.
Signs and Symptoms: Hemodynamic instability and hypovolemia when the hemorrhage is severe, panic, and fear
Interventions and Treatments: The application of continuous and firm pressure at Little's area just below the nasal bone for about 15 seconds or more while the client is sitting up with their head forward, blood vessel cauterization, nasal packing, the placement of a large bore cannula or a balloon catheter when pressure does not successfully stop the epistaxis
Complications: Infections such as sinusitis and aspiration of and airway obstruction secondary to the dislodgement and displacement of any nasal packing or catheter
Foreign Bodies in the Nose
Brief Description: A foreign body like a piece of food, a button or a bead that is placed in the nose. Again, children are at risk for this trauma and other traumas associated with foreign objects being placed in bodily orifices.
Signs and Symptoms: Unilateral nose drainage which can be bloody and nasal pain
Interventions and Treatments: Having the client blow out the affected nostril while pinching off and occluding the unaffected nostril, and the careful removal of the foreign body using forceps while insuring that the foreign body does not get pushed into the nostril any further during this effort, a
Complications: Nasal trauma and bleeding
Air Bag Injuries
Brief Description: This trauma occurs when an automobile air bag is deployed. These injuries can affect the eyes, nose, face, ears and other bodily structures.
Signs and Symptoms: Contusions, lacerations, retinal tears, retinal detachment, hemorrhage, thermal burns, abrasions and pain
Interventions and Treatments: The treatment of the injuries according to their severity and location
Complications: Blindness, hemorrhage, hypovolemia, enucleation, corneal alkaline burns, permanent deformity
Orbital Blow Out Fractures
Brief Description: The boney structures of the eye's orbit are fractured and, when this occurs, intraorbital tissue is pushed out into one of the paranasal sinuses.
Signs and Symptoms: Impaired eye movement, swelling, pain, crepitus, retinal bruising, diplopia, corneal abrasions and a detached retina
Interventions and Treatments: The application of cold, and client education that underscores the client's need to protect the eye and to avoid sneezing and blowing the nose
Complications: Retinal detachment and enucleation
Corneal Foreign Body Trauma
Brief Description: Corneal foreign body trauma can occur as the result of many forces and causes such as an explosion, chiselling and using power tools without the use of safety goggles
Signs and Symptoms: Pain, ocular redness, a rust color appearance of the eye when a piece of metal has entered it and impaled itself in the eye, and a loss of vision if the foreign body is impaled in the eye
Interventions and Treatments: Fluorescein staining followed by an ophthalmologist's removal of the foreign body using a slit lamp, a moistened cotton bud, and a steady hand, and the application of antiseptic ocular drops to prevent secondary eye infections
Complications: Infection, visual losses, eye ulceration, corneal perforation and scarring
Globe Rupture
Brief Description: Globe rupture is a highly serious ocular emergency that results from a blunt or penetrating trauma such as occurs with the entry of a projectile or a knife into the globe. These traumatic injuries are classified and described as posterior and anterior globe ruptures. Posterior globe injuries affect the retina, sclera, and vitreous; and anterior globe injuries adversely affect the cornea, anterior chamber, iris and lens.
Signs and Symptoms: Chemosis, decreased intraocular pressure, pain, conjunctival pigmentation, impaired eye movement, nausea, diplopia and other visual impairments, a tear drop shaped pupil, and vitreous hemorrhage
Interventions and Treatments: Patching the unaffected eye is patched to decrease eye movement, pain management, corticosteroid drugs to decrease the risk of sympathetic ophthalmia, the avoidance of activities that can dangerously increase intraocular pressure such as heavy lifting, straining while moving the bowels, coughing, and bending over, and surgical interventions, as indicated and based on the location and the severity of the trauma, including the surgical enucleation of the affected eye to prevent sympathetic ophthalmia.
Complications: Enucleation and blindness
Hyphemia
Brief Description: Hyphemia is bleeding into the anterior chamber of the eye between the cornea and the iris. Hyphemia can occur as the result of external compression of the eye, a blunt trauma, falls and fist fights as well as from spontaneous, nontraumatic disorder related causes such as retinoblastoma, neurovascularization, xanthogranuloma which is a pediatric vascular abnormality, myotonic dystrophy, uveitis, Von Willebrand disease, rubeosis iridis, leukemia, hemophilia, and the use of anticoagulating medications.
Hyphemia is categorized and classified from a grade of 1 to 4. A grade 1 hyphemia is characterized with less than one third of the anterior chamber filled with blood; a grade 2 hyphemia is characterized with the anterior chamber's filling with more than one third but less than two thirds of the chamber; a grade 3 hyphemia is characterized with more than two thirds of the anterior chamber filled with blood but not with complete filling; and a grade 4 hyphemia is characterized with the complete filling of the eye's anterior chamber with blood.
Signs and Symptoms: Light sensitivity, pain, blurry vision, a small pool of blood in the cornea or at the bottom of the iris, a reddish colored tinge to the eye, and the loss of vision.
Interventions and Treatments: The goals of treatments and interventions include the prevention of secondary corneal blood staining, decreasing the possibility of any rebleeding within the eye, the elimination of risks associated with atrophy of the optic nerve and increased intraocular pressure. Interventions to achieve these goals include pharmacologic interventions to reduce intraocular pressure, pain management, patching the affected eye, surgical procedures to empty the anterior chamber of the eye of pooled blood and also prevent possible corneal blood staining.
Complications: Increased intraocular pressure and blindness
Retinal Detachment
Brief Description: Retinal detachments occur when the retina of the eye peels away from its underlying layer of support tissue. This serious disorder is a medical emergency; irreversible and permanent vision loss can occur when it evolves and progresses to a complete detachment without immediate and effective treatment. Retinal detachments are typically unilateral.
Signs and Symptoms: Client complaints of flashing lights, floaters and veiling or curtain effects in their visual field, photopsia, heaviness in the eye, the loss of central vision, and straight lines suddenly appear as though they are curved
Interventions and Treatments: Laser surgery or cryotherapy, vitrectomy and the placement of a scleral buckle to move the wall of the eye against the detached retina.
Complications: Permanent, complete and total blindness
In addition to the correction of any underlying disorder or condition and emergency cardiopulmonary resuscitation, the descriptions, the signs and symptoms, complications, and interventions and treatments for a number of oral medical emergencies include the following:
Dental Avulsions
Brief Description: The traumatic loss of a tooth or teeth
Signs and Symptoms: Pain, bleeding and the loss of a tooth or multiple teeth
Interventions and Treatments: Reimplantation of the tooth, immersion of the lost tooth in milk or normal saline to preserve its viability for reimplantation, and splinting of the oral area around the reimplantation after the reimplantation of the tooth is successfully accomplished
Complications: The permanent loss of the tooth or teeth
Dental Luxations
Brief Description: Dental luxation injuries are injuries that result in the partial displacement of a tooth or teeth from its socket.
Signs and Symptoms: Pain, bleeding and the partial loss of a tooth or multiple teeth
Interventions and Treatments: Like dental avulsions, there is no attempt to reposition the deciduous teeth so these affected deciduous teeth are typically extracted, permanent teeth are treated with repositioning of the teeth under local anesthesia while using the adjacent teeth as a guide and firm digital pressure is used for this repositioning and later splinting with glass ionomer cement powder alone or a combination of glass ionomer cement powder and a fine stabilizing wire.
Complications: The permanent loss of the tooth or teeth
Explaining Emergency Interventions to the Client
All emergency treatments and interventions should be explained to the client and informed consent should be obtained except under special circumstances such as when an emergency is occurring and the client is not mentally competent, alert and conscious enough to do so. Healthcare surrogates and proxies often make decisions for the client when they are not able to do so. However, when the client and/or the family are able to receive complete information, at a later time, this complete information must be given in the same manner that is done with clients who are competent enough to understand this information and to give informed consent.
Notifying the Primary Health Care Provider About the Client's Unexpected Responses and Emergency Situations
As with all other aspects of nursing care, nurses notify the client's health care provider about all unexpected responses, the rise of an emergency situation and all significant changes in the client's status in a timely, complete and accurate manner.
Performing Emergency Care Procedures
Basic emergency care procedures include cardio-pulmonary resuscitation, respiratory support, and defibrillation. More advance emergency care procedures include those measures that are done by registered nurses who have been ACLS (Advanced Cardiac Life Support) certified.
Learn more about a career as a Cardiac Care Nurse, Cardiac Catheterization Laboratory Nurse or Cardiovascular Operating Room Nurse.
Providing Emergency Care for Wound Disruption
Evisceration and dehiscence are two types of wound disruption. Dehiscence is the separation of a surgical incision and evisceration is the separation of a surgical incision in addition to the protrusion of an internal bodily organ through the separated surgical incision to the exterior environment.
Both dehiscence and evisceration can be a life threatening emergencies. The nurse provides emergency care by not leaving the client unattended, calling for the help of others, and, using a clean, sterile towel or sterile saline dampened dressing to cover the open wound. No attempts to reinsert the protruding organs should be done by the nurse; the nurse should simply apply and maintain light pressure on the wound until the medical doctor is present.
Evaluating and Documenting the Client's Response to Emergency Interventions
All aspects of care including the evaluation of the client's responses to emergency interventions, such as the restoration of spontaneous breathing and cardiac function, are done and documented. At times, the nurse may recommend changes in emergency treatments as based an unfavourable client response to emergency interventions. Some of the client responses to emergency interventions include things like the opening and maintenance of an open airway, the restoration of breathing, the restoration of the client's pulses including peripheral pulses, the restoration of the client's hemodynamics and the overall establishment and maintenance of the client's physical stability and normal functioning.
RELATED CONTENT:
- Alterations in Body Systems
- Fluid and Electrolyte Imbalances
- Hemodynamics
- Illness Management
- Medical Emergencies (Currently here)
- Pathophysiology
- Unexpected Responses to Therapies
SEE – Physiological Adaptation Practice Test Questions
