Managing burn emergencies

Learn how to provide emergency care for a burn patient, from safety at the scene to patient stabilization, and, if necessary, transport to a burn center.     

Managing geriatric psychiatric emergencies: delirium and dementia

As the population ages, nurses in various clinical settings must identify high-risk groups that are vulnerable to delirium and dementia. They also must be able to provide psychosocial and pharmacologic interventions that promote comfort and safety for patients and their families experiencing these distressful medical conditions. Efforts to facilitate healthy resolution and restore the patient and caregivers to an optimal level of functioning must be priorities.     

Hypertensive emergencies.

In summary, patients presenting with a true hypertensive emergency should be diagnosed quickly and promptly started on effective parenteral therapy (typically nitroprusside 0.5 microgram/kg/min or fenoldopam 0.1 microgram/kg/min) in an intensive care unit. Blood pressure should be reduced about 25% gradually over 2 to 3 hours. Oral antihypertensive therapy (often with an immediate-release calcium antagonist) can be instituted after 6 to 12 hours of parenteral therapy, and consideration should be given to secondary causes of hypertension after transfer out of the intensive care unit. Because of advances in antihypertensive therapy and management, "malignant hypertension" should be truly malignant no longer.     

Hyperglycemic emergencies.

Hyperglycemic emergencies are the most common endocrinopathies that require intensive care. It is estimated that between 10% and 15% of patients admitted to intensive care units experience complications of acute hyperglycemia. The common denominator of hyperglycemic emergencies is diabetes mellitus, a group of diseases in which, either because of beta-cell destruction of the pancreas or insulin receptor-site defects, there is a relative or absolute deficiency of insulin that results in hyperglycemia. In response to various precipitating factors, staggering hyperglycemia may develop in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNK). The existence of DKA has been known since ancient times, and critical care nurses are familiar with the diagnosis. The more lethal disorder of HHNK was "rediscovered" in the 1950s and is occurring with greater frequency as clinical awareness of the condition grows and the elderly (who are at greatest risk for the disorder) populate critical care units in increasing numbers. Prevention is instrumental in abating deadly hyperglycemic emergencies. A positive outcome can be realized but only with timely diagnosis and prompt hormonal and fluid replacement.     

Diabetic emergencies.

Diabetic emergencies include diabetic ketoacidosis, insulin-induced hypoglycemia, hyperosmolar coma and lactic acidosis. By determining the blood pressure, observing for evidence of dehydration or sweating and making a rapid qualitative assessment of blood glucose and ketonemia, the physician can usually identify the condition promptly. When adequate facilities are available, continuous intravenous insulin infusion is preferred for treatment of diabetic ketoacidosis. The nonketotic hyperosmolar state should be corrected gradually, not rapidly, in order to avoid cerebral edema.     

Hypoglycemic emergencies.

Optimal control of blood glucose requires a balance of diet, exercise, and in some cases, medications. Many factors can cause a state of imbalance, resulting in extremes of glucose control. Hypoglycemia is defined generally as a blood glucose level lower than 50 mg/dL. Although the causes of hypoglycemic episodes are diverse, the management is always aimed at normalizing the plasma glucose concentration. Treatment ranges from simple carbohydrate ingestion in mild to moderate cases to intravenous administration of glucose when the reaction is severe and loss of consciousness occurs. Recognition of warning signs and prompt treatment is essential in all cases.     

Hypertensive emergencies.

The clinical syndrome of accelerated hypertension is a relatively rare complication of hypertensive disease. The syndrome is recognized by high blood pressures, progressive neurologic and visual symptoms, acute renal damage, cardiac failure, and microangiopathic hemolytic anemia. When diagnosed, it must be recognized as an acute medical emergency. The patient should be admitted to an intensive care unit, arterial lines should be placed, and the blood pressure lowered as soon as possible. Once blood pressure has been controlled, oral medications should be begun. Long-term results in the treatment of hypertensive emergencies are gratifying. It is anticipated that with more experience gained in the use of medications in this situation, an even better prognosis will be achieved.     

Intrapartum obstetric emergencies.

Shoulder dystocia, uterine inversion, and prolapse of the umbilical cord are three uncommon complications of the intrapartum period. These complications share several common characteristics in that they are rare, difficult to predict, and can result in significant morbidity and mortality. This article describes the etiology, predisposing factors, and methods of management of these complications.