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CHAPTER I

INTRODUCTION

1.1.

ISSUE BACKGROUND
Many studies have shown that a high proportion of patients attending
accident and emergency (A&E) departments have only trivial or nonurgent complaints. A&E staff treat these inappropriate attenders while
recognizing that this detracts from the care given to more serious cases.
Dwindling resources and higher attendances make it a matter of necessity
that inappropriate attenders be treated by general practioners or equivalent
primary care services. In this study, the authors examined the feasibility of
methods of reducing inappropriate attendance. The authors investigated
patients' ability to accurately assess the urgency of their condition and,
hence, their need for A&E services. The authors concluded that there is
probably no practical way of reducing inappropriate attendance that does
not involve risk to a proportion of patients. The possibility of extending
the role of the A&E department to provide more general primary care is
discussed.
Emergency room visits can be defined as a situation where someone
needed help immediately because if they are not getting help immediately
it can be life-threatening or cause disability permanent. Emergencies often
occur in the community, among others state of a person who had stopped
breathing, cardiac arrest, unconsciousness suicide, accidents, injuries, such
as broken bones, strokes, seizures, poisoning, and disaster victims. The
causative agent of emergency room visits, among others because traffic
accidents, illness, fire or natural disasters. Emergency cases due to traffic
accidents is the leading cause of death d major urban areas (Media
Aeculapius, 2007)

Emergency nurses are nurses who work in emergency medicine


facilities, such as emergency rooms or trauma centers, with other medical
professionals. They generally have a degree in nursing plus further
education or training. They must be knowledgeable about many health
conditions, triage care, be decisive, and able to take quick action.
First aid is the initial care provided to someone who has suddenly
fallen ill, or who has been injured, until more advanced care is provided or
the person recovers. Immediate and effective first aid may reduce the
severity of the injury or illness and promote recovery. Knowledge of first
aid is important for everyday life at home, work, or in the community.
Verbal reporting, a verbal report to a supervisor, a parent or caregiver of a
minor, or emergency services, such as Paramedics may be required. All
first aiders should have sufficient oral communication skills in order to
make an accurate verbal report. Incident details must be conveyed clearly
and accurately. Only facts should be stated. Written reports, although the
initial report is done verbally, it can be useful to also do a written report.
Memory often fails us when having to respond urgently in an emergency
situation. Record keeping- Records of the incident must be kept for at least
5 years from the date that the incident was notified. Ensure strict security
practices are upheld to restrict access as required and keep personal
information private. Security practices are also required to ensure the
records are kept and not lost and that back-ups are made.

1.2.

PROBLEM FORMULATION
The formulation of the problem which we discuss in this paper are:
1.2.1. What definition about the accident and emergency?
1.2.2. What job duties nurse in emergency room?
1.2.3. What nurse do when the accident happened?

1.3.
1.3.1.
1.3.2.
1.3.3.

PURPOSE OF THE PAPER


The purpose of this paper is:
Knowing definition about the accident and emergency
Knowing job duties nurse in emergency room
Knowing nurse do when the accident happened

CHAPTER II
DISCUSSION

2.1.

Definition About The Accident and Emergency


The aacident or an accident is an unplanned, undesired event which

may or may not result in injury or property damage, that interferes with the
completion of an assigned task. (Awcd, TT).
An accident, also known as an unintentional injury, is an
undesirable, incidental and unplanned event that could have been prevented
had circumstances leading up to the accident been recognized, and acted upon,
prior to its occurrence. Most scientists who study unintentional injury avoid using
the term "accident" and focus on factors that increase risk of severe injury and that
reduce injury incidence and severity (Robertson, 2015).
An emergency is a situation that poses an immediate risk
to health, life, property, or environment.[1] Most emergencies require urgent
intervention to prevent a worsening of the situation, although in some situations,
mitigation may not be possible and agencies may only be able to offer palliative
care for the aftermath.
Emergency nursing began during the era of Florence Nightingale, but
the specialty practice of emergency nursing has evolved during the past 25 years.
By definition, emergency nursing is: care of individuals of all ages with perceived
or actual physical or emotional alterations of health that are undiagnosed or that
require further interventions. (Marett, 2000).
2.2.

Job Duties Nurse In Emergency Room


The most important responsibility for an emergency nurse is understanding

triage, which is a method of prioritizing injuries based on medical need. An


emergency nurse must have the ability to make quick and accurate assessments
about incoming patients, including both physical and mental health conditions.
Time management is crucial in this job. Along with triage, emergency
nurses must quickly ascertain the following information from incoming patients:
a. Identify the medical problem

b. Document medical history


c. Check for any allergies and current medications
d. Obtain height, weight, body temperature, heart rate and blood pressure
Other responsibilities include moving patients, taking blood samples,
cleaning and bandaging wounds, administering medications and maintaining
proper supplies of medical equipment.
As with other health care professionals, emergency nurses are expected to
comply with protocols, procedures and safety policies of a health care facility.
Emotional stability, communication, leadership, sympathy and attention to detail
are traits common among successful emergency nurses. (Study.com. 2003).
Beside that, any job duties nurse are:
a. Critical-Thinking Skills: Nurses will need to assess a patient's health, as
well as detect changes in symptoms, health or pain, and will need to
know when action is necessary.
b. Compassion: Nurses help people. They should be sympathetic to a
patient's needs, and be able to deal with people in various states of pain,
trauma and tragedy.
c. Attention to Detail: Nurses can help doctors operate, administer
medicines and work with specific treatments that, if wrong could prove
fatal. Attention to detail is crucial.
d. Organizational Skills: Nurses will face multiple patients, with differing
needs, stages of health and risks. Being organized and knowing how to
prioritize will be helpful.
e. Calm Under Pressure: ER Nurses face urgent, life-or-death situations
almost daily. Being able to function in the heat of emergency will be
necessary.
f. Patience: Giving care under stressful circumstances requires patience.
g. Communication Skills: Nurses communicate directly with patients who
are scared, in pain or in shock. Families will have questions and want
answers. Good nurses need to be patient listeners and good

communicators to help keep everyone calm and help them understand


the situation. (Snagajob.2000).
2.3.

The Things Must Nurses Do When A Patient Accident


In general, a nurse can stop and ask the person "Are you OK?" and

initiate the appropriate steps of cardiopulmonary resuscitation (CPR), as


indicated by the individual's condition, without getting into much trouble.
Nurses and others always can activate emergency services. But be aware that
this is a gray area, Good Samaritan-wise, if a nurse becomes involved in
treatment.
But if accident happened, the nurse can reviewing about:
A. Primary Survey
Primary survey provide a systematic evaluation, detection and
management of complications due immediately life threatening severe trauma.
survey primary goal is to identify and fix the problem as soon as life threatening.
priority on primary surveys conducted among others (Fulde,2009):
Primary survey is performed to ensure safety of the rescuer and victim to
avoid more casualties. Moreover, primary survey is done to be able to administer
effective and appropriate first aid in times of medical emergencies. Primary
survey consists of five priorities: danger, response, circulation, airway and
breathing.

Primary survey: danger


Before attempting to deliver safe and prompt emergency aid, first ensure

that no danger can come to the first aider. It will make things more difficult to
have to treat more casualties.
1) Check the immediate surroundings.

2) Move and hazardous objects or any possible source of danger away from
the victim to allow the rescuer to deliver first aid, eliminating any risks for
supplemental injury.
3) As a last resort, move the victim if absolutely necessary, such as in burning
areas or in the wilderness. Emergency services are in the best position to
move a victim.

Primary survey: response

After ensuring that there is no danger in the environment, check for


responsiveness of the casualty to see if the victim is conscious.
1) Shout a command such as open your eyes
2) Tap them on the shoulders and ask are you ok?
3) If no response was obtained, attract bystanders by calling for help.
4) Call for emergency medical services.
-

Primary survey: circulation


It is important to immediately check for pulse as cells begin to die within

four to six minutes without oxygen. Timing is critical for pulseless emergencies.
1) Check the pulse by placing two fingers in the groove of the neck for 10
seconds. The radial pulse may also be checked.
2) If there is no pulse, give two rescue breaths and 30 chest compressions.
Repeat this cycle until paramedics arrive or until victim is resuscitated.

Primary survey: airway


The victim will not be able to breathe if the airway is blocked. One

common body organ that blocks the airway is the tongue. It is, however, easy to
keep the airway open.

1) Kneel by the victims head.


2) Place the first hand on the victims forehead. Place the index and middle
fingertips of the second hand on the chin.
3) Gently tilt the head back. Lift and hold to keep the airway open.

Primary survey: breathing

1) Once the victims airway is opened, it is necessary to check for breathing


to complete the primary survey.
2) Still knelt beside the victim, place own cheek above the victims nose and
mouth. Feel for air on the cheek. Watch for rise and fall of chest. Do this
for no more than ten seconds.
3) If necessary, give rescue breaths.
B. Secondary Survey
This assessment is a complete examination of the patient from top to
toe, both front and back. Pitfalls:
1. Head and face
a. Posterior scalp lacs/compound skull fractures
b. Pupil changes since primary survey
c. Visual deficits
2. Neck
a. Injuries under the hard collar are not seen
b. In line immobilisation while the collar is off
3. Chest
a. Clinical rib #s and sternal #s are missed
i. many do not show on the chest X-ray
ii. they can compromise the patient
iii. X-ray 'proof' is not required

4. Abdomen
a. Pain or tenderness or bruising requires further investigation
b. The inaccessible abdomen with appropriate mechanism requires
investigation.
i. FAST or DPL in the unstable
ii. CT in stable patients
c. Vaginal examination in female patients with pelvic fractures or
vaginal bleeding. In pregnancy this examination should be deferred to
an obstetric specialist.
d. A nasogastric tube is contraindicated in the presence of facial
fractures (an orogastric tube should be inserted)
e. a urinary catheter should only be inserted if there is no blood at
the urethral meatus, no perineal bruising, and rectal examination is
normal.
5. Back
a. Log roll takes 5 people, 3 body, one head, one examining
b. Inspection and palpation
c. Perform the rectal examination at this time.
6. Extremities
a. Inspect and palpate each limb for tenderness, crepitation, or
abnormal movement.
b. If the patient is cooperative ask him or her to move the limbs in
response to command in preference to passive movement in the first
instance.
c. Adequately splint any injuries.
d. Reassess after splints, traction or manipulation
7. Neurological examination
a. Repeat the Glasgow Coma Scale - record scores for E, V and M as
well as the total score
b. Re-evaluate the pupils

c. Look for any localising/lateralising signs


d. Look for signs of cord injury

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CHAPTER III
CONCLUSION
3.1.

Conclusion
An accident, also known as an unintentional injury, is an undesirable,

incidental and unplanned event that could have been prevented


had circumstances leading up to the accident been recognized, and acted upon,
prior to its occurrence. Most scientists who study unintentional injury avoid
using the term "accident" and focus on factors that increase risk of severe
injury and that reduce injury incidence and severity (Robertson, 2015).
Emergency nursing began during the era of Florence Nightingale, but
the specialty practice of emergency nursing has evolved during the past 25
years. By definition, emergency nursing is: care of individuals of all ages with
perceived or actual physical or emotional alterations of health that are
undiagnosed or that require further interventions. (Marett, 2000).
Time management is crucial in this job. Along with triage, emergency
nurses must quickly ascertain the following information from incoming
patients:
a. Identify the medical problem
b. Document medical history
c. Check for any allergies and current medications
d. Obtain height, weight, body temperature, heart rate and blood pressure
But if accident happened, the nurse can reviewing about:
A. Primary survey
B. Secondary survey
3.2.

Suggest

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This paper is expected by the nurse a better understanding of the


accident and emergency.
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Awcd. TT. Accident Causes, Prevention, and Control. (Online). Available at


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Available at http://www.medscape.com/viewarticle/840797.
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Marett, B. E. 2000. Emergency Nursing More Than Meets The Eye. (Online).
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Downloaded at October 4th 2016.

Ottawa. 2013. Steps to Doing a Primary Survey First Aid. (Online). Available at
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Snagajob. 2000. Emergency Room Nurse Job Description. (Online). Available at


http://www.snagajob.com/job-descriptions/emergency-room-nurse/.
Downloaded at October 4th 2016.

Study.com. 2003. Emergency Nurse: Job Description, Duties and Requirements.


(Online). Available at
http://study.com/articles/Emergency_Nurse_Job_Description_Duties_
and_Requirements.html. Downloaded at October 4th 2016.

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