I.

Definition
Keparawatan emergency is profesioanal nursing care that is given to patients with urgent and
critical needs . But the emergency department and emergency clinics are often used for
problems that are not urgent . Which later philosophy of nursing into a comprehensive
emergency , emergencies that any experienced patients or families should consider as
hedaruratan

II . System Emergency Services

Emergency services not only provide services to cope with emergencies in the natural
condition of patients but also provides nursing forces opened to cope with the anxiety of
patients and families .
Pelayana contingency system so that nurses and other medical personnel should have the
ability , skills , techniques and knowledge in delivering emergency relief kepeda pesien

III . In the Emergency Department Triage Nursing

That scenario aid that will be provided after the phase state of the patient . Patients who
threatened his life should be given top priority . Triage in emergency nursing derurat used to
mengklasifikasian keperahan illness or injury and prioritize the needs of the use of efficient
health care personnel and resources .
Standart time that is required to perform triage is 2-5 minutes for an adult and 7 minutes for
pediatric patients .
Triage done by a professional nurse ( RN ) who are trained in the principles of triage, a
minimum of 6 months experience working at the ER, and has kualisifikasi :

- Demonstrate competence emergencies

- Certification of ATLS , ACLS , PALS , ENPC
- Passed Trauma Nurse Core Currikulum ( TNCC )
- Knowledge of policies intradepartemen
- Skills appropriate assessment , etc.
IV . Triage system
Spot check
25 % ED use this system , nurses assess and classify patients within 2-3 minutes . This allows
the systems of identification immediately .
Comprehensive
Triage is a basic standard in use. And supported by the ENA ( Emergenci Nurse Association)
includes:
A ( Airway )
B ( Breathing )
C ( Circulation )
D ( dissability of Neurity )
E ( Exposure )
F (Full - set of Vital sign)
Pulse Oximetry
Trise two-tier
This Sistenm memetluhan second person who acts as a second helper who served in
mensortirpasien to do a more detailed assessment .
Triage Expanded
This system may be added to the system komprohensif and includes a two-tier management
protocols :
1. First Aid ( splints, compresses, wound care )
2. Diagnostic tests
3. Drug administration
4. Test lab ( Blood , KGD , Urinalysis , etc. )

Triage Bedside Patients in this system is not classified triasenya , directly handled by the
nurse on duty , immediately without waiting in line .

V. CATEGORIES / CLASSIFICATION TRIAS 61 % use four categories of decision-making

by using color hartu / classification status as a sign that the Red ( emergen ) , yellow
( Urgent ) , green ( non Urgent ) , black ( expectant )

VI . Red ( Emergent ) Ie victims who need immediate stabilization . That is a life threatening
condition and requires immediate attention . Example: - Shock by various causes -
Respiratory disorders - Head trauma with pupils anisokor - Massive external hemorrhage
VII . Yellow ( Urgent )
Ie victims who require strict oversight, but treatment can be delayed temporarily . Conditions
are medisyang disignifikan problems and need a stylist carrying on as soon as possible .
Client vital signs are still stable .
Example
multiple fractures
fractures of the femur / pelvis
Victims of the risk of shock ( the victim with heart problems , trauma , severe obdomen )
extensive burns
Altered consciousness / head trauma
Victim with uncertain status .
All the victims with this category should be given intravenous fluids, strict monitoring of the
likelihood of complications and provide treatment as soon as possible .

VIII . Green ( non- urgent)

That group of victims who did not require treatment or treatment delivery can be delayed .
Illness or minor injury
Example
- Fektur minor
- Minor Injuries
- Minor burns

IX . Black ( expectant )
Victims who died Bunia or potentially to death
- 6 % on a system of four classes:
1. Kelas1 : Critical ( threatening life , limb , sight or immediate action )
2. Class II : Acute ( there is a significant change , immediate action may be )
3. Class III : Urgent (significant , tikdakan at the right time )
4. Class IV : Non Urgent ( there is a risk that needs to be handled )
- 10 % used the system five levels namely
the instance level
1 Critical Immediate Cardiac
2 Unstable Fractures 5-15 minutes mayor
3 Potential unstable 30-60 minutes Abdominal pain
4 Stable 1-2 hours Sinusitis
5 Routine 4 hours Appointment stitches

Emergency First Aid ( PPGD )

A. Basic Principles PPGD
PPGD required in the implementation of the principle of P - A- T - U - T should be
understood , understood and practiced.

Q : Helper help themselves

A : Secure victims
Q : Mark the scene
U : Try to contact the medical team
Q : aid measures

While the goal of saving- is :

Preventing death / save lives
Preventing worse condition / disability
supporting healing

B. Systematics First Aid

1. Do not Panic .
2. Remove or avoid the next victim of the accident .
3. Note the victim's breathing and heart rate .
4. Bleeding .
5. Watch for signs of shock .
6. Do not move the victim in a hurry .
7. Immediately transported the victim to a central treatment
C. Position Steady A steady lateral position is a position given to victims / patients who are
not aware , but there is a pulse and spontaneous breathing

. This position is a continuation of the action BHD ( basic life support ) where action BHD
has successfully done so that the return of the victim's pulse and breathing spontaneously

. This position is done in the pre hospital ( in the field) are temporary until medical
assistance / ambulance attendants came to provide more help

. Interest steady lateral position : Prevent aspiration Provide a stable position of the victim so
that we can help other victims ( if casualties numbered more than one )

The procedure provides a steady lateral position :

Victim Lying on a supine position , the helper kneel on the right side of the victim
The right hand side of the victim at the victim's head straightened out .
The left hand is bent crosses the victim 's chest until the palms are right shoulders of
the victim.
Left knee bent to the right of victims
The position of the left hand on the left shoulder victim's helper , the helper right hand
in the crook of your left knee victim

Pull the victim with both hands simultaneously to the right until the victim's right
slant ( 90 degrees ) hold the victim's body with both feet helper so that victims are not
overturned.
 Slowly tilt again the victim's body ( thighs are supported by the helper ) until the
victim is in a tilted position .
Check the carotid pulse and breathing returned victims , if there are still new victims
can be left
Reevaluate the victim's pulse and respiration until ambulance officers arrive

D. Cardiac Pulmonary Resuscitation ( CPR )

If a situation is found with the victim early assessment there is interference with blockage of
the airway , breathing and not found or there is no pulse , then the rescuer must immediately
take action called by the term BASIC LIFE SUPPORT ( BHD ) .

Basic life support consists of a few simple ways that can help maintain a person's life for a
while . Some of these are simple ways on how to master and freeing the airway , how to
provide assistance penafasan and how to help the blood flow to the important place in the
victim's body , so that the supply of oxygen to the brain awake to prevent the death of brain
cells.
Assessment and treatment are carried out in basic life support is very important in order to
proceed further ketahapan . This should be done carefully and continuously included the
responses of victims at relief process
When these actions are taken as a complete unity then this action is known as
cardiopulmonary resuscitation ( CPR ) .

To facilitate its implementation , the use of acronyms A- B - C universally applicable .

A = Airway control or mastery airway

B = Breathing Support or assisted respiration
C = Circulatory Support or aid circulation , better known by heart massage Affairs and stop
the massive bleeding
Each stage begins with the ABC of CPR assessment phase :
response assessment , breathing and pulse .
Airway Control ( Mastery Airway )
If no response to the victims of the next steps are helper assess whether the victim breathing
is adequate ? To vote then the victim should lie supine with the airway open

The tongue of the most frequent causes of airway obstruction in cases of adult victims no
response , because when the victim lost consciousness muscles , including the muscles will
become weak base of the tongue will fall back so that the airway is so closed . Another cause
is the presence of foreign bodies , especially in infants and children . Mastery of the airway is
a priority on all the victims . The procedure is highly variable ranging from the simple to the
most complex and surgical treatment . Other acts that little chance to succeed if the victim's
airway is still disturbed

Some ways are known and are often made to free the airway

a. Forehead Lift the chin Press :

This technique is performed on the victim suffered trauma to the head , neck and spine .
b . Down maneuver is pushing jaw ( Jaw Thrust Maneuver )
This technique is used in lieu of press forehead chin lift technique . This technique is very
difficult to do but it is a safe technique to open the airway for the victim who suffered trauma
to the spine. With this technique, the victim's head and neck are made in a natural position /
normal .
Remember : This technique is only for victims who suffered suspected spinal trauma or
spinal trauma

Examination Airway
Once the airway is open , then check the airway to the opening of the airway and clean very
necessary for adequate breathing . The state of the airway can be determined if the victim is
conscious , response and can talk to rescuers.
Note the pronunciation is good or distracted , and be careful to provide an assessment to the
victims with mental disorders .
For victims who disorientation , feeling floating , confused or not a response should be wary
of the possibility of the presence of blood , vomit or saliva excessive fluid in the airways .
This method will be explained further on page ways airway examination

C. Cleaning Airway

- Recovery Position If the victim can breathe well and there is no suspicion of a neck injury ,
spine or other injuries that could worsen as a result of these actions then put the victim in the
recovery position , or known as a steady lateral position . This position is useful to prevent
blockage and if there is fluid , the fluid will flow through the mouth and into the airways .
- Sweep Finger Technique is only done for patients who are not aware , rescuers using his
finger to get rid of objects that interfere with the airway

BREATHING SUPPORT ( HELP BREATHING )

When a person stops breathing , the rescuers should attempt to provide breathing assistance .

The technique used to provide respiratory assistance , namely :

a. Using a helper mouth :

1. Mouth to mask CPR
2. Mouth to APD
3. Mouth -to-mouth / nose

Circulatory SUPPORT ( Circulation Help )

The most important action on aid circulation is Heart Massage Affairs . External Cardiac
Massage can be done given the majority of the heart is located between the sternum and spine
so the emphasis from the outside can cause effects on the heart pump that is considered
sufficient to regulate blood circulation minimal on the state of clinical death

Emphasis is made on the midline of the sternum 2 fingers over the surface of the left and
right rib arch . Depth emphasis tailored to the age group of patients .
- Adults : 4-5 cm
- Children and infants: 3-4 cm
- Baby : 1,5 - 2,5 cm

In general it can be said that when the heart stops beating , the breathing will immediately
follow , it does not work in reverse . A person may only experience respiratory failure with
the heart still beating , but in a short time will be followed by cardiac arrest due to lack of
oxygen .

At the time of the cessation of this system a person is declared as clinically dead . Armed
with the understanding of the above then the next action Cardiac Pulmonary Resuscitation
E. INTRODUCTION TO DRUGS DRUGS OUTSIDE

1. rivanol
2. Plaster
3. Betadine
4. Eucalyptus oil
5. Alcohol
6. Eye drops
7. Bioplasenton
8. counterpain
9. Cotton
10. Bandages
11. Oxycan

DRUGS IN
1. CTM
2. Paracetamol / antalgin
3. Norit & Milk
4. Promag
5. Napacin
6. Enterostop
7. Feminax

Bandages and Pembalutan

1 ) PembalutMacam kinds of dressings :

a) Bandages gauze gulung

b) perekatc gauze dressings
c) Bandages penekand )
d) Kasa suppressant sterile ( various sizes )
e) The rolls of cotton
f) triangular Bandages ( mitella )

2 ) Wrapping
 a) Wrapping triangle on the head , forehead
b) Wrapping triangle to the end of the hands or feet
c) Packaging triangles to make gendungan hand
d) Embraces the palm of the hand with a bandage tie

e ) Wrapping spiral in hand

f ) Wrapping a bandage form a figure 8 to the hand or wrist injury.