Emergency Room and Trauma

This is an area where the therapist will have to quickly apply critical thinking and make clinical decisions.

COPD

COPD exacerbation patients either require NPPV or intubation. And this can be determined by their level of consciousness and the arterial blood gas. The most common protocol are labs, ABG, aerosol treatments x 3, NPPV, and worse case…intubation.

GSW

With gun shot wound victims, hospitals will often heighten the security for staff safety. Secondly, GSW patients usually have a short window before they deteriorate quickly (usually due to the loss of blood). GSW wounds to the head usually have a poor prognosis

ANGIOEDEMA

There have been increased cases of subcutaneous airway swelling due to adverse reactions from ACE inhibitors. Angioedema can also present with patients that have severe food allergies, such as peanuts or egg products. Corticosteroids alone may not resolve the airway swelling quickly. This is when the therapist has to be proactive and gather airway equipment, or at least have it readily available. In severe cases, the patient may require a cricoidthyrotomy.

ASTHMA

Acute asthma exacerbations are often pre-diagnosed in the triage area by an RN or by an RN and RT at the bedside. In a busy ER facility, the physician may not arrive before the clinical staff have made their assessment. As a therapist, he or she can determine the severity with a mild, moderate, or severe assessment. With hospital protocols implemented, the therapist can also start beta 2 agonists with repeated doses until the provider arrives at the bedside. With an already heightened state of anxiety by the patient due to respiratory distress, the therapist should also display calm and a sense of confidence. If you’re having trouble with an anxious patient or family member, approach them with self assurance and firmly tell them “you don’t nervous until I get nervous.”

MOTOR VEHICLE ACCIDENTS

MVA patients don’t always present with just fractures and bruises. They may also have an internal injury that is not visibly noted. And not all of them require intubation. However, watch for these signs for the possible use of advanced airway techniques: low Hb, decreased LOC, cervical spine injury, bruising of the neck, GCS score of 8 or less, or significant maxillofacial injuries.

Most common initial diagnostics are head and chest CT, CBC, chest radio graph. Patient evaluation should include an evaluation for tracheal deviation, diagnostic percussion, and adequate chest rise.