Emergency Nursing at a Glance E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: At a Glance (Nursing and Healthcare)
• Sprache: Englisch

Seitenzahl: 432

Veröffentlichungsjahr: 2025

Beschreibung

Everything you need to know about Emergency Nursing… at a Glance!

Emergency Nursing at a Glance, Second Edition, remains an essential resource for nursing students and newly qualified practitioners working in emergency and urgent care environments. This concise, visually engaging book provides up-to-date, evidence-based knowledge across a broad range of emergency presentations. Building on the strengths of the first edition, Emergency Nursing at a Glance is fully updated to ensure relevance in today’s clinical landscape. New peer-reviewed content—organised into themed chapters that reflect the diverse nature of emergency nursing—includes infectious diseases, frailty, safeguarding vulnerable adults, and sickle cell crisis.

Equipping readers with the knowledge and confidence to provide safe, responsive care in the fast-paced and ever-evolving emergency care setting, Emergency Nursing at a Glance:

• Addresses a full spectrum of care needs in adults, children, mental health, and people with a learning disability
• Incorporates the latest evidence-based guidance and clinical best practices
• Supports understanding of triage, assessment, and common emergency presentations across multiple settings
• Includes updated content on legal, professional, and ethical responsibilities
• Presented in a user-friendly format designed for quick reference, effective learning, and revision

Emergency Nursing at a Glance is ideal for undergraduate and postgraduate nursing students studying emergency care as part of BSc or MSc Nursing programmes in adult, child, mental health, and learning disability fields. It is also a valuable reference for newly qualified nurses and junior staff in emergency departments, urgent treatment centres, minor injuries units, and a useful resource when undertaking CPD.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright Page

About the editors

Contributors

Preface

Acknowledgements

Section 1: The ED journey

1 The context of emergency nursing

ED team

4‐hour target

Areas within the ED

2 Pre‐hospital care

Pre‐hospital environment

Patient assessment

Care provision

3 Major incidents

Types of major incidents

Role of emergency services

Triage ‘sieve and sort’

Hospital response

CBRNe incidents

Decontamination of casualties

4 Discharge planning

Planning for discharge

Safeguarding

Safety netting

Medications

Discharge equipment

Follow‐up

Transport

Discharge summary

5 Patient transfer

Safe transfer principles

Section 2: Patient assessment

6 Initial assessment and triage

Manchester triage system

Problem identification

Gathering and analysing

7 The ‘ABCDE’ approach

Using the ‘ABCDE’ approach

Ongoing management

8 Track and trigger systems

National Early Warning Score 2 (NEWS2)

SBAR

9 Pain

Pain assessment

Other pain assessment tools

Pain management

Evaluation and Documentation

Section 3: Airway and breathing

10 Airway assessment and management

Causes of airway problems

Airway assessment

Airway equipment

Airway management

Definitive airway

11 Assessment of breathing

History

Structured assessment

Investigations

12 Oxygen therapy

Critical illness

Acute illness

Chronic obstructive pulmonary disease and patients at risk of hypercapnia

Maximising oxygenation

Nebuliser delivery

Non‐invasive ventilation (NIV)

13 Respiratory conditions

Asthma

Chronic obstructive pulmonary disease

Pneumonia

Pulmonary embolism

Spontaneous pneumothorax

Section 4: Circulation

14 Assessment of circulation

Non‐invasive haemodynamic assessment

Indicators of organ perfusion

Invasive haemodynamic assessment

15 Circulation interventions

Peripheral IV access

Central venous catheter

Intraosseous access

Fluid challenge

Blood transfusion

Other interventions

16 Shock

Stages of shock

17 12‐lead electrocardiogram (ECG)

Indications

Preparation

Recording the ECG

Basic interpretation

18 Cardiac arrhythmias

Sinus rhythms

Arrhythmias

Assessing and managing the patient

19 Acute coronary syndrome (ACS)

Presentation and triage

Rapid assessment

Priorities of care: The first hour

20 Heart failure

Symptoms, causes and management

Acute heart failure in the Emergency Department (ED)

Nursing care

Treatment

21 Advanced life support (ALS)

Chain of survival

ALS algorithm (Figure 21.2)

Section 5: Disability

22 Assessment of neurological function

ACVPU (Alert, Confused, Voice, Pain, Unresponsive)

GCS

Pain stimulus

Pupil assessment

Limb assessment

23 The unconscious patient

Consciousness

Causes of lowered consciousness

Significance of lowered consciousness

Assessment and management of patients with lowered conscious levels

24 Stroke

Aetiology

Onset and symptoms

Diagnosis

Treatment

Related conditions

25 Seizures

Seizures and epilepsy

Causes

Symptoms

Drug therapy

Emergency nursing care

Psychological and social considerations

Functional seizures

26 Headache

Tension‐type headache

Migraine

Cluster headache

Primary headache management

Secondary headache

Red flags

Section 6: Major trauma

27 Trauma in context

Mechanism of injury

Types of trauma

Trauma systems

Pre‐hospital trauma

Assessment

The trauma team

28 Primary survey

Catastrophic haemorrhage

Airway with cervical spine control

Breathing and ventilation

Circulation with haemorrhage control

Disability

Exposure

29 Head and spinal injury

Head injury

Neck injury

30 Chest trauma

Assessment of chest injuries

Tension pneumothorax

Open pneumothorax

Massive haemothorax

Flail chest

Cardiac tamponade

The patient with a chest drain

31 Limb injuries

Open and closed fractures

Assessment of limb trauma

Management of limb trauma

Traumatic amputation

Compartment syndrome

32 Abdominal and pelvic trauma

Abdominal trauma

Pelvic trauma

33 Massive haemorrhage

Coagulopathy

Management of massive haemorrhage

Massive haemorrhage protocol

34 Burns

Classification

Total body surface area burned

Fluid requirements

Management of burns

Electrical burns

Chemical burns

Definitive care

35 Trauma: Special circumstances

The pregnant trauma patient

Older adults

Section 7: Emergency presentations

36 Abdominal pain

Assessment

Appendicitis

Cholecystitis

Pancreatitis

Bowel obstruction

Peritonitis

Ruptured abdominal aortic aneurysm (AAA)

37 Gastrointestinal bleed

Assessment

Management

Peptic ulcer disease (PUD)

Variceal bleeding

38 Genitourinary conditions

Urinary tract infection (UTI)

Pyelonephritis

Acute urinary retention

Renal colic

Testicular torsion

39 Acute kidney injury (AKI)

AKI Staging

Management

Renal replacement therapy (RRT)

40 Diabetic emergencies

Diabetic ketoacidosis (DKA)

Pathophysiology of DKA

Management of DKA

Hyperosmolar hyperglycaemic state (HSS)

Hypoglycaemia

41 Sickle cell crisis

Assessment

Management

Pain management

42 Gynaecological presentations

General principles

Vaginal bleeding

Pelvic pain

Ectopic pregnancy

Miscarriage

Early pregnancy assessment units (EPAUs)

43 Obstetric presentations

Background

Migrants and pregnancy

Pre‐eclampsia

Hyperemesis

Thromboembolism

Emergency delivery and labour

Postpartum problems

Accidents and falls

Section 8: Poisoning and overdose

44 Poisoning: Assessment and management

Assessment

Decontamination and elimination

Referral and follow‐up

45 Poisoning: Prescription and non‐prescription drugs

Prescription drugs

46 Poisoning: Other substances

Environmental sources

Household sources

Industrial sources

47 Alcohol misuse

Acute alcohol intoxication

Section 9: Infection prevention and control

48 Management of infectious diseases

Infection prevention and control

Respiratory illnesses

Infectious diarrhoea and vomiting

Blood‐borne viruses

49 Common notifiable diseases

Hepatitis

Malaria

Meningococcal septicaemia

Tuberculosis

Whooping cough

Measles

50 Sexually transmitted infections

Chlamydia

Gonorrhoea

Genital herpes

Syphilis

Section 10: Vulnerable adults

51 Safeguarding vulnerable adults

Key Principles

Recognising signs of abuse

Risk factors for adults

Trauma‐informed safeguarding

Reporting signs of abuse

52 People with a learning disability

4C Framework for Reasonable Adjustments

53 Domestic abuse

Signs of domestic abuse

Management of domestic abuse

Reporting domestic abuse

54 Sexual assault

Recognition of sexual violence

Forensic evidence of sexual assault

Medical care in the ED

Sexual Assault Referral Centres

55 Frailty

Assessment

Common causes of ED attendance

Environment

56 Falls and hip fracture

Assessment

Interventions

Safeguarding

Hip fracture

57 Dementia

Background

Assessment

Communication

Environment

Screening for dementia in the ED

58 End‐of‐life care

End‐of‐life care

Care after death

Staff support

Resources

Section 11: Mental health

59 The mental health patient in the emergency department (ED)

Assessment techniques

The ED and the Mental Health Act 1983

60 Risk assessment, self‐harm and suicide

Introduction

Self‐harm

Suicide

Risk assessment

61 Common mental health problems

Acute psychosis

Section 12: Children in the emergency department (ED)

62 Children in the emergency department (ED)

The current trend

Special considerations

63 Safeguarding children

Key principles

Identifying maltreatment

Consent

64 Recognising the sick child

Assessment

65 Common illnesses in children

Sepsis

Fever

Viral‐induced wheeze

Bronchiolitis

Non‐blanching rash

Croup (laryngotracheobronchitis)

66 Paediatric advanced life support

Cardiorespiratory arrest

Circulatory access

Paediatric advanced life support

67 Trauma in children

Catastrophic haemorrhage

Airway with cervical spine (c‐spine) control

Breathing and ventilation

Circulation with haemorrhage control

Disability

Exposure

Parents or carers

68 Minor injuries in children

Injury prevalence

Minor head injury

Pulled elbow

Fractures

Lacerations and gluing

Section 13: Urgent care

69 Lower limb injuries

Toes

Ankle injuries

Knee injuries

70 Upper limb injuries

The neck

The shoulder

The elbow

The wrist

71 Wounds

Common wounds in an ED

Wound assessment

Infection prevention and control

Patient advice

72 Eye conditions

The acute painful red eye

The acute nonpainful red eye

Other eye complaints

73 Ear, nose and throat conditions

Ear conditions

Nose problems

Epistaxis

Throat problems

74 Minor illness

Cellulitis

Gastroenteritis

Impetigo

Rash illness

Insect bites and stings

Feverish illness

Abscesses

Further reading/references

Index

End User License Agreement

List of Tables

Chapter 12

Table 12.1 Examples of acute illness

List of Illustrations

Chapter 1

Figure 1.1 Emergency department nursing roles

Figure 1.2 Areas within the emergency department

Chapter 2

Figure 2.1 Methods of pre‐hospital transport

Figure 2.2 Pre‐hospital environment: Scene assessment for RTC

Figure 2.3 Care provision

Figure 2.4 ASHICE

Chapter 3

Figure 3.1 Major incident ‘sieve and sort’

Figure 3.2 Major incident triage categories

Figure 3.3 Decontamination zones in a chemical, biological, radiol...

Chapter 4

Figure 4.1 DSTRESS mnemonic

Figure 4.2 Discharge safety checklist

Figure 4.3 Special considerations on discharge

Figure 4.4 Minor head injury advice

Figure 4.5 TTA medication advice

Figure 4.6 Pathways for virtual wards

Figure 4.7 Eligibility criteria for non‐emergency patient transpor...

Figure 4.8 Professional Record Standards Body discharge summary re...

Chapter 5

Figure 5.1 Example adult critical care stretcher set up

Figure 5.2 Sample adult transfer kit bag list

Figure 5.3 Example transfer record sheet

Chapter 6

Figure 6.1 MTS presentational flowchart unwell adult

Figure 6.2 MTS triage categories

Figure 6.3 MTS Five‐step process

Chapter 7

Figure 7.1 Causes of acute deterioration

Figure 7.2 Observation chart showing deterioration

Figure 7.3 ABCDE approach: Assessment

Figure 7.4 ABCDE approach: Management

Chapter 8

Figure 8.1 The NEWS2 scoring system

Figure 8.2 NEWS2 observation chart

Figure 8.3 Clinical response to NEWS2 scores

Chapter 9

Figure 9.1 Algorithm for treatment of undifferentiated acute pain ...

Figure 9.2 SOCRATES mnemonic for assessing pain

Chapter 10

Figure 10.1 Airway equipment

Figure 10.2 Head‐tilt and chin‐lift

Figure 10.3 Oropharyngeal airway

Figure 10.4 Nasopharyngeal airway

Figure 10.5 Definitive airway

Figure 10.6 RSI equipment

Chapter 11

Figure 11.1 Causes of dyspnoea

Figure 11.2 History taking in dyspnoea

Figure 11.3 Signs of dyspnoea

Figure 11.4 ABG normal values

Figure 11.5 Respiratory failure

Figure 11.6 Acid–base disorders

Figure 11.7 Normal CXR

Figure 11.8 Common abnormal findings on CXR

Figure 11.9 PEFR meter

Chapter 12

Figure 12.1 Oxygen therapy flow chart

Figure 12.2 Reservoir mask

Figure 12.3 Nasal cannula

Figure 12.4 Simple face mask

Figure 12.5 Venturi mask

Figure 12.6 Nebuliser

Figure 12.7 Non‐invasive ventilation

Chapter 13

Figure 13.1 Management of acute asthma in adults in the emergency...

Chapter 14

Figure 14.1 Methods of haemodynamic assessment

Figure 14.2 Normal ranges

Figure 14.3 Relationship between blood pressure and cardiac outpu...

Figure 14.4 Arterial blood pressure

Figure 14.5 Central venous catheter

Chapter 15

Figure 15.1 Standard IV cannula

Figure 15.2 IV cannula flow rates

Figure 15.3 Determinants of cannula flow rate

Figure 15.4 (a, b) Central venous catheter

Figure 15.5 Intraosseous device

Chapter 16

Figure 16.1 Classification of shock

Figure 16.2 Compensated versus decompensated shock

Figure 16.3 Compensated versus decompensated shock

Figure 16.4 Identifying risk of severe illness or death from seps...

Chapter 17

Figure 17.1 ECG calibration

Figure 17.2 Limb electrode positions

Figure 17.3 Standard ECG chest electrode positions

Figure 17.4 A normal 12‐lead ECG

Figure 17.5 12‐lead ECG territories

Chapter 18

Figure 18.1 Cardiac conduction system

Figure 18.2 Rapid rhythm analysis

Figure 18.3 Sinus rhythm

Figure 18.4 Ventricular ectopic

Figure 18.5 Atrial fibrillation

Figure 18.6 Atrial flutter

Figure 18.7 Supraventricular tachycardia

Figure 18.8 Ventricular tachycardia

Figure 18.9 Ventricular fibrillation

Figure 18.10 Heart blocks

Chapter 19

Figure 19.1 Pathophysiology of ACS

Figure 19.2 OLDCARTS chest pain assessment tool

Figure 19.3 Classification of ACS

Figure 19.4 ACS on the 12‐lead ECG

Figure 19.5 ECG territories

Figure 19.7 Primary percutaneous coronary intervention

Figure 19.6 ACS: Nursing care

Chapter 20

Figure 20.1 The structurally normal heart and the heart with an e...

Figure 20.2 Common symptoms associated with heart failure

Figure 20.3 Peripheral oedema

Figure 20.4 A chest X‐ray from a patient with left heart failure...

Figure 20.5 Symptoms and interventions for cardiogenic shock

Chapter 21

Figure 21.1 Chain of survival

Figure 21.2 ALS algorithm

Figure 21.3 Confirm cardiac arrest

Figure 21.4 Chest compressions

Figure 21.5 Attach defibrillator

Chapter 22

Figure 22.1 ACVPU

Figure 22.2 The GCS

Figure 22.3 Recording and reporting the GCS

Figure 22.4 Central pain stimulus for assessment of consciousness...

Figure 22.5 Pupil observations

Figure 22.6 Limb assessment

Chapter 23

Figure 23.1 Trauma

Figure 23.2 Care of the unconscious patient

Chapter 24

Figure 24.1 FAST

Figure 24.2 The ROSIER scale

Figure 24.3 Emergency care

Figure 24.4 Thrombolysis exclusions

Chapter 25

Figure 25.1 Emergency management of seizures

Chapter 26

Figure 26.1 Types of primary headache

Figure 26.2 History taking in headache

Figure 26.3 Analgesic management

Figure 26.4 Headache red flags

Chapter 27

Figure 27.1 Example of trauma call criteria

Figure 27.2 Types of trauma assessment

Figure 27.3 The trauma team

Chapter 28

Figure 28.1 Trauma assessment

Figure 28.2 Life‐threatening thoracic injuries

Figure 28.3 Breathing and ventilation assessment

Figure 28.4 Common bleeding sites in the trauma patient

Chapter 29

Figure 29.1 Subarachnoid and skull fracture

Figure 29.2 Moderate to severe head injury adults

Figure 29.3 Indications for CT following head injury

Figure 29.4 Discharge information and advice

Figure 29.5 Common causes of neck injury

Figure 29.6 Risk factors for neck injury

Figure 29.7 Hard collar

Chapter 30

Figure 30.1 Types of chest injuries

Figure 30.2 Assessment of breathing

Figure 30.3 Cardiac tamponade

Figure 30.4 Thoracotomy

Figure 30.5 Chest drains

Chapter 31

Figure 31.1 Compound fracture

Figure 31.2 5Ps

Figure 31.3 Patients at high risk of complications

Figure 31.4 (a, b) Traction splints

Chapter 32

Figure 32.1 Abdominal anatomy

Figure 32.2 Management of trauma patient

Figure 32.3 Pelvic anatomy

Figure 32.4 Pelvic binders

Chapter 33

Figure 33.1 Lethal triad

Figure 33.2 Control of catastrophic haemorrhage

Figure 33.3 Massive haemorrhage protocol example

Chapter 34

Figure 34.1 Types of burn

Figure 34.2 Burns classification and characteristics

Figure 34.3 Estimated body surface area by burns

Figure 34.4 Burns referral criteria example

Chapter 35

Figure 35.1 Anatomical and physiological changes during pregnancy...

Figure 35.2 Left lateral tilt and manual displacement

Figure 35.3 Physiological changes in the older adult

Chapter 36

Figure 36.1 Causes of acute abdominal pain

Figure 36.2 General management

Figure 36.3 Abdominal pain assessment

Figure 36.4 Types of abdominal pain

Figure 36.5 Abdominal examination

Figure 36.6 Types of bowel obstruction

Chapter 37

Figure 37.1 Causes of GI bleed

Figure 37.2 Types of GI bleed

Figure 37.3 Relevant history in GI bleed

Figure 37.4 Endoscopic image of a deep gastric ulcer

Figure 37.5 Oesophageal varices

Chapter 38

Figure 38.1 Symptoms of a UTI

Figure 38.2 Symptoms of pyelonephritis

Figure 38.3 Bladder distension in urinary retention

Figure 38.4 Testicular torsion

Figure 38.5 Paraphimosis

Chapter 39

Figure 39.1 Classification of AKI

Figure 39.2 Patients at greatest risk of AKI

Figure 39.3 Patient assessment

Figure 39.4 Management

Chapter 40

Figure 40.1 DKA assessment

Figure 40.2 DKA management

Figure 40.3 HHS causes

Figure 40.4 Hypoglycaemia

Chapter 41

Figure 41.1 Normal and sickle cells

Figure 41.2 Common sites of acute and chronic complications of si...

Figure 41.3 ACT NOW

Figure 41.4 Compassionate and coordinated care

Figure 41.5 Flowchart for management of acute painful sickle cell...

Chapter 42

Figure 42.1 Normal and ectopic pregnancy

Figure 42.2 Signs and symptoms of ectopic pregnancy

Figure 42.3 Urine hCG pregnancy test

Figure 42.4 Types of miscarriage

Figure 42.5 Psychosocial care during and after pre‐24‐week pregna...

Chapter 43

Figure 43.1 Changes in pregnancy

Figure 43.2 High‐risk pregnancy

Figure 43.3 Emergency delivery equipment

Chapter 44

Figure 44.1 Common toxins with antidotes/treatment

Figure 44.2 Assessment

Figure 44.3 Common effects of toxic substances on body

Figure 44.4 Activated charcoal

Chapter 45

Figure 45.1 Tricyclic antidepressant overdose: assessment and man...

Figure 45.2 Signs and symptoms of paracetamol overdose

Figure 45.3 Paracetamol treatment nomograph

Figure 45.4 Paracetamol overdose treatment regimens

Figure 45.5 Opioid overdose: assessment and management

Chapter 46

Figure 46.1 Sources of carbon monoxide

Figure 46.2 Signs and symptoms of carbon monoxide poisoning

Figure 46.3 Questions to ask

Figure 46.4 Carbon monoxide poisoning: Assessment and management...

Chapter 47

Figure 47.1 Acute alcohol intoxication: Assessment and management...

Figure 47.2 Effects of excess alcohol on the body

Figure 47.3 Effect of stopping excess alcohol

Figure 47.4 Wernicke’s encephalopathy (WE): Signs and symptoms

Figure 47.5 Alcohol units by drink

Chapter 48

Figure 48.1 World Health Organizations' five moments for hand hyg...

Figure 48.2 Management post needlestick injury

Chapter 49

Figure 49.1 Notifiable diseases UK: Diseases notifiable to local ...

Figure 49.2 TB risk factors

Figure 49.3 Types of hepatitis

Chapter 50

Figure 50.1 Chlamydial conjunctivitis

Figure 50.2 Herpes lesion

Figure 50.3 Syphilis rash to hands

Chapter 51

Figure 51.1 Definition of a vulnerable adult

Figure 51.2 Types of abuse

Figure 51.3 The six principles of adult safeguarding

Chapter 52

Figure 52.1 4C Framework for Making Reasonable Adjustments

Figure 52.2 Examples of signs, symbols and medical care pictures ...

Figure 52.3 The Hospital Passport

Figure 52.4 Vignette

Chapter 53

Figure 53.1 Protecting staff

Figure 53.2 Signs of domestic abuse

Figure 53.3 British Medical Association: Recommended questions/st...

Chapter 54

Figure 54.1 Adult sexual offence categories from Sexual Offences ...

Figure 54.2 Evidence collected by a Forensic Medical Examiner at ...

Figure 54.3 Advice for victims to preserve forensic evidence befo...

Figure 54.4 Techniques that stimulate the parasympathetic nervous...

Chapter 55

Figure 55.1 9‐point Clinical Frailty Scale

Figure 55.2 Comprehensive Geriatric Assessment

Chapter 56

Figure 56.1 Factors that increase risk of falls

Figure 56.2 Measurement of lying/standing blood pressure

Figure 56.3 Multifactorial falls assessment and interventions in ...

Chapter 57

Figure 57.1 Support for the patient with dementia

Figure 57.2 The Abbey Pain Scale

Figure 57.3 Mental capacity assessment

Chapter 58

Figure 58.1 Gold Standards Framework – Proactive Identification G...

Figure 58.2 Principles of breaking bad news

Figure 58.3 Emergencies in palliative and EOLC

Figure 58.4 Bereaved relatives' room

Figure 58.5 Reporting to the coroner in the UK

Figure 58.6 Bereaved booklet information

Chapter 59

Figure 59.1 Issues to explore through questioning and observation...

Figure 59.2 Assessment techniques

Chapter 60

Figure 60.1 Mental health risk assessment matrix

Chapter 61

Figure 61.1 Key features of psychosis

Figure 61.2 Key features of bipolar disorder

Figure 61.3 Key features of depression

Figure 61.4 Key issues of personality disorder presentation may i...

Chapter 62

Figure 62.1 The unique considerations of children

Figure 62.2 The United Nations Convention on the Rights of the Ch...

Figure 62.3 Summary of recommendations: The Children's Act (1989,...

Chapter 63

Figure 63.1 Signs of maltreatment in children

Figure 63.2 Gillick competency and Fraser guidelines

Chapter 64

Figure 64.1 Consequences of progressive respiratory or circulator...

Figure 64.2 Pulse and respiratory rates (age‐related parameters a...

Figure 64.3 Paediatric Early Warning Score (PEWS)

Chapter 65

Figure 65.1 Common respiratory illness in children

Figure 65.2 Signs and treatment of SEPSIS in Under 16s (The UK Se...

Figure 65.3 Non‐blanching rashes signifying septicaemia

Figure 65.4 Westley Croup Scoring System (total individual compon...

Chapter 66

Figure 66.1 Head positioning for airway patency

Figure 66.2 Airway and breathing adjuncts

Figure 66.3 Positioning for chest compressions

Figure 66.4 IO drill, needle and giving set

Figure 66.5 Paediatric advanced life support algorithm

Chapter 67

Figure 67.1 A pad beneath the shoulders creates a neutral airway ...

Figure 67.2 Airways

Figure 67.3 Paediatric Glasgow Coma Scale

Chapter 68

Figure 68.1 Modified Paediatric Glasgow Coma Scale

Figure 68.2 Head injury guidelines (NICE, 2023)

Figure 68.3 ‘Pulled elbow’

Figure 68.4 Salter Harris Type 2 growth plate fracture

Figure 68.5 Torus ‘buckle’ fracture

Figure 68.6 Greenstick fracture

Figure 68.7 Displaced supracondylar fracture

Chapter 69

Figure 69.1 Buddy strapping

Figure 69.2 Ankle fracture dislocation

Figure 69.3 Base of fifth metatarsal

Figure 69.4 Ottawa ankle rules

Figure 69.5 Knee anatomy

Figure 69.6 Undisplaced patella fracture

Chapter 70

Figure 70.1 Shoulder joint

Figure 70.2 X‐ray of dislocated shoulder

Figure 70.3 Fractured clavicle

Figure 70.4 Broad arm sling in situ

Figure 70.5 Elbow anatomy

Figure 70.6 Elbow (olecranon) fracture

Figure 70.7 Wrist and hand anatomy

Figure 70.8 Colles fracture – dorsal displacement of the distal r...

Chapter 71

Figure 71.1 Chronic and acute wounds

Figure 71.2 Types of wounds

Figure 71.3 Wound closure methods

Chapter 72

Figure 72.1 Eye anatomy

Figure 72.2 Snellen Chart for testing visual acuity

Figure 72.3 Fluorescein staining

Figure 72.4 Discharge typical with bacterial conjunctivitis

Figure 72.5 Subconjunctival haemorrhage

Figure 72.6 Chemical (alkali) eye injury

Chapter 73

Figure 73.1 Ear anatomy

Figure 73.2 Otitis media

Figure 73.3 Anatomy of the nasal cavity and throat

Figure 73.4 Nasal packing

Figure 73.5 Bilateral peritonsular abscess

Figure 73.6 Acute epiglottitis seen with ultrasound

Chapter 74

Figure 74.1 Cellulitis

Figure 74.2 Impetigo

Figure 74.3 Meningitis rash

Figure 74.4 Non‐blanching rash and the tumbler test

Guide

Cover Page

Table of Contents

Title Page

Copyright Page

About the editors

Contributors

Preface

Acknowledgements

Begin Reading

Further reading/references

Index

Wiley End User License Agreement

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Emergency Nursing at a Glance

Second Edition

Edited by

Paul Newcombe

Sarah Laslett

Series Editor: Ian Peate

This edition first published 2026© 2026 John Wiley & Sons Ltd

Edition HistoryWiley Blackwell (1e, 2016)

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Library of Congress Cataloging‐in‐Publication Data

Names: Newcombe, Paul editor | Laslett, Sarah editorTitle: Emergency nursing at a glance / [edited by] Paul Newcombe, Sarah Laslett.Description: Second edition. | Hoboken, NJ, USA : Wiley, 2026. | Series: At a glance (nursing and healthcare) | Includes index.Identifiers: LCCN 2025043868 (print) | LCCN 2025043869 (ebook) | ISBN 9781394272914 paperback | ISBN 9781394272938 adobe pdf | ISBN 9781394272921 epubSubjects: LCSH: Emergency nursingClassification: LCC RT120.E4 E475 2026 (print) | LCC RT120.E4 (ebook)LC record available at https://lccn.loc.gov/2025043868LC ebook record available at https://lccn.loc.gov/2025043869

Cover Design: WileyCover Image: © Monkey Business Images/Shutterstock

About the editors

Paul Newcombe is a senior nursing academic and healthcare consultant with extensive experience in emergency care education. Having held leadership positions at a number of London universities, he has led the development of undergraduate and postgraduate programmes and is widely published in the field of urgent and emergency care.

Sarah Laslett is a registered adult nurse with a clinical background as an Emergency Nurse Practitioner and a Clinical Nurse Specialist. A former senior lecturer at Canterbury Christ Church University, her teaching and research interests include health inequalities and social justice. She currently works in primary care and holds an honorary academic position.

Contributors

Las AiyathuraiLecturerCanterbury Christ Church UniversityEngland

Francis AkorStaff Grade PaediatricianDartford and Gravesham NHS TrustEngland

Sarah‐Jane AnscombSenior LecturerCity St George’s, University of LondonLondon

Chris BrunkerFormer Clinical Nurse SpecialistNeuro‐Intensive CareSt George's University NHS Foundation TrustLondon

Kate ButtonSenior LecturerCanterbury Christ Church UniversityEngland

Eimear CardwellSenior LecturerUniversity of GreenwichLondon

Sarah Cave‐McMullanSenior LecturerCanterbury Christ Church UniversityEngland

John ClulowConsultant Advanced Clinical Practitioner, Emergency MedicineGreensands Health Centre, Linton, KentSenior LecturerCanterbury Christ Church UniversityEngland

Sadie ConnollyForensic Nurse PractitionerEngland

Amba Cooper‐MorrisParamedic/LecturerCanterbury Christ Church UniversityEngland

Meg CoreyLecturerCanterbury Christ Church UniversityEngland

Elizabeth CotterLecturerCanterbury Christ Church UniversityEngland

Marissa DaintonSenior LecturerCanterbury Christ Church UniversityEngland

Emily DekkerRegistered Nurse and LecturerBirmingham City UniversityEngland

Inmaculada Diaz AlonsoSenior LecturerCanterbury Christ Church UniversityAdvanced Clinical Practitioner, Emergency, Urgent and Primary CareMedway Practices AllianceEngland

Kim FittallLead Advanced Clinical Practitioner, FrailtyEast Kent Hospitals University NHS Foundation TrustEngland

Raquel GonzagaAdvanced Clinical Practitioner, Emergency MedicineMaidstone and Tunbridge Wells NHS TrustEngland

Matt HartSenior LecturerCanterbury Christ Church UniversityEngland

Sarah HassiemLecturerUniversity of Doha for Science and TechnologyQatar

Caron IrelandFreelance NurseEngland

Catherine JonesSenior LecturerUniversity of RoehamptonPractice Educator Major TraumaSouth West London and Surrey Trauma NetworkLondon

Krishan JosephGP FellowUniversity of RoehamptonEngland

Stefani KonstantinouLecturerCanterbury Christ Church UniversityEngland

Joan LawrencePrinciple Lecturer, Faculty Strategic Lead for Equity and InclusionSenior Lecturer in MidwiferyCanterbury Christ Church UniversityEngland

Sarah LeylandSenior LecturerUniversity of RoehamptonEngland

Daniel MarsdenSenior Lecturer/Learning Disability NurseCanterbury Christ Church UniversityEngland

Shauna McCuskerPrincipal Lecturer in Forensic InvestigationSpecialist in Violence Against Women and GirlsCanterbury Christ Church UniversityEngland

Janet Melville‐WisemanProfessor of Social WorkCanterbury Christ Church UniversityEngland

Emma Menzies‐GowSenior Lecturer Adult NursingKing’s College LondonLondon

Alero OmaghomiLead Paediatric Haemoglobinopathy Clinical Nurse SpecialistDartford and Gravesham NHS TrustEngland

Jaime PhippsLecturer in Adult Nursing and Non‐Medical PrescribingCanterbury Christ Church UniversityAdvanced Nurse Practitioner NHSEngland

Ollie PhippsPrincipal Lecturer in Advanced Practice and Non‐Medical PrescribingCanterbury Christ Church UniversityAdvanced Clinical Practitioner, Emergency DepartmentMaidstone and Tunbridge Wells NHS TrustEngland

Nicole PollockAssociate Head of School, Practice LearningSimulation and Immersive TechnologyCanterbury Christ Church UniversityEngland

Anna RyanMatron, Virtual Ward/Rapid ResponseCroydon Health Services NHS TrustEngland

Catherine SiggeryAcute Learning Disability/Autism Liaison NurseDartford and Gravesham NHS TrustEngland

Sari Sirkia‐WeaverSpecialist Associate LecturerCanterbury Christ Church UniversityKent and Medway Medical SchoolUniversity of Exeter Medical SchoolEngland

Claire SmitheramSenior LecturerCity St George’s, University of LondonLondon

Suzan ThompsonSenior LecturerCity St George’s, University of LondonLondon

Preface

Since the first edition, the demand for emergency care in the UK has continued to rise alongside a growing awareness of the inequities experienced by some patient groups. Models of service provision continue to be developed to ensure that care is delivered to the right people, in the right place, at the right time. Emergency nursing is an exciting and rewarding career, although sometimes challenging. It requires a broad knowledge base and a commitment to lifelong learning.

This revised edition offers up‐to‐date, peer‐reviewed content that provides readers with written and visual information relating to all aspects of emergency nursing. Chapters are organised into themes, exploring the diverse experiences of patients from pre‐hospital care to discharge or end‐of‐life. Each chapter covers a clinical topic or patient group and includes background information, guidelines for assessment and care and management of common presentations. The text is accompanied by clear illustrations, photographs, diagrams and flow charts to further support learning. New topics in this edition include discharge planning, infection control, frailty and sickle cell crisis.

The ‘At a Glance’ format provides quick reference to the knowledge and skills required for emergency nursing, making it perfect for student nurses or nurses new to the emergency department.

Acknowledgements

We would first like to thank the co‐editor and contributors from the first edition: Natalie Holbery, Jim Blair, Chris Hart, Heather Jarman, Matthew Parkes and Nicola Shopland. We would also like to thank all the contributors to the second edition and Wiley for keeping us on track. Finally, thanks to Nichola Brown, Oscar Cavero, Zander Cortez, Alero Omaghomi, Jasper Ross and Penelope Ross for posing as models.

Section 1The ED journey

Chapters

1The context of emergency nursing

2Pre‐hospital care

3Major incidents

4Discharge planning

5Patient transfer

1The context of emergency nursing

Natalie Holbery and Inmaculada Diaz Alonso

Figure 1.1 Emergency department nursing roles

Figure 1.2 Areas within the emergency department

The emergency department (ED) is a busy, fast‐paced, unpredictable and often highly emotive place to work. ED nurses need to be proficient in assessing, recognising and caring for patients across the lifespan with undiagnosed illness or injury. They are required to process large amounts of information to facilitate decision‐making, often in time‐pressured situations. Violence and aggression towards ED staff have increased in recent years, so nurses need to be adept at conflict resolution and proficient in communicating with all members of the public. Knowledge of legal and professional issues relating to consent, mental capacity, restraint, information sharing, forensics and end‐of‐life care is key to delivering safe and competent care. Several core and advanced ED nursing roles exist in the UK (Figure 1.1).

Patients arrive in the ED in a number of ways (Chapter 2). In the UK, public education redirects people away from the ED when possible, promoting alternative services such as a pharmacist, general practitioner (GP) or urgent treatment centre (UTC) for non‐emergency conditions. Most patients self‐refer to the ED; however, others may be referred by a telemedicine service (e.g. NHS 111), a GP, pharmacist or community nurse.

ED team

ED care is delivered by an inter‐professional team of nurses, doctors and healthcare support workers as well as paramedics and physician associates. Allied health professionals, such as speech and language therapists, physiotherapists, occupational therapists and dieticians, also work alongside ED nurses to address patients' physical and social needs as required.

4‐hour target

A drive to reduce waiting times and expedite care saw the introduction of the 4‐hour target in the UK. Most patients should be seen, treated and discharged within 4 hours of arrival. Approximately 25% of patients in the UK are admitted to hospital from the ED, with the remainder discharged to their usual place of residence. To support the delivery of care within 4 hours, medical and (in some places) surgical units have been established across the UK. These are separate from EDs and have developed as specialties in their own right.

Areas within the ED

EDs vary in size, but all are structured to accommodate a variety of urgent and emergency presentations (Figure 1.2).

Initial assessment, streaming and triage

Initial assessment should occur within 15 minutes of the patient's arrival at the ED. The purpose is to identify the presenting complaint and assess acuity. Initial assessment involves streaming and triage (usually undertaken by the ED nurse) or rapid assessment and treatment (RAT) undertaken by a team that includes a senior ED doctor or Advanced Clinical Practitioner, nurses and support staff.

Streaming allocates patients to the most appropriate area of the ED or to other specialist services. Triage prioritises patients according to acuity (Chapter 6). Basic observations should be undertaken, and first aid and simple analgesia given. Complex investigations and interventions should not be done at this point.

RAT is a more complex process, generally used for higher acuity patients. Investigations and treatments can be initiated quickly to improve patient outcomes.

Resuscitation area

The resuscitation area, or ‘resus’, is designed for critically ill and injured patients with high acuity on a triage scale. Examples include trauma, cardiac arrest, stroke, respiratory distress, sepsis and altered conscious levels. This area should be staffed by experienced, specially trained ED nurses with appropriate knowledge, skills and competence.

Majors

‘Majors’ tends to be the core of the ED and is usually the largest part of the department. It accommodates acutely unwell patients with a wide variety of medical, surgical, gynaecological and obstetric and mental health presentations. It is usually staffed by core ED nurses. In some departments, emergency advanced nurse practitioners see, treat and discharge patients from majors.

Minors/UTC

‘Minors’ is a term that has been traditionally used to describe patients with lower acuity. Recent restructuring of emergency care led to the development of UTCs, some of which are attached to an ED. Regardless of the term used, patients seen in this area are lower acuity with minor injuries or minor health problems. Examples include limb injuries, epistaxis, cellulitis, eye conditions, back pain, ear, nose and throat conditions, and simple wounds. Minors is usually staffed by core ED nurses, emergency nurse practitioners and doctors.

Children

Children account for approximately 25% of emergency attendances (see Section 12). They and their families should have audiovisual separation from adult patients. This usually includes a separate triage area, waiting room and treatment area. Attention should also be paid to security and child‐friendly facilities such as toilets, toys, and food and drink areas. A play specialist is recommended in departments that see more than 16,000 children a year. Registered children's nurses should be available to care for unwell or injured children. Registered adult nurses will also come into contact with children and their families in areas such as triage, resus and, occasionally, urgent care.

Observation and assessment units

The introduction of the 4‐hour target led to the establishment of areas within EDs aimed at providing holistic care beyond 4 hours. These areas usually consist of hospital beds and food and drink facilities. Patients who require allied health assessment or social care input benefit from these areas. Care is often pathway led and may also include patients with low‐risk conditions who are waiting for serial blood tests or other investigations.

2Pre‐hospital care

Paul Newcombe and Amba Cooper‐Morris

Figure 2.1 Methods of pre‐hospital transport

Source: (a) Oxyman / Wikimedia commons / CC BY SA 3.0; (b) Copyright Paul Newcombe; (c) Derek Blackadder / Wikimedia commons / CC BY SA 2.0; (d) Oxyman / Wikimedia commons / CC BY SA 3.0; (e) Matthew Bell / Wikimedia commons / CC BY SA 3.0

Figure 2.2 Pre‐hospital environment: Scene assessment for RTC

Figure 2.3 Care provision

Figure 2.4 ASHICE

Across the UK, there are 14 different ambulance services, each with its own policies and procedures and vehicles (Figure 2.1). Doubled crewed ambulances (DCA) are usually staffed by a paramedic and a supporting role such as an Emergency Care Support Worker (ECSW) or Associate Ambulance Practitioner (AAP). Single response vehicles (SRV) are usually crewed by a paramedic with more than 2 years' experience or a specialist role such as paramedic practitioner or critical care paramedic. Some services have volunteer roles known as community first responders who can start immediate life‐saving treatment while they await a DCA or SRV.

There are 21 Air Ambulance Charities across the UK, who can provide further critical care to patients. This allows patients to be transferred swiftly via air to specialist hospitals when a road ambulance could take extensive amounts of time. Air ambulances are usually staffed by a doctor and a paramedic and have a scope of practice that includes, but is not limited to, rapid sequence induction (Chapter 10) and the provision of blood products.

Pre‐hospital environment

Patients come from a variety of pre‐hospital environments including home, work, school, residential care facilities and public places. On arrival at a scene, ambulance personnel will undertake a scene assessment (Figure 2.2) to establish if there is any danger, the number of casualties, the nature of illness or injury and the need for extra help. They will declare a major incident, if appropriate (Chapter 3). They frequently work alongside other emergency services such as the police and fire and rescue services. This can be a volatile environment to work in, with verbal, physical and sexual assaults on ambulance staff increasing.

Patient assessment

Patient assessment in the pre‐hospital environment is a dynamic process using a structured approach.

History

It is imperative that history taking is as accurate as possible. Information can be gained from the patient and from bystanders, such as family or those who witnessed the incident, giving paramedics a well‐rounded picture of events. While patients in their own homes may have readily available health information such as their prescribed medications, those in a public place can present with little to no background information, even nameless. Ambulance services have no way of accessing hospital or GP records. This lack of information can lead to conflict with emergency department (ED) services as receiving staff require this information to be able to book the patient into the department.

Physical assessment

The pre‐hospital approach to patient assessment takes the form of the initial primary survey, followed by a secondary survey. The primary survey follows the mnemonic DRCABCDE.

Check for Danger

Is the patient Responsive?

Is there a Catastrophic bleed?

Is the Airway clear?

Is Breathing normal?

Is Circulation normal?

Any neurological Disability?

Is the patient Exposed to an environment that could impact their health?

Any problems must be addressed before moving to the next stage of the assessment.

A secondary survey is then undertaken. This is a top‐to‐toe examination to inspect, palpate, percuss and auscultate (IPPA).

Psychological assessment

Increasingly, paramedics are seeing patients experiencing an acute mental health crisis, and they must be able to assess if that person carries a risk to themselves (Chapters 60 and 61). They are also able to assess capacity and make decisions using the Mental Capacity Act (2005) to act within a patient's best interest if at that time they lack the capacity to make decisions for themselves.

Care provision

Paramedics are autonomous in their practice, formulating a working diagnosis. They can avoid conveyance to the ED by providing care and treatment for a large number of conditions. They also have access to local referral pathways aimed at avoiding hospital admission where possible and appropriate, including social services referrals.

Interventions

A range of interventions can be provided (Figure 2.3). Paramedics have the same scope of practice nationally; however, not all DCAs are crewed by paramedics, which can limit the availability of some interventions until further crews arrive.

Transfer to ED

If a patient requires conveyance to the ED for further investigations or emergency treatment, the paramedic must consider local protocols and specialist care pathways for conditions such as myocardial infarction, acute stroke and major trauma, as this will determine which hospital they convey to. If emergency conveyance is required, this is done using blue lights and sirens to hasten the journey and a pre‐alert call is made to the ED to enable staff to prepare for the arrival. The mnemonic ASHICE is used to structure the pre‐alert call (Figure 2.4).

Handover

Handover is a crucial point in the patient journey and requires good communication and documentation skills on the part of ambulance and ED staff. Each ED has its own approach to receiving ambulances, but this process should be carried out in a thorough and efficient manner. Handover should be patient centred and protect privacy and dignity as far as possible. It is essential that all relevant information is correctly received and recorded to ensure continuity and safety, and to maximise patient outcomes.

3Major incidents

Heather Jarman and Las Aiyathurai

Figure 3.1 Major incident ‘sieve and sort’

Figure 3.2 Major incident triage categories

Figure 3.3 Decontamination zones in a chemical, biological, radiological, nuclear and explosive (CBRNe) incident

A major incident is an event that requires special arrangements to be made by pre‐hospital services, emergency departments (EDs) and hospitals due to the number or types of patients (casualties) involved. It requires a pre‐defined, coordinated response called a ‘major incident plan’.

Types of major incidents

A major incident can be caused by a number of different events:

Natural causes (e.g. floods, earthquakes and hurricane)

Major accidents (e.g. train derailment, building collapse and large‐scale fire)

Health related (e.g. pandemics and influenza)

Hostile acts (e.g. terrorism).

A ‘CBRNe’ incident is a particular type of event that involves the deliberate release of chemical, biological, radiological or nuclear and explosive materials with the intention of causing harm.

Role of emergency services

Major incidents involve a multi‐agency response in which all the emergency services work together to rescue those injured or affected by the event:

Police – overall coordination, investigation of the incident, evidence gathering and liaison with families.

Fire service – detection and management of hazardous materials, search and rescue.

Ambulance – treatment and stabilisation of casualties at the scene, and transport of casualties to hospital.

Hospital – assessment, stabilisation and definitive treatment of casualties.

Triage ‘sieve and sort’

In incidents involving a large number of casualties, it is necessary to ensure that those most severely injured are prioritised. At the site of the incident, this is performed by ambulance personnel. It is similar to the concept of triage applied in EDs (Chapter 6) but where ‘sieve’ is a rapid primary assessment based on any signs of life, and ‘sort’ involves a more thorough secondary clinical assessment (Figure 3.1). Casualties are assigned categories or priorities based on the severity of injury using an algorithm (Figure 3.2). The ‘Expectant’ category is unique to major incidents and used when the number of casualties overwhelms the available resources. This means that casualties at the scene who have injuries incompatible with life are triaged ‘to wait’ and other priority 1 casualties are treated first. Triage is a dynamic process, and casualties are re‐triaged by senior clinical staff on arrival at hospital.

Hospital response

All NHS hospitals have a major incident plan detailing the hospital‐wide response to any such event. This plan will include a range of departments and wards in addition to the ED. The hospital is usually notified of a major incident by the ambulance service and is either placed on ‘standby’ when there is preliminary advice to anticipate a major incident or ‘declared’ when there is implementation of the full plan.

When a major incident is declared, the hospital will activate a pre‐determined series of alerts to key staff and set up a command centre to coordinate the response. This involves discharging patients from the wards and stopping non‐emergency surgery to ensure that theatres are able to take casualties from the major incident.

The role of the ED

The primary role of the ED in a major incident is the reception of casualties. It provides treatment according to their injuries or symptoms. In the first few hours after a major incident is declared, it is the focus of the activity and a large number of clinical staff from across the hospital will arrive to assist.

Patients who arrive at the ED who are not a casualty of the major incident are encouraged to seek treatment elsewhere, and other ambulances are diverted to hospitals not involved in the major incident.

CBRNe incidents

Incidents that are suspected of involving the deliberate release of hazardous materials require a special type of major incident response aimed at reducing the effects of exposure to the contaminant. Potential contaminants are as follows:

Chemical – chemical agents (e.g. cyanide, mustard gas and nerve agents).

Biological – bacteria, viruses or toxins (e.g. anthrax, botulism and smallpox). Release can be into the environment, or food and water sources.

Radiological – radioactive material released through an explosive ‘dirty bomb’, or radioactive material being left in a public place.

Nuclear – nuclear material released accidentally or through a terrorist act.

Recognising a CBRNe incident

Recognition of potential exposure to a CBRNe incident is crucial to managing, treating and preventing further spread of the contaminant, as described in the Joint Emergency Services Interoperability Programme. Owing to the wide variety of agents, it is possible that casualties may present to an ED with a range of non‐specific symptoms, such as rashes, burns, breathing problems and vomiting, whose onset is sometimes hours but may not occur until weeks after exposure. Emergency nurses should be aware of multiple patients arriving from the same location and presenting to the ED with similar symptoms. Advice can be sought through the health protection or public health agencies.

Decontamination of casualties