It is critical
Definitions
Delirium
What am I
Why do it in the ED
100
TRAUMA....It is the lethal 3
1. hypothermia: trauma patients lose heat through blood loss, exposure, and cold IV fluids. As core temperature drops, clotting enzymes stop functioning efficiently, and vasoconstriction worsens tissue oxygenation. Reinforce that nurses must keep trauma patients warm from the start—use warm blankets, warmed fluids, and avoid prolonged exposure.
2. acidosis: inadequate perfusion from shock causes tissue hypoxia and anaerobic metabolism, producing lactic acid. This acid-base disturbance decreases cardiac function and further impairs coagulation. Emphasize the importance of rapid recognition of shock—monitoring trends in lactate levels can indicate worsening acidosis.
3 coagulopathy: ongoing blood loss, hemodilution from excessive crystalloids, and hypothermia all impair the body’s ability to form stable clots. Once coagulopathy sets in, even small bleeds become uncontrolled. Early blood product transfusion using balanced ratios (1:1:1) helps restore coagulation factors.
100
BPSD - ITS NOT EASY TO MANAGE - WHAT IS IT
Behavioural and Psychological Symptoms of Dementia (BPSD)
•Agitation, aggression, wandering, restlessness, anxiety, hallucinations, and sleep disturbance.
•These can escalate in the unfamiliar, overstimulating ED environment.
•Approach calmly; maintain eye level and soft tone.
•Validate emotions: 'You seem upset. Can you tell me what’s bothering you?'
HOW TO MANAGE THE NOT SO EASY TO MANAGE
•Redirect gently with familiar objects or conversation topics.
•Reduce noise, dim lights, minimize staff changes.
•Engage family for reassurance or distraction.
•Ensure safety - remove hazards, maintain clear paths.
100
give me a.....
D E L I R I U M S
what have you got once you figure them out
Causes of DELIRIUMS
D – Drugs: medications such as anticholinergics, opioids, benzodiazepines, and alcohol
E – Environmental factors: lack of assistive devices (e.g., hearing aids, eyeglasses), sleep/wake cycle disturbances, immobilization
L – Low oxygen: conditions like myocardial infarction, pulmonary embolism, or anemia
I – Infection: pneumonia, urinary tract infections, skin ulcers, sepsis, shock
R – Retention: urinary retention or constipation
I – Intracranial issues: seizures, strokes, space-occupying lesions, head trauma
U – Underhydration/undernutrition: dehydration or poor oral intake
M – Metabolic disturbances: electrolyte imbalances, glucose abnormalities, thyroid disorders, liver or kidney dysfunction
S – Sleep disturbances: disruption of normal sleep patterns
100
I Views frailty as the accumulation of health deficits—diseases, cognitive issues, sensory loss, mobility limitations, etc.
I will use the Clinical Frailty Scale (CFS) to score from 1 (very fit) to 9 (terminally ill).
I am more than just frail because I Capture multidimensional decline and functional status.
What is the Rockwood Deficit Accumulation Model (2005)
100
Frailty Models
Frailty models provide structure to clinical intuition. Using them helps nurses shift from reactive to proactive geriatric care in the emergency setting.
200
match me
A B C D E
1. Fully expose to find hidden injuries ;Prevent hypothermia: warm fluids, blankets
2. Assess chest rise, rate, and oxygenation; Identify life-threatening chest injuries; Provide high-flow O₂ or assist ventilation; Treat pneumothorax or open chest wounds early
3. Assess LOC (use GCS);Check pupils (PERRL);Look for motor/sensory deficits; Rule out hypoglycemia; consult neurosurgery if needed
4. Ensure airway patency (top priority), Maintain cervical spine precautions; Use jaw-thrust; avoid head tilt; Prepare advanced airway if GCS ≤ 8
5. Control external bleeding; Establish 2 large-bore IVs or IO access; Begin balanced fluid resuscitation; Recognize shock; activate MHP early
A=4; B= 2; C=5; D=3; E=1
200
Name three distinct attributes that distinguish Delirium from Dementia, from Depression
delirium- sudden - fixable
Dementia - progressive
Depression - mood related
200
I said "yes" the pt has been more confused lately what test did Ido? what test should I do now
what is SQiD - single question screening tool
UB-2 = 2 more questions - name it backwards or pick a day of the week
or
CAM or 4AT what????200
My phenotype is fried - If I reverse those two main words - what am I and what is used as criteria
Frailty Model as a physical syndrome with five measurable criteria:
1. Unintentional weight loss (>10 lbs in 1 year)
2. Weak grip strength
3. Self-reported exhaustion
4. Slow walking speed
5. Low physical activity
Frailty is present if 3 or more are positive; pre-frail if 1–2.
200
•Place high-risk patients near nursing stations.
•Provide non-slip socks and ensure floor is clutter-free.
•Keep call bell and personal items within reach.
•Reassess pain and toileting needs during hourly rounding.
Do this in the ED to prevent FALLS
300
7 TS FOR MASSIVE HEMORRHAGE PROTOCOL
The 7 Ts Framework:
•Triggering – Recognizing when to activate the MHP-4 units of blood within one hour;loss of one-half the patient’s blood volume within a three-hour period;significant ongoing blood loss at a rate of 150 mL per minute
•Team – Clear roles and communication
•TXA-Tranexamic Acid – Early use to stabilize clot formation, given within 1 hour of injury, prevents the breakdown of formed clots,
•Testing – Monitoring labs and coagulation
•Transfuse to Target – Guided, ratio-based transfusion
•Temperature – Preventing hypothermia to support coagulation
•Termination – Knowing when to stop or step down the protocol
300
It is all about the ventilator settings can you name them?? the RRT can!!! (7)
•FiO₂ – Fraction of inspired oxygen.
•Respiratory Rate – Breaths per minute.
•Tidal Volume (Vₜ) – Amount of air delivered per breath.
•Inspiratory Pressure – Pressure applied during inspiration.
•PEEP – Positive end-expiratory pressure to prevent alveolar collapse.
•I:E Ratio – Ratio of inspiration to expiration time.
•Flow Rate and Sensitivity (Trigger) – Adjust patient comfort and synchrony.
300
Name 3 factors that predispose me for Delirium
Advanced age (>75)
Pre-existing cognitive impairment or dementia
Frailty or multiple comorbidities
Sensory impairment (hearing, vision)
Malnutrition or dehydration
Functional dependence
300
None of are exactly alike but I am ...
The Most common cause (60–70%).
Gradual onset of memory loss, word-finding difficulty, and disorientation.
Patients are often calm but may become anxious or fearful in unfamiliar environments.
ED Implication: Provide reassurance, reduce overstimulation, and avoid rushing.
Alzheimer’s Disease (AD):
300
to warm or not to warm??? - why and what is the product
Hypothermia can exacerbate bleeding and coagulopathy
no warming to platelets YES to RBC and plasma
core temp less than 36 - rewarm - with
blankets, warm air and get the rapid warming transfuser
400
THE ANSWER IS....Airway with cervical spine protection.
THE QUESTION MUST BE..... WHAT STEP is first in trauma assessment?
400
What is FRC - Functional Residual Capacity
The volume of air remaining in the lungs at the end of a normal, passive exhalation, typically measuring around 2.2–3 liters in adults.
400
Idenitify 5 factors you should expect me to become delirious over when treating me in your emergency
•Infection (UTI, pneumonia)
•Hypoxia or metabolic imbalance
•Pain, constipation, urinary retention
•Psychoactive or anticholinergic medications
•Environmental changes, prolonged ED stays, sleep deprivation
400
I am needed if this exists:
COPD exacerbation, ARDS, pneumonia, sepsis, asthma, overdose ; Neuromuscular disease (Guillain-Barré, ALS, myasthenia gravis); Shock or severe chest trauma (flail chest, burns, smoke inhalation;
PaCO₂ > 55 mmHg or pH < 7.20 (hypoventilation)
Tidal Volume < 5 mL/kg or Respiratory Rate > 35/min CANNOT get enough air in
Vital Capacity < 10 mL/kg or MIP ≥ –20 cmH₂O - too tired or weak to get in a big breath and
•Minute Ventilation > 10 L/min; PaO₂/FiO₂ < 200 (hypoxemia) I cannot exchange the alveoli
criteria that indicates the need for ventilator support
but just look at the vitals, with the VBGs and ABGs the patient respiratory effort and other assessment info and you will be ready
400
HELP... I am cognitively impaired - what should you do in the ED
•Calm, respectful approach: Tone and body language communicate safety more than words.
•Simple language: Use short sentences, one question at a time (e.g., 'Do you feel pain?' instead of 'Are you feeling better now?').
•Validation: Instead of correcting a false belief, validate emotion (e.g., 'You miss your husband. Tell me about him.')
•Eye contact and presence: Always approach from the front, introduce yourself by name and role, and explain what you’re doing.
•Time and patience: Allow 10–15 seconds for responses. Silence can be therapeutic.
•Environmental control: Turn off unnecessary alarms or reduce background noise. Dim lights during the night.
•Family involvement: Family can interpret patient preferences and provide comfort.
500
What is the key nursing action during massive transfusion? name three
Monitor temperature, calcium levels, and transfusion reactions.
Rationale: Calcium replacement prevents citrate toxicity; warming prevents hypothermia.
500
I am programmed for three modes - what are they
1. inspiration will end when set tidal volume is reached
2. inspiration will end when a set pressure limit is reached
3. inspiration ends after a pre-set inspiratory time has elasped
what is
1. Volume cylcled ventilation
2. Pressure cycled ventilation
3. Time cycled ventilation
or you can mix it up.
500
Which medications should generally be avoided in the older adult?
Anticholinergics
These drugs impair cognition and increase confusion by blocking acetylcholine, a key neurotransmitter in attention and memory.
500
M M M M M ?????
The 5Ms are interrelated domains representing the key priorities for older adult care:
• Mind: Cognition, mood, and mentation—focus on delirium, depression, dementia.
• Mobility: Gait, balance, falls, and physical function.
• Medications: Polypharmacy, adverse effects, and drug interactions.
• Multicomplexity/Maintenance: Multiple chronic conditions, social factors, and system navigation.
• What Matters: Goals, preferences, and what truly matters to the patient.
500
lots of people are delirious - why does it matter to assess for it in the ED??? - at least 4 reasons
Early detection through structured screening prevents escalation of delirium, reduces LOS, and improves outcomes in older ED patients.
patient safety, tailor nursing interventions focused on reduction of risk factors, reduces incidence of other health related factor - ie - immobility = deconditoning