Emergency nursing requires rapid decision-making in high-pressure environments where seconds can mean the difference between life and death. The core of this specialty is triage, the systematic sorting of patients based on the severity of their illness or injury rather than their order of arrival. In Nigerian healthcare facilities, nurses often face overwhelming patient loads, making effective triage essential for resource allocation.
The ABCDE approach provides a standardized framework for identifying and managing life-threatening conditions in any emergency patient. Every healthcare provider must follow this exact sequence because an issue in a preceding step will cause failure in subsequent interventions. Resuscitation occurs simultaneously with assessment whenever an immediate danger is found.
A patient talking in full sentences generally has a patent airway, adequate breathing, and sufficient brain perfusion, giving a quick initial snapshot of their stability. Skipping steps or failing to re-evaluate after an intervention leads to missed deterioration.
Opening and maintaining the airway takes absolute priority over all other resuscitative efforts. In any trauma case, assume a cervical spine injury is present until clinical assessment or imaging proves otherwise.
Once the airway is secure, the nurse evaluates whether the patient is breathing effectively. Look for chest symmetry, use of accessory muscles, and respiratory rate. Auscultate lung fields bilaterally to ensure air is entering both lungs equally.
Life-threatening conditions such as tension pneumothorax or flail chest can develop rapidly and compromise ventilation. A tension pneumothorax causes air to enter the pleural space without escaping, shifting the mediastinum and compressing the heart. This requires immediate needle decompression before waiting for chest X-ray confirmation.
Circulatory assessment focuses on evaluating tissue perfusion by checking pulse rate, blood pressure, capillary refill time, and skin color. Hemorrhage remains the leading cause of preventable death after trauma, making bleeding control a top priority.
The disability assessment provides a quick baseline of the patient's neurological status during the primary survey. Clinicians commonly use the AVPU scale for rapid screening or the more detailed Glasgow Coma Scale (GCS) to evaluate eye opening, verbal response, and motor response.
A sudden drop in GCS score indicates rising intracranial pressure, hypoxia, or cerebral hypoperfusion, requiring immediate re-evaluation of airway and circulation.
Exposure involves removing the patient's clothing to perform a thorough head-to-toe physical examination while preventing hypothermia. Environmental heat loss occurs rapidly in emergency rooms, especially when cold intravenous fluids are infused or wet clothes remain on the patient. Warm blankets and thermal management must accompany exposure.
Once immediate life threats are managed and the patient is stable, the secondary survey begins. This involves taking a detailed medical history using the SAMPLE mnemonic (Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to injury) and performing a comprehensive head-to-toe physical assessment.
Clear communication and accurate documentation are vital components of emergency care. Critical details must be relayed swiftly to incoming team members or receiving units without omitting essential clinical data. The ISBAR framework (Introduction, Situation, Background, Assessment, Recommendation) provides a structured format for verbal handovers.
Contemporaneous documentation ensures that every intervention, medication dose, and vital sign change is recorded with exact timestamps. In busy Nigerian emergency departments where shifts change frequently, structured handovers prevent critical errors and maintain continuity of care for unstable patients.