Nursing Foundation - Emergency Management Notes With MCQs Practice

Emergency Management Nursing Notes – Complete Guide for BSc Nursing & NORCET

Emergency Management Notes: This complete nursing guide explains the systematic approach to emergency patients, triage, primary survey, ABCDE assessment, SAMPLE history, emergency interventions, shock, trauma, breathing emergencies, cardiac emergencies, altered consciousness, poisoning, burns, seizures, anaphylaxis, bleeding, disaster situations, nursing responsibilities, documentation, handover and important examination points.

Emergency management is the organized and rapid assessment and treatment of a patient with an acute illness or injury that may threaten life, organ function or long-term health. In emergency nursing, the priority is not simply to identify the diagnosis first. The immediate priority is to identify and treat life-threatening problems as early as possible.

For nursing students, the most important principle is: assess first, identify immediate threats, intervene immediately, reassess continuously and communicate clearly.

This article is useful for BSc Nursing, GNM Nursing, NORCET, AIIMS Nursing, ESIC Nursing, Staff Nurse, Nursing Officer and other competitive nursing examinations.

📚 Table of Contents

1. Definition of Emergency Management
2. Objectives of Emergency Management
3. Principles of Emergency Nursing
4. Emergency Assessment Sequence
5. Emergency Triage
6. Primary Survey
7. ABCDE Approach
8. A – Airway
9. B – Breathing
10. C – Circulation
11. D – Disability
12. E – Exposure
13. SAMPLE History
14. Secondary Survey
15. Vital Signs in Emergency
16. Emergency Management of Shock
17. Bleeding and Hemorrhage
18. Cardiac Emergency
19. Respiratory Emergency
20. Anaphylaxis
21. Seizure
22. Suspected Stroke
23. Poisoning
24. Burn Emergency
25. Trauma Management
26. Fracture and Musculoskeletal Emergency
27. Altered Mental Status
28. Obstetric Emergencies
29. Pediatric Emergency
30. Infection Prevention in Emergency Care
31. Nursing Responsibilities
32. Documentation
33. Emergency Handover and SBAR
34. Disaster and Mass-Casualty Management
35. Reassessment
36. Common Emergency Equipment
37. Important Examination Points
38. Frequently Asked Questions
39. MCQs for Practice
40. MCQ Answer Key

1. Definition of Emergency Management

Emergency management is a systematic process of rapidly recognizing, assessing, prioritizing and treating patients with acute illnesses or injuries that can cause death, disability or deterioration if treatment is delayed.

Emergency care may be required in the emergency department, ward, intensive care unit, operation theatre, ambulance, community, disaster area or any other healthcare setting.

Key Concept: In an emergency, the nurse should focus on immediate threats to life before completing a detailed history or full physical examination.

2. Objectives of Emergency Management

• Rapidly identify life-threatening conditions.
• Maintain airway patency.
• Support adequate breathing and oxygenation when clinically indicated.
• Maintain circulation and tissue perfusion.
• Control life-threatening external bleeding.
• Recognize and treat shock according to the cause and local protocol.
• Identify altered mental status and neurological deterioration.
• Prevent further injury.
• Relieve pain appropriately.
• Prevent complications.
• Provide timely definitive treatment or arrange appropriate transfer.
• Communicate important information accurately.
• Document assessment, interventions and patient response.

3. Principles of Emergency Nursing

1. Safety first: Ensure the scene and healthcare environment are safe.
2. Rapid assessment: Do not delay assessment of potentially life-threatening problems.
3. Prioritize: Treat immediate threats before less urgent problems.
4. ABCDE approach: Use a systematic assessment method.
5. Intervene while assessing: Correct immediately reversible life threats when identified.
6. Continuous reassessment: Emergency patients can deteriorate rapidly.
7. Teamwork: Emergency care requires coordinated multidisciplinary action.
8. Clear communication: Use structured communication such as SBAR.
9. Accurate documentation: Record findings, time, interventions and response.
10. Respect and dignity: Maintain privacy and communicate respectfully even during urgent care.

4. Emergency Assessment Sequence

A practical emergency sequence is:

Safety → Triage/Recognition → Initial Impression → ABCDE → Immediate Intervention → SAMPLE History → Secondary Survey → Investigations → Definitive Management/Transfer → Reassessment → Documentation

The sequence may change according to the patient's condition, available resources and local emergency protocols.

General sequence

1. Ensure personal, patient and scene safety.
2. Use appropriate PPE according to exposure risk.
3. Recognize that the patient may be critically ill.
4. Call for help early when required.
5. Perform rapid triage.
6. Assess responsiveness.
7. Check airway.
8. Assess breathing.
9. Assess circulation and major bleeding.
10. Assess disability/neurological status.
11. Expose sufficiently to identify major injuries while preventing hypothermia.
12. Start immediate life-saving interventions.
13. Obtain focused SAMPLE history.
14. Perform secondary survey.
15. Arrange investigations and definitive management.
16. Reassess after every major intervention.
17. Document and hand over clearly.

WHO/ICRC Basic Emergency Care uses the ABCDE approach as a systematic method for identifying and managing time-sensitive problems. The approach is repeated whenever the patient's condition changes or deteriorates.

5. Emergency Triage

Triage is the process of rapidly assessing patients and prioritizing them according to the urgency of treatment.

Purpose of triage

• Identify patients requiring immediate treatment.
• Prevent delays in life-saving care.
• Use limited emergency resources effectively.
• Identify patients who can safely wait.
• Recognize deterioration early.

Common priority concept

Priority	Meaning	Examples
Immediate / Emergency	Life-threatening condition requiring immediate intervention.	Cardiac arrest, severe respiratory distress, uncontrolled major bleeding, severe shock.
Urgent / Priority	Needs prompt assessment and treatment but may not require immediate resuscitation.	Moderate breathing difficulty, significant pain, suspected fracture with stable circulation.
Non-urgent	Stable condition where short waiting is less likely to cause immediate harm.	Minor wound, mild stable symptoms.

Triage systems differ between institutions and countries. Always follow the emergency department's approved triage system and local policy.

6. Primary Survey

The primary survey is a rapid assessment designed to identify immediately life-threatening problems.

The classic sequence is:

A – Airway
B – Breathing
C – Circulation
D – Disability
E – Exposure

If a life-threatening problem is found at one step, it should be addressed promptly before moving forward, while maintaining an overall focus on the patient's immediate needs.

7. ABCDE Approach

A	Airway Is the airway open and protected? Look for obstruction, secretions, blood, vomitus, foreign body or swelling.
B	Breathing Assess respiratory rate, effort, chest movement, oxygenation, breath sounds and signs of respiratory distress.
C	Circulation Assess pulse, blood pressure, skin perfusion, capillary refill, major bleeding and signs of shock.
D	Disability Assess consciousness, pupils, glucose when indicated and neurological status.
E	Exposure Expose enough of the patient to identify injuries or important clinical signs while maintaining privacy and preventing hypothermia.

8. A – Airway Assessment and Management

Signs of airway obstruction

• Inability to speak normally.
• Noisy breathing.
• Stridor.
• Gurgling.
• Snoring-type sounds.
• Visible foreign body.
• Blood or vomitus in the airway.
• Facial or neck swelling.
• Reduced consciousness with loss of airway protection.

Initial nursing actions

• Call for appropriate assistance.
• Position the patient appropriately when safe.
• Clear visible obstruction when appropriate.
• Use suction when indicated and available.
• Provide airway support according to training and protocol.
• Consider cervical spine protection when trauma is suspected.
• Prepare for advanced airway management when required.

Important: Do not blindly insert fingers into a patient's mouth to search for an unseen foreign body.

9. B – Breathing Assessment and Management

Assess

• Respiratory rate.
• Respiratory effort.
• Chest expansion.
• Symmetry of chest movement.
• Oxygen saturation when available and clinically appropriate.
• Skin and mucous membrane appearance.
• Breath sounds.
• Ability to speak.
• Signs of fatigue or impending respiratory failure.

Danger signs

• Severe respiratory distress.
• Markedly reduced or absent air entry.
• Cyanosis in an appropriate clinical context.
• Altered consciousness associated with breathing difficulty.
• Severe exhaustion.
• Abnormal breathing pattern.
• Inability to speak because of breathlessness.

Oxygen should be administered when clinically indicated and according to the patient's condition, prescribed target range where applicable, and institutional protocol.

10. C – Circulation

Assess circulation

• Pulse rate and quality.
• Blood pressure.
• Capillary refill where clinically useful.
• Skin temperature and appearance.
• Level of consciousness.
• Urine output when monitored.
• Presence of major external bleeding.
• Signs of shock.

Signs suggesting poor perfusion

• Weak or abnormal pulse.
• Hypotension, when present.
• Cool or clammy skin.
• Delayed capillary refill.
• Altered mental status.
• Reduced urine output.
• Tachycardia.
• Progressive deterioration.

11. D – Disability / Neurological Assessment

Disability focuses on rapid neurological assessment.

Assess

• Level of consciousness.
• AVPU: Alert, responds to Voice, responds to Pain, Unresponsive.
• Glasgow Coma Scale when appropriate and trained.
• Pupil size and reaction.
• Blood glucose when indicated.
• Motor or sensory abnormalities.
• Seizure activity.

AVPU

Letter	Meaning
A	Alert
V	Responds to Voice
P	Responds to Pain
U	Unresponsive

12. E – Exposure

Exposure means examining enough of the patient to identify important injuries or clinical findings.

• Look for bleeding.
• Inspect skin and body for injuries.
• Assess for burns.
• Look for deformities.
• Check for medical alert information.
• Assess for environmental exposure.
• Maintain privacy.
• Prevent unnecessary heat loss.

13. SAMPLE History

After immediate life-threatening problems have been addressed, obtain a focused history.

Letter	Meaning	Information
S	Signs & Symptoms	What symptoms are present? When did they begin?
A	Allergies	Drug, food or other allergies.
M	Medications	Current medicines, recent medicines and anticoagulants where relevant.
P	Past Medical History	Major illnesses, surgery, pregnancy status where relevant, previous episodes.
L	Last Oral Intake	Last food, drink or medication intake.
E	Events	What happened immediately before the emergency?

14. Secondary Survey

The secondary survey is performed after immediate life threats have been addressed and the patient is sufficiently stabilized.

Components

• Detailed head-to-toe assessment.
• Focused history.
• Review of vital signs.
• Pain assessment.
• Neurological assessment.
• Medication and allergy review.
• Focused diagnostic investigations.
• Assessment of injuries.
• Review of treatment response.

15. Vital Signs in Emergency Management

Parameter	What to assess	Emergency significance
Temperature	Temperature and trend.	Fever, hypothermia or temperature-related illness may indicate serious disease.
Pulse	Rate, rhythm, volume and peripheral pulses.	Tachycardia or abnormal pulse may indicate pain, shock, arrhythmia or other acute illness.
Respiration	Rate, depth, rhythm, effort and oxygenation.	Abnormal breathing can indicate respiratory compromise or systemic deterioration.
Blood Pressure	Systolic, diastolic and trend.	Abnormal BP may occur with shock, hypertensive emergency or other acute conditions.
SpO₂	Oxygen saturation with clinical context.	Helps assess oxygenation but should always be interpreted with the clinical picture.
Pain	Location, intensity, character, onset and associated symptoms.	May indicate serious disease or injury and requires reassessment after treatment.
Level of consciousness	AVPU/GCS where appropriate.	Changes can indicate hypoxia, hypoglycemia, stroke, trauma, poisoning or other critical illness.

16. Emergency Management of Shock

Shock is a state of inadequate tissue perfusion resulting in insufficient oxygen and nutrient delivery to tissues.

Major categories

• Hypovolemic shock.
• Distributive shock.
• Cardiogenic shock.
• Obstructive shock.

Possible signs

• Tachycardia.
• Altered mental status.
• Cool or clammy skin in many forms of shock.
• Weak peripheral pulses.
• Abnormal blood pressure.
• Delayed capillary refill.
• Reduced urine output.
• Rapid breathing.
• Progressive deterioration.

Nursing priorities

1. Recognize shock early.
2. Call for emergency assistance.
3. Identify and address the underlying cause.
4. Control external bleeding when present.
5. Maintain airway and support breathing.
6. Monitor vital signs frequently.
7. Establish IV access when indicated and within scope/protocol.
8. Administer prescribed fluids, blood products or medications as indicated.
9. Monitor urine output when appropriate.
10. Prevent hypothermia.
11. Reassess response continuously.

17. Emergency Management of Bleeding and Hemorrhage

Recognition

• Visible external bleeding.
• Rapid blood loss.
• Signs of poor perfusion.
• Weakness or dizziness.
• Altered mental status.
• Tachycardia.
• Falling blood pressure may occur later in significant blood loss.

Basic priorities

• Ensure scene safety.
• Use PPE.
• Apply appropriate direct pressure to external bleeding.
• Use an appropriate tourniquet for life-threatening extremity bleeding when trained and indicated by protocol.
• Call for emergency medical assistance.
• Monitor ABCDE.
• Prepare for IV access and blood products according to medical orders and local protocol.

Do not delay treatment of life-threatening hemorrhage while attempting to complete a detailed history.

18. Cardiac Emergency and Cardiac Arrest

Cardiac arrest requires immediate recognition and coordinated resuscitation.

Immediate priorities

1. Recognize unresponsiveness and abnormal or absent breathing.
2. Activate the emergency response system.
3. Begin high-quality CPR according to current resuscitation guidelines.
4. Use an AED/defibrillator as soon as available and follow its prompts.
5. Continue coordinated resuscitation until return of spontaneous circulation, transfer of care, termination according to authorized protocol, or other appropriate endpoint.

The 2025 AHA Adult Basic Life Support guidelines update recommendations for recognition of cardiac arrest, high-quality CPR, AED use and foreign-body airway obstruction. 1

For actual CPR, healthcare professionals must follow their current institutional resuscitation protocol and the latest applicable national/international guidelines.

19. Respiratory Emergency

Respiratory emergencies include conditions in which ventilation or oxygenation is inadequate or may rapidly deteriorate.

Examples

• Acute severe asthma.
• Acute exacerbation of COPD.
• Pneumonia with respiratory compromise.
• Pulmonary edema.
• Pneumothorax.
• Foreign-body airway obstruction.
• Anaphylaxis.
• Respiratory failure.

Nursing priorities

• Assess airway immediately.
• Assess respiratory effort.
• Monitor oxygenation.
• Position appropriately according to condition.
• Administer oxygen when indicated.
• Prepare prescribed bronchodilator or other emergency medication.
• Monitor response.
• Escalate care if deterioration occurs.

20. Anaphylaxis

Anaphylaxis is a severe, potentially life-threatening systemic hypersensitivity reaction that can cause airway, breathing or circulatory compromise.

Possible features

• Sudden difficulty breathing.
• Wheeze.
• Stridor or upper airway swelling.
• Urticaria.
• Facial or tongue swelling.
• Hypotension or signs of shock.
• Vomiting or abdominal symptoms.
• Rapid deterioration.

Emergency priorities

• Recognize rapidly.
• Call for emergency assistance.
• Administer first-line emergency treatment according to current protocol and authorized scope.
• Support airway and breathing.
• Monitor circulation.
• Prepare for escalation and advanced airway management if needed.
• Observe for recurrence according to clinical protocol.

Current AHA resuscitation guidance includes anaphylaxis among special circumstances requiring specific emergency management considerations. 2

21. Emergency Management of Seizure

During a seizure

• Protect the patient from injury.
• Move dangerous objects away.
• Do not forcibly restrain the patient.
• Do not put objects or fingers into the mouth.
• Maintain airway awareness.
• Time the seizure.
• Observe the seizure characteristics.
• Call for emergency assistance when indicated.

After seizure

• Assess airway and breathing.
• Place in an appropriate recovery position when safe and appropriate.
• Check consciousness.
• Check glucose when clinically indicated.
• Assess for injury.
• Monitor vital signs.
• Document duration and characteristics.

22. Suspected Stroke

Stroke is time-sensitive. Early recognition and rapid transfer to an appropriate stroke-capable facility are essential.

Possible warning signs

• Sudden facial asymmetry.
• Sudden arm or leg weakness.
• Sudden speech difficulty.
• Sudden vision changes.
• Sudden severe imbalance.
• Sudden severe headache in some cases.

Nursing priorities

• Establish exact or last-known-well time when possible.
• Perform rapid neurological assessment.
• Check blood glucose when indicated.
• Maintain airway and breathing.
• Monitor vital signs.
• Keep the patient NPO until swallowing safety has been assessed when clinically appropriate.
• Arrange urgent medical evaluation and imaging.

23. Poisoning and Overdose

Assessment

• What substance was involved?
• How much was taken or exposed?
• When did exposure occur?
• Route of exposure?
• Was alcohol or another substance involved?
• What symptoms are present?
• What medications does the patient normally take?

Management priorities

• Ensure scene safety.
• Protect healthcare workers from exposure.
• Perform ABCDE assessment.
• Contact the appropriate poison information service when available.
• Support airway, breathing and circulation.
• Do not induce vomiting unless specifically directed by an appropriate toxicology protocol.
• Bring the container or packaging when safe and useful.
• Monitor continuously for deterioration.

24. Burn Emergency Management

Burns may cause local tissue injury as well as systemic complications. Airway and breathing problems may be particularly urgent in patients with suspected inhalation injury.

Initial priorities

• Stop the burning process and ensure scene safety.
• Assess airway and breathing.
• Assess circulation.
• Remove contaminated clothing when appropriate and safe.
• Cool thermal burns with appropriate running cool water when indicated by current first-aid guidance.
• Do not apply ice directly to significant burns.
• Cover appropriately.
• Prevent hypothermia.
• Arrange medical assessment for significant burns.

25. Trauma Management

Primary trauma priorities

• Scene safety.
• Mechanism of injury.
• Airway.
• Breathing.
• Circulation.
• Major hemorrhage.
• Neurological status.
• Spinal precautions when indicated.
• Exposure and prevention of hypothermia.

Look for

• External bleeding.
• Chest injury.
• Abdominal injury.
• Pelvic injury.
• Head injury.
• Spinal injury.
• Fractures.
• Burns.
• Crush injuries.

26. Fracture and Musculoskeletal Emergency

Possible signs

• Pain.
• Swelling.
• Deformity.
• Abnormal movement.
• Loss of function.
• Shortening or abnormal position.
• Neurovascular changes.

Nursing priorities

• Assess circulation, sensation and movement distal to the injury.
• Immobilize according to training and protocol.
• Control bleeding from associated wounds.
• Do not attempt unnecessary manipulation.
• Assess pain.
• Monitor for neurovascular compromise.

27. Altered Mental Status

Altered mental status can result from many conditions and should be treated as potentially serious until an appropriate cause is identified.

Possible causes

• Hypoglycemia.
• Hypoxia.
• Stroke.
• Head injury.
• Seizure.
• Poisoning or drug overdose.
• Infection.
• Electrolyte disturbance.
• Metabolic disorders.
• Shock.

Immediate assessment

• Airway.
• Breathing.
• Circulation.
• Level of consciousness.
• Pupils.
• Blood glucose when indicated.
• Temperature.
• History of trauma or medication exposure.

28. Important Obstetric Emergencies

Pregnant and postpartum patients may develop rapidly progressive emergencies. Emergency assessment should consider both the mother and fetus when applicable.

Examples

• Postpartum hemorrhage.
• Eclampsia.
• Severe preeclampsia.
• Placental abruption.
• Placenta previa with bleeding.
• Ectopic pregnancy.
• Maternal shock.
• Obstructed labour.

Nursing priorities

• Rapid maternal ABCDE assessment.
• Recognize and manage major bleeding according to protocol.
• Monitor vital signs.
• Establish appropriate IV access as indicated.
• Prepare emergency medications and blood products when ordered.
• Monitor fetal status when applicable.
• Arrange urgent obstetric review.

WHO updated the postpartum haemorrhage component of its Basic Emergency Care programme in November 2025 to align with updated recommendations. 3

29. Pediatric Emergency Management

Children may deteriorate quickly, and normal values vary with age. Always interpret vital signs and clinical findings using age-appropriate references.

Important principles

• Use age-appropriate assessment.
• Assess breathing carefully.
• Recognize dehydration and shock early.
• Assess mental status.
• Check blood glucose when indicated.
• Use weight-based medication calculations according to authorized protocols.
• Maintain temperature.
• Involve caregivers appropriately.

WHO's Emergency Triage Assessment and Treatment framework emphasizes early identification of children with emergency signs and rapid initiation of emergency treatment. 4

30. Infection Prevention in Emergency Care

Emergency situations do not eliminate infection-control responsibilities. Standard precautions should be used for every patient, with additional precautions based on risk and suspected infection.

• Perform hand hygiene.
• Use PPE based on anticipated exposure.
• Practice respiratory hygiene and cough etiquette.
• Handle sharps safely.
• Use safe injection practices.
• Clean and disinfect equipment appropriately.
• Handle contaminated linen carefully.
• Use appropriate patient placement or isolation when indicated.

CDC states that Standard Precautions apply to all patient care and are based on risk assessment, hand hygiene, PPE, respiratory hygiene, appropriate patient placement, equipment/environmental cleaning, safe handling of textiles and safe injection practices. 5

31. Nursing Responsibilities in Emergency Management

Before arrival / preparation

• Ensure emergency equipment is available.
• Check oxygen supply.
• Check suction equipment.
• Check emergency trolley/crash cart according to institutional policy.
• Ensure IV supplies are available.
• Ensure PPE is accessible.
• Check monitoring equipment.

During emergency care

• Perform rapid assessment.
• Recognize deterioration.
• Call the appropriate team.
• Initiate authorized emergency interventions.
• Monitor vital signs.
• Administer medications safely.
• Maintain IV access when indicated.
• Assist with procedures.
• Prepare equipment.
• Provide psychological support.
• Maintain patient dignity.

After stabilization

• Continue monitoring.
• Document care.
• Prepare patient for transfer/admission.
• Provide structured handover.
• Ensure investigations and treatments are followed up.
• Communicate with family according to institutional policy and scope.

32. Emergency Nursing Documentation

Emergency documentation should be timely, objective and accurate.

Document

• Time of arrival.
• Initial condition.
• Initial vital signs.
• Level of consciousness.
• Relevant history.
• Assessment findings.
• Emergency interventions.
• Medication name, dose, route and time when administered.
• IV fluids and blood products when applicable.
• Oxygen therapy.
• Procedures performed.
• Patient response.
• Communication with medical/emergency team.
• Transfer or disposition.

Documentation rule: Record what was assessed, what was done, when it was done, by whom when required, and how the patient responded.

33. Emergency Handover – SBAR

SBAR	Content
S – Situation	What is happening right now?
B – Background	Relevant medical history and events.
A – Assessment	Current vital signs, findings and clinical concerns.
R – Recommendation	What is needed next? What should be monitored or escalated?

A good emergency handover should be concise but contain the information required for safe continuation of care.

34. Disaster and Mass-Casualty Management

A disaster or mass-casualty incident may produce more patients than available resources can immediately manage. The focus shifts from individual routine care to population-level prioritization while still providing life-saving interventions.

Important components

• Scene safety.
• Incident command.
• Triage.
• Rapid life-saving interventions.
• Resource allocation.
• Patient identification.
• Communication.
• Transport coordination.
• Documentation.
• Psychological support.

Nurse's role

• Participate in triage according to training.
• Perform rapid assessment.
• Provide basic life-saving care.
• Assist with stabilization.
• Prepare patients for transport.
• Maintain infection control.
• Communicate patient information.
• Support disaster documentation.

35. Reassessment – A Critical Step

Emergency management does not end after the first intervention. A patient's condition may improve, remain unchanged or deteriorate.

ABCDE → Intervention → Reassess ABCDE → Intervention → Reassess

Reassess after:

• Oxygen administration.
• Fluid therapy.
• Medication administration.
• Bleeding control.
• Airway intervention.
• Pain treatment.
• Seizure management.
• Any major change in patient condition.
• Transfer between care areas.

36. Common Emergency Equipment

Equipment	Purpose
Oxygen delivery devices	Support oxygenation when clinically indicated.
Suction apparatus	Remove secretions, blood or vomitus when required.
Bag-valve-mask	Provides assisted ventilation when indicated and used by trained personnel.
Pulse oximeter	Assesses oxygen saturation and pulse rate.
Blood pressure apparatus	Measures blood pressure.
ECG monitor	Assesses cardiac rhythm and electrical activity.
Defibrillator/AED	Used for appropriate cardiac arrest rhythms according to protocol.
Emergency drugs	Medications required for specific emergencies according to authorized protocols.
IV access equipment	Used for appropriate IV therapy.
PPE	Protects healthcare workers and patients from exposure.
Glucose testing equipment	Helps identify hypoglycemia or hyperglycemia when indicated.

37. Important Examination Points for Nursing Students

1. Emergency assessment commonly follows the ABCDE sequence.

2. A = Airway.

3. B = Breathing.

4. C = Circulation.

5. D = Disability.

6. E = Exposure.

7. SAMPLE is used for focused emergency history.

8. AVPU is a rapid consciousness assessment.

9. Major external bleeding is an immediate emergency.

10. Emergency patients require repeated reassessment.

11. Triage prioritizes patients according to urgency.

12. Standard precautions apply to all patient care.

13. In suspected stroke, document the last-known-well time when possible.

14. During seizure, protect the patient from injury and never put objects into the mouth.

15. Current CPR practice should follow the latest applicable resuscitation guidelines and local protocol.

38. Latest Updates in Emergency Management

Emergency nursing practice continues to evolve with new evidence, resuscitation recommendations and emergency-care systems.

• 2025 AHA CPR & ECC Guidelines: The American Heart Association published updated CPR and emergency cardiovascular care recommendations in 2025.
• Adult BLS: The 2025 AHA Adult BLS guideline updates recommendations for recognition of cardiac arrest, high-quality CPR, AED use and foreign-body airway obstruction.
• Foreign-body airway obstruction: The 2025 AHA guidance streamlined management recommendations for severe foreign-body airway obstruction.
• Naloxone: The 2025 AHA guidelines emphasize availability and use of naloxone in suspected opioid-related emergencies where appropriate.
• WHO Basic Emergency Care: WHO/ICRC materials continue to emphasize systematic ABCDE assessment, SAMPLE history, trauma, breathing difficulty, shock and altered mental status.
• Postpartum hemorrhage: WHO updated the PPH component of its BEC programme in November 2025 to align with updated recommendations.
• Infection prevention: Standard precautions remain fundamental during emergency care, including hand hygiene, risk-based PPE, respiratory hygiene, safe injections and appropriate equipment cleaning.

39. Frequently Asked Questions – Emergency Management

Q1. What is the first priority in emergency management?

The first priority is to ensure safety and rapidly identify life-threatening problems. The ABCDE approach is then used to identify and manage immediate threats.

Q2. What does ABCDE stand for?

A – Airway, B – Breathing, C – Circulation, D – Disability and E – Exposure.

Q3. What is triage?

Triage is the rapid prioritization of patients according to the urgency of their condition and need for treatment.

Q4. What is SAMPLE history?

SAMPLE stands for Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake and Events.

Q5. What does AVPU mean?

AVPU means Alert, responds to Voice, responds to Pain and Unresponsive.

Q6. Why is reassessment important?

Emergency patients can deteriorate quickly. Reassessment determines whether the patient's condition is improving, unchanged or worsening after interventions.

Q7. What should a nurse do during a seizure?

Protect the patient from injury, maintain awareness of airway and breathing, time the seizure, avoid restraint and never place objects or fingers into the patient's mouth.

Q8. What is the role of the nurse in shock?

The nurse rapidly identifies signs of poor perfusion, supports ABCDE, controls bleeding when applicable, monitors the patient, administers prescribed treatment and reassesses the response.

Q9. Why is documentation important in emergency care?

Accurate documentation provides a clinical record of the patient's condition, interventions, timing, response and transfer of care.

Q10. Which approach is used for systematic emergency assessment?

The ABCDE approach is widely used for systematic initial assessment of acutely ill and injured patients.

40. Emergency Management – 20 MCQs for Practice

Q1. What is the correct sequence of the primary survey?

1. ABCDE
2. BEDAC
3. CABDE
4. EDCBA

Q2. In ABCDE assessment, A stands for:

1. Assessment
2. Airway
3. Alertness
4. Arterial pressure

Q3. What does B represent in ABCDE?

1. Blood pressure
2. Brain
3. Breathing
4. Bleeding

Q4. What does C represent in ABCDE?

1. Circulation
2. Consciousness
3. Cardiac output only
4. Communication

Q5. Which of the following is part of the SAMPLE history?

1. Allergies
2. Blood group only
3. Height
4. Occupation only

Q6. In AVPU, the letter U means:

1. Unstable
2. Urgent
3. Unresponsive
4. Unable to speak

Q7. The primary purpose of triage is to:

1. Complete detailed documentation first
2. Prioritize patients according to urgency
3. Discharge all stable patients
4. Measure temperature only

Q8. Which is an important sign of possible shock?

1. Improved mental status
2. Good peripheral perfusion
3. Altered mental status
4. Normal circulation

Q9. During a seizure, the nurse should:

1. Forcefully restrain the patient
2. Put a spoon in the mouth
3. Protect the patient from injury
4. Give oral fluids immediately

Q10. Which assessment should be performed immediately when a life-threatening airway problem is suspected?

1. Detailed dietary history
2. Airway assessment and appropriate intervention
3. Family history
4. Discharge planning

Q11. Which is a component of SAMPLE?

1. Last oral intake
2. Laboratory values only
3. Electrocardiogram only
4. Body mass index

Q12. Which finding may indicate poor tissue perfusion?

1. Normal mental status with warm well-perfused skin
2. Altered mental status
3. Normal urine output
4. Normal pulse

Q13. Which is an important nursing action in major external bleeding?

1. Ignore the bleeding until history is complete
2. Apply appropriate bleeding-control measures
3. Give food
4. Delay emergency assistance

Q14. What does E represent in ABCDE?

1. Electrolytes
2. Exposure
3. Emergency drug
4. Evaluation only

Q15. Why is reassessment important in emergency care?

1. Patients never change after treatment
2. Emergency conditions can deteriorate rapidly
3. It replaces the initial assessment
4. It is needed only at discharge

Q16. Which communication method can structure an emergency handover?

1. SBAR
2. SOAP only
3. ABCDE only
4. APGAR only

Q17. Which infection-control principle applies to all patient care?

1. Standard precautions
2. No PPE ever
3. Isolation for every patient
4. No hand hygiene during emergencies

Q18. In suspected stroke, which information is especially important to establish?

1. Patient's favorite food
2. Last-known-well time
3. Preferred sleeping position
4. Daily television time

Q19. What is the purpose of a secondary survey?

1. To replace ABCDE
2. To perform a more detailed assessment after immediate threats are addressed
3. To delay emergency treatment
4. To discharge the patient

Q20. Which statement about emergency management is correct?

1. Assessment is performed only once
2. Life-threatening problems should be identified and treated promptly
3. Documentation is unnecessary
4. Triage is not required during emergencies

41. Answer Key

Question	Correct Answer	Explanation
1	A – ABCDE	ABCDE provides a systematic primary assessment sequence.
2	B – Airway	A stands for Airway.
3	C – Breathing	B stands for Breathing.
4	A – Circulation	C stands for Circulation.
5	A – Allergies	Allergies are included in SAMPLE history.
6	C – Unresponsive	U means Unresponsive.
7	B – Prioritize patients according to urgency	Triage determines treatment priority based on clinical urgency.
8	C – Altered mental status	Altered mental status can be a sign of inadequate perfusion or another critical condition.
9	C – Protect the patient from injury	The patient should be protected from injury and objects should never be placed in the mouth.
10	B – Airway assessment and appropriate intervention	Airway compromise is an immediate threat to life.
11	A – Last oral intake	L in SAMPLE stands for Last oral intake.
12	B – Altered mental status	Neurological changes can occur with poor perfusion and serious illness.
13	B – Apply appropriate bleeding-control measures	Life-threatening external bleeding requires rapid control.
14	B – Exposure	E stands for Exposure.
15	B – Emergency conditions can deteriorate rapidly	Repeated assessment identifies improvement or deterioration.
16	A – SBAR	SBAR provides a structured format for clinical communication.
17	A – Standard precautions	Standard precautions are used for all patient care.
18	B – Last-known-well time	This information is important in suspected acute stroke.
19	B – More detailed assessment after immediate threats are addressed	The secondary survey follows stabilization of immediate life threats.
20	B – Life-threatening problems should be identified and treated promptly	Rapid recognition and treatment are central principles of emergency care.

42. Emergency Management – Quick Revision

Emergency → Safety → Triage → ABCDE → Immediate Intervention → SAMPLE → Secondary Survey → Investigations → Definitive Care → Reassessment → Handover → Documentation

ABCDE: Airway → Breathing → Circulation → Disability → Exposure

SAMPLE: Signs/Symptoms → Allergies → Medications → Past history → Last oral intake → Events

AVPU: Alert → Voice → Pain → Unresponsive

SBAR: Situation → Background → Assessment → Recommendation

43. Conclusion

Emergency management is one of the most important clinical skills for nurses because deterioration can occur within minutes. A systematic approach helps the nurse avoid missing life-threatening problems.

The most important framework to remember is ABCDE. However, ABCDE should not be considered a one-time checklist. The patient must be reassessed after interventions and whenever the clinical condition changes.

For nursing examinations, focus particularly on triage, ABCDE, SAMPLE history, AVPU, shock, bleeding, airway obstruction, respiratory emergencies, cardiac arrest, seizure management, stroke recognition, poisoning, burns, trauma, emergency documentation and SBAR communication.

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Educational Disclaimer:
This article is intended for nursing education, examination preparation and general clinical learning. Emergency treatment must be performed by appropriately trained healthcare professionals according to current evidence-based guidelines, institutional protocols, scope of practice and local regulations. Medication doses, fluid therapy, airway procedures, resuscitation and other advanced interventions should not be performed solely on the basis of this article.

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