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Emergency Nursing

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By Craig Button Clinical Nurse Educator and current grad student
Jayesh Dhanani, John F Fraser, Hak-Kim Chan, Jordi Rello, Jeremy Cohen, Jason A Roberts
Drug dosing in critically ill patients is challenging due to the altered drug pharmacokinetics-pharmacodynamics associated with systemic therapies. For many drug therapies, there is potential to use the respiratory system as an alternative route for drug delivery. Aerosol drug delivery can provide many advantages over conventional therapy. Given that respiratory diseases are the commonest causes of critical illness, use of aerosol therapy to provide high local drug concentrations with minimal systemic side effects makes this route an attractive option...
October 7, 2016: Critical Care: the Official Journal of the Critical Care Forum
Diane M Billings
This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes the benefits and challenges of using a "flipped" classroom to promote active engagement among learners and more meaningful interaction between learners and educators.
September 2016: American Journal of Nursing
Firat Bektas, Secgin Soyuncu
INTRODUCTION: Transcutaneous cardiac pacing (TCP) is a rapid, time-saving, and noninvasive ventricular stimulation that is tolerated by conscious patients despite the painful intervention for treatment of symptomatic bradycardias. The goal of this study was to determine the efficacy of TCP in unstable bradycardia patients in emergency department (ED). METHODS: This single-central, observational clinical study was conducted on patients older than 18 years who presented with acute unstable bradycardia to the tertiary care university ED...
July 15, 2016: American Journal of Emergency Medicine
Edward James Walter, Mike Carraretto
An elevated temperature has many aetiologies, both infective and non-infective, and while the fever of sepsis probably confers benefit, there is increasing evidence that the central nervous system is particularly vulnerable to damage from hyperthermia. A single episode of hyperthermia may cause short-term neurological and cognitive dysfunction, which may be prolonged or become permanent. The cerebellum is particularly intolerant to the effects of heat. Hyperthermia in the presence of acute brain injury worsens outcome...
July 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
Chris H L Lim, Angus Turner, Blanche X Lim
BACKGROUND: Published audits have demonstrated that corneal abrasions are a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. OBJECTIVES: The objective of this review was to assess the effects of patching for corneal abrasion on healing and pain relief. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2016), EMBASE (January 1980 to May 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2016), System for Information on Grey Literature in Europe (OpenGrey) (January 1995 to May 2016), the ISRCTN registry (www...
2016: Cochrane Database of Systematic Reviews
Giuseppe Lippi, Paola Avanzini, Gianfranco Cervellin
OBJECTIVES: Samples drawn through intravenous catheters are frequently hemolyzed. We planned a prospective, randomized study to establish whether hemolysis in samples drawn from intravenous catheters may be reduced using S-Monovette® tubes collected by manual aspiration as compared with standard vacuum tubes. DESIGN AND METHODS: We studied 52 consecutive patients admitted to the ED. Blood was drawn through a 20-gauge intravenous catheter. A 5.0mL, Becton Dickinson Vacutainer® SST II Plus serum tube was collected and discarded...
May 2013: Clinical Biochemistry
Nicholas J Heyer, James H Derzon, Linda Winges, Colleen Shaw, Diana Mass, Susan R Snyder, Paul Epner, James H Nichols, Julie A Gayken, Dennis Ernst, Edward B Liebow
OBJECTIVE: To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. RESULTS: A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0...
September 2012: Clinical Biochemistry
Douglas P Barnaby, Andrew Wollowitz, Deborah White, Scott Pearlman, Michelle Davitt, Laura Holihan, Polly Bijur, E John Gallagher
OBJECTIVES: The objective was to test the hypothesis that exclusive use of butterfly needles for phlebotomy, compared with sample collection via intravenous (IV) catheter, will reduce rates of sample hemolysis. METHODS: This was an observational study of hemolysis rates before and after implementation of a "butterfly-only" phlebotomy protocol. Weekly hemolysis rates, generated by the central laboratory, were collected and the proportion of hemolyzed specimens before and after protocol implementation were compared...
February 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daniel Leisman, Benjamin Wie, Martin Doerfler, Andrea Bianculli, Mary Frances Ward, Meredith Akerman, John K D'Angelo, Jason A Zemmel D'Amore
STUDY OBJECTIVE: We evaluate the association of intravenous fluid resuscitation initiation within 30 minutes of severe sepsis or septic shock identification in the emergency department (ED) with inhospital mortality and hospital length of stay. We also compare intravenous fluid resuscitation initiated at various times from severe sepsis or septic shock identification's association with the same outcomes. METHODS: This was a review of a prospective, observational cohort of all ED severe sepsis or septic shock patients during 13 months, captured in a performance improvement database at a single, urban, tertiary care facility (90,000 ED visits/year)...
September 2016: Annals of Emergency Medicine
Polly E Bijur, Purvi D Shah, David Esses
OBJECTIVE: The objective was to compare agreement between three non-invasive measures of temperature and rectal temperatures and to estimate the sensitivity and specificity of these measures to detect a rectal temperature of 38°C or higher. METHODS: We conducted a study of the diagnostic accuracy of oral, tympanic membrane (TM) and temporal artery (TA) thermometry to measure fever in an urban emergency department (ED). Data were collected from adult patients who received rectal temperature measurement...
June 22, 2016: Emergency Medicine Journal: EMJ
Lauren J Tilton, Kristin H Eginger
No abstract text is available yet for this article.
May 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Critical Care Nurse
Eva Rojas, Richard Schultz, Heather Heil Linsalata, Debra Sumberg, Maria Christensen, Cathlyn Robinson, Mark Rosenberg
PROBLEM: The aging population and the growing number of home hospice patients have resulted in increased utilization of emergency departments. This situation poses a clinical challenge to the ED staff in determining when lifesaving treatment is indicated and when end of life care begins. METHODS: Through a shared governance model, ED physicians and nursing staff aimed to implement a best practice model for the care of dying patients. An ED interdisciplinary team identified gaps and brainstormed methods to improve palliative measures and comprehensive care for actively dying patients...
May 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Hesham R Omar, Maya Guglin
INTRODUCTION: Multiple studies found a significant correlation between B-type natriuretic peptide (BNP) level and clinical severity of heart failure (HF). We aim to study the ability of a single BNP measurement to predict the degree of congestion in acute systolic HF. METHODS: Patients enrolled in the ESCAPE trial who were admitted with acute systolic HF were divided into tertiles according to baseline BNP level with comparison of the degree of congestion across tertiles using clinical signs of congestion as well as objective parameters of overload checked by the pulmonary artery catheter...
June 2016: Journal of Critical Care
Fiona Winterbottom, Misty Jenkins, Marlene Alonzo
This column provides an update on the current literature related to sepsis as a new quality core measure. Sepsis care for adult patients in the acute care setting is outlined. J Contin Educ Nurs. 2016;47(5):204-206.
May 1, 2016: Journal of Continuing Education in Nursing
Dana Bartlett
Overdoses of β-blockers and calcium channel blockers can produce significant morbidity and mortality, and conventional therapies often do not work as treatments for these poisonings. High-dose insulin/glucose therapy has been successful in reversing the cardiotoxic effects of these drugs in cases where the standard therapies have failed, and it appears to be relatively safe. Many successes have been well documented, but the clinical experience consists of case reports, the mechanisms of action are not completely understood, and guidelines for use of the therapy are empirically derived and not standardized...
April 2016: Critical Care Nurse
Thomas Lawson, Susan Yeager
Status epilepticus is a medical emergency that requires rapid diagnosis and treatment. Nonconvulsive status epilepticus is frequently underdiagnosed and therefore undertreated, which can lead to permanent neuronal damage resulting in disability or death. Despite the frequent occurrence and morbidity associated with status epilepticus, this topic has received little attention within the literature. A systematic approach to treatment should start with management of airway, breathing, and circulation, followed by administration of benzodiazepines and intravenous antiepileptic drugs, and rapid escalation of therapy to prevent morbidity and mortality...
April 2016: Critical Care Nurse
Masaji Nishimura
High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F(IO2), and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients...
April 2016: Respiratory Care
Suman Prinjha, Alison Chapple, Roger Feneley, Joanne Mangnall
AIMS: To explore the information needs of long-term indwelling urinary catheter users, the consequences for patients of inadequate information and how these needs could be met. BACKGROUND: Previous studies have drawn attention to the lack of information given to indwelling catheter users and how users would benefit from more. Little is known about the varied and detailed information needs of long-term indwelling catheter users. DESIGN: A qualitative interpretative approach was used, combining thematic analysis with constant comparison...
June 2016: Journal of Advanced Nursing
Robert Eley, Chantelle Judge, Lisette Knight, Goce Dimeski, Michael Sinnott
AIMS: Urinalysis provides direction in diagnosis and treatment of patients in the emergency department (ED). Midstream urine (MSU) collection from female patients has a high contamination rate. Verbal instruction by nurses to patients reduces contamination but is inconsistent owing to lack of time and professional knowledge. This study aimed to determine if an alternative mode of instruction requiring minimal staff input may be effective. METHODS: A pseudorandomised controlled trial was undertaken with 240 female patients for whom urinalysis was clinically required...
October 2016: Journal of Clinical Pathology
2016-02-21 14:29:13
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