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Emergency Nursing

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By Craig Button Clinical Nurse Educator and current grad student
https://www.readbyqxmd.com/read/30013702/simple-changes-to-emergency-department-workflow-improve-analgesia-in-mechanically-ventilated-patients
#1
Derek L Isenberg, Katrina M Kissman, Ellie P Salinski, Mark A Saks, Loreen B Evans
Introduction: In 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). These guidelines recommend using an analgesia-first strategy in mechanically ventilated patients as well as reducing the use of benzodiazepines. Benzodiazepines increase delirium in ICU patients thereby increasing ICU length of stay. We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines...
July 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30489421/treatment-with-intravenous-alteplase-for-acute-ischemic-stroke-after-reversal-of-dabigatran-with-idarucizumab-a-case-study
#2
Sheila Jala, Elizabeth O'Brien
Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentation...
November 27, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/30316621/do-orthostatic-vital-signs-have-utility-in-the-evaluation-of-syncope
#3
Jason T Schaffer, Samuel M Keim, Benton R Hunter, Jonathan M Kirschner, Robert A De Lorenzo
BACKGROUND: Syncope is a common presentation in the emergency department (ED). The differential diagnosis is long and includes benign conditions as well as acute life threats, such as dysrhythmias or pulmonary embolism. OBJECTIVE: The specific goals of this review are twofold: 1) to define the diagnostic utility of orthostatic vital signs (OVS) as a test for orthostatic syncope, and 2) to determine whether OVS help diagnose or exclude life-threatening causes of syncope in ED patients...
October 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30470514/emergency-department-crowding-is-associated-with-delayed-antibiotics-for-sepsis
#4
Ithan D Peltan, Joseph R Bledsoe, Thomas A Oniki, Jeffrey Sorensen, Al R Jephson, Todd L Allen, Matthew H Samore, Catherine L Hough, Samuel M Brown
STUDY OBJECTIVE: Barriers to early antibiotic administration for sepsis remain poorly understood. We investigated the association between emergency department (ED) crowding and door-to-antibiotic time in ED sepsis. METHODS: We conducted a retrospective cohort study of ED sepsis patients presenting to 2 community hospitals, a regional referral hospital, and a tertiary teaching hospital. The primary exposure was ED occupancy rate, defined as the ratio of registered ED patients to licensed ED beds...
November 20, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/30514596/treatment-of-caffeine-toxicity-with-metoprolol
#5
Siu Fai Li, Lindsey Edwards, Vincent Nguyen
A 27-year-old man presented with an intentional overdose of concentrated caffeine powder that he bought over the internet. The patient received benzodiazepines and ondansetron for symptomatic treatment when he arrived in the Emergency Department (ED). Subsequently, he developed recurrent supraventricular tachycardia in the ED. The SVT was successfully treated with metoprolol. The patient's caffeine level was >90 mg/L. This is the first known report of treatment of caffeine-induced supraventricular tachycardia with metoprolol...
November 26, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30508444/how-would-you-manage-this-patient-with-gout-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#6
Risa B Burns, C Christopher Smith, Robert H Shmerling, Anjala Tess
Gout is the most common form of inflammatory arthritis. In 2012, the American College of Rheumatology (ACR) issued a guideline, which was followed in 2017 by one from the American College of Physicians (ACP). The guidelines agree on treating acute gout with a corticosteroid, nonsteroidal anti-inflammatory drug, or colchicine and on not initiating long-term urate-lowering therapy (ULT) for most patients after a first gout attack and in those whose attacks are infrequent (<2 per year). However, they differ on treatment of both recurrent gout and problematic gout...
December 4, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/30470687/approach-to-syncope-in-the-emergency-department
#7
Matthew James Reed
Syncope is a common reason for ED attendance and it presents a major management challenge with regard to the appropriate workup and disposition. Nearly 50% of patients are admitted, and for many this is unnecessary; clinical decision rules have not proven to decrease unnecessary admissions. The European Society of Cardiology has recently developed guidance for managing syncope in the ED. This article highlights the key steps in evaluating syncope in the ED, factors involved in determining risk of a cardiac cause, and considerations for admission, observation or discharge...
November 23, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/30406954/non-invasive-ventilation-or-high-flow-oxygen-therapy-when-to-choose-one-over-the-other
#8
REVIEW
Jean-Pierre Frat, Rémi Coudroy, Arnaud W Thille
It has been found that high-flow oxygen therapy (HFOT) can reduce mortality of patients admitted to intensive care unit (ICU) for de novo acute respiratory failure (ARF) as compared to non-invasive ventilation (NIV). HFOT might therefore be considered as a first-line strategy of oxygenation in these patients. The beneficial effects of HFOT may be explained by its good tolerance and by physiological characteristics including delivery of high FiO2 , positive end expiratory pressure (PEEP) effect and continuous dead space washout contributing to decreased work of breathing...
November 8, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/30470513/triage-performance-in-emergency-medicine-a-systematic-review
#9
Jeremiah S Hinson, Diego A Martinez, Stephanie Cabral, Kevin George, Madeleine Whalen, Bhakti Hansoti, Scott Levin
STUDY OBJECTIVE: Rapid growth in emergency department (ED) triage literature has been accompanied by diversity in study design, methodology, and outcome assessment. We aim to synthesize existing ED triage literature by using a framework that enables performance comparisons and benchmarking across triage systems, with respect to clinical outcomes and reliability. METHODS: PubMed, EMBASE, Scopus, and Web of Science were systematically searched for studies of adult ED triage systems through 2016...
November 20, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/30478188/nurses-need-to-be-aware-of-their-professional-responsibilities-when-engaging-with-social-media
#10
David Barrett
No abstract text is available yet for this article.
November 26, 2018: Evidence-based Nursing
https://www.readbyqxmd.com/read/30412710/2018-acc-aha-hrs-guideline-on-the-evaluation-and-management-of-patients-with-bradycardia-and-cardiac-conduction-delay-executive-summary-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice-guidelines-and
#11
Fred M Kusumoto, Mark H Schoenfeld, Coletta Barrett, James R Edgerton, Kenneth A Ellenbogen, Michael R Gold, Nora F Goldschlager, Robert M Hamilton, José A Joglar, Robert J Kim, Richard Lee, Joseph E Marine, Christopher J McLeod, Keith R Oken, Kristen K Patton, Cara N Pellegrini, Kimberly A Selzman, Annemarie Thompson, Paul D Varosy
No abstract text is available yet for this article.
October 31, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29242010/heart-rate-variability-analysis-in-patients-who-have-bradycardia-presenting-to-the-emergency-department-with-chest-pain
#12
Jeffrey Tadashi Sakamoto, Nan Liu, Zhi Xiong Koh, Dagang Guo, Micah Liam Arthur Heldeweg, Janson Cheng Ji Ng, Marcus Eng Hock Ong
BACKGROUND: Heart rate variability (HRV) is a noninvasive method to measure the function of the autonomic nervous system. It has been used to risk stratify patients with undifferentiated chest pain in the emergency department (ED). However, bradycardia can have a modifying effect on HRV. OBJECTIVE: In this study, we aimed to determine how bradycardia affected HRV analysis in patients who presented with chest pain to the ED. METHODS: Adult patients presenting to the ED at Singapore General Hospital with chest pain were included in the study...
March 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30449038/nurse-leaders-strategies-to-foster-nurse-resilience
#13
Holly Wei, Paige Roberts, Jeff Strickler, Robin Webb Corbett
AIM: To identify nurse leaders' strategies to cultivate nurse resilience. BACKGROUND: High nursing turnover rates and nursing shortages are prominent phenomena in healthcare. Finding ways to promote nurse resilience and reduce nurse burnout is imperative for nursing leaders. METHODS: This is a qualitative descriptive study that occurred from November 2017 to June 2018. This study explored strategies to foster nurse resilience from nurse leaders who in this study were defined as charge nurses, nurse managers, and nurse executives of a tertiary hospital in the United States...
November 18, 2018: Journal of Nursing Management
https://www.readbyqxmd.com/read/30295762/managing-the-patient-with-heart-failure-in-the-emergency-department
#14
Tal Hasin, Todd Zalut, Yonathan Hasin
No abstract text is available yet for this article.
October 7, 2018: European Heart Journal
https://www.readbyqxmd.com/read/30276776/-reducing-blood-culture-contamination-rates-in-the-emergency-department
#15
Qiao-Hui Huang, Yi-Chen Lin, Wei-Siang Huang
BACKGROUND: Rate of contamination is a well-known indicator of quality of care in the emergency department. Blood-culture results may affect clinical decision making. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. PURPOSE: Using a quality improvement strategy, this project aimed to (1) identify potential factors contributing to the high blood culture contamination rate and (2) achieve a blood culture contamination rate below 3%...
October 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/30257028/use-of-continuing-education-to-increase-nurses-knowledge-of-chronic-wound-care-management
#16
Laynette Goudy-Egger, Karen S Dunn
BACKGROUND: Providing effective management of chronic wounds can be a major challenge for nurses practicing in health care systems. As the older adult population continues to increase, the prevalence of chronic health-related diseases that can lead to chronic wounds has also increased. Nurses have reported a lack of preparation in the management of chronic wounds. METHOD: The purpose of this pretest-posttest research designed study was to determine whether nurses' knowledge regarding current chronic wound care management would differ after attending an educational workshop that emphasized evidence-based clinical practices in chronic wound management...
October 1, 2018: Journal of Continuing Education in Nursing
https://www.readbyqxmd.com/read/30170929/ed-treatment-of-migraine-patients-has-changed
#17
Michael Ruzek, Peter Richman, Barnet Eskin, John R Allegra
STUDY OBJECTIVES: Numerous studies have shown benefits of nonnarcotic treatments for emergency department (ED) migraine patients. Our goal was to determine if ED treatment of migraine patients and the rate of return within 72 h have changed. METHODS: Design: Multi-hospital retrospective cohort. POPULATION: Consecutive ED patients from 1-1-1999 to 9-31-2014. PROTOCOL: For determining treatments, we examined charts at the beginning (1999-2000) and end (2014) of the time period...
August 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30205922/is-the-liberal-use-of-oxygen-associated-with-worse-outcomes-among-critically-ill-patients
#18
EDITORIAL
Michael Gottlieb, Corey Goldstein, Edward J Ward
No abstract text is available yet for this article.
September 8, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/30230083/nursing-handover-of-vital-signs-at-the-transition-of-care-from-the-emergency-department-to-the-inpatient-ward-an-integrative-review
#19
Rachel Cross, Julie Considine, Judy Currey
AIM: To examine nursing handover of vital signs during patient care transition from the emergency department (ED) to inpatient wards. BACKGROUND: Communication failures are a leading cause of patient harm making communication through clinical handover an international healthcare priority. The transition of care from ED to ward settings is informed by nursing handover. Vital sign abnormalities in the ED are associated with clinical deterioration following hospital admission...
September 19, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/30147067/understanding-the-characteristics-of-frequent-users-of-emergency-departments-what-role-do-medical-conditions-play
#20
Jens Rauch, Jens Hüsers, Birgit Babitsch, Ursula Hübner
Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate...
2018: Studies in Health Technology and Informatics
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