Advanced Emergency Nursing Journal最新文献

Background: The opioid epidemic has created challenges in treating patients who inject drugs or those who are at risk of overdose due to psychiatric illnesses. Patients who self-inject into their vascular access devices (SIVADs) are at risk of infection, prolonged hospitalization, suboptimal care, overdose, or death. In response to incidents where patients have overdosed by SIVAD, the intravenous (IV) CareLock™ device was developed to prevent patients from accessing their IVs while still allowing providers to administer medications.

Methods: We engaged a multidisciplinary team to analyze mitigation methods and perform a gap analysis to create a comprehensive protocol to reduce SIVAD.

Results: A multidisciplinary protocol identified patients at risk of SIVAD to guide the use of our IV CareLock™ device. This protocol prevented SIVAD while allowing providers to continue using the IV.

Conclusions: Our novel device and protocol allowed providers to safely care for at-risk patients, reducing the potential for adverse outcomes.

Chest pain and shortness of breath are frequent reasons for visits to the emergency department and may indicate life-threatening conditions - a cannot miss being pulmonary embolism. To aid in the diagnosis and exclusion of PE, several clinical decision support tools are available including the Wells score, PERC, Geneva score and the YEARS algorithm. The Research to Practice column critically evaluates recent studies and translates their findings, within the context of a clinical case, into actionable changes for emergency care. This article examines the findings of a recent systemic review and meta-analysis that evaluated the diagnostic accuracy of YEARS algorithm in identifying suspected PE, with a particular focus on minimizing the use of unnecessary advanced imaging.

Single-plane ultrasound (US) probes are commonly used to initiate ultrasound-guided peripheral intravenous (USGPIV) access for patients with difficult intravenous access (DIVA) in the emergency department (ED), although their use is not yet standardized across all EDs. This pilot project introduced the use of a biplane US probe for USGPIV access at a Level 1 Trauma Center ED. Following the training of 10 registered nurses (RNs) in the application of biplane US probes, the project aimed to decrease reliance on ED providers (e.g., NPs, PAs, and physicians) for USGPIV insertions in DIVA patients, allowing providers to focus on other critical tasks and improving patient care efficiency. Primary outcomes measured included the average number of attempts required, progression to critical care access devices, ED patient flow times, and RN utilization rates of the biplane US probe post-training. Results showed that the biplane method improved outcomes compared to the single-plane method, with a 23.8% decrease in the average number of attempts required to obtain access, an 80% decrease in subsequent critical care vascular access placement, and an increase in the rate of both single-plane and biplane US probe use after training compared to baseline. While ED flow rate did not improve, this pilot project demonstrated that biplane US probes for USGPIV access in the ED setting improve patient outcomes.

Aortic stenosis (AS) is a progressive valvular disease that presents with subtle symptoms in the emergency department, leading to delayed diagnosis. While acute presentations of valvular pathology exhibit dramatic clinical signs, most cases are chronic and commonly discovered incidentally during routine evaluations. Compensatory adaptations, including cardiac remodeling and atrial augmentation of preload, temporarily sustain cardiac function and mask disease severity, increasing the risk of heart failure and sudden cardiac death. This case-based article details the diagnostic journey of a 59-year-old male who presented with elevated blood pressure and lightheadedness. Abnormal electrocardiogram (ECG) findings prompted further evaluation, underscoring the importance of early recognition of ECG abnormalities. The article highlights the crucial role of advanced practice emergency providers in conducting timely cardiac assessments. By proposing a systematic approach from initial ECG findings to definitive imaging, it aims to enhance early intervention and ultimately improve patient outcomes in cases of AS.

Keeping up-to-date is imperative for healthcare workers, given the rapidly evolving nature of modern medicine. However, this task is logistically challenging in resource-constrained settings where electricity and internet access are unreliable. Continuing Medical Education Solutions is a series of technology solutions developed by Techies Without Borders (TWB) to bridge this gap. The technology enables improved access to high-quality medical education and point-of-care resources for healthcare professionals in low-resource settings worldwide. TWB has partnered with multiple healthcare institutions in The Gambia, a low-income country in West Africa, to enhance care quality by providing better access to evidence-based medical knowledge. In the Gambia, as with many resource-constrained nations, registered nurses are often the most qualified medical providers at a facility. They frequently function, essentially, as nurse practitioners. They are tasked with organizing community health initiatives, running clinics, and identifying and managing disease throughout the lifespan despite lacking the formal training as an advanced practice registered nurse. Given this, they benefit significantly from the increased educational materials provided by TWB. This article showcases the form and structure of the partnership between The Gambia and TWB. This relationship will continue to blossom and bear fruit in the form of improved patient outcomes and potentially pave the way for the formal implementation of nurse practitioners in a very low-resource setting, where access to essential resources is a critical public health problem.

Beta-blocker (BB) overdose presentations to the emergency department represent a significant contributor to cardiovascular toxic exposures and associated morbidity and mortality. Overdose is characterized primarily by bradycardia, hypotension, atrioventricular blockade, and cardiogenic shock, alongside potential central nervous system depression. The severity of clinical manifestations is influenced by agent-specific pharmacologic properties, formulation (e.g., extended-release), and dose. Specific therapies discussed include atropine, glucagon, hyperinsulinemic euglycemia therapy, intravenous lipid emulsion, methylene blue, and extracorporeal treatments such as hemodialysis and extracorporeal membrane oxygenation. BB overdose requires prompt recognition in the emergency department and a tiered therapeutic approach tailored to the severity of presentation and specific agent involved. While foundational interventions remain vital, adjunctive therapies such as hyperinsulinemic euglycemia therapy and methylene blue offer mechanistically distinct options that may improve outcomes in refractory cases. Further studies are warranted to clarify optimal treatment sequencing, comparative efficacy, and long-term outcomes in BB toxicity.

Pulmonary embolism (PE) is a potentially fatal condition that often presents with nonspecific symptoms, making diagnosis challenging in the emergency department (ED). This case study details the presentation of a 37-year-old woman with a history of PE, who presented to the ED with pleuritic chest pain and a history of a recent cesarean section. Despite a negative d -dimer, which generally suggests a low likelihood of PE, her clinical presentation raised suspicion, prompting further evaluation. A CT pulmonary angiography revealed a single-subsegmental PE, underscoring that negative d -dimer results should not rule out PE, particularly in high-risk patients or those with a prior thromboembolic history. This case emphasizes the importance of clinical judgment in the ED setting, where rapid diagnosis is critical. While a negative d -dimer is valuable in excluding PE in low-risk patients, imaging remains the gold standard for diagnosing high-risk cases. The patient's management included outpatient anticoagulation with Eliquis, reinforcing the need for personalized treatment based on risk stratification in the ED. This case highlights the importance of clinicians in the ED being cautious when interpreting negative d -dimer results and considering imaging when clinical suspicion remains high.

Lyme disease, much like the nymphs and adult ticks that transmit the disease, can be tricky and at times hard to identify. When the disease presents with hallmark symptoms, such as the erythema migrans rash with central clearing, diagnosis and treatment are often straightforward. However, especially when practicing in an endemic area, health care providers can be presented with a wide range of clinical presentations and symptoms, which can lead to variable testing and treatment recommendations based on the stage of the disease the patient presents in. Therefore, a thorough understanding of Lyme disease is necessary when managing patients with this complex disease.