Advanced Emergency Nursing Journal最新文献

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) poses a rare yet critical concern among postpartum individuals, increasingly recognized as a significant trigger for acute myocardial infarction. Timely identification, accurate diagnosis, and prompt treatment are paramount for clinicians confronted with this condition. Patients with P-SCAD commonly manifest signs and symptoms akin to acute coronary syndrome but have different etiology and treatment. SCAD is defined as a non-traumatic, non-iatrogenic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma or intimal disruption compromising the lumen at the site of dissection. Diagnosis is made with a comprehensive history and physical examination, cardiac biomarkers, a 12-lead ECG, transthoracic echocardiogram, and confirmed with coronary angiography. Stable patients are managed medically, while more severe cases may require additional intervention.

Background: Delays in sepsis recognition contribute to delays in antibiotic administration, which lead to increased morbidity and mortality in patients with sepsis. Our objective was to create an Emergency Department (ED) Code Sepsis Nurse-led team to reduce the time to antibiotics and mortality in patients with sepsis.

Methods: This initiative was implemented at a community hospital in Southern California in response to previous undesirable sepsis outcomes. In fiscal year 2021, the ED Sepsis Nursing Team was launched with the goal of improving sepsis-related outcomes. The following interventions were implemented: First, a group of dedicated Sepsis Nurses with training specific to sepsis recognition was created, and an electronic ED-sepsis screening tool was developed and implemented. Next, the dedicated sepsis nurses designed and educated to a "Code Sepsis" activation process. The code triggered a multidisciplinary response and implementation of standing orders for blood cultures, lactate, complete blood count, complete metabolic panel, and chest x-ray or urinalysis if indicated. Finally, the Sepsis Team Registered Nurse (RN) Captain led house-wide monthly Sepsis Task Force meetings to improve unit-level engagement and to allow the team to have ownership over sharing wins and losses.

Results: By Quarter 4 (Q4) of Fiscal Year 2021, door-to-antibiotic time for sepsis patients dropped from 196.7 min (Q1) to 144.7 (Q4). Additionally, mortality dropped below the health system average (10.4% vs. 13.5%), and Fiscal Year 2021 surpassed the readmissions benchmark of <1.0 at a rate of 0.5.

Conclusion: An RN-led, interprofessional response to accepted sepsis identification criteria enhanced staff and physician engagement and improved sepsis outcomes for patient mortality and hospital reporting outcomes. The process was adopted with very few obstacles that were easily overcome as the understanding of the role and its significance was realized.

This case study examines the delayed presentation of a facial dog bite, an uncommon occurrence in the periorbital area. Initially perceived as a minor injury, the wound was disregarded in its early stages. However, as the infection progressed, prompting urgent evaluation in the emergency department (ED) as the severity became evident. The patient was diagnosed with an acute facial infection carrying the potential for periorbital cellulitis and abscess formation, necessitating immediate imaging. Prompt evaluation of penetrating animal bites, particularly dog bites, is crucial due to their high infection risk. As emphasized by Hamed-Assam et al., immediate attention and prophylactic antibiotics are advised for such cases, preferably broad-spectrum antibiotics with anaerobic coverage. The patient underwent treatment in the ED approximately a day after the incident, receiving antibiotics and subsequently discharged following advanced diagnostic imaging. This case underscores the importance of recognizing and promptly addressing delayed dog bites, emphasizing the significance of immediate medical intervention post-penetrating animal bites.

Patient overcrowding in emergency departments (ED) impact quality of care by increasing length of stay which often leads to delayed patient dispositions. Emergency Department Observation Units (EDOUs) are protocol driven units staffed by ED providers that can alleviate overcrowding concerns and accommodate patients that require further diagnostics for a final disposition. Virtual rounding on EDOUs can be leveraged to maximize provider shortages and increase access to quality care. We present a case report of a patient who arrived at an ED for abdominal pain and was eventually admitted to an EDOU that practiced virtual rounds. This case report demonstrates the benefits of utilizing a clinical hybrid model that combines telemedicine and observation medicine to achieve quality care while improving ED operational flow.

Ocular point-of-care ultrasound (POCUS) has emerged as a pivotal tool in evaluating ocular emergencies in the emergency department (ED), addressing millions of annual visits for eye complaints in the United States. Compared to traditional imaging methods, ocular POCUS's advantages include efficiency, repeatability, and safety. Adequate patient preparation, positioning, and transducer selection are essential for obtaining high-quality images. Ocular POCUS offers static and dynamic imaging,aiding in diagnosing conditions like retinal detachment and increased intracranial pressure. Emergency nurse practitioners (ENPs) can use ocular POCUS to expedite diagnosis and interventions, improving patient outcomes. Overall, ocular POCUS represents a rapid, non-invasive, and effective means of evaluating ocular emergencies in the ED, promising improved diagnostic accuracy, treatment initiation, and, ultimately, enhanced patient care.

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of chronic pain exacerbation to explore the study by Eucker et al., titled "An Adaptive Pragmatic Randomized Controlled Trial of Emergency Department Acupuncture for Acute Musculoskeletal Pain Management".

Fever is the most common complaint for children of all ages who present to an emergency department (ED) for evaluation and treatment. Although most children with fever have a self-limiting viral illness, the infant less than 60 days of age with fever poses a higher risk for an underlying serious bacterial illness (SBI) including urinary tract infections, bacteremia and bacterial meningitis, or an invasive bacterial infection (IBI) including bacteremia. This case is a discussion of a high-risk febrile infant that was evaluated in the emergency department and was ultimately diagnosed with Streptococcus B meningitis. This case emphasizes the importance of heightened vigilance in this high-risk age group for the risk of infection. To prevent mortality and long term morbidities that may result from inadequate treatment or delayed diagnosis and treatment, it is critical to know and strictly adhere to the clinical practice guidelines.