Advanced Emergency Nursing Journal最新文献

Heat-related illnesses, namely, heatstroke is on the rise and is a public health concern nationally and internationally. Heatstroke is generally considered to be a core body temperature greater than 40 °C (104 °F) with dry, hot skin, and central nervous system manifestations. Heatstroke is characterized by a systemic inflammatory response that leads to multiple-organ dysfunction and ultimately death if not treated in a timely manner. Rapid recognition and cooling are imperative, as mortality is high, especially in the elderly. There are many cooling methods that have been studied that include cold-water immersion, tarp-assisted cooling with oscillation (TACO), evaporative cooling (misting/fanning), commercial ice packs, cooling vests and jackets, cold showers, and ice sheets. Although cold-water immersion is the fastest method for cooling, it is not usually feasible in an emergency department (ED). TACO is the most feasible and effective cooling method for EDs. It is vital that EDs have a specific plan in place before implementing TACO, as it requires 30-40 gallons of ice water, a tarp or waterproof sheet, core temperature monitoring, and an ample number of ED staff members to oscillate the water over the patient. Further research is needed to study TACO in the ED setting. As the incidence of heatstroke is expected to increase in the coming years, EDs must have a plan in place to rapidly recognize and treat patients with heatstroke so that patients will have improved outcomes and reduced mortality.

The purpose of this quality improvement (QI) initiative was to implement a human trafficking (HT) education module for the emergency department (ED) staff and providers along with implementation of a policy and protocol for screening, identification, and referral of HT victims in the ED to increase provider knowledge of HT and ensure provider compliance with the HT protocol via documentation of red flags and screening questions in the electronic medical record along with social services referrals. The goal of the social services referral was to connect the HT victim with community resources that facilitated placement, food, and shelter in the event the trafficking victim accepted rescue. HT is a public health concern, globally, nationally, and at the state and local levels. ED providers, which include advanced practice registered nurses such as nurse practitioners and clinical nurse specialists, are positioned to be able to identify and treat victims of HT. Therefore, HT victims are being seen and treated in EDs; however, health care providers are not recognizing them. Project design was a QI initiative, which utilized a convenience sample of ED providers. All ED providers and staff completed the HT Education module in Health Stream with pretest/posttest assessments via the PROTECT instrument, which evaluated ED staff/provider knowledge, perceived, actual, and confidence of HT, demographics, previous contact with HT victims, and participant preference for future HT training. HT Education resulted in improved knowledge of participants' perceived, actual, and confidence of HT as demonstrated by statistical significance from pretest to posttest scores; therefore, the HT educational training proved to be beneficial.

The purpose of this case study on giant cell arteritis (GCA) is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process to prevent serious complications such as permanent blindness in patients presenting to the emergency department (ED). The case study reviews emergency management of GCA, which includes diagnostic workup, pharmacological treatment, consults, disposition, follow-up care, and when to return to the ED. The classification criteria will be discussed for GCA from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. In addition, risk assessment, clinical presentation, and physical examination findings will be listed. After reviewing this case study, ENPs should be able to identify GCA and manage care to reduce complications and recurrence of GCA in a patient presenting to the ED.

Postpartum preeclampsia has not received the needed attention that preeclampsia has. It is the lesser-known hypertensive disorder but can be just as life-threatening as eclampsia. Because of the scarcity of qualitative research on postpartum preeclampsia, the purpose of this study was to help fill this gap by exploring personal experiences of this dangerous complication as described in online blogs. Using Google search engine, 25 stories of postpartum preeclampsia were located. Krippendorff's content analysis for qualitative data was the research design used. Five themes were identified: (1) Not even on my radar as a new mom, (2) Bombarded with physical and emotional symptoms, (3) Life-threatening situation: Dismissed or misdiagnosed, (4) Heartbroken: Separation from my newborn, and (5) Trust your instincts and advocate for yourself. Advanced practice nurses and other health care providers need to be on alert for postpartum preeclampsia when a woman, who recently gave birth, presents at the emergency department.

This Research to Practice article is designed to help aid advanced practice registered nurses (APRNs) with up-to-date research guidelines in order to establish evidence-based changes in clinical practice within emergency medical care. The article, "Activated Charcoal and Poisoning: Is It Really Effective?" by Aksay et al. (2022), examines whether the usage of activated charcoal (AC) in current treatment protocols for ingested poisonings adds benefits, given recent controversies in its use. Study variables included clinical findings in relation to the drug being ingested, the frequency and usage of an antidote, the rate of being intubated, and the duration of being hospitalized comparing poisoned patients who received AC with those who did not. APRNs need to be aware of the current guidelines to help establish the appropriateness of use when administering AC and be able to evaluate patients during and after the administering of AC. Improved awareness and education regarding the different treatment modalities for toxicology patients such as AC can help with certain kinds of poisonings in the emergency department.

A peritonsillar abscess (PTA) is a localized collection of pus in the peritonsillar space, between the palatine tonsillar capsule and the superior pharyngeal constrictor muscle (G. Gupta & R. McDowell, 2022). It is the most commonly occurring abscess in the head and neck region. Patient presentation usually includes odynophagia, unilateral otalgia, trismus, and voice changes. Managing a pediatric patient may be challenging, as children may not be able to describe their history of illness and symptoms. The management of a PTA can also differ between pediatric and adult patients (S. Ahmed Ali et al., 2018). It is important for practitioners to consider all aspects when providing treatment. This article describes the encounter and individualized treatment plan of an 11-year-old nonverbal autistic child who presented with fever, decreased oral intake, and left neck swelling. It also provides a general overview of PTAs and procedural steps to perform drainage through needle aspiration and incision and drainage.

The predictive accuracy of 12-lead electrocardiogram (ECG) machines is often challenged across all clinical settings. Emergency clinicians must beware of computer-generated ECG reports specifically during the initial medical screening process. Blindly trusting computer-generated reports may delay care for patients with an acute cardiac disorder. Cardiology consultation is always advised, and there should be no hesitation when it comes to abnormal ECGs. However, cardiologists are often consulted on patients based on incorrect ECG interpretation, misdiagnosis, or overdiagnosis by computer-generated reports. The following 12-lead ECGs should encourage emergency providers to take caution and challenge computer-generated reports. The purpose of this exercise is to carefully review a set of 12-lead ECGs and determine whether the computer-generated interpretations are accurate.

There are concerns about the accuracy of Emergency Severity Index (ESI) triage system in the geriatric population. This study was performed to compare the correlation of ESI triage with injury severity score (ISS) between adults with trauma younger than 60 years and those 60 years of age and older and to determine the ability of ESI to predict an ISS of greater than 15 in these two age groups. This was an observational study performed in an academic trauma center in Kerman, Iran. A convenience sample of trauma patients older than 16 years was included. Five-level ESI triage was performed by nurses with 2-10 years of exclusive experience in triage. The ISS scores were calculated by the researchers. Both numerical and categorical (ISS >15) forms of the score were considered as outcomes. Ultimately, a total of 556 patients were enrolled in the study. No difference in undertriage was seen between the age groups (p = 0. 51). Spearman's correlation coefficient between ESI level and ISS was -0.69 and -0.77 in patients younger than 60 years and those aged 60 years or older, respectively (z = 1.20). The areas under the curves (AUCs) for prediction of ISS of greater than 15 were also similar between the two age groups (0.89 in less than 60 and 0.85 in 60 or more). In conclusion, the performance of ESI was similar between the two age groups. Therefore, the application of the ESI triage system for initial categorization of trauma patients seems to be a reliable and easy-to-learn method for the triage of elderly as well as younger age groups.