Advanced Emergency Nursing Journal最新文献

Diaphragmatic injuries are uncommon but are associated with high mortality rates in acute and chronic presentations. Mortality increases with complications of diaphragmatic hernia, which include strangulated bowel, perforation, and peritonitis. Traumatic diaphragmatic injury (TDI) is notoriously underdiagnosed and delayed presentations are common. Firearm injuries and stab wounds account for the majority of TDI. Blunt TDI is frequently associated with severe injuries including pneumothorax and hemorrhaging shock. Contrast enhanced computed tomography imaging is the gold standard for diagnosis in both blunt and penetrating mechanisms of injury. Laparoscopy is a useful nonoperative tool for diagnosing TDI. Small lacerations may not warrant further investigation or repair at the index admission. Patients with clinical instability and/or evidence of TDI with blunt trauma warrant emergent operative intervention. Recognition of TDI is essential for nurse practitioners and physician assistants, given disease mortality, frequency of delayed presentations, and the lack of guidance on surveillance for initially nonoperative injuries.

Objective: The purpose of this study was to assess the practicality and efficacy of balloon insufflation versus syringe-based modified Valsava maneuver (VM) for terminating paroxysmal supraventricular tachycardia (PSVT).

Methods: Pressure generation tests compared latex balloons (uninflated diameters: 5.7-6 cm) and 10-ml syringes. A total of 103 hemodynamically stable PSVT patients presenting in the emergency department (ED) were random assigned to perform the modified VM using either a balloon ( n = 58) or a syringe ( n = 45). Primary outcome was a cardioversion of sinus rhythm.

Results: We found that when blowing air into a balloon, we were able to reach the target intrathoracic pressure (40-60 mmHg; mean 47.8 mmHg for 5.8-cm balloon) required for VM. A total of 103 patients were randomized to perform the modified VM. Among them, cardioversion success was 50% (29/58) in the balloon group versus 55.6% (25/45) in the syringe group ( p = .575). Balloon insufflation was visibly effective in 100% of patients versus 36.4% with syringes ( p < .001).

Conclusion: In this study, the patients in the ED showed that the modified VM using a balloon was effective in terminating PSVT with which the balloon allowed for visible insufflation. Its simplicity and visibility make it preferable in emergency and community settings, reducing reliance on invasive interventions.

Therapeutic thoracentesis is an invasive procedure performed to relieve symptoms in patients with large pleural effusions identified on diagnostic imaging. Untreated effusions can lead to respiratory compromise or hemodynamic instability. Factors such as poor patient compliance, worsening disease progression, or limited outpatient follow-up availability may increase the need for therapeutic thoracentesis in the emergency department (ED). This article provides a comprehensive overview of the procedure with point-of-care ultrasound (POCUS) guidance and discusses indications, contraindications, and post-procedure care in the ED setting. Competence in thoracentesis and POCUS enables the emergency nurse practitioner to optimize procedural utilization and deliver safe, high-quality care for patients with significant pleural effusions.

Background: Migraine is an often-disabling condition and a common presentation to the Emergency Department (ED). Rapid and effective treatment are essential to reduce symptom burden, prevent recurrence, and improve patient outcomes. This review provides a comprehensive, evidence-based overview of the pharmacologic management of acute migraine in the ED, including first-line therapies, rescue medications, adjunctive care strategies, and considerations for special populations. First-line agents for acute migraine include dopamine antagonists, nonsteroidal anti-inflammatory drugs, and triptans, with treatment tailored to severity, comorbidities, and previous response. Rescue therapies such as dexamethasone, valproic acid, magnesium sulfate, and, in rare cases, dihydroergotamine and caffeine, are indicated for refractory or recurrent symptoms. Supportive interventions such as intravenous fluids and antiemetics can enhance treatment response. Special populations, including pregnant individuals, pediatric, and geriatric patients, as well as those with cardiovascular disease, require individualized management. It is critical for ED personnel to provide not only optimal pharmacotherapy but also safe medication administration, astute monitoring for adverse effects, and the provision of discharge education to prevent migraine recurrence and ensure outpatient follow-up.

As the number of nurse practitioners working in emergency care (ENP) has grown over the past decade, the alignment of ENP knowledge, skills, and abilities with those of the NP populations has not been fully explored. To identify overlapping themes among the emergency nurse practitioner (ENP) specialty and the eight nurse practitioner population foci's knowledge, skills, and abilities, national leaders and expert faculty collaborated on a crosswalk analysis of NP competencies, certification examination content and procedures. This project revealed that the ENP specialty competencies, certification exam blueprint items, and procedures are not entirely subsumed within an existing nurse practitioner population focus.

Patients experiencing foreign bodies in the knee joints may attempt to manage the situation at home before seeking care from their primary care provider. The delay in care may result in infection or sepsis of the knee joint. This case depicts how the delay in care can lead to hospitalization and delayed recovery. Timely diagnosis of foreign bodies in the knee joint leads to efficient removal and control of infection. Patient rapport and proper diagnostic testing are key to the efficient delivery of care.

Sudden visual disturbances are of significant concern and often among the most challenging scenarios for emergency providers in underserved communities without on-call ophthalmology services. Vulnerable areas in emergency training vary among nurse practitioners, physician assistants, and even physicians. Urgent and non-urgent ophthalmology disorders are commonly cited in the literature as one of the most challenging areas for emergency providers. Ophthalmology is frequently not included as a mandatory clinical rotation in medical school, resulting in limited exposure to this specialty. Similarly, anecdotal evidence suggests that nurse practitioner and physician assistant training often lack sufficient exposure to ophthalmology. The purpose of this emergency ophthalmology case study is to review the management of central serous chorioretinopathy, an acute and often benign eye disorder, and to examine how it escalated to a workup for a cerebrovascular accident in the absence of an ophthalmology consultation.