Advanced Emergency Nursing Journal最新文献

Borealpox, formerly known as Alaskapox, is a novel zoonotic orthopoxvirus with a limited but concerning emergence in Alaska, part of the boreal ecosystem. To date, only 7 human cases have been confirmed, with transmission likely occurring from small wild mammals via intermediary domestic animals such as cats. While the illness is typically mild, it can lead to severe complications including death in immunocompromised patients. This case highlights the diagnostic and clinical challenges associated with orthopoxvirus infections in high-risk populations. Management is primarily supportive, with antiviral and immunoglobulin therapy reserved for severe presentations. Emergency clinicians, including advanced practice clinicians, should be familiar with the clinical manifestations, diagnostic approaches, and emerging treatment strategies for borealpox as cases are expected to increase. Early recognition, appropriate reporting, and interdisciplinary collaboration are essential to optimizing outcomes, particularly in vulnerable populations.

Human immunodeficiency viruses (HIV) and, subsequently, acquired immune deficiency syndrome emphasize the significance of prevention and treatment, especially among vulnerable populations. Some subgroups of the LGBTQIA+ community, namely men who have sex with men (MSM) and transgender individuals, can be disproportionately affected by this disease. As the health care community recognizes this health concern, post-exposure prophylaxis has become important in preventing HIV spread. The current practices depend on two-pill approaches that combine emtricitabine/tenofovir with either dolutegravir or raltegravir. However, the introduction of the one-pill bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) improves the chances of receiving prophylactic treatment by people with serious renal health issues. The purpose of the clinical recommendation is to present MSM and transgender patients who might have contracted HIV with an alternative treatment of BIC/FTC/TAF that reduces renal side effects and requires a single pill a day.

Acute abnormal uterine bleeding is a frequent reason for emergency department visits and, in severe cases, can become life-threatening. Tranexamic acid is a potential treatment option. However, its use in this setting remains under-researched. The Research to Practice column critically evaluates a recent study and translates its findings, within the context of a clinical case, into actionable changes for emergency care. This article examines the conclusions drawn from a comprehensive literature review and an international expert panel, aiming to establish consensus recommendations for managing acute menorrhagia and providing evidence-based guidance to healthcare professionals.

Background: The emergency department (ED) serves as a safety net for individuals with limited access to primary care. ED nurses are often the first point of contact for those with few resources. Literature shows a link between social determinants of health (SDoH) and frequent ED use.

Purpose: This qualitative descriptive study explored ED nurses' knowledge, attitudes, and practices in addressing SDoH, aiming to better understand this issue and elevate nurses' voices.

Methods: A qualitative descriptive design examined how ED nurses address SDoH and their related knowledge, attitudes, and practices.

Results: Eighteen ED nurses participated in semi-structured interviews. Thematic analysis yielded 45 codes, 17 categories, and six themes: practical wisdom, navigating barriers, integrated solutions, professional and ethical stewardship, time constraints and institutional influences, and educational empowerment.

Conclusions: Results highlight the complexity of addressing SDoH in the ED and the need for more resources, education, and research on interventions and long-term outcomes.

Patients with psychiatric disorders presenting to the Emergency Department (ED) are at increased risk for cardiac complications when treated with antipsychotic medications. Many antipsychotics are associated with unpredictable effects on cardiac conduction, particularly QTc prolongation, which may lead to life-threatening arrhythmias such as Torsades de Pointes and ventricular tachycardia. These risks are heightened in agitated patients who require high doses of antipsychotics. Selecting an appropriate agent demands a careful balance between psychiatric stabilization and cardiovascular safety. First- and second-generation antipsychotics, including the commonly used haloperidol and ziprasidone, are known to cause QTc prolongation, the most clinically significant ECG abnormality. Effective management requires individualized assessment, vigilant ECG and electrolyte monitoring, and informed antipsychotic selection. This case study highlights the clinical presentation and potential ECG changes associated with antipsychotic medication use in the ED.

The purpose of this article is to discuss wound assessment and management for advanced practice registered nurses (APRNs). Skin anatomy is reviewed, and the stages and methods of wound healing are also addressed. Common types of wound/skin disruption are listed. The importance of a thorough and meticulous history and physical exam outlining the appropriate initial evaluation of wounds and including the identification of potential complications such as infection, retained foreign bodies, and neurovascular injuries are also considered. Clinical decision-making and the formulation of differential diagnoses for patients presenting with wounds will be discussed along with a management plan for patients requiring laceration repair. Information regarding the procedural phase of care [e.g., anesthesia use, common wound closure techniques (e.g., suture, tissue adhesives, staples)], offering guidance on technique selection based on wound characteristics and location will also be given. A comprehensive plan of care including patient disposition, and referral and documentation exemplars with practical pearls to avoid litigation will also be provided. APRNs will also be offered evidence-based strategies to deliver safe and effective wound care and management.

Guttate psoriasis (GP) is a variant of psoriasis. Approximately 2-4% of the world population is affected by psoriasis; of this, about 30% will be diagnosed with guttate psoriasis. GP primarily affects children and young adults. Like other psoriasis, guttate psoriasis is an immune-mediated dermatological disorder. GP is distinct, given it is classically an acute rash following a streptococcal infection.