Advanced Emergency Nursing Journal最新文献

Adrenal insufficiency is a disorder of the adrenal glands, where the glands fail to produce adequate mineralocorticoids, glucocorticoids, and adrenal androgens. The most common cause of primary adrenal insufficiency in developed countries is autoimmune; however, medications, infectious diseases, and trauma can also induce adrenal insufficiency. Exogenous steroid use is also a common cause of secondary adrenal insufficiency. Symptoms are related to alterations in the salt and water balance in the body and develop slowly over several months. Patients usually develop fatigue, nausea, vomiting, abdominal pain, myalgias, weight loss, and salt craving. Hyponatremia and hyperkalemia are common. Most patients eventually develop hyperpigmented skin and mucus membranes without treatment. Acute adrenal crisis is a medical emergency characterized by hypotension, lethargy, tachycardia, nausea and vomiting, and hypoglycemia. This requires prompt treatment with intravenous fluids, blood pressure support, and stress dosing of intravenous hydrocortisone. Patients who are correctly identified and treated can make a full recovery, although they will require lifelong replacement of mineralocorticoids and glucocorticoids. Patients who have stabilized their replacement regimens will also require increased doses during periods of illness or stress, such as viral infections or surgery. Emergency clinicians should be aware of the signs and symptoms of adrenal insufficiency and be ready to intervene to prevent life threatening complications.

Point of Care Ultrasound (POCUS) is increasingly integrated into emergency medicine to improve clinical decision-making and patient outcomes. While POCUS training is a standard component of emergency medicine fellowship programs, training for Emergency Nurse Practitioners (ENPs) remains underdeveloped and lacks standardized competency assessment. The American College of Emergency Physicians (ACEP) recommends online didactic training to supplement in-person sessions focused on image acquisition and interpretation. This pilot project aimed to enhance POCUS training for ENPs by incorporating ACEP's online modules into the existing ENP sonogram program. Former and current ENP students completed a confidence survey based on their sonogram skills, with former students receiving traditional in-person training and current students completing online didactic modules before their lab sessions. Results indicated a significant increase in confidence across several ultrasound applications, including Extended Focused Assessment with Sonography in Trauma (eFAST) and echocardiograms. The addition of online training resulted in increased confidence in performing eFAST (28.57% increase), focused echocardiograms (25% increase), ocular sonograms (41.67% increase), but a decrease was seen in vascular access by 16% due to limited time spent on this exam. Students who completed the new training method demonstrated higher proficiency in performing eFAST exams on live models. Integrating online modules into ENP sonogram training is a cost-effective method for delivering didactic content, allowing more time for hands-on practice.

The Research to Practice column focuses on improving the research critique skills and translation of research findings into emergency care clinical practice. In this issue, we discuss the findings of Chaudry et al. (2024) on risk factors associated with major adverse cardiovascular events after discharge in emergency department patients with markedly elevated blood pressures without evidence of target organ injury. The investigators conclude that there are a number of clinical characteristics and symptoms that build on the clinical policy recommendations by the American College of Emergency Physicians on which patients should receive routine diagnostic screening or antihypertensive treatment while in the emergency department to reduce their risk of adverse outcomes.

Patients may have tunnel dialysis catheters utilized for chronic maintenance hemodialysis. Patients can develop infected thrombi with the catheter which can further result in the development of septicemia. This case illustrates a patient who was sent to the Emergency department due to fever, chills, hypotension and significant mental status changes. He was successfully treated with appropriate intravenous antibiotics utilizing culture results and combined use of activated factor Xa inhibitors (Apixaban) to provide early resolution of infected thrombi bacteremia.

Transgender individuals face significant discrimination in daily life and disproportionately high health disparities compared to the general population, including elevated rates of poverty, substance abuse, and mental health challenges. When seeking emergency department care in the United States, they encounter additional barriers such as stigma, lack of provider cultural competence, and limited clinical experience with transgender patients. These barriers often lead transgender people to delay or avoid emergency healthcare, resulting in poorer health outcomes.This study aimed to examine the knowledge, attitudes, and beliefs of Advanced Practice Providers toward transgender adult patients, comparing those with less than three years of ED experience to those with more. A qualitative, 20-question Likert-scale KAB survey was conducted online to assess differences between groups. Primary findings revealed differences in perceptions that could inform transgender-focused educational initiatives within healthcare institutions, guide practice modifications among APPs, and improve outcomes for transgender patients in emergency care settings.

The political climate after the overturning of Roe V. Wade in 2022 has made abortion care difficult to obtain in some regions, causing concern for a potential uprising of self-managed abortions. Most visits to emergency departments for complications related to induced abortions occurred in southern states where abortion bans are the strictest. Following the overturning of Roe V. Wade internet searches for abortion medications notably increased. To increase access to care, telehealth has expanded to include medication abortion services. This has contributed to an observable trend toward greater utilization of medication abortion. As medication abortions increase in availability, emergency providers should prepare themselves to manage potential complications. A case is presented about an adult female who obtained misoprostol from an online pharmacy to terminate a pregnancy at home.

Epistaxis is a common nasal emergency with an estimated 1.7 per 1,000 visits annually to emergency departments. Treatment options depend on the severity of epistaxis, frequency, and equipment availability in the provider's setting. In addition, the treating provider should look at comorbidities, medications, and perform a thorough history and physical exam to attempt visualization of the source of epistaxis. Managing epistaxis should begin with the least to most invasive options, beginning with pressure and application of topical vasoconstrictors and moving to more invasive procedures should hemostasis not be achieved. This article describes a case of a 76-year-old male with a new onset of epistaxis that presents to an emergency department. This article will review the patient's emergency department visit, two follow-up visits, and epistaxis to increase the skills of emergency Advanced Practice Registered Nurses.