Advanced Emergency Nursing Journal最新文献

Leprosy is a complex and interesting bacterial infection affecting individuals across the world. This is not just an ancient disease from antiquity, but one that is still present today. The diagnosis and treatment of leprosy is complex, and often there is a significant delay in diagnosis from the onset of the disease. Understanding the varied clinical presentations of leprosy and how to treat it can improve clinical outcomes. Healthcare practitioners need to be knowledgeable about all diseases, not just the most common ones.

Diabetic ketoacidosis (DKA), seen with relative frequency in the emergency department, is a potentially life-threatening complication of both type I diabetes mellitus and type II diabetes mellitus (T2DM) characterized by hyperglycemia, ketosis, and acidosis. However, an uncommon variation of DKA, termed euglycemic diabetic ketoacidosis (euDKA) has been increasing in frequency due to the abundance of patients with T2DM being managed on sodium-glucose cotransporter-2 inhibitors, which pose an increased risk of euDKA. The diagnosis of euDKA can be elusive as the typical presentation of substantial hyperglycemia is absent, which can lead to delayed diagnosis and treatment. This case study highlights the clinical presentation and management of euDKA patients to help increase awareness.

Sepsis remains a global health challenge, with millions affected and high mortality rates. Early recognition is critical for improving outcomes, particularly in prehospital settings where timely interventions can significantly impact patient survival. This literature review examines screening tools used in prehospital environments, focusing on their predictive abilities, ease of use, and limitations in detecting sepsis. Tools such as the quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Systemic Inflammatory Response Syndrome, and Monocyte Distribution Width offer varied strengths and applications in identifying sepsis. Research shows that NEWS and NEWS2 demonstrate higher sensitivity for predicting mortality, while qSOFA offers simplicity but may lack sensitivity outside of acute care settings. Differential diagnoses, such as pulmonary embolism and adrenal crisis, can mimic sepsis, making accurate assessment essential. The review highlights the role of Emergency Medical Services (EMS) and Family Nurse Practitioners in early detection and emphasizes the importance of evidence-based practices and clear protocols. This review aims to provide EMS and Nurse Practitioners with the knowledge and tools to recognize sepsis early, ensuring appropriate referrals and improving patient outcomes.

Although often considered a historical disease, plague remains a modern-day public health concern with global relevance. Caused by the bacterium Yersinia pestis and transmitted to humans primarily through infected flea bites or contact with infected animals, plague persists worldwide, including parts of the southwestern United States. The disease presents in three main forms: bubonic, septicemic, and pneumonic. Bubonic plague, the most common form, is characterized by painful swollen lymph nodes known as buboes. Septicemic plague occurs when the infection enters the blood stream, while pneumonic plague, the most virulent and transmissible form, poses a serious bioterrorism threat due to its ability to spread via respiratory droplets and high fatality rate. Though rare today, with an average of seven cases annually in the U.S., plague still demands awareness and preparedness by emergency nurse practitioners and other clinicians. Early diagnosis, timely antibiotic treatment, and vigilant public health measures are critical to reducing its morbidity and mortality.

Abdominal pain is a common chief complaint in Emergency departments (EDs) nationwide which presents a wide array of potential etiologies including acute coronary syndrome ( Daniels et al., 2020 ). High-sensitivity troponin I (hs-TnI), a biomarker traditionally linked to cardiac injury, can also be elevated in noncardiac conditions, such as acute cholecystitis. This case study underscores the advantages of hs-TnI over conventional troponin tests, specifically among patients with abnormal ECGs. This case also highlights the hs-TnI superior sensitivity in detecting or excluding subtle myocardial injuries that may arise from conditions like acute cholecystitis ( Babic et al., 2012 ). By integrating hs-TnI into the diagnostic workup, advanced practice registered nurses can more effectively stratify patient risk, thereby enhancing the quality of early diagnosis and management of acute cholecystitis.

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.

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.

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.