Advanced Emergency Nursing Journal最新文献

Tick-borne diseases occur throughout the United States, with a disease burden that ranges from mild to severe. As temperatures rise with climate change, the active season for ticks increases, and more tick-borne illness is seen (Centers for Disease Control and Prevention, 2022a). Many patients present to the ED for suspected tick bites, rashes, and generalized medical complaints that may be related to a tick-borne disease, so it is important for the emergency nurse practitioner (ENP) to accurately diagnose these conditions. Because of this increasing disease burden, it has become vital for these illnesses to be recognized early, as early diagnosis can reduce possible complications of chronic illness. Familiarity with the cutaneous rashes present in several tick-borne diseases can aid the ENP to effectively diagnose and treat these conditions.

This article reviews the results of a randomized controlled trial, "Rapid Agitation Control with Ketamine in the Emergency Department: A Blinded, Randomized Controlled Trial" by D. Barbic et al. (2021), comparing time to sedation, level of sedation, and adverse outcomes between intramuscular ketamine versus intramuscular midazolam and haloperidol among acutely agitated patients presenting to the emergency department (ED). The findings are discussed in the context of practice change for patient stabilization within the ED. Emergency department nurse practitioners must employ continuing education and remain current with clinical practices and treatment options to ensure that patients receive optimal safe care. Although the use of midazolam and haloperidol has historically been the first-line treatment for the acutely agitated patient, use of ketamine shows promise in providing a safe alternative for expedited patient stabilization for acutely agitated patients presenting to the ED.

A catamenial pneumothorax is a very rare condition resulting in spontaneous and recurrent pneumothoraces that occur in relationship with menses (T. Marjański et al., 2016). Although rare, emergency providers should consider this condition when female patients present to the emergency department with chest discomfort and dyspnea during menstruation. This case describes a patient who presented to the emergency department with abdominal pain who was incidentally found to have a catamenial pneumothorax on diagnostic imaging for her complaint of acute abdominal pain.

Acute bacterial skin and skin-structure infections (ABSSSIs) are frequent clinical presentations to emergency departments (EDs) across the nation that can require substantial resources to treat due to several factors. These include an increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) as the causative organism, limited availability of oral antibiotics that treat ABSSSIs secondary to MRSA, absorption and pharmacodynamic concerns with oral therapy, and regimen adherence. In patients who are unable to tolerate oral therapy, or are unable to adhere to prescribed antibiotics, inpatient admission for intravenous (IV) antibiotics may be necessary. Although inpatient IV antibiotics used to treat MRSA, such as vancomycin, are relatively inexpensive, hospital admission itself incurs significant associated costs. The introduction of the long-acting lipoglycopeptides, dalbavancin and oritavancin, has many potential advantages for the treatment of ABSSSIs including one- or two-dose regimens, allowing patients to receive their dose in the ED or infusion center and avoid inpatient admission altogether. Existing data have borne out these results, demonstrating that these agents can significantly reduce the length of hospital stay and the overall treatment cost of ABSSSIs. However, as these agents have nontraditional therapeutic regimens compared with alternative IV and oral agents that require consistent dosing, it is imperative to have decision support tools in place to ensure that this therapy is utilized in appropriate patients with ABSSSIs and that its true benefits can be realized for both the patient and the health care system.

The emergency department (ED) is a stressful workplace for nurses, due to heavy workload and work shifts, which affect sleep quality, causing occupational fatigue. As a result, nurses burn out and turn over and quality of care is impaired. The aim of this study was to investigate sleep disturbance (SD) and occupational fatigue (OF) in emergency nurses of public hospitals in Greece. This descriptive cross-sectional study was conducted in the ED of tertiary public hospitals in Greece from September 2019 to October 2021, after the approval from the scientific and ethical committee of hospitals and the full informed consent of participants. The Standard Shift work Index (SSI) questionnaire was used, which includes 12 question groups about sleep habits and OF evaluation for shift workers, as nurses. Two hundred and ten ED nurses were recruited for the purpose of the study. In this research their quality of life, sleep completeness, and fatigue levels were studied. A moderate level of SD (total score = 70.54) of nurses was found that was related to marital status, presence of children, and underlying diseases (p = 0.012, p = 0.024, and p = 0.002, respectively). OF was assessed at low levels (score = 27.34) and was mainly related to age, with younger nurses reporting less fatigue compared with older nurses. The effect of work shifts in SD and OF of ED nurses was well documented. ED nurses' OF was correlated with increased SD, age, and marital status. Further research is needed for a better assessment and understanding of the factors that influence SD and OF of ED nurses to plan a strategy to optimize sleep patterns of work shift ED nurses.