Journal of Emergency Nursing最新文献

Traumatic arteriovenous fistulas, accounting for most cases (approximately 82%-98%), are typically the consequence of penetrating injuries. The ulnar and radial arteries are the most common sites of occurrence, whereas incidents at the distal radial and ulnar arteries are rare. This emphasizes the critical role of systematic clinical reasoning when evaluating patients with unclear or atypical presentations. Emergency nurses play a vital role in recognizing red flags, escalating care, and advocating for further investigation when standard treatments fail. A previously healthy 55-year-old woman presented with a pulsating and painful swelling on the volar aspect of her right hand, which gradually increased in size after a puncture injury from a fishbone. Emergency nurses should recognize that such presentations require immediate vascular assessment, given that the pulsatile nature and progressive enlargement are key clinical indicators that distinguish arteriovenous fistulas from simple soft tissue injuries. On clinical assessment, a pulsatile mass was noted. Duplex ultrasound, along with angiography, confirmed the presence of an arteriovenous fistula. Differential diagnoses, such as pseudoaneurysm or soft tissue hematoma, were considered but ruled out based on imaging and flow characteristics. A successful embolization procedure was performed to treat the arteriovenous fistulas in her right hand, yielding a positive outcome. For emergency nurses, this case emphasizes the importance of thorough neurovascular assessment in all penetrating hand injuries, regardless of apparent severity. Early recognition of pulsatile masses, assessment of distal perfusion, and prompt escalation to vascular specialists are crucial nursing interventions. The diagnosis of arteriovenous fistulas should not be underestimated, given that they can potentially lead to serious complications such as infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. Emergency nurses play a pivotal role in early detection through systematic assessment and patient education about warning signs, ultimately preventing progression to life-threatening complications through timely intervention.

Introduction: Chest pain is a leading cause of emergency department visits worldwide. At a Midwest urban level 1 trauma center, chest pain accounts for an average of 2530 emergency department visits annually and constitutes the highest number of observation admissions. This quality improvement initiative aimed to educate emergency nurses and implement an evidence-based chest pain pathway to reduce observation admissions and decrease length of stay.

Methods: Emergency nurses completed pre- and post-education surveys. Educational sessions, delivered both online and in-person, were provided based on the results of a pre-survey. An evidence-based chest pain pathway was implemented. Patients' electronic health records were reviewed and analyzed.

Results: Emergency nurses' chest pain knowledge significantly improved after education [χ² (1) = 6.125; P =.008]. The admission rate (observation and inpatient) among patients meeting the inclusion criteria decreased from 31.16% to 28.55%. The emergency department discharges increased from 68.84% to 71.45%. The length of stay did not significantly increase (P = .89). By sustaining the 2.61% increase in discharges, there is a projected annual variable cost savings of $104,544.66.

Conclusion: This quality improvement initiative resulted in increased knowledge among emergency nurses. This was clinically significant given that it enhanced interdisciplinary collaboration, facilitating an increase in discharges among patients with chest pain. Furthermore, this initiative improved transitions of care across different settings. Future work is recommended to assess the applicability of the initiative and the sustainability of results in other organizations.

Pediatric emergency nurses play a central role in mass casualty incident response, yet persistent gaps in readiness remain. This quality improvement project evaluated baseline mass casualty incident readiness among registered nurses in a large pediatric emergency department and assessed the impact of an educational intervention combining didactic review and simulation-based functional exercises. Using a pre-/postintervention design, nurses completed a readiness survey and participated in timed functional tasks to assess knowledge, confidence, and efficiency. The intervention comprised a didactic review of institutional protocols, a practical review of supply locations, and 30-minute functional simulation drills focused on zone leader responsibilities. A total of 63 nurses completed preassessments, and 64 completed postassessments. After the intervention, 92% accurately identified supply locations, 98% described zone leader roles, and 100% reported feeling at least neutral in preparedness. Knowledge gains in this project were statistically significant (P < .001). The results indicate that structured education combined with simulation improved pediatric emergency nurses' readiness for mass casualty incidents within this setting. The intervention's effectiveness was further demonstrated when it was applied successfully during an actual mass casualty incident. Incorporating pediatric-focused mass casualty incident training into ongoing ED education may continue to enhance nurse competence, support team performance, and strengthen institutional disaster preparedness.