Pub Date : 2024-07-01DOI: 10.1016/S0099-1767(24)00141-7
{"title":"Board of Directors","authors":"","doi":"10.1016/S0099-1767(24)00141-7","DOIUrl":"https://doi.org/10.1016/S0099-1767(24)00141-7","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Page A6"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.01.007
Shannon S. Olivieri DNP, RN-BC, CEN, CNE, Monica L. Diamond-Caravella DNP, RN, AE-C, LuAnn Nowak Etcher PhD, GNP-BC, CPG
Introduction
Human trafficking is a heinous crime and violation of human rights affecting between 25 and 27 million adults and children globally each year. Current immigration and refugee policy could exacerbate the human trafficking public health crisis. Health care providers working in emergency department and urgent care settings interact with human trafficking victims and provide life-changing care. Research identifies a significant need for coordinated, consistent, and standardized education on human trafficking. The purpose of this study was to determine the effectiveness of online educational training in human trafficking on the knowledge and self-confidence of registered nurses and nurse practitioners working in the emergency department and urgent care settings in New York.
Methods
An asynchronous, online education module was designed for emergency department and urgent care registered nurses and nurse practitioners to address key components of human trafficking identification, assessment, and treatment. Using a 1-group pretest/posttest design, participants completed an existing published survey tool before and 6 weeks after education.
Results
Findings revealed statistically significant improvement (P < .05) in knowledge and confidence regarding components of identifying, assessing, and treating victims of human trafficking. Data demonstrated 63.8% of participants had never received human trafficking training, and 80% reported no history of contact with patients known or suspected of being trafficked.
Discussion
Results in this study demonstrate the need for increased standardized education regarding HT for frontline health care workers.
{"title":"Closing the Educational Gap on Human Trafficking: There’s No Better Time Than Now!","authors":"Shannon S. Olivieri DNP, RN-BC, CEN, CNE, Monica L. Diamond-Caravella DNP, RN, AE-C, LuAnn Nowak Etcher PhD, GNP-BC, CPG","doi":"10.1016/j.jen.2024.01.007","DOIUrl":"10.1016/j.jen.2024.01.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Human trafficking is a heinous crime and violation of human rights affecting between 25 and 27 million adults and children globally each year. Current immigration and refugee policy could exacerbate the human trafficking public health crisis. Health care providers working in emergency department and urgent care settings interact with human trafficking victims and provide life-changing care. Research identifies a significant need for coordinated, consistent, and standardized education on human trafficking. The purpose of this study was to determine the effectiveness of online educational training in human trafficking on the knowledge and self-confidence of registered nurses and nurse practitioners working in the emergency department and urgent care settings in New York.</p></div><div><h3>Methods</h3><p>An asynchronous, online education module was designed for emergency department and urgent care registered nurses and nurse practitioners to address key components of human trafficking identification, assessment, and treatment. Using a 1-group pretest/posttest design, participants completed an existing published survey tool before and 6 weeks after education.</p></div><div><h3>Results</h3><p>Findings revealed statistically significant improvement (<em>P</em> < .05) in knowledge and confidence regarding components of identifying, assessing, and treating victims of human trafficking. Data demonstrated 63.8% of participants had never received human trafficking training, and 80% reported no history of contact with patients known or suspected of being trafficked.</p></div><div><h3>Discussion</h3><p>Results in this study demonstrate the need for increased standardized education regarding HT for frontline health care workers.</p></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 551-566"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.04.002
Chien-Tai Huang MD, Wan-Ching Lien MD, PhD
The “double tongue sign” is a characteristic finding in patients with Ludwig's angina, a potentially life-threatening infection due to airway compromise. Management primarily focuses on early airway protection and antibiotic administration. Submandibular sialolithiasis, on the other hand, could present with the double tongue sign without symptoms suggestive of airway involvement. Unlike Ludwig’s angina, conservative treatment is usually the first-line approach for sialolithiasis. The importance of rapidly recognizing and distinguishing between the 2 conditions is emphasized through effective triage and risk stratification, particularly in rural areas where physicians are not readily available.
{"title":"Submandibular Sialolithiasis Mimicking Ludwig’s Angina: A Case Report and Brief Clinical Review","authors":"Chien-Tai Huang MD, Wan-Ching Lien MD, PhD","doi":"10.1016/j.jen.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.jen.2024.04.002","url":null,"abstract":"<div><p>The “double tongue sign” is a characteristic finding in patients with Ludwig's angina, a potentially life-threatening infection due to airway compromise. Management primarily focuses on early airway protection and antibiotic administration. Submandibular sialolithiasis, on the other hand, could present with the double tongue sign without symptoms suggestive of airway involvement. Unlike Ludwig’s angina, conservative treatment is usually the first-line approach for sialolithiasis. The importance of rapidly recognizing and distinguishing between the 2 conditions is emphasized through effective triage and risk stratification, particularly in rural areas where physicians are not readily available.</p></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 491-495"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.03.001
Michael Keenan MD, Susan Wojcik PhD, Brian M. Clemency DO, Jeanna Marraffa PharmD
Introduction
Activated charcoal is the most common form of gastrointestinal decontamination used for the poisoned patient. One limitation to its use is patient tolerability due to palatability. Some recommend mixing activated charcoal with cola to improve palatability. An important question is whether mixing activated charcoal with cola affects the ability of the activated charcoal to adsorb xenobiotic.
Methods
This was a prospective randomized controlled crossover trial. Five healthy adults aged 18 to 40 years were recruited. Participants received 45 mg/kg acetaminophen rounded down to the nearest whole tablet. One hour later, they were randomized to receive 50 g of an activated charcoal-water premixture alone or mixed with cola. Acetaminophen levels were collected. The area under the curve of acetaminophen concentrations over time was measured as a marker for degree of absorption. Participants also completed an appeal questionnaire in which they rated the activated charcoal preparations. Participants would then return after at least 7 days to repeat the study with the other activated charcoal preparation.
Results
Four male participants and 1 female participant were recruited. There was no statistical difference in preference score for activated charcoal alone versus the cola-activated charcoal mixture. There was no statistical difference in the area under the curve of acetaminophen concentrations over time between activated charcoal alone and the cola-activated charcoal mixture. Of note, the study is limited by the small sample size, limiting its statistical power.
Discussion
The absorption of acetaminophen in an overdose model is no different when participants received activated charcoal alone or a cola-activated charcoal mixture as suggested by area under the curve. In this small study, there was no difference in preference for activated charcoal alone or a cola-activated charcoal mixture across a range of palatability questions. On an individual level, some participants preferred the activated charcoal-cola mixture, and some preferred the activated charcoal alone.
{"title":"Does Mixing Activated Charcoal With Cola Improve Tolerability Without Affecting Pharmacokinetics? A Randomized Controlled Crossover Trial","authors":"Michael Keenan MD, Susan Wojcik PhD, Brian M. Clemency DO, Jeanna Marraffa PharmD","doi":"10.1016/j.jen.2024.03.001","DOIUrl":"10.1016/j.jen.2024.03.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Activated charcoal is the most common form of gastrointestinal decontamination used for the poisoned patient. One limitation to its use is patient tolerability due to palatability. Some recommend mixing activated charcoal with cola to improve palatability. An important question is whether mixing activated charcoal with cola affects the ability of the activated charcoal to adsorb xenobiotic.</p></div><div><h3>Methods</h3><p>This was a prospective randomized controlled crossover trial. Five healthy adults aged 18 to 40 years were recruited. Participants received 45 mg/kg acetaminophen rounded down to the nearest whole tablet. One hour later, they were randomized to receive 50 g of an activated charcoal-water premixture alone or mixed with cola. Acetaminophen levels were collected. The area under the curve of acetaminophen concentrations over time was measured as a marker for degree of absorption. Participants also completed an appeal questionnaire in which they rated the activated charcoal preparations. Participants would then return after at least 7 days to repeat the study with the other activated charcoal preparation.</p></div><div><h3>Results</h3><p>Four male participants and 1 female participant were recruited. There was no statistical difference in preference score for activated charcoal alone versus the cola-activated charcoal mixture. There was no statistical difference in the area under the curve of acetaminophen concentrations over time between activated charcoal alone and the cola-activated charcoal mixture. Of note, the study is limited by the small sample size, limiting its statistical power.</p></div><div><h3>Discussion</h3><p>The absorption of acetaminophen in an overdose model is no different when participants received activated charcoal alone or a cola-activated charcoal mixture as suggested by area under the curve. In this small study, there was no difference in preference for activated charcoal alone or a cola-activated charcoal mixture across a range of palatability questions. On an individual level, some participants preferred the activated charcoal-cola mixture, and some preferred the activated charcoal alone.</p></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 516-522"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.03.002
Landon D. Hamilton PhD, Scott Binns RN, MS, Kim McFann PhD, Nikiah Nudell MS, Julie A. Dunn MD
Introduction
Noninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making.
Methods
This study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the “gold standard” brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings.
Results
VitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and “gold standard” clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the “gold standard.”
Discussion
Taken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.
{"title":"A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit","authors":"Landon D. Hamilton PhD, Scott Binns RN, MS, Kim McFann PhD, Nikiah Nudell MS, Julie A. Dunn MD","doi":"10.1016/j.jen.2024.03.002","DOIUrl":"10.1016/j.jen.2024.03.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Noninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making.</p></div><div><h3>Methods</h3><p>This study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the “gold standard” brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings.</p></div><div><h3>Results</h3><p>VitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and “gold standard” clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the “gold standard.”</p></div><div><h3>Discussion</h3><p>Taken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.</p></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 503-515"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.04.001
Michael L. Callihan PhD, RN, CEN, FAEN, Lisa A. Wolf PhD, RN, CEN, FAEN, FAAN
{"title":"Translation of Research to Practice","authors":"Michael L. Callihan PhD, RN, CEN, FAEN, Lisa A. Wolf PhD, RN, CEN, FAEN, FAAN","doi":"10.1016/j.jen.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.jen.2024.04.001","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 499-502"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jen.2024.04.004
Elizabeth Francis DNP, PMHNP-BC
Introduction
Substance misuse in the United States has continuously proven to be a public health issue. The impact of substance use disorder and the injury and illness it produces creates challenges in the public health sector. This quality improvement project aimed to increase screening and referral rates in a rural emergency department.
Methods
The CAGE-AID screening tool was implemented into the triage process in the Meditech Expanse system; 1077 patients were included in this quality improvement project. This initiative used Plan-Do-Study-Act cycles, collecting data weekly.
Results
There were 1077 patients available for the new screening process. This included 468 males (43.5%) and 609 females (56.5%). Of the 1077 patients, all (100%) were screened with the leading question. All patients (100%) were subsequently screened with the 4-item CAGE-AID tool if they answered “yes” to the leading question. Of these patients, 962 screened negative (89.3%) and 115 screened positive (10.7%). For those 115 positive screens, 63 denied referrals (54.8%) and 52 (45.2%) accepted referral. Of those 52 who accepted referral, 9 (17.3%) scheduled themselves for a follow-up appointment within 30 days of the new process going live.
Conclusion
It is possible for substance use disorder screening and referral to be implemented in every emergency department across the nation and beyond to help identify patients struggling with substance misuse and refer them to the appropriate treatment upon discharge. Substance use disorder screening and referral are an evidence-based method, and sufficient evidence supports the current practice of emergency departments implementing routine substance use disorder screening and referral as standard of care.
{"title":"Implementing a Screening Tool and Referral Process for Substance Use Disorders in the Emergency Department: A Quality Improvement Project","authors":"Elizabeth Francis DNP, PMHNP-BC","doi":"10.1016/j.jen.2024.04.004","DOIUrl":"10.1016/j.jen.2024.04.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Substance misuse in the United States has continuously proven to be a public health issue. The impact of substance use disorder and the injury and illness it produces creates challenges in the public health sector. This quality improvement project aimed to increase screening and referral rates in a rural emergency department.</p></div><div><h3>Methods</h3><p>The CAGE-AID screening tool was implemented into the triage process in the Meditech Expanse system; 1077 patients were included in this quality improvement project. This initiative used Plan-Do-Study-Act cycles, collecting data weekly.</p></div><div><h3>Results</h3><p>There were 1077 patients available for the new screening process. This included 468 males (43.5%) and 609 females (56.5%). Of the 1077 patients, all (100%) were screened with the leading question. All patients (100%) were subsequently screened with the 4-item CAGE-AID tool if they answered “yes” to the leading question. Of these patients, 962 screened negative (89.3%) and 115 screened positive (10.7%). For those 115 positive screens, 63 denied referrals (54.8%) and 52 (45.2%) accepted referral. Of those 52 who accepted referral, 9 (17.3%) scheduled themselves for a follow-up appointment within 30 days of the new process going live.</p></div><div><h3>Conclusion</h3><p>It is possible for substance use disorder screening and referral to be implemented in every emergency department across the nation and beyond to help identify patients struggling with substance misuse and refer them to the appropriate treatment upon discharge. Substance use disorder screening and referral are an evidence-based method, and sufficient evidence supports the current practice of emergency departments implementing routine substance use disorder screening and referral as standard of care.</p></div>","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Pages 567-572"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141096815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/S0099-1767(24)00142-9
{"title":"Information for Readers","authors":"","doi":"10.1016/S0099-1767(24)00142-9","DOIUrl":"https://doi.org/10.1016/S0099-1767(24)00142-9","url":null,"abstract":"","PeriodicalId":51082,"journal":{"name":"Journal of Emergency Nursing","volume":"50 4","pages":"Page A8"},"PeriodicalIF":1.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141483453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}