Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.
{"title":"Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology.","authors":"Anne J. Hunt","doi":"10.7748/EN.2019.E1926","DOIUrl":"https://doi.org/10.7748/EN.2019.E1926","url":null,"abstract":"Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"340 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77317858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.
{"title":"How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder.","authors":"Michael Brian Haslam","doi":"10.7748/EN.2019.E1930","DOIUrl":"https://doi.org/10.7748/EN.2019.E1930","url":null,"abstract":"Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"148 1","pages":"20-24"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82273038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.
{"title":"Full-thickness burns due to contact with gastric acid.","authors":"R. Fenwick, R. Price","doi":"10.7748/EN.2019.E1941","DOIUrl":"https://doi.org/10.7748/EN.2019.E1941","url":null,"abstract":"This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78650552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis. It also explores the evidence base for commonly prescribed anticoagulants.
{"title":"Non-medical prescribing: a reflective case study on prescribing anticoagulation for deep vein thrombosis.","authors":"S. Gonet","doi":"10.7748/EN.2019.E1897","DOIUrl":"https://doi.org/10.7748/EN.2019.E1897","url":null,"abstract":"Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis. It also explores the evidence base for commonly prescribed anticoagulants.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85298935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AIM To identify the views and experiences of emergency nurses and doctors of the presence of family members during invasive procedures and resuscitation events. METHODS 84 staff members from three emergency departments in one UK trust responded to a paper-based 22-item questionnaire developed by the authors. FINDINGS Staff expressed positive views about family presence during such traumatic events, but also expressed non-evidenced concerns about negative aspects of family presence. CONCLUSION Future research should focus on exploring the views of patients and their families in culturally diverse societies or across culturally different countries. Such data could underpin culturally sensitive policies to guide the practice of family presence and identify the education required to support successful development of such policies. Using simulation-based learning methodology integrated with existing advanced life-support/advanced trauma life-support training could support successful implementation of family presence policies.
{"title":"A survey of emergency department staff's opinions and experiences of family presence during invasive procedures and resuscitation.","authors":"E. Magowan, V. Melby","doi":"10.7748/EN.2019.E1908","DOIUrl":"https://doi.org/10.7748/EN.2019.E1908","url":null,"abstract":"AIM\u0000To identify the views and experiences of emergency nurses and doctors of the presence of family members during invasive procedures and resuscitation events.\u0000\u0000\u0000METHODS\u000084 staff members from three emergency departments in one UK trust responded to a paper-based 22-item questionnaire developed by the authors.\u0000\u0000\u0000FINDINGS\u0000Staff expressed positive views about family presence during such traumatic events, but also expressed non-evidenced concerns about negative aspects of family presence.\u0000\u0000\u0000CONCLUSION\u0000Future research should focus on exploring the views of patients and their families in culturally diverse societies or across culturally different countries. Such data could underpin culturally sensitive policies to guide the practice of family presence and identify the education required to support successful development of such policies. Using simulation-based learning methodology integrated with existing advanced life-support/advanced trauma life-support training could support successful implementation of family presence policies.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78151253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-08DOI: 10.1542/aap.ppcqr.396256
A. T. Andreasen
Last summer, the National Institute for Clinical Excellence (NICE) published Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. The recommendations on computed tomography (CT) in this guidance for minor head injuries are similar to the Canadian CT head rule published in 2001.
{"title":"Head injuries.","authors":"A. T. Andreasen","doi":"10.1542/aap.ppcqr.396256","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396256","url":null,"abstract":"Last summer, the National Institute for Clinical Excellence (NICE) published Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. The recommendations on computed tomography (CT) in this guidance for minor head injuries are similar to the Canadian CT head rule published in 2001.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"2 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88792822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this article is to review the literature on pre-hospital assessment of pain in paediatric patients. Many articles highlight the under-treatment of pain in paediatrics by pre-hospital clinicians, showing that this is an area falling short of best practice. This article evaluates the effectiveness of two established pain assessment tools authorised for the pain assessment of children in pre-hospital environments.
{"title":"Pre-hospital pain assessment in paediatric patients.","authors":"M. Parker, Nicola Brown","doi":"10.7748/EN.2019.E1905","DOIUrl":"https://doi.org/10.7748/EN.2019.E1905","url":null,"abstract":"The aim of this article is to review the literature on pre-hospital assessment of pain in paediatric patients. Many articles highlight the under-treatment of pain in paediatrics by pre-hospital clinicians, showing that this is an area falling short of best practice. This article evaluates the effectiveness of two established pain assessment tools authorised for the pain assessment of children in pre-hospital environments.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"6 1","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82534411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment.
{"title":"Nerve agents: a guide for emergency nurses. Part 1.","authors":"S. Mcghee, A. Finnegan, N. Angus, J. Clochesy","doi":"10.7748/EN.2019.E1896","DOIUrl":"https://doi.org/10.7748/EN.2019.E1896","url":null,"abstract":"Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82186293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ultrasound sonography, in which a high-pitched sound wave travels at different speeds through objects of variable density, offers effective clinical diagnostic applications to identify problems, such as free abdominal fluid following blunt trauma, cardiac effusion and long bone fractures.
{"title":"How much training in ultrasound would emergency nurses need?","authors":"T. Scott","doi":"10.7748/en.26.2.5.s1","DOIUrl":"https://doi.org/10.7748/en.26.2.5.s1","url":null,"abstract":"Ultrasound sonography, in which a high-pitched sound wave travels at different speeds through objects of variable density, offers effective clinical diagnostic applications to identify problems, such as free abdominal fluid following blunt trauma, cardiac effusion and long bone fractures.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"1 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78544414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How one emergency department achieved a 70% rise in patients receiving life-saving sepsis treatment within an hour.
一个急诊科如何在一小时内使接受救命的败血症治疗的病人增加了70%。
{"title":"An Epic outcome.","authors":"P. Kendall-Raynor","doi":"10.7748/EN.26.2.12.S10","DOIUrl":"https://doi.org/10.7748/EN.26.2.12.S10","url":null,"abstract":"How one emergency department achieved a 70% rise in patients receiving life-saving sepsis treatment within an hour.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"7 1","pages":"12-4"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87598316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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