Advanced Emergency Nursing Journal最新文献

{"title":"ED Nurse-Led Code Sepsis to Reduce Time to Antibiotics.","authors":"Leslie Gomez, Kelli LeClair, Danisha Jenkins, Mary Ann David, Jillian Downing, Julie Graham","doi":"10.1097/TME.0000000000000551","DOIUrl":"https://doi.org/10.1097/TME.0000000000000551","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869714","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}

{"title":"Point of Care Ultrasonography for the Evaluation of Ocular Emergencies.","authors":"Juan M Gonzalez, Johis Ortega, Kenya Snowden, Patricia Larrieu-Jimenez, Nichole Crenshaw, Catherine Nadeau, Stephen McGhee","doi":"10.1097/TME.0000000000000549","DOIUrl":"10.1097/TME.0000000000000549","url":null,"abstract":"<p><p>Ocular point-of-care ultrasound (POCUS) has emerged as a pivotal tool in evaluating ocular emergencies in the emergency department (ED), addressing millions of annual visits for eye complaints in the United States. Compared to traditional imaging methods, ocular POCUS's advantages include efficiency, repeatability, and safety. Adequate patient preparation, positioning, and transducer selection are essential for obtaining high-quality images. Ocular POCUS offers static and dynamic imaging,aiding in diagnosing conditions like retinal detachment and increased intracranial pressure. Emergency nurse practitioners (ENPs) can use ocular POCUS to expedite diagnosis and interventions, improving patient outcomes. Overall, ocular POCUS represents a rapid, non-invasive, and effective means of evaluating ocular emergencies in the ED, promising improved diagnostic accuracy, treatment initiation, and, ultimately, enhanced patient care.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786605","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}

{"title":"ED Regional Anesthesia Practice and the Basics on Local Anesthesia Toxicity.","authors":"B J Olsen","doi":"10.1097/TME.0000000000000554","DOIUrl":"https://doi.org/10.1097/TME.0000000000000554","url":null,"abstract":"<p><p>In the United States and the United Kingdom, where the author resides, many Emergency Departments utilize nerve blocks for fractures waiting to be seen by orthopedic surgery. As emergency nurses, be it advance practice nurse or staff nurse, it is our professional responsibility to be aware of emergencies that can result from these nerve blocks, namely local anesthetic toxicity (LAT). In the United Kingdom, there are protocols and guidelines for the treatment of this adverse event, which are shared in this article as a knowledge base for identifying and treating LAT. This paper also discusses the similarities in symptoms of LAT and anaphylaxis.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786601","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}

{"title":"Reducing the Risk: An Evidence-Based Approach to the Febrile Infant <60 Days of Age in the Emergency Department.","authors":"Kathleen S Jordan, Sara H Steelman, Elizabeth C McInnis","doi":"10.1097/TME.0000000000000547","DOIUrl":"https://doi.org/10.1097/TME.0000000000000547","url":null,"abstract":"<p><p>Fever is the most common complaint for children of all ages who present to an emergency department (ED) for evaluation and treatment. Although most children with fever have a self-limiting viral illness, the infant less than 60 days of age with fever poses a higher risk for an underlying serious bacterial illness (SBI) including urinary tract infections, bacteremia and bacterial meningitis, or an invasive bacterial infection (IBI) including bacteremia. This case is a discussion of a high-risk febrile infant that was evaluated in the emergency department and was ultimately diagnosed with Streptococcus B meningitis. This case emphasizes the importance of heightened vigilance in this high-risk age group for the risk of infection. To prevent mortality and long term morbidities that may result from inadequate treatment or delayed diagnosis and treatment, it is critical to know and strictly adhere to the clinical practice guidelines.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786639","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}

{"title":"Dog Bites With Resultant Periorbital Cellulitis.","authors":"Julie-Kathryn Graham, Pedro A Colio","doi":"10.1097/TME.0000000000000548","DOIUrl":"https://doi.org/10.1097/TME.0000000000000548","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786362","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}

{"title":"The Integration of Nurse Practitioners Into Mass Gathering Medical Teams.","authors":"Sarah Seiler, Stephan Russ, Jared McKinney, Ashley Panas","doi":"10.1097/TME.0000000000000552","DOIUrl":"https://doi.org/10.1097/TME.0000000000000552","url":null,"abstract":"<p><p>Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a \"treat and release\" disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733004","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}

{"title":"It's Probably Just Heart Burn! A Case of Pregnancy-Associated Spontaneous Coronary Artery Dissection.","authors":"Catherine Nadeau, Juan M Gonzalez, Christina Cardy, Mary A Cain, Daniela Crousillat","doi":"10.1097/TME.0000000000000550","DOIUrl":"https://doi.org/10.1097/TME.0000000000000550","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732656","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}

{"title":"Dream of the Endless: Special Considerations in Procedural Sedation.","authors":"Kyle A Weant, Abby M Bailey","doi":"10.1097/TME.0000000000000546","DOIUrl":"https://doi.org/10.1097/TME.0000000000000546","url":null,"abstract":"<p><p>Procedural sedation and analgesia (PSAA) is integral to facilitating painful and anxiety-inducing medical procedures in the emergency department (ED). Optimal PSAA enhances procedural success and improves both patient and provider satisfaction. The selection of appropriate sedative and analgesic agents, routes, and dosages, which depend on various patient- and procedure-specific factors is a complex process. Alternative routes of administration, such as intranasal, intramuscular, and oral, are all options, each with their own inherent benefits and limitations. It is important for providers to take into account patient-specific considerations, including age, medical history, body weight composition, and pregnancy, which can significantly impact PSAA effectiveness and safety. Implementation strategies targeted to minimize medication errors and optimize workflow are also important considerations in PSAA. By adopting a comprehensive and evidence-based approach, health care providers can navigate the intricacies of PSAA and ensure the best possible care for patients in the ED.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732422","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}

{"title":"Historical Evolution of Emergency Nurse Practitioner Education: A Comprehensive Review.","authors":"Jennifer Wilbeck, Paula Tucker, Wesley D Davis","doi":"10.1097/TME.0000000000000534","DOIUrl":"10.1097/TME.0000000000000534","url":null,"abstract":"<p><p>This manuscript explores the historical evolution of emergency nurse practitioner (ENP) education from its inception to its current state. It discusses key milestones, innovative leaders, curricular approaches and current program characteristics. The paper concludes with a review of the current state of ENP education, persistent challenges, and future directions. Professional organizations that have shaped both the ENP role and education over time are also considered. By examining the historical context, this review provides insights into the evolution of ENP education, contributing to a deeper understanding of the ENP role and education's significance in emergency care.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":"329-341"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298153","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}

{"title":"10th Anniversary of the American Academy of Emergency Nurse Practitioners.","authors":"K Sue Hoyt","doi":"10.1097/TME.0000000000000540","DOIUrl":"https://doi.org/10.1097/TME.0000000000000540","url":null,"abstract":"","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"46 4","pages":"283-285"},"PeriodicalIF":0.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591842","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}