{"title":"Fluid Resuscitation in the Treatment of Acute Pancreatitis: Rate and Volume Controversies.","authors":"Philip Davis, Dian Evans","doi":"10.1097/TME.0000000000000569","DOIUrl":"https://doi.org/10.1097/TME.0000000000000569","url":null,"abstract":"<p><p>The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of left upper quadrant pain to explore the study by de-Madaria et al., titled \"Aggressive or moderate fluid resuscitation in acute pancreatitis\".</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664731","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}
Kathleen S Jordan, Cody Carpenter, Sara H Steelman
{"title":"Button Battery Ingestion: A Tiny Object with the Potential for a Catastrophic Outcome.","authors":"Kathleen S Jordan, Cody Carpenter, Sara H Steelman","doi":"10.1097/TME.0000000000000565","DOIUrl":"https://doi.org/10.1097/TME.0000000000000565","url":null,"abstract":"<p><p>Foreign body ingestion is a common complaint encountered in the emergency department among both adults and children. Children under the age of 6 years are at especially high risk of foreign body ingestion, including coins, toys, jewelry and batteries. The button battery is the most common battery ingested and has the highest potential for serious and fatal injuries in infants and children. Over the past decade there has been a dramatic increase in the incidence of button battery ingestions directly related to the widespread expansion and availability of common consumer electronics powered by button batteries. Most ingested foreign bodies pass through the gastrointestinal system spontaneously and without complications. However a button battery that becomes lodged in the nasopharynx, oropharynx, trachea, esophagus, or any part of the gastrointestinal tract is associated with an exceptionally high rate of complications, including death. Button batteries lodged in the esophagus are especially dangerous and require immediate removal as serious tissue damage may occur in as little as 2 hours. Emergency care providers must maintain a high index of suspicion and be fully aware of the dangers of button battery ingestion. Initial symptoms may be variable nonspecific symptoms including fussiness, decreased appetite or refusal to eat or drink, drooling, difficulty swallowing, hematemesis or abdominal pain. Obtaining plain radiographs for foreign body ingestion should not be delayed. In addition, emergency care providers can be advocates for the safety and protection of button battery ingestions through knowledge dissemination and public advocacy.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664659","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":"Updates on the Use of Osmotherapy in the Emergency Department.","authors":"Kyle A Weant, Haili Gregory","doi":"10.1097/TME.0000000000000559","DOIUrl":"https://doi.org/10.1097/TME.0000000000000559","url":null,"abstract":"<p><p>Elevated intracranial pressure (ICP) is a critical condition associated with significant morbidity and mortality, requiring prompt and effective management. Mannitol and hypertonic saline (HTS) are the two most widely used hyperosmolar agents in clinical practice for ICP reduction, each with distinct pharmacologic properties, efficacy profiles, and safety considerations. This review aims to provide a comprehensive assessment of the mechanisms, clinical efficacy, safety, practical considerations, and guideline recommendations associated with the use of mannitol and HTS for the management of elevated ICP. Current available data does not clearly support one hyperosmolar agent over another and both agents are considered equivalent. Consensus recommendations vary, but the most recent recommendations seem to support the use of HTS over mannitol, mostly due to potential pharmacodynamic advantages that have been shown in smaller investigations. Further research is warranted to refine dosing strategies, clarify administration concerns, and address knowledge gaps in comparative efficacy and safety.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664734","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}
Leslie Gomez, Kelli LeClair, Danisha Jenkins, Mary Ann David, Jillian Downing, Julie Graham
{"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":"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":"64-74"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","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}
Catherine Nadeau, Juan M Gonzalez, Christina Cardy, Mary A Cain, Daniela Crousillat
{"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":"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":"55-63"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","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":"","doi":"10.1097/TME.0000000000000558","DOIUrl":"https://doi.org/10.1097/TME.0000000000000558","url":null,"abstract":"","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"47 1","pages":"E1"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068627","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":"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":"31-36"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","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":"Point of Care Ultrasonography for the Evaluation of Ocular Emergencies.","authors":"","doi":"10.1097/TME.0000000000000557","DOIUrl":"https://doi.org/10.1097/TME.0000000000000557","url":null,"abstract":"","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"47 1","pages":"E2"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068635","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":"Advancing Telemedicine: Virtual Rounding and Care in an Emergency Department Observation Unit.","authors":"Autherine Abiri, Paula Tucker","doi":"10.1097/TME.0000000000000553","DOIUrl":"10.1097/TME.0000000000000553","url":null,"abstract":"<p><p>Patient overcrowding in emergency departments (ED) impact quality of care by increasing length of stay which often leads to delayed patient dispositions. Emergency Department Observation Units (EDOUs) are protocol driven units staffed by ED providers that can alleviate overcrowding concerns and accommodate patients that require further diagnostics for a final disposition. Virtual rounding on EDOUs can be leveraged to maximize provider shortages and increase access to quality care. We present a case report of a patient who arrived at an ED for abdominal pain and was eventually admitted to an EDOU that practiced virtual rounds. This case report demonstrates the benefits of utilizing a clinical hybrid model that combines telemedicine and observation medicine to achieve quality care while improving ED operational flow.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":" ","pages":"80-84"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013814","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}
Juan Manuel Gonzalez, Johis Ortega, Kenya Snowden, Patricia Larrieu-Jimenez, Nichole Crenshaw, Catherine Nadeau, Stephen McGhee
{"title":"Point of Care Ultrasonography for the Evaluation of Ocular Emergencies.","authors":"Juan Manuel 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":"37-48"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","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}