{"title":"Heatstroke on the Rise: A Guide to Implementing Tarp-Assisted Cooling With Oscillation (TACO) in the Emergency Department.","authors":"","doi":"10.1097/TME.0000000000000477","DOIUrl":"10.1097/TME.0000000000000477","url":null,"abstract":"","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"E7"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883610","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 Diagnostic Challenge of an Older Adult With Epigastric Pain in the Emergency Department: High Risk and High Volume.","authors":"Karen Sue Hoyt, Kathleen S Jordan","doi":"10.1097/TME.0000000000000475","DOIUrl":"10.1097/TME.0000000000000475","url":null,"abstract":"<p><p>Epigastric pain is a common complaint in patients who present to the emergency department (ED); abdominal pain is the most common chief complaint in older adult patients who request treatment by a provider (A. B. Friedman et al., 2022). These patients may experience atypical presentations, which can result in delayed or missed diagnosis altogether, increasing morbidity, and mortality. This is the case of an older adult man who presented with chest and epigastric pain. The clinical presentation, atypical signs, and symptoms of gangrenous gallbladder are presented herein along with the differential diagnoses and diagnostics for this patient. The care for and the \"what not to miss\" in the management of this patent are also examined in this article. It is imperative that ED providers diagnose gangrenous gallbladder early on, especially in the older adult population, who may present with covert signs and symptoms to prevent complications and avoid poor outcomes including death in this age group.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"187-194"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883613","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":"Spontaneous Pneumothorax: Controversies in Treatment.","authors":"Marlen Alvarez, Dian Dowling Evans, Paula Tucker","doi":"10.1097/TME.0000000000000465","DOIUrl":"10.1097/TME.0000000000000465","url":null,"abstract":"<p><p>The Research to Practice column critiques a current research article and translates the findings, in the context of a case, to a practice change within emergency settings. This article reviews the findings of a randomized controlled trial conducted by A. Theille et al. (2017) comparing the use of needle decompression versus chest tube insertion for management of spontaneous pneumothorax. The study found that use of needle aspiration was safe and effective and was associated with fewer procedure-related complications and significantly shorter hospital stays. The investigators concluded that needle aspiration be used as a first-line, definitive treatment in management of a spontaneous pneumothorax. As emergency providers examine improved and equally effective approaches to care that are associated with less costs and potential complications, needle aspiration offers a beneficial approach and should be shared with patients when discussing treatment options to ensure shared decision making.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"169-176"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886126","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":"Intracranial Hemorrhage Presenting With ST-Segment Elevation and T-Wave Inversion Concerning for Acute Myocardial Infarction.","authors":"Evan Rusoja, Amandeep Singh","doi":"10.1097/TME.0000000000000471","DOIUrl":"10.1097/TME.0000000000000471","url":null,"abstract":"<p><p>Acute neurologic injury and increased intracranial pressure are associated with electrocardiographic (ECG) changes that include rhythm disturbances as well as ECG mimics of myocardial ischemia, such as focal or diffuse ST-segment or T-wave abnormalities. Both the mechanism and significance of these ECG changes are not clear. The authors report a case of a patient with a complex medical history who became hypotensive after he presented with acute intracranial hemorrhage. A subsequent ECG showing ST-segment elevation in the inferior and lateral leads was concerning for acute myocardial infarction. ST-segment elevation in the setting of acute intracranial hemorrhage can lead to diagnostic confusion and/or premature narrowing of the differential diagnosis. This case report starts with an example of this exact scenario, provides a concise overview of potential mechanisms, and concludes with several possible strategies that the emergency provider can use to identify this effect in an undifferentiated patient.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"217-221"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886132","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}
Jason Cucchiara, Julie Thompson, Michael Zychowicz, Adam McHone, Robert Williamson
{"title":"Splint Quality Assessment and Improvement Among Emergency Department Staff.","authors":"Jason Cucchiara, Julie Thompson, Michael Zychowicz, Adam McHone, Robert Williamson","doi":"10.1097/TME.0000000000000474","DOIUrl":"10.1097/TME.0000000000000474","url":null,"abstract":"<p><p>The purpose of this quality improvement project is to assess and improve the quality of splint application in the emergency department (ED), as well as the splint application confidence level of the ED staff. Consistent and high-quality splint application is critical in fracture stabilization and prevention of further injury. Significantly high turnover and a lack of formal training of ED staff has led to poor splint application, and in some cases, patient injuries related to the splints themselves. These injuries include pain, edema, and skin complications (A. P. Carino, 2017). A random, Likert-based analysis was performed on 20 ED-applied splints. Once analysis was complete, training courses were implemented to improve splint application techniques. Using the same Likert-based tool, applications of 20 posttraining splints were analyzed. In addition, ED staff confidence levels were scored before and after the training courses. Overall, statistically significant improvement was achieved in splint application quality and staff confidence. Correct splint applications increased from 50% to 95% after the educational sessions. Staff confidence in splint application also increased, from 35% to 77.1%. Quality splint application affects all patients. The higher risk population is more likely to suffer the consequences of poor splint application. This project had a positive impact on the region's marginalized patient population. These patients have limited resources, including lack of transportation, financial limitations, and typically are at higher risk for complications due to comorbidities.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"240-247"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886128","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":"Heatstroke on the Rise: A Guide to Implementing Tarp-Assisted Cooling With Oscillation (TACO) in the Emergency Department.","authors":"Lucy Tucker, Emily Evans","doi":"10.1097/TME.0000000000000470","DOIUrl":"10.1097/TME.0000000000000470","url":null,"abstract":"<p><p>Heat-related illnesses, namely, heatstroke is on the rise and is a public health concern nationally and internationally. Heatstroke is generally considered to be a core body temperature greater than 40 °C (104 °F) with dry, hot skin, and central nervous system manifestations. Heatstroke is characterized by a systemic inflammatory response that leads to multiple-organ dysfunction and ultimately death if not treated in a timely manner. Rapid recognition and cooling are imperative, as mortality is high, especially in the elderly. There are many cooling methods that have been studied that include cold-water immersion, tarp-assisted cooling with oscillation (TACO), evaporative cooling (misting/fanning), commercial ice packs, cooling vests and jackets, cold showers, and ice sheets. Although cold-water immersion is the fastest method for cooling, it is not usually feasible in an emergency department (ED). TACO is the most feasible and effective cooling method for EDs. It is vital that EDs have a specific plan in place before implementing TACO, as it requires 30-40 gallons of ice water, a tarp or waterproof sheet, core temperature monitoring, and an ample number of ED staff members to oscillate the water over the patient. Further research is needed to study TACO in the ED setting. As the incidence of heatstroke is expected to increase in the coming years, EDs must have a plan in place to rapidly recognize and treat patients with heatstroke so that patients will have improved outcomes and reduced mortality.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 3","pages":"210-216"},"PeriodicalIF":0.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886130","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":"Education Improves Emergency Department Providers' Knowledge of Human Trafficking.","authors":"Stephanie P Arceneaux","doi":"10.1097/TME.0000000000000455","DOIUrl":"https://doi.org/10.1097/TME.0000000000000455","url":null,"abstract":"<p><p>The purpose of this quality improvement (QI) initiative was to implement a human trafficking (HT) education module for the emergency department (ED) staff and providers along with implementation of a policy and protocol for screening, identification, and referral of HT victims in the ED to increase provider knowledge of HT and ensure provider compliance with the HT protocol via documentation of red flags and screening questions in the electronic medical record along with social services referrals. The goal of the social services referral was to connect the HT victim with community resources that facilitated placement, food, and shelter in the event the trafficking victim accepted rescue. HT is a public health concern, globally, nationally, and at the state and local levels. ED providers, which include advanced practice registered nurses such as nurse practitioners and clinical nurse specialists, are positioned to be able to identify and treat victims of HT. Therefore, HT victims are being seen and treated in EDs; however, health care providers are not recognizing them. Project design was a QI initiative, which utilized a convenience sample of ED providers. All ED providers and staff completed the HT Education module in Health Stream with pretest/posttest assessments via the PROTECT instrument, which evaluated ED staff/provider knowledge, perceived, actual, and confidence of HT, demographics, previous contact with HT victims, and participant preference for future HT training. HT Education resulted in improved knowledge of participants' perceived, actual, and confidence of HT as demonstrated by statistical significance from pretest to posttest scores; therefore, the HT educational training proved to be beneficial.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 2","pages":"138-144"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9362253","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":"Emergency Medicine Case Study on Giant Cell Arteritis.","authors":"Davina L Vea, April T Hill","doi":"10.1097/TME.0000000000000452","DOIUrl":"https://doi.org/10.1097/TME.0000000000000452","url":null,"abstract":"<p><p>The purpose of this case study on giant cell arteritis (GCA) is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process to prevent serious complications such as permanent blindness in patients presenting to the emergency department (ED). The case study reviews emergency management of GCA, which includes diagnostic workup, pharmacological treatment, consults, disposition, follow-up care, and when to return to the ED. The classification criteria will be discussed for GCA from the American College of Rheumatology and the European Alliance of Associations for Rheumatology. In addition, risk assessment, clinical presentation, and physical examination findings will be listed. After reviewing this case study, ENPs should be able to identify GCA and manage care to reduce complications and recurrence of GCA in a patient presenting to the ED.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 2","pages":"103-108"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9362249","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":"Guest Editorial: Nurse Practitioners in Emergency Care: The Evidence.","authors":"Wesley D Davis, Jennifer Wilbeck","doi":"10.1097/TME.0000000000000459","DOIUrl":"10.1097/TME.0000000000000459","url":null,"abstract":"","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 2","pages":"87-89"},"PeriodicalIF":0.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9362252","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":"Postpartum Preeclampsia: What Can Stories Posted on the Internet Tell Us?","authors":"Cheryl Tatano Beck","doi":"10.1097/TME.0000000000000457","DOIUrl":"https://doi.org/10.1097/TME.0000000000000457","url":null,"abstract":"<p><p>Postpartum preeclampsia has not received the needed attention that preeclampsia has. It is the lesser-known hypertensive disorder but can be just as life-threatening as eclampsia. Because of the scarcity of qualitative research on postpartum preeclampsia, the purpose of this study was to help fill this gap by exploring personal experiences of this dangerous complication as described in online blogs. Using Google search engine, 25 stories of postpartum preeclampsia were located. Krippendorff's content analysis for qualitative data was the research design used. Five themes were identified: (1) Not even on my radar as a new mom, (2) Bombarded with physical and emotional symptoms, (3) Life-threatening situation: Dismissed or misdiagnosed, (4) Heartbroken: Separation from my newborn, and (5) Trust your instincts and advocate for yourself. Advanced practice nurses and other health care providers need to be on alert for postpartum preeclampsia when a woman, who recently gave birth, presents at the emergency department.</p>","PeriodicalId":45446,"journal":{"name":"Advanced Emergency Nursing Journal","volume":"45 2","pages":"154-163"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9362255","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}