The Use of Ketamine for the Management of Acute Pain in the Emergency Department
Ketamine has been used as an anesthetic agent for over 50 years. At the upper end of the dosing range, it displays dissociative anesthetic and amnestic effects, while at lower doses, it acts as an analgesic and demonstrates opioid-sparing capabilities. Ketamine is unique in its preservation of hemodynamic stability and respiratory function, and is used extensively in the emergency department (ED) for procedural sedation and the facilitation of brief painful procedures. Despite evidence supporting its safety and efficacy as an analgesic agent at sub-dissociative doses, its use in the ED for the management of acute pain rema...
Source: Advanced Emergency Nursing Journal - April 1, 2019 Category: Emergency Medicine Tags: APPLIED PHARMACOLOGY Source Type: research
Utilization of Point-of-Care Ultrasonography (POCUS) for Small Bowel Obstruction
Small bowel obstruction is a frequently encountered condition throughout emergency departments and accounts for a large number of surgical hospital admissions. Point-of-care ultrasonography (POCUS) by emergency providers can serve as a valuable tool to assist in prompt and accurate diagnosis, which could potentially reduce the quantity of undesirable effects such as radiation and cost seen with other advanced imaging modalities (e.g., computed tomography). (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - April 1, 2019 Category: Emergency Medicine Tags: IMAGING Source Type: research
The Use of Ketamine as an Adjunct to Treating Opioid Refractory Cancer-Related Pain in the Emergency Department
The Research to Practice column is designed to provide advanced practice registered nurses (APRNs) with an analysis of a current research topic with implications for practice change within the emergency care settings. This review examines a recent study conducted by K. J. Bowers, K. B. McAllister, M. Ray, and C. Heitz (2017) entitled “Ketamine as an adjunct to opioids for acute pain in the emergency department: A randomized controlled trial.” The authors conducted a randomized, double-blinded, placebo-controlled trial at a single academic emergency department (ED) to compare standard opioid pain control in the ED popul...
Source: Advanced Emergency Nursing Journal - April 1, 2019 Category: Emergency Medicine Tags: RESEARCH TO PRACTICE Source Type: research
This One's For You: A Tribute to Reviewers
No abstract available (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - April 1, 2019 Category: Emergency Medicine Tags: FROM THE EDITOR Source Type: research
Word Catheter Placement for Bartholin's Gland Abscess: Applications for Clinical Practice and Simulation
This article presents the diagnostic and treatment approaches to Bartholin's abscesses and describes in detail both low- and high-fidelity simulations for Word catheter placements. (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
Recognizing Fournier's Gangrene in the Emergency Department
Fournier's gangrene is a rare disease with a significant mortality rate. The potentially fatal disease stems from both aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases are idiopathic or derived from perineal and genital skin infections. Comorbid risk factors include diabetes mellitus, alcohol misuse, and immunosuppression (Benjelloun et al., 2013). The infection initially presents as a cellulitis in the perineum or perianal area. As Fournier's gangrene progresses, the infected tissue becomes swollen, significantly painful, and necrotic. The progression of infection can l...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: DERMATOLOGY DILEMMAS Source Type: research
Type A Aortic Dissection Complicated by Renal and Lower Extremity Malperfusion
This article highlights a case of a 49-year-old man who developed renal and lower extremity malperfusion secondary to Stanford Type A aortic dissection. Important historical clues and objective findings characteristic of acute aortic dissection and end-organ ischemia are discussed with the purpose of increasing reader knowledge of aortic dissection and signs of organ malperfusion with the hope that better awareness results in improved patient outcomes. (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: CASES OF NOTE Source Type: research
Sever's Disease (Calcaneal Apophysitis)
Sever's disease, or calcaneal apophysitis, is the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years. Primary risk factors in pediatric athletes are obesity and high levels of physical activity. Sever's injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus. Clinical diagnosis can be confirmed by performing a “squeeze test” of the heel on physical examination. Diagnostic imaging findings include increased sclerosis and fragmentation...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: IMAGING Source Type: research
Alcohol Use and Sexual Assault Among College Students: Implications for APRN Practice
The Research to Practice column is designed to provide advanced practice nurses (APRNs) with an analysis of a current research topic with implications for practice change within emergency care settings. This review examines a recent study conducted by Tadros, Sharon, Hoffman, and Davidov (2018), titled “Emergency Department Visits for Sexual Assault by Emerging Adults: Is Alcohol a Factor?” The authors conducted a retrospective chart review of emergency department (ED) visits for sexual assault among a college-age population and found most patients were female (98%) and 70% were younger than 21 years. Additionaly, amon...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: RESEARCH TO PRACTICE Source Type: research
Subdissociative Ketamine Use in the Emergency Department
No abstract available (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: CE Test Source Type: research
Exploring Emergency Department Provider Experiences With and Perceptions of Weight-Based Versus Individualized Vaso-Occlusive Treatment Protocols in Sickle Cell Disease
Treatment of vaso-occlusive episodes (VOEs) is the most common reason for emergency department (ED) treatment of sickle cell disease (SCD). We (1) compared perceptions of the usability and ability to manage VOE pain between ED nurses and other ED provider types, ED sites, and VOE protocols (individualized vs. weight-based), and (2) identified ED nurse and other provider protocol suggestions. A secondary analysis of provider survey data collected immediately after caring for a patient enrolled in a randomized controlled trial comparing weight-based versus individualized opioid dosing for VOE. Research staff asked the ED nur...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
Managing Acute Salicylate Toxicity in the Emergency Department
Salicylates are among the oldest and most widely used medication to date and are utilized for a variety of purposes including the management of fever, inflammation, pain, and cardiovascular prophylaxis. Reports from U.S. Poison Control Centers indicate that over 40,000 Americans are exposed to salicylate-containing substances annually, and although generally deemed safe, fatal intoxications can occur from a single ingestion. Although some ingestions are intentional, many are not, and are a result of the prevalence of salicylates in a wide array of prescription and over-the-counter substances. Because of the wide range of s...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
Alcohol Withdrawal Syndrome: Improving Recognition and Treatment in the Emergency Department
Alcoholism continues to be a persistent health problem in the United States, accounting for up to 62% of emergency department (ED) visits. This quality improvement (QI) project examined whether identifying the benefit for early use of Alcohol Use Disorders Identification Test (AUDIT C) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIW-ar) in the ED would avoid escalation of care and offset poor outcomes of alcohol withdrawal syndrome (AWS). A preimplementation chart review (N = 99) showed an average of 12%–15% of patients requiring escalation of care at the project site. The QI project utilized ...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
A Review of the Management of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
Stevens–Johnson syndrome and toxic epidermal necrolysis represent a spectrum of severe cutaneous adverse reactions that carry the potential for severe, long-term adverse effects, including death. Although medications are most commonly implicated in the development of these diseases, other factors, including infection and genetics, play a role. Management is generally supportive in nature and includes maintenance of the patient's airway, breathing, and circulation. Special disease considerations include the use of skin barrier management, unique infection prevention measures, and systemic immunomodulatory therapies. (Sour...
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
Oral Diclofenac Potassium Versus Intravenous Acetaminophen in Acute, Isolated, Closed-Limb Trauma
In this study, both drugs could decrease the pain score effectively and safely in isolated limb trauma. (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research
