Evaluating an Order Set for Improvement of Quality Outcomes in Diabetic Ketoacidosis
The timely management of diabetic ketoacidosis (DKA) is essential to avoid lengthy hospitalizations and poor clinical outcomes. There is often an absence of ownership for glycemic management in hospitalized patients, most notably in those with a diagnosis other than diabetes. Evidence supports the use of evidence-based DKA protocols. The purpose of this project was to determine whether utilization of an evidence-based order set versus an individualized provider approach for the treatment and management of DKA decreases resolution time and occurrences of hypoglycemia and improves clinical outcomes. Preintervention and posti...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research
Implementation of an Asthma Self-Management Education Guideline in the Emergency Department: A Feasibility Study
This study examines the feasibility of implementing an asthma self-management guideline in a tertiary care center ED. Despite protocol utilization by physicians (87%), nurse practitioners and physician assistants (66.7%), and nurses (41.7%), total compliance with national guideline was accomplished in only 25.93% of cases. Barriers to protocol implementation included staff education, high workload, rapid turnover, and competing initiatives within the department. Linear regression analysis identified high daily census as a predictor of protocol noncompliance (p = 0.033). (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research
What the Advanced Practice Nurse in the Emergency Department Needs to Know About the Health Risks and Hazards of Electronic Cigarette Use by Youth
Despite the decline in traditional tobacco use among teens and young adults, the rapid increase in electronic cigarette (EC) use has filled the gap, raising concern that this will usher in a new generation of tobacco users. Although long-term effects have not been clearly established, EC use is not without risks or hazards that may be encountered by the advanced practice nurse in the emergency department (ED). The ED presents an opportune moment for health promotion and risk reduction education for patients and families, but there are also dangers to EC use that the practitioner should be aware of and prepared to manage. N...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research
Tranexamic Acid: Promise or PanaceaThe Impact of Air Medical Administration of Tranexamic Acid on Morbidity, Mortality, and Length of Stay
The MATTERs and CRASH-2 studies demonstrate that tranexamic acid (TXA) reduces mortality in patients with traumatic hemorrhage. However, their results, conducted in foreign countries and with U.S. military soldiers, provoke concerns over generalizability to civilian trauma patients in the United States was reported. The evaluation of patient outcomes following treatment with TXA by a civilian air medical program. A retrospective chart review of trauma patients transported by air service to a Level 1 trauma center was conducted. For the purposes of intervention evaluation, patients meeting this criterion for the 2 years (20...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research
Spontaneous Vertebral Artery Dissection in a Healthy 26 Year Old Female Patient: A Case Study
Spontaneous vertebral artery dissection (SVAD) is an extremely rare, yet life-threatening, event that can potentially result in ischemic stroke or subarachnoid hemorrhage, depending on the origin and extension of the dissection. Vertebral artery dissection is more commonly associated with traumatic injury to the neck, resulting in compromised structural integrity of the vertebral artery wall. This case study discusses the clinical presentation, physical examination, diagnosis, clinical course, and outcome for a young, otherwise healthy, female patient who presented to the emergency department with a SVAD. (Source: Advanced...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research
The Specialty of Emergency Nurse Practitioner Practice: Erratum
No abstract available (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Erratum Source Type: research
A Case of Drug-Induced Severe Endocrinopathies: What Providers in the Emergency Department Need to Know
The purpose of this article is to present a discussion of immune checkpoint inhibitors (ICIs) that are relatively new, yet growing, form of cancer therapy. Immune checkpoint inhibitors increase host immune response against neoplastic cells. Strengthened immunological response increases the potential for adverse events such as life-threatening endocrinopathies. The case of a 66-year-old man with metastatic melanoma treated with nivolumab and ipilimumab presented to the emergency department with marked hyperglycemia and elevated anion gap 19 days after receiving both agents is discussed. The patient received a diagnosis of i...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Applied Pharmacology Source Type: research
Hip Fractures
Hip fractures are associated with significant morbidity and mortality and a major health problem in the United States (L. M. Brunner, L. Eshilian-Oats, & T. Y. Kuo, 2003). Eighty percent of hip fractures are experienced by 80-year-old women. Plain radiographs usually confirm the diagnosis, but if there is a high level of suspicion of an occult hip fracture, magnetic resonance imaging or bone scan is the next step to confirm the diagnosis. Areas of the hip bone have varied bone strength and blood supply, making the femoral neck one of the most vulnerable areas for fracture. A consultation to an orthopedic surgeon will deter...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Imaging Source Type: research
Emergency Department Use of Contrast Computed Tomography in Patients With Renal Dysfunction
The Research to Practice Column is designed to improve translational research critique skills of advanced practice nurses. In this issue, the article “Risk of Acute Kidney Injury After Intravenous Contrast Media Administration” (J. S. Hinson, et al., 2017) is discussed in the context of a patient presenting to the emergency department with acute abdominal pain. The study was designed to assess the risk of acute kidney injury and adverse clinical outcomes in patients receiving intravenous contrast for computed tomography. Advanced practice nurses need to be aware of advances in types of intravenous contrast and current ...
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Research to Practice Source Type: research
A Tribute
No abstract available (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: From the Editor Source Type: research
Orbital Floor Fractures
No abstract available (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - October 1, 2017 Category: Emergency Medicine Tags: CE Test Source Type: research
The Effect of Apneic Oxygenation on Reducing Hypoxemia During Rapid Sequence Induction and Intubation in the Acutely Ill or Injured
Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. Over the last 5 years, there have been several studies published on this topic with differing results. Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings. Because of the low risk of adding a nasal cannula during intubation and the p...
Source: Advanced Emergency Nursing Journal - October 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research
Reducing Unnecessary Head Computed Tomography in Mild Traumatic Brain Injury
This article examines recent research to determine which of these tools has proven to be the most effective at safely reducing the use of head CT scans. The reviewed studies concluded that both the Canadian CT Head Rule and the New Orleans Criteria had similar sensitivities, but the Canadian CT Head Rule showed superior specificity in predicting the presence of a clinically significant brain injury. The authors of this article recommend that the Canadian CT Head Rule be used in the evaluation of minor head injury to reduce unnecessary CT scans. (Source: Advanced Emergency Nursing Journal)
Source: Advanced Emergency Nursing Journal - October 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research
Intravenous Push Cephalosporin Antibiotics in the Emergency Department: A Practice Improvement Project
Delays in administration of appropriate antibiotics to patients with septic shock are associated with increased mortality. To improve the care of patients with sepsis within our 73-bed emergency department (ED), a “first-dose” intravenous push (IVP) cephalosporin antibiotic protocol was initiated. This project was aimed at improving the time from provider order of antibiotic to administration, which follows the Sepsis Core Measure of timely antibiotic administration.
This was a single-center, retrospective analysis of a practice improvement study. Time from provider order of an IV cephalosporin antibiotic to administr...
Source: Advanced Emergency Nursing Journal - October 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research
A Randomized, Double-Blind Trial to Determine if Vapocoolant in the Adult Population Improves Patient Perception of Pain With Peripheral Intravascular Access
The purpose of this study was to investigate whether the use of a topical anesthetic spray (vapocoolant) at the site of intravenous access reduces pain and anxiety associated with peripheral intravenous (PIV) catheter insertion in an adult emergency department population. A randomized, double-blind, placebo-controlled, single-center trial, conducted from July to August, in an adult emergency department where 72 patients with orders for PIV insertion receiving either topical vapocoolant spray (n = 38) or placebo spray (n = 34). Vapocoolant or placebo was applied to the intravenous site and allowed to evaporate before cleans...
Source: Advanced Emergency Nursing Journal - October 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research
