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Emergency Nursing

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By Craig Button Clinical Nurse Educator and current grad student
https://read.qxmd.com/read/31356253/choosing-the-correct-ase-in-acute-ischemic-stroke-alteplase-tenecteplase-and-reteplase
#1
George M Dillon, Stacie Stevens, Wendy L Dusenbury, Lori Massaro, Florence Toy, Barbara Purdon
Alteplase is a tissue plasminogen activator approved for treating acute ischemic stroke (AIS), acute myocardial infarction (AMI), and acute massive pulmonary embolism. Two additional tissue plasminogen activators, tenecteplase and reteplase, are also approved for AMI treatment. However, neither tenecteplase nor reteplase is approved for AIS treatment. The U.S. Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can lead to potential overdose...
July 2019: Advanced Emergency Nursing Journal
https://read.qxmd.com/read/31241140/procalcitonin-to-distinguish-viral-from-bacterial-pneumonia-a-systematic-review-and-meta-analysis
#2
Ishan S Kamat, Vignesh Ramachandran, Harish Eswaran, Danielle Guffey, Daniel M Musher
Because of the diverse etiologies of community acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not...
June 25, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://read.qxmd.com/read/31247143/norepinephrine-for-early-shock-control-in-sepsis
#3
Matthew Tung, Jerome Cerullo Crowley
No abstract text is available yet for this article.
June 27, 2019: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/31248320/maximum-norepinephrine-dosage-within-24-hours-as-an-indicator-of-refractory-septic-shock-a-retrospective-study
#4
Daisuke Kasugai, Akihiko Hirakawa, Masuyuki Ozaki, Kazuki Nishida, Takao Ikeda, Kunihiko Takahashi, Shigeyuki Matsui, Norimichi Uenishi
BACKGROUND: The management of refractory septic shock remains a major challenge in critical care and its early indicators are not fully understood. We hypothesized that the maximum norepinephrine dosage within 24 hours of intensive care unit (ICU) admission may be a useful indicator of early mortality in patients with septic shock. METHODS: In this retrospective single-center observational study, patients with septic shock admitted to the emergency ICU of an academic medical center between April 2011 and March 2017 were included...
June 27, 2019: Journal of Intensive Care Medicine
https://read.qxmd.com/read/31290779/improving-sepsis-bundle-implementation-times-a-nursing-process-improvement-approach
#5
David L Threatt
BACKGROUND: Early recognition of sepsis in the emergency room (ER) has been shown to improve treatment intervention times and decrease mortality. LOCAL PROBLEM: Failure to recognize early signs and symptoms of sepsis in the ER has led to poor sepsis bundle completion times. METHODS: A comparison of preintervention and postintervention data was performed to determine whether sepsis bundle implementation times, mortality, and length of stay (LOS) improved...
July 8, 2019: Journal of Nursing Care Quality
https://read.qxmd.com/read/31263012/contextual-barriers-to-communication-between-physicians-and-nurses-about-appropriate-catheter-use
#6
Milisa Manojlovich, Jessica M Ameling, Jane Forman, Samantha Judkins, Martha Quinn, Jennifer Meddings
BACKGROUND: Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. OBJECTIVES: To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. METHODS: Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital...
July 2019: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://read.qxmd.com/read/31262411/beyond-mean-arterial-pressure-and-lactate-perfusion-end-points-for-managing-the-shocked-patient
#7
REVIEW
Stephen D Hallisey, John C Greenwood
Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. Early, aggressive resuscitation of patients in shock is essential, using macrocirculatory, microcirculatory, and clinical end points to guide interventions. Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use...
August 2019: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/31089763/what-s-new-in-oxygen-therapy
#8
EDITORIAL
Massimo Girardis, Waleed Alhazzani, Bodil Steen Rasmussen
No abstract text is available yet for this article.
May 14, 2019: Intensive Care Medicine
https://read.qxmd.com/read/31166204/inotropes-and-vasopressors-use-in-cardiogenic-shock-when-which-and-how-much
#9
Bruno Levy, Julie Buzon, Antoine Kimmoun
PURPOSE OF REVIEW: Data and interventional trials regarding vasopressor and inotrope use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In this article, we review the current use of vasopressor and inotrope agents during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was not sufficient evidence to prove that any one vasopressor or inotrope was superior to another in terms of mortality...
August 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/31198282/the-influence-of-cervical-collar-immobilization-on-optic-nerve-sheath-diameter
#10
Joseph Yard, Peter B Richman, Ben Leeson, Kimberly Leeson, Guy Youngblood, Jose Guardiola, Michael Miller
Background: Prior research has revealed that cervical collars elevate intracranial pressure (ICP) in patients with traumatic brain injury. Two recent small studies evaluated the change in optic sheath nerve diameter (ONSD) measured by ultrasound as a proxy for ICP following cervical collar placement in healthy volunteers. Objective: We sought to validate the finding that ONSD measured by ultrasound increases after cervical collar placement within an independent data set...
April 2019: Journal of Emergencies, Trauma, and Shock
https://read.qxmd.com/read/30702481/certified-and-advanced-degree-critical-care-nurses-improve-patient-outcomes
#11
Patricia Conley
The need for highly skilled and knowledgeable critical care nurses continues to evolve today and will in the future. Demands in critical care medicine for nurses with advanced degrees (master's in nursing: clinical nurse specialist; or doctorate in nursing: doctorate of philosophy in nursing or doctor of nursing practice) working in intensive care units or progressive care units can help meet these challenges. Nurses with certification and advanced degrees in nursing can be employed to work in 1 or combined roles such as nurse leaders and nurse researcher or intermittently fulfill roles as bedside nurses...
March 2019: Dimensions of Critical Care Nursing: DCCN
https://read.qxmd.com/read/30928476/orthostatic-vital-signs-do-not-predict-30-day-serious-outcomes-in-older-emergency-department-patients-with-syncope-a-multicenter-observational-study
#12
Jennifer L White, Judd E Hollander, Anna Marie Chang, Daniel K Nishijima, Amber L Lin, Erica Su, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Carol L Clark, Deborah B Diercks, Bret A Nicks, Manish N Shah, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Benjamin C Sun
BACKGROUND: Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope. METHODS: We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope...
March 25, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30852043/balanced-crystalloids-versus-normal-saline-for-fluid-resuscitation-in-critically-ill-patients-a-systematic-review-and-meta-analysis-with-trial-sequential-analysis
#13
Chao Liu, Guangming Lu, Dong Wang, Yi Lei, Zhi Mao, Pan Hu, Jie Hu, Rui Liu, Dong Han, Feihu Zhou
INTRODUCTION: Fluid resuscitation is a fundamental component of the management of critically ill patients, but whether choice of crystalloid affects patient outcomes remains controversial. Therefore, we performed this meta-analysis to compare the efficacy and safety of balanced crystalloids with normal saline. METHODS: We searched the MEDLINE, Cochrane Central and EMBASE up to October 2018 to identify randomized controlled trials (RCTs) that compared balanced crystalloids versus normal saline in critically ill patients...
March 1, 2019: American Journal of Emergency Medicine
https://read.qxmd.com/read/30820692/management-of-hyperkalemia-in-the-acutely-ill-patient
#14
REVIEW
François Dépret, W Frank Peacock, Kathleen D Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
PURPOSE: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute...
February 28, 2019: Annals of Intensive Care
https://read.qxmd.com/read/30835798/enhancing-your-professional-presence-on-social-media
#15
EDITORIAL
Amy J Barton
No abstract text is available yet for this article.
March 1, 2019: Journal of Nursing Education
https://read.qxmd.com/read/30773327/management-of-urinary-retention-in-patients-with-benign-prostatic-obstruction-a-systematic-review-and-meta-analysis
#16
REVIEW
Markos Karavitakis, Iason Kyriazis, Muhammad Imran Omar, Stavros Gravas, Jean-Nicolas Cornu, Marcus J Drake, Mauro Gacci, Christian Gratzke, Thomas R W Herrmann, Stephan Madersbacher, Malte Rieken, Mark J Speakman, Kari A O Tikkinen, Yuhong Yuan, Charalampos Mamoulakis
CONTEXT: Practice patterns for the management of urinary retention (UR) secondary to benign prostatic obstruction (BPO; UR/BPO) vary widely and remain unstandardized. OBJECTIVE: To review the evidence for managing patients with UR/BPO with pharmacological and nonpharmacological treatments included in the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. EVIDENCE ACQUISITION: Search was conducted up to April 22, 2018, using CENTRAL, MEDLINE, Embase, ClinicalTrials...
May 2019: European Urology
https://read.qxmd.com/read/30815951/hot-off-the-press-low-dose-magnesium-sulfate-versus-high-dose-in-the-early-management-of-rapid-atrial-fibrillation-randomized-controlled-double-blind-study
#17
Corey Heitz, Justin Morgenstern, Christopher Bond, William K Milne
No abstract text is available yet for this article.
September 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://read.qxmd.com/read/30772916/how-best-to-resuscitate-patients-with-septic-shock
#18
EDITORIAL
Derek C Angus
No abstract text is available yet for this article.
February 19, 2019: JAMA: the Journal of the American Medical Association
https://read.qxmd.com/read/30777470/what-is-the-most-appropriate-dose-of-n-acetylcysteine-after-massive-acetaminophen-overdose
#19
Robert G Hendrickson
While the traditional intravenous N -acetylcysteine (NAC) dosing regimen works well for the vast majority of acetaminophen overdoses, there may be cases of massive overdose where additional NAC may be necessary. Recent evidence suggests that patients with acetaminophen concentrations above the "300-line" develop hepatotoxicity at a higher rate than those below the 300-line, suggesting that an increase of dose may be beneficial at this cut-off. Additional clinical data suggest a further increase in doses at the 450-line and 600-lines...
August 2019: Clinical Toxicology
https://read.qxmd.com/read/30786094/factors-affecting-the-first-attempt-success-rate-of-intravenous-cannulation-in-older-people
#20
Sercan Yalçınlı, Funda Karbek Akarca, Özge Can, Alper Şener, Cemile Akbinar
AIMS AND OBJECTIVES: To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients. BACKGROUND: In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important. DESIGN: This is a prospective, observational, descriptive study. METHODS: Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors...
June 2019: Journal of Clinical Nursing
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