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Emergency Nursing

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By Craig Button Clinical Nurse Educator and current grad student
Stephen Y Liang, Daire R Jansson, Patrick G Hogan, Tyler W Raclin, Melanie L Sullivan, Carol E Muenks, Satish Munigala, Stacey L House, Stephanie A Fritz
STUDY OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) transmission dynamics in the emergency department (ED) are not well defined; environmental surfaces may serve as reservoirs for transmission. This study investigates the effect of patients with a history of MRSA colonization or infection on subsequent MRSA contamination of the ED environment. METHODS: Adult ED patients with evidence of an MRSA-positive surveillance result or clinical microbiologic culture in the year preceding their current ED visit were enrolled...
February 4, 2019: Annals of Emergency Medicine
Thomas W L Scheeren, Jan Bakker, Daniel De Backer, Djillali Annane, Pierre Asfar, E Christiaan Boerma, Maurizio Cecconi, Arnaldo Dubin, Martin W Dünser, Jacques Duranteau, Anthony C Gordon, Olfa Hamzaoui, Glenn Hernández, Marc Leone, Bruno Levy, Claude Martin, Alexandre Mebazaa, Xavier Monnet, Andrea Morelli, Didier Payen, Rupert Pearse, Michael R Pinsky, Peter Radermacher, Daniel Reuter, Bernd Saugel, Yasser Sakr, Mervyn Singer, Pierre Squara, Antoine Vieillard-Baron, Philippe Vignon, Simon T Vistisen, Iwan C C van der Horst, Jean-Louis Vincent, Jean-Louis Teboul
BACKGROUND: Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use. METHODS: From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM)...
January 30, 2019: Annals of Intensive Care
A Harley, A N B Johnston, K J Denny, G Keijzers, J Crilly, D Massey
AIM: Sepsis is a significant and time-sensitive clinical concern for patients who present to Emergency Departments (EDs). Existing guidelines do not define nurses' roles in managing sepsis. This study explored ED nurses' experiences and perceptions around recognising and responding to patients with sepsis, and their awareness of sepsis screening and prognostic tools. The knowledge and insights gained from this study may be used to inform local and international ED policies, and enrich nursing educational packages that may be used to improve quality of patient care and patient outcomes...
February 4, 2019: International Emergency Nursing
Olivier Lesur, Eugénie Delile, Pierre Asfar, Peter Radermacher
BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera's box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues...
October 29, 2018: Annals of Intensive Care
Michael Joannidis, Sebastian J Klein, Marlies Ostermann
No abstract text is available yet for this article.
January 14, 2019: Intensive Care Medicine
Diane K Newman
Urinary incontinence (UI) is one of the most common conditions among residents of post-acute and long-term care facilities. UI is seen in at least 55% of nursing home residents and is the second leading cause of institutionalization of older adults. UI has been shown to be an independent risk factor for unplanned hospitalization of home care individuals. Prompted voiding (PV) is a toileting program that combines scheduled voiding with "prompting" from a caregiver and is appropriate for older adults with all types of UI and in individuals who may have impaired cognitive function...
February 1, 2019: Journal of Gerontological Nursing
Christopher W Jones, Lauren B Remboski, Brian Freeze, Valerie A Braz, John P Gaughan, Samuel A McLean
STUDY OBJECTIVE: The objective of this pilot study is to assess the feasibility and necessity of performing a large-scale trial to measure the effect of intravenous fluid therapy on migraine headache pain. METHODS: This was a single-center, pilot randomized controlled trial. We randomized adult emergency department migraine headache patients to receive 1 L of normal saline solution during 1 hour (fluid group) or saline solution at 10 mL/hour for 1 hour (control group)...
February 2019: Annals of Emergency Medicine
Christopher E Grigoriadis, David P Cork, Walter Dembitsky, Brian E Jaski
BACKGROUND: The United States has recently undergone increases in the legalization and use of marijuana. There have been previous reports on the association of cannabis use and myocardial dysfunction, however, few on the association with acute stress cardiomyopathy and cardiogenic shock. CASE REPORT: This is a case of a 58-year-old female with a history of inhaled cannabis use, no history of diabetes, and no known history of cardiac disease, that illustrates an association between cannabis use and the recurrent development of stress cardiomyopathy and cardiogenic shock...
January 10, 2019: Journal of Emergency Medicine
Teresa Bigand, Cristina Lee Anderson, Mary Lee Roberts, Michele Rose Shaw, Marian Wilson
BACKGROUND: Increasingly, states are legalizing cannabis for recreational use. Improved accessibility may allow adults with pain to use cannabis more liberally. Greater understanding is needed about how adults with pain perceive the effects of cannabis, particularly those who also use opioid analgesics. PURPOSE: To examine the perceived effects of cannabis among adults who have been prescribed opioids for persistent pain. METHODS: A survey-based study was conducted on 150 adults with persistent pain...
December 13, 2018: Nursing Outlook
Timothy P Young, Mark D Schaefer, Heather M Kuntz, Molly K Estes, Michael Kiemeney, Brian J Wolk, Mindi Guptill
Introduction: Opportunities for chest tube placement in emergency medicine training programs have decreased, making competence development and maintenance with live patients problematic. Available trainers are expensive and may require costly maintenance. Methods: We constructed an anatomically-detailed model using a Halloween skeleton thorax, dress form torso, and yoga mat. Participants in a trial session completed a survey regarding either their comfort with chest tube placement before and after the session or the realism of Yogaman vs...
January 2019: Western Journal of Emergency Medicine
Ahmed Adel Amin, Eman Ibrahim Alabsawy, Rajiv Jalan, Andrew Davenport
Acute kidney injury (AKI) is a common presentation in patients with advanced cirrhosis hospitalized with acute decompensation. A new revised classification now divides AKI in cirrhotic patients into two broad subgroups: hepatorenal syndrome AKI (HRS AKI) and non-hepatorenal syndrome AKI (non-HRS AKI). HRS AKI represents the end-stage complication of decompensated cirrhosis with severe portal hypertension and is characterized by worsening of renal function in the absence of prerenal azotemia, nephrotoxicity, and intrinsic renal disease...
January 2019: Seminars in Nephrology
Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: Rhabdomyolysis is a medical condition caused by muscle breakdown leading to potential renal damage. This can result in significant morbidity and mortality if not rapidly identified and treated. OBJECTIVE: This article provides an evidence-based narrative review of the diagnosis and management of rhabdomyolysis, with focused updates for the emergency clinician. DISCUSSION: Rhabdomyolysis is caused by the breakdown of muscle cells leading to the release of numerous intracellular molecules, including potassium, calcium, phosphate, uric acid, and creatinine kinase...
January 2, 2019: American Journal of Emergency Medicine
Karmila Qarima Isa, Muhammad Adib Ibrahim, Hjh-Hartini Abdul-Manan, Zainatul-Ashiqin H Mohd-Salleh, Khadizah H Abdul-Mumin, Hanif Abdul Rahman
BACKGROUND: developing coping strategies to use in stressful situations is an essential nursing skill. Prolonged and constant stress is harmful to nurses' health and leads to organisational inefficiency, high staff turnover and decreased job satisfaction. AIM: to identify nurses' stress coping strategies and determine the relationship between coping strategies and sociodemographic factors. METHOD: a descriptive cross-sectional study using a self-administered questionnaire was undertaken at an emergency department and critical care units at the largest referral hospital in Brunei...
January 10, 2019: British Journal of Nursing: BJN
Warren Chapman, Keith Siau, Fiona Thomas, Selvajothi Ernest, Shriya Begum, Tariq Iqbal, Neeraj Bhala
This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding...
January 10, 2019: British Journal of Nursing: BJN
Sophie Shrapnel, Elsa Dent, Caroline Nicholson
BACKGROUND: Hospital Emergency Departments (EDs) experience high presentation rates from older adults residing in Aged Care Facilities (ACFs), yet very few intervention studies have addressed the care needs of this population group. We designed and implemented a nurse-led model of care for older adults from ACFs, and determined its impact on patient outcomes. METHODS: This 12-month pre-post intervention study was conducted during 2013-2014, with follow-up during 2015-2016...
January 7, 2019: Aging Clinical and Experimental Research
Alice Ferguson, Daniel Evan Coates, Scott Osborn, Christopher Craig Blackmore, Barbara Williams
: Background: Sepsis is one of the leading causes of hospital mortality and readmission. For the past 20 years, sepsis research has focused on best practices for treating patients with the most severe manifestations of sepsis, while the treatment of patients outside of critical care or ED settings, who have early or less severe signs and symptoms of sepsis, have received little attention. OBJECTIVE: The goal of this quality improvement (QI) initiative was to promote early recognition and treatment of sepsis through the establishment of a multidisciplinary, executive-led sepsis guiding team that leveraged nursing skills and expertise...
January 2019: American Journal of Nursing
Lila de Tantillo, Joseph P De Santis
Charged with making decisions to protect and enhance patient well-being, a nurse relies on nursing judgment to render effective patient care. Nursing judgment is the culmination of education, experience, and insight that allows nurses to execute the best action possible on behalf of patients. This concept analysis uses the Walker and Avant method to demonstrate the role of nursing judgment in assessments and interventions, delegation of tasks, and prioritization of care. Nurses, other health care collaborators, and recipients of health care should be aware of the role played by nursing judgment to improve patient care and the health care system...
December 10, 2018: ANS. Advances in Nursing Science
Danielle Hart, Wilma M Hopman, Sharlene Hammond, Damian P Redfearn
BACKGROUND: Between 2010 and 2012, the Heart Rhythm team in a tertiary care hospital completed a retrospective study that found that atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED). PROBLEM: Patients who attend the ED with AF are at high risk of hospital admission. APPROACH: A nurse practitioner (NP) was added to the Heart Rhythm team to create a program to improve AF care after an ED visit...
December 21, 2018: Journal of Nursing Care Quality
Jason N Batten, Katherine E Kruse, Stephanie A Kraft, Bela Fishbeyn, David C Magnus
OBJECTIVES: To explore how nonphysicians and physicians interpret the word "treatable" in the context of critical illness. DESIGN: Qualitative study using in-depth interviews. SETTING: One academic medical center. SUBJECTS: Twenty-four nonphysicians (patients and community members) purposively sampled for variation in demographic characteristics and 24 physicians (attending physicians and trainees) purposively sampled from four specialties (critical care, palliative care, oncology, and surgery)...
December 21, 2018: Critical Care Medicine
Anne Henrieke Tavenier, Renicus Suffridus Hermanides, Jan Paul Ottervanger, Peter Gerrit Johannes Ter Horst, Elvin Kedhi, Adriaan W J van 't Hof
Although opioids are recommended and frequently used in the acute phase of ST-elevation myocardial infarction (STEMI), their use is accompanied by serious side effects. In particular, gastrointestinal adverse effects may disturb absorption of essential oral medication like platelet inhibitors. This may cause suboptimal platelet inhibition and increased risk of acute stent thrombosis. Some clinical studies have already demonstrated these negative results. Alternative strategies to optimize platelet inhibition and pain relief in STEMI are being investigated...
December 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
2018-12-22 13:19:55
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