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    304 results match your criteria Advanced Emergency Nursing Journal[Journal]

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    The Effect of Apneic Oxygenation on Reducing Hypoxemia During Rapid Sequence Induction and Intubation in the Acutely Ill or Injured.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):309-317
    Emergency Department, Naval Medical Center Portsmouth, Portsmouth, Virginia.
    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. Read More

    Reducing Unnecessary Head Computed Tomography in Mild Traumatic Brain Injury.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):300-308
    Medical Associates, LLP, Emergency Department, Community Health Network, Indianapolis, Indiana (Mr Webster); Gulf Coast Internists, Palm Harbor, Florida (Mr Moore); and Advanced Practice Nursing Dept, Indiana State University, Terre Haute (Dr Stewart).
    There is growing concern about the frequency of computed tomographic (CT) scans performed for evaluation of adults with suspected mild traumatic brain injury. The Canadian CT Head Rule and the New Orleans Criteria are the most studied head CT decision tools that aid providers in determining which patients do not require a CT scan. 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. Read More

    Intravenous Push Cephalosporin Antibiotics in the Emergency Department: A Practice Improvement Project.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):295-299
    UCHealth, University of Colorado Hospital, Aurora, Colorado (Dr McLaughlin and Ms Scott); UCHealth, Longs Peak Hospital, Longmont, Colorado (Ms Koenig); and Skaggs School of Pharmacy, University of Colorado, Aurora, Colorado (Dr Mueller).
    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. Read More

    A Randomized, Double-Blind Trial to Determine if Vapocoolant in the Adult Population Improves Patient Perception of Pain With Peripheral Intravascular Access.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):288-294
    Parkland Health & Hospital System, Dallas, Texas.
    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 cleansing and insertion. Read More

    Barriers to Research Recruitment of Women Experiencing a Pregnancy Loss in the Emergency Department.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):280-287
    University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Punches, Johnson, Felblinger, and Gillespie); and University of Cincinnati School of Social Work, Cincinnati, Ohio (Dr Acquavita).
    Women often come to the emergency department (ED) with signs and symptoms suggesting an early pregnancy loss; yet, little is known about their experience and how it relates to future outcomes. To improve patient outcomes and experiences of women seeking care for a pregnancy loss, research is required. However, recruitment of participants experiencing an event such as a pregnancy loss is challenging. Read More

    Changing the Emergency Department's Practice of Rapid Sequence Intubation to Reduce the Incidence of Hypoxia.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):266-279
    Vanderbilt University School of Nursing and Vanderbilt University Medical Center-LifeFlight, Nashville, Tennessee (Dr Gooch); TeamHealth at Maury Regional Medical Center, Columbia, Tennessee (Dr Gooch); Middle Tennessee School of Anesthesia, Madison, Tennessee (Dr Gooch); and Loyola University Chicago Marcella Niehoff School of Nursing, Chicago, Illinois (Dr Roberts).
    Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Read More

    Postpartum Headache.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):258-265
    Pacific Lutheran University School of Nursing, Tacoma, Washington. Dr Richardson is a retired Army Nurse Corps officer.
    Approximately 40% of all women report experiencing headaches during the postpartum period, regardless of a previous headache history. This case narrative describes the clinical case of a 22-year-old woman who presented for the evaluation of an intractable headache for 2½ weeks. It demonstrates the inherent difficulty in diagnosing patients not presenting with "textbook" symptoms and highlights the fact that signs and symptoms of eclampsia/preeclampsia, such as elevated blood pressure, may fall below the threshold for hypertensive emergencies and not be considered in the differential. Read More

    Sugammadex for Neuromuscular Blockade Reversal.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):248-257
    Emory University Hospital, Atlanta, Georgia.
    Postoperative residual neuromuscular blockade is associated with an increased risk of respiratory insufficiency, aspiration, and potential pulmonary complications. The standard of care for reversal of residual block centers on anticholinesterases such as neostigmine. However, these medications provide inconsistent or inadequate effect while being associated with potentially severe adverse effects. Read More

    Orbital Floor Fractures.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):240-247
    School of Nursing and Health Sciences, Robert Morris University, Moon Township, Pennsylvania (Dr Ramponi); and Department of Nursing, Edinboro University, Edinboro, Pennsylvania (Drs Astorino and Bessetti-Barrett).
    The orbital bones are thin and exposed, making the orbital walls vulnerable to fractures. The floor of the orbit is the weakest portion of this 4-sided pyramid structure. Blunt force trauma is the primary mechanism of injury in young men between the ages of 18 and 30 years. Read More

    Does Suprapubic Stimulation in Infants Facilitate Collection of a Clean Catch Urine Specimen?
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):236-239
    Makenna David Pediatric Emergency Department, University of Kentucky Chandler Hospital, Lexington (Dr Hall-Million); University of Kentucky College of Nursing, Lexington (Dr Hall-Million); and Emergency Services, University of Kentucky HealthCare, Lexington (Dr Howard).
    Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Faster Clean Catch Urine Collection (Quick Wee Method) From Infants: Randomised Controlled Trial." This prospective study enrolled 344 infants between 1 and 12 months of age seeking care in an emergency department with a complaint that led to the ordering of a clean catch urine specimen. Use of the Quick Wee procedure yielded clean catch urine specimens without the use of an invasive procedure. Read More

    The Specialty of Emergency Nurse Practitioner Practice.
    Adv Emerg Nurs J 2017 Oct/Dec;39(4):231-235
    Editor Advanced Emergency Nursing Journal Chair American Academy of Emergency Nurse Practitioners Clinical Professor & Emergency Nurse Practitioner Specialty Coordinator Emory University Nell Hodgson Woodruff School of Nursing Atlanta, GA Founder American Academy of Emergency Nurse Practitioners Professor of Clinical Nursing & Director of Emergency/Trauma Nurse Practitioner Concentration University of Texas Health Science Center Houston Houston, TX Founding Chair American Academy of Emergency Nurse Practitioners Associate Professor & Emergency Nurse Practitioner Specialty Coordinator Vanderbilt University School of Nursing Nashville, TN Guest Editors.

    Postgraduate Emergency Nurse Practitioner Fellowships: Opportunities for Specialty Education.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):224-230
    Vanderbilt University School of Nursing, Nashville, Tennessee.
    Specialty trained emergency nurse practitioners (ENPs) can meet the demands of an unpredictable emergency care environment within an overburdened health care system. Although existing literature supports fellowship training as a method for bridging academic knowledge with clinical experiences for the novice nurse practitioner, the currently available emergency care postgraduate fellowship programs are inconsistent in approach. Building upon descriptive data provided by the existing 9 postgraduate ENP fellowship programs, a comparison and gap analysis of program content was conducted to identify perceived standards for ENP specialty education and the congruence with published ENP competencies. Read More

    Importance of Early Detection and Cardiovascular Surgical Intervention in Marfan Syndrome.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):217-223
    Texas Woman's University, Houston, Texas (Dr DelloStritto and Mss Chemmachel, Patel, Skolkin, Gilani, and Uleanya); and Texas Tech University, Lubbock, Texas (Dr Branham).
    Marfan syndrome is an autosomal dominant connective tissue disorder that affects multiple systems, including the skeletal, ligamentous, oculofacial, pulmonary, abdominal, neurological, and cardiovascular systems. Cardiovascular complications, which involve the aorta and aortic valve, contribute most significantly to patient morbidity and mortality. A literature review was conducted on pathophysiology of the disease and recommendations for early diagnosis and treatment. Read More

    Implementing Interprofessional Alcohol Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Evidence-Based Quality Improvement Initiative.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):199-216
    School of Nursing, Loyola University Chicago, Maywood, Illinois (Drs Bacidore and Letizia); and Health and Community Systems Department, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261 (Dr Mitchell).
    Alcohol misuse is one of the leading causes of illness, disease, injury, and death in the Unites States. For many patients, the emergency department (ED) visit may provide the only therapeutic opportunity to influence problematic drinking behavior. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach that may reduce alcohol-related morbidity and mortality and improve health outcomes and quality of life. Read More

    Chemical Burns of the Eye.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):193-198
    School of Nursing and Health Sciences, Robert Morris University, Moon Township, Pennsylvania.
    Chemical burns of the eye are one of the most common eye injuries. The extent of the ocular surface damage is influenced by the type, temperature, volume, and pH of the corrosive substance and duration of exposure. Limbal ischemia found on eye assessment is the primary determinant of eventual visual outcome. Read More

    Cerebellar Stroke: A Missed Diagnosis.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):184-192
    School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Berry); School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Platt-Mills); Emergency Department, University of North Carolina Health Care, Chapel Hill, North Carolina (Drs Berry and Platt-Mills and Mss Rafferty and Tiu).
    Cerebellar strokes account for less than 10% of all strokes but lead to significantly poor outcomes. Cerebellar strokes that are initially missed have a mortality rate of 40%, and half of the patients who survive have long-term deficits. The patient's history may provide clues that point to a cerebellar stroke. Read More

    Update on Sepsis Treatment in the Emergency Department.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):176-183
    Pharmacy Services, Medical University of South Carolina, Charleston (Dr Weant); Department of Pharmacy Services, University of Kentucky HealthCare, Lexington (Dr Bailey); and Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington (Dr Bailey).
    Sepsis continues to be a devastating, costly, and challenging syndrome to manage in emergency departments (ED) across the nation, and its impact seems to be only increasing. Recently, consensus recommendations have made some profound changes in the way we approach, classify, and treat sepsis. The ED serves as an important initial screening and intervention point for sepsis, and ED care can have a profound impact on overall morbidity and mortality. Read More

    Metatarsal Stress Fractures.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):168-175
    School of Nursing and Health Sciences, Robert Morris University, Moon Township, Pennsylvania (Dr Ramponi); and Department of Nursing, Edinboro University, Edinboro, Pennsylvania (Drs Hedderick and Maloney).
    Metatarsal stress fractures are also called "march fractures" or "marcher's foot." They most commonly occur in the distal second and third metatarsals. The second and third metatarsals receive the majority of stress during ambulation and are less mobile compared with the other metatarsals. Read More

    Prevalence of Pulmonary Embolism in Patients Presenting to the Emergency Department for Syncope.
    Adv Emerg Nurs J 2017 Jul/Sep;39(3):161-167
    Emory University, Atlanta, Georgia.
    The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse (RN) and to assist with the translation of research into practice. For each column, a topic and a research study are selected. The research article is then reviewed and critiqued, and the findings are discussed in relation to a patient scenario. Read More

    The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):152-158
    Center for Healthcare Innovation and Policy Research (Dr Pines and Mr Zocchi), Department of Emergency Medicine (Dr Pines), and School of Medicine and Health Sciences (Ms Buchanan), The George Washington University, Washington, District of Columbia; Department of Emergency Medicine, The University of Wisconsin-Madison (Dr Shah); and School of Nursing (Dr Travers) and Department of Emergency Medicine (Dr Travers), The University of North Carolina at Chapel Hill.
    We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. Read More

    Emergency Nurse Practitioner Core Educational Content.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):141-151
    Emergency Nurse Practitioner Program, Vanderbilt University School of Nursing, Nashville, Tennessee (Drs Wilbeck and Rudy); Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois (Dr Roberts); and Vanderbilt Adult Emergency Department, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Rudy).
    Increasing numbers of patients are presenting to national emergency departments (EDs). This is occurring simultaneously with reductions in providers along with ED closures, creating a significant gap in emergency care. According to the advanced practice registered nurse consensus model, specialty-specific knowledge and practice build upon generalist nurse practitioner (NP) population foci. Read More

    Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):123-140
    Thomas More College, Crestview Hills, Kentucky, (Dr Tacy); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Donaworth and Ballman).
    Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21. Read More

    Measuring Fatigue in Triage: A Pilot Study.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):114-122
    Duke University Health System, Durham, North Carolina (Ms McMahon and Drs Hudson, Prewitt, and Carman); and Duke University Health System, Raleigh, North Carolina (Ms Engleson).
    : Given the critical nature of triage in facilitating emergency department (ED) functions, an understanding of the factors that impact triage nurses' ability to accurately assign triage scores and the ways in which these factors may affect various patient outcomes is extremely important; yet, there exists a paucity of such research in the literature. To further develop this knowledge base, an investigation of triage nurse fatigue and the role it may play in the ability to accurately assign triage scores was developed. The purpose of this pilot study was to determine how the length of a triage shift affects perceived fatigue levels among triage nurses. Read More

    A Case of Exertional Rhabdomyolysis: When Exertion Exceeds Capacity.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):106-113
    Mid-Atlantic Emergency Medicine Associates, Charlotte, North Carolina (Dr Jordan); School of Nursing, The University of North Carolina at Charlotte (Dr Jordan); and Western Carolina University and Haywood Regional Hospital, Clyde, North Carolina (Dr Mannle).
    The purpose of this article is to present a discussion of a young adult patient with exertional rhabdomyolysis. Rhabdomyolysis is the process of muscle tissue destruction and damage to the cell membrane, with subsequent release of the intracellular myocyte contents into the systemic circulation. This leads to the potential for the life-threatening systemic complications of electrolyte abnormalities, cardiac dysrhythmias, acute kidney injury, compartment syndrome, and disseminated intravascular coagulopathy. Read More

    Antiemetic Use in the Emergency Department.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):97-105
    Pharmacy Services, Medical University of South Carolina, Charleston (Drs Weant and Calhoun); Department of Pharmacy Services, University of Kentucky HealthCare, Lexington (Drs Bailey and Baum); Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington (Drs Bailey and Baum); and Clinical Pharmacy Services, St. Claire Regional Medical Center, Morehead, Kentucky (Dr Justice).
    Nausea and vomiting are 2 of the most common complaints of patients presenting to the emergency department (ED). In addition, antiemetics are the most commonly prescribed medications in the ED behind analgesics. Treating these conditions can be complex, especially as one considers that nausea and/or vomiting could be the primary presenting illness or simply a symptom of a more complex etiology. Read More

    Management of Hand Injuries: Part III.
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):86-96
    Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California (Dr Hoyt) University of Texas Health Science Center, Houston (Dr Ramirez).
    Assessment of Acute Hand Injuries was discussed in Part I (). Part I reviewed approaches to the assessment of the patient with a hand injury and established a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand were discussed, and examples of the assessments were provided. Read More

    Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?
    Adv Emerg Nurs J 2017 Apr/Jun;39(2):81-85
    Emergency Services, University of Kentucky HealthCare, Lexington (Dr Kunz Howard); and Department of Emergency Medicine at Grady Hospital, Emory University, Atlanta, Georgia (Ms Gisness).
    : Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial." This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Read More

    Emergency Nurses as Second Victims of Error: A Qualitative Study.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):68-76
    Medical Ethics and Law Research Center (Drs Abbaszadeh and Borhani), Department of Medical Surgical Nursing (Dr Ajri-Khameslou), School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    There are many nurses who are victims of errors in the hospital environment. It is quite essential to perceive the outcome of mistakes in nurses' profession. The aim of this scientific study was to interpret the causes that place nurses in danger of errors in emergency departments and also the consequences resulting from confronting the errors in the job environment. Read More

    An Exemplar Interprofessional Academic Emergency Nurse Practitioner Program: A Blueprint for Success.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):59-67
    Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA (Dr Evans); Department of Emergency Medicine, Emory University and Grady Memorial Hospital, Atlanta, GA (Ms Ashooh); Georgia Baptist College of Nursing, Mercer University, Atlanta, GA (Dr Kimble); Department of Emergency Medicine, Emory University, Atlanta, GA (Dr Heilpern).
    Emergency department census rates and manpower gaps have continued to rise over the past decade, creating a demand for well-prepared emergency nurse practitioners (ENPs). The implementation of the consensus model for advanced practice nurses has brought acknowledgment by leading health care, physician, and nursing organizations of the ENP specialty as critical to building a high-quality emergency care workforce. Recognition of the ENP's unique skill set, and therefore need of specialty certification, has led to a growing interest in the expansion of nurse practitioner curricula in emergency care. Read More

    Initiation of Therapeutic Hypothermia in the Emergency Department: A Quality Improvement Project.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):52-58
    St John Medical Center, Tulsa, Oklahoma (Dr Yochum); and Missouri State University, Springfield (Dr Utley).
    Therapeutic hypothermia (TH) postresuscitation has been recommended by the American Heart Association (AHA) since 2005. Early initiation of TH and fast achievement of goal temperatures have been associated with better neurological outcomes. The objective of this study was to evaluate the effectiveness of a specific TH protocol for the emergency department (ED) in increasing ED use of TH and decreasing the time from return of spontaneous circulation (ROSC) to initiation of cooling measures. Read More

    Identification and Management of Human Trafficking Victims in the Emergency Department.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):31-51
    Department of Nurse-Midwifery and Women's Health, University of Cincinnati, Cincinnati, Ohio (Dr Hachey); and Vanderbilt University School of Nursing, Nashville, Tennessee (Dr Phillippi).
    Health care practitioners serve an important role in identification and assistance of human trafficking victims. Advanced practice registered nurses, including certified nurse midwives, clinical nurse specialists, and nurse practitioners, are in a unique position to interact with persons trafficked and seen in the clinical setting, yet they require knowledge to identify the signs of human trafficking. Lack of training and education has been identified as a barrier for health care professionals to recognize human trafficking victims and implement needed health care services (; ). Read More

    Metformin-Associated Lactic Acidosis: An Atypical Presentation.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):26-30
    Department of Emergency Medi-cine, North Shore University Health Systems, Evanston, Illinois.
    Many Type 2 diabetic patients take metformin for its safety profile and lack of hypoglycemia. Although this drug is safe in those without renal dysfunction, lactic acidosis may rarely occur. Metformin-associated lactic acidosis is a potentially fatal yet rare diagnosis. Read More

    Chemotherapy in the Emergency Department? There Is a Role for That: Methotrexate for Ectopic Pregnancy.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):18-25
    Medical University of South Carolina, Charleston (Drs Weant and Calhoun); Departments of Pharmacy Services and Pharmacy Practice and Science, College of Pharmacy, University of Kentucky HealthCare, University of Kentucky, Lexington (Drs Bailey and Baum); and Clinical Pharmacy Services, St. Claire Regional Medical Center, Morehead, Kentucky (Dr Justice).
    Approximately 1.6% of all emergency department (ED) visits in the United States are for vaginal bleeding in early pregnancy, translating to around 500,000 ED visits per year. A potentially life-threatening condition, ectopic pregnancy occurs in 1. Read More

    An Unusual Case of Chest Pain in an Adolescent Male: Important Cues to Differential Diagnosis.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):10-17
    The University of North Carolina, Charlotte, North Carolina (Dr Jordan); and Haywood Regional Hospital Clyde, North Carolina (Dr Mannle).
    Chest pain is a common presenting symptom in the pediatric population, and in contrast to adults, the etiology is rarely cardiac or life-threatening. The majority of chest pain complaints in children and adolescents are benign and can be managed with reassurance and follow-up. The emergency care provider must obtain a comprehensive history and physical examination, as the differential diagnosis of pediatric chest pain is extensive and serious underlying organic pathology may be present. Read More

    Caring for Young Children Exposed to Marijuana.
    Adv Emerg Nurs J 2017 Jan/Mar;39(1):3-9
    Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
    This article reviews the research report, Marijuana Exposure Among Children Younger Than Six Years in the United States (), and, using a case study approach, applies the findings to advanced practice registered nurses. B. extracted data from the National Poison Data System showing an increasing trend in marijuana exposure in children, especially in states where marijuana has been legalized for either medicinal use or recreational use. Read More

    Reducing Inappropriate Antibiotic Prescribing for Adults With Acute Bronchitis in an Urgent Care Setting: A Quality Improvement Initiative.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):327-335
    Duke University School of Nursing, Durham, North Carolina (Drs Link and Hendrix); FastMed Urgent Care, Holly Springs, North Carolina (Dr Link); Department of Pharmacy, Durham Veterans Affairs Medical (Dr Townsend), and Geriatric Research, Education, and Clinical Center (Dr Hendrix), Durham VA Medical Center, Durham, North Carolina; FastMed Urgent Care, Henderson, North Carolina (Dr Leung); and FastMed Urgent Care, Clayton, North Carolina (Dr Kommu).
    Acute bronchitis is a predominantly viral illness and, according to clinical practice guidelines, should not be treated with antibiotics. Despite clear guidelines, acute bronchitis continues to be the most common acute respiratory illness for which antibiotics are incorrectly prescribed. Although the national benchmark for antibiotic prescribing for adults with acute bronchitis is 0%, a preliminary record review before implementing the intervention at the project setting showed that 96% (N = 30) of adults with acute bronchitis in this setting were prescribed an antibiotic. Read More

    Recognition of Asymptomatic Hypertension in an Urban Emergency Department: Where Are We Now?
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):320-326
    Department of Emergency Medi-cine, Mount Sinai Icahn School of Medicine, New York (Drs Souffront and Richardson and Ms Gestal); and New York University College of Nursing, New York (Dr Melkus).
    Persistently elevated blood pressure ([BP]; hypertension [HTN]) occurs at higher rates in the emergency department ([ED]; 44%) than in the general population (27%) and disproportionately affects black patients and older adults. The American College of Emergency Physicians recommends referral to primary care for HTN confirmation and management when patients are asymptomatic and their BP is persistently elevated (). However, adherence to this clinical policy is suboptimal. Read More

    The Triage Interruptions Assessment Tool: An Instrument Development.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):308-319
    College of Nursing, University of Cincinnati, Cincinnati, Ohio (Drs Johnson and Gillespie); and Emergency Department, University of Cincinnati Medical Center, Cincinnati, Ohio (Dr Vance).
    Interruptions contribute to catastrophic errors in health care. Interruptions are breaks in the performance of a human activity initiated by a source internal or external to the recipient. Errors during the initial triage assessment can lead to errors in estimating the acuity of a patient and resources required for appropriate care. Read More

    Unique Educational Needs of Emergency Nurse Practitioners.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):300-307
    Loyola University Chicago, Maywood, Illinois (Drs Keough, Tell, and Andreoni); and Duke University, Durham, North Carolina (Dr Tanabe).
    The purpose of this study is to identify the unique educational needs of emergency nurse practitioners (ENPs). A survey from 167 nurse practitioners (NPs) practicing in the emergency department (ED) settings was analyzed. A variety of certified NPs practice in EDs: family NPs (30%), adult NPs (18%), acute care NPs (40%), and some with 2 or more certifications (12%). Read More

    Presentation of Testicular Torsion in the Emergency Department.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):295-299
    University of Cincinnati College of Nursing, Cincinnati, Ohio.
    Testicular torsion is a urological emergency affecting 3.8 per 100,000 males younger than 18 years. Differential diagnosis of the acutely painful scrotum is crucial for the advance practice nurse to understand. Read More

    A Review on the Reversal of the Old and New Anticoagulants.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):279-294
    University of Kentucky HealthCare, Lexington (Drs Bailey, Blackburn, and Horn); University of Kentucky College of Pharmacy, Lexington (Dr Bailey); Charleston Area Medical Center, Charleston, West Virginia (Drs Crowley and Schultz); University of Charleston School of Pharmacy, Charleston, West Virginia (Drs Crowley and Schultz); West Virginia University School of Pharmacy, Morgantown (Drs Crowley and Schultz); and St. Claire Regional Medical Center, Morehead, Kentucky (Dr Justice).
    It is not uncommon for providers in the emergency department to take care of patients who are taking anticoagulant therapy in the outpatient setting. However, the bigger challenge is caring for these patients when they present with bleeding that could be secondary to 1 or more of these medications. In recent years, this class of medications has expanded from warfarin to include direct thrombin inhibitors and Factor Xa inhibitors. Read More

    Management of Hand Injuries: Part II.
    Adv Emerg Nurs J 2016 Oct/Dec;38(4):266-278
    University of Texas Health Science Center Houston (Dr Ramirez); and Hahn School of Nursing and Health Science: Beyster Institute for Nursing Research, University of San Diego, San Diego, California (Dr Hoyt).
    Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. "Assessment of Acute Hand Injuries" Part I was discussed in the Advanced Emergency Nursing Journal (). Read More

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