Advanced emergency nursing journal
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Recognizing the adverse impact that trauma has on a patient's overall well-being and hemodynamic stability is key to successful management and improved outcomes for this patient population. It is well established that trauma is accompanied by deadly pathophysiological sequelae, referred to as the "trauma triad." This triad is characterized by hypothermia, acidosis, and coagulopathy. This triad is cyclic and, moreover, each element of the triad builds upon one another to exacerbate the next. Hence, evidence demonstrates that it is important to recognize the cycle and intervene early to reduce or prevent negative outcomes.
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Review
Body surface mapping improves diagnosis of acute myocardial infarction in the emergency department.
Traditionally, the diagnosis of acute myocardial infarction (AMI) in emergency departments is done through an assessment of history and presenting symptoms, 12-lead electrocardiogram (ECG), and cardiac biomarkers. The 12-lead ECG is not highly sensitive for detecting ECG changes, and some infarctions may be missed. Failure to identify patients in the early stages of AMI can result in failure to provide beneficial therapies. ⋯ Body surface mapping has greater sensitivity in detecting AMI in the inferoposterior portions of the left ventricle and the right ventricle. Portable hardware and user-friendly software coupled with an easily applied disposable torso vest containing the electrodes produce a 12-lead ECG, 80-lead ECG, and color contour torso or flat map showing ECG changes. Recent studies support the use of 80-lead body surface mapping for detecting AMI in the emergency department.
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Hospital emergency departments (EDs) throughout the United States are faced with overwhelming challenges due to the high demand for services, an increasing number of visits, overuse and misuse of services, and escalating healthcare costs. The result of this situation is that EDs are overcrowded, patients are experiencing long wait times, ambulances are being diverted, admitted patients are being boarded, and patients in need of emergency medical care are leaving without treatment. The purpose of this article is to present a quality improvement initiative designed and implemented to improve patient flow through an ED by redesigning the triage process to increase the efficiency and timeliness of initial patient contact with a licensed medical provider, increasing patient satisfaction, and decreasing the number of patients who leave without being seen. ⋯ The results of this initiative have proven to be positive in goal attainment. The time from patient arrival to initial contact with a licensed medical provider has decreased from 75 to 25 min. The percentage of patients who leave without being seen has decreased from 3.6% to 0.9%.
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A recent clinical research study with a case study approach is used to illustrate the importance of translational research in the role of the advanced practice nurse. The case study module used in this column is "Adverse Drug Events in the Emergency Department: Why Genetics Matters in Practice." The study results showed that patients taking multiple drugs metabolized through the cytochrome P450 enzyme system had a higher prevalence of drug-drug exposure. These drug-drug exposures may lead to potentially serious drug-drug interactions. The implications and clinical relevance of these findings for advance practice nurses are discussed.
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As health care systems across the United States continue to grapple with emergency department (ED) crowding and identify mechanisms to improve ED throughput, quantification of intradepartmental efficiency and workload is required to provide much-needed objective measures to assist in the continuing development, implementation, and evaluation of these strategic initiatives. In an attempt to establish a straightforward measure of ED efficiency in relation to daily census and ED crowding, T. J. ⋯ S. community hospital setting. This application of the ED Census Model yielded 3 components: the ED Census Component, the ED Throughput Component, and the ED Efficiency Threshold Component. The components provide information necessary for understanding the impact of patient arrivals and departures on the underlying workflow processes that determine throughput.