Advanced emergency nursing journal
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Implantation of left ventricular assist devices (LVADs) is becoming more common with the advancement of mechanical circulatory support technology and the continued insufficient number of organ donors available for heart transplantation. Modern LVADs provide a mechanically induced, nonpulsatile, continuous blood flow that drastically alters the hemodynamic and coagulation profile of patients using these devices. ⋯ Although LVAD therapy can prolong life, the majority of patients will experience an adverse event following implantation and many of these complications can result in emergency department visits. By understanding the pathophysiology and management of LVAD complications, emergency nurses will be able to provide prompt and quality care for this unique patient population.
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The most common fracture of the foot is a fracture of the proximal fifth metatarsal. In general, there are 3 types of fractures involving the proximal fifth metatarsal area, including a proximal diaphyseal stress fracture, a Jones fracture, and an avulsion fracture of the tuberosity. ⋯ Avulsion fractures of the tuberosity often heal without difficulty, yet fractures distal to the area of insertion of the peroneus brevis tendon are prone to nonunion and delayed healing (). Differential diagnosis of a fifth metatarsal midfoot injury includes ankle sprains, midfoot sprains, plantar facial ruptures, peroneus tendon ruptures, and other foot fractures.
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The role of nurse practitioners (NPs) in emergency care continues to evolve. A new and exciting role is the provider-in-triage (PIT) role. This innovative role has been implemented in many emergency departments (EDs) across the country. ⋯ Patient satisfaction, quality measures, and financial improvements have been attributed to using a PIT. The emergency NP is an optimal choice for this role. Advanced emergency nursing knowledge, skills, and decision making confer the NP a cost-effective provider to improve throughput in the ED while providing quality emergency care.