Advanced emergency nursing journal
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Intraosseous (IO) access is a standard of care for pediatric emergencies in the absence of conventional intravenous access. Intraosseous needles provide access for resuscitation fluids and medications and are often placed in the emergency department. However, there are no studies to date that describe the characteristics of pediatric IO needle recipients or their dispositions and outcomes. ⋯ Of those admitted to hospital, 58% (n = 83) were ultimately discharged home. Intraosseous access provides a safe and reliable method for rapidly achieving a route for administration of medications, fluids and blood products. It is a lifesaving measure with most IO needles successfully placed by referring facilities prior to transport, with few reported complications.
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This study addresses the development of a modified early warning system (MEWS) to predict hospital admissions from emergency departments (EDs) using the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). A MEWS score was created for each patient in the NHAMCS data set using the vital signs recorded at admission. Multiple logistic regression analyses indicated that for every 1 unit increase in the MEWS score, patients were 33% more likely to be admitted to the hospital for further care even after controlling for demographics. ⋯ A MEWS score of 13 resulted in almost 90% chance of admission to the hospital. Results indicate that an early warning system may be used to identify signs of physiological decline in many health care settings. Use of MEWS in EDs could be a helpful predictor of the need for hospitalization and could serve as a focus for early decision making and as a point of comparison for efficacy of interventions both in the emergency department and if the patient is admitted to the hospital.
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Pulmonary embolism can present with a wide range of symptoms, from asymptomatic to cardiac arrest, making diagnosis challenging. Alteplase is a fibrinolytic that is indicated for the treatment of pulmonary embolism in intermediate- and high-risk patients. Controversy exists as to the patient population that will benefit most from fibrinolytic therapy, as well as the proper dose and administration technique. ⋯ Nurses at the bedside must monitor for signs of bleeding when alteplase is administered. Fibrinolytic therapy will frequently be started in the emergency department, and the nurse must ensure that alteplase is administered in a safe and effective manner. This review discusses the clinical evidence for alteplase in pulmonary embolism and its specific role in treatment.
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Emergency departments (EDs) across the country are inundated with patients and they struggle to provide the expected standard of care while meeting set benchmarks. A shortage of emergency medicine physicians further complicates the situation, and many facilities are utilizing nurse practitioners to bridge the gap. A clinical case study was conducted at Touro Infirmary, a large urban hospital in New Orleans, LA, to provide an in-depth look at the implementation and positive outcomes of nurse practitioners in one ED. ⋯ The percentage of significant returns also remained constant at less than 1% in both 2012 and 2013. Assessment of the CMS (Centers for Medicare & Medicaid Services) Quality Measures and PRQS (Physician Quality Reporting System) Indicators do not reveal any change of statistical significance. The average of all providers was shown to be at or above the benchmark set for each measurement/indicator.