Advanced emergency nursing journal
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Delirium occurs frequently in older patients in the emergency department (ED), is underrecognized, and has potentially serious consequences. Despite its seriousness, delirium is frequently missed by emergency providers, and patients with unrecognized delirium are often discharged from the ED. ⋯ Appropriate management includes nonpharmacological management with medication intervention reserved for emergencies. We have developed a new, comprehensive, evidence-based protocol for diagnosis/recognition, management, and disposition of geriatric delirium patients in the ED with a focus on identifying and treating commonly missed contributing causes.
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Length of stay (LOS) is a key measure of emergency department (ED) efficiency and a marker of overcrowding. The use of clinical practice guidelines (CPGs) has been shown to decrease the time spent in the ED. The objective of this study was to determine whether the utilization of a CPG for evaluation of acute pelvic pain in the ED would reduce patient LOS. ⋯ Of significance was the willingness of the health care providers to utilize the CPG (86%). Time of day, availability of in-house ultrasound, and individual provider judgment influence ED LOS and subsequent imaging performed. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS, reducing provider disparities, and ensuring patient safety.
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Malignant hyperthermia (MH) is a high-risk, low-occurrence medical emergency with symptoms that include a severe increased rate of metabolic activity and rigid skeletal muscles. Clinicians should be knowledgeable and prepared for an MH event because it can occur in areas outside the operating room and without anesthetic triggers. Patients who have this rare genetic condition may come to the emergency department (ED) presenting with symptoms of heat stroke. ⋯ Measuring accurate core temperatures, applying effective cooling methods, and administering dantrolene are key concepts in caring for a patient who is experiencing an MH event. Advanced practice emergency nurses can participate in reducing vulnerability for this population by applying the Emergency Nurses Association Clinical Nurse Specialist competencies to MH-related vulnerabilities. Enhancing preparedness, evaluating and coordinating education programs, advocating for report submissions to the North American Malignant Hyperthermia Registry, and assessing opportunities for community collaboration are among the strategies discussed for reducing vulnerability for the MH-susceptible population.