Advanced emergency nursing journal
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Comparative Study
Comparison of High-Sensitivity Troponin T Assay to Conventional Troponin T Assay for Rule Out of Acute Coronary Syndrome in the Emergency Department.
Approximately 5% of all emergency department (ED) visits require evaluation of chest pain and atypical symptoms for diagnosis or exclusion of myocardial infarction or acute coronary syndrome (ACS) (P. ). Health care providers rely on effective tests and assessment protocols for definitive diagnosis of ACS. Cardiac biomarkers in troponin T assays enable rapid exclusion of ACS. ⋯ In the preintervention group, 4 (2.7%) patients were readmitted within 30 days with ACS; no readmissions were reported for the postintervention group. Findings supported outcome improvements with the high-sensitivity troponin T assay. Using high-sensitivity troponin T assay in the diagnosis protocol can improve length of stay for patients with exclusion of ACS and reduce unnecessary stress tests during the ED stay.
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Intimate partner violence (IPV) is a significant public health problem that has profound effects on the physical and psychological well-being of millions of Americans. It is known that strangulation is one of the most lethal forms of IPV. ⋯ Because the emergency department (ED) is frequently the first point of contact for an individual who has experienced any type of IPV, it is imperative that providers have the knowledge and skill set for the identification and management of this patient population. The purpose of this article is to present a discussion of the challenges faced by ED providers in the clinical decision-making process when caring for a patient who has experienced nonfatal strangulation.
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Randomized Controlled Trial
Effects of Video Discharge Instructions on Patient Understanding: A Prospective, Randomized Trial.
Previous studies demonstrated that patients have difficulty understanding and retaining discharge instructions due to the lack of time spent counseling patients and low health literacy rates. The purpose of this study was to evaluate the effects of video instructions on patient understanding of their discharge instructions. This was a prospective, randomized, controlled trial of a convenience sample conducted in a military hospital emergency department. ⋯ Baseline characteristics between groups were not significantly different (30 video discharge instructions and 30 standard discharge instructions). We found a significant difference between groups with respect to discharge instructions knowledge in favor of the video discharge instructions group (4.53 vs. 4; p = 0.009). Video discharge instructions, used as an adjunct to standard verbal and written discharge methods, improved patient understanding and retention of their discharge instructions.
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Pediatric concussions are common and many children seek care in emergency departments. Providing concussion discharge instructions to patients and families is part of routine standard of care. The objective of this study was to determine whether the use of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) improves the caregiver's knowledge of injury management, specifics about returning to school and sports activities, and outpatient follow-up. ⋯ Demographic characteristics were similar between groups. Caregivers who received the ACE-ED DI reported a 24% increase in helpfulness of written materials (p < 0.001), a 25% increase in perceived understanding about concussion injury and management (p < 0.001), a 23% increase in understanding about returning to school activities (p < 0.001), and were 17% more likely to follow up with their primary care provider (p < 0.001). The ACE-ED DI used in a PED was found to be more effective at increasing caregivers' perceived knowledge of concussion management, specifics about returning to school and sports activities, and outpatient follow-up.
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Necrotizing fasciitis is a rapidly progressing soft tissue infection associated with a high rate of mortality. Vibrio vulnificus, a gram-negative bacillus found in warm seawater, is a rare but serious cause of necrotizing fasciitis. Definitive treatment is often delayed because of the vague clinical manifestations associated with the early stages of the disease. ⋯ Health care providers in northern and inland areas must be aware of patients who have recently traveled to regions where V. vulnificus is more common, such as warm coastal regions. Early fasciotomy, debridement, and culture-directed antimicrobial therapy are essential to improve survival. The case presented in this report highlights the importance of early diagnosis of V. vulnificus-associated necrotizing fasciitis.