Advanced emergency nursing journal
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Rapid sequence intubation is a stepwise process developed to assist health care providers in placing emergent artificial airways for patients requiring assisted ventilation. This practice includes routine administration of sedative and neuromuscular blocking agent (NMBA) medications for patient comfort during endotracheal tube placement. ⋯ Recent drug shortages have forced many health care professionals to use alternative medications with which they are less familiar. The intent of this review is to familiarize health care providers with the pharmacology and adverse effect profiles of alternative sedative and NMBA medications used in emergent airway placement in light of recent drug shortages.
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Randomized Controlled Trial
EMLA application exceeding two hours improves pediatric emergency department venipuncture success.
The purpose of this study was to determine whether placing Eutectic Mixture of Local Anesthetics (EMLA) at emergency department (ED) triage improves venipuncture success. Emergency department triage nurses prospectively identified patients aged 0-18 years assessed to have 50% or greater chance of needing venipuncture while in the emergency department. Identified patients received EMLA or no intervention according to randomized 24-h blocks. ⋯ Barriers to triage EMLA placement should be evaluated. Application longer than 2 h should be studied further as a means to improve success. EMLA was supplied as a part of the Investigator-sponsored study program of AstraZeneca.
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Social media is a growing and popular means of communication. It is understandable that health care providers may not share identifying information on patients through these sources. ⋯ The health care provider may be faced with an ethical and possibly legal dilemma when social media is present in the emergency department. This article seeks to discuss the legal and ethical principles surrounding social media in the emergency department.
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This study aimed to describe characteristics, outcomes, and post-emergency department (ED) departure medical requirements of patients who did not wait (DNW) or left against medical advice (LAMA) after presenting to an Australian hospital ED over a 6-month period. This was a prospective cohort follow-up study. Children and adults were compared in terms of ED characteristics and outcomes. ⋯ One in four of the DNW/LAMA patients were children (<16 years). Most (87%) waited longer than the recommended time before leaving the ED, the majority (56%) sought care elsewhere, and some (n = 174, 13%) re-presented to the ED within 7 days; 20 of those required hospital admission. Strategies addressing front-end ED systems are required to mitigate the proportion of patients who DNW/LAMA.
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Case Reports
The differential diagnosis of syncope: a guide for emergency department advanced practice nurses.
Syncope is common in patients presenting in the emergency department, and it is essential that advanced practice nurses (APNs) be able to quickly and efficiently risk-stratify these patients. The importance of a thorough and accurate history and physical examination cannot be understated in diagnosing the pathology of syncope. Although vasovagal syncope is the most common cause of syncope, it is important to rule out the life-threatening causes of syncope first. ⋯ APNs can also decide whether an inpatient admission is warranted or whether the patient can be safely discharged with outpatient follow-up. The importance of the history and physical examination as the best tool that APNs can use has been highlighted. Finally, implications for APNs in treating patients presenting with syncope are discussed.