Advanced emergency nursing journal
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Out-of-hospital cardiac arrest continues to be associated with high morbidity and mortality as the mortality rate has been documented to be as high as 90% in patients who experience the insult at home. For those who survive, more than 50% will have some form of brain damage. ⋯ However, therapeutic hypothermia has been evaluated in 2 landmark randomized, controlled trials in patients who experienced an out-of-hospital cardiac arrest with the results showing an improvement in both neurologic outcomes and mortality. Providers must be familiar with the rationale behind the therapy, the physiological effects of the cooling and rewarming processes, and the pharmacologic management that aides in improved outcomes and minimizes complications.
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Review Meta Analysis
Therapeutic hypothermia initiated in the pre-hospital setting: a meta-analysis.
After resuscitation of the cardiac arrest patient, reperfusion to the brain begins a cascade of events that may lead to permanent brain damage. Cooling suppresses the inflammatory response related to ischemia and metabolic demand, improving oxygen supply to anoxic areas. Until recently, cooling was only performed in the hospital setting. ⋯ The primary purpose of this study was to examine the feasibility and safety of pre-hospital hypothermia via data extraction from randomized controlled trials and statistical meta-analysis. Studies included in this analysis did show a significant statistical difference with the ability to lower the body temperature when beginning pre-hospital cooling immediately, making it feasible to start therapeutic hypothermia in the pre-hospital setting. Further research is needed to determine neurological and discharge outcomes as the studies were not powered to determine statistical significance.
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Skin and Soft Tissue Infections (SSTI's) with abscess are commonly seen in the Emergency Department (ED) setting. Given the increasing prevalence of methicillin-resistant Staphylococcus-aureus (MRSA)-related abscesses, appropriate evidence-based decisions are essential in assuring successful treatment. ⋯ Evidence indicates that the use of Clinical Decision Support (CDS) tools is valuable in improving provider awareness and adherence to clinical guidelines. This study was conducted to examine whether the development of a CDS tool to guide order entry for the treatment of MRSA-related SSTI's and embed it into the electronic medical record program would improve provider adherence to the North Carolina Consensus Guideline for Management of Suspected Commmunity-Acquired MRSA Skin and Soft Tissue.
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This case study describes a 72-year-old man who complained of epigastric abdominal pain, indigestion, fatigue, and shortness of breath for 2 days. He subsequently sustained a witnessed cardiac arrest with resuscitation and return of circulation. ⋯ This article discusses the pathophysiology, use of the hypothermia protocol and also inclusion and exclusion criteria. Educational information within the article provides guidelines for the advanced practice nurse regarding the use of therapeutic hypothermia in resuscitated patients.
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The purpose of this review was to summarize the findings of published reports that investigated quality-related outcomes and emergency department (ED) crowding. Of 276 data-based articles, 23 reported associations between patient outcomes and crowding. These articles were grouped into 3 categories: delay in treatment, decreased satisfaction, and increased mortality. ⋯ Nursing care has been shown to contribute to both positive and negative patient outcomes in other settings. Building an understanding of how ED crowding affects the practice of the emergency nurse is essential to examining how nursing care, surveillance, and communication impact outcomes of emergency patients. Investigation into nurse-sensitive quality indicators in the ED has potential to develop strategies that deliver high quality of care, regardless of crowded conditions.