Advanced emergency nursing journal
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This study identifies characteristics of patients who return to the emergency department (ED) within 72 hr after an initial visit. An exploratory quantitative descriptive study was conducted to identify characteristics of patients with unscheduled 72 hr ED returns. The sample consisted of all patients with 72 hr ED return visits for the month of January 2009 at the study facility. ⋯ The most common diagnoses were for gastrointestinal complaints. Over a third of the patients who returned had chronic health conditions. There were more emergency department return visits in individuals who lacked access to primary care.
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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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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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This is Part II of a 2-part series on wound care and laceration repair for advanced practice nurses. In Part I, the phases and categories of wound healing were outlined. The factors that affected wound healing were also discussed along with an approach for systematic wound management. ⋯ Patient preparation, including wound cleansing, irrigation, scrubbing, and debridement were also covered along with anesthetic and analgesic tips and techniques for advanced practice nurses (APNs) in emergency care. In Part II, wound closure (e.g., sutures, staples, and adhesives) and wound closure techniques are discussed along with the pertinent aftercare instructions for patients with these wounds. Implications for APNs caring for patients with wounds in emergency care are also presented in this article.