Advanced emergency nursing journal
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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.
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Nursemaid's elbow (subluxation of the radial head) is a common pediatric upper extremity injury encountered in the emergency and urgent care settings. Subluxation of the radial head accounts for more than 20% of upper extremity injuries in the pediatric population. A clinical case of a three-year old girl who presented to the emergency department with a nursemaids elbow requiring reduction is presented in this article. The purpose of this article is to discuss the identification and treatment of this injury and delineate the two methods of supination and pronation for reduction of the annular ligament.
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Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.
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Case Reports
Factors affecting fluid resuscitation in the burn patient: the collaborative role of the APN.
Throughout the first critical 24 hr after the injury is sustained, the burn patient must receive fluid resuscitation to prevent hypovolemia and ensure adequate tissue perfusion. Delayed or inadequate fluid resuscitation results in suboptimal tissue perfusion, which can lead to multisystem organ failure and death. Overresuscitation can be more problematic than underresuscitation and has been associated with the development of abdominal compartment syndrome, compartment syndrome of the extremities, airway obstruction, and pulmonary edema. ⋯ Factors affecting fluid resuscitation in the burn patient are at the cornerstone of burn management. The advanced practice nurse (APN) can play a vital role in implementing strategies to ensure optimal resuscitation in the burn patient. Through collaboration, the APN in both the burn center and the emergency department must make certain that the educational needs of the staff are addressed and be diligent in providing significant education, essential tools, and assistance to the staff nurses in an effort to promote best-practice and evidence-based care.
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The purpose of this study was to examine how and to what extent current societal and healthcare trends impact the educational needs of the emergency nurse. In addition, this study sought to draw upon that information to facilitate the development of expert consensus about the major educational priorities for emergency nurses during the time period from 2008 to 2018. A mixed methodology, qualitative-then-quantitative study design using a Delphi method was employed for this research. ⋯ Societal and healthcare trends that were ranked as having the most significant impact on emergency nursing included emergency department overcrowding, increasing patient complexity and acuity, access to healthcare, mental and behavioral health needs, and an aging population. Educational themes or topics that were ranked as being an extremely high priority for emergency nursing included critical thinking, core emergency nursing competencies, triage, pediatric patient care, medication and patient safety, and individualized orientation programs for emergency nurses. An analysis of the highest priority educational themes indicates that emergency nursing experts are concerned with not only the content of educational programs but also the pedagogy used to provide educational opportunities to current and future emergency nurses.