Advanced emergency nursing journal
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Apneic oxygenation during intubation is the application of oxygen via a nasal cannula, which is left in place throughout laryngoscopy. The flow rate of oxygen is set to at least 15 L/min and theoretically reduces the risk of oxygen desaturation and hypoxemia during the procedure. ⋯ Despite conflicting results, use of apneic oxygenation is becoming more prevalent and is being implemented into standard operating procedures in some clinical settings. Because of the low risk of adding a nasal cannula during intubation and the potential benefit of reducing the incidence of hypoxemia and severe oxygen desaturation, it would be prudent to implement apneic oxygenation when available.
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Randomized Controlled Trial
A Randomized, Double-Blind Trial to Determine if Vapocoolant in the Adult Population Improves Patient Perception of Pain With Peripheral Intravascular Access.
The purpose of this study was to investigate whether the use of a topical anesthetic spray (vapocoolant) at the site of intravenous access reduces pain and anxiety associated with peripheral intravenous (PIV) catheter insertion in an adult emergency department population. A randomized, double-blind, placebo-controlled, single-center trial, conducted from July to August, in an adult emergency department where 72 patients with orders for PIV insertion receiving either topical vapocoolant spray (n = 38) or placebo spray (n = 34). Vapocoolant or placebo was applied to the intravenous site and allowed to evaporate before cleansing and insertion. ⋯ Eighty-nine percent of nurses and patients would use vapocoolant in future procedures, whereas 74% would use placebo; the difference was not significant (p > 0.05). No skin blanching or lesions were noted. Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a topical anesthetic spray or placebo.
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The purpose of this article is to present a discussion of a young adult patient with exertional rhabdomyolysis. Rhabdomyolysis is the process of muscle tissue destruction and damage to the cell membrane, with subsequent release of the intracellular myocyte contents into the systemic circulation. ⋯ Rhabdomyolysis as a syndrome can be difficult to recognize and diagnose in the emergency care setting due to the fact that there are many etiologies and variations in symptomatology. The emergency care provider must have an astute knowledge base of this disease process and consider this pathology in the differential diagnosis of any patient at risk to achieve optimum patient outcomes and reduce morbidity and mortality.
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Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. ⋯ The plan-do-study-act model was applied with descriptive analysis of the data. Reflective of established specific aims of the project, there was increased (1) support for the use of evidence-based practice guideline among the ED providers and staff, (2) use of evidence-based practices, (3) connection of patients to community resources, (4) evidence-based education for patients, and (5) overall satisfaction with pain management. The effectiveness of the application of this primary care guideline in the ED opens the way both for region-wide application of the guidelines and for the introduction of other primary care practice guidelines for patients who present to the ED with other chronic conditions.
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Health care practitioners serve an important role in identification and assistance of human trafficking victims. Advanced practice registered nurses, including certified nurse midwives, clinical nurse specialists, and nurse practitioners, are in a unique position to interact with persons trafficked and seen in the clinical setting, yet they require knowledge to identify the signs of human trafficking. ⋯ A patient-centered, trauma-informed approach can provide a safe environment to sensitively screen patients for human trafficking. Advanced practice registered nurses should be able to assess for trafficking indicators, collaborate with multidisciplinary service providers, and ensure understanding and availability of federal, state, and local resources to manage the care of victims of trafficking.