Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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Patients with excited delirium present a challenge to both law enforcement and health care personnel because handcuffs, the traditional method used to keep persons from harming themselves and others, may be fatal. The patient's survival depends upon rapid recognition and treatment, including chemical sedation, decreased environmental stimulation, intravenous fluids, and other supportive interventions. Excited delirium protocols should be established to ensure rapid and appropriate treatment to ensure patient survival and the safety of those caring for them.
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Children who require emergency care have unique needs, especially when emergencies are serious or life-threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. ⋯ These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the Academic Pediatric Association, American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Pediatric Surgical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, Society for Academic Emergency Medicine, and The Joint Commission.
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Children account for numerous ED visits each year, with the majority of children reporting pain or requiring painful procedures. The fast-paced, noisy environment, varying resources, and staff trained in taking care of pediatric patients make the ED a unique place to care for children in pain. Nonpharmacological interventions are an essential part of pain management. The purpose of this review was to examine what nonpharmacological interventions EDs are using for pain management in children ages birth to 18 years. ⋯ Findings suggest nonpharmacological interventions such as distraction, positioning, sucrose, and cold application may be helpful in pediatric pain management in the ED. Nurses can implement these methods independently when caring for children and their families. In addition, nonpharmacological methods are relatively inexpensive to organizations.
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Admission of in-custody patients into an overtaxed emergency department is often frustrating for both law enforcement and ED staff. To facilitate collaboration between law enforcement and ED staff, it would be advantageous to initiate a professional interagency task force. ⋯ One common area of overwhelming agreement between the agencies was the need for such a task force. The data suggest the urgent need for mutually agreed upon policies and procedures for in-custody patients for both agencies to provide a safe environment for all involved.