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The first part of this series dealt with guidelines for the care of ischemic stroke. This issue applies the same principles of evidence-based medicine to hemorrhagic stroke and traumatic brain injury. Hemorrhagic stroke is less common than ischemic stroke, but can be more devastating.
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While rhythm disturbance may be a common presenting complaint among adult emergency department (ED) patients, the incidence of cardiac dysrhythmia among pediatric patients is relatively low. In one retrospective review, primary cardiac arrhythmias were identified in 13.9 per 100,000 pediatric ED visits.1 The incidence of these dysrhythmias peaked during infancy and then again in adolescence.1 Cardiac dysrhythmias in children may be due to primary conduction abnormalities or may occur in the setting of structural heart disease, metabolic derangements from toxic ingestions, or infections. Supraventricular tachycardias (SVT) represent the most common pediatric dysrhythmias in adolescents (an estimated 63% of all documented tachycardias).1 After a brief review of initial emergency management of dysrhythmia, the authors will emphasize important pediatric ECG parameters and how they differ from adults.
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Christiana Hospital in Newark, DE, averages between 315 and 320 patients per day. It's a huge ED, taking up a lot of space, explains Amy Whalen, RN, BSN, SANE-A, the assistant nurse manager in the ED.
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Process improvements typically take center stage whenever hospital administrators decide that patient throughput and patient satisfaction are not where they need to be.
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There is nothing like working on the front lines in a busy emergency department to learn about the impact of traumatic injuries. Consider, for example, the experiences of Brent Parry, NREMTP. Serving as a paramedic for LifeFlight, and as a tech for the ED at Geisinger Wyoming Valley (GWV) Medical Center in Wilkes-Barre, PA, Parry is often among the first to see patients who have been seriously injured.
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Pediatric stroke remains one of the top 10 causes of death in children, with a mortality rate of 0.6 deaths per 100,000 strokes, and almost all of those affected have a residual neurologic deficit.
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Measuring the number of ED malpractice claims that are avoided by calling patients post-discharge is difficult, acknowledges Jeanie Taylor, RN, BSN, MS, vice president of risk services for Emergency Physicians Insurance Company (Epic) in Roseville, CA. "It is hard to measure what did not occur, so the effectiveness of callback programs from a claims perspective is largely anecdotal," she says.
