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One new study suggests that crowding in the ED does not necessarily prevent patients who are having ST-segment-elevation myocardial infarction (STEMI) heart attacks from receiving needed treatment quickly.
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Like many EDs across the country, the ED at St. Charles Medical Center in Bend, OR, sees its share of patients with urgent or primary care needs, and many of these patients frequent the ED 10 or more times a year.
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The medical literature is rife with information on the trends of various infectious diseases. Much of this begins with the diagnosis made and helps us connect the diagnosis to a preferred regimen of antimicrobials or antivirals. The real detective work starts before this. Our tools are constant vigilance for subtle clues in the history and physical examination, some nonspecific laboratory tests (for example white blood cell [WBC] count or lactate), and a high level of suspicion for infection.
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Regardless of hospital trauma level designation, every emergency department (ED) manages patients with traumatic injury and needs to address the pain and discomfort that accompanies it.
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My hospital has a contract to provide medical care to the county jail. At any one time, there are more than 10,000 inmates in the county jail facilities supervised by the sheriff's office. We often see patients who are in custody and have sustained trauma, sometimes from less than lethal weapons. In my humble opinion, these devices reduce the risk of injury to the law enforcement officer when attempting to arrest or control a violent individual, and they greatly reduce the risk of serious injury or even death to the violent individuals themselves. However, even these less than lethal force weapons can cause significant damage when used at close range or on individuals with underlying medical conditions that render them vulnerable to the effects of these weapons.
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My emergency department (ED) has had an electronic medical record for the past two years. Part of that record includes a medication list that is created from past encounters and updated by the triage nurse. Because it is electronic and prints out nicely in the triage summary, it has the appearance of truth. My experience with the list is likely similar to some of yours: Patients are often taking medications not on the list and are not currently taking those that are.
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ED patients often don't understand important information in their discharge instructions, according to a new study, which can result in bad outcomes and needless repeat visits.
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Patients with shortness of breath are "one of the highest priority patients" for ED nurses because of their tendency to rapidly deteriorate, says Alexandra Penzias, RN, MEd, MSN, CEN, an ED educator at Tufts Medical Center in Boston, MA. "We perform a complete set of vital signs, oxygen saturation, and peak flow measurements at triage," she says.
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A young girl experiencing hallucinations presents to an ED after being evaluated at another hospital, and twice referred for psychiatric care. "Her diagnosis was, in fact, a potentially life-threatening underlying cardiac disorder. Unfortunately, that missed diagnosis is not uncommon," says Deena Brecher, MSN, RN, ACNS-BC, CEN, CPEN, a clinical nurse specialist in the ED at Alfred I. duPont Hospital for Children in Wilmington, DE.
