Advanced Emergency Nursing Journal

doi: 10.1097/tme.0000000000000368pmid: 34397494

doi: 10.1097/tme.0000000000000369pmid: 34397498

Hoyt, K. Sue; Dowling Evans, Dian; Hoyt, K. Sue; Davis, Wesley D.; Wilbeck, Jennifer

doi: 10.1097/tme.0000000000000366pmid: 34397491

Evans, Dian Dowling; Davis, Philip; Evans, Dian Dowling

doi: 10.1097/tme.0000000000000359pmid: 34397492

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse and to assist with the translation of research into practice. A topic and a research study are selected for each column. A patient scenario is presented as a vehicle, in which to review and critique, the findings of the selected research study. In this column, we review the conclusions of A. Malinovska, L. Pitasch, N. Geigy, C. H. Nickel, and R. Bingisser (2019) from their article, titled “Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients.”

Weant, Kyle A.; Matuskowitz, Andrew J.; Weant, Kyle A.; Gregory, Haili; Field, Michael E.; Calhoun, Chara; Bushkar, Brent J.; Hall, Gregory A.; Caporossi, Jeffrey

doi: 10.1097/tme.0000000000000358pmid: 34397493

Martinez, Nicole; Shahidi-Dadras, Mohammad; Shahrigharahkoshan, Shaghayegh; Yazdi, Esmat; Fatemi, Alireza; Mahboubi-Fooladi, Zahra; Dadkhahfar, Sahar

doi: 10.1097/tme.0000000000000361pmid: 34397495

COVID-19 is a major health issue, and patients with underlying conditions are more susceptible to catastrophic outcomes. Toxic epidermal necrolysis (TEN) is a severe systemic disease caused by an immune system hypersensitive reaction. We present a case of TEN induced following sulfasalazine administration that later on complicated with COVID-19, deep vein thrombosis, pulmonary emboli, and eventually death.

Ramponi, Denise R.; Sweeney, Michael; Ramponi, Denise R.

doi: 10.1097/tme.0000000000000362pmid: 34397496

A 9-year old male presented to the emergency department for the evaluation of a sore throat. Initial history of present illness stated in the triage note was that “the child complained of a sore throat,” suggesting possible pharyngitis. There was no evidence of stridor, sialorrhea, hypoxia, or aphonia. Further investigation of the history of present illness identified the concern for a possible esophageal foreign body. Imaging studies of the neck identified a fishbone in the esophagus. This case presentation discusses an atypical presentation of an esophageal foreign body and the subtle findings on assessment and imaging. This case highlights the importance of illiciting a history of present illness and the subtleties of esophageal foreign body identification.

Wilbeck, Jennifer; Campo, Theresa M.

doi: 10.1097/tme.0000000000000356pmid: 34397497

Lacerations to the face and lips are commonly seen in the emergency setting from dog bites, falls, and blunt trauma (motor vehicle crash, strike with an object, etc.). Lip lacerations, especially involving the vermilion border, can be most challenging and deforming, especially when greater than 25% of the lip is involved. These lacerations require preciseness for a good cosmetic outcome. Lips are a highly visible facial structure and consist of 3 layers: skin, muscle, and oral mucosa. They are used for speech, food consumption, and tactile sensation (Lammers & Scrimshaw, 2019; Lent, 2020).

Davis, Wesley D.; Davis, Wesley D.; Goettl, Bradley; Bowden, Leah

doi: 10.1097/tme.0000000000000357pmid: 34397499

An 87-year-old female patient presented with altered mental status. During the routine workup for altered mental status, an electrocardiogram (ECG) was obtained. The ECG showed T-wave morphology known to be consistent with myocardial infarction. Although the ECG is a crucial diagnostic tool to recognize myocardial ischemia and infarction promptly, it must be understood that T-wave abnormalities can represent noncardiac pathology. A case presentation illustrates a unique ECG change whose presence is associated with catastrophic central nervous system diseases that cause increased intracranial pressure.

Shillington, Kelly; Thompson, Cameron; Saraga, Stephanie; Soch, Laura; Asomaning, Nana; Borgundvaag, Bjug; McLeod, Shelley L.

doi: 10.1097/tme.0000000000000363pmid: 34397500

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.