Ultrasound-guided fascia iliaca blocks in the emergency department

Each year, over 300,000 individuals aged 65 and older are hospitalized for hip fractures in the United States.¹ Traditional pain management in the elderly population is difficult because of physiologic changes and comorbidities.² Peripheral nerve blocks are often placed by anesthesia professionals following hip surgery as part of a multi modal pain management program. Recently, the placement of fascia iliacal blocks has been successfully utilized in the emergency department for geriatric patients suffering from hip fractures. This technique can be easily mastered with proper training for use in the emergency department and pre-hospital environments reducing the pain of hip fracture and its associated risks of morbidity. This article provides a detailed review of anatomy and an ultrasound-guided technique for placement of the fascia iliaca block.     

Medication safety issues in the emergency department

Medications used in emergency medicine are often "high alert" medications that have to be handled with deliberation. These medications, used every day in the emergency department, are associated with numerous errors. Even newer medications are prone to error. This makes it important for emergency department nurses and health care professionals to develop and implement mechanisms for preventing error. Safety data has shown that these "high alert" medications must be handled appropriately.     

Local anesthetics and peripheral nerve blocks in the emergency department

The emergency physician has a variety of options for providing effective pain relief. A solid understanding of the local anesthetic agents and regional anesthetic techniques is an essential component of every emergency physician's analgesia armamentarium.     

Personal safety in the accident and emergency department

Violence and aggression continues to be a significant problem for staff practising in accident and emergency (A&E) areas. In recent years the number of articles examining factors related to violence and aggression in the A&E department have steadily increased, allowing for a more in-depth examination of data. This article considers the characteristics of individuals who assault A&E staff, introducing the reader to the "recreational fighter", an individual who enjoys and is attracted to violent confrontations. The article goes on to consider the role of gender, alcohol, age and social history in relation to the characteristics of individuals who assault nursing staff practising in A&E and offers a number of strategies for nursing staff to consider when attempting to minimize the risk of personal physical assault.     

Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department

We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41 year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. The AC joint was located by US, and bupivacaine was injected into the joint effusion under US guidance, yielding near complete resolution of pain. In orthopedics and physiatry literature, US guided AC joint injections have been shown to be far more efficacious than landmark guided AC joint injections, yet this is the first known case documenting injection in the Emergency Department (ED). The superficial location of the AC joint, its ease of identification by US, and the rapid onset of analgesia by intra-articular injection makes the US-guided anesthetic injection of the AC joint an ideal tool to incorporate into a multimodal approach to pain management in AC joint separations.     

急诊科单个病例的非技术性急救管理问题探讨

急救是急诊科最重要的工作内容,急救具有突发性、严重性及复杂性等特点。急救管理,是指在急救发生时对急救过程的一系列组织管理,使急救规范、有序进行,以提高急救成功率及减少风险。急救中的非技术性问题是指病情判断、用药、手术方法或策略等技术性问题之外的其他问题,     

Principles of basic wound evaluation and management in the emergency department

The primary objectives of basic wound management center around promoting optimal wound healing and cosmesis. These objectives may be achieved through the systematic assessment, preparation, and repair of the laceration supplemented with appropriate patient care instructions. The meticulous and methodical management of traumatic wounds described in this article will assist the emergency physician in decreasing overall complication rates and help improve patient satisfaction.     

The safety of single-physician procedural sedation in the emergency department

Background

Pevious research has shown the safety of procedural sedation in the emergency department in university settings involving multiple emergency physicians.

Objective

To examine sedation in the emergency department conducted by a single emergency physician with monitoring by the emergency nurse.

Methods

The Procedural Sedation in the Community Emergency Department Registry is a prospective observational database of procedural sedation cases directed by the emergency physicians. Among other parameters, the registry tracts whether emergency physicians or emergency nurses monitored patient sedation. The incidence of complications and outcomes were compared between these two monitoring groups.

Results

1028 procedural sedations were performed on 977 patients at 14 sites. In 885 (86.1%) cases the emergency physician directed the sedation, and performed the procedure with monitoring by the emergency nurse. Complications occurred in 42 (4.1%) patients, 35 (4.0%) EN monitored patients and 6 (4.2%) EP monitored patients (p>0.7). Procedures were successful in 863 (97.5%) cases monitored by emergency nurses and in 140 (97.9%) patients monitored by emergency physicians (p>0.7).

Conclusion

Procedural sedation in the emergency department performed by a single emergency physician is safe and effective.Procedural sedation in the emergency department has been reported to be safe in university settings involving multiple physicians.^1,2,3,4,5 This study examines whether similar outcomes occur in procedures carried out by single emergency physicians with monitoring by the emergency nurse.     

流程管理在门急诊输液安全管理中的应用

目的探讨流程管理在门急诊输液安全管理中的应用。方法运用流程管理的理论和方法,调查分析门急诊输液安全管理中存在的问题并进行流程改善,重新制定出更加规范、科学的输液流程及安全管理规定,并实施、评价。调查统计新流程执行前后输液相关安全事件发生率、护士依从性、病人满意度。结果新流程执行后:(1)门急诊输液相关安全事件发生率明显降低(P0.001);(2)护士依从性明显提高(P0.001);(3)病人满意度明显增加(P0.001)。差异均有极显著意义。结论运用流程管理的科学理论和方法,可以有效提高门急诊输液安全管理质量。     

Improving the safety of continuously infused fluids in the emergency department

When an unexpected crisis happens to patients with multiple continuous infusion fluids in the emergency department (ED), nurses need to recognize specific medication promptly and accurately for appropriate action. This study aims to evaluate the efficiency of colour‐coded label system in ED fluids during an uneventful crisis simulation event. Promptness and accuracy of finding the correct fluid between the pre‐ and postintervention in each three groups (emergency nurses, intensive care unit nurses and nursing students) for three different scenarios (potassium, heparin and normal saline scenario) were assessed. Time improvement for all three groups from pre‐ to postintervention for all three scenarios were statistically significant (P < 0.001). There were no incorrect fluids indicated by all three groups of participants at postintervention analysis. Colour‐coded labelling system in a simulated environment significantly improved the promptness and accuracy of finding the correct fluid from multiple infused continuous fluids.     

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.     

Improving medication safety and patient care in the emergency department.

INTRODUCTION: Medication errors are well documented in medical literature and the lay press. Through participation in a nationwide institute for healthcare improvement initiative, our emergency department performance improvement group focused on human and system factors that contributed to potential medication errors. METHODS: A survey conducted of ED staff examined barriers to reporting medication errors and potential "near misses." members of the emergency department performance improvement group examined contents of the ed Pyxis machines, assessing medications that physically resembled one another, similar sounding medications located in close proximity, and medications available in differing doses. RESULTS: Fifty-eight members participated in a 4-question survey. Half reported they would be likely to self-report a "near miss" if the patient was not harmed. About half would report the medication error of a colleague under certain circumstances. Fifty-one percent believed there would be repercussions for reporting medication error, but most believed they would receive support from supervisors for addressing other safety problems. Nearly one quarter of the 278 medications identified in the Pyxis survey were similar in appearance or name or existed in multidose formulations. DISCUSSION: Measures to decrease the potential of medication errors include: (1) a workplace environment that promotes reporting of medication errors or "close calls" by staff, with counseling events utilized as learning opportunities versus punitive incidents; (2) increased frequency of medication safety in-service sessions; and (3) periodic monitoring of Pyxis machine inventories to survey contents for optimum patient safety.     

门急诊输液护理管理软件的开发与应用

目的调查分析半开放式精神病院院内感染情况，以寻求降低院内感染率的措施。方法查阅汕头大学精神卫生中心2003年住院患者病案，按医院感染调查表格要求逐项登记，按全国医院感染统一标准确定为院内感染的资料进行分析。结果半开放式精神病院院内感染率为8．5％，远低于封闭式精神病院的19．5％，与综合医院的8．0％相近。其中呼吸道感染为68．1％，胃肠道感染为14．9％，泌尿道感染为6．4％，皮肤软组织感染为10．6％。结论半开放式精神病院住院患者由于患病，生活自理差，导致入院初期院内感染率高，加强对住院精神患者的生活料理是降低半开放式精神病院院内感染的关键。     

Invasive ventilation in the emergency department: Part 2: Implications for patient safety

The use of mechanical ventilation in the Emergency Department requires adequate resources in order to maintain patient safety and avoid potential risks. Moreover, developments in technology require increased knowledge of mechanical ventilation techniques to address the complexity of decision-making involved. Organisational issues and system factors have the potential to negatively impact on the ability of the emergency service to provide optimum care to patients receiving mechanical ventilation. These issues include staffing and skill-mix, demand on emergency services, role-delineation, scope of practice, and current mechanisms for monitoring of quality and safety. Furthermore, in response to advances in ventilator technology, current education programs for both nursing and medical staff require review to ensure that they provide comprehensive information about the types of ventilation techniques now available and the relative risks and benefits associated with their application.This article is the second in a two-part series and explores the educational and organisational factors that impact upon safety and quality of care delivered to patients receiving mechanical ventilation in the emergency department. Recommendations for future policy development, curriculum review and reporting mechanisms to support further research in the application of mechanical ventilation in the emergency department are made.     

急诊科危重症患者院内转运的循证实践

目的 将急诊科危重症患者院内转运的最佳证据应用于临床实践,促进临床护理质量持续改进.方法 本研究以"证据的持续质量改进模式图"为理论框架,运用循证方法检索数据库获取最佳证据并应用于临床,比较最佳证据应用前后系统层面、护士层面及患者层面结局指标的变化.结果 系统层面,完善了急诊科危重症患者院内转运制度流程,修订了院内住院...     

Effectiveness and safety of droperidol in a United States emergency department

BackgroundDroperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED).MethodsObservational cohort study of all droperidol administrations from 1/1/2012 through 4/19/2018 at an academic ED. The primary endpoint was mortality within 24 h of droperidol administration. Secondary endpoint included use of rescue analgesics.ResultsA total of 6,881 visits by 5,784 patients received droperidol of whom 6,353 visits authorized use of their records for research, including 5.4% administrations in children and 8.2% in older adults (≥65). Droperidol was used as an analgesic for pain (N = 1,387, 21.8%) and headache (N = 3,622, 57.0%), as a sedative (N = 550, 8.7%), and as an antiemetic (N = 794, 12.5%). No deaths secondary to droperidol administration were recorded within 24 h. Need for rescue analgesia occurred in 5.2% of patients with headache (N = 188) and 7.4% of patients with pain (N = 102); 1.1% of patients with headache received rescue opioids (N = 38) after droperidol, as did 5.4% of patients with pain other than headache (N = 75). No patients had fatal arrhythmias. Akathisia occurred in 2.9%.ConclusionNo fatalities were seen among this large cohort of patients who received droperidol in the ED. Our findings suggest droperidol's effectiveness and safety when used as an analgesic, antiemetic and/or sedative.