Emergency department

The ambulance vehicle should be prepared properly to receive and transport the victim and possibly the rescuers. All personnel involved in the transport should be properly dressed in protective clothing. The hospital should be advised immediately of the situation so prepzirations can be made to prevent contamination of emergency department. Bring all available information on the contaminant to the hospital. 

In assessing Ms. Potter, age 52 years, in the emergency department you find that she has a decreased urinary output, concentrated urine, and poor skin turgor and is confused. She reports nausea and states she has been vomiting all morning. Explain what is the most important information obtained from your assessment of Ms. Potter. Determine what action you would take first. 

Ms. tbnes is admitted to the emergency department in hypertensive crids. Nitroprusdde therapy is begun, and you are asked to monitor this patient. Discuss important pomts that the nurse should keep in mind when adminidering this drug. Identify methods you would use to monitor the patient and prevent complications. 

A patient enters the emergency department with an acute MI. Thrombolytic therapy is begun with streptokinase Discuss ongoing assessments that are important for the nurse to perform. 

If tiie drug cannot be taken orally for any reason or if diarrhea occurs, contact the primary health care provider immediately. If you are unable to contact tiie primary health care provider before the next dose is due, go to the nearest hospital emergency department (preferably where the original treatment was started or where the primary health care provider is on tiie hospital staff) because the drug has to be given by injection. 

Substance Abuse and Mental Health Services Administration Emergency Department Trends from the Drug Abuse Warning Network, Preliminary Estimates January-June, 2001 with Revised Estimates 1994—2000 (DHHS PublNoSMA-02-3634). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2001... 

SharmaAN, Lombardi MH, Illuzzi FA, et al Management of gamma-hydroxybutyrate withdrawal. Ann Emerg Med 38 603-607, 2001 Sherlock K, Wolff K, Hay AW, et al Analysis of illicit ecstasy tablets implications for clinical management in the accident and emergency department. Emerg Med J 16 194-197, 1999... 

Weiner AL, Vieira L, McKay CA, et al Ketamine abusers presenting to the emergency department a case series. J Emerg Med 18 447-M51, 2000... 

Williams H, Dratcu L, Taylor R, et al Saturday night fever ecstasy related problems in a London accident and emergency department. Emerg Med J 15 322—326, 1998... 

Anthony F, Brown T, McKinnon D, Chu K Emergency department anaphylaxis a review of 142 patients in a single year. J Allergy Clin Immunol 5 2001 108 861-866. 

Smit DV, Cameron PA, Rainer TH Anaphylaxis presentation in a emergency department in Hong Kong incidence and predictors of biphasic reactions. J Emerg Med 2005 28 381-388. 

Retrospective studies involving a review of emergency department records [28], or a cross-sectional survey [29], indicate that 16-19% of people who require an initial dose of epinephrine in food-triggered anaphylaxis in community settings subsequently required a second dose. 

Many people who have experienced anaphylaxis in the community and are therefore at risk for recurrence have never received a prescription for an epinephrine autoinjector from an emergency department physician [38, 39] or from their primary care physician. Some of those who have received a prescription for an epinephrine autoinjector do not follow through and get it filled [40]. Even if they do get the epinephrine autoinjector dispensed, they may fail to carry it with them at all times [41]. Adherence to instructions to carry epinephrine can be improved with regular input from a healthcare professional [42] however, healthcare professionals need to master the complexities of epinephrine autoinjector use [43] before instructing others. People who have survived a mild anaphylaxis episode that was not treated at all, or was treated only with an antihistamine or an asthma puffer, sometimes fail to inject epinephrine because they erroneously assume that their subsequent reactions will also be mild [44]. 

Clark S. Bock SA, Gaeta TJ, Brermer BE, Cydulka RK. Camargo CA Mulficenter study of emergency department visits for food allergies. J AUergy Clin Immunol 2004 113 347-352. 

Clark S, Long AA, Gaeta TJ, Camargo CA Jr Mulficenter study of emergency department visits for insect sting allergies. J Allergy Clin Immunol 2005 116 643-649. 

Gaeta TJ. Clark S, Pelletier AJ. Camargo CA National study of US emergency department visits for acute allergic reactions, 1993-2004. Ann Allergy Asthma Immunol 2007 98 360-365. 

CT scanners are now nearly ubiquitous in or near the emergency departments of most North American hospitals. With multislice scanners, a noncontrast CT (NCCT) examination of the brain can be performed in well under 1 minute, with the newest scanners able to scan the head in 10 seconds or less. In most centers, the first (and sometimes only) imaging study undertaken for patients with suspected acute stroke is NCCT. 

Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG. CT and conventional and diffusion-weighted MR imaging in acute stroke study in 691 patients at presentation to the emergency department. Radiology 2002 224 353-360. 

Patient care areas Acute stroke teams Written care protocols Emergency medical services Emergency department Stroke unit... 

Schwamm LH, Rosenthal ES, Hirshherg A, Schaefer PW, Little EA, Kvedar JC, Petkovska I, Koroshetz WJ, Levine SR. Virtual Telestroke support for the emergency department evaluation of acute stroke. Acad Emerg Med. 2004 11 1193-1197. 

Depending upon the location and severity of the stroke at admission, patients may have cardiac and/or respiratory instability at the time of presentation to the emergency department (ED). They may need to be stabilized hemodynamically or intubated for airway protection or respiratory distress. Blood pressure management is often a crucial management issue, and the use of vasopressor or antihypertensive medications is common. In stroke patients at risk for malignant cerebral... 

Fewer than half of all patients with acute stroke are seen in the emergency department (ED) within 3 hours of symptom onset." Patients in remote locations or in hospitals without available stroke expertise may have even more limited access to thrombolysis. In a study of non-urban East Texas communities in the United States, only 1.4% of patients with ischemic stroke received IV rt-PA, versus 14.7% at a university hospital in Houston, the nearest major city. Other studies have linked racial, ethnic, geographic, or socioeconomic differences to low rates of rt-PA utilization," suggesting that populations most underserved by stroke expertise may have the lowest rates of rt-PA delivery. 

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