Abstract Paronychia is a common emergency department presentation, representing up to 35% of hand infections. Standard of care involves incision and drainage, with systemic antibiotic therapy dependent upon the severity of the presentation. The treating emergency nurse practitioner (ENP) should consider factors that may impact wound healing, medications, comorbidities, and perform a thorough history and physical examination to properly address this common infection. This article describes a case of a 43-year-old female with about four weeks of gradually developing paronychia that presented to a community emergency department (ED) for treatment. This article will review the patient's case, including history and management to increase the skills of Emergency Advanced Practice Registered Nurses.
Abstract Pertussis, or as it is commonly known, whooping cough, is a highly contagious respiratory illness. Infants carry the burden of both significant morbidity and mortality from pertussis. Diagnosis can be complex because of the variability in symptoms and their varying onset, along with nonspecific symptoms of early disease. Luckily, there is an effective vaccine to prevent this serious infection. Therefore, as a nurse practitioner, we need confidence not only in the diagnosis and treatment of the disease but also in advocating for immunization to prevent infection.
Abstract Nurses play a key role in disaster management. Established disaster nursing competencies are available but lack consistent integration into curricula. As advanced practice registered nurses (APRNs), clinical nurse specialists (CNSs) have demonstrated evidence of leadership through crisis. Additional evidence is needed regarding CNS experiences during the pandemic to validate evidence of disaster competencies and clarify gaps. The study aims were to describe (1) how CNSs modified practice to respond to pandemic demands and (2) outcomes associated with CNS practice. This was a qualitative descriptive study involving 17 CNSs across the US Focus groups were conducted using a semi-structured interview guide. Data were analyzed using content analysis. The overarching category associated with CNS practice was “navigating the unknown.” Six subcategories emerged, including creating best practices, being a communication conduit, adapting work routines, providing psychological support, filling education gaps, and coordinating care. CNSs are the practice leaders from the front line to the boardroom, ready to inform strategic planning, and systems to prepare and respond to emergencies. Advanced level disaster management preparation is essential for APRNs to actualize strategic capabilities within health care systems. Disaster management education recommendations based on study results should be used to inform CNS practice competencies and academic curriculum.
Abstract Calcium channel blocker (CCB) overdose is a life-threatening toxicologic emergency characterized by profound cardiovascular instability. Emergency medicine personnel play a critical role in the early recognition, hemodynamic stabilization, and ongoing monitoring of these patients. This review provides a clinically focused discussion of the pathophysiology, clinical presentation, and emergency department management of CCB toxicity, with particular emphasis on intravenous fluids, atropine, calcium salts, vasopressors, hyperinsulinemic-euglycemic therapy, intravenous lipid emulsion, methylene blue, and extracorporeal membrane oxygenation. This review highlights the priorities in the monitoring and titration of therapies, underscoring the importance of a structured, multimodal approach to treatment. Early recognition and timely escalation of care are essential to improving outcomes in this high-risk population.
