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A simple fall in a healthy person shouldn't result in multiple facial injuries, except if the patient was intoxicated, says Regina Curry, RN, an ED nurse at Thomas Jefferson University Hospital in Philadelphia. Instead, patients might break their wrist or skin their knees and hands from trying to break the fall, she says.
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Once a patient with violence-related traumatic injuries is stable and about to be discharged, you have to consider something equally important: Will he or she be safe after they leave your ED?
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If a patient complains of chest pain, you probably suspect a myocardial infarction (MI) and obtain an immediate electrocardiogram (EKG). But it doesn't show any signs of a heart attack. What do you do next?
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"Undiagnosed or new-onset seizure in infants is always a critical emergency, mostly because we need to figure out the underlying cause and treat it before it worsens," says Jennifer Anders, MD, an ED physician at Johns Hopkins Children's Center in Baltimore.
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Has your patient used cocaine? Not knowing the answer to this question could be life-threatening for your patient because the wrong medications might be given, says a new report on management of cocaine-associated chest pain and myocardial infarction.
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Young people with a history of Type I diabetes, juvenile obesity, hypertension, sickle cell anemia, smoking, or recreational drug use are at considerable risk for myocardial infarction (MI), even in their 20s, says James Hardecki, RN, ED nurse at Henry Ford Hospital in Detroit.
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Always ask about recent cocaine use when a younger individual presents to the ED with possible cardiac symptoms, says Pamela Tokarski, RN, an ED nurse at Henry Ford Hospital in Detroit.
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Patients may be hesitant to admit cocaine use, either because they fear legal consequences or because they don't want family members to know, says Pamela Tokarski, RN, an ED nurse at Henry Ford Hospital in Detroit. Do the following to obtain a truthful response:
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Because a woman with chronic pain failed to tell ED nurses about the fentanyl patch she was wearing, she was given a second fentanyl patch and intravenous morphine for breakthrough pain.
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Young gymnasts may be more stoic than other kids you treat. "So you really have to use all your clinical tools: History, physical exam and X-rays to determine whether it's something more significant or not," says Robert Frederick, MD, sports medicine specialist at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia.
