Academic literature on the topic 'Emergency nursing Victoria Case studies'

Case Presentation: A 37-year-old man with severe obstructive sleep apnea presented to the emergency department with burning pain, redness and swelling in his hands and feet, worsening for several weeks. Pertinent laboratory studies revealed polycythemia. Discussion: Erythromelalgia is a clinical diagnosis characterized by painful burning, erythema, warmth, and edema usually involving the distal extremities. Therapeutic goals are focused on symptom reduction, while also managing the underlying condition in cases of secondary erythromelalgia. Pharmacological and non-pharmacological therapies have proven to be of limited success.

Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology. Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis. Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day. Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.

Introduction: Point-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock. Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings. Case Report: We discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention. Conclusion: In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.

Case Report: A 38-year-old male with no pertinent medical history presented with suicidal ideation and alcohol intoxication after an altercation with the police. The patient received two CEW exposures during an encounter with law enforcement prior to transport to the emergency department. He was asymptomatic, but an ECG was performed as part of the triage process given his reported CEW exposure. His initial ECG showed ST-segment and T-wave changes in the precordial leads similar to those found in Brugada syndrome. After a three-hour period of observation and resolution of the patient’s alcohol intoxication, a repeat ECG was performed that showed resolving Brugada morphology. Conclusion: Review of the literature surrounding the safety profile associated with CEW exposure shows few if any documented concerning cardiac electrophysiology changes and suggests that routine electrocardiographic studies or monitoring is not required. This case presents an isolated but interesting instance of a transient ECG abnormality associated with a CEW exposure.

Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.

Introduction: Stress-induced cardiomyopathy is a rare but serious cause of chest pain, which in recent studies has been shown to carry a similar in-hospital mortality to acute ST-elevation myocardial infarction. The pathophysiology of the disease is thought to be secondary to dysregulated catecholamine effects on myocardium. Case Report: We present a case of a previously healthy female without known thyroid disease who presented to the emergency department for acute chest pain and was found to have thyroid storm-induced cardiomyopathy in a typical stress-induced cardiomyopathy pattern without evidence of coronary disease on catheterization. Conclusion: Thyrotoxicosis can cause dysregulation of catecholamines and is a rare cause of stress-induced cardiomyopathy. It requires distinct therapies and should be considered by emergency physicians in the workup of acute chest pain with concern for stress-induced cardiomyopathy.

The Australian Catholic University (ACU National at www.acu.edu.au) is a public university funded by the Australian Government. There are six campuses across the country, located in Brisbane, Queensland; North Sydney, New South Wales; Strathfield, New South Wales; Canberra, Australian Capital Territory (ACT); Ballarat, Victoria; and Melbourne, Victoria. The university serves a total of approximately 27,000 students, including both full- and part-time students, and those enrolled in undergraduate and postgraduate studies. Through fostering and advancing knowledge in education, health, commerce, the humanities, science and technology, and the creative arts, ACU National seeks to make specific and targeted contributions to its local, national, and international communities. The university explicitly engages the social, ethical, and religious dimensions of the questions it faces in teaching, research, and service. In its endeavors, it is guided by a fundamental concern for social justice, equity, and inclusivity. The university is open to all, irrespective of religious belief or background. ACU National opened its doors in 1991 following the amalgamation of four Catholic tertiary institutions in eastern Australia. The institutions that merged to form the university had their origins in the mid-17th century when religious orders and institutes became involved in the preparation of teachers for Catholic schools and, later, nurses for Catholic hospitals. As a result of a series of amalgamations, relocations, transfers of responsibilities, and diocesan initiatives, more than twenty historical entities have contributed to the creation of ACU National. Today, ACU National operates within a rapidly changing educational and industrial context. Student numbers are increasing, areas of teaching and learning have changed and expanded, e-learning plays an important role, and there is greater emphasis on research. In its 2005–2009 Strategic Plan, the university commits to the adoption of quality teaching, an internationalized curriculum, as well as the cultivation of generic skills in students, to meet the challenges of the dynamic university and information environment (ACU National, 2008). The Graduate Diploma of Education (Secondary) Program at ACU Canberra Situated in Australia’s capital city, the Canberra campus is one of the smallest campuses of ACU National, where there are approximately 800 undergraduate and 200 postgraduate students studying to be primary or secondary school teachers through the School of Education (ACT). Other programs offered at this campus include nursing, theology, social work, arts, and religious education. A new model of pre-service secondary teacher education commenced with the introduction of the Graduate Diploma of Education (Secondary) program at this campus in 2005. It marked an innovative collaboration between the university and a cohort of experienced secondary school teachers in the ACT and its surrounding region. This partnership was forged to allow student teachers undertaking the program to be inducted into the teaching profession with the cooperation of leading practitioners from schools in and around the ACT. In the preparation of novices for the teaching profession, an enduring challenge is to create learning experiences capable of transforming practice, and to instill in the novices an array of professional skills, attributes, and competencies (Putnam & Borko, 2000). Another dimension of the beginning teacher experience is the need to bridge theory and practice, and to apply pedagogical content knowledge in real-life classroom practice. During the one-year Graduate Diploma program, the student teachers undertake two four-week block practicum placements, during which they have the opportunity to observe exemplary lessons, as well as to commence teaching. The goals of the practicum include improving participants’ access to innovative pedagogy and educational theory, helping them situate their own prior knowledge regarding pedagogy, and assisting them in reflecting on and evaluating their own practice. Each student teacher is paired with a more experienced teacher based at the school where he/she is placed, who serves as a supervisor and mentor. In 2007, a new dimension to the teaching practicum was added to facilitate online peer mentoring among the pre-service teachers at the Canberra campus of ACU National, and provide them with opportunities to reflect on teaching prior to entering full-time employment at a school. The creation of an online community to facilitate this mentorship and professional development process forms the context for the present case study. While on their practicum, students used social software in the form of collaborative web logging (blogging) and threaded voice discussion tools that were integrated into the university’s course management system (CMS), to share and reflect on their experiences, identify critical incidents, and invite comment on their responses and reactions from peers.

Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.