The Relationship Between Colles' Fractures and Leukocytosis in the Emergency Department.

In Taiwan, emergency physicians often perform wrist joint reduction and cast immobilization before orthopedic surgeons arrange for surgical management. Prophylactic antibiotics can decrease the risk of wound infection and have been routinely employed in orthopedic surgery. In Taiwan, emergency physicians also regularly perform blood investigations and administer prophylactic antibiotics to prevent infection if the patient exhibits leukocytosis. However, pain and pressure also cause leukocytosis, making it difficult to discern if the cause is infection or injury. Therefore, we explored the relationship between Colles' fractures and leukocytosis to determine if antibiotic treatment is necessary for this type of injury.

Implementing an entrustable professional activities programmatic assessments for nurse practitioner training in emergency care: A pilot study.

BACKGROUND: Entrustable professional activities (EPAs), as new methods used to operationalize competency-based education, are gaining acceptance in medical professions. However, no EPA-based framework exists to evaluate emergency care nurse practitioners' competencies in clinical practice. OBJECTIVES: To develop, implement, and evaluate an EPA-based framework for emergency care nurse practitioners. DESIGN: Prospective observational study. SETTING: An accredited nurse practitioner training program in the emergency department of a University-affiliated Hospital. PARTICIPANTS: Eight novice nurse practitioners and eighteen clinical instructors. METHODS: A working group of academic educators, nurse practitioner leaders, and clinical instructors developed a set of EPAs using a participatory design method. We scheduled weekly ad hoc evaluations for the nurse practitioners in emergency care, and we collected several observations from multiple assessors for analysis. RESULTS: Four nested EPAs were developed that adopted a 1-5 supervision-entrustment scale to measure performance. The results of the 20-month assessments illustrated that the average scores of EPA1, which measured the assessment and management of patients with acute medical presentations in the emergency department, differed significantly but were not positively correlated with the nurse practitioners' increasing subspecialty and department seniority levels (Kruskal-Wallis test P = .011 and 0.006, respectively). In addition, the most time required for the nurse practitioners to achieve a stable level 5 entrustability score for all EPAs for at least 3 consecutive months was 18 months. Clinical instructors noted that recognizing limits is a skill that is essential for a nurse practitioner to earn clinical instructors' trust. CONCLUSIONS: Entrustability scores may not correlate with nurse practitioners' increasing seniority, and patient care requires the longest training time (18 months) for emergency care nurse practitioners to achieve autonomy. Program directors should adjust the supervision-entrustment level expected at various stages of training according to the complexity of individual EPAs. An EPA-based assessment framework in a nurse practitioner training program may assist in overseeing the development of competencies for emergency care nurse practitioners.

A Female Patient With a Urinary Tract Infection and Multiple Vaginal Ulcers.

This report is to describe a rare case of urinary tract infection (UTI) with multiple vaginal ulcers. In the report, the 45-year-old female patient was diagnosed with a UTI, but white blood cells and neutrophil are higher than reference value. A vaginal ultrasound was performed with a positive fi nding of uterine myoma and multiple painless vaginal ulcers in the vaginal wall. Also, elevated antinuclear antibodies were found. After treated with antibiotic, self-healed vaginal ulcers were observed even without topical ointment use for vaginal ulcers. In conclusion, UTIs are a common disease in females. This is a rare case of a UTI with multiple vaginal ulcers. Observation of the genital condition is necessary if a woman has a UTI. Treating the source of the UTI is necessary, and the vaginal ulcerations also require appropriate treatment and follow up.

Clinical Manifestations and Prognostic Factors of Pulmonary Embolism in Adult Patients Visiting the Emergency Department: A Single Institute Experience.

BACKGROUND AND PURPOSE: To investigate the clinical manifestations of a pulmonary embolism (PE) in patients visiting the Emergency Department (ED) and to identify possible prognostic factors among the patients. METHODS: Patients who suspected as PE and presented to the ED with chest tightness, chest pain, or syncope were enrolled. Wells score, revised Geneva score, and PE severity Index (PESI) were all recorded for analysis. Twelve patients who were diagnosed with a PE after a serial work-up were further analyzed for possible prognostic factors. The demographic characteristics, serum lab data, clinical presentations, management strategies, computed tomography (CT) angiography findings, and final outcomes were analyzed retrospectively. Chi-squared tests with Fisher's exact tests, and t-test analyses were applied to evaluate the prognostic factors. RESULTS: Among the 763 patients enrolled, poor prediction effectiveness of Geneva score and Wells score were noticed, and PESI was also found with no significant predictive value in our study group. The initial vital signs, syncope, chest pain, leg edematous changes, dyspnea, D-dimer levels, CT angiography-measured thrombus diameter, the presence of a right atrium (RA) or right ventricular (RV) thrombus, and presence of lung consolidations all revealed no predictive values in this study (p > 0.05). Notably, the presence of a cardiac disease history showed possible prognostic factors for satisfactorily predicting patient outcomes (p = 0.02). The presence of left atrium (LA) thrombus showed a border significant differences in comparison (p = 0.05). CONCLUSIONS: Although the number of patients analyzed was relatively low, our findings suggest that a history of cardiac disease is predictive of a relatively lethal or severe condition in patients with a PE. The diagnosis and prediction of outcomes for patients with a PE remains a challenge and further study is necessary in the future.