The Resurgence of Measles: A Rash From the Past.

Measles, or rubeola, remains a highly contagious infectious disease with a concerning resurgence in the United States. Despite previous control efforts, the number of reported cases continues to rise, surpassing the total for the previous year in just the first quarter of 2024 (CDC, 2024a). Emergency nurse practitioners and other emergency clinicians are likely to encounter patients presenting with concerns of or exposure to measles. However, given the low frequency of cases in the past, many emergency clinicians have likely not previously encountered measles, making identification more challenging. Early recognition and isolation are paramount in containing the spread of this virus and mitigating potential complications. This article aims to provide a review of measles, covering its pathophysiology, clinical presentations, and recommended management strategies for suspected or confirmed cases in emergency care settings.

Atopic Dermatitis: A Common Pediatric Diagnosis That Is Not Just Another Rash.

Emergency nurse practitioners are expected to assess and manage a variety of patients. These patients may present with urgent care-type complaints to severe life-threatening illnesses or injuries. For some, dermatological problems can sometimes be just as challenging as a critically ill patient. Atopic dermatitis (AD) is one, if not, the most common chronic inflammatory disease. Its presentation can vary depending on the age of the patient, the patient's skin tone, and other comorbidities. Patients often seek emergency care related to the condition itself or associated complications. This article includes a review of the pathophysiology, clinical manifestations, and standard management of AD. Finally, the potential complications of AD are discussed. A better understanding of AD will allow emergency nurse practitioners to properly identify and treat this chronic condition, as well as its complications.

A New Rash Differential: CoVID-19.

The CoVID-19 pandemic has impacted all areas of health care, especially emergency medicine. Most commonly, CoVID-19 is associated with respiratory and typical viral presentations. However, nonrespiratory presentations are becoming more common. Reported CoVID-19 dermatological changes include maculopapular and urticarial rashes, chilblain-like and livedo reticularis discolorations, and less commonly vesicular and petechial rashes. As frontline clinicians, emergency nurse practitioners should be aware of these skin findings to recognize potentially infected and otherwise asymptomatic patients. Early recognition could potentially lead to an earlier diagnosis and limit the spread of severe acute respiratory syndrome coronavirus 2.

Preventing Cauliflower Ear.

Traumatic auricular hematomas may be encountered in emergency care settings due to blunt trauma such as assaults or contact sports. Emergency nurse practitioners should be able to recognize and treat this injury to prevent complications. Treatment usually consists of evacuation of the hematoma by aspiration or incision and drainage using local or regional anesthesia, followed by the application of a pressure dressing or suturing. Without proper evacuation and steps to prevent reaccumulation, tissue necrosis and deformity (i.e., cauliflower ear) may occur.

Restriction-free antimicrobial stewardship initiative targeting fluoroquinolone reduction across a regional health-system.

BACKGROUND: Fluoroquinolone (FQ) antibiotics have become a target of many antimicrobial stewardship programmes. Multiple post-marketing warnings from the Food and Drug Administration caution against use of this drug class for certain infections due to risk of harmful adverse effects outweighing benefit. Commonly employed strategies to affect antibiotic prescribing can be restrictive and without improvement in overall antibiotic appropriateness or decrease in collateral damage. AIM: To develop a strategy for sustainable optimization of FQ antibiotics. SETTING: Multi-state health-system of 14 hospitals and medical centers. METHODS: The health-system antimicrobial stewardship program identified the opportunity to improve FQ utilization. In collaboration with our data and analytics team, specific targets of FQ use in pneumonia and chronic obstructive pulmonary disease were established. Face-to-face provider education and prospective audit and feedback were the mainstays of the campaign. Enhancements to the electronic medical record to support the initiative were also implemented. FINDINGS: There was an overall decrease in FQ utilization by 56.9%. For pneumonia use of FQs decreased from 16.4% to 8.1% and in COPD changed from 29.6% to 9.7% over the same time period. CONCLUSIONS: A non-restrictive FQ optimization initiative based on education and feedback decreased both FQ consumption and total antibiotic use across a large multi-hospital health-system.

Changing the Emergency Department's Practice of Rapid Sequence Intubation to Reduce the Incidence of Hypoxia.

Rapid sequence intubation (RSI) is an advanced procedure performed by nurse practitioners in the emergency department (ED). Hypoxia is one of the most common complications associated with RSI, which may lead to serious sequela, including death. Hypoxia may result from medications that are given to facilitate the procedure or the underlying disease process. Without preventive measures, oxygen levels may fall rapidly when patients are no longer actively breathing. The incidence of RSI-induced hypoxia may be mitigated with proper education, preoxygenation, positioning, and the utilization of passive (apneic) oxygenation. The purpose of this project was to determine whether RSI practice could be changed through education and implementation of an evidence-based protocol in the ED of a hospital in south central United States. Baseline practice was determined by chart audits and compared with practice after educational sessions and protocol implementation. Change occurred as evidenced by an increase in the utilization of all 3 hypoxia prevention interventions included in the protocol. Staff education and utilization of a protocol changed the care provided, which can influence patient outcomes and decrease the incidence of RSI-induced hypoxia.

Pharmacologic Strategies for Treatment of Poisonings.

Poisoning is the leading cause of injury-related mortality in the United States. Data suggest that nonmedical use of pharmaceuticals is increasing, along with a proportional increase in subsequent adverse events. The widespread use of illegal drugs contributes to the challenge, because these drugs may produce a wide array of clinical presentations that warrant time-critical recognition and treatment. Common legal and illegal poisonings highlighting clinical presentations in terms of toxidromes as a means of categorically recognizing these emergencies is the focus of this article. To optimize outcomes for situations such as these, pharmacologic considerations are discussed and explored.

Identifying acid-base and electrolyte imbalances.

Acid-base and electrolyte imbalances often complicate patient management in acute care settings. Correctly identifying the imbalance and its cause is vital. This article will review the physiology of acid-base and electrolyte balance, their common disturbances, associated causes, clinical manifestations, and management implications for nurse practitioners.