An Unusual Presentation of Intussusception.

This is the case of a 9-month-old female infant who presented to the emergency department with a history of several episodes of nonbilious and nonbloody emesis. The patient was found to be afebrile with normal vital signs and an otherwise normal physical examination. Initial plain film radiography was concern for possible obstruction. Imaging studies with ultrasonogram demonstrated intussusception. This was an unusual case of intussusception because children are typically more ill-appearing with vomiting, diarrhea, fevers, lethargy, and blood in stool. Management options included surgery, pneumatic enema reduction, and barium enema reduction. Pneumatic enema reduction was performed. This procedure has been shown to have superior outcomes in infants with intussusception. Advanced practice providers need to provide a detailed history, complete a thorough physical examination, order the appropriate diagnostics, and be vigilant of the clinical manifestation of intussusception.

Management of Hand Injuries: Part III.

Assessment of Acute Hand Injuries was discussed in Part I (). Part I reviewed approaches to the assessment of the patient with a hand injury and established a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand were discussed, and examples of the assessments were provided. Diagnostic approaches to support physical findings were discussed, and methods of radiological assessment provided assistance to the audience in making appropriate diagnosis in relation to hand injuries. Management of bony hand injuries was discussed in Part II. In Part II, the authors also described the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. In this article, Part III, the management of tendon, ligamentous, neurovascular, and other specific hand injuries, along with the management of selected chronic hand conditions, is discussed.

Management of Hand Injuries: Part II.

Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. "Assessment of Acute Hand Injuries" Part I was discussed in the Advanced Emergency Nursing Journal (). Part II herein discusses the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. Part III will discuss the management of tendon, ligamentous, neurovascular, and other special hand injuries along with the management of selected chronic hand conditions.

Assessment of acute hand injuries: part I.

More than 140,000 hand injuries occur yearly, and an estimated 5 days of loss of work per patient occurs (Bureau of Labor Statistics, 2012). Advanced practice registered nurses (APRNs) are responsible for managing many of these injuries in primary and emergency care settings. Hand injuries are responsible for approximately 10% of all emergency department visits annually (P. Shayne, S.H. Plantz, & F. Talavera, 2012). This article reviews approaches to the assessment of the patient with a hand injury and establishes a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand will be discussed and examples of the assessments will be provided. Diagnostic approaches to support physical findings will be discussed, and methods of radiologic assessment will support the audience in making appropriate diagnosis in relation to hand injuries. This is Part I of a three-part series that will validate the approaches to hand assessment for adults and children and identify specific injuries and their management for the APRN.