Emergency Nurse Practitioner

Hypothyroidism Patient will be complaining of generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain PE will show periorbital edema, dry skin, and coarse brittle hair Labs will show high TSH and low free T4, antithyroid peroxidase, and antithyroglobulin autoantibodies Most commonly caused by Hashimoto’s thyroiditis Treatment is levothyroxine Comments: Takes about 6 weeks to see treatment effects. Monitor TSH Hashimoto’s: Risk factor for non-Hodgkin lymphoma Sample Question: A 55-year-old woman presents to your office with complaints of fatigue, read more…

Hyphema Patient with a history of blunt or penetrating trauma Complaining of blurry vision PE will show unequal pupils, injected conjunctiva/sclera and blood in anterior chamber Treatment is eye protection and rest with the head of the bed at 30-45 degrees all the times A 13-year-old boy is brought to the urgent care clinic by his mother. He read more…

Meniere Disease Example: A patient complains of a 6-month history of tinnitus and vertigo that occurs with nausea, vomiting and a sensation of “ears full of water.” These symptoms occur intermittently in attacks at a frequency of once or twice a week. He denies head trauma, headache, photophobia or focal neurologic deficits. Otoscopic examination reveals no read more…

Osgood-Schlatter Disease Example: A 12-year-old boy presents to his pediatrician’s office for right knee pain that started three months ago after starting basketball practices. On physical exam, the boy is tender to palpation over the anterior tibial tubercle. There is no erythema or warmth to the area. A lateral radiograph of the knee reveals elevation of read more…

Example: A 28-year-old woman presents with complaints of double vision and fatigue. These symptoms are generally better in the morning and progress throughout the day. She works long hours and says toward the end of her shift she is extremely fatigued and has difficulty completing her tasks. Which of the following is the most likely etiology?

Multiple Myeloma Patient will be elderly Complaining of back pain PE will show CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions/Back pain Labs will show monoclonal antibody spike X-ray will show lytic lesions Peripheral blood smear: Rouleaux formations Serum protein electrophoresis: M spike Protein electrophoresis urine analysis: Bence-Jones proteins Most commonly caused by single clone plasma cell read more…

Molluscum Contagiosum Patient will be a school-age child Presenting with “warts” PE will show multiple waxy, dome-shaped papules with umbilicated appearance Most commonly caused by poxvirus Treatment is self-limiting

Complex Regional Pain Syndrome Patient will have a history of previous extremity injury or fracture Complaining of light touch causing extreme pain and allodynia (pain felt from a nonpainful stimulus, such as clothes or bed sheets on the skin) Treatment is NSAIDs, gabapentin, sympathectomy

Bacterial Tracheitis Patient will be 3–5 years old High fever, barky cough, stridor Treat as airway emergency! Comments: Patient will look like croup but toxic appearing Sample Question: A 3-year-old boy presents in severe respiratory distress. His mother informs you that he has been ill for the last five days, initially with a low-grade fever and “barky cough.”  read more…

Absence Seizures Patient will be a 5–10 years old Sudden mental status alteration without motor activity or a blank stare EEG during an event would show symmetric 3 Hz spike and wave activity Treatment is ethosuximide Comments: There will be no aura or postictal state

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Causes: adhesions (pelvic surgery) > tumor > hernia (inguinal) Proximal: bilious vomiting  Distal: feculent vomiting High pitched bowel sounds X-ray: dilated bowel, air-fluid levels, “stack of coins” or “string of pearls” sign Modality of choice: CT NGT, surgery

Appendicitis Patient will be complaining of fever, pain that began periumbilical then moved to RLQ, nausea and anorexia PE will show Psoas sign (RLQ pain on extension of right hip), Obturator sign (RLQ pain on internal rotation of flexed right hip), Rovsing sign (right lower quadrant pain when the left lower quadrant is palpated) Diagnosis is made by ultrasound, CT Most commonly caused read more…

In January 2017, the American Academy of Nurse Practitioners Certification Board, also known as the AANPCB, in conjunction with the American Academy of Emergency Nurse Practitioners, also known as the AAENP, launched the first of its kind emergency nurse practitioner (ENP) certification exam. Successful completion of the emergency nurse practitioner exam will earn you the emergency nurse practitioner certification or ENP-C.

According to Godwin et al., during procedural sedation and analgesia, a nurse or other qualified individual should be present for continuous monitoring of the patient, in addition to the provider performing the procedure.

Question: In patients undergoing procedural sedation and analgesia in the emergency department, what is the minimum number of personnel necessary to manage complications?

According to Godwin et al., do not delay procedural sedation in adults or pediatric patients in the ED based on fasting time. No reduction in risk of emesis or aspiration has been shown with any fasting duration. This is a Level B recommendation.

You are planning to perform procedural sedation to reduce a fracture. The patient’s last meal was 4 hours ago. How much additional time should you wait to perform the procedure?