Why you should read this article: • To enhance your knowledge of the signs and symptoms of mallet finger injuries, including common presentations and the mechanism of injury • To understand how to assess a patient with a suspected mallet finger injury, and the options for management • To count towards revalidation as part of your 35 hours of continuing professional development (CPD), or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.
Our continuing professional development (CPD) articles are designed to assist with your nursing skills and practice.
Sepsis is a medical emergency that should always be considered in acutely unwell patients
This article aims to increase emergency nurses’ knowledge of acute aortic dissection
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines ( BTS/SIGN) (2016) .
Over the past ten years there has been a significant rise in the number of people who present to emergency departments with Lyme disease. Although some patients remain asymptomatic many present with a rash around a previous tick bite and others may present with a range of debilitating symptoms that can be problematic if left untreated. Due to the growing prevalence of Lyme disease in the UK and the US this article gives an overview of the vector-borne condition and provides emergency nurses with information about the pathophysiology, prevention, presenting signs and symptoms and management.
Infrequent presentation of this patient group to emergency departments can cause stress and anxiety to front-line clinicians when they are faced with patients with a traumatic burn injury. Assessment relies on accurate evaluation of burn aetiology, size and depth, and initial management is directly responsible for patients’ outcomes and quality of life. This is the second article in a two-part series that gives an overview of the minimum standard of care in burns first aid, and highlights the likely challenges in assessment of burn depth and size. The aim of the two articles is to enhance emergency clinicians’ knowledge and confidence in burn management, and to build awareness of the life-changing implications of the initial clinical interventions in burn care.
Caring for patients with burn injuries can be traumatic for staff. Non-specialist clinicians in emergency departments are often the first point of contact for patients with burn injuries and their families. Lack of burns education, exacerbated by infrequent presentations, can add to front-line clinicians’ stress and anxiety. Assessment relies on accurate evaluation of burn aetiology, and the size and depth of the injuries, and initial management is directly responsible for patients’ outcomes and quality of life. This is the first article in a two-part series that highlights the criteria and process of referral to a specialist burn service and gives an overview of the challenges posed by the burn mechanism and subsequent unique treatment considerations. The aim of the two articles is to enhance emergency clinicians’ knowledge and confidence in burn management, and to build awareness of the clinical guidance and support available via the specialist burn service providers.
Concussion in sport is a common presentation in urgent and emergency care settings, so it is essential that nurses have a full understanding of the condition. Most patients who attend an emergency department with concussion are discharged and discharge advice must be well-informed and evidence based. This article outlines the normal anatomy of the brain and the pathophysiology of concussion, and discusses the guidelines on returning to sport following this injury.
Chickenpox is an extremely contagious infectious disease caused by varicella zoster virus (VZV). It is a common childhood illness characterised by an itchy vesicular rash and fever, which usually resolves spontaneously without medical intervention. Serious, and rarely fatal, complications can occur, including pneumonia, central nervous system infection, overwhelming secondary bacterial infections, especially with Group A streptococcus, and necrotising fasciitis. Therefore it is crucial that emergency department (ED) nurses can recognise the signs and symptoms that indicate deterioration. This article reviews best practice management of children with chickenpox, gives up-to-date guidance on the safe use of antipyretics, the avoidance of ibuprofen and discusses immunisation against VZV. It also includes implications for nursing practice and a case study that illustrates some of the challenges that ED nurses may encounter.
In the UK 127,000 people are diagnosed with Parkinson’s disease, many of whom are frequently admited to hospital. However, Parkinson’s disease is not usually the primary cause of admission. Emergency department (ED) nurses must be aware of the medication needs of people with Parkinson’s disease and how these can be met in emergency setings to ensure the stability of their condition and to prevent the development of neuroleptic malignant syndrome, a potentially fatal condition caused by abrupt omission of Parkinson’s medication. This article highlights the importance of ensuring that patients with Parkinson’s disease continue their medication regimen while in an ED, even if they are temporarily unable to swallow, and uses a case study to illustrate various ways of achieving this.
Skin tears are frequently encountered in emergency and unscheduled care, and are prevalent in older people. Patients may present soon after an acute skin tear, or at a later stage when the wound presentation is different and there are complications. This article describes evidence-based recommendations and strategies for the prevention, assessment and management of skin tears, discusses risk factors and explains when to refer patients for specialist management.
After 40 years, the Glasgow Coma Scale (GCS) is the resource of choice for assessing the level of consciousness in patients with neurological conditions. Clinicians’ ability to monitor patients’ conditions, identify deterioration and make clinical decisions depends on their ability to carry out GCS assessments, so it is vital that they understand it. This article explores how best to use the GCS in clinical practice and examines some of the factors that can affect the accuracy of assessments. The article also explains the difference between peripheral and central stimuli.