Characteristic ST- and T-wave changes in the precordial electrocardiogram leads may indicate acute coronary syndrome, cardiomyopathies, channelopathies, catecholamine surge states, or perimyocarditis. This case presented involves a man who presented after sudden loss of consciousness. The patient's electrocardiogram was concerning for Type B Wellens sign, and cardiac biomarkers were low. Coronary artery occlusion was considered despite an absence of chest pain and the presence of left ventricular hypertrophy. Cardiac testing revealed pathognomonic obstruction of the left anterior descending artery associated with Wellens syndrome.

Single-plane ultrasound (US) probes are commonly used to initiate ultrasound-guided peripheral intravenous (USGPIV) access for patients with difficult intravenous access (DIVA) in the emergency department (ED), although their use is not yet standardized across all EDs. This pilot project introduced the use of a biplane US probe for USGPIV access at a Level 1 Trauma Center ED. Following the training of 10 registered nurses (RNs) in the application of biplane US probes, the project aimed to decrease reliance on ED providers (e.g., NPs, PAs, and physicians) for USGPIV insertions in DIVA patients, allowing providers to focus on other critical tasks and improving patient care efficiency. Primary outcomes measured included the average number of attempts required, progression to critical care access devices, ED patient flow times, and RN utilization rates of the biplane US probe post-training. Results showed that the biplane method improved outcomes compared to the single-plane method, with a 23.8% decrease in the average number of attempts required to obtain access, an 80% decrease in subsequent critical care vascular access placement, and an increase in the rate of both single-plane and biplane US probe use after training compared to baseline. While ED flow rate did not improve, this pilot project demonstrated that biplane US probes for USGPIV access in the ED setting improve patient outcomes.

Skin and soft tissue infections, known as cutaneous abscesses, are a frequent problem seen in primary and acute care settings. The gold standard of treatment for cutaneous abscesses is conventional incision and drainage (CID). The loop drainage technique (LDT) is a safe and effective alternative to CID to avoid premature closure, pain from packing and repacking, and reducing the need for follow-up medical care. Utilization of LDT also requires smaller incisions, resulting in smaller scars, which is particularly important for cosmetic outcomes. LDT offers a patient-centered, cosmetically favorable, and efficient alternative to CID, with improvements in comfort, adherence, and outcomes across care settings, while representing a practical option for emergency clinicians managing cutaneous abscesses.

Lyme disease, much like the nymphs and adult ticks that transmit the disease, can be tricky and at times hard to identify. When the disease presents with hallmark symptoms, such as the erythema migrans rash with central clearing, diagnosis and treatment are often straightforward. However, especially when practicing in an endemic area, health care providers can be presented with a wide range of clinical presentations and symptoms, which can lead to variable testing and treatment recommendations based on the stage of the disease the patient presents in. Therefore, a thorough understanding of Lyme disease is necessary when managing patients with this complex disease.

The opioid epidemic has created challenges in treating patients who inject drugs or those who are at risk of overdose due to psychiatric illnesses. Patients who self-inject into their vascular access devices (SIVADs) are at risk of infection, prolonged hospitalization, suboptimal care, overdose, or death. In response to incidents where patients have overdosed by SIVAD, the intravenous (IV) CareLock™ device was developed to prevent patients from accessing their IVs while still allowing providers to administer medications. We engaged a multidisciplinary team to analyze mitigation methods and perform a gap analysis to create a comprehensive protocol to reduce SIVAD. A multidisciplinary protocol identified patients at risk of SIVAD to guide the use of our IV CareLock™ device. This protocol prevented SIVAD while allowing providers to continue using the IV. Our novel device and protocol allowed providers to safely care for at-risk patients, reducing the potential for adverse outcomes.

Borealpox, formerly known as Alaskapox, is a novel zoonotic orthopoxvirus with a limited but concerning emergence in Alaska, part of the boreal ecosystem. To date, only 7 human cases have been confirmed, with transmission likely occurring from small wild mammals via intermediary domestic animals such as cats. While the illness is typically mild, it can lead to severe complications including death in immunocompromised patients. This case highlights the diagnostic and clinical challenges associated with orthopoxvirus infections in high-risk populations. Management is primarily supportive, with antiviral and immunoglobulin therapy reserved for severe presentations. Emergency clinicians, including advanced practice clinicians, should be familiar with the clinical manifestations, diagnostic approaches, and emerging treatment strategies for borealpox as cases are expected to increase. Early recognition, appropriate reporting, and interdisciplinary collaboration are essential to optimizing outcomes, particularly in vulnerable populations.

Diabetic Ketoacidosis (DKA) is a severe complication typically observed in individuals with type 1 diabetes, but it can also occur with type 2 diabetes under certain circumstances. It is characterized by insulin deficiency leading to hyperglycemia, ketosis, and metabolic acidosis, necessitating immediate medical intervention to prevent severe complications and possible death. This article presents a case report of a 76-year-old man with no prior history of diabetes who presented in DKA with a thrombotic complication at the emergency department. The vascular endothelium serves as a barrier against thrombosis but is also a primary target of hyperglycemia. The presence of high glucose levels triggers adverse intracellular processes, leading to endothelial dysfunction. Hyperglycemia and insulin resistance contribute to increased platelet sensitivity, coagulation factor abnormalities, and impaired fibrinolysis (Li et al., 2021). This article delves into the identification and treatment of DKA complicated by the pro-thrombotic state, presenting a contentious treatment approach.

Leprosy is a complex and interesting bacterial infection affecting individuals across the world. This is not just an ancient disease from antiquity, but one that is still present today. The diagnosis and treatment of leprosy is complex, and often there is a significant delay in diagnosis from the onset of the disease. Understanding the varied clinical presentations of leprosy and how to treat it can improve clinical outcomes. Healthcare practitioners need to be knowledgeable about all diseases, not just the most common ones.

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of left upper quadrant pain to explore the study by de-Madaria et al., titled "Aggressive or moderate fluid resuscitation in acute pancreatitis".