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9/24/2011

From one coast to another ... San Diego 2012

Another Annual Conference has ended. And how was the Tampa experience? We’ll let Joy Davis, RN, CEN, from Chicago, tell you.

“I had a wonderful time,” Davis said. “This is my third conference. I went to everything … from the minute I got here until this afternoon at the very, very end. I loved it. I brought two new people this year who’ve never been before. Each one of them is going to go back to work and tell a whole bunch more, the worker bees, the people who do the work, and we’re going to bring them to San Diego.”

Mark your calendars for the 2012 ENA Annual Conference, Sept. 11-15 at the San Diego Convention Center.

See you there!

Posted at 6:27 PM by Amy Carpenter-Aquino | Permalink | Email this Post | Comments (0)

Closing Session Urges Attendees to Overcome Their Own Disability

Aimee Mullins After days of gaining new knowledge, hands-on training, networking opportunities, having fun and expanding your horizon, the message of inspiration, adapting to change one’s perspective, overcoming defeat and choosing your own identity presented at this year’s closing session was an empowering way to end the 2011 Annual Conference.

Keynote speaker Aimee Mullins urged attendees to see beyond the limitations that people often place on themselves and to embrace and value change, which can be beneficial in both personal and professional growth.

“I think adversity is another word for change. We put the negative connation on it. We see it as hard times, but really it’s just change that we haven’t adapted ourselves to … yet,” Mullins said. “The good news is it is up to us. We can control how long it takes us to adapt. From adversity comes opportunity.”

The highly sought-after speaker shared her personal story of her own triumphs and challenges. Born with fibular hemimelia, Mullins’ parents were told she would never walk. Today, Mullins has gained recognition in the world of fashion and has become a prominent person in disabled sports, including setting the world record for the long jump.

Mullins encouraged the audience to determine their own disability.

“What do you want to change? What really is your disability right now? Everyone has their own disability. People always assume my disability is my prosthetic legs, but they’re wrong. A disability is anything that undermines our confidence and capabilities. A disability does not define a person. It doesn’t create our identity,” Mullins said. “We should choose our own identities. Don’t let others choose it for you.”

Kendra Y. Mims

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How to Use the ENA Workplace Violence Toolkit

A panel of members of the 2009-2010 ENA Workplace Violence Work Team presented an overview with key points and tips from the ENA Emergency Department Workplace Violence Toolkit Friday. Karen K. Wiley, MSN, RN, CEN; Diane A. Hochstetler, BSN, RN, CEN; Tracy Jenkins, BS, RN; and Jessica Taylor, BSN, RN, CEN, urged attendees to download the toolkit at the ENA Web site under the IENR tab and modify it to suit their department.

“What the toolkit provides is about 30 goals attached with outcomes and action plans, so your team does not need to recreate wheels,” said Hochstetler. “Use your data and decide where you want your team to go and modify the tools to your need.”

“This has to be meaningful to stretcherside nurses,” she added. “Everything you do has to protect you and your colleagues.”

“No two EDs are the same,” Wiley said. “This tool is beautiful, because you can adapt it to your own culture and ED. What we have done here is a beginning. We want you to compare your statistics and perform an evidence-based study to see how you fit in.”

Amy Carpenter Aquino

Posted at 6:02 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

Spice? Nutmeg? Salts? Nurses Need to Know What’s Cooking With These Drugs

Synthetic cannabis, a.k.a. “Spice” and “K2,” was banned in the United States as a Schedule 1 drug last November, but it doesn’t mean you won’t be seeing its users in your emergency department.

Produced outside the U.S. as a nonspecific plant mixture, sold in condom-like pouches and undetectable in drug tests except when metabolites are measured in urine, Spice continues to be sold illicitly and can cause agitation, nausea, vomiting and hallucinations.

And it’s not the only unconventional drug to watch for now, warned Audrey Snyder, PhD, RN, ACNP-BC, CEN, FAEN, FAANP, in her presentation Saturday.

Nutmeg is becoming popular among teens for its psychotropic effects when snorted, drank or smoked. Emergency nurses should be suspicious if they detect a strong nutmeg smell coming off a patient.

Another substance for your watch list? Bath salts. Users snort, inject, smoke and swallow them, with symptoms including paranoia, chest pain and a powerful urge to redose. The salts have been banned in six states and one county in Missouri, largely because of the efforts of emergency nurses.

Meanwhile, the Poison Control Center is a resource for solving some of the mysteries.

“Utilize the poison center to help you when you have these patients that you know are using something but you don’t know what that substance actually is,” Snyder said.

Michon Dohlman, BSN, RN, said she’s seen “a surge” of Spice and salts abusers in her emergency department in Rochester, Minn., with a case every couple of weeks.

“Our nursing department as a whole has had little exposure to the education about it,” Dohlman said. “This is very valuable. I can take it back to my department and help educate my nurses.”

Josh Gaby

Posted at 5:03 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

With Alcohol Withdrawal, Another Round Can Be a Very Good Thing

If you’re treating a patient for alcohol withdrawal syndrome, a lot goes a long way.

That means a heavy focus on nutritional resuscitation and, if necessary, a large amount of benzodiazepine, Bill Hampton, DO, told emergency nurses at his laugh-a-minute fast track session Friday.

Alcohol withdrawal can have up to four non-linear stages: tremulousness (generally six to 12 hours after the patient’s last drink), hallucinosis (1-2 days), withdrawal seizures (1-2 days) and the rare-but-very serious delirium tremens (3-5 days or fewer), in which the patient loses control of his or her vital signs.

Treatment at any stage means aggressively feeding with a banana-bag approach: niacin, folate, magnesium, glycogen, phosphate and generous amounts of thiamine.

“We need to nutritionally resuscitate these people,” Hampton said.

A benzodiazepine increases GABA production, taking the place of alcohol as an inhibitory neurotransmitter to achieve moderate sedation and get vitals under control, Hampton said. He presented dosing schedules for each, adapted from guidelines by the American Society of Addiction Medicine.

“I’ve got to tell you, benzodiazepines are incredibly safe, even in very, very high doses,” he said. “Be aggressive. Far better that we oversedate somebody than we undertreat them and they seize.”

Hampton advised using the Clinical Institute Withdrawal Assessment of Alcohol Scale and the Richmond Agitation Sedation Scale to settle arguments about the severity of a withdrawal. And don’t just assume any tremors or seizures are because of alcohol withdrawal. Run CT scans to rule out other possible causes, he said.

Danielle Bone, ADN, RN, of Fayetteville, N.C., planned to take Hampton’s information back to some of her providers to see if more could be done for patients.

“It’s amazing to see how much we undertreat alcohol withdrawal because people are too afraid to be aggressive about it,” she said.

Josh Gaby

Posted at 4:55 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

‘A Hot Topic That Is Never Going to Go Away’

Attendance was near full capacity for ENA’s Executive Director Sue Hohenhaus’, MA, RN, CEN, FAEN, discussion on psychiatric emergencies involving children. The fast track session Crying for Help: Triaging the Pediatric Psychiatric Patient allowed attendees to share their stories and methods of what was working for their hospitals as Hohenhaus engaged them with thought-provoking questions: Were they using the risk of suicide questionnaire for screening? At what ages were they screening children? Is their hospital using contracts with child patients?

Hohenhaus presented data from the Department of Health and Human Services that stated that 1 in 10 children suffers from mental illness, but only 20 percent will get needed care.

Hohenhaus also used various scenarios to let the audience determine as a group if the children in cases presented should be considered sick. She revealed at the end of the session that the 14-year-old patient described in one of the scenarios was actually her daughter.

“I am a pediatric nurse. I see a lot of kids, and it is a very big issue. I also have seen Sue speak before, and I knew that she would give good insight, such as with the risk of suicide questionnaire. I’m not using that at my hospital, so that is something to look into. It’s very basic and easy to put into practice,” Mary Kelly, BSN, RN, said.

Lisa Garber, BSN, RN, CPEN, from Pennsylvania, felt she learned a lot from the session.

“The thing I learned the most is that we are not screening children at 8 years. We start screening at age 14, so it was eye-opening to me that we should be screening at a younger age. That is something that I can bring back,” Garber said.

Kendra Y. Mims

Posted at 4:31 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

Just Because We Like This Photo of AnnMarie Papa

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Don’t Be a Dangerous DIYer

All of us know that one person who insists on doing everything around the house on their own. Whether it’s plumbing, painting a room, remodeling a rooftop, or knocking down a wall, a true do-it-yourselfer is intent on making it happen independently without assistance from a professional. Attendees at the Home Improvement Warriors: Keeping Us in the Trauma Business session learned about the dangers of being a DIYer and the safety measures that they need to take to keep them out of the emergency department.

Nancy Denke, MSN, FNP-BC, ACNP-BC, CEN, CCRN, shared real-life scenarios and tragedies that have found their way to the emergency department as a result of DIY projects. From ladder injuries, to a palm tree trimming accident, to wounds from power tools, the results from the scenarios ranged from central cord syndrome (garden hose accident) to hand amputations (power tools) and a CT maxillofacial-LeFort III fracture (scaffolding accident). She also discussed a man who died after falling while hanging Christmas tree lights.

The data presented showed that ladder injuries remain number one among DIYers. Denke informed the audience about how to take caution and use practical measures to avoid accidents, and that educating others about the safety of using ladders, as well as other household items, is key. She suggested making education a community service.

“If you have an injury prevention program, think about teaching people how to put holiday lights up and how to do it safely,” Denke said.

“I learned about all of the injuries that can happen when you’re in your house,” said Mary McCue, RN, from Woodbridge, Virginia. “I think she was really good and quite entertaining.”

Kendra Y. Mims

Posted at 3:44 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

Don’t Wait for Invitation to Help Control Youth Violence

Beyond tending to traumas inflicted on young people by young people, emergency nurses are often struck and screamed at by violent teens. Meanwhile, they aren’t being included in community efforts to address the larger problem. Vickie McElfresh, BSN, RN, SANE-A, thinks it’s time all of that changed.

She wants “a little ripple” – from you.

McElfresh and fellow forensic nurse Andrea Moreno, MSN, RN, SANE-A, have crusaded to reduce youth violence in Dayton, Ohio, focusing on kids ages 13-17 with the common traits of decreased economic opportunity and poor rode models. At Breaking the Cycle Thursday, they urged all emergency nurses to resist being passive and get involved.

“We have a great and a tremendous opportunity to educate and engage in the emergency room, and that’s one thing where I think we are undervalued in our role as a nurse,” McElfresh said. “If you’re tired of it and you want to stop it, know that you can take an active and a proactive approach to this.”

Start by respectfully drawing a line with an aggressive young patient.

“You are able to say to these people, ‘This is not acceptable. I’m not talking to you like that, I’m not cussing at you, and I expect you not to do it to me while you’re here,’” she said. “It’s really surprising, the response you might get from them.”

Moreno advised nurses to gather adolescent crime information using local juvenile court statistics and their state’s specific revised code. The Web site www.CrimeSolutions.gov is a valuable resource for violence-prevention programs.

Lacey Joens, RN, planned to take those tips back home to Spearfish, S.D.

The session “guided me where I can find our South Dakota data and get some information for research,” Joens said.

Josh Gaby

Posted at 3:37 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

Pierced Patients? Handle Their Hardware with Hardware of Your Own

Vanessa Alvarado-Greer, MSN, ACNP, can’t believe the things young people are having done to their bodies: barbells through their upper ears and nipples; piercings through their mouths and on their genitals; plates that permanently mutate their earlobes. Body modifications can lead to infections, tearing, scarring and nerve damage, among a host of issues.

That’s why emergency nurses need the knowledge and tools to treat problems related to piercings and to safely remove unconventional jewelry, Alvarado-Greer told the audience at her session Friday.

Some of the adornments these days amount to unlicensed surgery, she said.

“There’s sutures here, sutures here,” she said, showing a graphic photo of dermal anchors implanted in a man’s scalp.

A proper ED toolbox includes hemostats, Pennington clamps and ring expanders, depending on what needs removal. Throw in gloves, cotton swabs, 2x2 gauze, surgical lubricant and 14-gauge angio catheters and nylon sutures to preserve a piercing – which many patients will insist upon.

Barbells can be pulled apart or unscrewed. Pry open captive-bead rings – and be careful to catch the bead. Document all removals and treat jewelry “like money.”

And if there’s no time to be twisting off bling or dealing with messy bodily fluids?

“In an emergency, it’s probably preferable to leave everything in if you don’t have the right device to take them out,” Alvarado-Greer said.

Clinical specialist Mark Goldstein, MSN, RN, NREMT-P, a delegate from Grosse Point, Mich., left feeling enlightened.

“[As] one that has no tattoos, one that has no body piercings, I want to break down the barriers of the potential discrimination or even how to manage patients with these and their emergencies, because no one else is teaching me this,” Goldstein said.

Josh Gaby

Posted at 3:29 PM by Amy Carpenter-Aquino | Category: Concurrent Sessions | Permalink | Email this Post | Comments (0)

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9/24/2011

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