2018 ENA Today

ENA 2018 Closing Session: That’s a Wrap

All good things must come to an end.

Emergency Nursing 2018’s final day of educational offerings kicked off with the closing session, which featured popular critical care blogger Dr. Scott Weingart, who declared to the audience of emergency nurses, “You are the masters of resuscitation.”

Scott Weingart, MD

The ED intensivist and EMCrit blog founder spoke with candor about his idea of the “new cardiac arrest.” He said that in the past eight to 10 years there has been a sense that taking care of cardiac arrest is like a cookbook—there’s a recipe you follow. But Weingart wants more, which he explained in two talks and a live question-and-answer segment.

He addressed the idea of and his unyielding support for the nurse-led code, which earned him boisterous cheers from the audience. He delineated the responsibilities of the nurse code leader, many of which he said nurses are doing anyway.

“The nurse already spurs docs when to do what,” he said to an appreciative crowd. “At that point, the doc is already the puppet, so just take out the middle man. You’re the ones looking at the clock, you’re the ones with your head down keeping track of everything that’s going on.”

During his second talk, Weingart called on all emergency nurses to re-brand themselves to include the title resuscitationist – a term he said represents the overlap responsibilities that bridge ICU and ED nurses. It’s a maximally aggressive mindset, in which the nurse endeavors to give all they’ve got to every patient, every time, even for those he called the 1 percent – patients who are deemed to have next to no chance of survival.

“Don’t say you’re an emergency nurse, say you’re an emergency nurse and a resuscitationist,” he urged. “Nurse resuscitationists are error-preventing machines!”

Weingart said the nurse resuscitationist must strive for mastery, not just competence. They must pursue self-learning, and they must not let the culture of rule enforcement affect the best care of a patient.

He assured emergency nurses that they are the key to making the system work.

“You are all underpaid and overworked. But remember that you are essential. You’re the heroes, and you are loved,” he said.

 

Closing Session Offers ENA Election Results, Reports and Look Ahead

A traditional staple of the closing session is a bit of exciting housekeeping, including the ENA National Election results. ENA President Jeff Solheim took pleasure in announcing the organization’s changing of the guard, opening each envelope and announcing the winners like those of an entertainment award show. The crowd ate it up, and Solheim even teased attendees, pretending to leave out the pinnacle result of the election – the president-elect and ultimately 2020 president.

And the winners are …

 

President-elect: Michael Hastings, MSN, RN, CEN

Secretary/Treasurer: Ron Kraus, MSN, RN, EMT-B, CEN, ANCS-BC

Directors:

Joop Breuer, RN, CEN, CCRN, FAEN

Kristen Cline, BSN, RN, CEN, CFRN, CTRN, TCRN

Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN

Ryan Oglesby, PhD, MHA, RN, CEN, CFRN, NEA-BC (one-year term)

 

Nominations and Elections Committee

Region 1: David Samuelson, MSN, RN, CEN, CPEN, CTRN, CCRN

Region 3: Nicholas Nelson, MS, RN, CEN, CPEN, CTRN, CCRN, NRP, TCRN

Region 5: Marge Letitia, BSN, RN, EMT-P, CE

 

“I wish them all the best as they take on these important roles in the future,” Solheim said of the newly elected officials.

Solheim also presented the annual ENA President’s Award to his son, Brandon, for providing invaluable support to him during his presidency.

Of course, as is tradition, Solheim handed the baton to ENA President-elect Patti Kunz Howard, who will officially take office Jan. 1. Howard said her platform will center on advocacy, for the profession and for each other, with a focus on inclusivity and diversity, innovation and injury prevention.

“I promise to work diligently to move the organization forward,” she said. “I couldn’t imagine a world without emergency nurses.”

ENA Foundation Chairperson Steven Jewell also acknowledged the foundation’s record-setting year, boasting $223,000 raised during the annual ENA State Challenge and $23,000 raised last Thursday during the conference welcome party, Neon Nights.

With a look to Austin for Emergency Nursing 2019, Solheim bid the packed convention center hall a “bittersweet” farewell and sent the audience on their way to enjoy the few remaining sessions of the conference.

Ketamine: The New Wonder Drug

Emergency nurses see a diverse population of patients requiring equally diverse treatments. But one dynamic drug seems to be a go-to treatment for more health care complaints than most.

Developed in the 1960s as a derivative of PCP, Ketamine seems to be the new wonder drug, and for good reason.

“Ketamine is a hot drug in the clinical setting as we are discovering the multitude of patients receiving a positive effect from its use and not as many adverse effects,” said Cindy Joseph, who presented the session “Willy Wonka and the Ketamine Factory” on Saturday.

Joseph drew from the storyline in the 1960s film Willy Wonka and the Chocolate Factory to highlight situations in which ketamine can be used.

The drug is becoming better understood, she said. And as it does, emergency nurses can safely use it in a multitude of patients and possibly avoid the side effects and poor outcomes from other treatments that are currently the standard, most notably the numerous opioid treatments that have contributed to a global health care crisis.

“From the trauma patient who needs airway management to the status epileptic who is refractory to other medications, ketamine can be an effective and even safer treatment than the traditional treatments we commonly use,” she said. “We have an opioid epidemic as well, and ketamine offers a way for us to still treat our patients but also fight a bigger issue facing our nation.”

Emergency nurses will benefit from a better understanding of this medication, Joseph said. If they can see how ketamine works and its many benefits, they will be more comfortable using it and provide a safer practice for patient care.

“I can’t stress it enough; this drug is an incredible drug for some patients,” she remarked.

The subject of ketamine was a hot topic in Pittsburgh last week, with two other sessions focusing on the medication. In “Pink Dragons & Purple Unicorns: Ketamine for analgesia, sedation, depression,” Texas ENA State Council President Steven Jewell covered the administration, dosing and monitoring of ketamine for sedation, pain management and major depressive disorder. Meanwhile, Darleen Williams and Baily Constantine focused on pharmacology and the appropriate uses of ketamine in the emergency department in their session, “Special K: Dissociating Fact from Fiction.”

Dangerous Dares on Social Media Bring Challenges to the ED

In a session last week on global social media challenges that have spurred countless visits to the emergency department, UPMC St. Margaret Quality Manager Faith Colen encouraged participants to educate themselves about these often-self-imposed dares and the associated traumas that do and will likely continue to ensue.

A continually growing number of social media users, especially adolescents, are recording or otherwise documenting risky, unusual or subjectively funny behavior to try to garner more likes and shares on their various channels. Some individuals have even made sustainable income from their viral videos and become household names on video sharing sites like YouTube and Vine.

One of the most successful social media challenges was the ALS Ice Bucket Challenge in 2014. The challenge, aimed at raising awareness of and donations for Lou Gehrig’s disease, involved the participants pouring a bucket of ice cold water over their heads and posting the video online. The challenge went viral and caught the attention and participation of many celebrities.

But the lure of celebrity and the excitement of worldwide popularity through positive reinforcement on social media have encouraged the escalation of “challenges” to a level of one-upmanship that often becomes unsafe or unhealthy, Colen said Saturday in her session “Social Media Challenges: Child, Adolescent and Adult Trauma Risk.”

She noted two categories of challenges—food and drink and risky behavior—and the potential symptoms patients could present with as a result. She said it was vital emergency nurses be in the know about the trending social media challenges because when it goes awry, patients often disguise the very behavior that landed them in the ED.

“If the patient’s story in the ED doesn’t line up, it could be related to a challenge,” Colen said.

She also recommended nurses participate in community outreach programs at schools to talk students through the risks of social media challenges. Highlighting the life-altering results of some challenges might help them recognize the dangers of trying to be a viral sensation, she remarked.

 

Trending Social Media Challenges, Potential Risks

There is a seemingly unending list of internet-based challenges being performed worldwide every day. And the challenges continue to grow. Below is a list of just some of the challenges emergency nurses may see the effects of on any given day.

Ghost pepper challenge: Eating a raw ghost pepper, which typically results in heartburn and vomiting.

Sprite and banana challenge: Eating a banana and then chugging a Sprite. It often results in lengthy bouts of projectile vomiting.

Warhead challenge: How many warhead candy pieces can you put in your mouth? It results in a lot of drool and a choking risk. A variation of this challenge is the “chubby bunny” challenge, in which the participant stuffs as many marshmallows in the mouth as possible while still being able to say the phrase for which it’s named.

Gallon of milk challenge: No one can drink a gallon of milk and not end up vomiting.

Cinnamon challenge: Eating a tablespoon of cinnamon results in the inhalation of the spice into the lungs and subsequent aspiration.

Cactus challenge: Eating a cactus means a great risk of airway obstruction and damage to the esophagus.

Eyeballing: Participants pour an ounce or more of vodka into their eyeball. This can cause a number of ophthalmological injuries, including retinal lacerations and even total loss of acuity.

Neknominate: The idea is to chug a pint of whiskey and then do something out of the ordinary. The original challenge has escalated to chugging a fifth of a gallon of whiskey. One victim did so and put himself into the trunk of his car. He didn’t make it out alive.

Butt chugging and vodka tampons: Rumors abound of adolescents funneling alcohol directly into the anus and inserting vodka-soaked tampons. Both acts put participants at an increased risk of alcohol poisoning.

Skittle parties: Teens are mixing loose prescription drugs from their homes into a bowl for parties. This behavior can lead to overdosing and myriad other complications from mixing drugs and alcohol.

Jenkem: This challenge has participants inhaling methane gas to get high. In some instances, the gas is produced from human feces in a covered jar placed in the sun for a time, while in rural areas, some have put traffic cones over cow droppings to produce the same intoxicating gases. Since methane displaces oxygen, it can be an asphyxiant in the right ratios.

Salt and ice challenge: Participants apply salt to skin and add ice, creating a thermal reaction that causes burning. In severe cases, patients have burned through an artery.

Car surfing and ghost riding: Passengers surf moving vehicles. Drivers dance alongside when a particular song plays. The trauma risk is great.

Mock Traumas Strengthen Team, Save Lives

“Trauma is the leading cause of death in the United States, and it is an impact that lasts a lifetime,” said Darleen Williams of Orlando. She said she believes trauma centers need to do everything they can to remain on top of their games, no matter what type of trauma comes through the emergency department doors.

During “All Mocked Up Simulated Trauma Alerts: Practice Makes Perfect,” Williams and session co-presenter Michelle Inglis said their hospital relies heavily on simulation to prepare team members to care for traumas in their EDs. These practice sessions include the use of manikins, equipment and hands-on role-playing to reinforce training. During mock trauma alerts, team members follow through with the procedures –  inserting IVs, administering IV push medications and inserting chest tubes. There’s no play acting, Williams said.

After each mock trauma alert, the team conducts a debriefing and discusses what they learned with all team members involved. Each participant is asked what he or she felt went well and identify any areas for improvement.

“In the beginning, we had responses of ‘I am too busy or I am too tired,’” Williams said, noting that the “grumblers” have since embraced the practice and even made suggestions for future simulations.

The simulated trauma alerts have proven beneficial for prepping the team for trauma alert patients who arrive in the ED. Three months ago, the team saw the results of their efforts in action when a full-term pregnant woman involved in a trauma had to deliver in the ED. Having performed that scenario just three weeks earlier, the team was able to confidently care for the woman and effectively employ the equipment that was infrequently used in trauma.

“Practice has paid off,” Williams said, noting the simulations strengthen agency collaboration and enable process re-evaluation.

Most importantly, the training improves everyone’s skills and ability to save lives, and that is what matters most, she added.

“We like to be the best part of someone’s worst day,” Williams said.

Chilling Facts About IPV, Strangulation

When she reviewed the literature on strangulation, Maria Tackett said she had her biggest a-ha moment. She asked herself, “How many times have I missed this type of injury?”

The nurse director at Hartford Hospital in Connecticut discovered alarming statistics and information related to strangulation and its connection to intimate partner violence. She shared her knowledge with attendees at the session “Has This Patient Been a Victim of Strangulation” on Saturday.

She said one in three women will experience IPV, and 68 percent of those in IPV situations will experience near-fatal strangulation. Nearly 90 percent of strangulation victims have a history of IPV. And once experiencing strangulation, that person has a chance of being killed eight times greater than someone who hasn’t been strangled.

Tackett told session attendees that pregnancy also plays a significant role in IPV. As much as 30 percent of domestic violence starts when a woman is pregnant and IPV is the leading cause of death during pregnancy, she explained.

“Intimate partner violence and strangulation are all about power and control,” Tackett said, noting that the perpetrators often don’t intend to kill their partners, but rather aim to assert domination and control.

But of the strangulation victims who present to the emergency department, only half show visible signs. So, it’s up to ED nurses to know the subtle signs and symptoms of strangulation to ensure these patients get the best care and the best chance at getting out of the dangerous situation in which they find themselves.

Tackett went on to cover the basics of strangulation—what it is, how little pressure it takes to strangle someone, and common symptoms. She said the most common complaint is a sore throat, and the most characteristic sign is petechiae, especially in and around the eyes.

Since so few patients will tell their ED nurse that they’ve been strangled, nurses have to do the work to find out what’s really wrong. Tackett recommended going beyond just asking if the patient has been strangled.

“Ask specific, descriptive questions when interviewing a patient, and always have a high level of suspicion,” she said. “They are not going to bring it up. They are counting on you to bring it up. That makes triage one of our first places to make a difference.”

Attendees in Wonderland

Neon Nights rakes in $23k for ENA Foundation

Emergency nurses let their passion shine through Thursday night at the annual conference welcome party – Neon Nights.

Draped in neon or black light-friendly white, attendees danced the night away to the new-wave stylings of party cover band The Spazmatics, all while raising money for the ENA Foundation. Glowing lounge areas, light tables filled with candy, streamers, balloons and tall Dr. Seuss-like lamps offered a party atmosphere akin to childhood dreams.

Hundreds of party-goers purchased blinking, white and brightly colored hats, suspenders, wands, wigs and jewelry to get into the spirit and give to the cause. The Foundation raised more than $23,000 from product sales, drink purchases and ticket sales. The money goes toward ENA Foundation scholarships and research grants in 2019.

The Spazmatics filled the large room with the ’80s top pop hits intermittently for nearly three hours. But it wasn’t enough. Attendees groaned as the lights came up, and they begrudgingly left the convention center in search of an after party – the sign of a good ENA conference kick-off celebration.

Innovative Fast-Track Format a Hit

The fast-track sessions returned to Emergency Nursing 2018 with a value-add – attendees could select their own adventure from their session-room chairs.

At each designated start time, three presenters delivered talks simultaneously, while attendees listened along through headsets, toggling between each as desired with the press of a button.

Four sets of speakers presented, for a total of 12 presentations in a two-hour session. The new format provided more information in a shorter amount of time than in previous years.

Some attendees came for a specific session, while others clicked around until they found the session most interesting to them.

“The cool thing was that if you started listening and it wasn’t exactly what you thought it would be, you could switch to something different without leaving your seat,” said Carol Tulley of Winfield, Illinois. “I thought it was a really great setup.”

Her colleague Zankhana Desai, also of Winfield, echoed Tulley’s response, noting it was a more effective learning environment than she expected.

“I thought I’d be distracted by the other screens and presenters, but once I got into it and focused on the person, it wasn’t distracting at all,” she said.

Highlights of the fast-track sessions included:

“But It’s Healthier than Smoking: Vaping Emergencies”

There is a common misconception that smoking e-cigarettes, known as vaping, is not as dangerous as smoking conventional cigarettes. In fact, vaping comes with its own set of dangers according to presenter Justin Milici. He said it can present to the emergency department in a variety of ways, including “popcorn lung,” which can lead to respiratory failure, pneumonia or pneumothorax; ingestion of liquid nicotine, often by small children; and burns from exploding lithium batteries.

“Electronic cigarettes are not without their risks, so it is very important to educate patients, caregivers and the community on the long-term health consequences of e-cigarette use and the consequences that can lead to an emergent situation resulting in a patient being admitted to the emergency department,” Milici said.

“Management of Posterior Stroke: When FAST and NIHSS Fail You”

Posterior stroke accounts for approximately 20 percent of stroke patients, but their treatment rate is just 3 to 4 percent. This session presenter demonstrated the use of the BEFAST screening tool, which adds balance and eye evaluation to the assessment, and reviewed the “D’s”—dizziness, dysequilibrium, dystaxia, dysmetria, diplopia, dysarthria, and dysphagia—which can provide structure to an assessment.

“Screening for acute onset and sustained difficulties with balance and vision is both sensitive and specific for posterior stroke,” speaker Wanda Pritts said of the extended screening. “Adding the assessment of balance and vision, the effectiveness of screening for stroke rises to 85 percent.”

“Peds Needs: Tips and Tricks for Caring for our Pediatric Patients”

This session was full of tips and tricks and guidelines to make caring for small patients and their parents as easy as possible.

“When you understand the concept that play is the work of the child, it becomes easier to integrate that concept into daily care,” said presenter Joyce Foresman-Capuzzi. “This clearly helps with establishing trust, performing assessment, collecting specimens, providing treatment and administering medication. Most of these can incorporate playful activities so the child is more cooperative, the family comforted and the nurse less stressed.”

Treating Transgender Patients in the ED

Open-mindedness, professionalism and tact can go a long way when caring for transgender patients or, really, any identified group within society.

“Being educated, nonjudgmental and having some idea of how to ask appropriate questions will help with any culture we are unfamiliar with,” said Christine Marshall, an emergency nurse at St. Joseph Emergency Care Center in Orange, California. 

Transgender Patients in the Hospital

1:30 – 2:30 p.m.

Saturday

Room 413, 414, 415

Marshall will speak on the subject in her presentation, “Transgender Patients in the Hospital,” which will introduce attendees to the lesbian, gay, bisexual, transgender and queer/questioning culture. Specifically, and for starters, she will define terms to describe gender and sexuality and explain the distinct differences between the two. 

“My session is an introduction to the care of transgender patients, and attendees will leave with a greater sense of how they feel about caring for this vulnerable population,” she said. 

Marshall will explore different medical treatments available for transgender patients and related complications. Transgender patients are often on hormones, she said, which can cause many complications, including sterility, blood clots, hypertension, weight gain and other blood and cardiac disorders.

Sex reassignment surgery can also cause complications including infections, strictures and ischemia, she added. 

The discussion will touch on behavioral health issues common in LGBTQ patients and the many barriers they might encounter while in the ED. Marshall explained that members of the LGBTQ population are often at a higher risk for anxiety, depression, suicide, substance use and homelessness.

“LGBTQ people are twice as likely to use drugs and alcohol as well as engage in high-risk sexual behaviors and self-harm,” she said. “About 60 percent of this population has considered suicide, while as much as 41 percent may have attempted suicide.”

Barriers the LGBTQ population encounter in an ED setting include lack of knowledge on the part of staff, discrimination and the feeling of being judged for their appearance, Marshall said. She added that emergency nurses can feel more comfortable communicating with this population if they respect these patients’ preferences and apologize for any mistakes or misunderstandings rather than ignoring them.

“Nurses can overcome the barriers to treating LGBTQ patients by remembering that we don’t have to understand their lifestyle, we just need to respect it and value all differences,” Marshall said. 

LGBTQ Defined

Sex – a matter of the body genetically and phenotypically

Gender – an internal sense of being male, female or other

L – Lesbian: female-identified person attracted to other females

G – Gay: male-identified person attracted to other males

B – Bisexual: person of any gender identity who is attracted to people of the same sex and of various genders

T – Transgender: person whose gender identity does not coincide with the sex or gender they were identified as at birth

Q – Queer: umbrella term for non-heterosexual gender identity

I – Intersex: person born with genitalia, chromosomes or reproductive organs that don’t fit the typical definitions for males or females at birth

A – Asexual: person who doesn’t experience sexual attraction

Human Trafficking: ED Nurses on the Front Line

With human trafficking remaining a nationwide, multibillion-dollar criminal industry, the ED is one of the few places where the lives of trafficking victims intersect with the general population. As such, emergency nurses have a unique opportunity to help victims. 

“Survivor-led statistics are making it obvious that trafficked persons are being seen in the emergency department setting, but we are not equipped as a profession to adequately identify and help these disadvantaged people,” said Steven Donahue, co-leader of a deep-dive session at 10:15 a.m. today. “This session is about giving emergency nurses much-needed educational training in order to recognize and treat human trafficking victims.”

Steven Donahue

Donahue said victims rarely receive preventive care for medical needs and are typically brought to the ED when their conditions begin to hurt their economic value to their traffickers.

“One recent study surveyed hundreds of trafficking victims and found that 88 percent reported they received medical care during their captivity. Of those, 63 percent had been seen and treated in a hospital emergency department,” he said. “We have been lucky enough to meet trafficking survivors and hear their stories. When survivors speak about their interaction with health care workers, they often discuss that they wish their doctor or hospital had done more — or anything — to help them. We want to change this.”  

Human Trafficking Emergency: A Comprehensive Training for Emergency Department Personnel

10:15 a.m. – 12:45 p.m.

Saturday

Room 304

The session will be led by Donahue and Michael Schwien, emergency nurses at Main Line Health outside of Philadelphia. Topics will include statistics, myths and misconceptions, health implications and presentation characteristics, vulnerable populations, red flags and clinical markers for identifying possible victims, trauma-informed care and discussing the human trafficking hotline.

“Health care professionals must understand that the lack of education in health care creates a disparity for victims of trafficking,” Schwien said. “This disparity leads to trafficking victims not receiving the appropriate resources and referrals they need. Hospitals can be a place to empower the individual in making steps toward getting them safe.”

Donahue and Schwien will be joined by Diane Horn, assistant district attorney from Delaware County, Pennsylvania, with the special victims unit. She will discuss current legislation and legal definitions regarding trafficking, reporting requirements for ED personnel, recommendations for charting in order to assist law enforcement, prosecution process for traffickers, legal process for survivors and an example of trafficking within Pennsylvania.

Victim advocate Joy Medori will lead the “In Her Shoes” experience. This interactive activity provides participants the opportunity to place themselves in the shoes of a trafficked person and make decisions based on what the participant would do if they were placed in similar situations.

Donahue and Schwien will provide details on how they successfully implemented a human trafficking protocol within their health system.

“We hope that at the end of this training session, not only will participants be able to better identify and treat victims, but they will be supplied with the tools necessary to distribute education to their coworkers and become change agents at their own hospitals,” Donahue said.

Austin to Host ENA in 2019

It’s never too early to start planning for Emergency Nursing 2019, and ENA is helping attendees do just that.

Next year’s conference – Sept. 29 to Oct. 2 – in Austin, Texas, will provide everything attendees have come to expect from the premier emergency nursing educational and networking event, on top of all that Austin has to offer.

“ENA is excited to host the annual conference in Austin,” said ENA President-elect Patricia Kunz Howard. “Emergency Nursing 2019 will feature exceptional educational opportunities, networking and social events in a city filled with great entertainment. Emergency nurses should plan now to attend this event next September.”

And it’s not just ENA that is excited about next year’s conference; the “live music capital of the world” is ready to welcome the event and its more than 3,000 attendees and exhibitors with open arms.

“We are thrilled to have ENA’s annual conference in Austin next year,” said Bridget Portier, Austin’s Assistant director of Convention Services. “Whether you are interested in history, music, outdoor adventures or shopping, Austin offers something for everyone. ENA attendees can definitely expect to enjoy great food, live music and southern hospitality at its best.” 

Attendees in Pittsburgh ready to register for Austin at the lowest possible cost can visit the designated booth near registration in the main foyer of the David L. Lawrence Convention Center any time this week. And those equally excited to present their research next year in ePosters will have the chance to do so shortly after Emergency Nursing 2018 concludes. ENA is slated to put out a call for abstracts for Emergency Nursing 2019 on Monday.  

For those who can’t wait for next year to enjoy more ENA educational programming and networking opportunities, head down to Orlando Nov. 8 and 9 for the ENA Fall Regional Symposium.

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