September 27, 2018

APRNs Learn Hands-on at Pre-session

The number of individuals seeking advanced degrees in nursing has increased exponentially in recent years. So, it’s no surprise ENA has responded to the needs of advanced practice nurses with increased educational programming. This year, Emergency Nursing 2018 offered for the first time an all-day APRN pre-session. The eight-hour Advanced Practice Procedural Skills Lab was designed to demonstrate the risks, benefits, considerations and potential complications of performing skills common to advanced emergency nursing practice and to give participants the opportunity to apply those skills in a hands-on setting.

“Advanced practice is much more than technical skills, and these interactive simulations help APRNs in building the clinical reasoning and diagnostic skills required to deliver safe and effective emergency care,” said Margaret Carman, director of ENA’s Institute of Emergency Nursing Advanced Practice.

The session began with a guide to basic suturing techniques, followed by a refresher on sterile gowning and gloving. Participants then split into groups and began their hands-on practice, rotating between seven stations and performing ear, nose and throat procedures, central line insertion and lumbar puncture—both with ultrasound guidance—advanced airway management and dental procedures. They also took part in two full-scale simulations that included management of a patient in adrenal crisis and a pediatric patient with heat-related illness.

Experts were located at each station to provide instruction, walk participants through the procedure and offer guidance as each person practiced his or her techniques. Activities wrapped up with an introduction to ultrasound—the basic science behind ultrasound images and its uses at the bedside.

Attendees expressed enthusiasm for the hands-on learning opportunities of the pre-session.

“As advanced practice nurses, we are expected to do advanced procedures that are not necessarily part of our basic education,” said Michael Nickerson of Portsmouth, New Hampshire. “It’s nice to be able to come to the session and pick up techniques and best practices. It’s all hands-on, and that’s the best way to learn.”

Alex Swan of Orange County, California, said she is currently in an online program to become a family nurse practitioner, so the experience she gained at the session is invaluable, much more so than any online learning module alone.

“Being in the field is not the time for trial and error,” she said. “In an online program, you don’t get class tutorials. Procedurals are home-taught or learned through YouTube.”

Swan said the all-day session was a way to hear professionals explain their way of performing these skills.

Attendees arrived at the pre-session having already reviewed recorded lecture content, allowing them to have more time for hands-on learning. By reviewing the evidence-based medicine module prior to the conference and taking the provided online quiz, they were also able to receive up to eight hours of CME credit.

Discover the ‘Fire Within’

Allison Massari is no stranger to emergency care. Although she is not a nurse herself, she has experienced firsthand the incredible work emergency nurses do daily. As a survivor of two near-fatal car crashes, one in 1998 and another in 2001, she has a unique story to tell today during her keynote address at the opening session. Her address, titled “The Fire Within,” describes the internal resilience required to overcome unimaginable adversity.

Opening Session

7:30 – 9:30 a.m.
Hall C

“This is my story of being a burn survivor, the man who saved my life and the countless health care professionals who had a profound impact on me through the care I was given,” Massari said. “It includes many personal and professional takeaways to support people in their lives. Ultimately, it is a message on the incredible healing power of kindness and compassion in the sacred space of health care.”

The Healer by Allison Massari

As the daughter of a nurse and an oncology surgeon, Massari was already familiar with the rigors of life in the health care field. But during her recovery from second- and third-degree burns, she gained a deeper appreciation for patient-centered care and the nurses who helped her along the way. 

Allison Massari

“I have a very special place in my heart for emergency nurses,” she said. “I vividly remember the care and compassion I was given. To show them my appreciation for their commitment to patients is incredibly meaningful for me. My hope is they will walk away renewed with a sense of the incredible role they play in the lives of so many people.

“Emergency nurses have an incredible commitment to their jobs,” she continued, noting the excellence of their technical abilities and how they care for people in what is often physically and emotionally exhausting work. They have such significant demands on their time and are always having to move on to the next patient. She said because of this, it is important for emergency nurses to hear appreciation from patients willing to offer it.

“Equally important is to share with them how someone like myself, who was so close to death, ultimately overcame it all and came out the other side to a life that is beautiful,” she said. “Without people like them, I would not be here.”

One of the ways Massari helped herself to heal was through art. Her artwork serves as the backdrop to her presentation. 

“Each image that goes up on the screen matches the feeling of each story I am telling,” she said. “At the end of my talk, I will be giving away a signed print of my artwork, called ‘The Healer,’ to a member of the audience. It is one of my favorite pieces.”

Massari’s courageous and inspirational journey will only be part of the dynamic Opening Session. It will also highlight the culmination of the Follow the Flame initiative. Dozens of lanterns have traveled the country, visiting chapters and state councils to showcase the great things members do. The session will feature a dramatic opening with a video, and the once widely dispersed lanterns will come through the crowd to unite on stage. 

After the fanfare, presenters will deliver quick TED-style talks on important emergency nursing topics of the day, followed by short debates on stage.

SIM Wars is Back, Bigger

SIM Wars is about to get real. The scenarios for the competition showcasing team-based collaboration and life-saving skills might be simulated, but the patients — and their portrayed loved ones — are live.

Interacting with screaming or erratic patients as well as parents, spouses or other nervous loved ones adds a layer of complexity for the competitors.

“The goal of the SIM Wars scenarios is to suspend the disbelief of the participants as much as possible,” said Todd Vreeland, a consultant who worked closely with the organizers. “Human patients can give real-time feedback, verbal and non-verbal, in a manner that cannot be matched by a manikin.”

Starting today, 16 teams of four will begin facing off on two stages in the DisastER area of the exhibit hall. You can’t miss them; they flank the only full-size medical helicopter parked in the building.

Attendees who didn’t experience SIM Wars at Emergency Nursing 2017 in St. Louis are in for a treat. Each team will work to achieve the best possible outcomes for their patients in a mock ED, facing high-stakes scenarios in timed rounds. And with live patients and bystanders, anything could happen. 

The teams are pumped and poised to do battle for the coveted trophy, year-long bragging rights and an etched brass plate on a larger SIM Wars trophy gleaming in the front lobby of ENA headquarters in Schaumburg, Illinois.

So far, only Legacy Health has its name on the trophy after ED nurses from several of the Portland, Oregon-area health system’s facilities won the inaugural SIM Wars tournament last year.

But the competition is stiffer this year. Legacy faced only seven other teams in St. Louis, but the tournament was so popular, the conference planning committee saw fit to allow as many as 16 teams to vie for the championship.

The teams with the highest scores advance in the tournament, with the top six scorers competing in the finals for the championship.

Can’t-Miss Thursday Sessions

For those looking to improve your trauma nursing skills, Emergency Nursing 2018 has you covered. Don’t miss these Thursday sessions that run the gamut from general and geriatric trauma to pediatric mental health and critically ill newborns.

Heading Down the Wrong Path: Trauma Cases That Surprised Us

2:30 – 3:30 p.m.

Rooms 403, 404, 405

Have you ever been surprised when a stable trauma patient starts to clinically deteriorate? Emergency nurses tend to place patients on a fixed clinical path during their trauma work-ups, sometimes before all injuries have been discovered. This session discusses case-based scenarios of adult and pediatric trauma patients with changing physical exams during their work-up in the emergency department.

Pediatric Altered Mental Status: An Interactive ED Case-Based Adventure!

2:30 – 3:30 p.m.

Rooms 408, 409, 410

This case series of pediatric patients with altered mental status is designed to teach by working through each case. When is deviation from the ABCDEs necessary? How has the ALTE work-up changed? What are critical actions in a pediatric patient with a focal neuro deficit? This presentation allows the audience to take a timeout, discuss what is going on with the presenting patient, consider the patient and then proceed through the remainder of each case to its conclusion. Session leaders will emphasize the importance of obtaining history from multiple sources.

Case Studies in Trauma: Spines, Brains, and Missing Legs

3:45 – 4:45 p.m.

Rooms 403, 404, 405

This session will review a number of trauma topics through interactive case studies. Using mobile phones, participants will be able to respond to questions that will prompt discussions in trauma management. The presenter will then review the latest studies and literature, as well as available management guidelines. Discussion topics might include interventions for the critically brain-injured patient, controversy surrounding spinal immobilization and trauma system preparation for farm incidents and out-of-hospital amputations.

From Door to Disposition: Geriatric Trauma Triage Considerations and Pitfalls

3:45 – 4:45 p.m.

Room 406

Geriatric trauma patients have increased mortality risk and are under-triaged more frequently than their younger counterparts. In this session, participants will review physiologic considerations in assessing and evaluating geriatric trauma patients and explore best practices that can improve outcomes for this ever-growing patient population.

Bad Things in Small Packages

3:45 – 4:45 p.m.

Rooms 317, 318

The neonatal period extends to 28 days of life, and nearly all emergency nurses will be called to manage critically ill babies who are born outside the hospital or who are discharged and return for emergency care. This presentation will help prepare for this eventuality by providing a physiological foundation and simple algorithmic approach to the resuscitation, differential diagnosis and initial management of very young, very ill patients.

Granny! Where’s Your Helmet!? 

5 – 6 p.m.

Room 407

An increasing number of motorcyclists and bicyclists are dying or suffering significant injuries due to their age. Some attribute this to “mid-life crises” and increased discretionary income. Others think it is related to change in body physiology, strength and inability to compensate when injured. This session will look at the risks older adults take when hitting the road on two wheels.

Because We Asked … Pediatric Emergency Department Suicide Screening

5 – 6 p.m.

Rooms 413, 414, 415

The rates of suicide for children and adolescents has significantly increased over the past decade. This session discusses one pediatric hospital’s journey of identifying a best practice for screening all ED and urgent care patients 10 years of age and older for suicide, regardless of chief complaint. The session will also explore lessons learned for overcoming the biggest obstacle—team members’ reluctance to discuss suicide with pediatric patients and families.

Amish Health Care

Kay Ella Bleecher knows a thing or two about the Amish community.

She grew up in Lancaster County, Pennsylvania – the heart of Amish country – and the differing health care environments therein. Her knowledge of the community and her nursing career enabled her to pull back the curtain on how Amish patients are treated, during Wednesday’s session “Amish Health Care: Plain not Fancy.”

“We can help the patient better if we understand them,” said Bleecher.

She enumerated countless health care learnings from religious beliefs to societal habits for the audience, including:

  • A woman’s white bonnet, which they regard as a necessity to pray to God, must never be removed.
  • Strokes are more prevalent, while heart disease and diabetes cases are less so.
  • The Amish do not get immunizations.
  • The Amish are stoic. “If they ask for Tylenol or a pain reliever, it must be bad,” Bleecher said.
  • Most injuries in the Amish community, including serious traumas, come from buggy and farm accidents

When it comes to health care, the Amish often accept health outcomes with the expression of “God’s will prevails,” Bleecher explained.

Shattering the Six-hour Stopwatch

The American Heart Association’s evidence-based guideline for the early management of patients with acute ischemic stroke covers the selection of eligible patients for endovascular therapy with a mechanical thrombectomy within six hours of what health care workers call the last known normal.

Since the published guideline’s last update in 2015, however, clinical trials of two additional studies have demonstrated that some patients can benefit from the procedure more than six hours and possibly up to 24 hours following a stroke

“Emergency nurses are on the cutting edge of identifying stroke patients who were previously considered outside the window of tPA and/or thrombectomy treatment. It is imperative that the ED nurse recognize these stroke patients as quickly as possible,” presenter Patrice Callagy of Belmont, California, said Wednesday during her session “The New DAWN for Stroke Patients.”

The expansion of the window from six to 24 hours provides greater opportunity to get a CT scan using new software that illustrates a patient’s actual stroke versus tissue at risk. By seeing the two states, medical teams can potentially stop a stroke before it happens or minimize the damage by administering a thrombectomy.

“Stroke progression is variable [among patients],” said co-presenter Eric Bernier. He shared two case studies that showed the same type of clot, where one was slow progressing over 11 hours while the other was three hours. In both cases, the expanded window for LKN made the difference between complete recovery and the need for long term care.

Both Bernier and Callagy agreed the key is for emergency departments to rapidly identify first that it is a neurological condition and second that it possibly could be a stroke. Sometimes, patients present with vision issues that could lead teams to consider other conditions, burning valuable time for diagnosis, Callagy said.

“Recognition and treatment within 24 hours will significantly decrease the disability and mortality rate for these patients,” Callagy said.

Thanks to the new stroke window, “we can treat double the number of patients as well as treat patients far away,” Bernier said. “It completely shatters the six-hour stopwatch.”

Emcee Todd Thomas Returns

Those who remember laughing, singing and dancing at Emergency Nursing 2017 in St. Louis probably remember Conference Emcee Todd Thomas.

Conference Emcee Todd Thomas

And great news: He’s in Pittsburgh and ready to entertain Emergency Nursing 2018 attendees with his spirited presence and dynamic dance moves.

“I love entertaining—it’s in my DNA,” Thomas said. “But I really thrive off the energy of a fun and engaging group, and the ENA conference last year was one of my favorite events I’ve ever done.”

Thomas, who is St. Louis-based and has been a professional emcee and entertainer for 25 years, said he had so many favorite experiences at Emergency Nursing 2017 that it’s hard to pick just one. 

“But I’d say a highlight was my opening-day introduction where I came out and told my story of who I was and how I got there,” he said. “That set the tone that the attendees knew I was a fun and funny guy, and I knew they would be engaging and responsive. Also, the different dance moves I did for them to break up the time between speakers was a riot.” 

At the end of last year’s conference, the meeting’s planners asked if Thomas was available for 2018, which is unusual because ENA traditionally picks an emcee from whichever city is hosting the conference that year. 

“That meant a lot to me that they liked me so much they wanted to fly me out to Pittsburgh for year No. 2,” he said. “However, now the pressure is on. I’ve been brainstorming about some creative new ‘bits’ to showcase this year.” 

Thomas said he has never been to Pittsburgh before, so not only is he excited to emcee Emergency Nursing 2018, but also to explore the city. 

Save a Life, Ask the Question ‘Have You Been Strangled or Choked?’

Non-fatal strangulation is a serious but often overlooked condition in the emergency department. Emergency nurses need to know the principles of the violent act so they are better able to identify and treat it in their emergency departments.

Frequently patients present to the ED with minor and non-specific signs and symptoms that can be easily attributed to other causes. This can be deceiving and might be minimized by first responders and ED staff.

In a Wednesday session, titled “The Edge of Death: Principles of Non-Fatal Strangulation Every ED Nurse Should Know,” Joyce Foresman Capuzzi identified some of these principles to help attendees better understand the nuances of the condition.

Joyce Foresman Capuzzi

“Strangulation is the last violent act before homicide,” Capuzzi said, adding that 90 percent of strangulation cases accompany a history of prior intimate partner violence.

Patients who experience even one episode of IPV, she said, have a 68 percent chance of being strangled at some point.

Capuzzi said ED nurses must be especially vigilant in assessing for elusive signs and symptoms of non-fatal strangulation as well as directly asking patients about strangulation. She underscored the fact that the signs and symptoms of strangulation can be hard to spot. In fact, less than 50 percent of strangled patients who present to the ED have visible signs of the event.

“Just because we don’t see something doesn’t mean something didn’t happen,” Capuzzi said. “At the same time, no one sign or symptom will point to nonfatal strangulation.”

She highlighted various signs emergency nurses can look for, such as wounds to the neck, mouth or eyes, as well as gastrointestinal, respiratory and neurological problems. She also pointed out symptoms the patient may have, including neck pain, voice changes or swallowing variations.

Other topics covered during the session included the types of strangulation, delayed injuries to watch out for, pediatric strangulation, documentation, and the importance of effective forensic testing.

Highlights of the Exhibit Hall

There’s never a dull moment on the exhibit floor. Take a walk around and discover vendor booths, hands-on education, professional development and more. 

Exhibitors: Be sure to stop by the more than 200 exhibitor booths to learn about new products and services.

DisastER: This area offers talks from Air & Surface Transport Nurses Association nurses and a medical helicopter the group parked in the middle of the area. And don’t miss the lively SIM Wars competition on two stages scheduled throughout Thursday and Friday.

AdvancED: This fully equipped, mock two-bed emergency department provides nurses at any stage of their careers with the opportunity to practice their skills in clinical simulations and receive immediate feedback from facilitators.

ED Talks: Take advantage of additional learning opportunities through short, informative talks about new products and services to enhance any emergency department. 

ENA Learning Lab: The newest addition to the exhibit floor is a stand-alone dedicated space for clinical education sessions. Topics include IV infiltration, intubation, obstetric cases in the ED and more.

Professional Development and Career Fair: Get professional headshots, unwind in the relaxation station, look for new job opportunities and maybe even score an interview with a potential employer.

ENA Experience: Your one-stop shop for everything, ENA lets you renew your membership, purchase products, donate to the ENA Foundation and more.

State Council Tables: Visit with your ENA state council, and see how to get more involved. 

Escaping a Mass Casualty Incident

New Alternative to MCI Drill Makes Participants Think Critically

Dozens of attendees this week are spending time earnestly trying to get out of one session as quickly as possible.

Participants of the Escape Room, an alternative to the full-scale mass casualty incident drills found in Emergency Nursing 2015 and 2017, will work against the clock to solve MCI-level patient scenarios.  

Unlike traditional escape rooms in which participants might flee from zombies or diffuse a bomb, Emergency Nursing 2018 Escape Room teams of as many as seven are trapped in a mock ED with one or more patients facing a critical situation that must be appropriately diagnosed and treated within 30 minutes. 

Wednesday marked the first day of competition, with trials continuing today and Friday.

Smiling winners said it was definitely challenging, in part because they were teamed with people from different hospitals.

“Each faculty teaches its own processes, so working with people you don’t know made it even more challenging,” said Kolt Merrill of Ft. Collins, Colorado. “I would highly recommend it. It’s a good refresher on things we hadn’t done in a while.”

ENA’s Emergency Nursing 2018 Education Planning Committee jumped at the chance to approve the escape room concept. They believed it would keep the MCI component of the conference fresh and exciting. 

“We wanted to do something educational but fun,” said Denise Abernethy, who led the team that designed the game for the conference. “Many attendees come to the conference every year expecting days of lectures. Having something different is exciting and entertaining. The goal is for them to go back home remembering what they learned.”

But Abernethy said no one should come into the Escape Room thinking it’s going to be easy.

“We have a couple concepts in the game that a lot of nurses aren’t necessarily trained in,” she said in a recent article in ENA Connection. “We’re not going the route of obvious problems. There will be some disaster leadership skills they’re not used to employing.”

If teams get stuck and need some help, monitors are available to offer hints — but they come at a price. Each hint given adds time to the clock, making an already small window of time to complete the challenge even smaller.

The scenario doesn’t change from team to team, so secrecy is key to the success of the event. But Abernethy isn’t worried; self-preservation is a strong motivator to keep silent.

“No team that competes will want to talk about it, because that will make it easier for the teams behind them to escape,” she said.