2018 ENA Today eHighlights

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.”

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