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Critical Care / Emergency / Trauma
A catastrophic diagnosis puts nursing care to the test
The complicated case of a retiree with a newly diagnosed lung tumor kicks off our new “Case Study” department.
A close call for a patient with a rare skin reaction
Stevens-Johnson syndrome has a 15% mortality rate. For one patient, accurate assessment of this rare skin condition led to a full recovery.
A new patient-acuity tool promotes equitable nurse-patient assignments
When a 2 acuity rating isn’t truly a 2
Act fast against pneumothorax
Stop life-threatening pneumothorax with quick thinking and action.
Act fast against severe hypoglycemia
With quick thinking and immediate action, you can save this patient.
Act fast when new neurologic deficits arise
Alert clinicians take immediate steps to eliminate a life threatening epidural hematoma.
Acute traumatic coagulopathy: The latest intervention strategies
Our evolving understanding of how blood loss causes shock is changing trauma resuscitation methods.
Ambulance diversions increase mortality
A new study finds that ED diversion is associated with increased mortality.
Anxiety attack or myocardial infarction?
The patient thinks she knows what’s causing her chest pain. Her nurse knows she must rule out myocardial infarction.
Astute assessment prevents paralysis
What seems like a simple pulled muscle to a shipping clerk turns out to be cauda equina syndrome, a potentially paralyzing injury that warrants immediate surgery.
Attacking anterior-wall myocardial infarction in time
More than 1 million Americans a year suffer a myocardial infarction (MI). This article tells you how – and how quickly – you need to respond to the most dangerous MI.
Avoiding complications from an acute GI bleed
When a patient begins to vomit bright red blood, a nurse relies on his knowledge of Mallory-Weiss tears-and the adroit interventions of the rapid response team.
Baby pictures: Preserving precious moments in the NICU
For one nurse, taking pictures of preemies develops into an art form.
Battlefield nursing at the Boston Marathon
Three yellow balloons danced through the air, hovering over the finish line after being released by the bomb blast that…
Calming a thyroid storm
Saving a patient’s life may rest on recognizing which findings are red herrings and which hold the key to the crisis.
Care during crisis
ANA brings nurses, experts together to shape practice policy during disasters
Care, not chaos
A new document created by ANA and other groups delineates emergency care principles for psychiatric patients.
Case Study: How much is enough?
Three-year-old Christy* has been in the hospital’s pediatric intensive care unit (PICU) since birth, when she was diagnosed with McCune-Albright…
Challenging nursing’s sacred cows
Do you routinely instill normal saline solution into endotracheal tubes before suctioning? Use only the Glasgow Coma Scale for neurologic assessment? Evidence on these and other sacred cows of nursing practice might surprise you.
Coffee drinking and arrhythmias
Coffee drinkers are less likely to be hospitalized for cardiac arrhythmias, according to a report presented at the American Heart…
Continuous renal replacement therapy: Dialysis for critically ill patients
This technique slowly removes wastes and excess plasma water, helping patients recover from their illness.
CRRT spells success against acute renal failure in critically ill patients
Why critically ill patients with acute renal failure need continuous renal replacement therapy.
Dealing with the dangers of dog bites
Dog bites can cause serious or even fatal injuries. Find out how to assess and intervene when your patient has been bitten.
Defeating horizontal violence in the emergency department
The authors share how they defused horizontal violence in their ED.
Derailing disaster after pulmonary aspiration
Thanks to an alert nurse, an elderly patient avoids respiratory failure during her recovery from hip fracture surgery.
Derailing potentially deadly dehydration
When a dehydrated patient falls into a stupor and her vital signs head south, a rapid response team can help unit nurses stabilize her quickly – and avoid the semmingly inevitable.
Detect compartment syndrome in time
Early recognition and action can save a limb.
Detecting, managing, and preventing pulmonary embolism
Pulmonary embolism (PE) kills about 25% of those it strikes. This article explains how deep vein thrombosis (DVT) sets the stage for PE and describes how to assess, manage, and prevent both DVT and PE.
Detecting, managing, and preventing pulmonary embolism
Pulmonary embolism (PE) kills about 25% of those it strikes. This article explains how deep vein thrombosis (DVT) sets the stage for PE and describes how to assess, manage, and prevent both DVT and PE.
Differentiating diabetes complications: What’s your call?
A patient who collapsed at home arrives at the hospital with a blood glucose level off the charts, plus extreme thirst and polyuria. Think his diagnosis is cut and dried? Think again.
Dodging a trach tragedy
When a patient’s O2 Sat falls and subcutaneous neck edema arises, adroit troubleshooting identifies the cause.
During an emergency: Be safe!
Thousands of accidental chemical spills and leaks take place in this country each year. Providing nurses with adequate first-receiver training can help ensure that we can care for contaminated patients without endangering ourselves.
Emergency nursing: A specialty unlike any other
The president of the Emergency Nurses Association tells why she’s proud to be an emergency nurse.
Ethics for nurses in everyday practice: Insubordination in the ICU?
What happens when there is no room in the ICU for an ED patient?
Evaluating the neurologic status of unconscious patients
Assessing the neurologic status of unconscious or comatose patients can be a challenge because they can’t cooperate actively with your…
Excessive opioids lead to a close call for a burn patient
Tim Waters, age 28, is admitted to a burn intensive care unit for treatment after a natural gas explosion in…
Family initiated rapid response team
Rapid response isn’t just for staff. More hospitals are allowing, even encouraging, patients and their families to make the call for help.
Family presence during resuscitation: The in’s and out’s
When the family wants to be with the patient, this advice will help you guide the conversation and manage the situation.
Family presence during resuscitation: Who decides?
Effective communication enables nurses and physicians to negotiate a collaborative decision that honors the family’s wishes.
Fending off disaster for a frostbite victim
Without effective treatment, more than 40% of frostbite
victims require digital amputation. Can Jonathan’s toes
be saved?
From our readers: My first code—A retrospective report of a premature promotion and a crisis situation
The elevator’s walls were covered in bronze and silver raised metal squares that gave the appearance of a magic eye…
From our readers. . . Is disaster relief nursing for you?
Recently I had the opportunity to provide nursing services after an earthquake disaster in the Caribbean. In this article, I…
From our readers…A staff nurse perspective on the IOM Future of Nursing Report
A staff nurse gives his perspective on this important report.
From our readers…How my bad experiences with call lights formed my nursing practice
I have been a critical care nurse since 2008. In our unit, patients have call lights, and of course, patients…
Halting postpartum hemorrhage
When excessive blood loss during delivery threatens a mother’s life, quick assessment, effective interventions, and expert aid from the rapid response team maneuver her postpartum course back onto a normal track.
Hospital patients with chronic diseases at risk for unintentional stoppage of medications
A study in JAMA found that patients with chronic diseases who are admitted to the hospital are at increased risk…
Identify the vessel, recognize the stroke
Stroke signs and symptoms vary with the affected blood vessel. Here’s what you need to know when assessing suspected stroke victims.
Improving palliative care and communication in the ICU
Looking for more information on evidence-based practices? Read this first article in a series from the National Institute of Nursing Research.
Improving patient education with Health Failure Mode and Effects Analysis
Learn how this tool helped an ICU analyze and correct flaws in its patient-education process
Infants in peril: Assessing sepsis in newborns
The author explains not the Newborn Scale of Sepsis she developed helps nurses quantify the clinical signs and laboratory markers of severe bacterial infection.
Keeping cardiac arrest patients alive with therapeutic hypothermia
Create a protocol for this lifesaving intervention at your facility.
Last Breath: The ethics of pharmacologic paralysis
Should patients receive neuromuscular blockers while mechanical ventilation is withdrawn?
Letters to the Editor
A wrenching decision As a nursing student, I’ve been present on several occasions when a patient has coded. So your…
Letters to the Editor – July 2007
Oversight not needed As a recent graduate of a nurse practitioner (NP) program, I appreciated your article “Retail-based clinics: New…
Managing acute decompensated heart failure
Patients with stable chronic heart failure may suddenly start decompensating. Do you know how to recognize this condition and help avert organ failure?
Managing chest tubes: Air leaks and unplanned tube removal
Once treated only in high-acuity settings, patients with chest tubes now receive care in inpatient medical-surgical floors, outpatient procedural areas…
MARS®: The new frontier in treating acute liver failure
A type of dialysis, MARS removes toxins and replaces
lost liver functions.
My First Day in the ED
Note: This article was written before Kenneth graduated from nursing school. My first experience in an emergency department (ED) setting…
Never fear—the critical-care resource nurse is here
Creating a critical-care resource nurse role has helped one hospital
ensure that critically ill patients get the same level of care no
matter where they’re admitted.
New minimally invasive technique treats acute DVT
Pharmacomechanical thrombectomy removes dangerous clots to restore healthy function in hours.
Nurses respond to the Virginia Tech disaster
Nurses from Montgomery Regional Hospital describe their role in treating patients from the Virginia Tech disaster.
Ogilvie’s syndrome: No ordinary constipation
A patient complains of bloating, abdominal tenderness, and constipation. Nothing unusual? Maybe. But if you’re too quick to dismiss these symptoms, you could be overlooking a serious condition called Ogilvie’s syndrome.
Overcoming the fear of tonic-clonic seizures
A thoroughly rational approach to the most frightening of seizures.
PA catheter controversy
Standard of care in the ICU – or object of overuse, abuse, and misuse? The authors explain why they believe PA catheter use may harm more critically ill patients than it helps.
Persevering against pediatric pulmonary hypertension
Despite recent gains in treating pulmonary arterial hypertension, a cure is a long way off. Diagnosis and therapy can be tricky, and prognosis remains poor. Still, there are ways nurses can help slow disease progression and improve quality of life for a child with this condition.
Polymyalgia rheumatica: A possible cause of pericardial effusion
Suspect polymyalgia in patients who continue to decline after treatment for pericardial effusion.
Post-concussive syndrome: What patients and providers need to know
Patients with traumatic brain injuries can suffer from this syndrome for months or even years after injury.
Post-intensive care syndrome: What it is and how to help prevent it
ICU stays can cause physical and cognitive problems for years after discharge. Find out how to improve patient outcomes.
Precision and perfection
Our Editor-in-Chief tells the story of her experience as a patient.
Preventing organ damage from hypertensive crisis
A recent stroke, a history of hypertension and renal disease, and a sudden surge in blood pressure alert caregivers to a patient’s hypertensive urgency.
Preventing the high-pressure complications of abdominal compartment syndrome
Avoid multiple organ failure with early monitoring and early intervention.
Psychiatric emergencies in med-surg patients: Are you prepared?
Rodney, age 47, was admitted to the hospital 2 days ago with rib and femur fractures and facial contusions. He appears well nourished and well groomed.
Putting the breaks on pulmonary edema
I.V. fluids should help a dehydrated patient, but for one with a history of atrial fibrillation and coronary artery disease, they could contribute to pulmonary edema. For Grace Johnson, quick assessment and action staved off a poor outcome.
Q&A with David Westman, Executive Director of the Emergency Nurses Association
What is the Emergency Nurses Association? The Emergency Nurses Association (ENA), an ANA organizational affiliate, is devoted to safe practice…
Quiz time
Which of the following does not help address issues related to post-intensive care syndrome? a. Diaries kept jointly by family,…
Recognizing a ruptured right bronchial artery
Follow the signs and symptoms to this unusual source of life-threatening bleeding.
Recognizing aortic dissection: A race against time
Four in 10 victims die immediately. For those who make it to the ED alive, survival hinges on the healthcare team’s ability to promptly recognize aortic dissection.
Recognizing spinal cord compression
For a postoperative laminectomy patient, sudden left-sided weakness and sensation loss warrant a STAT return to the OR.
Recognizing ventricular arrhythmias and preventing sudden cardiac death
Saving a patient from sudden death starts with recognizing the dangerous ventricular arrythmia that precedes it.
Recovery lessons from the Sandy Hook trauma
Children are people with small hearts and big emotions that often come from the people around them, particularly family members.…
Reducing ambulance diversions without compromising care
How one community hospital dealt with the twin problems of a saturated emergency department and ambulance diversions.
Researchers Explore Ways to Curb ED Violence
Experts say registered nurses who work in hospital emergency departments are at greater risk of violence from patients than nurses in other specialties.
Responding to a hypertensive crisis
Clifton Jones, an African-American male aged 59, comes to the emergency department (ED) complaining of headache and blurred vision. After…
Resurgence of pertussis in infants and children
Learn more about this dangerous disease in children.
Saving a snakebite victim
While hiking, Paul Sawyer, age 31, is bitten twice on the right hand by a rattlesnake. When he arrives at the emergency department (ED), the team obtains STAT laboratory tests, including a complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, fibrin, chemistry panel, blood typing and crossmatch, urinalysis, and urine myoglobin.
Sepsis signposts: Can you spot them?
Sepsis can show up in any setting. So even if you don’t work in a critical care unit, you need to know how to detect it. This article describes warning signs that should arouse your suspicion.
Severe hypoglycemia leads to a seizure
The team scrambles to save a patient with diabetes.
Shhhhhh! Quiet zone
Nurses play a significant role in helping patients to get the sleep they need.
So you want to be an emergency nurse?
How to get going in this exciting specialty.
Speeding to save a stroke victim
The swift response of the healthcare team helps a patient avoid the most devastating effects of a stroke.
Spotting and stopping increased ICP
Rising intracranial pressure calls for fast action.
Stemming a lethal immunologic response
When a patient shows signs of systemic inflammatory response syndrome, her survival hinges on the nurse’s expert assessment skills and the clinical team’s swift interventions.
Stemming the rising tide of acute kidney injury
By obtaining a thorough history and conducting a careful assessment, you can help patients avoid this condition.
Stopping a downward spiral
For a patient with chronic heart failure, failure to take prescribed diuretics triggers a perilous chain of events
Stopping a seizure in a pregnant patient
The rapid response team works quickly to try to prevent fetal injury.
Stroke in a child with sickle cell anemia
Adrienne Johnson, age 5, is admitted to the general pediatric unit. She has sickle cell anemia (hemoglobin SS subtype) and…
Study: Decriminalization of marijuana increases pediatric ED admissions
A study in the Annals of Emergency Medicine found dramatic increases in children requiring medical intervention in states that decriminalized…
Study: Distracted driving more lethal
According to a recent study, from 2005 to 2010, the national number of pedestrians struck and killed by distracted drivers…
Study: ICU transfer timing affects mortality
A study in the American Journal of Critical Care found that transferring patients out of the ICU before or later…
Study: No same-day play for athletes with concussion symptoms
Any athlete with concussion symptoms should not be allowed to return to play on the same day, according to the…
Suppressing a COPD flare-up
Nursing vigilance helps a patient with chronic obstructive oulmonary disease stave off respiratory failure.
SWAT nursing: A unique specialty
What does SWAT stand for? So Where Are They? Smart, Witty, and Talented? Smiling, Willing, Able, Technical? (more…)
Take Note – December 2006
CDC recommends HIV screening for everyone New recommendations from the Centers for Disease Control and Prevention (CDC) call for routine…
Take Note – December 2007
Previous pneumonia vaccination reduces ICU admissions Among adults hospitalized for pneumonia, those who’ve been vaccinated against the disease are less…
Take Note – February 2009
WEB EXCLUSIVE! A monthly round-up of clinical and practice news and alerts.
Take Note – July 2007
On-line video-based course on emergency preparedness The need for better coordination between governmental agencies and hospitals became apparent after 9/11…
Taking the ICU to the Patient
How one rapid response team prevents cardiac arrest and provides other life-saving benefits outside the ICU.
The five P’s spell positive outcomes for ARDS patients
Protect your ARDS patients from danger with perfusion, positioning, protective lung ventilation, protocol weaning, and prevention of complications.
This one’s ours!
Nurses know best when it comes to care coordination.
Thwarting a pneumothorax
As a patient deteriorates, assessment and history findings guide
clinicians to the right diagnosis and interventions.
To sleep, perchance to heal
Sleep doesn’t come easily for ICU patients. Many suffer chronic sleep deprivation, which can raise stress levels, depress immune responses, and impair wound healing. To help them sleep, some ICU’s are enforcing regular quite times.
Touch and go for a patient with a pneumothorax
The nurse’s high index of suspicion helps halt a life-threatening emergency.
Turning the tide in a hypertensive emergency
When a patient’s blood pressure goes stratospheric, the first priority is to check for signs of organ damage.
Using the FOUR Score scale to assess comatose patients
Move over, Glasgow. There’s a new coma scoring tool in town.
Weapon use predicts subsequent abuse incidents
Women are up to 83% more likely to experience repeat abuse by their male partners if a weapon is used…
What every nurse needs to know about the clinical aspects of child abuse
Child-abuse cases can be the mot difficult ones for nurses to cope with. But with the right knowledge and tools, you can care for abused children more effectively.
What works: An ED goes vertical to improve patient flow and satisfaction
In the midst of unprecedented change in health care, hospitals and emergency departments (EDs) are attempting the impossible — increase…
What Works: Improving documentation of restraints in the neuro ICU
Learn how one unit implemented their project, including outcomes and how to overcome barriers.
When closeness breeds cruelty: Helping victims of intimate partner violence
We may not realize it, but most nurses have frequent contact with domestic abuse victims. Shame and fear of reprisal keep many victims from reporting the problem. Caregivers’ discomfort with the topic or unfamiliarity with its signs and symptoms can lead to missed opportunities to identify and help victims.
When nurses speak up, they pay a price
Leah Curtin discusses the effects of whistleblowing on nurses’ lives
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