Home 2014


6 surprising best resuscitation practices

Nothing is more important to the patient’s outcome than properly performed chest compressions.

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

AACN President unveils new theme

On May 19, Kristine J. Peterson, RN, MS, CCNS, CCRN, the new president of the American Association of Critical-Care Nurses, unveiled AACN’s theme for...

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.
anterior-wall myocardial infarction

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 brought the 2013 Boston...

Brain Booster – Summertime Emergencies

Exercise your intellect with this summertime crossword puzzle.

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 syndrome and multiple other...

Challenge to CPR

In the Jan. 27 issue of The New England Journal of Medicine, Gust H. Bardy, MD, suggests the value of CPR may be overrated....

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 Association’s 50th Annual Conference...

Compression-only CPR better for out-of-hospital cardiac arrest

A meta-analysis in The Lancet reports that compression-only bystander CPR is better than standard CPR (compressions and ventilations) for out of hospital cardiac arrest....

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.

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

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

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.

ED nurses continue to be victims of workplace violence according to new report

The latest data from the “Emergency Department Violence Surveillance Study,” an ongoing survey study from the Emergency Nurses Association (ENA), show rates of physical...

Emergency nursing: A specialty unlike any other

The president of the Emergency Nurses Association tells why she’s proud to be an emergency nurse.


Our new crossword puzzle test your knowledge of medical emergencies.

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

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 examination. But once you...
Excessive opioids

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 his home causes deep...

Factors influencing treatment delay for patients with acute myocardial infarction

According to a study in Applied Nursing Research, factors that lead to delay in treatment for acute MI after symptom onset include being at...

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.

FDA approves drug for scorpion sting

The U.S. Food and Drug Administration (FDA) had approved Anascorp, the first specific treatment for a scorpion sting by Centruroides scorpions. Read more.

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?

Four drugs or drug types account for most adverse events resulting in emergency hospitalizations

A study the New England Journal of Medicine found that 67% of emergency hospitalizations related to adverse drug events were caused by four medications...

From our readers: My first code—A retrospective report of a premature promotion and a...

The elevator’s walls were covered in bronze and silver raised metal squares that gave the appearance of a magic eye puzzle and smelled of...
disaster relief psychological practical prepare

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 share my insights gained...

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

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 and families want them...

Gangs don’t protect against crime

A study by the Crime Victims’ Institute at Sam Houston State University found that gang members are twice as likely to be crime victims...

Genetic variation increases risk of sudden cardiac arrest

A meta-analysis has shown that a type of genetic variation increases the risk of sudden cardiac arrest.  Read more.

HAI significantly increases ICU mortality

A study of hospital-acquired infections (HAIs) in the ICU presented at the 22nd European Congress of Clinical Microbiology and Infectious Diseases found that inpatient...

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 for unintentional discontinuation of...
Early recognition and treatment of stroke

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.

JAMA study reports on mortality 3 years after trauma

A study in JAMA found that 3-year cumulative mortality after trauma was 16% and discharge to a skilled nursing facility was associated with a...

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 article “Family presence during resuscitation:...

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 option for nurses” in the...

Long ED wait linked to more adverse outcomes

According to a study published online by the British Medical Journal, longer waiting times in the ED are associated with a higher risk of...

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?
chest tubes

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 (such as interventional radiology),...

MARS®: The new frontier in treating acute liver failure

A type of dialysis, MARS removes toxins and replaces lost liver functions.

More strokes predicted, especially in Mexican-Americans

Research presented at the American Stroke Association’s International Stroke Conference 2011 states that the number of strokes among non-Hispanic whites is expected to rise...
emergency department nurse

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 happened last week at Frankfort...

Nearly half of U.S. EDs overcrowded

A HealthLeaders Media Intelligence Report survey of healthcare leaders in the United States found that 46% of respondents say their EDs are overcrowded. Nearly...

NEJM studies support bystander compression only CPR

Two studies published July 29 by the New England Journal of Medicine support compression only CPR for bystanders. Both found no difference in patient...

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.

New resuscitation guidelines improve survival in non-shockable OHCA

A study in Circulation reports that survival from non-shockable out-of-hospital cardiac arrest (OHCA) improved after new resuscitation guidelines were implemented. Read more.

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.
Managing atrioventricular blocks

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 and safe care in emergency...

Quiz time

Which of the following does not help address issues related to post-intensive care syndrome? a. Diaries kept jointly by family, ICU staff, and physicians b. Post-ICU...

Recognizing a ruptured right bronchial artery

Follow the signs and symptoms to this unusual source of life-threatening bleeding.
Recognizing aortic dissection

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. As a pediatric nurse...

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 the triage nurse measures...

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.

Skin Tear Survey

Skin tears are acute wounds resulting from trauma to the skin. The appropriate care of the patient with a skin tear can present a...

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 recently was discharged after...

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 marijuana, although the overall...

Study: Delayed transfer to ICU increases mortality risk

A study that will be presented at the ATS 2013 International Conference has found that delayed transfer to the ICU in patients who are...

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 increased from 344 to...

Study: ED charges vary widely

Authors of a study published by PLoS ONE found wide variations in emergency department (ED) charges in patients who paid out of pocket and...

Study: Functional problems common in ED elderly

Functional problems affect most older patients who go to the ED, according to “Profiles of Older Patients in the Emergency Department: Findings From the...

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 an optimal time window...

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 latest consensus statement on...

Study: Older adults with TBI admitted on weekends have higher mortality

Older adults (mean age 78 years) with traumatic brain injury (TBI) who are admitted to the hospital on weekends have 14% greater odds of...

Study: Patients needing mental health care linger in EDs

A new study from the Foundation for Healthy Communities highlights the challenges of ensuring patients in the emergency department (ED) who have mental health...

Suppressing a COPD flare-up

Nursing vigilance helps a patient with chronic obstructive oulmonary disease stave off respiratory failure.
SWAT nursing specialty

SWAT nursing: A unique specialty

What does SWAT stand for? So Where Are They? Smart, Witty, and Talented? Smiling, Willing, Able, Technical? At the University of Michigan Health System (UMHS),...
ibuprofen medication meds pills pill

Take Note – December 2006

CDC recommends HIV screening for everyone New recommendations from the Centers for Disease Control and Prevention (CDC) call for routine human immunodeficiency virus (HIV) screening...
colonoscopy cancer note nurse healthcare

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 likely than unvaccinated patients to...

Take Note – February 2009

WEB EXCLUSIVE! A monthly round-up of clinical and practice news and alerts.
type 2 diabetes

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 and again after Hurricane Katrina....

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

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 in the initial abuse...

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 both patient volume and...

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

Why continuous pulse oximetry monitoring is a must in critical care

Continuous pulse oximetry monitoring immediately alerts clinicians to hypoxemia in unstable critically ill patients, so they can intervene before tissue hyposia sets in.

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For Nurse Practitioners

uterine fibroids

Do Vitamins, Plants Help Uterine Fibroid Risk or Treatment?

A research team out of Poland recently undertook a comprehensive examination of published data to determine the role that vitamins and diet might play...