Weekly Review #13

I quite like the EM in 5 site, they have brief, to the point tutorials discussing clinical topics. this week Anna Pickens discussed the assessment of chest pain, and ruling out the "deadly 6": Acute MI, pneumothorax, myocarditis/pericarditis/pericardial effusion, aortic dissection, and esophageal rupture. This post is a short video that starts by discussing a general approach to physical assessment and history taking, moves on to discussing the clinical features for each of the deadly differentials, and finishes with suggestions on diagnoses using cardinal findings, labs, and diagnostic imaging methods. I think this is a great review for nurses: it's clear, concise, and reviews foundational knowledge, well worth the 5 minutes.

http://emin5.com/2015/08/05/approach-to-chest-pain/




There was a nice review of managing asthma exacerbation by Anand Swaminathan posted simultaneously on both Core EM and REBEL EM this week. The post starts with a discussion of the epidemiology and pathophysiology of asthma exacerbation, discusses typical presentation features, reviews the fundamentals of medical management, and finishes with follow-up and discharge recommendations. This is a clear and concise review of the medications typically used for acute asthma exacerbations, their doses, mechanisms of action, and side effects. A great review for any nurse working in emergency.

http://coreem.net/core/basic-asthma-management/





Julie Miller published a review in Nursing 2015 of some dogmatic practices and controversies "sacred cows" of nursing practice. In this article she discusses the results of a 2356 nurse survey designed to assess nurses understanding of current best practices. This article is very readable, the content is presented as the original true/false question (as seen on the questionnaire), the percentage of responses as true/false, and a discussion of the correct answer with accompanying rationale and relevant research. This is a quick easy read, and the content reviewed is applicable to almost all fields of nursing. This is FOANed at it's finest!

http://journals.lww.com/nursing/Fulltext/2015/08000/20_questions__Evidence_based_practice_or_sacred.13.aspx

There are new NICE (National Institute for Health and Care Excellence) trauma guidelines out. St.Emlyn's provides links to the source documents: the full guidelines, key recommendations, and evidence behind the recommendations; as well as a brief synopsis of some of the recommendations. They strongly (thankfully) recommend against crystalloid fluids in actively hemorrhaging patients, endorse restrictive approaches to volume resuscitation, support early IO access, and TXA within 3 hours of injury. Well worth a read for all nurses working in Emergency/Trauma to keep abreast of current practice recommendations.


http://stemlynsblog.org/speak-up-nice-guidance-major-trauma/


St. Emyln's also had a two part review of the value of respiratory rate as a vital sign in the pediatric population. In these two posts Natalie May discusses a couple of articles that came out this month discussing raised respiratory rate in infants. She discusses and summarizes the key points discussed in the studies:

- Tachypnea can be a normal finding: Periodic breathing,
- That respiratory rate should be assessed using auscultation, and by listening for 60 seconds (In part two there's a great discussion about how terminal digit preference shows that we're not),
- Some tips on physical assessments and diagnostics to rule out life threatening processes,
- Suggestions on follow up once life threatening processes have been ruled out.

This is a great review, the source content is freely available, the review is succinct and highly applicable to nurses working in emergency, another great read.

http://stemlynsblog.org/jc-dont-write-off-the-respiratory-rate-1/

http://stemlynsblog.org/jc-dont-write-off-the-respiratory-rate-2/