Editor-in-Chief: K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN
Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
ISSN: 1931-4485
Online ISSN: 1931-4493
Frequency: 4 issues / year

Editors' Remarks

  Editor Karen Sue Hoyt

 

 Editor Jean A. Proehl

 Editor Karen Sue Hoyt

 

Editor Jean A. Proehl 

Editors' Remarks

   

Dear Colleague,

Welcome to the American Academy of Emergency Nurse Practitioners!

 

The newly formed American Academy of Nurse Practitioners (AAENP) has adopted the AENJ as their official journal. Both AENJ and the AAENP seek to promote high quality, evidence-based care so this relationship is a natural fit. There are many opportunities for collaboration and mutual gain which will translate into improved resources for ENPs and improved care for patients.

Members will have free on-line access to AENJ as a benefit of membership and may also subscribe the print journal at a deeply discounted rate.  AAENP Founder, Elda Ramirez, is a long-time AENJ board member and AENJ Editor, K. Sue Hoyt, is now an AAENP board member so our collegial relationship is well established.

If you're an ENP who doesn't already belong to AAENP, you can see what you're missing at www.aaenp-natl.org.

Sue and Jean

Online Editor's Suggestions

Want to exceed 8%? You may need to provide ECMO Life Support!

Over several years, there's been a growth in extreme resuscitation with the application of extracorporeal life support to cases of prolonged resuscitation or that are complicated by hypothermia, pulmonary embolus, or trauma. In Scott Weingart's phrase: "bringing upstairs care downstairs." In some places, it is even brought out into the field or to air retrieval services!

Clearly, capability, availability, transport, system organization are resource intensive, and not suited for all areas. And, high-quality public CPR cannot be lessened in emphasis. 

Read and analyze these, you may find yourself in agreement: "We can't accept 8% anymore!" 

Groups: 

ED ECMO.org. "Resuscitationist-initiated Extra-Corporeal Life Support and Enhanced CPR." 

Extracorporeal REsuscitation ConsorTium. Emergency Department ECMO Collaborative.

 

Articles of interest, and Resources, by date. 

Weingart, Scott. Podcast 057 – Resuscitative Extra-Corporeal Life Support (ECMO). September 26, 2011. EMCrit.org

Reid, Cliff. ECMO retrieval. SydneyHEMS.com. October 20, 2011. 

Singer, Ben & McCreary, David. LTC Podcast 6 Prehospital ECMO. Royal College of Emergency Medicine FOAMed. March 12, 2015. Reporting on prehospital endovascular treatments discussed at London Trauma Conference, 2014. 

Eyre, Dr. Michael. 'Coolest car in London' saves lives. BBC Health Check. 3 November 2014. 

Salm, Leopold, et al. Meeting Abstracts: London Trauma Conference 2014. (9-12 December 2014). Published 11 September 2015. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015, Volume 23 Suppl 2.  

Plaster, Logan. French Connection: Vive le SAMU!. Emergency Physicians Monthly. December 23, 2015. {Physician-led prehospital response to terrorism, and dedicated prehospital ECMO response.} 

Stark, Christopher, MD. ECMO in the Emergency Department. Penn State Hershey. PDF hand-out of presentation discussing controversies in ED ECMO. [No Date.] 

Mosier, J. M., Kelsey, M., Raz, Y., Gunnerson, K. J., Meyer, R., Hypes, C. D., ... & Spaite, D. W. (2015). Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Critical Care, 19(1), 1. [PDF.

Leeuwenburg, Tim. Keeping It Real – Forget ECMO, Crowdsourced Community CPR Is Needed. KIDocs.org.  January 5, 2016. {A pragmatic view looking askance at field ECMO.} 

Sweeney, Brett. Extracorporeal Membrane Oxygenation (ECMO) in the Emergency Department. January 21, 2016. emDocs

Heightman, A.J., MPA, EMT-P. Young Man Saved by ECMO after Being Found Frozen. JEMS Journal of Emergency Medical Services. January 21, 2016. {Flash Video of news report provided.} 

"Dr. Swadon", Bypass the OR: ECMO in the ED. April 4, 2016. 

Shaw, Gina. Special Report: ECMO in the ED: 'We Can't Accept 8% Anymore.' Emergency Medicine News. August 2016 - Volume 38 - Issue 8 - p 24–25.  

Kloepping, Klint W., FP-C, NRP, C-NPT, AAS. Thoughts from a Clinician: ECMO in Out Of Hospital Cardiac Arrest! FlightBridgeED.com. August 28, 2016. 

Wang, Yan. ECMO in Emergency Medicine. Open Access Journal of Surgery. V1, No. 3. September 2016. 

ECPR by Vincent Pellegrino. Resuscitationist's Awesome Guide to Everything (RagePodcast.com). September 25, 2016. 

Tonna, J. E., Johnson, N. J., Greenwood, J., Gaieski, D. F., Shinar, Z., Bellezo, J. M., ... & Fair, J. F. (2016). Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO). Resuscitation, 107, 38-46. October 2016. {abstract, paywall} 

Guthrie, Kane. Own the ECMO. Three videos comprising talk by Dr. Hergen Buescher for the Intensive Care Network. Life in the FastLane.com. November 13, 2016.
  

        Sincerely,

                   Tom Trimble, RN CEN 

         All opinions are solely those of the author.
         Users are responsible for the validity to their own practice.

 

Advanced Emergency Nursing Journal is always looking for authors, articles, and suggestions for topics that inform the work of our specialty and excite the readers. If you have an article or concept to propose, or suggestions and opinions that would help us meet your needs, please use our "Feedback" form to contact the Editors. It's a direct line of communication, and the free registration of your email allows us to respond to your suggestions, and makes the entire website and all other LWW Journals more useable and functional for you.

Current Issue Highlights

Actions
View
Actions
View

AENJ-10th Logo-WEB-sized-Shadow.png

 

Official Journal of the American Academy of Nurse Practitioners

 

Login

Clinical Tips from AENJ

# 184 Seize control!

Sometimes, when doing airway or ENT endoscopy, one needs to pull the tongue forward or to the side for access or visualization. With macroglossia (as in Down's or Beckwith-Wiedemann syndromes), or tongues swollen by edema or hematoma, the very bulk of the base of the tongue obstructs the airway.

Mild situations may be helped by suctioning the tip of the tongue with the open end of the suction tubing (prolonged attachment at high negative pressures might cause a hematoma), or grasping with gloved fingers, ideally with unfolded gauze wrapped around the tongue for traction.

If you foresee the possible difficulty with wet tissues, it's wise to give glycopyrrolate or atropine to dry secretions in advance.

I've previously noted controlling the tongue with a tongue clamp instrument, a suture, a towel clip, or a safety-pin; all used like a stay-suture to hold & guide.

Remember that a nasotracheal or nasopharyngeal tube has a preferential path to get behind the tongue and towards the trachea. Combined with glossal traction or a jaw-thrust, one may overcome the problem.

Inhaled epinephrine or intraglossal injection of epinephrine may reduce threatening edema. Of course, the vasoconstriction caused by epinephrine will have no effect upon space-occupying lesions, tumor mass, hematomata, radiation scarring, fixed tracheal stenosis, etc.; any effect would be upon reactive or inflammatory edema.

If the laryngoscopist intubator is struggling to achieve pharyngeal space or laryngeal view, their view may be greatly improved (perhaps by one or more grades of Cormack & Lehane view) by an assistant facing the patient thrusting the mandible forward with bilateral support posterior to the rami in an upwards direction. A 'skyhook' upwards pull of the chin and jaw may also create space.

Consider that a paralyzing agent may lessen the tension of tissues for easier control, versus, if tissues are so swollen or redundant that resulting flaccidity may collapse the airway. Be prepared, to 'cut to air" for 'front of the neck access to the airway'; i.e., cricothyrotomy. Preparation may need to be a 'double set-up' ready to go at any moment, even simultaneously in a critical situation. Do not delay the crike until it's a peri-mortem or post-mortem attempt. Its purpose is to oxygenate the patient until better control or formal tracheostomy can be obtained.


 All Tips: 2013  2014  2015  2016  

Upcoming Conferences

Western Institute of
Nursing Conference
"50 Years of Leadership:
Continuing the Vision"

April 19th - 22nd, 2017
Colorado Convention Center
Denver, Colorado

 

AANP 2017
National Conference

June 20th - 25th, 2017

Pennsylvania Convention Center
Philadelphia, Pennsylvania 

 

Contact us with information upon
conferences of interest to the readership.

Author Alert!

Advanced Emergency Nursing Journal is seeking authors, articles, and topics. If you are interested in writing for publication, please check our current (2015)  "Topics of Interest" for your project. Please contact our Editors if you have an additional proposal or suggestion.