DiversityNursing Blog

By Laura Geggel

www.foxnews.com

A boy in Canada mysteriously became allergic to fish and nuts after he received a blood transfusion, according to a new case report.

The 8-year-old boy had no history of being allergic to any foods, and was undergoing treatment for medulloblastoma, a type of brain cancer. A few weeks after receiving a blood transfusion, he experienced a severe allergic reaction called anaphylaxis within 10 minutes of eating salmon, according to the report, published online April 7 in the Canadian Medical Association Journal.

His doctors suspected that the blood transfusion had triggered the reaction, they wrote in the report. After treating the patient with a drug containing antihistamines, the doctors advised him to avoid fish and to carry an epinephrine injector in case he had another reaction. [9 Weirdest Allergies]

But four days later, the boy was back in the emergency department after eating a chocolate peanut butter cup. Blood tests and a skin prick test suggested that he was allergic — at least temporarily — to peanuts and salmon, so his doctors advised him to avoid nuts and fish.

"It's very rare to have an allergic reaction to a previously tolerated food," said the report's senior author, Dr. Julia Upton, a specialist in clinical immunology and allergy at the Hospital for Sick Children in Toronto. "The overall idea is that he wasn't allergic to these foods," but in the blood transfusion, he received the protein that triggers an allergic reaction to them, she said.

That protein, called immunoglobulin E, is an antibody associated with food allergies, Upton said. When it encounters a specific allergen, it causes immune cells to release chemicals such as histamine that lead to an allergic reaction. 

However, because the boy's body itself did not make such antibodies against fish and nuts, his doctors said they suspected his allergies would go away within a few months.

Acquiring allergies from a blood donor is rare, but not without precedent. The researchers found two other case reports, both in adults, in which patients acquired temporary allergies from blood plasma. In a 2007 case, an 80-year-old woman had an anaphylactic reaction to peanuts. An investigation showed that her 19-year-old plasma donor had a peanut allergy, according to the report in the journal Archives of Internal Medicine.

In the new case, the 8-year-old also received plasma, the liquid part of blood that contains antibodies. The researchers inquired about the donor to Canadian Blood Services, and found that the donor did have an allergy to nuts, fish and shellfish. The service did not have any more blood from the donor, and subsequently excluded the individual from making future donations, the researchers said. 

About five months later, blood tests showed that the boy's immunoglobulin E levels to salmon and peanut were undetectable. By six months, his parents had gradually and successfully reintroduced nuts and fish back into their son's diet.

However, Upton said, "In general, we would recommend that this be done under medical supervision," just in case there is a medical emergency.

It's unclear how doctors could prevent future cases, she said. Neither Canadian nor American blood service organizations bar people with allergies from donating blood. And testing donated blood for levels of immunoglobulin E doesn't always predict allergies. Some people with high levels of immunoglobulin E don't have allergies, and others with low levels of the protein do, she said.

"Clearly, the safety of the [blood] supply is of everyone's utmost concern," but more research is needed to determine how best to avoid the transfer of allergies, and how frequently this happens, Upton said.

"I think it's hard to make sweeping recommendations based on one case report," Upton said.

In the United States, "If a donor is feeling well and healthy on the day of donation, they are typically eligible to donate," said Dr. Courtney Hopkins, the acting chief medical officer for the east division of the American Red Cross. "We will defer donors on the day of donation if they are not feeling well and healthy, if they have a fever, or if we notice they have problems breathing through their mouth."

Donors can learn more about blood-donation eligibility here. Individuals with allergies shouldn't be dissuaded from donating, Hopkins added.

"We always need blood. We always need blood donors," Hopkins told Live Science.

By Debra Anscombe Wood, RN

While credentials may seem like an alphabet soup after one’s name, the letters tell the world much about a nurse’s qualifications, including licensure, certifications and fellowships.  

“Credentials are not only a source of pride for the nurse, but communicate to patients, colleagues and hospital leaders the nurse’s commitment to standards of excellence,” said Mary Frances Pate, PhD, RN, CNS, associate professor at the University of Portland School of Nursing in Oregon and chairwoman of the board of directors for AACN Certification Corporation, the certification organization for the American Association of Critical-Care Nurses.

Other academic nurses agree. “Credentials matter to the public,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, Lucy Jo Atkinson Scholar in Perioperative Nursing at Case Western Reserve University in Cleveland, adding that they also demonstrate growth and lifelong learning valuable to the nurse and to nurse managers and administrators.

Depending on the position, “some nursing positions require certification demonstrating expertise, and some do not,” said Robert Hanks, PhD, FNP-C, RNC, assistant professor and clinical/FNP track director at the University of Texas Health Science Center at Houston School of Nursing. 

Marianne Horahan, MBA, MPH, RN, CPHQ, director of certification services at the American Nurses Credentialing Center, reported an increase in certification applications this year, in part because of employers’ promotion of certification. A new “Success Pays” program allows the hospital to directly pay for successful exam completion. 

Employers also seek nurses with degrees, as evidence suggests organizations with a higher percentage of BSN- or MSN-prepared nurses have greater patient outcomes, said Paulette Heitmeyer, MSN/ED, RN, CNO at Marina Del Rey Hospital in California. 

Pate said nurses whose clinical skills and judgment have been validated through certification often make patient care decisions with greater confidence, recognize problems and intervene appropriately.

While many believe credentials lead to better care and patient outcomes, research is limited. The Institute of Medicine recently released a research agenda to help fill this gap. 

Nurses should list the highest degree first, immediately after their name, then licensure, any state designations, national certifications, awards, honors and other recognitions, according to the ANCC. 

“Certification provides a foundation for lifelong learning and professional development,” Horahan said. “The purpose of certification is to assure the public that this individual has mastered the body of knowledge and acquired skills in the specialty.”

Source: http://news.nurse.com

By Elizabeth Cohen

But, in the midst of this despair, a miracle arrived at Project Medishare. CNN Senior Photographer Ferre Dollar caught these images seconds after she arrived. Look closely at the center of the photo.

This 4-month-old baby had spent four days alone in the rubble and was unconscious and extremely dehydrated. No one knew if she would live or die. 

But look at her now!

CNN medical producer John Bonifield and I had the pure joy of seeing this wonderful young lady again last week. Her name is Jenny, and she's 5 years old and a pre-kindergartner in Miami. She can write her name and loves to color and dress up as a princess and is adorable and spunky and smart and funny. 

Here are all the miracles that it took to save her life: 

1. That someone happened to find Jenny in the rubble four days after the quake. 

2. That at a time when vehicles were in short supply, Jenny's rescuers flagged down a car to rush her to the hospital. 

3. That the Medishare team of doctors and nurses, led by Dr. Karen Schneider, an emergency medicine physician at Johns Hopkins, managed to get fluids into her. Jenny was so dehydrated her veins had collapsed and Schneider had to put a needle through her shinbone and directly into her bone marrow to deliver fluids. They didn't have to sedate her -- Jenny was so unconscious she didn't even cry.

4. That Project Medishare found a flight headed immediately to Miami, because she needed surgery the tent hospital couldn't provide. Hospital workers flagged down a UN truck and promised the driver they'd name the baby after her if she got the airport on time. 

5. That the baby, then named Patricia after the truck driver, survived the flight to Miami and the emergency surgery. 

When the baby arrived in Miami, it was presumed her parents were dead. She'd been found in the rubble next to the body of a woman, thought to be her mother. 

But that woman turned out to be her baby sitter. Shortly after the baby arrived in Miami, a couple came forward saying they were her parents. Many people doubted them, thinking they just wanted to get to Miami, but DNA testing showed they were telling the truth and the baby's name was actually Jenny. 

Now Jenny and her parents, Nadine Devilme and Junior Alexis, and her 17-month-old little sister, Naima, live in an apartment in North Miami. Her parents have explained to Jenny that the bumpy scars on her left arm are from when she was crushed in the rubble of the Haiti earthquake. They've told her she's a miracle, that Jesus saved her. 

Jenny nods her head and says she understands. But really she's a little embarrassed by all the attention and just wants to go put on her Cinderella dress and go outside and ride her bike and then draw pictures of big red flowers under a sun and sign her name: 

Jenny Alexis.

Source: www.cnn.com

By ERIC WHITNEY

When a fire department gets a call for medical help, most of them scramble both an ambulance and a fully staffed fire truck. But that's way more than most people need, according to Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.

"It's not the prairie and the Old West anymore, where you have to be missing a limb to go to the hospital," Lewis says, "Now it's a sore throat or one day of cold or flu season sometimes, and that can be frustrating for people, I know it is."

South Metro receives more than 12,000 emergency medical calls a year, and takes about 7,000 patients to area hospitals. Somebody who's been running a fever for a couple of days may need help — just not necessarily a ride to the ER. That disconnect can be frustrating for both ambulance crews and patients.

Crews aren't required to transport everyone who calls, but Lewis says they fear lawsuits if they were to leave and a patient got worse. Also, ambulance companies typically don't get paid unless they take somebody to the hospital. So Lewis teamed up with Mark Prather, an emergency room doctor, to try and come up with a better way.

"We created a mobile care unit that can go to a given patient, if we think they're safe to treat on scene, and provide definitive on-scene treatment," says Prather.

The mobile care unit is, basically, a station wagon. Advance practice paramedic Eric Bleeker shows off some of the gear. "This one is a suture set, so it has everything for wound closure, from staples to regular sutures," he says.

Ambulances don't have that kind of equipment, so even someone who just needs a few stitches gets a ride to the emergency department.

Several cities across the country are using paramedics as physician extenders, sending ambulance crews to do routine things like hospital follow-up visits in places where basic health care is hard to get. South Metro's model focuses on responding to calls. The team always includes at least one nurse practitioner, who can prescribe basic medicines that they stock in the mobile unit.

"A lot of what we do is sort of that mid-level between the acute care you receive in an emergency department and what the paramedics can currently do," says Bleeker.

It's kind of like an urgent care clinic on wheels.

There's also a miniature medical lab. "We can run full blood chemistry, we can do complete blood counts, we can check for strep throat, we can check for influenza," he says. Those are capabilities that even many doctors' offices don't have on site.

South Metro Fire also relies heavily on Colorado's new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that's more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.

That person who called 911 because they were running a fever could end up being diagnosed and treated in their living room by South Metro's station wagon for about $500, instead of spending a lot more for similar care at an emergency room.

Insurance companies don't yet pay for this, though, says Prather.

"That's maybe why nobody has done it yet," he says, laughing.

For the last nine months South Metro has been running the service basically for free, to prove that it saves money. But Prather thinks that's about to change because of Obamacare. The law aims to get insurance companies, Medicare and Medicaid to stop paying for too much medical care. And it can penalize health care providers who contribute to overuse of emergency rooms.

"It allowed us to think about payment differently, and basically switch from a volume situation to a quality situation," he says.

But it's not like the law just flips a switch and starts paying for appropriate care instead of rewarding providers who see a high number of patients and do lots of procedures. The change to reward efficient, appropriate health care is just starting to happen. Slowly. But Prather is now in talks with insurers and hopes to be getting paid soon.

Source: http://www.npr.org

Emergency department nurses aren't like the rest of us - they are more extroverted, agreeable and open - attributes that make them successful in the demanding, fast-paced and often stressful environment of an emergency department, according to a new study by University of Sydney.

"Emergency nurses are a special breed," says Belinda Kennedy from Sydney Nursing School, a 15 year critical care veteran who led the study.

"Despite numerous studies about personalities of nurses in general, there has been little research done on the personalities of nurses in clinical specialty areas.

"My years working as a critical care nurse has made me aware of the difficulty in retaining emergency nurses and I have observed apparent differences in personality among these specialty groups. This prompted me to undertake this research which is the first on this topic in more than 20 years.

"We found that emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness, and extroversion personality domains compared to the normal population.

"Emergency departments (ED) are a highly stressful environment - busy, noisy, and with high patient turnover. It is the entry point for approximately 40 per cent of all hospital admissions, and the frequency and type of presentations is unpredictable.

"Emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community.

"They must also able to develop a rapport with individuals from all age groups and socioeconomic and cultural backgrounds, in time-critical situations and often at a time when these individuals are at their most vulnerable.

"For these reasons, ED staff experience high levels of stress and emotional exhaustion, so it's understandable that it takes a certain personality type to function in this working environment.

"Our research findings have potential implications for workforce recruitment and retention in emergency nursing.

"With ever-increasing demands on emergency services it is necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Assessment of personality and knowledge of its influence on specialty selection may assist in improving this.

"The retention of emergency nurses not only has potential economic advantages, but also a likely positive impact on patient care and outcomes, as well as improved morale among the nursing workforce," she said.

Since this article is from Aulstralia, do you agree that Emergency Room Nurses in the US should have the same characteristics to be successful in a US Emergency Room?

Source: http://sydney.edu.au

By Elizabeth Landau via CNN

(CNN) -- Hospitals near Aurora, Colorado, were flooded with victims after a movie theater shooting Friday morning.

An Aurora Fire Department call log reveals the urgency of the situation.

"If they're dead just leave them," a voice tells a fire department responder who reported that police said there may be a number of people dead inside the theater. "We're in a mass casualty situation at this time. Please make sure that you guys set up some kind of transport officer over there that can contact the hospitals so we don't overload one."

The emergency department at Denver Health Hospital was chaotic as staff prepared for the arrival of patients from the shooting, said Dr. Christopher Colwell, director of emergency medical services there. The hospital received seven victims, but called in extra personnel and was ready to take in more patients.

"You're not sure how they're going to arrive to you, so you prepare for the worst," he said.

Shooter had 100-round rifle magazine

Gunshot wound patients are fairly regular at Denver Health, although not on this scale, he said. In a mass shooting situation, staff assess the severity of the wounds and what steps must be taken -- some need to go straight to the operating room, others can wait, still others may not require surgery.

Colwell was a physician who treated victims at the scene of the Columbine High School shootings in 1999. Five patients were transferred to Denver Health; all survived.

"We have obviously done a lot of training exercises since then to try to prepare for an event like that," Colwell said.

Dr. Frank Lansville, medical director of emergency services at Aurora South Hospital, told CNN his hospital had seen 18 patients so far, 12 of whom suffered from gunshot wounds. There were several tear gas victims who were stable, he said. They had been seen, decontaminated and discharged. "The others had horrific gunshot wounds to various parts of their body," he said.

At Aurora Medical Center, the first victim of the movie theater shooting came in before the staff had even heard about the attack, said Tracy Lauzon, director of EMS and trauma services at the hospital.

Few hints of movie-theater shooting suspect's past

Soon after, the trauma surgeon learned more victims were headed their way. Four other trauma surgeons, two orthopedic surgeons and various other physicians came to help. Six patients have gone through surgery.

Aurora Medical Center has taken in 15 patients from the shooting, she said. Eight have been treated and discharged from the emergency room; the other seven were admitted.

"We do drills twice a year anticipating this kind of thing, so people are very well prepared and the hospitals are very well prepared," Lauzon said.

Most of the hospitals in the Denver area follow established federal guidelines for emergency response, said Nicole Williams, spokeswoman for Swedish Medical Center, which treated four victims from the shooting at the movie theater. "We were extremely prepared coming into this," she said because the hospital has already completed a couple of disaster drills this year.

During such a drill, a mass page goes out to the hospital administration alerting officials that EMS has multiple patients who could be transported to area hospitals, and the staff is told be on standby. Emergency workers call the hospitals to see how many beds are available and how many critical patients they can take.

Then, the hospital brings in essential staff, in addition to extra trauma surgeons or other specialists as needed.

"It's a very controlled atmosphere," Williams said. "We all try to stay very calm and just serve the community to the best of our abilities."

Theater shooting unfolds in real time over social media

Staff at Swedish Medical Center's command center fielded hundreds of phone calls "from very panicked people looking for their husbands, their wives, their children," Williams said.

Swedish Medical Center was still treating three patients for gunshot wounds: an 18-year-old male in fair condition, a 20-year-old male in critical condition and a 29-year-old female in critical condition. A fourth patient, a 19-year-old female, came in a few hours after the shootings with minor injuries, possibly caused by shrapnel. She was treated and released.

The family members of the victims at the hospital have been notified, Williams said. "All of the victims have loved ones -- family or friends -- by their side, while they're here," she said.

Kari Goerke, Swedish Medical Center's chief nursing officer, worked in the operating room in the aftermath of the Columbine shootings of 1999. Swedish Medical Center treated four Columbine victims, all of whom survived.

"We had them all in the operating room within an hour of the event," Goerke said. "That gives them much better chances."

The staff responded with expertise and compassion both in 1999 and on Friday morning, she said.

Aspiring sports reporter killed in shooting

"Afterwards you kind of think about what's happened and the shock and awe of the whole situation and how horrific it is," she said. Her voice cracked as she discussed the emotional aftermath. "Taking care of kids is always hard. I'm a mom, I can relate. That makes it difficult."

But, she added, "it's what we're trained to do."