- Email: [email protected]
Rapid sequence intubation kit
LETTERS/May
Rapid sequence intubation kit
Dear Editor: In our small rural hospital (where we see about 8500 ED patients per year), our pharmacy manager and I put together a rapid sequence intubation kit. This kit has all the drugs needed for rapid sequence intubation in little divided compartments, as well as a copy of our protocol. It is kept with our crash cart, and drugs are checked and updated monthly by pharmacy personnel. This kit also has enough vecuronium to use for a drip, if necessary. We often have long transport times to a higher level of care because of weather in the winter, so patients can be in our emergency department 3 hours or longer. We believe this approach keeps neuromuscular agents away from any other medications and decreases the chance of disasterous errors that can happen under stressful high-risk situations.—Lisa Barber, RN, CCRN, CEN, Manager, Emergency and Trauma Services, Mt Carmel Hospital, Colville, Wash; Email: [email protected] doi: 10.1016/j.jen.2004.07.079
Challenge to CEN radioactive contamination review question
Dear Editor: This letter is written in reference to question No. 1 in the June 2004 article bKnowledge Assessment and Preparation for the Certified Emergency Nurses Examination,Q1 which reads as follows: While caring for a victim of radiation exposure, which of the following procedures would be the priority intervention after proper disposal of the patient’s clothes? A. Insert a Foley catheter to contain contaminated urine. B. Cleanse the contaminated area(s) with rubbing alcohol. C. Decontaminate open wounds with saline solution. D. Wash the patient’s hair thoroughly with soap and water. I work as the Director of Emergency Preparedness for the Hospital Corporation of America (HCA) and have provided educational classes on bED’s Response to a Radiological Incident.Q I would like to point out some difficulties with this question.
October 2004
30:5
1. All patients should be medically stabilized from any traumatic injuries before radiation injuries are considered. Patients are then evaluated for either external radiation exposure or radioactive contamination. This is one of the most important points for nurses to be educated on—the difference between exposure and contamination during a radiation incident. 2. An external radiation source with enough intensity and energy can cause tissue damage (eg, bone marrow depression or skin burns and cutaneous injuries). This exposure from a source outside the person does not make the person radioactive. Even such lethally exposed patients are no hazard to the medical staff. 3. Radioactive material may have been deposited on or in the person (ie, contamination). More than 90% of surface radioactive contamination is removed by removal of the patient’s clothing. Most remaining contamination will be on exposed skin and is effectively removed with soap, warm water, and a wash cloth. 4. Radioactive contamination in wounds or burns should be handled as if it were simple dirt. If an unknown metallic object is encountered, it should only be handled with instruments such as forceps and should be placed in a protected or shielded area. 5. When there is any type of radiation incident, many persons will want to know if they have been exposed or are contaminated. Nurses need to be educated to be able to differentiate between the two and initiate the appropriate treatment. Your question states, bWhile caring for a victim of radiation exposure,Q when in actuality you are stating that you are caring for a victim with radiation contamination. Even though your answer talks about open wounds allowing internal contamination, the question itself is misleading. Care should be taken if any debris are encountered during exploration by removing the debris with long-handled instruments. Again, the priority is not decontamination of the open wounds but the ABC’s of a trauma patient care. Please feel free to contact me if you have any questions.—Judith T. Edwards, RN, BSN, MS, CEN, Director Emergency Preparedness, HCA Quality Department; E-mail: [email protected]
JOURNAL OF EMERGENCY NURSING
399
Rapid sequence intubation kit
Dear Editor: In our small rural hospital (where we see about 8500 ED patients per year), our pharmacy manager and I put together a rapid sequence intubation kit. This kit has all the drugs needed for rapid sequence intubation in little divided compartments, as well as a copy of our protocol. It is kept with our crash cart, and drugs are checked and updated monthly by pharmacy personnel. This kit also has enough vecuronium to use for a drip, if necessary. We often have long transport times to a higher level of care because of weather in the winter, so patients can be in our emergency department 3 hours or longer. We believe this approach keeps neuromuscular agents away from any other medications and decreases the chance of disasterous errors that can happen under stressful high-risk situations.—Lisa Barber, RN, CCRN, CEN, Manager, Emergency and Trauma Services, Mt Carmel Hospital, Colville, Wash; Email: [email protected] doi: 10.1016/j.jen.2004.07.079
Challenge to CEN radioactive contamination review question
Dear Editor: This letter is written in reference to question No. 1 in the June 2004 article bKnowledge Assessment and Preparation for the Certified Emergency Nurses Examination,Q1 which reads as follows: While caring for a victim of radiation exposure, which of the following procedures would be the priority intervention after proper disposal of the patient’s clothes? A. Insert a Foley catheter to contain contaminated urine. B. Cleanse the contaminated area(s) with rubbing alcohol. C. Decontaminate open wounds with saline solution. D. Wash the patient’s hair thoroughly with soap and water. I work as the Director of Emergency Preparedness for the Hospital Corporation of America (HCA) and have provided educational classes on bED’s Response to a Radiological Incident.Q I would like to point out some difficulties with this question.
October 2004
30:5
1. All patients should be medically stabilized from any traumatic injuries before radiation injuries are considered. Patients are then evaluated for either external radiation exposure or radioactive contamination. This is one of the most important points for nurses to be educated on—the difference between exposure and contamination during a radiation incident. 2. An external radiation source with enough intensity and energy can cause tissue damage (eg, bone marrow depression or skin burns and cutaneous injuries). This exposure from a source outside the person does not make the person radioactive. Even such lethally exposed patients are no hazard to the medical staff. 3. Radioactive material may have been deposited on or in the person (ie, contamination). More than 90% of surface radioactive contamination is removed by removal of the patient’s clothing. Most remaining contamination will be on exposed skin and is effectively removed with soap, warm water, and a wash cloth. 4. Radioactive contamination in wounds or burns should be handled as if it were simple dirt. If an unknown metallic object is encountered, it should only be handled with instruments such as forceps and should be placed in a protected or shielded area. 5. When there is any type of radiation incident, many persons will want to know if they have been exposed or are contaminated. Nurses need to be educated to be able to differentiate between the two and initiate the appropriate treatment. Your question states, bWhile caring for a victim of radiation exposure,Q when in actuality you are stating that you are caring for a victim with radiation contamination. Even though your answer talks about open wounds allowing internal contamination, the question itself is misleading. Care should be taken if any debris are encountered during exploration by removing the debris with long-handled instruments. Again, the priority is not decontamination of the open wounds but the ABC’s of a trauma patient care. Please feel free to contact me if you have any questions.—Judith T. Edwards, RN, BSN, MS, CEN, Director Emergency Preparedness, HCA Quality Department; E-mail: [email protected]
JOURNAL OF EMERGENCY NURSING
399