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Journal scan
Science Photo Library
THIS META-ANALYSIS compares randomised controlled trials of two approaches to the management of raised intracranial pressure (ICP) in traumatic brain injury: the use of mannitol versus that of hypertonic sodium. ICP is a predicator of neurological deterioration in patients with brain injury and measures to stop it rising are often taken in emergency departments before quantitative monitoring begins. The literature reviewed for this metaanalysis does not state whether mannitol or hypertonic sodium is more effective in reducing raised ICP. The authors conclude that the evidence from six randomised controlled trials involving a total of 171 patients suggests that mannitol and hypertonic saline effectively lower ICP. However, the evidence also indicates a trend favouring the use of hypertonic saline. It is sobering to think that, although evidence-based medicine lies at the heart of emergency practice, there is a paucity of evidence for a variety of common clinical interventions. This issue is highlighted by the researchers, who conclude that further robust research into the agents and their use as part of a care bundle in EDs is required. Rickard A, Smith J, Newell P et al (2014) Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. Emergency Medicine Journal. doi: dx.doi.org/10.1136/ emermed-2013-202679
Managing intracranial pressure is crucial in brain injury
EMERGENCY NURSE
Science Photo Library
Traumatic brain injury
Data indicate a link between thunderstorms and exacerbation of symptoms in people with asthma
Thunderstorm asthma AN ASSOCIATION between asthma and thunderstorms based on retrospective data has been noted in several papers. This study, however, draws on almost-real-time, anonymised attendance data from 35 emergency departments (EDs) in the UK, and lightning-strike plots from the Met Office. The study reports an increase in the number of patients with exacerbation of asthma who presented to EDs on July 23 2013, and suggests a link with several large thunderstorms over the UK on this day. The authors acknowledge that analysis of other meteorological or environmental factors is required, but state that their research adds to a growing evidence base for ‘thunderstorm asthma’. As such, this short report should be read by ED practitioners and managers concerned about the increasing attendance of people with asthma during thunderstorms. Elliot A, Hughes H, Hughes T et al (2014) The impact of thunderstorm asthma on emergency department attendances across London during July 2013. Emergency Medicine Journal. doi: 10.1136/emermed-2013-203122
Bedside monitoring SEMI-AUTOMATIC BEDSIDE monitors are increasingly being used in acute and critical care areas to record patients’ vital signs and alert clinical staff to potentially life-threatening situations. There are no generally accepted guidelines on the level of monitoring required by patients
in emergency departments (EDs), however, and there has been little evaluation of the use of continuous monitoring systems, particularly in relation to their audible alarms. This article describes an observational study of semi-automatic bedside monitors carried out over a six-week winter period in the ED at the John Radcliffe Hospital, Oxford. If a monitor’s audible alarm was sensitive to the clinical status of a patient, its effect was categorised as positive; if there was no link between the alarm and a patient’s clinical status, the effect was categorised as negative. The results show that, in a ten-bed majors area, there was a high probability of nearcontinuous background noise, with alarm noise being generated for 29% of the observed time. Results also show that alarm-limiting parameters were adjusted to suit individual patients only after 5% of alarms in the resuscitation area, and 6% of those in the majors rooms, had been silenced. The study suggests that audible alarms can be detrimental to the wellbeing of patients, relatives and staff. The authors recommend the retention of alarms, but suggest a number of ways to limit unnecessary alarm noise. Way R, Beer S, Wilson S (2014) What’s that noise? Bedside monitoring in the emergency department. International Emergency Nursing. doi: dx.doi.org/10.1016/j.ienj.2014.01.001 Journal scan is compiled by Philip Angrave, senior lecturer in acute and critical care at Canterbury Christ Church University, Kent October 2014 | Volume 22 | Number 6 13
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Journal scan
Science Photo Library
THIS META-ANALYSIS compares randomised controlled trials of two approaches to the management of raised intracranial pressure (ICP) in traumatic brain injury: the use of mannitol versus that of hypertonic sodium. ICP is a predicator of neurological deterioration in patients with brain injury and measures to stop it rising are often taken in emergency departments before quantitative monitoring begins. The literature reviewed for this metaanalysis does not state whether mannitol or hypertonic sodium is more effective in reducing raised ICP. The authors conclude that the evidence from six randomised controlled trials involving a total of 171 patients suggests that mannitol and hypertonic saline effectively lower ICP. However, the evidence also indicates a trend favouring the use of hypertonic saline. It is sobering to think that, although evidence-based medicine lies at the heart of emergency practice, there is a paucity of evidence for a variety of common clinical interventions. This issue is highlighted by the researchers, who conclude that further robust research into the agents and their use as part of a care bundle in EDs is required. Rickard A, Smith J, Newell P et al (2014) Salt or sugar for your injured brain? A meta-analysis of randomised controlled trials of mannitol versus hypertonic sodium solutions to manage raised intracranial pressure in traumatic brain injury. Emergency Medicine Journal. doi: dx.doi.org/10.1136/ emermed-2013-202679
Managing intracranial pressure is crucial in brain injury
EMERGENCY NURSE
Science Photo Library
Traumatic brain injury
Data indicate a link between thunderstorms and exacerbation of symptoms in people with asthma
Thunderstorm asthma AN ASSOCIATION between asthma and thunderstorms based on retrospective data has been noted in several papers. This study, however, draws on almost-real-time, anonymised attendance data from 35 emergency departments (EDs) in the UK, and lightning-strike plots from the Met Office. The study reports an increase in the number of patients with exacerbation of asthma who presented to EDs on July 23 2013, and suggests a link with several large thunderstorms over the UK on this day. The authors acknowledge that analysis of other meteorological or environmental factors is required, but state that their research adds to a growing evidence base for ‘thunderstorm asthma’. As such, this short report should be read by ED practitioners and managers concerned about the increasing attendance of people with asthma during thunderstorms. Elliot A, Hughes H, Hughes T et al (2014) The impact of thunderstorm asthma on emergency department attendances across London during July 2013. Emergency Medicine Journal. doi: 10.1136/emermed-2013-203122
Bedside monitoring SEMI-AUTOMATIC BEDSIDE monitors are increasingly being used in acute and critical care areas to record patients’ vital signs and alert clinical staff to potentially life-threatening situations. There are no generally accepted guidelines on the level of monitoring required by patients
in emergency departments (EDs), however, and there has been little evaluation of the use of continuous monitoring systems, particularly in relation to their audible alarms. This article describes an observational study of semi-automatic bedside monitors carried out over a six-week winter period in the ED at the John Radcliffe Hospital, Oxford. If a monitor’s audible alarm was sensitive to the clinical status of a patient, its effect was categorised as positive; if there was no link between the alarm and a patient’s clinical status, the effect was categorised as negative. The results show that, in a ten-bed majors area, there was a high probability of nearcontinuous background noise, with alarm noise being generated for 29% of the observed time. Results also show that alarm-limiting parameters were adjusted to suit individual patients only after 5% of alarms in the resuscitation area, and 6% of those in the majors rooms, had been silenced. The study suggests that audible alarms can be detrimental to the wellbeing of patients, relatives and staff. The authors recommend the retention of alarms, but suggest a number of ways to limit unnecessary alarm noise. Way R, Beer S, Wilson S (2014) What’s that noise? Bedside monitoring in the emergency department. International Emergency Nursing. doi: dx.doi.org/10.1016/j.ienj.2014.01.001 Journal scan is compiled by Philip Angrave, senior lecturer in acute and critical care at Canterbury Christ Church University, Kent October 2014 | Volume 22 | Number 6 13
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
