Do you have plans for October 21st, 2016? I certainly hope so! This is the date of our annual “Meet in the Middle” Conference and AGM. This years topic “Change with the Times” and the impressive line-up of presenters and hands-on facilitators will definitely give you something to ruminate on AND may even inspire change. I plan on having a lot of fun with those skill stations. For our newer ER nurses this could be new and enlightening. For our experienced nurses this could be a fresh, new way to look at old information. Either way let’s enjoy it!

We will not have a hospitality suite this year but plan to meet any of you who arrive Thursday night in the lounge in the main lobby of the hotel. I look forward to putting faces to the many names I have learned this year while I was addressing your envelopes for your NENA-AB pins when you renewed.

Our first EPICC course is set to run in November. We filled our 24 spots in record breaking time and then opened it up to a total of 36 with still some on the waiting list. This is exciting! It reveals how much Emergency nurses are eager for more learning, more training and increased expertise. With this first EPICC course we will be training our first group of instructors from across Alberta so that more courses will happen next year.

I want to brag about a couple of our NENA-AB members. Dawn Paterson from Calgary applied for and was accepted for the position of Western Canada’s representative on NCAC(National Course Administration Committee of NENA Canada). Ashleigh Malarczuk from the Peace River area applied for and was accepted as one of the members of the Directors at Large- part of the executive of National NENA. Margaret Dymond has created an impressive online study

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SEPTEMBER 2016

NENA-­‐AB  

From the President’s Desk

program to help nurses preparing to write their CNA Certification in Emergency Nursing. These are just 3 of our NENA-AB membership that are inspiring nurses. Well done!

I read an article about the 4 athletes from the paralympics who ran in the 1500 meter race with times better than the gold winning athletes in the Rio Olympics. I was mightily inspired! I began thinking of all the people in my life who inspire me…my daughters, my husband(had to say that since he is looking over my shoulder), friends and then I thought of the nurses I work with in the Emergency department. Nurses who serve people at their most vulnerable and difficult times. Nurses who walk people through loss, grief and fear. Nurses who support each other when there are too many patients and not enough places to care for them. Nurses who challenge each other to know more, learn more. Nurses who delight in making their work place better- another Lean project, a batch of cookies for their co-workers, words of encouragement, teamwork. Nurses who advocate for their patients- analgesics, comfort measures or the right stream of care. Nurses who juggle several patients in several emergent states without hesitation. Nurses who laugh and cry in the break-room. Nurses who exercise professionalism when they really want to ask “how did you do that…” and “why did you think that was a good idea?” Nurses who work with everything from an infected toe to necrotizing fasciitis to a cardiac arrest from unknown causes. Emergency nurses. And, just like those paralympic champions who surprised and delighted the world, there might be other things you are good at but this, this unique career of Emergency Nursing, this you are exceptional at. In the words of The Lorax, “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” Thank you that you care a whole awful lot.

Jean Harsch RN, President NENA-AB

"Let us touch the dying, the poor, the lonely and unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work.” Mother Theresa

From the President’s Desk Cont’d.

Regional  Representative  Fall  Reports:

Joanne Yurko RN CNE For Calgary Rural:

Things in our region are pretty quiet. Our staff are looking forward to staffing getting back to normal post vacations, sick calls etc… Fall education is starting to ramp up again. We are looking forward to Meet in the Middle on Oct 21st in Red Deer. Hoping to see lots of Calgary-rural nurses in attendance!

Stephanie Glisson RN, BSN for the Southern Region

It has been a busy summer in our Emergency department ! We are excited to have the Pediatric KidsSIM exercise coming again in December. This learning opportunity is something many of us have had the privilege to participate in. We truly appreciate the expertise and skill shared with us when this team comes. We are also involved with a new initiative for pediatric patients, this involves our most acute pediatric patients who are to be transferred to ACH. We will refer to RAPPID and this will prompt telehealth session as needed, which would involve intensivists @ ACH viewing the patients and advising. Some of us will also be attending TNCC in Lethbridge Oct. 5 and 6.

Dawn Patterson RN for Urban Calgary Zone

Like everyone else we are feeling the start of flu season early. The number of patients holding in Emergencies for admission is on the climb already. We have also seen an recent surge in pediatric asthma cases, this could be due to the weather changes and large amounts of rain we have had.

Fall education courses are underway and numbers in some are decreased. We wonder if this maybe due to the economics at this time.

South Health Campus is running a PALs course Nov 2 and 3 and ACLS December 6 and 7/TNCC Nov 28 and 29 at FMC/ACLS at RGH Oct 31 and November 1/ENPC Sept 21,22,23 at ACH.

AHS continues to have numerous funding opportunities for staff to apply for to assist with educational costs.

I am also now the Western Representative on the National Course Administration Committee of NENA National.

Dawn Peta RN BN for South Zone Rural

We have been working really hard to transition staff to maintain their own competencies and be accountable for staying current. The summer has been pretty quiet as far as education sessions. The fall presents some upcoming educational changes in our region; we have the MUSE cardiology system going LIVE on September 27th which will be a real benefit provincially for continuity of care and information sharing of electrocardiograms. I have put up NENA information posters at each site and continue to encourage membership with any new hires to Emergency. I have also added a NENA section to each of my education boards at all my sites to provide increased visibility of the organization and any upcoming learning sessions and support resources. Staff challenges continue to be the same in ensuring compliance of staff certifications , I am working in conjunction with my managers by keeping a binder with each staff members completed my learning link report card for quick reference. Staff must submit these annually to their manager.

I look forward to seeing many of you at our conference in October.

Ashleigh Malarczuk RN BScN ENC(C)for North Zone

Fall already seems to have started up in the North Zone with cooler weather and shorter days. There are however things to look forward to. There are many education opportunities coming up including ACLS and TNCC. To get more information or to register please see My Learning Link (for AHS staff), the HSFC resuscitation portal, or www.mobilemedi.ca for courses offered in Grande Prairie or surrounding rural areas. We are looking forward to the upcoming 2nd Annual Rural Healthcare Conference on Oct 15/16 with a theme of "Managing the Acutely Ill" to be held in Grande Prairie. Looking forward to seeing our provincial NENA members when we "Meet in the Middle" Oct 21! See you soon!

Regional  Representative  Fall  Reports  cont’d.:

(Stephanie Glisson RN, BSN for the Southern Region cont’d.)

One of the other initiatives we have been involved with is the development and trial of new ER charts. The Emergency Clinical Strategic Network, with input from rural emergency nurses, is developing a new chart that will be used throughout the province in rural sites. This is an exciting step, I would anticipate it would be beneficial to those who work in urban centers to have a universal chart with all the patients we send your way!

Kristen MacKenzie RN, BScN, EMT-A for the North Zone

It's been an interesting few months up here in parts of the North! As the Med Rec project is winding down, several of their educators are being transitioned into general Clinical Educators. Hence, we have some educational coverage in areas that may not have had any for several years. This is great news, but it also is an arduous task; there is a large gap that needs to be filled in terms of competency and tracking that is on the horizon. The Emergency Assessment Record is also being trialed in a nice chunk of Northern sites, some with great success and appreciation, and some with a few more challenges. Overall, change is coming in some shape or fashion, and mostly for the good!

Mary Toronchuk RN for Edmonton Rural

Education opportunities continue to flourish throughout the area with courses in ACLS, ENPC and TNCC being offered, please look for posters at your sites and signup ASAP.

Specialized Clinical Competencies are being offered at the sites these are monitored to ensure that we offer the latest modules, guidelines, and documentation.

Process Improvement continues to aid in improving patient care in a timely manner with the recent “Practice Support Document” protocols for the treatment of pain and fever with Ibuprofen and Acetaminophen at triage or once the patient is in a treatment space prior to Physician or NP seeing patient. It is great that the guidelines offer criteria for both fever and pain and the acetaminophen protocol has guidelines for treatments of adults. The full protocols can be found on Insite on the” Emergency Departments-Edmonton Zone” page.

Throughout the zone various sites have piloted the Medication Reconciliation form to offer feedback to the Zone Quality Council, thank you to everyone for your hard work to trial and submit feedback about the format so we can have a chart page specific to the Emergency Department.

Regional  Representative  Fall  Reports  cont’d.:

IN THIS ISSUE NENA-AB Executive President: Jean Harsch jeanharsch@gmail.com NENA Canada- Board Member(and one of our Past Presidents): Pat Mercer-Deadman pat_mercerdeadman@yahoo.com

Office Administrator: Geri St.Jean Geri.StJean@albertahealthservices.ca

Treasurer: Miriam Abbott miriam.abbott@covenanthealth.ca

Communication: Jean Harsch jeanharsch@gmail.com

Newly elected Communications Officer: Navkiran Tiwana(begins her role Oct.1st) nakiran@ualberta.ca

Regional Representatives: NORTH REGION: Ashleigh Malarczuk ashleigh_malarczuk@hotmail.com Kristen MacKenzie kristen.mackenzie@albertahealthservices.ca

CENTRAL REGION: Deb Currie debandray@shaw.ca

EDMONTON AND EDMONTON RURAL: Tannis Semeniuk tannis.zimmer@covenanthealth.ca Mary Toronchuk mary.toronchuk@albertahealthservices.ca

CALGARY AND CALGARY RURAL: Dawn Paterson purpledawn@shaw.ca Joanne Yurko joanne.yurko@albertahealthservices.ca

SOUTH REGION: Stephanie Glisson glissons@gmail.com Dawn Peta dawn.Peta@albertahealthservices.ca

NENA-­‐AB NENA CARNA

1 From the President’s Desk

2 Regional Representative September Reports

3 Regional Representative September Reports

4 Regional Representative September Reports

5 Regional Representative September Reports

6 In this Issue

7 Communicable Diseases…Can You Recognize the Symptoms

10 Canadian Emergency Nurses Certification Exam Prep Course

15 Anaphylaxis in the ER: Not Just Another Puffy Face

20 Meet in the Middle: Change with the Times

8 Communicable Diseases…Can You Recognize the Symptoms

11 CNA Certification in Emergency Nursing

18 What does our constitution say…

22 What’s Happening?

9 The Full Moon Phenomena

13 Anaphylaxis

19 Nomination form for Treasurer

24 Who are we?

Request for submissions Visit our Facebook page: www.facebook.com/EnigNenaAlberta and follow our Twitter feed https://twitter.com/AbdirectorNena

Communicable,Diseases…Can,You,Recognize,the,Symptoms?,

One$Sunday$morning$in$the$not$so$distant$past,$I$was$working$at$triage.$$Three$families$in$the$waiting$room$with$cough$cold$like$symptoms,$one$waiting$for$consult$to$plastics$and$one$for$an$ultrasound.$$Have$isolation$precautions$been$started$on$the$ILI$(influenza$like$illness)?$$Is$there$anything$specific$about$each$one$of$these$children?$$Handover$reveals$they$are$all$pretty$straight$forward$symptomology…$or$so$it$seems.$

I$start$to$do$reassessment$in$the$waiting$room$and$one$of$the$children$starts$to$cough.$$The$child$(4$yrs$old)$was$triaged$for$cold$like$symptoms,$had$a$mask$on$but$has$now$pulled$it$off$and$continues$to$cough,$cough,$cough,$cough,$cough$…..$and$as$the$child$tries$to$catch$his$breath$there$is$that$distinctive$sound$of$a$whoop$($and$then$vomit).$This$child$is$most$likely$not$vaccinated.$$Children$who$have$received$the$vaccination$may$still$contract$whooping$cough$in$a$much$milder$form$but$often$do$not$have$the$whoop$associated$with$the$cough.$$$I$need$a$gown,$gloves$and$mask$and$then$I$can$assess$this$child$and$get$them$into$an$isolation$room.$$Thankfully$the$family$had$been$asked$to$sit$in$a$little$alcove$off$to$the$side.$$Housekeeping$is$required$to$do$an$isolation$clean$of$the$area.$$This$child$will$go$home$on$erythromycin$or$clarithromycin.$$A$few$hours$later$the$charge$nurse$has$heard$through$the$grapevine$that$I$had$suspected$pertussis$in$the$waiting$room.$$The$fact$that$the$previous$triage$nurse$put$them$in$an$alcove$by$themselves,$I$had$the$forethought$to$put$on$my$PPE$(personal$protective$equipment)$and$have$the$area$cleaned$as$an$isolation$clean,$mitigated$much$of$the$intensive$follow$up$required$to$all$families$in$the$waiting$room$during$that$period$and$all$staff$that$had$contact$with$the$child$having$to$take$a$course$of$erythromycin.$

As$the$morning$progresses,$a$family$arrives$with$their$child$whom$they$are$concerned$about$this$rash$that$the$child$has.$$The$child$is$4$years$old$and$has$had$symptoms$of$cough,$runny$nose,$fever,$headache$

and$“wants$to$stay$in$bed$under$the$covers”.$$The$rash$is$irregular,$started$on$the$face$and$neck$and$is$working$it$ways$down$the$torso.$$In$the$back$of$my$mind$I$am$thinking$this$looks$like$measles,$sounds$like$measles$but$we$have$not$had$measles$for$months.$$I$apologize$to$the$parents$but$explain$that$I$need$to$bring$a$picture$up$for$comparison$as$it$will$determine$which$room$I$place$them$in.$$Dr.$Google’s$picture$and$the$child$match,$I$suspect$we$have$

measles.$$I$need$a$true$isolation$room$and$explain$isolation$precautions$to$the$family.$$There$is$now$a$line$up$at$triage$but$everything$needs$to$be$cleaned$down$first.$$A$few$hours$later,$the$physician$comes$by$and$says$“Good$catch!”$$Being$that$measles$is$viral$in$nature,$treatment$is$aimed$at$supportive$

therapy.$

An$hour$and$a$half$later$the$triage$line$is$down$to$the$occasional$presentation$but$the$waiting$room$is$getting$quite$full.$$A$mother$arrives$concerned$

about$the$rash$on$her$child’s$body.$$She$brought$her$child$to$the$medicenter$on$Friday$for$a$sore$throat.$$

She$is$still$waiting$to$hear$back$from$them.$$This$young$man$(6$yrs$old),$has$a$fever$of$39.3$and$a$very$

hoarse$voice.$$His$rash$is$a$blotchy$bright$pink$red$rash$all$over$his$body.$$If$I$was$a$gambler,$I$would$

place$bets$that$netcare$will$show$the$throat$swab$is$positive$for$Group$Strep$A.$$I$was$right.$$This$child$

has$a$complication$of$untreated$Group$Strep$A$W$Scarlet$fever.$$It$$is$a$an$infection$that$develops$in$those$

who$are$infected$with$Strep$A$and$not$treated$with$antibiotics.$$This$child$needs$some$antibiotics,$

analgesics,$threat$lozenges$and$I$hint$to$mom$–$popsicles$or$freezies.$

As$the$morning$progresses,$there$are$themes$of$

rashes$and$coughs$and$colds.$$A$dad$comes$in$with$

his$2$year$old$son$who$he$says$has$been$more$

irritable$than$normal,$fever,$does$not$want$to$eat$or$

drink$and$these$red$spots$and$peeling$rash$on$his$

hands.$$On$closer$inspection$the$child$has$the$rash$

on$his$feet$and$some$sores$in$his$mouth.$$Hand,$

foot$mouth$disease$–$it$is$viral$in$nature,$spreads$

easily,$last$for$about$10$days$and$treatment$is$

symptom$relief.$$$

It$is$12$noon$and$extra$staff$are$coming$in.$$The$morning$flew$by$and$it$is$time$to$go$for$a$break.$$With$

20+$children$in$the$waiting$room,$it$takes$a$while$to$give$handover.$$Mask$on$all$the$ILI$positive$children$

and$they$are$in$one$area$of$the$waiting$room,$febrile$neutropenic,$child$with$sickle$cell$crisis$and$2$day$

old$neonate$in$a$small$corner$waiting$for$the$next$bed,$and$a$few$healthy$siblings$running$around.$

On$returning$from$break,$a$few$more$children$have$

come$in.$$There$are$two$who$havea$rash,$fever$and$

headache…”it’s$just$viral…some$Tylenol$and$they$will$

feel$better.”$$As$I$approach$the$family$for$reassessment$

and$to$offer$analgesic,$mom$is$concerned$that$this$rash$

is$spreading.$$There$are$some$flat$red$spots,$some$

raised$red$spots$and$a$few$blisters$and$the$child$is$

complaining$that$it$is$itchy.$$It$started$as$what$looked$

like$a$blister$on$the$nose$and$spread$to$his$chest$and$then$the$back.$$Mom$is$concerned$this$might$be$

chicken$pox$as$her$niece$and$nephew$have$it$and$they$were$visiting$them$10$days$ago.$$The$entire$

waiting$room$has$been$exposed.$$$

Why$are$communicable$diseases$on$the$rise$up?$$We$have$lost$herd$immunity.$$So$where$do$we$go$from$

here.$$First,$nurses$need$to$become$more$aware$of$the$signs$and$symptoms$of$communicable$diseases.$$I$

may$have$an$easier$time$recognizing$these$as$I$remember$having$many$of$these$childhood$illnesses$

which$are$not$isolated$to$childhood.$$If$one$person$in$the$community$had$it,$everyone$was$invited$over$

to$your$house$to$be$exposed$“and$build$everyone’s$immunity”.$$For$many$years$we$have$been$

considering$these$presentations$as$rare.$$They$are$not$so$rare$anymore.$$Second,$we$as$nurses$need$to$

educate.$$Next$newsletter$I$will$share$with$you$some$pearls$of$wisdom$for$educating$families$on$immunization.$

The$challenge$is$on!$$Brush$up$on$your$symptoms$and$treatments$of$communicable$diseases.$$Next$newsletter$will$have$tips$and$tricks$on$who$and$how$to$educate$families,$a$quiz$to$test$your$knowledge$and$did$I$mention$there$will$also$be$prizes.$$Details$to$come$in$the$next$newsletter.$

(All$pictures$from$Google$Pictures).$

$

$

Geri St. Jean RN, BScN Clinical Nurse Educator University of Alberta Hospital, Stollery Children”s Hospital and Mazinkowski Heart Institute, Emergency Services. Edmonton, Alberta

educate.$$Next$newsletter$I$will$share$with$you$some$pearls$of$wisdom$for$educating$families$on$immunization.$

The$challenge$is$on!$$Brush$up$on$your$symptoms$and$treatments$of$communicable$diseases.$$Next$newsletter$will$have$tips$and$tricks$on$who$and$how$to$educate$families,$a$quiz$to$test$your$knowledge$and$did$I$mention$there$will$also$be$prizes.$$Details$to$come$in$the$next$newsletter.$

(All$pictures$from$Google$Pictures).$

$

$

I’m writing a fun but serious article for the College & Association of Registered Nurses of Alberta (CARNA) website about whether the "full moon" phenomena— where many nurses report unpredictable changes in their patients—actually exists.

I'm looking at peer-reviewed research (there is some actually!), of course, but also seeking a real nurse (or two) who has experienced this occurrence, and who is willing to share his or her experiences with me. Since it seems common in the emergency room situation, I thought your association would be a good place to start.

Can you suggest someone, perhaps yourself, even? All that would be involved is a short telephone interview with me to discuss experiences. Total anonymity can be granted, however, most nurses seem to experience this, so I don't think anyone need feel uncomfortable.

Please feel free to forward this request to your members, and encourage anyone to call me at 647-453-2752 or drop me a line at lesleywriterforhire@gmail.com. I'll follow up that way.

I  got  this  very  fun  email  from  Lesley  who  is  writing  for  CARNA.    Please  read:

!!

Course'designer'and'author:'Margaret!Dymond!Director!of!Education!National!Emergency!Nurses!Association!(NENA)!Margaret.dymond@albertahealthservices.ca!Course'assistant'author'Michelle!Tipert!Nurse!manager,!Bridgewater,!Nova!Scotia!!

August!18,!2016!!

Canadian'Emergency'Nursing'Certification'Exam'Prep'Course,'2016''

Dear'fellow'emergency'nurse,'! Welcome!to!this!on!line!program!that!is!designed!to!assist!you!in!preparing!to!write!the!canadian!emergency!nursing!certification!exam.!The!program!offers!a!systems!based!approach!and!follows!the!Canadian!Nurses!Association!(CNA)!emergency!nursing!exam!blueprint!materials.!The!program!is!not!mean’t!to!be!all!inclusive!but!does!cover!core!material.!!The'program'is'free!!!!'!

Instructions'to'access'the'core'learning'modules'Step'One:''! On!the!internet!search!!“Open!Learning!“!!or!go!to!!“openlearning,com”!Step'Two:''! Create!your!student!account!Step'Three:''! Once!logged!in,!search!for!the!course!!! “!Canadian!Emergency!Nursing!certification!Exam!Prep!Course”!Step'four':''! Click!on!the!course!and!click!“Join!Course”!Step'five:'! Click!on!“Video!and!activities”!and!select!the!module!you!would!like!to!complete.!!

The'modules':'! The!design!of!the!program!is!in!a!powerpoint!format.!One!slide!will!pose!a!question,!the!next!slide!will!provide!the!answer!and!rationale.!The!program!is!designed!to!be!interactive.!Useful'information:'

! At!the!end!of!the!program,!students!can!print!a!certificate!of!completion!! The!modules!are!in!PDF!format.!Go!to!“View”!on!the!tool!bar!and!select!“Read”!

or!“full!screen”!

*CANADIAN NURSES ASSOCIATION and the CNA logo are registered trademarks of the Canadian Nurses Association/Association des infirmières et infirmiers du Canada.

CNA Certification in Emergency Nursing

Care to Bethe Best

*

“ The National Emergency Nurses Association encourages all its members to obtain CNA certification in emergency nursing, as it promotes expertise in the field and helps RNs keep current with current emergency nursing knowledge. Numerous studies have shown that the presence of nurses with their ENC(C) credential contributes to better patient outcomes.”

Sherry UribePresident, National Emergency Nurses Association

Did you know over 1,100 emergency RNs across Canada now have their national ENC(C) certification designation? Alberta ........................................109 British Columbia ............116 Manitoba ...................................... 61 New Brunswick ............... 54 Newfoundland & Labrador ......... 50 Nova Scotia ...................114 Northwest Territories ................... 15 Ontario ...........................551 Prince Edward Island ................... 11 Quebec ............................. 53 Saskatchewan .............................. 61 Yukon/Nunavut ................. *

What distinguishes CNA-certified nurses• An advanced clinical expertise with a commitment to lifelong learning• Recognized specialty knowledge, authenticated by exacting national

standards• Their clear dedication to evidence-based care and patient safety

What employers of certified nurses are saying• Certification confirms an RN’s enhanced competency and specialized

knowledge.• Certification helps our organization recruit and retain the best nurses.• Having certified RNs on staff not only fosters safe, high-quality care, it

also raises the organization’s entire education culture.

NEW DATES FOR EXAMSWrite the 2016 computer-based exam any time between September 19 and October 7. Submit your online application from April 11 to July 1.

For more information, visit getcertified.cna-aiic.ca.

Note: Once CNA certified, your ENC(C) credential is valid for a five-year term.

* Information suppressed to protect privacy (1 to 4 candidates)

NENA  in  partnership  with  CNA  wants  to  encourage  Emergency  Nurses  to  pursue  their  certification  in  Emergency  Nursing.    Be  that  distinguished  

CNA-­‐certified  nurse  that  pursues  lifelong  learning.

!

1!!

Anaphylaxis+What%is%it?%A+life+threatening+systemic+immune+response+to+an+allergy+causing+substance+that+can+affect+all+ages.+It+is+a+medical+emergency+that+is+potentially+fatal.+It+requires+prompt+recognition+and+immediate+intervention.+Symptoms!can!include!respiratory!difficulty!such!as!tightness!in!throat,!hoarse!voice,!swelling!of!tongue,!stridor,!wheezing,!increasing!accessory!muscle!use,!tracheal!tug!or!respiratory!arrest.!Other+symptoms!include!hypotension,!tachycardia,!itchiness,!hives,!generalized!swelling,!nausea,!vomiting,!cramps!and!diarrhea.!These!symptoms!result!from!the!action!of!mast!cell!mediators,!like!histamine!and!lipid!mediators!such!as!leukotriene’s!and!platelet!activating!factor!on!shock!tissue.!The!shock!tissue!includes!blood!vessels,!mucous!glands,!smooth!muscle,!and!nerve!endings.!Within!minutes!of!antigen!exposure!anaphylaxis!may!occur.!!A!late!reaction!may!occur!hours!after!the!initial!reaction.+For!Prevention!and!management!of!anaphylaxis,!all!caregivers!need!to!follow!current!policy!and!be!aware!of!the!four!R’s:!1.! Realize!the!risk!2.! Recognize!the!signs!and!symptoms!3.! Respond.calmly!and!quickly!to!the!situation!4.! Review!the!situation!to!prevent!a!recurrence!

Remain!with!patient,!discontinue!causative!agent!if!relevant!and!summon!help.!Notify!a!physician!to!initiate!protocol!but!don’t!delay!treatment.!“In!emergent!situations!where!it!is!not!possible!to!obtain!an!order!prior!to!initiating!a!protocol,!contacting!the!authorized!prescriber!can!happen!at!the!same!time!as!the!protocol!and!interventions!within!it!are!being!implemented.”!(Medication!Guidelines,!CARNA,!2015)!

1. Administer!high!flow!oxygen!by!mask.!2. Adults!and!children!30!kg!or!greater!administer!Epinephrine.1mg/ml.(1:1000.solution)!

0.5.mg.IM.(intramuscular).to.thigh!every!5R15!minutes!to!a!maximum!of!3!doses.!3. Children!less!than!30!kg!administer!0.01.mg/kg.IM.to.thigh.every!5R15.minutes!to!

maximum!of!3!doses.!a. !0R10!kg!=!0.1mg!(0.1!ml)!b. 11R15!kg!=0.15mg!(0.15ml)!c. 16R20!kg!=!0.20mg!(0.2ml)!d. 21R25!kg!=!0.25mg!(0.25ml)!e. 26R30!kg!=!0.30mg!(0.3ml)!

4. Then:.1. Initiate!IV!therapy!according!to!your!site!policies!and!any!other!medications.!2. Monitor!patient!response!to!treatment.!3. Monitor!patient!vital!signs.!4. Document!according!to!your!site!policy.!

.

!

2!!

1. !If!a!patient!has!taken!their!own!epinephrine!REMEMBER+you!still!follow!protocol!and!if!after!5B15!minutes!they!are!still!symptomatic!proceed!according!to!AHS!Policy!and!Procedures.!

2. If!a!patient!has!used!an!outdated!EpiBpen,!that!is!not!discolored!nor!has!precipitate!in!vial,!literature!shows!this!is!not!ideal!but!it’s!better!to!receive!some!treatment!as!opposed!to!no!treatment.!www.ncbi.nlm.nih.gov/pubmed/10808186.!

!If+they+show+up+to+your+facility+and+are+still+symptomatic+you+must+do+a+full+assessment+and+follow+protocols.+!

! ! !

What%is%an%Anaphylactoid%Reaction?!Anaphylactoid!reactions!resemble!anaphylactic!reactions!and!may!occur!after!the!first!exposure!to!a!substance.!Also,!anaphylactoid!reactions!are!not!allergic!reactions!because!immunoglobulin!E!(IgE),!the!class!of!antibodies!involved!in!allergic!reactions,!does!not!cause!them.!The!reaction!is!caused!directly!by!the!substance.+The+most+common+triggers+of+anaphylactoid+reactions+are+blood+transfusions,+opioids,+dyes+that+can+be+seen+on+xDrays+(radiopaque+dyes),+aspirin+and+other+nonDsteroidal+antiDinflammatory+drugs+(NSAIDs);+even+exercise!can!be!a!trigger.!!!The!same!four!R’s!apply:!

1. Realize!the!risk!2. Recognize!the!signs!and!symptoms!3. Respond!calmly!and!quickly!to!the!situation!4. Review!the!situation!to!prevent!a!recurrence.!!

Remove!causative!agent!and!education!for!patient!and!family!is!vital!to!ensure!no!future!exposure!to!reactive!substance.!Medical!alert!bracelets!are!recommended!as!well!as!carrying!a!wallet!card!and!updated!medical!records.!..References:.!David!M.!Lang,!MD;!Michael!B.!Alpern,!MD;!Paul!F.!Visintainer,!PhD;!Stephen!T.!Smith,!MD!Arch+Intern+Med.!1993;153(17):2033B2040.!doi:10.1001/archinte.1993.00410170119012!

Ewan,!P.W.!Anaphylaxis.+Br!Med!J.!1998;!316:1442–1445.!! !

Medication!Guidelines,!CARNA,!2015.!

! Dawn  Peta    

I  am  the  NENA  representaDve  for  Rural  South  Zone.    I  have  been  a  nurse  for  22  years,    I  moved  to  criDcal  care  nursing  in  the  ICU  in  2004-­‐2009  and  in  2009  moved  to    Emergency  Nursing.  In  2014  I  accepted  a  Clinical  Instructor  posiDon  with  AHS  for  the  Rural  South  West  Zone  in  Acute  Care/ER.    I  sDll  work  casual  in  the  Lethbridge  Emergency  and  instruct  TNCC,  CTAS  and  NRP.  

I  received  these  two  great  articles  on  the  topic  of  “Anaphylaxis”.  I  liked  the  first  article  for  its  presentation  from  the  standard  perspective  of  anaphylaxis…the  most  common  way  we  think  of  anaphylaxis.    The  second  article  includes  what  a  lot  of  recent  research  is  identifying  as  expanding  the  boundaries  on  the  definition  of  anaphylaxis.    Presently  AHS  is  working  on  a  new  policy/procedure  document  that  will  embrace  the  “old”  and  the  “new”.    Thanks  to  Dawn  Peta  and  to  Teri  Fahner  for  their  great  articles.

Anaphylaxis+in+the+ER+ 1+

Anaphylaxis+in+the+ER:+Not+Just+Another+Puffy+Face+Teri+Fahner,+RN,+BScN++ In+the+Emergency+Department+nurses+will+encounter+a+variety+of+conditions+requiring+urgent+and+immediate+interventions.+One+of+these+situations+is+anaphylaxis,+which+is+defined+as+“a+serious+allergic+reaction+that+is+rapid+in+onset+and+may+cause+death”+(Kim+&+Fischer,+2011).+For+those+nurses+that+are+working+in+the+emergency+department+it+is+of+utmost+importance+that+they+can+quickly+and+thoroughly+assess+and+identify+when+anaphylaxis+is+occurring+in+order+to+deliver+effective+and+timely+treatment+for+their+patients.+Anaphylaxis+is+a+term+that+“is+often+reserved+to+describe+immunological,+especially+IgEPmediated+reactions.+A+second+term,+nonPallergic+anaphylaxis,+describes+clinically+identical+reactions+that+are+not+immunologically+mediated.+The+clinical+diagnosis+and+management+are,+however,+identical”+(Lockey,+2012).+With+this+description+in+mind,+it+is+imperative+that+nurses+working+in+emergency+departments+are+capable+of+properly+recognizing+anaphylaxis+and+preparing+for+immediate+and+appropriate+intervention.+++ Most+nurses+would+be+capable+of+recognizing+anaphylaxis+if+it+presents+with+the+most+common+manifestations+which+are+“cutaneous+symptoms,+including+urticaria+and+angioedema,+erythema+(flushing),+and+pruritus+(itching).+Patients+also+describe+a+sense+of+impending+doom”+(Kim+&+Fischer,+2011).+The+reactions+occur+quickly+and+are+unpredictable,+the+symptoms+“typically+develop+within+minutes+after+exposure+to+the+offending+allergen,+but+may+occasionally+occur+as+late+as+1+hour+post+exposure”+(Kim+&+Fischer,+2011).+It+is+important+to+be+aware+that+in+recent+years+there+have+been+adaptations+to+the+criteria+that+identify+anaphylaxis,+as+well+as+recognizing+that+the+most+crucial+area+of+focus+for+the+proper+diagnosis+lies+in+the+patient+history+(prnEducation,+2015).+++ When+assessing+a+patient+with+a+potential+case+of+anaphylaxis+in+the+emergency+department,+the+acknowledgement+of+thorough+history+is+paramount;+“history+is+the+most+important+tool+to+establish+the+cause+of+anaphylaxis+and+should+take+precedence+over+diagnostic+tests”+(Kim+&+Fischer,+2011).+When+retrieving+the+history+nurses+must+include+clinical+appearance,+exposure+encountered+before+the+incident,+as+well+as+patient+activity+preceding+the+event,+such+as+exercise+or+sexual+activity.+++ There+are+three+categories+into+which+anaphylaxis+falls+in+terms+of+diagnostic+criteria.+The+first+of+these+is+exposure+and+airway+problems.+These+are+typically+caused+by+an+injection+source+of+exposure+(prnEducation,+2015).+This+is+the+category+of+anaphylaxis+that+is+the+most+common+and+also+“includes+involvement+of+the+skin,+mucosal+tissue,+or+both”+(Kim+&+Fischer,+2011).+This+criterion+is+the+common+presentation+which+involves,+but+is+not+limited+to,+the+typical+angioedema+leading+to+throat+tightness,+tongue+swelling,+and+hives.+The+second+category+that+is+included+in+the+diagnostic+criteria+is+“the+impact+of+two+or+more+body+systems+after+the+likely+exposure+to+an+allergen”+(prnEducation,+2015).+There+are+five+body+systems+which+are+included+in+this+category.+These+body+systems+include+integumentary,+respiratory,+gastrointestinal,+cardiovascular,+and+other,+which+includes+anxiety+and+the+sense+of+impending+doom+(prnEducation,+2015).+The+third+category+which+contributes+to+the+diagnostic+criteria+is+“reduced+blood+pressure+after+exposure+to+a+known+allergen+for+that+patient.+A+blood+pressure+is+considered+reduced+when+it+is+>30%+decrease+

Anaphylaxis+in+the+ER+ 1+

Anaphylaxis+in+the+ER:+Not+Just+Another+Puffy+Face+Teri+Fahner,+RN,+BScN++ In+the+Emergency+Department+nurses+will+encounter+a+variety+of+conditions+requiring+urgent+and+immediate+interventions.+One+of+these+situations+is+anaphylaxis,+which+is+defined+as+“a+serious+allergic+reaction+that+is+rapid+in+onset+and+may+cause+death”+(Kim+&+Fischer,+2011).+For+those+nurses+that+are+working+in+the+emergency+department+it+is+of+utmost+importance+that+they+can+quickly+and+thoroughly+assess+and+identify+when+anaphylaxis+is+occurring+in+order+to+deliver+effective+and+timely+treatment+for+their+patients.+Anaphylaxis+is+a+term+that+“is+often+reserved+to+describe+immunological,+especially+IgEPmediated+reactions.+A+second+term,+nonPallergic+anaphylaxis,+describes+clinically+identical+reactions+that+are+not+immunologically+mediated.+The+clinical+diagnosis+and+management+are,+however,+identical”+(Lockey,+2012).+With+this+description+in+mind,+it+is+imperative+that+nurses+working+in+emergency+departments+are+capable+of+properly+recognizing+anaphylaxis+and+preparing+for+immediate+and+appropriate+intervention.+++ Most+nurses+would+be+capable+of+recognizing+anaphylaxis+if+it+presents+with+the+most+common+manifestations+which+are+“cutaneous+symptoms,+including+urticaria+and+angioedema,+erythema+(flushing),+and+pruritus+(itching).+Patients+also+describe+a+sense+of+impending+doom”+(Kim+&+Fischer,+2011).+The+reactions+occur+quickly+and+are+unpredictable,+the+symptoms+“typically+develop+within+minutes+after+exposure+to+the+offending+allergen,+but+may+occasionally+occur+as+late+as+1+hour+post+exposure”+(Kim+&+Fischer,+2011).+It+is+important+to+be+aware+that+in+recent+years+there+have+been+adaptations+to+the+criteria+that+identify+anaphylaxis,+as+well+as+recognizing+that+the+most+crucial+area+of+focus+for+the+proper+diagnosis+lies+in+the+patient+history+(prnEducation,+2015).+++ When+assessing+a+patient+with+a+potential+case+of+anaphylaxis+in+the+emergency+department,+the+acknowledgement+of+thorough+history+is+paramount;+“history+is+the+most+important+tool+to+establish+the+cause+of+anaphylaxis+and+should+take+precedence+over+diagnostic+tests”+(Kim+&+Fischer,+2011).+When+retrieving+the+history+nurses+must+include+clinical+appearance,+exposure+encountered+before+the+incident,+as+well+as+patient+activity+preceding+the+event,+such+as+exercise+or+sexual+activity.+++ There+are+three+categories+into+which+anaphylaxis+falls+in+terms+of+diagnostic+criteria.+The+first+of+these+is+exposure+and+airway+problems.+These+are+typically+caused+by+an+injection+source+of+exposure+(prnEducation,+2015).+This+is+the+category+of+anaphylaxis+that+is+the+most+common+and+also+“includes+involvement+of+the+skin,+mucosal+tissue,+or+both”+(Kim+&+Fischer,+2011).+This+criterion+is+the+common+presentation+which+involves,+but+is+not+limited+to,+the+typical+angioedema+leading+to+throat+tightness,+tongue+swelling,+and+hives.+The+second+category+that+is+included+in+the+diagnostic+criteria+is+“the+impact+of+two+or+more+body+systems+after+the+likely+exposure+to+an+allergen”+(prnEducation,+2015).+There+are+five+body+systems+which+are+included+in+this+category.+These+body+systems+include+integumentary,+respiratory,+gastrointestinal,+cardiovascular,+and+other,+which+includes+anxiety+and+the+sense+of+impending+doom+(prnEducation,+2015).+The+third+category+which+contributes+to+the+diagnostic+criteria+is+“reduced+blood+pressure+after+exposure+to+a+known+allergen+for+that+patient.+A+blood+pressure+is+considered+reduced+when+it+is+>30%+decrease+

Anaphylaxis+in+the+ER+ 2+

in+systolic+blood+pressure+from+the+normal+patient+measurement”+(Kim+&+Fischer,+2011).+With+the+knowledge+of+these+categorizations+in+mind,+it+is+paramount+that+nurses+are+aware+of+the+patient+history+and+understand+that+a+patient+may+have+no+respiratory+or+cutaneous+involvement+whatsoever+in+the+presence+of+anaphylaxis.+It+is+of+great+significance+that+the+nurse+can+identify+the+recent+exposure+to+the+known+or+potential+allergen+in+order+to+rapidly+and+adequately+treat.++

+ Once+the+diagnosis+of+anaphylaxis+has+been+established,+the+prompt+initial+treatment+is+essential+as+“even+a+few+minutes+delay+can+lead+to+hypoxicPischemic+encephalopathy+or+death”+(Simons+et+al.,+2013).+The+patients’+airway,+breathing,+and+circulation+must+be+assessed+quickly+and+immediate+interventions+provided+as+necessary.+The+drug+of+choice+for+the+initial+treatment+of+anaphylaxis+is+epinephrine,+and+“epinephrine+should+be+given+immediately+to+any+patient+with+a+suspected+anaphylactic+episode...even+if+the+diagnosis+is+uncertain+since+there+here+are+no+contraindications+to+the+use+of+epinephrine”+(Kim+&+Fischer,+2011).+Epinephrine+should+be+given+intramuscularly+in+the+lateral+thigh.+This+is+the+route+of+choice+as+“it+allows+for+more+rapid+absorption+and+higher+plasma+epinephrine+levels...it+can+be+given+every+5P20+minutes+as+necessary+if+no+improvement”+(Kim+&+Fischer,+2011).+The+administration+will+not+stop+the+anaphylactic+episode+from+occurring,+however,+it+will+provide+supportive+measures+to+the+body+by+restoring+cardiovascular+support,+stopping+respiratory+and+airway+swelling,+and+stopping+fluid+shifts,+ultimately+resulting+in+the+prevention+of+the+development+or+worsening+of+distributive+shock+caused+by+anaphylaxis+(prnEducation,+2015).+It+has+also+been+found+that+“In+actual+studies+of+individuals+who+have+died+as+a+result+of+anaphylaxis+epinephrine+was+under+used,+not+used+at+all,+or+administration+was+delayed”+(prnEducation,+2015).+The+administration+of+this+medication+is+absolutely+paramount+in+the+management+of+anaphylaxis+and+favourable+outcomes+for+the+patient.++++ During+the+initial+treatments+of+anaphylaxis,+antihistamines+are+not+recommended+to+be+used+instead+of+epinephrine.+They+are+not+intended+for+the+reason+that+“they+do+not+relieve+lifePthreatening+respiratory+symptom+or+shock,+although+they+decrease+urticaria+and+itching”+(Simons+et+al.,+2013).+Nurses+should+be+mindful+that+antihistamines+can+be+provided+for+the+treatment+of+cutaneous+symptoms+and+secondPline+treatment+related+to+these+symptoms;+however+it+will+not+be+useful+in+preventing+distributive+shock+and+respiratory+compromise,+amongst+other+life+threatening+complications.+“Intravenously+administered+H1Pantihistamines+can+also+cause+hypotension”+(Simons+et+al.,+2013)+which+is+not+favourable+during+anaphylactic+episodes+as+“massive+fluid+shifts+can+occur+rapidly+in+anaphylaxis+due+to+increased+vascular+permeability”+(Kim+&+Fischer,+2011).+Understanding+that+there+is+a+likelihood+of+substantial+fluid+shifts+and+hypotension+is+also+an+indication+that+the+nurse+can+anticipate+the+initiation+of+intravenous+access,+preferably+with+a+large+bore+catheter,+and+the+administration+of+fluid+for+intents+of+resuscitation.+In+order+to+prevent+adverse+effects+of+fluid+shifts+and+hypotension,+nurses+should+also+“ensure+that+patients+are+lying+supine+with+their+legs+elevated,+except+if+they+have+shortness+of+breath+or+vomiting...do+not+allow+the+patient+to+stand+abruptly+as+the+fluid+shift+is+a+likely+cause+of+cardiovascular+collapse+in+the+patient+experiencing+anaphylaxis,+which+is+the+second+most+common+cause+of+death,+following+airway+swelling”+(prnEducation,+2015).+++

Anaphylaxis  in  the  ER:  Not  Just  Another  Puffy  Face  cont’d.  

Anaphylaxis+in+the+ER+ 2+

in+systolic+blood+pressure+from+the+normal+patient+measurement”+(Kim+&+Fischer,+2011).+With+the+knowledge+of+these+categorizations+in+mind,+it+is+paramount+that+nurses+are+aware+of+the+patient+history+and+understand+that+a+patient+may+have+no+respiratory+or+cutaneous+involvement+whatsoever+in+the+presence+of+anaphylaxis.+It+is+of+great+significance+that+the+nurse+can+identify+the+recent+exposure+to+the+known+or+potential+allergen+in+order+to+rapidly+and+adequately+treat.++

+ Once+the+diagnosis+of+anaphylaxis+has+been+established,+the+prompt+initial+treatment+is+essential+as+“even+a+few+minutes+delay+can+lead+to+hypoxicPischemic+encephalopathy+or+death”+(Simons+et+al.,+2013).+The+patients’+airway,+breathing,+and+circulation+must+be+assessed+quickly+and+immediate+interventions+provided+as+necessary.+The+drug+of+choice+for+the+initial+treatment+of+anaphylaxis+is+epinephrine,+and+“epinephrine+should+be+given+immediately+to+any+patient+with+a+suspected+anaphylactic+episode...even+if+the+diagnosis+is+uncertain+since+there+here+are+no+contraindications+to+the+use+of+epinephrine”+(Kim+&+Fischer,+2011).+Epinephrine+should+be+given+intramuscularly+in+the+lateral+thigh.+This+is+the+route+of+choice+as+“it+allows+for+more+rapid+absorption+and+higher+plasma+epinephrine+levels...it+can+be+given+every+5P20+minutes+as+necessary+if+no+improvement”+(Kim+&+Fischer,+2011).+The+administration+will+not+stop+the+anaphylactic+episode+from+occurring,+however,+it+will+provide+supportive+measures+to+the+body+by+restoring+cardiovascular+support,+stopping+respiratory+and+airway+swelling,+and+stopping+fluid+shifts,+ultimately+resulting+in+the+prevention+of+the+development+or+worsening+of+distributive+shock+caused+by+anaphylaxis+(prnEducation,+2015).+It+has+also+been+found+that+“In+actual+studies+of+individuals+who+have+died+as+a+result+of+anaphylaxis+epinephrine+was+under+used,+not+used+at+all,+or+administration+was+delayed”+(prnEducation,+2015).+The+administration+of+this+medication+is+absolutely+paramount+in+the+management+of+anaphylaxis+and+favourable+outcomes+for+the+patient.++++ During+the+initial+treatments+of+anaphylaxis,+antihistamines+are+not+recommended+to+be+used+instead+of+epinephrine.+They+are+not+intended+for+the+reason+that+“they+do+not+relieve+lifePthreatening+respiratory+symptom+or+shock,+although+they+decrease+urticaria+and+itching”+(Simons+et+al.,+2013).+Nurses+should+be+mindful+that+antihistamines+can+be+provided+for+the+treatment+of+cutaneous+symptoms+and+secondPline+treatment+related+to+these+symptoms;+however+it+will+not+be+useful+in+preventing+distributive+shock+and+respiratory+compromise,+amongst+other+life+threatening+complications.+“Intravenously+administered+H1Pantihistamines+can+also+cause+hypotension”+(Simons+et+al.,+2013)+which+is+not+favourable+during+anaphylactic+episodes+as+“massive+fluid+shifts+can+occur+rapidly+in+anaphylaxis+due+to+increased+vascular+permeability”+(Kim+&+Fischer,+2011).+Understanding+that+there+is+a+likelihood+of+substantial+fluid+shifts+and+hypotension+is+also+an+indication+that+the+nurse+can+anticipate+the+initiation+of+intravenous+access,+preferably+with+a+large+bore+catheter,+and+the+administration+of+fluid+for+intents+of+resuscitation.+In+order+to+prevent+adverse+effects+of+fluid+shifts+and+hypotension,+nurses+should+also+“ensure+that+patients+are+lying+supine+with+their+legs+elevated,+except+if+they+have+shortness+of+breath+or+vomiting...do+not+allow+the+patient+to+stand+abruptly+as+the+fluid+shift+is+a+likely+cause+of+cardiovascular+collapse+in+the+patient+experiencing+anaphylaxis,+which+is+the+second+most+common+cause+of+death,+following+airway+swelling”+(prnEducation,+2015).+++

Anaphylaxis+in+the+ER+ 3+

+ After+patients+have+been+treated+for+anaphylaxis,+the+patient+must+be+observed+and+monitored+for+a+period+of+time+in+order+to+ensure+that+the+likelihood+of+a+biphasic,+or+rebound,+reaction+is+less.+It+is+stated+that+“experts+have+recommended+observing+patients+for+4P6+hours+following+an+anaphylactic+reaction,+with+prolonged+observation+times+for+patients+with+severe+or+refractory+symptoms”+(Kim+&+Fischer,+2011).+It+is+also+important+to+note+that+individuals+who+have+experienced+anaphylactic+reactions+should+be+given+epiPauto+injectors,+ideally+more+than+one+in+the+event+that+they+experience+another+exposure+to+the+responsible+allergen+in+the+future.++++ Anaphylaxis+is+a+medical+emergency+that+has+a+rapid+onset+and+requires+immediate+attention.+It+is+categorized+by+three+different+criteria+and+the+involvement+of+the+respiratory+and+integumentary+systems+are+not+absolute.+It+requires+the+immediate+administration+of+intramuscular+epinephrine+accompanied+by+intravenous+fluids,+and+secondary+treatment+using+antihistamines,+if+necessary.+The+nurse+also+needs+to+ensure+close+observation+for+biphasic+reactions+as+well+as+patient+education+regarding+the+risk+of+future+anaphylactic+episodes.+It+is+seen+in+the+emergency+department+and+nurses+must+have+preparation+and+knowledge+to+accurately+recognize+when+it+is+occurring+and+be+able+to+anticipate+its+management+in+order+to+achieve+optimal+patient+care+and+outcome.+++++

References++Kim,+H.,+Fischer,+D.+(2011).+Anaphylaxis.+Allergy,(Asthma,(&(Clinical(Immunology,(7(56),+1P7.++ Retrieved+from+http://www.aacijournal.com/content/7/S1/S6++Lockey,+R.+(2012).+Anaphylaxis:(Synopsis.+Retrieved+from+the+World+Allergy+Organization++ website:+http://worldallergy.org/professional/allergic_diseases_center/++ anaphylaxissynopsis.php++prnEducation.+(Producer).+(2015,+August+1).+Episode(7:(Anaphylaxis([Audio+Podcast].++ Retrieved+from+http://nursem.org/en/episodes/episodeP7Panaphylaxis/++Simons,+F.,+Ardusso,+L.,+Dimov,+V.,+Ebisawa,+M.,+ElPGamal,+Y.,+Lockey,+R.,+SanchezPBorges,+M.,++ Senna,+G,+Sheikh,+A.,+Thong,+B.,+Worm,+M.+(2013).+World+Allergy+Organization++ Anaphylaxis+Guidelines:+2013+Update+of+the+Evidence.+International(Archives(of(( Allergy(and(Immunology,(162(3),+193P204.+Retrieved+from++ http://www.karger.com/Article/FullText/354543+++

Anaphylaxis+in+the+ER+ 3+

+ After+patients+have+been+treated+for+anaphylaxis,+the+patient+must+be+observed+and+monitored+for+a+period+of+time+in+order+to+ensure+that+the+likelihood+of+a+biphasic,+or+rebound,+reaction+is+less.+It+is+stated+that+“experts+have+recommended+observing+patients+for+4P6+hours+following+an+anaphylactic+reaction,+with+prolonged+observation+times+for+patients+with+severe+or+refractory+symptoms”+(Kim+&+Fischer,+2011).+It+is+also+important+to+note+that+individuals+who+have+experienced+anaphylactic+reactions+should+be+given+epiPauto+injectors,+ideally+more+than+one+in+the+event+that+they+experience+another+exposure+to+the+responsible+allergen+in+the+future.++++ Anaphylaxis+is+a+medical+emergency+that+has+a+rapid+onset+and+requires+immediate+attention.+It+is+categorized+by+three+different+criteria+and+the+involvement+of+the+respiratory+and+integumentary+systems+are+not+absolute.+It+requires+the+immediate+administration+of+intramuscular+epinephrine+accompanied+by+intravenous+fluids,+and+secondary+treatment+using+antihistamines,+if+necessary.+The+nurse+also+needs+to+ensure+close+observation+for+biphasic+reactions+as+well+as+patient+education+regarding+the+risk+of+future+anaphylactic+episodes.+It+is+seen+in+the+emergency+department+and+nurses+must+have+preparation+and+knowledge+to+accurately+recognize+when+it+is+occurring+and+be+able+to+anticipate+its+management+in+order+to+achieve+optimal+patient+care+and+outcome.+++++

References++Kim,+H.,+Fischer,+D.+(2011).+Anaphylaxis.+Allergy,(Asthma,(&(Clinical(Immunology,(7(56),+1P7.++ Retrieved+from+http://www.aacijournal.com/content/7/S1/S6++Lockey,+R.+(2012).+Anaphylaxis:(Synopsis.+Retrieved+from+the+World+Allergy+Organization++ website:+http://worldallergy.org/professional/allergic_diseases_center/++ anaphylaxissynopsis.php++prnEducation.+(Producer).+(2015,+August+1).+Episode(7:(Anaphylaxis([Audio+Podcast].++ Retrieved+from+http://nursem.org/en/episodes/episodeP7Panaphylaxis/++Simons,+F.,+Ardusso,+L.,+Dimov,+V.,+Ebisawa,+M.,+ElPGamal,+Y.,+Lockey,+R.,+SanchezPBorges,+M.,++ Senna,+G,+Sheikh,+A.,+Thong,+B.,+Worm,+M.+(2013).+World+Allergy+Organization++ Anaphylaxis+Guidelines:+2013+Update+of+the+Evidence.+International(Archives(of(( Allergy(and(Immunology,(162(3),+193P204.+Retrieved+from++ http://www.karger.com/Article/FullText/354543+++Teri has been living with her family in and around Edmonton, Alberta and working as a Registered Nurse at the Grey Nuns Hospital in the emergency department since graduating in 2012. She has also worked in a rural hospital in both emergency and acute care. Teri has developed a passion for working with those individuals who are acutely and/or critically ill and frequently developing and learning ways to enhance their outcomes. On days off Teri enjoys spending time with

Anaphylaxis  in  the  ER:  Not  Just  Another  Puffy  Face  cont’d.  

What  our  constitution  says  about  electing  new  officers  to  the  NENA-­‐AB  

Executive.

11.  Elections:  

11.1  The  election  of  officers  shall  be  by  secret  ballot  unless  by  acclimation.  Members  not  attending  the  Annual  General  Meeting  may  vote  by  signed  proxy  through  another  member  who  will  be  attending  the  meeting  or  with  a  proxy  signed  by  one  witness  and  sent  to  the  NENA-­‐AB  Administration  Officer  prior  to  the  election.  Proof  of  signed  proxy  must  be  given  at  the  Annual  meeting.  

11.2    The  nominaDon  of  Officers  shall  be  received  at  the  Annual  General  MeeDng.  

11.3    The  official  elecDon  results  shall  be  documented  at  the  Annual  General  MeeDng,  and  circulated  to  the  membership  by  the  Secretary,  within  four  weeks  of  the  elecDon.  

7.  Officers:    

  .   7.1    The  Executive  shall  consist  of:  President    

    -­‐    President-­‐Elect  /Past  President    

    -­‐  AdministraDon  Officer.    

    -­‐Treasurer    

    -­‐CommunicaDon  Officer    

  .   7.2    The  terms  of  office  for  the  President,  Administration  Officer  Treasurer,  and  Communication  Officer  shall  be  three  years.  The  term  of  office  for  the  President-­‐Elect  and  the  Past  President  shall  be  two  years.  The  office  of  the  President-­‐Elect  and  Past  President  shall  be  active  during  alternate  terms.    

  .   7.3    The  term  of  office  will  begin  on  July  1,  of  the  designated  year  following  election  at  the  Annual  General  Meeting.    

  .   7.4    To  facilitate  knowledge  transition  of  current  Emergency  nursing  practice  and  trends,  the  NENA-­‐AB  Executive  Members,  will  be  given  the  opportunity  to  attend  the  annual  NENA  Conference.  Conference  registration,  and  airfare/or  hotel  accommodation  will  be  covered  by  NENA-­‐AB.  

  Treasurer Job Description:

1. Shall be responsible for the finances and account of NENA-AB and shall report thereon at all meetings, as well as prepare a financial statement and budget for the Annual General Meeting.

2. Shall prepare the annual financial statement for a financial review/ auditing purposes.

3. Shall prepare receipts of NENA-AB business/financial affairs (items) as appropriate, with assistance from the Administration Officer.

4. Shall have the responsibility for paying outstanding accounts on behalf of NENA-AB

5. Shall assist with organization of meetings, educational activities and fundraising.

The Treasurer’s term is 3 years.

OCTOBER 21, 2016

MEET IN THE MIDDLE:

CHANGE WITH THE TIMES

Sheraton Hotel, Red Deer, Alberta Presented by NENA Alberta $95 for members, $120 for non members (Includes breakfast, lunch and refreshments for the day)

Doors will open at 0730

with breakfast being served

Topics for this

Education Day will include:

Presentations Changing Perspectives

Rosemarie Schmidt

Leaders as Change Agents

Marlisse VanDijk

Changing View of Drug Overdose

EPS Calgary

Sexual and Gender Minorities in Healthcare

Michel Lévesque Derek Fehr

Skill Stations

New and Updated Skills

Hemorrhagic Control, ACLS Updated,

Anatomy of a Changed Rhythm,

Intranasal Medications, Disaster or Delivery, Splinting and more…

NOMINATIONS AND ELECTIONS FOR POSITION OF

TREASURER PROPOSED POLICY FOR SPECIAL FUNDING

PRESENTATION OF BURSARIES

NENA –AB AGM WILL BE HELD AT LUNCH

REGISTRATION FOR NENA AB

MEET IN THE MIDDLE CHANGING WITH THE TIMES

NAME: ___________________________________________ □RN □LPN

Payment: NENA AB Member $95.00 □

Non-member $120.00 □ If you are not a member, you can also register for membership at www.NENA.ca

and pay the Members fee for the conference.

Make cheque or money order payable to NENA Alberta. Payment must be received by the registration deadline of October 13, 2016. Sorry, we are unable to accept Credit Card payments.

MAILING ADDRESS: ____________________________________________________________________________________

____________________________________________________________________________________

TELEPHONE NUMBER WHERE YOU CAN BE REACHED: __________________________________________

EMAIL ADDRESS FOR CONFIRMATION (Please print clearly): ___________________________________________________________________________________

Only registrants providing a current email address will be notified with confirmation of attendance. Please send your payment to:

Miriam Abbott #8 Greystone Crescent, Spruce Grove, Alberta, T7X 0A7

Receipts for payment will be handed out at the education day on October 21, 2016.

"The organizers reserve the right to change program, date, meeting venue, speakers or content without further notice and assumes no liability for these changes." The HPA mandates that each health care professional must develop and implement an individual learning plan. This education day provides an excellent method of incorporating education into your learning plan.

For those who have special dietary needs we are able to offer:

□ Vegetarian □ Gluten Free

This course provides an excellent knowledge base for assessment and intervention when caring for children from the doctor’s office to the emergency room to the pediatric floor.

October 28,2016 0800 - 1730 October 29,2016 0800 –1730

October 30 2016 0800 – approx. 1400 hours Cost: $375– NENA-AB Members

$400 – non members (cost includes manual/lunch)

Spencer Room, Northeast Community Health Centre To register, please contact Mary Toronchuk mary.toronchuk@albertahealthservices.ca or Mary Martin mary.martin@albertahealthservices.ca NECHC

(780)- 342-4006 or (780) 342-4177 Cheques to be made out to NECHC Emergency Education Fund

Payment in full at the time of registration

Deadline for registration October 1,2016For more information, please contact Cathy at (780) 407-7568 or email me at Cathy.Falconer@albertahealthservices.ca

! Expert caring makes a difference®

780.451.0043 1.800.252.9392 Fax: 780.452.3276

11620 – 168 St NW Edmonton, Alberta T5M 4A6

nurses.ab.ca

Memorandum Date: September 13, 2016 To: • Alberta Health Services – Dave Bilan, VP Collaborative Practice, Nursing &

Health Professions (Interim) • Covenant Health – Lynn Klein, Director, Professional Practice, Research &

Libraries • Covenant Health – Sheli Murphy, Senior Operating Officer, Rural Services • United Nurses of Alberta – Heather Smith, President • Faculties and Colleges of Nursing – Deans and Directors • Specialty Practice Groups – Presidents

Cc: From: Penny Davis, RN, MN – Policy and Practice Consultant Re: Guidelines for Hand Hygiene (June, 2016) CARNA Provincial Council has approved the joint document Guidelines for Hand Hygiene (June, 2016) at the June Provincial Council meeting. The document was created in collaboration with the College of Physicians & Surgeons of Alberta and the Alberta College of Pharmacists. We periodically review our documents with members and stakeholder involvement to ensure that it:

• is evidence informed, • aligns with best practices, and • addresses changing societal needs, values, and conditions that impact registered

nurses in their practice. Thank you to all those that were involved in this process! The document is attached for your information and can also be accessed by clicking here. For further information on this document, please contact CARNA at 1-800-252-9392. All CARNA documents are available on our website: www.nurses.ab.ca.

clicking here.

Membership fees: • $45 per year • can be paid online via PayPal on

the NENA website

Who are we? NENA- AB, is actually Emergency Nurses Interest Group of Alberta and we are a Specialty Practice Group of the College of Alberta Registered Nurses Association (CARNA) and a member of the National Emergency Nurses Association Inc. (NENA)

What is our purpose? Our primary purpose is to bring together emergency nurses whose intent is to improve the health wellness and quality of life of

patients across the lifespan. We believe that this association can: promote exchange of professional issues; continue with educational programs using professional

knowledge fully; and utilize the available community health resources in our endeavours to maintain, and improve health care standards.

What are our objectives? I. To promote the specialty of emergency nursing II. To promote and provide continuing learning opportunities in emergency nursing. III. To promote interdisciplinary networking/communication opportunities for nurses. IV. To promote and disseminate emergency nursing research. V. To promote an awareness and liaison with community resources. VI. To identify issues relating to emergency nursing. VII. To present the views and serve as a resource and support for emergency nurses. VIII. To contribute to the collective voice of nursing from the unique perspective of the emergency nurse.

What are membership benefits? •Active member status in NENA- AB & NENA •Receive issues of the provincial newsletter and the NENA Journal “Canadian Journal of Emergency Nursing”. •Educational opportunities at reduced costs. •Notification of upcoming conferences. •Networking opportunities with peers and other Health Care professionals. •Support for Certification in Emergency Nursing through the Canadian Nurses’ Association. •Access to: -NENA websites -Trauma Nursing Core Course (TNCC) -Emergency Nursing Pediatric Course (ENPC) -Course for Advanced Trauma Nursing (CATN-11) -Support for TNCC ENPC & CATN Instructors -Bursary Awards at Provincial and National levels. -Published NENA Position Statements & Standards of Emergency Nursing

What does it cost? $45.00 per year

Where do we register? www.membership.nena.ca

Membership fees: • $45 per year + $1 paypal

charge • can be paid online via PayPal on

the NENA website

What does it cost? $45.00 per year

Where do we register? www.membership.nena.ca

NEN

A A

LBER

TA

A Call for Submissions This  newsletter  is  only  as  good  as  it’s  

contributors.    We  do  not  want  the  articles  in  this  newsletter  to  come  from  only  one  source...what  a  limited  picture  that  paints!    If  you  have  an  interest  to  contribute  short  articles,  interest  pieces,  article  reviews  please  contact  me.    If  you  have  suggestions  as  to  what  you  would  want  to  be  presented  in  this  newsletter  please  contact  me.      

We  are  interested  in  having  educational  courses  that  are  available  in  Alberta  advertised  here.    If  you  are  aware  of  any  courses,  workshops  or  conferences  please  send  that  information  my  way  or  contact  your  Regional  Representative.  I  am  also  looking  for  suggestions  on  how  to  better  use  our  Facebook  

page  to  generate  good  discussion  and  to  disseminate  information  

Suggestions?  contact  me  at:    jeanharsch@gmail.com    

Alberta  cannot  be  adequately  represented  by  one  city  so  please  help  us  by  contributing  to  this  your  newsletter.    

Visit  our  Facebook  page:      www.facebook.com/EnigNenaAlberta    and  follow  us  on  twitter:  https://twitter.com/AbdirectorNena    

To:

JEAN HARSCH, NENA-AB PRESIDENT 8604-38 AVE. EDMONTON, ALBERTA T6K 0E6