How Not to Kill Your Patient

Measles: It's Back, It's Contagious, and You Probably Haven't Seen It Before

In this episode, Kevin and Dr. Lisa Wolf dig into the return of a disease we thought had been eradicated in 2000. In case you missed it—we're in the middle of a national measles outbreak, and chances are high you've never actually seen a real case. Measles is back, and we need to be on high alert, as it remains one of the most contagious diseases in the world.

What happens when a patient with a suspicious rash sits in your waiting room for hours? How long does measles hang in the air? (Spoiler: it's longer than you think.) From triage missteps to public health policies, this episode walks through how to identify, isolate, and respond to highly contagious diseases—especially when you've never seen them in real life.

We also bust the autism myth (again), talk about vaccine hesitancy, and explore what your ED should be doing to prepare right now.

Centers for Disease Control and Prevention. (2023, September 6). Measles signs and symptoms. U.S. Department of Health & Human Services. https://www.cdc.gov/measles/signs-symptoms/index.html

Centers for Disease Control and Prevention. (2023, September 6). Photos of measles. U.S. Department of Health & Human Services. https://www.cdc.gov/measles/signs-symptoms/photos.html

Child Vaccination Schedule

https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html

Eggertson, L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ: Canadian Medical Association Journal, 182(4), E199–E200. https://doi.org/10.1503/cmaj.109-3179

Hviid, A., Hansen, J. V., Frisch, M., & Melbye, M. (2019). Measles, mumps, rubella vaccination and autism: A nationwide cohort study. Annals of Internal Medicine, 170(8), 513–520. https://doi.org/10.7326/M18-2101

Tanne, J. H. (2002). MMR vaccine is not linked with autism, says Danish study. BMJ: British Medical Journal, 325(7373), 1134.

Cohen, J. (2019, May 1). How measles causes the body to 'forget' past infections by other microbes. Science. https://www.science.org/content/article/how-measles-causes-body-forget-past-infections-other-microbes

In this episode, Kevin and Dr. Wolf delve into a critical but often underestimated condition: alcohol withdrawal syndrome (AWS). They challenge the assumptions and biases emergency nurses may bring to patient care, particularly in identifying withdrawal symptoms in individuals who don't fit the "typical" profile.

The discussion emphasizes the importance of early recognition, exploring how biases can cloud clinical judgment and hinder effective decision-making. Kevin and Dr. Wolf also provide essential insights into screening, scoring, and treating AWS, equipping emergency nurses with the knowledge needed to improve patient outcomes for this potentially life-threatening condition.

MD Calc CIWA -AR https://www.mdcalc.com/calc/1736/ciwa-ar-alcohol-withdrawal

Prediction of Alcohol Withdrawal Severity Scale https://www.mdcalc.com/calc/10102/prediction-alcohol-withdrawal-severity-scale#pearls-pitfalls

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Thank you for being a part of our AOEN community!

In this episode, Kevin and Dr. Wolf dive deep into the critical role that leadership plays in communicating change. Dr. Wolf, shares insights from a soon to be published study on how emergency nurses are being left in the dark regarding changes in practice laws, particularly around pregnancy complications in states with restrictive abortion policies. We explore the consequences of silence, including fear, uncertainty, and potential patient harm. The full article will be out in the April Journal of Nursing Administration JONA

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To support the show:

• Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them.
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Thank you for being a part of our AOEN community!

When "Do Everything" Isn't the Answer. In this episode we discuss one of the most complex and emotionally charged aspects of emergency care: navigating code status and advance directives.

We unpack the nuances of "Do Not Resuscitate" (DNR) orders, the dynamics of family presence during resuscitations, and the moral dilemmas that arise when patient wishes conflict with family demands.

If you've ever found yourself mid-code wondering, "Are we doing the right thing here?"—this is the conversation you won't want to miss.

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Twitter: @AoenPodcast

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To support the show:

• Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them.
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Thank you for being a part of our AOEN community!

In this episode, Kevin and Dr. Wolf dive deep into the complex world of behavioral health in the emergency department. Too often, psychiatric patients are treated as though their visit is a carceral event—stripped of autonomy, dignity, and decision-making capacity. We explore the ethical dilemmas, systemic barriers, and practical challenges that emergency nurses face when caring for patients with behavioral health needs.

Some links to the documents referenced during the episode:

• Ethnoracial disparities in care on a consultation-liaison service at an academic hospital
• Racial and ethnic disparities in emergency department restraint use: A multi center retrospective analysis
• Refining the model for an emergency department-based mental health nurse practitioner outpatient service
• Psychiatric Emergencies and the Potential Role of Psychiatric–Mental Health Nurse Practitioners

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To support the show:

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Thank you for being a part of our AOEN community!

Kevin and Dr. Wolf dive into the critical skill of the medication assessment. They explore how understanding a patient's medication list can provide invaluable insights into their overall health and guide essential clinical decisions, especially in high-stakes environments like the emergency department. The pair discusses the ethical and legal responsibilities tied to medication administration, stressing the "rights" of medication administration and the need for vigilance in following them. This episode is a must-listen for new and seasoned nurses alike.

In this crossover episode of "How Not to Kill Your Patient" and "Art of Emergency Nursing," we dive into the critical topic of moral courage within the nursing profession. Kevin and Lisa discuss Lisa's recent study on how emergency nurses handle ethical dilemmas, particularly in states with restrictive abortion laws. We explore the complexities of balancing professional and personal ethics, the barriers nurses face in acting with moral courage, and the systemic challenges that impact their ability to provide ethical care.

Find the article here: https://journals.sagepub.com/doi/abs/10.1177/09697330241265415

View the nursing Code of Ethics here https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

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Twitter: @AoenPodcast

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To support the show:

• Leave an honest review on iTunes. Your ratings and reviews greatly contribute to the success of the podcast, and I appreciate each and every one of them.
• Subscribe on Apple Podcasts, Google Podcasts, or your preferred podcast platform to never miss an episode.

Thank you for being a part of our AOEN community!

In this episode, Lisa and Kevin discuss the importance of accurate triage in emergency departments and its impact on patient outcomes. They critique current triage models that prioritize metrics such as length of stay and door-to-physician time over patient outcomes. They remind us that a thorough nursing assessment is essential for patient safety and effective care. The episode highlights the disconnect between business-driven metrics and the clinical reality of patient care.

I found this episode from 2022 never posted so I updated the episode, but it didnt show up as a new episode so this is the repost. In this episode, Kevin and Dr. Wolf talk about emergency nurses floating out to the department into other areas. Hopefully, this doesn't happen often but we talk about what to expect when it happens and how not to kill your floor patients.

This episode of HNTKYP features Kevin and Dr. Lisa Wolf discussing anxiety. They explore the complexities of diagnosing anxiety, emphasizing the importance of ruling out serious underlying conditions before attributing symptoms solely to anxiety. They stress the importance of not dismissing physical symptoms like tachycardia, tachypnea, and numbness as mere anxiety until ruling out all other potential causes. Remember that even patients with anxiety can still have medical problems. Tune in to learn more about how to effectively triage potential anxiety in the ED and ensure that no patient's symptoms are overlooked.

Anxiety is the Last Diagnosis on the ListLisa Wolf, MS, RN, CEN Published:February 01, 2010https://www.jenonline.org/article/S0099-1767(10)00002-4/fulltext (subscription required)