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. Measles Resources 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 Vaccinations and Autism 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. Immune Memory Loss & Measles 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  Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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, 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 Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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!

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. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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, 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 Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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!

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/    Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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)  

In this special collaborative episode, part of the "Nurses Podcrawl," Dr. Wolf and Kevin delve into the fascinating world of distributive shock. As part of a unique project featuring seven different podcasters, each covering a specific type of shock, our hosts take on distributive shock, exploring its nuances and critical aspects and this super cool type of shock Listen to all the episodes here: @icuscenarios @theqwordpodcast @straightanurse @nursedosepodcast @therapidresponsern @upmynursinggame   #distributiveshock #cardiogenicshock #hypovolemicshock #obstructiveshock Obstructive Shock; Critical Care Scenarios and Rapid Response RN https://podcasts.apple.com/us/podcast/104-obstructive-shock-with-guests-bryan-boling-and/id1535997752?i=1000655162568  Distributive shock with Straight A Nursing https://podcasts.apple.com/us/podcast/346-distributive-shock-simplified/id1210975738?i=1000655023378 Cardiogenic Shock: With Up My Nursing Game and Nurse Dose Podcast https://podcasts.apple.com/us/podcast/cardiogenic-shock-with-annie-from-up-my-nursing-game/id1486427611?i=1000654832483 

This episode of HNTKYP Kevin and Dr. Lisa Wolf take a deep dive into the high-stakes world of shock management.  Why does it matter you ask?  If you miss the early signs of septic shock, and 30% of those patients won't make it home. This episode provides a comprehensive overview of the different types of shock – hypovolemic, distributive, cardiogenic, and obstructive – detailing their causes, signs, and appropriate treatments.

This episode of HNTKYP delves into the crucial distinction between merely knowing nursing protocols and truly understanding them. Kevin and Dr. Wolf discuss the importance of nurses not merely performing tasks or following protocols blindly but grasping the underlying pathophysiology and the reasoning behind the actions they take and the medications they give. This episode highlights the importance of critical thinking and the application of knowledge in nursing to prevent errors, enhance patient care, and, fundamentally, avoid causing harm. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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!

This episode of HNTKYP takes a no-holds-barred look at burnout among emergency nurses, and it's not for the faint of heart. We're getting real about the brutal reality of the emergency department, where the relentless pressure cooks even the toughest among us. We talk about how burnout not only affects the nurse, but the team and most importantly the patient. It's a deep dive into the dark side of nursing, where stress isn't just a part of the job—it's the job. But it's not all doom and gloom; we're also tackling how to fight back, recognize the warning signs, and protect both our patients and our sanity. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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!

Understanding how to prioritize patient care is essential, particularly for new ER nurses. This HNTKYP episode offers a systematic approach to assessing and managing a typical patient assignment ranging from four to six individuals. We delve into the critical nature of effective report-giving and receiving, the significance of delegation and teamwork, and the risks associated with the forgotten patient behind door number two.  Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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, Kevin makes it back from the brink of death from the deadly "man flu." Just kidding, but he really was sick, and it inspired this week's topic on the respiratory season. We cover some of the most prevalent viral respiratory diseases and how to prevent them.  We discuss red flags that may signify that your patient is in trouble.  Our conversation delves into the collective responsibility we hold during what is no longer just a flu season but a battlefield against a plethora of respiratory viruses, including RSV and COVID-19. Get ready for this critical and timely update.

In this episode, Kevin and Dr. Wolf explore the scary task of triaging a pediatric patient.   We will discuss the differences in completing a pediatric triage.  We will talk about common emergencies by age and the fine art of a pediatric assessment.   Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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 "intoxicating" episode of HNTKYP, Kevin McFarlane and Dr. Lisa Wolf explore the challenges of triaging intoxicated patients in the emergency department. They emphasize that managing intoxicated patients is far more complex than often perceived. The discussion includes intoxication as either a primary issue or a secondary complication, the pitfalls of anchoring bias, and the poor correlation between blood alcohol level (BAL) and the behaviors exhibited by the patient. Grab a beer, sit back, and enjoy this episode—unless you're driving, of course.  This episode pairs well with these other great episodes  HNTKYP-Behavioral-Health HNTKYP Altered-Mental-Status Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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, Kevin and Dr. Wolf explore the effects of heat on both the body and mind. They discuss common heat emergencies, identify populations at heightened risk for heat-related issues, and discuss how certain medications can impact the body's capacity to cope with elevated temperatures. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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, join Kevin and Dr. Lisa Wolf as they delve into the updates of the Emergency Severity Index (ESI) triage algorithm fifth edition.  As the first contributor to this latest iteration, Dr. Wolf brings invaluable expertise, and provides profound insights into the changes incorporated in version 5.  We will discuss practical guidance on how to implement this updated version into your own triage practice, ensuring optimal outcomes for patients. Follow us on: Facebook: https://www.facebook.com/Art-of-Emergency-Nursing-276898616569046/ YouTube: https://www.youtube.com/channel/UCJTnz4phtCTjojTIDJo2afA?view_as=subscriber Twitter: @AoenPodcast Instagram: https://www.instagram.com/artofemergencynursing/ 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!

Good documentation allows for a retrospective understanding of a patient's condition when they arrived and how it has progressed.  Vital signs are particularly critical as they reveal trends and can help detect potential issues.  But here's the real challenge, finding that sweet spot between meeting the demands of documentation and actually delivering hands-on care. We'll break down the struggle and explore how emergency nurses can balance both worlds. Join Kevin and Dr. Wolf as they dig deep into the importance of accurate documentation in capturing a patient's journey and keeping the entire healthcare team in the loop. Plus, we'll touch on the legal side of things and how thorough charting can save your bacon if any legal issues arise.

In this episode, Lisa and Kevin have a special guest, Annie Fulton, from Up My Nursing Game. Join us as we dive into the topic of delirium, a commonly overlooked and misdiagnosed condition in emergency departments with serious implications for patients. In this episode, we'll explore delirium identification, effective treatment options, and discuss how the emergency department can set the stage for success throughout a patient's hospital visit. This episode is part of the 2023 Nurses' PodCrawl, a collaboration between different podcast hosts who come together for a week to release episodes around one unifying theme. The goal is to provide varying perspectives on a single theme. Check out these other delirium episodes from amazing podcasts: Walking Home from the ICU Cup of Nurses Good Nurse Bad Nurse FreshRN The Rapid Response RN https://www.upmynursinggame.com/podcrawl/

In this episode, Kevin and Dr. Wolf delve into the crucial topic of assessing and addressing changes in mental status. Mental status changes can be alarming and could be a result of various underlying medical conditions, which require prompt evaluation and management. During the episode, we will provide a comprehensive review of the most common causes of changes in the level of consciousness (LOC). By identifying the root cause, emergency nurses can better diagnose and manage patients effectively. To aid in memory retention, Kevin and Dr. Wolf share two helpful mnemonics that will assist in remembering the most critical causes of mental status changes.  

This episode is a little different, In this episode, Kevin and Dr. Wolf have a conversation about a viral video showing a healthcare worker striking a patient who spits on him.  This video had a lot of mixed reactions from healthcare workers online.  Give it a listen and see how we think this is just a symptom of bigger problems.    Links to a couple of articles mentioned in the Episode: NOTHING CHANGES, NOBODY CARES:  Authors: Lisa A. Wolf, PhD, RN, CEN, FAEN, Altair M. Delao, MPH, and Cydne Perhats, MPH, hthttps://www.sciencedirect.com/science/article/abs/pii/S0099176713005618 Here is a link to some of the amazing articles by Dr. Gordon Gillespie Check them out.   https://scholar.google.com/scholar?hl=en&as_sdt=0%2C22&q=gordon+gillespie+workplace+violence&oq=gordon+gillespie   

How Not to Kill your Patient. Just how vital are vital signs?   In this episode, Lisa and Kevin talk about how vital signed effect your triage designation.   

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.   

Kevin and Dr. Wolf discuss communication with providers and communicating a great hand-off.  This information just might save your patient's life.  Enjoy.   If you are interested in the report sheet click here

In this episode, Kevin and Dr. Wolf provide a little feedback to a question that was posted online by a new grad nurse.  If you have clinical questions you would like to have discussed send a message to Kevin on social media or by email kevin@artofemergencynursing.com.     

We think of the obstetric patient as a special population, one that we want to get the heck out of our EDs ASAP. However, lots of Obstetric units have closed, and in the current climate after Dobbs, patients will have a hard time getting good care, whether they want to be pregnant or not. Guess where all those patients are going to go? Exactly. Your ED. Have a listen on recognizing and managing OB and postpartum emergencies.   Links mentioned in the episode: https://www.nejm.org/doi/pdf/10.1056/NEJMp2207423 https://www.jdsupra.com/legalnews/emtala-v-state-abortion-laws-navigating-6251610/ https://www.justsecurity.org/wp-content/uploads/2022/07/Texas-Complaint.pdf 

In this episode, Kevin and Dr. Wolf talk about assessing and addressing pain in the emergency department.  This is the episode that will help new and even experienced emergency nurses to see the pain assessment in a whole new light.   

Geriatric patients make up a large portion of the people who come to the ER.  In this episode Kevin and Dr. Wolf talk about what to look for in geriatric patients and how not to kill grandma when she shows up in triage.  

In this episode, Kevin and Dr. Wolf talk about triaging respiratory patients.  This is the episode everyone needs to hear during the pandemic.   

Kevin McFarlane and Dr. Lisa Wolf take a look at the many causes of headaches.  From the minor to the critical.  Missing some of these in triage could definitely kill your patient.  Enjoy.  

Kevin McFarlane and Dr. Lisa Wolf explore the varied presentation of behavioral health patients.  Presentations may be complicated by factors like health, medications, and alcohol.     Here is a link to a great article about anxiety https://www.jenonline.org/article/S0099-1767(10)00002-4/pdf

Dr. Wolf and Kevin review the ins and outs of chest pain.  

HNTKYP is a series that address symptomatic presentation and how to move to a working diagnosis and plan for patient care. Kevin McFarlane and Lisa Wolf cover red flags, cognitive pitfalls, and ways to make sure your patients survive their encounter with the health system. In this episode, they review all the possibilities of trauma.