Topic suggestions for presentation @ Nursing Conference?

[FDNewbie]

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I'm gonna be presenting a topic of my choice at an upcoming Nursing Conference, and I'm having trouble coming up with a GOOD topic. I obviously want it to be informative and actually helpful/useful, so I'm trying to avoid discussing something mundane (like what's been done in the past), eg. DKA, hip fx, etc. Maybe I'm being overly ambitious, but I was thinking of doing a presentation on "the top XX # of misconceptions/pitfalls in EM," to hit specific aspects of topics ppl aren't comfortable with/knowledgable in. What made me think of this was the many times I'd order something, and a nurse would come up to me and ask me "why aren't we doing this or that?" And typically the answer lay in a more in-depth understanding of pathophys. And as a result, you realize that pattern recognition & repitition can only take you so far, and such subtle points change management drastically. And once the point/premise was explained, the nurse(es) found it to be tremendously helpful. So THAT'S what I'm goin for. The problem is, these questions/topics are all over place (vs. on a single unified topic). Any thoughts or suggestions? Points you've found your nursing staff to typically be a lil superficial/unfamiliar with?

 

[Blake300m]

swabbing for strep throat and Centor criteria - this often is ordered by the nurses from triage when frequently not appropriate. most nurses i've spoken with have never heard of Centor, but have always been very interested to learn.

venous blood gas and when they are useful (almost always in my opinion). i sometimes get kick back (you sure you don't want an abg?) and i think if there was some education on this it would be a bit more smooth.

 

[zeitgeber]

so many topics to choose from... I like your idea of presenting multiple topics... it'll keep it fresh and interesting throughout the observation.

If your place has nurse driven protocols then try to focus on all the common issues and present the evidence behind the studies:

1. Nexus
2. nontraumatic back pain
3. when to terminate resuscitation efforts
4. hyperkalemia
5. antibiotics for strep/om
6. minor head injury
7. use of lactate
8. vit k, ffp, prbc, platelet transfusions


throw in a few self deprecating physician jokes and you're money.

 

[bulgethetwine]

so many topics to choose from... I like your idea of presenting multiple topics... it'll keep it fresh and interesting throughout the observation.

If your place has nurse driven protocols then try to focus on all the common issues and present the evidence behind the studies:

1. Nexus
2. nontraumatic back pain
3. when to terminate resuscitation efforts
4. hyperkalemia
5. antibiotics for strep/om
6. minor head injury
7. use of lactate
8. vit k, ffp, prbc, platelet transfusions


throw in a few self deprecating physician jokes and you're money.

Cardiac enzymes. When to send them and, more importantly - when not to

 

[gutonc]

Cardiac enzymes. When to send them and, more importantly - when not to

I was under the impression that post-mortem was the only time you shouldn't send them.

 

[FDNewbie]

First, lemme thank everyone for the awesome suggestions!

I got a good # of topics:

Trauma:
1. Minor head injury: New Orleans Criteria & Canadian CT Head Rule
2. Clearing C-spines (Nexus & Canadian)
3. Terminating resusc efforts
4. Snuff box tenderness

Labs:
5. Hyperkalemia
6. VBG vs ABG
7. Vit K, FFP, PRBCs, platelets: Our hospital's pharmacy actually has a table/guideline to follow based on INR, life threatening bleeding (present or absent), etc, so that's a quick one

To Treat or Not to Treat
8. Strep throat & Centor criteria
9. Acute suppurative otitis media vs. secretory (serous) otitis media

I'm unclear about:
A. Non-traumatic back pain: Are you referring to if it isn't traumatic, and there aren't alarming neurologic deficits (sugg. cauda equina) then it can be worked up w/ an MRI as an outpatient?

B) Use of lactate: I'm guessing as a measure of resuscitation efforts. This one I gotta read up a bit more on, as one of my fellow residents just got reamed by one of the Trauma Surgeons for continuing to give fluids based on the patient's lactate. Any suggestions for a good straightforward article/rule?

Lastly, any suggestions for the title? Wanna make sure it's nothing that comes off even remotely condescending, while still leaving the audience curious.

TIA!

 

[gutonc]

First, lemme thank everyone for the awesome suggestions!

I got a good # of topics:


7. Vit K, FFP, PRBCs, platelets: Our hospital's pharmacy actually has a table/guideline to follow based on INR, life threatening bleeding (present or absent), etc, so that's a quick one

Be sure to include my favorite factoid about FFP. The INR of straight FFP is ~1.6. Also, a chart review study from MGH a few years ago found that <1% of patients with INR <1.85 can be corrected to "normal" with FFP.

 

[bulgethetwine]

Be sure to include my favorite factoid about FFP. The INR of straight FFP is ~1.6. Also, a chart review study from MGH a few years ago found that <1% of patients with INR <1.85 can be corrected to "normal" with FFP.

Yeah, agree that it is somewhere around 1.4 - 1.6. I tell the exact same thing to the residents all the time, though that doesn't necessarily mean you can't correct lower... because if it's a true factor deficiency, it could help lower even beyond the intrinsic INR of the actual FFP.

I think your overall point is well taken though -- it's very difficult to get below 1.4 (maybe your MGH study suggests it's even tough to get below 1.8, though I usually see the sticky point being 1.4). To correct from supratherapeutic to ~ 1.4 - 1.8 can usually be achieved with a precious few units, but to go lower requires almost logarithmic amounts... often times, at least a fruitless exercise, and at worst, could be harmful.

 

[gutonc]

Yeah, agree that it is somewhere around 1.4 - 1.6. I tell the exact same thing to the residents all the time, though that doesn't necessarily mean you can't correct lower... because if it's a true factor deficiency, it could help lower even beyond the intrinsic INR of the actual FFP.

I think your overall point is well taken though -- it's very difficult to get below 1.4 (maybe your MGH study suggests it's even tough to get below 1.8, though I usually see the sticky point being 1.4). To correct from supratherapeutic to ~ 1.4 - 1.8 can usually be achieved with a precious few units, but to go lower requires almost logarithmic amounts... often times, at least a fruitless exercise, and at worst, could be harmful.

Yeah...this would be better aimed at our interventional colleagues who obsess over getting an INR <1.5. If it's 2.5, I'm cool with pouring in a few units of FFP to make them feel better. But if it's 1.7 and you're not going to take them to the OR/IR suite because of that, that's just crazy talk.

And yes, if they're bleeding out, a little FFP/Cryo/Plt, shaken or stirred, never hurt anybody (assuming it comes with lasix/APAP/benadryl as part of the cocktail), but treating to a number (as nursing is wont to do...the subject of the OP) is nuts.

 

[FDNewbie]

Thanks for all the suggestions guys. From the feedback I got, the presentation went GREAT =-)

 

[gro2001]

Thanks for all the suggestions guys. From the feedback I got, the presentation went GREAT =-)

Curious: what did you end up choosing as the title?

 

[FDNewbie]

Curious: what did you end up choosing as the title?

"Why'd We Do That? A Review of 10 Common Questions in EM Care"

 

[gro2001]

"Why’d We Do That? A Review of 10 Common Questions in EM Care"

Nice, doesn't sound like a '10 things I wish nurses knew' kinda thing it could have turned out to be 🙂

 

[FDNewbie]

Nice, doesn't sound like a '10 things I wish nurses knew' kinda thing it could have turned out to be 🙂

LOL yea, def. didn't want it to come across that way. That woulda been a pretty bad...

 

[xaelia]

"Stop freaking out over giving 8mg of morphine yet somehow being totally cool with 2mg of dilaudid."