Jeff Solheim

It’s Electric!

I n 1752, when Ben Franklin first flew his kite with an attached key to demonstrate that lightening was electricity, he likely did not realize that 251 years later, this event would meld with tobacco, laying the groundwork for the development of the electronic cigarette. This year the electronic cigarette turns 10 years old. First used in China, “e-cigarettes” eventually spread to Europe and the United States, creating an industry that projected to generate revenues of one billion dollars in product sales. The growth of this industry has now infiltrated emergency departments as electronic cigarettes are showing up in our waiting areas and even patient rooms. Several months ago, a question regarding how emergency departments were handling electronic cigarette usage showed up on the ENA listserv. Electronic cigarette usage raises several concerns ranging from how emergency departments are handling this type of tobaccoless “smoking” to the impact of exhaled vapors on family members, other patients, and staff. Electronic cigarettes, referred to as ENDS (electronic nicotine delivery systems) by the World Health Organization, are devices that use electricity to convert nicotine into a vapor that is inhaled and then exhaled by the user. 5 Although ENDS lack tobacco, a variety of chemicals mixed with the nicotine have led to claims that the exhaled vapor may contain toxic carcinogens. Thirdhand smoke—the nicotine residue from smoking—has been found to stick to and linger for years in various surfaces in our homes, workplaces, and cars. This “lingering” sets up the potential for the third-hand smoke to interact with other chemicals, producing

A Case of Leprosy: Not as Rare as One Might Expect

July in the community of Petit-Goâve, Haiti, is best described as oppressively hot and humid. When our medical team arrived early in the morning to set up a temporary clinic in this locale, each team member clambered for a location that would provide maximum shade and reprieve from the suffocating heat (Figure 1). The stifling temperatures were only made worse by the mass of people who showed up to take advantage of the free medical care we were offering. By midday, the line of people waiting to be seen seemed to grow rather than shrink, despite the fact that we had already seen and treated over 200 patients (Figure 2). As the charge nurse for the day’s clinic, I found myself being pulled in numerous directions to solve problems as they arose. Our makeshift pharmacy had run out of crucial medications, and I had to figure out where to secure replacements. One patient had an infected wound requiring transport to a local hospital for surgical debridement. Another patient in the back of the line had just passed out from exhaustion and dehydration. It was against this backdrop of chaos that I was approached by one of the nursing students traveling with our team. She timidly asked me to consult on a patient she had been assigned to care for, stating that she believed the patient had leprosy. Although I had encountered several cases of leprosy in the 23 years I have been involved in international humanitarian medical work, its incidence in the world is declining today, so I had every reason to doubt the authenticity of the nursing student’s suspicions. I followed the nursing student to the area to which she had been assigned, and as we neared her patient, the signs of leprosy were, in fact, evident. The 16-year-old girl had small bumps all over the exposed skin of her arms and face. Her nose had taken on the classic flattened and enlarged

Military Experience Talks

This month is dedicated to the men and women who every day keep us safe and enable us to do what we do. We reached out to emergency nurse leaders and asked them to share with us their thoughts on how their experience in the military affected their leadership and how being an emergency nurse affected their military career. We offer our heartfelt thanks to these nurses and to all our brothers and sisters currently serving in the armed forces and the veterans and heroes who have served before. Thank you for building our road to freedom and being the wind beneath our wings! The moon gives you light, And the bugles and the drums give you music; And my heart, O my soldiers, my veterans, My heart gives you love. –Walt Whitman

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Answer 1: We have not changed our job description for expert nurses who are older than 45 years, but we do offer them positions within their job description that are sensitive to their physical challenges. There are a number of strategies we have successfully implemented to reduce the physical burden on our aging nurses. An option for 8 versus 12 hour shifts is given, experienced nurses are often asked to precept new graduate nurses, and our older population is given the option to work as Medical Incident Command Nurses, allowing them to sit at the radio and communicate with EMS staff on destination and plan of care in the field, reducing the physical workload for that shift. All of these roles within the emergency department capitalize on these nurses’ experience. The physical challenges that are accommodated by this division of labor include arthritic joints, chronic back injuries (from years of service to outpatients) and lower fatigue threshold.—Kelly Bernatine, RN, BSN, Emergency Department Nurse Manager, Arrowhead Regional Medical Center, San Bernadino, Calif