Emergency Department Critical Care

The Broselow tape as an effective medication dosing instrument: A review of the literature.

by Timothy Clapper

Meguerdician, M. J., & Clapper, T. C. (2012, in press). The Broselow tape as an effective medication dosing instrument: A review of the literature. Journal of Pediatric Nursing.

The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for... more The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. However, since the development of the Broselow tape, there has remained a controversy over the accuracy of the tape for estimating weight to determine pediatric resuscitation needs. Using multiple search engines, this review of the literature examined the potential of the Broselow tape to be an effective guide for emergency medicine teams. The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, it is the most reliable predictor in most situations, especially in younger pediatric patients. Ultimately, the Broselow tape is only a guide that should be considered, whereas the final determination of drug dosage and equipment sizes will be determined by the patient situation and the clinical provider's experience and training. Objective: Pediatric emergency medicine departments can be overwhelmed with conflicting literature on the accuracy of the Broselow tape. The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. We present an analysis of literature and research of the Broselow tape as a means of estimating weight in pediatric patients to address medication dosing. Methods: A systematic review was conducted using three primary search engines, including PubMed, Ebscohost, and ProQuest. Inclusion criteria included (a) peer-reviewed literature and (b) original research articles. Literature related to or appearing to have a commercial interest was not included in this review. The initial search showed 84 publications, 24 with relevance to this review. Results: Although the Broselow tape may underestimate the weight of outlier pediatric patients, it is still the most accurate tool available. In addition, it appears to be more accurate for use with younger patients. Conclusion: The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, the Broselow tape is the most reliable predictor in most situations, especially in younger pediatric patients.

Accident and emergency as a clinical learning environment

by Rod Ward

Experiences of emergency department staff: Alcohol-related and other violence and aggression

by Sandra Jones

Gilchrist H, Jones SC & Barrie L (2011) Experiences of emergency department staff: Alcohol-related and other violence and aggression. Australasian Emergency Nursing Journal 14(1), 9-16.

Introduction
Alcohol-related violence is a significant and growing problem in Australia and overseas, however... more Introduction
Alcohol-related violence is a significant and growing problem in Australia and overseas, however there is no up to date information regarding the self-reported experiences of hospital emergency department (ED) workers in Australia.
Methods
Ninety-one ED staff in two major hospitals in the Illawarra region of New South Wales completed a short survey designed to measure the amount and causes of violence experienced by staff and canvas possible solutions.
Results
Eighty participants reported being verbally abused at least once a month, and 39 reported this as a daily occurrence. Twenty-three staff had experienced physical assault at least once a month. Alcohol was the most commonly listed factor contributing to the violence and aggression (n=71). Seventy-one staff felt that alcohol-related violence had increased since they had begun working in the ED. There was some confusion at one hospital regarding policies and procedures around alcohol-related violence. Staff suggestions for how to manage alcohol-related violence included the provision of more security staff and better training.
Conclusions
Alcohol-related violence continues to be a significant issue for ED workers and further investigation of policies and procedures around alcohol-related violence in the ED is warranted.

Treatment of persons with mental illness and substance use disorders in medical emergency departments in the United States

by Mona Shattell

Shattell, M., & Andes, M. (2011, February). Treatment of persons with mental illness and substance use disorders in medical emergency departments in the United States. Issues in Mental Health Nursing, 32(2), 140-141.