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AAENP is pleased to welcome two new board members, who will begin their terms on November 1, 2022.
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David T. House, DNP, CRNP, ENP-C, FNP-BC, CNS, CEN, CNE, FAEN, is an Associate Professor at the University of Alabama at Birmingham (UAB) School of Nursing where he serves as Co-Coordinator of the Emergency Nurse Practitioner (ENP) Pathway and teaches in both the master’s and doctoral programs. He is a Scholar with the UAB Center for Interprofessional Education and Simulation and a Fellow of the 2019-2020 UAB Interprofessional Leadership program. He specializes in emergency services with over 23 years’ experience in administrative and clinical roles and has practiced as an ENP for more than 14 years. His passion and interests include emergency nursing, advanced practice, simulation, and interprofessional education and collaboration with an overarching goal to enhance healthcare outcomes. Dr. House’s service to AAENP includes Lead Regional Director since 2019 and Bylaws committee Chair for two years. Most recently, he served as co-author of the 2021 ENP Competencies.
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Nicole Martinez, PhD, RN, FNP-BC, ENP-C, PHN, is Director of the DNP Program at Sue and Bill Gross School of Nursing at the University of California, Irvine. She received her PhD in Nursing from the University of San Diego, her Master’s in Nursing at Western University of Health Sciences and a Bachelor of Science in Biology from the University of California, Los Angeles. She has over 16 years of experience in emergency health. Dr. Martinez’ service to AAENP includes past Western Regional Director and Co-Chair of the membership committee. She is an active member of the American Association of Nurse Practitioners (AANP) and California Association of Nurse Practitioners (CANP) and is the Associate Editor and past dermatology column editor for the Advanced Emergency Nursing Journal. She also is Co- Chair for the National Organization of Nurse Practitioner Faculty Emergency Special Interest Group and served on the AANP-CB task force for FNP Practice Analysis. Dr. Martinez is a published author, textbook and journal reviewer, and contributor to Lippincott’s online procedural manual.
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Sincere gratitude is extended to Past-President Dr. Andrea Smith-Brooks whose term on the board ends October 31, 2022. Under Dr. Smith-Brooks' term as President between 2019 - 2021, AAENP established the Kincaid Student Scholarship, successfully transitioned management companies and cultivated relationships with partner organizations. She has served as the AAENP representative to the ACEP Emergency Care Quality Measures Consortium since 2020, providing a voice for NPs among this multidisciplinary national group. Most importantly, Dr. Smith-Brooks sustained organizational operations throughout the pandemic. The Board of Directors is grateful for her service.
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Did you know that AAENP is advocating nationally for your work?
Through our work with the Nursing Community Coalition, AAENP supported the following:
NCC Sends Letter to Appropriators Updating FY 2023 Funding Requests
On September 15, sixty-two members of the Nursing Community Coalition (NCC) sent a letter to the House and Senate Appropriations Committees requesting at least $324.472 million for Title VIII Nursing Workforce and Development Programs and at least $208.571 million for the National Institute of Nursing Research for Fiscal Year (FY) 2023 as outlined in the House Appropriations Committee passed bill.
NCC Sends Letter to Congress Outlining Top Legislative Priorities
On September 26, sixty-two members of the Nursing Community Coalition (NCC) signed onto a letter urging Congress to pass top legislative priorities impacting our current and future nursing workforce before the end of the 117th Congress.
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How Nurses Can Support Patients with Medical Trauma and PTSD
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Medical treatments, procedures, and hospital admissions can have a long-lasting psychological impact. Procedures and treatments can be traumatic events that trigger post-traumatic stress disorder (PTSD) in patients. One meta-analysis found...
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AAENP is pleased to partner with ROSH REVIEW to support all NPs in emergency care learning opportunities. Check out the exclusive NP Journey in Emergency Care here:
Not familiar with ROSH? Test your knowledge with this ENP question from ROSH.
Description: A 64-year-old woman with a history of hypertension arrives by EMS with mental status changes. Paramedics orotracheally intubated the patient after she was found to be unresponsive. Her vital signs are T 37.7°C, BP 222/98 mm Hg, HR 130 bpm, and RR 16/min, assisted. Glucose is 100 mg/dL. Her pupils are pinpoint, but are sluggishly reactive to a strong light source. The neurologic exam is unobtainable secondary to pharmacologic paralysis. Continuous EEG monitoring shows no acute seizure activity. CT scan of her head shows a large hemorrhage in the region of the pons. Which of the following is the most appropriate next step in management?
Answer-Options:
- Administer mannitol
- Administer nicardipine
- Administer phenytoin
- Administer recombinant factor VIIa
- Hyperventilate to pCO2 < 30 mm Hg
Correct-Answer: Administer nicardipine
Explanation:
Nicardipine is a quick-acting calcium channel blocker commonly used for hypertension in the setting of acute intracranial hemorrhage. Persistently elevated BP in patients with intracranial hemorrhage contributes to hematoma expansion and is associated with poorer outcomes. For patients presenting with intracerebral hemorrhage and a systolic blood pressure of 150–220 mm Hg, the latest guidelines recommend lowering to a goal systolic blood pressure of 140 mm Hg. For those presenting with an initial systolic blood pressure > 220 mm Hg, a continuous intravenous infusion of antihypertensive medication is recommended to acutely lower the systolic blood pressure to 140–160 mm Hg. When BP reduction is indicated, intravenous medications such as nicardipine (by continuous infusion) or labetalol (by intermittent bolus) are recommended.
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Mannitol (A) is an osmotic diuretic that shifts water across the blood-brain barrier. It has been used clinically to reduce intracranial pressure with varying success. Many patients with intracranial hemorrhage present after a seizure or have a seizure during hospitalization. Seizures have not been associated with worsened outcome or mortality. Several studies have shown that treatment with prophylactic phenytoin (C) in the absence of seizure led to a worse outcome. Despite plausible utility based on physiologic understanding of the coagulation cascade, activated factor VIIa (D) has not been shown to be of any clinical benefit in patients with acute intracranial hemorrhage. Carbon dioxide causes the cerebral vasculature to dilate, leading to increased intracranial blood volume and increased intracranial pressure. Hyperventilation (E) leads to decrease in the carbon dioxide levels and has been tested as an adjunct to intracranial hemorrhage management. Unfortunately, this treatment can lead to decreased cerebral perfusion pressures and increased ischemia, so it is not recommended.
Rapid Review:
Intracerebral Hemorrhage
- Patient will be > 50 years of age
- History of hypertension and atherosclerotic risk factors
- Neurological deficits (indistinguishable from ischemic)
- PE
- Pontine lesion: pinpoint pupils, coma, decerebrate posturing
- Cerebellar: vomiting, dizziness, CN VI palsy
- Most commonly caused by spontaneous bleeding from arterioles
- Treatment is blood pressure control (nicardipine), ICP control, reverse all coagulopathies
One Step Further Question: Who should be considered for emergent ventriculostomy placement?
One Step Further Answer: Patients with a GCS 8, those with transtentorial herniation, or those with significant intraventricular hemorrhage or hydrocephalus.
References:
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Want more questions like this? Click here to start a free trial!
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Looking for a way to get involved at AAENP? State Representatives are essential connections to our members and actively support the values and mission of AAENP. If interested, please apply through the AAENP website at https://www.aaenp-natl.org/get-involved
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