Anaphylaxis. How to manage and prevent this medical emergency.

Anaphylaxis is a dramatic, major medical emergency. Understanding of the pathogenesis, emergency treatment, and subsequent prophylaxis can reduce both morbidity and mortality. Treatment of anaphylaxis should begin with a high degree of suspicion. Taking a wait-and-see attitude in hopes that the reaction will be mild may have serious results.     

Understanding dizziness. How to decipher this nonspecific symptom

Dizziness is a common but often nonspecific symptom. Through careful history taking and physical examination, primary care physicians can usually determine the type of sensation (vertigo or light-headedness) and its source. Although most causes of dizziness are benign, disorders of the central nervous system tend to be ominous and require immediate referral to a specialist.     

Disseminating research: how joint NHS and university posts can support this process

This article outlines the key challenges inherent in sharing and disseminating research findings within NHS organisations. Staff working in joint posts between universities and clinical settings are in a unique position to address these challenges. They should encourage article publication, presentations, and the implementation of recommendations that are locally relevant. An action research approach is key to boosting the likelihood of findings being implemented. Such steps would also enable clinical staff to become more research aware.     

How to spot this catheter complication

Although it's most commonly seen in cancer patients, superior vena cava syndrome is an easily overlooked threat to anyone who has a central venous access device in place. Carefully piecing together vague patient complaints with data from a chest X-ray and other diagnostic tests will allow prompt treatment.     

How to try this: the mini-cog

As the population grows and the proportion of older adults increases, the incidence and prevalence of dementia are expected to increase dramatically. Health care providers' lack of awareness of current geriatrics practice and persistence in holding the outdated belief that confusion is a normal part of aging contribute to significant under recognition of dementia in all settings. Early recognition and diagnosis are critical to carrying out best practices in the care of older patients. The Mini-Cog is a simple, effective, easily administered screening tool that can uncover cognitive impairment in its earliest stages. The tool consists of a three-item recall task and a simple clock-drawing task. The Mini-Cog takes only three to five minutes to administer and requires minimal training. For a free online video demonstrating the use of this tool, go to http://links.lww.com/A204.     

How to try this: detecting delirium

For patients and their loved ones, delirium can be a frightening experience. A fluctuating mental status is important to identify because it often signals a need for additional treatment. The Confusion Assessment Method (CAM) diagnostic algorithm enables nurses to assess for delirium by identifying the four features of the disorder that distinguish it from other forms of cognitive impairment. It can be completed in five minutes and is easily incorporated into ongoing assessments of hospitalized patients. (This screening tool is included in the series Try This: Best Practices in Nursing Care to Older Adults, from the Hartford Institute for Geriatric Nursing at New York University's College of Nursing.) For a free online video demonstrating the use of this tool, go to http://links.lww.com/A209.     

Stress fractures in athletes. How to spot this underdiagnosed injury

Stress fractures are an increasingly common injury in competitive athletes, especially runners. Amenorrheic athletes are at particularly high risk. A radionuclide bone scan should be considered when the index of suspicion for stress fracture is high. Plain radiographs are of little use in establishing the diagnosis in the early stages of the injury. Early diagnosis and prompt institution of conservative therapy allow for a favorable outcome in most cases. Avoidance of or reduced participation in the inciting activity is important for pain control. Certain stress fractures, such as those involving the femoral neck, should be monitored closely and treated aggressively with internal fixation when conservative measures fail. Runners who have exercise-induced amenorrhea should be advised to decrease their training intensity to a level where menses resume. Cyclic therapy with conjugated estrogens and progesterone should also be considered, as should daily calcium supplementation.     

How to try this: Fulmer SPICES

Fulmer SPICES is a framework for assessing older adults that focuses on six common "marker conditions": sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. These conditions provide a snapshot of a patient's overall health and the quality of care. The SPICES assessment, done regularly, can signal the need for more specific assessment and lead to the prevention and treatment of these common conditions. For a free online video demonstrating the use of SPICES, go to http://links.lww.com/A100.     

How to read a research article.

Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

Systemic lupus erythematosus. How to manage this chronic, complicated disorder

Systemic lupus erythematosus is an autoimmune disease of unknown cause characterized by exacerbations and remissions. Disease manifestations are diverse, but the most common symptoms are fatigue, fever, weight loss, skin rash, arthritis or arthralgias, and anemia. Clinical findings and measurement of antibody titers are the most common diagnostic criteria. Individualized therapy with corticosteroids, immunosuppressives, or antimalarial agents and careful monitoring of disease activity are essential.