Editor-in-Chief: K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN
Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
ISSN: 1931-4485
Online ISSN: 1931-4493
Frequency: 4 issues / year

Editors' Remarks

  Editor Karen Sue Hoyt


 Editor Jean A. Proehl

 Editor Karen Sue Hoyt


Editor Jean A. Proehl 

Editors' Remarks


Dear Colleague,

Welcome to the American Academy of Emergency Nurse Practitioners!


The newly formed American Academy of Nurse Practitioners (AAENP) has adopted the AENJ as their official journal. Both AENJ and the AAENP seek to promote high quality, evidence-based care so this relationship is a natural fit. There are many opportunities for collaboration and mutual gain which will translate into improved resources for ENPs and improved care for patients.

Members will have free on-line access to AENJ as a benefit of membership and may also subscribe the print journal at a deeply discounted rate.  AAENP Founder, Elda Ramirez, is a long-time AENJ board member and AENJ Editor, K. Sue Hoyt, is now an AAENP board member so our collegial relationship is well established.

If you're an ENP who doesn't already belong to AAENP, you can see what you're missing at www.aaenp-natl.org.

Sue and Jean

Online Editor's Suggestions

When you only have time for a few blogs …


These are Top-Tier, High-Yield, High-Density emergency medicine and critical care sites, of use to emergency staff, that are a delightful pleasure to read. I prefer blogs and websites that inform me by email of new material. It helps that I don't have to go hunting for it. Many also use RSS feeds, "follows," Twitter, podcast subscriptions, etc. to help keep one informed. Review them thoroughly as there is a vast amount of content.




                              Tom Trimble, RN
                              Online Editor


                              Opinions are those of the author.
                              Readers must verify validity to their own practice.


Advanced Emergency Nursing Journal is always looking for authors, articles, and suggestions for topics that inform the work of our specialty and excite the readers. If you have an article or concept to propose, or suggestions and opinions that would help us meet your needs, please use our "Feedback" form to contact the Editors. It's a direct line of communication, and the free registration of your email allows us to respond to your suggestions, and makes the entire website and all other LWW Journals more useable and functional for you.

Current Issue Highlights


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Official Journal of the American Academy of Nurse Practitioners



Clinical Tips from AENJ

# 162  I'm looking into it.

There are 3 types of endoscopy done in the ED:

  1. Ad hoc: The emergency provider does it because it must be done and no one else will.

  2. On Behalf Of: "I'm sending this guy to be checked, but I'm not coming in, unless you find something bad."

  3. In Aid Of: "We need to do this guy, but our lab is closed, O.R. won't help, and I'd like you to do the sedation because you've got better drugs."

Beware of providing anesthesia services to other services "out of hours". It's better to use the on-call anesthesia provider, as you are unlikely to have special equipment and knowledge for procedures not usually performed, or readiness to receive another emergency patient. Liability trap.


Tongue blade, head-mirror or head-light, penlight; direct or video laryngoscope used in tomahawk fashion (after topicalization); flexible nasopharyngoscope or flexible bronchoscope, may be in the ED. The location of some metallic foreign bodies might be indicated by the security officer's search wand, or by xray.

Rigid endoscopes (°angle tips vary); other flexible endoscopes and specialized instruments, {or better, a consult} may need to be gotten from ENT, GI, PULM., O.R.





Levitan, RM, MD. Nasoendoscopy a Useful Skill for Emergency Physicians - ACEP Now. April 14, 2015. American College of Emergency Physicians.
***Do not miss this appeal from an Airway Master.


Levitan, RM, MD, et al. SMACC-Dub Airway Workshop. View three videos of Nasoendoscopy workshops at the SMACC-Dub conference this year. {Check other related workshops in the page's tabs.} 2016. The Sharp End.   
***Note video of above author, and others.


Yokoyama, T., Yamashita, K., & Manabe, M. (2006). Dental mirror is a relief for difficult endotracheal intubation. Anesthesia & Analgesia, 103(4), 1059.

Yen, D., Hu, S. C., Chen, L. S., Liu, K., Kao, W. F., Tsai, J., ... & Lee, C. H. (1997). Arterial oxygen desaturation during emergent nonsedated upper gastrointestinal endoscopy in the emergency department. The American journal of emergency medicine, 15(7), 644-647. [abstract - paywall]
**Even unsedated, the patient may desaturate.

Birrer, R. B., & Garven, B. A. (2001). Tooth aspiration in a six-year-old boy. The American journal of emergency medicine, 19(7), 598-600. {abstract, paywall} 

Mansourian, H. R., Sadrearhami, A. R., & Yazdi, A. A. S. (2008). Accuracy of Chest X-Ray in the Diagnosis of Tracheobronchial Foreign Bodies in Children. Tanaffos, 7(1), 58-62.
**Small Iranian study (n=32) comparing CXR & bronchoscopic findings. 

Warshawsky, ME, MD FACP FCCP.Foreign Body Aspiration Treatment & Management. December 31, 2015. Medscape.
** General Review for EM providers. 


Lee, F. P. (2004). Removal of fish bones in the oropharynx and hypopharynx under video laryngeal telescopic guidance. Otolaryngology--Head and Neck Surgery, 131(1), 50-53. {abstract, paywall}


BMI of Texas. [Bariatric Medical Institute of Texas]. EGD (Upper Endoscopy). February 2, 2010. Video. YouTube. {Adjacent sidebar should link to other endoscopies.}
**View endoscopic videos with narration.


Sung, J. J., Tang, R. S., Ching, J. Y., Rainer, T., & Lau, J. Y. (2016). The use of capsule endoscopy in the emergency department as a triage of patients with GI bleeding. Gastrointestinal endoscopy. [abstract - paywall]
**Small randomized study suggests fewer admissions, no change in outcomes or mortality.


ACEP In The News. Video Capsule Endoscopy in the ER Could Prevent Costly Hospital Admissions. February 2013.
**Suggests fewer admissions, safer discharges from ED.


"Admin" re Meltzer, AC, MD. Video Capsule Endoscopy in the ED. October 21, 2013. Physicians Weekly.
**Suggests 92% agreement between EM & GI physicians, and possible triage tool for disposition.


Ginsberg, GG & Pfau, RR. CHAPTER 25 Foreign Bodies, Bezoars, and Caustic Ingestions. In Sleisenger and Fordtran's Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition.
**Chapter excerpt of content interest.


Farvardin, M., Mehryar, M., Karanjam, M. A., Ashraf, H., Mehdizadeh, M., Rahimi, M., ... & Mosallaei, M. (2008). The accuracy of ocular sonography in detection and measurement of intraocular foreign bodies. Iranian Journal of Ophthalmology, 20(4), 20-23.
**Good locating of different substances, tend to overestimate size.


Soft Tissue Sonography 

Alerhand, Stephen, MD. Ultrasound for Retained Radiolucent Foreign Body in Soft Tissue. June22, 2016. emDocs.

Morag, Y., & Jacobson, J. A. (2009). Sonographic surface localization of subcutaneous foreign bodies and masses.
**From U. Mich., a technique is described for skin marking of FBs by sono.

Nwawka, O. K., Kabutey, N. K., Locke, C. M., Castro-Aragon, I., & Kim, D. (2014). Ultrasound-guided needle localization to aid foreign body removal in pediatric patients. The Journal of Foot and Ankle Surgery, 53(1), 67-70. [2 pediatric podiatric cases] PDF.
**Good locating; needle marker allows smaller incisions.


Shiels 2nd, W. E., Babcock, D. S., Wilson, J. L., & Burch, R. A. (1990). Localization and guided removal of soft-tissue foreign bodies with sonography. AJR. American journal of roentgenology, 155(6), 1277-1281.
**Older study on sono for FBs.


Lyon, M., Brannam, L., Johnson, D., Blaivas, M., & Duggal, S. (2004). Detection of soft tissue foreign bodies in the presence of soft tissue gas. Journal of ultrasound in medicine, 23(5), 677-681.
**Experimental model to determine interference by wound gas in sono evaluation. Sensitivity 100%, but except for bone, echo characteristics led to error in determining substance with metal vs. glass most difficult.


 All Tips: 2013  2014  2015  2016  

Upcoming Conferences

EM Day of Service

Your Community
TBA September 2016

ENA Emergency Nursing 2016
Los Angeles, CA
September 14th - 17th, 2016

ACEP 16 Scientific Assembly
Las Vegas, NV
October 19 th - 21st, 2016

Contact us with information upon conferences of interest to the readership.

Author Alert!

Advanced Emergency Nursing Journal is seeking authors, articles, and topics. If you are interested in writing for publication, please check our current (2015)  "Topics of Interest" for your project. Please contact our Editors if you have an additional proposal or suggestion.