Someone recently shared with me that "vaping" helped him quit smoking after enabling the habit for over 20 years. It occurred to me, trading one habit for another, what is the impact of e-cigarettes? 

An electronic cigarette, otherwise known as an e-cig, personal vaporizer (VP), or an electronic nicotine delivery system (ENDS), is essentially a battery powered device that vaporizes a liquid solution called an e-liquid. 
E-liquids usually contain a mixture of propylene glycol, glycerin, nicotine and/or flavorings. It's the assumption because "vaping" does not burn tobacco, that it should be safer than conventional cigarette smoking. However, e-liquids decompose into known carcinogens such as formaldehyde and acetone, when aerosolized. Additionally, both conventional cigarettes and e-cigarettes deliver nicotine. 

One component of the marketing efforts promote e-cigarettes as a smoking cessation product. However, a recent article in the Journal of the American Medical Association states that "data supporting the effectiveness of e-cigarettes at helping smokers quit are lacking." 

Data shows that manufacturers are also marketing these products toward minors and individuals who have never smoked. Nicotine cartridges can be found in different appealing flavors such as fruit, candy and cola. The device itself can resemble a decorated accessary or even a cartoon character. Some of these products also have refillable cartridges to allow e-liquids to be changed or mixed, which has resulted in an increase in unintentional overdoses. 

The simple truth is that e-cigarettes have not been fully studied. We don't fully understand the potential risks of e-cigarettes when used as intended. We don't know how much nicotine or other potentially harmful chemicals are being inhaled during use. This includes secondhand vapors that can be inhaled by bystanders. The World Health Organization (WHO) has recommended that e-cigarettes should be banned indoors, because they emit chemicals potentially as dangerous as cigarettes and have a potential passive smoking risk. 

We also don't know whether there are any benefits associated with using these products. The California Department of Public Health has issued a health advisory warning related to the toxicity of e-cigarettes, stating the nicotine in them is as addictive as the nicotine in conventional cigarettes. There is also concern that e-cigarettes can increase nicotine addiction among young people and lead kids to try other tobacco products, including conventional cigarettes, which are proven to cause disease and lead to premature death. 

Currently, the FDA only regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. However, efforts have been made by the FDA to extend its tobacco authority to additional tobacco products, including e-cigarettes. 

Contact Aguirre Legal Nurse Consulting to keep you up to date on the latest medical trends, practices and techniques. Call (443) 598-2562 or email us at AguirreLegalNurseConsulting@gmail.com  

Concussions that are unrecognized or are mismanaged increase the risk of developing a potentially catastrophic sequelae known as Second Impact Syndrome. This results when an athlete has not fully recovered from an initial concussion before sustaining a subsequent concussive injury. This in turn causes diffuse brain swelling and severe, permanent neurological dysfunction or death. This type of repetitive head trauma can occur from participation in contact sports such as boxing, football and/or ice hockey.

Pre-season concussion screenings are relatively new to youth sports, but obtaining pre-injury baseline data on athletes who engage in contact sports can make sideline assessment more accurate. Concussion screenings are typically a short computerized test that measures selected brain processes, such as word description and memory. It also measures processing speed and reaction time. The scores obtained at completion establishes each athlete's baseline score. Without establishing an individual's baseline, the athlete's post-injury performance on assessment must be interpreted by comparison with a generalized "normal" based on a large population sample. In the event, an athlete sustains a concussion during the season, he or she can take a re-test and the scores will be compared to the baseline. These computerized tests do not diagnose concussion, however they can be helpful during the management or treatment of a concussion. The changes or improvements in scores over time can assist in evaluating progress toward recovery. 

The following is a list of some of the computerized concussion screening programs available:

• Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)
• King-Devick Test for Concussions
• Computerized Cognitive Assessment Tool (CCAT)
• Concussion Resolution Index (CRI)

What should you do if you think your child has a concussion? SEEK MEDICAL ATTENTION RIGHT AWAY. A health care professional will be able to decide how serious the concussion is and when it is safe for your child to return to regular activities, including sports. 

The National Quality Forum (NQF), a voluntary organization that sets consensus standards for health care quality, has adopted a list of 28 "Never Events" and the first condition listed is pressure ulcers stages III and IV. As a result, the Centers for Medicare & Medicaid Services will not reimburse or pay for costs incurred to the patient if a stage III or stage IV pressure ulcer develops while the patient is hospitalized.    

The cornerstone of pressure ulcer management is prevention. Recognizing and assessing patients who have not yet developed a pressure ulcer provides a framework for implementation of a prevention strategy that reduces the risk of pressure ulcer occurrence. This in turn can decrease a patient's morbidity and mortality as well as increase comfort and general quality of life.  

Most healthcare facilities utilize standardized tools, such as the Braden Scale, to assess risk for developing a pressure ulcer. Dependent upon the calculated level of risk, electronic medical records (EMR) have been beneficial in “planning” what necessary interventions should be implemented. Essentially, the computer either automatically assigns the necessary intervention(s), or it provides a drop down list with suggestions for measures to be implemented. However, checking a box in a computer system does not guarantee an action is always performed.   

It is important to note when attempting to stage a pressure ulcer that if “slough” or “eschar” is present in the ulcer bed, that the ulcer is “unstageable.” Until this dead tissue is removed to expose the base of the ulcer and a the true depth, a stage cannot be determined. 

The National Pressure Ulcer Advisory Panel (NPUAP) serves as an authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment. Keep an eye out, they will be announcing a new and updated pressure ulcer staging system in 2016.

This is a brief summary of ulcers; there are still many other types of ulcers caused by trauma and dermatologic disease. The nurses at Aguirre Legal Nurse Consulting can assist you in properly identifying which type of ulcer is involved in your legal case. We also know some of the best wound care experts available to provide testimony. Call us at (443) 598-2562 or email AguirreLegalNurseConsulting@gmail.com

Stay tuned for my next post on pressure ulcer prevention….

How do you measure pain and suffering? Pain is subjective; it is what an individual says it is. To add more ambiguity, no two persons will experience the same level of pain from a similar injury as a result of unique, individual pain thresholds. There is great difficulty in estimating the true value of subjective symptoms in the comparative absence of physical signs.

If the injured client involved in your legal case is receiving pharmaceutical interventions for pain, then assess what medication is being prescribed, along with the dosage, the route, and the frequency. There is a wide range of pharmaceutical interventions utilized for pain management. Different drug classifications are used for different types of pain as well as the intensity of pain experienced. Some classes are “stronger” than others. There are also therapies that involve combinations of drugs useful to manage acute breakthrough pain with extended-release drugs used to deliver therapeutic effects over a period of time.

Higher pain medication dosages typically indicate an increased level of pain. However, dosages may be adjusted if an individual’s pain tolerance changes over time. An increased frequency in taking pain medications also may indicate an increased level of pain.

Lastly, the route in which a pain medication is administered impacts the time by which therapeutic effects are achieved. Is the pain medication administered intravenously or through epidural injection? Is it ordered to be given by mouth or via patch? Injectable administration of pain medications is typically administered for more acute and/or severe pain.

Aguirre Legal Nurse Consulting understands the management of pain. We can assess injuries and identify contributing factors that could affect your settlement value. We can also help identify and locate medical experts who can support your case. Call (443) 598-2562 or feel free to email AguirreLegalNurseConsulting@gmail.com

Since Medicare and the National Healthcare Safety Network started mandating prevention policies and monitoring device-associated infections (i.e. catheter-associated UTIs, central-line associated blood stream infections and ventilator-associated pneumonia), the incidences of these infections have declined tremendously. In fact, studies show that these device-associated infections only account for approximately 25% of hospital-associated infections.  Today, one of the most common hospital-associated infections is hospital-acquired "nonventilator" pneumonia and can be prevented by basic nursing and oral care!

The hospital presents another myriad of problems regardless of age. A patient’s natural immune defense is weakened. The ability to maintain basic hygiene often declines. Additionally, changes in oral bacterial colonization occur within 48 hours of admission. Microaspiration combined with decreased mobility and changes in the oral flora create a perfect environment for microbes to flourish in the respiratory tract. 

Hospital-acquired "nonventilator" pneumonia has the same mortality as ventilator-associated pneumonia. The costs are higher; it leads to prolonged hospital stays and creates a greater risk for readmission within 30 days. Evidenced-based nursing and oral care can make a difference!

Let one of our nurses at Aguirre Legal Nurse Consulting help you define the applicable standard of care and provide authoritative research on clinical practice guidelines for your next medical malpractice case! Call (443) 598-2562 or email AguirreLegalNurseConsulting@gmail.com 

Sudden cardiac arrest is one of the leading causes of death in the U.S. About 360,000 cases occur yearly, and a person currently has about a 5% chance of surviving an incident of cardiac arrest. It can happen to anyone, anytime, anywhere and at any age. An automated external defibrillator (AED) is the only effective treatment for restoring a regular heart rhythm during sudden cardiac arrest and is an easy to operate tool for someone with no medical background.

Time is of the essence! The average response time for first responders once 911 is called is approximately 8-12 minutes. For each minute defibrillation is delayed, the chance of survival is reduced by 10%.

Neurological injuries, to include neuropsychological disturbances, can be completely disabling and adjusting to these changes can be a challenge. The individual may have to learn to deal with and accept the life-long physical and mental changes and the impact on their family and vocational function. Thus, the residual disability from a TBI must be objectively assessed to support the damages impacting the ability to work and change in quality of life. 

Need help on your TBI case??? Contact Aguirre Legal Nurse Consulting. We can assist you in analyzing the medical records, providing a summary or research and even locating medical experts to support your case. Call us at (443) 598-2562.