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Twenty-five percent are in the esophagus or hypopharynx.

One-fourth of intubated patients brought in by emergency medical services (EMS) may have a misplaced endotracheal tube.


These findings come from a study of the incidence of unrecognized misplacement of endotracheal tubes inserted by paramedics working in an urban, decentralized EMS system. This rate of misplacement is higher than those revealed in previous studies, which excluded certain types of patients and were conducted in EMS systems directed by academic EMS directors with tightly controlled oversight of paramedic training and practice. The current study may be a more accurate estimate of the incidence of endotracheal tube misplacement in the community.


Upon the arrival at an ED (within the EMS system) of any intubated patient during an eight-month period, the tube's placement was evaluated by auscultation of the chest and epigastrium, end-tidal carbon dioxide monitoring, and if necessary, direct laryngoscopy. Among 108 patients, 75% had a correctly placed tube, 17% had the tube in the esophagus, and 8% had the tube in the hypopharynx. Trauma patients were more likely to have a misplaced tube than were medical patients.


Katz SH, Falk JL. Ann Emerg Med 2001;37(1):32-7.



Recognition in middle-aged women is less likely.

Triage nurses may be more likely to recognize the possibility of a myocardial infarction (MI) in a man than in a woman presenting with the same symptoms, a recent study suggests.


Cardiovascular disease (CVD) is the primary killer of women in the United States, and in fact, more women than men die of it. Women having an AMI present with atypical symptoms more often than men do.


A nurse researcher developed three pairs of vignettes describing patients with identical clinical characteristics at presentation, except for sex: in each pair, one patient was male, and one was female. She mailed a questionnaire and the three paired vignettes to each of 500 members of the Emergency Nurses Association.


Two of the vignette pairs described cardiac cases. In one case, respondents were significantly more likely to assign a cardiac diagnosis to a 43-year-old man than to a 43-year-old woman with the same symptoms. Discrepancies correlated to differences in sex were seen in the level of urgency assigned and in the admission unit selected. Respondents certified in emergency nursing were more likely to select a cardiac diagnosis than were uncertified respondents. There were no differences attributable to sex in the second cardiac vignette, which involved a 66-year-old man and a woman of the same age.


While the incidence of MI in middle age is lower among women than it is among men, middle-aged women with MI are at the greater risk of dying of their infarction, making recognition of symptoms in this population a priority.


Arslanian-Engoren C. Nursing Research 2001;50(1):61-6.



One in four results from frequent use of cocaine.

Cocaine use is responsible for one quarter of all nonfatal myocardial infarctions (MIs) in people 18 to 45 years old, according to a recent study.


Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used to examine the relationship between cocaine use and nonfatal stroke and MI. Among 10,085 adults aged 18 to 45, there were 46 nonfatal MIs and 33 nonfatal strokes. A total of 731 (7.2%) respondents reported infrequent cocaine use (fewer than 10 times in their lives), and 532 (5.3%) reported frequent use (more than 10 times in their lives). Those who used cocaine frequently had a sevenfold greater risk of nonfatal MI, compared with nonusers. Infrequent cocaine use wasn't associated with a greater risk of MI. Also, cocaine use wasn't significantly associated with stroke.


Statistical analysis revealed that 25% of MIs resulted from frequent cocaine use. Cocaine increases myocardial oxygen demand by increasing adrenergic activity, and it's also associated with increased platelet aggregability, coronary vasoconstriction, and accelerated atherosclerosis.


Qureshi AI, et al. Circulation 2001;103(4):502-6.


The application of honey to the surgical wounds of mice after laparoscopic cancer surgery was found to significantly reduce the risk of tumor implantation development at the trocar wound site-called trocar site recurrence. The study, published in the December 2000 issue of Archives of Surgery, reveals that honey may provide a barrier to tumor implantation. Honey is highly bactericidal and has been used to accelerate wound healing for thousands of years.


A gentle human touch intervention for preterm infants was associated with decreased levels of both motor activity and behavioral distress in a study published in the December 2000 issue of Research in Nursing & Health. This soothing intervention may be useful in the care of preterm infants, who experience many stressors in the NICU.