Why Practitioners Need to be More Informed About Infantile Spasms

Why Practitioners Need to be More Informed About Infantile Spasms

Infantile spasms are a rare but serious form of epilepsy that is often misdiagnosed. The disorder occurs in approximately 3 cases per 10,000 live births and usually begins in the first 4-8 months of life but can occur in children up to age 3. Most cases are associated with an abnormal brain wave pattern that can cause harm to a young, developing brain. Recognizing symptoms and initiating early treatment are critical in diminishing the long-term effects on these children. Because of this reason, raising awareness and aiding in early recognition is critical.

Recognizing the Symptoms of Infantile Spasms

Sadly, most cases of infantile spasms are misdiagnosed as reflux, colic, or normal startle reflex of infancy. These seizures can look like sudden stiffening of the arms and legs, bending forward of the body, or arching of the back. The key to differentiating these from normal infancy movements is that they often occur in clusters lasting 1-2 seconds and can occur up to 100 times per day. Spasms are also most likely to occur when the baby has just woken up.

Children with infantile spasms are at a much higher risk for developing intellectual disability, autism, and epilepsy. These spasms may also be associated with specific disorders such as genetic abnormalities, brain injury, or infection. In some children, no cause is found. The best plan of attack for infantile spasms is prompt recognition of the spasms, a full medical workup, and early intervention.

Parents vs. Practitioners: A Team Approach is Essential

The first line of recognition falls on parents, but too often, their concerns are dismissed by practitioners. It is important to educate both parties on infantile spasms, including what the spasms look like and the need for prompt evaluation and treatment.

If parents know the symptoms, they need to document and record them in real-time so there’s evidence. Then, they should urgently seek medical attention. Parents are encouraged to use their cell phones for video evidence of what they are seeing, and it can be beneficial in helping the practitioners acknowledge their concerns. Learning the appropriate language to communicate to physicians can also make dismissal less likely. It can be helpful to describe these spasms in detail, including words like “stiffening” and “clusters” and how often they occur.

Healthcare workers need to be informed on how to recognize the symptoms of infantile spasms and the necessary workup and treatment after an initial diagnosis. To find a diagnosis, practitioners are responsible for recognizing the concerns of the parents or caretakers and analyzing the available evidence in addition to a workup that includes a neurological exam, EEG, and MRI. Most of these workups require admission to the hospital so they can be performed in a timely manner, and appropriate therapy can be initiated on an urgent basis. Infantile spasm cases can come into the pediatrician’s office, urgent care, or even the emergency department, making widespread education necessary. Early and effective treatment for these infants can improve the prognosis and lessen the severity of future epilepsy and degree of developmental delay.

Staying Educated and Informed 

All healthcare workers are required to complete continuing medical education regularly. Part of this CME could include information and the most up-to-date statistics for infantile spasms. It is the responsibility of the healthcare community to create these in-services and provide this material to bring awareness and education. As mentioned before, these children can present to a multitude of different doctors and clinics, so widespread education is needed for everyone. Recognizing, testing, and treating requires a multi-faceted team approach that could consist of pediatricians, nurse practitioners, Emergency Physicians, and neurologists. These providers can take the information, stay informed on the standards of care, and help spread awareness to their fellow practitioners. This awareness can make all the difference in the world for the next infant that comes into the ER with spasms and gets the correct treatment instead of being discharged.

Recognizing Infantile Spasm Awareness Week

Infantile Spasms Awareness Week (ISAW)  is held annually, December 1-7, to raise awareness of infantile spasms for everyone, especially parents and health practitioners. As an ER physician and mother of a little boy with a genetic abnormality, Duplication 15q Syndrome, I understand the essential need to spread awareness of this seizure disorder. When going through the stressful process of diagnosing my son, my family was a victim of a physician dismissal even though I’m a physician myself. We had recognized developmental delay issues in our son for almost an entire year before we convinced the pediatrician to run the necessary tests that led to his Duplication 15q Syndrome diagnosis. This specific genetic condition is associated with hypotonia, developmental delay, and infantile spasms with a high incidence of future epilepsy. Even as a physician, I was unprepared and uninformed when it came to his diagnosis and complications while also being a physician in the past who was not educated on infantile spasms or similar disorders.

As a result, I decided to educate myself on the most up-to-date information regarding spasms and their evaluation and treatment. I took every opportunity to educate my co-workers on my son’s diagnosis as well as on infantile spasms so that we could spread awareness and effective medical care. Receiving my son’s diagnosis was the hardest thing I have gone through and came with a huge emotional journey. However, it has also made me a much better physician. Since his diagnosis and my educational journey, I have conducted seminars on infantile spasms and personally cared for and treated several babies in the ER with possible spasms. I have been able to recognize the symptoms and arrange full workups and consultations to identify the underlying cause and initiate treatment. I encourage other healthcare workers, especially those who work in ERs, to seek similar education on infantile spasms and understand how critical early intervention is with this disorder.

Heroic Nurses, Ariana Stemple and Cori Holloway, Save Friend’s Life with CPR in Colorado

Heroic Nurses, Ariana Stemple and Cori Holloway, Save Friend’s Life with CPR in Colorado

Robyn Morgan, Ariana Stemple, and Cori Holloway became friends working together at St. Joseph Hospital in Denver, Colorado. These friends are bonded for life after a shopping trip at Murdoch’s in Grand Junction this past September.

Morgan, leader of medical imaging at Saint Joseph Hospital in Denver, wasn’t feeling well shopping, and before she knew it, she was on the ground unconscious. Holloway and Stemple, both cardiac nurses, rushed over instinctively, performing CPR.

Daily Nurse proudly names Ariana Stemple and Cori Holloway the Nurses of the Week. Their swift reaction to Morgan’s medical emergency saved her life.

“Every minute that a patient in cardiac arrest goes without getting CPR, their chances of survival decrease by about 10% every minute. So having bystanders out in the community performing that CPR to get patients to the hospital is the only way to improve survival and outcomes,” says Jamie Hogan, chest pain coordinator at Saint Joseph Hospital.

Morgan says she wasn’t feeling well and was looking for a place to sit down. And that’s her last memory of what happened.

Morgan had no pulse, and both nurses had never performed CPR outside of the hospital, so the first time they performed CPR, it was on their friend.

That was something Morgan had long teased them about.

They jumped into action. And it paid off. CPR kept Morgan alive until EMS arrived to take her to the hospital. Both Holloway and Stemple said they were relieved they were close by when it happened so they could help.

“It’s interesting that I’ve given them a hard time for that for so long, and then the first time they do CPR is on me,” Morgan says.

After getting to the hospital, Morgan learned that she had gone into cardiac arrest and suffered a skull fracture when she fell and hit her head. The three nurses save lives every day at her work, but Morgan never expected her own life would need saving.

The actions of Stemple and Holloway forged their friendship into a permanent lifelong bond.

Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter. 

National Burn Awareness Week and Specialized Work of Burn Nurses

National Burn Awareness Week and Specialized Work of Burn Nurses

February 4th to 10th is National Burn Awareness Week , and Daily Nurse is recognizing the specialized work of burn nurses. Burn nurses are known for their exceptional skills, commitment, and unwavering dedication to patient care. They work tirelessly to treat individuals who have been affected by burn injuries and to advocate for burn injury prevention within their communities.

Meet Emily Werthman, PhD (c), MSN, RN, CBRN, the Burn Program Manager at The Johns Hopkins Burn Center. She is also a member of the Board of Certification for Emergency Nursing (BCEN) board of directors for the 2024-2025 term and shares her insights on burn nursing as a specialized nursing practice.

-What are your title and credentials at The Johns Hopkins Burn Center?

Burn Program Manager

PhD (c), MSN, RN, CBRN

-How long have you worked there?

13 years

-What do you enjoy most about your role as burn program manager?

I love the detective aspect of my job: finding a problem, discovering its root cause, and then developing a plan to fix it. I also work with an amazing interdisciplinary team that makes it exciting to come to work every day.

-Talk about how you ascended to that role.

I started as a BICU nurse and loved our burn program’s research and quality aspects. I knew that burn nursing was where I wanted to practice, but I also wanted to further my career options by pursuing an advanced degree. After about 10 years at the bedside, the burn program manager position became available while I was obtaining my MSN in nursing education. I was so happy to be able to combine my love of research, quality, and bedside burn nursing knowledge into this role. I am also incredibly fortunate to work for a health system that encourages and supports its nurses’ continuing education so I can continue with my PhD.

-What inspired you to become a burn nurse?

My mother died in a house fire shortly after my college graduation. Knowing that her nurses were with her, providing the best possible care, inspired me to do the same for all the families and patients we care for here at the Johns Hopkins Burn Center.

What associations are you a member of, and how have they helped your career?

I am an American Burn Association (ABA) member, serving as the lead nurse planner. I volunteer with the Board of Certification for Emergency Nursing (BCEN), serving as a CBRN Exam Construction Review Committee member, and have just been appointed to BCEN’s board of directors.

These roles have allowed me to work outside of my hospital system to impact the work of burn nurses nationally and internationally. My work with the ABA has allowed me to progress from member to committee member to lead nurse planner. Similarly, at BCEN, I started as an item writer and have continued to work within the organization to support its mission. Both organizations have provided opportunities for professional growth through networking and continuing education.

-What does a burn nurse do?

There is not a typical day in burn. We see patients at their worst on the first day they are injured, their best on the day they are discharged, and everything in between. Burn is unique because we know our patients and their families through one-on-one interactions during daily wound care sessions. A shift in the BICU or BWU will usually involve all your standard nursing interventions but with a healthy dose of specialized wound care, wound vac placement, dressing takedowns, and lots of psychosocial support for our patients and their families.

Burn nurses are more than trauma care. Can you talk about the other types of care they provide patients?

Burn nurses genuinely care for the patient across the entire continuum from admission to discharge and then reconstruction procedures in the years following an injury. In addition to critical care, they provide outstanding psychosocial support to families and patients. Many burn nurses participate in prevention activities like outreach at local schools and partnerships with local firefighters.

-How do you become a burn nurse?

After graduating with a history degree, I returned to school to get my AS in nursing, eventually earning a BSN and MSN. I am currently preparing to defend my PhD dissertation, as well. I knew when I entered nursing school that burn nursing was my calling. I contacted the burn center for my senior honors project to arrange a guest lecture at my nursing school. I kept in touch with them after graduation so that they were aware of my interest in the burn center and to let them know when I applied for an open position there.

Talk about the need for burn nursing and BCEN specialty certification.

I seek to effect change in the field of burn nursing as a subject matter expert, test question writer, and exam content review committee member for the CBRN exam. Specialty certification is an essential part of recognizing burn nurses’ unique work. As more hospitals move toward Magnet certification, standing with other certified nurses offers burn nurses the ability to demonstrate our commitment to quality care.

-What are the benefits of being a burn nurse? 

Burn nursing is a challenging field. But it is just as rewarding as it is difficult. We see patients progress through their recovery, and through our work with the Burn Therapy Program, we continue to see them for years as they return to their lives.

Talk about the reward of being a burn nurse.

The payoff is the outcome. When we see a patient with substantial burn injuries overcome their injuries and go on to live happy, successful lives, it makes all the long, hot days in a tub room worth it.

Talk about being 1 of 12 expert nurses selected by BCEN to serve on the Burn Nursing Role Delineation Study Advisory Committee.

No other specialty provides you with a level of interaction with patients and their families, all while providing life-saving critical care. The burn nurse is truly the best representation of a holistic nurse that I know—integrating critical care with psychosocial care, wound care, focused systems assessments/interventions, and all that comes with the care of surgical patients. Being selected to help define what a burn nurse does was an honor. And to be able to work with some of my role models in burn care (Gretchen Carrougher and Katie Hollowed, in particular) was so exciting. To think that we could work together with burn experts from all over the country to help on our path to certification was life-changing.

How does the committee’s work serve as a roadmap for nurses who sit for the CBRN exam?

In our work, we helped define what the burn nurse does, which helped define the parameters of the CBRN exam.

-Do you have anything else to add for Burn Awareness Week?

This year’s theme is preventing flammable liquid injuries, so I encourage people to check out the resources available at ameriburn.org to ensure they are following all appropriate safety measures!

Meet Joe Schmuecker, the U of I Nurse Who Answers His Patients’ Letters to Santa

Meet Joe Schmuecker, the U of I Nurse Who Answers His Patients’ Letters to Santa

During the most challenging time of year for patients and their families in the University of Iowa Hospital’s Pediatric Emergency Department , ED nurse Joe Schmuecker, RN, has gone above and beyond to spread a little holiday cheer over the last five years.

Every Christmas, Schmuecker sets up a homemade red mailbox for children in the pediatric department to send letters to the North Pole. Then, Schmuecker and a team of his colleagues answer every letter.

For Schmuecker, it’s a chance to connect with patients and bring a little joy within the stress of a hospital visit.

Daily Nurse is proud to name Joe Schmuecker our Nurse of the Week for his dedication to positively impacting his young patients and helping to spread joy throughout the holiday season.

Schmuecker says he wants to give kids a sense of normalcy in the hospital.

“This whole project started to bring out the holiday spirit in our department and to create some positive moments with patients and their families,” he says.

He expects 75-100 letters to be stuffed in the mailbox each year. The letters ask for the child’s name, age, what presents are on their wish list, and – most importantly – if they should be on the naughty or the nice list.

Schmuecker says the team has gotten the replies down to about five minutes each, but when they fill out a full page, it’s not just a quick response. It’s a very thoughtful letter responding to what the kids said. And then, if he got to work with that patient, they throw some things in there that would make it more personal and believable for them.

“The letters that stand out to me the most are the ones where the child checks the ‘I’ve been naughty’ box, though the kids do have a chance to explain why they think they’ve been naughty,” says Schmuecker. “There are also the letters that ask for selfless acts, like having their sibling not be sick. Those messages stay with you.”

Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter. 

World’s First Burn Nursing Specialty Certification Now Available

World’s First Burn Nursing Specialty Certification Now Available

The Board of Certification for Emergency Nursing (BCEN)  launched the world’s first Certified Burn Registered Nurse (CBRN) burn nursing specialty certification. To earn the CBRN credential, eligible RNs and APRNs must pass a rigorous national exam spanning the burn nursing continuum, including prehospital care and initial management, acute and critical care, post-acute rehabilitation, outpatient and community care, and aftercare and reintegration, as well as injury prevention, education, and psychosocial patient and family support.

“At last, tremendously skilled and compassionate burn nurses worldwide have the opportunity to have their advanced clinical and professional knowledge and expertise validated through board certification,” says CEO Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC. “The best possible thing a burn patient could have is a CBRN-certified nurse taking care of them.”

Nurses play critical roles in every aspect of burn care and recovery, and research links burn care specialty expertise to improved outcomes in patients with burn injuries.

In a new burn nursing video, burn nurse experts and American Burn Association (ABA) leadership comment on the development and future impact of BCEN’s CBRN certification program.

Burn injuries significantly cause disability and death, affecting all ages.

  • In the U.S., over 400,000 seek medical treatment for burn injuries annually, with 40,000 hospitalizations, including 30,000 at hospital burn centers, and over 3,800 deaths.
  • Worldwide, there are approximately 11 million burn cases and 180,000 deaths annually.
  • Learn more about burn injuries, care, and burn nursing in Burn Nursing Excellence: The CBRN.

Eligible nurses with a U.S. RN or APRN, or equivalent, may apply to sit for the CBRN exam here. Nurses educated or licensed outside the U.S., Canada, or Australia must first go through BCEN’s international credential evaluation process. BCEN offers exam discounts to ABA members, U.S. military active-duty service members, reservists, and veterans. Volume discounts are available through the BCEN Voucher Program. A CBRN practice exam and interactive burn nursing CE courses are available on the award-winning BCEN Learn professional development platform.

ED Nurses Going Beyond the Call of Duty: Meet ENA Connection’s 20 Under 40 Class

ED Nurses Going Beyond the Call of Duty: Meet ENA Connection’s 20 Under 40 Class

From flight nurses to military members and mayors to parents, emergency nurses go beyond the call of duty and the 2023 ENA Connection 20 Under 40 class has it all.

ENA announced the third class of 20 extraordinary nurses as part of the celebration of Emergency Nurses Week.

Each honoree in the 2023 class has achieved significant milestones in their healthcare careers and demonstrated positive contributions beyond their professional work. One nurse from Bhutan created the BEAR, or Bhutan Emergency Aeromedical Retrieval Team, which uses his country’s only helicopter for rescue missions. Another helped launch a program called “Caring for the Caregiver” to help nurses cope with critical incidents. Those are just the beginning of what this class of honorees has accomplished.

Many in the new class were inspired by nurses they had encountered in the past. Some followed in their family’s footsteps, while others fell into the profession later. One thing they all have in common is the goal of helping people and inspiring and teaching the next generation of nurses.

“Having seen what these 20 nurses have accomplished, I can say with certainty that the future of emergency nursing is in good hands,” says ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN. “The amount of knowledge, passion, drive, and skill we have among the ENA membership is outstanding. I can’t wait to see how these young professionals continue to contribute to emergency nursing throughout their careers.”

Meet the ENA Connection’s 2023 class of 20 Under 40 honorees featured in the magazine’s October issue.

  • Christine Alston, DNP, RN, CEN, TCRN, CPEN, CFRN, CTRN, of Florida
  • Levon Aharonyan, MSN, RN, PHN, GRN, NPD-BC, of California
  • Tyler Babcock, MSN, MBA, RN, CEN, TCRN, of Pennsylvania
  • Jermaine Clayborne, MSN, APRN, NEA-BC, NNP-BC, CCRN-Neonatal, CCRN-Adult, CFRN, FP-C of Virginia
  • Kiran Biswa Diyali, RN, Flight Nurse, of Bhutan
  • Megan Duke, MSN, RN, CNS of California
  • Sean Elwell, MSN, RN, NE-BC, TCRN, EMT, of New Jersey
  • Juan M. González, DNP, APRN, AGACNP-BC, FNP-BC, ENP-C, CEN, CNE, FAANP, of Florida
  • Kelsea Heiman, MSN, RN, CEN, TCRN, of Texas
  • Shannen Kane, BSN, RN, CEN, of North Carolina
  • Adam Lawrence, BSN, RN, CTRN, CEN, TCRN, EMT, of New York
  • Jacob Miller, DNP, RN, APRN-CNS, APRN-CNP, RN, of Ohio
  • Daniel A. Misa, MSN, RN, CEN, CPEN, NE-BC, of New Jersey
  • Wilson Pierce, DNP, RN, CNE-CL, TCRN, of Georgia
  • Philip Prousnitzer, MSN, RN, CEN, TCRN, CCRN, CPEN, CTRN, CFRN, of Arkansas
  • Heather Purcell-Mullins, MSN, RN, ACCNS-AG, CEN, CPEN, CDR, Nurse Corps, USN, of California
  • Jamin Rankin, RN, EMT, CEN, CFRN, TCRN, CPEN, CTRN, of Louisiana
  • Crystal Rose, PhD, MHA, RN, CNE, of Arkansas
  • Lena Sutch, MSN, RN, CEN, of Maryland
  • Jessica Wilson, MS, RN, CEN, CPEN, TCRN, EBP-C, of Maryland

Each class of honorees is chosen by a panel of reviewers who assess their accomplishments in their profession and communities, their contributions to emergency nursing, and how they plan to shape the future of the specialty. Their peers nominated 44 nurses, and 75 nurses submitted applications.