The article provides the clinician with core information about the aetiology and treatment of nasal congestion and discusses nasal blood vessels, autonomic nerves, nasal cycle, effects of posture, subjective sensation of congestion, objective assessments of congestion and medical and surgical treatments.

No abstract

M any times in my career, I have looked back on the patient care I have provided and thought about what I could or should have done that might have led to an even better result. Being reflective about our practice and discussing it with our knowledgeable colleagues often will provide us with new ideas. These ideas can motivate us to seek out what, if any, evidence exists to support a new patient care practice.In nursing, we must be vigilant lifelong learners. The data and science behind our practice is ever changing. It is imperative that we know and implement the most current evidence to prevent harm to our patients and promote the best possible outcomes. Advanced planning, or as many of us know it, "the plan of care," is what distinguishes nurses' contributions to the perioperative arena in a positive and productive way.One of the ways perioperative nurses proactively contribute to the prevention of harm in the OR is by correctly positioning patients for each and every procedure. Surgical positions are often complicated, and maintaining the patient's proper body alignment can be a challenge. Each year, an estimated 2.5 million patients in US health care facilities develop pressure injuries, and these injuries lead to death for approximately 60,000 patients annually. 1 Even more concerning is the high rate of pressure injuries for patients undergoing surgical procedures, estimated at 8.5% for procedures that last longer than three hours. 2 Overall, pressure injuries that develop in the perioperative setting are estimated to account for 45% to 66% of all health care-associated pressure injuries. 2,3 This is a much higher percentage than many of us would have believed, and this problem certainly requires our attention. CORRECT POSITIONINGYears ago, before we had the advanced positioning devices and supplies we have today, we used a variety of items to help position a patient. We might have used everything from a rolled-up sheet to an IV fluid bag. Today, we know much more about what is effective for positioning a patient to reduce the risk of injury. For example, we know that pillows, blankets, and molded foam devices are not effective for pressure distribution. Towels and sheet rolls do not reduce pressure and may even cause a positioning injury as a result of friction. 4Being the patient's advocate requires knowledge of the correct positioning practices. Too often we hurry through the positioning process without taking the time to really evaluate the patient's risks and mitigate them. Core concepts we should keep in mind include, but are not limited to, the following.• Injuries resulting from improper positioning are preventable and are a liability.• Surgical patients are often in unnatural positions and are unable to communicate or adjust to alleviate their discomfort or pain. It is up to the surgical team to identify and correct any problems in the patient's position.• Personnel should communicate and document all positioning interventions before, during, and after the procedure and communicate all relevant po...

S eptember is the designated disaster-preparedness month. Disasters can be natural or man-made, and when they occur, there are serious consequences. Disasters often come without warning and leave behind destruction and human suffering. As nurses, we are wired to help others, and in the case of a disaster, we rise to the occasion. Nurses may be the first responders or the first to care for the victims brought into their facilities. As perioperative nurses, we are devoted to making sure the patient in need of a surgical procedure is cared for safely no matter the circumstances.Maybe you have experienced a disaster in your community. Many years ago, I was working as an OR manager when a tornado hit downtown Nashville, Tennessee. Our OR was full of patients, with 15 of 17 rooms in use. It was almost 3 PM, when most of the staff members would normally be leaving to go home for the day. I remember stopping people as they came out of the locker room and telling them they needed to stay. I asked them to line up in teams that could staff an OR as needed.We had no idea how many victims would be coming through the door. We quickly tried to move patients out of the holding area and the postanesthesia care unit (PACU), and we stopped all elective surgery. There was a risk of losing power or steam, so we asked the surgical teams to finish up the procedures as quickly as they could.We also were concerned about our families. The hospital day care where my four-year-old son and the children of several colleagues were staying was near where the tornado touched down and was most likely damaged. The internal conflict of duty to patients and family certainly was real for me that day. Luckily, we only received a couple of patients who needed surgery and we were able to find out that all the children were safe. I remember that day like it was yesterday, and it really drove home for me the need to prepare for the unlikely event of a disaster striking. PERIOPERATIVE DISASTER PLANNINGThe AORN Emergency Preparedness Tool Kit, available to members on the AORN web site, contains an Emergency Preparedness Disaster Plan Preparation Guide 1 intended for use in developing or reviewing a disaster plan for perioperative services in a hospital or an ambulatory surgery center. In this guide, the first step is to put together a multidisciplinary team representing all the key stakeholders. Personnel from the emergency room, anesthesia department, materials management, security, and central sterile processing all need to come to the table to put together the best plan possible. Items that the team should consider include communication methods, equipment and supplies needed, patient throughput, suspension of elective procedures, facility security, facility evacuation plans, health care worker emotional safety, education, and procedures for handling different types of disasters. 1 The guide contains a checklist with questions to answer in each of these categories to help the team develop a robust plan.

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.