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CJEM

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https://www.readbyqxmd.com/read/29212567/the-quebec-emergency-department-guide-a-cross-sectional-study-to-evaluate-its-use-perceived-usefulness-and-implementation-in-rural-emergency-departments
#1
Richard Fleet, Sandrine Hegg-Deloye, Julie Maltais-Giguère, France Légaré, Mathieu Ouimet, Julien Poitras, Alain Tanguay, Patrick Archambault, Jean-Frédéric Levesque, Geneviève Simard-Racine, Gilles Dupuis
OBJECTIVES: The Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management. METHODS: We invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec's rural hospitals to complete an online survey (144 questions)...
December 7, 2017: CJEM
https://www.readbyqxmd.com/read/29202888/octreotide-for-the-treatment-of-intentional-insulin-aspart-overdose-in-a-non-diabetic-patient
#2
Catherine M Dewaal, Eric McGillis, Matt Mink, Scott Lucyk
Intentional insulin overdose may lead to severe and refractory hypoglycemia. Exogenous dextrose administration is the mainstay of therapy for these patients and is effective in most cases. However, in patients with a functional pancreas, exogenous dextrose administration may precipitate endogenous insulin release leading to rebound hypoglycemia. We describe a case report of a 41-year-old woman who injected 300 units of insulin aspart with suicidal intent. Her initial blood glucose was 2.3 mmol/L (41 mg/dL)...
December 5, 2017: CJEM
https://www.readbyqxmd.com/read/29202886/rhythm-and-rate-control-of-atrial-fibrillation-in-the-emergency-department-a-large-community-based-observational-study
#3
Cameron J Gilbert, Paul Angaran, Zana Mariano, Theresa Aves, Paul Dorian
OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia presentation to the emergency department (ED) and frequently results in admission to the hospital. Although rarely life-threatening and not usually an emergent condition, AF places a large burden on our health-care system. The objective of this study was to describe the practices of ED physicians in the management of AF in a large urban Canadian city. METHODS: From January 1, 2010 to December 31, 2010, patients with a primary diagnosis of AF were identified across 10 EDs in Toronto, Canada (N=2,609)...
December 5, 2017: CJEM
https://www.readbyqxmd.com/read/29199945/evaluating-mental-health-service-use-during-and-after-emergency-department-visits-in-a-multisite-cohort-of-canadian-children-and-youth
#4
Mario Cappelli, Paula Cloutier, Amanda S Newton, Eleanor Fitzpatrick, Samina Ali, Kathryn A Dong, Clare Gray, Allison Kennedy, John S Lyons, Christine Polihronis, Rhonda J Rosychuk
OBJECTIVES: The goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed. METHODS: A 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction...
December 4, 2017: CJEM
https://www.readbyqxmd.com/read/29151401/evaluation-of-a-primary-care-paramedic-stemi-bypass-guideline
#5
Jonathan L Kwong, Garry Ross, Linda Turner, Chris Olynyk, Sheldon Cheskes, Adam Thurston, P Richard Verbeek
OBJECTIVE: Limited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline. METHODS: We reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria...
November 20, 2017: CJEM
https://www.readbyqxmd.com/read/29151394/opioid-analgesics-is-it-time-for-risk-stratification-prior-to-use-erratum
#6
Maureen A Allen
No abstract text is available yet for this article.
November 20, 2017: CJEM
https://www.readbyqxmd.com/read/29117873/implementation-of-an-emergency-department-atrial-fibrillation-and-flutter-pathway-improves-rates-of-appropriate-anticoagulation-reduces-length-of-stay-and-thirty-day-revisit-rates-for-congestive-heart-failure
#7
David Barbic, Chris DeWitt, Devin Harris, Robert Stenstrom, Eric Grafstein, Crane Wu, Cristian Vadeanu, Brett Heilbron, Jenelle Haaf, Stanley Tung, Dan Kalla, Julian Marsden, Jim Christenson, Frank Scheuermeyer
OBJECTIVES: An evidence-based emergency department (ED) atrial fibrillation and flutter (AFF) pathway was developed to improve care. The primary objective was to measure rates of new anticoagulation (AC) on ED discharge for AFF patients who were not AC correctly upon presentation. METHODS: This is a pre-post evaluation from April to December 2013 measuring the impact of our pathway on rates of new AC and other performance measures in patients with uncomplicated AFF solely managed by emergency physicians...
November 9, 2017: CJEM
https://www.readbyqxmd.com/read/29041997/a-web-based-module-and-online-video-for-pain-management-education-for-caregivers-of-children-with-fractures-a-randomized-controlled-trial
#8
Stevi Golden-Plotnik, Samina Ali, Amy L Drendel, Tammy Wong, Frank Ferlisi, Sydney Todorovich, Kyle Canton, Michael Miller, Julia Younan, Sharlene Elsie, Naveen Poonai
Introduction Over 80% of children experience compromise in functioning following a fracture. Digital media may improve caregiver knowledge of managing fracture pain at home. OBJECTIVES: To determine whether an educational video was superior to an interactive web-based module (WBM) and verbal instructions, the standard of care (SOC). METHODS: This randomized trial included caregivers of children 0-17 years presenting to the emergency department (ED) with non-operative fractures...
October 18, 2017: CJEM
https://www.readbyqxmd.com/read/29039292/an-innovative-short-stay-health-care-model-for-treatment-of-uncomplicated-vaso-occlusive-crisis-in-adult-sickle-cell-disease-patients-in-canada-to-reduce-emergency-department-utilization
#9
Andrew Binding, Richard Ward, Chai Phua, Veronique Naessens, Tara O'Brien, Sacha Bhatia, Hayley Baranek, Husayn Marani, Geetha Mukerji
OBJECTIVES: Patients with sickle cell disease (SCD) with vaso-occlusive crises (VOC) often visit the emergency department (ED) for management of painful episodes. The primary objective of this pilot study was to evaluate the acceptability of a short-stay model for treatment of VOC in SCD outside of the ED in Toronto, Canada. Secondary objectives were to assess patient satisfaction of this model, barriers to its use and comparison of clinical outcomes to a historical control. METHODS: Adult SCD patients with symptoms of an uncomplicated VOC between October 2014 to July 2016 were managed according to best practice recommendations in a short-stay unit as an alternative to the local emergency room...
October 17, 2017: CJEM
https://www.readbyqxmd.com/read/29032788/using-the-bergman-paris-question-to-screen-seniors-in-the-emergency-department
#10
Antoine Lague, Philippe Voyer, Marie-Christine Ouellet, Vale Rie Boucher, Marianne Giroux, Mathieu Pelletier, E Milie Gouin, Raoul Daoust, Simon Berthelot, Miche le Morin, Thien Tuong Minh Vu, Jacques Lee, Audrey-Anne Brousseau, Marie-Jose E Sirois, Marcel E Mond
OBJECTIVES: In the fast pace of the Emergency Department (ED), clinicians are in need of tailored screening tools to detect seniors who are at risk of adverse outcomes. We aimed to explore the usefulness of the Bergman-Paris Question (BPQ) to expose potential undetected geriatric syndromes in community-living seniors presenting to the ED. METHODS: This is a planned sub-study of the INDEED multicentre prospective cohort study, including independent or semi-independent seniors (≥65 years old) admitted to hospital after an ED stay ≥8 hours and who were not delirious...
October 16, 2017: CJEM
https://www.readbyqxmd.com/read/29032777/acute-urinary-retention-after-black-widow-envenomation-a-case-report
#11
Matthew Carere, Russel Sterret, Nicholas Timmerman, Ian Taylor
Latrodectism following Black Widow envenomation is rare in Canada. We present the case of a previously healthy 50 year old male who presented with an acute abdomen, hypertension, and urinary retention. After a thorough work up it was determined to be as a result of a Black Widow spider bite. Due to climate change we may see more cases of Latrodectism in the future and it should be considered as a differential diagnosis in anyone presenting with an acute abdomen after an insect bite.
October 16, 2017: CJEM
https://www.readbyqxmd.com/read/28965522/apical-hypertrophic-cardiomyopathy-treated-as-st-elevation-myocardial-infarction
#12
Christopher J Parr, Rajat Sharma, Philip J Garber
Electrocardiographic changes resulting from apical hypertrophic cardiomyopathy may mimic an acute coronary syndrome. A 67-year-old Sudanese male without cardiac risk factors presented to hospital with chest pain and electrocardiographic findings of septal ST-segment elevation, ST-segment depression in V4-V6, and diffuse T-wave inversion. He was treated as an acute ST-elevation myocardial infarction with thrombolytics. There was no cardiac biomarker rise and coronary angiography did not reveal evidence of significant coronary arterial disease...
October 2, 2017: CJEM
https://www.readbyqxmd.com/read/28965519/accuracy-of-the-ottawa-ankle-rules-applied-by-non-physician-providers-in-a-pediatric-emergency-department
#13
Joe MacLellan, Teya Smith, Jason Baserman, Shawn Dowling
OBJECTIVE: The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Limited data support its use by other health care workers in children. Our objective was to determine the accuracy of the OAR when applied by non-physician providers (NPP). METHODS: Children aged 5 to 17 years presenting with an acute ankle or foot injury were enrolled...
October 2, 2017: CJEM
https://www.readbyqxmd.com/read/28965509/extending-the-boundaries-of-emergency-medical-simulation-education-into-high-risk-low-probability-events
#14
Paul P Rega, Brian N Fink
No abstract text is available yet for this article.
October 2, 2017: CJEM
https://www.readbyqxmd.com/read/28958216/creating-opioid-dependence-in-the-emergency-department
#15
Suneel Upadhye
Clinical question What is the risk of creating opioid dependence from an ED opioid prescription? Article chosen Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017;376:663-73, doi:10.1056/NEJMsa1610524. OBJECTIVE: This study examined the risk of creating long-term opioid dependence from a prescription written in an opioid-naive patient in the ED.
September 29, 2017: CJEM
https://www.readbyqxmd.com/read/28934995/quality-improvement-primer-part-2-executing-a-quality-improvement-project-in-the-emergency-department
#16
Lucas B Chartier, Antonia S Stang, Samuel Vaillancourt, Amy H Y Cheng
The topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28934993/can-a-single-primary-care-paramedic-configuration-safely-transport-low-acuity-patients-in-air-ambulances
#17
Homer Tien, Bruce Sawadsky, Michael Lewell, Sean Moore, Michael Peddle, Alun Ackery, Brodie Nolan, Russell D MacDonald
OBJECTIVE: To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances. METHODS: We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario's Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28927481/a-system-wide-solution-to-antidote-stocking-in-emergency-departments-the-nova-scotia-antidote-program
#18
Nancy G Murphy, D Ruth Bona, Theresa A Hurley
OBJECTIVE: Inadequate stocking of essential antidotes in hospitals is an internationally documented problem. A concrete and sustainable system-wide solution for easy access to antidotes in emergency departments (EDs) was developed and implemented in Nova Scotia, Canada. METHODS: Antidote stocking guidelines and a systemwide antidote management strategy were established. A standardized collection of antidotes housed in highly visible containers in provincial EDs was implemented for timely access...
September 20, 2017: CJEM
https://www.readbyqxmd.com/read/28920564/intentional-overdose-of-the-novel-anti-epileptic-drug-eslicarbazepine-presenting-with-recurrent-seizures-and-ventricular-dysrhythmias
#19
Jesse Thompson, James D Powell, Daniel H Ovakim
Eslicarbazepine is a novel anti-epileptic agent indicated for the treatment of partial-onset seizures. We present the case of an 18 year old female that presented to the Emergency Department four hours after a reported intentional ingestion of an estimated 5600 mg of eslicarbazepine. Although initially hemodynamically stable and neurologically normal, shortly after arrival she developed confusion, rigidity and clonus, followed by recurrent seizures, hypoxemia and cardiac arrest which responded to cardiopulmonary resuscitation and wide complex tachycardia requiring defibrillation...
September 18, 2017: CJEM
https://www.readbyqxmd.com/read/28918769/emergency-physicians-attitudes-and-perceived-barriers-to-the-implementation-of-take-home-naloxone-programs-in-canadian-emergency-departments
#20
Lauren Lacroix, Lisa Thurgur, Aaron M Orkin, Jeffrey J Perry, Ian G Stiell
OBJECTIVES: Rates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians' attitudes and perceived barriers to the implementation of take-home naloxone programs...
September 18, 2017: CJEM
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