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Patrick M Archambault, Colleen McGavin, Katie N Dainty, Shelley L McLeod, Christian Vaillancourt, Jacques S Lee, Jeffrey J Perry, François-Pierre Gauvin, Antoine Boivin
OBJECTIVE: To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research. METHODS: We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium...
April 25, 2018: CJEM
Devon McLean, Leanne Hewitson, Paul Atkinson, David Lewis, Jacqueline Fraser, Glenn Verheul, Jayanand Mekwan, Bryn Robinson
CLINICIAN'S CAPSULE What is known about the topic? Ultrasound simulation is an invaluable resource in medical education. However, the equipment required is often prohibitively expensive. What did this study ask? Does the use of a low-cost ultrasound simulator in trauma simulation improve diagnostic capabilities? What did this study find? Study participants experienced improvements in diagnostic accuracy, confidence, and precision following the use of this ultrasound simulator. Why does this study matter to clinicians? This low-cost ultrasound simulator provides an alternative to current technology and can easily be implemented into medical simulations...
April 18, 2018: CJEM
Derin Karacabeyli, Garth D Meckler, David K Park, Quynh Doan
CLINICIAN'S CAPSULE What is known about the topic? Clinical decision units (CDUs) may reduce short-stay hospitalizations (<48 hours), which are associated with longer lengths of stay, increased staffing needs and higher costs. What did this study ask? What are the disposition outcomes and emergency department (ED) return rates following CDU care? Has CDU implementation changed short-stay hospitalization rates? What did this study find? Most CDU patients were discharged, and short-stay hospitalization rate significantly decreased by 0...
April 15, 2018: CJEM
Erica Beatty, Maude Deschênes, Patrick Archambault
Clinical questionWhat is the prevalence of Salter-Harris type I distal fibula fractures in children with lateral ankle injuries?Article chosenBoutis K, Plint A, Stimec J, et al. Radiograph-negative lateral ankle injuries in children occult growth plate fracture or sprain? JAMA Pediatr 2016;170(1):e154114.
April 15, 2018: CJEM
Catherine M J Cox, Samuel A Stewart, Katrina F Hurley
CLINICIAN'S CAPSULE What is known about the topic? Injuries from non-powder firearms are common and potentially life-altering. The Canadian Pediatric Society urges stricter controls on non-powder guns. What did this study ask? What are the Canadian contextual trends in paediatric firearm injuries? What did this study find? In this study, the rate of paediatric firearm injuries was stable from 2006 to 2013. Eye injuries inflicted by non-powder firearms were most common. Most firearm injuries occurred through recreation and sport...
April 15, 2018: CJEM
Shannon M Fernando, Warren J Cheung, Stephen B Choi, Lisa Thurgur, Jason R Frank
CLINICIAN'S CAPSULE What is known about the topic? Mentorship is perceived to be an important component of residency education; however, evidence on its influence in emergency medicine is lacking. What did this study ask? We surveyed emergency physicians in Canada to identify the association between mentorship during residency and professional development and attitudes regarding mentorship. What did this study find? While many participants consulted their mentor regarding their first job, fewer contacted their mentor regarding subspecialty training or research...
April 10, 2018: CJEM
Louis Staple, Janet MacIntyre, Nancy G Murphy, Stephen Beed, Constance LeBlanc
CLINICIAN'S CAPSULE What is known about the topic? Patients who die from poisoning are potential organ or tissue donors but may represent an under-referred population. What did this study ask? Do Canadian emergency physicians under-refer patients who die from poisoning for organ or tissue donation, and what characteristics influence referral rates? What did this study find? In a simulated context, poisoned patients were under-referred as potential organ or tissue donors, and both environmental and clinician characteristics influenced rates...
April 10, 2018: CJEM
Sebastian de Haan, Hein Lamprecht, Michael K Howlett, Jacqueline Fraser, Dylan Sohi, Anil Adisesh, Paul R Atkinson
CLINICIAN'S CAPSULE What is known about the topic? Emergency physicians and trainees have high rates of stress and burnout. What did this study ask? How do reported stressors for emergency physicians and trainees differ between high and low resource settings? What did this study find? Trainees in the low resource setting reported higher stressors. Trainees reported higher levels of stressors than specialists in general. Why does this study matter to clinicians? High levels of reported stressors among trainees, and in low resource settings should be acknowledged and mitigated where possible...
April 6, 2018: CJEM
Kyle McGivery, Paul Atkinson, David Lewis, Luke Taylor, Tim Harris, Kathleen Gadd, Jacqueline Fraser, George Stoica
CLINICIAN'S CAPSULE What is known about the topic? Current diagnostic tools for heart failure in the emergency department (ED) have limited accuracy and often lead to delays in management. What did this study ask? What is the accuracy of early bedside lung ultrasound in the diagnosis of acute decompensated heart failure? What did this study find? This meta-analysis found that the sensitivity and specificity of bedside lung US in ADHF is 82.5% and 83.6%, respectively. Why does this study matter to clinicians? The implementation of early bedside lung US in the ED may lead to more accurate and timely diagnoses of ADHF...
April 5, 2018: CJEM
Leila Salehi, Prashant Phalpher, Rahim Valani, Christopher Meaney, Qamar Amin, Kiki Ferrari, Mathew Mercuri
CLINICIAN'S CAPSULE What is known about the topic? Bed boarding is one of the major contributors to emergency department overcrowding. What did this study ask? What are the characteristics of patients with prolonged boarding times, and what are the impacts on patient-oriented outcomes? What did this study find? Patients who were older, sicker, and had isolation and telemetry requirements experienced longer boarding times, and longer inpatient length of stay even after correcting for confounders. Why does this study matter to clinicians? Organization-wide interventions to improve efficiency and flow are required to mitigate the burden of bed boarding...
April 5, 2018: CJEM
Skye Crawford, John Tallon
Article chosenHayward GN, Hay AD, Moore MV, et al. Effect of oral dexamethasone without immediate antibiotics vs. placebo on acute sore throats in adults: a randomized clinical trial. JAMA 2017;317(15):1535-43.
April 5, 2018: CJEM
Ian G Stiell
No abstract text is available yet for this article.
April 4, 2018: CJEM
Grant Innes, Andrew McRae, Eric Grafstein, Michael Law, Joel M H Teichman, Bryce Weber, Kevin Carlson, Heidi Boyda, James Andruchow
CLINICIAN'S CAPSULE What is known about the topic? Most ureteral stones pass spontaneously, but intervention is an option. No trials have compared conservative vs. interventional treatment. What did this study ask? We compared 60-day outcomes for ED patients with ureteral colic in Calgary and Vancouver. What did this study find? Index intervention rate was seven-fold higher in Calgary. Calgary patients had more subsequent ED revisits and hospitalizations. Adverse outcomes were associated with intervention for small stones and with non-intervention for large stones...
April 4, 2018: CJEM
Matthew P Lowe, Christopher Cox
Acute flank pain from suspected urolithiasis is a common presenting complaint in the Emergency Department. Multiple computed tomography (CT) has traditionally been the standard imaging modality used to diagnose obstructive kidney stones, however point of care ultrasound (PoCUS) can play an important role in the diagnostic algorithm and risk stratification of acute flank pain. Here, we present the case of a 29-year-old female with suspected urolithiasis, who underwent PoCUS that revealed right-sided hydronephrosis and normal left kidney, bladder, and aorta...
April 2, 2018: CJEM
Rachit Batta, Robert Carey, Martin Ashley Sasbrink-Harkema, Taofiq Olusegun Oyedokun, Hyun J Lim, James Stempien
CLINICIAN'S CAPSULE What is known about the topic? There are concerns regarding unequal treatment towards First Nations people when engaged with health care services. What did this study ask? Whether quantitative differences in care exist between First Nations and non-First Nations patients in the ED. What did this study find? First Nations presenting with abdominal pain were found to have no difference in the time-related care parameters relative to non-First Nations patients. Why does this study matter to clinicians? Future quantitative and qualitative studies will be necessary to further understand the care inequality that has been expressed among First Nations patients...
March 28, 2018: CJEM
Alison Lee, Mariana Deevska, Karly Stillwell, Tyler Black, Garth Meckler, David Park, Ali Eslami, Quynh Doan
CLINICIAN'S CAPSULE What is known about the topic? Emergency clinicians are not specifically trained to assess and manage mental health emergencies; thus, they have wide practice variation while determining disposition for children with mental health crises.What did this study ask?What is the inter-user reliability of a new emergency psychosocial assessment and management guiding tool, HEARTSMAP, and the impact of implementing it in a pediatric emergency department?What did this study find?The tool demonstrated strong inter-rater reliability between PED clinicians and was associated with high rates of outpatient resource connectivity...
March 28, 2018: CJEM
Ingo Graeff, Sylvia Schacher, Stefan Lenkeit, Catherine N Widmann, Jens-Christian Schewe
The eligibility criteria for applying extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest are currently unclear. For those patients with hypothermic cardiac arrest, the European Resuscitation Council (ERC) Guidelines recommend considering ECPR only for patients with potassium <8 mmol/L and a body temperature below 32°C, whereas the American Heart Association Guidelines (AHA) do not express this in a specific manner. We report the case of an urban unwitnessed out-of-hospital cardiac arrest patient found with her head immersed in water at a temperature of 23°C...
March 25, 2018: CJEM
John R O'Leary, Natasha L Goumeniouk, Alexander S Cormier, Daniel J Potter, Filip Gilic, Erin E Brennan
No abstract text is available yet for this article.
March 23, 2018: CJEM
Daniel K Ting, Eddy S Lang
Clinical question Should I use apneic oxygenation when intubating patients in the emergency department to increase peri-intubation oxygen saturation and first-pass success? Article chosen Oliveira JE, Silva L, Cabrera D, Barrionuevo P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med 2017;70(4):483-94. OBJECTIVE: The purpose of this study was to synthesize and appraise the apneic oxygenation literature for its effect on peri-intubation outcomes...
March 20, 2018: CJEM
Puneet Kapur, Melanie Baimel, Jordan Chenkin
Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries...
March 16, 2018: CJEM
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