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CJEM

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https://www.readbyqxmd.com/read/29032788/using-the-bergman-paris-question-to-screen-seniors-in-the-emergency-department
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28905693/sgem-hot-off-the-press-management-of-bronchiolitis-in-community-hospitals
#12
Josh J Wang, Rohit Mohindra, Ken Milne, Anthony Crocco, Chris Bond
No abstract text is available yet for this article.
September 14, 2017: CJEM
https://www.readbyqxmd.com/read/28899440/the-impact-of-social-media-promotion-with-infographics-and-podcasts-on-research-dissemination-and-readership
#13
Brent Thoma, Heather Murray, Simon York Ming Huang, William Ken Milne, Lynsey J Martin, Christopher M Bond, Rohit Mohindra, Alvin Chin, Calvin H Yeh, William B Sanderson, Teresa M Chan
OBJECTIVE: In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership. METHODS: CJEM publications in the "Original Research" and "State of the Art" sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians...
September 13, 2017: CJEM
https://www.readbyqxmd.com/read/28893344/four-strategies-to-find-evaluate-and-engage-with-online-resources-in-emergency-medicine
#14
Andrea Lo, Eric Shappell, Hans Rosenberg, Brent Thoma, James Ahn, N Seth Trueger, Teresa M Chan
Despite the rapid expansion of online educational resources for emergency medicine, barriers remain to their effective use by emergency physicians and trainees. This article expands on previous descriptions of techniques to aggregate online educational resources, outlining four strategies to help learners navigate, evaluate, and contribute online. These strategies include 1) cultivating digital mentors, 2) browsing the most popular free open access medical education (FOAM) websites, 3) using critical appraisal tools developed for FOAM, and 4) contributing new online content...
September 12, 2017: CJEM
https://www.readbyqxmd.com/read/28893339/spontaneous-tumor-lysis-syndrome-in-a-patient-with-newly-diagnosed-metastatic-colonic-adenocarcinoma
#15
Ross Berringer
Acute tumor lysis syndrome in the absence of cytotoxic therapy is an uncommon event but has been reported with hematologic malignancies. The case described below illustrates spontaneous tumor lysis syndrome in the context of a rapidly proliferating metastatic colonic adenocarcinoma. Clinicians should consider ordering phosphate, uric acid, and calcium when assessing patients with recently diagnosed or suspected malignancy.
September 12, 2017: CJEM
https://www.readbyqxmd.com/read/28893338/a-cluster-of-patients-with-rhabdomyolysis-after-eating-crayfish
#16
Wen-Xuan Yang, Kit-Ling Fan, Ling-Pong Leung
Crayfish or Procambarus clarkii is a freshwater crustacean with worldwide distribution. Tons of crayfish are consumed each year. In this report, four adult patients with rhabdomyolysis after consuming crayfish were described. All of them presented to the emergency department with myalgia. The diagnosis of rhabdomyolysis was supported by an elevated creatine kinase level. All recovered with supportive treatment. The clinical picture of these 4 patients was compatible with Haff disease. Haff disease is a syndrome in which rhabdomyolysis develops subsequent to consumption of certain cooked seafood...
September 12, 2017: CJEM
https://www.readbyqxmd.com/read/28875864/pulmonary-embolism-with-cardiac-arrest-a-stemi-patient-s-unexpected-course
#17
Zoë Piggott, Tomislav Jelic
We describe the successful use and complications of bolus-dose alteplase to treat strongly suspected pulmonary embolism (PE) with cardiac arrest in a patient initially presenting as ST-elevation myocardial infarcation (MI). Case description is followed by a review of the indications, safety, and dosing of systemic thrombolytic therapy for high-risk PE in the emergency department (ED). Diagnostic and therapeutic approach to PE in critically ill patients is also considered, including the potential utility of point-of-care ultrasound (PoCUS) in the ED...
September 6, 2017: CJEM
https://www.readbyqxmd.com/read/28870273/factors-associated-with-delay-in-trauma-team-activation-and-impact-on-patient-outcomes
#18
Rory Connolly, Michael Y Woo, Jacinthe Lampron, Jeffrey J Perry
OBJECTIVE: Trauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation. METHODS: We assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management...
September 5, 2017: CJEM
https://www.readbyqxmd.com/read/28835305/cannabinoid-hyperemesis-syndrome-presentation-to-the-emergency-department-a-two-year-multicentre-retrospective-chart-review-in-a-major-urban-area
#19
Jeremy M Hernandez, Jared Paty, Ira M Price
OBJECTIVE: Cannabinoid hyperemesis syndrome (CHS) is a paradoxical side effect of cannabis use. Patients with CHS often present multiple times to the emergency department (ED) with cyclical nausea, vomiting, and abdominal pain, and are discharged with various misdiagnoses. CHS studies to date are limited to case series. The objective was to examine the epidemiology of CHS cases presenting to two major urban tertiary care centre EDs and one urgent care centre over a 2-year period. METHODS: Using explicit variables, trained abstractors, and standardized abstraction forms, we abstracted data for all adults (ages 18 to 55 years) with a presenting complaint of vomiting and/or a discharge diagnosis of vomiting and/or cyclical vomiting, during a 2-year period...
August 24, 2017: CJEM
https://www.readbyqxmd.com/read/28831949/the-opioid-crisis-a-case-for-shifting-from-tertiary-to-primary-prevention
#20
Jonathan Gravel
No abstract text is available yet for this article.
August 23, 2017: CJEM
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