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CJEM

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https://www.readbyqxmd.com/read/28412987/back-pain-in-the-emergency-department-pathological-fracture-following-spinal-manipulation
#1
Christopher Skappak, Erik J Saude
Back pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. An initial evaluation with thoracolumbar radiographs revealed no significant findings...
April 17, 2017: CJEM
https://www.readbyqxmd.com/read/28399958/the-immigrant-effect-factors-impacting-use-of-primary-and-emergency-department-care-a-canadian-population-cross-sectional-study
#2
Robert Ohle, Helena Bleeker, Krishan Yadav, Jeffrey J Perry
OBJECTIVE: In 2011, Canada had a foreign-born population of approximately 6,775,800. They represented 20.6% of the total population. Immigrants possess characteristics that reduce the use of primary care. This is thought to be, in part, due to a lower education level, employment, and better health status. Our objective was to assess whether, in an immigrant population without a primary care physician, similar socioeconomic factors would also reduce the likelihood of using the emergency department compared to a non-immigrant population without primary care...
April 12, 2017: CJEM
https://www.readbyqxmd.com/read/28399946/impact-of-a-multifaceted-antimicrobial-stewardship-program-a-front-line-ownership-driven-quality-improvement-project-in-a-large-urban-emergency-department
#3
Adam Jonathan Kaufman, Janine McCready, Jeff Powis
BACKGROUND: Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers...
April 12, 2017: CJEM
https://www.readbyqxmd.com/read/28382879/frequent-users-of-the-pediatric-emergency-department
#4
Jade Seguin, Esli Osmanlliu, Xun Zhang, Virginie Clavel, Harley Eisman, Robert Rodrigues, Maryam Oskoui
OBJECTIVES: Emergency department (ED) crowding is associated with increased morbidity and mortality. Its etiology is multifactorial, and frequent ED use (defined as more or equal to five visits per year) is a major contributor to high patient volumes. Our primary objective is to characterize the frequent user population. Our secondary objective is to examine risk factors for frequent emergency use. METHODS: We conducted a retrospective cohort study of pediatric emergency department (PED) visits at the Montreal Children's Hospital using the Système Informatique Urgence (SIURGE), electronic medical record database...
April 6, 2017: CJEM
https://www.readbyqxmd.com/read/28367771/the-effect-of-step-stool-use-and-provider-height-on-cpr-quality-during-pediatric-cardiac-arrest-a-simulation-based-multicentre-study
#5
Adam Cheng, Yiqun Lin, Vinay Nadkarni, Brandi Wan, Jonathan Duff, Linda Brown, Farhan Bhanji, David Kessler, Nancy Tofil, Kent Hecker, Elizabeth A Hunt
OBJECTIVES: We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality. METHODS: We analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training...
April 3, 2017: CJEM
https://www.readbyqxmd.com/read/28367768/rates-and-predictive-factors-of-return-to-the-emergency-department-following-an-initial-release-by-the-emergency-department-for-acute-heart-failure
#6
Pierre-Géraud Claret, Lisa A Calder, Ian G Stiell, Justin W Yan, Catherine M Clement, Bjug Borgundvaag, Alan J Forster, Jeffrey J Perry, Brian H Rowe
OBJECTIVES: Following release by emergency department (ED) for acute heart failure (AHF), returns to ED represent important adverse health outcomes. The objective of this study was to document relapse events and factors associated with return to ED in the 14-day period following release by ED for patients with AHF. METHODS: The primary outcome was the number of return to ED for patients who were release by ED after the initial visit, for any related medical problem within 14 days of this initial ED visit...
April 3, 2017: CJEM
https://www.readbyqxmd.com/read/28343457/development-of-a-model-to-quantify-the-accessibility-of-a-canadian-trauma-system
#7
Gavin Tansley, Nadine Schuurman, Mete Erdogan, Matthew Bowes, Robert Green, Mark Asbridge, Natalie Yanchar
OBJECTIVES: Trauma systems have been widely implemented across Canada, but access to trauma care remains a challenge for much of the population. This study aims to develop and validate a model to quantify the accessibility of definitive care within one provincial trauma system and identify populations with poor access to trauma care. METHODS: A geographic information system (GIS) was used to generate models of pre-scene and post-scene intervals, respectively. Models were validated using a population-based trauma registry containing data on prehospital time intervals and injury locations for Nova Scotia (NS)...
March 27, 2017: CJEM
https://www.readbyqxmd.com/read/28318458/first-do-no-harm-advocating-for-opioid-prescribing-guidelines-in-canadian-emergency-departments
#8
Kieran Moore, Julia Lew, Samantha Buttemer, Lauren Kielstra
No abstract text is available yet for this article.
March 20, 2017: CJEM
https://www.readbyqxmd.com/read/28294100/on-the-tip-of-the-tongue
#9
Rachel Orchard, Sheena Belisle, Rodrick Lim
No abstract text is available yet for this article.
March 15, 2017: CJEM
https://www.readbyqxmd.com/read/28294095/the-simple-query-do-you-want-more-pain-medication-is-not-a-reliable-way-to-assess-acute-pain-relief-in-patients-in-the-emergency-department
#10
Jean-Marc Chauny, Martin Marquis, Jean Paquet, Gilles Lavigne, Alexis Cournoyer, Christiane Manzini, Raoul Daoust
OBJECTIVE: The management of acute pain constitutes an essential skill of emergency department (ED) physicians. However, the accurate assessment of pain intensity and relief represents a clinically challenging undertaking. Some studies have proposed to define effective pain relief as the patient's refusal for additional analgesic administration. The aim of this study was to verify whether such a refusal is effectively indicative of pain relief. METHODS: This prospective cohort study included ED patients who received single or multiple doses of pain medication for an acute pain problem...
March 15, 2017: CJEM
https://www.readbyqxmd.com/read/28264750/bilateral-nail-gun-traumatic-brain-injury-presents-as-intentional-overdose-a-case-report
#11
Judith Alain, Pascal Lavergne, Maude St-Onge, Myreille D'Astous, Stéphane Côté
This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. Although voluntary intoxication is the most frequent form of suicide attempt, emergency physicians must be alert and maintain a broad differential diagnosis...
March 7, 2017: CJEM
https://www.readbyqxmd.com/read/28251880/choosing-wisely-canada%C3%A2-five-tests-procedures-and-treatments-to-question-in-emergency-medicine
#12
Amy H Y Cheng, Sam Campbell, Lucas B Chartier, Tom Goddard, Kirk Magee, Jill McEwen, Atul K Kapur, Brian R Holroyd, Suneel Upadhye, Stephanie Couperthwaite, Brian H Rowe
OBJECTIVES: Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. METHODS: The CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned...
March 2, 2017: CJEM
https://www.readbyqxmd.com/read/28179038/an-environmental-scan-of-academic-emergency-medicine-at-the-17-canadian-medical-schools-why-does-this-matter-to-emergency-physicians-corrigendum
#13
G Stiell, J D Artz, E S Lang, J Sherbino, L J Morrison, J Christenson, J J Perry, C Topping, R Woods, R S Green, R Lim, K Magee, J Foote, G Meckle, M Mensour, S Field, B Chung, M Kuuskne, J Ducharme, V Klein, J McEwen
No abstract text is available yet for this article.
February 9, 2017: CJEM
https://www.readbyqxmd.com/read/28356167/sgem-hot-off-the-press-computer-provider-order-entry-cpoe-and-emergency-department-flow
#14
Katie Lin, Kenneth Chan, Rohit Mohindra, Ken Milne, Brent Thoma, Chris Bond
No abstract text is available yet for this article.
March 2017: CJEM
https://www.readbyqxmd.com/read/28238290/a-determination-of-emergency-department-pre-triage-times-in-patients-not-arriving-by-ambulance-compared-to-widely-used-guideline-recommendations-corrigendum
#15
https://www.readbyqxmd.com/read/27573205/orthostatic-symptoms-of-transient-ischemic-attack-revised
#16
Ariel Hendin, Lisa M Fischer, Jeffrey J Perry
Transient ischemic attacks (TIA) are a common presentation to the emergency department (ED) and are associated with an estimated 9% risk of stroke within 90 days. 1 We report the case of a 72-year-old female who presented with orthostatic symptoms of facial weakness and dysarthria; that is, the patient's symptoms were present when she was standing and resolved when supine. Neurological deficits present only when standing should alert the clinician to the importance of advanced neuroimaging to evaluate for acute arterial occlusion...
March 2017: CJEM
https://www.readbyqxmd.com/read/26584627/comparison-of-tamsulosin-nifedipine-and-placebo-for-ureteric-colic
#17
Michael Gottlieb, Damali Nakitende
Clinical question Do calcium channel blockers or alpha blockers improve renal stone passage when compared with placebo? Article chosen Pickard R, Starr K, MacLennan G, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386(9991):25-31, doi: 10.1016/S0140-6736(15)60933-3.
March 2017: CJEM
https://www.readbyqxmd.com/read/28115027/real-time-visual-feedback-during-training-improves-laypersons-cpr-quality-a-randomized-controlled-manikin-study
#18
Enrico Baldi, Stefano Cornara, Enrico Contri, Francesco Epis, Dario Fina, Beatrice Zelaschi, Cinzia Dossena, Ferdinando Fichtner, Michela Tonani, Marzia Di Maggio, Elisa Zambaiti, Alberto Somaschini
OBJECTIVE: The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality. METHODS: Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback...
January 24, 2017: CJEM
https://www.readbyqxmd.com/read/28077195/evidence-based-medicine-in-the-era-of-social-media-scholarly-engagement-through-participation-and-online-interaction
#19
Teresa Chan, N Seth Trueger, Damian Roland, Brent Thoma
The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice...
January 12, 2017: CJEM
https://www.readbyqxmd.com/read/28069098/bolus-dose-of-epinephrine-for-refractory-post-arrest-hypotension
#20
Michael Gottlieb
Post-cardiac arrest hypotension is associated with worse outcomes. However, a significant proportion of patients may not be responsive to intravenous (IV) fluids, and vasopressor infusions require significant time to initiate. This case series describes the successful use of a bolus dose of epinephrine to rapidly treat IV fluid refractory hypotension among three patients in the post-arrest period. A bolus dose of epinephrine may be considered as a treatment for post-arrest hypotension that does not respond to IV fluids, but further studies should be performed prior to routine use...
January 10, 2017: CJEM
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