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Onyinyechi Eke, Mercedeh Shanechi, Michael Gottlieb
Clinical question In patients taking antiplatelet therapy, does a platelet transfusion after acute spontaneous primary intracerebral hemorrhage reduce the risk of death or dependence? Article chosen Baharoglu MI, Cordonnier C, Al-Shahi Salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral hemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial. Lancet 2016;387(10038):2605-13. Study objective The primary objective of this study was to investigate whether a platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral hemorrhage associated with antiplatelet therapy use...
February 14, 2018: CJEM
Kerstin de Wit, Janet Curran, Brent Thoma, Shawn Dowling, Eddy Lang, Nebojsa Kuljic, Jeffrey J Perry, Laurie Morrison
OBJECTIVES: Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. METHODS: A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience...
February 12, 2018: CJEM
Mercedeh Shanechi, Onyinyechi Eke, Michael Gottlieb
Clinical question Does the analgesic effect of intravenous ketorolac differ if given in doses of 10, 15, or 30 mg to patients presenting to the emergency department with acute pain? Article chosen Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med 2017;70(2):177-84.
February 8, 2018: CJEM
Kevin J Solverson, Holly Lee, Christopher J Doig
Cases of liraglutide overdose are rare in the literature. Prior reports have not found hypoglycemia related to the medication overdose. We describe a case of a non-diabetic patient who intentionally overdosed on liraglutide leading to severe hypoglycemia. The patient required admission to the intensive care unit for a dextrose infusion and close monitoring. Glucagon-like protein-1 agonists are recognized for their safety and rarely causing hypoglycemia in diabetic patients. However, in this case the patient's non-diabetic status may have put him at risk for hypoglycemia in contrast to prior cases showing no hypoglycemia in diabetic patients...
February 5, 2018: CJEM
Ian G Stiell, Jeffrey J Perry, Jamie Brehaut, Erica Brown, Janet A Curran, Marcel Emond, Corinne Hohl, Monica Taljaard, Andrew D McRae
OBJECTIVE: The objective of Panel 2b was to present an overview of and recommendations for the conduct of implementation trials and multicentre studies in emergency medicine. METHODS: Panel members engaged methodologists to discuss the design and conduct of implementation and multicentre studies. We also conducted semi-structured interviews with 37 Canadian adult and pediatric emergency medicine researchers to elicit barriers and facilitators to conducting these kinds of studies...
January 30, 2018: CJEM
Andrew D McRae, Jeffrey J Perry, Jamie Brehaut, Erica Brown, Janet Curran, Marcel Emond, Corinne Hohl, Monica Taljaard, Ian G Stiell
OBJECTIVE: The objective of this panel was to generate recommendations to promote the engagement of front-line emergency department (ED) clinicians in clinical and implementation research. METHODS: Panel members conducted semi-structured interviews with 37 Canadian adult and pediatric emergency medicine researchers to elicit barriers and facilitators to clinician engagement in research activities, and to glean strategies for promoting clinician engagement. RESULTS: Responses were organized by themes, and, based on these responses, recommendations were developed and refined in an iterative fashion by panel members...
January 30, 2018: CJEM
Jennifer D Artz, Garth Meckler, Niran Argintaru, Roderick Lim, Ian G Stiell
OBJECTIVE: To complement our environmental scan of academic emergency medicine departments, we conducted a similar environmental scan of the academic pediatric emergency medicine programs offered by the Canadian medical schools. METHODS: We developed an 88-question form, which was distributed to pediatric academic leaders at each medical school. The responses were validated via email to ensure that the questions were answered completely and consistently. RESULTS: Fourteen of the 17 Canadian medical schools have some type of pediatric emergency medicine academic program...
January 28, 2018: CJEM
Hasan Sheikh, Edward Xie, Emily Austin
Sustained monomorphic ventricular tachycardia (VT) can result in hypoperfusion or devolve into more dangerous rhythms such as ventricular fibrillation. In an unstable patient with VT and a pulse, synchronized cardioversion is the first-line treatment. When the VT is refractory to standard cardioversion, the next step is to add an antiarrhythmic, such as amiodarone, that carries with it the risk of lowering blood pressure in the already hypotensive patient. Here we describe a case of double sequential synchronized cardioversion of a patient with unstable VT refractory to standard direct current cardioversion, resulting in a rapid conversion to sinus rhythm and return to hemodynamic stability...
January 23, 2018: CJEM
Brittany Ellis, Christopher Carpenter, Judy Lowthian, Simon Mooijaart, Christian Nickel, Don Melady
No abstract text is available yet for this article.
January 23, 2018: CJEM
Daniel Seitz
No abstract text is available yet for this article.
December 28, 2017: CJEM
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
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
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
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
Ian Stiell, Eddy Lang, Paul Atkinson
No abstract text is available yet for this article.
January 2018: CJEM
Geoffrey J Hoffman, Jerome R Hoffman, Michael Howlett, Paul Atkinson
No abstract text is available yet for this article.
January 2018: CJEM
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.
January 2018: CJEM
Heather Murray, Tyson Savage, Louise Rang, David Messenger
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache...
January 2018: CJEM
Gauri Ghate, Eric Clark, Christian Vaillancourt
OBJECTIVES: The aim of the study is to determine the performance of low-dose ketamine (LDK) as an analgesic for acute pain management in adult patients in the emergency department (ED). METHODS: We systematically reviewed electronic databases, grey literature, conference abstracts, and clinical trial registries. Two independent reviewers identified eligible studies. These selections were subsequently reviewed by one reviewer who identified the final eligible studies, using refined inclusion and exclusion criteria...
January 2018: CJEM
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 2018: CJEM
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