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Élizabeth Lalande, Chantal Guimont, Marcel Émond, Marc Charles Parent, Claude Topping, Brice Lionel Batomen Kuimi, Valérie Boucher, Natalie Le Sage
OBJECTIVES: The main objective of this study was to evaluate the feasibility of emergency department (ED) point-of-care ultrasound (PoCUS) for rib fracture diagnosis in patients with minor thoracic injury (mTI). Secondary objectives were to 1) evaluate patients' pain during the PoCUS procedure, 2) identify the limitations of the use of PoCUS technique, and 3) compare the diagnosis obtained with PoCUS to radiography results. METHODS: Adult patients who presented with clinical suspicion of rib fractures after mTI were included...
October 17, 2016: CJEM
Alexander K Leung, Shawn D Whatley, Dechang Gao, Marko Duic
OBJECTIVE: To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. METHODS: This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage...
October 17, 2016: CJEM
Amy Po Yu Tsai, Jimmy Po-Nien Tsai, Lauren Stewart, Jeffrey Brubacher, Ka Wai Cheung
OBJECTIVES: Patients who are tobacco users present to the emergency department (ED) with many medical conditions that are causally or potentially causally related to smoking. Previous studies have shown increased cessation rates for patients who accurately perceive that their ED visit is smoking-related. Our study goals were 1) to determine the prevalence of potential smoking-related conditions among tobacco users at a tertiary care academic ED, and 2) to determine which medical conditions are more or less likely to be perceived by patients as smoking-related...
October 17, 2016: CJEM
David Barbic, Brian Klinkenberg, Brian Grunau, Jim Christenson
OBJECTIVE: No prior work exists examining the relation between the geographic distribution of out-of-hospital cardiac arrest (OHCA) in the city of Vancouver and surrounding areas that may exhibit a clustering of cases. The primary objective of this study was to describe the distribution of OHCA within the Vancouver Coastal Health region using a geographic information system (GIS) analysis and appropriate statistical analyses. METHODS: This study was a post-hoc GIS-based analysis of OHCA patients in the city of Vancouver and surrounding areas, using data collected by the Resuscitation Outcomes Consortium between September 2007 and December 2011...
October 17, 2016: CJEM
Jacqueline Fraser, Paul Atkinson, Audra Gedmintas, Michael Howlett, Rose McCloskey, James French
OBJECTIVE: The emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS. METHODS: We collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed...
October 3, 2016: CJEM
Natalie Cram, Shelley McLeod, Michael Lewell, Matthew Davis
No abstract text is available yet for this article.
September 29, 2016: CJEM
Pin Pin Pek, En Yun Loy, Win Wah, Andrew Fu Wah Ho, Huili Zheng, Stephanie Man Chung Fook-Chong, Terrance Siang Jin Chua, Tian Hai Koh, Khuan Yew Chow, Nan Liu, Marcus Eng Hock Ong
OBJECTIVE: Early reperfusion therapy in the treatment of ST segment elevation myocardial infarction (STEMI) patients can improve outcomes. Silent myocardial infarction is associated with poor prognosis, but little is known about its effect on treatment delays. We aimed to characterize STEMI patients presenting without complaints of pain to the emergency departments (EDs) in Singapore. METHODS: Retrospective data were requested from the Singapore Myocardial Infarction Registry (SMIR), a national level registry in Singapore...
September 29, 2016: CJEM
Jan L Jensen, Andrew H Travers
Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals...
September 23, 2016: CJEM
Jaroslav Christopher Fabian, Monica Taljaard, Jeffrey J Perry
BACKGROUND: Frostbite is a common yet challenging injury to both diagnose and treat. McCauley's frostbite treatment protocol consists of 12 treatments that might well represent the standard of care. However, its effectiveness in preventing operative intervention has yet to be examined. Our objectives were to characterize frostbite injuries in Eastern Ontario, identify risk factors for deep injuries, and assess the protocol's efficacy in preventing operative outcomes. METHODS: This cohort study examined patients with frostbite over ten years at a tertiary care hospital...
September 22, 2016: CJEM
Justin Mausz, Seanan Donovan, Meghan McConnell, Corey Lapalme, Andrea Webb, Elizabeth Feres, Walter Tavares
OBJECTIVE: "Deliberate practice" and "feedback" are necessary for the development of expertise. We explored clinical performance in settings where these features are inconsistent or limited, hypothesizing that even in algorithmic domains of practice, clinical performance reformulates in ways that may threaten patient safety, and that experience fails to predict performance. METHODS: Paramedics participated in two recorded simulation sessions involving airway management, which were analyzed three ways: first, we identified variations in "decision paths" by coding the actions of the participants according to an airway management algorithm...
September 22, 2016: CJEM
Shawn Liu, Christian Vaillancourt, Ann Kasaboski, Monica Taljaard
OBJECTIVES: This study sought to measure bystander fatigue and cardiopulmonary resuscitation (CPR) quality after five minutes of CPR using the continuous chest compression (CCC) versus the 30:2 chest compression to ventilation method in older lay persons, a population most likely to perform CPR on cardiac arrest victims. METHODS: This randomized crossover trial took place at three tertiary care hospitals and a seniors' center. Participants were aged ≥55 years without significant physical limitations (frailty score ≤3/7)...
September 21, 2016: CJEM
Dhimitri A Nikolla, Jestin N Carlson
No abstract text is available yet for this article.
September 20, 2016: CJEM
Michael Gottlieb, Abdoulie Njie
Clinical Question Does the addition of cyclobenzaprine or oxycodone with acetaminophen to naproxen result in improved functional outcomes at one week when compared to placebo in patients with acute low back pain? Article Chosen Friedman B, Dym A, Davitt, M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA 2015:20;314(15):1572-80. Study Objective The primary objective of this study was to compare functional outcomes at one week and three months after emergency department (ED) presentation for acute low back pain among patients prescribed naproxen plus one of the following: (1) oxycodone/acetaminophen; (2) cyclobenzaprine; or (3) placebo...
September 19, 2016: CJEM
Emily Sullivan, Daniel Fuller, Quinten S Paterson, Shelby Huffman, Satyadeva Challa, Rob Woods
OBJECTIVES: The objective of this study was to evaluate the impact of a novel injury prevention intervention designed to prompt patients to initiate an injury prevention discussion with the ED physician, thus enabling injury prevention counselling and increasing bicycle helmet use among patients. METHODS: A repeated measures 2 x 3 randomized controlled trial design was used. Fourteen emergency physicians were observed for two shifts each between June and August 2013...
September 15, 2016: CJEM
Jason Imperato, Tyler Mehegan, John Patrick, Chase Bushey, Gary Setnik, Leon D Sanchez
BACKGROUND: Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs. OBJECTIVES: To determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics...
September 13, 2016: CJEM
Natalie Cram, Shelley McLeod, Michael Lewell, Matthew Davis
OBJECTIVE: To determine how often the Ambulance Call Record (ACR) was available to emergency department (ED) physicians and whether it contained information that changed the ED management of patients. METHODS: This was a prospective cohort study of adult patients transported to one of two tertiary care centre EDs. Physicians completed a data collection form for each patient regarding ACR availability and the perceived value of the ACR. This study began shortly after the implementation of a new electronic ACR (eACR) handover process (Round 1)...
September 13, 2016: CJEM
Dirk Prochnau, Ralf Surber, Matthias Hoyme, Sylvia Otto, Anna Selle, Tudor C Poerner
Atrial fibrillation (AF) is a frequent reason for emergency department visits. According to current guidelines either rate- or rhythm-control are acceptable therapeutic options in such situations. In this report, we present the complicated clinical course of a patient with AF and a rapid ventricular response. Because of paroxysmal AF, the patient was on chronic oral anticoagulation therapy with warfarin. Pharmacological treatment was ineffective to control ventricular rate, and immediate synchronized electrical cardioversion was performed...
September 13, 2016: CJEM
Jocelyn Gravel, Benoit Carrière, Antonio D'Angelo, Louis Crevier, Miriam H Beauchamp, Benoît Mâsse
OBJECTIVES: Assess the feasibility of a study evaluating one dose of oral ondansetron to decrease post-concussion symptoms at one week and one month following concussion in children aged 8 to 17 years old. METHOD: This was a pilot study for a randomized, triple-blind controlled trial of one dose of either ondansetron or placebo performed in a tertiary care pediatric emergency department. Participants were children aged 8 to 17 years who sustained a concussion in the previous 24 hours and visited a single emergency department...
September 9, 2016: CJEM
Audrey-Anne Brousseau, Marcel Émond, Marie-Josée Sirois, Raoul Daoust, Lauren E Griffith, Eddy Lang, Jacques Lee, Jeffrey J Perry, Marie-Christine Ouellet, René Verreault, Simon Berthelot, Éric Mercier, Nadine Allain-Boulé, Valérie Boucher, Pier-Alexandre Tardif, Natalie Le Sage
OBJECTIVES: The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a head injury on the functional outcomes six months post-injury in older adults who sustained a minor trauma. METHODS: This multicenter prospective cohort study in eight sites included patients who were aged 65 years or older, previously independent, presenting to the emergency department (ED) for a minor trauma, and discharged within 48 hours...
September 9, 2016: CJEM
Michael Gottlieb
: Clinical question In patients with uncomplicated abscesses receiving incision and drainage, does the addition of trimethoprim-sulfamethoxazole result in improved clinical resolution at 7 to 14 days after treatment when compared with placebo? Article chosen Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823-32. OBJECTIVE: The primary objective of this study was to compare the clinical cure rates at 7 to 14 days after the end of the treatment period among patients receiving either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo...
September 9, 2016: CJEM
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