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CJEM

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https://www.readbyqxmd.com/read/28810931/a-comprehensive-regional-clinical-and-educational-ecpr-protocol-decreases-time-to-ecmo-in-patients-with-refractory-out-of-hospital-cardiac-arrest
#1
Brian Grunau, Sarah Carrier, Jamil Bashir, William Dick, Luke Harris, Robert Boone, Dan Kalla, Frank Scheuermeyer, Brian Twaites, Ron Straight, James Abel, Ken McDonald, Ruth MacRedmond, David Agulnik, Joe Finkler, Jeanne MacLeod, Jim Christenson, Anson Cheung
OBJECTIVE: Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE). METHODS: In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital...
August 16, 2017: CJEM
https://www.readbyqxmd.com/read/28803593/predictors-of-obtaining-follow-up-care-in-the-province-of-ontario-canada-following-a-new-diagnosis-of-atrial-fibrillation-heart-failure-and-hypertension-in-the-emergency-department
#2
Clare L Atzema, Bing Yu, Noah M Ivers, Paula A Rochon, Douglas S Lee, Michael J Schull, Peter C Austin
OBJECTIVE: Patients with cardiovascular diseases are common in the emergency department (ED), and continuity of care following that visit is needed to ensure that they receive evidence-based diagnostic tests and therapy. We examined the frequency of follow-up care after discharge from an ED with a new diagnosis of one of three cardiovascular diseases. METHODS: We performed a retrospective cohort study of patients with a new diagnosis of heart failure, atrial fibrillation, or hypertension, who were discharged from 157 non-pediatric EDs in Ontario, Canada, between April 2007 and March 2014...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28803574/retrospective-evaluation-of-the-big-score-to-predict-mortality-in-pediatric-blunt-trauma
#3
Charlotte Grandjean-Blanchet, Guillaume Emeriaud, Marianne Beaudin, Jocelyn Gravel
OBJECTIVES: This study's objective was to measure the criterion validity of the BIG score (a new pediatric trauma score composed of the initial base deficit [BD], international normalized ratio [INR], and Glasgow Coma Scale [GCS]) to predict in-hospital mortality among children admitted to the emergency department with blunt trauma requiring an admission to the intensive care unit, knowing that a score <16 identifies children with a high probability of survival. METHODS: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016...
August 14, 2017: CJEM
https://www.readbyqxmd.com/read/28797315/the-case-for-quality-improvement-in-emergency-medicine
#4
Shawn Mondoux
No abstract text is available yet for this article.
August 11, 2017: CJEM
https://www.readbyqxmd.com/read/28797311/risk-factors-for-adverse-outcomes-in-older-adults-with-blunt-chest-trauma-a-systematic-review
#5
Jake Sawa, Robert S Green, Brent Thoma, Mete Erdogan, Philip J Davis
OBJECTIVES: The objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma. METHODS: EMBASE and MEDLINE were searched from inception until March 2017 for prognostic factors associated with adverse outcomes in older adults sustaining blunt chest trauma using a pre-specified search strategy. References were independently screened for inclusion by two reviewers...
August 11, 2017: CJEM
https://www.readbyqxmd.com/read/28774350/correlation-of-age-and-rurality-with-low-urgency-use-of-emergency-medical-services-luems-a-geographic-analysis
#6
Mikiko Terashima, Alix J E Carter
OBJECTIVES: Studies suggest that addressing the needs of the older population in rural areas may substantially reduce their low-urgency use of emergency medical services (LUEMS). It may ultimately also help improve the efficiency in our health system. There is, however, a dearth of evidence substantiating geographic patterns in LUEMS by different age cohorts. This exploratory study was aimed to clarify the understanding of emergency medical services (EMS) use in Nova Scotia through a geographic analysis...
August 4, 2017: CJEM
https://www.readbyqxmd.com/read/28758617/prevalence-of-pulmonary-embolism-in-syncope-patients
#7
Sean Crooks, Eddy Lang
Clinical question How often is pulmonary embolism (PE) found in patients admitted for syncope? Article chosen Prandoni P, Lensing A, Prins M, et al. Prevalence of pulmonary embolism among patients hospitalized for syncope (PESIT). N Engl J Med 2016;375:1524-31, doi: 10.1056/NEJMoa1602172. OBJECTIVE: To determine the prevalence of PE in patients hospitalized for a first episode of syncope.
July 31, 2017: CJEM
https://www.readbyqxmd.com/read/28758605/rescue-extracorporeal-membrane-oxygenation-therapy-in-methamphetamine-toxicity
#8
Laura K Morrison, J Kromm, J Gaudet, D Zuege, B Button, F Warshawski, S N Lucyk
Complications related to methamphetamine use and abuse are common presentations seen in the emergency department. Standard management focuses on addressing the central nervous system and cardiovascular effects with the use of sedation and hemodynamic support. We describe a case report of a patient with methamphetamine toxicity and subsequent severe cardiomyopathy refractory to conventional management that responded to cardiovascular support with extracorporeal membrane oxygenation therapy (ECMO). A 22-year-old female was admitted in severe cardiogenic shock following intravenous administration of methamphetamine and oral fentanyl use...
July 31, 2017: CJEM
https://www.readbyqxmd.com/read/28756779/quality-improvement-primer-part-1-preparing-for-a-quality-improvement-project-in-the-emergency-department
#9
Lucas B Chartier, Amy H Y Cheng, Antonia S Stang, Samuel Vaillancourt
Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training...
July 31, 2017: CJEM
https://www.readbyqxmd.com/read/28750692/opioid-analgesics-is-it-time-for-risk-stratification-prior-to-use
#10
Maureen A Allen
No abstract text is available yet for this article.
July 28, 2017: CJEM
https://www.readbyqxmd.com/read/28743323/teaching-diagnostic-reasoning-using-simulation-and-mixed-practice-to-build-competence
#11
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...
July 26, 2017: CJEM
https://www.readbyqxmd.com/read/28743320/mobility-assessments-of-geriatric-emergency-department-patients-a-systematic-review
#12
Debra Eagles, Krishan Yadav, Jeffrey J Perry, Marie Josée Sirois, Marcel Emond
OBJECTIVES: We wished to determine the impact of emergency department (ED) mobility assessments for older patients on hospitalization, return visits, future falls, and frailty. METHODS: We searched MEDLINE, Embase, CINAHL, Cochrane Library, PEDro, and OTseeker (September 2016). Two independent reviewers identified studies of patients ≥65 years with ED physical mobility assessments and outcomes of hospitalization, return to ED, falls, and frailty. Language was not restricted...
July 26, 2017: CJEM
https://www.readbyqxmd.com/read/28743319/nationwide-survey-on-current-management-strategies-of-toddler-s-fractures
#13
Jade Seguin, Daniel Brody, Patricia Li
BACKGROUND: Tibial fractures are common in children less than 3 years old. The traditional management involves immobilization in an above knee cast for both confirmed (positive x-ray) and presumed (normal x-ray) toddler's fractures. This carries health care implications and causes unnecessary burden for patients and their families. There is a paucity of literature describing the ideal immobilization strategy for this injury. OBJECTIVES: To determine: 1) the variation between Canadian emergency departments in management of toddler's fractures; 2) the variation in management between confirmed and presumed toddler's fractures; 3) the association between demographic variables and immobilization strategies...
July 26, 2017: CJEM
https://www.readbyqxmd.com/read/28738911/sentinel-visits-in-emergency-department-patients-with-diabetes-mellitus-as-a-warning-sign-for-hyperglycemic-emergencies
#14
Justin W Yan, Katherine M Gushulak, Melanie P Columbus, Alexandra L Hamelin, George A Wells, Ian G Stiell
OBJECTIVES: Patients with poorly controlled diabetes mellitus may have a sentinel emergency department (ED) visit for a precipitating condition prior to presenting for a hyperglycemic emergency, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). This study's objective was to describe the epidemiology and outcomes of patients with a sentinel ED visit prior to their hyperglycemic emergency visit. METHODS: This was a 1-year health records review of patients≥18 years old presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, DKA, or HHS...
July 25, 2017: CJEM
https://www.readbyqxmd.com/read/28726594/crowding-karenina-and-complexity-patient-flow-in-evolving-health-care-ecosystems
#15
David A Petrie
No abstract text is available yet for this article.
July 20, 2017: CJEM
https://www.readbyqxmd.com/read/28724473/imagessecondary-cardiac-cancer-mimicking-inferior-st-elevation-myocardial-infarction-diagnosed-using-point-of-care-ultrasound-in-the-emergency-department
#16
Taft Micks, Patricia Kousaie, Aaron Guinn
No abstract text is available yet for this article.
July 20, 2017: CJEM
https://www.readbyqxmd.com/read/28714427/discrepancy-between-information-provided-and-information-required-by-emergency-physicians-for-long-term-care-patients
#17
Richa Parashar, Shelley McLeod, Don Melady
OBJECTIVES: The primary objective of this study was to identify information included in long-term care (LTC) transfer documentation and to compare it to the information required by local emergency department (ED) physicians to provide optimal care and make decisions for LTC patients. METHODS: A retrospective chart review was conducted for a sample of LTC residents transferred by ambulance to the ED of an academic, tertiary care hospital over a 1-year period. All emergency physicians working at the institution were invited to complete an online questionnaire about information included in LTC transfer documentation and information required by emergency physicians to provide care for LTC patients...
July 17, 2017: CJEM
https://www.readbyqxmd.com/read/28714424/an-unusual-case-of-exertional-dyspnea-atrial-myxoma-on-point-of-care-ultrasound
#18
Derek J Murray, Daniel J Kim
No abstract text is available yet for this article.
July 17, 2017: CJEM
https://www.readbyqxmd.com/read/28703089/a-traumatic-tale-of-two-cities-a-comparison-of-outcomes-for-adults-with-major-trauma-who-present-to-differing-trauma-centres-in-neighbouring-canadian-provinces
#19
Jefferson Hayre, Colin Rouse, James French, Jacqueline Fraser, Ian Watson, Sue Benjamin, Allison Chisholm, George Stoica, Beth Sealy, Mete Erdogan, Robert Green, Paul Atkinson
OBJECTIVES: While the use of formal trauma teams is widely promoted, the literature is not clear that this structure provides improved outcomes over emergency physician delivered trauma care. The goal of this investigation was to examine if a trauma team model with a formalized, specialty-based trauma team, with specific activation criteria and staff composition, performs differently than an emergency physician delivered model. Our primary outcome was survival to discharge or 30 days...
July 13, 2017: CJEM
https://www.readbyqxmd.com/read/28703082/dental-injuries-in-younger-emergency-department-patients
#20
Vigil James, Yona R Vandersluis, Evangeline W J Zhang, Dennis Scolnik
BACKGROUND: Dental trauma is a relatively common occurrence in childhood, with an impact exceeding that of periodontal diseases. It places a significant burden on the public health system because of its high frequency, impact on quality of life and consumption of resources. OBJECTIVES: To identify changing trends of dental injury in patients between 0-18 years of age in Canada and provide a detailed assessment of dental injury patterns in patients attending a large pediatric tertiary care hospital...
July 13, 2017: CJEM
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