bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone
Authors: Manara Alessandro , Hantson Philippe , Vanpee Dominique , Thys Frédéric 
Published: July 2016

ABSTRACT
Salmeterol, a long-acting β2-adrenergic receptor agonist used for the treatment of asthma and chronic obstructive pulmonary disease, has an adverse effects profile that is similar to that of salbutamol and other β2-agonists. We report a sympathomimetic syndrome with metabolic acidosis and hyperlactatemia after intentional inhalation of salmeterol in a suicide attempt. A 16-year-old female patient was admitted to the emergency department approximately 2 hours after having inhaled 60 puffs of a combination of salmeterol xinafoate 25 μg and fluticasone propionate 50 μg. She presented in an anxious state with complaints of palpitations and chest pain. The electrocardiogram demonstrated sinus tachycardia and ST-segment depression in the inferior and anterolateral leads. Laboratory findings showed hypokalemia, hypophosphatemia, and lactic acidosis. Cardiac troponin I and creatine kinase MB remained within the normal range. Treatment was supportive and included intravenous fluids and cautious potassium supplementation. The next day, electrocardiographic and laboratory findings returned to normal. We hypothesize that stimulation of β2-adrenergic receptors by inhalation of salmeterol caused this patient's lactic acidosis. This observation is consistent with the hypothesis that the hyperlactatemia observed during asthma attacks is due in part to the administration of high doses of β2-agonists. Salmeterol overdose by inhalation appears to be sufficient to cause lactic acidosis.
Perceptions of graduates from Africa's first emergency medicine training program at the University of Cape Town/Stellenbosch University
Authors: Wen Leana S. , Geduld Heike I. , Nagurney J. Tobias , Wallis Lee A. 
Published: July 2016

ABSTRACTObjective:Africa's first postgraduate training program in emergency medicine (EM) was established at the University of Cape Town/Stellenbosch University (UCT/SUN) in 2004. This study of the UCT/SUN EM program investigated the backgrounds, perceptions, and experiences of its graduates.Methods:This was a cross-sectional descriptive study. The study population was the 30 graduates from the first four classes in the UCT/SUN EM program (2007–2010). We employed a scripted interview with a combination of closed and open-ended questions. Data were analyzed using the thematic method of qualitative analysis.Results:Twenty-seven (90%) graduates were interviewed. Initial career goals were primarily (78%) to practice EM in a nonacademic clinical capacity. At the time of the interview, 52% held academic positions, 15% had nonacademic clinical positions, and 33% had temporary positions and were looking for other posts. The three most commonly cited strengths of their program were diversity of clinical rotations (85%), autonomy and procedural experience (63%), and importance of being pioneers within Africa (52%). The three most commonly cited weaknesses were lack of bedside teaching in the ED (96%), lack of career options after graduation (74%), and lack of preparation for academic careers (70%).Conclusions:The lessons identified from structured interviews with graduates from Africa’s first EM training include the importance of strong clinical training, difficulty of ensuring bedside teaching in a new program, the necessity of ensuring postgraduation positions, and the need for academic training. These findings may be useful for other developing countries looking to start EM training programs.
How does “knowledge translation” affect my clinical practice?
Authors: Lang Eddy S. , Johnson David 
Published: July 2016

ABSTRACT
Knowledge translation is emerging as an increasingly important area of research and practice aiming to remedy the disconnection between evidence-based clinical care and real-life practice. The discipline is informed by a large body of literature and practical tools, which can inform providers and leaders in health care. Front-line clinicians should be aware of the principles of knowledge translation and the evidence that defines successful and suboptimal strategies for introducing evidence-based care at the system level.
Influenza assessment centres: a case study of pandemic preparedness to alleviate excess emergency department volume
Authors: Hall Geoffrey G. , Perry Alexander G. , vanDijk Adam , Moore Kieran M. 
Published: July 2016

ABSTRACTObjectives:Influenza assessment centres (IACs) were deployed to reduce emergency department (ED) volumes during the pH1N1 influenza outbreak in the Kingston, Frontenac, Lennox and Addington (KFL&amp;A) public health region of Ontario, Canada, in the fall of 2009. We present a case study for the deployment of IACs to reduce ED visit volume during both periods of pandemic and seasonal communicable disease outbreak.Methods:An emergency department syndromic surveillance system was used to trigger the deployment of eight geographically distributed IACs and to time their staggered closure 3 weeks later. We compared actual and expected ED visit volumes in the KFL&amp;A region to neighbouring regions where no IACs operated by time series regression analysis before, during, and after IAC operation.Results:The deployment of IACs was triggered with a rise in overall ED volume at the hospitals in the KFL&amp;A region to a level 10% above the 6-month running average. The IACs assessed 2,284 patients during 3 weeks of operation. Thirtythree patients were admitted directly to the hospital from the IACs, bypassing the EDs. During the operation of the IACs, the hospitals in the KFL&amp;A region experienced a modest decrease in daily visits when compared to the 3 previous weeks. Overall ED visit volume in the hospitals in the neighbouring regions increased 105% during the period of IAC operation.Conclusions:Operating stand-alone influenza IACs may reduce ED volumes during periods of increased demand, as observed during an anticipated pandemic situation.
Validity and reliability of an in-training evaluation report to measure the CanMEDS roles in emergency medicine residents
Authors: Kassam Aliya , Donnon Tyrone , Rigby Ian 
Published: July 2016

ABSTRACTBackground:There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework.Objective:The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER).Method:ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training.Results:A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/ Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α = 0.90 to 0.95 for each subscale and α = 0.97 overall. The combined, 24-item ITER used to assess residents’ competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles.Conclusions:Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.
Metabolic acidosis in toluene sniffing
Authors: Tuchscherer Jon , Rehman Habib 
Published: July 2016

ABSTRACTToluene sniffing, frequently described under the generic category of “glue sniffing,” is a potential cause of normal anion gap metabolic acidosis due to distal renal tubular acidosis. Urine anion gap is used to diagnose metabolic acidosis of a normal anion gap variety; however, pitfalls exist when using urine anion gap in the setting of toluene sniffing. We present the case of a young woman who had a normal anion gap metabolic acidosis due to toluene sniffing and an unexpectedly low urine anion gap. In such a scenario, the urine anion gap will underestimate the rate of ammonia excretion when the conjugate bases of acids other than HCl are excreted in large quantities. Estimation of the urine osmolal gap will provide a more accurate ammonia excretion rate in these circumstances. The challenges in interpretation of the urine anion gap and ammonia excretion in the setting of distal renal tubular acidosis due to toluene toxicity are discussed.
Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?
Authors: Van Zyl Hendrik P. , Bilbey James , Vukusic Alan , Ring Todd , Oakes Jennifer , Williamson Lykke D. , Mitchell Ian V. 
Published: July 2016

ABSTRACT

Objective:
Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine.

Method:
Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists.

Results:
Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25).

Conclusion:
Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.
Developing a Canadian emergency medical services research agenda: a baseline study of stakeholder opinions
Authors: Dainty Katie N. , Jensen Jan L. , Bigham Blair L. , Blanchard Ian E. , Brown Lawrence H. , Carter Alix J.E. , Socha Doug , Morrison Laurie J. 
Published: July 2016

ABSTRACTPurpose:This study forms the first phase in the development of the Canadian National EMS Research Agenda. The purpose was to understand the current state of emergency medical services (EMS) research through the barriers and opportunities perceived by key stakeholders in the Canadian system and to identify the recommendations this group had for moving forward.Methods:This qualitative study was conducted in the spring of 2011 using one-on-one semistructured telephone interviews. Purposeful sampling was used to recruit a cross section of EMS research stakeholders, representing a breadth of geographic regions and roles. Data were collected until thematic saturation was reached. A constant comparative approach was used to develop a basic coding framework and identify emerging themes.Results:Twenty stakeholders were invited to participate, and saturation was reached after 13 interviews. Thematic saturation was used to ensure that the findings were grounded in the data. Four major themes were identified: 1) the need for additional research education within EMS; 2) the importance of creating an infrastructure to support pan-Canadian research collaboration; 3) addressing the complexities of involving EMS providers in research; and 4) considerations for a national research agenda.Conclusion:This hypothesis-generating study reveals key areas regarding EMS research in Canada and through the guidance it provides is a first step in the development of a comprehensive national research agenda. Our intention is to collate the identified themes with the results of a larger roundtable discussion and Delphi survey and, in doing so, guide development of a Canadian national EMS research agenda.
Drowning: an overlooked cause of out-of-hospital cardiac arrest in Canada
Authors: Buick Jason E. , Lin Steve , Rac Valeria E. , Brooks Steven C. , Kierzek Gérald , Morrison Laurie J. 
Published: July 2016

ABSTRACTIntroduction:Drowning is a major public health concern, yet little is known about the characteristics of drowning patients. The objectives of this study were to describe the demographic and clinical characteristics of out-of-hospital cardiac arrest (OHCA) attributed to drowning in Ontario and to compare the characteristics of OHCA attributed to drowning to those of presumed cardiac etiology.Methods:A retrospective, observational study was carried out of consecutive OHCA patients of drowning etiology in Ontario between August 2006 and July 2011. Bivariate analysis was used to evaluate differences between drowning and presumed cardiac etiologies.Results:A total of 31,763 OHCA patients were identified, and 132 (0.42%) were attributed to drowning. Emergency medical services treated 98 patients, whereas the remaining 34 met the criteria for legislative death. Overall, 5.1% of drowning patients survived to hospital discharge. When compared to patients of presumed cardiac etiology, drowning patients were younger and their arrest was more likely to be unwitnessed, present with a nonshockable initial rhythm, occur in a public location, and receive bystander cardiopulmonary resuscitation (CPR). A nonsignificant trend was noted for drowning cases to more frequently have a public access AED applied. There were no significant differences in the gender ratio or paramedic response times. Drowning patients were more likely to be transported to hospital but had a trend to be less likely to arrive with a return of spontaneous circulation. They were also more likely to be admitted to hospital but had no difference in survival to hospital discharge.Conclusions:Significant differences exist between OHCA of drowning and presumed cardiac etiologies. Most drownings are unwitnessed, occur in public locations, and present with nonshockable initial rhythms, suggesting that treatment should focus on bystander CPR. Future initiatives should focus on strategies to improve supervision in targeted locations and greater emphasis on bystander-initiated CPR, both of which may reduce drowning mortality.
Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma
Authors: Carrière Benoit , Clément Karine , Gravel Jocelyn 
Published: July 2016

ABSTRACTBackground:Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologic evaluation in such cases.Objective:To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases.Design/Methods:A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval.Results:A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%.Conclusion:Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted.
A randomized, controlled trial of oral versus intravenous fluids for lowering blood glucose in emergency department patients with hyperglycemia
Authors: Arora Sanjay , Probst Marc A. , Andrews Laura , Camilion Marissa , Grock Andrew , Hayward Gregory , Menchine Michael 
Published: July 2016

ABSTRACTObjectives:Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. This study compared the efficacy and safety of oral versus intravenous fluids for reducing blood glucose in patients with hyperglycemia.Methods:We conducted a prospective, nonblinded, randomized, controlled trial. Inclusion criteria were blood glucose &gt; 13.9 mmol/L, age &gt; 18 years, and ability to tolerate oral fluids. Subjects were excluded for critical illness, contraindication to fluids, and/or hyperglycemia therapy prior to enrolment. Subjects were randomized to receive oral bottled water or intravenous normal saline (maximum 2 L) over 2 hours. The primary outcome of interest was a change in blood glucose at 2 hours across treatment arms.Results:The 48 subjects were randomized. Baseline blood glucose levels and total amount of fluid received were similar between the two groups. The mean decrease in blood glucose at 2 hours was similar for both treatment arms: a mean decrease of 3.4 mmol/L (20.2 mmol/L to 16.8 mmol/L) in the oral fluid group versus a mean decrease of 4.0 mmol/L (19.7 mmol/L to 15.7 mmol/L) in the intravenous fluid group. The mean difference between groups was −0.6 mmol/L (95% confidence interval −2.3–1.2;p= 0.51). No adverse events were observed in either group.Conclusion:In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.
An inventory of Canadian trauma systems: opportunities for improving access to trauma care
Authors: Evans Christopher C.D. , Tallon J.M. , Bridge Jennifer , Nathens Avery B. 
Published: July 2016

ABSTRACT

Objective:
Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care.

Methods:
We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. Targeted stakeholders included emergency physicians, trauma surgeons, trauma program medical directors and program managers, prehospital providers, and decision makers at the regional and provincial levels. A “snowball” approach was used to expand the sample base of the survey. Descriptive statistics were generated to quantify the nature and extent of trauma system development by region.

Results:
The overall response rate was 38.7%, and all levels of stakeholders and all provinces/territories were represented. All provinces were found to have designated trauma centres; however, only 60% were found to have been accredited within the past 10 years. Components present in 50% or fewer provinces included an inclusive trauma system model, interfacility transfer agreements, and a mechanism to track bed availability within the system.

Conclusion:
There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.
Postresuscitation debriefing in the pediatric emergency department: a national needs assessment
Authors: Sandhu Naminder , Eppich Walter , Mikrogianakis Angelo , Grant Vincent , Robinson Traci , Cheng Adam ,   for the Canadian Pediatric Simulation Network (CPSN) Debriefing Consensus Group
Published: July 2016

ABSTRACTObjectives:The objectives of this study were to assess current postresuscitation debriefing (PRD) practices in Canadian pediatric emergency departments (EDs) and identify areas for improvement.Methods:A national needs assessment survey was conducted to collect information on current PRD practices and perspectives on debriefing practice in pediatric EDs. A questionnaire was distributed to ED nurses, fellows, and attending physicians at 10 pediatric tertiary care hospitals across Canada. Summary statistics are reported.Results:Data were analyzed from 183 participants (48.7% response rate). Although 88.8% of the participants believed that debriefing is an important process, 52.5% indicated that debriefing after real resuscitations occurs less than 25% of the time and 68.3% indicated that no expectation exists for PRD at their institution. Although 83.7% of participants believed that facilitators should have a specific skill set developed through formal training sessions, 63.4% had no previous training in debriefing. Seventy-two percent felt that medical and crisis resource management issues are dealt with adequately when PRD occurs, and 90.4% indicated that ED workload and time shortages are major barriers to effective debriefing. Most responded that a debriefing tool to guide facilitators might aid in multiple skills, such as creating realistic debriefing objectives and providing feedback with good judgment.Conclusion:PRD in Canadian pediatric EDs occurs infrequently, although most health care providers agreed on its importance and the need for skilled facilitators.