bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glycyrrhizic acid toxicity caused by consumption of licorice candy cigars
Authors: Johns Christine 
Published: July 2016

ABSTRACT
A 49-year-old female physician presented with peripheral edema, weight gain and relative hypertension caused by the consumption of licorice candy cigars containing glycyrrhizic acid (GZA) found in natural licorice extract. Although the patient's response to GZA resolved spontaneously, emergency physician awareness of the toxic effects of natural licorice extract may avert symptom progression in early-identified cases. The benefits of natural licorice extract as a flavour enhancer and herbal medicine are recognized worldwide. The Canadian public is likely not generally aware of the toxic potential of GZA, or that it may be present in the following commonly consumed products: black licorice, chewing gum, herbal teas, soft drinks, tobaccos and herbal remedies for cough, stomach ailments and constipation. Emergency physicians should inquire about the consumption of products that may contain natural licorice extract when patients present with unexplained hypertension, hypokalemia, edema, rhabdomyolysis or myoglobinuria.
Emergency medicine preclerkship observerships: evaluation of a structured experience
Authors: Penciner Rick 
Published: July 2016

ABSTRACT

Objective:
Medical students are expected to make residency and career decisions early in their undergraduate medical education. In medical school curricula, there is limited exposure to emergency medicine (EM) in the preclerkship years. The purpose of this study was to evaluate a structured EM observership program for preclerks by surveying the students’ perceptions and attitudes about the program following their participation.

Methods:
A structured observership program was developed and implemented at the University of Toronto Medical School in February 2007. All first- and second-year students were eligible to participate on a voluntary basis. Nine emergency department (ED) teaching sites were enlisted, with each site recruiting interested preceptors. The observership consisted of two 4-hour shifts with 1 preceptor at 1 site. Specific expectations were provided to the students at the start of the observership. A convenience sample was used for the period between Feb. 26 and Nov. 4, 2007, to conduct an anonymous online survey about the students' experience after the ob servership.

Results:
During the study period, 82 students completed 99 observerships at 9 sites with 54 different preceptors. Of the 82 students who completed the observerships, 70 students completed the survey. Overall, all the students (70/70) found the experience to be worthwhile. Most students (68/70) viewed the preceptors as good role models. As a result of the observership, 47 of 70 students reported that their attitudes about and interest in EM had changed and most (59/70) planned on exploring other opportunities in EM (e.g., electives).

Conclusion:
Structured EM observerships are viewed by medical students to be worthwhile. These observerships can change attitudes about and interest in EM and allow students to make more informed career choices.
Erythroderma: a dermatologic emergency
Authors: Bruno Tony F. , Grewal Parbeer 
Published: July 2016

ABSTRACT
Erythroderma is a potentially fatal dermatologic emergency that is often mistaken for infection. Indeed, the fact that it is difficult to diagnosis is the main contributor to its significant mortality rate, as treatment is readily available. We present a case of a 36-year-old man who was incorrectly diagnosed and treated for 2 months. We review the etiologies, initial work-up and management of this disease. In our case, the patient was ill, had lost 11.3 kg and developed systemic inflammatory response syndrome. Without proper treatment he was at risk of developing full-blown sepsis. Although there are many causes of erythroderma, prompt initial treatment directed at the underlying etiology typically results in a rapid remission.
Temporal lobe seizures from a posterior cerebral artery aneurysm presenting as memory flashbacks
Authors: Peera Mohamed A. , LoCurto Michael 
Published: July 2016

ABSTRACT
Memory flashbacks are usually attributed to recreational drugs or psychiatric conditions. The differential diagnosis for memory flashbacks is diverse and challenging; moreover, management is influenced by the working diagnosis. We describe the case of a 35-year-old man who presented with memory flashbacks secondary to temporal lobe seizures from an unruptured aneurysm of the posterior cerebral artery. To our knowledge, a case of this nature has not been previously reported. This case demonstrates the need to recognize that, on rare occasions, a complaint of memory flashbacks can be the result of an organic etiology. We also discuss the challenging presentations of temporal lobe seizures, as they can easily be misdiagnosed as a psychiatric condition.
Community-associated methicillin-resistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors
Authors: Adam Heather J. , Allen Vanessa G. , Currie Andrea , McGeer Allison J. , Simor Andrew E. , Richardson Susan E. , Louie Lisa , Willey Barbara , Rutledge Tim , Lee Jacques , Goldman Ran D. , Somers Andrea , Ellis Paul , Sarabia Alicia , Rizos John , Borgundvaag Bjug , Katz Kevin C. ,   EMERGENT Working Group
Published: July 2016

ABSTRACTObjective:Community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA), which is caused primarily by the Canadian methicillin-resistantStaphylococcus aureus-10 (CMRSA-10) strain (also known as the USA300 strain) has emerged rapidly in the United States and is now emerging in Canada. We assessed the prevalence, risk factors, microbiological characteristics and outcomes of CA-MRSA in patients with purulent skin and soft tissue infections (SSTIs) presenting to emergency departments (EDs) in the Greater Toronto Area.Methods:Patients withStaphylococcus aureusSSTIs who presented to 7 EDs between Mar. 1 and Jun. 30, 2007, were eligible for inclusion in this study. Antimicrobial susceptibilities and molecular characteristics of MRSA strains were identified. Demographic, risk factor and clinical data were collected through telephone interviews.Results:MRSA was isolated from 58 (19%) of 299 eligible patients. CMRSA-10 was identified at 6 of the 7 study sites and accounted for 29 (50%) of all cases of MRSA. Telephone interviews were completed for 161 of the eligible patients. Individuals with CMRSA-10 were younger (median 34 v. 63 yr,p= 0.002), less likely to report recent antibiotic use (22% v. 67%,p= 0.046) or health care–related risk factors (33% v. 72%,p= 0.097) and more likely to report community-related risk factors (56% v. 6%,p= 0.008) than patients with other MRSA strains. CMRSA-10 SSTIs were treated with incision and drainage (1 patient), antibiotic therapy (3 patients) or both (5 patients), and all resolved. CMRSA-10 isolates were susceptible to clindamycin, tetracycline and trimethoprimsulfamethoxazole.Conclusion:CA-MRSA is a significant cause of SSTIs in the Greater Toronto Area, and can affect patients without known community-related risk factors. The changing epidemiology of CA-MRSA necessitates further surveillance to inform prevention strategies and empiric treatment guidelines.
A 4-year review of pediatric mental health emergencies in Alberta
Authors: Newton Amanda S. , Ali Samina , Johnson David W. , Haines Christina , Rosychuk Rhonda J. , Keaschuk Rachel A. , Jacobs Philip , Klassen Terry P. 
Published: July 2016

ABSTRACTObjective:We sought to determine and compare rates of pediatric mental health presentations and associated costs in emergency departments (EDs) in Alberta.Methods:We examined 16 154 presentations by 12 589 patients (patient age ≤ 17 yr) between April 2002 and March 2006 using the Ambulatory Care Classification System, a province-wide database for Alberta. The following variables of interest were extracted: patient demographics, discharge diagnoses, triage level, disposition, recorded costs for ED care, and institutional classification and location (i.e., rural v. urban, pediatric v. general EDs).Results:A 15% increase in pediatric mental health presentations was observed during the study period. Youth aged 13-17 years consistently represented the most common age group for first presentation to the ED (83.3%). Of the 16 154 recorded presentations, 21.4% were related to mood disorders and 32.5% to anxiety disorders. Presentations for substance misuse or abuse were the most prevalent reasons for a mental health-related visit (41.3%). Multiple visits accounted for more than one-third of all presentations. Presentations for mood disorders were more common in patients with multiple compared with single visits (29.3% v. 16.9%), and substance abuse or misuse presentations were more common in patients with single compared with multiple visits (47.4% v. 30.5%). The total direct ED costs for mental health presentations during the study period was Can$3.5 million.Conclusion:This study provides comprehensive data on trends of pediatric mental health presentation, and highlights the costs and return presentations in this population. Psychiatric and medical care provided in the ED for pediatric mental health emergencies should be evaluated to determine quality of care and its relationship with return visits and costs.
Important returns on investment: an evaluation of a national research grants competition in emergency medicine
Authors: Bawden Jaime , Manouchehri Namdar , Villa-Roel Cristina , Grafstein Eric , Rowe Brian H. 
Published: July 2016

ABSTRACTObjective:We sought to examine scholarly outcomes of the projects receiving research grants from the Canadian Association of Emergency Physicians (CAEP) during the first 10 years of national funding (i.e., between 1996 and 2005).Methods:We sent email surveys to 62 emergency medicine (EM) researchers who received funding from CAEP. We focused our data collection on grant deliverables and opinions using a 1–7 Likert scale with regard to the value of the award.Results:Fifty-eight recipients responded to our survey. Grants were most commonly awarded to residents (21 [36%]), followed by senior (16 [28%]) and junior (13 [22%]) emergency staff. Twenty-six applicants from Ontario and 11 from Quebec received the majority of the grants. Overall, 51 projects were completed at the time of contact and, from these, 39 manuscripts were published or in press. Abstract presentations were more common, with a median of 2 abstracts presented per completed project. Abstract presentations for the completed projects were documented locally (23), nationally (39) and internationally (37). Overall, 19 projects received additional funding. The median amount funded was Can$4700 with an interquartile range of $3250–$5000. Respondents felt CAEP funding was critical to completing their projects and felt strongly that dedicated EM research funding should be continued to stimulate productivity.Conclusion:Overall, the CAEP Research Grants Competition has produced impressive results. Despite the small sums available, the grants have been important for ensuring study completion and for securing additional funding. CAEP and similar EM organizations need to develop a more robust funding approach so that larger grant awards and more researchers can be supported on an annual basis.
Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses
Authors: Dallaire Clémence , Poitras Julien , Aubin Karine , Lavoie André , Moore Lynne , Audet Geneviève 
Published: July 2016

ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.
Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome
Authors: Hess Erik P. , Perry Jeffrey J. , Ladouceur Pam , Wells George A. , Stiell Ian G. 
Published: July 2016

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.
Comparison of tracheal intubation and alternative airway techniques performed in the prehospital setting by paramedics: a systematic review
Authors: Jensen Jan L. , Cheung Ka Wai , Tallon John M. , Travers Andrew H. 
Published: July 2016

ABSTRACT
This systematic review included controlled clinical trials comparing tracheal intubation (TI) with alternative airway techniques (AAT) (bag-mask ventilation and use of extraglottic devices) performed by paramedics in the prehospital setting. A priori outcomes to be assessed were survival, neurologic outcome, airway management success rates and complications. We identified trials using EMBASE, MEDLINE, CINAHL, The Cochrane Library, Web of Science, author contacts and hand searching. We included 5 trials enrolling a total of 1559 patients. No individual study showed any statistical difference in outcomes between the TI and AAT groups. Because of study heterogeneity, we did not pool the data. This is the most comprehensive review to date on paramedic trials. Owing to the heterogeneity of prehospital systems, administrators of each system must individually consider their airway management protocols.
Harmful effect of saline infusion in a patient with glycyrrhizic acid poisoning
Authors: Caubet-Kamar Natacha , Tubery Marie , Garrouste Cyril , Lauque Dominique , Kamar Nassim 
Published: July 2016

ABSTRACT
Alcohol-free licorice beverages contain glycyrrhizic acid. Excess glycyrrhizic acid is a well-known cause of excess mineralocorticoid syndrome. We report a case of glycyrrhizic acid poisoning in an abstinent alcoholic complicated by severe pulmonary edema following excessive hydration with intravenous normal saline.
Defining normal jugular venous pressure with ultrasonography
Authors: Socransky Steven J. , Wiss Ray , Robins Ron , Anawati Alexandre , Roy Marc-Andre , Yeung I. Ching 
Published: July 2016

ABSTRACT

Objective:
Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP.

Methods:
We conducted a prospective anatomic study on a convenience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 techniques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV's path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants.

Results:
We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively.

Conclusion:
The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.
A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air
Authors: Sivilotti Marco L.A. , Messenger David W. , Vlymen Janet van , Dungey Paul E. , Murray Heather E. 
Published: July 2016

ABSTRACTObjective:Important questions remain regarding how best to monitor patients during procedural sedation and analgesia (PSA). Capnometry can detect hypoventilation and apnea, yet it is rarely used in emergency patients. Even the routine practice of performing preoxygenation in low-risk patients is controversial, as supplementary oxygen can delay the detection of respiratory depression by pulse oximetry. The purpose of this study was to determine whether the capnometer or the pulse oximeter would first detect respiratory events in adults breathing room air.Methods:During a randomized clinical trial comparing fentanyl with low-dose ketamine for PSA with titrated propofol, patients were monitored using pulse oximetry and continuous oral–nasal sampled capnography. Supplemental oxygen was administered only for oxygen desaturation. Sedating physicians identified prespecified respiratory events, including hypoventilation (end-tidal carbon dioxide &gt; 50 mm Hg, rise of 10 mm Hg from baseline or loss of waveform) and oxygen desaturation (pulse oximetry &lt; 92%). These events and their timing were corroborated by memory data retrieved from the monitors.Results:Of 63 patients enrolled, 57% (36) developed brief oxygen desaturation at some point during the sedation. All responded to oxygen, stimulation or interruption of propofol. Measurements of end-tidal carbon dioxide varied substantially between and within patients before study intervention. Hypoventilation (19 patients, 30%) was only weakly associated with oxygen desaturation (crude odds ratio 1.4 [95% confidence interval 0.47 to 4.3]), and preceded oxygen desaturation in none of the 12 patients in whom both events occurred (median lag 1:50 m:ss [interquartile range 0:01 to 3:24 m:ss]).Conclusion:During PSA in adults breathing room air, desaturation detectable by pulse oximeter usually occurs before overt changes in capnometry are identified.
Sex differences in clinical presentation, management and outcome in emergency department patients with chest pain
Authors: Hess Erik P. , Perry Jeffrey J. , Calder Lisa A. , Thiruganasambandamoorthy Venkatesh , Roger Veronique L. , Wells George A. , Stiell Ian G. 
Published: July 2016

ABSTRACT

Objective:
We sought to assess sex differences in clinical presentation, management and outcome in emergency department (ED) patients with chest pain, and to measure the association between female sex and coronary angiography within 30 days.

Methods:
We conducted a prospective cohort study in an urban academic ED between Jul. 1, 2007, and Apr. 1, 2008. We enrolled patients over 24 years of age with chest pain and possible acute coronary syndrome (ACS).

Results:
Among the 970 included patients, 386 (39.8%) were female. Compared with men, women had a lower prevalence of known coronary artery disease (21.0% v. 34.2%, p &lt; 0.001) and a lower frequency of typical pain (37.1% v. 45.7%, p = 0.01). Clinicians classified a greater proportion of women as having a low (&lt; 10%) pretest probability for ACS (85.0% v. 76.4%, p = 0.001). Despite similar rates of electrocardiography, troponin T and stress testing between sexes, there was a lower rate of acute myocardial infarction (AMI) (4.7% v. 8.4%, p = 0.03) and positive stress test results (4.4% v. 7.9%, p = 0.03) in women. Women were less frequently referred for coronary angiography (9.3% v. 18.9%, p &lt; 0.001). The adjusted association between female sex and coronary angiography was not significant (odds ratio 0.63, 95% confidence interval 0.37–1.10).

Conclusion:
Women had a lower rate of AMI and a lower rate of positive stress test results despite similar rates of testing between sexes. Although women were less frequently referred for coronary angiography, these data suggest that sex differences in management were likely appropriate for the probability of disease.
Acute compartment syndrome of the dorsal forearm following noncontact injury
Authors: Crawford Brent , Comstock Sean 
Published: July 2016

ABSTRACTAcute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.