bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequent users of an inner-city emergency department
Authors: Geurts Jill , Palatnick Wes , Strome Trevor , Weldon Erin 
Published: July 2016

ABSTRACTBackground:Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits.Methods:Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit—demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay—were analyzed and compared to data from the entire ED population for the same period.Results:Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (p&lt; 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (p&lt; 0.05). Patients left without being seen in 15.8% of visits.Conclusions:High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.
Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?
Authors: Scheuermeyer Frank Xavier , Andolfatto Gary , Lange Lisa , Jong Danielle de , Qian Hong , Grafstein Eric 
Published: July 2016

ABSTRACTObjective:Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses.Methods:This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times.Results:Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI -1.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA.Conclusions:For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs.
Delayed pericardial effusion and cardiac tamponade following penetrating chest trauma
Authors: Donahoe Laura , Ouzounian Maral , MacDonald Scott , Field Simon 
Published: July 2016

ABSTRACT
We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. The patient's postinjury course was complicated by pericarditis and recurrent tamponade, which required repeated pericardiocentesis for management. This case illustrates the role of focused ED ultrasonography for diagnosis of pericardial effusion in penetrating trauma and the potential for delayed pericardial effusion and tamponade in such patients. Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of lifethreatening complications.
The Simulation Olympics: a resuscitation-based simulation competition as an educational intervention
Authors: Dagnone J. Damon , Takhar Amandeep , Lacroix Lauren 
Published: July 2016

ABSTRACTThe Department of Emergency Medicine at Queen's University developed, implemented, and evaluated an interprofessional simulation-based competition called the Simulation Olympics with the purpose of encouraging health care providers to practice resuscitation skills and foster strong team-based attitudes. Eleven teams (N= 45) participated in the competition. Teams completed three standardized resuscitation scenarios in a high-fidelity simulation laboratory with teams composed of nurses, respiratory therapists, and undergraduate and postgraduate medical trainees. Trained standardized actors and a dedicated technician were used for all scenarios. Judges evaluated team performance using standardized assessment tools. All participants (100%) completed an anonymous two-page questionnaire prior to the competition assessing baseline characteristics and evaluating participant attitudes, motivation, and barriers to participation. The majority of participants (71%) completed an evaluation form following the event focusing on highlights, barriers to participation, and desired future directions. Evaluations were uniformly positive in short-answer feedback and attitudinal scoring measures. To our knowledge, the Simulation Olympics competition is the first of its kind in Canada to be offered at an academic teaching hospital.
Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs
Authors: Little Anjuli , Tung David , Truong Christine , Lapinsky Stephen , Burry Lisa 
Published: July 2016

ABSTRACT
Colchicine has a low therapeutic index. Its toxic effects generally occur at doses ≥ 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited.
Management of hot tar burn using vitamin E ointment containing petroleum and polyoxyethylene sorbitan
Authors: Ng Karen , Dalen Dawn , Rhine David 
Published: July 2016

ABSTRACT
Tar burns are primarily an occupational hazard associated with the road paving or roofing industry. Management of tar burns requires safe and effective removal of solidified tar from the skin using a dissolution or emulsifying agent to prevent inflicting further injury and pain. We report a case of a patient with tar burns on 10% of his body surface area involving the lower arms bilaterally and splashes to the facial area. The tar was efficiently removed with Webber Vitamin E Ointment without toxicity, irritation, or other complications.
The role of physician assistants in pediatric emergency medicine: the physician's view
Authors: Doan Quynh , Piteau Shalea , Sheps Sam , Singer Joel , Wong Hubert , Johnson David , Kissoon Niranjan 
Published: July 2016

ABSTRACTObjective:To define the range of clinical conditions Canadian emergency pediatricians consider appropriate formanagement by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).Methods:We conducted a cross–sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N = 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions.Results:Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had ≥ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7–89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5–91.5% v. 82.2–84.7%).Conclusion:This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician.
Cohort Study on the Prevalence and Risk Factors for Delayed Pulmonary Complications in Adults Following Minor Blunt Thoracic Trauma
Authors: Plourde Miville , Émond Marcel , Lavoie André , Guimont Chantal , Le Sage Natalie , Chauny Jean-Marc , Bergeron Éric , Vanier Laurent , Moore Lynne , Allain-Boulé Nadine , Fratu Ramona-Florina , Dufresne Maryline 
Published: July 2016

ABSTRACTObjectives:The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma.Method:A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray.Outcomes:Delayed hemothorax occurred in 11.8% (95% CI 8.8–14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2–2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62–3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60–6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80–14.19) for the upper ribs (third to fifth rib) versus patients with no fractures.Conclusion:The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax.
Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review
Authors: Day Gregory S. , Swartz Richard H. , Chenkin Jordan , Shamji Adil I. , Frost David W. 
Published: July 2016

ABSTRACT
Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good.
Diagnosis of occult scaphoid fractures: a randomized, controlled trial comparing bone scans to radiographs for diagnosis
Authors: Hiscox Christina , LaMothe Jeremy , White Neil , Bromley Mark , Paolucci Elizabeth Oddone , Hildebrand Kevin 
Published: July 2016

ABSTRACTBackground:Many patients with suspected scaphoid fractures but negative radiographs are immobilized for ≥ 2 weeks and are eventually found to have no fracture. Bone scans are reportedly 99% sensitive for these injuries if done ≥ 72 hours postinjury.Objective:The purpose of this study was to determine if early bone scans would allow for shorter cast immobilization periods in patients with suspected scaphoid fractures.Methods:Twenty-seven patients with clinically suspected scaphoid fractures and negative radiographs were randomized to early diagnosis (bone scan within 3–5 days; n 5 12) or traditional diagnosis (radiographs 10–14 days postinjury; n 5 15). The primary outcome was number of days immobilized in a cast.Results:The mean number of days immobilized was 26 in the traditional group and 29 in the bone scan group. Overall, 6 patients had scaphoid fractures (2 in the traditional diagnosis group and 4 in the bone scan group; p &gt; 0.05), and 8 had other types of fractures. These other types of fractures included four distal radius fractures, two triquetral fractures, one trapezoid fracture, and one hamate fracture. There was no significant difference in the number of other types of fractures between groups. The Kaplan-Meier survival analysis using the log-rank test revealed that there was no statistically significant difference between days immobilized between the radiograph and bone scan groups (p 5 0.38).Conclusions:The current study suggests that the use of bone scans to help diagnose occult scaphoid fractures does not reduce the number of days immobilized and that the differential diagnosis of occult scaphoid fractures should remain broad because other injuries are common.
Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians
Authors: Ali Samina , Chambers Andrea , Johnson David W. , Newton Amanda S. , Vandermeer Ben , Williamson Janie , Curtis Sarah J. 
Published: July 2016

ABSTRACTObjectives:To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management.Methods:This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results:The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%).Conclusions:When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.
Administration and leadership competencies: establishment of a national consensus for emergency medicine
Authors: Thoma Brent , Poitras Julien , Penciner Rick , Sherbino Jonathan , Holroyd Brian R. , Woods Robert A. 
Published: July 2016

AbstractIntroduction: The Royal College of Physicians and Surgeons of Canada requires emergency medicine (EM) residency programs to meet training objectives relating to administration and leadership. The purpose of this study was to establish a national consensus on the competencies for inclusion in an EM administration and leadership curriculum.Methods: A modified Delphi process involving two iterative rounds of an electronic survey was used to achieve consensus on competencies for inclusion in an EM administration and leadership curriculum. An initial list of competencies was compiled using peer-reviewed and grey literature. The participants included 14 EM residency program directors and 43 leadership and administration experts from across Canada who were recruited using a snowball technique. The proposed competencies were organized using the CanMEDS Physician Competency Framework and presented in English or French. Consensus was defined a priori as >70% agreement.Results: Nearly all (13 of 14) of the institutions with an FRCPC EM program had at least one participant complete both surveys. Thirty-five of 57 (61%) participants completed round 1, and 30 (53%) participants completed both rounds. Participants suggested an additional 16 competencies in round 1. The results of round 1 informed the decisions in round 2. Fifty-nine of 109 (54.1%) competencies achieved consensus for inclusion.Conclusions: Based on a national modified Delphi process, we describe 59 competencies for inclusion in an EM administration and leadership curriculum that was arranged by CanMEDS Role. EM educators may consider these competencies when designing local curricula.
An exploration of Canadian emergency physicians' and residents' knowledge of computed tomography radiation dosing and risk
Authors: Barbic David , Barbic Skye , Dankoff Jerrald 
Published: July 2016

AbstractObjective: The objective of this study was to measure the current knowledge of Canadian emergency physicians and emergency medicine residents regarding computed tomography (CT) radiation dosing and its associated risks.Methods: Three focus groups were conducted as the qualitative element of this study. Cognitive debriefing was carried out to ensure the validity and reliability of the focus group findings and to aid with survey development. A 26-item electronic survey was developed and pilot tested for distribution to the membership of the Canadian Association of Emergency Physicians.Results: Eighteen emergency medicine physicians and three emergency medicine residents participated in the focus groups. Four major themes emerged: 1) physician knowledge of risks associated with CT, 2) risk management strategies, 3) communication, and 4) knowledge translation. The survey response rate was 49.8% (638 of 1,281). The mean respondent age was 40.9±9.9 years, and 70.7% were male. Of all respondents, 82.5% were actively practicing attending physicians, 56.4% of all respondents practiced in urban academic emergency departments, and the average time practicing was 10.7±9.6 years. Radiography and CT were correctly identified by 92.2% and 95.1% of respondents, respectively, as sources of ionizing radiation, whereas magnetic resonance imaging and ultrasonography were selected by 1.0% and 0.5%, respectively. With respect to the lifetime attributable risk (LAR) of malignancy due to CT, 82.2% of participants correctly identified that abdominal CT increases the risk of cancer by 0.2 to 2%, whereas 51.3% correctly identified that the LAR increases twofold in a 7- year-old boy. When asked to identify populations at risk for potential harm due to ionizing radiation, 92.2% of respondents identified children, 80.3% identified pregnant women, and 71.4% identified women of reproductive age. A minority (37.2%) reported communicating the potential risks of CT to a majority of their patients. Electronic platforms were identified by 74.8% of respondents as their preferred method of knowledge translation on this topic.Conclusions: Canadian emergency medicine physicians and emergency medicine residents demonstrated identifiable gaps in knowledge surrounding CT radiation dose and risk.
Studying with the cloud: the use of online Web-based resources to augment a traditional study group format
Authors: Chan Teresa , Sennik Serena , Zaki Amna , Trotter Brendon 
Published: July 2016

AbstractCloud-based applications such as Google Docs, Skype, Dropbox, and SugarSync are revolutionizing the way that we interact with the world. Members of the millennial generation (those born after 1980) are now becoming senior residents and junior attending physicians. We describe a novel technique combining Internet- and cloud-based methods to digitally augment the classic study group used by final-year residents studying for the Royal College of Physicians and Surgeons of Canada examination. This material was developed by residents and improved over the course of 18 months. This is an innovation report about a process for enhanced communication and collaboration as there has been little research to date regarding the augmentation of learner-driven initiatives with virtual resources.