CJEM

OBJECTIVES: The aim of this study is to identify the types of community paramedicine programs and the training for each. METHODS: A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies' methodological quality (full methodology on PROSPERO: CRD42017051774)...

OBJECTIVES: Transesophageal echocardiography (TEE) is a relatively new resuscitation tool in the emergency department. Recent studies have demonstrated that it can impact diagnosis and management of critically ill patients. The objective of this study is to determine the effectiveness of a simulation-based curriculum for teaching emergency medicine residents a five-view TEE protocol. METHODS: Emergency medicine residents with previous ultrasound experience were invited to attend a 1-hour TEE training session...

OBJECTIVES: Emergency medicine residents may be transitioning to practice with minimal training on how to supervise and assess trainees. Our study sought to examine: 1) physician comfort with supervision and assessment, 2) what the current training gaps are within these competencies, and 3) what barriers or enablers might exist in implementing curricular improvements. METHODS: Qualitative data were collected in two phases through individual interviews from September 2016 to November 2017, at the University of Toronto and McMaster University after receiving ethics approval from both sites...

OBJECTIVE: Emergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied. METHODS: We used administrative data to study all high-acuity Canadian Triage Acuity Scale 2-3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVES: Cannabis hyperemesis syndrome is characterized by bouts of protracted vomiting in regular users of cannabis. We wondered whether this poorly understood condition is idiosyncratic, like motion sickness or hyperemesis gravidarum, or the predictable dose-response effect of prolonged heavy use. METHODS: Adults with an emergency department visit diagnosed as cannabis hyperemesis syndrome, near-daily use of cannabis for ≥6 months, and ≥2 episodes of severe vomiting in the previous year were age- and sex-matched to two control groups: RU controls (recreational users without vomiting), and ED controls (patients in the emergency department for an unrelated condition)...

CLINICAL QUESTION: Is bougie use associated with increased first-pass success in emergency department (ED) intubations?Article chosen: Driver et al. The Bougie and First-Pass Success in the Emergency Department. Annals of Emerg Med 2017;70(4):473-478. OBJECTIVE: To compare data and assess whether bougie use is independently associated with first-pass success in ED intubations.

CLINICIAN'S CAPSULEWhat is known about the topic?Literature regarding the impact of incentive spirometry on patients with rib fractures is unclear; there are no recommendations for its use in the emergency department (ED).What did this study ask?The objective of this study was to assess the impact of incentive spirometry on delayed complications in patients with rib fractures in the ED.What did this study find?Unsupervised incentive spirometry use does not have a protective effect against delayed pulmonary complications after a rib fracture...

CLINICIAN'S CAPSULEWhat is known about the topic?Methoxyflurane is an inhalation analgesic with minimal sedative properties.What did this study ask?What is the success rate of methoxyflurane for acute anterior shoulder dislocation reduction and its impact on emergency department (ED) patient flow, as compared with propofol?What did this study find?Successful reduction was achieved in 80% of patients administered methoxyflurane; recovery time and ED length of stay was shorter, as compared with propofol sedation...

CLINICIAN'S CAPSULEWhat is known about the topic?A novel program was implemented to enhance the care provided by paramedics to patients with palliative goals of care.What did this study ask?This study asked about patient experience with the program and the comfort and confidence of paramedics to deliver this care.What did this study find?Patients praised the compassion of paramedics and staying home, and paramedics strongly agreed palliative care should be in their practice.Why does this study matter to clinicians?Knowledge of this program will support similar initiatives and increase access to care and death outside of the hospital setting...

CLINICIAN'S CAPSULEWhat is known about the topic?The influence of renal impairment upon emergency department-based outcomes in patients with atrial fibrillation or flutter (AFF) is unknown.What did this study ask?What was the impact of renal impairment upon adverse events (AE) and rate and rhythm control (RRC) attempts in emergency department (ED) AFF patients?What did this study find?When ED AFF patients with renal impairment are administered RRC, they have more than 10% excess AE risk.Why does this study matter to clinicians?Emergency physicians should be cautious about attempting RRC in ED AFF patients with renal impairment...

ABSTRACTCLINICIAN'S CAPSULEWhat is known about the topic?Palliative medicine is increasingly encountered in an emergency medicine setting, and emergency medicine residents desire further training in this field.What did this study ask?How many postgraduate emergency medicine programs in Canada have an existing palliative medicine curriculum?What did this study find?A minority (38.5%) of emergency medicine programs report having a formal palliative medicine curriculum, and the contents are variable.Why does this study matter to clinicians?It will be important to define how trainees will achieve competence in palliative medicine in the emergency department...

CLINICIAN'S CAPSULEWhat is known about the topic?Intravenous dextrose halts endogenous ketone production and is commonly recommended in dehydrated patients unable to tolerate oral intake.What did this study ask?Is there evidence that the addition of dextrose to intravenous fluids provides a clinically meaningful benefit in dehydrated patients?What did this study find?Intravenous dextrose has not been shown to provide any important benefit to patients in this setting, but further research is needed.Why does this study matter to clinicians?In dehydrated patients, clinicians should not feel obligated towards dextrose containing solutions, which may be more expensive and less readily available...

CLINICIAN'S CAPSULEWhat is known about the topic?Trauma recidivism rates range from 1% to 44%, yet the rate of major trauma recidivism is unknown at a provincial level.What did this study ask?What is the rate of major trauma recidivism in Nova Scotia, and what factors are associated with recidivism and mortality?What did this study find?Major trauma recidivism was infrequent; however, the adjusted odds of mortality were over three times greater for recidivists.Why does this study matter to clinicians?Screening and brief intervention in cases of major trauma involving violence or substance abuse may help reduce rates of recidivism...

CLINICIAN'S CAPSULEWhat is known about the topic?The rapid ultrasound for shock and hypotension (RUSH) exam has been suggested to help diagnose the etiology of undifferentiated shock.What did this study ask?What does the literature say regarding the diagnostic accuracy of the RUSH exam for shock etiology by subtype?What did this study find?The RUSH exam is better able to "rule in" than "rule out" most shock subtypes.Why does this study matter to clinicians?Diagnostic accuracy for shock evaluation can be improved with use of an ultrasound protocol, but additional clinical information should still be used...

No abstract text is available yet for this article.

CLINICIAN'S CAPSULEWhat is known about the topic?A lung ultrasound has good accuracy in finding the cause of acute dyspnea.What did this study ask?Can a simple lung ultrasound score, done early, detect dyspneic patients who will require intensive care?What did this study find?A modified lung ultrasound (MLUS) has very good accuracy in predicting intensive care unit admission and/or death.Why does this study matter to clinicians?Dyspneic patients with a high MLUS should be monitored and treated early.

No abstract text is available yet for this article.

Clinical questionDo patients with acute illness admitted to the hospital and treated with liberal oxygen therapy compared with those treated with conservative oxygen therapy have differences in mortality and morbidity?Article chosenChu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391(10131):1693-705. OBJECTIVES: To analyse the existing literature to assess the potential benefits or harms of supplemental oxygen use in acutely ill patients...