Hans Rosenberg, Ariel Hendin, Erin Rosenberg
A 67-year-old male presents to the emergency department (ED) in respiratory distress secondary to pneumonia. His oxygen saturation is 86% on a nonrebreather, respiratory rate is 32 respirations/minute, blood pressure 147/72 mmHg, heart rate 121 beats/minute, and temperature is 38.7° Celsius. The decision is made to intubate the patient. Fentanyl and propofol are used for analgesia and sedation, and rocuronium is used for paralysis. Using video laryngoscopy, the patient is successfully intubated, and now the ED team is awaiting your orders for the postintubation sedation care of this patient...
October 8, 2020: CJEM
Justin J Koh, Michelle Klaiman, Isabelle Miles, Jolene Cook, Thara Kumar, Hasan Sheikh, Kathryn Dong, Aaron M Orkin, Samina Ali, Elizabeth Shouldice
Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth...
October 8, 2020: CJEM
Patrick McLane, Ken Scott, Zainab Suleman, Karen Yee, Brian R Holroyd, Kathryn Dong, S Monty Ghosh, Josh Fanaeian, Jan Deol, Catherine Biggs, Eddy Lang, Heather Hair, Marshall Ross, Rob Tanguay, Asha Olmstead, Andrew Fisher, Scott Fielding
BACKGROUND: Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence. METHODS: The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics...
September 14, 2020: CJEM
Chase Krook, Domhnall O'Dochartaigh, Doug Martin, Zoë Piggott, Ryan Deedo, Sarah Painter, Gennifer vanWerkhoven, Darcy McKay, Dennis Nesdoly, J N Armstrong
No abstract text is available yet for this article.
September 11, 2020: CJEM
Brit Long, Elisha Targonsky, Alex Koyfman
A 23-year-old female presents with right lower quadrant pain that has been intermittent for the past several days. The pain suddenly worsened 1 hour ago. She denies vaginal bleeding or discharge, dysuria, fever, and back pain, but she has had several episodes of nausea with nonbloody, nonbilious vomiting. On examination, she is tender in the right lower quadrant, but her abdomen is not rigid.
September 11, 2020: CJEM
Michael K P Hale, Jason R Frank, Warren J Cheung
OBJECTIVE: Little is known about how the Royal College of Emergency Medicine (RCEM) residency programs are selecting their residents. This creates uncertainty regarding alignment between current selection processes and known best practices. We seek to describe the current selection processes of Canadian RCEM programs. METHODS: An online survey was distributed to all RCEM program directors and assistant directors. The survey instrument included 22 questions and sought both qualitative and quantitative data from the following six domains: application file, letters of reference, elective selection, interview, rank order, and selection process evaluation...
August 25, 2020: CJEM
Rajiv S Thavanathan, Michael Y Woo, Greg Hall
No abstract text is available yet for this article.
August 12, 2020: CJEM
Shannon M Fernando, Brian Grunau, Daniel Brodie
A 58-year-old man is brought by the ambulance to the emergency department (ED) of a tertiary care centre following an out-of-hospital cardiac arrest. Paramedics were called by the patient's wife after he had collapsed. She immediately initiated cardiopulmonary resuscitation (CPR). Prior to his collapse, he had been complaining of chest pain. His initial rhythm in the field was ventricular fibrillation, and he received defibrillation. An automated CPR device was applied prior to transport. En route, return of spontaneous circulation is achieved...
August 12, 2020: CJEM
Brodie Nolan
No abstract text is available yet for this article.
August 3, 2020: CJEM
Kiran L Grant, Dongjoo Lee, Ivy Cheng, G Ross Baker
BACKGROUND: In Canada, there were over 60,000 long-term care facility patient transfers to emergency departments (EDs) in 2014, with up to a quarter of them being potentially preventable. Each preventable transfer exposes the patient to transport- and hospital-related complications, contributes to ED crowding, and adds significant costs to the health care system. There have been many proposed and studied interventions aimed at alleviating the issue, but few attempts to assess and evaluate different interventions across institutions...
August 3, 2020: CJEM
Gord McEachen
No abstract text is available yet for this article.
August 3, 2020: CJEM
Colin Laverty, Homer Tien, Andrew Beckett, Avery Nathens, J P Rivest-Caissy, Luis Teodoro da Luz
OBJECTIVES: Military Forward Aeromedical Evacuation and civilian Helicopter Emergency Medical Services are widely used to conduct Primary Aeromedical Retrieval. Crew composition in Primary Aeromedical Retrieval missions varies considerably. The ideal composition is unknown. Thus, we conducted a descriptive systematic review on mortality and other outcomes for different Primary Aeromedical Retrieval crew compositions. METHODS: Medline, Embase, and Cochrane Controlled Trials Register were searched up to January 2020...
September 2020: CJEM
Barto Nascimento, Jerrold H Levy, Homer Tien, Luis Teodoro Da Luz
OBJECTIVES: The management of acquired coagulopathy in multiple clinical settings frequently involves fibrinogen supplementation. Cryoprecipitate, a multidonor product, is widely used for the treatment of acquired hypofibrinogenemia following massive bleeding, but it has been associated with adverse events. We aimed to review the latest evidence on cryoprecipitate for treatment of bleeding. METHODS: We conducted a narrative review of current literature on cryoprecipitate therapy, describing its history, formulations and preparation, and recommended dosing...
September 2020: CJEM
Alanna Wong, Aidan McParland, Brodie Nolan
OBJECTIVES: Population density can limit the level of care that can be provided in local facilities in Ontario, and as such, patients with severe illnesses often require interfacility transfers to access specialized care. This study aimed to identify causes of delay in interfacility transport by air ambulance in Ontario. METHODS: Causes of delay were identified by manual review of electronic patient care records (ePCRs). All emergent interfacility transfers conducted by Ornge, the sole provider of air-based medical transport in Ontario, between January 1, 2016 and December 31, 2016 were included...
September 2020: CJEM
Arshia P Javidan, Avery B Nathens, Homer Tien, Luis T da Luz
OBJECTIVES: There has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance. METHODS: Data were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers...
September 2020: CJEM
Russell D MacDonald, Aliya Ramjaun
OBJECTIVES: Early administration of blood products to patients with hemorrhagic shock has a positive impact on morbidity and mortality. Smaller hospitals may have limited supply of blood, and air medical systems may not carry blood. The primary outcome is to quantify the number of patients meeting established physiologic criteria for blood product administration and to identify which patients receive and which ones do not receive it due to lack of availability locally. METHODS: Electronic patient care records were used to identify a retrospective cohort of patients undergoing emergent air medical transport in Ontario, Canada, who are likely to require blood...
September 2020: CJEM
Russell D MacDonald, Michael Lewell, Sean Moore, Andy Pan, Michael Peddle, Bruce Sawadsky
The role of air medical and land-based critical care transport services is not always clear amongst traditional emergency medical service providers or hospital-based health care practitioners. Some of this is historical, when air medical services were in their infancy and their role within the broader health care system was limited. Despite their evolution within the regionalized health care system, some myths remain regarding air medical services in Canada. The goal is to clarify several commonly held but erroneous beliefs regarding the role, impact, and practices in air medical transport...
September 2020: CJEM
D Gregory Powell, Andrew L McCallum
No abstract text is available yet for this article.
September 2020: CJEM
Justin Godbout, Sean W Moore, Bruce Sawadsky, Andy Pan, Christian Vaillancourt
OBJECTIVES: We aimed to determine the rate of adverse events during interfacility transport of cardiac patients identified as low risk by a consensus-derived screening tool and transported by primary care flight paramedics (PCP(f)). METHODS: We conducted a health records review of adult patients diagnosed with a cardiac condition who were identified as low risk by the screening tool and transported by PCP(f). We excluded patients transported by an advanced care crew, those accompanied by a clinical escort from hospital, and those transported from a scene call, by rotary wing or ground vehicle...
September 2020: CJEM
Andrew Quirion, Mahvareh Ahghari, Brodie Nolan
OBJECTIVE: Timely access to definitive care is associated with improved outcomes in trauma patients. The goal of this study is to identify patient, institutional and paramedic risk factors for non-optimal resource utilization for interfacility transfers of injured adult patients transported by air ambulance to a LTC. METHODS: This is a retrospective cohort study of adult emergent interfacility transports via Ornge with data collected on patient demographics, clinical status, sending facilities, transport details and paramedic qualifications...
September 2020: CJEM
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