CJEM
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Multicenter Study
Risk of stroke is low after transient ischemic attack presentation with isolated dizziness.
Stroke presenting as dizziness is a diagnostic challenge in frontline settings, given the multitude of benign conditions that present similarly. The risk of stroke after episodic dizziness is unknown, leading to divergent guidance on optimal workup and management. Prior TIA risk scores have shown a history of dizziness is a negative predictor of subsequent stroke. Our objective was to assess the subsequent stroke risk within 90 days following emergency department assessment (ED) for isolated dizziness diagnosed as TIA during the index visit. ⋯ The risk of subsequent stroke following ED presentation for TIA is low when the presenting symptoms are isolated dizziness.
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This study investigates whether acute treatment with ibuprofen, acetaminophen, or both is associated with resolution of headache or reduction of headache pain at 7 days post-concussion in children and youth. ⋯ Exposure to ibuprofen, acetaminophen, or both in the acute phase does not decrease the risk of headache at 7 days post-concussion. Non-opioid analgesics like ibuprofen or acetaminophen may be prescribed for short-term headache relief but clinicians need to be cautious with long-term medication overuse in those whose headache symptoms persist.
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Randomized Controlled Trial
Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study.
A large vertical incision is recommended when performing front-of-neck access in patients with impalpable neck landmarks during a cannot intubate-cannot oxygenate (CICO) scenario. We investigated the impact of ultrasonography on vertical incision size of a front-of-neck access on an ultrasound-compatible impalpable porcine larynx model. ⋯ Ultrasound-guided identification of the cricothyroid membrane significantly reduced the recommended vertical incision size with similar success rates. However, there was an increased time when performing a Scalpel-Bougie-Tube cricothyroidotomy on an impalpable porcine larynx model by physicians in training. Ultrasonography should not be used in an emergency scenario of airway rescue. Its potential use to pre-mark the cricothyroid membrane should be considered in difficult airway management of impalpable neck.
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Canadian emergency departments (EDs) frequently provide care to patients undergoing early pregnancy loss. Unfortunately, in this setting, patients commonly have negative experiences, in part due to lack of appropriate follow-up and education on symptoms that may arise after discharge. In response to this gap, our team created a free, web-based, patient-informed educational platform for women to access accurate information on early pregnancy loss. This free and publicly accessible resource was launched in May 2022 at Mount Sinai Hospital in Toronto and was shared with EDs across Canada.
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There is mounting evidence of racial and ethnic discrimination in the Canadian health care system. Patient level race and ethnicity data are required to identify potential disparities in clinical outcomes and access to health care. However, it is not known what patient race, ethnicity, and language data are collected by Canadian hospitals. This gap limits opportunities to identify and address inequalities in the health care system. The emergency department (ED) is a major point of contact for many patients accessing the health care system, and is therefore a reasonable place to conduct analysis of patient data collection. This study aims to quantify the proportion of Canadian EDs that collect patient race, ethnicity, and primary language data. ⋯ The majority of Canadian EDs do not collect patient race, ethnicity, and language data. This gap limits our ability to identify inequalities in health outcomes or access to health care. Lack of race, ethnicity, and language data also hinders our ability to develop and evaluate programs and interventions that aim to correct these inequalities.