CJEM
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To perform a province-wide evaluation of adult major traumas and determine the proportion of patients who met clinical and/or anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA). ⋯ In this registry-based retrospective analysis, 1.5% of adult major trauma patients Nova Scotia were REBOA candidates based on resuscitative clinical presentation, while 0.5% were candidates based on post hoc anatomical injury patterns. Our findings suggest that using clinical findings and bedside imaging modalities as criteria may overestimate the number of candidates for REBOA.
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Anaphylaxis is a condition that warrants an observation period after symptoms resolution to detect rare but life-threatening delayed complications. There is a need for evidence to identify patients who would benefit from prolonged observation time. The purpose of this review was to identify factors that may influence the need for longer observation in the emergency department. ⋯ Observation time should be based on the provider's best estimation of the risk of biphasic anaphylaxis, although no single factor can predict their occurrence. The identified factors will allow the development of an early discharge screening tool.
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The Canadian clinical practice guidelines propose a novel diagnostic pathway incorporating a clinical decision tool and D-dimer to aid in risk stratifying patients for acute aortic syndrome. The objective of this study was to assess if implementation of a diagnostic pathway incorporating D-dimer would increase the usage of D-dimer and computed tomography (CT) in a tertiary care emergency department. ⋯ This single centre study found that a diagnostic pathway for acute aortic syndrome including D-dimer could be implemented without a significant increase in test ordering during this first 2 weeks after implementation. This study adds to the argument for use of D-dimer to help risk stratify patients for the diagnosis of acute aortic syndrome. Future studies are needed to confirm the diagnostic accuracy of this pathway and the long-term impact on resource utilization.
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Letter Case Reports
Anaphylactic reaction following administration of topical eyedrops.