CJEM
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Kussmaul's sign, the absence of a drop in jugular venous pressure or a paradoxical increase in jugular venous pressure on inspiration, can be evaluated as an indicator of right ventricular myocardial infarction. Right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarctions and is associated with increased mortality when compared to inferior myocardial infarction without right ventricular involvement. Early recognition allows maintenance of preload. We reviewed the diagnostic test accuracy studies for Kussmaul's sign for diagnosis of right ventricular myocardial infarction. ⋯ In the presence of acute myocardial infarction, Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.
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Multicenter Study Observational Study
Decrease in emergency medical services utilization during early stages of the COVID-19 pandemic in British Columbia.
To date in the COVID-19 pandemic, there has been a decrease in patients accessing emergency health services, (EHS) but research has been conducted in areas with a very high incidence of COVID-19. In an area with a low COVID-19 incidence, we estimate changes in EHS use. ⋯ In a single province with a low incidence of COVID-19, there was a 15% reduction in overall EHS use and a 9% reduction in critical illness. EHS planners will need to match patient need with available resources.
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The Timely Chest Compression Training (T-CCT) was created to promote more frequent training in chest compressions for personal support workers. This study aims to assess the efficacy of the T-CCT on the chest compression performance and to examine costs related to this intervention. ⋯ The T-CCT was an effective and low-cost initiative that allowed to train a large group of support workers in a short amount of time. Since they are actively involved in resuscitation efforts in Quebec (Canada), it may promote the delivery of high-quality compressions during in-hospital cardiac arrests. Our inquiry can incite and guide other organizations in the implementation of similar interventions.
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The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. ⋯ Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.