Can J Emerg Med
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To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions. ⋯ ACS is a limb-threatening condition for which early intervention is critical. Substantial delays occur after the time of patient presentation. For traumatic and non-traumatic ACS, increased physician awareness and faster operating room access may reduce treatment delays and prevent disability.
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Undergraduate and postgraduate emergency medicine (EM) education has developed rapidly over the last 20 years. Our objective was to establish a national educational inventory, cataloguing the human and financial resources provided to EM programs by Canadian faculties of medicine. ⋯ Despite major teaching and clinical responsibilities within the faculties of medicine, Canadian EM programs are poorly supported. Further investment of human and financial and human resources is required.
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Current evidence suggests that, in a small subset of acute stroke patients who can be treated within 3 hours of symptom onset, the administration of tissue plasminogen activator (tPA) confers a modest outcome benefit, but that this benefit is associated with an increased risk of intracranial hemorrhage that can be severe or fatal. The data show that tPA therapy must be limited to carefully selected patients within established protocols. Further evidence is necessary to support the widespread application of stroke thrombolysis outside research settings. ⋯ In such centres, emergency physicians should identify eligible patients, initiate low risk interventions and facilitate prompt computed tomography. Only physicians with demonstrated expertise in neuroradiology should interpret head CT scans used to determine whether to administer thrombolytic agents to stroke patients. Neurologists should be directly involved prior to the thrombolytic administration.
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Few health care professionals realize that topical anesthetic spray can cause methemoglobinemia. We describe a 56-year-old woman who was transferred to our emergency department when severe cyanosis and chest pain developed after administration of topical oropharyngeal benzocaine and lidocaine during outpatient endoscopy. ⋯ This article presents a detailed discussion of the pathophysiology, diagnosis and treatment of methemoglobinemia, as well as a qualitative systematic review of the English literature on methemoglobinemia induced by topical anesthetic. The implications of this condition for emergency physicians are also outlined.