Can J Emerg Med
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ABSTRACTA young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. ⋯ After 36 hours of ECMO (including 12 hours of electrical asystole), the patient's electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later.
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ABSTRACTObjectives:Requests for specialty consultation are common in emergency departments (EDs) and often contribute to delays in throughput. Our objectives were to describe the contribution of the consultation process to total ED length of stay (LOS) through novel metrics and illustrate causes of delay. Methods:We conducted a prospective cross-sectional study at three Canadian tertiary care centres. ⋯ Conclusion:The consultation process is highly variable and has an important impact on ED LOS. We describe novel measures related to consultation performance and provide an analysis of what causes delays. These results can be used to seek improvements in the consulting process.
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ABSTRACTTraumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.
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ABSTRACTObjectives:To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods:This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment. ⋯ Conclusions:When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.