Can J Emerg Med
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Clinical questionCan an oral regimen of rivaroxaban be used for the treatment of symptomatic pulmonary embolism?Article chosenBüller H, Prins M, Lensing A, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012;366:1287-97. ObjectiveTo determine the effectiveness and safety of oral rivaroxaban in the treatment of symptomatic pulmonary embolism when compared to current standard therapy.
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ABSTRACTBackground:Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known. Methods:Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. ⋯ There was no significant difference in death (OR 1.3, 95% CI 0.6-2.9, p = 0.5) after adjustment. Conclusions:A positive troponin assay during ED stay in discharged patients is an independent marker of risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.
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ABSTRACTObjective:Despite evidence that patients suffering major traumatic injuries have improved outcomes when cared for within an organized system, the extent of trauma system development in Canada is limited. We sought to compile a detailed inventory of trauma systems in Canada as a first step toward identifying opportunities for improving access to trauma care. Methods:We distributed a nationwide online and mail survey to stakeholders intended to evaluate the extent of implementation of specific trauma system components. ⋯ Conclusion:There is significant variability in the extent of trauma system development in Canada. Although all provinces have designated trauma centres, opportunities exist in many systems to implement additional components to improve the inclusiveness of care. In future work, we intend to quantify the strength of the relationship between different trauma system components and access to definitive trauma care.
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ABSTRACTAlthough penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. ⋯ Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such guiding principles apply to all patients with PNI until the nature of the injury is more accurately defined. In this report, we present the case of a patient who presented to the ED with a zone II open PNI, which occurred as a result of a stab wound.
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ABSTRACTObjectives:Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. ⋯ No adverse events were observed in either group. Conclusion:In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.