Can J Emerg Med
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Comparative Study
Emergency Department Visits after Diagnosed Chronic Obstructive Pulmonary Disease in Aboriginal People in Alberta, Canada.
This retrospective cohort study compared rates of emergency department (ED) visits after a diagnosis of chronic obstructive pulmonary disease (COPD) in the three Aboriginal groups (Registered First Nations, Métis and Inuit) relative to a non-Aboriginal cohort. ⋯ Aboriginal people with COPD use almost twice the amount of ED services compared to their non-Aboriginal counterparts. There are also important variations in patterns of ED services use among different Aboriginal groups with COPD in Alberta.
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Adult and pediatric emergency physicians have been using point-of-care ultrasound (POCUS) for many years. It is a fast, usually painless, noninvasive diagnostic tool that does not expose the patient to radiation. Information about its current implementation in pediatric emergency medicine (PEM) fellowship programs in Canada is lacking. ⋯ There is a wide variation in POCUS content and delivery across PEM fellowship programs, as well as differences in perceptions of current training and of needs by fellows and program directors. However, given that both groups feel POCUS is very important and essential for PEM training, the opportunity exists to develop a standardized curriculum across Canada.
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Cardiopulmonary resuscitation (CPR) is an inherently traumatic procedure. Successful resuscitations are often complicated by iatrogenic injuries to structures of the neck, thorax, or abdomen. ⋯ We describe a novel case of CPR-associated right ventricular rupture in a woman with acute-on-chronic pulmonary embolism and no known pre-existing cardiac disease. We propose that chest compressions in the setting of elevated right ventricular pressure resulted in cardiac rupture, in this case.
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Extracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation. ⋯ In our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.