Can J Emerg Med
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The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Limited data support its use by other health care workers in children. Our objective was to determine the accuracy of the OAR when applied by non-physician providers (NPP). ⋯ The sensitivity of the OAR when applied by NPP's was very good. More training and practice using the OAR would likely improve NPP's inter-observer reliability. Our data suggest the OAR may be a useful tool for NPP's to apply prior to physician assessment.
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Case Reports
Bilateral nail gun traumatic brain injury presents as intentional overdose: A case report.
This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. ⋯ Although rare, penetrating head injuries have increased in recent decades. As neurological symptoms can be minimal and penetration wounds small, this type of injury could potentially be overlooked.
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Emergency medicine (EM) residents face many challenges during residency. Given the negative effects of residency training and the paucity of information on EM resident wellness experiences, we conducted a national survey to characterize the current landscape of Canadian EM resident wellness. ⋯ Canadian EM residents face a multitude of psychosocial and physical wellness challenges, while supports may not be adequate. Opportunities exist to further investigate resident wellness with validated tools, engage stakeholders, and advance the EM resident wellness agenda.
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ABSTRACTThis paper describes the development and implementation of the INFO (immediate, not for personal assessment, fast facilitated feedback, and opportunity to ask questions) clinical debriefing process. INFO enabled charge nurses to facilitate a group debriefing after critical events across three adult emergency departments (EDs) in Calgary, Alberta. Prior to implementation at our institutions, ED critical event debriefing was a highly variable event. ⋯ The INFO clinical debriefing process addresses two significant barriers to regular ED clinical debriefing: a lack of trained facilitators and the focus on physician-led debriefings. Our experience shows that a nurse-facilitated debriefing is feasible, can be successfully implemented in diverse EDs, and can be performed by relatively inexperienced debriefers. A structured approach means that debriefings are more likely to take place and become a routine part of improving team management of high stakes or unexpected clinical events.
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Case Reports
Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department.
Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. ⋯ He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.