CJEM
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The history, ECG, age, risk factor (HEAR) score has been proposed to identify patients at sufficiently low risk of acute coronary syndrome that they may not require troponin testing. The objective of this study was to externally validate a low HEAR score to identify emergency department (ED) patients with chest pain at very low risk of 30-day major adverse cardiac events (MACE). ⋯ A HEAR score ≤ 1 can identify more than 17% of all patients as very low risk for index AMI and 30-day MACE and unlikely to benefit from troponin testing. Broad implementation of this strategy could lead to significant resource savings.
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The primary objective of this study is to identify emergency physician reported barriers to initiating patients on buprenorphine/naloxone in the emergency department (ED) for treatment of opioid use disorder. Secondary objectives include (1) physician reported attitudes about initiating buprenorphine/naloxone in the ED, and (2) comparison of barriers reported based on urban versus rural practice setting. ⋯ In this convenience sample of physicians working in urban and rural Canadian emergency departments, most physicians perceive barriers that inhibit their ability to initiate buprenorphine/naloxone for patients with opioid use disorder, but overall there is support for making changes to better facilitate this practice.
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Intranasal dexmedetomidine is a potentially effective anxiolytic but its role in pediatric laceration repair is only emerging. Future trials and clinical adoption of intranasal dexmedetomidine depend on understanding pediatric emergency providers' practice patterns surrounding anxiolysis and perceived barriers to intranasal dexmedetomidine for anxiolysis during suture repair in children. Our objectives were to characterize these parameters to inform future research and facilitate clinical adoption. ⋯ Most Canadian pediatric emergency providers believe that laceration repair in a young child is distressing. Despite questionable efficacy, most would provide intranasal benzodiazepines, but would consider intranasal dexmedetomidine if there was evidence of benefit.
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In 2018, Canadian post-graduate Emergency Medicine (EM) programs transitioned to Competence-by-Design. Residents are now assessed using Entrustable Professional Activities (EPAs). We developed and implemented simulation for assessment to mitigate anticipated challenges with residents completing the required number of observations of resuscitation-based EPAs. Our survey of trainees who participated in these sessions suggests that it may be a feasible and acceptable method for EPA assessment.