Can J Emerg Med
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Randomized Controlled Trial Multicenter Study
Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial.
We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days. ⋯ The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.
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We aimed to use the consensus opinion of a group of expert emergency physicians to derive a set of emergency diagnoses for acute abdominal pain that might be used as clinically significant outcomes for future research. ⋯ Our study identifies a set of abdominal pain conditions considered by expert emergency physicians to be clinically important to diagnose during the initial ED visit. These diseases may be used as "clinically significant" outcomes for future research on abdominal pain.
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Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta. ⋯ Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.
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We sought to characterize the perceptions of emergency medicine (EM) residents and fellows of their clinical and procedural competence, as well as their attitudes, practices and perceived barriers to reporting these perceptions to their supervisors. ⋯ Emergency medicine trainees report that they frequently do not feel competent when undertaking responsibilities without supervision. Barriers to reporting these feelings or reporting adverse events appear to relate to social pressures and authority gradients. Modifications to the training culture are encouraged to improve patient safety.
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We examined the records of patients presenting to the emergency department (ED) with low-impact pelvic fractures. We describe frequency, demographics, management and patient outcomes in terms of ambulatory ability, living independence and mortality. ⋯ Low-impact pelvic fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of time and resources in the ED are used during the workup of these patients and while awaiting their disposition from the ED. These injuries are important because they affect independence and seem associated with an increased risk of death.