Can J Emerg Med
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Multicenter Study Observational Study
Adverse events are rare among adults 50 years of age and younger with flank pain when abdominal computed tomography is not clinically indicated according to the emergency physician.
Many emergency physicians (EPs) order "confirmatory" abdominal computed tomography (CT) in young flank pain patients, despite a high clinical suspicion of renal colic and the risk of radiation exposure. We measured the adverse outcome rate among flank pain patients identified as not requiring abdominal CT by the EP on a data form, regardless of whether CT was eventually ordered. Our secondary objective was to describe diagnoses other than renal colic identified by CT in this population. ⋯ Adverse events were rare (< 1.5%) among patients < 50 years old with flank pain when CT was not required according to the clinical assessment of the EP. Future research should assess the adverse outcomes of withholding CT in low-risk patients using a larger patient sample.
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Observational Study
Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments.
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs. ⋯ MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.
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To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT). ⋯ Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policies may be unfounded, and further research in this area is warranted.
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We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. ⋯ Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of life-threatening complications.
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With the arrival of a technologically proficient generation of learners (often described with the moniker "digital natives") into Canadian medical schools and residency programs, there is an increasing trend toward harnessing technology to enhance education and increase teaching efficiency. We present an instructional method that allows medical educators to "reverse" the traditional classroom paradigm. Imagine that prior to an academic half-day session, learners watch an e-lecture on their own time; then during class, they do "homework" with tailored consultations from a content expert. ⋯ With this instructional method, the inefficient, repetitious delivery of recurring core lectures is no longer required. The reverse classroom is an effective instructional method. Using this technique, learners engage in high-order learning and interaction with teachers, and teachers are able to optimally share their expertise.