Can J Emerg Med
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Although alcohol withdrawal is common, the recognition of benzodiazepine-resistant alcohol withdrawal is a relatively new concept. To provide a framework for both literature review and future research, we assessed clinicians' personal definition of resistant alcohol withdrawal. ⋯ Our results did not identify one single preferred definition for resistant alcohol withdrawal even though a high total dose of benzodiazepine is a major component. Hourly requirements of 40 mg of diazepam equivalents or more emerged as a possible threshold. These findings serve as a base to explore consensus guidelines or future research.
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The aims of this study were to describe emergency department (ED) utilization by people in provincial prison and on release, and to compare with ED utilization for the general population. ⋯ People experiencing imprisonment in Ontario have higher ED utilization compared with matched people in the general population, primarily for urgent issues, and particularly in women and in the week after release. Providing high-quality ED care and implementing prison- and ED-based interventions could improve health for this population and prevent the need for ED use.
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Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents' perspectives on the level of QIPS education and support available to them. ⋯ Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
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Case Reports
Just the facts: Hypertonic saline is just as good as (and probably better than) mannitol.
A 27-year-old female is brought to the emergency department (ED) by ambulance following a motor vehicle collision at highway speed. She was the belted driver. She has no significant past medical history and is on no medications. Following a prolonged extrication, she is intubated due to decreased level of consciousness before transport.
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Case Reports
Just the facts: Organ donation in the emergency department: When you can't save one, save eight.
A 16-year-old female presents to a community emergency room following a suicide attempt by hanging. Prehospital, on arrival of paramedics, the patient was in a pulseless electrical activity rhythm. Paramedics provided advanced cardiac life support for 20 minutes before they obtained return of spontaneous circulation. ⋯ Her neurological exam shows pupils to be 3 mm and fixed bilaterally, absent cough and gag, and no response to central or peripheral pain. She occasionally triggers 2-3 spontaneous breaths per minute above the set rate on the ventilator. Her CT head scan shows severe anoxic changes and cerebral edema.