Can J Emerg Med
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Four percent of ST-elevation myocardial infarctions (STEMIs) are complicated by an out-of-hospital cardiac arrest (OHCA). Research has shown that shorter time to initial defibrillation in patients with ventricular fibrillation/tachycardia (VF/VT) arrests increases favourable neurologic survival. The purpose of this study is to determine whether routine application of defibrillation pads in patients with prehospital STEMI decreases the time to initial defibrillation in those who suffer OHCA. ⋯ Routine application of defibrillation pads in STEMI patients who suffer OHCA decreases time to initial defibrillation, which has previously been demonstrated to increase favourable neurologic survival.
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Oral health is an important part of an individual's overall health; however, dental care is not included in the Canadian public healthcare system. Many Canadians struggle to access dental care, and six million Canadians avoid visiting the dentist each year due to cost.1 The most vulnerable groups include children from low-income families, low-income adults, seniors, indigenous communities, and those with disabilities.1-5 The lack of affordable, equitable, and accessible dental care puts undue strain on emergency departments across the country, as patients desperately seek the care of a physician when they actually need the care of a dental professional.6 Emergency physicians do not have the same expertise or equipment as dentists and, in most cases, are only able to provide temporary symptom relief. This results in an increased reliance on prescription opioids that would otherwise be unnecessary if patients could access the dental care they required.
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Case Reports
Just the Facts: Diagnosis and treatment of diabetic ketoacidosis in the emergency department.
A 21-year-old male with known type 1 diabetes mellitus presented to the emergency department (ED) with two days of vomiting, polyuria, and polydipsia after several days of viral upper respiratory tract infection symptoms. Since his symptom onset, his home capillary blood glucose readings have been higher than usual. On the day of presentation, his glucometer read "high," and he could not tolerate oral fluids. ⋯ He was afebrile, and the remaining vital signs were normal. Other than dry mucous membranes, his cardiopulmonary, abdominal, and neurologic exams were unremarkable. Venous blood gas demonstrated a pH of 7.25 mm Hg, pCO2 of 31 mm Hg, HCO3 of 13 mm Hg, anion gap of 18 mmol/L, and laboratory blood glucose of 40 mmol/L, as well as serum ketones measuring "large."
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In June of 2016, the Collaborative Working Group (CWG) on the Future of Emergency Medicine presented its final report at the Canadian Association of Emergency Physicians (CAEP) annual meeting in Quebec City. The CWG report made a number of recommendations concerning physician Human Health Resource (HHR) shortfalls in emergency medicine, specific changes for both the Royal College of Physicians and Surgeons of Canada (FRCPC) and the College of Family Physicians of Canada (CCFP-EM) training programs, HHR needs in rural and remote hospitals, future collaboration of the CCFP-EM and FRCPC programs, and directions for future research. All recommendations were endorsed by CAEP, the Royal College of Physicians and Surgeons of Canada (RCPSC), and the College of Family Physicians of Canada (CFPC). ⋯ We believe that goals 1 and 2 can largely be accomplished by the CAEP annual meeting in 2020, and goal 3 by the CAEP annual meeting in 2021. Goal 4 is ongoing with both the RCPSC and the CFPC. We urge the EM community across Canada to engage with our committee to support improved access and EM care for all Canadians.