Can J Emerg Med
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The Ottawa Ankle Rules (OAR) are a clinical decision tool used to minimize unnecessary radiographs in ankle and foot injuries. The OAR are a reliable tool to exclude fractures in children over 5 years of age when applied by physicians. Limited data support its use by other health care workers in children. Our objective was to determine the accuracy of the OAR when applied by non-physician providers (NPP). ⋯ The sensitivity of the OAR when applied by NPP's was very good. More training and practice using the OAR would likely improve NPP's inter-observer reliability. Our data suggest the OAR may be a useful tool for NPP's to apply prior to physician assessment.
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Comment
Topical tranexamic acid for the treatment of epistaxis in patients using antiplatelet agents.
ABSTRACTClinical questionDoes the addition of topical tranexamic acid to anterior nasal packing decrease bleeding in patients with epistaxis who are taking antiplatelet medications?Article chosenZahed R, Jayazeri M, Naderi A, et al. Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized controlled trial. Acad Emerg Med 2018;25(3):261-6.
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Emergency medicine (EM) residents face many challenges during residency. Given the negative effects of residency training and the paucity of information on EM resident wellness experiences, we conducted a national survey to characterize the current landscape of Canadian EM resident wellness. ⋯ Canadian EM residents face a multitude of psychosocial and physical wellness challenges, while supports may not be adequate. Opportunities exist to further investigate resident wellness with validated tools, engage stakeholders, and advance the EM resident wellness agenda.
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ABSTRACTThis paper describes the development and implementation of the INFO (immediate, not for personal assessment, fast facilitated feedback, and opportunity to ask questions) clinical debriefing process. INFO enabled charge nurses to facilitate a group debriefing after critical events across three adult emergency departments (EDs) in Calgary, Alberta. Prior to implementation at our institutions, ED critical event debriefing was a highly variable event. ⋯ The INFO clinical debriefing process addresses two significant barriers to regular ED clinical debriefing: a lack of trained facilitators and the focus on physician-led debriefings. Our experience shows that a nurse-facilitated debriefing is feasible, can be successfully implemented in diverse EDs, and can be performed by relatively inexperienced debriefers. A structured approach means that debriefings are more likely to take place and become a routine part of improving team management of high stakes or unexpected clinical events.
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Tibial fractures are common in children less than 3 years old. The traditional management involves immobilization in an above knee cast for both confirmed (positive x-ray) and presumed (normal x-ray) toddler's fractures. This carries health care implications and causes unnecessary burden for patients and their families. There is a paucity of literature describing the ideal immobilization strategy for this injury. ⋯ Our study is the first to identify nationwide variation in the management of toddler's fractures. This variation highlights the need for future research to compare the different management strategies to determine families' preferences and functional outcomes in children with these injuries.