The dedicated team of physicians, nurses and other health professionals provide an exceptional level of care, knowledge, skill and compassion for each patient we serve in the Emergency Departments of St. Paul’s and Mount St. Joseph’s Hospitals, part of Providence Health Care.
We provide comprehensive care for a wide range of patients and we strive to continuously improve how we treat acute illnesses and injuries.
We are committed to further promote the Academic Department of Emergency Medicine’s vision of improving emergency care for all British Columbians.
Neither WBC or Fever are Sensitive nor Specific indicators of Appendicitis. We should be wary of relying on these findings when assessing for Appendicitis.
Acad Emerg Med 2004; 11:1021–1027. (Link)
Describing an RCT of the effectiveness of a 3-in-1 Femoral Nerve Block performed in the ED in the setting of Femoral Neck Fractures. The authors conclude that it is effective and a readily acquirable skill.
Ann Emerg Med. 2003;41:227-233. (Link)
The Authors of this study conclude:
"Treatment with rFVIIa within four hours after the onset of intracerebral hemorrhage limits the growth of the hematoma, reduces mortality, and improves functional outcomes at 90 days, despite a small increase in the frequency of thromboembolic adverse events. "
N Engl J Med 2005;352:777-85. (Link)
This paper demonstrated a significant difference between Emergency Physicians' perception of CHF severity and severity determined by Brain Naturietic Peptide (BNP) levels. They also demonstrated a significant difference in outcomes (mortality and readmission) between mild and severe CHF as determined by BNP levels.
These 2 articles showed that CPR is not often performed per protocol. They stop short of showing that the quality of CPR affects pt outcomes, but this is strongly implied.
In Hospital CPR
JAMA. 2005;293:305-310. (Link)
Out of Hosptial CPR
JAMA. 2005;293:299-304. (Link)
This article concludes that:
"Hydration with sodium bicarbonate before contrast exposure is more effective than hydration with sodium chloride for prophylaxis of contrast-induced renal failure. "
JAMA. 2004;291:2328-2334. (Link)
This paper concludes:
" No association was found between preprocedural fasting and the incidence of adverse events occurring with procedural sedation and analgesia."
Ann Emerg Med. 2004;44:454-459. (Link)
The landmark article describing the "Pill-in-the-Pocket" approach to recurrent Atrial Fibrillation. They conclude:
"In a selected, risk-stratified population of patients with recurrent atrial fibrillation, pill-in-the-pocket treatment is feasible and safe, with a high rate of compliance by patients, a low rate of adverse events, and a marked reduction in emergency room visits and hospital admissions."
A Meta-analysis of outcomes in patients with suspected PE managed based on CT pulmonary angiography compared to those managed based on conventional pulmonary angiography. They conclude that the safety and subsequent venous thromboembolic disease is similar in both groups.
A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack:
A number of recent Articles looking at the utility of CAC and Cardiovascular Diseases:
Coronary Artery Calcium, Carotid Artery Wall Thickness, and Cardiovascular Disease Outcomes in Adults 70 to 99 Years Old. Am J Cardiol 2008;101:186 –192 (Link).
This is the guideline from the BC Centre for Excellence in HIV/AIDS and Providence Healthcare. It includes Risk Assessments, Counselling Guidelines, and Post-Exposure Prophylaxis Information.
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Comparing the cosmetic outcomes in pediatric laceration repair when using Plain Gut and Nylon sutures.
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Evidence for the benefit and safety of adding Clopidogrel to ASA in patients with Myocardial Infarction, particularly STEMI.
2007 ACC/AHA Update of the 2004 Guidelines for the Management of ST Elevation Myocardial Infarction (Link to Paper)
An interesting article from 2007 that asks "Does an elevated troponin always mean ACS?" And if not, then what does the troponin mean?
ACS vs Non-Specific Troponin Rise (Link)
Another study looking at Toponin rise in patients without ACS - they conclude this occurs often, but that a troponin rise is a predictor of poor short- and long-term outcomes.
Cardiac Troponin I Elevation in Hospitalized Patients Without
Acute Coronary Syndromes (Link)
