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Clinical Posts and Updates

Welcome to our Clinical Section.

Here you will find Papers, Guidelines, Cases and other sources of Clinical Information.

If you have content you would like added, or you find out of date information, please let us know at:

Admin@sphemerg.ca.

Virtual Journal Club - The Chest Pain Pathway Paper

Tue, 05/08/2012 - 18:49 — traine

Virtual Journal Club

Dr Scheuermeyer and the reasearch group have recently published the validation of our beloved Chest Pain Pathway, in the Annals of Emergency Medicine.

This paper has the potential to change practice in EDs around the world, though as Dr Scheuermeyer can attest, there is significant resistance to the ideas presented in the paper especially with our American colleagues.

This paper has already been integrated into some high profile medical sites, being referenced in the Medscape Acute Coronary Syndrome article; is featured in Journal Watch; and garners a review by Ryan Radecki of the excellent EM Lit of Note Blog (follow on the blog and on Twitter - highly recommended).

The article can be found on:

PubMed PMID:22221842 (use this if you are at work or use UBC myVPN from home)

The Annals Website (use this if you have direct access to the journal online)



 

You're Going to put What, Where? The EZ-IO.

Tue, 04/24/2012 - 00:25 — traine

This is a post I have been meaning to write for over a year.  I recently discovered a trove of useful videos and documents about the EZ-IO, so it appears that the time is right.

I have used the EZ-IO a few times, with mixed success despite its reputation as being near idiot proof...

I am also fascinated by how squeamish people are with the idea of using a small needle well away from anything 'vital' (the IO), compared to using a 3-4 inch needle in and around someone's neck or groin...

So, here for your edification and mine, the EZ-IO Learning Primer:

Basic points:

1. Can only stay in for 24 hours.

2. Still have to use sterile technique (just sayin')

3. Can infuse just about anything that can go in a peripheral line (limit hypertonic saline to 30 min or less)

There is a 30 minute online Learning Tool here (you need to provide some info to be allowed in - name and where you work).  It goes over pretty much everything you need to know, including Lab test correlations.  You can navigate to individual slides if you want the Coles Notes version

The EZ-IO Training Page - this video is a long and cheesy ad, but a decent overview.

Only 2 of the PDFs listed in the side bar on the Training Page are of any use, and they both focus on the tibial plateau insertion: 1. How to Insert and Remove the System  2. Needle Sets Overview.

Much better are the YouTube videos:

The first 2 I will highlight are like the one on the Training Page - cheesy acting and music, but they cover both the Tibial and Humeral Insertiion techniques.

The next 3 are demos on real people (medical staff during their Haiti earthquake relief mission)

Next, learn from the mistakes of others.  YouTube superuser and Emergency Medicine junkie lmellick (160 videos - go look now, I'll wait) posts '6 Mistakes in Awake Adult IO Infusion'


Finally, if you need some flashy animation for a presentation, use this one (no Audio).

Virtual Journal Club - Early Repolarization or STEMI?

Mon, 04/23/2012 - 23:12 — traine

Virtual Journal Club

Dr Stephen Smith (University of Minnesota) is an Emergency Physician at Hennepin Medicial Centre.  He runs the most excellent Dr Smith's ECG Blog, a MUST READ Emergency Medicine Blog.

He and his colleagues have just published, in Annals of Emergency Medicine, an interesting article:

Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction

They have derived and validated a formula to aid in this often difficult situation.

Come on Cardiac & Research geeks, let us know what you think.

Review of Antidotes

Tue, 04/10/2012 - 05:35 — traine

Leon Gussow at The Poison Review points us to a 'superb' review of toxicological antidotes.  Read his take on this review here (please read this as he makes important points about specific areas of the article), and then leave you thoughts in the comments.

 

You can find the original here.

New Feature - Virtual Journal Club

Tue, 04/10/2012 - 05:34 — traine

In what I hope is not a vain attempt to make the site more useful and interactive, I will be featuring a variety of Emergency Medicine related articles.  I hope that many/some of you will read these articles.  Further, I hope that some/a few of you will take the time to login to the site and contribute your thoughts/concerns/critiques in the comments for each article.

The articles will be linked to via the UBC Library eLink.  This should work from within the hospital (theoretically).  If there are problems getting to the article, please let me know at <admin AT sphemerg DOT ca>

Creating Safety in the ED with Dr Garth Hunte

Mon, 03/12/2012 - 22:32 — traine
Creating Safety in an Emergency Department | UBC Centre for Health Care ManagementSt Paul's very own Dr Garth Hunte on Patient Safety in the ED.  If you have not seen or heard Garth give this talk (or one like it) before, please watch it now.
We should all be very aware of these issues, and how they arise.  Remember:
 
"...safety arises as a result of interactions between people."
 
so talk to each other, and let's keep our patient's and ourselves safe.

Ondansetron Interactions

Thu, 02/16/2012 - 20:11 — traine

Ondansetron vial crop

By Intropin (Own work)
[CC-BY-3.0 (www.creativecommons.org/licenses/by/3.0)],
via Wikimedia Commons

 

Ondansetron (Zofran) is being used more in our department (I know that I use it regularly, though rarely as a first-line agent). The most recent Clinical Pearl from the University of Maryland Department of Emergency Medicine  (umem.org) is a short review of Ondansetron's interactions.

Short Story - Prolongs QT.  Contraindicated in pt's on Cipro.

Ecstasy Alert

Fri, 01/06/2012 - 22:38 — traine

Ecstasy Alert (January 3, 2012) from Dr C Dewitt and Poison Control

We have had at least 8 serious cases of ecstasy toxicity in B.C. in the last 2 months, 3 of whom have died and 2 who are currently in critical condition. Hyperthermia (high body temperature) is the most serious symptom associated with ecstasy and can lead to seizures, brain damage, or death in some cases.

A review of the recent cases shows the following:

 

Hand Hygiene Peer Review

Mon, 10/03/2011 - 16:16 — traine

As part of the Emergency Department’s ongoing commitment to improving Hand Hygiene practices, the ED has agreed to support this pilot project for Hand Hygiene Peer Review. In the last quarter, the ED Hand Hygiene Compliance rate increased from 44% to 58%. Congratulations!

 

Goal of this project:

To increase staff awareness and understanding of the why when and how of hand hygiene and to decrease hospital acquired infections (VRE, MRSA, CDI etc) as a result.

 

How do I participate in this project?

Using the pilot PHC – Hand Hygiene Peer Review Tool, you observe a colleague while they practice hand hygiene and provide them with feedback.  Ideally each staff member will have the opportunity to observe and be observed.

There will be 4 binders of blank peer review tool forms for use. There will be staff lists in the binders located in the Acute and Fast Track areas.  Please check off your name when you have been observed and each time you have been the observer. Once the forms are completed, please slide them under the CNL’s office door (room 134) or place them in Kirsten Fuller’s mailbox. 

 

What is the benefit to me?

Each time you observe a colleague, your name will be entered into a monthly draw for an iTouch – once you have been observed try to observe more than one colleague per shift.

Allows you to be professionally supported and learn from others to improve your practice.

Obtaining peer feedback during this project will help you meet your professional practice standards.

 

 Where can I learn more?

You can also contact Kirsten Fuller or IPAC for details (IPAC 69357).