CJEM最新文献

{"title":"Understanding key strategies for exemplary leadership in high stakes emergency department clinical scenarios: a qualitative descriptive study.","authors":"Matthew Hacker Teper, Csilla Kalocsai, Lowyl Notario, Nicole Kester","doi":"10.1007/s43678-025-00989-0","DOIUrl":"10.1007/s43678-025-00989-0","url":null,"abstract":"<p><strong>Purpose: </strong>Emergency department (ED) care often requires the collaboration of team members who are recruited in ad hoc ways to preserve the lives of rapidly deteriorating patients. These moments are described as \"high stakes\" for their time-sensitive, complex, stressful, and emotional nature. The purpose of this manuscript is to describe how exemplary ED leaders and team members perceive optimal clinical leadership in high stakes moments.</p><p><strong>Methods: </strong>Semi-structured interviews were completed with 15 exemplary emergency department staff (Eight physicians, seven team members), as identified by their colleagues. The participants were asked to describe their perspectives on effective leadership in high stakes clinical moments and to explore strategies that leaders can perform to optimize team function. Data were analyzed via a qualitative descriptive approach with thematic analysis.</p><p><strong>Results: </strong>Exemplary ED leaders and team members jointly identified seven strategies that may be used in high stakes clinical ED care: (1) identifying and organizing resuscitation resources in anticipation of high stress moments, (2) declaring a single resuscitation leader, (3) checking in with team to gather input and feedback, (4) delegating tasks in manageable ways that reflect team member preference and competency, (5) maintaining a quiet room while exuding calm and confident energy, (6) adapting leadership strategies to fit the needs of the team, and (7) anticipating future directions while maintaining broad perspectives.</p><p><strong>Conclusion: </strong>Strategies identified in this manuscript provide detailed descriptions of how exemplary leaders can optimize team function during high stakes clinical ED patient care. The analysis also uncovers nuanced differences between leader expectations and team member preferences that should be considered in future high stakes clinical moments. The lessons learned may be relevant to informing the ongoing training of current and future ED personnel who wish to improve their clinical and resuscitative leadership.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating utilization and satisfaction of a pilot video-interpretation service in the emergency department.","authors":"Nadine Eltayeb, Nicolas Woods, Lawrence Yau","doi":"10.1007/s43678-025-00919-0","DOIUrl":"10.1007/s43678-025-00919-0","url":null,"abstract":"<p><strong>Introduction: </strong>Language barriers in healthcare settings have been associated with medical errors, increased resource utilization, re-admissions, poor health outcomes, and decreased patient satisfaction. There is considerable variability in how interpretation services are delivered in emergency departments (ED) and healthcare institutions across Canada. This study is one of the first to examine healthcare providers' utilization and satisfaction of these services.</p><p><strong>Methods: </strong>We administered cross-sectional surveys to ED physicians prior to, and to both physicians and nurses after the implementation of a pilot video-based interpretation service. Likert scales were used to examine utilization and satisfaction. Descriptive statistics were used to summarize characteristics. Mann-Whitney U tests and Wilcoxon-Signed Rank tests were used to compare utilization and satisfaction between phone and video interpretation services. Thematic analysis was performed on open-ended questions to examine barriers, improvements and suggestions described by healthcare providers.</p><p><strong>Results: </strong>46/112 physicians responded to the phone-based interpretation survey, and 32/113 physicians and 48/272 nurses responded to the video-based interpretation survey. Video-based interpretation was rated significantly higher than phone interpretation amongst healthcare providers across all domains including reliability, accuracy, ease of use, efficiency and satisfaction (p < 0.05). Nurses used video-based interpretation services significantly more often than phone-based interpretation services (p < 0.05). Thematic analysis revealed that healthcare providers described an improvement in accessibility of interpretation services and improved quality with the implementation of the video-based interpretation services; healthcare providers also felt that there should be better access to interpretation devices and more education surrounding the use of such devices.</p><p><strong>Conclusion: </strong>This study suggests that healthcare providers were more satisfied with video-based interpretation services and utilized it more often when compared to the phone-based interpretation service available in the ED. This study will help guide effective ED interpretation programs and promote equitable outcomes for patients with limited English proficiency across Canada.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"643-652"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary apoplexy, syndrome of inappropriate antidiuretic hormone secretion, and adrenal insufficiency in a 29-year-old male: case report.","authors":"David Fine, John Teijido, Matthew Treat, Rebecca Walsh","doi":"10.1007/s43678-025-00934-1","DOIUrl":"10.1007/s43678-025-00934-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"661-664"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedics and opioid use disorder: the case for a \"Lights and Sirens\" response.","authors":"Mark Froats, Michael A Austin","doi":"10.1007/s43678-025-00946-x","DOIUrl":"10.1007/s43678-025-00946-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"592-595"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast doesn't equal safe: rethinking sedation, risk, and responsibility in the field.","authors":"Michael A Austin, Justin Godbout, Andy Pan","doi":"10.1007/s43678-025-00977-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00977-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"578-579"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast-tracking falls - expediting emergency care with evidence.","authors":"Isabelle Gray, Kerstin de Wit","doi":"10.1007/s43678-025-00970-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00970-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"580-581"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic-initiated opioid agonist therapy: thinking beyond the first dose.","authors":"David Jerome, Sabrina Slade, Sean W Moore","doi":"10.1007/s43678-025-00960-z","DOIUrl":"https://doi.org/10.1007/s43678-025-00960-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"575-577"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic use of ketamine for severe agitation and violence.","authors":"Jonathan L Kwong, P Richard Verbeek, Yuen Chin Leong, Linda Turner, Maud Huiskamp, Ian R Drennan, Sarah Francom, Sarah Ropp, Sheldon Cheskes","doi":"10.1007/s43678-025-00963-w","DOIUrl":"10.1007/s43678-025-00963-w","url":null,"abstract":"<p><strong>Objectives: </strong>Safety of prehospital ketamine use for the management of violent and agitated patients remains controversial. In 2018, Ontario introduced a prehospital medical directive for ketamine use in emergency sedation. Our aim was to report the indications and adverse events of prehospital ketamine use.</p><p><strong>Methods: </strong>We completed a manual health records review of all electronic patient care records from three paramedic services (Peel, Simcoe and Halton) reporting ketamine administration from January 1, 2018 to May 31, 2022. Clinical indications, dosing, adverse events, and interventions to manage complications associated with ketamine administration were abstracted and analyzed using descriptive and bivariate statistics.</p><p><strong>Results: </strong>Of 332 cases identified, 19 cases were excluded (final sample = 313). The most common indication for ketamine use was for endogenous causes (e.g., drug-induced psychosis, agitation from brain injury, delirium) (82.1%), followed by procedural sedation (9.6%) and analgesia (8.3%). When ketamine was administered as the first sedative, it was most often given intramuscularly (81.5%) with an average dose of 4.2 mg/kg. There were no vital signs documented prior to administration in 34% of cases. 30.3% (N = 82) of cases had adverse events after ketamine was given. Hypoxia (15.4%), airway compromise (14.8%), and secretions/emesis (7.0%) were most common. When ketamine was used as the first sedative, 19.6% of patients received oxygen, 11.8% had an airway adjunct (oro- or nasopharyngeal airway) and 5.5% required bag-mask-ventilation. Advanced airways were inserted in six patients. There were three cardiac arrests after ketamine use.</p><p><strong>Conclusions: </strong>Prehospital ketamine is primarily used to sedate patients demonstrating severe violence or agitation related to various endogenous causes. Over 30% of patients develop adverse events after receiving ketamine. Although uncommon, we identified cases where patients required advanced airway placement and had cardiac arrest after ketamine administration. Paramedics should be prepared for the frequent number of adverse events after ketamine use.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"653-660"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirofiban for stroke without large- or medium-sized vessel occlusion.","authors":"Lauren Roberts, Shayan Shirazi, Brett Graham, Rob Woods","doi":"10.1007/s43678-025-00915-4","DOIUrl":"10.1007/s43678-025-00915-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"603-604"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of emergency physician adherence to standardized pulmonary embolism testing.","authors":"Yi Fan Kang, Sahar Zarabi, Elena Tataru, Natasha Clayton, Jocelyn Kuber, Yang Hu, Shriya Baweja, Fayad Al-Haimus, Haydar Al-Tukmachi, Federico Germini, Kerstin de Wit","doi":"10.1007/s43678-025-00930-5","DOIUrl":"10.1007/s43678-025-00930-5","url":null,"abstract":"<p><strong>Objectives: </strong>An evidence-based pathway for pulmonary embolism testing was implemented in two academic emergency departments as part of a prospective management study (the PEGeD study). This study aimed to identify factors associated with emergency physicians not following (deviating from) the PEGeD pulmonary embolism testing pathway.</p><p><strong>Methods: </strong>This was a health records review of cases from the PEGeD study which enrolled emergency patients with suspected pulmonary embolism. Emergency physicians documented the Wells score on hard-copy PEGeD pathway forms which guided the use of diagnostic imaging. Patient visits were classified as having pulmonary embolism testing adhering to or else deviating from the PEGeD pathway. Patient data were collected from electronic medical records. We calculated adjusted odds ratios (aORs) for prespecified predictors of deviation: patient age, patient sex, arrival day of week, arrival time of day, documented hypotension, higher Canadian Triage and Acuity Score (CTAS) allocation, active cancer, and a history of venous thromboembolism. The multivariable logistical regression analysis was clustered by individual physician.</p><p><strong>Results: </strong>In total 1570 PEGeD forms were received, 78 were excluded and 1492 patients were included for analysis. The mean age was 55, 62% female, 27% presented at the weekend, 44% presented after 4 pm, 19% with cancer history, 13% with prior venous thromboembolism, 3% had a systolic blood pressure less than 100 mmHg and 46% had a CTAS score of 1 or 2. The treating physician deviated from the PEGeD pathway in 81/1492 (5.4%, 95% CI 4.4, 6.7%)) patients, of whom 7 were diagnosed with pulmonary embolism. Deviation from the PEGeD pathway was associated with a CTAS score of 1 or 2 (aOR 2.02; 1.26, 3.24) and prior venous thromboembolism (aOR 1.85; 1.04, 3.30).</p><p><strong>Conclusions: </strong>Emergency physician deviated from the PEGeD pathway infrequently. Physicians should question whether imaging is needed when D-dimer blood testing has already excluded pulmonary embolism.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"638-642"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}