CJEM最新文献

筛选
英文 中文
Paramedic-initiated opioid agonist therapy: thinking beyond the first dose. 护理人员发起的阿片激动剂治疗:超越第一剂量的思考。
IF 2
CJEM Pub Date : 2025-08-01 DOI: 10.1007/s43678-025-00960-z
David Jerome, Sabrina Slade, Sean W Moore
{"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}
引用次数: 0
Paramedic use of ketamine for severe agitation and violence. 护理人员使用氯胺酮治疗严重躁动和暴力。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-07-25 DOI: 10.1007/s43678-025-00963-w
Jonathan L Kwong, P Richard Verbeek, Yuen Chin Leong, Linda Turner, Maud Huiskamp, Ian R Drennan, Sarah Francom, Sarah Ropp, Sheldon Cheskes
{"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}
引用次数: 0
Predictors of emergency physician adherence to standardized pulmonary embolism testing. 急诊医师对标准化肺栓塞检测依从性的预测因素。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-05-20 DOI: 10.1007/s43678-025-00930-5
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
{"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}
引用次数: 0
Tirofiban for stroke without large- or medium-sized vessel occlusion. 替罗非班用于无大、中型血管闭塞的脑卒中。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-05-16 DOI: 10.1007/s43678-025-00915-4
Lauren Roberts, Shayan Shirazi, Brett Graham, Rob Woods
{"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}
引用次数: 0
Improving quality and safety in emergency department cardiac ultrasound: an urgent need for change. 提高急诊科心脏超声的质量和安全性:迫切需要改变。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-02-13 DOI: 10.1007/s43678-025-00889-3
Joseph Bednarczyk, Tom Jelic
{"title":"Improving quality and safety in emergency department cardiac ultrasound: an urgent need for change.","authors":"Joseph Bednarczyk, Tom Jelic","doi":"10.1007/s43678-025-00889-3","DOIUrl":"10.1007/s43678-025-00889-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"584-587"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412017","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}
引用次数: 0
Massive Hemorrhage Protocol adoption and standardization with a provincial toolkit: a follow-up survey of Ontario hospitals. 大出血协议的采用和标准化与省级工具包:安大略省医院的后续调查。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-05-22 DOI: 10.1007/s43678-025-00929-y
Chantalle L Grant, Omar I Hajjaj, Kimmo Murto, Stephanie Cope, Andrew Petrosoniak, Troy Thompson, Katerina Pavenski, Jeannie L Callum
{"title":"Massive Hemorrhage Protocol adoption and standardization with a provincial toolkit: a follow-up survey of Ontario hospitals.","authors":"Chantalle L Grant, Omar I Hajjaj, Kimmo Murto, Stephanie Cope, Andrew Petrosoniak, Troy Thompson, Katerina Pavenski, Jeannie L Callum","doi":"10.1007/s43678-025-00929-y","DOIUrl":"10.1007/s43678-025-00929-y","url":null,"abstract":"<p><strong>Purpose: </strong>Massive Hemorrhage Protocols improve outcomes for adults with severe hemorrhage, yet only 65% of Ontario hospitals had implemented one by 2018. In response, a Massive Hemorrhage Protocol toolkit was developed and disseminated province-wide in 2021. This study compares Massive Hemorrhage Protocol adoption and content in Ontario hospitals in 2023 versus 2018 using a pre- and post-toolkit rollout survey.</p><p><strong>Methods: </strong>A 98-question survey was emailed to transfusion medicine laboratory directors or their delegate at 159 hospitals in 2023, 2 years after a provincial Massive Hemorrhage Protocol toolkit rollout that included a 1-day virtual symposium. Results were compared with the 2018 survey containing 82 identical core questions using Chi-square test, Fisher exact test, and Wilcoxon rank-sum nonparametric tests for quantitative data, and content analysis for qualitative data.</p><p><strong>Results: </strong>The 2023 survey achieved a 100% response rate (n = 159); most respondents (n = 156) were transfusion staff. Hospitals with a Massive Hemorrhage Protocol increased significantly from 65% (n = 150) in 2018 to 77% (n = 159) in 2023 (p = 0.02). Small transfusion hospitals (< 5000 red blood cell units transfused/year) saw an increase in Massive Hemorrhage Protocol adoption from 60 to 74% (p = 0.02). By 2023, 95% (n = 159) of hospitals had/were implementing a Massive Hemorrhage Protocol. However, gaps in alignment to evidence-based recommendations remained, including hypothermia monitoring (missing in 25% of Massive Hemorrhage Protocols) tranexamic acid dosing (missing in 19%), and quality metric tracking (missing in 55%). Pediatric content was absent in 45% of Massive Hemorrhage Protocols in health centers caring for children.</p><p><strong>Conclusion: </strong>The provincial Massive Hemorrhage Protocol toolkit's dissemination was feasible and associated with increased adoption in Ontario hospitals. Two-years post rollout, 77% of provincial hospitals have Massive Hemorrhage Protocols in place. Opportunities remain to align contents with evidence-based recommendations and expand to remaining hospitals. This strategy could guide other jurisdictions to improve Massive Hemorrhage Protocol adoption and harmonize practices.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"614-625"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Just the facts: ovarian hyperstimulation syndrome - a primer for emergency physicians. 事实是:卵巢过度刺激综合征——急诊医生的入门书。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-05-13 DOI: 10.1007/s43678-025-00931-4
Nicholas Prudhomme, Hans Rosenberg, Bryden Magee
{"title":"Just the facts: ovarian hyperstimulation syndrome - a primer for emergency physicians.","authors":"Nicholas Prudhomme, Hans Rosenberg, Bryden Magee","doi":"10.1007/s43678-025-00931-4","DOIUrl":"10.1007/s43678-025-00931-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"596-599"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060707","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}
引用次数: 0
Discharge with insufficient or inappropriate care in Canada's EDs: overcoming the challenges for people who use drugs. 加拿大急诊科护理不足或不适当的出院:克服吸毒者面临的挑战。
IF 2
CJEM Pub Date : 2025-08-01 Epub Date: 2025-05-20 DOI: 10.1007/s43678-025-00944-z
Nance E Cunningham, James Pierzchalski, Sandra Smiley, Jeffrey Eisen
{"title":"Discharge with insufficient or inappropriate care in Canada's EDs: overcoming the challenges for people who use drugs.","authors":"Nance E Cunningham, James Pierzchalski, Sandra Smiley, Jeffrey Eisen","doi":"10.1007/s43678-025-00944-z","DOIUrl":"10.1007/s43678-025-00944-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"588-591"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112827","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}
引用次数: 0
Global Research Highlights. 全球研究亮点。
IF 2
CJEM Pub Date : 2025-08-01 DOI: 10.1007/s43678-025-01005-1
{"title":"Global Research Highlights.","authors":"","doi":"10.1007/s43678-025-01005-1","DOIUrl":"https://doi.org/10.1007/s43678-025-01005-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 8","pages":"665-669"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982411","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}
引用次数: 0
Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal. 急诊科酒精戒断患者1年预后的性别差异
IF 2
CJEM Pub Date : 2025-08-01 DOI: 10.1007/s43678-025-00986-3
Frank Scheuermeyer, Skye Barbic, M Eugenia Socias, Amanda Slaunwhite
{"title":"Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal.","authors":"Frank Scheuermeyer, Skye Barbic, M Eugenia Socias, Amanda Slaunwhite","doi":"10.1007/s43678-025-00986-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00986-3","url":null,"abstract":"<p><strong>Background: </strong>Alcohol withdrawal is a common emergency department (ED) presentation, but differences in long-term outcomes between female and male patients are not clear.</p><p><strong>Methods: </strong>From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, British Columbia, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics and ED treatments. We linked with regional ED and provincial data to obtain the outcomes of 1-year return ED visits and mortality, respectively. The primary outcome was at least one return visit to the ED, and secondary outcomes included ED revisits and 1-week, 1-month, and 1-year mortality. We compared female patients with male patients using descriptive methods.</p><p><strong>Results: </strong>We identified 1,019 unique patients with 273 (26.8%) female. Median ages, ambulance arrival, initial withdrawal severity score, and index visit admission rates were similar. At 1 year, 186 (68.1%) female and 515 (69.0%) male patients reattended an ED, for a difference of 0.9%; (95% CI - 5.5 to 7.7%). A significantly greater proportion of male patients reattended at 1 week and 1 month, and the average number of male ED revisits was greater at 1 week, 1 month, and 1 year. By 1 year, a female patient (0.4%) and 19 males (2.6%) died, for a difference of 2.2% (95% CI 0.3-3.6%).</p><p><strong>Conclusion: </strong>Despite similar ED presentations, female patients with alcohol withdrawal had fewer 1-year ED visits and lower mortality. EDs may wish to incorporate sex-specific approaches to post-discharge management.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762679","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}
引用次数: 0
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信