CJEM最新文献

{"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":"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}

{"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":"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}

{"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}

{"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}

{"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}

{"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}

{"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}