CJEM最新文献

{"title":"Asynchronous simulation-based training of resuscitative transesophageal echocardiography in emergency physicians.","authors":"Kavish Chandra, Rawan Makhdom, Kiera Dolan, Pamela McDougall, Paul Atkinson, Rajiv Thavanathan, David Lewis","doi":"10.1007/s43678-026-01185-4","DOIUrl":"10.1007/s43678-026-01185-4","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency physicians are increasingly utilizing transesophageal echocardiography in the emergency department (ED) when caring for critically ill patients. Simulation-based transesophageal echocardiography training has been shown to be an effective learning tool. This study evaluated whether a brief asynchronous learning module combined with simulation-based practice is effective for emergency physicians who are already experienced in point-of-care ultrasound (PoCUS).</p><p><strong>Methods: </strong>We conducted a prospective study of emergency physicians with PoCUS experience at a single ED. Participants viewed a 30-min asynchronous module on transesophageal echocardiography in the ED and reviewed a four-view resuscitative protocol. They then completed a baseline simulation assessment, a brief guided practice session, and a post-intervention assessment. All views were recorded. The primary outcome was the proportion of successful transesophageal echocardiography views, scored by two blinded reviewers.</p><p><strong>Results: </strong>Twenty emergency physicians completed the study. The mean age was 39 years, 6 participants (30%) were female, the median clinical experience was 5.5 years, and all participants had PoCUS experience. The percentage of total successful views increased from 63% (95% CI 52-72%) at baseline to 93% (84-97%; p < 0.001) after guided practice.</p><p><strong>Conclusion: </strong>A brief 30-min asynchronous module combined with focused simulation-based training was effective in immediately improving the acquisition of core resuscitative transesophageal echocardiography views among emergency physicians with PoCUS experience. Future studies are needed to determine whether this approach leads to sustained skill retention and improved integration of resuscitative transesophageal echocardiography into clinical practice.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"817-821"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347744","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":"A pilot randomized trial of ketamine for suicidal ideation in a pediatric emergency department.","authors":"Yury Onikashvili, Heather Burt, Garth Meckler, Jeffrey N Bone, Tatsuma Hind, Kendra Sih, Roberto Sassi, Karly Stillwell, Tyler Black, Quynh Doan","doi":"10.1007/s43678-026-01190-7","DOIUrl":"10.1007/s43678-026-01190-7","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) visits by adolescents with suicidal ideation have increased, with no rapid-acting treatments identified for ED use. This pilot study explored the feasibility of a randomized controlled trial of ketamine in the ED for adolescents with suicidal ideation.</p><p><strong>Methods: </strong>Three-arm, triple-blinded randomized controlled trial comparing intravenous ketamine (0.5 mg/kg), midazolam (0.03 mg/kg), and saline (0.9%) in adolescents requiring hospitalization for suicidal ideation. We primarily reported recruitment proportion as a measure of feasibility. Secondary outcomes included: additional aspects of feasibility (barriers to enrolment, retention, blinding, and adverse events) and distribution of suicidal ideation scores 90 min post-infusion on questions 3-5 of the Columbia Suicide Severity Rating Scale, item 10 of the Montgomery-Åsberg Depression Rating Scale, and a pragmatic 0-10 Likert scale to estimate future randomized controlled trial sample size.</p><p><strong>Results: </strong>Out of 21 eligible patients and guardians, 15 (71%, 95% CI 48, 87%) agreed to participate when offered the opportunity. Key barriers to enrolment included limited ED resources and absence of a consenting parent at time of assessment. Retention at 7, 14, 21, and 28-days was 93, 86, 73, and 73%. No serious or unexpected adverse events occurred. Blinding appeared reasonably effective. The median [IQR] Columbia Suicide Severity Rating Scale, Montgomery-Åsberg Depression Rating Scale, and pragmatic Likert scale scores at 90 min were 0 [0, 2], 4 [2, 4], 5 [5, 6] for ketamine; 0 [0, 3], 3 [3, 6], 6 [3, 7] for midazolam; and 3 [2, 3], 4 [4, 5], 6 [6, 7] for saline.</p><p><strong>Conclusions: </strong>Despite a small sample, our participation rate was high and trial design appeared feasible and safe. Dedicated research nurses and a mature-minor consent process could address key barriers to enrolment in future trials to determine if ketamine could provide ED physicians with the first rapid-acting pharmacological treatment for acute pediatric suicidal ideation.</p><p><strong>Clinicaltrials: </strong>gov: NCT04955470.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"836-844"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152471","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":"Climate change and the Canadian pediatric emergency medicine experience: an integrated mixed-methods study.","authors":"Henry Annan, Nia King, Iwona Baran, Melanie Bechard","doi":"10.1007/s43678-026-01113-6","DOIUrl":"10.1007/s43678-026-01113-6","url":null,"abstract":"<p><strong>Background: </strong>Climate change disproportionately impacts child health and is associated with an increase in certain pediatric emergency department (ED) presentations. This study examines how the climate crisis impacts the pediatric emergency medicine physician experience in Canada.</p><p><strong>Methods: </strong>We conducted a convergent mixed-methods study of fully licensed attending or clinical associate physicians working in Canadian pediatric EDs. We developed and distributed an online survey to pediatric emergency physicians within the Pediatric Emergency Research Canada (PERC) database. We also conducted semi-structured interviews to delve further into their experiences and engaged in a 6-phase thematic analysis of transcripts.</p><p><strong>Results: </strong>The survey was sent to 382 physicians and yielded a completion rate of 21%. Multiple stages of non-response bias analysis revealed no significant difference between survey respondents and non-respondents. Most (95%) respondents were at least moderately worried about the impact of climate change on health and 79% believed that their institutions were either minimally or not prepared for climate-related events. Four themes emerged from our thematic analysis: (i) feeling human in a time of crisis, (ii) climate change manifesting in the practice of pediatric emergency medicine, (iii) the role of pediatric emergency medicine during a climate crisis, and (iv) preparing pediatric emergency medicine for climate change. Integrative analysis suggests that (i) many pediatric emergency physicians are concerned about the health impacts of climate change; (ii) many pediatric emergency physicians see the impacts of climate change in the types of cases presenting to the pediatric ED; (iii) climate change may influence clinical practice; and (iv) pediatric EDs may not be prepared to respond to the impacts of climate change.</p><p><strong>Conclusions: </strong>Climate change impacts the pediatric emergency physician experience in Canada. Further education on the health impacts of climate change could help the pediatric emergency community better prepare for the impending challenges.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"845-855"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286682","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":"ResusWars: an analysis of a novel simulation-based education event for Canadian undergraduate medical students.","authors":"Simran Lohit, Ivy Quan, Reuven Dichter, Linda Turner, Morgan Hillier","doi":"10.1007/s43678-026-01198-z","DOIUrl":"10.1007/s43678-026-01198-z","url":null,"abstract":"<p><p>Although simulation-based education is well known to support skill development such as Advanced Cardiovascular Life Support skills, it is not well incorporated in the Canadian junior undergraduate medical education curriculum. Medical students at the University of Toronto in collaboration with the local Base Hospital created ResusWars, a simulation-based education initiative. The aim of ResusWars is to introduce Advanced Cardiovascular Life Support theory and increase early access to simulation-based education for junior medical students. Pre- and post-event surveys showed that participants felt more confident managing time-sensitive scenarios and were more comfortable with simulation following participation in ResusWars.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"822-825"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595050","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":"Beyond bed block: emergency department crowding as an equilibrium outcome.","authors":"Stephenson Strobel","doi":"10.1007/s43678-026-01184-5","DOIUrl":"10.1007/s43678-026-01184-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"795-797"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140183","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":"Delayed ultrasound in ectopic pregnancy: clinical selection, time-dependent diagnosis, and the limits of reassurance.","authors":"Ali Çelik","doi":"10.1007/s43678-026-01196-1","DOIUrl":"10.1007/s43678-026-01196-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"881-882"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297890","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":"Just the facts: bronchiolitis in the pediatric population.","authors":"Jason Emsley, Breanna Hargreaves, Rachel Creighton","doi":"10.1007/s43678-026-01130-5","DOIUrl":"10.1007/s43678-026-01130-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"802-805"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146204240","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":"An evaluation of emergency pain assessment and management practices in fragility vertebral compression fractures.","authors":"Camille Dagenais, Krishan Yadav, Ramtin Ghasemi, Justin Lalonde, Marie-Joe Nemnom, Debra Eagles","doi":"10.1007/s43678-026-01178-3","DOIUrl":"10.1007/s43678-026-01178-3","url":null,"abstract":"<p><strong>Background: </strong>Vertebral compression fractures are a common ED presentation in older adults and often lead to significant pain and functional decline. Oligoanalgesia can worsen morbidity. We aimed to describe pain assessment and management practices for older adults presenting to the ED with fragility vertebral compression fractures.</p><p><strong>Methods: </strong>We conducted a retrospective health records review of adults ≥ 65 years presenting to two tertiary EDs with acute thoracic or lumbar fragility vertebral compression fractures between August 2017 and August 2022. Patients with polytrauma, pathologic, or age-indeterminate fractures were excluded. Eligible cases were identified by ICD-10-CA codes, and data were abstracted using a standardized form. Primary outcomes were initial pain assessment, pain reassessment, and analgesic administration. Secondary outcomes included use of consultant and allied health services, discharge prescriptions, disposition, and 30-day return ED visits. Descriptive statistics were used.</p><p><strong>Results: </strong>Of 646 screened patients, 296 met inclusion criteria. Mean age was 81.4 (SD 8.3) years; 69.0% were female. An initial pain assessment was documented in 65.5%, but only 4.1% had a discharge pain score documented. Of those who had an initial pain assessment, 51.7% had pain reassessments during their ED care. 10.1% of patients received no analgesia. Acetaminophen (68.6%), opioids (54.7%), and NSAIDs (25.7%) were most frequently used. Consultants were contacted for 45.3% of patients. Allied health services were consulted for 23.3% of patients. Nearly one-third (30.4%) were admitted, primarily for pain management (62.2%); 19.3% of discharged patients returned within 30 days.</p><p><strong>Conclusion: </strong>Emergency department care of older adults presenting with acute fragility compression fractures is suboptimal. Nearly one in three older adults did not have a pain assessment and one in ten received no analgesia during their ED visit. Identifying and overcoming barriers to quality care is crucial to ensure effective pain management for this population.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"870-874"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200937","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":"Scoring points-or missing the point? Rethinking pain assessment and analgesia in older adults.","authors":"Kayla Furlong, Kira Gossack-Keena, Jamie Vander Ende, Isabelle Colmers-Gray","doi":"10.1007/s43678-026-01262-8","DOIUrl":"https://doi.org/10.1007/s43678-026-01262-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"28 9","pages":"793-794"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932159","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":"Oral metoclopramide for pediatric migraine management in the ED: health records review.","authors":"Paola Andrea Rouge Elton, Nathalie Lucas, Evelyne D Trottier, Sarah Mousseau, Geneviève Tourigny-Ruel, Marie-Elaine Métras, Jocelyn Gravel","doi":"10.1007/s43678-026-01169-4","DOIUrl":"10.1007/s43678-026-01169-4","url":null,"abstract":"<p><strong>Objectives: </strong>Migraine is a common presentation in pediatric emergency departments (ED), and non-invasive treatment options are desirable. This study evaluated what proportion of children treated with oral metoclopramide would not need a rescue medication for the treatment of migraine in the ED.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a tertiary pediatric ED in Montréal, Canada, over a one-year period. Patients aged 8-18 years diagnosed with migraine and treated with either oral or intravenous metoclopramide were included. The primary outcome was headache relief, defined as no need for rescue medication. Secondary outcomes included ED length of stay, adverse events, return visits within 7 days, and reduction in pain scores measured by the 10-point verbal numeric rating scale. The primary analysis was the proportion of children who did not need a rescue medication restricted to children treated with oral metoclopramide. Secondary exploratory analyses compared oral to intravenous administrations on primary and secondary outcomes.</p><p><strong>Results: </strong>Of the 225 patients included, 78 received oral and 147 received intravenous metoclopramide. Headache relief was achieved in 83% (95% CI 73-91%) of the oral group. This compared favorably to the intravenous group (difference: 4%; 95% CI -7 to 14%). ED length of stay was shorter in the oral group (median 314 vs 500 min). Adverse events occurred only in the intravenous group (4%) and return visit proportions were similar between groups (difference 2%; 95% CI - 6 to 12%).</p><p><strong>Conclusions: </strong>Oral metoclopramide is an effective and well-tolerated treatment for 80% of children with migraine in the ED. On exploratory evaluation, it offered comparable outcomes to intravenous administration with the added benefits of shorter ED stays and reduced procedural pain. Oral metoclopramide should be considered as a first-line treatment option for pediatric migraine in the emergency department.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"826-835"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792144","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}