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60 results

Page 1 of 3

  • Just the Facts: The Five F's of Focused Echocardiography in Shock
  • Paul Atkinson, Mandy Peach, David Lewis
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 5 / September 2020
  • Published online by Cambridge University Press: 13 August 2020, pp. 655-657
  • Print publication: September 2020
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    A 60-year-old female presents to the emergency department (ED) with a 3-day history of fatigue and mild breathlessness. She has a history of lung cancer. Her vitals indicate shock with a heart rate of 140 bpm, a systolic blood pressure (SBP) of 65 mmHg, a respiratory rate of 28, with an oxygen saturation of 90% on 100% a nonrebreather mask, and a normal temperature at 36°C. Her electrocardiograph (ECG) shows sinus tachycardia. She appears mottled and pale.

  • Just the Facts: Hypertension in the emergency department
  • Aaron K. Sibley, Paul Atkinson, Philip Shayne
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 4 / July 2020
  • Published online by Cambridge University Press: 07 May 2020, pp. 456-458
  • Print publication: July 2020
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    A 65-year-old female smoker complains of dizziness and mild headache. While at the local pharmacy buying acetaminophen, she decides to check her blood pressure to see if it could be “causing her symptoms.” Her initial measurement is 220/96 mm Hg. In consultation with the on-duty pharmacist she is instructed to immediately attend the emergency department (ED) for management of her hypertension.

  • Just the Facts: Point-of-care ultrasound in the management of shoulder dislocations
  • Ryan Henneberry, Tara Dahn, Paul Atkinson
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 3 / May 2020
  • Published online by Cambridge University Press: 20 April 2020, pp. 287-290
  • Print publication: May 2020
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    A 59-year-old man presents with left shoulder pain after falling while playing with his dog at the park. He drove himself to the emergency department (ED). He reports 5/10 pain and has reduced range of motion of the shoulder. His shoulder looks normal on exam and is not squared off. You wonder if he might have a posterior shoulder dislocation.

  • Just the Facts: Airway management during the coronavirus disease 2019 (COVID-19) pandemic
  • George Kovacs, Nicholas Sowers, Samuel Campbell, James French, Paul Atkinson
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 4 / July 2020
  • Published online by Cambridge University Press: 30 March 2020, pp. 440-444
  • Print publication: July 2020
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    A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.

  • Cause and effect: A universal nonlinearity principle
  • Paul Atkinson
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 2 / March 2020
  • Published online by Cambridge University Press: 25 March 2020, pp. 139-141
  • Print publication: March 2020
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  • Just the facts: Pediatric Dental and Oral Injuries
  • Aaron K. Sibley, Paul Atkinson, Kevin Lobay
  • Journal: Canadian Journal of Emergency Medicine / Volume 22 / Issue 1 / January 2020
  • Published online by Cambridge University Press: 15 November 2019, pp. 23-26
  • Print publication: January 2020
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    A 16-month-old presents to the emergency department (ED) after a fall while running at home. Her mother noted some blood in the child's mouth and believed there was a tear in the skin above the front teeth.

  • Do combined ultrasound and electrocardiogram-rhythm findings predict survival in emergency department cardiac arrest patients? The Second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED2) study
  • Nicole Beckett, Paul Atkinson, Jacqueline Fraser, Ankona Banerjee, James French, Jo-Ann Talbot, George Stoica, David Lewis
  • Journal: Canadian Journal of Emergency Medicine / Volume 21 / Issue 6 / November 2019
  • Published online by Cambridge University Press: 30 September 2019, pp. 739-743
  • Print publication: November 2019
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  • View abstract
    Objectives

    Point-of-care ultrasound (POCUS) is used increasingly during resuscitation. The aim of this study was to assess whether combining POCUS and electrocardiogram (ECG) rhythm findings better predicts outcomes during cardiopulmonary resuscitation in the emergency department (ED).

    Methods

    We completed a health records review on ED cardiac arrest patients who underwent POCUS. Primary outcome measurements included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge.

    Results

    POCUS was performed on 180 patients; 45 patients (25.0%; 19.2%–31.8%) demonstrated cardiac activity on initial ECG, and 21 (11.7%; 7.7%–17.2%) had cardiac activity on initial POCUS; 47 patients (26.1%; 20.2%–33.0%) achieved ROSC, 18 (10.0%; 6.3%–15.3%) survived to admission, and 3 (1.7%; 0.3%–5.0%) survived to hospital discharge. As a predictor of failure to achieve ROSC, ECG had a sensitivity of 82.7% (95% CI 75.2%–88.7%) and a specificity of 46.8% (32.1%–61.9%). Overall, POCUS had a higher sensitivity of 96.2% (91.4%–98.8%) but a similar specificity of 34.0% (20.9%–49.3%). In patients with ECG-asystole, POCUS had a sensitivity of 98.18% (93.59%–99.78%) and a specificity of 16.00% (4.54%–36.08%). In patients with pulseless electrical activity, POCUS had a sensitivity of 86.96% (66.41%–97.22%) and a specificity of 54.55% (32.21%–75.61%). Similar patterns were seen for survival to admission and discharge. Only 0.8% (0.0–4.7%) of patients with ECG-asystole and standstill on POCUS survived to hospital discharge.

    Conclusion

    The absence of cardiac activity on POCUS, or on both ECG and POCUS together, better predicts negative outcomes in cardiac arrest than ECG alone. No test reliably predicted survival.

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