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Tiny Tip: Is this a ‘CASE’ of an elbow fracture?

In Medical Concepts, Tiny Tips by Graham Wilson0 Comments

An elbow fracture is a common pediatric injury in emergency medicine. These fractures present challenges in diagnosis due to the maturing skeletal anatomy and the subtlety of these injuries.1 Plain radiographs are adequate to detect elbow fractures in most cases and a systematic approach can help learners diagnose these pathologies.2,3 An approach to reading elbow radiographs: After confirming patient identification and appropriate radiographic view, a mnemonic to help guide your approach to elbow …

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IV Lipid emulsion for drug toxicity in the ED

In Medical Concepts by Jared Baylis3 Comments

What is the role of intravenous lipid emulsion in drug toxicity in the emergency department? A 32-year-old male with depression and chronic neuropathic pain presents to your ED after an intentional overdose of 50 x 75 mg tablets of amitriptyline one hour ago. On exam, his blood pressure is 92/54 mmHg and his heart rate is 128 bpm. He is somewhat somnolent and gets rushed to your resuscitation bay from triage. His initial …

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Tiny Tips – Cauda Equina Syndrome

In Medical Concepts, Tiny Tips by Mike Craig0 Comments

Cauda Equina Syndrome (CES) is a collection of signs and symptoms resulting from compression of neural elements at the cauda equina.  Although CES has no universal definition, the most commonly cited clinical presentation involves severe lower back pain, bladder dysfunction, and sensory deficits in the sacral nerve root distribution. Associated symptoms can include radicular leg pain, lower extremity weakness, and erectile dysfunction. A recent review explores this variation in definitions and the diagnostic …

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The Case of the Awake Intubation Kit, Episode 3

In Medical Concepts by Jared Baylis0 Comments

Thank you to all who have participated in the discussion to crowd-source an awake intubation kit in both previous installments of this series (Episode 1 and Episode 2). In this final installment, we discuss the implementation of our kit and the ongoing process involved in making this an effective and sustainable quality improvement intervention. Introduction Two years ago, we treated a critically ill patient in our trauma bay who needed an awake intubation. …

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Shared decision making

In Editorial, Featured, Opinion by Shahbaz Syed1 Comment

Resource utilization in medicine is becoming an increasingly critical issue (as also noted by the number of discussions we’ve had on it here at CanadiEM), and this acknowledgement is important. However, once we’ve accepted the harms (to the patient and system) with excessive over-utilization, we can begin to look at ways to address and optimize physician behaviour. There are many ways to approach the subject, and one that is often cited is Shared Decision Making …