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Opioid Use Disorder Treatment: Opioid Agonist Therapy Induction

In Medical Concepts by George KachkovskiLeave a Comment

Venus is a 29-year-old female who presents to the ED with tremor and diaphoresis. You learn that she has presented to the ED with similar symptoms before, and has a 5yr history OUD, using about 5 points (0.5 g) a day. She has no other medical conditions and blood work is within normal limits. Venus is tachycardic at 105 bpm, with dilated pupils, piloerection, slight tremors, and flushed face. You remember a previous …

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Approach to Unhoused Patients Presenting to the Emergency Department with a History of Opioid Use Disorder

In Knowledge Translation by Richard ChengLeave a Comment

Editor’s Note: This is part 2 of a 2-part series on homelessness. Check out Part I about the Ottawa Inner City Health Initiative. ‘Ken’ is a 47-year-old unhoused man presenting to the Emergency Department (ED) with severe opioid withdrawal symptoms. After taking his history, you learn that he has been unhoused for the past 2 years and using non-prescribed fentanyl for the past 8 months. His last dose was 28 hours ago. You …

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Improving Emergency Care For Individuals Experiencing Homelessness

In Knowledge Translation by Soha KhorsandLeave a Comment

Editor’s Note: This is part 1 of a 2 part series on patients with homelessness. Stay tuned for Part 2 which will deal with the intersection of homelessness and opiate drug use. A 29-year-old male named Billy presents to your emergency department with a 4-day history of progressive leg tenderness. On exam, you note a poorly demarcated area of erythema on the leg which is warm and tender to the touch, suggestive of …

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CJEM Visual Abstract – Machine learning for the diagnosis of acute coronary syndrome using a 12-lead ECG: a systematic review

In Infographics by Samuel WilsonLeave a Comment

For the October 2023 issue of CJEM, we collaborated with their team to present “Machine learning for the diagnosis of acute coronary syndrome using a 12-lead ECG: a systematic review”​1​​ in a visually simplified format. Many of us see the interpretation that is included on the top or side of each ECG, with common practice being to approach these diagnoses with caution. We often rely on our clinicians interpretation of the 12-lead, instead. …

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Tiny Tips: Hematuria: IS THIS PP RED?

In Tiny Tips by Alex SengerLeave a Comment

Mnemonics to remember differential diagnoses are usually cumbersome, difficult to remember, and unnecessary. However, sometimes one stands above the crowd. Sometimes, one is so perfect that the world around you seems brighter… the greens greener… the sky bluer… your lunch tastier… Feel your mental status exam improve as I present to you “IS THIS PP RED?” for hematuria. The best part about the mnemonic? – The two most important etiologies are first! This …

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Clinical Question: Which ultrasound-guided nerve block is best for acute pain management of rib fractures in the ED?

In Clinical Questions by Sulman ZahidLeave a Comment

A 72-year-old male presents to the emergency department (ED) with severe chest pain and difficulty breathing after an MVC. Physical examination reveals tenderness and localized swelling over the left lateral chest wall, with X-ray confirming multiple rib fractures. The patient’s vital signs are stable, but he is visibly distressed and struggling to find a comfortable position. What are nerve blocks? Nerve blocks involve administering local anesthetic near specific nerves to block pain signals …