An estimated 300,000-500,000 patients present to the emergency department (ED) every year inCanada with complaints of chest pain.1 In USA, the numbers are even more staggering at 8million per year.2 Given its prevalence, having a structured and rapid approach to chest pain isessential. Use the mnemonic PETMAC as an approach to these 6 cannot-miss causes of chestpain in the ED. Just think of your friendly neighbourhood pet, Mac! P: Pulmonary Embolism Classically presents …
Tiny Tips: The COWS Scale
As the opiate crisis continues to escalate, emergency departments are seeing higher numbers of patients with complaints and complications related to opiate use disorder. There is strong evidence for opiate agonist treatment in preventing opiate related deaths. Additionally, Suboxone (buprenorphine-naloxone) is the recommended first line treatment.1 Suboxone Treatment For a full Suboxone start, a patient is required to be in moderate withdrawal, meaning a Clinical Opiate Withdrawal Scale (COWS) score of greater than …
Tiny Tip: WOBBLER as an approach to ECGs for syncope
Syncope makes up approximately 1% of acute care visits in Canadian emergency departments and is a common symptom for a wide range of underlying etiologies.1 Identifying any serious underlying condition for syncope and disposition planning is the main area of focus in the emergency department. In addition to a comprehensive history and physical, the 12-lead ECG is a part of the initial evaluation in any patient presenting with syncope. The mnemonic, WOBBLER can …
Tiny Tip: HOUSE as a discharge guide for marginalized patients that incorporates the social determinants of health
Emergency Departments are often the primary source of healthcare for marginalized patients with substance use disorders and precarious housing1. As such, we have unique opportunities to intervene and initiate change. While many screening tools exist to identify substance use disorders, the novel H.O.U.S.E. mnemonic is the first to cover high yield items to be discussed with patients prior to discharge2. It can be used as an easy to remember tool to ensure that …
Tiny Tips: Causes of Atrial Fibrillation
Atrial fibrillation is the most common arrhythmia encountered and managed in the emergency department.1,2 In addition to ensuring hemodynamic stability and subsequent management of the arrhythmia, the emergency physician must identify and treat potential underlying causes. Atrial fibrillation itself may be a sequela of an underlying life-threatening disease process such as pulmonary embolism or sepsis. In some instances, treatment of the underlying cause may lead to the resolution of the arrhythmia.1 It is …
Tiny Tips: Pediatric Airway Anatomy Considerations
Intubation in children is an uncommon but high-risk procedure in the emergency department.1 The incidence of adverse events during intubation is high, particularly desaturation and hypotension.1 Thus, pediatric airway management is an important and lifesaving skill. The pediatric airway has significant anatomical differences from an adult. To remember these variations, consider the mnemonic “CHILD”. How is it different? How do we change management? Cricoid2 Narrowest portion of airway. Risk of subglottic stenosis. …