A 63-year-old man, Andrew, presents to the emergency department with a several-day history of worsening diarrhea. He has abdominal pain rated 6/10, has been having over 8 loose stools per day for 4 days, and tells you he has seen some blood and mucus in his stools. He denies any nausea, vomiting, fevers or chills, sick contacts or recent travel. However, he tells you that he is under-going active treatment for Stage IV …
Sirens to Scrubs: Acute Coronary Syndromes, Part Two – To the Lab!
Disclaimer: The procedures and therapies discussed in this post are extrapolated from a number of ambulance services globally. This does not replace the direction of readers’ ambulance service clinical guidelines or protocols and should not be used in place of local guidelines or protocols. If you believe something in this post would benefit your ambulance service, contact your local medical director(s) before altering your own practice. In Part One of this series our …
Blood & Clots Series: How do you choose an anticoagulant for stroke prevention in atrial fibrillation?
All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, health advocate, communicator Case Description A 52 year old lady attends the emergency department with a several week history of palpitations. She is found to have atrial fibrillation. You have started a beta blocker and she is in a stable condition for discharge. You evaluate the need for stroke prevention and discuss the options with her. …
FLOW Hacks 7 – Doc in the Box: Improving Physician Initial Assessment Time in the Emergency Department
To continue our FLOW Hacks series, Dr. Joanna Bostwick writes about her team’s innovation aimed at improving physician initial assessment time in the ED. Setting This intervention was carried out at Hôpital Montfort, Ottawa, Ontario, an academic francophone community hospital with 56, 000 ED visits per year. Description of the innovation Our ED has applied an adapted version of Physician in Triage (PIT) termed “Doc in the Box” with the goal of decreasing physician …
CPR Update Series Part 2 – Depth of Compression
Editor’s note: This post marks the second in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton. Follow along as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation. To guide the depth of our compressions during CPR, the 2015 AHA guidelines state: “During manual CPR, rescuers should perform chest compressions at a depth of at least 2 …
HiQuiPs: Preparation Part 2 – Stakeholder Engagement and Behavior Change
You have recently finished a review of incidents that have been flagged in your ED. You have chosen a pertinent issue to tackle, formed a core group to work on the project, and formulated a SMART aim statement after reading our last HiQuiPs post. The median time for obtaining 12-lead ECGs is 13 minutes, while guidelines recommend less than 10 minutes.1 Your aim is to decrease the initial 12-lead ECG acquisition time by …