scholarly journals P049: Post-intubation sedation in the emergency department: a survey of national practice patterns

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
S. Freeman ◽  
M. Columbus ◽  
T. Nguyen ◽  
S. Mal ◽  
J. Yan
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Improve Patient Safety ◽  
Teaching Hospitals ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Canadian Association ◽  
Clinical Scenarios ◽  
Post Intubation

Introduction: Endotracheal intubation (ETI) is a lifesaving procedure commonly performed by emergency department (ED) physicians that may lead to patient discomfort or adverse events (e.g., unintended extubation) if sedation is inadequate. No ED-based sedation guidelines currently exist, so individual practice varies widely. This study's objective was to describe the self-reported post-ETI sedation practice of Canadian adult ED physicians. Methods: An anonymous, cross-sectional, web-based survey featuring 7 common ED scenarios requiring ETI was distributed to adult ED physician members of the Canadian Association of Emergency Physicians (CAEP). Scenarios included post-cardiac arrest, hypercapnic and hypoxic respiratory failure, status epilepticus, polytrauma, traumatic brain injury, and toxicology. Participants indicated first and second choice of sedative medication following ETI, as well as bolus vs. infusion administration in each scenario. Data was presented by descriptive statistics. Results: 207 (response rate 16.8%) ED physicians responded to the survey. Emergency medicine training of respondents included CCFP-EM (47.0%), FRCPC (35.8%), and CCFP (13.9%). 51.0% of respondents work primarily in academic/teaching hospitals and 40.4% work in community teaching hospitals. On average, responding physicians report providing care for 4.9 ± 6.8 (mean ± SD) intubated adult patients per month for varying durations (39.2% for 1–2 hours, 27.8% for 2–4 hours, and 22.7% for ≤1 hour). Combining all clinical scenarios, propofol was the most frequently used medication for post-ETI sedation (38.0% of all responses) and was the most frequently used agent except for the post-cardiac arrest, polytrauma, and hypercapnic respiratory failure scenarios. Ketamine was used second most frequently (28.2%), with midazolam being third most common (14.5%). Post-ETI sedation was provided by > 98% of physicians in all situations except the post-cardiac arrest (26.1% indicating no sedation) and toxicology (15.5% indicating no sedation) scenarios. Sedation was provided by infusion in 74.6% of cases and bolus in 25.4%. Conclusion: Significant practice variability with respect to post-ETI sedation exists amongst Canadian emergency physicians. Future quality improvement studies should examine sedation provided in real clinical scenarios with a goal of establishing best sedation practices to improve patient safety and quality of care.

scholarly journals ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physicians

CJEM ◽  
2008 ◽  
Vol 10 (05) ◽  
pp. 413-419 ◽  
Author(s):  
Clare L. Atzema ◽  
Michael J. Schull
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Mail Survey ◽  
Good Evidence ◽  
Low Risk ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Electrocardiographic Monitoring ◽  
Canadian Association ◽  
Pain Patients

ABSTRACT Objective: Current guidelines suggest that most patients who present to an emergency department (ED) with chest pain should be placed on a continuous electrocardiographic monitoring (CEM) device. We surveyed emergency physicians to determine their perception of current occupancy rates of CEM and to assess their attitudes toward prescribing monitors for low-risk chest pain patients in the ED. Methods: We conducted a cross-sectional, self-administered Internet and mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians. Main outcome measures included the perceived frequency of fully occupied monitors in the ED and physicians' willingness to forgo CEM in certain chest pain patients. Results: The response rate was 66% (199 respondents). The largest group of respondents (43%; 95% confidence interval [CI] 36%–50%) indicated that monitors were fully occupied 90%–100% of the time during their most recent ED shift. When asked how often they were forced to choose a patient for monitor removal because of the limited number of monitors, 52% (95% CI 45%–60%) of respondents selected 1–3 times per shift. Ninety percent (95% CI 84%–93%) of respondents indicated that they would forgo CEM in certain cardiac chest pain patients if there was good evidence that the risk of a monitor-detected adverse event was very low. Conclusion: Emergency physicians report that monitors are often fully occupied in Canadian EDs, and most are willing to forgo CEM in certain chest pain patients. A large prospective study of CEM in low-risk chest pain patients is warranted.

scholarly journals Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices

2020 ◽  
Vol 9 (9) ◽  
pp. 2790
Author(s):  
Per Sindahl ◽  
Christian Overgaard-Steensen ◽  
Helle Wallach-Kildemoes ◽  
Marie Louise De Bruin ◽  
Hubert GM Leufkens ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inappropriate Prescribing ◽  
Plasma Sodium ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Scenarios ◽  
Hypotonic Fluids ◽  
Hospital Acquired ◽  
The Impact

Background: Hyponatraemia is associated with increased morbidity, increased mortality and is frequently hospital-acquired due to inappropriate administration of hypotonic fluids. Despite several attempts to minimise the risk, knowledge is lacking as to whether inappropriate prescribing practice continues to be a concern. Methods: A cross-sectional survey was performed in Danish emergency department physicians in spring 2019. Prescribing practices were assessed by means of four clinical scenarios commonly encountered in the emergency department. Thirteen multiple-choice questions were used to measure knowledge. Results: 201 physicians responded corresponding to 55.4% of the total population of physicians working at emergency departments in Denmark. About a quarter reported that they would use hypotonic fluids in patients with increased intracranial pressure and 29.4% would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. Also, 29.4% selected the correct fluid, a 3% hypertonic saline solution, for a patient with hyponatraemia and severe neurological symptoms, which is a medical emergency. Most physicians were unaware of the impact of hypotonic fluids on plasma sodium in acutely ill patients. Conclusion: Inappropriate prescribing practices and limited knowledge of a large number of physicians calls for further interventions to minimise the risk of hospital-acquired hyponatraemia.

scholarly journals P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S66-S66
Author(s):  
D. Wiercigroch ◽  
S. Friedman ◽  
D. Porplycia ◽  
M. Ben-Yakov
Keyword(s):  
Regional Anesthesia ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Practices ◽  
Canadian Association ◽  
Modifiable Factors ◽  
Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

scholarly journals The core emergency ultrasound curriculum project: A report from the Curriculum Working Group of the CAEP Emergency Ultrasound Committee

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Paul Olszynski ◽  
Dan Kim ◽  
Jordan Chenkin ◽  
Louise Rang
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Working Group ◽  
Focused Ultrasound ◽  
Position Statement ◽  
Emergency Ultrasound ◽  
Emergency Physicians ◽  
The Core ◽  
Canadian Association ◽  
Curriculum Project

Emergency ultrasound (EUS) is now widely considered to be a “skill integral to the practice of emergency medicine.”1The Canadian Association of Emergency Physicians (CAEP) initially issued a position statement in 1999 supporting the availability of focused ultrasound 24 hours per day in the emergency department (ED).2

scholarly journals Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

2020 ◽  
pp. 102490792093171
Author(s):  
Tsz Ha Tang ◽  
Marc LC Yang ◽  
On Yee Chan ◽  
Lily PS Chan ◽  
Hiu Fai Ho
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Endotracheal Intubation ◽  
Statistical Tests ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Post Intubation

Objectives: In some trauma centres, anaesthesiologists have the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians establish a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the emergency department between emergency physicians and anaesthesiologists. Methods: We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. A total of 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (anaesthesiologists = 205 patients, emergency physicians = 144 patients). Patients’ baseline demographics, 30-day all-cause mortality and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality was performed. Results: Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression (adjusted odds ratio = 1.253, p = 0.607). Both groups also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications, mortality in intensive care or high-dependency unit, post-intubation cardiac arrest, post-intubation hypotension and post-intubation hypoxia. Conclusion: Endotracheal intubation by emergency physicians is not associated with increased 30-day all-cause mortality when compared to anaesthesiologists after accounting for confounders.

scholarly journals Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 155-166 ◽  
Author(s):  
David E. Newman-Toker ◽  
Ernest Moy ◽  
Ernest Valente ◽  
Rosanna Coffey ◽  
Anika L. Hines
Keyword(s):  
Emergency Department ◽  
Large Population ◽  
Population Based ◽  
Teaching Hospitals ◽  
Older Individuals ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Cerebrovascular Events ◽  
Asian Pacific ◽  
Sectional Analysis

AbstractSome cerebrovascular events are not diagnosed promptly, potentially resulting in death or disability from missed treatments. We sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics.Cross-sectional analysis using linked inpatient discharge and ED visit records from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases and 2008–2009 State ED Databases across nine US states. We identified adult patients admitted for stroke with a treat-and-release ED visit in the prior 30 days, considering those given a non-cerebrovascular diagnosis as probable (benign headache or dizziness diagnosis) or potential (any other diagnosis) missed strokes.There were 23,809 potential and 2243 probable missed strokes representing 12.7% and 1.2% of stroke admissions, respectively. Missed hemorrhages (n=406) were linked to headache while missed ischemic strokes (n=1435) and transient ischemic attacks (n=402) were linked to headache or dizziness. Odds of a probable misdiagnosis were lower among men (OR 0.75), older individuals (18–44 years [base]; 45–64:OR 0.43; 65–74:OR 0.28; ≥75:OR 0.19), and Medicare (OR 0.66) or Medicaid (OR 0.70) recipients compared to privately insured patients. Odds were higher among Blacks (OR 1.18), Asian/Pacific Islanders (OR 1.29), and Hispanics (OR 1.30). Odds were higher in non-teaching hospitals (OR 1.45) and low-volume hospitals (OR 1.57).We estimate 15,000–165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. Physicians evaluating these symptoms should be particularly attuned to the possibility of stroke in younger, female, and non-White patients.

Abstract 17571: Use of Goal Directed Transesophageal Echocardiography in the Arresting Patient

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shoeb Ahsan ◽  
Robert Arntfield
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Transesophageal Echocardiography ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
And Function ◽  
Management Changes

Background: With outcomes from cardiac arrest remaining generally poor, there is an urgency to evaluate interventions that allow physicians to manage cardiac arrest more effectively. Transesophageal echocardiography (TEE) can be used at the point of care in a goal-directed manner and can rapidly provide a flurry of data on cardiac structure and function. TEE in the arrested patient is unobtrusive to resuscitation and can provide vital information regarding the potential etiology of arrest, guidance of certain procedures and prognosis. As such, some centers, including our own, have adopted increasingly routine use of TEE in this context. Given the paucity of data in this area, we sought to examine the influence of point-of-care TEE conducted by emergency physicians or intensivists at our institution for patients in or immediately after cardiac arrest. Methods: Goal-directed TEE in the emergency department (ED) or intensive care units (ICU) and their reports were archived in a dedicated point-of-care ultrasound imaging database. We conducted a search of all TEE examinations archived between December 2012 and April 2015 in the peri-arrest period (in or immediately after cardiac arrest). The details from reports were abstracted. TEE-directed management changes were noted when recommendation(s) regarding initiation/escalation of inotropes, fluid administration, termination of resuscitation or surgical procedure were featured in the TEE report. Results: A total of 57 peri-arrest TEE exams were identified (21 in ICUs and 36 in EDs). Goal-directed TEE changed management in 61.4% of cases. TEE facilitated the escalation/initiation of inotropes (35.3%), decision to terminate resuscitation (32.4%), guided fluid management (23.5%) and surgical procedures (8.8%). TEE studies altered management in 66.7% of cases in the Intensive Care Unit and in 58.3% of cases in the Emergency Department. Conclusions: Goal-directed TEE performed by emergency physicians or intensivists has an impact on management on patients in the peri-arrest setting the majority of the time. Given the lack of reliable diagnostic and therapeutic options in arresting patients, a larger study examining the influence of goal-directed TEE on patient outcomes in cardiac arrest should be carried out.

scholarly journals Executive summary of the CAEP 2014 Academic Symposium: How to make research succeed in your department

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Ian G. Stiell ◽  
Jennifer D. Artz ◽  
Jeffrey Perry ◽  
Christian Vaillancourt ◽  
Lisa Calder
Keyword(s):  
Emergency Medicine ◽  
Best Practices ◽  
Leadership Education ◽  
Teaching Hospitals ◽  
Diagnostic Tools ◽  
Emergency Physicians ◽  
Executive Summary ◽  
Medicine Research ◽  
Canadian Association ◽  
Funding Opportunities

AbstractThe vision of the recently created Canadian Association of Emergency Physicians (CAEP) Academic Section is to promote high-quality emergency patient care by conducting world-leading education and research in emergency medicine. The Academic Section plans to achieve this goal by enhancing academic emergency medicine primarily at Canadian medical schools and teaching hospitals. It seeks to foster and develop education, research, and academic leadership amongst Canadian emergency physicians, residents, and students. In this light, the Academic Section began in 2013 to hold the annual Academic Symposia to highlight best practices and recommendations for the three core domains of governance and leadership, education scholarship, and research. Each year, members of three panels are asked to review the literature, survey and interview experts, achieve consensus, and present their recommendations at the Symposium (2013, Education Scholarship; 2014, Research; and 2015, Governance and Funding).Research is essential to medical advancement. As a relatively young specialty, emergency medicine is rapidly evolving to adapt to new diagnostic tools, the challenges of crowding in emergency departments, and the growing needs of emergency patients. There is significant variability in the infrastructure, support, and productivity of emergency medicine research programs across Canada. All Canadians benefit from an investigation of the means to improve research infrastructure, training programs, and funding opportunities. Such an analysis is essential to identify areas for improvement, which will support the expansion of emergency medicine research. To this end, physician-scientist leaders were gathered from across Canada to develop pragmatic recommendations on the improvement of emergency medicine research through a comprehensive analysis of current best practices, systematic literature reviews, stakeholder surveys, and expert interviews.

scholarly journals Strategies for managing a busy emergency department

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 271-276 ◽  
Author(s):  
Samuel G. Campbell ◽  
Douglas E. Sinclair ◽  
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Patient Flow ◽  
Management Strategies ◽  
Clinical Decision ◽  
Emergency Physicians ◽  
Flow Management ◽  
Time Space ◽  
Canadian Association ◽  
Exit Block

ABSTRACT In a time of increased patient loads and emergency department (ED) exit block, the need for strategies to manage patient flow in the ED has become increasingly important. In March 2002 we contacted all 1282 members of the Canadian Association of Emergency Physicians and asked them to delineate strategies for enhancing ED patient flow and ED productivity without increasing stress levels, reducing care standards or compromising patient safety. Thirty physicians responded. Their suggested flow management strategies, which ranged from clinical decision-making to communication to choreography of time, space and personnel, are summarized here.

Sign in / Sign up

Export Citation Format

Share Document