Concurrent Sessions: Research; Traumatologie; Pediatric Trauma; Choosing Wisely; Diagnostic Imaging; Toxicology 201

June 6, 2016

11:00  –  12:30
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Track 1

Track 1 – RESEARCH

Track Chair: Dr. Jeff Perry

Lightning Orals

ID Number Title Presenter
*** Top Pediatric Abstract Award Winner
LO046 Factors associated with hospital admission following asthma exacerbations: a systematic review Brian Rowe
LO047 Predictors of treatment failure in renal colic patients discharged from the emergency department Grant Innes
LO048 Systematic Review of the Use of Low-Dose Ketamine for Analgesia in the Emergency Department Gauri Ghate
LO049 Ibuprofen or oxycodone? An observational cohort study of post-emergency department discharge management of children’s fracture pain. Samina Ali***
LO050 The Predictive Value of Pre-Endoscopic Risk Scores to Predict Adverse Outcomes among Emergency Department Patients with Upper Gastrointestinal Bleeding – A Systematic Review Rosa Ramaekers
LO051 Validation of a Clinical Decision Rule to Detect Patients with Adverse Drug Events in the Emergency Department Corinne Hohl
LO052 Sticks and stones may break your bones, but does having a car crash in a rural location effect your access to EMS care and surgical intervention? The initial analysis of a unique EMS and Trauma Dataset. Matthew Kenney
LO053 Follow- up head CT scan after mild traumatic brain injury: is it really necessary? Charles Gariepy
LO054 The emergency department usage and utility of ISAR and CAM assessment tools in identifying hip fracture patients at risk for developing delirium. Cameron Thompson

Track 2

Track 2 – TRAUMATOLOGIE : LES GRANDS BRÛLÉS 

Track Chair: Dr Martin Leblanc

Les grands brûlés : de l’arrivée à l’admission aux soins
Dr Francis Gill

Les patients grand-brûlés représentent un défi de taille pour le médecin d’urgence. Tout d’abord cette pathologie n’est pas fréquente. De plus l’évaluation et le traitement de ces patients présentent des particularités qui leur sont propres. Nous reviserons donc l’approche de ces derniers en salle d’urgence en plus d’explorer les dernières avancées sur le sujet.

Objectifs d’apprentissage

  • Évaluer un grand-brûlé dans un contexte d’urgence
  • Établir un plan de traitement initial
  • Préparer adéquatement le patient pour son transfert à l’unité des grands-brûlés

Victimes de brûlures graves – suite de la prise en charge aux soins intensifs
Dr Jean-François Savard

Les aspects de l’évolution clinique aux soins intensifs d’une victime de brûlures graves seront décrits. La connaissance de l’évolution attendue de cette clientèle aux soins intensifs permettra une meilleure prise en charge initiale à l’urgence.

Objectif d’apprentissage

  • Avoir une meilleure connaissance des conditions que peuvent présenter les victimes de brûlures graves pendant leur séjour aux soins intensifs et les impacts de la gestion de la réanimation initiale

Les grands brûlés : prise en charge et traitement des plaies
Dre Ariane Bussières

L’évaluation et le traitement des brûlures sont primordiaux dans la prise en charge des grands brûlés. De l’estimation de la surface corporelle atteinte, à la nécessité d’interventions chirurgicales, en passant par les soins topiques, tous ces aspects peuvent influencer l’évolution du patient brûlé. Le soin des plaies vise à minimiser la douleur et les risques d’infection, à favoriser la guérison, à préserver la fonction et à limiter les déformations esthétiques. Cette présentation a pour objectif de démystifier l’aspect cutané du traitement des grands brûlés.

Objectifs d’apprentissage

  • Approfondir l’évaluation et la classification des brûlures
  • Approfondir la prise en charges des brûlures incluant les soins topiques
  • Comprendre les principes chirurgicaux fondamentaux incluant le débridement et les greffes cutanées

Track 3

Track 3 – PEDIATRIC II – PEDIATRIC TRAUMA

Track Chair: Dr. Joe Nemeth

Pediatric Trauma – Who’s Better at This? A Debate on the Role of Pediatric EDs on Trauma
Dr. Anthony Crocco & Joe Nemeth

This debate, moderated by Dr. Crocco, will address whether pediatric patients are better served by a pediatric ED trauma team or a general ED trauma team.

Learning Objectives

  • Understand the limitations of PEDs in managing trauma
  • Understand the limitations of general EDs in managing pediatric patients
  • Feel comfortable with the role of PEDs and general EDs in pediatric trauma

How Did it get this Bad? Chaos in the ED – Identifying Non-technical Skills that Will Help You Cope and be Safe
Dr. Antonio D’Angelo

We’ve all lived through the worst experiences in the ED and have seen or heard stories of others who’ve lived through even worse. Dr. Angelo’s presentation will explore the factors that bring chaos into the crash room and in the ED. He will identify the non-technical skills that contribute to being able to survive the inevitable worst days, avoiding potential errors and improving teamwork. The session will also explore the concepts of anticipation and situational awareness in the context of a busy ED.

Learning Objectives

  • Understand the factors that contribute to the chaos of the resuscitation bay and a busy ED
  • Identify the nontechnical skills associated with patient safety that should be developed in a team leader
  • Understand the concepts of anticipation and situational awareness

Injury Prevention & Control – A Priority for Emergency Medicine
Dr. Suzanne Beno

How important is injury? As a leading cause of hospitalization, morbidity and death, injury/trauma prevention is key to improving health outcomes in children. Dr. Beno’s session will review evidence, media, educational curricula and governmental/public health policies to explore current and proposed roles for injury prevention and control within the ED and for the individual clinician.

Learning Objective

  • Recognize injury as a critical public health concern, and be able to describe its landscape within Canada
  • Understand current concepts in injury prevention and control as they relate to children
  • Engage in opportunities to improve injury prevention education, advocacy and strategies within your health care setting

Abstracts

ID Number Title Presenter
LO055 Increased Utilization of Bier Block for Pediatric Forearm Fracture Reduction Following Simulation and Web-Based Training Emmanuelle Fauteux-Lamarre
LO056 Perceptions and provision of analgesia for acutely painful conditions in children: a multi-centre prospective survey of caregivers David Wonnacott
LO057 Association between metoclopramide treatment in the ED for concussion and persistent post-concussion headaches: a propensity score matching analysis Natalie Bresee

Track 4

Track 4 – CHOOSING WISELY

Track Chair: Dr. Brian Rowe

Choosing Wisely in Emergency Medicine – Background, List Developments, and Dissemination
Dr. Brian Rowe

Choosing Wisely is a resource stewardship initiative first developed and implemented by the American Board of Internal Medicine (ABIM) Foundation in 2012. This program was developed in collaboration with US Consumer Reports with the goal of encouraging discussion between patients and physicians regarding the necessity of medical tests, procedures and treatments. Choosing Wisely Canada (CWC) launched in 2014 in partnership with the Canadian Medical Association and is led by Dr. Wendy Levinson at the University of Toronto. In the spring of 2014, the Canadian Association of Emergency Physicians (CAEP) was invited to formulate a Top-5 list for CWC. Dr Rowe will discuss how since CWC’s launch, more than 35 medical specialty societies have developed more than 165 recommendations of medical tests, procedures and treatments to question in their practice. The leadership at CAEP elected to develop their Top-5 list and release it in June 2015 at the CAEP conference in Edmonton.

Learning Objectives

  • Describe the Choosing Wisely Canada campaign
  • Introduce the first Top-5 list for Canadian emergency physicians
  • Discuss how best to implement these recommendations

Early Adopters and Successful CWC Implementation
Dr. Doug Sinclair

Choosing Wisely is an excellent initiative to improve the appropriateness of tests and investigations for our patients. The challenge is implementing these guidelines both at a hospital and system level. Dr. Sinclair’s presentation will focus on the integration of efforts in the ED and at the hospital level to implement sustainable changes in practice.

Learning Objectives

  • Learn practical strategies to implement Choosing Wisely guidelines in their hospital setting
  • Understand how accurate real time data and IT can facilitate this work and understand the effect on patient safety and ED flow

Abstracts

ID Number Title Presenter
LO058 Reducing Unnecessary Coagulation Studies in Suspected Cardiac Chest Pain Patients Shawn Dowling
LO059 CT Head Scans Yield No Relevant Findings in Patients Presenting to the Emergency Department with Bizarre Behavior Pearlly Ng

Trying to Get Choosing Wisely into Your Institution and Integrate it with the ED – While Doing the Rest of Your Job
Dr. Samuel Campbell

Choosing Wisely has reminded us of our roles as stewards of the public healthcare budget. Lots of inappropriate testing is done in the ED for a number of reasons. Dr. Campbell will make a presentation about how the undifferentiated nature of emergency medicine makes emergency physicians who associate with the greatest number of allied acute care services, perhaps best suited to take an institutional lead in this area.

Learning Objectives

  • Identify opportunities for reducing inappropriate diagnostic testing
  • Sell these ideas to non-confrontational EM colleagues
  • Convince consultant colleagues that may not understand Bayesian reasoning well

Track 5

Track 5 – DIAGNOSTIC IMAGING

Track Chair: Dr. Michael Garner

Reading the Abdominal CT in Trauma: A Primer for Emergency Physicians
Dr. Maxime Rioux

The main goal of Dr. Rioux’s presentation is to explain to emergency physicians what to look for when interpreting an abdominal CT in a trauma context. It is a step-by-step approach with key points to look for at each step. The first point is where to look for pneumoperitoneum. The second point is where to look for hemoperitoneum and the third point is to always look for possible traumatic aortic injury. It will be a crash course for abdominal CT interpretation for emergency physicians with pictures and examples.

Learning Objectives

  • Easily detect pneumoperitoneum and hemoperitoneum
  • Triage which patient will need surgery on the basis of abdominal imaging in the context of trauma
  • Understand additional imaging in trauma and when to ask for CT-cystogram

Abstracts

ID Number Title Presenter
LO060 Diagnostic and prognostic value of hydronephrosis in emergency department patients with acute renal colic Grant Innes
LO061 Variation in Emergency Department use of Computed Tomography for Investigation of Acute Aortic Dissection Robert Ohle
LO062 Ultrasound-Assisted Distal Radius Fracture Reduction Paul Atkinson

Radiation Exposure for our Patients: What are the Real Risks?
Dr. Eric Notebaert

To order or not to order a CT-Scan? As emergency physicians, we use more and more CT-Scans for many purposes: Pan-Scan for traumas, angioscan for PE, uroscans, CT-scans for headaches, etc. Is this practice really without risks? Will we be the cause of an epidemic of cancers in a few decades? Is there some good data to help guide our practice? And what about the patient’s opinion? Does the patient know that there may be risks? Dr. Noteabaert’s session will help you guide your practice.

Learning Objectives

  • Evaluate the radiation dose received by the patient for different radiologic examinations
  • Evaluate the cancer risks linked to a specific exam
  • Discuss with patients the benefits versus risks associated with a specific CT-Scan

Track 6

Track 6 – TAKING CARE OF THE INTOXICATED PATIENT – TOXICOLOGY 201

Track Chair: Dr. Alexandre Larocque

Synthetic Cannabinoid Receptor Agonist Overdose
Dr. Robert Hoffman

Synthetic cannabinoid receptor agonists (SCRAs) have sprung onto the market as one of the most prevalent novel psychoactive substances used in the US and elsewhere. Their promotion as synthetic marijuana, combined with low cost, their ability to bypass legal controls and their ability to avoid detection on standard urine drug screens, has led to a massive epidemic. Common acute toxicities include wild agitation, deep sedation, and complications such as stroke, kidney failure, alveolar hemorrhage, myocardial infarction and long lasting drug-induced psychosis. Over 300 new molecules are characterized and the numbers are growing daily. Dr. Hoffman will review the history, epidemiology, pharmacology, clinical effects and treatment of acute SCRA toxicity.

Learning Objectives

  • Discuss the mechanisms that foster the diversion of research chemicals into the drug abuse market
  • Explain how chemical modifications of SCRAs might alter clinical presentations
  • Describe the function of cannabinoid receptors and explain the specific effects of SCRAs on these receptors
  • Explain current treatment strategies for management of patients with SCRA overdose

Too Much of a Good Thing: Toxicity Associated with Antiepileptics
Dr. Sophie Gosselin

Dr. Gosselin’s presentation will discuss the clinical signs and symptoms associated with the use of antiepileptics in overdose (carbamazepine, phenytoin, phenobarbital, levetiracetam, topiramate). This session will help participants decide when extracorporeal therapies and treatment with carnitine are indicated, as well as recognize valproate-induced hyperammoniemic encephalopathy and adopt strategies to manage barbiturates withdrawal.

Learning Objectives

  • Construct a patient management strategy incorporating risk assessment for the use of GI decontamination and intubation
  • Decide if extracorporeal therapies are indicated in the management of antiepileptic overdose
  • Recognize valproate-induced encephalopathy

How to Fix a Broken Heart in Toxicology: Asking Why First
Dr. Maude St-Onge

Dr. St-Onge’s presentation will discuss the different causes of shock seen with cardiotoxicants and the management of patients poisoned with cardiotoxicants. She will also discuss the approach for patients poisoned with multiple co-ingestions.

Learning Objectives

  • Identify different causes of shock in cardiotoxicants poisonings
  • Describe how to manage specific cardiotoxicants poisonings
  • Describe an approach to cardiogenic shock in poisonings involving multiple co-ingestants