Anesthesiologist and Emergency Medicine Physician Attitudes and Knowledge Regarding Etomidate for Intubation.

Purpose: The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood.

Between- and within-site variation in medication choices and adverse events during procedural sedation for electrical cardioversion of atrial fibrillation and flutter.

Objectives: Although procedural sedation for cardioversion is a common event in emergency departments (EDs), there is limited evidence surrounding medication choices. We sought to evaluate geographic and temporal variation in sedative choice at multiple Canadian sites, and to estimate the risk of adverse events due to sedative choice.

Methods: This is a secondary analysis of one health records review, the Recent Onset Atrial Fibrillation or Flutter-0 (RAFF-0 [n=420, 2008]) and one prospective cohort study, the Recent Onset Atrial Fibrillation or Flutter-1 (RAFF-1 [n=565, 2010 - 2012]) at eight and six Canadian EDs, respectively.

Tranexamic Acid for Epistaxis--A Promising Treatment That Deserves Further Study.

Clinical Question: Does the application of topical tranexamic acid reduce bleeding as compared to anterior packing?

Article Chosen: Zahed R, Moharamzadeh P, Alizadeharasi S, et al. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31(9):1389-92.

Targeted temperature management: It is not yet time to change your target temperature.

Unlabelled: Clinical question In unconscious patients of out-of-hospital cardiac arrest, does targeted temperature management to 36°C (96.8°F) improve outcomes compared to the standard target of 32°C-34°C (89.6°F-93.

The development and validation of hand motion analysis to evaluate competency in central line catheterization.

Objectives: Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire.

Assessment of lumbar puncture skill in experts and nonexperts using checklists and quantitative tracking of needle trajectories: implications for competency-based medical education.

Unlabelled: CONSTRUCT: With the current shift toward competency-based education, rigorous assessment tools are needed for procedurally based tasks.

Background: Multiple tools exist to evaluate procedural skills, each with specific weaknesses.

Approach: We sought to determine if quantitative needle tracking could be used as a measure of lumbar puncture (LP) performance and added discriminatory value to a dichotomous checklist.

The economic and societal benefits of adult cochlear implant implantation: A pilot exploratory study.

Background: Cochlear implantation has been shown to result in significant improvements in communication and quality of life, but little is known about the effect of cochlear implantation and changes in a person's employment status and earning potential. The purpose of this study is to measure the extent to which personal income changes in people who receive a cochlear implant.

Methods: We mailed a survey to a random selection of 150 cochlear implantees who receive health services in a large urban setting.

Changes in the cochlear vasculature and vascular endothelial growth factor and its receptors in the aging c57 mouse cochlea.

Introduction. Previous work has shown a strong association between alterations in cochlear vasculature, aging, and the development of presbycusis. The important role of vascular endothelial growth factor (VEGF) and its receptors Flt-1 and Flk-1 in angiogenesis suggests a potential role for involvement in this process.

An Unusual Presentation of Ludwig's Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature.

Ludwig's angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig's angina complicated by necrotizing fasciitis in an elderly patient.

Changes in expression of vascular endothelial growth factor and its receptors in the aging mouse cochlea, part 1: the normal-hearing mouse.

Background: Presbycusis is the most common degenerative otologic condition. New research is pointing toward vascular changes within the cochlea with age. Vascular endothelial growth factor (VEGF) and its receptors, Flt-1 and Flk-1, are important regulators of angiogenesis.

Improved hearing with cochlear implantation in Fabry's disease.

Objective: To describe our center's experience with cochlear implantation in patients suffering from Fabry's disease, an inherited mutation resulting in an alpha-galactosidase A enzyme deficiency.

Clinical Presentation: Case report of two patients aged 49 and 59 at implant, with genetically confirmed Fabry's disease and progressive hearing loss.

Intervention: Surgical implantation of Clarion (Advanced Bionics) and Nucleus Freedom (Cochlear) cochlear implants.

Telephone use and the factors influencing it among cochlear implant patients.

Objective: To investigate telephone use in cochlear implant patients and to determine factors most likely to influence telephone use.

Methods: Surveys were mailed to 504 cochlear implant patients treated at Sunnybrook Health Sciences Hospital.

Results: Two hundred four patients returned surveys (49%), 87% were classified as telephone users.