Nicotine Toxicity From Repeat Use of Nicotine Pouches.

Background: Nicotine pouches have emerged as a novel way to administer concentrated nicotine and come as a white powder in flavored, microfiber pouches placed between the cheek and gums to dissolve without requiring spitting. While marketed as a safe alternative to smoking, nicotine pouches have the potential for toxic exposure to users.

Case Presentation: We present a case of a 21-year-old male with acute nicotine toxicity through repeated administration of nicotine pouches.

Vision Transformer-based Decision Support for Neurosurgical Intervention in Acute Traumatic Brain Injury: Automated Surgical Intervention Support Tool.

Purpose To develop an automated triage tool to predict neurosurgical intervention for patients with traumatic brain injury (TBI). Materials and Methods A provincial trauma registry was reviewed to retrospectively identify patients with TBI from 2005 to 2022 treated at a specialized Canadian trauma center. Model training, validation, and testing were performed using head CT scans with binary reference standard patient-level labels corresponding to whether the patient received neurosurgical intervention.

Macrocirculatory and Microcirculatory Endpoints in Sepsis Resuscitation.

Sepsis is a common disease process encountered by physicians. Sepsis can lead to septic shock, which carries a hospital mortality rate in excess of 40%. Although the Surviving Sepsis Guidelines recommend targeting a mean arterial pressure (MAP) of 65 mmHg and normalization of lactate, these endpoints do not necessarily result in tissue perfusion in states of shock.

Predictors of mortality and cost among surgical patients requiring rapid response team activation.

Background: Prior studies of rapid response team (RRT) implementation for surgical patients have demonstrated mixed results with respect to reductions in poor outcomes. The aim of this study was to identify predictors of in-hospital mortality and hospital costs among surgical inpatients requiring RRT activation.

Methods: We analyzed data prospectively collected from May 2012 to May 2016 at The Ottawa Hospital.

Resident learning during a pandemic: Recommendations for training programs.

Resident education in emergency medicine (EM) relies upon a variety of teaching platforms and mediums, including real-life clinical scenarios, simulation, academic day (lectures, small group sessions), journal clubs, and teaching learners. However, the coronavirus disease 2019 (COVID-19) pandemic has disrupted teaching and learning, forcing programs to adapt to ensure residents can progress in their training. Suddenly, academic days cannot be held in person, emergency department (ED) volumes are dynamically changing, and the role of residents in ED procedures has been questioned.

Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures.

Background: Opioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem.

Impact of Anticoagulation on Mortality and Resource Utilization Among Critically Ill Patients With Major Bleeding.

Objectives: Patients with major bleeding are commonly admitted to the ICU. A growing number are on either oral or parenteral anticoagulation, but the impact of anticoagulation on patient outcomes is unknown. We sought to examine this association between anticoagulation therapy and mortality, as well as the independent effects of warfarin compared to direct oral anticoagulants.

Preadmission Antiplatelet Use and Associated Outcomes and Costs Among ICU Patients With Intracranial Hemorrhage.

Introduction: Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage.

Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa.

Objective: The aim of this study was to determine what clinically important events occur in ST-elevation myocardial infarction (STEMI) patients transported for primary percutaneous coronary intervention (PCI) via a primary care paramedic (PCP) crew, and what proportion of such events could only be treated by advanced care paramedic (ACP) protocols.

Methods: We conducted a health record review of STEMI transports by PCP-only crews and those transferred from PCP to ACP crews (ACP-intercept) from 2011 to 2015. A piloted data collection form was used to extract clinically important events, interventions during transport, and mortality.

Design and validation of pictograms in a pediatric anaphylaxis action plan.

Background: Current anaphylaxis action plans (AAPs) are based on written instructions without inclusion of pictograms.

Objectives: To develop an AAP with pictorial aids and to prospectively validate the pictogram components of this plan.

Methods: Participants recruited from the emergency department and allergy clinic participated in a questionnaire to validate pictograms depicting key counseling points of an anaphylactic reaction.