Emergency Medicine Ottawa

EMOttawa Journal Club Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial Methodology: 4/5... Usefulness: 3.5/5 Baksaas-Aasen K, et al. Intensive Care Med. 2020 Oct 13. doi: 10.1007/s00134-020-06266-1. Question and Methods: Pragmatic, European, multi-center RCT comparing outcomes in trauma patients who received empiric massive transfusion protocols (MTPs) augmented either by viscoelastic hemostatic assays (VHAs) or conventional coagulation test (CCT)-guided intervention. Findings: Primary outcome at 24h, no difference in the proportion of patients who were alive and free of massive transfusion between groups. No differences in any secondary outcomes. In the pre-specified subgroup with TBI, mortality benefit at 28d in the VHA-guided group Limitations: Less coagulopathy than expected, lower observed vs predicted effect size in primary outcome possibly under-powered. Empiric administration of 1:1:1 blood products in both arms and the lack of a sequential VHA algorithm might have masked benefits. No comment on surgical sources of bleeding and if these were corrected. Interpretation: First larger-scale RCT comparing VHA (both TEG and ROTEM) to CCT-guided MTP. Study findings suggest that all-comers do not benefit from VHA-guided MTPs though limitations dampen this statement. Future study should test a stepwise VHA protocol and identify injury types that may benefit from a VHA-guided approach, e.g. severe TBI. By: Dr. Richard Hoang

EMOttawa Awards Congratulations to our colleagues Drs. Jen Leppard, Christian Vaillancourt, Sarah Reid and Ian Stiell for being recognized by Canadian Association of Emergency Physicians - CAEP in the latest CAEP Annual Awards. We are very proud of them all! Dr. Jennifer Leppard: Helen Karounis Memorial Award for Professionalism in Emergency Medicine ... Dr. Christian Vaillancourt: Ian Stiell Researcher of the Year Award Dr. Sarah Reid: Marilyn Li Pediatric EM Leadership Award Dr. Ian Stiell: Receiving an Honourary Lifetime Membership See more

EMOttawa News Don't miss Canadian Association of Emergency Physicians - CAEP National Grand Rounds, November 18th at 7pm, featuring our very own Dr. Jeff Perry discussing TIA risk stratification. Other great speakers including former EMOttawa Grads Drs. Robert Ohle and Justin Yan. The Grand Rounds are free. Make sure to pre-register for the event: https://caep.ca/cpd-courses/caep-national-grand-rounds/

EMOttawa News Every year the Cancer Quality Council of Ontario gives awards for Quality and Innovation in the delivery of Cancer Care in Ontario. This afternoon a team from TOH won and accepted the Quality Award in a virtual ceremony! Congratulations to Katie Nichol, Sara Olivier, Lisa Galitzine, Dr. Lisa Fischer, and Dennis Garvin! Please click on the link below to see the overview of their palliative care project in the ED! Congratulations all!... https://www.cqco.ca//quality-innovation-aw/2020-recipients

SRPC COVID-19 Virtual In-Situ Simulation Curriculum One of our residents, Dr. Wilson Lam, is part of a team looking to offer Rurals EDs across Canada as a way to complement and grow their rural emergency medicine practice by helping develop SIM programs for rural doctors and ED’s. See the great video below and please contact [email protected] for more information https://www.youtube.com/watch?v=VAd-EP3M2QI&feature=emb_logo

EMOttawa Blog Title: The D-Dimer Dilemma: It’s Use In Low-Risk PE Author: Dr. Jim Yang... Pulmonary embolism is often a nebulous diagnosis with various nuances. COMMON: They affect 25-100 people per 100,000, or approximately 30,000 Canadians every year Potentially FATAL: 3rd most deadly cardiovascular disease, after Heart Attack and Stroke Associated with LONG-TERM CONSEQUENCES: survivors are at high-risk for pulmonary hypertension As such, prompt identification of at-risk patients is IMPORTANT. To learn more, please click on the link below: https://emottawablog.com//the-d-dimer-dilemma-use-of-ddim/

EMOttawa JC Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. Methodology: 2/5... Usefulness: 2/5 Johnston SC, et al. N Engl J Med. 2020 Jul 16;383(3):207-217. Question and Methods: Multicentre, double-blind RCT of ASA vs Ticagrelor-ASA among 11016 patients with high-risk TIA or minor stroke for prevention of stroke/death within 30 days. Findings: Ticagrelor-ASA decreased overall rates of stroke/death (5.5 vs 6.6%, HR 0.83; 95% CI 0.71-0.96). However, there was no difference in disability, and more severe and intracranial bleeding with combination therapy. Limitations: Industry was heavily involved Interpretation: Insufficient evidence to recommend ticagrelor-ASA for secondary stroke prevention. Previous evidence suggests Clopidogrel-ASA has fewer side effects especially when limited to 21 days. By: Dr. Michael Wong https://emottawablog.com//ticagrelor-and-aspirin-or-aspir/

EMOttawa Blog Title: A Crash Course on Competence Committees Author: Dr. Jeff Landreville A Competence Committee (CC) is a key component of Competence by Design (CBD), the Royal College of Physicians and Surgeons of Canada’s version of Competency-Based Medical Education. A CC is a sub-committee of the Residency Program Committee (RPC) that provides robust and transparent resident performance review. The goal of the CC is to ensure all residents achieve the requirements of the discipline through synthesis and review of qualitative and quantitative assessment data at each stage of training and to provide recommendations on future learning activities.