ACEP 2013

Just got back from ACEP in Seattle.  As always these conferences back so much into so little time.  Here are a few highlights:

1) There seems to be a move to half dose tPA in submassive PEs.  This seems to have no impact on mortality but decreases long term complications such as pulmonary hypertension.

2) Posterior dislocations of shoulders can be treated with simple should immobilizer and avoid that gunslinger cast that cant fit in any doorway!

3) Tranfusing GI bleeds seems to cause more harm.  A permissive approach had better results.

4) When you compare people on plavix vs warfarin after had injury the plavix group does worse and will likely need hospitalization after initial CT whereas the warfarin group might be able to go home with good follow-up.

5) Concussion management is complex.  Make sure you dont send that player back on the field too early.  Rest that brain means no computers kids!

6) There are some cool toys coming down the pipe - smaller ultrasounds, telemedicine robots, hemorrhage clamps, gortex treated lab coats...  I couldn't believe how big the display area was.

Subgroup Analysis (Ortho and Psych)

Subgroup Analysis (Ortho and Psych) - Poster Presentation to ICCH15 (Fairbanks, Alaska)

It was a busy summer of research presentations (and moving).  After helping to unload a moving truck in Victoria I flew up to Alaska to present the data on outcomes for orthopedic and psychiatry patients back in 2009.  What this study was looking at was the ability of clinicians to predict the acuity of these two sets of patients.  Does the gestalt that the receiving clinical get on the phone correlate with the patient's need for hospitalization?  The answer, according to this analysis is yes.

Impact of Teleradiology on Patient Transfers

Impact of Teleradiology on Patient Transfers (2012) - CAEP oral powerpoint presentation
ICEM (Dublin) Poster Presentation

In 2010, the GNWT rolled out a pan-territorial PACS system that allowed clinicians at any site across the territory to view xray, ultrasound or CT images from any other facility.  Given that the ER in Yellowknife was often the receiver of all the sickest patients I wondered what impact if any did the PACS system have on patient transfer rates.  What I did was simply compare the transfer rates pre and post PACS.  The data seemed to indicate a drop in transfers with the adoption of PACS.

Medevac Retrospective Review 2010

Medevac Retrospective Review - CAEP 2010 Poster Presentation

In 2009 I reviewed all of the data that Medical Travel (NWT) collected on medevacs and urgent transports for a one year period.  Here I found that there were far more people being transports on air ambulances than by using commercial flights.  Some of these patients (simple upper limb fractures for example) were getting medevacs when they could have likely come on the less costly commercial flights.  The question of how these cases were triaged and how the transport decisions were made was something I tried to improve on.  I realized that only with high quality prospective data could one develop an evidence based algorithm to sort this out.

Telephone Outcome Study: Power Point Presentation to ICCH 2009

In 2009, I presented some preliminary data at the Circumpolar Health Congress in 2009 about the experience in the Yellowknife ER with fielding calls from remote nursing stations and peripheral hospitals.  What we found was that there are a lot of calls asking to transport patients into Yellowknife.  We also found that there were lots of holes in the data that had been captured.  This lead to developing a better data capture process and to future studies on how we could improve pre-hospital care with the technology we had (at that time just a telephone and a fax machine).

The Meaning of Life (2/11) Movie CLIP - The Miracle of Birth (1983) HD