Sunday, May 26, 2019 • 10:15 - 11:45
Track 2 - Just the Facts 1, the Whole Facts, and Nothing but the Facts!
Track Chair: Dr. Aaron Sibley

Oral Trauma in the ED: Who Needs a Dentist? Literally! - Dr. Aaron Sibley

Description: Using case examples, the presenter will provide “need to know” information to help participants manage common oral and dental emergencies.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Distinguish between oral injuries that do or do not need intervention
  2. Learn the steps to stabilize dental trauma until the patient can be seen by a dentist
  3. Learn a simple approach to single tooth anesthesia

Pearls

  1. Most oral lacerations need only conservative management
  2. Teeth can be splinted with dermabond and the nasal bridge from N95 mask
  3. A periapical nerve block is a simple way to obtain proper anesthesia in dealing with emergencies of the maxillary teeth

Dr. Sibley is a staff physician at the Queen Elizabeth Hospital in Charlottetown, PEI, Clinical Assistant Professor of Emergency Medicine at Dalhousie University and Associate Medical Director for the Bachelor of Science in Paramedicine at UPEI. His teaching and research interests focus on various aspects of prehospital and disaster medicine.

Fascia Iliaca Blocks - Why Are You Not Doing This for Your Hip Fracture Patients? - Dr. Rob Woods

Description: Rapid fire presentation covering “need to know” information about fascia iliaca blocks.

Learning Objectives
At the end of the presentation, participants will be able to:

  1. Compare and contrast the risks and benefits of different methods of analgesia in elderly patients who sustain a hip fracture
  2. Describe how to landmark externally for a Fascia Iliaca Block
  3. Describe how to safely administer local anesthetic to the area

Pearls

  1. Fascia Iliaca blocks are quite easy to do with external landmarks only
  2. You need to put in 30-40mLs of local anesthetic volume in order to effectively anesthetize the nerves
  3. You should start doing this in all your hip fracture patients!

Behavioural Control of Agitated Geriatric ED Patients - Dr. Lorri Beatty

Description: We will discuss a safe and effective approach to achieving behavioural control and avoiding over-sedation in the agitated geriatric population, especially those with dementia and/or delirium.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Appreciate the nuances to managing agitated behavior in the ED for geriatric patients with delirium or dementia.
  2. Employ an appropriate dosing regimen for haloperidol and lorazepam that will successfully control agitated behavior in patients with dementia in the ED, without causing over-sedation.
  3. Recognize patients with dementia in whom it would be unsafe to use antipsychotic medications in the ED.

Pearls

  1. Geriatric patients, especially those with dementia and delirium, are very sensitive to sedative and neuroleptic medications.
  2. Used in appropriate doses, haloperidol and lorazepam can be used safely in most agitated patients with dementia to achieve chemical restraint and behavioural control.
  3. Antipsychotics, especially first-generation ones, should be avoided in patients with Lewy Body dementia to avoid serious and potentially irreversible side effects.

Lorri has been a staff emergency physician at the QEII in Halifax since finishing her residency there in 2012, with a special interest in wilderness medicine. She is the Assistant Program Director for the Royal College program, and unit head for a Clerkship unit.

Eye Trauma - What You Can't See Can Hurt You - Dr. Vuthana Suon

Description: Eye trauma is a common ED presentation. This talk will review why it’s so important to properly examine an eye that’s been traumatized, and will provide tips on examining these eyes.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Review some common causes of blunt eye trauma
  2. Review ultrasound techniques to examine eyes with swollen eyelids
  3. Review physical exam techniques to examine the swollen eye

Pearls

  1. A swollen eyelid can hide a lot of pathology
  2. Ultrasound can be a useful adjunct to your exam
  3. A well placed Q tip is your friend. So is tetracaine.

Hailing from windy Winnipeg, I did my emerg training in Saskatoon before being escorted out to Nova Scotia by my Caper wife. Now living the east coast dream.

Asymptomatic Hypertension in the ED: Please Sign My Petition to Ban Pharmacy Blood Pressure Machines! - Dr. Aaron Sibley

Description: The presenter will discuss the management of ED patients with severe asymptomatic hypertension. We will acknowledge when it is a true emergency and requires intervention in the ED and when the patient can be safely observed and discharged.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Understand the definition of a true hypertensive emergency
  2. Distinguish between patients who do, or not not need a work-up in the ED
  3. Discuss options for patients with hypertension in the ED and no reliable follow-up

Pearls

  1. Most patients presenting to the ED with asymptomatic hypertension do not need treatment in the ED- and treatment could cause harm
  2. Many patients with asymptomatic hypertension in the ED do not need a work-up during that visit
  3. In patients with pre-existing hypertension who are non adherent to treatment, resumption of their medications is usually sufficient treatment

Growth Plate Fractures - You Can Draw the Figures, but Can You Recognize Them on an X-Ray? - Dr. Rob Woods

Description: Rapid fire presentation covering “need to know” information about growth fractures.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Recognize and categorize growth plate fractures of the wrist
  2. Recognize and categorize growth plate fractures of the knee
  3. Recognize and categorize growth plate fractures of the ankle

Pearls

  1. Growth plate fractures of the wrist and ankle are most commonly Salter-Harris II – look for them!
  2. Bucket handle or corner fractures of abuse are also Salter-Harris II fractures – you should not see these in non-
    ambulatory children
  3. Salter Harris III fracture of the knee and ankle are often difficult to see and missed – look closely for them

The First 5 Minutes - Preparing for the Arrival of an Unstable Patient - Dr. Lorri Beatty

Description: We will discuss what you can to do prepare your room, your team, and yourself for the emergency department arrival of a critically ill or unstable patient.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Develop an approach to preparing your team and equipment for the arrival of a critically ill patient which will improve initiation of life-saving care.
  2. Employ self-talk and imagery to improve mental preparedness for the arrival of a critically ill patient to the ED.
  3. Use tactical breathing and power postures to lessen stress response and improve performance during the care of a critically ill patient.

Pearls

  1. Having equipment ready and checked before patient arrival will allow immediate initiation of life-saving procedures.
  2. Assigning tasks and roles before patient arrival allows for seamless initiation of care on arrival.
  3. Preparing mentally for patient arrival with breathing, posture and positive self-talk and imagery can improve performance in critical situations.

Priapism pearls - Dr. Vuthana Suon

Description: Priapism is a rare but serious emergent condition that many of us will see. Often it is referred to urology, but is something that we can manage well in the emergency department.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Successfully manage this
  2. Review non needle management
  3. Understand management tips

Pearls

  1. Stairs to reduce a priapism?
  2. Don’t worry about the dorsal penile block – just do a local block
  3. Use a three way stopcock with butterfly needle

Just the Facts Panel: Tips Tricks and Hacks - Drs. Aaron Sibley, Rob Woods, Lorri Beatty, Vuthana Suon

Description: Our panel of Just the Facts presenters will give you their best tips tricks and hacks in a fast paced and fun session.

Learning Objectives
At the end of this presentation, participants will be able to:

  1. Describe simple tips to improve performance of common ED procedures.
  2. Show potential modifications to emergency department equipment that simplify patient care.
  3. Share communication tips that may improve doctor-patient interactions and physician satisfaction.