Wednesday, May 30, 2018 • 10:30 - 12:00
Track 1 - OUT OF THE IVORY TOWER
Track Chair: Dr. Alan Drummond
Get Off My Lawn: Trauma Tips from the Ivory Tower - Dr. Chris Hicks
Description: The first 10 minutes of a trauma resuscitation are critical, particularly outside of a trauma centre. Here we will discuss a refined early approach to the trauma patient in shock.
- Define controlled resuscitation and its implications for trauma resuscitation
- Targeted volume resuscitation: How much, and to what targets?
- Untangling the brain/blood trade off: How to resuscitate the brain and not promote bleeding
- Controlled resuscitation: Smaller fluid boluses, tolerating lower SBPs
- Preference given to blood and blood products over crystalloid
- Early priorities are adequate (not perfect) tissue perfusion and clot formation
Biography: I am an emergency physician and trauma team leader at St. Michael’s Hospital, as well as a Clinician-Educator in the Department of Medicine at the University of Toronto. I use high fidelity human patient simulation to help make teams work better and more safely.
What to do with #MeToo - Managing Sexual Assault in the Rural ED - Dr. Kari Sampsel
Description: Sexual assault is a disturbingly common phenomenon and the ED for many is the entry point for care. These patients are time consuming, complex and at the interface between the medical and legal systems.
- Overview of medical care of the sexually assaulted patient
- Overview of forensic care of the sexually assaulted patient
- Documentation, privacy and anonymity of the sexually assaulted patient
- Medical care is a combination of usual trauma and needlestick injury care
- Injury pattern recognition and documentation is the same as for child abuse and carries the same emotional weight
- Forensic kit completion and maintenance of chain of evidence is as simple as following the instructions
Biography: Dr. Kari Sampsel is a staff Emergency Physician and the Medical Director of the Sexual Assault and Partner Abuse Care Program at the Ottawa Hospital and an Assistant Professor at the University of Ottawa. She undertook fellowship training in Clinical Forensic Medicine at the Victorian Institute of Forensic Medicine in Melbourne, Australia, and is currently the only Canadian physician to hold this designation. She has been active in the fields of forensic medicine and medical education, with multiple international conference presentations, publications and committee work. Dr. Sampsel has been instrumental in working with numerous groups and launching a number of community initiatives, including bystander intervention training for preventing sexual assault and has been honoured with a number of national awards in recognition of her commitment to education and awareness.
MONA, MONA? - Dr. Ken Milne
Description: Does the evidence support M.O.N.A. therapy for ACS?
- What is the potential benefit and potential harm for morphine, oxygen, nitrates and ASA therapy for patients presenting with ACS?
- Morphine – May be considered second line for pain control
- Oxygen – Only if hypoxic (saturations <90%)
- Nitrates – Mortality benefit early and harm if PDE5-I
- ASA – Potential benefit greater than potential harm
Biography: Dr. Milne is the Chief of Staff at South Huron Hospital Association in Exeter, Ontario, Canada. He has been doing research for over 30 years publishing on a variety of topics. He is passionate about skepticism and critical thinking. He is the creator of the knowledge translation project, The Skeptics’ Guide to Emergency Medicine (www.TheSGEM.com).
Ketamine: The Rural Physician's Friend (and EVERYONE Is Rural Sometimes) - Dr. Constance LeBlanc
Description: Emergency medicine is a cross-cutting and includes the scariest bits of many other specialties: pain management, agitated or violent patients, toxicology, and airway management, to name a few. Some tools are better than others and when you and your patient are running into trouble. “Vitamin K” can be your friend.
- Use the mechanism of action of ketamine to inform its use in the ED
- Recognize the firm indications and possible indications for its use in the ED
- Use best-evidence for dosing and routes for ketamine in different situations
- Non-opioid analgesia with ketamine
- SDK of LDK as an option in a variety of situations
- Ketamine combos???
Biography: I am a professor of Emergency Medicine and Associate Dean for Continuing Medical Education and Education Research at Dalhousie University in Halifax, NS. Although this sounds like a city, it is rural by Toronto standards. I enjoy the peace and quiet ketamine brings to our work environment.
Lyme and Other Friends: Update on Tick-Borne Diseases in Canada - Dr. Elizabeth Shouldice
Description: The rate of tick-borne illness in Canada is on the increase. Acute Lyme infections have risen drastically since 2009. Although other tick-borne infections are less common, they are worth knowing about and keeping on a broad differential in tick-endemic areas.
- Briefly review non-Lyme tick-borne infections in Canada
- To cover current epidemiology of tick-borne illness
- Review evidence on prophylaxis, diagnosis and treatment
- Acute lyme cases have increased drastically since 2009.
- In endemic areas, often ticks do not need to be sent away for analysis.
- There is currently no regimen for lyme prophylaxis in children under 8.
Biography: Dr. Elizabeth Shouldice is an Emergency Physician at The Queensway Carleton Hospital where she is Vice President of the Medical Staff Association. Expanding on an interest in public health and prevention, she obtained a Master of Public Health from Johns Hopkins Bloomberg School of Public Health in 2013. Recently, she took over the role of medical director for the Advanced and Primary Care Paramedic Programs at Algonquin College.
What May Become of the Rural ED - Dr. Alan Drummond
Description: Rural Canadian emergency departments are faced with unique challenges no more pressing than the difficulty with providing continuous staffing and ensuring access. Regionalization is one proposed solution but the devil is in the details.
- What is the extent of the threat
- How has regionalization been approached in the past
- What is the way forward – one person’s view
- All Canadians deserve timely access to quality emergency services
- Regionalization is the way forward
- Rural physician engagement is key
Biography: A sommelier and occasional family/emergency physician in Perth, Ontario. A clinical assistant professor in Family Medicine at Queen’s and University of Ottawa, with a cross-appointment in Emergency Medicine at the University of Ottawa (although they conveniently forget that!). A Past President of CAEP and chair of the OMA Section on Emergency Medicine.