Heart Failure Risk Scale and Atrial Fibrillation

This week we had the pleasure of welcoming a guest speaker for grand rounds, prominent EM researcher and well-known clinical decision rule/tool expert from Ottawa, Dr. Ian Stiell. The focus of his talk was on the Canadian Heart Failure Risk Scale and atrial fibrillation, with some personal travel blogging and joking scattered throughout. Beginning with its derivation and subsequent validation, Dr. Stiell provided a background to the current phase of study that Queen’s will be a part of, the revision and validation of the Canadian Heart Failure Risk Scale. Approximately 1 million people are seen in the ED annually in Canada for acute heart failure, 40-60% of which are admitted to the hospital.  The Heart Failure Risk Score hopes to provide guidance and standardize practice for ED physicians across the country with respect to admission decisions in this population.  The group had a rich discussion about factors included, surprises found in the literature, and predicted utility of the tool. Dr. Stiell pointed out that in order to find out whether this tool will change practice, an implementation trial would have to ensue – stay tuned! In the meantime, check out the score and look for the bright yellow forms to fill out on your next shift in the ED!

The Canadian Heart Failure Risk Scale

Dr. Stiell finished his talk with a review of his work on management of acute atrial fibrillation and flutter. Refer to the updated Canadian CV Society Guidelines for the latest (see algorithm below). Dr. Stiell is now working with CAEP to adapt these guidelines to the ED – stay tuned!

BONUS feature: Dr. Stiell sold us on two new phone applications to check out – The Ottawa Rules Application and Thrombosis.

Thanks for coming Dr. Stiell (@EMO_Daddy)!

 

 

Mass Gatherings and ED Ultrasound

On February 2 we had the pleasure of welcoming back Dr. Colin Bell, a recent FRCP EM grad, all the way from Denver for a talk on ED Ultrasound and hearing some more stories from Dr. Terry O’Brien.

The legendary TOB started the morning off with a talk on mass gatherings, using the last Tragically Hip concert as an example. He took us through the planning, equipment, personnel involved, and lessons learned on the day. Our crew of one nurse (thanks Patti!), multiple residents, staff physicians, and essential administrative assistants provided excellent care and diverted 35 people away from the crowded hospital. EMS was instrumental in the success of the event as well. Kingston’s population received an additional 25, 000 that day!

Here are some resources on mass gatherings to take a look at in preparation for the next big event:

Colin Bell then took us through ‘The Second Phase of POCUS’, illustrating the growing utility of ED ultrasound with a few key cases in which management was altered based on bedside images. It is an exciting time for POCUS and is becoming more of an essential adjunct to diagnostic workups in the ED, especially when time is of utmost importance.

Don’t be shy to ask Colin about the cool new initiatives he is taking part in across the border – he also has some interesting stories to tell practicing EM in an entirely different context than we see here in Kingston.

Here is a reminder of a previous post in which we included a number of valuable online resources for ED ultrasound.

 

Thyroid Emergencies and CBME EPAs

On January 25th Dr. Andrew Hall gave us a reminder the concept of CBME and what it will look like next year. Dr. Heidi Wells followed with an excellent overview of Thyroid disorders encountered in the ED.

Andrew re-iterated the model of CBME and how it will fit into our emergency medicine program starting July 2017. He provided a list of the current entrustable professional activities (EPAs) for emergency medicine and a rich discussion ensued. Overall, it is an exciting time in medical education and Andrew convinced me that our already great program will only get better with this shift towards an outcomes-based, learner centered model! Feel free to ask Dr. Hall all about it, or refer to the PGME website for more information.

Heidi then took us through an approach to thyroid disorders in the ED – with tons of clinical pearls and important take home points to use on your next shift. See the infographic below for a summary of the key messages, and click here for a downloadable pdf version:

Interestingly, Queen’s wasn’t the only institution focused on thyroid disorders that week – the twittersphere was lighting it up!

In true FOAMed spirit, check these resources from the Bold City EM program in Jacksonville, Florida on endocrine, metabolic and nutrition themed topics. Thanks Bold City EM!