Canadian Journal of Emergency Medicine最新文献

Purpose: Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec.

Methods: We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development.

Results: Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF.

Conclusions: In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.

Objectives: Physician documentation plays a central role in the delivery of safe patient care. It describes a physician's clinical decision-making and supports essential communication between healthcare providers within the patient's circle of care. Good documentation can potentially also decrease a physician's medico-legal risk. This study provides examples of documentation issues attributed to physicians practicing emergency medicine as identified by peer experts in civil legal actions, regulatory authority complaints (College) and hospital complaints (collectively, medico-legal cases) in Canada.

Methods: We conducted a descriptive study and content analysis of medico-legal cases involving emergency department physicians from a national repository at the Canadian Medical Protective Association. Cases with peer expert criticism of an emergency physician's documentation, which were closed between 2016 and 2020, and occurred in an emergency department were included in our analysis.

Results: Of the 1628 cases involving emergency medicine, our inclusion criteria identified that absent or insufficiently detailed documentation was present in 24% of cases (391/1,628). A detailed review of 20% of the cases (79/391), selected randomly, found that documentation issues were most often associated with the assessment and investigation stage of care. This pertained to documenting details of the clinical examination, relevant medical history, diagnosis, and differential diagnosis.

Conclusions: For physicians practicing emergency medicine, criticism of documentation was frequently observed in medico-legal cases. Based on the findings of this study and the expert criticism related to documentation, emergency medicine physicians may consider reflecting upon their documentation of the care provided to determine if their documentation provides a clear and accurate chronicle of the care and the rationale for their clinical decisions.