Le 11 septembre 2001, les auteurs participaient à une rencontre sur des essais cliniques à New York. De concert avec leurs collègues chercheurs, ils ont participé à l’opération de sauvetage pendant les 16 premières heures suivant le pire acte de terrorisme de l’histoire moderne. Le présent article résume leur expérience.

Clinical teaching is an integral part of emergency medical practice. With the growing number of medical students and residents in the emergency department there are increasing expectations for clinicians to teach. But there are many challenges and obstacles to overcome when teaching in a busy department. By incorporating diverse strategies and techniques, we can become more effective and efficient emergency medicine teachers.

Poisoning is an uncommon but potentially fatal outcome of toxic alcohol ingestion. The toxic alcohols methanol, ethylene glycol and isopropyl alcohol are commonly found in household and commercial products. Because the toxic effects are caused by the metabolites of methanol and ethylene glycol rather than the agents themselves, there is often a substantial delay between ingestion and onset of clinical toxicity. Anion and osmolar gaps are often used for the diagnosis and exclusion of these sometimes subtle overdoses. The pitfalls of using these tests to rule out alcohol ingestion are reviewed. Ethanol infusion is the traditional therapy for such overdoses. In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed.

It is important for clinicians to be aware of the sensitivity and limitations of commonly used methods to confirm endotracheal tube placement. Overreliance on insensitive indicators can lead to delayed recognition of esophageal intubation. The case presented highlights this concern.

In April 2001, the Commission on the Future of Health Care in Canada was established. The Honorable Roy Romanow was given the mandate to “inquire into and undertake dialogue with Canadians on the future of Canada’s public health care system” and “to develop recommendations that will ensure the long-term sustainability of a high quality, universally accessible, publicly administered health care system, for all Canadians.”

The Canadian Association of Emergency Physicians (CAEP) recognized an obligation to share in this public dialogue, to communicate the current state of emergency medicine, and to identify the components necessary to achieve excellence in emergency care. The CAEP Advocacy Committee was asked to develop a document that would educate and enlighten the Commissioner. Basic themes were identified, and authors from across the country were invited to write brief, factual essays with achievable recommendations. The resulting series of essays was presented on April 30, 2002, at the Health Care Commission’s open public hearing in Calgary, Alberta.

This article, part 2 of a 2-part series, includes discussions on Emergency Department Overcrowding, Human Resources Issues in Emergency Medicine, Standardization of Care and Clinical Practice Guidelines, Informatics and the Electronic Health Record, and Research in Emergency Medicine.

Emergency physicians use diagnostic tests extensively, and the ability to order and interpret test results appropriately is a critical skill. An understanding of sensitivity, specificity, predictive values and likelihood ratios, as well as an awareness of the importance of pre-test probability, is essential. The purpose of this article is to explain, in a straightforward and clinically applicable manner, the core concepts related to diagnostic testing.

Ethical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions.

Understanding the legal and ethical basis for advance directives allows emergency physicians to determine when the directives should be followed and when they should be questioned. Resource allocation decisions are among the toughest decisions emergency physicians make. Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient’s wishes, that it is achievable, and that competing claims for the same resource are considered.

Learning from others’ experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.

A case of occupational hydrofluoric acid exposure is presented, accentuating the importance of eliciting an occupational history during the initial emergency department evaluation. Patients who present with major hydrofluoric acid burns are at risk for systemic complications, including potentially fatal hypocalcemia. Information regarding the accident and workplace circumstances may well allow the physician to anticipate the exposed patient’s course. These patients should be considered occupational index cases that will require follow up by government occupational health services. Identification of potential hazards, risk assessment and enforcement of recommendations for change (such as engineering controls, personal protective equipment, education) may be key to preventing similar injuries in the future.

The large number of abstracts submitted and the short time interval between submission and publication did not permit communication with authors, abstract revision or CJEM editorial review. The following abstracts are presented, unedited, as they were submitted to the CAEP Research Committee. Abstract authors are from the department or division of emergency medicine of their respective universities unless otherwise specified.

This paper outlines 3 cases of acute isolated peroneal (lateral) compartment syndrome following exertion, minor trauma or overuse. Compartment syndromes are usually associated with crush injuries or fractures; they are an uncommon development following minor trauma or overuse. In acute isolated peroneal compartment syndrome the diagnosis is often delayed, resulting in permanent impairment. Persistent or worsening pain following a minor injury or overuse is typical, and the initial physical findings are often nonspecific, although swelling and tenderness out of proportion to the described injury are common. Marked increase in pain with passive inversion and dorsiflexion of the ankle should suggest the diagnosis. In cases that present late or where the diagnosis is initially missed, there is often a common peroneal nerve palsy. As with all compartment syndromes, prompt diagnosis and surgical decompression is necessary to prevent permanent impairment.

Lateral canthotomy and cantholysis is a simple procedure that can be performed by emergency physicians. It has the potential to save vision, particularly in cases of blunt ocular trauma. The case of a 37-year-old man with blunt ocular trauma, a retrobulbar hemorrhage and rapidly increasing orbital pressure requiring an urgent lateral canthotomy and cantholysis is presented. Pathophysiology, indications, contraindications, procedure and follow-up care are described.