CJEM Articles: Christopher M.B. Fernandes

Displaying 1-5 of 5 results

  • Adult epiglottitis: a five-year retrospective chart review in a major urban centre
    November 2005 7 6
    Andrew Worster, Christopher M.B. Fernandes, Ian Preyra, Ira M. Price, Karen Woolfrey

    Objective: There is an increasing awareness of unvaccinated adults presenting with epiglottitis to the emergency department. This study examines the clinical presentations and outcomes of diagnosed cases of adult epiglottitis presenting to all emergency departments in Hamilton, Ont., between 1999 and 2003.
    Methods: We employed explicit protocols with defined variables, trained abstractors and standardized abstraction forms, and reviewed all diagnosed cases of adult epiglottitis during a 5-year period. Inter-rater agreement was measured using a kappa statistic.
    Results: Inter-rater reliability for data abstraction was κ = 1. From a total of 1 million emergency department admissions, 54 cases of epiglottitis were identified. The mean age was 49, and 69% of the patients were male. The 3 most frequently documented symptoms were sore throat (100%) odynophagia (94%) and inability to swallow secretions (63%). The 2 most frequently documented signs were swelling of the epiglottis/supraglottis (100%), and tachycardia (53%). Organisms were isolated from blood in 11% of the cases. There was a white blood cell count >20 × 109/L in 4 of the cases (7.4%). From the 54 cases, 9 of the patients were intubated and all patients were safely discharged from hospital.
    Conclusion: Adults presenting with epiglottitis to the emergency department in Hamilton have good outcomes, with less airway management required than previously reported in children. Further study is needed to see if these conclusions are similar in other populations.

  • Spinal epidural abscess
    September 2005 7 5
    Amy Louis, Christopher M.B. Fernandes

    Spinal epidural abscess is an uncommon condition. Predisposing factors include spinal surgery, recent trauma, immunosuppression, a distal site of infection and intravenous drug use; however, these are not always present, as illustrated by this case report describing a patient who had repeated emergency department visits and delayed diagnosis that was ultimately confirmed via magnetic resonance imaging.

  • Clinical research in the emergency department conducted by non-emergency physicians: potential problems and proposed recommendations
    July 2005 7 4
    Andrew Worster, Bjug Borgundvaag, Brian H. Rowe, Christopher M.B. Fernandes, Duncan S. Mackey, Ian G. Stiell, Jacques S. Lee, Karen Woolfrey, Marco L.A. Sivilotti, Riyad B. Abu-Laban, Sam G. Campbell
  • Vasopressin versus epinephrine for out-of-hospital cardiopulmonary resuscitation
    January 2005 7 1
    Andrew Worster, Christopher M.B. Fernandes, Suneel Upadhye
  • Root cause analysis of laboratory turnaround times for patients in the emergency department
    March 2004 6 2
    Andrew Worster, Catherine McCallum, Christopher M.B. Fernandes, Kevin Eva, Stephen Hill

    Introduction: Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays.
    Methods: Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests.
    Results: The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = -5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium.
    Conclusions: The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.