CJEM Articles: Garth Dickinson

Displaying 1-10 of 19 results

  • Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter
    May 2010 12 3
    Catherine M. Clement, Cheryl Symington, Christian Vaillancourt, David Birnie, Garth Dickinson, Ian G. Stiell, Jeffrey J. Perry, Martin S. Green

    Objective: There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias.

    Methods: This cohort study enrolled consecutive patient visits to an adult university hospital ED for recent-onset atrial fibrillation or flutter managed with the Ottawa Aggressive Protocol. The protocol includes intravenous chemical cardioversion, electrical cardioversion if necessary and discharge home from the ED.

    Results: A total of 660 patient visits were included, 95.2% involving atrial fibrillation and 4.9% involving atrial flutter. The mean age of patients enrolled was 64.5 years. In total, 96.8% were discharged home and, of those, 93.3% were in sinus rhythm. All patients were initially administered intravenous procainamide, with a 58.3% conversion rate. A total of 243 patients underwent subsequent electrical cardioversion with a 91.7% success rate. Adverse events occurred in 7.6% of cases: hypotension 6.7%, bradycardia 0.3% and 7-day relapse 8.6%. There were no cases of torsades de pointes, stroke or death. The median lengths of stay in the ED were as follows: 4.9 hours overall, 3.9 hours for those undergoing conversion with procainamide and 6.5 hours for those requiring electrical conversion.

    Conclusion: This is the largest study to date to evaluate the Ottawa Aggressive Protocol, a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. Our data demonstrate that the Ottawa Aggressive Protocol is effective, safe and rapid, and has the potential to significantly reduce hospital admissions and expedite ED care.

  • Medical Mythology: an introduction to a new section
    March 2003 5 2
    Garth Dickinson
  • Emergency Medicine attains departmental status at University of Ottawa
    March 2003 5 2
    Garth Dickinson
  • Eruptions in the sky
    September 2002 4 5
    Garth Dickinson
  • CME in the Sun
    September 2002 4 5
    Garth Dickinson
  • Adventures at 35 000 feet
    July 2002 4 4
    Garth Dickinson
  • 2001 CAEP Membership Report
    March 2002 4 2
    Garth Dickinson
  • Food-dependent exercise-induced anaphylaxis
    October 2001 3 4
    A. Adam Cwinn, Garth Dickinson, Michael Y. Woo, William H. Yang

    Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods within the preceding several hours. When patients present to the emergency department (ED) with allergic reactions, careful history regarding these 2 factors is required to establish the correct diagnosis. Correct diagnosis of FDEIA will allow patients to take control of their lifestyles and avert repeated events and ED visits. Two cases of FDEIA are presented, and the diagnosis, pathophysiology and therapy of food-dependent exercise-induced anaphylaxis are reviewed.

  • A survey of emergency medicine in 36 countries
    April 2001 3 2
    David Han, Garth Dickinson, Jeffrey L. Arnold, Ming-Che Tsai

    Objective: To assess the current level of development of emergency medicine (EM) systems in the world.
    Design: Survey of EM professionals from 36 countries during a 90-day period from Aug. 25 to Nov. 24, 1998.
    Participants: Thirty-six EM professionals from 36 countries and 6 continents completed the survey. Thirty-five (97%) were physicians, of whom 25 (69%) gave presentations at 1 of 4 international EM conferences during the study period. Three potential participants from 3 countries were excluded because of language barriers. Five additional participants from 5 other countries did not respond within the study period and were excluded.
    Measurements: Respondents completed a 103-question questionnaire about the presence of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries.
    Results: The overall response rate was 88%. Nearly all respondents (97%) stated that their countries had hospital-based emergency departments (EDs). More than 80% of respondents reported that their countries have emergency medical services (EMS), national EMS activation phone numbers and ED systems for pediatric emergency care. More than 70% stated that their countries had national EM organizations, EM research, ED systems for patient transfer and peer review and emergency physician (EP) training in Advanced Cardiac Life Support (ACLS) and the ability to perform rapid sequence intubation. More than 60% reported ED systems for trauma care and triage and EP training in Advanced Trauma Life Support (ATLS) and the ability to perform thrombolysis for acute myocardial infarction. Fifty percent reported EM residency training programs, official recognition of EM as an independent specialty, and EM journals.
    Conclusions: Basic emergency medicine components now exist in the majority of countries
    surveyed. These include many specialty, academic, patient care and administrative systems. The foundation for further EM development is widely established throughout the world.

  • A survey of emergency medicine in 36 countries (page ii)
    April 2001 3 2
    David Han, Garth Dickinson, Jeffrey L. Arnold, Ming-Che Tsai