CJEM Articles: Munsif Bhimani

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  • Ramsay Hunt syndrome presenting as simple otitis externa
    May 2008 10 3
    Daniel Kim, Munsif Bhimani

    Ramsay Hunt syndrome is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection occurs in the geniculate ganglion, causing otalgia, auricular vesicles and peripheral facial paralysis. Because these symptoms do not always present at the onset, this syndrome can be misdiagnosed. We report the case of a patient who was diagnosed with simple otitis externa after presenting to the emergency department (ED) with a 3-day history of right-sided otalgia. Her condition subsequently evolved to include right-sided auricular vesicles and right-sided facial weakness. She presented to the ED again after 2 days and was correctly diagnosed with Ramsay Hunt syndrome. We describe the clinical presentation, diagnostic findings and management of this uncommon but important entity.

  • EM training
    May 2008 10 3
    Daniel Kim, Gordon Dickie, Munsif Bhimani, Seamus Donaghy, Shelley McLeod
  • Emergency medicine training demographics of physicians working in rural and regional southwestern Ontario emergency departments
    November 2007 9 6
    Daniel Kim, Gordon Dickie, Munsif Bhimani, Shelley McLeod

    Objectives: We sought to determine the emergency medicine training demographics of physicians working in rural and regional emergency departments (EDs) in southwestern Ontario.

    Methods: A confidential 8-item survey was mailed to ED chiefs in 32 community EDs in southwestern Ontario during the month of March 2005. This study was limited to nonacademic centres.

    Results: Responses were received from 25 (78.1%) of the surveyed EDs, and demographic information on 256 physicians working in those EDs was obtained. Of this total, 181 (70.1%) physicians had no formal emergency medicine (EM) training. Most were members of the College of Family Physicians of Canada (CCFPs). The minimum qualification to work in the surveyed EDs was a CCFP in 8 EDs (32.0%) and a CCFP with Advanced Cardiac and Trauma Resuscitation Courses (ACLS and ATLS) in 17 EDs (68.0%). None of the surveyed EDs required a CCFP(EM) or FRCP(EM) certification, even in population centres larger than 50 000.

    Conclusion: The majority of physicians working in southwestern Ontario community EDs graduated from family medicine residencies, and most have no formal EM training or certification. This information is of relevance to both family medicine and emergency medicine residency training programs. It should be considered in the determination of curriculum content and the appropriate number of residency positions.