#ICEM2025 May 27th Recap!
- May 27
- 31 min read
Updated: May 28
Day 3 brought the energy – and the heart – of the emergency medicine community to the forefront. Docs That Rock the night before was a highlight, reminding us that behind every resuscitationist is a rock star in disguise.
The room was electric, and in true Montréal fashion, the night closed with a spontaneous and spirited “Olé, Olé, Olé” chant that brought everyone to their feet.
The clinical content today matched the atmosphere – practical, cutting-edge, and deeply human. Here are the top takeaways from every part of the conference.
🌟 Plenary Session One: Defining and Delivering EM in Developing Countries
Speakers: Dr. Yeisey Yadkinnie Cruaz, Dr. Olita Shilpakar, Dr. Lise Mumporeze, moderated by Dr. Aisha Terry
🌟 Plenary Session Two: Defining and Delivering EM in Developing Countries
Speakers: Dr. Don Melady
🩺 Morning Concurrent Tracks
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Speaker: Dr. Claire Heslop
PoCUS Pokes
Point-of-care ultrasound (POCUS) has become an essential tool in emergency medicine—not just for diagnostics, but for enhancing procedural accuracy, pain control, and patient safety. This high-yield session explored practical applications of ultrasound to improve nerve blocks and vascular access in the ED.
🦴 Block the Hip: Ultrasound-Guided Fascia Iliaca Block
Ultrasound-guided nerve blocks are now standard of care for patients with hip fractures in many settings—including Ontario’s provincial hip fracture quality standard.
Why do it?
Provides excellent pain relief
Associated with lower morbidity and mortality
Reduces risk of:
Delirium (NNT = 14)
Infection (NNT = 7)
How to do it:
Use an in-plane technique for needle alignment with the probe
Identify the fascia iliaca—watch for muscle-fascia separation during test dosing
Recommended anesthetic mix:
20 cc 0.5% bupivacaine
10 cc lidocaine with epinephrine
1 mL dexamethasone (prolongs block duration)
🫁 Block the Chest Wall: Serratus Anterior or Erector Spinae Block
These chest wall nerve blocks are effective for:
Rib fractures
Chest tubes
Herpes zoster
Key clinical point:
Elderly patients face increasing mortality with each rib fracture. Regional anesthesia can reduce morbidity by up to 40%.
Erector spinae block tip:
Freezes ~4 ribs above and below the injection site. A practical and straightforward addition to your analgesia toolkit.
💉 Master the IV: Ultrasound-Guided Peripheral Access
Up to 30% of ED patients have difficult IV access. POCUS is a game-changer—but only when used with intention.
Top 3 tips:
Sit down – take your time
Be picky – aim for veins ≤1 cm deep and ≥1 cm wide
Line up – pre-map the vein, especially for out-of-plane approaches
Technique:
Out-of-plane: Never lose sight of your needle tip
In-plane: Preferred by most for direct visualization of needle path
Final Thought
Whether you’re blocking a hip, numbing a rib, or placing a tricky IV, POCUS isn’t just a “nice-to-have”—it’s a must-have procedural enhancer.
Better pain control. Fewer complications. More confident procedures.
Speaker: Dr. Christopher Colbert
Its a Small World: Global ID on your Street Corner
What can a tour of duty in Iraq, a measles outbreak in 2024, and a case of subtle tetanus teach us about clinical vigilance and global health?
A Lieutenant Colonel in the U.S. military, with experience across continents and crises, delivered a powerful reminder: we grow not only through clinical knowledge, but by listening, traveling, sharing, and learning from others.
🦟 2007: Iraq – Dengue and the Power of the Tourniquet Test
In a case from Iraq, a tourniquet was applied to a patient’s arm—without blood being drawn—to screen for severe dengue fever.
The insight?
If petechiae develop after a tourniquet application, it can suggest capillary fragility and thrombocytopenia, raising the clinical suspicion of dengue severity. This classic test—also called the Rumpel-Leede or Hess test—is a simple but powerful bedside tool in resource-limited settings.
🧒 2024: Measles Epidemic – The Role of Vitamin A
During a measles outbreak, Koplik spots appeared 1–4 days before the classic rash. In that setting, oral vitamin A was administered for 2 days—based on longstanding but debated evidence showing it may reduce morbidity and mortality in pediatric measles cases.
This intervention, while simple, reflects the value of low-cost, high-impact care guided by global literature and context.
🫁 Extrapulmonary Tuberculosis – What Are You Missing?
One of the session’s most important takeaways:
“It’s not about what you didn’t miss—it’s about what you might have.”
Extrapulmonary TB remains under-recognized. Practitioners everywhere must remain vigilant for non-respiratory presentations of tuberculosis—especially in immunocompromised or migrant populations.
🤐 Tetanus – Look for the Grin
Infrequent but fatal, tetanus can present subtly. Watch for risus sardonicus—a fixed, exaggerated grin caused by facial muscle spasms. These early signs of tetany are easy to overlook but critical to recognize.
🌍 Final Reflections: Medicine is a Global Conversation
Whether it’s dengue in Iraq or TB in North America, medicine is strengthened when we learn from others, share experiences, and broaden our lens.
“Every day, you can move the needle—locally and globally. Interpretation, conversation, and connection are what drive better care.”
The session closed with a nod to the strength of organizations like CAEP and ICEM, where international collaboration turns stories into shared wisdom—and shared wisdom into better care.
Speaker: Dr. Dennis Cho
Evidence-Based Laceration Care
Lacerations are a common ED complaint—and one of the top sources of patient litigation, second only to fracture care. So why are we still relying on tradition over evidence?
This ICEM 2025 session tackled the most persistent myths in laceration repair and offered practical, evidence-based updates every clinician should know.
🚫 Myths to Drop — And What to Do Instead
❌ Myth: Never use epinephrine in fingers
✅ Reality: No digital ischemia has been reported from accidental 1:1000 epi injections in the fingers. Emerging evidence suggests it may actually be safe—and possibly beneficial.
❌ Myth: There’s a magic time cutoff for closing wounds
✅ Reality: There is no fixed time window. Use patient-specific factors (location, contamination, comorbidities) to decide whether to close.
❌ Myth: You must wear sterile gloves
✅ Reality: A large ICU trial showed no difference in infection rates between sterile and clean gloves. Choose what fits and functions best.
❌ Myth: Always irrigate
✅ Reality: Skip irrigation for clean wounds of the face and scalp.
Irrigation is most useful when:
Wound is contaminated
Tissue is devitalized
Injury is old or not on the face/head
And don’t stress about pressure or volume—neither affects infection, healing, or cosmesis.
💧 Irrigation: Use Tap Water, Not Sterile Saline
A Cochrane review confirms: tap water is just as effective (if not better) than sterile water or saline for wound cleansing. It’s safe, effective, and accessible.
💉 Local Anesthetics: Think Beyond Lidocaine
No difference in onset between lidocaine and bupivacaine
Bupivacaine lasts longer (~5 hours vs. 2 hours) and may be preferred for prolonged analgesia
Pain-reduction tips:
Use smaller gauge needles
Warm the solution
Pre-ice the area (RCT evidence supports it)
For digital blocks: single palmar poke is as effective as the two-poke dorsal approach (per SR & meta-analysis)
🧵 Absorbable Sutures Are Just as Good
Compared to non-absorbable sutures, absorbable options show no difference in:
Cosmesis
Infection
Patient satisfaction
Dehiscence
Best used when:
Primary care access is limited
Patients prefer not to return for removal
✨ Glue ≈ Sutures (For the Right Cases)
According to a 2022 Cochrane review:
No cosmetic difference
Less pain
Quicker repair
Slightly higher risk of dehiscence
Great option for select patients and settings—shared decision-making is key.
🧴 Stop the Antibiotic Ointment
A meta-analysis found no benefit to topical antibiotics like bacitracin or polymyxin B in terms of:
Infection rates
Healing
Cosmesis
Best practice: plain petroleum jelly is all you need for aftercare.
✂️ Empower Patients: Let Them Remove Sutures
For simple repairs, give patients clear instructions and let them take control. This promotes autonomy and avoids unnecessary follow-ups.
Final Word
Where does your practice come from—dogma or evidence?
Laceration management is full of myths. It’s time to align your approach with what the research actually shows—simpler, smarter, and safer care for both patients and providers.
Medical Education and Lifelong Learning: This track highlights evolving strategies to train, support, and sustain emergency clinicians through all stages of their careers.
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Speaker: Dr. Nicholas Monfris
PEM Pearls: Pediatric Resuscitation
Pediatric resuscitation requires deliberate choices in access, airway, and pharmacology — and it starts with staying calm and structured in your approach.
🩸 Vascular Access: Prioritize IO Early
Obtaining IV access during pediatric resuscitation is notoriously difficult. Don’t wait — use IO early.
✅ IO Tips:
Use a blue (25mm) IO needle in children >6 months
Preferred sites: pre-tibial and proximal femur
In very young patients, consider manual insertion (without powered drill)
Lidocaine infusion significantly decreases IO-related pain
🫁 Airway Management: Medication Matters
RSI in pediatrics requires thoughtful agent selection:
Pre-treatment:
Oxygenation only — no routine role for atropine
Induction/Sedation:
Ketamine is the preferred agent — well tolerated and effective across ages
Paralysis:
Use Rocuronium (at high dose)
Avoid Succinylcholine due to:
Rapid desaturation
Contraindications (e.g., hyperkalemia, neuromuscular disease)
More side effects
No onset advantage over high-dose rocuronium
🧪 Don’t Forget the Basics
A critical reminder during any pediatric resuscitation:
🔍 Always check blood glucose. Hypoglycemia is a common and correctable contributor to altered mental status and cardiovascular instability in sick children.
Final Takeaway
Pediatric resuscitation isn’t just a small adult code — it requires different tools, meds, and expectations. Master the fundamentals of IO access, use safe and effective RSI agents, and never forget the glucose.
Speaker: Dr. Kathleen Stephanos
Little Beats: Essentials of Pediatric ECG interpretation
Pediatric ECGs are not just small adult ECGs. A structured, age-informed approach can help clinicians distinguish what’s normal from what needs urgent attention.
The 3 S’s of Pediatric ECG Acquisition
Capturing a quality ECG in a child requires more than speed — it requires strategy:
🍼 Soothe – Calm the child to minimize artifact
✂️ Snip – Trim leads lengthwise to fit small chests
🐢 Slow – Slow the tracing to better visualize P waves
Stepwise Interpretation Framework
Dr. Stephanos recommends a systematic approach:
❤️ Rate
Tachycardia is common
Use age-based norms; bradycardia thresholds are lower than in adults
📈 Rhythm
Sinus arrhythmia is often pronounced and benign
SVT is the most common pathologic rhythm
• >220 bpm in neonates
• >150 bpm in older children
➡️ Axis
Starts rightward in neonates; normalizes after 6 months
Watch for upright aVF by 6 months
⏱️ Intervals
QTc <450 ms in children (up to 490 ms in infants)
PR <200 ms
Wide QT or pre-excitation (short PR + QRS >40 ms) = red flags
Waveform Patterns: What’s Normal vs Worrisome?
🧠 Q Waves
✅ Normal: narrow, <8mm, seen in inferior/lateral leads in children <3 years
⚠️ Concerning: narrow and deep in inferior/lateral leads (suggests HCM)
💓 QRS
✅ Normal: RSR′ in V1 (with R′ < R)
⚠️ Concerning: R′ > R or pure R in V1 after 6 months → think RVH
🌊 T Waves & ST Segments
✅ Neonates: all upright T waves
✅ Older kids: T-wave inversions in V1–V3 are normal
⚠️ TWI in inferior or lateral leads = abnormal
⚠️ Look out for Brugada (coved/saddle-back T waves in V1)
Final Takeaway
Pediatric ECGs may look unfamiliar at first glance — but with the right tools and framework, they’re entirely approachable. Use the 3 S’s to get a clean read, and interpret systematically from rate to T waves.
Recognize what’s age-appropriate, and keep a close eye on red flags like wide QT, SVT, HCM patterns, and Brugada syndrome.
Speaker: Dr. Jocelyn Gravel
Identification and Management of Metabolic Emergencies of the Infant
Metabolic emergencies in infants are rare but life-threatening. They often present subtly and require a high index of suspicion. Early recognition and targeted investigations can make all the difference.
Recognizing the Red Flags
Infants with metabolic disorders can present in a variety of ways, and often with non-specific signs. Dr. Jocelyn Gravel reminds us of a few key clinical features to watch for:
Clinical Presentation
Neurologic deterioration (e.g., lethargy, irritability, coma)
Hypotonia
Seizures
Hepatomegaly
Hypoglycemia or hepatic insufficiency
History Clues
Family history: Consanguinity or early deaths in siblings
Triggers: Recent illness, fasting, protein intake
Ethnic origin: Some disorders have higher prevalence in specific populations
Physical Exam Pearls
General assessment, plus:
Odour: Atypical smells (e.g., maple syrup, sweaty feet, musty) may hint at specific inborn errors
Liver size: Hepatomegaly is a key clue
Fever Doesn’t Rule It Out
One key teaching point:
🔍 An unwell newborn without fever warrants metabolic screening. But the presence of fever does not rule out a metabolic disease.
The Workup: Go Beyond the Basics
In addition to your usual newborn labs, include:
Blood gas
Lactate
Ammonia
Liver enzymes
Urine (check for ketones and organic acids)
🧠 Clinical Pearl:
A vomiting, tachypneic newborn with normal oxygen saturation but concerning blood gases may be in the midst of a urea cycle disorder.
Example:
pH: 7.51
pCO₂: 13
This reflects respiratory compensation for metabolic alkalosis from ammonia accumulation.
Initial ED Management:
Stop protein intake
Initiate IV hydration
Call for urgent metabolic support
Important Considerations
Hyperammonemia is a true metabolic emergency in neonates. Always consider it when babies present with altered LOC, vomiting, or respiratory changes.
Urinary ketones should not be present in healthy newborns. If they are, consider metabolic disease.
Key Takeaways
Always suspect a metabolic disorder in an unwell newborn, especially with:
Vomiting
Tachypnea
Neurologic changes
Hypoglycemia or hepatomegaly
Order the right labs early to catch life-threatening diagnoses
Early protein restriction and hydration are critical
Collaborate early with metabolic specialists
Metabolic emergencies are rare, but when they do occur, emergency physicians are often the first line of defense. Recognizing the subtle signs and initiating appropriate investigations can save lives.
Speaker: Stephen Freedman
Shiga toxin-Producing E. Coli (STEC) Infections
STEC is the leading cause of pediatric acquired acute kidney injury, with high-risk strains leading to hemolytic uremic syndrome (HUS) in 15–20% of cases. Early identification and supportive management — particularly fluid resuscitation and careful monitoring — are key to improving outcomes. Avoid antibiotics, NSAIDs, and antimotility agents, and maintain vigilance even in patients who initially appear well.
STEC is the most common cause of pediatric acquired AKI.
Children <5 years old account for 60% of infections.
15–20% of high-risk STEC infections develop HUS, half of whom will require dialysis.
Mortality is approximately 1–3%.
Pathophysiology and Risk Stratification
All STEC produce Shiga toxins (Stx), but risk varies by toxin type:
Stx1 only: very low risk of HUS
Stx2 only: 15–20% risk of HUS
Stx1 + Stx2: ~10% risk
Stx2-producing strains are associated with bloody diarrhea and are referred to as “high risk”.
Clinical Pearls
HUS typically develops around Day 7 of illness.
Vital signs and labs can be falsely reassuring early in the illness.
Platelet counts may appear normal — it’s crucial to track trends over time.
Key ED Management Principles, If STEC suspected (e.g. bloody diarrhea):
Test for STEC
Do NOT give:
Antibiotics
NSAIDs
Antimotility agents
Platelet transfusions (unless actively bleeding)
Supportive Care:
Isotonic or balanced IV fluids to reverse dehydration
PRBCs as needed
Treat hyponatremia and hypertension if present
Initiate renal replacement therapy if necessary
Real-World Implications
Many children are initially discharged from the ED, but:
17% go on to develop HUS
40% of those discharged return to the ED
Early identification, daily labs, and close outpatient follow-up during the high-risk window are critical.
Final Thoughts
Emergency physicians play a key role in identifying and managing STEC early. Don’t be misled by reassuring appearances or early lab values. Maintain high suspicion in young children with bloody diarrhea, avoid harmful interventions, and ensure appropriate follow-up.
Planetary Health in Emergency Medicine: This track explores the intersection of environmental change and emergency care, highlighting how climate-related events, resource scarcity, and ecological disruption are shaping patient presentations and system demands.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
Speaker: Dr. Simon Carley
Training for Halo Procedures
Some of the most high-stakes procedures in emergency medicine are also the least frequently performed—but when they’re needed, they’re needed now.
Dr. Simon Carley delivered a compelling ICEM 2025 session focused on optimizing readiness for High Acuity, Low Occurrence (HALO) procedures. These rare but life-saving interventions—like surgical airway, thoracotomy, lateral canthotomy, or even resuscitative hysterectomy—require a training strategy that extends well beyond the textbook.
So how do we get ready for what we may only see once in a career?
Dr. Carley outlined a three-pronged proactive approach to training for HALO events:
1. Psychomotor Skill Development: Train Your Hands
Mastering the technical aspects of HALO procedures requires repeated, realistic practice across escalating fidelity:
✅ Simulation models
✅ Animal labs (recommended annually)
✅ Human cadavers (ideally every 5 years)
✅ In-person practice whenever possible
This helps ensure that when the rare case presents itself, muscle memory takes over.
2. Individual Mental Readiness: “Beat the Stress, Fool!”
Mental rehearsal can be just as important as technical training. Dr. Carley recommends:
BTSF Framework:
Breathe
Talk (to yourself – positive self-direction)
See (visualize the steps)
Focus (use a trigger word)
This approach helps combat stress paralysis, enhancing decision-making in moments of high pressure.
Also key:
Use the IFTT model (If this, then that) to predetermine thresholds and actions.
Practice talking through cases out loud—“Is this teachable? Drainable?” Ask yourself: What’s my trigger to act?
3. Team-Based Immersive Simulation: Make It Real
HALO procedures aren’t solo missions—they demand tight coordination. That’s why realistic team simulation is essential.
Use live actors (not mannequins)—because people engage with people
Add emotional realism: sounds, smells, makeup
Place instructors at the back to allow full immersion
The goal: tap into the emotional experience of crisis, so the team can regulate stress and work together seamlessly when it really counts.
Final Word
HALO procedures may be rare—but your readiness shouldn’t be.
By combining hands-on practice, mental rehearsal, and team-based simulation, we can ensure that when the moment comes, we’re ready to do the right thing—for our patients, our teams, and ourselves.
“You don’t rise to the occasion. You fall to the level of your training.” – Simon Carley
Speaker: Dr. Sara Gray
Heart Failure and Cardiogenic Shock
To read Dr. Gray's summary on cardiogenic shock - check it out here!
Speaker: Dr. Ankur Verma
Sequential Approach to Trauma
Trauma resuscitation has come a long way since the first ATLS course in 1978. In this compelling session, Dr. Ankur Verma pushed us to go beyond checklists and adopt a sequential, team-based approach—one that’s rooted in shared mental models, physiological nuance, and continuous learning.
🧠 From Protocol to Purpose: The Modern Trauma Mindset
Trauma care isn’t just task-based—it’s about teamwork, ownership, and anticipation. It starts even before the primary survey.
Dr. Verma introduced the Zero Point Survey using the STEP UP framework:
Self-check
Team briefing
Environment prep
Patient overview
Update
Priorities
This primes the team to operate cohesively before the trauma bay even gets busy.
🫁 Airway in Trauma: It’s Complicated
Not every trauma patient needs a tube. And in fact, intubation in an unstable patient can be harmful—increasing thoracic pressure, reducing preload, and potentially worsening hemorrhagic or obstructive shock.
When deciding to intubate, consider:
Hemodynamic status
Whether it facilitates resuscitation
Projected course of deterioration
Clinical gestalt over reflexive action
🔑 Take-Home Points
Dr. Verma’s key pearls for modern trauma resuscitation:
✅ Shared mental model: Everyone on the same page, same priorities
✅ Think beyond ATLS: Use it as a scaffold, not a ceiling
✅ Resuscitate before you intubate: Stabilize preload, oxygenation, volume
✅ Recognize occult shock: Use shock index to spot what vitals might miss
✅ Titrate induction: Lower your dose in hypotensive patients—don’t push them off the cliff
Final Word
In trauma, sequencing matters—and so does shared understanding. ATLS taught us how to approach trauma. Now it’s time to refine it with physiology, team dynamics, and critical thinking.
“Don’t just follow the algorithm. Understand the physiology. Lead the team.”
🩺 Afternoon Concurrent Tracks 1
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Speaker: Dr. David Lewis
Ready for your TEE time?
Transesophageal echocardiography (TEE) offers game-changing advantages in cardiac arrest care by providing real-time cardiac imaging, improving diagnostic accuracy, and reducing interruptions in CPR. While there are barriers to implementation, the potential impact on outcomes is significant.
Why TEE in Cardiac Arrest?
In the high-stakes environment of a resuscitation, TTE (transthoracic echo) often fails to deliver. Image quality can be poor, especially when chest compressions are ongoing or when using mechanical CPR devices. More critically, monitors and pulse checks may mislead.
TEE addresses these limitations by offering:
Continuous visualization of cardiac activity during CPR and ROSC
Clearer views of cardiac contractility
Direct assessment of CPR quality
Visualization of potentially reversible causes (e.g., tamponade, PE, hypovolemia)
By reducing the need to pause compressions, TEE aligns with resuscitation best practices — keeping “hands on chest” while still informing decision-making.
Core Clinical Questions TEE Can Answer
Is there any cardiac contractility?
How effective is the CPR being delivered?
Are there visible reversible causes of arrest?
Is the patient’s cardiac function changing during resuscitation?
These insights can help refine care, especially in prolonged or undifferentiated cardiac arrest cases.
Key Views to Use
Two views are most commonly used during cardiac arrest:
Mid Esophageal Four-Chamber View
Mid Esophageal Long Axis View
These views are achievable with minimal probe manipulation and provide actionable information during resuscitation.
What You Need to Start a TEE Program
Before implementing TEE in your emergency department, consider the following:
✅ Staffing:
Minimum of 2 MDs per shift trained in TEE
✅ Resources:
TEE probe with a compatible machine
Funding for maintenance and sterilization
✅ Systems Support:
Timely access to critical care and cardiology services for further management
Sufficient volume of cardiac arrest cases to support skill maintenance and program utility
Challenges & Limitations
While promising, TEE is not without barriers:
Low volume of cardiac arrest cases in some centers
Incompatibility with supraglottic airways
Cost and maintenance of equipment
Training and credentialing requirements for emergency physicians
Final Thoughts
TEE represents a powerful tool in the resuscitation arsenal. While implementation requires planning, resources, and team buy-in, the clinical benefits — from continuous cardiac visualization to improved decision-making — make a compelling case.
In resuscitation, seconds matter. TEE helps make those seconds count.
Speaker: Dr. Sean Moore and Dr. Sarah Giles
Tick Talk: Expanding Tick Borne Illnesses Core Facts
As the climate warms, tick populations are expanding, bringing with them a rise in tick-borne illnesses. Clinicians need to recognize the common presentations, understand transmission timelines, and treat promptly to reduce complications. Doxycycline remains the go-to treatment for many, but not all, tick-related infections.
The Spread of Ticks: Driven by Climate Change
Over the last 100 years, tick habitat has expanded significantly.
Warming climates increase tick survival and extend their seasonal activity.
In North America, black-legged ticks (Ixodes scapularis) are the primary vectors of tick-borne diseases.
Ticks 101
Arachnids (like spiders), ticks feed exclusively on blood.
Transmission timing matters:
Lyme disease (Borrelia burgdorferi) and anaplasmosis require ≥24 hours of attachment.
Powassan virus can be transmitted in as little as 15 minutes.
Tick Removal: Do It Right
Use forceps to grasp the tick as close to the skin as possible and pull straight up.
Leftover parts do not transmit disease, so no need for further intervention unless signs of infection develop.
Lyme Disease: When to Prophylax
Offer prophylaxis with a single dose of doxycycline 200 mg if all the following are true:
Tick bite occurred in a Lyme-endemic area
Tick is identified as a black-legged tick
Tick was attached for ≥24 hours
Prophylaxis started within 72 hours of removal
Special considerations:
Pregnant: Amoxicillin
Pediatric: Lower dose doxycycline or amoxicillin
If There’s a Rash: Treat
Erythema migrans (bullseye lesion) = Lyme diagnosis
Treat with doxycycline 100 mg BID for 10–14 days, even if prophylaxis was given.
Systemic symptoms (neuro, cardiac, or arthritic involvement) warrant 14–21 days of treatment.
Be aware of the Jarisch-Herxheimer reaction: Up to 15% of patients may experience transient symptom worsening in the first 48 hours of treatment.
Beyond Lyme: Other Tick-Borne Threats
🦠 Anaplasmosis
Increasing incidence
Presents like the flu, may affect the CNS
Treat with doxycycline
🦠 Powassan Virus
Tick-borne flavivirus
No rash
Rapid transmission (within 15 minutes)
Symptoms: Fever, headache, vomiting, myalgia
Severe cases: encephalitis or meningitis
No specific treatment
🦠 Babesiosis
Parasitic infection (like malaria)
Symptoms: Fever, headache, vomiting, fatigue
High risk in asplenic or immunocompromised patients
Doxycycline is not effective; specific antiparasitic therapy is needed
🦠 Rocky Mountain Spotted Fever (RMSF)
Symptoms: Fever, chills, malaise, arthralgias, purpuric rash
Mortality: 30% if untreated, <1% with prompt doxycycline
Treat with doxycycline immediately
Take-Home Points
✔ Climate change is expanding tick ranges and tick-borne illness risk
✔ Know which illnesses require longer attachment to transmit
✔ Doxycycline is first-line for most—but not all—tick illnesses
✔ Recognize when to treat without waiting for confirmatory testing
✔ Don’t delay—timely treatment can be life-saving
🕷 As tick seasons lengthen and cases rise, staying informed is our best defense. For every patient with a suspicious tick bite or systemic symptoms in summer, think broadly—and act fast.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Speaker: Naveen Pooni
Procedural Sedation in Children: Balancing Comfort with Safety
Bottom Line
💉 Ketamine as a single agent for pediatric procedural sedation is associated with fewer serious adverse events than other agents or combinations.
🚫 NPO status does not predict aspiration risk and should not delay sedation.
🤢 Ketamine-induced vomiting—its most common side effect—can be reduced with ondansetron pre-treatment.
⚠️ Caution is warranted with propofol and midazolam due to higher risks when used alone or in combination.
Case-Based Pearls from the Emergency Department
1. “They just ate—should I delay?”
In a case of a toddler needing traction for a femur fracture shortly after eating, Dr. Poonai challenged the traditional fasting dogma. Drawing on a cohort of ~140,000 sedations, he noted:
Only 10 aspiration events, 8 of whom had fasted appropriately.
NPO status was not an independent predictor of aspiration or major complications.
✅ Take-home: Don’t delay PSA purely based on recent eating.
2. “Which agent is safest?”
When comparing sedation strategies for fracture reduction:
Agent | Serious Adverse Event (SAE) Rate |
Propofol alone | 3.7% |
Ketamine + fentanyl | 3.2% |
Ketamine + propofol (Ketofol) | 2.1% |
Ketamine alone | Lowest risk |
✅ Ketamine monotherapy had the best safety profile in this comparative analysis (Bhatt et al., 2020).
3. “What about emergence agitation?”
Although commonly feared, emergence agitation after ketamine is:
Not linked to age
Not improved by benzodiazepines
More likely with:
Higher ketamine doses (>2.5 mg/kg IV)
Increased post-procedural pain
4. “How can I reduce ketamine side effects?”
The most common adverse event with ketamine? Vomiting, occurring in 8–10% of cases. Risk factors include:
Older age (peak at 12 years)
IM administration
High total doses (>5 mg/kg)
🟢 Solution: Pre-treatment with ondansetron effectively reduces this risk.
5. “Should I use midazolam or propofol?”
Midazolam lacks high-quality evidence for monotherapy and increases the risk of respiratory complications when combined with other agents.
Propofol has no analgesic properties, and as monotherapy, is associated with the highest rate of SAEs: apnea, laryngospasm, bradycardia, and hypotension.
Take It to Work Summary
✔ NPO status should not delay PSA.
✔ Ketamine alone offers the safest and most effective sedation.
✔ Pre-treat with ondansetron to reduce vomiting.
✔ Avoid propofol monotherapy for painful procedures.
✔ Reconsider midazolam, especially in combinations.
Speaker: Dr. Brett Burstein
New Approaches to the Management of Febrile Young Infants
Fever is one of the most common reasons for emergency department visits in infants ≤90 days old, yet ~10% will have a UTI or invasive bacterial infection (IBI). Historically, this group has undergone invasive, resource-intensive investigations—often including lumbar puncture (LP), blood cultures, IV antibiotics, and mandatory hospitalization.
Modern data, clinical prediction tools, and shared decision-making are challenging this “one-size-fits-all” model.
📊 Febrile Infant Basics
2% of all term infants under 90 days present with fever
~8% have UTIs
~2% have bacteremia
~0.5% have meningitis
🏥 The Old Approach: Full Septic Work-Up
Catheterized urine, bloodwork, CSF, empiric IV antibiotics, admission
Up to 5% complication rate
Significant pain, anxiety, and parental distress
Massive variability in practice across hospitals
🧪 The Power of Inflammatory Markers (IMs) in Risk Stratification
Marker | AUC for IBI |
WBC | 0.48 |
ANC | 0.61 |
CRP | 0.77 |
PCT | 0.91 |
Procalcitonin (PCT) is the most reliable single marker when available.
🛠 Validated Clinical Decision Tools
PECARN (Kuppermann et al.)
Step-by-Step
Aronson Rule
✅ Sensitivities: 92–100%
⚠️ Specificities: 27–60%
These tools integrate IMs like PCT, CRP, and ANC alongside urinalysis.
📘 AAP Clinical Practice Guidelines (2021)
Age-based guidance:
8–21 days: Full septic workup, LP, hospitalization, antibiotics
22–28 days: Risk-stratify with PCT, CRP, ANC + UA
29–60 days: May defer LP and antibiotics if low risk
61–90 days: UTI focus; apply 29–60 day approach if needed
🔍 What About When PCT Isn’t Available?
Montreal data (2018–2023, 1987 infants):
Using CRP ≤22.2, ANC ≤4500, Temp ≤39.0 yielded:
100% Sensitivity
100% NPV
84% Specificity
Compared to 46% specificity with CRP alone.
The “Aronson Rule” (score ≤1) without PCT offers:
Sensitivity 93%
NPV 99%
💡 Do Parents Want This Workup?
Surprisingly, only 10% of parents preferred LP, and 21% wanted hospitalization when given options. Hospital stay was identified as the most stressful part of the visit.
🧠 Shared Decision-Making in Practice
The CPS (Canadian Paediatric Society) now supports:
No LP for infants ≤60 days if well-appearing + low-risk on validated tools
Deferral of LP/hospitalization in some cases, with close follow-up
✅ Key Takeaways
Febrile infants ≤90 days old are not all the same—IBI prevalence is ~10%, meningitis <1%.
Historic full work-ups are overly invasive and variably applied.
PCT > CRP > ANC > WBC when choosing inflammatory markers
Validated tools like PECARN support safer, targeted care
Parents value involvement in decisions and often prefer less invasive management
Shared decision-making and risk stratification are now endorsed by CPS and AAP
Planetary Health in Emergency Medicine: This track explores the intersection of environmental change and emergency care, highlighting how climate-related events, resource scarcity, and ecological disruption are shaping patient presentations and system demands.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
Speaker: Dr. Christopher Hicks
The Traumatized Airway: Avoiding the Four Horsemen of Inevitable Failure
Airway management in trauma is one of the most daunting challenges we face in emergency medicine. In this compelling talk, Dr. Christopher Hicks reminds us that success isn’t about having exotic tools in your back pocket—it’s about mastering simple, well-practiced principles and recognizing when your usual approach might lead to disaster.
“I don’t fear the competitor who’s practiced 1,000 kicks—I fear the one who’s practiced one kick 10,000 times.”
🚨 Case Example: Dual Threat
A young patient arrives with a blunt neck trauma and ongoing junctional hemorrhage from the groin. He’s in shock, not in respiratory distress, but clearly sick. Does he need an airway? Yes. But the priority is hemorrhage control.
Dr. Hicks emphasizes an adaptive, patient-centered approach over rigid algorithms—what he calls resequencing resuscitation:
Start with the most pressing physiologic threat, not the step you’re most comfortable with.
🧠 The Four Horsemen of Airway Failure
When dealing with a traumatized airway, our usual fallbacks may actually worsen the situation. Here are the four pitfalls—Dr. Hicks’ “Four Horsemen”:
1. Worsening Obstruction During Intubation
Instrumenting a swollen or damaged upper airway can convert a partial obstruction into a complete one. A patient maintaining their airway with minimal tone may rapidly decompensate with RSI.
2. False Passage Creation
Especially in penetrating neck trauma, blindly advancing a tube can result in false passages, leading to soft tissue emphysema and catastrophic delay.
3. Tracheal Transection
Attempting a surgical airway in a partially transected trachea can convert a survivable injury into an irreversible disaster. The distal trachea may retract into the chest, leaving no airway to access.
4. Over-reliance on Fallbacks
Positive pressure ventilation above the level of injury can worsen subcutaneous emphysema and distort landmarks. The tools we trust—bag-valve masks, supraglottic devices, and surgical airways—may all fail in these scenarios.
Sometimes the right move is doing nothing—at least for now.
🔄 Resequencing & Reframing the Approach
Dr. Hicks advocates for a deliberate framework:
Pre-brief with your team—quick, simple, nurse-led at St. Mike’s:
What are we expecting?
What do we need?
What tools will help?
Who’s doing what?
Reconsider the collar and position: If they’re sitting up and breathing, don’t force them flat. Spinal immobilization is a conversation, not a rule.
Don’t rush to CT: Static imaging can miss dynamic airway compromise. Transport may be unsafe and misleading.
Use awake airway assessment tools: MP scopes and video laryngoscopy can provide real-time, dynamic insights—especially for superglottic injuries.
💊 Ketamine & Topicalization: The Right Blend
Cooperative, stable patients: Consider topical anesthesia and gentle dissociation
Less cooperative or unstable: Lean more heavily on ketamine for deeper dissociation
Tailor your approach to the patient’s physiology and mental status
🧠 Final Pearls
✅ Avoid paralyzing a tenuous airway
✅ Delay intervention if the patient is stable
✅ Understand that your usual airway rescue methods may fail catastrophically
✅ Do less, better—know your “10,000 kicks”
“There is a real joy in doing nothing—for the right patient, at the right time.”
This talk wasn’t about rare airway techniques. It was about restraint, wisdom, and preparation. Trauma airways don’t forgive false steps—so build a plan rooted in physiology, teamwork, and deliberate execution.
Speaker: Dr. Peter Kas
ROSC: Now What?
Resuscitation is not a finish line. It’s a continuum. And when you achieve ROSC (Return of Spontaneous Circulation), the real work begins.
In this fast-paced and practical session, Dr. Peter Kas walked us through the post-ROSC landscape—not just as an abstract protocol, but through the story of Basil, a 68-year-old man who collapsed at his daughter’s engagement party and lived to tell the tale.
🔄 Cardiac Arrest & ROSC: One Continuum
Resuscitation is all about one goal: restoring and maintaining output. Everything we do after ROSC is about preserving that output and minimizing secondary injury.
Dr. Kas emphasized a key shift: Don’t leave the cubicle after ROSC. The arrest may be over, but the resuscitation isn’t.
⚠️ Post-Cardiac Arrest Syndrome: Two Main Threats
Cardiac Stunning
Begins in the first 30–40 minutes post-ROSC
Ejection fraction drops, LVEDP rises
True cardiac failure can occur ~6 hours later
Hypoxic Brain Injury
Reperfusion injury is complex and damaging
Early prognostication is unreliable
Cerebral autoregulation is often impaired—even brief hypotension can be devastating
🧭 Post-ROSC Management: Key Domains
💉 1. Blood Pressure
Target MAP ≥ 65 mmHg (borrowed from sepsis literature)
Go higher (75–80 mmHg) if:
History of hypertension
Signs of hypoperfusion (e.g. low U/O, high lactate)
Best monitored with:
Arterial line – Insert early, even during CPR
If using NIBP: watch end-tidal CO₂ closely. Drops can signal hypotension before your cuff does.
✅ Bottom line: Loss of BP = loss of ROSC
🌬️ 2. Oxygenation
Initial 100% FiO₂ during arrest
Titrate to SpO₂ 94–98% ASAP
Hyperoxia causes harm—turn it down within the first hour
Exact trial (Bernard, AU): signal of harm with SpO₂ < 94%
🫁 3. Ventilation
Aim for normocapnia
Hypercapnia doesn’t appear beneficial in general ROSC care
May consider higher PaCO₂ for specific groups (e.g. congenital heart disease)
🔥 4. Temperature
Avoid fever
Passive rewarming is fine if hypothermic
Routine targeted temperature management (TTM) still controversial
Consider cooling in deep coma, seizures, or high lactate—though evidence is mixed
⚡ 5. Seizure Recognition
Post-anoxic myoclonus is common (~30%)
Look for subtle triggers (e.g., touch, noise)
Active seizures = treat
Persistent myoclonus doesn’t always equal poor outcome—but often does
📈 6. ECG Interpretation
Don’t rush to the cath lab unless ST-elevation persists
Serial ECGs are critical:
ST-elevation may resolve (false positive)
Ischemic changes may evolve later
If ST-elevation remains at 20–30 min → discuss with cardiology
No ST-elevation? → Delayed/selective angiography preferred (per COACT, TOMAHAWK)
🧑🔧 Basil’s Story: A Good Outcome
Basil got ROSC, and with careful post-arrest management, survived neurologically intact. He retired, plays backgammon daily, and still wins more than he loses—though he pretends not to remember how.
Summary Checklist for Post-ROSC Care:
MAP ≥ 65 (higher if hypertensive or hypoperfused)
SpO₂ 94–98% (avoid hyperoxia early)
Maintain normocapnia
Avoid fever
Treat seizures
Do serial ECGs—interpret with caution
Final Word from Dr. Kas:
“ROSC is just the start. Don’t walk away—lean in. This is when you save the brain, the heart, and the future of the person you just brought back.”
Speaker: Dr. Axel Benhamed
Optimizing Practice in Geriatric Trauma Care: Key Specificities and Practical Enhancements
Older trauma patients often present falsely reassuring signs—normal vitals or low-energy mechanisms that mask serious injury. Dr. Axel Benhamed offered practical updates to help emergency clinicians better identify and treat trauma in older adults.
🧠 Think Beyond Traditional Thresholds
SBP < 90 mmHg? That’s too low for older patients. Consider 100–110 mmHg as your red flag.
Shock Index > 0.9? May miss the sickest seniors—0.7–0.8 is more appropriate.
🚑 Fix the Triage Gap
Current prehospital criteria under-triage older adults. Updates include:
SBP cutoff: 100 mmHg
GCS: raise from 13 to 14
1 long bone fracture = trauma
Road traffic collisions and any fall warrant trauma center consideration
Despite this, only 1.9% of eligible older adults reach trauma centers.
🏥 Trauma Centers Matter
Admission to trauma centers reduces mortality, delirium, and long-term care dependency. Even secondary transfers improve outcomes—it’s not too late.
🚨 Age Bias in Team Activation
Only 25% of older adults with ISS >15 received trauma team activation (vs 43% of younger adults)
One study showed that patients ≥70 with any trauma (excluding ground-level falls) had:
27% ISS >15
50% ICU admissions
10% intubated in ED
👉 We need age-based trauma criteria—and track compliance.
🩸 Don’t Underserve the Elderly
Massive transfusion? Still worthwhile in older adults—many survive even with 8–9 units of PRBCs.
Acute coagulopathy remains a key mortality risk—identify and treat aggressively.
🩺 Afternoon Concurrent Tracks 2
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Fast, Fair and Compasionate: ED Approaches to Adults with Sickle Cell Pain
To read Dr. Bryan's summary in both English and French, click here.
Speaker: Dr. Katie Lin
Commonly Missed Stroke Syndromes
Up to 20% of strokes are missed — and those misses carry significant risk. Patients with non-classical symptoms, altered mental status, or posterior circulation strokes are at highest risk for delayed recognition.
Stroke Remains a Global Threat
2nd leading cause of death
3rd leading cause of disability
1 in 10 strokes occur in patients under age 50
Women, minorities, and patients with language barriers are more likely to be misdiagnosed
Why Are Strokes Missed?
Strokes may be missed when:
Symptoms are transient, non-lateralizing, or mild
There is altered mental status
The stroke involves posterior circulation
The patient is confused, uncooperative, or has low GCS
Assessing the Altered Patient
🧠 In patients with altered mental status or low GCS, consider stroke in the differential — especially when the cause is unclear.
Key exam tips:
Don’t rely on total GCS — examine each domain individually
Assess for eye tracking, neglect, and conjugate gaze
Check for asymmetric movement or brainstem reflexes
Stroke Syndromes You Don’t Want to Miss
🟠 Anterior Cerebral Artery (ACA) Stroke
May present with disinhibition or behavioural changes
Look for unilateral leg weakness
🔵 Posterior Circulation Stroke (for more, read here)
Cranial nerve abnormalities — the “Dangerous D’s”
Visual deficits, nystagmus, extraocular movement problems
Ataxia (truncal or limb)
Crossed findings: facial palsy with contralateral limb weakness
🧠 Basilar Artery Syndromes
Top of the Basilar Syndrome
Look for Collier’s sign: inability to look up
Locked-In Syndrome
Profound paralysis with only vertical eye movement preserved
Clinical Pearls
Migraine history doubles the risk of stroke
Sudden onset neurologic symptoms = stroke until proven otherwise
Be aware of biases that lead to missed diagnoses
When in doubt, escalate for advanced imaging and consultation
Conclusion:
Posterior and atypical strokes require vigilance and nuance in assessment. Don’t let the absence of focal deficits distract from the diagnosis — stroke can look subtle, especially in younger, altered, or systemically well patients.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Speakers: Dr. Wee-Jhong Chua
TEN-4-FACESp: The Intersection of Research and Advocacy in Pediatric Physical Abuse
Bottom Line
Bruising is the most common visible sign of physical abuse in young children.
The TEN-4-FACESp Clinical Decision Rule (CDR) provides a validated, evidence-based approach to differentiate accidental from abusive bruising.
TEN-4 Day is a growing advocacy and awareness campaign helping clinicians, systems, and communities recognize and act on signs of child maltreatment.
What Is TEN-4-FACESp?
TEN-4-FACESp is a bruising Clinical Decision Rule (BCDR) developed through rigorous research by Dr. Mary Clyde Pierce and colleagues at Lurie Children’s Hospital. It helps clinicians identify bruising patterns concerning for abuse:
TEN: Bruising on the Torso, Ears, or Neck in children <4 years, or any bruising in infants <4 months
FACESp: Bruising on the Frenulum, Angle of the jaw, Cheeks, Eyelids, or Sclera, with added emphasis on patterned bruising
Why Focus on Bruises?
While bruises can result from normal play or accidental trauma, specific bruising patterns in infants and toddlers—especially in non-mobile children—raise red flags. In 2023 alone, the U.S. recorded:
~2,000 pediatric deaths due to abuse or neglect
Nearly half of these occurred in infants <1 year
62,000 confirmed cases of physical abuse
TEN-4-FACESp gives clinicians a validated tool to act early, appropriately, and confidently.
From Research to Advocacy: The Birth of TEN-4 Day
Launched in Kentucky in 2019, TEN-4 Day began as a grassroots initiative to spread awareness and promote early recognition of abuse. Now observed in multiple states, it involves:
Multidisciplinary collaboration: Pediatricians, nurses, EMS, social workers, administrators, policymakers, legal professionals, and more
Community engagement: From local hospitals to state legislatures, the initiative has gained visibility and support across the U.S.
Training and outreach: Using tools like L-CAST (Lurie Children’s Child Injury Plausibility Assessment Support Tool) and targeted education campaigns
Organizing Your Own TEN-4 Day
Dr. Chua shared key steps to organizing a local TEN-4 event:
Partner with local hospitals, trauma centers, and EMS agencies
Engage stakeholders in child protection, advocacy, and policy
Coordinate with professional societies and public affairs groups
Leverage media and legislative opportunities to raise awareness
Promote inclusive, bias-aware, and culturally sensitive education
Speaker: Dr. Nathalie Gaucher
Pediatric Palliative Care in the Emergency Department
Pediatric palliative care (PPC) is distinct from adult palliative care in several important ways. As emergency physicians, understanding these differences can help us deliver more compassionate, coordinated, and effective care to some of our most vulnerable patients.
🌟 What Is Pediatric Palliative Care?
PPC aims to:
Improve quality of life
Relieve suffering across multiple domains (physical, emotional, spiritual)
Facilitate informed decision-making
Support ongoing coordination across care teams
Unlike many adult patients, children are often followed by PPC teams for years, with uncertain prognoses. This longitudinal care creates a unique dynamic between families and providers.
📊 Who Are These Patients?
The demographics of PPC patients have changed. Historically, many were oncology patients, but today, a growing proportion are children with:
Neurological conditions
Congenital anomalies
These children often have complex, chronic conditions and are deeply supported by PPC teams, who they rely on for continuity of care.
🚨 When PPC Patients Present to the ED
Families receiving PPC typically avoid the emergency department unless absolutely necessary. When they do present, it is often serious:
55% of ED visits occur in the evening or overnight
50% are triaged as CTAS 1 or 2 (resuscitation/emergent)
Most common presenting complaints:
34% respiratory distress
13% pain
12% seizures
9% fever
💬 Goals of Care (GOC) in the ED
Only 38% of patients presenting to the ED had GOC discussions previously documented through PPC. Yet these conversations can be pivotal.
What do families say about GOC discussions in the ED?
Should be initiated by a known clinician or team when possible
Are painful but necessary—don’t bring them up unless clinically relevant
Require sensitivity to the setting, word choices, and timing
Don’t beat around the bush
A helpful tool:
📄 Serious Illness Conversation Guide – Pediatrics (Canuck Place Hospice)
🛠 How to Approach GOC Discussions in the ED
Begin with what matters most to the family
Clinicians then translate these into treatment goals
Avoid simply listing off potential interventions
🕊 End-of-Life (EOL) Considerations in the ED
Although uncommon, end-of-life care may occur in the ED for pediatric patients. A thoughtful approach can make a lasting difference.
Key considerations:
Offer mementos (handprints, locks of hair)
Include siblings when appropriate
Accompany the child and family to the exit door
Ensure documentation is complete
Provide bereavement care and ensure follow-up is arranged
💡 Takeaway
Caring for pediatric palliative patients in the ED is a rare but significant responsibility. These children and their families deserve an approach that is clinically informed, emotionally sensitive, and deeply human.
Being prepared—knowing how to discuss goals of care, recognizing presenting complaints, and understanding the family context—can transform these challenging moments into compassionate care experiences.
Speaker: Christian Pulcini
Emergency Care of Children with Medical Complexity
Children with medical complexity (CMC) are a growing and increasingly important population in pediatric emergency medicine. As survival improves for children with chronic and congenital conditions, EDs must adapt to provide timely, coordinated, and effective care.
👶 Who Are Children with Medical Complexity?
Children with medical complexity typically have:
Multiple significant chronic health problems
Involvement of multiple organ systems
Functional limitations
High health care needs and utilization
Often require or depend on medical technology (e.g., tracheostomy, feeding tubes, ventilators)
📈 A Growing Population
CMC now make up 1–3% of the pediatric population.
Why the increase?
Improved neonatal resuscitation
More advanced technologies
Better oncologic and ICU care
Increased survival of children with congenital anomalies
🏥 Disproportionate Impact on the Health System
Even though they’re a small fraction of children, CMC account for a significant portion of healthcare usage:
20% of ED visits
>50% of ICU admissions
25–49% of total hospital days
10–19% of all pediatric hospital admissions
This highlights the urgency of optimizing emergency care pathways for these children.
❗ What’s the Problem?
A 2020 qualitative review (DOI: 10.1016/j.acap.2020.09.006) identified three recurring challenges in delivering quality ED care to CMC:
Time constraints
Data inaccessibility
Communication barriers
A systematic mapping review (SMR) found no rigorous studies assessing the quality of ED care for CMC in real time.
🧩 What Are the Proposed Solutions?
❌ What hasn’t worked:
Apps, apps, apps: Many tools have been developed but cannot interface with EMRs, making integration impossible.
Emergency Information Forms (EIFs): Introduced in the US in 2010, these paper forms are static, outdated, hard to digest, and not user-friendly.
🛠 A New Approach: The ECAP
Dr. Pulcini and his team are currently developing a new tool:
✅ Emergency Care Action Plan (ECAP)
Inspired by the Asthma Action Plan
Built through human-centered design
Developed using focus groups of key stakeholders:
Pediatricians
Emergency physicians (rural and urban)
Specialists
Families
The ECAP prototype is now being tested in a local RCT in Vermont, with plans to expand to a multicenter hybrid trial in June 2025.
🧠 Why It Matters
The ultimate goal of ECAP is to:
Streamline ED care for CMC
Improve communication and coordination
Potentially prevent hospital admissions, reducing burden on patients, families, and the health system
📢 Takeaway
Children with medical complexity challenge traditional models of emergency care. We must meet this challenge with innovation, collaboration, and user-centered design. Tools like ECAP could bridge the gap between high needs and effective care—keeping children safer and hospitals more efficient.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
Speakers: Dr. Garrick Mok and Dr. Victoria Myers
Measuring and Improving Cardiac Arrest Resuscitation in the Emergency Department (MI-CARE)
Thank you to everyone who joined us for another inspiring and impactful day at ICEM 2025. From powerful plenaries to practical clinical sessions, today highlighted the global heart of emergency medicine — reminding us that our work transcends borders.
A special thank you to all our presenters, volunteers, and attendees for your energy and engagement throughout the day. We’re looking forward to seeing you tomorrow for the final day of the conference, as we wrap up an unforgettable week of learning, connection, and collaboration.
See you soon!
Comentários