The rural hospital environment differs from the urban hospital environment in that there are fewer physicians available to share the workload and to help out in an emergency. When a rural physician on call for emergency writes admission orders rather than disturb the patient’s family physician, that rural physician accepts full responsibility for the patient until the patient’s physician actually examines the patient and assumes care.

Chaque année, 100 000 Canadiens sont hospitalisés pour des syndromes coronariens aigus (SCA) (infarctus aigu du myocarde et angine instable); un aussi grand nombre de patients sont hospitalisés pour que soit finalement «écarté» le diagnostic de SCA. Le diagnostic de SCA doit être rapide et exact afin de réduire le taux de mortalité et de prévenir la progression de l’angine instable vers un infarctus du myocarde. En même temps, on doit limiter les coûts inutiles liés au traitement de ces patients. Malheureusement, aucune épreuve ou stratégie particulières ne permettent d’identifier de façon définitive tous les patients atteints de SCA. Les unités de douleur thoracique à l’urgence, de plus en plus populaires, permettent de réduire le nombre d’hospitalisations aux unités de soins critiques en appliquant des protocoles diagnostiques intensifs au département d’urgence. Mais ces unités diminuent-elles les coûts ou ne font-elles qu’augmenter la proportion de patients soumis à des épreuves? Plutôt que de soumettre tous les patients au même processus diagnostique, les urgentologues devraient classer les patients selon leur risque parmi l’une des trois catégories suivantes : ceux dont la probabilité de SCA est faible qui nécessitent un minimum d’épreuves à l’urgence; ceux qui présentent des signes évidents de SCA et qui doivent être hospitalisés; et ceux dont la probabilité de SCA est intermédiaire et qui doivent subir différentes épreuves.

A 9-year-old girl accidentally injected her right thumb with an adult dose of epinephrine through an auto-injector syringe, delivering 0.3 mg of 1:1000 epinephrine. This injection caused immediate ischemic changes in the digit. This is the first reported case of accidental self injection by a child of an adult dose of epinephrine and its successful treatment with low-dose phentolamine simultaneously infiltrated directly into the puncture area and along the course of the digital artery. The use of phentolamine as a specific competitive alpha-adrenergic antagonist to epinephrine has been well documented in adults and animal models. This report compares the management of a pediatric case to that of all reported adult cases of accidental subcutaneous epinephrine injections. This case suggests a pattern of infiltration with low-dose phentolamine that may be the most effective form of treatment for this condition in a patient of any age.

Our CJEM Journal Club consists of two sections. The first, “Critically Appraised Topics,” is devoted to evidence-based reviews of specific EM-related questions. Questions will be answered by using a focused literature review and presenting the results in a CAT (Critically Appraised Topic) format. The aims of this section are to address clinical or administrative questions, to demonstrate the application of evidence-based medicine methods in answering such questions, and to accumulate a CAT database for emergency physicians.

Africa’s first conference on emergency medicine was held in October 1998 in Johannesburg, South Africa. Attended by 305 delegates from 13 countries, it was an important milestone in the development of Africa, emergency medicine’s last frontier. The violence of South Africa’s post-apartheid society was portrayed in mock scenario demonstrations of the private sector emergency medical services (EMS) system. Many of the presentations had a distinctly African flavour; they dealt with penetrating trauma and with making the best of extremely limited resources. A session reviewing the activities of traditional healers was not only terrifyingly revealing, it also upset and offended a segment of the African audience. The conference ended positively with the creation of the Emergency Medicine Society of South Africa, a step toward recognition of emergency medicine as a specialty in Africa.

Welcome to the first section on “Resident Issues” in our new journal. With this section, CAEP reaffirms its commitment to the future of Canadian emergency medicine and future leaders in our specialty. Resident Issues will focus on work by and about future emergency physicians in Canada. The overall goal of this section is to promote

An informal discussion of the possibilities of combining emergency medicine and international work during a residency program. A brief summary of emergency medicine related illness in the international setting is presented. An example of a successful combination of international work during residency is given. A list of tips and a starter’s list of resources are provided.

Canada is the only country with two colleges governing emergency medicine (EM) certification. Does this serve us well or does it divide us and our resources? If most CCFP(EM) graduates practise strictly EM, with no family or rural practice, then reform in the certification process may be necessary. At the same time, FRCPC residencies seem excessively long and lack the numbers to develop “critical mass.” Shortening the length of training would allow more residency positions to be created, thus advancing the goal of optimum emergency care for the Canadian public. Canadians deserve one standardized, certified, accredited EM training program that produces the highest quality emergency physicians.