Objectives: Despite evidence-based clinical practice guidelines for the emergency management of asthma, substantial treatment variation exists. Our objective was to assess compliance with the Canadian Association of Emergency Physicians (CAEP) / Canadian Thoracic Society (CTS) Asthma Advisory Committee's "Guidelines for the emergency management of asthma in adults" in the emergency department (ED) of a university-affiliated tertiary care teaching hospital. Methods: This retrospective study was conducted in a Canadian inner city adult ED. Investigators reviewed all ED records for the period from Jan. 1, 20011, , to Dec. 31, 2001, and identified adult patients (i.e., >18 years of age) with a primary ED diagnosis of asthma. Hospital records were then reviewed to document compliance with the CAEP/CTS asthma guidelines. Descriptive statistics, including means, standard deviations and frequencies were used to summarize information. Results: Overall compliance with the guidelines was 69.6%, (95% confidence interval, 64.7%-74.5%), but compliance ranged from 41.4% for severe asthma, 67.1% for moderate asthma, and 88.6% for mild asthma. Interobserver reliability for compliance assessment was excellent. Conclusions: Despite publication and dissemination of evidence-based guidelines for the management of acute asthma in adults, guideline compliance at a university-affiliated, inner city, tertiary care teaching hospital ED is suboptimal.

Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.

OBJECTIVES: To assess the impact of dementia on evidence-based medication use after admission for patients with acute coronary syndrome (ACS) across different age groups. METHODS: Of 87,298 patients hospitalized for ACS between January 1, 2006 and December 31, 2007, 1835 patients with dementia and 3670 matched patients without dementia (1:2 ratio, matched by age, gender, and admitted hospital level) were identified from Taiwan's National Health Insurance Research Database. Use of evidence-based medications post-discharge were compared between patients with and without dementia across different age groups (Յ65, 66-75, 76-85, Ͼ85). Multivariate logistic regression models were performed to examine the impact of dementia on use of evidence-based medications. RESULTS: Overall, dementia was associated with a 22% lower likelihood of use of evidence-based medications (adjusted odds ratio (OR) ϭ 0.78, CIϭ0.68-0.89) in ACS patients. The use of evidence-based medications decreased with age, and dementia worsened the utilization. The proportions of patients receiving evidence-based medications were 85.6% (without dementia) versus 73.6% (with dementia) in the youngest age group and 62.0 % (without dementia) versus 55.6% (with dementia) in the oldest age group. CONCLUSIONS: Dementia and aging were associated with the use of evidence-based medications in ACS patients.

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