Nephrotoxicity has recently been reported with the use of 5-aminosalicylic acid (5-ASA) which has structural similarities to phenacetin and aspirin. The present paper describes 2 cases of interstitial nephritis and 1 case of end-stage failure associated with 5-ASA treatment. The first patient presented with severe renal failure which was partially reversed with 5-ASA discontinuation and steroid therapy. The second had severe renal failure (serum creatinine 469 mmol/l) but renal function stabilized with 5-ASA withdrawal. The third patient had end-stage renal failure and underwent hemodialysis and a successful kidney transplant.

The purpose of this study was to determine the dose-response relationships for edrophonium antagonism of mivacuriuminduced neuromuscular block. Sevent~fa,e ASA I or H adults were given mivacurium 0.15 rag" kg -t followed by an infusion (7 I~g" kg -L rain -~) edrophonium (0.0, 0.125, 0.25, 0.5, 0.0012, 0.0025, 0.005, were administered by random allocation. Edrophonium doses of 0.25, were different from placebo with regard to time to attain a TOF ratio (fourth twitch in TOF[ TI) = 0.7 (13.8 5= 4.5, 11.1 5= 3.5, 11.4 + 3.0 vs 19.7 + 4.7 min P < 0.05). Doses of O.5 and LO mg" kg -1 permitted faster recovery time of T! from 10 to 95% (T1o_95) than did placebo (7..5 5= 3.8, 8.9 + 3.5 vs 14.5 + 5.0 min P < 0.05 [, Datex, Helsinki, Finlande). La vitesse de peqf~sion ~tait modif~,e aux cinq minutes afin de maintenir l'amplitude de la premibre stimulation du TOF (Tt) ,~ 5% de la valeur contrrle. ,~ la fin de l'intervention, on administrait de fafon aldatoire $drophonium (0,0, 0,125, 0,25, 0,5 ou 1,0 mg" kg -1) + glycopyrrolate (0,0, 0,0012, 0,0025, 0,005 ou 0,01 rag" kg-l). Les doses d'~drophonium de 0,25 0,5 et 1,7 compar~ au placebo (13,8 + 4,5, H,1 • 3,5, H,4 + 3,0 vs 19,7 + 4,7 min P < 0,05~ La rdcup$ration du T t de 10 d 95% (7"10_95) S'est effectu~e plus rapidement avec ddrophonium 0,5 et 1,0 mg" kg -t qu'avec le placebo (7,5 =t = 3,8, 8,9 + 3,5, vs 14,5 5= 5,0 rain P < 0,05 Ce travail vise ~ dtablir i'effet de diffdremes doses d'ddrophonium sur l'antagonisme du bloc neuromusculaire induit par le mivacurium. Une dose de mivacurium (0,15 rag" kg -I) suivie d'u~ perfusion (7 #g" kg -1. min -1) a dtd administrde ~ 75 adultes (ASA L II) sous anesthdsie (alfentanil-propofol-N20-enflurane). On proc~dait alors ~ une stimulation "train-dequatre" (TOF) du neff cubital aux 20 sec et ~ I'enregistrement de la rdponse ~ l'dminence th

IntroductionIn situ simulation (ISS) consists of performing a simulation in the everyday working environment with the usual team members. The feasibility of ISS in emergency medicine is an important research question, because ISS offers the possibility for repetitive, regular simulation training consistent with specific local needs. However, ISS also raises the issue of safety, since it might negatively impact the care of other patients in the emergency department (ED). Our hypothesis is that ISS in an academic high-volume ED is feasible, safe and associated with benefits for both staff and patients.MethodsA mixed-method, including a qualitative method for the assessment of feasibility and acceptability and a quantitative method for the assessment of patients’ safety and participants’ psychosocial risks, will be used in this study.Two distinct phases are planned in the ED of the CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus) between March 2021 and October 2021. Phase 1: an ISS programme will be implemented with selected ED professionals to assess its acceptability and safety and prove the validity of our educational concept. The number of cancelled sessions and the reasons for cancellation will be collected to establish feasibility criteria. Semistructured interviews will evaluate the acceptability of the intervention. We will compare unannounced and announced ISS. Phase 2: the impact of the ISS programme will be measured with validated questionnaires for the assessment of psychosocial risks, self-confidence and perceived stress among nonselected ED professionals, with comparison between those exposed to ISS and those that were not.Ethics and disseminationThe CHU de Québec-Université Laval Research ethics board has approved this protocol (#2020–5000). Results will be presented to key professionals from our institution to improve patient safety. We also aim to publish our results in peer-reviewed journals and will submit abstracts to international conferences to disseminate our findings.

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