ED Rounds – January 2016

The first ED rounds of 2016 were well aligned. Dr Chris Vaillancourt presented an update from his recent attendance to the American College of Allergy and Immunology Conference in Texas, and Dr Todd Way presented an interactive session on ED Dermatology.



The take home messages from Dr Vaillancourt’s presentation were:

  • Peanut introduction should be recommended between 4-11 months for high risk infants. See the LEAP study.
  • Ace Inhibitor induced Angioedema is mediated by Bradykinin (not Histamine) so Antihistamines / Steroids are unlikely to be effective.
  • Allergy_Update_-_CV_-_Jan_2016_pdf__page_18_of_32_
  • Consider nebulised (aerosol) epinephrine for symptomatic tongue swelling (see ref).
  • Consider Icatibant in cases where intubation may be required. A small study in the NEJM has provided some evidence of efficacy, although the control was questionable and the cost of the drug is very high.
  • Patients who present with anaphylaxis from a known food allergen are less likely to have a biphasic reaction, whereas those who present with either more widespread systemic reaction or the allergen is unknown may have a biphasic reaction and this reaction may occur later than previous guidelines suggest. A recent meta-analysis looked at  the Time of Onset and Predictors of Biphasic Anaphylactic Reactions. The median time to biphasic reaction was 11 hours (0.2-72 hours).

Dr Vaillancourt’s full presentation can be seen here

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DEM Rounds – October 14th 2014

A big welcome to our nursing / nurse practitioner colleagues at todays rounds. Recent attendance at m&m’s and rounds has been increasing significantly, and a larger venue may soon be required! Just a reminder that ALL (Students, Residents, Physicians, Nurses, NPs, etc) are invited to these CPD (continuous professional development) events.

Dr Chris Vaillancourt  presented the recent update in Food Allergies

We were remind that we are frequently faced with patients and their parents requiring advice on the hot topic of food allergies and especially ‘prevention’ of food allergies

Notes from rounds:

If one parent with a food allergy the child has 30% chance of developing Atopy (atopic dermatitis, childhood Asthma, food allergy, allergic rhinitis) in that order – allergic march – developed over childhood in this order
If two parents  with food allergy = child risk = 70%

Allergen exposure in early infancy is good if its via the gut, bad if its via the skin (especially if atopic via atopic skin rash)
Due to activation of T-Helper Cells – TH1 vs TH2 = less allergies if TH1 activated via gut than TH2 vis skin

Current Strategies  – debunked
Maternal hypoallergenic food eating – false
No cat in house – false – in fact a cat in the house with new infant may be protective

Most kids are getting sensitised via ‘broken skin’ in first year life
Via T-Helper 2 system
Getting exposed via gut stims TH1 system  – reduced risk of allergy

Window of opportunity
For kids at risk
4-6 months window for oral sensitisation – may reduce risk of later food allergy

Other Recommendations
No evidence for using soy milk to prevent food allergy

Breast feed until 4-6months then feed them what you want

Wait fro LEAP study – big RCT looking at food allergies and due to present results in next 2 months



Dr Peter Ross  presented on Ebola. An extremely stimulating review of the current situation and state of preparedness of own own system. Much discussion was had both during and after the presentation.

It was noted that there is a Provincial plan for managing patient with suspected Ebola. This can be accessed via the Horizon Intranet (Skyline Homepage) This is updated regularly. SJRHEM has printed copies of the plan in accessible areas of the department. These should be accessed and read by all. We have already completed an in-situ simulation for a ‘potential’ ebola case this month. The report for this can be accessed in the Simulation Files  – InSitu Sessions – Oct 3rd.

PPE Training is ongoing

Dr Howlett will be posting an update to this website in the next week

Video: here

Full presentation here : 

Download (PDF, 796KB)


Dr David Lewis presented on limping kids

Take home pearls:

  • A limping/NWB child that can crawl is likely to have pathology below the knee
  • Examine least likely source of symptoms first.
  • Flex, Adduct and Int Rot hip most likely manoeuvre to elicit pain in hip pathology
  • Children >8yrs – X-ray hip first
  • If fever (>38°) or > 24hrs then bloods (incl CRP)
  • CRP < 12 is very reassuring
  • Positive ultrasound is most likely to be irritable hip
  • Negative ultrasound – X-ray leg

Full presentation here: 

Download (PDF, 2.08MB)


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DEM Rounds April 8th 2014


Dr Chris Vaillancourt – Epistaxis

Dr Mobin Ataellahi – Spontaneous Splenic Rupture

Both talks are available for download in the CPD Files|Rounds

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Take Home Messages


Spontaneous Splenic Rupture

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