Peds DKA
Don't forget we have an ED PED Diabetic Ketoacidosis Initial Mgmt Fluid Resuscitation (DKA, 2-bag system) powerplan, which is different from the adult version. For kids please use the pediatric version — there are differences in the initial management (see attached Peds DKA Algorithm for awareness).
Dynamic SIM (FREE CME)
Next session is scheduled for September 9th at Queens. See attached poster and let [email protected] know if you can attend.
📄 Dynamic Simulation — Sept 2026 Poster
Telestroke Process
Gentle reminder to call the telestroke physician at the same time as you start the Code Stroke process — rather than waiting until imaging is done. They're happy to assist in gathering additional info. See the attached posters/workflows.
Obstetrical Patients in ER with Non-Obstetrical Concerns
FYI — if pregnant patients arrive to ER with concerns unrelated to pregnancy (e.g. MSK injury), the triage nurse may coordinate with the OB on-call to arrange fetal assessment while the patient is awaiting their turn to see the ERMD. Patients may go up to L&D and return to the ER, or fetal tracings may be done in the ER prior to ED provider assessment.
📄 Pregnant Patients Requiring Medical Care — Clinical Guideline
Peds Nebulizers
FYI — the RTs have new Aerogen Ultra nebulizers available that are significantly more efficient than the old jet nebulizers:
- Delivers ~6× greater lung dose than a standard jet nebulizer (34.1% vs 5.2% delivered dose, p<0.001)
- Much lower residual dose volume (2.4% vs 62.8%, p=0.008)
- Delivers significantly more medication in half the time
- Works with or without O₂; usable with either mask or mouthpiece
Mental Health Assessments
A reminder that collateral information is a core component of our ongoing mental status assessment, particularly when discharging a patient. Collateral can provide important information to help inform our assessment of risk, functioning, supports, and the appropriateness of the proposed disposition.
Please ensure that attempts to obtain relevant collateral, as well as any information received, are clearly documented. If collateral is not available, document the attempts made and the outcome. Where a patient declines consent, we can still seek information from family, supports, or other relevant sources — however, we must not disclose patient information to the collateral source. Any information obtained should be considered alongside the patient's presentation and other available assessment information.
In a landmark decision, the Supreme Court of Canada confirmed the existence of a public safety exception to physician-patient confidentiality. The Court held that, in appropriate circumstances, danger to public safety can provide a justification for the disclosure of privileged or confidential information. Courts are to consider the following factors:
- There is a clear risk to an identifiable person or group of persons.
- The risk is one of serious bodily harm or death.
- The danger is imminent.
The Supreme Court noted that these factors will often overlap and vary in importance and significance depending on the circumstances of each case, but they all must be considered. The test appears to be objective — the question is whether a reasonable person, given all the facts, would consider the potential danger to be clear, serious, and imminent.
Please ensure this is incorporated into our ongoing assessment and clinical documentation, particularly when determining risk and disposition, and that it is clearly documented on the patient's medical record.
🔗 CMPA — Medical-Legal Handbook for Physicians in Canada
Telestroke — ENITS Downtime
ENITS is down on August 27, 2026, beginning at 8:00 PM until midnight. During the scheduled maintenance window, there will be two planned downtime periods:
- Downtime #1: up to 15 minutes, from 8:30–8:45 PM
- Downtime #2: up to 15 minutes, from 9:30–9:45 PM
Telestroke is aware that they won't be able to see images but are still available for consultation regardless.
Community Ward
FYI — KW4 Community Ward is a multidisciplinary program in the community that connects vulnerable patients with community supports (SW, mobility specialists, NP, pharmacists). Have a look at their website.
Reminder — no department meeting this week.