Definition – Set of clinical decision instruments to help predict pretest probability in various injuries and need for further radiographical studies
Clinical Significance – There are four Ottawa Rules clinical decision instruments that are currently used:
Foot and Ankle
Head CT in mild head injury
History – Named after The Ottawa Hospital Research Institute and the University of Ottawa over series of publications from 1992-2001. These publications have been validated numerous times and shown to decrease health care costs, unnecessary radiographic studies, and decrease throughput time in the emergency department. The brain behind these studies is Ian Stiell, a Canadian physician researcher who received his medical doctorate from the University of Ontario and completed his residency at McGill University. With over 370 publications to his name, he is a powerhouse in the realm of emergency medicine research.
Firkin BG and Whitwirth JA. Dictionary of Medical Eponyms. 2nd ed. New York, NY; Parthenon Publishing Group. 1996.
Bartolucci S, Forbis P. Stedman’s Medical Eponyms. 2nd ed. Baltimore, MD; LWW. 2005.
Yee AJ, Pfiffner P. (2012). Medical Eponyms (Version 1.4.2) [Mobile Application Software]. Retrieved http://itunes.apple.com.
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001; 286(15):1841-8. [pubmed]
Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Annals of emergency medicine. 1995; 26(4):405-13. [pubmed]
Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Annals of emergency medicine. 1992; 21(4):384-90. [pubmed]
You have a patient in the ED with an aortic dissection and are managing them while awaiting the cardiovascular surgeon to arrive.
What are the two most important things to control?
How do you go about doing that?
The main aims of acute medical management of aortic dissections are to decrease the rate of left ventricular contraction and decrease the velocity of the contraction, which will overall decrease the shear stress at the site of the tear and slow progression.
Start with intravenous beta-blockade and titrate to a heart rate of 60 betas/minute
If systolic blood pressure is > 120 mmHg after successful beta-blockade, then add a vasodilator or afterload reducer.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010; 121(13):e266-369. [pubmed]
Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005; 112(24):3802-13. [pubmed]
Wes Johnson, MSPAS, PA-C, (soon to be), DHSc was a former student of mine at UAB and was a respiratory therapist prior to PA school. He is the Regional Director of Clinical Education for Island Medical Management Emergency group in North Alabama. He won the Preceptor of The Year award from UAB in 2016 and currently finishing up his doctorate degree from A.T. Still University.