Rodrick Lim | Western University Canada (original) (raw)
Papers by Rodrick Lim
Paediatrics & Child Health
Background and Objective Bronchiolitis is the most common reason for admission to hospital in the... more Background and Objective Bronchiolitis is the most common reason for admission to hospital in the first year of life, with increasing hospitalization rates in Canada. Respiratory support with high-flow nasal cannula (HFNC) is being routinely used in paediatric centres, though the evidence of efficacy is continuing to be evaluated. We examined the impact of HFNC on intubation rates, hospital and paediatric critical care unit (PCCU) length of stay (LOS), and PCCU admission rates in paediatric tertiary centres in Canada. Methods We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to postimplementation of HFNC for bronchiolitis. Data were obtained from the Canadian Institute for Health Information database. Paediatric tertiary centres that introduced HFNC between 2009 and 2014 were included, and data were collected from April 2005 to March 2017. Results A total of 17,643 patients met inclusion criteria. There was no significant change in intubat...
CJEM
Objectives We sought to conduct a major objective of the Canadian Association of Emergency Physic... more Objectives We sought to conduct a major objective of the Canadian Association of Emergency Physicians (CAEP) Wellness Committee, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools. Methods An 89-question questionnaire was distributed to academic heads or wellness leads. The responses were verified by the lead author to ensure that the questions were answered completely and consistently. Results While formal wellness programs may exist in varying degrees across the 17 universities, most were found to exist only at local, divisional, or departmental levels. A broad variability of established leadership positions exists. Shift practices varied greatly. In day to day practice, availability for food and debriefing were high and childcare, sleep rooms, and follow-up following critical incidents were low. Sabbaticals existed in the majority of centers. Roughly 50% of departments have gender equity program and annual retreats. Centers re...
Canadian Medical Education Journal
Objective: To implement a University Faculty mentorship program in the Division of Emergency Medi... more Objective: To implement a University Faculty mentorship program in the Division of Emergency Medicine. Methods: A program based on a unique Schulich faculty mentorship policy was implemented with the help of a Provider Value Officer. The process involved creating a training program which defined the roles of the mentors and mentees and established the principles of an effective mentor-mentee relationship. Faculty received training on how to participate effectively in a Schulich faculty mentorship committee. Each committee consisted of a mentee, and two mentors at the associate professor level (one internal and one external) . Thirteen distinct external divisions were represented. They were instructed to meet twice per year, as arranged by the mentee. The mentee created mentor minutes using a template, and then submitted the minutes to the members of the mentorship committee and the Chair/Chief of Emergency medicine. The Chair/Chief used the minutes during the annual Continuing...
Journal of Allergy and Clinical Immunology
Pediatric emergency care, Jan 20, 2018
Elucidating a medical history and gaining patient consent and buy-in are difficult in any teenage... more Elucidating a medical history and gaining patient consent and buy-in are difficult in any teenager presenting to a North American pediatric emergency department, but especially so when they present with limited English fluency. Translators can make this process easier, but both limited availability and impreciseness in translation can reduce their utility. We describe 2 teenage females who presented to our pediatric emergency department within 48 hours with similar presentations but no obvious organic cause or examination findings to suggest a specific diagnosis. We demonstrate how complex language translation issues in these adolescents contributed to prolonged diagnoses and advocate for independent interpreters to be available on first presentation to hospital.
The journal of allergy and clinical immunology. In practice, Jan 28, 2018
Current pediatric reviews, Jan 11, 2017
Trauma remains the leading cause of death in children, of which the majority of patients have ort... more Trauma remains the leading cause of death in children, of which the majority of patients have orthopedic injuries. The range of injured bones is various, each requiring knowledge and expertise to appropriately manage in a timely fashion. The importance of a systematic approach to the pediatric polytrauma patient is paramount. This chapter will highlight orthopedic issues important to the pediatric polytrauma patient including the unique anatomy and properties of pediatric bone. A systematic approach to the pediatric polytrauma patient will also be discussed. Also, an approach to spinal injury, spinal injuries unique to children such as spinal cord injury without evidence of radiographic abnormality (SCIWORA), high-energy injuries such as atlanto-occipital dislocations and the use of clinical decision rules in cervical spine assessment will be discussed. The special importance of pediatric pelvic fractures will also be discussed, as well as characteristic pediatric fracture patterns ...
Current pediatric reviews, 2018
The focus of this review is to examine the current state of paediatric Point of Care Ultrasound (... more The focus of this review is to examine the current state of paediatric Point of Care Ultrasound (POCUS) in the injured patient. POCUS has become useful across various medical specialties owing to its ease of use, reproducibility and non-ionizing qualities. Point of care ultrasound has advanced over the past years and has proven to be an extremely useful adjunct in the injured child. Discussion will center around the challenges on when and how to best utilize POCUS. This includes but is not limited to: detection of peritoneal free fluid, pneumothoraces, hemothoraces, pericardial effusions, a wide array of fractures, lung contusions and many other applications. Discussion will also be focused on the evolution of POCUS, as well as a discussion around the determination of training standards.
Current pediatric reviews, Apr 11, 2018
Physicians caring for children in trauma settings must consider and treat hypothermia as a cause ... more Physicians caring for children in trauma settings must consider and treat hypothermia as a cause for morbidity and mortality. Knowledge of treatment of accidental hypothermia with and without an asphyxial event is paramount. Clinicians need to identify hypothermia immediately and be aware of the overall management utilizing aggressive rewarming and cardiopulmonary resuscitation to help improve the survival of these critically ill children. This section reviews the epidemiology, clinical effects, and management options for accidental hypothermia in children.
Current pediatric reviews, Jan 7, 2018
It is important for physicians treating children to be aware of unique presentations that require... more It is important for physicians treating children to be aware of unique presentations that require expertise and knowledge. One area of importance when caring for traumatized children are Thermal Burn Injuries. Burns commonly result in morbidity in children; as such, the appropriate identification of the severity of the burn and appropriate management are integral to minimize the complications of burns during the acute phase. Attention to proper fluid management is paramount. Knowledge of types of solutions to use during Burn treatment is important. The evolution of wound management with newer biologic dressings and skin analogues for optimal skin recovery is discussed.
Pediatric emergency care, 2018
Forefoot fractures account for 6% to 10% of fractures in children, and although the majority heal... more Forefoot fractures account for 6% to 10% of fractures in children, and although the majority heals with supportive treatment, complications may lead to pain and disability. No previous study in children has evaluated complication risk in the emergency department based on initial assessment characteristics. The study aim was to identify the radiological and clinical variables that increase the complication rate of pediatric forefoot fractures. This may help emergency physicians refer patients who require more thorough follow-up or surgical intervention. We evaluated 497 forefoot fractures on initial presentation to a pediatric emergency department at the Children's Hospital at London Health Science Centre over a 6-year period. We collected variables such as degree of angulation, displacement, number of concurrent fractures, and demographic data such as age and sex. We then determined the variables associated with complications by reviewing each patient's chart. Overall, there...
Pediatric emergency care, Jan 16, 2017
Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation ... more Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation in children. One form known as a cecal bascule has only previously been reported in children with neurodevelopmental issues or with severe chronic constipation. We present the case of a 10-year-old boy who presented with an acute history of left lower quadrant abdominal pain, who upon investigation was found to have a cecal bascule.
Immunity, inflammation and disease, 2017
Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the di... more Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the differences in clinical characteristics and management of DIA between adults and children. We assessed the percentage, diagnosis, and management of DIA among all anaphylaxis visits in three pediatric and one adult emergency departments (ED) across Canada. Children presenting to the Montreal Children's Hospital (MCH), British Columbia Children's Hospital (BCCH), and Children's Hospital at London Health Sciences Center and adults presenting to Hôpital du Sacré-Coeur with anaphylaxis were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized data form documenting the reaction and management was completed and patients were followed annually to determine assessment by allergist and use of confirmatory tests. From June 2012 to May 2016, 51 children were recruited from the pediatric centers and 64 adults from the adult center with drug-induced anaphyalxis. More th...
Pediatric Emergency Care
Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatri... more Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. We describe a case where the administration of adenosine was successful via a mixed method administration.
Pediatric Emergency Care
Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute ... more Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute injuries in sports that involve aggressive twisting of the knee, such as soccer and snowboarding. We present a case of a 17-year-old male adolescent who sustained an acute dislocation of the anterolateral tibiofibular joint with routine ambulation, who had a chronic history of subluxation. To our knowledge, this has not been previously reported. The diagnosis requires a high level of awareness and suspicion, and plain radiographs may aid in the diagnosis especially if contralateral comparison views are obtained.
Paediatrics & Child Health
Background and Objective Bronchiolitis is the most common reason for admission to hospital in the... more Background and Objective Bronchiolitis is the most common reason for admission to hospital in the first year of life, with increasing hospitalization rates in Canada. Respiratory support with high-flow nasal cannula (HFNC) is being routinely used in paediatric centres, though the evidence of efficacy is continuing to be evaluated. We examined the impact of HFNC on intubation rates, hospital and paediatric critical care unit (PCCU) length of stay (LOS), and PCCU admission rates in paediatric tertiary centres in Canada. Methods We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to postimplementation of HFNC for bronchiolitis. Data were obtained from the Canadian Institute for Health Information database. Paediatric tertiary centres that introduced HFNC between 2009 and 2014 were included, and data were collected from April 2005 to March 2017. Results A total of 17,643 patients met inclusion criteria. There was no significant change in intubat...
CJEM
Objectives We sought to conduct a major objective of the Canadian Association of Emergency Physic... more Objectives We sought to conduct a major objective of the Canadian Association of Emergency Physicians (CAEP) Wellness Committee, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools. Methods An 89-question questionnaire was distributed to academic heads or wellness leads. The responses were verified by the lead author to ensure that the questions were answered completely and consistently. Results While formal wellness programs may exist in varying degrees across the 17 universities, most were found to exist only at local, divisional, or departmental levels. A broad variability of established leadership positions exists. Shift practices varied greatly. In day to day practice, availability for food and debriefing were high and childcare, sleep rooms, and follow-up following critical incidents were low. Sabbaticals existed in the majority of centers. Roughly 50% of departments have gender equity program and annual retreats. Centers re...
Canadian Medical Education Journal
Objective: To implement a University Faculty mentorship program in the Division of Emergency Medi... more Objective: To implement a University Faculty mentorship program in the Division of Emergency Medicine. Methods: A program based on a unique Schulich faculty mentorship policy was implemented with the help of a Provider Value Officer. The process involved creating a training program which defined the roles of the mentors and mentees and established the principles of an effective mentor-mentee relationship. Faculty received training on how to participate effectively in a Schulich faculty mentorship committee. Each committee consisted of a mentee, and two mentors at the associate professor level (one internal and one external) . Thirteen distinct external divisions were represented. They were instructed to meet twice per year, as arranged by the mentee. The mentee created mentor minutes using a template, and then submitted the minutes to the members of the mentorship committee and the Chair/Chief of Emergency medicine. The Chair/Chief used the minutes during the annual Continuing...
Journal of Allergy and Clinical Immunology
Pediatric emergency care, Jan 20, 2018
Elucidating a medical history and gaining patient consent and buy-in are difficult in any teenage... more Elucidating a medical history and gaining patient consent and buy-in are difficult in any teenager presenting to a North American pediatric emergency department, but especially so when they present with limited English fluency. Translators can make this process easier, but both limited availability and impreciseness in translation can reduce their utility. We describe 2 teenage females who presented to our pediatric emergency department within 48 hours with similar presentations but no obvious organic cause or examination findings to suggest a specific diagnosis. We demonstrate how complex language translation issues in these adolescents contributed to prolonged diagnoses and advocate for independent interpreters to be available on first presentation to hospital.
The journal of allergy and clinical immunology. In practice, Jan 28, 2018
Current pediatric reviews, Jan 11, 2017
Trauma remains the leading cause of death in children, of which the majority of patients have ort... more Trauma remains the leading cause of death in children, of which the majority of patients have orthopedic injuries. The range of injured bones is various, each requiring knowledge and expertise to appropriately manage in a timely fashion. The importance of a systematic approach to the pediatric polytrauma patient is paramount. This chapter will highlight orthopedic issues important to the pediatric polytrauma patient including the unique anatomy and properties of pediatric bone. A systematic approach to the pediatric polytrauma patient will also be discussed. Also, an approach to spinal injury, spinal injuries unique to children such as spinal cord injury without evidence of radiographic abnormality (SCIWORA), high-energy injuries such as atlanto-occipital dislocations and the use of clinical decision rules in cervical spine assessment will be discussed. The special importance of pediatric pelvic fractures will also be discussed, as well as characteristic pediatric fracture patterns ...
Current pediatric reviews, 2018
The focus of this review is to examine the current state of paediatric Point of Care Ultrasound (... more The focus of this review is to examine the current state of paediatric Point of Care Ultrasound (POCUS) in the injured patient. POCUS has become useful across various medical specialties owing to its ease of use, reproducibility and non-ionizing qualities. Point of care ultrasound has advanced over the past years and has proven to be an extremely useful adjunct in the injured child. Discussion will center around the challenges on when and how to best utilize POCUS. This includes but is not limited to: detection of peritoneal free fluid, pneumothoraces, hemothoraces, pericardial effusions, a wide array of fractures, lung contusions and many other applications. Discussion will also be focused on the evolution of POCUS, as well as a discussion around the determination of training standards.
Current pediatric reviews, Apr 11, 2018
Physicians caring for children in trauma settings must consider and treat hypothermia as a cause ... more Physicians caring for children in trauma settings must consider and treat hypothermia as a cause for morbidity and mortality. Knowledge of treatment of accidental hypothermia with and without an asphyxial event is paramount. Clinicians need to identify hypothermia immediately and be aware of the overall management utilizing aggressive rewarming and cardiopulmonary resuscitation to help improve the survival of these critically ill children. This section reviews the epidemiology, clinical effects, and management options for accidental hypothermia in children.
Current pediatric reviews, Jan 7, 2018
It is important for physicians treating children to be aware of unique presentations that require... more It is important for physicians treating children to be aware of unique presentations that require expertise and knowledge. One area of importance when caring for traumatized children are Thermal Burn Injuries. Burns commonly result in morbidity in children; as such, the appropriate identification of the severity of the burn and appropriate management are integral to minimize the complications of burns during the acute phase. Attention to proper fluid management is paramount. Knowledge of types of solutions to use during Burn treatment is important. The evolution of wound management with newer biologic dressings and skin analogues for optimal skin recovery is discussed.
Pediatric emergency care, 2018
Forefoot fractures account for 6% to 10% of fractures in children, and although the majority heal... more Forefoot fractures account for 6% to 10% of fractures in children, and although the majority heals with supportive treatment, complications may lead to pain and disability. No previous study in children has evaluated complication risk in the emergency department based on initial assessment characteristics. The study aim was to identify the radiological and clinical variables that increase the complication rate of pediatric forefoot fractures. This may help emergency physicians refer patients who require more thorough follow-up or surgical intervention. We evaluated 497 forefoot fractures on initial presentation to a pediatric emergency department at the Children's Hospital at London Health Science Centre over a 6-year period. We collected variables such as degree of angulation, displacement, number of concurrent fractures, and demographic data such as age and sex. We then determined the variables associated with complications by reviewing each patient's chart. Overall, there...
Pediatric emergency care, Jan 16, 2017
Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation ... more Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation in children. One form known as a cecal bascule has only previously been reported in children with neurodevelopmental issues or with severe chronic constipation. We present the case of a 10-year-old boy who presented with an acute history of left lower quadrant abdominal pain, who upon investigation was found to have a cecal bascule.
Immunity, inflammation and disease, 2017
Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the di... more Data is sparse on drug-induced anaphylaxis (DIA) and there have not been studies assessing the differences in clinical characteristics and management of DIA between adults and children. We assessed the percentage, diagnosis, and management of DIA among all anaphylaxis visits in three pediatric and one adult emergency departments (ED) across Canada. Children presenting to the Montreal Children's Hospital (MCH), British Columbia Children's Hospital (BCCH), and Children's Hospital at London Health Sciences Center and adults presenting to Hôpital du Sacré-Coeur with anaphylaxis were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized data form documenting the reaction and management was completed and patients were followed annually to determine assessment by allergist and use of confirmatory tests. From June 2012 to May 2016, 51 children were recruited from the pediatric centers and 64 adults from the adult center with drug-induced anaphyalxis. More th...
Pediatric Emergency Care
Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatri... more Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. We describe a case where the administration of adenosine was successful via a mixed method administration.
Pediatric Emergency Care
Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute ... more Tibiofibular joint injury in children is an uncommon injury. It is usually associated with acute injuries in sports that involve aggressive twisting of the knee, such as soccer and snowboarding. We present a case of a 17-year-old male adolescent who sustained an acute dislocation of the anterolateral tibiofibular joint with routine ambulation, who had a chronic history of subluxation. To our knowledge, this has not been previously reported. The diagnosis requires a high level of awareness and suspicion, and plain radiographs may aid in the diagnosis especially if contralateral comparison views are obtained.