Poster Abstracts - Monday

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M001

BASE DEFICIT PROFILING IN PATIENTS WITH ISOLATED BLUNT TRAUMATIC BRAIN INJURY.

S. Waheed 1, M. Waqas 1, A. Feroze 1

1

Aga Khan University Hospital, Karachi, Pakistan

Background: To determine the utility of base deficit at presentation in traumatic brain injury in assessing the severity of head injury. <FILE IMAGE='140_20150531151606.jpg'> Methods: Cross-sectional study. Patients with isolated TBI presenting within 24 hours of injury to the ED were included. Glasgow Coma Scale and base deficit values were taken at presentation, the patients were followed and CT scan brain findings were recorded and graded as per the Rotterdam scale, Relationship of base deficit with GCS, GOS, CT scan Brain and length of stay was calculated using Spearman`s correlations.

Results: 154 patients were enrolled in the study. Mean age was 30 years and 137(89) were males. The severity of brain injuries as per the GCS was moderate in 33(24) and severe in 109(70). Correlation was significant at the 0.01 level with GCS on presentation and the base deficit 0.004. Area under the curve for base deficit with GCS was 0.65.

Conclusions: Base deficit at presentation was found to be a good predictor of severity of brain injury

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M002

CAUDA EQUINA SYNDROME WITH BULLET IN LUMBAR SPINAL CANAL AFTER MULTIPLE GUNSHOT INJURIES.

C. Dalla Vecchia 1, A. Moughty 1

1

Mater Misericordiae University Hospital, Dublin, Ireland

Background: We present a peculiar case of gunshot injury with a retained bullet in the lumbar spinal canal causing a cauda equina syndrome. <FILE IMAGE='72_20150504133858.jpg'> Methods: This 32 y old gentlemen was brought to the Emergency Department (ED) after being shot 5 times on the back. The patient was complaining of subjective reduced sensation of groins, penis and distal legs, neurological examination was positive only for reduced anal tone and perianal sensation. Non contrast enhanced computer tomography of the abdomen revealed a bullet within spine tract centrally at L5 level. The bullet is clearly seen in figure 1 which is taken from a non-contrast computer tomography (CT) of the abdomen performed emergently in the ED. Results: Gunshot wounds to spine are uncommon in the civilian population, but are increasing nowadays because of easily available firearms and growing criminal rates [1]. Traumatic injury caused by firearms are a major cause of morbidity and mortality especially among young people [2] and are associated with high incidence of paralysis, with complete distal sensormotion loss of function in 73% of cases [3]. There is still lack of strong evidences regarding positive neurological outcome after surgery in this patients [4] and treatment remain controversial [5].

Conclusions: This case is an uncommon presentation in the emergency department (ED) and reveals the importance of full neurological examination in the setting of gunshot injuries.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M003

CHARACTERIZING THE EPIDEMIOLOGY OF PATIENTS PRESENTING TO CALIFORNIA EMERGENCY DEPARTMENTS WITH TRAUMATIC BRAIN INJURIES

A. Elrefaie 1, B. Chakravarthy, U. Ogbu, A. Murthy, T. Tsay

1

University of California, Irvine Medical Center Department of Emergency Medicine, Orange, USA

Background: Traumatic brain injury (TBI) is a major source of morbidity and mortality in the United States with 1.7 million cases occurring annually. Direct and indirect costs resulting from these injuries estimate to $77 billion annually. Greater than 85% of these injuries are evaluated and discharged from emergency departments (ED) annually, yet there is little public information about TBI patients who present to EDs. California’s size, diversity, and accessibility to recent data provide an optimal approach to study and characterize patients who present to EDs with TBI. Methods: This is a retrospective cohort study of 2010 – 2012 data obtained from the California Office of Statewide Health Planning and Development (OSHPD), which captures patient demographic and clinical information from hospitals in California. Encounters from 2010 – 2012 were identified using International Classification of Diseases, Ninth Revision (ICD-9). Patient characteristic values obtained include: age, gender, race/ethnicity, state, county, mechanism of injury, disposition, and expected payer.

Results: From 2010 – 2012, there were 607,507 patients evaluated in California EDs with diagnosis of TBI. Overall average annual rate of TBI evaluated in California EDs was 504.7 cases per 100,00 population. 53.9% were male. Rates were highest in ages 0 – 9 years (971.2), 10 – 19 (647.5), and age greater than 70 (1043.5).

Whites (49.4%) represented the most common race experiencing TBI. Falls (56.3%) were the most common mechanism of TBI. 95.9% of patients with TBI were discharged from the ED. Conclusions: Compared to national CDC data collected in 2006, Californians experienced a greater annual average rate of TBIs presenting to the ED (540.7 vs 468.0 cases per 100,000 population). Secondary to an increasing aging population, California’s population had a greater rate of falls compared to the national rate (304.4 vs 178.4 cases per 100,000 population). California ED physicians are tasked with a greater responsibility to recognize TBI, follow appropriate concussion guidelines, and provide recommendations for follow-up.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M004

EVALUATION OF PEDIATRIC TRAUMA THAT REFERRED TO PEDIATRIC EMERGENCY TRAUMA WARD TO NAMAZI HOSPITAL BASED ON AGE GENDER AND KIND OF MECHANISMS OF TRAUMA DURING 6 MONTH IN 2014

M. Kalantari Meibodi 1, S. Esfandiari 1, H. Sarikhani 1

1

Shiraz University Of Medical Science, Shiraz, Iran

Background: trauma (head and extremity and chest and abdomen) injury is a major health problem all over the world, especially in children. Trauma is one of the most common causes of morbidity and mortality in developed societies. Traumatic injuries to the head can occur as a result of motor vehicle crashes, falling from height, being beaten and also brain injuries caused by child abuse. The most common causes of trauma in children are child abuse and motor vehicle accidents in developed countries and other societies respectively Methods: In this six-month cross-sectional study, which was conducted during march until September 2014, 1800 patients under eighteen with head trauma who were admitted or discharged or released to the pediatric trauma emergency department of Namazi Hospital, Iran, whether transferred by an ambulance or the patients' attendants, were investigated. Regardless of their gender, these children were in an age range between newborn to 18. After attending the hospital, these patients or their attendants were asked about their medical history and the patients' vital signs were examined by a 24-hour triage nurse who had successfully completed a triage course.

Results: Among these subjects, there were 1100 male and 700 female patients with an average age of 6 years old. 790 subjects had fallen from height; 510 had a car accident; 490 had a motorcycle accident; and 10 of the patients were admitted due to beating. Finally, 200 patients were discharged, 250 were released, 440 were hospitalized, and 910 were categorized in level 3 and monitored. Among 1000 subjects who had a brain CT scan order, just 900 of them had it done with 540 subjects having a normal CT scan and 360 of them having an abnormal one.

Conclusions: The results of this study show that many accidental injuries in children are due to the parents' recklessness, especially in high-risk environments in terms of accidents. Therefore, public education in this regard and educating drivers to be more careful in areas where children pass can play a significant role.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M005

IS CONSENT FOR CT IN ACUTE TRAUMA FEASIBLE?

M. Langdorf 1, N. Zuabi 1, R. Rodriguez 2

1

University Of California, Irvine Department Of Emergency Medicine, Orange, Usa, San Francisco Department Of Emergency Medicine, San Francisco, Usa

2

University Of California,

Background: Computed tomography (CT) is increasingly used to evaluate victims of blunt trauma. The â&#x20AC;&#x153;pan scanâ&#x20AC;? strategy to evaluate head, cervical spine, chest abdomen and pelvis is common in American trauma centers. Exposure to diagnostic radiation is thought to increase the risk of cancer later in life. Despite knowledge regarding these risks, imaging is often obtained without informing patients of risks, costs and consequences of diagnostic radiation. Our objective is to evaluate the feasibility and time required to provide informed consent to multiple blunt trauma patients in the standard workflow of trauma evaluation.

Methods: Multicenter prospective cohort study with two phases. First, for 384 patients per center (n=1536), we recorded GCS and timed the interval between completion of the Advanced Trauma Life Support secondary survey, until the patient left the resuscitation room (trauma gap time) in four American College of Surgeons verified Level I trauma centers. Second, for 11 patients per center (n = 44), we had physicians read a verbal informed consent script to patients not requiring a CT scan, had the physician answer questions, and asked whether the patient would consent. We timed the duration of these conversations (CT threshold time).

Results: Data collection is ongoing. We will report the average interval between secondary survey and leaving for CT and the duration of the consent conversation. The % Feasible for CT Consent will be the following proportion: # of trauma patients who have a GCS of 15 and a Trauma Gap > CT Threshold Time/ total # of trauma patients enrolled in the main phase of the study.

Conclusions: Although CT consent in blunt trauma is currently uncommon, literature dictates that patients desire and value this. There is commonly enough time between completion of secondary trauma evaluation and move to CT scanner to accomplish verbal informed consent.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M006

PREDICTIVE VALUE OF COAGULOPATHY IN PATIENTS WITH ISOLATED BLUNT TRAUMATIC BRAIN INJURY â&#x20AC;&#x201C; A COHORT OF PAKISTANI POPULATION

M. Waqas 1, S. Waheed 1, M. Qadeer 1, I. Patoli 1, E. Bari 1

1

Aga Khan University Hospital, Karachi, Pakistan, 2 Aga Khan University Hospital, Karachi, Pakistan, 3 Aga Khan University Hospital, Karachi, Pakistan, 4 Aga Khan University Hospital, Karachi, Pakistan, 5 Aga Khan University Hospital, Karachi, Pakistan Background: Most of the data on coagulopathy are from West. We sought to determine frequency of coagulopathy in our population and determine the relationship of coagulation parameters and other clinical variables with unfavorable outcomes of patients with TBI. <FILE IMAGE='140_20150529130733.jpg'> Methods: This was an observational cohort study conducted in a tertiary care facility from 1st January 2010 to 31st December 2012. All the patients with isolated traumatic brain injury presenting within 24 hours of injury were included in the study. Coagulation parameters at presentation were recorded and Glasgow Outcome Scale calculated on last follow up. Outcomes were dichotomized into favorable and unfavorable outcomes.

Relationship of coagulopathy with GCS, GOS, RTS and unfavorable outcomes was calculated using Pearson`s correlation and Receiver Operator Curve analysis.

Results: 121 patients were included in the study. Mean age was 38.86 years (Âą 16.71).Overall frequency of coagulopathy was found to be 6 %. In severe head injury group it was 14%.Area under curve (AUC) for aPTT was found to be 0.702 (95%CI =0.602-0.802, p < 0.001) indicating its strong predictive value. Predictive value of platelets and INR was not found to be significant. APTT, INR, RCTS, Age, GCS and RTS were found to be significantly correlated with GOS. Conclusions: Overall incidence of coagulopathy in our population was 6 %. APTT, INR, RCTS, Age, GCS and RTS in emergency are correlated with outcomes of patients with TBI.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M0064

SELF-EFFICACY IN BYSTANDER CARDIOPULMONARY RESUSCITATION: A NATIONWIDE COMMUNITY SURVEY

Y. Ro 1, S. Shin 1

1

Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea

Background: We hypothesized that recent hands-on practice for cardiopulmonary resuscitation (CPR) would be strongly associated with a higher likelihood of self-efficacy in bystander CPR among laypersons.

Methods: We used the National Korean Community Health Survey database of 228,921 representatively sampled responders from 253 counties in 2012. Laypersons who had previous CPR training were eligible.

Exposure variable was having had CPR training with hands-on practice with a manikin within the last 2 years.

Primary outcome was self-efficacy in bystander CPR. We calculated adjusted odds ratios (AORs) of CPR training, individual and household factors for self-efficacy adjusting for potential confounders.

Results: Of 62,425 eligible respondents who have had CPR training, 20,213 (32.4%) had CPR training with hands-on practice recently. Laypersons who were young, male, had good self-rated health, non-manual workers, high school graduate, and had high household income were more likely to have attended CPR training with hands-on practice within last 2 years (all p<0.01). Persons who had comorbidities or lived with ill household member with heart disease or cancer were less likely to attend recent hands-on practice (all p<0.01).

AORs for self-efficacy were 4.08 (3.78-4.41) for recent CPR training with manikin, 2.61 (2.50-2.73) for male, 1.26 (1.16-1.36) for good self-rated health, 1.19 (1.10-1.29) for high school graduate, and 1.19 (1.01-1.39) for living with stroke patients in household. History of stroke (0.66, 0.48-0.91) and being never-married (0.88, 0.80-0.97) were negatively associated with outcomes.

Conclusions: Self-efficacy in bystander CPR was higher in person with recent CPR training with hands-on practice with a manikin.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M007

THE RELATIONSHIP BETWEEN RISK FACTORS OF HEAD TRAUMA WITH CT SCAN FINDINGS IN CHILDREN WITH MINOR HEAD TRAUMA ADMITTED TO HOSPITAL

B. Masoumi 1, K. Golshani 1, R. Azizkhani 1, A. Omrani Nava 2, M. Khatami 3

1

Isfahan University Of Medical Sciences, Isfahan, Iran, 2 Aja University Of Medical Sciences, Tehran, Iran, 3 The Islamic Republic Of Iran Medical Council, Tehran, Iran Background: In Emergency Medicine for determining the intracranial injury (ICI) in children with head trauma, usually Brain CT Scan is performed. Since Brain CT Scan especially in children has some disadvantages, it is ideal to find a method which could help to choose only the children with real head trauma injury for Brain CT Scan.

Methods: Method of this study was descriptive, Analytic and Non interventional. We reviewed the archived files of children with head trauma injuries admitted in emergency department of Imam Hossein hospital within two years .Findings of Brain CT scan included ICI (intracranial injury), Isolated FX and Normal condition. Out of 368 patients, 326 patients had normal Brain CT Scan. 28 of them showed signs of ICI consisting IVH, Contusion, SAH, SDH, EDH, and Pneumocephalus. Since, patients with isolated FX usually discharge quickly from Emergency Department; their data did not included in outcome of this study. The Patients has been divided into two groups: 1- ICI, 2- without ICI. RR (relative risk), CI (Confidence interval) and sensitivity, PPV, NPV and association of these risk factors with ICI were assessed with Chi-2 test.

Results: The evaluated risk factors consisted of Gender, Age, Mechanism Of Trauma, Signs of Skull Fracture, Abnormal Mental Status, Vomiting, LOC (loss of consciousness), PTA (post traumatic amnesia), Post Traumatic Seizure, Focal Neurological Deficit and Craniofacial Soft Tissue Injury. Evaluating the relation between these risk factors and ICI findings in Brain CT Scan showed that five of these risk factors including Skull FX, Abnormal Mental Status, Focal Neurologic Deficit, presence of Skull FX in X-ray and Brain CT Scan has a significant relationship with ICI. The highest NPV, Sensitivity belonged to Abnormal Mental Status, and the highest PPV, Specificity belonged to Focal Neurologic Deficit and the clinical signs of Skull FX. Conclusions: In the end to determine the indications of CT scan, presence of one of these five risk factors is important including: Abnormal Mental Status, Clinical signs of Skull FX, history of vomiting, Craniofacial Soft Tissue Injury (including Subgaleal Hematomas or Laceration)

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M009

TRAUMA INDUCED PNEUMORRHACHIS IN A JOCKEY

L. Juarbe Rivera 1, J. Mercado, J. Falc贸n

1

University Of Puerto Rico Medical Science Campus, San Juan, Puerto Rico, Carolina, Puerto Rico

2

Hospital Upr Dr. Federico Trilla,

Background: Pneumorrhachis, or air within the spinal canal, is a very rare occurrence (5). This term was first coined by Newbold et. al, to describe a case in which air in the subarachnoid space at the cervical level was observed leading to spinal cord compression (8, 17). It has been noted that complex midface fractures, such as Le Fort II have a greater association with increased mortality and more serious intracranial injury than simple midface fractures, even in the absence of altered consciousness (2). However, cervical Pneumorrhachis secondary to skull fracture, maxillofacial fractures and severe intracranial injuries in association with pneumocephalus is still an uncommon event. The purpose of this case report and literature review is to assess how patients sustaining complex midface fractures were more likely to die and/or develop unexpected intracranial injuries, such as pneumorrachis.

Methods: Case Report.

Results: A 34year old male presented to the emergency room after suffering a fall from a horse. Upon arrival, the patient was conscious with a Glasgow Coma Scale of 12/15. After the successful intubation, his right eye reveal pupillary anisocoria. The patient was transferred to a Level 1 Trauma Center (Centro Medico) for immediate evaluation by Neurosurgery. A CT scan of the face revealed bilateral nasal bone fractures, right LeFort type II-like fractures with nondisplaced fractures of the right anterior and posterior maxillary walls, pterygoid processes, orbital floor, infraorbital foramen and foramen rotundum. The head CT scan showed diffuse brain edema and subarachnoid hemorrhage, bilateral panhemispheric subdural hematoma, intraventricular hemorrhage, as well as pneumocephalus resulting in left to right midline shift. Finally the Cervical CT scan showed upper lung Contusion, displaced fractures of the clivus and pneumorrachis with epidural hematoma.

Conclusions: Early imaging and close monitoring of these patients could expedite recognition of evolving expected and unexpected intracranial injuries.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M010

HYOID BONE FRACTURE DUE TO MOTOR VEHICLE ACCIDENT

D. Devrimsel Dogan 1, B. Nakis 2, M. Dogan 3, E. Unal Akoglu 4, O. Ecmel Onur 5

1

Fatih Sultan Mehmet Education and Research Hospital- Department of Emergency Medicine, Istanbul, Turkey

Background: Hyoid bone fractures are rare and can be difficult to diagnose. They are mainly caused by strangulation, asphyxiation injuries, trauma to the neck and motor vehicle accidents. Clinical manifestations differ from subcutaneous edema, neck pain, dysphonia, dysphagia to dyspnea, hemoptysis, and respiratory distress.

Diagnosis is made with strong suspicion of history and physical examination supported by radiographic images.

The treatment depends on the presenting symptoms and generally these fractures don't require surgical intervention. In this case, we report a 36 year-old woman presented to emergency department describing head trauma after motor vehicle accident. Vital signs were stable and physical examination revealed hematoma and skin laceration on her front. Neurological, musculoskeletal and systemic evaluation detected no additional physical findings. <FILE IMAGE='205_20150531000854.JPG'> Methods: Radiographic imaging was performed. CT images demonstrated fracture of the great horn of the hyoid bone. The patient underwent nasopharyngoscopy demonstrating normal endolarynx without laceration, swelling or hematoma.

Results: After 24 hours of asymptomatic observation, the patient was discharged with recommendation of outpatient control.

Conclusions: Airway obstruction can occur immediately after laryngotracheal fractures as well as delayed onset. Awareness of this potentially lethal conclusion, emergency physician should pay attention subtle clinical and physical findings of this fracture and keep in mind as a differential diagnosis.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma M011 DEVELOPMENT OF TRAUMA SYSTEM IN THE REGION N. Boma 1 1

Al Rahba Hospital, Abu Dhabi, United Arab Emirates

Background: Trauma is the 3rd leading cause of death in 2008 & 2nd leading cause in 2010 in UAE and this has a tremendous impact on the lives of the residents of the country. The magnitude of traumatic injury as a public health problem is enormous. To further the concept, thru initiative of Al Rahba Hospital (ARH) team, organized a first ever meeting of representatives of the major healthcare facilities in Abu Dhabi with purpose of creating a working group to further the vision of a trauma system for the Emirate. In furtherance to this, the first ever Abu Dhabi Trauma System Initiative (ADTSI) Working Group was born at ARH to device an effective trauma system through systematic trauma system transformation using innovative quality tools of 6-sigma.

Why trauma care?

The ultimate evaluation outcome of trauma system implementation is a reduction in morbidity and mortality.

This goal can be accomplished through trauma-system/trauma-center planning and implementation of process-of-care-improvement, enhancement-of-system-performance, use of evidence-based-research, development/implementation of targeted injury prevention programs/revisions to trauma-system plans based-on system assessments/data-based needs. <FILE IMAGE='30_20150506134321.jpg'> Methods: Diverse/wise multidisciplinary-team including physicians/nurses/acting trauma manager to improve trauma care/to organize/set-up the trauma program of the hospital Consultative-survey by the American College of Surgeon for level-II Trauma Center in the Middle East (Dr. Donald Trunkey & Stephen Smith), with the following recommendations: Results: Full-time Trauma Program Manager (appointed in January-2010) Initiated Abu-Dhabi-Central-Trauma-Registry Established/refined a robust Performance Improvement & Patient Safety (PIPS) Program: 2010 Simplify the trauma team activation: 2010 Obtain modern-CT: 2011 Obtained MRI-availability Initiated the creation of an advisory board in the establishment of ADTSI Conclusions: Established 11-trauma-KPIs for ARH using PIPS-Algorithm Establishment of Trauma-Registry being on-going since 2010. Influenced the creation of Abu Dhabi Central-Trauma-Registry on January 2014; including 8 other facilities in the network Consider a Trauma-System-Consultationâ&#x20AC;&#x201C;Play the vital role in the establishment of the Abu Dhabi Trauma System Initiative (Trauma Advisory Committee through HAAD) Established an outreach & education program - partially achieved through community outreach projects under nursing Opening of MRI at ARHâ&#x20AC;&#x201C;2012

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M012

ACCURACY OF EMERGENCY TRANSFUSION SCORE (ETS) IN PREDICTION NEED FOR BLOOD TRANSFUSION AMONG MULTIPLE TRAUMA PATIENTS

F. Bidari Zerehpoosh 1, H. Alimohammadi 2

1

Shahid Beheshti University Of Medical Sciences, Department Of Pathology, Tehran, Iran, University Of Medical Sciences, Department Of Emergency Medicine, Tehran, Iran

2

Shahid Beheshti

Background: Prediction of need blood transfusion in trauma patients has always been presented as a serious and chalenging problem in most of trauma centers. Since providing each blood unit imposes a high cost on the health care system and these products have a limited time for consumption, the aim of this study was assessing the accuracy of Emergency Transfusion Score (ETS) in detecting real patients need blood transfusion Methods: In this cross-sectional study profiles of all trauma patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from March to August 2014, were assessed to determining the accuracy of ETS scoring.

Each patient was assessed based on variables such as age, trauma mechanism, systolic blood pressure, unstable pelvic ring, and presence of free fluid in ultrasonography. ETS mean of all patients was analyzed and a comparison done between ETS mean and blood transfusion.

Results: 793 patients were entered to the study of whom 54 (6%) ones received blood (84% male). The mean of ETS score for all patients was 3.91Âą0.93. There was a significant correlation between ETS scores more than 3 and amount of blood receiving (p=0.004). Sensitivity, specificity, positive and negative predictive value of this method were 98.1%, 13.8%, 7.7%, 99%, respectively. The area under the curve was 0.84 Conclusions: Based on the present findings, ETS can be considered as an appropriate tool for prioritize of trauma patients need blood transfusion. Therefore, by applying this scoring scale, it can be prevented from inappropriate requests for blood transfusion and following high costs imposed on health care system

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M013

BILATERAL ACUTE ON CHRONIC SUBDURAL HEMATOMA: CASE REPORT

A. Aydin 1, E. Ars 2, C. Aktas 3, D. Tas 4

1

Koc University Hospital, Istanbul, Turkey, 2 Koc University Hospital, Istanbul, Turkey, 3 Koc University Hospital, Istanbul, Turkey, 4 Haseki Training And Research Hospital, Istanbul, Turkey Background: Subdural hemorrhage is a collection of blood accumulating in the potential space between the dura and arachnoid mater of the meninges around the brain (1). Subdural hemorrhage has 4 phases including hyperacute, acute, subacute and chronic.

Methods: An 85-year-old man presented to the emergency room with progressive cognitive impairment and difficulty walking. He had been well until 4 weeks earlier, when he suffered a fall with minor head trauma. In the following weeks, he experienced mild headache, additional falls, and again suffering minor head trauma. He has been using Metformin 3x1000mg and Coraspin 1x100mg on routine base. On admission, his Glascow Coma Scale (GCS) was 13(E3M6V4), physical examination revealed severe lethargy, mental slowness and he had spontaneous movements on four extremities; and he had no papilledema. Vital parameters and blood chemistry, hematology and coagulation laboratory data were normal. Cranial CT (Fig.1) showed bilateral extraaxial crescent shaped hypodens fluid collections at bilateral frontoparietal region, compatible with bilateral chronic subdural hematoma and each collection had hyperdense liquid-liquid levels compatible with bilateral acute subdural hematoma.

The patient admitted to the neurosurgery department for operative care. He was treated with burr hole evacuation of his subdural hematomas under general anesthesia with post-operative closed suction drainage for 24 hours (Fig. 2). He had an uncomplicated recovery to a normal state by the time of his discharge. <FILE IMAGE='267_20150605141733.jpg'> Results: According to the CT characteristics, this patient was suffering from bilateral subdural hematomas of different ages. A bilateral presence is infrequent and has been described in cases of head trauma, ruptured cerebral artery aneurysm, cerebral neoplasms, lumbar puncture, spinal anesthesia, lumbar discectomy, anticoagulant therapy, coagulopathy and thrombocytopenia, among others (2, 3). Recurrent trauma at different times explains the coexistence of both acute and chronic hemorrhages.

Acute on chronic SDH refer to a second episode of acute hemorrhage into pre-existing chronic subdural hematoma (4). CT remains the preferred diagnostic procedure for SDH (5).

Conclusions: Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M014

FACTORS AFFECTING AT 30 DAYS MORTALITY AFTER ADMISSION IN SEVERE TRAUMA PATIENTS WITH INITIAL HYPOTENSION IN THE EMERGENCY DEPARTMENT: A SINGLE CENTER STUDY

W. Sung 1, Y. Moon 2

1

Emergency Medicine, College Of Medicine, Eulji University, Daejeon, South Korea, 2 Trauma Surgery, College Of Medicine, Eulji University, Daejeon, South Korea Background: Early assessment of injury severity is important in the management of major trauma patients.

Generally, hypotensive major trauma patients show more severe outcomes from injuries compared with the normotensive major trauma patients. In this study, we analyzed the clinical features of the severe trauma patients with initial hypotension and made an effort to determine the prognostic factors of mortality in these patients.

Methods: A retrospective study was performed within our Hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS >15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure that was lower than 90 mmHg were included (N = 77). The patients were divided into two groups â&#x20AC;&#x201C; those who survived and those who expired â&#x20AC;&#x201C; and the differences in initial and final values were compared between the two groups.

Results: Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate, gender ratio, and previous hypertension prevalence between the two groups. There were no significant differences in the ratio of presence of head injury and presence of surgical and vascular interventions between the groups (p=0.606, p=0.614). The expired group showed low Glasgow Coma Scale (GCS), systolic blood pressure, revised trauma score, initial pH, and follow-up pH, compared with the survived group. The expired group also showed higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. The multivariate logistic analysis showed that age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57) and follow-up base excess (p=0.041, OR 0.799) are independently associated with mortality.

Conclusions: The patient`s age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the major trauma patients with initial hypotension in the emergency department. <FILE IMAGE='11_20150313022205.jpg'>

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M015

COPEPTIN AS POTENTIAL MARKER IN HEAD TRAUMA PATIENTS.

I. Zanotti 1, F. Settanni 2, G.C. Avanzi 1, M.L. Castello 1

1

Department Of Traslational Medicine, Eastern Piedmont University, Novara, Italy, Endocrinology, University Hospital, Torino, Italy

2

Department Of

Background: Copeptin is the C-terminal domain of the Arginin-Vasopressin (AVP) precursor peptide.In murine experimental traumatic brain injury (TBI), the inhibition of AVP V2 receptors reduced intracranial pressure, post-traumatic brain edema, brain damage and functional deficits suggesting that AVP/AVPReceptor axis plays a role in the pathophysiological process of brain injury.Plasma concentration of Copeptin have been demonstrated to correlate with AVP plasma levels. In severe TBI adult patients, high levels of plasma Copeptin have been shown to be independent predictors of mortality, injury severity, and functional outcome. Similar results have been shown in pediatric population, however no data exist on Copeptin levels in moderate and minor head trauma.

Methods: This is a single-center, prospective study conducted in ER. Inclusion criteria have been: after minor TBI (Glasgow Coma Score GCS 14-15) trauma timing up to eight hours, age >18 Y, exclusion criteria have been: concomitant thoraco-abdominal trauma, TBI or cerebrovascular events in the previous three months. Each patient underwent to medical history, clinical examination, blood tests at admission including plasma copeptin, sodium concentration and osmolality, brain CT scanin-hospital neurological observation. The outcome was also evaluated one month after the TBI through structured telephone interview.

Results: 105 patients have been enrolled. Neurological deficit at admission and elevated serum sodium demonstrated a significant association to worse outcome. Post traumatic damage CT scan evidences at admission, but not at 24 hours, are significantly associated with worse outcome. Copeptin levels do not seem to correlate with the dynamics or energy of trauma, with nausea, vomiting or other symptoms, and was not associated with increased levels of sodium, glucose, or leukocytes Conclusions: Our results seems associate high level of Copeptin with minor adverse events (headache, nausea, vomiting, syncope, dizziness and post-concussive syndrome) at follow-up, while, surprisingly, lower Copeptin plasma levels are associated with more serious events (death, hospitalization, neurosurgery) at 30 days

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M016

EVALUATION OF DIAPHRAGMATIC INJURY DUE TO PENETRATING ABDOMINAL INJURY

S. Kaymak 1, A.K. Coskun 1, M. Yilmaz 1, R. Senocak 1, E. Lapsekili 1

1

Gmma Department of General Surgery, Ankara, Turkey

Background: Diaphragmatic injuries are rarely seen and may result from blunt or penetrating trauma and injuries. We wanted to evaluate the diaphragmatic injury accompanying the penetrating abdominal injuries in this study. <FILE IMAGE='331_20150629000712.png'> Methods: Clinical records of patient who were treated in General Surgery Department because of having diaphragmatic hernia accompanying penetrating abdominal hernia in last three years.

Results: There were total 14 patients, one of whom was female. In 12 patients injury was consisted with high velocity weapons while only 2 had low velocity weaponsâ&#x20AC;&#x2122; injury. All patients had multiple injuries.8 patients had right and others had left diaphragmatic injury. 9 of patients had injured with penetrating effect while others were by blast effect. The most injured organs were liver, colon, spleen, lung, stomach, kidney, intestine and pancreas respectively(Table 1).

25 % of cases had postoperative complications including anastomotic leakage, bleeding, abscesses and infections. Mortality was not seen in any of cases.

Conclusions: Diaphragmatic injuries accompanying penetrating abdominal traumas are not common. But bullet or shrapnel wounds in upper abdomen can cause diaphragmatic injuries with direct effect or blast effect either. It must kept in mind that such of these injuries might lead unexpected complications.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M017

TRAUMATIC AORTIC DISSECTION TWO CASES

Y. Emre Arik 1, G. Pamukcu Gunaydin 1, E. Karaoglu 2, F. Icme 1, S. Gokhan 2

1

Ataturk Training and Research Hoispital, Ankara, Turkey, Turkey

2

Yildirim Bayezit University Medical School, Ankara,

Background: Aortic injuries are uncommon complications after chest trauma and can be easily missed in polytrauma patients due to either associated injuries or vagueness of physical examination findings. Especially in young adults without associated injuries, relatively low atherosclerotic changes may limit the dissection of traumatic aortic dissections. We present two cases of De Bakey type 3 traumatic aortic dissections. <FILE IMAGE='364_20150630220017.jpg'> Methods: 38 years old woman presented to emergency department after a car accident. She had asthma in her medical history. Her vital signs were; blood pressure 90/60 mmHg, heart rate: 110/min, respiratuar rate 22/min, Sp02:% 90. On her physical exam she had corneal injury on his left eye and chest pain on the left side of thorax.

Her laboratory findings were; white blood cell count: 11.100 K/ul, hemoglobin: 8 g/dl, platellets: 154.000 K/ul, urea: 42mg/dl creatinine: 0,61mg/dl, AST: 68 U/L, ALT: 41 U/L, INR: 1.12. Her computed tomography imaging revealed pneumothrax on left hemithorax and type 3 aortic dissection. Tube thoracostomy was performed and she was transferred to cardiovascular surgery intensive care unit for thoracic endovascular aortic repair. She was completely recovered and discharged.

19 years old man presented to emergency department after a car accident. He did not have any disorders in his medical history. His vital signs were; blood pressure 100/50 mmHg, heart rate: 105/min respiratuar rate: 20/min, Sp02:%94. On his physical exam he had hematoma on his right clavicula and subcutane emphsema on his neck. His laboratory findings were white blood cell count: 21.900K/ul, hemoglobin: 15, 2 g/dl, platelets: 249.000, urea: 22mg/dl, creatinine: 1,21mg/dl, AST: 148U/L, ALT: 80U/L, INR: 1.18. His thorax computed tomography revealed type 3 aortic dissection. He also had pneumothorax at right hemithorax. Tube thoracostomy was performed. Patient was transferred to cardiovascular surgery intensive care unit for thoracic endovasculer aortic repair. His follow-up continues in our intensive care unit.

Results: Conclusions: Traumatic aortic dissection is a rare presentation and life threatening situation after chest trauma.

Physical examination findings of traumatic aortic dissection may be subtle in polytraumatized patients. Patients cannot describe their symptoms because of additional injuries. Emergency physician should suspect traumatic aortic dissection in multiple trauma patients with thoracal injury.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M018

INJURY AND ILLNESS AMONG ATHLETES DURING AN EIGHT-DAY ELITE CYCLING ROAD RACE. MEDICAL REPORT OF 51 ST THE PRESIDENTIAL CYCLING TOUR OF TURKEY.

S. Yanturali 1, O. Canacik 2, E. Karsli 3, S. Suner 4

1

Dokuz Eylul University, Izmir, Turkey, 2 Dokuz Eylul Uiniversity, Izmir, Turkey, Turkey, 4 Brown University, Providence, Usa

3

Dokuz Eylul University, Izmir,

Background: Although road bicycle races are held is longer than a century, literature has more focused on mountain bike and off-road races. The Presidential Cycling Tour of Turkey (TUR) is a multi-day, bicycle road race. The purpose of this study is to present the injury, illness patterns among athletes and the management provided. <FILE IMAGE='293_20150701151830.JPG'> Methods: Study Setting This study was conducted between April 26 and May 3, 2015, during the TUR which covered 1258 km with 166 athletes representing 21 teams. The medical team consisted of physicians, paramedics with 2 cars, 3 motorcycles and 4 ambulances which travelled with the group of riders. Medical care was provided before and after the race at the start and finish lines, during the race from moving vehicles and on the scene of crashes.

Data Collection Data included on the forms were: if the encounter involved an injury or illness; type of injury; anatomical location of injury; details regarding the medical encounter; location of intervention; treatment provided; medication and supplies used, and disposition of the patient. All medical encounters were included.

Results: Injuries, illness and associated details are presented in table 1, 2, 3. The most commonly injured body regions were limbs. Medical care was given to two riders (6%) at the start area, a total of 28 riders (85%) during the race and to 3 rides (9%) in the finish area. The number of interventions through the window of the physicianâ&#x20AC;&#x2122;s vehicle was 22 (66%) while the number of interventions at the side of the racetrack where a rider had stopped owing to a fall or crash was 6 (19%). The most common medical intervention during the race was wound care with 38 incidents (64% of all interventions). In most cases these injuries were due to sliding after falls, resulting in typical wounds often referred to as road rash.

Conclusions: Requirement for hospital transfer and athlete withdrawal from a bicycle road race is rare.

Serious trauma can occur and a health team with the appropriate equipment must be present to handle such events.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M019

THORACIC STAB INJURIES IN EMERGENCY DEPARTMENT: A 2-YEAR REVIEW

M. Unaldi 1, H. Eryigit 2, K. Aciksari 1, B. Yildirim 3, O. Sogut 4, M. Yigit 4

1

Medeniyet University Goztepe Training And Research Hospital-Emergency Department, Istanbul, Turkey, 2 Kartal Training And Research-Department Of Thorax Surgery, Istanbul, Turkey, 3 Mugla Sitki Kocman University Hospital-Emergency Department, Mugla, Turkey, 4 Bezmialem University School Of Medicine-Emergency Department, Istanbul, Turkey Background: The chest trauma ranks third in all the trauma. Although blunt trauma in thoracic injuries is with a higher rate, penetrating stab wounds are at very high rates in emergency department. In this study, we aimed to review chest stab injuries in ED (Emergency Department) a two-year process and to draw attention to the social significance.

Methods: A total of 45 (forty-five) cases with stab wounds penetrating the chest who present to emergency department were evaluated in terms of age, sex, clinical and radiologic findings and therapeutic approaches reviewing patient records between February 2012-March 2014.

Results: Cases were 16-59 years old, mean age was 30, 29. Forty-one were male, four were female. The incision length in thorax ranged from 1-10 centimeter and the mean was 2,62. There were on left (32), right (11) and bilateral (2). 20 of injuries penetrating thorax were in 5th intercostal gap, 9 of them were in 4th intercostal gap. Anterior axillary (n=15), medium axillary (n=10), midscapular (n=7) were the most frequently injured region.

There were hemopneumothorax (21), pneumothorax (13) and hemothorax (11). Tube thoracostomy (35), conservative approach (10), thoracotomy (2) were treatment methods.

Conclusions: Thoracic injuries should be quickly treated because it contains organ injuries, which is of vital importance and impaired cardiopulmonary system dynamics should be corrected urgently. Thorax injuries are never isolated and therefore the other system injuries should be revised absolutely. As in all thorax injury cases, to ensure rapid transport to emergency department and proper treatment with early diagnosis will contribute in reducing the rate of mortality and morbidity.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M020

CORRELATION OF INJURY SEVERITY ACCORDING TO TRAUMA SCORING WITH SURVIVAL, IN TRAUMA PATIENTS REFERRED IN ONE YEAR BY AIR MEDICAL TRANSPORT TO SHOHADAYE-7 TIR HOSPITAL

N. Tavakoli 1, A. Asri 2, M. Mehrazi 3, M. Hosseini 4

1

Iran University Of Medical Science, Tehran, Iran, 2 Iran University Of Medical Science, Tehran, Iran, University Of Medical Science, Tehran, Iran, 4 Iran University Of Medical Science, Tehran, Iran

3

Iran

Background: The following study has performed to evaluation the injury severity of trauma patients according to trauma scoring (ISS, RTS, GCS).

Methods: The study is a longitudinal retrospective one performed on samples of patient referred to shohadaye 7_tir hospital in one year.

Data of all patients presented to the emergency ward were collected based on mechanism of injury, GCS, RTS, ISS & other criteria in the questionnaire.

The patients were followed till the time of discharge or death. Description of surgical procedures &other treatments are also mentioned in the questionnaire to determined ISS. Results: 60 patients were evaluated in the study. Mechanism of injury was mostly (93%) related to transportation.

Among all the patients & (13.3%) died. 93.3% of these patients were injured due to car accident. (p< 0.001) There was a significant associate between ISS, GCS & patients death in logistic regression.

Conclusions: Findings of this study showed that ISS &GCS factors evaluating injury of severity, can predict death in trauma patients. However it seems that GCS is more accurate for prediction of death than factors.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M021

THE EFFECT OF POST-TREATMENT OF FLUVASTATIN IN HEMORRHAGIC SHOCK IN RATS

H. Kwon 1, K.H. Lee 1, O.H. Kim 1, K.C. Cha 1, Y.S. Cha 1, H. Kim 1, S.O. Hwang 1

1

Department Of Emergency Medicine, Wonju College Of Medicine, Yonsei University, Wonju, South Korea

Background: A novel lipid-independent mechanism of action for statins, which is unrelated to their inhibitory potential on HMG-CoA reductase, has been defined very recently by showing that statins may exert an anti-inflammatory effect. . The aim of our study was to investigate the clinicopathologic and immunologic effect of post-treatment of fluvastatin in cases of hemorrhagic shock in rat model.

Methods: The experimental rats were randomly divided into 4 groups; (1) The control group didnâ&#x20AC;&#x2122;t receive any drug without hemorrhagic shock (HS). (2) The control + statin group received fluvastatin 1mg/kg without HS. (3) The HS group received normal saline after HS. (4) The HS + statin group received fluvastatin 1mg/kg + normal saline after HS. HS was produced by bleeding from a femoral arterial catheter to remove 30% of total blood volume. The mean arterial pressure and heart rate were monitored for 2 h after the start of blood withdrawal.

Arterial blood gas and complete blood count were measured at baseline, 2hrs after administration of shock, and 48hrs after post-resuscitation. And also cytokines as interleukin (IL)-1b, IL-6, IL-10, IL-12p70, Interferon-gamma, and Tumor necrosis factor-alpha were measured. Kidney, lung and small intestine were removed for pathology examination at 48 h after HS Results: HS group and HS + statins group reduced bicarbonate, base excess, and platelet count, all of which differed significantly from values in control group and control + statin groups at the end of the resuscitation period. HS + statin group significantly elevated the serum IL-10 at 2hr after resuscitation compared with the other group (*p<0.05). But in the cytokine profile except IL-10, the group-time interaction was not significant. <FILE IMAGE='312_20150624033655.jpg'> Conclusions: This study showed that post-treatment with fluvastatin increased the anti-inflammatory cytokines as IL-10 production. In post-treatment of fluvastatin, it still affect the cytokine profiling after hemorrhagic shock in rat.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M022

OUTCOME AND SIDE-EFFECTS OF ROAD TRAFFIC INJURIES IN HOSPITALIZED PATIENTS

H. Hatamabadi 1, M. Amini 2

1

Safety Promotion and Injury Prevention Research Center, Tehran, Iran, Medical Sciences, Tehran, Iran

2

Shahid Beheshti University Of

Background: The present study aims to retrospectively evaluate the outcome and side effects of road traffic incidents (RTI) in those who were injured and hospitalized due to a traffic accident. The results of this study will help determine the outcome and effects of RTI based on type of accident, age, sex, and other underlying and clinical factors.

Methods: The present study is a retrospective cohort one, with a one-year follow-up. Data were extracted from the profiles of the hospitalized patients who were injured in RTI and had an accident with at least 1 vehicle.

Outcome of the patients was evaluated at the time of discharge including their living state (dead or alive), presence of a disability or complete recovery; and 1-year later to divide them into 2 groups based on desirable (full recovery, mild or moderate disability) and undesirable outcome (severe disability, vegetative state, death).

Results: 1735 patients were studied with the mean age of 32.8 Âą17.0 (82.8% male). 312 (18.0%) were discharged with full recovery, while 571 (32.9%) had mild disability, 684 (39.4%) had moderate disability, and 85 (4.9%) had severe disability at the time of discharge. In the end, 53 (3.05%) died. In the 1-year follow-up 1165 (69.3%) patients had fully recovered, 194 (11.5%) had mild disability, 43 (2.6%) had moderate disability, 9 (0.5%) had severe disability, and 7 (0.4%) were in a vegetative state. Presence of an underlying disease (p = 0.03), loss of consciousness for more than 24 hours (p = 0.04), spinal injury (p = 0.002), presence of multiple trauma (p = 0.01), increased ISS (p < 0.001), need for ventilator (p < 0.001), and organ injuries during hospitalization (p < 0.001) are independent factors that increase the risk of poor outcome in RTI patients.

Conclusions: The results of the present study showed that most of those injured in RTI are male (82.8%) and young; moreover motorcycle accidents were the most important cause of RTI injury. In the end, 3.05% of the patients died.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M023

MAD COW DISEASE

O. Cristiu 1, N. O'connor

1

Our Lady of Lourdes Hospital, Drogheda, Ireland

Background: Farming in Ireland is one important part of economy and culture. Increasing age is also one of the risk factors for severe outcomes for trauma patients.

Methods: We present 4 cases of severe trauma patients after cow and bull contacts in the rural areas. Two patients had died because of the injuries.

Case 1: 64 F transferred by ambulance after being attached by a cow in a rural area, injuries sustained: right hemothorax with flail chest and left pneumothorax 5 rib fractures, died delayed cardiac tamponade Case 2: 54 M transferred by ambulance after being attached by a cow injuries sustained: complex facial fractures and soft tissue injury of face diffuse bleeding from area, subdural right midline shift died from massive head injury case 3 : 65 M transferred by ambulance after attached by bull injuries sustained flail chest on the right pulmonary contusion total admission time 65 days Case 4: 23 M transferred by ambulance after attached by bull injuries sustained fracture right acetabulum and right femur total admission time 22 days Results: In our Emergency Department over the months of May and June we have seen 10 farming injuries after contact with animals. This represent an increased compared to the previous years. The outcome of the patients was complicated by age and location of the patient.

Conclusions: Farming injuries after contact with animals are not frequently presented in the literature but they are one of the frequent presentation to the Emergency Department in our area.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Trauma

M024

STUDY THE CURRENT STATE OF THE SEATBELT AND AIRBAG TRAUMA

Y. Ooya 1, A. Nakano 1, S. Sugita 1, D. Furuya 1, M. Nemoto 1

1

Saitama Medical University International Medical Center, Hidaka, Japan

Background: Seatbelt and airbag systems are safety devices used while operating a motor vehicle. Many countries have lows requiring the use of seatbelts and airbags are standard equipment in many cars. Seatbelt and airbag systems are effective, but many people received trauma from using seatbelt and/or airbags. We studied the injuries which are considered to be due to the seatbelt and/or airbags in a car accidents.

Methods: This is retrospective study. Patients who came to our hospital as a result of cars accidents in January-December 2014 were investigated. We defined seatbelt injury and airbag injury as an injury where the patient was using a seatbelt and/or where an airbag was activated at the time of an accident, seemingly resulting in trauma due to impact of the seatbelt and/or airbag.

Results: Total patients were 135. Using seatbelt were 87, not using seatbelts were 29, unknown were 19. At the time of the accident, activated airbags were 63, not activated airbag were 51, unknown were 21. Hospitalization rate and seatbelt usage and/or airbag activation did not correlate. In using the seatbelt group, activated airbag were 53, and 21(40%) patients received injuries to their chest and/or abdomen.

Conclusions: This study shows that in the using seatbelts and activated airbag group, 40% of patients received got injuries to in their chest and/or abdomen. Seatbelts and airbag systems are safety device used in motor vehicle, but they are not perfect. Sometimes injuries are caused by them. We recommend to take caution at when operating a motor vehicle. As well, we need to make improvements to safety devices and develop new safety systems.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Burn Care

M025

EXAMINING DISASTER PLANNING MODELS FOR LARGE SCALE BURN INCIDENTS â&#x20AC;&#x201C; CAN WE BE BETTER PREPARED?

O. Weissman Haik 1, 3

1, 3,

H. Israeli 1, H. Rosengar 1, G. Shenhar 2, N. Farber 1, D. Stavrou 1, E. Winkler 1, S. Stahl 1, J.

1

1. Department Of Plastic And Reconstructive Surgery And The Burn Unit, Sheba Medical Center, Tel Hashomer, Israel, Ramat Gan, Israel, 2 2. Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute For Epidemiology And Health Poli, Tel Aviv, Israel, 3 3. The Talpiot Medical Leadership Program, Sheba Medical Center, Hashomer, Israel. Ramat Gan, Israel Background: Introduction: The escalation of global terrorist attacks has resulted in a rise of traumatic injuries. Planning for mass casualty incidents (MCI) is critical to decrease the morbidity and mortality that ensues after large-scale terrorist attacks.

This study provides criteria for the management of burn victims following large-scale disasters.

Methods: Methods: Mass casualty outcomes from three disasters involving commercial aircraft crashes were analyzed. The three events included the El-Al cargo Aircraft crash near the Amsterdam Schiphol Airport in 1992, the World Trade Center attacks in New York and the attack against the Pentagon in Washington, D.C. on 9/11/01.

Results: Results: Using the data obtained from these events, the severity of injuries in patients were determined. The result is a general template that may be customized with locally or regionally specific data, in order to evaluate the preparedness of a specific burn alignment for such a scenario.

Conclusions: Conclusion: Recommendations based on the analysis of previous MCI's were put forth. Based on the needs recognized during these past events, suggestions were made to enhance the preparedness of burn units, hospitals and national agencies as well as municipal authorities.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Burn Care

M026

EXPERIENCES OF EMERGENCY NURSES IN THE BURN HOSPITAL

F. Azizi 1, S. Shahed 1, M. Ayaz 2

1

Non Faculty Member of Nursing $ Midwifery Shiraz University, Shiraz, Iran, 2 Non Faculty Member of Nursing $ Midwifery Shiraz University, Shiraz, Iran, 3 Faculty Member of Medicine Shiraz University, Shiraz, Iran Background: Nurses are known as the first therapy and caring line of patient’s evaluation in the emergency ward. Specific and critical condition of burned patients, issue related events, parent and relative concerns are the factors affecting the primary care of patients by nurses. This study was done to explain the “experiences of emergency nurses in the burn hospital”.

Methods: This study is a qualitative research with phenomenological approach. Experiences of 14 Nurse in emergency ward analysis was done by deep unstructured interviews. Sampling was carried out on a purpose – based approach and was continued until saturation of the data occurred. Data analysis was conducted by qualitative content analysis method “ colaizzi”.

Results: Findings show four themes for this study: stress, caregiver communicational challenges, work load and education.

Conclusions: According to the results factors which increase nurse’s stress are: exposure to the variety of critical and emergency patient’s situations, patient’s heartbreaking appearance and humanitarian arousal.

Relatives fear and anxiety about burn consequences often makes them to behave violently to nurses and sometimes avoid communication. The denial of Self-immolation or burned by close relatives is one of the challenges that stop the communication and offering the correct information to the nurse in the initial evaluation of the patients. High work load is another experience of physical and mental stress in these nurses. Need for training of professional staff working in emergency care was expressed by them, especially about burn degree diagnosis in the correct and quick way and its treatments in doctors and nurses. Supervisors’ knowledge of nurse’s experiences for challenge solving is effective in order to improve nursing care quality and nursing health promoting.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Burn Care

M027

LET'S SNIFF SOME DEODORANT

O. Cristiu 1, N. O'connor

1

Our Lady of Lourdes Hospital, Drogheda, Ireland

Background: Inhalation of volatile agents is becoming popular once more as a form of recreational drug abuse.

These substances are well recognized as causing elevated mood and hallucinogenic effects.

Methods: We received a pre-hospital alert from the Ambulance Control Unit of a house explosion. We received 4 teenagers aged 13-14 years, all of whom had burns and were in a critical but stable condition. They had been inhaling deodorants when one lit a cigarette and there was an explosion which partially blew out a wall. Twenty five cans of deodorant were found in the room.

Results: All 4 patients had 35-45% burns with 20-25% being full thickness. They were managed as per ATLS guidelines for suspected blast injuries as well as burns. One patient with airway and facial burns was intubated in the Emergency Department. One required a CT of the abdomen which was normal. They were all transferred to the Regional Burn Unit. All were hospitalized for 2 months.

Conclusions: Sniffing deodorant is becoming more popular between the teenagers. These agents are cheap and freely available. In the presence of a naked flame, this practice can potentially lead to serious injuries and a prolonged hospitalization period.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M028

ILLICIT DRUG ABUSE IN DRIVERS OF MOTOR VEHICLE COLLISIONS

M. Kalantari Meibodi 1, S. Esfandiari 1, S. Roosta 1, H. Sarikhani 1

1

Shiraz University Of Medical Science, Shiraz, Iran

Background: Motor vehicle Traffic injuries are indeed one of the most important worldwide health problems.

Opioids can induce a depressant effect on the central nervous system which may increase the risk of traffic accidents. This cross-sectional case-control study was conducted in Marvdasht, Iran to investigate the presence of drugs in hospitalized non-fatally injured drivers of motor vehicles.

Methods: The cases were 500 drivers of motor vehicle, injured in the road traffic accident and referred to the emergency ward. The controls were 500 patients hospitalized in the same emergency department due to non-traumatic reasons. They were asked about the abuse of any substance during the 72 hours before their referral to the hospital. Urinary samples of patients with negative history of drug consumption were analyzed.

This study was approved by ethics committee of Trauma Research Center of Shiraz University of Medical Sciences. The informed consent was taken from the patients. They volunteered to participate in the study and were ensured that the information will remain confidential. A code was considered for each person. Data were analyzed using SPSS software for Windows (SPSS Inc., Chicago, III., USA).

Results: From the drivers, 237 (47.4%) of the case group and 278 (55.6%) of the control group had positive-substance consumption. Opium was the common drug abused in the two groups. An eight fold increased risk of road accident was observed for drivers who had used tramadol (OR= 8.2, 95% CI 4.9-13.7, p<0.001). Two or more illicit drugs (poly drug abuse) were detected in 24% of the cases and 31.8% of the controls (50.6% and 57.2% of drug abusers, respectively). Just for tramadol, the prevalence was higher in cases than controls.

Conclusions: our results confirm that opium continues to be the most illicit drug frequently consumed in Iran and demonstrate the high proportion of illicit drug abuse in Iranian drivers. Also this study indicated that most of drug abusers were male and more than half of drug abuser drivers consumed more than one drug. More health education and policies are necessary to steadily decrease drug abuse in the community.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M029

RECOGNITION SYSTEM AND INDIVIDUAL IMPROVEMENT IN AN EMERGENCY DEPARMENT

L. Manclús Montoya 1, M. Cuenca Torres 1, B. Valenzuela Molina 1, J. Izquierdo Soriano 1, P. Garcia Bermejo 1, C. Trescoli Serrano 1, J. Ruiz López 1

1

Hospital Universitario La Ribera, Alzira, Spain

Background: The “Professional Career “is a management tool that allows medical staff to progress individually in their professional careers. Its objective is to recognize the individual professional development in achieving predefined objectives: Clinical Quality (CQ), Knowledge achievement (KA) and Organization Compromise (OC).

Methods: This is an observational, descriptive and retrospective study at the Emergency Department of the Hospital Universitario de la Ribera.

It described the total and specific achievements of the objectives of the professional career in 2013 Objectives: 1) Organization Compromise (OC) goals were communication skills, Emergency Medicine Knowledge, proficiency in the procedures and clinical guidelines in the clinical management, initiative and anticipation and, interpersonal relationships skills. 2) Knowledge achievement (KA)goals were: Continuous Medical Education (either external sources as the Hospital Universitario de la Ribera teaching programme) and Teaching and Research activity and; 3) Quality Care (QC) Objectives were: Patients Medical Treatment Perception/Satisfaction questionnaires, Hospital Quality improvement enterprises (Leadership and participation), achievement of a predefined hospital quality indicators according with the hospital annual management plan Results: 28 Medical Staff from the Emergency Department of the Hospital Universitario de la Ribera were studied 21,4 % were Clinicians, 53,6% were Experts and, 25% were Referents during 2013.

Total objective achievement were 61% (D.S= 17 %): QC,, 67 % ± 23,6%, KA, 67 ± 23,6% and in the OC, 55% ± 20% .

Personal relationship skills and Medical Emergency Knowledge had the highest score in the OC goals (Table 1) External Continuous Medical Education was the most used by the Emergency Department Medical Staff to improve their medical knowledge (Table 2) Emergency Medicine Knowledge and proficiency in the procedures and clinical guidelines iin clinical management achieved the highest score in the Clinical Quality Goals, 3 out of 4 medical staff who was in position to be promoted to a higher level did achieved it.

Conclusions: The continuous analysis of the professional career objective achievement allows us to detect weakness areas that could be improved and therefore, to achieve a greater objective achievement score.

Emergency Department, Hospital and patients will benefit of those improvements. <FILE IMAGE='24_20150522105432.png'>

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M030

SHOULD NURSING STAFF BE TRAINED IN ELECTROCARDIOGRAM INTERPRETATION?

M. Esquer Peris 1, M. Cuenca Torres 1, A. Revert Cogolllos 1, M. Romany Casany 1, L. ManclĂşs Montoya 1, P. Garcia Bermejo 1

1

Hospital Universitario La Ribera, Alzira, Spain

Background: The electrocardiogram is one of the non-invasive techniques, performed by the nurse to diagnose the cardiac pathology.

AIM: Assess the ER nursesâ&#x20AC;&#x2122;s knowledge of the electrocardiogram interpretation.

Methods: Study based on observation, description and prospection carried out with ER nurses at Hospital Universitario de la Ribera during the period ranging from the 15th February to the 15th April 2014.

A theoretical-practical questionary was put together, including 8 theoretical questions and 7 rhythm strips to interepret the electrocardiogram, which were given a value of one point per question.

Results: A poor degree of knowledge was observed after performing the aforementioned theoretical-practical questionary (being 8/15 the average correct answers) Conclusions: The nursery professional should not be considered responsible of a cardio pathology diagnosis however being a time-dependent pathology, the early- detection of any anomaly by this group may prioritize the proceedings aiming at applying the correct treatment in time, thus it is necessary to train this group in electrocardiogram interpretation.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M031

CERVICAL WHIPLASH-ASSOCIATED DEPARTMENTS

DISORDER

EVALUATION

PROTOCOL

FOR

EMERGENCY

L. ManclĂşs Montoya 1, M. Cuenca Torres 1, J. Tenias Burillo 2, S. Navarro Gutierrez 1, M. Tarraso Gomez 1, P. Garcia Bermejo 1, A. Lluch Sastriques 3

1

Hospital Universitario La Ribera, Alzira, Spain, 2 Escuela Valenciana De Estudios De La Salud (eves), Valencia, Spain, 3 Hospital Universitario Y PolitĂŠcnico La Fe, Valencia, Spain Background: Cervical whiplash-associated disorder (WAD) is commonly underestimated by Emergency Medicine (EM) physicians according to several studies. During 2014 a retrospective study was conducted at the EM Department in our center confirming a wide variability among physicians regarding diagnosis and treatment recommendations. After assessing initial results, we decided to update the initial approach to this disease and adapt the treatment and recommendations to the latest guidelines.

Methods: The study was conducted at the Hospital Universitario La Ribera, with the participation of different departments. Traumatology, Teaching and Research and EM personnel took part. A systematic search of clinical practice guidelines on care of patients with cervical whiplash was performed. We use the AGREE II training tools in order to assess the best quality guideline.

Results: Five clinical practice guidelines were found but only four of them met criteria to be included in the study: last update not exceeding five years, specifically targeting: cervical whiplash, and special enhancement on those guidelines that embraced diagnosis and treatment at Emergency Departments (EDs).

The four guidelines selected were assessed by the AGREE II training tool. The GPC TRACSA. (South Australian Centre for Trauma and Injury Recovery (TRACSA) Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders Australian Government, National Health and Medical Research Council Report number 2008) obtained the best score.

We use therefore that guide to design a protocol for ED. Conclusions: During April 2015 and after review by the different participating Departments, the protocol was finally implemented. Its effectiveness will be first evaluated in June 2015 with biennial reviews to be scheduled.

Protocol compliance will be defined by evaluation of defined quality criteria.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M032

THE TIME OF THE ESBL, IS ESCHERICHIA COLI SENSITIVITY TO FOSFOMYCIN IN URINARY TRACT INFECTIONS IN AN EMERGENCY DEPARTMENT

M. Cuenca 1, J. Colomina Rodriguez 1, J.L. Ruiz López 1, L. Manclús Montoya 1, J.C. Montalvá Barra 1, P. Garcia Bermejo 1, A. Guerrero Espejo

1

Hospital Universitario La Ribera, Alzira, Spain

Background: The empirical treatment of urinary tract infections must take into account the sensitivity of the bacteria that cause them.

Methods: This was a retrospective, ecological, descriptive, observational study performed in the Emergency department of La Ribera University Hospital (Hospital Universitario de la Ribera). We analyzed all the Escherichia coli positive cultures from the urine samples collected in our department during the year 2013.

Results: 848 urine cultures were positive for Escherichia coli. They were mainly from female patients (63.3%) with an average age of (60.17 ± 25.36) years. 6, 7% were children’s. β-lactam penicillin sensitivity was 36% to ampicillin and 72% to amoxicillin-clavulanic. Cephalosporins showed 83% sensitivity to cefotaxime, 70% to cefazolin, 87% to ceftazidime and 78% to cefuroxime.

Regarding quinolones, sensitivity levels to ciprofloxacin were 60% and 56% to norfloxacin. Clotrimazole as a representative of sulfonamides and trimethoprim showed a sensitivity of 70%. From the group of other antibiotics, fosfomycin was sensitive in 94% of the cases and nitrofurantoin in 93%.

12,68% of urine cultures were positive for Extended-Spectrum β-lactamase-producing Escherichia coli (ESBL), 21% of them were resistant to fosfomycin.

Conclusions: Knowing the sensitivity patterns of the most common microorganisms present in urine samples, in the case of this Escherichia coli study, allows us to apply the most adequate empirical treatment when we suspect an infection in the Emergency department.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M033

ECONOMIC IMPACT OF UNUSED PERIPHERAL INTRAVENOUS CATHETERS

P. Garcia Bermejo 1, P. Garmilla Ezquerra 1, A. Revert Cogollos 1, M. Cuenca Torres 1, L. Manclús Montoya 1, J. Ruiz López 1

1

Hospital Universitario La Ribera, Alzira, Spain

Background: To describe the use of intravenous peripheral catheters and analyze the economic impact of the intravenous catheters which are no used. <FILE IMAGE='20_20150417193505.jpg'> Methods: Observational descriptive and retrospective study of the intravenous peripheral catheters inserted in the Emergency department patients of the Hospital Universitario de La Ribera (University Hospital La Ribera, HULR) in May 2013, yellow and green triage priority.

Results: We included a total of 1,206 patients, mainly women and an average age of 59. High percentage of them classified as green triage priority, who attended with poorly established signs, symptoms and status.

86% of the patients had an iv peripheral catheter inserted. A third of these were not used. Most of the iv catheters were used for drug administration and all of the above mentioned patients had alternative routes.

The economic impact of the unused iv peripheral catheters on the month of the study was 1,402.98€, which meant an approximate annual cost 17,411.41€.

Conclusions: A third part of the inserted iv peripheral lines are not used. Most of the iv lines were used to administer drugs which had alternative route of administration.

The economic impact of the unused peripheral iv catheters had considerable direct costs, as seen.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M034

USING A FLUOROGENIC SUBSTRATE IN ANTIBIOTIC SUSCEPTIBILITY TESTING OF BACTERIA.

J.J. Gil-Tomás, J. Colomina-Rodríguez, M. Cuenca Torres, J.L. Ruiz López, S. Drogett, M. Soto

1

Hospital Universitario La Ribera, Alzira, Spain

Background: The aim of this study was to evaluate the usefulness of the compound 4-methylumbelliferyl-β-D-glucuronide (MUG), fluorogenic substrate for Escherichia coli specific enzyme β-glucuronidase, in the acquisition of faster antimicrobial susceptibility testing results.

Methods: 20 strains of Escherichia coli from patients with significant bacteriuria and variable sensitivity to several antibiotics commonly used were selected randomly. In all strains, antibacterial susceptibility study using two pairing procedures: A) standard method (gold standard) = MicroScan Walkaway system NUC52 panels (Siemens); and B) method to study = use of such panels but with the addition of 10 uL/well of 1% MUG, aerobically incubated at 37 °C and readings every hour under UV light. A comparative analysis of antimicrobial susceptibility results obtained by the two procedures was performed.

Results: The median time of fluorescence detection in the method B (method to study) was 6 hours. In one strain, the fluorogenic substrate was not hydrolyzed (non-interpretable results), whereas in the remaining 8 strains, the following discrepancies were detected: one in 1 strain, two in 6 strains and three in 1 strain. The antibiotic that showed more discordant results was cefuroxime. The sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the method B for each of the antibiotics studied, using the method A as gold standard, are shown in Table 1. The sensitivity of the method B to cefotaxime, norfloxacin, fosfomycin, gentamicin, nitrofurantoin and cotrimoxazole was high. Specificity was excellent for ampicillin, fosfomycin and gentamicin; and zero for cefotaxime and nitrofurantoin. The positive predictive value was elevated in all cases. One limitation of method B is false fluorescence observed when antibiotics containing a β-lactamase inhibitor are analyzed.

Conclusions: The use of the fluorogenic substrate MUG on antibiotic susceptibility testing can shorten the time to obtain results. However, additional studies are required in order to investigate other types of fluorogenic substrates and to improve the reliability of the results obtained.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M035

ASSESSMENT OF THE HAND WASHING TECHNIQUE IN AN EMERGENCY DEPARTMENT

S. Gomis Baldoví, I. Gisbert Pérez 1, M. Cuenca Torres 1, L. Manclús Montoya 1, M. Tarrasó Gómez 1, S. Navarro Gutierrez 1, P. Garcia Bermejo 1

1

Hospital Universitario La Ribera, Alzira, Spain

Background: To evaluate how correctly the hand washing technique is performed on the A & E Ward of Hospital Universitario de la Ribera.

Methods: An observational, descriptive and prospective study on the hand washing procedure in nursing personnel (nurses, auxiliary nurses and orderlies) was carried out from December 15th, 2013 to January 31st, 2014.

Results: The areas that showed less friction were the thumbs and wrists among those professionals that had received previous training; and nails and interdigital spaces for those with no training. In both cases the palms were the best rubbed areas. More experienced professionals washed their hands better.

Conclusions: This study reveals that non facultative health professionals working in the A & E department of Hospital de la Ribera did not perform the hand washing procedure properly. Therefore, it is essential to conduct new training programs aimed at reaching a high level of hygiene in order to reduce the incidence of preventable infectious diseases.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M036

VIABILITY OF THE EMERGENCY DEPARTMENT FOR RECRUITMENT IN LONGITUDINAL HYPERTENSION STUDIES

R. Dawood 1, L. Buis 2, A. Brody 1, K. Dawood 3, L. Schwiebert 4, C. Mcnaughton 5, L. Mango 1, P. Levy 1

1

Wayne State University, School Of Medicine, Department Of Emergency Medicine, Detroit, Usa, 2 University Of Michigan, Department Of Family Medicine, Ann Arbor, Usa, 3 Wayne State University, College Of Nursing, Detroit, Usa, 4 Wayne State University, Department Of Computer Science, Detroit, Usa, 5 Vanderbilt University, Department Of Emergency Medicine, Nashville, Usa Background: Hypertension (HTN) affects more than 40% of African Americans (AA) and is associated with long term cardiovascular morbidity. AA patients in underserved settings facing barriers in access to primary care (PC) often utilize the emergency department (ED) for this purpose. Identifying patients in either site for participation in clinical trials occurs regularly but how differing locations relate to enrollment success in longitudinal HTN studies is unknown.

Methods: Demographic and recruitment/retention data were compiled for AA patients with uncontrolled HTN enrolled in a prospective, randomized trial where text message reminders were evaluated as means to improve medication adherence and blood pressure control at 30 days post-randomization. Patients were divided into those recruited from ED and PC settings and data were compared using t-test, Chi2 or Wilcoxon tests as appropriate.

Results: 124 total patients (59 PC, 65 ED) were enrolled (Table) over 2 years. A significantly shorter time period was required to enroll ED patients (441 vs. 735 days; p= 0.0144) and retention rates were comparable (92.3% vs. 86.4%; p = 0.82). ED patients were younger (46.3 vs. 52.2 yrs; p<0.001), more likely to be male (53% vs.

33%; p=0.023), and less often reported having medical insurance (35% vs. 74%; p=0.012). However, ED patients were more likely to be actively employed (54% vs. 30%; p < 0.001), and more likely to report an average income of >$20,000 per year (37% vs. 27%; p = 0.028). <FILE IMAGE='291_20150623164903.jpg'> Conclusions: Of AA patients enrolled in a consumer technology based HTN study from ED and PC populations, significantly less time was required to recruit from the ED than PC clinics and study retention was equivalent.

Contrary to commonly held assumptions about the ED patient population, more than half were employed, and income was higher than those enrolled from the PC setting. Our data show the ED to be a viable, and efficient location for recruitment of participants in longitudinal HTN studies.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Research Design / Research Education / Research Methodology / Biostatistics

M038

E-LEARNING PLATFORM AND TRAINING ON WHIPLASH PATHOLOGY

R. Pérez Castillo 1, L. Manclus Montoya 1, M. Cuenca Torres 1, J. Soriano Izquierdo 1, O. Martinez Ferris 1, A. Lluch Sastriques 2, P. Garcia Bermejo 1

1

Hospital Universitario De La Ribera, Alzira, Spain, 2 Hospital Universtario La Fe, Valencia, Spain

Background: According to recent reports, we have in Spain more 25,000 cases of whiplash annually, normally due to traffic accidents. In most cases, this condition is underestimated by emergency physicians. (EP) The aim of this action was to update the knowledge of EP and to adapt patients care to the latest recommendations. We conducted a training set using the methodology on-line avoiding difficulties to schedule lectures due to disparate work shifts.

Methods: A course was offered: Whiplash: Tools for anamnesis, diagnosis and treatment of patients in Emergency Departments, rewarded with 1.2 credits by National Teaching Commission. Duration of the course: 5 hours. The online platform was enabled for 10 days, allowing access 24 hours a day. 40 places were offered. the on-line platform of our hospital, called “moodle”, was used. This platform allows access to information from anywhere using a personal identification. It has the support of technical staff to solve any technical issues.

The course was divided into 3 parts, theory part, online forum and final evaluation test.

Results: 35 persons participate of the 40 places offered (87.5%). The online tool had 2233 visits (average 63'51 and standard deviation 65'867). The resources offered were visited 426 times (average 12'17 and standard deviation 6'951). The forum was accessed 1797 times (average 51'34 and standard deviation 63'034). To overcome the course, it was necessary to participate in the forums, solve correctly 2 of the 3 proposed clinical cases (100 % of the students overcome both cases) and overcome a test of knowledge acquired after training, with multiple choice answers, with an average note of 6.45.

Final score was over 100 points. To overcome the course the students needed to get at least 50 points. The average grade was 71,67 (range: 0-100 points).

Conclusions: It is necessary to carry out actions to improve the care the patients receive in emergency departments.

E-Learning platforms demonstrated to be an effective to for services with wide variability of shifts.

In result of this action, whitplash care has been improved.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M039

ASSOCIATION OF PLASMA PRO-ENKEPHALIN WITH RENAL DYSFUNCTION AND MORTALITY IN AN ALL COMERS POPULATION ADMITTED TO THE EMERGENCY DEPARTMENT

R. Marino 1, L. Magrini 1, L. Cavalieri 1, G. Adducchio 1, J. Struck 2, A. Bergamann 2, O. Hartmann 2, M. Rehfeldt 2, S. Di Somma 1

1

Emergency Departmentpost Graduate School La Sapienza Sant Andrea H, Rome, Italy, 2 Emergency Departmentpost Graduate School La Sapienza Sant Andrea H, Rome, Italy, 3 Emergency Departmentpost Graduate School La Sapienza Sant Andrea H, Rome, Italy, 4 Emergency Departmentpost Graduate School La Sapienza Sant Andrea H, Rome, Italy, 5 Sphingotec Gmbh, Hennigsdorf, Germany, 6 Sphingotec Gmbh, Hennigsdorf, Germany, 7 Sphingotec Gmbh, Hennigsdorf, Germany, 8 Sphingotec Gmbh, Hennigsdorf, Germany, 9 Emergency Departmentpost Graduate School La Sapienza Sant Andrea H, Rome, Italy Background: Plasma Pro-Enkephalin has been shown to be associated with renal dysfunction and mortality in several acute diseases, including sepsis and acute myocardial infarction. Actually, little is known about the behavior of pro-ENK when measured at admission, in patients referring to emergency department for acute conditions.

Methods: This was a prospective, observational trial enrolling 97 patients consecutively admitted to the emergency department of Sant’ Andrea Hospital in Rome for acute pathological conditions, and further hospitalized. For each enrolled patient, clinical laboratory data and plasma pro-ENK values were collected at arrival. A phone 60-day follow-up was performed after hospital admission.

Results: Studied patients (60% male, mean age 76±12 years) had the following final diagnoses: sepsis (22%), acute heart failure (41%), localized infection (19%), acute dehydration (3%), acute gastrointestinal disorders (10%), acute kidney injury (4%), pulmonary embolism (1%).

The 60-day survival rate was 81.4%. There was no statistical significant association of plasma pro-ENK with a particular final diagnosis. Pro-ENK was correlated with serum creatinine (Spearman’s test r=0.54) and was strongly associated with the renal SOFA score component (chi2=26.5, p=0 (Kruskal-Wallis). In the absence of renal dysfunction (renal SOFA 0), pro-ENK levels were essentially within the normal range. Pro-ENK outperformed NGAL and eGFR in prediction of 60-day mortality (chi2=23.42 vs 18.0 and 20.53) and added prognostic value to the APACHE II score.

Conclusions: In patients admitted to the Emergency Department for acute conditions (infections or not) plasma pro-ENK is associated with renal dysfunction and mortality. This is not influenced by the final diagnosis of the patients. These findings point to a potential broad application of pro-ENK as easily accessible plasma marker in the Emergency Department.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M040

PROGNOSTIC VALUE OF , THE SOLUBLE FORM OF AN INTERLEUKIN 1 RECEPTOR FAMILY MEMBER (SST2) IN PATIENT WITH CHEST PAIN ADMITTED IN EMERGENCY DEPARTMENT

R. Marino 1, L. Magrini 1, F. Orsini 1, V. Russo 1, P. Cardelli 2, G. Salerno 2, S. Di Somma 1

1

Emergency Department Sant Andrea Hospital, Post Graduate School Of Emergency Medicine, University La Sapienza, Rome, Italy, 2 Department Of Clinical And Molecular Medicine, School Of Med And Psychology, Sapienza University, Sant Andrea Hospital, Rome, Italy Background: Once patients with suspected Acute Coronary Syndrome present to Emergency Department an immediate diagnosis and risk stratification assessment are both mandatory in order to start an appropriate treatment. High sensitive cardiac Troponin I (hs-cTnI), and soluble isoform of an interleukin 1 receptor family member (sST2) have already been demonstrated to be useful prognostic biomarkers in patients with acute coronary syndrome. Aim of this study was to compare in patients with chest pain, at Emergency Department arrival, the short term prognostic value on mortality of hs-cTnI and sST2.

Methods: In 157 consecutive chest pain patients hs-cTnI and sST2 assays were assessed. A 30 days followâ&#x20AC;&#x201C;up was performed to assess the occurrence of cardiac deaths. On the basis of final diagnosis, patients were subdivided in acute coronary syndrome group, and no acute coronary syndrome group.

Results: Incidence of acute coronary syndrome was 37% in chest pain population. sST2 (Odds Ratio 20.13, p<0.0001) and hs-cTnI (Odds Ratio 2.61, p<0.0008) independently predicted cardiovascular deaths at 30 days but sST2 showed an high independent predictive power (univariate: Odds Ratio 14.58, multivariate: Odds Ratio 12.10) with greater prognostic value in ST-segment Elevation Myocardial Infarction (area under curve 0.80, p<0.001) compared to Non ST-segment Elevation Myocardial Infarction patients (area under curve 0.72, p<0.05) when Receiver Operating Characteristics curves were constructed. In No acute coronary syndrome hs-cTnI and sST2 area under curve for prediction of 30 days mortality was 0.52 ( p=0.80) and 0.61 (p=0.2) respectively. In ST-segment Elevation Myocardial Infarction, 16/33 (51%) patients with at Emergency Department arrival a value of sST2>35 ng/mL died during 30 days follow up.

Conclusions: sST2 assessment at Emergency Department arrival in patients with chest pain and with subsequent diagnosis of acute coronary syndrome, has higher prognostic role for 30 days follow-up cardiac deaths compared to High sensitive cardiac Troponin I. No prognostic role seem to have both biomarkers in No acute coronary syndrome group. A sST2 value > 35 ng/ml seems to have the highest significant power for predicting short mortality in the half of patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M041

PROGNOSTIC ROLE OF BIOMARKERS IN THE MANAGEMENT OF PATIENT WITH ACUTE RESPIRATORY FAILURE TREATED WITH NON INVASIVE VENTILATION

D. LuvarĂ 1, C. Bucci 1, I. Lalle 1, B. De Berardinis 1, V. Russo 1, S. Santarelli 1, F. Travaglino 1, L. Magrini 1, G. Salerno 2, P. Cardelli 2, S. Di Somma 1

1

Emergency Department Azienda Ospedaliera Sant Andrea, Faculty Of Medicine And Psychology Sapienza University, Rome, Italy, 2 Clinical And Molecular Medicine Department Azienda Ospedaliera Sant Andrea,ii School Of Medicine Sapienza, Rome, Italy Background: The aim of the study was to evaluate the individual and collective ability of BNP, procalcitonin (PCT) and ST2 for predicting in-hospital mortality in patients presenting in emergency department with acute respiratory failure treated with non invasive ventilation (NIV) and hospitalized.

Methods: This is a prospective, observational study, enrolling patients admitted to our emergency department for acute respiratory failure, requiring NIV and hospitalization; as ventilationâ&#x20AC;&#x2122;s mode, pressure support ventilation (PSV) will be used. The blood samples for biomarkers measurements and blood gas analysis were performed: before starting NIV, 24 hours (T24) after the start of NIV and after 48 hours (T48).

Results: We enrolled 52 patients (M/F 27/25): the main causes of acute respiratory failure were acute pulmonary edema (n 12), acute exacerbation of chronic obstructive pulmonary disease (n 20), pneumonia (n 9) and acute respiratory distress syndrome/sepsis (n 11). 20/52 (38%) patients died during hospitalization.

At the time of presentation the median values of BNP, PCT and ST2 were respectively: 314.9 pg/ml [128-718.7], 0.25 ng/ml [0.35-1.14] and 114.8 ng/ml [65.3-201.7].

Compared to survivors, patients who died during hospitalization showed significantly higher levels of ST2 in each time analyzed: at T0 137.4 [50.4-204.5] vs 108 [65.5-204] (p 0.03), at T24 117.9 [80.6-210.9] vs 88.2 [98.2-175] (p 0.04) and T48 116.2 [78.5-192.3] vs 60.1 [43.2-153.5] (p 0.03).

Analyzing the prognostic value of biomarkers in terms of prediction of in-hospital mortality we found that the best biomarker in predicting mortality was PCT with an AUC=0.75 at T24 (p 0.009).The combination of BNP, PCT and ST2 showed a good prognostic value at each time analyzed with the best value at T24: AUC=0.81 (p 0.05).

Age, PCT, pO2 and FiO2 >35% administered during ventilation were significant predictive factors at the univariate analysis.

Conclusions: ST2, in combination with BNP and PCT, seems to be new biomarker for prognostic stratification of patients with acute respiratory failure needing NIV in emergency department.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M042

BNP AND PROCALCITONIN (PCT )UTILITY IN THE MANAGEMENT OF ACUTE HEART FAILURE PATIENTS WITH OR WITHOUT INFECTIONS IN THE EMERGENCY ROOM

I. Lalle 1, G. Adducchio 1, L. Magrini 1, F. Travaglino 1, G. Salerno 2, P. Cardelli 2, S. Di Somma 1

1

Emergency Department, Sant Andrea Hospital, Faculty Of Medicine And Psychology Sapienza University, Rome, Italy, 2 Department Of Clinical And Molecular Medicine, Sant'andrea Hospital, School Of Medicine And Psychology, Sapienza Univers, Rome, Italy Background: Aim of this work was to evaluate the independent association between PCT and in-hospital mortality in a cohort of patients admitted from emergency department with diagnosis of acute heart failure with or without evidence of active infection, compared with a group of patients admitted for respiratory infection.

Methods: This was a retrospective analysis. All patients were admitted for dyspnea with a final diagnosis of respiratory infection or acute heart failure with or without infection.

We evaluated the serum level of PCT in these different groups of patients focusing our attention on patients with AHF in terms of prognostic role for in-hospital mortality Results: We analyzed data from 351 patients classified in three groups: pulmonary infection (n 154), acute heart failure without infection (n 146) and respiratory infection complicated by acute heart failure (n 51).

18/351 (5.1%) patients died during hospitalization. Compared to the other two groups, in patients with acute heart failure, the mean PCT values were significantly lower (0.24 ± 0.56 ng/ml).

Because a “not-negative” PCT value, 70/146 patients with acute heart failure without diagnosis of infection, received antibiotic therapy. Analyzing the PCT value, patients who received antibiotic therapy showed significantly higher level compared to patients who did not (median value 0.15 ng/ml vs 0.09 ng/ml, p 0.0006).

Comparing survivors vs non survivors, although not significantly, both PCT and BNP mean values were increased in non-survivors.

PCT AUC of ROC curve for in-hospital mortality was significantly predictive and, respectively, 0.74 in acute heart failure, 0.79 in acute heart failure+infection, 0.70 in pneumonia patients.

Conclusions: From our analysis PCT is the best predictor of in-hospital mortality in all considered groups of patient, while BNP remains a good predictor of in-hospital mortality for AHF patients .

Our results could suggest that the activation of inflammatory response mediated by production and release of pro-inflammatory cytokines during acute heart failure could interfere with PCT expression and may elevate serum PCT levels.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M043

RELANTIONSHIP BETWEEN GALECTIN-3 AND ECHOCARDIOGRAPHIC ASSESSMENT IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE IN THE EMERGENCY DEPARTMENT

C. Gori 1, C. Bongiovanni 1, L. Magrini 1, G. Salerno 2, R. Marino 1, A. Picone 1, P. Cardelli 2, S. Di Somma 1

1

Emergency Medicine, Sant'andrea Hospital, Faculty Of Medicine And Psychology, Sapienza University, Rome, Italy, 2 Biomedical Technologies And Translational Medicine, Faculty Of Medicine And Psychology, Sapienza University, Rome, Italy Background: Acute decompensated heart failure is the new onset or worsening of a cardiac condition attributed to the impairment of the left ventricle. Galectin-3 is a beta-galactoside-binding lectin that has been shown to be elevated in patients with acute heart failure representing a prognostic biomarker for future adverse events. The adverse outcome in patients with elevated circulating level of Galectin-3 has been linked with the presence of enhanced amount of the fibrosis of the heart. The echocardiographic assessment may unmask the pathophysiological leading cause of heart failure which can be associated with reduced or preserved ejection fraction. Our primary endpoint was to evaluate if ejection fraction performed at admission in emergency departmentis was correlated to Galectin-3 values in patients affected by decompensated acute heart failure.

Methods: We conducted a prospective, observational study for a period of 10 months. We enrolled 74 patients with ADHF. Each patient underwent also an echocardiographic assessment to determine the presence or not of systolic and diastolic dysfunction by measuring Ejection Fraction% (Simpson method). Blood samples were collected for Galectin-3 (VIDAS, Biomerieux, France) measurements at the time of arrival in emergency department.

Results: 74 patients (M=30; F=44)(mean age of 77.9Âą9.55) were studied. Our preliminary data demonstrate that there is a statistically significant inverse correlation between Galectin-3 and the left ventricle diastolic performance measured by E/a ratio (r= -0.79, p<0.03), the presence of hypertrophy (r= -0.59, p<0.04) and the percentage of collapsibility of the inferior cava vein (r= -0.49, p<0.02), while there is a significant direct correlation with the presence of tricuspid insufficiency (r=0.44, p<0.02).We evaluated also the subgroup of patients with atrial fibrillation in whom the diastolic function cannot be assed, and a good correlation with Galectin-3 levels (r=0.48, p<0.02) has been shown.

Conclusions: We think that the final data of this study will clarify the correlation of Galectin-3 with the systolic and diastolic function in patients with acute decompensated heart failure with preserved or reduced ejection fraction.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M044

USEFULNESS OF COPEPTIN IN PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN: A PRELIMINARY STUDY.

S. Vigolo 1, G. Vettore 1, N. Artusi 1, F. Della Rocca 1, A. Scudeller 1, M. Zoleo 1, F. Tosato 1, L. Babuin 2, L. Schiavon 3, A. Casarotti 3, M.M. Mion 3, M. Zaninotto 3, M. Plebani 3

1

Emergency Department,hospital Of Padova, Padova, Italy, 2 Department Of Cardiac, Thoracic And Vascular Sciences, University-Hospital Of Padova, Padova, Italy, 3 Department Of Laboratory Medicine, University-Hospital Of Padova, Padova, Italy Background: Copeptin has been shown to be a useful diagnostic and prognostic marker in several acute conditions. We evaluated the usefulness of copeptin, compared to troponin I, in patients admitted to the emergency department (ED) with chest pain: a) to help clinicians in the evaluation of chest pain severity; b) as a prognostic marker for ED readmission due to chest pain relapse and/or death.

Methods: From October to December 2014, 43 non-consecutive > 18 years old patients admitted to ED with chest pain were enrolled in the study. Copeptin was determined in blood samples (K2EDTA plasma) collected at admission in ED, using a fully automated immunoassay (BRAHMS copeptin ultrasensitive assay). Data about patients’ prognosis were collected by consulting hospital’s electronic records.

Results: In our population (24 males; 19 females; mean age 75.05±16.7 years, range 26-100) we measured a copeptin concentration of 20.96 pmol/L (median, range: 2.98-1304.0). 28 (65%) patients had positive copeptin levels (>12 pmol/L). Troponin-I values were positive (>0.045 ug/L) in 34 (79%) patients (range: <0.017-2.130) in the first sample. No correlation was found between troponin and copetin levels (r= 0,491). 4 among all patients were readmitted to ED within 30 days: copeptin was elevated in 3 (75%) out of 4 patients (+LR= 5.449, 95% CI 1.946-15.259) and troponin was elevated in all (100%) readmitted patients (+LR= 1.300, 95%CI 1.095-1.544). 9 among all patients were readmitted to ED within 90 days: copeptin was elevated in 6 (67%) out of 9 readmitted patients (+LR= 1.030, 95% CI 0.610-1.741) and troponin was elevated in 8 (89%) out of 9 readmitted patients (+LR= 1.162, 95% CI 0.864-1.564). 5 (12%) among all patients died during hospitalization: all (100%) these patients had elevated levels of troponin (+LR= 1.310, 95% CI 1.098-1.564), only 3 (60%) of deceased patients had elevated levels of copeptin instead (+LR= 0.912, 95% CI 0.43-1.934; -LR= 1.169, 95% CI 0.366-3.732).

Conclusions: Copeptin measurement does not provide additional information to the ED clinician, neither for the evaluation of chest pain severity nor for identifying patients at short-medium risk of ED readmission and/or death.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Biomarkers

M045

GAS6 AND SOLUBLE MER PLASMA LEVELS IN SIRS AND SEPSIS

S. Negro 1, N. Fiotti 2, F. Mearelli 3, G.C. Avanzi 1, L.M. Castello 1

1

Department Of Traslational Medicine, Eastern Piedmont University, Novara, Italy, 2 Department Of Medical, Surgical And Health Science, University Of Trieste, Trieste, Italy, 3 Department Of Medicine, University Hospital, Trieste Background: GAS6 is a ligand of Mer receptor and its activation is involved in the innate immune system, inhibiting moncytes/macrophages's activity and phagocytosis and reducing IL6, TNFalfa and IFN levels in vitro.

Some proteases, activated during inflammation, can split Mer in soluble form (sMer) consisting of the extracellular receptor region.

Previous studies, conducted on patients affected by SIRS, sepsis, severe sepsis and septic shock, demonstrated that GAS6 levels correlates with clinical severity, organ dysfunction, levels of IL6 and PCT, but not with severity of prognosis. Unpublished preliminary data, from our group, demonstrated a correlation between sMer levels and clinical severity in patients with septic shock. The aim of this study was to evaluate the diagnostic accuracy of GAS6 and sMer plasma levels in the differentiation of sepsis from SIRS and the prognostic value of the two biomarkers.

Methods: This study has been conducted in collaboration with Novara, Trieste and Turin University hospitals.

We enrolled adult patients presenting with SIRS, sepsis, severe sepsis or septic shock. Patients have been randomly selected between those enrolled. Gas6 and SMer plasma levels have been measured by ELISA method. For statistical analysis, severe sepsis and septic shock have been considered as a single group (SSSh).

Results: We analyzed 271 patients, diagnosis were non-infectious SIRS in 17%, sepsis in 47%, SSSh in 37%.

GAS6 showed higher concentrations in patients with sepsis and SSSh in respect of non infectious SIRS (p=0,0037), while sMer showed increasing concentrations in the three groups (SIRS<sepsis<SSSh) with significant differences between all (p=0,0001). We didn't observe significant differences of GAS6 concentrations between patients who survived or died at 7 and 30 days from the enrollment. However, plasma sMer showed higher concentrations in patients who died at day 7.

Conclusions: Our data suggest that both biomarkers can be useful in the differentiation of sepsis from other SIRS; moreover they suggest the possibility that sMer can be used as a marker of severity of acute inflammation and can be a short term prognostic indicator.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Public Health, Screening, and SBIRT

M046

PROPOSAL: A MNEMONIC TO ASSIST THE PUBLIC HEALTH NEOPHYTE’S DECISION-MAKING CAPABILITIES DURING THE EARLY STAGES OF A LOCAL CRISIS

P. Rega 1, B. Fink 1

1

University Of Toledo College Of Medicine, Toledo, Ohio, Usa

Background: Local public health departments are the safety “net” of a community. Their early engagement is advisable in a crisis. In many cases, that involvement is ancillary (e.g. HAZMAT train derailment). Sometimes, public health’s involvement will be essential (e.g. meningitis outbreak). While post-graduate courses and exercises are becoming fundamental aspects of public health, they do not occur with the frequency and quality that will assist any public health neophyte in making efficacious decisions. Therefore, a mnemonic was developed and a pilot study was initiated to assess its usefulness.

Methods: The mnemonic was I-N-C-I-D-E-N-T. I = Incident Command System; N = Needs (departmental/communal: manpower, equipment, expertise, therapies); C = Communications (departmental, external agencies, public); I = Intra-infrastructural surge capabilities (traditional/non-traditional responders); D = Deployments (shelters, alternative care sites, points of distribution); E = Evacuation (local/general; delayed, urgent, immediate); N = Nurture (educational/physical/mental health requirements: staff, partners, public); T = Triumph (recovery/planning).

The mnemonic was distributed to a class of MPH candidates. Four scenarios were provided (meningitis outbreak, active shooter incident, a grain silo explosion, and a train derailment/HAZMAT release). A questionnaire was provided to assess whether they believed the mnemonic was useful in identifying and prioritizing their immediate response to those scenarios. A 5-point Likert scale was used: 5 = Very helpful; 4 = Partially helpful; 3 = Minimally helpful; 2 = Not helpful; 1 = Don’t know. This class received ICS and disaster management training previously. They recently conducted a tornado tabletop and functional exercises.

Results: Of 31 class attendees, 21 responses were returned (20 completed [64.5%]). Eleven of the 20 felt the mnemonic was helpful (55.0%), 8 stated the mnemonic was partially helpful (42.8%). One stated it was minimally helpful (5.0%). Comments included the following: 1) The mnemonic was too long; 2) Certain priorities were incorrectly ordered due to the mnemonic; 3) Different actions were submitted contrary to the ones previously assigned (e.g. T – Treatment).

Conclusions: INCIDENT may be a useful mnemonic tool for neophyte public heath administrators who may inadvertently be on the front-line when a crisis develops.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Public Health, Screening, and SBIRT

M047

UTILITY OF TERRITORYâ&#x20AC;&#x2122;S PREVENTION OF HOSPITAL READMISSION FOR HEART FAILURE BY ITINERARY VISITS IN ITALY INCLUDING BNP+BIVA ASSESSMENT

C. Bartoli 1, R. Marino 1, L. Magrini 1, S. Navarin 1, M.R. Di Somma 2, M. Impellizzeri 2, O. Vitali 2, S. Di Somma 1

1

Emergency Department Of S. Andrea Hospital - La Sapienza University, Rome, Italy, Patients Association (aisc), Rome, Italy

2

Italian Heart Failure

Background: Heart failure is a chronic disease with a high degree of mortality. A controlled and standardized program of early diagnosis, and prevention of heart failure is recommended. The objective of the study was to prove that medical visits in several Italian areas outside the hospital with an itinerant journey by medicalized camper could be helpful in identifying patients without symptoms but with possible not well controlled status.

Methods: This was an observational study by using a medicalized camper traveling through the Italian country.

Patients underwent to health questionnaire to test the presence/absence of symptoms/signs of heart failure.

Physical examination, vital signs, BNP Test measurement (pg/ml) (AlereTM Heart Check), moreover Bioelectrical Impedance Vector Analysis (Akern) were performed.

Results: 100 patients were enrolled (M/F 56/44), mean age 67.69Âą13.13. On the basis of recorded data patients were divided into four groups: group 1, patients without heart failure (36%); group 2, patients with unrecognized heart failure (21%); group 3, patients with controlled chronic heart failure (19.4%); group 4, patients with heart failure not controlled by therapy (23.6%). In group 1 median [IQR] of BIVA was 73.7%[73-73.9], and of BNP 52[35-91]pg/ml; in group 2 BIVA 79%[76.3-81.5], and BNP 270[189.7-383]pg/ml; in group 3 BIVA 73.7%[73.5-73.8], and BNP 132.5[73-221]pg/ml; in group 4 BIVA 80.9%[77.6-84.9], and BNP 241[151.7-460.2]pg/ml with significant difference within the groups both for BIVA and for BNP: group1 vs group2 (p<0.0001); group1 vs group4 (p<0.0001); group2 vs group3 (p<0.0001); group 3 vs group4 (p<0.0001). A direct correlation was found between BNP and Hydration% (r=0.34, p<0.003), and a significant inverse correlation between BNP and reactance (r= -0.38, p=0.001). Patients taking diuretic were 38%, those not taking 62% (group 1 patients taking diuretic was 1, group 2 were 4, group 3 were 15, and group 4 were 17).

Conclusions: Preventive, on territory, examination of patients at risk for heart failure could be useful to identify those subjects with heart failure apparently asymptomatic, or misunderstood. This initiative could be useful for primary heart failure prevention and better management in order to avoid re-hospitalizations for worsening heart failure.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M048

HEALTH AND SOCIAL NEEDS OF EVALUATION PATIENTS WHO REQUIRE CAREGIVING ADMITTED TO EMERGENCY DEPARTMENT

E. Tavas 1, S. Kiyan 2, G. Kitapcioglu 3

1 3

Ege University Emergency Department, Izmir, Turkey, 2 Ege University Emergency Department, Izmir, Turkey, Ege University Department Of Biostatistics And Medical Informatics, Izöir, Turkey

Background: Because better treatments have extended the lifespans of most patients with chronic illnesses and comorbid conditions, the patient population that needs caregiving keeps increasing over years, also bringing a burden upon the emergency services. The problems encountered by the patients, caregivers and emergency medicine services have not been studied in emergency medicine literature before.

Methods: This analytical cross-sectional study was designed in Ege University Faculty of Medicine, Department of Emergency Medicine, which treats approximately 120,000 patients per year. The emergency room applications of patients who required caregiving (terminal stage malignencies, neurological disease patients, Alzheimer’s disease, Stage D congestive heart failure patients, chronic obstructive pulmonary disease patients requiring home oxygen therapy, bedridden patients due to trauma, mental retarded patients, etc.) were observed for 3 months. Part two of the form was a survey, filled according to the answers of caregivers, to questions about their caregiving skills and caregiver burden.

Results: The median age among the patients was 71,78± 15,1 (18 – 100). The most common reason for coming to the emergency department was shortness of breath or general weakness. Patients were mostly transferred to the hospital by ambulance upon arrival, however, transfers to home or hospice were mostly with private vehicles.

Arrival and externation times were mostly at work-hour periods. Caregivers were mostly women relatives.

According to Zarit Caregiver Burden Scale, 24.8% of caregivers were under heavy burden and 15.4% were under moderate burden. Most caregivers did not have the required knowledge and skills for caregiving, and were in need for someone to support them, however, they could not effectively utilize (or could not utilize at all) home care services.

Conclusions: The fact that caregivers do not have the necessary skills for caregiving and the fact that home-care services are not widely established, together cause many complications. As a result, there is an increase in emergency room applications, contributing to health care costs and emergency room overcrowding.

This situation is also uncomfortable for caregivers since they need to transfer the patient to and fro, spending effort and time and money.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M049

EMERGENCY DEPARTMENT PROTOCOLS â&#x20AC;&#x201C; HOW TO IMPROVE EMERGENCY STAFF USE?

J. Ashkar 1

1

Emergency Medicine Department, Hadera, Israel, 2 Emergency Medicine Department, Hadera, Israel

Background: Jallal Ashkar, MD, Pavel Peschansky, MD, Margarita Medvedovsky, MD,Igor Tulchinsky, MD BACKGROUND: Effective decision-making is especially important in the uncertain and often chaotic environment of the Emergency Department (ED), which can cause patient safety to be compromised.

Evidence-based protocols help emergency physicians organize the clinical decision process and become more efficient and less prone to error. These protocols are used in addition to the adherence to the general principles of emergency care that are found in the ACLS and ATLS. The 21st Century reality of ED overcrowding in conjunction with a renewed call to rein in health care spending while minimizing errors in medicine, will force clinicians to search for ever-improving diagnostic and therapeutic efficiency.

Methods: METHOD: The Hillel Yaffe Emergency Department has organized a computerized file containing the various therapeutic and diagnostic approaches to the most common emergency conditions. In this way it is available and easily accessed by ED staff. In addition to this computerized file, we internally published a guidebook in 2012, containing these protocols. It is portable and is distributed to our caregivers to be studied at their convenience.

Results: CONCLUSION: The use of evidence-based protocols in medical care, and especially in the Emergency Department, is vital. The education of health care staff must include thorough comprehension and understanding of these protocols. This will improve patient outcome and will protect the staff from possible medico-legal difficulties. Our poster presents an example of one of our locally used protocols. We have observed a steady improvement in the diagnostic/therapeutic approach of the ED caregivers since the organization and computerization in 2012 of the most commonly used protocols. In light of new wide-spread technological opportunities, such as smartphones, perhaps in the future these protocols can be introduced as an Application for use by our caregiving staff.

Conclusions: In light of new wide-spread technological opportunities, such as smartphones, perhaps in the future these protocols can be introduced as an Application for use by our caregiving staff.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M050

THE FINAL POINT IN ILLEGAL IMMIGRATION: HYPOTHERMIA: A CASE REPORT

G. Yilmaz, S. Kiyan

1

Emergency Department Of Ege University Medical Faculty, Izmir, Turkey

Background: Near-drowning mean is rescued from sinking in the liquid and was a right after 24 hours.

The number of unknown cases of drowning ,neardrowning in our country also unfortunaly academicstudy is not enough for the information. However, our country is surrounded on 3 sides by the sea therefore thought to be high underestimate this rate.

Methods: This case, a man was stay abouth 15 hours in sea due to boat is sank that is use for human smuggling by the seaway. Our aim to both explain near-drowning cases’ clinical data, nursing care is presented in order to draw attention to human smuggling that known as modern slawery.

Results: Case: 33-year- old Syrian male patient was the only survivor of 12 refugees. They tried to go Europe by seaway in an unsafe boat. The boat sank and all of his friends died. He hold a wooden for 15 hours in sea and then transferred to our emergency department after rescued by the Turkish coastguard.Vital sings was systolic tension: 141, diastolic 87, pulse 89/min., respiration 26 / min, saturation of O2 89, rectal temperature: 33 ° C, glukoz: 61mg / dL, GCS was 13. The case was monitoring, reassessment his life symptoms, the procedure was hipotermic terapy applied by the intravenous(IV). IV fluids were given heating, external heat was applied.Tthe patient can’t speak Turkish for communicate therefore found medical staff who know Arabic. In the patient's follow-up muscle enzymes (CK: 4133, CK-MB: 62, Myoglobin: 1662) were increased, rhabdomyolysis findings were observed with the fluid monitoring, laboratory values in nursing care. Total parenteral nutrition support is provided after 4 hours. We start feeding the patient orally after 8 hours of admission. He well tolerated the foods. We discharged the patient after 24 hours of admission with non-sequel. .

Conclusions: Our effective and multidisplinary approach saved the near-drowning patient with non-sequel discharge. Nursing care is the most important part of this approach. Otherwise for illegal immigration, alongside legal sanction of the economic and social dimensions, taking into consideration of importance of human life is a universal responsibility

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M051

THE IMPACT OF THE LEVEL OF INTERCULTURAL SENSITIVITY SCALE COMMINICATION THE RELATION LANGUAGE IN HEALTH WORKER

TO THE PROBLEMS OF

G. Yilmaz, D. Kayis, Y.A. Altunci, A. Funda

1

Emergency Department Of Ege University Medical Faculty, Izmir, Turkey

Background: The aim of this study examine the intercultural sensitivity level of prospective in health workers according to gender,grade level type of education,the impact of The level of Intercultural Sensitivity Scale to the problems of comminication the relation language.

Methods: This descriptive,cross-sectionall study was conducted by applying sociodemografic questionnaire form prepared Intercultural Sensitivity Scale developed by Chen and Starosta.In addition,whether to acquire different character in their sensitivity level of intercultural communication in accordance with certain variables were analyzed.The researchers applied to the Ethics Committee for study and continues with data from a larger patient population.

Results: The study included 153 health workers in emergency department.There were 54,9%nurses.The most of the participants were 25-34 years of age.The according to years of work,the most participants were between 0-5 years 60.8%.64.1%participants were born in Ege region,13% participants were born in Southeast and Eastern Anatolia region,4% participants were born in abroad.94.8% participants’ native language was Turkish,3.3%participants’ native language was Kurdish, 1.3% participants’ native language was Arabic.77.2%of participants were spoke one more language without native language. 64.1%of participants’ answers were often experienced problems related to language.29.3%participants were spoke to patients by one more language for dialogue without Turkish due to patients were no spoke Turkish,the most Kurdish, Engilish,Arabic.43.8%participants’ answers were if patients no speak Turkish they could themself understood by caregivers who speak Turkish and nonverbal communication.72.7%participants’ answers were yes to question that did the patient's behavior change when spoken patients’ native language and behavors explained as increase of reliance,decrease of anxiety, the adapted to suggestion quickly.The participants levels of intercultural sensitivity were measured andCronbach’s Alpha reliability coefficient as 0.74.The analysis between intercultural sensitivity levels and native language was statistically significant difference F=2.35 p=0,01.According to research between levels of intercultural sensitivity and sociodemografic no differ significantly.

Conclusions: To understand the impact of language and culture on health care it’s important to look at the issues that influence health care.Intercultural communication sensitivity has shown itself as asubstantially strong demand ,requirement in today world that globalization,Therefore to analyze level of intercultural sensitivity studies carries a key quality reserve for academically, socially.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M052

THE PERCEPTION OF MALE NURSES IN TURKEY

H. DĂśnmez 1, A. Demir 1, G. Yilmaz 1, S. Kiyan 1

1

Emergency Department Of Ege University Medical Faculty, Izmir, Turkey

Background: Nursing is a profession usually dominated by women all over the world and also in our country.

Nursing care has been identi ed as a traditional role and profession for women in its historical process.

Therefore, nursing has been infuenced by gender-related prejudices. The contribution of males to nursing will increase the social status of the profession.

Aim of this study,has been conducted to determine men nurse image of the Turkish Society.

Methods: The study that was conducted in cross-sectional design was realized on 100 the relatives of the patient in emergency unit . Questionnaire that is prepared by literatur knowledge that used to by Kaya and at all, were filled by discussing with cases face-to-face. Average, percentage methods were used in evaluation of data.

Results: Age year range of cases within the scope of the research is 36%, 40-59 range. It was determined that 58% of the female, 64% is married, 30% is graduated from high school. 91% casesâ&#x20AC;&#x2122; profession not related to healty system. 35% cases stated that they havenâ&#x20AC;&#x2122;t got healty worker in their family. 88% cases stated that they knew that men were able to work as nurse in Turkey and 56% cases stated that the information by they learned in during hospital. 28% cases stated that they would be ashamed of care by men nurse, 27 % cases stated that they would hesitate and 21% cases stated that they would be surprised. 52% stated that men nurses would contribute in development of social status of nursing although 32% cases preferred female nurse for their care.

60% stated that men nurses had to work in every field in hospital environment. 79% stated that success of nurses in practice was more important than gender.

Conclusions: Men nurse image in Turkey is generally positive. However, a positive point of view against men nurses by all the society should be ensured. The cases preferred female nurse for their care although they said that quality of nursing care was more important than gender.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Social role of emergency medicine

M053

PERCEPTION VERSUS ACTUALITY: BODY MASS INDEX CLASSIFICATION IN A LARGE SAMPLE OF PREDOMINANTLY HISPANIC EMERGENCY ROOM PATIENTS

R. Wells 1, S. Monks 1, O. Baker 1

1

Texas Tech University Health Sciences Center El Paso, Department Of Emergency Medicine, El Paso, Texas, Usa Background: Obesity rates in the US have consistently risen over the last thirty years. This trend calls for an increased focus on weight management practices as well as awareness of obesity and its relationship to co-morbid disease. In order to improve such practices, patients must first be able to identify that they are not at a healthy weight and that it may impact their well-being. Weight management practices should be discussed with oneâ&#x20AC;&#x2122;s primary care physician (PCP), however, for many, their only contact with a provider is during emergency room (ER) visits where it is not the focus of care. In these instances, it is unlikely that patients are made aware of their weight status.

The purpose of this study was to examine the perceived (self-identified) and actual (calculated) BMI classification in a sample of predominately Hispanic ER patients and to assess the relationship between patients' weight and co-morbidities.

Methods: This cross-sectional study was conducted using a convenience sample of 1000 ER patients. Patients were invited to complete an anonymous survey with information regarding demographics, perceived BMI classification, co-morbidities, and healthcare access. Researchers completed the height and weight portion of the survey and calculated patient BMI. Results: The study sample was 55% female and 82% Hispanic with a mean age of 43 years. BMI classification was 1% underweight, 22% normal weight, 35% overweight, 23% obese, and 19% obese class II and III. The majority recognized that health status and weight were related (75%), desired to lose weight (58%), and attested to not having a PCP (51%). Patients were categorized by both their calculated and self-identified BMI classification (Figure 1). In addition, self-reported incidences of co-morbidities were categorized by calculated BMI classification (Table 1).

Conclusions: Study findings suggest that the majority of ER patients do not self-identify appropriately into BMI classification categories. There was a general upward trend in the incidence of reported co-morbidities among patients in elevated BMI classifications. Study implications include a need to increase awareness of ER patients' actual weight, their healthy weight, and the relationship between weight and disease.<FILE IMAGE='313_20150628191939.jpg'>

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M054

A STUDY ABOUT THE USEFULNESS OF RAPID STREP VERSUS LE TEST FOR STREP PHARYNGITIS.

K. Nibhanipudi 1

1

Nymc, Metropolitan Hospital Center, New York, Usa

Background: bjective: A study to compare the usage of throat swab testing for leukocyte esterase on a test strip(urine dip stick-multi stick) to rapid strep test for rapid diagnosis of Group A Beta hemolytic streptococci in cases of acute pharyngitis in children.

Hypothesis: The testing of throat swab for leukocyte esterase on test strip currently used for urine testing may be used to detect throat infection and might be as useful as rapid strep.

Methods: Methods: All patients who come with a complaint of sore throat and fever were examined for erythema and exudates and 3 swabs were taken from pharyngo-tonsillar region, testing for culture, rapid strep & LE. Results: .

Results: Total number is 100. Cultures 9(+); for rapid strep== 84(-) and 16 (+); For LE== 80(-) and 20(+) Table 1: depicting the results: Throat cultures Rapid strep test LE test 9 positives 16 (+)ve 20 (+)ve 91 negatives 84 (-)ve 80 (-)ve Statistics: From data configuration Rapid Strep versus LE test donâ&#x20AC;&#x2122;t seem to be a random (independent) assignment but extremely aligned. The Statistical results show rapid and LE show very agreeable results.

Calculated Value of Chi Squared Exceeds Tabulated under 1 Degree Of Freedom (P<.0.0001) reject Null Hypothesis and Conclude Alternative Conclusions: Conclusions: Leukocyte esterase on throat swab is as useful as rapid strep test for rapid diagnosis of strep pharyngitis on test strip currently used for urine dip stick causing acute pharyngitis in children.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M055

IS CENTOR CRITERIA ENOUGH FOR STREP PHARYNGITIS?

K. Nibhanipudi 1

1

Nymc, Metropolitan Hospital Center,, New York, Usa

Background: Objective: A study to determine Centor Criteria for pharyngitis.

Hypothesis: In children, Centor Criteria does not cover all the symptoms and signs of acute strep pharyngitis. It does miss some signs and symptoms like palatal hemorrhages.

Methods: Methods: 100 patients with a complaint of sore throat were enrolled in the study. All the patients were examined clinically using the Centor Criteria. They were also examined for other signs and symptoms like palatal hemorrhages, and other symptoms like abdominal pain. All the patients had Rapid Strep and Throat culture. No one was given any antibiotic till culture results.

Results: Results: The sample size is 100. All 100/100 had Fever, sore throat, and erythema of tonsils. # of patients with exudates is 20/100; However 4 cases of erythematous tonsils with no exudate had strep culture positive. Tender ant. Cervical lymph nodes is 85/100 and absence of cough 86/100.

Significant omission is palatal hemorrhage 8/100. 6 out of 8 had culture positive strep. Only 7 out 20 with exudate had positive strep culture. 9/100 had culture positive but positive rapid strep is16/100 with none of rapid strep negative had culture positive.

Conclusions: Conclusion: Our study show in addition to using Centor Criteria, special attention to be paid to palatal hemorrhages and old dictum enunciated by Dr. Oski, prudent to culture all red looking throats

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M056

IMPACT OF EARLY GOAL DIRECTED THERAPY, HIV AND PREDICTORS OF MORTALITY IN SEPSIS

D. Mccormack 1, A. Ruderman 1, S. Pasichow 1, M. Kulkarni 1, S. Keller 1

1

Rutgers University, Newark, Nj, Usa

Background: The Surviving Sepsis Campaign recommends Early Goal Directed Therapy (EGDT) for sepsis management. EGDT is thought to decrease mortality however the ProCESS and ARISE trials challenged its validity in immunocompetent patients. The impact of EGDT on mortality in HIV patients is unknown. We sought to determine if EGDT decreases mortality in HIV patients and identify predictors of mortality.

Methods: A retrospective chart review was conducted over one year. Inclusion criteria consisted of patients with severe sepsis with lactate >4 mmol/L and documented infection. Three hour EGDT included lactate, blood cultures, antibiotics and >30mL/kg crystalloid bolus. The primary outcome was in-hospital mortality. Statistical analysis was performed using chi-square or t-test and logistic regression analysis was used to identify predictors of mortality. Variables included in the regression model were age, gender, cigarette smoking, cardiac disease, positive HIV status, lactate >10 mmol/L, albumin <2.5 gm/dL, glucose <70 mg/dL, endotracheal intubation, and EGDT components.

Results: 125 patients met inclusion criteria. Mortality was 28% and 23% were HIV positive. For HIV patients, antibiotic adherence was significantly higher (72% vs. 38%, P< 0.05) and hospital day of death was earlier (3.7 Âą 3.3, 95%CI 1.4-6.0 vs. 10.9 Âą 20.7, 95%CI 2.4-19.5, P=0.28). Adherence was higher for lactate (86% vs. 68%, P=0.05) and blood cultures (69% vs. 50%, P=0.07) and lower for crystalloid bolus (17% vs. 24%, P=0.44) but not significant. There was no association between HIV mortality and adherence to lactate (P=0.11), blood cultures (P=0.06), antibiotics (P=0.45) and crystalloid bolus (P=0.49). Logistic regression found increased mortality based on odds ratios (OR) for lactate >10 mmol/L (OR 18.7, P=0.02), albumin <2.5 gm/dL (OR 12.4, P=0.0001) and endotracheal intubation (OR 4.1, P=0.001). Positive HIV status did not increase mortality (P=0.26).

Conclusions: EGDT did not decrease mortality in sepsis and HIV patients did not have higher mortality. HIV patients were more likely to receive antibiotics within three hours. Hyperlactemia, hypoalbuminemia and endotracheal intubation were associated with increased mortality. Our results suggest that obtaining albumin levels in the Emergency Department is critical for sepsis risk assessment.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M057

USEFULNESS OF THE LEUKOCYTE ESTERASE TEST STRIP REAGENTS IN THE RAPID DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS

S. Hashemian 1, M.D. Sharifi 1, B. Rezvani Kakhki 1, S. Shamsaei

1

Emergency Medicine Reasearch Center, Faculty Of Medicine, Mashhad University Of Medical Sciences, Mashhad, Iran Background: Spontaneous bacterial peritonitis (SBP) is a common and important clinical problem and is life-threatening in decompensated liver disease.

This study is aimed at evaluation of the sensitivity and specificity of leukocyte esterase test strip in the diagnosis of SBP. Methods: A prospective study of 100 patients with ascites and liver cirrhosis [mean age 38.9 Âą 6.54 years, average 6.54, SD 38.9:64men] attending to Emergency Department from March 2011 to February 2014 was made. SBP was defined as having a polymorphonuclear ascites count of >= 250/mm3 and WBC> 500 CELL. All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, urine test strip (LER strip test)(ConvergysÂŽUrine Matrix 11) and culture. Strips were considered positive at grade >= 3 (>= 125 leukocytes/mL). Leukocyte esterase dipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative test result.

Results: A total of 100 ascitic fluid and liver cirrhosis samples were obtained. There were 19 episodes of SBP. Median age was 47 (range 25-70 year) years; 36% were female. The sensitivity specificity, positive and negative predictive values of the leukocyte esterase test strips were all 100%. The sensitivity, specificity, positive and negative predictive value of the leukocyte esterase test strips were 95%, 96.3%, 85%, 97.5%, 95%, respectively.

Conclusions: The use of leukocyte esterase urine dipstick test can be considered as a quick and easy method in early diagnosis of SBP

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M058

THE ACUTE ABDOMEN PITFALLS: CASE REPORT

L. Pagani 1, G. Savioli 2, S. Marra 1, F.G. Panizzardi 1, M. Bonzano 1, I.F. Ceresa 2, G. Ricevuti 1, M.A. Bressan 2

1 2

Scuola Di Specializzazione Di Medicina Di Emergenza E Urgenza, Università Degli Studi Di Pavia, Pavia, Italy, Struttura Complessa Pronto Soccorso Accettazione, Irccs Policlinico San Matteo, Pavia, Italy

Background: A 31 years old man came to Emergency Department complaining of fever, abdominal pain and walking difficulties for three days. Past medical history: he was cocaine and heroin addicted now in methadone treatment. The vital signs were normal: BP 105/75 mmHg, HR 77 bpm, spO2 98% on RA, TC 38.1°C. Clinical examination: tense and intractable abdomen, bowel sounds present, good hemodynamic compensation, pain at the lumbar spine. The lab tests showed neutrophilic leukocytosis and PCR increase. The patient continued to be symptomatic despite analgesic therapy and the clinical presentation was unchanged; we performed an abdomen TC that did not show pathological conditions. The orthopedic and abdominal surgeon did not detect clinical conditions that required their acute intervention. We performed two sets of blood cultures, we started intravenous antibiotic therapy and the patient was hospitalized in the infectious diseases department The MRI showed a subdural empyema at L1-L3 level without cord compression in suspected HIV infection or bone marrow conversion condition.

Methods: / Results: Subdural empyema represents a loculated suppuration between the dura mater and the arachnoid.The organisms reach the subdural space via: a hematogenous spread; a contiguous infection. Iatrogenic causes (lumbar puncture or injection of anesthetic agents) are very frequent. Conditions or disease diminishing patient’s resistance to infection (diabetes, lue, Crohn disease, multiple sclerosis, rheumatoid arthritis, drug abuse, AIDS, tumors) or abnormalities of the spinal cord (midline neuroectodermal defects) may be present in many cases. The diagnosis is made by laboratory analysis: white blood cell count, C-reactive protein and erythrocyte sedimentation. The MRI with gadolinium enhancement is the gold standard diagnostic procedure.

The treatment option are surgical drainage followed by appropriate antibiotic therapy.

Conclusions: The spinal epidural empyema is a very rare and serious condition that can result in devastating consequences, irreversible paralysis, and even death4. It should be early suspected when symptoms such as fever back pain, para / tetraparesis, bladder dysfunction and motor deficit are present, mainly in immunocompromised patients. The early diagnosis and treatment are associated with a better outcome.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Infectious Disease & Sepsis

M059

STUDY OF ILIOPSOAS ABSCESS CHARACTERISTICS

A. Nakano 1, Y. Ooya 1, S. Sugita 1, D. Furuya 1, M. Nemoto 1

1

Saitama Medical Univrsity International Medical Center, Hidaka, Japan

Background: Iliopsoas abscess is relatively uncommon, but it comes across occasionally in emergency center.

Mostly, it requires time to be diagnosed of iliopsoas abscess. Then, symptoms become severe, and duration of treatment is long term.

Methods: We used and considered medical records of 16 patients, diagnosed of iliopsoas abscess , who were admitted to in our department from April 2008 to December 2014.

Results: 10 male and 6 female. 10 patients had chief complaints of lumber backache. Duration of hospital stay was 33.7±28.3days. Age was 65.0±11.4. WBC was 17425±12732/micro. CRP was 23.3±10.3mg/dl S-Alb was 2.04±0.74g/dl.

Conclusions: More than half, 62.5% patients came in because of lumbr backache in studied case.All patients had hypoalbuminemia because process time was long or poor nutritional state was risk factor. When backache and high inflammatory with considering iliopsoas abscess. Moreover, when there is no symptoms, we check iliopsoas abscess if patients have hypoalbuminemia for long period is expected and high inflammatory reaction on blood test are seen.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M060

ELECTROCARDIOGRAPHIC FINDINGS OUT-OF-HOSPITAL CARDIAC ARREST

OF

INTRACRANIAL

HEMORRHAGE

Y. Kim 1, W. Kim 1, B. Ko 1, S. Ryoo 1, S. Ahn 1, C. Sohn 1, D. Seo 1, K. Lim

1

AS

A

CAUSE

OF

1

University Of Ulsan College Of Medicine, Asan Medical Center, Seoul, South Korea

Background: Electrocardiogram (ECG) changes in intracranial hemorrhage (ICH) are described as ST-T changes that reflect acute coronary heart disease, the most common cause of out-of-hospital cardiac arrest (OHCA). The aim of this study was to analyze ECG characteristics in ICH patients after resuscitation from OHCA and compare the ECG findings between subarachnoid hemorrhage (SAH) and other ICH types.

Methods: A retrospective data analysis was conducted of all adult non-traumatic OHCA survivors who underwent noncontrast computed tomography during the first 3 hours after cardiac arrest between January 2004 and December 2013 at our hospital.

Results: Of a total of 194 patients identified, 36 had ICH, 27 (75.0%) had SAH and 9 (25.0%) had other types of ICH. The most common arrest rhythm was asystole (69.4%). Most patients had tachycardia (86.1%) and a QTc prolongation (52.8%). ST-segment deviations and T wave inversions were found in 100% and 55.6% of patients, respectively. Twenty-eight patients (77.8%) had ST-segment elevation in at least one lead, mostly (85.7%) in aVR or V1 leads. A higher number of leads showed ST-segment depression than showed ST-segment elevation (5.0 [2.3â&#x20AC;&#x201C;7.0] vs. 1.0 [1.0â&#x20AC;&#x201C;2.0], p < 0.05). The number of leads with ST-segment elevation was nonsignificantly different between the SAH and other ICH groups (1.0 vs. 2.0, respectively; p = 0.26).

Conclusions: ECG findings suggestive of ICH involve ST-segment elevation in aVR or V1 leads, ST-segment depression in multiple leads, and T wave inversion. ST-segment elevation in two contiguous leads is rarely seen in OHCA patients with ICH.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M061

ASSOCIATION BETWEEN PROPORTIONS OF HIGHLY EDUCATED NEIGHBORHOOD WITH PROVISION OF BYSTANDER CARDIOPULMONARY RESUSCITATION

S. Lee 1, Y. Ro 1, S. Shin 1, K. Song 1

1

Seoul National University Hospital, Seoul, South Korea

Background: Bystander cardiopulmonary resuscitation (BCPR) is one of crucial community factor for out-of-hospital cardiac arrest (OHCA). We studied the association between the education level of neighborhood and provision of BCPR. Methods: Emergency medical service (EMS)-treated OHCA with presumed cardiac etiology in Korea were enrolled from January 2012 through December 2013, excluding cases that were witnessed by EMS providers or have unknown outcome. Exposure was proportion of highly educated (more than bachelor) neighborhood in community, categorized in four groups from Q1 (low) to Q4 (high). Endpoints were provision of BCPR for study population and short time interval (<4 minutes) from arrest to initial compression (AIC) for witnessed OHCAs. Multivariable logistic regression was performed to adjust for potential confounders.

Results: Total of 26,073 OHCAs were included, 41.0% were witnessed and 36.9% had BCPR. BCPR was provided for 31.3% in Q1, 33.6% in Q2, 35.6% in Q3, and 41.8% in Q4 group. Among witnessed patients, 24.4% had short AIC in Q1, 29.3% in Q2, 29.9% in Q3, and 35.8% in Q4 (p<0.01). The AORs (95% CIs) compared with Q1 for BCPR were 1.01 (0.91-1.12) in Q2, 1.08 (0.98-1.18) in Q3, and 1.29 (1.17-1.43) in Q4. For short AIC, the AORs were 1.19 (0.99-1.44) in Q2, 1.21 (1.01-1.45) in Q3, and 1.45 (1.20-1.75) in Q4 for witnessed OHCA. Conclusions: Proportion of highly educated neighborhood in incident site of OHCA is associated with receiving BCPR and short AIC. Targeted public intervention may be needed for community with relatively low education level.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M063

PROGNOSTIC PERFORMANCE OF THE GRAY-TO-WHITE MATTER RATIO ON BRAIN COMPUTED TOMOGRAPHY IN OUT-OF-HOSPITAL CARDIAC ARREST SURVIVORS ACCORDING TO ETIOLOGY

K. Song 1, H.C. Kim

1

2

Chonnam National University Hospital, Gwangju, South Korea, Korea

2

Gwangju Veterans Hospital, Gwangju, South

Background: The gray-to-white matter ratio (GWR) from brain computed tomography (CT) is associated with outcomes in cardiac arrest survivors. Using multicenter registry data, we tested the prognostic performance of the GWR in out-of-hospital cardiac arrest survivors treated with therapeutic hypothermia. Survivors were grouped according to cardiac arrest etiology and the influence of the time interval to brain CT on GWR was assessed.

Methods: This retrospective multicenter observational study using data from the Korean Hypothermia Network (KORHN) registry included subjects who had brain CT within 24 h and survived 72 h upon return of spontaneous circulation (ROSC). Attenuation of gray matter (caudate nucleus, putamen [P], medial cortex at the level of the centrum semiovale and high convexity) and white matter (posterior limb of internal capsule, corpus callosum [CC], medial white matter at the level of the centrum semiovale and high convexity) were measured and the GWR calculated. The primary outcome was functional status at discharge.

Results: Of 447 patients, 288 (64.4%) were discharged with poor neurologic outcomes. Lower GWRs were associated with poor neurologic outcomes. The P/CC ratio showed the strongest prognostic performance (area under curve [AUC], 0.648; 95% confidence interval [CI], 0.602 - 0.693). The median time interval between ROSC and CT was 55 min. Time interval had no association with the GWR. Two hundred eighty three (63.3%) arrests were of a cardiac etiology and 164 (36.7%) were non-cardiac. The prognostic performance of P/CC was higher in the non-cardiac etiology group (AUC, 0.718; 95% CI, 0.642 - 0.785) than the cardiac etiology group (AUC, 0.615; 95% CI, 0.555 - 0.672)(p = 0.048).

Conclusions: The prognostic performance of the GWR is poor. However, the P/CC shows better prognostic performance in the non-cardiac etiology group. ROSC-to-CT times have no association with the GWR within 24 h after ROSC.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M065

INTERACTION EFFECT BETWEEN PREHOSPITAL AIRWAY MANAGEMENT AND WITNESSED STATUS ON SURVIVAL OUTCOMES IN OUT-OF-HOSPITAL CARDIAC ARREST

K. Kang 1, S. Jeong 1, T. Kim 2, S.D. Shin 1, Y.S. Ro 3, J.Y. Kim 3, K.J. Song 1, J.H. Park 1, T.H. Kim

1

1

Department Of Emergency Medicine, Seoul National University Hospital, Seoul National University College Of Medicine, Seoul, South Korea, 2 Department Of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College Of Medic, Seongnam-Si, South Korea, 3 Laboratory Of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institude, Seoul, South Korea Background: Itâ&#x20AC;&#x2122;s still controversial on optimal out-of-hospital cardiac arrest (OHCA) airway management strategies. Recent studies reported survival was higher among patients who received bag-valve-mask (BVM) than those receiving endotracheal intubation (ETI) or supraglottic airway (SGA). We conducted this study to determine whether the effect size of prehospital airway on survival in OHCA patients would be different by witnessed status.

Methods: We used the Korean nationwide OHCA cohort database from 2010 to 2013. The inclusion criteria were all OHCA adults with presumed cardiac etiology, resuscitated by level-1 emergency medical technician.

Patients were excluded if their information about the techniques of prehospital airway or clinical outcomes at hospital discharge were not available. The primary outcome was survival discharge with good neurologic status.

We compared study outcomes by prehospital airway among three group (ETI vs SGA vs BVM) using multivariable logistic regression with interaction model.

Results: Of 98896 patients with OHCA, 32513 were included in analysis. Patients receiving BVM were 29684 and 2829 underwent advanced airway management including 1634 with SGA and 1195 with ETI. Compared with BVM, ETI showed higher the primary outcome in full cohort (adjusted OR, 1.405; 95% CI, 1.1001-1.971). In the interaction model, ETI showed higher the primary outcome compared with BVM in the patients with unwitnessed arrest (adjusted OR, 1.735; 95% CI, 1.291-2.332).

Conclusions: In the Korean nationwide OHCA cohort, ETI achieved significantly higher hospital discharge with good neurologic outcome compared with BVM. The effect size of ETI on favorable outcome was more prominent in unwitnessed arrest patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M066

THE EFFECT OF RESUSCITATION POSITION ON RESUSCITATION IN PORCINE CARDIAC ARREST MODEL

SURVIVAL

AFTER

CARDIOPULMONARY

Y. Park 1, T. Kim 2, T. Kim 1, S. Shin 1, K. Song 1, D. Jang 3, H. Moon 3, J. Kim 3, S. Song 4, S. Kim

5

1

Seoul National University Hospital - Department Of Emergency Medicine, Seoul, South Korea, 2 Seoul National University Bundang Hospital -Department Of Emergency Medicine, Seoul, South Korea, 3 Seoul National University Hospital Biomedical Research Institute - Laboratory Of Emergency Medical Services, Seoul, South Korea, 4 Jeju National University Hospital - Department Of Emergency Medicine, Jeju, South Korea, 5 Seoul Metropolitan Fire Academy, Seoul, South Korea Background: The body position of cardiopulmonary resuscitation (CPR) could be selected with mechanical chest compression devices. The former studies showed that head-up tilt at 30° position with CPR is hemodynamically beneficial than supine position in porcine cardiac arrest model.

To verify the effect of head-up position on survival after CPR in porcine cardiac arrest model.

Methods: This is a randomized experimental trial using female farm pigs (n=18) (42 ± 3kg) sedated, intubated, and paralyzed on a tilt table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support (BLS) was performed in a position randomly assigned to either head-up tilt at 30° or supine with mechanical CPR device, Lucas-2 (L) and an impedance threshold device (ITD).

And it was followed by 20 minutes of advanced cardiac life support (ACLS) with L-CPR+ITD in same position.

The main outcome of the study is 24-hr survival, analyzed by Fisher’s exact test.

Results: Baseline hemodynamic parameters among pigs were not different. 2 pigs were excluded because severe lung contusion and hemothorax, maybe due to improper chest compression. In head-up position group, 8 pigs were included, only one pig had the recovery of spontaneous circulation (ROSC), but expired after 24hr.

After all, all 8 pigs are expired in head-up group. In supine position group, 8 pigs were included, 6 pigs had the ROSC, and survived 24-hr at all. Only 2 pigs were expired (no ROSC) in supine group. There was statistical significance between two groups (p<0.01 by Fisher’s exact test).

Conclusions: Head-up 30° position of mechanical CPR had no benefit on survival than traditional supine position, even it looks harmful for survival, in porcine cardiac arrest model.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M067

THE EFFECT OF RESUSCITATION POSITION ON CEREBRAL AND CORONARY PERFUSION PRESSURE DURING MECHANICAL CARDIOPULMONARY RESUSCITATION IN PORCINE CARDIAC ARREST MODEL

Y. Park 1, T. Kim 2, S. Shin 1, K. Song 1, D. Jang 3, H. Moon 3, J. Kim 3, S. Song 4, S. Kim 5, S. Jeong 1

1

Seoul National University Hospital - Department Of Emergency Medicine, Seoul, South Korea, 2 Seoul National University Bundang Hospital -Department Of Emergency Medicine, Gyeong Gi, South Korea, 3 Seoul National University Hospital Biomedical Research Institute - Laboratory Of Emergency Medical Services, Seoul, South Korea, 4 Jeju National University Hospital - Department Of Emergency Medicine, Jeju, South Korea, 5 Seoul Metropolitan Fire Academy, Seoul, South Korea Background: Mechanical compression devices can allow us to select a positon during transport with cardiopulmonary resuscitation (CPR) in a small space (like elevator) to reduce the length of stretcher cart.

To evaluate whether resuscitation position is associated with cerebral perfusion pressure (CePP) or coronary perfusion pressure (CoPP).

Methods: This is a randomized crossover experimental trial using female farm pigs (n=12) (42 ± 3kg) sedated, intubated, and paralyzed on a tilt table. After surgical preparation, 6 minutes of untreated ventricular fibrillation was induced followed by 3 minutes in 0° supine position as a stabilization period with mechanical CPR device, Lucas-2 (L) and an impedance threshold device (ITD). Then, 5 minutes of L-CPR+ITD was performed in a position randomly assigned to either head-up tilt at 30°, 45°, or 60° or head-down tilt at 30°, 45°, or 60° followed by 5 minutes of L-CPR+ITD in crossover position to the other. We measured and compared the CePPs and CoPPs at the positions using ANOVA with Duncan post-hoc test.

Results: Baseline hemodynamic parameters among pigs were not different. From head-down to head-up by elevation of angle, mean aortic pressures slightly decreased and intracranial pressure significantly decreased.

With 60°, 45°, 30° head-down, 0°(supine), and 30°, 45°, 60° head-up positioning, CePPs increased linearly as follows: 2.4± 3.1, 9.3±3.9, 16.5±5.0, 27.0±2.3, 35.1±1.2, 39.4±12, 39.9±1.5mmHg respectively (p<0.001 by ANOVA and all significant for post-hoc test). CoPPs was peak in head-up 30 °: 12.9± 4.2, 13.3±5.0, 12.8±2.9, 18.1±2.0, 30.3±1.5, 24.1±1.7, 26.5±1.9 mmHg respectively (p<0.001 by ANOVA post-hoc test except between head-down -30° and -65°).

Conclusions: Mechanical CPR position was associated with different cerebral perfusion pressure by head-up angles. The head-up 30° showed the peak coronary perfusion pressure.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M068

STEMI TREATMENT AND OUTCOMES IN THE RURAL U.S. FRONTIER

D. Gerard 1, J. Langabeer Ii 2, W. Segrest 3, D. Smith 4, B. Leonard 3, M. Seo 2, T. Owan 5, M. Khan 6, C. Krell 7, M. Eisenhauer 8

1

Campbell County Memorial Hospital, Gillette, Wy, Usa, 2 University Of Texas Health Science Center, Houston, Tx, Usa, 3 American Heart Association, Denver, Co, Usa, 4 University Of Wyoming, Laramie, Wy, Usa, 5 University Of Utah, Salt Lake City, Ut, Usa, 6 South Lincoln Medical Center, Kemmerer, Wy, Usa, 7 Cardiologist, Casper, Wy, Usa Background: Comparatively less is known about ST-elevation myocardial infraction (STEMI) treatment and outcomes in rural and frontier regions than those in urban metropolitan areas. Rural geographies pose unique challenges due to weather, mountainous terrain, excessive driving distances, mostly volunteer emergency medical service crews, and limited number of percutaneous coronary intervention (PCI) facilities. The impact of these rural factors on time-to-treat outcomes and treatment protocols are not well understood. Through a three-year program sponsored by the American Heart Association, we sought to assess and systematically measure the change in treatment and outcomes for STEMI patients that presented in and around the state of Wyoming.

Methods: We analyzed all 395 STEMI patients that presented for primary PCI to all 10 facilities and around Wyoming from January 1, 2013 to December 31, 2014. This dataset represents a 2-year observational period, only, and data collection is on-going. We implemented standardized protocols for treating STEMI, conducted multiple training programs, and implemented technologies to allow for transmission of electrocardiogram (ECG) from the ambulance to the receiving facility. We calculated outcome metrics, including both time-to-treat (door to balloon, total ischemic time) and mortality for all patients. A multivariate regression was developed to measure the impact of transfer patients, utilization of emergency medical services, and other confounding factors on total ischemic time (measured in minutes).

Results: Nearly 65% of all patients were first seen at an acute facility and transferred to definitive care, versus the national average of approximately 30%. Median door in-door out (DIDO) time for the referring hospitals was 130 minutes prior to transfer, and onset to arrival at first facility median was 120 minutes. Multivariate regression confirmed that transfers, utilization of EMS, and gender are statistically related to total ischemic times for (R2=.21, p<.001).

Conclusions: Outcomes in rural regions are impacted by distance, low utilization of EMS, and high transfer rates from acute care and critical access hospitals. These findings suggest the need for continued focus on collaboration, aggressive reperfusion strategies on eligible transfer patients, standardized treatment plans, and continuing STEMI process education.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M069

CARDIAC ARRESTS IN NORTHERN EMIRATES, UAE: A ONE YEAR REVIEW

A. Al-Hajeri 1, A. Batt 1,2, B. Haskins 1,3, M. Minton 1, F. Cummins 1,3,4

1

National Ambulance Llc, Abu Dhabi, United Arab Emirates, 2 Centre For Prehospital Research, University Of Limerick, Limerick, Ireland, 3 Charles Sturt University, Nsw, Australia, 4 Graduate Entry Medical School, University Of Limerick, Limerick, Ireland Background: Emergency Cardiovascular Care (ECC) chain of survival, requires five elements to be acted upon to improve a patient’s chance of survival from cardiac arrest: • Immediate recognition of cardiac arrest / activation of the emergency response system • Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions • Rapid defibrillation • Effective advanced life support • Integrated post-cardiac arrest care In recognition of this chain, a newly launched ambulance service has sought to provide King County Criteria Based Dispatch training to all its emergency dispatchers to ensure staff were able to quickly recognise a patient in cardiac arrest, and immediately offer the caller CPR and pre-hospital defibrillation advise prior to the ambulances arrival. Alongside these initiatives Ambulances Communication Centre (ACC) utilised geo location technology to appropriately dispatch emergency personnel thereby also minimising delays delivering the patient to emergency care facilities.

Methods: To evaluate the effect of these initiatives, the ambulance service also began working collaboratively with the Pan Asian Resuscitation Outcomes Study (PAROS). Data from cardiac arrest calls entered into the PAROS database were reviewed to determine the number of cardiac arrests attended in a one-year period, frequency with which CPR advice was provided and acted upon, and the rate of Return of Spontaneous Circulation (ROSC).

Results: In the first year, 385 cardac arrests were entered into the PAROS database. 100% were provided with diapatcher-assisted CPR instructions, 70% acknowledged these instrctin, and 30% had bystander CPR performed. 100% had an AED applied (1% had an AED applied by a bystander; 99% applied by NA personnel).

71% had a mechanical CPR device applied by National Ambulance personnel, and 84% had an advanced airway inserted by National Ambulance personnel.

Conclusions: These findings demonstrate that the early initiation of the chain of survival is positively effecting cardiac arrest survival outcomes in the population studied. Overall ROSC rate can increase dramatically with cooperation between National Ambulance and hospitals on PAROS data and community initiatives

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M070

OUT OF HOSPITAL CARDIORRESPIRATORY ARREST IN GALICIA (SPAIN)

L. Sanchez Santos 1, A. Rodriguez Rivera 1, L. Chayan Zas 1, J.M. Aguilera Luque 1, C. López Unanua 1, G. Pérez López 1, M.V. Barreiro Díaz 1, J.A. Iglesias Vazquez 1

1

Emergencies Medical System Of Galicia - 061, Santiago, Spain

Background: To describe the characteristics and outcome of the out-of-hospital cardiorespiratory arrest in Galicia, a community with a high-scattered population, with 2750000 people.

Methods: Prospective, observational database including all the out-of-hospital cardiorespiratory arrests (OHCA) registered by the Emergency Medical Systems (EMS) of Galicia, with data collected according to Utstein style.

Period of study: October 2013 to September 2014.

Results: In this period 408 OHCA were registered. Of them, 302 (74.02%) were ale. Mean age was 63,03±15.0 years. The event occurred at home in 51.5% and was witnessed in 93.1% of cases (by a bystander in 59.1%, EMS staff in 24.7%, and first responder in 16.2%). Basic life support was provided in 61.7% of cases (by a bystander in 36.0%, and first provider in 64.0%). The first detected rhythm was non-shockable in 62.5% and shockable in 37.5%. The arrest’s aetiology was cardiac in 56.9%, respiratory in 23.3%, traumatic in 15.2%, drowning in 1.5%, neurological in 2.0%, and others in 0.5%. ROSC was achieved in 36.8% patients and 3.4% were admitted to hospital in on-going CPR. Survival at hospital discharge was 15.9%, and 10.6% had good neurologic condition at that time.

Conclusions: Despite Galicia is a community with a high-scattered population, survival and neurological condition of survivors to an OHCA are at hospital discharge, similar to those found in communities or locations with much more higher densities of population. Even though in Galicia the current rate of bystander CPR is acceptable, considering the special circumstances of our population must be increased. ROSC, survival to hospital discharge and neurological outcome in these patients need to be improved by means of multifaceted resuscitation strategies.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M071

DEFINING THE EMERGENCY CODE CALLS IN A STATE MILITARY HOSPITAL: SCOPE AND TIME

N. Salman 1, O. Tezel 1, Y.A. Acar 1, Y. Arslan 2

1

Etimesgut Military Hospital Department Of Emergency Medicine, Ankara, Turkey, Department Of Pulmonary Medicine, Ankara, Turkey

2

Etimesgut Military Hospital

Background: Emergency code calls includes cases requiring resuscitation or in need of immediate medical attention. At our state military hospital, we respond to code calls with a four member medical emergency team in day time. We aimed to obtain characteristics of code calls and responses at a 18 month time period with this study. We are presenting the preliminary report of a 12 month time of this observation.

Methods: A prostective observational study. Emergency department registration officer recorded the call date, call mode (by phone or bystander), location, call time. After the procedure, physician of the team completed the dataset per patient (time of reaching to location, patient name-surname-ID number, diagnose and result).

Response time was recorded in seconds, and distance of location was recorded in meters.

Results: During 12 month period, 34 code calls occurred. The median age of patients was 21 (17-80), 8.8 % (n=3) of the patients were female and 91.1% (n=31) of the patients were male. Patients were grouped into three groups (policlinic admission patients 67.6 %, n=23; inpatients 14.7 %, n=5; visitors and hospital personnel 17.6 %, n=6). 64.7 % (n=22) of code activations were made by none â&#x20AC;&#x201C; healthcare professionals and 82.3 %, n=22 of code activations were made by the way of telephone calls. Mean distance of response points from emergency department was 129.83 (40-174) meters and mean response time was 103.82 (60-180) seconds.

Cardiopulmonary resuscitation was performed for only one patient in a suicide case of visitor group.

Conclusions: In our hospital settings, visitors and hospital personnel are under the risk of emergent conditions as much as inpatients. Basic life support education of bystanders is important because majority of code calls were witnessed and notified by non-healthcare professionals. Telephone system is enough efficacious for code call activation for a medium scaled hospital.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M072

THE PREVALENCE AND SIGNIFICANCE OF TRACHEAL INTUBATION-RELATED IN-HOSPITAL CARDIAC ARREST

Y. Park 1, R. Ahn 2, S.M. Ryoo 1, S. Ahn 1, C.H. Sohn 1, D.W. Seo 1, K.S. Lim 1, J.W. Ko 3, W.Y. Kim

1

1

Asan Medical Center, Department Of Emergency Medicine, Seoul, Korea, Seoul, South Korea, 2 Ulsan University College Of Medicine, Department Of Emergency Medicine, Ulsan, Korea, Ulsan, South Korea, 3 Chosun University College Of Medicine, Department Of Ophthalmology, Gwangju, Korea, Gwangju, South Korea Background: Less attention has been paid to prevalence and outcome of emergency tracheal intubation-related cardiac arrest (CA). This study describes and compares the clinical features and outcomes of intubation-related CA and other causes of in-hospital CA. Methods: All study patients were consecutive adults (= >18 years) who developed CA in our emergency department between January 2007 and December 2011. Emergency tracheal intubation-related CA was defined as CA that occurred < = 20 minutes after successful intubation. Clinical variables were compared between patients with intubation-related CA and intubation-unrelated CA. The primary outcome was a good neurological outcome, which were defined as a cerebral performance category score of 1–2. The secondary outcome was survival to hospital discharge.

Results: Of 251 patients treated at our hospital who developed CA, 41 were excluded due to trauma-related CA or ‘do not resuscitate’ protocols, thereby leaving 210 patients available for analysis. The prevalence of intubation-related CA was 23.3%, and the median duration between successful intubation and CA was 5.0 minutes (interquartile range = 2.0–9.5). Pulseless electrical activity was more commonly noted as the first arrest rhythm in the intubation-related CA group (75.5% vs 59.0%; p=0.03) compared with patients with other causes of CA. However, the rates of good neurological outcomes (14.3% vs 21.1%) and survival to discharge (34.7% vs 35.4%, respectively) were not significantly higher in intubation-related CA group (both p > 0.05).

<FILE IMAGE='160_20150528104554.jpg'> Conclusions: Tracheal intubation related-CA occurred higher than commonly appreciated. Furthermore, patient outcomes were not better in comparison with other causes of CA. These data suggest that further efforts are needed to prevent intubation-related CA.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M073

EFFECTS OF ALTERNATING HANDS DURING 30:2 COMPRESSION-TO-VENTILATION CARDIOPULMONARY RESUSCITATION USING ONE-HANDED CHEST COMPRESSIONS

RATIO

G. Seo 1, G.H. Jung 1, J.H. Oh 1, C.W. Kim 1, S.E. Kim 1, D.H. Lee 1

1

Department Of Emergency Medicine, Chung-Ang University Hospital, Seoul, Republic Of Korea, Seoul, South Korea Background: This study was conducted to determine whether compression depth changes during one-handed chest compression (OHCC) and to evaluate the effect of changing the compression technique from the OHCC to the two-handed chest compression (THCC) and alternating compression hands every other cycle.

Methods: A 5-year-old child-sized manikin was used, and 50 medical students participated. The participants performed OHCC with a 30:2 compression-to-ventilation ratio on the floor (baseline test). Second, the compression technique was changed from the OHCC to the THCC when they became subjectively fatigued (test 1). Third, the compression hand was alternated every other cycle (test 2). All tests were performed for 5 min.

The test 1 and 2 sequences were allocated randomly with a cross-over design. Average compression depth (ACD) data were collected using an accelerometer device. All data were calculated at 1-min intervals using the Q-CPR review software.

Results: ACD changed significantly during the baseline test (0–1 min: 44.5 ± 5.3 mm, 1–2 min: 43.7 ± 6.1 mm, 2–3 min: 43.4 ± 6.5 mm, 3–4 min: 43.2 ± 6.5 mm, and 4–5 min: 42.3 ± 6.5 mm, P = 0.012). However, no significant differences were observed during test 1 (0–1 min: 43.8 ± 5.6 mm, 1–2 min: 44.5 ± 5.8 mm, 2–3 min: 44.6 ± 5.2 mm, 3–4 min: 44.2 ± 5.4 mm, and 4–5 min: 44.5 ± 5.1 mm, P = 0.169) or test 2 (0–1 min: 43.9 ± 5.3 mm, 1–2 min: 43.8 ± 5.6 mm, 2–3 min: 43.7 ± 5.9 mm, 3–4 min: 44.1 ± 6.2 mm, and 4–5 min: 44.2 ± 6.1 mm, P = 0.426). The baseline ACD value for the 4–5-min interval (95% CI, 40.5–44.2 mm) was significantly lower than those in test 1 (95% CI, 43.0–45.9 mm, P = 0.004) and test 2 (95% CI, 42.4–45.9 mm, P = 0.004).

Conclusions: Compression depth decreased significantly after 4 min during 30:2 ratio OHCC. However, it was maintained by changing from the OHCC to the THCC or by alternating compression hands every other cycle.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M074

A COMPARISON OF EFFECTS OF EARLY PLEVIX TREATMENT WITH DOSAGE OF 150MILLIGRAMS AND 300 MILLIGRAMS IN EMERGENCY WARDS

S. Esfandiari 1, M. Kalantari Meibodi 1

1

Shiraz University Of Medical Science, Shiraz, Iran

Background: considering the high rate of cardiovascular disease in Iran and the high morality rate related to such conditions its imperative to allocate resources to treat those already affected while continuing the current trend of emphasis on disease prevention tactics. Because coronary conditions demonstrate a wide range of signs and symptomes (from un stable until MI) and treatment should be done in a manner consistent with the syndrome observed, a quick diagnosis should be a priority for the medical staff in emergency wards Methods: First of all we choose shiraz hospitals which received a great number of cardiovascular patients (namazi Hospitals). Early doses of Plavix was administered to patients with cardiovascular conditions. In 50 patients in namazi hospital the initial dose was chosen at 150 milligrams while in 50 patients in emergency room it was decided to set the initial dose at 300 milligrams. This drug is found in the market in two forms. One Iranian made and the other made by the original manufacturer Results: Patients suffering from acute coronary condition, which given a dose of 150 milligrams, were hospitalized for 48 to 72 hours and then discharged while patients of a similar condition who were not given the shot or recived 300 miligram were usually hospitalized for 96 hours before being discharged. It seems that early administration of 150 milligrams of Plavix has a positive effect on quick recovery of patients with coronary conditions.Patients with acute coronary conditions who reported to namazi hospital were given an initial dose of 300 milligrams or not any drug Conclusions: It could be concluded that taking special circumstances of our country into account, administering an early low dose of Plavix (at emergency ward stage) is preferable to a later administration after thorough medical examination and it is also preferable to the administration of high doses. Others may study the difference between the effects of the generic version with that of the original version to complement the current study.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M075

ANTIOXIDATIVE PROFILE IN PATIENTS WITH DILATED CARDIOMYOPATHY AND HEALTHY INDIVIDUALS

I. Milinkovic 1, D. Simeunovic 1,2, A.D. Ristic 1,2, I. Zivkovic 1, A. Pavlovic 1, G. Radovanovic 1, P.M. Seferovic 1,2

1

Department Of Cardiology, Clinical Center Of Serbia, Belgrade, Serbia, Belgrade, Belgrade, Serbia

2

School Of Medicine, University Of

Background: The role of oxidative stress in the pathogenesis and progression of chronic heart failure has been investigated. The aim of our study was to compare antioxidative profile in patients with dilated cardiomyopathy (DCM) and healthy controls, before and after exercise testing.

Methods: Prospective study included 82 patients with DCM (age 48.88±13.7; 81.7% males) and 45 healthy control subjects (age 44.89±7.73; 71.1% males). All patients had previously established diagnosis of idiopathic DCM based on clinical presentation, echocardiography and normal coronary angiogram. We determined levels of antioxidative enzymes (superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase) and antioxidative non-enzyme component vitamin C, in rest and after cardiopulmonary exercise testing. Enzyme components were measured in washed red blood cells (superoxide dismutase by the method of McCord and Fridovich, catalase by the method of Beutler, glutathione reductase and glutathione peroxidase by the methods of Paglia and Valentine). Plasma was separated from whole blood and used to determine levels of non-enzyme component vitamin C by Okamura method.

Results: DCM patients had significantly higher levels of superoxide dismutase compared to control group (2768.82±714.17 vs. 2372.89±761.96, p=0.004). Also, levels of glutathione reductase and glutathione peroxidase were higher in DCM group (5.77±1.03 vs. 4.28±0.73, p<0.001 and 14.67±2.13 vs. 11.9±1.42, p<0.001, respectively). Additionally, healthy individuals had higher levels of catalase (16.26±3.23 vs.

12.18±2.75, p<0.001). Vitamin C levels were higher in control group in comparison to DCM patients (45.97±9.68 vs. 37.43±14.63, p<0.001). After exercise testing, superoxide dismutase, glutathione reductase and glutathione peroxidase were also higher in DCM patients than in controls (p=0.008, p<0.01 and p<0.001, respectively).

Levels of catalase and vitamin C were significantly higher in controls (p<0.001 and p<0.001, respectively) after exercise testing.

Conclusions: This study revealed higher levels of superoxide dismutase, glutathione reductase and glutathione peroxidase in DCM than in healthy controls. Catalase and vitamin C were higher in control group. Antioxidative profile remained unchanged after cardiopulmonary exercise testing between DCM and control group. Although, abnormal antioxidative stress profile in DCM in comparison to controls was revealed in this study, further research is needed to clarify its clinical significance.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M076

FIRST STUDY WITH HEART SCORE CALCULATED WITH HIGH SENSITIVE TROPONIN IN THE EVALUATION OF PATIENTS WITH CHEST PAIN IN EMERGENCY ROOM

L. Santi 1, G. Farina 1, M. Cavazza 1

1

Policlinico S. Orsola-Malpighi, Pronto Soccorso E Medicina D' Urgenza, Bologna, Italy

Background: Chest pain is one of the most common reason for Emergency Department evaluation. The challenge is to rapidly identify patients with non-urgent or even absence of disease who can be safely discharged avoiding unnecessary diagnostic procedures and hospital monitoring lasting from several hours to days. The HEART score is a recently developed simple bedside scoring system that quantifies the risk of major adverse cardiac events in patients presenting with undifferentiated chest pain. It has been validated for conventional troponin and not for high sensitive troponin. We tested the hypothesis that patients with a low HEART score calculated with high sensitive troponin can be safely discharged, decreasing the utilization of cardiac tests and the length of the hospital stay. Furthermore we evaluate the performance of the HEART score with high sensitive troponin to predict MACE within 180 days in the three HEART score groups (low, intermediate, high). To the best of our knowledge, this is the first study to have used the high sensitive troponin in the calculation of the HEART score. <FILE IMAGE='101_20150514145537.jpg'> Methods: We retrospectively analyzed the HEART scores of consecutive 688 patients admitted for chest pain of our Hospital in the period lasted from January 1 to March 7 2014. A 180 days follow up was performed to evaluate the numbers of major adverse cardiac events. A total of 595 patients were included. In 36 (6.4%) cases, the follow-up was incomplete. The study therefore consisted of the remaining 559 patients.

Results: None of the patients with HEART score between 0 and 3 had a MACE within 180 days. The difference between the cumulative incidence of events at 180 days in the three HEART score groups was statistically significant (p<0.0001). The area under the ROC curve was > 0.8, with a negative predictive value of 100%.

Conclusions: We demonstrate that the HEART score with high sensitive troponin is a very simple tool able to identify a group of 232 patients (41.5% in our series) presenting with chest pain who can be easily discharged without any other observational period or further cardiac tests.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M077

MANAGEMENT OF NSTEMI IN AN EMERGENCY DEPARTMENT: RESCUS REGISTRY (ABOUT 96 PATIENTS)

N. Azaiez 1, A. Zorgati 2, L. Boukadida 3, K. Belhaj Ali 4, W. Kacem 5, A. Jerbi 6, R. Boukef 7

1

Sahloul Hospital, Emergency Department, Sousse, Tunisia

Background: Chest pain is a common reason for emergency department visit. The STEMI remains the ultimate emergency to eliminate first. Currently more attention is paid for NSTEMI because of its long term risk of mortality. American and Europeen guidelines recommend an early recognition and management in Emergency department using risk stratification and respect of recommended delays. An improvement in the overall management requires a better practice on our emergency departments.

Methods: we used data from ReSCUS (Coronary Syndrome Registry Emergency Sahloul) over a period of 11 months. ReSCUS is an observational database of the pre-hospital and hospital management of patients with acute coronary syndrome. We collected detailed demographic informations, cardiovascular history, risk factors, co morbidities, clinical presentation, delays of ECG realization, drugs administration, strategy of medical care and discharge.

Results: We included 95 patients . The average age was 55 years. sex ratio = 1.8. patients consulted directly to our emergency department are 62 while 25 are referred. Only 10% of cases were taken care by SAMU. Hypertension, smoking and dyslipidemia are the three predominant risk factors . Diabetes is present in less than a third of cases. The average time to ECG was 38 minutes. The most electrical abnormality found was the ST segment depression (60% of cases).Two pointâ&#x20AC;&#x2122;s troponins are made for all our patients.

The clinical presentation was complicated in 26 cases: three patients (3.15%) by a cardioloogenic shock, Eighteen patients presented pulmonary oedema; 5 patients (5.35%) had conduction disorders. There were more than 21.4% of patients having a high risk of hospital mortality according to the TIMI score.

All NSTEMI positive troponins were admitted to the Cardiology Department. 62.1% which were initially oriented to ICU-cardiology, n = 36 the cardiology ward. The median time of consultation -Hospitalization was 7h31min (min 1 hour, max 18 hours) for patients with a TIMI score > = 5. Many patients were hospitalized in our observation unit till hospitalization.

Conclusions: The management of NSTEMI depends mainly on risk stratification. It remains unsatisfying in our emergency department in accordance of the long care delay and discharge.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M078

SEVERE HYPERTENSIVE IN THE EMERGENCY DEPARTMENT: EVALUATING BLOOD PRESSURE RESPONSE TO REST AND TO ANTIHYPERTENSIVE DRUG

H. Ghazali 1, S. Kskes, N. Elheni, M. Bayar, A. Yahmadi, J. Essid, S. Chiboub, S. Souissi

1

Regional Hospital, Emergency Department, Ben Arous, Tunisia

Background: The aim of this study was to determine the efficacy and safety of two therapeutic strategies, rest versus use of antihypertensive drugs (Lopril 25mg) to manage patients with severe hypertension without acute target organ damage in emergency department.

Methods: Prospective, randomized, open label over 6 months study. Inclusion: patients (age>= 18 years old) with severe hypertension, defined as a diastolic blood pressure level >=110 mmHg and, or a systolic blood pressure level >=180 mmHg. Exclusion criteria: patients with acute target organ damage or if they had received an antihypertensive drug within the previous 60 minutes. Pregnant women were also excluded. Randomization of patients into two groups: Group 1 (rest): put to rest for two hours, Group 2 (Lopril 25mg): put under a single dose of Lopril 25mg. The blood pressure is measured at 60 and 120 min. Outcomes: a satisfactory blood pressure response (defined as post-intervention systolic blood pressure <180 mmHg and diastolic blood pressure <110 mmHg, with at least a 20 mmHg reduction in basal systolic blood pressure and , or a 10 mmHg reduction in basal diastolic blood pressure) and no adverse events or rapid decline in blood pressure > 20% of baseline values.

Results: Inclusion of 86 patients. . Mean age = 60 Âą 12 years. Sex ratio = 0.9. Group (rest): n = 44 , Group (Lopril25mg) : n = 42 . At 60 min , responders to lopril were 40 (95 %) patients versus 36 (81 %) patients in Group (rest) (p = 0.02). At 120 min , responders to lopril were 40 (95 %) patients versus 40 (90 %) patients in Group (rest) (p = NS) . A rapid decline in blood pressure> 20% was observed in 15 (35 %) patients in Group (Lopril 25mg) versus 4 (9 %) patients in Group (rest) (p = 0.004) . No major adverse events were observed in the two groups.

Conclusions: The introduction of medical treatment can be effective and safe for the management of patients with severe hypertension in emergency department.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M079

THE IMPACT OF EMERGENCY DEPARTMENT IN DELIVERING CARE FOR NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

Z. Guermazi 1, N. Nouira 1, R. Farah 1, I. Makki 1, N. Elouafi 1, A. Missaoui 1, M. Ben Cheikh 1

1

Service D'accueil Des Urgences, La Marsa, Tunisia

Background: Because millions of patients visit emergency departments with coronary syndrome non-ST-segment elevation , including non-ST-segment elevation myocardial infarction, and unstable angina, we must evaluate the medical approch of these patients in emergency services, Purpose: to assess the influence of emergency department structure and care processes in the treatment of patients with non-ST-segment elevation acute coronary syndromes: specificity of clinical presentation, medical approach and outcome Methods: A prospective study including 140 patientsâ&#x20AC;&#x2122;18-years old and more, admitted for non-ST elevation ACS to the emergency department between June 2014 and April 2015.

Results: The mean age was 62 years with a sex ratio of 1.63. In 83,2% of cases patients consult directly emergency . 10,7% of cases were referred from other hospitals. 90,5% of patients consult the emergency department using their own means of transport. The median time to consultation was about 6h. The risk factors found were mainly: hypertension (61,4%), diabetes (52,6%) and tobacco (46,7%). In 84,7% of cases the chest pain was typical. Ultrasensitive troponins were positive in 63,5% of the cases. All patients had anti-ischemic drug treatment at admission in ED: Aspirin (96,4%), Clopidogrel (93,4%), anticoagulation by LMWH (91,2%), statins (86,9%), ACE inhibitor (59,9%), BB (45,3%). nitrates (50,4%), 6 patients had non invasive ventilation and 2 patients had ymechanical ventilation, an external electric shock for one patient with ventricular tachycardia. In 42,6 % of cases patients were hospita lized in the cardiology department of the same hospital, coronary angiography was performed for the majority of patients, 45,1% of patients were discharged at home without any coronary investigation, the average ED stay was about 75h. are easily hospitalized in the cardiology department: the smoking patients (p=0,02),the younger (p=0,01), diabetics with a blood glucose level less than 2g/l (p=0,04).

Conclusions: Non-ST-segment elevation ACS is a particularly challenging clinical entity due in part to limitations in the diagnostic tools employed to detect it and the wide range of therapeutic options available to treat it. the urgentist must be familiar with appropriate diagnostic and therapeutic treatment measures, especially given the limited capacity of cardiology hospitalization.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M080

VIRAL GENOME CHANGES IN MYOCARDIUM IN 6-MONTH FOLLOW-UP AND THE IMPACT OF PARVOVIRUS B19 PRESENCE ON CELLULAR INFILTRATION IN PATIENS WITH INFLAMMATORY CARDIOMYOPATHY.

D. Mlejnek 1, J. Krejci 1, P. Hude 1, T. Freiberger 3, V. Zampachova 2, E. Nemcova 3, R. Stepanova 4, L. Spinarova 1

1

Department Of Cardiovascular Diseases, St. Annes University Hospital,, Brno, Czech Republic, 2 1st Department Of Pathologic Anatomy, St. Annes University Hospital, Brno, Czech Republic, 3 Centre For Cardiovascular Surgery And Transplantation, Brno, Czech Republic, 4 International Clinical Research Center, St. Anns University Hospital, Brno, Czech Republic, 5 Masaryk University, Brno, Czech Republic Background: Issue of inflammatory cardiomyopathy and presence of pathological agents, especially viruses, in myocardium is very controversial topic. Impact of viral presence in myocardium at inflammatory changes is uncertain.

Methods: 44 patients with biopsy-proven myocarditis and with left ventricular ejection fraction below 40% were enrolled in this study. The number of infiltrating cells was assessed in the time of diagnosis, a detection of pathological agents in the myocardium was performed by PCR for Parvovirus B19(PVB 19), Cytomegalovirus(CMV), Epstein-Barr virus(EBV), Herpes simplex virus 1 and 2(HSV 1, 2), Human herpes virus 6(HHV-6) and Adenovirus(AV), Borrelia burgdorferi and enterovirus(EV). Examinations were repeated in 6 months follow-up.

Results: CMV at baseline in 6,8% (3/44), at 6 months in 14% (6/43), EBV at baseline 11% (5/44), at 6 months in 9% (4/43). HHV-6 at baseline 5% (2/44), at 6 months 5% (2/43). HSV 1 and 2 at baseline 5% (2/38), at 6 months none was found. PVB 19 at baseline in 71% patients (31/44), at 6 months in 52% (23/44). Adenovirus, enterovirus and Borrelia burgdorferi were not detected in any of the samples.

In group of patients with decrease PVB 19 viral load there was significant decrease in number of infiltrating leucocytes(LCA+) from 32 ± 42 to 17 ± 22 cells/mm2 and T-lymfocytes(CD3+) from 9 ± 11 to 7 ± 11 cells/mm2 and in the group with no change or increase of PVB 19 viral load there were aswell decrease in LCA + from 20 ± 5 to 13 ± 5 cells/mm2 and CD3+ from 6 ± 5 to 4 ± 2 cells/mm2 (all p < 0,05). Between both groups there were no significant difference in change of LCA + -15 ± 44 cells/mm2 compared to -7 ± 7 cells/mm2 (p=0.231) and CD3 + -3 ± 14 cells/mm2 compared to -3 ± 4 cells/mm2 (p=0.614).

Conclusions: There was almost no difference between baseline and 6 months follow-up in presence of viral agents. In the most frequent virus PVB 19 was not found any correlation between change of viral load and change of level of inflammatory activity in myocardium.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M081

PREDICTORS OF 6 MONTHS OUTCOME IN PATIENTS WITH ACUTE CORONARY SYNDROMES WITHOUT PERSISTENT ST-SEGMENT ELEVATION

H. Ghazali 1, S. Mahdhaoiui, G. Chaabeni, A. Yahmadi, W. Bousselmi, M. Mougaida, M. Mguidich, S. Souissi

1

Regional Hospital, Emergency Department, Ben Arous, Tunisia

Background: Objective: Identify predictive factors of 6-month mortality in patients with non-ST-segment elevation in emergency department.

Methods: Prospective observational study was conducted over two years. Patients were eligible for inclusion if the diagnosis of non-ST-segment elevation acute coronary syndrom was made (based on anamnestic, clinical, electrocardiographic and biological criteria). The demographics, co-morbidities, clinical, biological data and in-hospital procedures were collected. The prognosis was evaluated on the 6-month mortality. Multivariate analysis by multiple logistic regressions was performed to identify predictors of mortality.

Results: Inclusion of 111 patients. Mean age = 63 Âą 10 years. Sex ratio = 1.5. Comorbidities n (%): hypertension 66(59), diabetes mellitus 51(46), coronaropathy 42(38), hypercholesterolemia 31(28) and current smoker 36(33). Mortality rate was 8.1%. In multiple logistic regression age> = 75 years (odds ratio adjusted = 23.5; p<0,001; 95% confidence interval (4.92 -11)), a Thrombolysis in Myocardial Infraction (TIM)I score >= 4 (odds ratio adjusted = 6.7; p=0,01; 95% confidence interval (1.32 -35)), a Global Registry of Acute Coronary Events (GRACE) score >= 145 (odds ratio adjusted= 27; p<0,001; 95% confidence interval (3.22 -22)) and a bypass history (odds ratio adjusted = 28.85;p=0,01; 95% CI (2.32 -35)) were independent predictors of poor prognosis Conclusions: This study shows that age > = 75 years, a TIMI score >= 4, GRACE score >= 145, a bypass history were independently associated with a higher mortality at 6 months.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M082

COMPARISON OF THE ELECTROCARDIOGRAPHIC FINDINGS IN PATIENTS WITH NON ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: CLINICAL CHARACTERISTICS AND PROGNOSIS

R. Jabri 1, H. Ghazali, M. Bayar, A. Yahmadi, M. Gammoudi, A. Azouzi, R. Aloui, S. Souissi

1

Regional Hospital, Emergency Department, Ben Arous, Tunisia

Background: Objective: Compare the clinical characteristics and outcomes of non ST-segment elevation myocardial infarction subgroups: ST segment depression, T wave depression and no ischemic changes.

Methods: Prospective observational study was conducted over two years. Inclusion: patients (age>18 years old) with the diagnosis of non ST-segment elevation myocardial infarction. The demographics, co-morbidities, clinical, biological data and in-hospital procedures were collected. Subjects were divided into three groups based on baseline electrocardiogram findings: no ischemic changes, T-wave inversion and ST-segment depression.

The prognosis was based on the evaluation of mortality at 6 months. Multivariate analysis by multiple logistic regressions was performed.

Results: Inclusion of 111 patients. Mean age: 63 Âą 10 years. Sex ratio: 1.52. Co-morbidities n (%): hypertension 66(59), diabetes 51(46), known coronary artery disease 42(38), dyslipidemia 31(28).

Thirty four patients (31%) had no ischemic changes, 30(27%) had T-wave inversion and 46(42%) had ST-segment depression in their baseline electrocardiogram.

The demographics, co-morbidities, clinical, biological data were similar in the three groups. Hospital revascularization was made for all patients in the three groups.

The mortality rate at 6 months was 0% for the no ischemic group, 3% for the T-wave inversion group and 13% for the ST-segment depression group.

Patients with ST-segment depression were 4 times more likely to die within 6 months than patients with T-wave inversion (odds ratio adjusted =4, 25, p <0,001, 95% confidence interval 0,773 to 0,972), and 2 times more than the no ischemic changes group (odds ratio adjusted = 2, 05, p <0, 02, 95% confidence interval 6 to 10, 2).

Conclusions: Patients with ST-segment depression have a greater risk of adjusted in-hospital mortality compared with the other groups. These findings highlight the importance of integrating the presenting electrocardiogram findings into the risk stratification algorithm for patients with non ST-segment elevation myocardial infarction.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M083

DIAGNOSTIC AND PROGNOSTIC VALUE OF BNP, NGAL, ST2, TRIHS IN PATIENTS WITH HYPERTENSIVE CRISIS IN THE EMERGENCENCY DEPARTMENT

F. Cristofano 1, V. Amadoro 1, I. Lalle 1, L. Magrini 1, G. Salerno 2, P. Cardelli 2, S. Di Somma 1

1

Department Of Medical Surgery Sciences And Translational Medicine, Emergency Department, Sapienza University Of Rome, Rome, Italy, 2 Clinical And Molecular Medicine Department, Sapienza University Of Rome, Sant Andrea Hospital, Rome, Italy Background: Aim of this study was to investigate the diagnostic and prognostic role of biomarkers BNP, NGAL, ST2 and TrIHs in patients with hypertensive crisis referring to emergency room, and to evaluate their possible role in the differential diagnosis between hypertensive emergencies or urgencies.

Methods: This was a prospective observational study in hypertensive crisis patients (Systolic Blood Pressure > 180 mmHg and/or Diastolic Blood Pressure > 120 mmHg), presenting to the Emergency Department of Sant’Andrea University Hospital of Rome from August 2014 – February 2015. At emergency department arrival, for each patient the clinical history, physical examination, laboratory and instrumental diagnostic tests results, BNP, NGAL, ST2 and TrIHs were obtained.

Results: 73 patients (M/F 40/35; mean age 66.39±14.05 years) with hypertensive crisis (34 hypertensive emergencies; 39 hypertensive urgencies). Were evaluated patients’ diagnosis at admission in ED was: acute ischemic coronary disease (n 8/34, 24%), acute pulmonary edema (n 8/34, 24%), acute cerebrovascular disease (13/34, 38%), acute renal failure (5/34, 14%). Compared to patients with hypertensive urgencies, patients with hypertensive emergencies showed significantly higher levels of biomarkers (BNP 358.36 ± 504.68 vs 4.80 ± 36.94 pg/ml (p= 0.001); NGAL 85.55 ± 75.33 vs 53.40 ± 22.23 ng/ml (p= 0.04); TrIHs 11.80 [3.34 – 3.67] pg/ml vs 3.75 [2.2 - 8] pg/ml (p < 0.0007). ST2 levels were not different in the two subgroups of patients: ST2 31.55 [21.5 – 51.7] ng/ml e 31.5 [19.42 – 51.07] ng/ml (p= 0.66). We analyzed the prognostic value of biomarkers in terms of probability of hospitalization: BNP showed a significant prognostic value (AUC 0.744, sensitivity 100%, specificity 45%, p<0.0001) similar to the combination of the three biomarkers (AUC 0.672, sensitivity 86%, specificity 50%, p<0.03) Conclusions: BNP, NGAL, ST2 seem to be a potential useful tool in distinguishing hypertensive emergencies from urgencies in Emergency Department. Moreover, BNP, NGAL seem to have a good prognostic value for in-hospital mortality in those patients hospitalized for hypertensive emergency.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M084

MYOCARDIAL INFARCTION AFTER A BLUNT CHEST TRAUMA WITH BRASS KNUCKLES

T. Baykal 1, T. Bicer, M. Dogan, D. Devrimsel Dogan, D.S. Ozalp, R. Yorulmaz, O.E. Onur

1

Fatih Sultan Mehmet Egitim Ve Arastirma Hastanesi - Department Of Emercency Medicine, Istanbul, Turkey

Background: Myocardial infarction (MI) secondary to coronary artery total occlusion of the proximal right coronary artery (RCA) after blunt chest trauma is a rare entity. Although rare, blunt chest trauma is one of the non-atherosclerotic mechanisms leading to acute MI. We are reporting a case of a 58-year-old man with no cardiac disease history who presented with inferior ST elevation MI secondary to an occlusion of right coronary artery after a blunt chest trauma with brass knuckles. Early recognition of myocardial infarction in patients presenting with chest trauma and differentiating it from other causes of chest pain in this setting is critical in guiding the diagnosis and management of this rare, but potentially fatal complication. <FILE IMAGE='200_20150530172740.jpg'> Methods: We used a 12 derivated electrocardiograph for taking an ecg. Initial electrocardiogram (ECG) revealed sinus rate with segment (ST) elevation in D2-D3-aVF leads. A diagnosis of myocardial infarction was made. On this basis, an anjiography practiced to patient and recorded proximal RCA total oclusion.

Results: The patient treated with primer pci succesfully without any complications. 3 days after the operation the patient discharged.

Conclusions: Myocardial infarction after blunt chest trauma is a rare but fatal entity and emercency medicine practitioner should be alarmed about post traumatic chest pain and myocardial infarction.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M085

THE PLASMA UROTENSIN 2 LEVELS MAY BE A PROGNOSTIC MARKER IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTUS ON ADMISSION TO EMERGENCY.

A. Bayir 1, M. Akinci 1, H. Kara 1, K. Demir 1, A. Unlu 1, A. Avci 1, H. Baran 1, A. Ak 1, S. Kayis 2

1

Selçuk University, Konya, Turkey, 2 Karabük University, Karabük, Turkey

Background: Aim: To investigate the relationship between the levels of plasma Urotensin 2 levels and prognosis in patients with acute myocardial infarctus.

Methods: Methods: Patients with acute anterior myocardial infarctus over 18 years old were included in the study. The control group was selected among healthy people in same age. The patients with acute stroke, acute or chronic renal failure, acute hepatic failure, hematologic disease, endocrinologic disease, metabolic disease, trauma, oncologic disease and infection were excluded from the study. It was recorded each patients age, gender, risk factors for acute coronary syndrome. Venous blood samples were taken in order to determine the blood Urotensin 2 and troponin I levels of each patient on admission to emergency. Echocardiography was performed for each patients. Patients were followed up 6 months for mortality and major cardiovascular events.

The data of the patient and control groups were compared with each other by Mann-whitney test.

Results: Results: It was included to the patients group 56 (46 male, 10 female) volunteers. The control group consisted of 34 (15 male, 19 female) healty volunteers. It was determined significantly lower the mean plasma urotensin level of patients group (202.6 ±168.2 fmol/mL) than the mean plasma urotensin level of control group (386.2 ± 298.8 fmol/mL) (p=0.0015). It was found a negative correlation between plasma urotensin level and ejection fraction (EF) in patients group (r= -0.21). However, this correlation was not statistically significant (p=0.132). The mean plasma urotensin level of patients who died in six month follow up (6 patients) was higher (360.5±175.7 fmol/mL) than those survivors (183.6±158.7 fmol/mL) (p=0.009). It was determined a significantly difference between patients who died in six month follow up and survivors for EF (p=0.033).

Conclusions: Conclusion: The higher plasma urotensin levels in patients with acute myocardial infarctus may be indicator of poor prognosis on admission to emergency.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M086

PACEMAKER MALFUNCTION WITH DIZZINESS

R. Ak, F. Doganay, E. Ünal Akoglu, O. Ecmel Onur

1

Fatih Sultan Mehmet Education And Research Hospital, Istanbul, Turkey

Background: The phrase ‘pacing system malfunction’ includes problems that might arise from any of the components of the system. Inappropriately programmed pacemaker parameters, although they do not represent abnormal pacing system function, may be suboptimal for the patient. However the patient and the clinician should be aware of the symptoms of bradycardia including weakness, dizziness, lightheadedness, loss of consciousness and easily fatigability, that might indicate a pacemaker malfunction. The aim of this case is to remind that; as pacemaker implanted patients are one of the ED admission groups, the management and treatment of pacemaker malfunctions is important and crucial for EPs. Methods: A sixty eight year-old male patient presented to the emergency department with the complaint of dizziness. Vital signs were T: 36.1°C, BP: 146/87 mmHg, sp02: 99% on room air , pulse 89 beats per minute. He was implanted a pacemaker for 2:1 AV block that caused hemodynamic instability six years ago. On physical examinations, the patient was in no distress and was pain-free. There was no cardiomegaly, infiltrates, effusions or other abnormality seen on chest X-ray. The EKG obtained showed a ventricular paced rhythm with intermittent spikes without QRS complex most easily seen in V2-6 which we considered as failure to capture malfunction, atrial sensing appeared to be intact-ventricular pacing spikes following each P wave. Hemogram, biochemistry, cardiac enzymes and coagulation panel were obtained and found within normal limits. Then the patient was transported to the cardiology service. He was admitted to CCU for further evaluation, where the malfunction of the pacemaker was found as undersensing during monitorization. After the calibration of the pacemaker he was discharged home .

Results: 1 Conclusions: The number of pacemaker implants is growing because of newer indications. There are a few million pacemaker patients worldwide with hundreds of thousands of new implants yearly. Knowledge of different modes, timing cycles and event markers, as well as newer algorithms, is necessary for accurate diagnosis of pacing system malfunction.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M087

EVALUATION OF CT ANGIOGRAPHIC SCORES FOR PULMONARY EMBOLISM IN THE EMERGENCY MEDICINE

O. Ünal 1, A. Ünal 1, G. Arslan 2, E. Göksu 1

1

Akdeniz University, Department Of Emergency Medicine, Antalya, Turkey, Radiology, Antalya, Turkey

2

Akdeniz University, Department Of

Background: Diagnosis of pulmonary embolism (PE) is a challenging issue in the Emergency Department (ED).

Computed tomography pulmonary angiography (CTA) is the preferred method in the ED for the detection of acute PE. Some of the published articles have recently shown that the severity of acute PE can be estimated by scoring systems according the vascular bed involved that is detected in CTA (1-3). These two scoring systems were described by Qanadi et al (2), Mastora et al (3) (Mastora global, Mastora central). Previous studies have shown that right ventricular dilatation on bedside ultrasound was highly specific (98%) but had poor sensitivity (50%) in the diagnosis of PE (4). Right ventricular dysfunction dictates adverse clinical outcome in patients with acute PE. The aim of the present study was to compare point of care ultrasound finding of right ventricular dilatation with CT obstruction indices in patients with PE. Methods: In our prospective randomized study we performed bedside ultrasound and CTA to the patients that have a clinical suspicion of acute PE. All CTAs were read by an experienced radiologist blind to clinical data, ultrasound results and 30-day outcomes.

Results: Our study, like previous studies, showed that right ventricular dysfunction can predict hemodynamic instability and circulatory collapse (5). We also found that there was no relationship between obstruction indices and mortality within a month but right ventricular dilatation detected by bedside ultrasound can predict it.

Conclusions: Future larger prospectivestudies may better define the roles of clotting scores in patients with acute PE.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M088

ACUTE CORONARY SYNDROME IN THE ELDERLY: THE CONTRIBUTION OF THE EMERGENCY DEPARTMENT.

N. Nouira 1, I. Makki 1, Z. Guermazi 1, R. Ammar 1, I. Kallel 1, N. Elouafi 1, M. Ben Cheikh 1

1

Service Des Urgences Chu Mongi Slim, La Marsa, Tunisia

Background: Introduction: The inevitable aging of the world population will cause a significant increase in ischemic heart disease, the leading cause of death among elderly. Few experts are interested in this subject in emergency department.

Purpose: We plan to study the specificity of clinical presentation, medical approach and outcome in elderly patients admitted to the emergency department with non-ST elevation Acute Coronary Syndrome (ACS).

Methods: Methods: A prospective study including 75 patientsâ&#x20AC;&#x2122; 65-years old and more, admitted for non-ST elevation ACS to the emergency department.

Results: Results: The mean age was 74 + 6 years with a sex ratio of 1.37. In 84,2% of cases patients consult directly the ED. 10% of cases were referred from other hospitals. Transport was provided by medical transport in 9% of cases. The median time to consultation was 13h30min. The risk factors found were mainly: hypertension (68,4%), diabetes (56%) and tobacco (28%). In 29% of cases the symptoms were atypical (dyspnea (17%), epigastralgia (7%)...), in this group the median time to consultation was significantly prolonged (p= 0,02). All patients had anti-ischemic drug treatment at admission in ED, 3 patients had non invasive ventilation and 2 patients had mechanical ventilation, an external electric shock for one patient with ventricular tachycardia. In 53% of cases patients were discharged at home without any coronary investigation, the average ED stay was about 75h.

Conclusions: conclusion: Policymakers should opt to create cardiac-geriatric care sectors, to adapt the needs to the care supply of these seniors.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M089

IS IT RELEVANT THE PRESENCE OF AUTOIMMNUNE DISEASE IN PATIENTS ADMITTED AFTER ACUTE CORONARY SYNDROME?

N. Lozano 1, C. Marras Fernandez-Cid 1, F. Pastor Perez 1, P. Flores Blanco 1, M. Gomez Molina 1, A. Bermudez Torrente 1, L.F. Linares 1, P. Pastor Perez 1, P. Mesa Del Castillo 1, F.A. Martinez Angosto 1

1

University Hospital Virgen Arrixaca, Murcia, Spain

Background: Patients with autoimmune diseases (AID) have a high burden of cardiovascular disease with premature morbidity and mortality. But it is unclear if it is due to a higher prevalence of cardiovascular disease, to a worse case fatality or to a different management after an index event. The aim of the study is to assess the prevalence of AID in patients with acute coronary syndrome (ACS), the management and prognostic implications Methods: The study included consecutive patients admitted after ACS from January 2011 to May 2014. For AID patients, in-hospital management and ACS presentation was compared to non-AID patients. We also compared in-hospital and 1-year major adverse events (MACE): death, recurrent myocardial infarction, stroke and major bleeding, between groups. The percentage lost to follow-up was <1%.

Results: Of 964 patients, 53 had AID (5.5%): 11 rheumatoid arthritis, 9 inflammatory bowel disease, 7 ankylosing spondylitis, 7 psoriatic arthritis, 5 polymyalgia rheumatica, 4 systemic lupus erythematosus and 10 miscellanea. Mean evolution of the disease was 14Âą3 years. No differences were found in clinical and demographics characteristics between groups except for a higher percentage of previous stable coronary heart disease in non-AID patients. Compared to non-AID patients, AID patients had similar clinical ACS presentation and no differences were found with respect to revascularization strategies or medical treatment at discharge.

There were 207 MACE (69% during hospitalization): 108 deaths, 52 recurrent myocardial infarctions, 19 ischemic strokes and 28 major bleedings. The two groups had comparable rates of MACE both during hospitalization (9.6% vs 12.2 %, p=0.58) and at 1 year (26.4% vs 19.1%, p=0.19), AID vs non-AID respectively.

The presence of AID was not associated with increased in-hospital mortality (OR 1.1, 95% CI 0.4 to 3.3) but it was a risk factor for higher 1-year crude mortality (OR 2.2, 95% CI 1.1 to 4.4). However after multivariable adjusting, this association was not longer significant (OR 1.7, 95%CI 0.8 to 3.9).

Conclusions: The presence of AID did not change ACS presentation and clinical management. Moreover it is not independently associated with worse outcomes both during hospitalization and during follow-up.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M090

OUTPATIENT TREATMENT OF PULMONARY EMBOLISM: SPESI SCORE AND HIGHLY SENSITIVE TROPONIN CAN BE HELPFUL

M. Kartal 1, A. Yuruktumen, E. Goksu, D. Yilmaz

1

Akdeniz University Faculty Of Medicine Department Of Emergency Medicine, Antalya, Turkey

Background: The aim of this study is to investigate the relationship between high-sensitivity troponin levels with poor prognosis in patients with pulmonary embolism. At the same time the effectiveness of the SPE scores were also tested.

Methods: All the patients have dyspnea, chest pain, haemopytisia were included study. If patients specifications include: 1) Clinical gestalt of pulmonary embolism 2) According to the Wellâ&#x20AC;&#x2122;s algorithm patients who have 2 or more scores undergo CT examinations for pulmonary embolism. If patients MdRD GFR levels sammal than 60 mlt/second pulmonary perfusion scintigraphy scan was performed. Venous blood sample were collected and all patients highly sensitive troponin T levels was obtained. If patients have pulmonary embolism were consulted with chest disease unit for admission or follow up. A month later, all patients were questioned about the death by phone.

Results: A total of 70 patients were included in the study. Among the study population 15 patients (%21,4) died and 53 patients (%78,6) lived after diagnosis of pulmonary thromboembolism. Logistic regression model was created in order for poor prognosis markers. The troponin level, the sPESI score, right ventricular dilatation, heart rate, systolic blood pressure and oxygen saturation was added to regression model. Pozitive troponin level ( Odds ratio: 5,23 and %95 CI 1,0341 to 26,5129) and sPESI score ( Odss ratio 2,147 and %95 CI 1,0008 to 4,6057) was found significant.

Conclusions: Patients with pulmonary embolism, sPESI score zero and with normal highly sensitive troponin levels, can be treated as outpatient.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M091

INDIVIDUAL EDUCATIONAL LEVEL AND DELAY OF PREHOSPITAL AND IN-HOSPITAL TIME INTERVALS FROM SYMPTOM ONSET TO REPERFUSION IN ST ELEVATION MYOCARDIAL INFARCTION

H. Juyeon 1, H. Ki Jung 1, S. Sang Do 1, S. Kyung Jun 1, R. Young Sun 1

1

Seoul National University Hospital, Seoul, South Korea

Background: Early access from symptom onset to reperfusion therapy is important in ST elevation myocardial infarction (STEMI). Individual educational level could affect delay of each time interval during prehospital and in-hospital time period. The goal of this study is to assess the effect of individual educational level on delay of each time interval during prehospital and in-hospital period in STEMI patients.

Methods: We used data from nationwide emergency department based cardiovascular disease surveillance operated by Korean Centers for Disease Control and Prevention. We enrolled STEMI cases enrolled into the database between Nov.2007 and Dec. 2012. Cases were excluded if age is under 18 years old or educational level was missing. We classified educational level by 3groups, low educational group below elementary school, middle educational group with middle or high school and high educational group with more than bachelor. We measure the time interval between each time components during symptom onset to reperfusion therapy. We compared each time delay between 3 educational levels. We assessed the effect of educational level on symptom to destination hospital time using general linear regression model.

Results: 31 emergency departments enrolled 9,034 patients with STEMI. For EMS use group, Median time of symptom to destination hospital was 144 minute, 76 minute, 68 minute in low, middle, high education group (p<0.01). Time interval from symptom to call, call to hospital arrival was also increased to decreased educational level. Symptom to balloon time was 353, 269, 230 minute in low, middle, high group (p<0.01). But no significant difference of door to balloon time was observed between educational levels. Low and middle education level showed delay or 27.2 (95% CI: 15.9-38.5) and 19.1 (95% CI: 15.9-38.5) minute in general linear regression model referent to high education level.

Conclusions: Low educational level delayed symptom onset to reperfusion in STEMI patients. Symptom onset to hospital arrival was delayed to decreased educational level but no significant difference in in-hospital time interval was observed between educational levels.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M092

STOKES-ADAMS SYNDROME: CONCEALED JEOPARDY IN FORM OF EPILEPSY

Y. Eyinc 1, F. Doganay 1, R. Ak 1, T.C. Ozturk 1, E.U. Akoglu 1, O.E. Onur 1, O.C. Tuzer 1

1

Fatih Sultan Mehmet Training And Research Hospital, Istanbul, Turkey

Background: Epilepsy is a common condition caused by brain hyperexcitability. However, many cardiovascular disorders may cause blackouts, complicated by abnormal movements due to generalized cerebral hypoxia, which may mimic seizures, leading to an incorrect diagnosis. Stokes-Adams Syndrome, defined as an abrupt, transient loss of consciousness due to sudden but pronounced decrease in cardiac output, which is caused by a sudden change in the heart rate or rhythm. In this case, we report a patient whose previous EEGs and 24h holter monitorings were normal yet diagnosed as Stokes-Adams Syndrome in ED. <FILE IMAGE='388_20150711000234.JPG'> Methods: A 77 years old man presented to emergency department with dizziness approximately half an hour after a GTC seizure that lasted for a minute. Vital signs were normal. Physical and neurological examinations were unremarkable. He had no knowledge of any previous medical problem and denied taking any medications yet mentioned about such epileptic seizures several times last year. Blood tests and toxicology screenings were normal. He was observed in ED with continuous cardiac monitoring and in his second hour of admittance he experienced a sudden loss of consciousness followed by a generalized convulsion, which terminated spontaneously within a few seconds. The same, seizure-like symptoms happened again after about half an hour.

He neither had an aura before nor post-ictal period after his seizures yet cardiac monitor was portraying the typical period of heart rhythm slowing down almost to 30bpm then an asystolic period accompanied by a short episode of seizure. The patient was resuming the previous conversation without being aware of the pause produced by the period of arrhythmia-induced cerebral ischemia. ECG taken before and at the time of the seizure depicted a sinus rhythm converting into a 3rd degree AV-block.

Results: Patient was admitted to cardiology for pacemaker therapy Conclusions: Epileptical movements caused by cardiac syncopes may be puzzling for physicians. A convulsion of only secondsâ&#x20AC;&#x2122; duration and with rapid return of consciousness implies syncope not epilepsy. Since it is difficult to prove a cardiac syncope which are sometimes life-threatening, 24h cardiac monitoring of a patient with atypical seizure history is crucial

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M093

OUTCOME OF LOW RISK CARDIAC CHEST PAIN IN THE EMERGENCY DEPARTMENT.

M. Dorrance, L. Stewart, A. Maguire, S. Das

1

West Suffolk Hospital, Bury St Edmunds, United Kingdom

Background: Chest pain is a common reason for patients to present to an emergency department (ED). It is crucial not to miss presentations of the potentially life-threatening acute coronary syndrome (ACS), although often these people may present with a non-diagnostic ECG. The prevalence of patients presenting with chest pain constitutes only 8-10% of total number of patients presenting to the emergency department.

Difficulties in recognition of ACS and the subsequent inconsistencies in management of these patients are well known and challenge clinicians worldwide.

Methods: A retrospective study was carried out in a medium sized district general hospital in the United Kingdom. All patients presenting with one week period between 2nd of February to the 9th of February was included in the study.

Patients with ECG changes were excluded from the study. Many of these patients with significant EGC changes were seen by the ambulance services are taken straight to nearby PCI center. All patients had an ECG and a troponin test done within the hour of their arrival. Patients who presented with chest pain within the first 6 hours of the onset of pain had a second troponin.

Results: A total of 85 patients were evaluated In the ED. The mediadian age was 59 years and the range was from 25 years to 93 years. 68% (58) patients were discharged home from ED. The rest were admitted and evaluated by the cardiology team. 10% (6) of the discharged patient readmitted to ED and underwent further evaluation. 6% of patients were admitted under the cardiology team. All patient readmitted had a normal coronary angiogram, except for one patient who had atrial flutter. No harm resulted in patients discharged.

Among the patients admitted two patient died of AKI and hyperkalema. 3 patients had pneumonia and 3 patient has gastritis and one had asthma in their final diagnosis.

Conclusions: Overall simple rule of clinical assessment, ECG and troponin markers are effective tools to rule out a serious cause of chest pain. The use of validated scores is useful but difficult to implement.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M094

THE PROGNOSTIC ROLE OF RIGHT VENTRICULAR DYSFUNCTION SIGNALS ON COMPUTED TOMOGRAPHY IN ACUTE PULMONARY EMBOLISM IN HEMODYNAMICALLY STABLE PATIENTS: A PRELIMINAR STUDY.

F. Campanini 1, A. Villa 2, B. Tagliaferri 2, G. Nucera 2, E. Ragazzini 1, G. Ricevuti 1

1

UniversitĂ Di Pavia, Pavia, Italy, 2 Ospedale Fatebenefratelli E Oftalmico, Milano, Italy

Background: Objective: the aim of the study was to investigate the correlation between right ventricular dysfunction signals on Computed Tomography Pulmonary Angiography and adverse outcomes (at 15 days from the onset) risk, in hemodynamically stable patients with Acute Pulmonary Embolism. In fact a fast, simple and around the clock available, prognostic stratification system could be helpful in Emergency Department.

Methods: Our work was carried out at Emergency Department of Fatebenefratelli e Oftalmico Hospital in Milan, Italy in collaboration with University of Pavia, Italy. The cohort was made of 27 (20 women and 7 men, with an average age of 64 years) hemodynamically stable patients with Acute Pulmonary Embolism, admitted in our Emergency Department from 2010 to 2014. Right ventricular dysfunction was defined as an increased right to left telediastolic ventricular diameters ratio, gauged on axial view of a Pulmonary Angiography Computed Tomography. Adverse clinical outcome was defined as the presence of at least one of the followings: respiratory failure, severe hypotension, cardiogenic shock, syncope, sudden death. Two operative groups performed the measurements to detect the interobserver variability between an expert operator (Group A) and a less expert one (Group B). Chi-square test, sensibility and specificty were calculated.

<FILE IMAGE='366_20150630204911.jpeg'> Results: Results: Adverse clinical otucomes occurred in 11 patients, 9 of which showed an increased ratio and 2 didn't. On the other side a better course occurred in 16 patients, 9 with a normal ration agaist 7 with an increased one (Chi-square p-value < 0,005), with 92% sensibility and 72% specificity. Interobserver variability showed a good overlapping between the two grups, with an 11% of overestimations and none underestimations from the Group B toward the Group A. Conclusions: Conclusions: right to left ventricular diameters ratio is an indipendent predictor of poor prognosis.

The negative prognostic value of this tecnique instead didn't show the same evidence. This could be because of the high number of false positive results. Interobserver variability is good, showing a short learning curve.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M095

THE T WAVE INVERTION IN LEAD AVL: IS IT IMPORTANT?

R. Ak, F. Doganay, E. Unal Akoglu, T. Cimilli Ozturk, O. Ecmel Onur

1

Fatih Sultan Mehmet Education And Research Hospital, Istanbul, Turkey

Background: T wave changes in lead aVL might be considered nonsignificant by most physicians; however, a limited number of studies have shown the value of T wave changes in recognition of right ventricular involvement in inferior wall MI and sign of mid-LAD lesion. We represent a case of new onset T wave inversion in emergency room(ER) and we want to emphasize the importance of recognition of this finding and importance of early appropriate referral to a cardiologist. <FILE IMAGE='209_20150708174552.jpg'> Methods: A 49-year-old woman with history of hypertension admitted to emergency department with chest pain and shortness of breath for 15 minutes. She complained of a substernal chest pain radiating to her left shoulder.

Vital signs were as follows: temperature: 36,2째C, blood pressure: 158/101 mmHg, pulse: 87 beats per minute, sp02: %99. Physical examination was unremarkable. Her initial electrocardiogram (ECG) showed normal sinus rhythm (NSR) and no ischemic changes (Figure 1). The first troponin, serum electrolytes, hemogram, coagulation studies and chest X-ray were normal. A control ECG showed NSR and new onset T wave inversion in lead aVL and V2 (Figure 2). Transthoracic echocardiography revealed left ventricular segmenter contraction disability (apex hypokinetic) and the ejection fraction was found %50. The second troponin (after 3 hours) was 0.39 ng/ml (normal 0-0.03 ng/ml). She was given clopidogrel bisulfate, ASA, and unfractionated heparin and sent for emergency cardiac catheterization. Angiography revealed a 99% mid-LAD lesion and she received a stent.

Results: 1 Conclusions: Dynamic ECG changes are helpful in detecting ongoing myocardial injury. Isolated T wave inversion in the neglected lead aVL may be the only ECG variable significantly predicting mid-segment LAD lesion. Second look to ECG for aVL is important for ER physicians.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M096

SPODICK’S SIGN: AN ELECTROCARDIOGRAPHIC CLUE FOR ACUTE PERICARDITIS

R. Ak, F. Doganay, E. Unal Akoglu, O. Ecmel Onur, T. Cimilli Ozturk

1

Fatih Sultan Mehmet Education And Research Hospital, Istanbul, Turkey

Background: Spodick’s sign, which mention to PR depression in association with diffuse ST segment elevation and down-sloping TP-segments. Patient who have not typical elecetrocardiographic findings, this sign can help physicians. <FILE IMAGE='209_20150705153049.jpg'> Methods: A twenty seven years old male without any cardiac or chronic disease admitted to emergency department with chest pain, started 5 hours ago. He denied having any trauma or drug use. He had no operation or medical history. On admission vital signs were as follows: 36.4°C, sp02: 97%, pulse: 96 beats per minute, blood pressure: 123/75 mmHg. His initial electrocardiogram showed normal sinus rhythm and down-sloping TP segment in V2-6 (Figure 1). The troponin was 0.001 ng/ml (normal value: 0.0-0.04 ng/ml), hemogram and serum electrolytes were normal. Transthoracic echocardiography revealed no wall motion abnormalities and the ejection fraction was found 60%. The patient was discharged with a NSAID treatment.

Results: 1 Conclusions: Pericarditis is one of the possible etiologies of chest pain. Recognization is very important because the therapy differs from other common causes of chest pain. Spodick’s sign serves as an important feature to distinguish acute pericarditis from acute coronary syndrome.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M097

BRUGADA PATTERN INDUCED BY FEVER

D. Ageib 1, L. R

1

Imam Abdulrahman Bin Faisal National Guard Hospital, Dammam, Saudi Arabia

Background: Brugada syndrome is characterized by right bundle-branch block pattern on Electrocardiogram (ECG), right precordial ST-segment elevation [usually leads V1/V2] and syncope/sudden cardiac death in absence of significant electrolyte abnormalities, ischemia or structural heart disease. In the absence of these symptoms Brugada pattern is right term to be used. These ECG changes are caused by alterations in the cardiac action potential due to a genetic defect in the cardiac sodium channel function which have been shown to be temperature dependent. We describe a 49year-old man presented with chest pain, fever with ECG similar to Brugada syndrome which have disappeared or became less prominent when the fever subsided Keywords: Brugada syndrome, Fever <FILE IMAGE='393_20150715181616.jpg'> Methods: A 49year-old man with history of hypertension presented to our emergency department(ED) with chest pain, shortness of breath and fever. Initial electrocardiogram showed characteristic Brugada pattern with coved type ST-segment elevation in leads V1-V3. However acute coronary syndrome was ruled out. He had no cardiac complaints and did not have a history of syncope or a family history of sudden cardiac death. In the emergency room, his temperature was 39.2째C, the blood pressure was 144/90 mm Hg and the pulse was 99/bpm and a respiratory rate of 22/ minute. Apart from higher white blood cell count other hematological and biochemical tests including cardiac enzymes and electrolytes were within normal limits. Chest X-ray shoed right side side pneumonia and echocardiography examination was normal. Patient was admitted for pneumonia treatment. The next day the patient was afebrile and interestingly, his previous ECG features became less prominent almost disappear, and the patient discharged home after his pneumonia has been treated and labeled as Brugada pattern.

Results: Electrophysiological study was not done because neither the patient nor any of his family members had experienced any symptom related to Brugada syndrome; however, we recommended screening his family members.

Conclusions: Physicians should be aware of the variation of Brugada syndrome and of its often transient ECG features associated with fever which should be aggressively treated.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / Non-CPR/Non-Resuscitation

M098

COMBINING ED ADMISSION BNP PLUS HOSPITAL DISCHARGE BIVA FOR PREDICTION OF CARDIOVASCULAR MORTALITY IN PATIENTS HOSPITALIZED FOR ACUTE HEART FAILURE.

S. Santarelli 1, V. Russo 1, I. Lalle 1, B. De Berardinis 1, S. Navarin 1, L. Magrini 1, A. Piccoli 2, M. Codognotto 2, M.M. Mion 2, L.M. Castello 3, G.C. Avanzi 3, H. Villacorta 4, B.L. Campanario Precht 4, P.B. De Araujo Porto 4, S. Di Somma 1

1

Emergency Department Sant'andrea Hospital, Postgraduate School Of Emergency Medicine, University La Sapienza, Rome, Italy, 2 Department Of Medicine, University Of Padova, Padova, Italy, 3 Department Of Traslational Medicine, University Of Piemonte Orientale, Novara, Italy, 4 Universidade Federal Fluminense, Departimento De Ciencias Cardiovasculares, Rio De Janeiro, Brazil Background: Heart Failure is a chronic disease with high mortality, and frequent relapses, and it represents a common leading cause of admission to Emergency Department and hospitalization. Aim of this study was to investigate the ability of combining Brain Natriuretic Peptide (BNP), and peripheral congestion detected by Bioelectrical Impedance Vector Analysis (BIVA), to identify acute heart failure (AHF) patients who are more likely to die during 90-days follow up.

Methods: This was an observational multicentre study in the Cardiology ward of Fluminense Federal University of Rio de Janeiro (Brazil), and in Emergency Ward centers in Italy (Santâ&#x20AC;&#x2122; Andrea University Hospital of Rome, Novara University Hospital, Padua University Hospital). We enrolled acute heart failure patients arriving to ED. BNP measurement was performed at arrival, while BIVA was performed at discharge. A 90-days follow up phone call was made evaluating cardiovascular death, and patients were divided in survivors and non survivors.

Results: 292 AHF patients were enrolled. BNP level at arrival was significantly higher in non survivors (p<0.01)(mean value of 838 pg/ml vs 515 pg/ml in survivor patients). In non-survivorâ&#x20AC;&#x2122;s patients, BIVA showed the persistence of fluid retention. Hydration Index (HI) and Reactance (Xc) at discharge showed statistically significant difference in patients who died than in survivors (respectively: HI 85 vs 74, p<0.001; Xc 26.7 vs 37, p<0.001; R 445 vs 503, p=0). Discharge HI and Xc had prognostic value in predicting death (area under curve respectively, HI: 0.715, p<0.0007; Xc: 0.712, p<0.004; R: 0.65, p<0.024), and when combined with BNP they showed greater prognostic power (combined ROC: area under curve 0.74; p<0.001).

Conclusions: Arrival BNP, and a discharge BIVA with persistency of congestion has a significant predictive value for subsequent 90 days mortality in patients presenting to emergency department for AHF. The combined use of BNP and BIVA increases prognostic power of cardiovascular events in these patients. The achievement of a state of normal hydration detected by BIVA at discharge, should be one of the major targets in the management of AHF patients in order to improve their life expectancy.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M099

ACUITY AND MORTALITY BETWEEN TRAUMA AND NON-TRAUMA EMERGENCY PATIENTS IN A TERTIARY HOSPITAL IN YAOUNDE, CAMEROON

Y. Jung 1, S. Shin 1, Y. Ro 1, J. Jeong 2, D. Wi 3, K. Sun 1, Y. Park 1, J. Park 4

1

Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea, 2 Yaounde Emergency Center, Yaounde, Cameroon, 3 Wonkwang Unversity School Of Medicine, Sanbon, South Korea, 4 Hallym University College Of Medicine, Dongtan, South Korea Background: Cameroon is the one of developing African countries which have limited resources for prehospital and hospital emergency department (ED) services. We compared the acuity and mortality between trauma and non-trauma emergency patients in a hospital ED. Methods: Eligible patients were all who visited a teaching and tertiary care hospital ED of YaoundĂŠ from July 4 to 18 (2 weeks), 2014. A designed patient care report (PCR) form was used to collect demographic, socioeconomic, clinical, time variables, specific for trauma, diagnosis, treatment, and outcomes variables. All PCRs were filled up through face-to-face primary interview with patients for primary demographic information, secondary interview with ED physicians for in-depth clinical information, and medical records review for complementary information. Study endpoints were ED mortality and acuity. The demographics and characteristics between trauma and non-trauma were compared using the Chi-square test.

Results: Of 810 patients during the study period, 544 patients were included. About half (49.3%) of the patients visited ED by taxi and only 2.0 % used prehospital EMS system. The proportion of trauma was 39.3% and of these, traffic accident was 41.4%. Most cases (89.3%) were paid directly by the patients and three fourths (73.0%) were discharged from ED. High acuity groups defined by La Classification Clinique des Malades des Urgences 4 and 5 were 19.1% in trauma and 14.0% of non-trauma emergency (p<0.05). In-ED mortality rate was 3.9% (trauma 4.2%, non-trauma 3.6%) (p<0.05) Conclusions: The ED in YaoundĂŠ showed higher acuity, and higher mortality in trauma patients than those in non-trauma patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M100

CIRCADIAN VARIATION IN THE FREQUENCY OF EPISODES OF ACUTE CARDIOGENIC PULMONARY EDEMA TREATED BY EMERGENCY MEDICAL SERVICE

J. Callerova 1, R. Skulec 1, P. Merhaut 1, J. Knor 1

1

Emergency Medical Service Of The Central Bohemian Region, Kladno, Czech Republic

Background: Several studies have shown that the incidence of acute cardiogenic pulmonary edema (CPE) in hospital or in emergency room has circadian variability, demonstrating the highest incidence in the early morning. However, no study evaluating circadian variability of CPE in the field has been published. Therefore, we decided to evaluate circadian variation in the frequency of episodes of CPE and of its subtypes in the patients who were treated by Emergency Medical Service (EMS) of the Central Bohemian Region, Czech Republic.

Methods: We extracted all dispatches to CPE cases from local database of EMS for the period from 1.11.2008 to 30.6.2014 and analyzed its circadian variation. We identified the patients presenting with CPE coupled with arterial hypertension (systolic blood pressure >140 mm Hg) and arterial hypotension (systolic blood pressure <90 mm Hg) and compared the subgroups.

Results: From 4747 cases of CPE, 51.9 % presented with arterial hypertension, 5.9 % with hypotension.

Maximal occurrence of CPE was detected between seven and ten o'clock a.m.. In this period was observed 20.8 % of all CPE patients (07.01-08.00: 7.0 %, 08.01-09.00: 7.7 %, 09.01-10.00: 6.1 % of all cases), distinctly more than in other daytime (p<0.05). While CPE with hypertension reached maximal occurrence in the ninth hour (7.4 % of all cases, p<0.05), CPE with hypotension was most frequent in the fourteenth hour (8.6 % of all cases, p<0.05).

Conclusions: We observed that the highest incidence of CPE in the field occurrs not in the early morning but between seven and ten o'clock a.m. and there are differences in circadian variability between CPE with hypertension and hypotension. Knowledge ot these patterns may have an impact both on the logistic of pre-hospital care and on preventive measures in the patients who have previously undergone CPE.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M101

EVALUATION OF PATIENT TRANSFERS TO THE EMERGENCY DEPARTMENT OF EGE UNIVERSITY HOSPITAL BY THE 112 EMERGENCY SERVICE

H. Dรถnmez, A. Demir, G. Yilmaz, S. Kiyan

1

Emergency Department Of Ege University Medical Faculty, Izmir, Turkey

Background: There is an increasing demand for Emergency Medical Services (EMS) in the Turkey and around the world. Pre-hospital emergency services (ES) are accessed in Turkey by dialing '112'. In this study, a definition of the current status has been aimed at by means of examining the quantity of forms issued for the patients brought to Ege University Medical Faculty Emergency Department with the 112 Emergency mobile Service (EMS).

Methods: The forms of 100 patients transferred to our ES with random sampling technique from the Izmir Centrum, Izmir district and surrounding provinces in June 2015 were examined in terms, the most fruquent symptoms or reasons, initial diagnosis, the length stay in emergency service, last status at discharge from emergency unit and their demographic features. Patients were evaluated with the 112 ambulance patient register form data collected from the archives of the hospital and the computer recordings. In the data analysis; Statistical Package for Social Sciences for Windows Version 18.0 package program was used.

Results: The admitted of the patients 55% were male and 45% were female. 43% patients of the range of age was 60 years of age and over. 65% of cases were admitted cause of medical diseases. The most symptom was respiratory distress (17%) in medical symptoms. 61% of patients were accepted to category 3 according to stages of 5 triage scales. 47% of patients have got comorbity that the most disease was hypertension (16%).

19% of patients were stay in ES at two days and over, mean length of stay in ES was 29,79 hours. (min:23hours max:95 hours) . The most of reel diagnosis was cardiac disease that percentage was 25%.when the outcomes of patients were reviewed 16% of patients were transferred other services/intensive units in our hospital and 15% of patients were transferred other hospitals for need of intensive care.

Conclusions: 112 plays an effective role in transfer of critical patients. 112 compries the most important step of the hospital referral chain. The higher admittance rate and longer length of stay in ES affects patient density negatively.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M102

MANAGEMENT OF THE ACUTE EXACERBATIONS OF CHRONIC DISEASES AT THE SCHOOL. THE SCHOOL ALERT PROGRAM

E. Perez Meiriño 1, L. Sánchez Santos 1, C. Mirás Bello 1, C. Prado Pico 1, M. Bernárdez Otero 1, G. Pérez López 1, J.A. Iglesias Vázquez 1

1

Emergencies Medical System Of Galicia Fpusg - 061, Santiago, Spain

Background: Eventual acute crises of chronic illnesses in children, along the time they spend at school, are a challenge for the teachers. The Emergencies Medical System (EMS) of Galicia developed a program in 2008, including all children aged from 3 to 14 years, with a previous diagnose of allergy, diabetes, epilepsy or loss of consciousness to identify and to provide the optimal treatment and management of these patients in case of crisis. We assess the results of the School Alert Program from 2008 to 2013. <FILE IMAGE='171_20150623165451.png'> Methods: After the specific diagnostic provided by their paediatrician, the parents filled a form to include the boy in the database of the EMS. Once the boy was included, the parent left in the school a dose of epinephrine (in case of allergy) or glucagon (in case of diabetes) identified with the name of the boy. In case of crisis, the teacher called to the Emergencies Coordination Centre (ECC) of the EMS, and the physician of the ECC after confirming the situation, if needed, decided to administer the medication, mobilize an ambulance, and transfer the patient to a primary care centre (PCC) or to a hospital facility.

Results: 1850 patients were included in the program, and a total of 128 (6,92%) in-calls were received in the ECC. 59 cases (46,09%) were solved in situ, 19 (14,84%) in a PCC, and 50 (39,06%) in a hospital facility. 44,1% patients were included by allergy, 17,14% by diabetes, 18,16% by epilepsy and 20,59% by loss of consciousness. 80% with loss of consciousness were managed in a PCC, whereas the 50,85% of the crisis of epilepsy were transferred to a Hospital facility. Most of the crisis regarding hypoglycaemia (60,42%) or anaphylaxis (43,75%), were solved in situ by providing the adequate treatment.

Conclusions: Since the anticipation in emergencies is critical, the School Alert Program is an optimal tool to provide the adequate treatment and management of chronic ill children in case of severe crisis. The teachers guided step-by-step, by the physician of the ECC are able to administer with safety the treatment required.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M103

VARIABILITY OF THE MANAGEMENT OF ACUTE AGITATION IN EMERGENCY MEDICAL SERVICES IN SPAIN. “SOSEGA” STUDY.

A. Casal Sánchez 1, L. Sánchez Santos 1, F. Aranda Aguilar 2, R. Rodríguez Calzada 3, J. Martínez Bausela 3, J. Abia González 3, F. Hermoso Gadeo 4, L.A. Ambrosio Carrasco 4, R. Canabal Berlanga 4, M.L. Lassalle Orti 5, A. Trigo González 6, P. Montero París 7, I. Unzaga Ercilla 7, I. Casado Florez 8, E. Corral Torres 8, A. Iglesias Vázquez 1, M. Bernardez Otero 1, M.A. Suárez 9, P. Roset 9

1

Emergencies Medical System Of Galicia - Fpusg -061, Santiago, Spain, 2 Empresa Pública De Emergencias Sanitarias (epes), Andalucía, Sevilla, Spain, 3 Gerencia De Emergencias, Castilla Y León, Valladolid, Spain, 4 Gerencia De Urgencias, Emergencias Y Transporte Sanitario, Castilla La Mancha, Toledo, Spain, 5 Emergencies Medical System 061 Cantabria, Santander, Spain, 6 Servicio De Asistencia Médica Urgente (samu), Asturias, Oviedo, Spain, 7 Gerencia De Atención De Urgencias 061 Baleares, Mallorca, Spain, 8 Servicio De Asistencia Municipal De Urgencia Y Rescate (samur), Madrid, Spain, 9 Ferrer, Barcelona, Spain Background: Early identification of acute agitation in the pre-hospital setting is critical to stabilise the patient by providing the adequate treatment, and to transfer to the hospital psychiatric services, including if needed the involuntary admission. We describe the management of the acute agitation by the EMS of Spain.

Methods: SOSEGA is an observational retrospective study that includes the data from seven out of the seventeen EMS in Spain. The data gathering process included a structured questionnaire regarding the protocols and the procedures related to the management of the acute agitation by the EMS, as well as the data obtained from the official activity reports including the number of total psychiatric emergencies in-calls, and specifically those related to potential acute agitation in-calls received at the Emergencies Coordination Centres (ECC), as well as to the first healthcare provider in charge of the psychiatric emergencies, classified as sanitary personnel of primary care or EMS staff of the advanced life support (ALS) ambulances.

Results: The target population includes 18006952 people. All of the EMS included have an electronic database, and the codification process is done by ICD-9 in five. A specific in-calls protocol management regarding psychiatric emergencies (including acute agitation) in the Emergencies Coordination Centres (ECC) is present in 4 out of the seven EMS. Integral procedures involving both ECC and EMS ambulances are present in three EMS. The codification process is done by all, but with a huge variability (EMS staff elaborate a medical report in all of them but ICD-9 codification is performed only in 4, Emergencies Medical Technicians report diagnosis in three, and sanitary personnel of primary care just elaborate a medical report) Conclusions: There is a huge variability in the management of the acute agitation by EMS in Spain, including the lack of specific procedures including step-by-step protocols addressed to the different personnel involved in the management. There is a need to develop homogeneous and specific protocols for the pre-hospital setting, and to elaborate a common database to provide the most adequate and optimal management.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M104

INCIDENCE OF ACUTE AGITATION IN EMERGENCIES MEDICAL SERVICES IN SPAIN “SOSEGA” STUDY

E. Perez Meiriño 1, E. Corral Torres 2, I. Casado Florez 2, I. Unzaga Ercilla 3, P. Montero París 3, A. Trigo González 4, M.L. Lassalle Orti 5, F. Hermoso Gadeo 6, L.A. Ambrosio Carrasco 6, R. Canabal Berlanga 6, R. Rodríguez Calzada 7, J. Martínez Bausela 7, J. Abia González 7, F. Aranda Aguilar 8, M.J. García Ochoa Blanco 2, M. Bernárdez Otero 1, J.A. Iglesias Vázquez 1, P. Roset 9

1

Emergencies Medical System Of Galicia - Fpusg -061, Santiago, Spain, 2 Servicio De Asistencia Municipal De Urgencia Y Rescate (samur), Madrid, Spain, 3 Gerencia De Atención De Urgencias 061 Baleares, Palma De Mallorca, Spain, 4 Servicio De Asistencia Médica Urgente (samu), Asturias, Oviedo, Spain, 5 Emergencies Medical System 061 Cantabria, Santander, Spain, 6 Gerencia De Urgencias, Emergencias Y Transporte Sanitario, Castilla La Mancha, Toledo, Spain, 7 Gerencia De Emergencias, Castilla Y León, Valladolid, Spain, 8 Empresa Pública De Emergencias Sanitarias (epes), Andalucía, Sevilla, Spain, 9 Ferrer, Barcelona, Spain Background: Early identification of acute agitation in the pre-hospital setting is critical to stabilise the patient by providing the adequate treatment, according to the protocol to transfer these patients to the hospital psychiatric services, including if needed the involuntary admission. The SOSEGA purpose is to describe the management of acute agitation by the Emergencies Medical Services (EMS) in Spain. <FILE IMAGE='171_20150616104426.png'> Methods: This is an observational retrospective study that includes the data from seven out of the seventeen EMS in Spain. The period covered by the study is January to December of 2013 (one year). The data were collected from the official activity reports of the different EMS, added to one structured study questionnaire including the number of the total psychiatric emergencies in-calls, and specifically those related to potential acute agitation in-calls received at the Emergencies Coordination Centres (ECC), as well as to the first healthcare provider in charge of the psychiatric emergencies, classified as sanitary personnel of primary care or EMS staff of the advanced life support (ALS) ambulances.

Results: The target population of the 7 EMS includes 18006952 people. In the period of study a total of 4437388 in-calls were registered at the ECCs (rate 239.1/1000 people) Out of them, 2.6% (111599) were classified as psychiatric (rate 6.2/1000 people), and 76.1% (84933) qualified as emergencies (rate 4.0/1000 people) Of the total of those psychiatric emergencies, 44.7% (37951) were diagnosed as acute agitation (rate 2.0/1000 people) The first provider was a primary care physician in 16.7% of cases, and EMS staff of ALS ambulances in 61.6% Conclusions: The incidence of acute agitation accounts for almost half of the total psychiatric emergencies in the pre-hospital setting, so this could be considered as a frequent aetiology of the in-calls received in the ECCs. Since there are different healthcare providers in charge, specific protocols are needed to provide the most adequate and optimal management, including both identification and codification criteria as well as treatment procedures.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M105

EXPERIENCE OF NURSES WORK IN GENERAL AMBULANCE EMERGENCY MEDICAL HELP

A. Jus 1

1

Medical Health Center, M, Slovenia

Background: Ambulance means the implementation of emergency measures healthcare team in a patient who has an illness or injury directly vitally threatened, or when it would rise to such a threat. Work in this area is extremely demanding and responsible. The purpose of the thesis is to present experiences and work by nurses in emergency medical clinic.

Methods: For the study, we used a systematic method of obtaining, sorting and analyzing data from the literature. We used a questionnaire consisting of demographic data and sixteen sets of closed questions, individual questions are designed by Likert scale. The survey was conducted between June and July 2013.

Results: Based on the processing of the survey questionnaire can be found that in addition to work experience is also required written instructions for work in the general outpatient emergency medical, respondents were of the opinion that they are qualified for the job. Details on the implementation of the vitally threatened us show that the majority of respondents carry out all these measures are often so go competencies. Conflicts in the workplace are common, most of the patients and their relatives. More than half of the respondents faced with conflicts between employees.

Conclusions: The study has shown that triage and immediate treatment vital risk patients the most important factor when receiving. The nurse is with their knowledge and ability assessment of a patient's condition is one of the key elements in the clinic for emergency medical assistance. Its role should be based on knowledge and sovereignty, which are obtained by continuous education and self-criticism of their own knowledge.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M106

RESPONSE TIMES OF THE PREHOSPIAL UNITS MARIBOR TO PATIENTS WITH EMERGENCY CONDITIONS

A. Jus 1

1

Medical Health Center, Maribor, Slovenia

Background: Access time in the prehospital treatment of emergencies means the period from the beginning of reception of emergency calls, until the arrival of the intervention team of emergency medical aid to the patient at the venue, has a significant impact on the favorable outcome of urgent intervention.

Methods: The data in the study were collected using quantitative data collection method, a random sample of all emergency interventions for a period of three months in 2013. Handled all emergency interventions, which were recorded in the control book, it was during this period 455 urgent interventions are divided according to the distance from the starting point Prehospital unit of Maribor and the closest hospitals into three groups. We monitored the time available and the intervention in emergency situations remote from Prehospital units Maribor from 1 km to 15 km from the nearest hospital from 15 km to 30 km, and the type of emergency situation and the outcome of the intervention.

Results: During the period chosen for treatment was 63.1% internist intervention and 36.9% of interventions due to injury. The outcome of interventions with death is recorded in 7.6%. The results showed that in emergency situations at a distance of 15 km prehospital units and more accessible to the average life ranged from 9.5 to 22.3 minutes and dispersion data 17,60. The results of t-test one sample showed a statistically significant difference between the measured average time Prehospital units Maribor and internationally recommended time (p = 0.004). In the event of death were rescuers Prehospital units Maribor on-site emergency event in 14.0 Âą 16.5 minutes.

Conclusions: The results showed that the average access time of emergencies at a distance of 15 km and more than Prehospital units Maribor and 25 km or more from the nearest hospital slightly above the extreme recommended international guidelines. Access times and the survival rate is changed during the period from May to November, when working in the field rescuer on the motorcycle who significantly help to reduce the access time.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M107

EMERGENCY MEDICAL SERVICES UTILIZATION IN EMS PRIORITY CONDITIONS IN BEIRUT, LEBANON

M. El Sayed 1, H. Tamim 2, A. Al-Hajj Chehadeh 1, A. Kazzi 1

1

American University Of Beirut Medical Center,department Of Emergency Medicine, Beirut, Lebanon, American University Of Beirut Medical Center,department Of Internal Medicine, Beirut, Lebanon

2

Background: Early activation and use of Emergency Medical Services (EMS) is associated with improved patients’ outcomes in EMS priority conditions as defined by the NHTSA EMS Outcome Project. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon <FILE IMAGE='299_20150621121031.jpg'> Methods: We conducted a cross-sectional study of a random sample of adult patients presenting to the ED of a tertiary care center in Beirut with one of the following EMS priority conditions: Chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest and airway obstruction. Patient or proxy survey (20 questions) and chart review were completed. The responses to the survey questions were: disagree neutral or agree, and were coded as 1, 2 and 3 (3 being best answer for EMS use). A total scale score ranging from 20 to 60 was created and transformed from 0 to 100%. Data were analyzed based on mode of presentation (EMS vs. other).

Results: Among the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age was 63.7 (±18.8) with 56.5% males. Mean clinical severity score (Emergency Severity Index) was 2.5 (±0.7) and mean pain score was 3.1 (±3.5) at ED presentation. Over half (60.5%) needed admission to hospital with 21.8% to an ICU care level.

Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS Activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment and immediate availability of another mode of transport (p < 0.05).

Older patients (OR=0.97, 95% CI (0.96 – 0.99)) were less likely to use EMS. Functional screening i.e. requiring full assistance (OR=5.28, 95% CI (2.15 – 12.95)), or partial assistance (OR=2.06 (1.06 – 4.01)), lack of insurance coverage (OR=1.84 (1.10 – 3.07)) and higher scale scores (OR=2.99, 95% (2.20 – 4.07)) were significant predictors of EMS use.

Conclusions: EMS use in EMS priority conditions in Lebanon is low. Several predictors of EMS use were identified. Improved awareness about EMS is needed.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M108

ASSOCIATION BETWEEN HELICOPTER VERSUS GROUND EMERGENCY MEDICAL SERVICES IN INTER-HOSPITAL TRANSPORT OF TRAUMA PATIENTS

J. Cho 1, J. Kim 1, S. Lee 1, B. Song 1, S. Oh 1, H. Lee 1

1

Gachon University Gil Medical Center, Incheon, South Korea

Background: To improve outcome of severe trauma patient, the shortening of transport time is needed.

Although helicopter emergency medical services (HEMS) is still a subject of debate, it must also be considered for trauma system. The aim of this study is to assess whether transport method (HEMS versus ground EMS) is associated with outcome among inter-hospital transport Methods: All trauma patients transported to regional emergency center by either HEMS or ground EMS from September 2011 to September 2014. We have classified patients according to two groups by transport method.

Age younger than 15 years and self-discharged patients were excluded Results: A total of 427 patients were available for analysis during this period. 60 patients were transported by HEMS and 367 patients were transported by ground EMS. HEMS group had higher mortality than ground EMS group (23.3% vs 3.5%; p<0.001), and included more patients with excess mortality ratio adjusted injury severity score (EMR-ISS) above 25(91.7% vs 48.8%; p<0.001). In the multivariable regression analysis, HEMS was not associated with improved outcome compared with ground EMS, but only EMR-ISS was associated with a mortality of patients (odds ratio, 1.06; 95% confidence interval, 1.04-1.09) <FILE IMAGE='283_20150615040127.jpg'> Conclusions: In this study, helicopter emergency medical services transport was not associated with a decreased of mortality among the trauma patients who inter-hospital transported to the regional emergency center

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M109

IMPLEMENTTATION OF A DE-NOVO AMBULANCE SERVICE IN THE UNITED ARAB EMIRATES

A. Al-Hajeri 1, A. Batt 1,2, B. Haskins 1,3, F. Cummins 1,3,4

1

National Ambulance Llc, Abu Dhabi, United Arab Emirates, 2 Centre For Prehospital Research, University Of Limerick, Limerick, Ireland, 3 Charles Sturt University, Nsw, Australia, 4 Graduate Entry Medical School, University Of Limerick, Limerick, Ireland Background: National Ambulance has been a provider of prehospital emergency care in Abu Dhabi and other regions of the United Arab Emirates (UAE) since November 2010. In addition to helping to develop the public ambulance system in Abu Dhabi and provide medical personnel for other contracts, in 2014 it launched a new ambulance service for the Northern Emirates Service Area.

Methods: As part of the process the following resources were reviewed: international standards, clinical guidelines and protocols; existing prehospital care systems and publications. An operational plan was constructed with consideration for its appropriateness for the UAEâ&#x20AC;&#x2122;S unique cultural and geographical requirements. A training progrmme for staff working the service was also developed using international best practice.

Results: Full details of the services call volume and workload will be presented in graphical format at the conference.

Conclusions: The National Ambulance Northern Emirates service is now fully functional. The service has responded to over 20,000 patients in its first year of service, transporting a large percentage of these to hospitals and facilities within the service area. Crews have responded to 385 cardiac arrests and successfully resuscitated 12 of these patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M110

EFFECTIVENESS OF THE DISPATCHER-ASSISTED CARDIOPULMONARY RESUSCITATION; AN ANALYSIS OF THE EMERGENCY MEDICAL SERVICES OF THE CZECH REPUBLIC IN 2014 (HRADEC KRALOVE REGION)

M. Plodr 1, M. Praunova 2, J. Krencikova 2, V. Svaba 2, D. Bejrova 2

1

Faculty Of Military Health Sciences, Hradec Kralove, Czech Republic, Hradec Kralove Region, Hradec Kralove, Czech Republic

2

Emergency Medical Services Of The

Background: The dispatcher-assisted CPR (DA-CPR) is useful and proved tool that can increase rates of survival and quality of life following out of hospital cardiac arrest. Detection rate of out-of-hospital cardiac arrest (OHCA) differs from one system to another as well as time to cardiac arrest identification and time to the first compression.

Methods: Retrospective analysis of the dispatchers recording was done. We reviewed dispatch recordings for 552 identified OHCA by dispatchers between January 1, 2014 and December 31, 2014. Evaluation with regard to recognition of OHCA (time to cardiac arrest identification a time to first compression) as well as survival to hospital discharge rate was done.

Results: We found out that dispatchers had correctly identified cardiac arrest in 96,4 % of cases in which they were able to assess patients´ consciousness and breathing. Overall survival to hospital discharge with good neurological status (CPC 1,2) was 8,4 %, for patients with initial rhythm of ventricular fibrillation it was 34 %. The median time from call to OHCA recognition was 39 seconds and from call to the first chest compression initiated by dispatcher was 2 minutes 30 seconds. Rate of overestimated cardiac arrest symptoms was 24 % - OHCA was not identified by crews on site.

Conclusions: Dispatchers are able to recognize OHCA in time, but the time to first compression is still longer than it is recommended. Delays are usually caused by factors beyond the control of the dispatcher – caller’s behavior and compliance. Emphasis on dispatchers´ continual education is highly recommended.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Pre-Hospital / EMS / Out of Hospital

M111

INVESTIGATING THE CAUSES OF PREHOSPITAL UNDERTRIAGE: A RETROSPECTIVE ANALYSIS OF SECONDARY TRANSFERS WITHIN THE SUSSEX TRAUMA NETWORK

A. Norton 1, E. Mcwhirter 2, M. Nelson 3

1

Brighton And Sussex Medical School, Brighton, United Kingdom, 2 Kent Surrey Sussex Air Ambulance, Redhill, United Kingdom, 3 Royal Sussex County Hospital, Brighton, United Kingdom Background: It is essential that patients with traumatic injuries are transported by prehospital services to a facility with the correct resources to provide definitive care. South East Coast Ambulance service (SECAmb) use a ‘Major-Trauma Decision Tool’ to identify patients who may have suffered from major trauma and direct them to an appropriate facility. Through retrospective analysis of cases requiring interfacility transfer, it is possible to identify subsets of patients who are at increased risk of prehospital under-triage.

The primary aim of this study was to establish which patients are at the highest risk of under-triage within Sussex. Secondary aims were to: i) Investigate effects of geographical location on triage decisions and ii) assess the relationship between injury severity score (ISS) and helicopter emergency service (HEMS) 999 call monitoring.

Methods: Primary study group contained all secondary transfers into the Sussex County Hospital between 01/04/2012 – 01/12/2014 (n=102). This was combined with prehospital records from the SECAmb Computer Aided Dispatch System and in-hospital data collected via patient notes. Univariate analysis of the relationship between HEMS notification and ISS score was performed using Pearson’s Chi Squared test.

Results: The primary study group contained 40 patients who met full inclusion criteria. Most prevalent mechanism of injury was ‘fall from <2m’ (n=25) and 45% of patients were >65 years old (n=18). Open lower limb fractures were present in 20% of cases (n=8). It was found that 21% of patients were delivered to trauma units as they were >45 minutes transfer-time from an MTC. Median delay to definitive MTC care in this group was 4.7 hours. No significant relationship was detected between ISS score and HEMs monitoring (p=0.088).

Conclusions: A high proportion of under-triaged patients are elderly and/or suffering from open fractures of the lower limb. Geographical location was shown to contribute to triage decision in a significant number of patients included in the study. Number of secondary transfers may be reduced by extending maximum transfer times for ambulance services. Continued monitoring of patients who have undergone secondary transfer will provide key evidence for future revisions of the decision tool.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M112

EMERGENCY WARD DESIGNING IN NAMAZI HOSPITAL

M. Sharifi 1

1

Shiraz Medical University, Shiraz, Iran

Background: Emergency ward most important ward of hospitals and designing this ward is very important

Methods: At first we done meeting with head of hospital and talk about this and get agreement about this design And coordinating with nursery office and engineering of hospital Results: After 1 month we bought bed and screen and designing fast track and screen and physician room and level observation and decrease morbidity and mortality rate of emergency ward

Conclusions: We conclude if we have a standard ward of emergency we can management better the patients and decries morbidity and mortality rate

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M113

OREGON'S DEATH WITH DIGNITY LAW IS NOT A SLIPPERY SLOPE

D. Woods 1

1

Rogue Regional Medical Center, Medford, Usa

Background: As Palliative Care becomes a more important part of medical practice it is important for Emergency Physicians to understand issues surrounding end of life care. One of the more difficult issues is how to manage the occasional patient whose pain cannot be adequately controlled or whose concerns about loss of autonomy and dignity cannot be fully addressed. The Netherlands, Luxembourg, Belgium, Washington state, Vermont, and Oregon have passed Death with Dignity Laws to address this issue. One significant ethical concern discussed in the 27 states and many countries who have considered such laws in the last year is that there would be a slippery slope to euthanasia or other abuses of the law. Oregon is in the 18th year of this law and is ideally suited to examine these concerns.

Methods: Data review. Convenience sample poll of Oregon Emergency Physicians and Nurses.

Results: In 2014 105 Oregonians (or .000026% of the population) ended their life using Death with Dignity medication. There has been roughly a 20% annual increase in patients ending their own lives with this medication since the inception of the law in 1998. Just over 1% of licensed physicians participated in this program in 2014. 95% of the patients were in hospice care, 95% were caucasian, and 47% had college degrees.

All were within 6 months of the end of life in the opinion of 2 licensed physicians and 3 patients received psychological evaluation. In a convenience sample poll of 100 Oregon Emergency Physicians and Nurses only 1% had knowingly cared for a patient who had requested medication, only 2% were aware of the physicians in the community who participated in Death with Dignity, and only 4% were aware of at least 3 provisions of the law.

Conclusions: The Death with Dignity Law provides significant comfort to a tiny percentage of dying Oregonians like Brittany Maynard but has little impact on the overall practice of medicine in Oregon or the daily lives of most Oregonians. Concerns about a slippery slope are unwarranted based on the Oregon experience.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M114

EMERGENCY DEPARTMENT CONGESTION: A PILOT STUDY

C. Jebali 1, N. Ibn Hassine 1, N. Chbili 1, L. Boukadida 1, A. Zorgati 1, R. Boukef 1

1

Emergency Department Of Sahloul, Sousse, Tunisia

Background: Emergencies departments are a link, between taking vital pre-hospital care and hospitalization of patients. They are one of the main points of contact with the population and branding of hospitals. Moreover, Emergencies services are dysfunctional that hinder their proper functioning and sound quality of services offered. Our country, like many countries, is not immune to the problem of congestion emergencies departments, they are currently the subject of a national policy aiming their restructuring. However, no objective index measuring this space.

Aim: To evaluate emergencies departments overcrowding at a time.

Methods: The study was prospective leads into four multipurpose emergency Sousse (two academic and two regional) by two nurses. In addition to demographic information, information on emergencies departments overcrowding were prospectively collected on 13/02/2015 at 20:00. The choice of that date was made by lot one day during February.

Results: There was an average of two patients a box of consultation and all emergencies had more than 1 patient per treatment space. There was also evidence of lack of staff, with an average of 4.5 patients per nurse and a patient / nurse ratio> 4 in 50% of emergencies. There was an average of 4 patients per physician and 25% of emergency had more than six patients per doctor.

Conclusions: This study demonstrates that the services of the Emergency Hospital and regional hospitals are crowded. This situation raises an action on the contributing factors.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M115

REVISED RISK PRIORITY NUMBER TO MODIFY FAILURE MODES AND EFFECTIVE ANALYSIS MODEL FOR HEALTHCARE SYSTEM

M. Yarmohammadian 1, F. Rezaei, A. Haghshenas

1

Health Management And Economics Research Center, Isfahan University Of Medical Sciences, Isfahan, Iran, Health Management And Economics Research Center, Isfahan University Of Medical Sciences, Isfahan, Iran, Faculty Of Health, University Of Technology, Sydney, Australia

2 3

Background: Failure Modes and Effect Analysis is now having known as the main methods of risk assessment and the accreditation requirements for many organizations. The Risk Priority Number (RPN) approach is generally preferred, especially for its easiness of use. Indeed it does not require statistical data, but it is based on subjective evaluations given by the experts about the Occurrence (O i), the Severity (Si) and the Detectability (D i) of each cause of failure.

Methods: This study is a quantitative â&#x20AC;&#x201C; qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment was conducted to calculate RPN score.

Results: We have studied patientâ&#x20AC;&#x2122;s journey process in surgery ward and the most important phase of the process determined Transport of the patient from the holding area to the operating room. Failures of the phase with the highest priority determined by defining inclusion criteria included severity (clinical effect, claim consequence, waste of time and financial loss), occurrence (time- unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) and quantifying risks priority criteria in the context of RPN index. Ability of improved RPN reassess by root cause (RCA) analysis showed some variations.

Conclusions: Finally, It could be concluded that understandable criteria should have been developed according to personnel specialized language and communication field. Therefore, participation of both technical and clinical groups is necessary to modify and apply these models.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M116

READINESS ASSESSMENT OF EMERGENCY DEPARTMENTS FOR RESPOND TO BIOLOGICAL, RADIOLOGICAL AND NUCLEAR INCIDENTS IN EDUCATIONAL HOSPITALS

CHEMICAL,

M. Yarmohammadian 1, M. Nasr Isfahani 2, E. Anbari 3

1

Health Management And Economics Research Center, Isfahan University Of Medical Sciences, Isfahan. Iran., Isfahan, Iran, 2 Department Of Emergency Medicine, Isfahan University Of Medical Science,isfahan,iran., Isfahan, Iran, 3 School Of Health Management And Information Sciences, Isfahan University Of Medical Sciences, Isfahan, Iran, Isfahan, Iran Background: Appropriate, immediate and effective response to Chemical, Biological, Radiological and Nuclear (CBRN) incidents is an important responsibility of hospitals. This study was conducted to assess the level of preparedness, capacity and capability of responding to CBRN incidents in teaching hospitals of Isfahan City.

Methods: This was a descriptive-analytic study conducted during 2013-2014. The statistical population consisted of 43 people including managers, matrons, educational supervisors, emergency supervisors and head-nurses in teaching hospitals (12 hospitals) of Isfahan city. Data collection tool was a checklist translated by the researcher and its content validity was verified by the facts and concepts mentioned in valid sources and by university professors and experts.Data was gathered by interview and observation, and then entered to a checklist which has been validated from point of views of experts. Data analysis was carried out via descriptive statistics.

Results: 43 people including managers, nursing supervisors and emergency department directors were participated in this research. Percentage of male participants was 35, the female was 60 and the rest of them were unspecified. Findings indicated that most of the hospitals did not have any CBRN Incident Response Program incidents. Only the A hospital had the special emergency services for response to CBRN. In addition at hospital A, the mean of readiness and response programs were 71.6% and 65.6% good and fair, respectively.

Most of the hospitals had disaster management committee and some of them had incident command system. In addition hospitalsâ&#x20AC;&#x2122; staff has been educated in nuclear incidents readiness and response.

Conclusions: According to the results it is emphasized that the educational hospital are needed to be provided readiness generic programs and protocols for response to the CBRN incidents by focusing on determining the safety degree of decontamination zones, maps of decontamination zones, decontamination process, triage classifications, personal protective equipment, and supplies and antidotes for decontamination.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M117

PATIENT TRACKING CHALLENGES DURING DISASTER AND EMERGENCIES

N. Tavakoli 1, M. Yarmohammadian 2, R. Safdari 3, M. Keyvanara 4

1

Health Management And Economics Research Center, Isfahan University Of Medical Sciences, Isfahan. Iran., Isfahan, Iran, 2 Health Management And Economics Research Center, Isfahan University Of Medical Sciences, Isfahan. Iran., Isfahan, Iran, 3 Health Information Management , Tehran University Of Medical Sciences, Tehran.

Iran., Tehran, Iran, 4 Social Determinant In Health Research Center, Isfahan University Of Medical Sciences, Isfahan. Iran., Isfahan, Iran Background: One of the greatest challenges in disaster and emergencies is tracing and tracking patients. In Emergency Medicine, the concept of tracking has different denotations. One of the meanings refers to tracking patients’ physical locations and the other meaning refers to the advancements in patients’ treatments and tracking patients ‘medical needs during providing emergency services. The main goal of patient tracking is to provide patient safety during disaster and emergencies and manage the flow of patient and information in different locations. In most of cases, there are not sufficient and accurate data regarding the number of injuries, medical conditions and their accommodation and transference. The objective of the present study is to survey on patient tracking issue in natural disaster and emergencies.

Methods: This was a narrative study in which the population was E-Journals and electronic database such as PubMed, Proquest, Science direct, Elsevier, etc. Data was gathered by Extraction Form. All data were analyzed via content analysis.

Results: Currently, there is no appropriate and rapid method for tracking patients and transferring victims after the occurrence of incidents. The absence of reliable data of patients’ transference and accommodation, even in the initial hours and days after the occurrence of disasters, and coordination for appropriate resource allocation, have faced evaluating needs and services for rescue with challenges. Currently, most of emergency services are based on paper systems, while these systems do not act appropriately in great disasters and incidents and this issue causes information loss. Applying and implementing a system of tracking and monitoring patients result in improving workflow and work procedures of medical teams.

Conclusions: Patient tracking system should update the location of patients or evacuees and information related to their states. Patients’ information should be accessible for authorized users to continue their treatment, accommodation and transference. Also it should include timely information of patients’ location as soon as they arrive somewhere and leave therein such a way that health care professionals can be able to provide patients’ proper medical treatment.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M118

URGENT SUBMISSION ANALYSIS OF OUTPATIENTS IN THE RIBERA HEALTH DEPARTMENT (SPAIN)

R. Pérez Castillo 1, J. Ruiz Lopez 1, M. Cuenca Torres 1, P. Garcia Bermejo 1

1

Hospital Universitario De La Ribera, Alzira, Spain

Background: Our Emergency patient’s attendance, is divided into 2 care levels: the pimer care patient’s emergency, located in peripheral Healthcenters (Basic Health Units) and those attended at Hospital Emergency department (HED). Both levels intended to provide the best attention to patients, according severity of their condition and proximity to their homes.

The different Health centers submit the patients to the HED when they need accurate diagnostic-therapeutic tests not available in them.

The aim of this study: Determine the rate of submission to the HED, know the conditions that cause major submissions, analyzing them according to the Basic Health Units and describe the discharge destination of the summited patients after they are attended.

Methods: Descriptive, retrospective, observational study conducted at the Health Department of La Ribera.

Valencia (Spain) January 2012 to December 2014.

All patients submitted to HED from the Prime Care Emergency from Basic Health Units were studied.

Selected Variables: sex, age, Basic Health Unit of origin, pathology Triage priority assigned in the HED under international Manchester Triage System, care unit in HED and discharge destination.

The results analysis was performed using SPSS 19.0.

Submission rate was calculated as the number of submissions among all the outpatients attended at the Basic Health Unit emergency room in a year. 3 years were analyzed avoiding epidemic situations bias.

For inadequate submission, the assigned HED Triage priority was studied; considering inappropriate HED Triage priority assigned Blue (p5) or the care destination unit was the consulting room of banal pathology Results: Females predominated (51%) average age 47.8 median 46.80 + - 28,646.Triage priority mainly P4.

Most prevalent diseases submission: trauma (15.9%) and respiratory (11.2%). Cardiological pathology including, hypertension only reached 6.4%.

8.10% inadequate submissions.

Leading discharge destination: home (73%) only 18.9% were admitted.

Submmit rate was increased annually: derivation rate 7.68%.

Conclusions: The study of the submissions of the different basic health units helps detecting improvement areas in urgent care that can be remedied by planning specific and targeted training activities. Training activities were planned in the areas of orthopedics and urgent respiratory diseases.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M119

EVALUATION OF PSYCHOSIS IN PATIENTS REFERRED TO THE EMERGENCY MEDICAL DEPARTMENT

G. Masoumi 1, M. Ahmadi 1

1

Iran University Of Medical Sciences, Tehran, Iran

Background: Introduction: Psychosis can come on suddenly or can develop very gradually. There may be early warning signs, such as social withdrawal, or feeling suspicious, anxious, tense, irritable or depressed. Changes in concentration, memory and thinking may occur as well as changes in appetite, energy level and patterns of sleep. In this article it has been attempted to study the Rate of Occurrence & Intensity of Psychosis in patients that referred to the Emergency Medical Department of Shohadaye Hafte Tir hospital.

Objectives: Mental disease is not exclusive to a specific class of society and it includes all social classes. But for different reasons, traumatic patients experience so many mental pressures and stresses related to accident status and are naturally more exposed to this type of disease.

Methods: The study is descriptive- cross â&#x20AC;&#x201C; sectional and was performed in emergency centers of Tehran hospitals especially at the Shohadaye Hafte Tir hospital. Study population comprised of all patients referred to the Emergency Medical Department who volunteer in emergency departments. After coordination with the relevant authorities to conduct research hospital, the staff of the section was selected by random sampling method.100 patients were selected voluntarily and evaluated based on SCL-90 clinical test.

Results: Most of the patients were between 20 to 32 years old (34.9% of them). 7.3% of them were female and 71% of the studied patients were single. Studies have shown that there is a significant relation between gender and psychosis, residential status and psychosis, family income and psychosis, psychiatric diseases and psychosis in which X2 indicates expected frequency.

Conclusions: The results of findings in regard to specifying the rate of occurrence and intensity of psychosis have shown that the rate of psychosis in patients that referred to the Emergency Medical Department of Shohadaye Hafte Tir hospital, is 28.3% and some solutions were offered to improve the situation.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M120

THE AFFECT OF QUALIFICATIONS OF PATIENTS AND THE NUMBER OF THE PATIENT’S RELATIVES ON PATIENT’S SATISFACTION AT ADMISSION

T. Korkmaz 1, B. Balaban 2, H. Onder 2, F. Salacin 2

1

Izmir University Department Of Emergency, Izmir, Turkey, Emergency, Bolu, Turkey

2

Bolu Abant Izzet Baysal University Department Of

Background: Patient satisfaction surveys are important information sources for the evaluation of the quality and continuity of medical care. Waiting and treatment time, interest of doctor-nurse, reliance on knowledge of staff, and qualifications of patients may have on impact on the patient satisfaction. In this study, it is aimed to investigate the impact of patient’s qualifications (such as educational background) and the number of patient’s relative on the patient satisfaction.

Methods: In the first part of the study including all patients over 18 years old who have applied to emergency department within one month, the patients and the relevant patient information were recorded. In the second part of the study, the patients and patient’s relatives were asked questions by an unrelated staff after the patient was discharged.

Results: The average age of 264 patients is 30.5 30.5 ± 1.2, the average of those satisfied with emergency services is 100 ± 0.9 (%95CI Lower Bound 88.4, Upper Bound 92.3). It was observed that the patient satisfaction is directly proportional to the age and inversely proportional to the educational level (respectively r=0.241 p=0.0001, r= - 0.236 p=0,0001). It was found out that the patients who were brought into the emergency department by ambulance, hospitalized and had 2 and above accompanists were statically more satisfied however; there was no relationship between the patient satisfaction and the complaints and the presence of an accompanist. (respectively p=0.002, p=0.408) (Table). It was seen that the most common reason of dissatisfaction was “waiting for a long time during examination and treatment process”. <FILE IMAGE='249_20150630161945.tiff'>± Conclusions: In order to make the first stabilization of patient rapidly and without disruption, the emergency department should be treated different from other units of hospital in terms of infrastructure, staff numbers and quality. Since the patient satisfaction survey allows feedback for evaluation of medical care, it should be useful and necessary. However, it should be noted that satisfaction evaluated by a patient does not indicate the patient care quality always and, the patient care quality perception may vary between patients and healthcare staff.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M121

FOLLOW-UP AFTER EMERGENCY DEPARTMENT VISIT-EXPERIENCE OF A COMMUNITY HOSPITAL EMERGENCY DEPARTMENT IN NORTHERN TAIWAN

P. Chih 1

1

En Chu Kong Hospital, New Taipei City, Taiwan

Background: Follow-up after emergency department (ED) visit is critical for patient safety issues. Though varied follow-up rate after ED discharge had been broadly published, the trend in Asian countries was rarely reported.

The purpose of the study was to determine the follow-up rate of ED discharged patients in a community hospital in northern Taiwan.

Methods: A convenience sample of patients discharged from the ED in 4 designated day shifts were enrolled in the study. Follow-up appointment with specialty outpatient clinic of the same hospital was scheduled. A printed appointment sheet along with discharge instructions were given to the patient before leaving. Most of the follow-up visits were scheduled within 3 days of discharge. Follow-up rate was recorded according to retrospective electronic medical record review.

Results: There were 32 trauma and 29 non-trauma patients in this study. Forty-one of them presented for follow-up visits as scheduled. Follow-up rate for trauma patients was 63% while that for non-trauma patients was 72%. Statistical significance was not calculated due to small sample size.

Conclusions: ED provides timely medical care for a variable of conditions that admission may not be necessary. For those discharged from ED, follow up care would be important no matter what the presenting cause is. Though access to care has been cited as barrier to follow-up care for ED discharged patients, this is not the case for the population in this study. Due to affordable and population-based health insurance coverage, neither is economic concerns a barrier to follow-up visits. In a health care system in which patients can enjoy free of choice and unlimited access, the reasons of follow-up or not after the ED visits may go beyond our current understanding.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Administration, Health Policy, and Legislation

M122

A STUDY TO DETERMINE THE POST-DISCHARGE INSTRUCTIONS FOLLOW-UP IN PEDIATRIC EMERGENCY ROOM BY SPANISH SPEAKING PARENTS.

K. Nibhanipudi 1

1

Nymc,metropolitan Hospital Center, New York, Usa

Background: Objective: A Study to determine post discharge instructions follow up by Spanish speaking parents with regards to discharge instructions for a disease specific (DSD) versus generic discharge (GD) in pediatric Emergency room.

Methods: Methods: 500 parents volunteered to participate in the study. The parents scored the survey for both generic as well as disease specific discharge instructions as per their choice, using the scoring system. All the parents in survey, who have most acceptable in generic 44/500 and DSD 410/500 were contacted by telephone.

Results: Results: 500 parents participated in the survey study. Survey results show majority favor DSD (410/500) over GD instructions (44/500). However the results of post telephone call observation is different. After 2 to 5 days, the parents were (38/44 of GD and 350/410 of DSD) were able to be contacted by phone, and had the following positive responses in all 5 categories. (i) Diagnosis (condition of the child) and how the childâ&#x20AC;&#x2122;s condition is improving: GD-36/38and for DSD 340/350 (ii) Clinical information: GD30/38and DSD 287/350. (iii) Medications prescribed, frequency & dosages: GD35/38 & DSD 340/350 (iv) Return to the ER when condition worsen: GD 35/38 & DSD 340/350 (v) Follow up of appointment: GD 20/38 & DSD 182/350 Both the positive and negative responses in all 5 categories were compared and unpaired t-test result show statistically significant two tailed p-value of 0.0032

Conclusions: Conclusions: Spanish speaking parents have the same preference both for specific disease discharge as well as generic discharge instructions

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines

M123

CLINICAL DECISION UNIT IN THE EMERGENCY DEPARTMENT A GATEWAY TO REDUCE OVERCROWDING AND IMPLEMENTING CLINICAL DECISION RULES: A PERSPECTIVE FROM PAKISTAN

S. Waheed 1, I. Qamar Khan 1, E. Siddiqui 1, A. Feroze 1

1

Aga Khan University Hospital, Karachi, Pakistan

Background: Overcrowding has been an issue many EDs all over the world are facing and different measures are undertaken to reduce the waiting time and improving the care in such stressful situations where the ED is pushed to their maximum capacity. The aim of our study was to evaluate the effect of the clinical decision units on to the patient flow, length of ED stay and the implementation of clinical decision rules in these areas to facilitate patient disposition decisions.

Methods: We conducted a cross-sectional study in Aga Khan University Hospital, a tertiary care hospital. A retrospective analysis in median emergency department length of stay and admission visits at CDU was done.

The data was gathered from Jan 2013 to December 2013.

Results: A total of 1515 patients presented to the Emergency Department of the hospital. Majority, 65% of the patients were from the P3 and P4 category. 26% of the patients were of the Acute Gastroenteritis Followed by the Acute Coronary Syndrome 18%. Majority 43% of the patients were admitted in the concerned department within 12-24 hours.

Conclusions: The Clinical Decision Unit has significant impact in reducing the length of stay and expediting the decisions of the patients. The implementation of these units can play an important role in improving the timely disposition and management of patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines

M124

MANAGEMENT OF HIP FRACTURES IN THE EMERGENCY DEPARTMENT AT THE COUNTESS OF CHESTER HOSPITAL

B. Roberts 1, A. Williams

1

Countess Of Chester Hospital, Chester, United Kingdom

Background: Hip fractures are a relatively common presentation in A&E given the ageing population and the high prevalence of hip fractures above the age of 80. The high morbidity associated with hip fractures is well documented. Optimisation of early management of hip fractures is important to improve patient outcomes.

Methods: This audit is designed to evaluate the management of hip fractures in the Emergency Department.

Using recommendations from NICE guidance and CEM standards, we have formulated a data collection tool to assess the management of patients with a diagnosis of fractured neck of femur. 15 patients presenting over a one month period were analysed. We used parameters such as timing and quality of pain relief (including reassessment of pain following analgesia), as well as timings of investigations and referral to appropriate speciality.

Results: The main finding was inconsistencies in documentation. Several, but not all, patient notes contained a designated NOF fracture pathway (though most did not have adequate completion of the pathway documented).

Analysis showed a mean time of 101 minutes for receiving analgesia. 45% received IV paracetamol, with 50% of those receiving morphine in addition. 10% were given Tramadol and 20% were given codeine only. Of particular concern was the lack of documented evidence to show that these patients were re-assessed following administration of analgesia. It is unlikely that Paracetamol, for example, would be sufficient to relieve pain, yet in some cases paracetamol was the sole analgesic documented (with no subsequent documentation to assess pain score following the analgesia). Very few patients received a fascio-iliaca block, and of those who did, none of which were administered by A&E doctors.

Conclusions: Incidentally, it is noted that the increased time to adequate analgesia for those needing fascio-iliaca blocks could be reduced by ensuring A&E staff are competent in performing the technique.

This audit identifies the need for consistent documentation, and highlights the possibility of creating a simplified NOF pathway to guide clinicians, enabling closer adherence to guidelines set out by national organisations, therefore optimising the management, and subsequently improving outcomes, of patients with NOF fractures.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines

M125

A DESCRIPTIVE STUDY OF THE PATIENTS ADMITTED TO THE CLINICAL DECISION UNIT (CDU) IN CORK UNIVERSITY HOSPITAL (CUH) OVER A TWELVE MONTH PERIOD

E. O'shea 1, S. Cusack

1

University College Cork, Cork, Ireland, 2 Cork University Hospital, Cork, Ireland

Background: Clinical decision units (CDUs) are areas within a hospital providing an alternative to discharge or hospital inpatient admission for the emergency department patient who may benefit from an extended observation period. The benefits of CDUs include improved patient care and decreased readmission rates.

Methods: This retrospective study is set in the CDU of the ED in CUH and uses HIPE data obtained from the CUH medical records department and CDU specific data from CUH IT department. There was no active recruitment of patients, with all patients being acquired from the CUH HIPE database. Eligible participants were any patient admitted to the CDU from the ED during the period 01 January to 31 December 2012. Five patient characteristics to assess included age, gender, principal diagnosis and average length of CDU stay from CUH HIPE data, and care provider data from CUH IT department. Data was recorded and assessed on Excel and GraphPad Prism.

Results: There were 2307 patients admitted to the CDU in 2012, 57% male and 43% female, with an overall average age of 41.7 years. Of the total admitted, 2126 (92%) were discharged home from the CDU. The average length of stay (ALOS) of a patient in the CDU was 29 hours. The most common diagnosis admitted to the CDU was chest pain (9.5%), which was more common in males, followed by headache (7.2%), more common in females. The inpatient ward with the most number of CDU patients was the cardiothoracic ward.

Cardiology and neurosurgery were the most common care providers to CDU patients following referral.

Conclusions: Approximately 4% of all Emergency attendances were treated in the CDU. We identified 503 different diagnostic codes with 12 codes responsible for the majority of admissions. Patients with matched discharge diagnostic codes admitted to general wards had an ALOS of 3.9 days compared to CDU admitted patients indicating possible significant savings for the institution, estimated at â&#x201A;Ź2 million. We believe this is one of only two reports of this model of care in Ireland. More support for and research into this model of care is needed.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines

M126

EVALUATION OF PAIN MANAGEMENT IN AN EMERGENCY DEPARTMENT

W. Kerkeni 1, Y. Yahia, S. Mareghli

1

Emergency Departement, Chu Taher Sfar, Mahdia, Tunisia

Background: Inadequate pain management remains a major challenge for health care providers. The aim of this study was to evaluate the prevalence of oligoanalgesia and its causes.

Methods: We performed a prospective observational study over a period of one month. Patients with age>15 years with moderate or severe pain [visual analog scale (VAS) >30mm or numeric scale (NS) >3] at hospital admission were included. Patients not communicating or confused were excluded. The quality of pain management was evaluated according to information in the ED medical records by using a standardized collection form, and its impact on patients (evolution of the pain and the degree of patient satisfaction) was recorded with a questionnaire at discharge. Oligoanalgesia was defined as a NS>3 or VAS>30mm at hospital discharge.

Results: During the study period 580 patients were included (mean age 41Âą18 years, sex ratio = 0.97). Of them, 67% had pain. The pain was assessed by the medical staff only in 55% of cases during the care and in only 2% at discharge. The majority of patients (n=457) had moderate or severe pain and 15% of them did not express their pain spontaneously. The pain was essentially evaluated by the numeric scale (79% of cases), then by the simple verbal scale and visual analog scale in 16% and 5% of case respectively. Only 48% of patients enrolled received analgesic treatment. Morphine was used only for 7 patients while 33% of patients had severe pain. The analgesic was prescribed on median time 22min (IQR25-75, 14-37). The prevalence of oligoanalgesia was 80% and only 26% of patients were satisfied at discharge.

Conclusions: Our study demonstrates that acute pain is undertreated. The oligoanalgesia was essentially due to the not evaluation of the pain and combination of undelivered and delivered but unachieved analgesia.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines

M127

IS IT NICE TO USE GUIDELINES FOR HEAD INJURIES? AN AUDIT ON THE MALTESE EXPERIENCE

M. Ashraf 1, C. Vassallo 1, E. Wongso 1

1

Mater Dei Hospital - Department Of Accident And Emergency, Msida, Malta

Background: Head injuries are a common presentation to the Emergency Department. They are seen more commonly amongst those between 15-24 and those above 80 years of age.

For head injuries, the major cost at ED level is a non-contrast CT of the brain with its associated radiation.

Methods: We looked at all patients who had a CT brain in the ED in the first 3 weeks of March 2014 using the new NICE guidelines published in January 2014. We looked at all patients above the age of 14 that had a CT scan including those on anti-clotting agents.

Patients necessitating CTs of more than just their brain were excluded.

Results: 502 patients had CT scans in the Emergency Department. 146 patients had at least 1 inclusion criterion. 20.33% of 59 patients with loss of consciousness had a positive CT consistent with TBI. 5 out of 16 patients with retrograde amnesia had a TBI. We found 8 patients had a GCS of less than or equal to 13 and 4 of them had positive CTs. 5 out of 16 patients with 1 episode of vomitting had a positive CT. 54% of 13 patients with facial injuries had positive CT scans.

Of the 12 patients that had neurological deficits, 5 had positive CT findings. 12 patients had a dangerous mechanism of injury and 4 of them had a positive CT. We found that 27 patients did not fulfill any criteria for CT scans (18.5%).

The average age of the patients that were admitted was 62.75 years. <FILE IMAGE='330_20150629115845.jpg'> Conclusions: Patients presenting more than 12 hours after the event and are not on anti-clotting therapy do not need a CT brain if they do not have any neurological deficits. Patients with no immediate indication and only on medications that would put them at risk for haemorrhage, should be admitted if presenting acutely with no CT needed in the ED. The presence of other injuries can be useful in assessing patients with head injury because they demonstrate mechanical properties of the fall that can help request lifesaving investigations.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Clinical Policies / Practice Guidelines M128

MANTRELS: A MANTRA FOR APPENDICITIS?

M. Ashraf 1, C. Vassallo 1, S. Mizzi 2

1

Mater Dei Hospital - Department Of Accident And Emergency, Msida, Malta, 2 Mater Dei Hospital - Department Of Surgery, Msida, Malta Background: Acute appendicitis is one the most common causes of an acute abdomen. Yet, its diagnosis and treatment has been fraught with uncertainty and confusion.

The ALVARADO / MANTRELS score was devised to reduce uncertainty regarding diagnosis and aid in clinical decision making.

For patients with low scores, discharge is deemed appropriate and for patients with higher scores surgical intervention has been the norm. Patients with intermediate scores have usually had radiological imaging with a clinical decision being made after an ultrasound or CT. Methods: We looked at all patients that presented with abdominal pain over a span of 3 months (April 2014 June 2014) and had either ultrasounds or CTs regardless of admission. We calculated ALVARADO scores retrospectively based on clinical notes and discharge letters.

We followed up the patients that underwent surgery with histology reports and theatre notes highlighting macroscopic pathology.

Results: We looked at 310 patients in 3 months that had scans in the ED. In addition 41 patients had appendicectomies without imaging. 277 ultrasound scans were performed for patients with an average score of 4.33. Out of these, 57 had a positive finding with an average score of 5.52. 44 of these patients had positive histology findings. 30% of children had a positive ultrasound, 48.98% of adult males and 17.64% of adult females.

The sensitivity and specificity for appendicitis in intermediate scoring patients was 93% and 42.81% respectively.

Surgical patients that had no imaging had an average score of 6.07.

Patients that had a CT scan in the ED had an average score of 4.84. 19.14% of these patients were discharged.

42.85% of patients with a low score had a positive histological diagnosis. <FILE IMAGE='330_20150627205755.jpg'> Conclusions: An ultrasound is acceptable only if the patient has an intermediate score and is male. A CT has no role in the diagnosis of appendicitis in the ED. Low scoring patients should be offered admission unless they are asymptomatic with a score close to 0. The ALVARADO scoring system is less useful for low scores and other scores should be tested for such patients.

MEMC - GREAT Rome (Italy), 05/09/2015 - 09/09/2015 Topic: Cardiovascular / CPR / Resuscitation

M62

COMPARISON OF QUALITY OF CARDIOPULMONARY RESUSCITATION BETWEEN CONVENTIONAL VERSUS DISPATCH-ASSISTED BASIC LIFE SUPPORT TRAINING PROGRAM; A RANDOMIZED SIMULATION STUDY

T. Kim 1, S. Shin 1, Y. Lee 1, H. P:ark 2, E. Lee 1, K. Song 1, D. Jang 2, H. Lee 2, Y. Ro 2

1

Department Of Emergency Medicine, Seoul National University College Of Medicine And Seoul National University Hospital, Seoul, South Korea, 2 Laboratory Of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea Background: Home bystanders such as elderly or women who have lesser chance of cardiopulmonary resuscitation (CPR) training and less competency nor retention of skill and knowledge. We developed the dispatch-assisted-basic life support (DA-BLS) training program to improve the quality of CPR performed by home bystanders.

We compared the quality of CPR of bystanders educated with new DA-BLS training program to conventional BLS training program.

Methods: This is a randomized simulation study. 24 elderly or housewives without previous CPR education were enrolled. Participants were randomized into 2 groups of BLS training programs (Conventional vs. DA-BLS).

The DA-BLS, video-based 60-min. training program, included current dispatch-assisted BLS protocols, dispatcher instructions, BLS skill session and debriefing session. The conventional BLS training was the American Heart Association BLS provider course. After completing each education program, participants performed 5 minutes of CPR as bystanders in a simulated environment. Quality of CPR was measured and recorded by simulation manikins. Primary outcome was no flow time in 5 minutes of CPR. Results: Among 24 participants, 2 participants (8.3%) with mechanical failure of simulation manikin and 1 participant (4.2%) with simulation protocol violation were excluded. Mean no flow time was 83.2±19.5 seconds for DA-CPR program group and 148.7±38.1 seconds for conventional education group (p<0.01). Mean percentages of adequate rate of chest compression and adequate depth of chest compressions for each groups (DA-BLS vs. conventional) were 70.0±20.7% vs 56.0±30.5 % (p=0.23) and 12.1±23.8% vs 23.7±38.6 % (=0.41) respectively.

Conclusions: Bystanders educated with the new DA-BLS training program were shown to perform better bystander CPR in simulated OHCA