Top 4 Oral Abstracts

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

Topic: Administration, Health Policy, and Legislation T01

SEWS RELIABILITY TO PICK UP THE ACUTELY ILL PATIENTS IN A BUSY EMERGENCY DEPARTMENT M.A. Majeed 1, A. Naveed 1, S. Imam 1, G. Giovannetti 1 1

University Hospital Birmingham, Birmingham, United Kingdom

Background: Early warning systems (EWS) are bedside tools used to assess basic physiological parameters to identify patients with potential or established critical illness.1 Current evidence suggests that they may predict risk of intensive care admission, death and length of hospital stay.

OBJECTIVES: To establish whether a ‘SEWS’ scoring of >= 4 on patient's arrival to A&E is useful in predicting critically ill, likelihood of patient deterioration and need for direct ITU admission.

Methods: We performed a retrospective single center cohort study including 500 patients attended the Emergency Department of University Hospital Birmingham during December-November 2013. It was decided from previous experience to define a SEWS of 4 or more as a “critical score”.

Primary endpoints were ITU/HDU admissions, admission to a non-critical ward, discharged, self discharged, transfer to another hospital and death within 1 month of the admission.

Inclusion criteria: • Adult patients were included.

Exclusion criteria: • Under 16 years old.

Results: We went through the notes of 500 patients. Overall, 49.4% (247) of patients were male, and 46.6% (233) were female. The mean age of patients was of 54 years.

21.2 % of patients were admitted to ITU/CCU, of this only 43% had a sews of 4 or more on arrival. Meanwhile this was true for 8.6% of the 39.4% ward admissions, and 2.2% of the 36.2% patients that were discharged home from A&E. Conclusions: A patient with a SEWS of <4 still has got more than 50% chance of being admitted to an Intensive Care Unit.

The results show that SEWS is a rather sensitive tool but less specific in picking up acutely ill patients. It might be useful supporting the more inexperienced doctors and nurses in assessing the risk of deterioration for their patients, initiating early and focused investigations and treatment.

DISCUSSION: Currently, there are several hundred unique yet similar EWS systems in use worldwide. Our results indicatethat SEWS variables in isolation may have little or no practicalusefulness in detecting critically ill, patient deterioration or intensive care unit admission.

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

Topic: Simulation Projects

T02

DEVELOPMENT AND EVALUATION OF A NOVEL SIMULATION TOOL TO TEACH THE REMOVAL OF AN EMBEDDED CORNEAL FOREIGN BODY: PILOT STUDY

P. Rega 1, B. Fink 1, J. Awbrey 1, V. Kazan 1

1

University Of Toledo College Of Medicine, Toledo, Usa

Background: There about 3.9 million annual emergency department visits for ocular trauma in the United States. A significant amount involves the extraction of an embedded corneal foreign body. While emergency medicine texts describe the procedure in varying degrees of detail, much of the training is still relegated to the archaic “see one – do one – teach one.” Medical simulation, in various iterations, has become a validated component of emergency medical education, as a means to learn and retain skills, as well as to improve patient safety. A medical literature search uncovered only several attempts at developing simulation models to enhance educational efforts associated with embedded corneal foreign body removal. These models, while serviceable, require time and money to construct; factors that can discourage their frequent utilization. Therefore, the authors have designed a new simulation model, incorporating slit lamp education that utilizes inexpensive, easy-to-acquire items that can facilitate and augment the educational process of teaching the removal of an embedded corneal foreign body.

Methods: A model was created using a hard-boiled egg impregnated with ground peppercorns. The egg-peppercorn model was attached to the slit lamp. During their emergency medicine rotation, medical, nursing, pharmacy, and public health students (plus a multi-disciplinary faculty (n=15) received education about slit lamps and corneal foreign-body removal. They simulated corneal foreign body removal using the egg-peppercorn technique and compared this model with one of the previously published techniques. A brief survey comparing the educational benefits of both techniques was administered.

Results: At the introductory session, 100% of the healthcare learners favored the experimental model over the previously-published model to teach corneal foreign body removal during simulation education. Similarly, when this model was field-tested using non-traditional healthcare providers, it received a similar assessment.

Conclusions: It is proposed that this simulation model, because of its cost, accessibility, and elemental design will increase the frequency of training, thereby enhancing the psychomotor skills of emergency medicine specialists for ophthalmologic emergencies and ensuring patient safety. During surge capacity augmentation, non-traditional healthcare providers may also benefit from this type of education during catastrophes.

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

Topic: Pre-Hospital / EMS / Out of Hospital

T03

ISOPROPYL ALCOHOL NASAL INHALATION INTERVENTION OF NAUSEA IN THE EMERGENCY DEPARTMENT: A RANDOMIZED PLACEBO-CONTROLLED HUMAN TRIAL

A. Helbling 1, K. Beadle 2, S. Love 1, C. Hunter 1

1

San Antonio Military Medical Center - Department Of Emergency Medicine, Fort Sam Houston, Tx, Usa, 2 Eglin Hospital - Department Of Emergency Medicine, Eglin Afb, Fl, Usa Background: ISO has been shown to alleviate NV postoperatively. This study is the first to examine ISO for NV in the ED. This study evaluated nausea and vomiting (NV) relief, and satisfaction with treatment with nasally inhaled isopropyl alcohol (ISO) vs saline placebo in emergency department (ED) patients before access to traditional antiemetics. We hypothesized both would be better in the ISO group. <FILE IMAGE='219_20150531050155.jpg'> Methods: Randomized, prospective, blinded placebo-controlled trial in an urban military level-I trauma center ED. Subjects were blinded by masked substance packets and ignorance of the identities of the study substance and placebo. Investigators were blinded by masked packets and by distance from open packets. A convenience sample of 84 patients aged 18-65, able to breathe nasally, English literate, and complaining of NV was enrolled.

Exclusions were pregnancy, ISO allergy, use of medications with antiemetic or disulfiram effect, recent URI, or clinical intoxication. Subjects described nausea on an 11-point Verbal Numerical Response Score (VNRS) at 0, 2, 4, 6, and 10 minutes (min). At 0, 2, and 4 min subjects inhaled from the study packet for 60 seconds. A 3-point change on the VNRS was set as significantly different. Patient satisfaction was recorded on a 5-point Likert Scale at the study conclusion.

Results: 80 subjects completed the trial. 4 withdrew. None were excluded after enrollment. No adverse events were noted. 72.9% had significant nausea relief within 4 min of inhalation with ISO vs 4.6% with placebo (p<0.001). 56% had nausea relief at 10 min with ISO vs 2.3% with placebo (p<0.002). 64.8% were satisfied with ISO vs 2.3% with placebo (p<0.001) Conclusions: Nasally inhaled ISO is a safe and effective treatment for NV in the ED with relief onset by 4 min and persisting through the 10 min study duration.

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

Topic: Cardiovascular / CPR / Resuscitation

T04

THE ROLE OF EMERGENCY ULTRASOUND IN CARDIOPULMONARY RESUSCITATION

Y. Matsuoka 1, N. Hata 1, T. Hayashi 1, K. Ariyoshi 1

1

Kobe City Medical Center General Hospital - Department Of Emergency Medicine, Kobe, Japan, Kobe, Japan

Background: Emergency ultrasound is a useful diagnostic tool for identifying reversible causes of cardiopulmonary arrests, at bedside, without interrupting standard resuscitation. However, there are no clear guideline recommendations for its use during cardiopulmonary resuscitation. The aim of our study was to determine the effectiveness of emergency ultrasound for diagnosing the etiology of cardiopulmonary arrests.

Methods: We conducted a retrospective analysis of adult patients with non-traumatic out-of-hospital cardiac arrests who were brought to an urban emergency department between April 2010 and March 2014 in Japan. To evaluate the diagnostic value of emergency ultrasound, we compared the results of emergency ultrasound performed by emergency physicians with autopsy-proven diagnoses. Data were abstracted from records at Kobe City Medical Center General Hospital and the Medical Examiner’s Office of Hyogo Prefecture. Only patients who underwent autopsy and who were examined with emergency ultrasound during cardiopulmonary resuscitation were enrolled. The exclusion criteria were as follows: age <18 years, traumatic injuries, known terminal illness, and prior completion of a “do not resuscitate” form.

Results: A total of 268 patients with non-traumatic out-of-hospital cardiac arrests underwent autopsy (168 men [62.7%], 100 women [37.3%]; mean age, 71.3 ± 15 years). Of them, 202 patients (75.3%) were examined by emergency physicians using emergency ultrasound. The most common cause of cardiac arrest was acute coronary syndrome (72 cases, 36 %), followed by aortic pathology (21, 10%), arrhythmia (20, 10%), and pulmonary embolism (9, 4.6%). The following causes of out-of-hospital cardiac arrests were detected by emergency ultrasound in 19 patients: cardiac tamponade (14 cases), rupture of abdominal/thoracic aortic aneurysm (3), and pulmonary embolism (2). Emergency ultrasound identified causes of cardiopulmonary arrests with a sensitivity of 54.3% (95% confidence interval, 44.1–58.4), specificity of 98.8% (96.7–99.7), and overall accuracy of 91.1% (87.6–92.5).

Conclusions: Emergency ultrasound identified potentially reversible causes of cardiopulmonary arrests with a high accuracy. Advanced life support with emergency ultrasound would improve the quality of cardiopulmonary resuscitation compared with standard protocols.