Wuhan University, China
Cardiac remodeling is the common Patho physiological process of a variety of heart diseases toward heart failure. The existing treatments are still poor efficacy in a number of patients with the poor prognosis. It was well known that micro RNAs are endogenous non-coding RNA molecules that regulate gene expression, which result in either gene degradation or translational repression. The miRNAs are critically involved in many biological processes in disease. Previous studies have shown that miR-30 could decrease autophagic activity in cancer cells by negatively regulating Beclin-1 gene expression. However, the research on miR-30 is blank in the field of cardiac remodeling. This study aimed to investigate the functional significance of miR-30 in cardiac remodeling induced by pressure overload using conditional miR-30 knockout mice. We found that miR-30 deficiency resulted in severe hypertrophy, fibrosis and dysfunction in mice compared with the control group which used the wild-type mice. We discovered that the expression of Beclin-1 was significantly increased in miR-30 deficiency hearts when compared with control hearts. Our study suggests that miR-30 might be a novel target for the treatment of pathological cardiac hypertrophy and failure.
Biography:
Zhouyan Bian got MD and Ph.D of Cardiology from Renmin Hospital of Wuhan University. She worked in Cardiovascular Research Institute of Wuhan University, and was mainly responsible for the research on cardiac remodeling. Her research showed that natural immunity plays an important role in the pathological process of cardiac remodeling. Several signaling molecules in natural immunity signaling pathway were displayed to be determinants in the outcomes of cardiac remodeling. These investigations implicate natural immunity as a novel therapeutic target for cardiac remodeling. Now she worked as an associate chief physician in Department of Cardiac Care Unit, Renmin Hospital of Wuhan University.
1Clinical researcher in National Ambulance UAE
2National Ambulance CEO, UAE
3Medical Director of National Ambulance, UAE
4Clinical Auditor, UAE
Objectives: To describe the characteristics of out-of-hospital cardiac arrest patients, who were treated and transported to hospitals by National Ambulance. This study represent the percentage of patients who had return of spontaneous circulation (ROSC) prior arrival to emergency departments in the emirates of Sharjah, Ajman, Ras-al-Khaimah, Fujairah and Umm Al-Quwain in united Arab emirate.
Methods: This is a prospective descriptive cohort study of out-of-hospital cardiac arrest cases transported by the national ambulance crews between July 2017 and June 2018 in the Northern Emirates. We report demography of incidence, sex, mean age, locations, witnessed cardiac arrests, bystander CPRs, presenting rhythms, pre-hospital shocks, advanced airway, medications and return of spontaneous circulation (ROSC) in the field.
Results: Number of patients included in this study was 715 patients. 77% (548) of patients were males and 23% (167) females. The median age of these patients was 50 years. Resuscitation and transportation was attempted by national ambulance for 95% (682) and 5% (33) were pronounced dead at scene.
Majority of victims was from Asian Nationalities 55.1% (394), Arabic people 35.2% (252), from the Arab 15.8% (113) were Emirati citizens. The lowest number of cardiac arrest patients were Europeans 2.2% (16) and Africans 3.2% (23). From the total OHCA cases 4.1% (30) their ethnicity were unknown. In this period most of victims had cardiac arrest in their home resident 66.7% (477), 19.3% (138) in the streets and public places and 6.1% (44) in workplace.
First step in chain of survival is early recognition of cardiac arrest, in north emirates 51.7% (370) cases were witnessed by bystander families, lay persons and bystander healthcare providers. Early bystander CPR is the second important step and it was performed for 27.5% (197) of the patients. Third step is early defibrillation and only 1.8% (13) had AED applied by bystanders before arrival of National Ambulance to the field. Non-shockable rhythms were the highest of the presenting rhythms 84.3% (603), for the shockable rhythms shock was delivered for 11% (80) by national ambulance crew. Advanced airway was used for 93% (670) of patients, as well as IV epinephrine administered for 44% (315). Prehospital return of spontaneous circulation (ROSC) for out of hospital cardiac arrest patients was 9.2% (66).
Conclusion: Our study illustrates out of hospital cardiac arrests in north emirates, 9.2% (66) had return of spontaneous circulation prior arrival to ED. More than a half of the cases were witnessed and recognized by bystanders, low rate of bystander CPR and access to public defibrillators was discovered. This study is essential to improve chain of survival implementation in UAE to reduce out of hospital cardiac arrest mortalities.
Biography:
Saad AlQahtani has completed his Master at the age of 26 years from Queensland University of Technology School of emergency and disaster medicine in Australia. He is the clinical researcher in National Ambulance UAE and Coordinator of Pan Asia resuscitation outcomes study in North Emirates. He has participated in many international projects in field of emergency and disasters.
Life Star Emergency, Slovakia
Acute coronary syndrome associated with mast-cells and platelets activation in the setting of hypersensitivity and allergic or anaphylactic insults defined as a Kounis syndrome.
Inflammatory mediators induce coronary vasoconstriction and platelets activation leading to plague erosion and rupture. They also induce tachycardia, dysfunctional ventricular contractility and blockade of atrioventricular conduction. Prolonged hypotension is another pathogenic mechanism for ACS.
87-year-old female patient with known allergy to Analgin, took Algifen droops for low back pain. Within 10 minutes she had anaphylactic shock with angioedema and hypotension. Her pulse rate was 120-160 per minute, irregular, blood pressure 57/30 mmHg, oxigen saturation 80 % on room air, she had an altered mental state (GCS 14) and complained of pain in the epigastrium. After prompt management with O2, Epinephrine ( 2 mcg/min), within 10 minutes the patient was stabilized — GCS 15, pulse rate 86 per minute, blood pressure 96/45 — 123/100 mmHg. 12 leads ECG showed atrial fibrillation, ST elevation in aVR> 4 mm and in V1 >2 mm, ST depression in precordial and limb leeds(STEMI equivalent, indicates LMCA lesion). Patient received Anopyrin 200 and Brilique 180 mg. Admission for PCI was denied bycardio center. Patient was admitted to the nearby hospital. Laboratory tests showed high troponins. Patient passed away on the third day of hospitaliztion. Kounis syndrome is not that rare, but it is rarely diagnosed and is hugely underestimated. Till now, the diagnosis of syndrome is based on its clinical manifestations.
Biography:
Iryna Domoratska, doctor anesthesiologist, currently working as an Emergency Medicine doctor in Life Star Emergency, Slovakia. Five years worked in Riyadh, Saudi Arabia as an anaesthesiologist in prominent private hospital. In year 2014 obtained European Diploma in Anaesthesiology and Intensive Care. Had presentations in international Emergency Medicine conferences and congresses — Slovakia, Czech republic, Austria.
West Middlesex University Hospital, United Kingdom
Medication errors in the hospital are preventable causes of patient harm and mortality. A recent report(1) analyzing 36 studies revealed that 237 million medication errors occur in the NHS in England every year. Research shows medication errors are most likely to happen in emergency departments and when patients are transferred from one level of care to another (2). A retrospective 10 year study identified omission of medications to be the commonest cause of medication administration errors in acute healthcare setting (3). Failing to prescribe important medications at hospital admission can lead to medication omissions during a patientʼs hospital stay. This is why, it is important to go through medication reconciliation process and prescribe patientsʼ regular medications early on. This is especially true for essential medications such as anticoagulants, antiparkinsonian medications and insulin.
This project investigated the use of inpatient drug chart in the ED observation unit, a small, short-stay ward within the department. Initial retrospective case note analysis showed that only 36% of patients admitted to the observation unit had undergone medication reconciliation and had the inpatient medication chart filled during admission. This caused omission of important medications and complicated patientsʼ discharges. In several cases, patients developed erratic blood sugar levels due to missing their insulin and needed longer admissions for correction. In one case, an elderly patient developed delirium after missing her regular eye drops.
In order to identify the main issues for the poor prescribing practice and opportunities for improvement, a survey was done amongst the ED doctors. The main issue identified was that ED doctors did not know how to access accurate medication history for confused and unwell patients. In order to address the issue, three main PDSA cycles were completed: 1-Five-minute verbal teaching during morning ward rounds,2-Placing information leaflets around the department and 3-Presentation at the departmental induction for new doctors. ED doctors were taught to access the Summary Care Record as a tool of obtaining accurate medication histories. Prescription rates improved with each intervention from 36% to 79%. The improvements were found to be sustainable over a longer period.
Makati Medical Center, Philippines
This is a rare case of non-accidental ingestion of lacquer thinner by a 24 year old male who presented with high anion gap metabolic acidosis and chemical burn to the mucosa. He was managed as a case of methanol toxicity and caustic ingestion, a medical emergency requiring immediate treatment.
Introduction: Lacquer thinner, one of the most common household and work place chemical used in thinning paint is known to contain a myriad of hydrocarbons. Current data shows that toluene, its aromatic hydrocarbon component, is responsible for the toxicity. This case revealed that lacquer thinners contain poisonous substances other than toluene such as methanol, acetic acid and methyl ethyl ketone.
Case Report: A 24 year old male was brought to the Emergency Department due to changes in behaviour and abdominal pain after deliberate ingestion of 150ml lacquer thinner. As a suicide attempt after an alleged fight with his spouse, he developed burning nonradiating epigastric pain an hour after ingestion. He then vomited a cup of blood and was subsequently taken to a local hospital where he was given sodium sulfate to hasten elimination. He was transferred to PGH 9 hours after initial treatment with stable vital signs, GCS 15 and no cardiorespiratory distress. He was clinically inebriated despite no co-ingestion. Physical exam showed whitish membranes on hard palate and posterior pharyngeal wall and direct tenderness on epigastric area suggesting alcohol intoxication and caustic injury. Significant laboratory findings included High Anion Gap Metabolic Acidosis (P02 90.2, pH 7.36, pC02 20.7, HCO3 10.4, Oxygen saturation 95Chloride 107). The patient was given Folinic Acid as an antidote to methanol. Immediate endoscopy showed grade 3A mucosal injury, circumferentially sloughed off mucosa of the esophagus and duodenum. The patient ultimately underwent exploratory laparotomy and tube jejunostomy insertion as definitive management.
Case Discussion: Methanol Toxicity Methanol is a toxic alcohol that is rapidly absorbed and distributed in the body. Formic acid, the metabolic by product of methanol, is a mitochondrial toxin which inhibits cytochrome oxidase and interferes with oxidative phosphorylation. Its accumulation leads to poisoning manifested by CNS depression, metabolic acidosis and visual changes. Management includes rapid correction of the acidosis and early prevention of the formation of this toxic metabolite. Its antidote--Folinic Acid accelerates detoxification of methanol by enhancing the metabolism of formic acid to harmless carbon dioxide and water.
Caustic Ingestion: The degree of injury upon ingestion of a caustic substance is determined by its pH, concentration, contact time, volume and pre-morbid condition. Ingestion of strong acids produces coagulation necrosis resulting in perforation, strictures and gastric obstruction. Endoscopy is the gold standard for evaluation of injury. Esophageal mucosal burns care classified by endoscopic grading system: grade 1 burns involve hyperemia of mucosa and tissue edema, grade 2 burns are blisters, erosions and whitish membranes and grade 3 burns involve deep ulcerations and extensive necrosis. The key priority in management is airway maintenance and stabilization.
Conclusion: Household and workplace products may contain various poisons that are capable of causing serious physiologic morbidity. Early identification of substance ingested is vital to anticipate potential damage and degree of toxicity. In this case, high clinical suspicion based on careful history and physical examination was a critical factor in the diagnosis and timely intervention.
Ministry of Health, Sudan
The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this article. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conducts.
Biography:
Abdeen Mustafa Omer (BSc, MSc, PhD) is an Associate Researcher at Occupational Health Administration, Ministry of Health and Social Welfare, Khartoum, Sudan. He has been listed in the book WHOʼS WHO in the World 2005, 2006, 2007 and 2010. He has published over 300 papers in peer-reviewed journals, 200 review articles, 7 books and 150 chapters in books.
Makati Medical Center, Philippines
Caissons Disease or Decompression Sickness is a condition that results from dissolved gases coming out of solution (blood) into bubbles inside the body brought about by rapid change in external pressure from high to low. It is an acute neurological emergency in Divers. There are currently no diagnostic criteria and studies of therapies lack an acceptable case definition for this disease.
We report a case of a 30 year old male, Asian, leisure diver, who presented with severe headache and vomiting after rapid ascent from a 29 meter dive. MRI of the brain, MRA of the intracranial vessels and subsequent MRV was done showed venous thrombosis, attenuated flow on the superior and inferior Sagital sinus and absent blood flow straight, right transverse, right sigmoid sinuses and right jugular. The patient was diagnosed with Patient was treated with Heparin Drip and Hyperbaric Therapy.
Headaches were improved but still recurring after hyperbaric therapy and patient was eventually transferred to an institution with a hyperbaric chamber for continuance of treatment. Although most cases results in 100 % recovery after hyperbaric therapy, 3 month follow ups showed persistent symptoms as much as 14.3% and 16% having permanent neurological sequale.
Keywords: Decompression Sickness; Caissons Disease; Divers Disease; Headache; Venous Thrombosis; Hyperbaric oxygen therapy
Rizal Medical Center Department of Emergency Medicine, Philippines
A 21 year old female who was apparently well sought consult at the Emergency room due to abdominal pain. The patient was initially managed as a case of acid peptic disease and was discharged from the ED. The patient developed undocumented fever and vomiting which prompted another ED consult. She presented with febrile episodes, abdominal pain, and hypotension. Hepatobiliary tree ultrasound revealed dilated proximal common bile duct with abrupt narrowing at the distal end. Common bile duct stricture vs. lithiasis was considered. The patient was managed as a case of sepsis secondary to acute cholangitis. She underwent Endoscopic Retrograde Cholangiopanreatography (ERCP) which revealed normal study of the common bile and hepatic ducts. Extraction of biliary ascariasis was done on this patient. The patient tolerated the procedure well and was eventually discharged.
Biography:
Dr. Samina Cousir A. Khan is a second year Emergency Medicine Resident from Rizal Medical Center in the Philippines. She graduated Bachelor of Science in Medical Technology in the University of Santo Tomas in 2011 and pursued her medical degree at the Far Eastern University Nicanor Reyes Medical Foundation in the Philippines. She had her post graduate internship at the Department of Health — Philippine centers for specialized health care and passed the Philippine Physician Licensure examination in 2016.
1International Agency for Research on Cancer, France
2Aristide Le Dantec Hospital, Senegal
Cervical cancer is the most frequent cancer among women in Senegal. However, there are few data concerning the HPV types inducing neoplasia and cervical cancers and their prevalence, in the general population of Senegal. The aim of this study is to determine the prevalence of HPV infection in Senegalese women aged from 18 years and older. A study was performed on 498 cervix samples collected from healthy women aged 18 and older in Dakar. 438 other samples were collected from three other regions, Thiès, Saint Louis and Louga. The samples were screened for 21 HPV genotypes using an HPV type-specific E7 PCR bead-based multiplex genotyping assay (TS-MPG) which is a laboratory-developed method for the detection of HPV. The prevalence for pHR/HR-HPV in the region of Dakar was 20.68%. HPV 52 (3.21%) was the most prevalent HPV type, followed by HPV 16 (3.01%) and HPV 31 (3.01%). In the regions of Thiès, Louga and Saint Louis, the prevalence for pHR/HR-HPV was 29.19%, 23.15% and 20%, respectively. The study revealed the specificity of the HR-HPV prevalence in Dakar and other regions of Senegal. The patterns differ from the one observed in the other regions of the world and raise the issue of the development of vaccination program in the country. Such a program should take into account the real HPV prevalence for an effective protection of HPV-associated diseases.
Biography:
Dr. El Hadji Seydou Mbaye was born in 1978 in Kaolack a region of Senegal. During 2008-2013, he earned his PhD in Biology and Human Pathologies with the collaboration of the International Agency for Research on Cancer (IARC) /WHO, Lyon (France); 2006-2007: Masters of Life and Health, Specialty Biology of microorganisms, Immuno-physiopathology; Virology; 2005: License of Biochemistry in Louis Pasteur University of Strasbourg (France); 2004: General Degree in Sciences and Technologies in University of METZ (France). He was certified Grade 10/10by the FIGO, the Accreditation Council of Oncology in Europe, the Institute Catalan of Oncology. Recognized as Physicianʼs Recognition Award by the American Medical Association, he was certified, by the United Nations, by IARC/WHO. He has published 1 Book with a style of philosophical story. Author of the world program against cancer in low and middle incomes countries, he is lead author of more than 90 peer-reviewed research articles published in reputed journals. He is Editorial Board Member of 19international Journals, associate membership of the World Society for Virology and also, member of BCNet International Working Group, IARC/WHO. Dr MBAYE has formed for free, more than 250 healthcare professionals for the techniques of cervical cancer screening in Senegal.
Emergency and Trauma Department of Shah Alam Hospital, Malaysia
Introduction: Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, usually triggered by an infectious episode, mostly of viral origin. Varicella zoster virus (VZV) is a rare cause of GBS, mainly in the case of latent infection reactivation. We present a case of a patient who developed GBS following chickenpox, after a short period of latency.
Case Report: A 23 years old man of Indian origin presented with bilateral lower limb weakness, numbness, difficult to ambulate, headache and slurred speech for the past 3 days. The patient had a history of 2 weeks of chickenpox rash prior to this but did not seek any treatment. Neurological examination showed bilateral facial nerve palsies with bulbar involvement. Muscle tone was decreased with weakness particularly over lower limb ( 4/5 ). Deep tendon reflexes were absent but sensation remains intact. Investigations revealed a normal computed tomography scan of the brain. The cerebrospinal fluid (CSF) was acellular and glucose normal, but CSF protein was high. Patient was treated with intravenous immunoglobulin for 5 days. Progressive neurological improvement occurred and resolution of paresthesias and weakness.
Conclusion and Discussion: VZV is a rare antecedent for GBS but this patient had all the significant clinical features found in GBS. Varicella zoster is associated with dreaded neurological complications. Varicella is easy to diagnose with typical rash and pain and it should be treated with antiviral immediately so as to prevent or reduce such complications.
Obtaining a full medical history and a complete neurological examination still play a vital role to make a correct diagnosis. Furthermore the immune compromised or at high risk patients may be immunized.
Biography:
Muhamad Syafiq Bin Mohammed Khalil is a medical officer with more than 5 years of experience in healthcare industry. He received his M.D from First Moscow State Medical University on 2013 and began his internship in the same year at Seremban Hospital, Malaysia. His particular area of interest is in emergency medicine. He recently did an oral presentation with topic regarding “difficult airway” during the 5th International Clinical Conference in Emergency Medicine (ICCEM) 2017 in Kuala Lumpur. He currently resides in Selangor, Malaysia.
University of Toronto, Canada
This presentation will provide the participant with a better understanding on how to manage pediatric patients in the office practices and emergency department. Fever is a common presentation and should be considered a symptom and not a disease. In 2018, the role of antibiotics and blood cultures should be questioned. The role of when to treat, investigate further, or send to the emergency department will be discussed. Furthermore, the role of advocating for having all eligible pediatric patients vaccinated and its impact on the role on fever management in the community will be reviewed.
Biography:
Dr. Rahim Valani has been practicing emergency medicine in some of Canadaʼs busiest emergency departments for over 18 years. Through his positions with St. Josephʼs Health Centre (Toronto), Brampton Civic Hospital and Hamilton Health Sciences, Dr. Valani has led teams to respond to the changing needs of patients, communities, and the healthcare system. Dr. Valani has been committed to developing future leaders and supporting individuals and teams to achieve their full potential. This passion led him to the positions of associate professor with the University of Toronto Faculty of Medicine and assistant professor with McMaster University where he received several accolades including the award for teaching excellence for contributions to the Emergency Medicine program. Dr. Valani received his Doctor of Medicine from Queenʼs University, a Masters in Medical Education from the University of Dundee, Scotland, and a Masters in Business Administration with a specialization in operations and strategy from the Wharton School of Business, University of Pennsylvania.
Department of Medicine, McMaster University and Department of Medicine, University of Toronto, Canada
Procedural sedation and analgesia (PSA) is commonly employed in the emergency department for the management of diagnostic or painful procedures. This session will review the medications most commonly employed with PSA, determining the risk assessment, appropriate monitoring, and post-procedure issues. The session will also look at complications related to PSA in the pediatric patient. New evidence using combination drugs such as ketamine — propofol (“ketofol”) will also be discussed.
Biography:
Dr. Rahim Valani has been practicing emergency medicine in some of Canadaʼs busiest emergency departments for over 18 years. Through his positions with St. Josephʼs Health Centre (Toronto), Brampton Civic Hospital and Hamilton Health Sciences, Dr. Valani has led teams to respond to the changing needs of patients, communities, and the healthcare system. Dr. Valani has been committed to developing future leaders and supporting individuals and teams to achieve their full potential. This passion led him to the positions of associate professor with the University of Toronto Faculty of Medicine and assistant professor with McMaster University where he received several accolades including the award for teaching excellence for contributions to the Emergency Medicine program. Dr. Valani received his Doctor of Medicine from Queenʼs University, a Masters in Medical Education from the University of Dundee, Scotland, and a Masters in Business Administration with a specialization in operations and strategy from the Wharton School of Business, University of Pennsylvania.
Department of Anesthesia & Interdepartmental Division of Critical Care Medicine/Toronto General Hospital/University of Toronto, Canada
In critically ill patients, transesophageal echocardiography (TEE) offers several advantages over transthoracic echocardiography (TTE), with reliable, continuous image acquisition and superior image quality. The hemodynamic monitoring capability and safety (without major complications), of a single-use miniaturized transesophageal echocardiography (mTEE) probe, left in place in ventilated critically ill patients, has been proven to provide useful information to invasive monitoring and has an impact on hemodynamic management inpatients with hemodynamic failure on ventilatory support(3,4).
Despite these advantages, TEE is not widely used by emergency physicians.TEE by emergency physicians (EPs) remains rare, with no many described training or focused TEE protocols for emergency department (ED) use been described. ED point-of-care based TEE, has showed a high degree of feasibility and clinical utility, with a diagnostic (up to 78%) and therapeutic influence (up to 67%) seen in the majority of cases. Focused TEE, specially the midesophageal four-chamber and transgastric view of the left ventricle, has a great value among intubated patients with either undifferentiated shock or cardiac arrest. EPs can successfully perform focused TEE protocols after a short workshop with retention of these skills at 6 weeks.(2).
Biography:
Jacobo Moreno Garijo is a full time Clinician-Scientist in the Department of Anesthesia at the Toronto General Hospital, Faculty of Medicine, University of Toronto since February 2015, his field expertise is in transesophageal echocardiography, being certified in Advanced Perioperative Transesophageal Echocardiography, as per the National Board of Echocardiography of the United States. He has been trained in the fields of Anesthesia (2004-08, Hospital de la Santa Creui Sant Pau, Barcelona, Spain), Critical Care Medicine (2008-09, University of Toronto, Canada), Emergency Medicine (2009-10, Masterʼs degree, Autonomous University of Barcelona, Spain), and Cardio-Thoracic Anesthesia (2013-15, Clinical Fellowship, Toronto General Hospital, University of Toronto, Canada).
McMaster University, Canada
The Best Evidence in Emergency Medicine (BEEM) program was founded in 2005 as a global knowledge translation project to provide Emergency Medicine (EM) providers with the latest high-quality evidence to guide clinical practice. It uses proven reliable methods to find and rate the highest quality evidence published in the medical literature relevant to EM practice, using a global network of EM experts. This evidence is then critically appraised, summarized and disseminated to a global EM audience on a regular basis. This session will highlight the unique BEEM process of finding, filtering and disseminating the best EM evidence annually, and recent practice-changing articles for EM practitioners.
Biography:
Dr. Upadhye is an Associate Clinical Professor of Emergency Medicine (EM) at McMaster University (Hamilton Ontario Canada). He is the current Chair of the Standards Committee for the Canadian Association of Emergency Physicians. He is a founding deputy chair of the McMaster Best Evidence in Emergency Medicine (BEEM) program, a global initiative in EM knowledge translation since 2005.
McMaster University, Canada
In the face of a global opioid crisis, Emergency physicians are in a unique situation with regards to balancing the needs of individual patients for compassionate adequate pain control, and the global burden of opioid misuse. This session will highlight recent research into Emergency Department opioid prescribing patterns, and the potential barriers and facilitators for safe prescribing.
Biography:
Dr. Upadhye is an Associate Clinical Professor of Emergency Medicine (EM) at McMaster University (Hamilton Ontario Canada). He is the current Chair of the Standards Committee for the Canadian Association of Emergency Physicians. He is also the inaugural Regional Research Lead for Emergency Medicine for Niagara Health Systems (Ontario Canada). He is a published researcher in a number of EM topics, including sepsis care and ED opioid prescribing. He is a founding deputy chair of the McMaster Best Evidence in Emergency Medicine (BEEM) program, a global initiative in EM knowledge translation since 2005.
1Department of Radiology, Alfred Hospital, Melbourne, Australia
2Department of Epidemiology and Preventive Medicine, Monash University, Australia
Introduction: It has not been investigated whether patients with intraluminal sinus gas may have a higher likelihood of DVST in the setting of trauma. We postulate that intrasinus gas seen on radiology studies may be a marker of sinus injury, suggesting an increased risk of sinus thrombosis. The aim of this study was to assess the association between intrasinus gas and dural venous sinus thrombosis (DVST) in patients with blunt head trauma.
Methods: One hundred and two consecutive patients with blunt head trauma imaged with non‐ enhanced CT and CT head venography at our institution between 1 July 2011 and 30 June 2016 were included. Image review was performed by two independent reviewers to assess for the presence of intrasinus or perisinus gas and DVST. Skull fractures involving a dural venous sinus, sinus hyperdensity, extraaxial haematoma, and/or extrinsic dural venous sinus compression were also recorded. Univariate and multivariate analyses estimated the associations between the imaging variables and DVST.
Results: Thirty‐seven cases of DVST were confirmed with CT venography: 10 (27.0%) occlusive, and 27 (73.0%) non‐occlusive. We detected 24 cases of intrasinus gas, all occurring with skull fractures. Gas localized to the sinus involved by the fracture in 23 (95.8%) of 24 cases. Additional gas within a contiguous sinus was present in nine (37.5%) cases. The association between intrasinus gas and DVST of the respective sinus was statistically significant (OR: 11.3, CI: 3.9—32.9, P < 0.0001). DVST was also significantly associated with the presence of a skull fracture (P = 0.04), fractures involving the sigmoid sinus (P = 0.0001), and sinus hyperdensity (P < 0.0001). Conclusion: Traumatic intrasinus gas is associated with DVST in patients with blunt head trauma. Its detection on non‐enhanced CT examinations in the emergency care setting infers a higher risk of DVST and should prompt consideration of CT venography.
1King Saud Medical City, Childrenʼs Hospital, Riyadh, Saudi Arabia
2King Fahad Medical City, Childrenʼs Hospital, Riyadh, Saudi Arabia
3Prince Sultan Medical City, Riyadh, Saudi Arabia
4University of South Carolina school of Medicine, USA
Objectives: Point-of-care ultrasound (US) is an emerging tool used by pediatric emergency physicians in the last decade. Currently in the Middle East, point-of-care US use and education are at an early stage, with no designed curriculum or guidelines for its implementation in pediatric emergency medicine (EM). The objective of this article is to describe the clinical and educational uses of point-of-care US among certified pediatric EM physicians.
Methods: A 19-question survey was sent to all certified pediatric emergency physicians and fellows in pediatric emergency fellowships in Saudi Arabia in February 2016. Reminders were sent weekly for 4 weeks.
Results: The response rate was 84 of 88 (95%). Fifty-one of 84 (61%) reported using point-of-care US. Focused assessment with sonography for trauma was the most frequent use of point-of-care US (37%), followed by procedures (19%). The most common barrier for not using point-of-care US was limited training (86%). The most preferred tool for point-of-care US teaching was courses by EM physicians. Currently, there is no specific curriculum designed for pediatric EM in the Middle East.
Conclusions: Despite the multiple applications of point-of-care US in pediatric EM, its use is still limited. Formal point-of-care US training with bedside sessions and courses was the mort preferred method of education. A designed curriculum needs to be implemented in pediatric emergency fellowships in Saudi Arabia.
Biography:
Abdullah S Alzayedi is a pediatric emergency consultant who did 4-year residency program in Saudi Arabia then he joins the Fellowship in pediatric emergency program for 2 years in 2017. He had a passion in the development of work environment with quality ensuring methods. His interest in the field of Pediatric is both clinical and academic. For the last 2 years, his main focus was on clinical work and house staff teaching. Abdullah Alzayedi anxiously looking forward to being a leading physician and role model for medical staff. He like sharing knowledge and doing research in the pediatric emergency field.
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