35 Years of Emergency Medicine, the New, the Old, the Recycled

Dennis Allin

University of Kansas, USA

The last three decades have seen incredible changes in medicine with an explosion of technology, new therapies, and an unprecedented “flattening” of the world relative to the practice of Emergency Medicine. This talk will explore how these changes have made the practice of Emergency Medicine easier, how it has made our decisions more complex and how old therapies have re-emerged, as well as how the evolving utilization and expectations of Emergency Medicine have changed our educational programs over the last 3 decades.

Biography:
Dennis Allin Undergraduate degree at Wichita State University, followed by an MD at the University of Kansas in 1983. Flexible Internship at Weiss Memorial Hospital in Chicago and Emergency Medicine Residency at Texas Tech University in El Paso Texas. He practiced Emergency Medicine 3 years in Kansas City, Kansas before joining the University of Kansas in 1989. He founding Chair of the Department of Emergency Medicine at the University of Kansas which now has a fully accredited 3 year Emergency Medicine Residency program. He also board certified in Undersea and Hyperbaric Medicine as well as Pre-hospital Emergency Medical Services and serve as the medical director of the EMS service in Kansas City.

Dangerous Effect of Unnecessary Oxygen and Hyperoxemia

Santiago Herrero

The Jilin Heart Hospital, China

High fractions of inspired oxygen (FiO₂) have been associated with several effects on lung tissue and gas exchange including diminished lung volumes and hypoxemia due to absorptive atelectasis, accentuation or production of hypercapnia, and damage to airways and pulmonary parenchyma.

Oxygen is prescribed in many Medical Emergencies in which tissue oxygenation is threatened because of respiratory failure, and/or reduced tissue perfusion. Depending on the mode of delivery, the fraction of inspired oxygen (FiO2) associated with oxygen therapy can range from 25 % to 100 %, compared with normal FiO₂ of 0.21 when breathing ambient air at sea level. Since FiO₂ determines PaO₂, high-dose oxygen therapy (FiO₂> 50 %) can cause PaO₂ to rise well more than the upper limit of the reference range, a condition called hyperoxemia that potentially results in hyperoxia (high O₂ in tissues).

Pulse oximetry (SpO₂) provides continuous visibility to arterial blood oxygenation in hypoxia and normoxia but cannot assess hyperoxia. During supplemental oxygen administration, clinicians often use the partial pressure of oxygen (PaO₂) to assess hyperoxia but this requires ABG that is intermittent and delayed. Between invasive sampling, changes in PaO₂ cannot be assessed and therefore unexpected hypoxia or unintended hyperoxia can occur.

Biography:
Santiago Herrero is Clinical Director of Postoperative Cardiac Surgical ICU at The Jilin Heart Hospital, Changchun, Jilin Province, China. Dr. Santiago Herrero is board certified critical care physician of the Spanish Society of Critical Care Medicine since 1989. Dr. Santiago Herrero received his Research Proficiency in 2008 by the University of Oviedo (2008). He is Fellow of the American College of Chest Physicians since 2004. Associate editor of Current Respiratory Medicine Reviews and of the Journal Critical Care and Shock. Recently he was awarded with The Mountain Changbai Friendship Award in September 2017 by the Changchun and Jilin Government, China.

Lesson Learnt from Nuclear Disasters - Health Hazards and its Prevention

Athar Ansari

Aligarh Muslim University, India

The United Nations Disaster Relief Organization (UNDRO) defines a disaster as “a serious disruption of the functioning of a society, causing widespread human, material, or environmental losses which exceed the ability of the affected society to cope using its own resources.”

Number of nuclear disasters has occurred in the world which include worst disaster of Hiroshima and Nagasaki bombing, Chernobyl disaster and Fukushima tragedy.

Acute Radiation Syndrome also known as radiation sickness caused by high dose of penetrating radiation. The three classic ARS Syndromes are: Bone Marrow Syndrome, Gastrointestinal (GI) Syndrome and Cardiovascular (CV)/ Central Nervous System (CNS) syndrome. Survival is extremely unlikely in case of GI syndrome whereas death may occur within two weeks in case of Cardiovascular syndrome.

Human beings are badly affected from head to toe by radiation exposure. There may be f hair loss in clumps, Damage to nerve cells leading to seizures, thyroid carcinoma, increased long term risk for leukaemia, lymphoma, sterility, and radiation burn etc.

The best prevention for radiation sickness is to minimize the exposure dose. This can be achieved by increasing the distance from the radiation source and early evacuation. We have to find out and respect the regulations regarding production, transport, handling and storage of radioactive substances. In case of nuclear fallout, stay in house/ shelter as advised. If a nuclear explosion occurs- take shelter behind a solid wall and if you are outside, lie down in a ditch facing the ground and protect your face with your arms.

Biography:
Athar Ansari after completing Doctor of Medicine course in Community Medicine at the Aligarh Muslim University, Aligarh, India, he joined the faculty in the Department of Community Medicine, J.N. Medical College. He is also involved in the research activities directed towards micronutrient deficiencies, HIV/AIDS, and disaster management. He has got 120 papers published and presented 140 papers in the conferences. He has been Coordinator/Principal Investigator/Co-investigator/Supervisor of various prestigious projects of different agencies like UNICEF, Bill & Melinda Gates Foundation, Nuclear Power Corporation of India Ltd. (NPCIL), Indian Council of Social Science Research (ICSSR), Indian Council of Medical Research (ICMR), New Delhi.

Human Bronchial Fibroblast as the Catalyst for Global Health Care Crisis and the Use of Heliox as Rescue Therapy for Asthma-Like Respiratory Syndromes

Sherwin Morgan^1*, Gokhan Mutlu² and Brenda L. Giles³

¹Department of Respiratory Care, Section of Pulmonary Critical Care: UChicago Medicine, USA
²Department of Medicine, Pulmonary Medicine: UChicago Medicine, USA
³Department of Pediatrics, Pediatric Pulmonary Medicine, Comer Childrenʼs Hospital: UChicago Medicine, USA

Respiratory syndromes caused by viral respiratory illness (VRI) range in severity from the common cold to severe acute respiratory distress that is asthma-like. Ongoing research has demonstrated that Human Bronchial Fibroblast (HBF) with transformation from fibroblast-to-myofibroblast under the influence of transforming growth factor (TGF-β₁) or (TGF-β₂) as the etiology of airway remodeling; bronchial wall thickening (BWT) and as the primary source of air-flow limitation (AFL). HBF is now being associated with multiple viral pathogens that is proving difficult to ameliorate the related AFL (BWT and atelectasis) with traditional respiratory treatment modalities. Viral identification is required via a respiratory viral panel for confirmation. Patients can have sudden onset or chronic persistent symptoms that are diagnosed as unspecific asthma, thought to be neutrophilic asthma. For decades, VRI continue to be a catalyst for global healthcare critical care crisis. During vast outbreaks, patients with flu/asthma-like symptom shave shown up in the emergency department in need of intensive urgent respiratory support. It may cause life threatening partial or complete respiratory collapse that quickly advance to salvage therapies. There are anecdotal reports dating back to 1935 where heliox was used successfully to treat asthma-likes syndromes related to status asthmaticus. It isinferred that 80% helium and 20% oxygen — (heliox) may reduce gas airway resistance through airways with BWT that act as a bridge support to improve alveolar gas exchange. More study is needed to understand the etiology of BWT, develop effective treatment medication modalities and define the role of heliox as a treatment option.

Biography:
Sherwin Morgan is a Registered Respiratory Therapist with The National Board for Respiratory Care in the United States. Current position: Research Coordinator for the Department of Respiratory Care Services (RCS), Pulmonary and Critical Care at The UChicago Medicine. Past role at UChicago Medicine: Associate Director of Clinical Operations / Critical Care RCS. He is an active member of the American Association for Respiratory Care. He has published more than 50 peer review papers regarding the emerging horizon in global Respiratory Care research. He has presented at many international venues that includes; Moderator for the Virology-Influenza Summit, Vienna Austria 2018.