Madridge Journal of Internal and Emergency Medicine

ISSN: 2638-1621

International Conference on Emergency Medicine and Critical Care

July 25-26, 2019, Rome, Italy
Scientific Session Abstracts
DOI: 10.18689/2638-1621.a2.006

Intracerebral Hemorrhage Presenting with Life Threatening Arrhythmia

Salama Al Neyadi*, Siddiqi M, Hussain J and Buhumaid R

Shiekh Khalifa Medical City, UAE

Background: Spontaneous intracerebral hemorrhage (ICH) represents up to 15% of acute strokes. Uncontrolled hypertension is the most common cause of spontaneous ICH. Patients with ICH classically presents with acute onset headache, vomiting, focal neurological deficits1. The case presented will demonstrate a rare presentation of spontaneous ICH.

Case: A 60 years old male, who is known diabetic, hypertensive, and ischemic heart disease, status post percutaneous coronary angiography (PCI) and stenting 8 months prior to the Emergency Department (ED) visit, presented to the emergency department by ambulance with a chief complaint of altered level of consciousness. Per the paramedicʼs report, his friend found him confused lying on the floor in his house with no evidence of trauma. Upon arrival to the ED, he was lethargic and diaphoretic. His vital signs were; heart rate = 224/ min, blood pressure = 70/43 mmHg, respiratory rate 16/min and oxygen saturation 99% on room air. An EKG revealed monomophic ventricular tachycardia. He was successfully Cardioverted to normal sinus rhythm using 200J after administering midazolam intravenously. The patientʼs vital signs and mental status improved, he was able to provide additional history of episodic chest pain for 2 days. Post cardioversion EKG revealed 0.5mm ST elevation V1-V2 with ST depression V5-6. Given the history of ischemic heart disease, history of chest pain, arrhythmia and the EKG changes adecision made to proceed with emergency PCI. During the preparation for PCI, the patientʼs mental status worsened, his GCS dropped from 15/15 to 11/15 (E2, V4, M5). A non-contrast CT scan of the brain revealed large left inferior frontal intraparen chymal hemorrhage. A CT angiography of the brain ruled out ruptured aneurysm or arterio venous malformation.

Discussion: Previous studies described the presence of EKG abnormalities in patients with hemorrhagic stroke without known structural heart disease or electrolyte abnormalities2. The most common reported EKG abnormality in ICH is prolonged QT interval3. This case illustratesa rare presentation of ICH with an unstable monomorphic ventricular tachycardia. Prior case reports associating polymorphic ventricular tachycardia and intracranial hemorrhage have been described, yet the mechanism of this association remains unclear4-8. To best of our knowledge, there were no previous reported cases of monomorphic ventricular tachycardia with ICH.

Biography:
Dr. Salama Al Neyadi PGY4 Emergency Medicine Resident from Sheikh Khalifa Medical City, Graduated from United Arab Emirates University, UAE.

Respiratory Syndromes; the Source of International Critical Care Health Care Crisis and the Use of Heliox as Rescue Therapy for Asthma-Like Air-Flow Limitations

Sherwin Morgan* and GM Mutlu

University of Chicago Medicine, USA

From the Sections of Respiratory Care Services and Pulmonary - Critical Care; UChicago Medicine

Respiratory syndromes caused by viral respiratory infections (VRI) in humans and animals range in severity from the common cold with flu-like symptoms to severe acute respiratory distress syndrome (SARS) that cause respiratory failure (RF). It may trigger bronchiectasis on top of asthma, bronchiolitis, or viral pneumonia that may appear in any multiple combinations and cause RF. All of this can lead to an underestimation that the primary cause of air-flow limitation (AL) is viral induced obstruction. This AL is difficult to ameliorate with traditional β2-agonist, airway clearance and lung hyperinflation techniques. Viral identification requires a respiratory viral panel (RVP) via polymerase chain reaction (PCR) to identify the virus or viruses that may be overlooked. Many viral outbreaks are vastly under reported as clinicians feel that the RVP is only an epidemiology numbers. Peri-bronchial wall thickening (PBWT) is a non-specific radiology term used to define airway structure changes, as a source of AL. Chest radiography was notable for; PBWT, Retro-cardiac atelectasis with mucus plugging, or sub segmental atelectasis usually in the left lower lobes (LLL). This can progress to intravascular hemorrhage with cytokine released and acute lung injury. Histopathology study from rat lung tissue is providing valuable information with regard to the inflammatory process and how a virus affects lung structure and provided information on how heliox may attenuate lung function. Viral lung infections are categorized as: influenza, non-influenza or zoonoticthat may appear in multiple combinations and different viral pathogens together. For decades, VRI continue to be a recurring challenge and etiology of global health critical care crisis, As the syndromes are not well defined and most treatments ineffective. Globally, H1N1 pandemic 2009 caused over 18,000 deaths and affected 214 countries. Viruses such as enterovirus (EV-D-68) has been having a profound effect globally, responsible for deaths 14 in 2014, and 2600 documented casesin America, and 70 deaths in the Philippines 2011, EV-D68 is associated with flaccid myelitis (non-polio) muscle weakness. Zoonotic viruses such as Coronavirus (HCoV) 229E has been associated with animal / human transmission and linked to Middle East Severe Acute Respiratory Syndrome (MERS). During viral outbreaks, large influx of patients with flu-like symptoms may show up in the emergency department in need of urgent advanced respiratory support; frequent coug h, dyspnea, wheezing and hypoxemia. It may cause life threatening partial or complete respiratory collapse that may quickly progress to salvage therapies such as; mechanical ventilation, proning, nitric oxide, extracorporeal membrane oxygenation (ECMO). This can lead to SARS and organ failure. There have been many anecdotal reports dating back to 1935 where heliox was used astherapy for RF related to influenza respiratory syndromes. It is inferred that heliox may reduce airway resistance through constricted central airways to act as a bridge support to decrease work of breathing and improve alveolar gas exchange. There is limited data and a lack of formal randomized trials for heliox for the treatment of VRI. Prospective studies and better training is needed for recognition, updated treatment plans and infection control to combat VRI.

Biography:
Sherwin Morgan RRT, RCP is a Registered Respiratory Therapist (RRT) - Clinical Respiratory Care Practitioner (RCP) at The U Chicago Medicine (UCM). In his current role at UCM, he serves as Clinical Practice and Development/Research Coordinator for the Department of Respiratory Care (RCS), Section of Pulmonary and Critical Care. Past position was Associate Director of Clinical Operations RCS. He has been active in the field of RCS for 39 years. He is board certified by the National Board for Respiratory Care (NBRC). He is an active member of the America Association for Respiratory Care (AARC). He has collaborated with many departments at UCM with regard to respiratory care related clinical research projects. He has accumulated more than 45 publications in peer review scientific journals with regards to the new horizons surrounding respiratory care clinical practice. His main focus of study is on respiratory syndromes, inhaled pulmonary vasodilators, helium-oxygen administration, and aerosolized medication drug delivery for adults and small children. The research has taken him too international destinations such as; Vienna Austria (Moderator, Virology Summit 2018), Toronto Canada (Keynote Speaker; Pediatric Pharmacology and Therapeutics) 2018, London, United Kingdom (UK), Berlin, Germany, Speaker and Co-Chairman at the Pediatric Emergency Conference in Atlanta Georgia 2016, and Keynote speaker at the Global Influenza Conference held in Birmingham, UK - 2017. He has presented at multiple different nationally and state organized conferences such as; American Thoracic Society, AARC.

Infectious Diseases Related to Patients with COPD in Emergency and Critical Care

Santiago Herrero

The Jilin Heart Hospital, China

COPD is a general term used to cover a variety of abnormalities that often coexist: chronic bronchitis, emphysema, and peripheral airway disease. Acute exacerbations of COPD (AECOPD) are common, particularly during the winter months, increasing the admissions in Hospitals. When patients worsening the lung function on a dramatic respiratory failure they are admitted in the intensive Care Unit (ICU) for ventilatory support. It is important to know every acute exacerbation it leads to an increasing deterioration of the respiratory function.

In the ICU the patients they are admitted requiring invasive and non-invasive ventilatory support. The role of respiratory infections associated with AECOPD is very heterogeneous involving not only those infections that patients present in the exacerbations but also those infections that are acquired in the ICU as community acquired-pneumonia (CAP) or ventilator associate-pneumonia (VAP) in those patients who are ventilated invasively for more than 5 days. Some tests can from the beginning help us to make a potential differential diagnosis between bacterial and viral infections. The diagnosis and treatment of bacterial pneumonia in patients who are receiving mechanical ventilation remain a difficult challenge. Some biomarkers could be an advance in the diagnosis and monitoring of this type of patients with pneumonia. The presence of soluble sTREM-1 in bronchoalveolar-lavage fluid from patients receiving mechanical ventilation may be an indicator of bacterial or fungal pneumonia. The union of different disciplines, such as intensivist, pneumologist, internist, microbiologist and bacteriologist can be fundamental for get an early diagnosis and treatment.

Biography:
Dr. 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 your 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.

Effect of Mass Casualty Training on Prehospital Care Providers in Kuwait

Ahmed Alharbi

Ministry of Health, Emergency Medical Services, Kuwait

Background: Pre hospital providers, both emergency medical technicians and paramedics need appropriate training to deal with major incidents. Despite the fact that Kuwait has experienced many major incidents and located into a politically conflict zone, there is no standardized preparedness training for prehospital care providers to disasters or major incidents. This study aimed to assess the effect of a training intervention in improving the knowledge and awareness of EMTs and paramedics in the Kuwait Emergency Medical Service (KEMS).

Methods: Thirty-one participants from different ambulance districts in Kuwait were invited to participate voluntarily in disaster management training at Kuwait EMS Department.

Results: The mean score of knowledge was significantly higher immediately after first training program [18.2; standard error (SD):1.9] than before (12.4; SD: 2.8) (P<0.001). The mean score three months later was significantly higher (19.8; SD: 0.5) immediately after the intervention program (P<0.001).

Conclusion: The primary aim of improving preparedness among prehospital care providers was been achieved through the training program. The tests results showed an improvement in score achieved by the participating prehospital care providers. This type of training courses would increase the competency and the confidence of prehospital care providers in providing emergency services.

Biography:
Ahmed Alharbi Paramedic working for Emergency Medical Services (EMS Department) as a Head of Clinical Audit Section-EMS Department. Also, a parttime lecturer in Paramedicine, Health and Safety, College of Health Science –Kuwait. Dr. Ahmed Alharbi got his B.S. degree in pre-hospital care Charles Sturt University in Australia. and his Master of Science in Health Professions Education in Arabian Gulf University at Bahrain in 2009 and PhD. In Candidate/Paramedicine - Health Science School -Latrobe University at Australia.

Management of Emergencies by General Practitioners in Australia

Milana Votrubec

Notre Dame University, Australia

General practitioners (GPs), primary care physicians in Australia, often find themselves in the unique position of providing first response emergency care in their communities. GPs represent an essential component of the Australian health care infrastructure, while playing a crucial role in coordinating the care of patients between health care providers for illnesses and injuries arising both during and after emergencies.

This presentation will introduce the audience to a series of fact sheets produced by the Royal Australian College of General Practitioners to manage emergencies brought on by natural disasters such as bushfires and extreme weather conditions including heatwaves, thunderstorms and floods. The focus will be on the necessity of planning and preparation that can easily translate into a variety of international settings.

Audience participation will be encouraged during the presentation through the sharing of common experiences in order to advance the practice of emergency medicine for better outcomes in community-based emergency situations, due to but not confined to natural disasters.

Biography:
Dr. Milana Votrubec is a general medical practitioner, pain management consultant, Senior Clinical Lecturer for the Graduate Medical Programs at both Sydney and Notre Dame Universities and Editor of the journal Pain Medicine Today. She is currently the Chair of the Specific Interest in Pain Management, and Life Member, of the Royal Australian College of General Practitioners. She is also a Fellow ofthe Faculty of Pain Medicine ofthe Australian and New Zealand College of Anaesthetists. Main interest is in chronic non-malignant pain as a result of physical and emotional trauma.

Emergency Radiology: Who, What, Why?

Jamlik-Omari Johnson

Emory University School of Medicine, USA

Trauma is the leading cause of death in persons less than 46 years in the US. The US healthcare costs and loss of productivity related to trauma exceed $671 billion annually. With over 146 million yearly visits, many emergency rooms are at or exceeding capacity. Treating patients in the emergent setting involves a plethora of diagnostic and interventional resources, tools and expertise. Imaging is a cornerstone of the patientʼs evaluation. Dedicated emergency radiologists are an integral part of the hospitalʼs emergency team involved in helping to diagnose the traumatized or acutely and chronically ill patient in real time. As subject matter experts, emergency radiologists are aptly positioned to provide timely consultation, well-versed in injury patterns and emergent presentations and specifically trained to function in the high volume, high stakes, quick-response and chaotic environment of the emergency department. Their inclusion into care teams promotes coordinated care, evidence-based, appropriate imaging and a better value for patients, hospitals and payors.

Biography:
Dr. Johnson has practiced emergency radiology for over 15 years in both private practice and Level 1 trauma academic medical centers. He is the founding director of the Emergency and Trauma Imaging Division at Emory University School of Medicine and the Chief of Radiology and Imaging Sciences at Emory University Midtown Hospital. Dr Johnson focuses not only on the imaging coordination, consultation and interpretation of acutely ill and injured patients but also the delivery of coordinated, evidence-based expertise with the goal of providing timely, appropriate and value based care at the patient, hospital and system levels.

Implementation of Medical Simulation for Emergency and Critical Care Residents

Sawsan Alyousef

Children Specialized Hospital, King Fahad Medical City, Saudi Arabia

Medical simulations aim to imitate real patients, anatomic regions, clinical tasks, virtual reality devices and electronic manikins or to mirror real-life situations in which medical services are rendered. Simulation –based learning (SBL) applies these modalities.

Benefits of medical simulation includes safe environment, mistake forgiving, trainee focused vs. patient focused, controlled, structured, proactive clinical exposure, reproducible, standardized, debriefing, deliberate and repetitive practice. Medical simulation can assess professional competence aspatient care, medical knowledge, practice-based learning & improvement, communication skills, professionalism and systems-based practice. Patient safety priorities are at the forefront of health providersʼ concerns. The see one, do one, teach one philosophy certainly should be eliminated. This is best summarized by “simulators have the potential to take the early and dangerous part of the learning curve away from patients”. Simulation has rapidly evolved as a learning tool and technology over the past 15 years, and has been shown to be an effective method for teaching. Despite this, the field of pediatric medicine is still in the primitive stages of adopting simulation. The reasons cited for this include: the high cost of simulators, a dearth of didactic curricula to accompany the psychomotor skill learned on a simulation, the wide variability and/or lack of consistency that exists among the simulation platforms, and a complete absence of large trials showing that this expensive technology actually improves patient outcomes.Despite all this, the Saudi Commission for health specialty now mandated and added certain simulation courses into pediatric R1 curriculum. From June 2017- May 2018 an condensed simulation course for pediatric R1 training resident under Saudi commission for health specialty was conducted once per month at CRESENT, KFMC, the course is 5 days include the following simulation sessions: pediatric airway management with crew resource management, central line insertion under US guidance, chest X-ray and ABG interpretation, Lung Ultrasound, thoracocentesis, chest tube insertion, bone marrow aspiration and biopsy, lumbar puncture, basic to advance cardiac simulation session. Total of 125 candidates were involved, in which all of them had undergone pre course knowledge and clinical assessment test followed by post course knowledge and clinical assessment test at the end of the course (similar to the pre test) plus the candidates had retention assessment test 6 months later with similar to pre and post assessment tests. The preliminary result showed 100% improvement in the scores at post knowledge and clinical assessment test compared to pre assessment test and non had decline results. The retention assessment test is pending but the preliminary result is promising as till now the scores were above precourse assessment test. 100% of them found these courses are enjoyable, safe, not stressful and very useful training methods, 97% enjoyed it mostly because it is repetitive and mistakes are forgiven with zero hazards to patients.100% feels video debriefment following medical scenarios is very helpful as it clarify areas for improvement much better than conventional training. In conclusion, although Simulation courses is expensive but it plays important role in patient safety so at the end it is cost effective so would encourage to make it mandatory in the curriculum for all pediatric residents and fellows.

Biography:
Sawsan Alyousef is an Assistant Professor in King Saud Bin Abdulaziz University and Health Science, Clinical and Research Pediatric Critical Care fellowship from University of Western Ontario, Canada, 2001, Clinical Pediatric Respiratory, University of Toronto, Canada, Arab and Saudi Board of Pediatrics, 1997. Currently Appointed as Consultant Pediatric Intensive Care and Pulmonory at King Fahad Medical City(KFMC),Chairperson of Post Graduate Simulation Department at Center for research, Education, Simulation enhance training (CRESENT) KFMC, Director of Saudi Commissioner for Health specialty for PICU Fellowship Examination Committee, Saudi Arabia.

Is it HELLP Syndrome? The Mimics of HELLP Syndrome

Amir A. Shamshirsaz

Baylor College of Medicine, USA

Several microangiopathic disorders that are encountered during pregnancy provides physician with a formidable diagnostic challenge. Severe preeclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and other obstetric and medical conditions produce similar clinical presentations and laboratory study results to preeclampsia. In addition, preeclampsia may superimpose upon of these conditions, further confounding an already difficult differential diagnosis. Because of the remarkably similar findings of these disease processes, even the most experienced physician will face a difficult diagnostic challenge. Therefore, an effort should be made to attempt to identify an accurate diagnosis given the fact that management strategies and outcome may differ among these conditions. The objectives for this talk is as follows:

1. Describes signs and symptoms of various syndromes confuse with HELLP syndrome

2. Describe diagnostic test available for these syndromes

3. Evaluate management and complications of these Syndrome

Biography:
Amir A. Shamshirsaz received his bachelorʼs degree in mathematics, He pursued his career in medicine. Amir A. Shamshirsaz finished his medical school in “National University of Medical Sciences” in Tehran, Iran. He moved to the USA for continuing his education. He was research associate in both “University of California Los Angeles; UCLA” and “Yale School of Medicine” for 2.5 years in obstetrics and gynecology department. He pursued his obstetrics and gynecology residency in George Washington University, Washington, DC for 4 years. As he was always interested in “Critical Care Medicine” as well, Amir A. Shamshirsaz decided to move to Houston. Amir A. Shamshirsaz finished combine “Maternal Fetal Medicine/Surgical Critical Care” fellowship at Baylor College of Medicine, Houston, Texas for 3.5 years. He has recently joined as assistant professor in both maternal fetal medicine and surgical critical care at Baylor College of Medicine, Houston.

Adolescent Trauma and New Consideration in Pre-Hospital Care

Stefania Barbieri1,2*, Feltracco P1, Bertoncello F1, Pasquale A4, Bertacco A4, Zambolin G4, Paoli A2, PietrantonioV2, Bilato P2, Rubini S3, Pavin A1, Barbieri C5, Salvagno M1 and Spagna A2

1Department of Emergency Medicine, University Padova Hospital, Italy
2Unit for Pre-hospital Emergency Care, Padova Hospital University Padova, Italy
3Experimental Zooprophylactic Institute of Lombardia and Emilia Romagna, Italy
4Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padua University, Italy
5Departmentʼs Court and Tribunal Services Padova, Italy

Background: Comprehensive, multi-level interventions are needed to reduce accidents caused by the negative effects of video games; health care providers (healthcare professionals in emergency department [ED] and ambulance clinicians) should be aware of their chief role in these prevention strategies, based on their direct interactions with road accident victims[1-3]. Multiple studies have shown that early identification of traumatized adolescents at high risk for mortality is important to guide clinical care [4-6].

Materials Methods: Analysis of the current primary dispatch models regarding times of clinical scene workflow, transport times and risk stratification screening instruments exist to distinguish vulnerable patients, particularly new mechanisms of trauma in critical adolescent rescue. Collection data of pre hospital procedures, medical decision-making, a dedicated primary dispatch protocols conformed with advanced clinical intervention in the scene of incidents are collected.

Results: Based on our experience, we offer a new classification of unintentional trauma in young people involving incisive action in secondary school. Pre-hospital team personnel with police training evaluated the relationship among injury severity, prehospital procedures at the scene for victims of trauma, and the adolescent risk-raking (e.g. substance abuse, alcohol games challenges, and unintentional injury during games with phones). The analysis of local data provides new mechanisms in addition to an analysis of common injury mechanisms. It is necessary to create institutional and technological protocols to guarantee dynamic data collection and constant training of the new categorised models of trauma in the primary triage process. Electronic databases of medical literature identify only ~50% of all relevant prehospital evidence.

Conclusion: Our study suggests that the specificity of an emergency triage system decreases when medical conditions related to adolescent trauma are unrecognised or misclassified. We argue that the best way to reduce injury related to adolescent risk-taking is to equip ED teams with the skills to capture events not coded in the Common Mechanisms of Injury classification. A multicentric dataset is also warranted to determine the extent of these events.

Biography:
Stefania Barbieri, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua Italy and Department of Emergency Medicine, University Padova Hospital, Italy. She has a Unit for Pre-hospital Emergency Care, Padova Hospital University, Italy. She worked at Medical Degree University of Padova-17 July 1989, Worked as a specialist in Anaesthesia, Resuscitation and Intensive Care (1994), Worked as a specialist in Toxicology in 2004, Worked as a specialist in Legal Medicine in Ferrara University in 2012 at School of Management EMMAS Bocconi Milano in 2013 and Worked as a specialist in Hygiene and Preventive Medicine in Ferrara University in 2017 HUET OPITO Helicopter Underwater Escape Training in 2019.

Hypertensive Hypotension- Itʼs Deadly

Ash Mukherjee

University of Western Australia, Australia

Clinical assessment has very poor sensitivity in the diagnosis of pulmonary hypertension. Patients presenting to primary care and EDʼs may commonly be managed as COPD/Asthma without pulmonary hypertension being recognized.

Early recognition in ED may help these patients be diverted to specialist PH specialist care. Management of patients with pulmonary hypertension complicated by sepsis or septic shock is a clinical challenge and often associated with high mortality. Applying early goal directed therapy [EGDT] strategy with aggressive fluid treatment in this group of patients is likely to be much riskier.

Hypertensive hypotension is a term I employ to describe systemic hypotension in the presence of pulmonary hypertension. I discuss strategies to encourage emergency physicians to look for evidence of pulmonary hypertension and manipulate the therapeutic strategies to improve outcomes in this cohort of patients.

Biography:
Dr. Ash Mukherjee obtained his undergraduate medical degree from Kolkata, India. He then completed his EM training in the UK and after 8 years as a NHS consultant decided to move to a sunny Perth. For the past 6 years he has been at Armadale Hospitalʼs emergency department as a consultant in emergency medicine and lead for point of care US. He is also a Senior Clinical Lecturer at University of Western Australia. He incorporated US into his clinical practice since 1999. With a passion for point of care echocardiography in emergency medicine he has a special interest in pulmonary hypertension and its undiagnosed existence in patients presenting critically ill to the emergency department.

Putting the ‘Care’ back in to Healthcare in the ER

Timothy E A Barrett

University of the West Indies School of Clinical Medicine & Research, Bahamas

The work in the ER is fast paced most of the time and in the Bahamas the space is inadequate for the numbers of patients and the trauma numbers are high. The majority of the ER workers are female as there are few male nurses and most physicians are female. Their concern was for the effect that the chronic stressful conditions would have on the healthcare workers personal, mental and physical, and consequently on the quality of service delivered to the ER patients. My role as the Liaison Psychiatrist was to address them in this regard and I chose that time to survey their attitudes toward patients and their work conditions.

Biography:
Dr. Timothy Barrett is a Bahamian who has been practicing medicine for the past 45 years. He is a Consultant Psychiatrist in private practice and an Associate Lecturer with the University of the West Indies School of clinical Medicine and Research, Bahamas. He is used extensively for lectures and seminars on a variety of topics and has presented original research along with a book chapter on the wellbeing of medical students in the teaching environment of today.

Warning Alert in Helicopter Rescue: Trauma and Challenges

Stefania Barbieri1,2*, Feltracco P1, Bertoncello F1, Pasquale A4, Bertacco A4, Zambolin G4, Paoli A2, Pietrantonio V2, Poles R1, Salvagno M1, Barbieri C5, Rubini S3, Pavin A1 and Spagna A2

1Department of Emergency Medicine, University Padova Hospital, Italy
2Unit for Pre-hospital Emergency Care, Padova Hospital University Padova, Italy
3Experimental Zooprophylactic Institute of Lombardia and Emilia Romagna Italy
4Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padua University, Italy
5Departmentʼs Court and Tribunal Services Padova, Italy

Background: The aim of the study was to improve knowledge regarding challenges of serious clinical trauma cases related to web challenges in young people [1-3].

Hospital admissions in Emergency Department (ED) following web challenges have been previously studied, however the clinical impact of these challenges remains mainly unknown for ED team.

Methods: A retrospective analysis was conducted on data from the ED of Padova collected between January 2017 - March 2019. Helicopter staff members (HEMS, physicians and nurses) collected data regarding serious traumatic events in young people (16-25 yrs), intubated at arrival, and admitted at the Padua University Hospital. Data about type of injury, severity, vital parameters, procedures performed before hospital admission were collected.

Results: HEMS teams coordinate a variety of incident requests with different clinical interventions. Trauma related to web challenges open questions on the need of dedicated protocols – especially from the legal point of view. We reported 50 severe trauma events in the young; in 9 cases a web challenge was the intent of trauma A quick interview with the witnesses (usually friends of the victim) was essential to correctly classify the events as related to a web challenge. No death was reported in these 9 cases but length of stay was over 20 days in all cases.

Conclusion: The identification of serious health conditions in trauma patients has always been a crucial role of HEAMS team intervention. Equally important is to understand the cause of trauma in order to ensure more personalised care for trauma patients. Currently, ICD-11 trauma classification does not consider web challenge as a possible manner/intent of trauma. A potential revision of the trauma classification may be necessary considering the diffusion of this new condition.

Biography:
Stefania Barbieri, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padua Italy and Department of Emergency Medicine, University Padova Hospital, Italy. She has a Unit for Pre-hospital Emergency Care, Padova Hospital University, Italy. She worked at Medical Degree University of Padova-17 July 1989, Worked as a specialist in Anaesthesia, Resuscitation and Intensive Care (1994), Worked as a specialist in Toxicology in 2004, Worked as a specialist in Legal Medicine in Ferrara University in 2012 at School of Management EMMAS Bocconi Milano in 2013 and Worked as a specialist in Hygiene and Preventive Medicine in Ferrara University in 2017 HUET OPITO Helicopter Underwater Escape Training in 2019.

Ten Radiological Near Misses in the Emergency Department

Ruwanthi Kaushalya De Silva*, N. Wickramaratne and R S Wickramasooriya

National Hospital of Sri Lanka, Sri Lanka

As an emergency physician, it is important to be familiar with the most commonly missed radiological findings. Studies are yet to define the ten most commonly missed radiological findings in Emergency Department and, in particular, those commonly missed are clinically significant.

These missed findings contributes to poor outcome and litigations. Which important radiological findings not to miss is questionable. Larger studies do not provide sufficient details on specific pitfalls to avoid. Studies comparing initial interpretation (emergency physician) to final interpretation (radiologist) show a “Clinically significant” discordance ranging from 3% or greater to less than 1%, depending on the series. Mostly the skeletal radiographs and fewer chest radiographs are included in them. Few details about the particular missed findings are given, so these data are of limited use.

Common pitfalls in emergency imaging would be; incorrect interpretation, inadequate images and over reliance on radiography leading to inadequate clinical examination. There are common injuries that present with subtle clinical and radiographic findings. These fractures are usually non displaced or minimally displaced. Posterior Shoulder dislocation, elbow fractures in children, Radial head fractures in adults and carpal fractures are some examples for above.

Biography:
Dr. Maramba Vidanage Ruwanthi Kaushalya De Silva is a registrar in Emergency Medicine graduated from Faculty of Medicine, University of Colombo. Her current placement is Emergency Treatment Unit, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.

Echocardiography at the Front Door

Ash Mukherjee

University of Western Australia, Australia

Clinical assessment of the heart has traditionally been done at the bedside with stethoscope as the major tool. I present a series of cases managed in our emergency department where echocardiography at the bedside performed by emergency physicians helped clinch the diagnosis which otherwise may have been missed. I would hope my presentation would encourage clinicians to appreciate the deficiencies of the stethoscope and embrace point of care echocardiography not solely but mainly for assessment of critically ill patients.

Biography:
Dr. Ash Mukherjee obtained his undergraduate medical degree from Kolkata, India. He then completed his EM training in the UK and after 8 years as a NHS consultant decided to move to sunny Perth. For the past 6 years he has been at Armadale Hospitalʼs emergency department as a consultant in emergency medicine and lead for point of care US. He is also a Senior Clinical Lecturer at University of Western Australia. He incorporated US into his clinical practice since 1999. With a passion for point of care echocardiography in emergency medicine he has a special interest in pulmonary hypertension and its undiagnosed existence in patients presenting critically ill to the emergency department.

Humanitas Cognitive Tutor: A Tool for Assessing and Promoting Diagnostic Reasoning Skills

Dana Shiffer1*, Chiara Colaizzi1, Roberto Mene2, Elena Castelnuovo1, Caterina Barberi1, Michele Sagasta1, Angelo Dipasquale1, Maria Susanna Grimaudo1, Giacomo Ramponi1, Enrico Brunetta1, Marco Folci1, Franca Dipaola1, Mauro Gatti2 and Raffaello Furlan1

1Humanitas University, Italy
2IBM Italy, Italy

Background: Diagnostic reasoning skills require efficient data collection and analytical abilities. The Humanitas Cognitive Tutor (HCT) program promotes such skills through exposure to life like clinical cases. Furthermore, its ability to track studentsʼ performance might identify specific knowledge gaps.

Methods: Twenty-five 5th-year Humanitas University medical students completed a HCT case on a patient presenting to the ED with dyspnea. Studentsʼ actions were recorded via log system for further analysis. Performance was analyzed against 7 metrics: identifying information in the presenting scenario; history taking; conducting physical examination; ordering medical tests; formulating diagnostic hypotheses; matching acquired data with the differential diagnosis; final diagnosis. A performance metric was built for each section, combining sensitivity (how many information in each section were found) and precision (how many correct actions were performed) metrics. The F1 score (0-1 range) provided a harmonic mean of sensitivity and precision metrics. The combined score reflected the studentʼs overall score. Dividing those 7 metrics into two groups represented information collection ability and analytical ability.

Results: Overall mean F1 performance was 0.600±0.056. 14 students scored between 0.6-0.7, 11 below 0.6. Grouping the 7 metrics into two domains provided specific insight on the studentʼs preparation, highlighting different educational needs. For example, although 2 students had identical overall scores, one performed worse at data collection while the other did poorly on data analysis.

Conclusions: The HCT may be used to assess studentsʼ ability to apply medical knowledge in a clinical context and detect specific areas which should be strengthened to solidify diagnostic reasoning skills.

Biography:
D ana Shiffer earned her Bachelor of Science (B.S.) degree in Physiological science from the University of California- Los Angeles in 2007. In 2017, she received her M.D. degree from the University of Milan, Italy. She is currently in her first year of residency in Emergency Medicine at the Humanitas University of Milan, Italy. Currently, her research interest in on autonomic nervous system disorders and the development of artificial intelligence algorithms to be used on big data.

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