Emergency Department Of University Hospital Research Articles

Early goal directed therapy versus a protocolized resuscitation care in early management of septic shock

ABSTRACT Objective Multicenter studies showed that early goal directed therapy (EGDT) did not improve outcome in patients with septic shock compared with undefined usual care. The aim of this study was to evaluate the efficacy of a protocolized resuscitation care compared to traditional EGDT in early management of septic shock on short-term mortality. Design A randomized controlled trail. Setting Emergency Department and Critical Care Units of Alexandria main university hospital. Patients 100 adult patients of both genders with septic shock. Methods All patients received early fluid resuscitation, empirical broad-spectrum antibiotic therapy and mechanical ventilation if indicated. Then, they were randomly assigned into two groups: Early goal directed therapy (EGDT) group (n = 50) and Protocolized resuscitation care (PRC) group (n = 50). Results EGDT group showed 20% reduction in need for vasopressor than PRC group with significant difference (p = 0.001). PRC group showed lower mortality rate than EGDT group but with no significant difference (p = 0.405). There were no differences in ICU stay, mechanical ventilation days and duration of vasopressor (p= 0.091, 0.243, 0.372 respectively). Conclusion A Protocolized resuscitation care may be beneficial as compared to EGDT in early management of septic shock with a non-significant trend to decrease mortality.

Comparison of paracetamol and hyoscine-N-butylbromide in the treatment of abdominal pain and cramps due to acute gastroenteritis

Background and objective: Hyoscine-N-butyl bromide (HBB) and paracetamol (acetaminophen)are widely used in emergency departments for abdominal pain and cramps. However, there is not enough data on the efficacy, safety, and superiority of each other in treating acute gastroenteritis (AGE) related abdominal pain and cramps. In this study HBB and paracetamol were compared for the treatment of abdominal pain and cramps related to acute gastroenteritis. Materials and methods: The study was conducted in a tertiary university hospital emergency department as a prospective, randomized-controlled, and double-blind study. Intravenous (IV) 1000 mg paracetamol and IV 20 mg hyoscine-N-butyl bromide (HBB) were used to treat abdominal pain and cramps related to AGE. Visual analogue scale (VAS) was used to evaluate the degree of abdominal pain before and after treatment. Results: HBB and paracetamol groups consisted of 123 and 158 cases respectively. In both groups, it was observed that the VAS score gradually decreased from the 0th hour to the 1st and 2nd hours (p<0.001).When comparing each time within itself, it was observed that HBB and paracetamol measurements had similar values (p>0.05). No severe side effects were observed in any of the patients. Conclusion: HBB and paracetamol were used for symptomatic treatment in AGE patients presenting with abdominal pain and cramps. A significant reduction in pain and cramps was achieved in both patient groups. There was no difference between the two drugs in terms of treatment efficacy and side effects. IMC J Med Sci 2022; 16(1): 009 *Correspondence: Hasan Gümüşboğa, Department of Emergency, Şehitkamil State Hospital, Gaziantep, Turkey, Posta code: 27500; Email: profhasan@hotmail.com; ORCID:0000-0003-2097-7102.

Epidemiology of Knife Injuries at Ain Shams University Hospital Emergency Department from 2018 to 2019: A Cross-Sectional Study.

PurposeFor knife-related injuries (KRI), a comprehensive understanding of the incidence, mechanism, and pattern of injury is required for the development of prevention strategies. Unfortunately, reliable data on knife-related injuries are difficult to obtain. In Egypt, there is no national routine surveillance system for all knife injuries. The aim was to examine the epidemiologic characteristics of knife-related injuries at the Ain Shams University Hospital (ASUH) emergency department (ED).Patients and MethodsA cross-sectional study was conducted on 140 patients who presented with knife injuries at the ASUH ED. Data collection was done during a randomly selected period of seven days each month from October 2018 to September 2019. The sociodemographic characteristics, injury-related variables, and outcomes of the injury were recorded on a structured worksheet.ResultsKnife-related injuries represented 22.9% of all injury cases that presented to the ED. Majority of the knife-related injuries (87.86%) were accidental, 7.9% were assault, and 4.3% were self-inflicted. Home was the most reported place of injury. Most of the victims were discharged from the ED (87.1%), and 84.3% recovered completely. The mean hospital stay was 3.6 ± 1.3 days.ConclusionMajority of the knife-related injuries were accidental, and the most common pattern was isolated chest injury with contusions. Cases that were not severe and had favorable prognosis (ie, complete recovery) comprised the largest proportion. Recommendations include development of a surveillance system may result in the effective control and prevention of this growing problem of knife-related injuries.

Clinical profile of elderly patients referred to liaison psychiatry for substance use disorders in an Academic Emergency Department

To describe the clinical characteristics and the outcomes of a group of elderly patients referred to a liaison psychiatry department in the emergency department of an Academic University Hospital. A group of 39patients aged over 65years (mean age: 70. years, 56% male), consecutively referred to a liaison psychiatry department between March 2017and December 2020, was compared to a group of 613patients aged under 65years (mean age: 42.0years, 69% male) following their admission to the emergency department of the Amiens University Hospital, France. The main reasons for admission in the emergency department were alcohol intoxication (54%), depressive symptoms (23%), and suicidal ideas or behaviors (24%), without significant difference with the group of patients aged under 65years of age. The rate of patients smoking tobacco on a daily basis was lower in the group of patients over 65years of age (respectively 28% versus 71%, P < 0.0001). The rates of patients who used alcohol on a daily basis, patients with current depressive disorders, patients with personality disorders, patients receiving antidepressants, benzodiazepines or hypnotic treatments were similar in both groups. The prescription of pharmacological treatments for smoking cessation and for alcohol cessation should be enhanced.

COVID-19 lockdown attack on headache emergency admissions: a multidisciplinary retrospective study.

BackgroundDuring the first COVID-19 lockdown in Italy, it was observed a reduction in emergency department (ED) attendances due to non-SARS-COV-2-related acute/chronic conditions.ObjectiveTo analyze the impact of the COVID-19 lockdown on patients reporting headache as the principal presenting symptom on admission to the ED of the tertiary care University Hospital of Trieste over the relevant period.MethodsWe retrospectively evaluated the frequency, features, and management of ED attendances for headache during the COVID-19 lockdown from 8 March to 31 May 2020, comparing it with the pre-lockdown period (January–February 2020) and the first 5 months of 2019.ResultsA reduction in ED total attendances was observed in the first 5 months of 2020 compared to the same period in 2019 (21.574 and 30.364, respectively; − 29%), in particular with respect to headache-related attendances (174 and 339 respectively; − 49%). During the COVID-19 lockdown, it was recorded a minor reduction in the ED access rate of female patients (p = 0.03), while no significant variation was detected in repeaters’ prevalence, diagnostic assessment, and acute treatment. The ratio of not otherwise specified, secondary, and primary headaches (48.4%, 30.6%, and 21.0% respectively) remained unchanged during the COVID-19 lockdown, in comparison to the control periods.ConclusionThe COVID-19 pandemic impacted the number of ED attendances for headache but not their management and setting. Despite a reduction of accesses for headache due to the pandemic emergency, the distribution of headache subtypes and the rate of repeaters did not change.

Identification and validation of objective triggers for initiation of resuscitation management of acutely ill non-trauma patients: the INITIATE IRON MAN study

BackgroundWhile there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol.MethodsAll CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]).ResultsThe any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients.ConclusionOur simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.

The effect of oral ondansetron on QT interval in children with acute gastroenteritis; a retrospective observational study

BackgroundIn mildly to moderately dehydrated patients with acute gastroenteritis (AGE), oral rehydration therapy (ORT) is the treatment of choice. Though ondansetron is a very effective antiemetics and leads to succeed ORT, there have been reports QT prolongation in patients using it. We investigated the effect of oral ondansetron on QT interval in mildly to moderately dehydrated children with AGE.MethodsThis retrospective observational study was conducted in a single pediatric emergency department (ED) of a tertiary university hospital. We collected the medical records of patients with a primary diagnosis of AGE who received oral ondansetron and underwent an electrocardiogram between January 2017 and June 2018. A pediatric emergency physician calculated the corrected QT interval (QTc) by Bazett’s method, and the calculations were reviewed by a pediatric cardiologist. QTc values before (preQTc) and after (postQTc) ondansetron administration were analyzed. ΔQTc was calculated as the change from preQTc to postQTc. We also investigated any cardiac complications from oral ondansetron.ResultsTotal 80 patients were included. The mean age of the patients was 53.31 ± 32.42 months, and 45% were male. The mean dose of oral ondansetron was 0.18 ± 0.04 mg/kg. The mean interval from administration of ondansetron to performance of the electrocardiogram was 65 ± 26 min. The mean preQTc was 403.3 ± 24.0 ms, and the mean postQTc was 407.2 ± 26.7 ms. Two patients had a preQTc ≥460 ms, and one patient had a postQTc ≥460 ms. ΔQTc was ≥30 ms in seven patients (8.8%). No ΔQTc was ≥60 ms. No pre- or postQTc was ≥500 ms. No patient had a fatal cardiac arrhythmia after taking ondansetron.ConclusionOral administration of a single dose of ondansetron in children with AGE did not cause high-risk QTc prolongation or fatal arrhythmia.

The impact of adherence to a guideline for minimizing opioid use for treatment of pain in an urban emergency department.

The opioid epidemic has significantly evolved over the last three decades. The initiation and continuation of prescription opioids for pain control were one of the primary contributors, across different medical settings. The emergency department (ED) is typically the first place patients go to for management of acute pain, and often where opioid naïve patients first become exposed to opioids. In 2018, the ED of University Hospital located in Newark, NJ implemented a pain guideline to ensure that patients are not unnecessarily exposed to opioids. The goal of our study was to determine whether provider adherence was successful in reducing opioid administration. We conducted a retrospective review of pharmacy records of patients treated for pain in the ED within the time frame January 1, 2017 and December 31, 2019. We analyzed the change in our practice by comparing the amount of opioid and non-opioid medications administered and the number of patients administered each type, as well as the change in our utilization of specific medications. The t-test or the χ2 test were used as applicable. There were decreases in the mean number of opioid doses administered in 2017 (1273) compared to 2019 (498; p = 0.027). There was an increase in non-opioid analgesics administered, (mean 2017: 1817, mean 2019: 2432.5, p = 0.018). There was also an increase in the proportion of patients given non-opioid analgesics (mean 2017: 22%, mean 2019: 28%, p < 0.0001). There were increases in administrations of acetaminophen (40% to 52%) and ibuprofen (30% to 35.1%), and decreases in administrations of hydromorphone (2.5% to 0.03%), morphine (11.5% to 5.6%), oxycodone (10.6% to 5.3%), and tramadol (5.7% to 1.9%) (all p < 0.0001). A guideline that emphasizes the use of non-opioid analgesics first line treatment for acute pain can be effective for reducing opioid administration in the ED. Through the use of our guideline, we reduced the number of patients who have received opioid analgesics and, at the same time, increased non-opioid analgesic administration. Future studies should explore readmission rates, duration of pain relief in patients managed with non-opioid versus opioid analgesics, and perception of relief through the use of satisfaction scores.

Are antigen tests useful as screening for the identification of SARS-CoV-2 in emergency rooms?

Abstract Background A quick and accurate case identification in the Emergency Department (ED) during the SARS-CoV-2 pandemic is crucial for clinical management and to prevent spread of infections. The gold standard for diagnosing SARS-CoV-2 infection is the real-time reverse transcription polymerase chain reaction (RT-PCR) test in upper airways swabs. However, the procedure is available in few specialized laboratories and requires an average sample processing time of about 6 hours from its inception. The development of reliable but cheaper and faster point-of-care tests was expected to be useful either for population-screening or as first aid tests in the ED. Rapid antigenic diagnostic tests (Ag-RDTs), directly detect SARS-CoV-2 proteins produced by the replicating virus in respiratory specimens, were proved to be candidates in both cases. However, data on their effectiveness are still few and controversial. The aim of the study is to establish the accuracy of antigen tests to identify SARS-CoV-2 in a high prevalence setting. Methods Results of 324 patients, consecutively admitted to the ED of San Luigi Gonzaga University Hospital in Orbassano (Turin, Italy) between 26 October and 10 November 2020 and subjected to both molecular and antigen tests, were compared. Results Using RT-PCR as gold standard, specificity and sensitivity of Ag-RDT were 0.94 (95%CI: 0.90-0.98) and 0.80 (95%CI: 0.75-0.85), respectively. The Ag-RDT positive predictive value was 0.96 (95%CI 0.93- 0.99), and the negative predictive value was 0.72 (95% CI: 0.65-0.79). Patients that tested negative to Ag-RDT but presented with fever and cough or had pneumonia at imaging were more likely to be false negatives. Ag-RDTs best performance occurs in the first days after symptom onset. Conclusions These results confirm the limits of antigenic tests as first line screening tests and suggest that the antigenic test should be integrated with clinical judgement, based on physical and instrumental examinations. Key messages Antigenic tests have a limited effectiveness as first line screening tests. In a high-prevalence setting these tests incorrectly judge as negative many COVID-19 symptomatic patients, making necessary to integrate their results with clinical judgement.

Acil Servise Göğüs Ağrısı ile Başvuran Hastalarda Nötrofil Lenfosit Oranının Kullanımı

Objective: Objective: In this study, we aimed to determine the roles of neutrophil, MPV, and NLR, in the diagnosis of ACS and the differentiation of ACS subtypes (ST-elevation myocardial infarction and non-ST elevation myocardial infarction), in patients presented to the emergency department with chest pain and were diagnosed with ACS (acute coronary syndrome).&#x0D; Methods: This study was designed as a single-center, cross-sectional, and retrospective. 402 patients who were applied to University Hospital Emergency Department between January 2020 and November 2020; and registered to hospital automation system with chest pain; and underwent further examinations and treatments were included in the study. Ethical approval was obtained from the Local Clinical Research Ethics Committee before the study. Patients who were hospitalized after further examination, who received medical treatment, and did not undergo PCI (Percutaneous coronary intervention) were accepted as NSTMI (n = 202). Patients who were hospitalized after further examination and underwent PCI were accepted as STMI (n = 200).&#x0D; Results: 36.3% of the patients were female (n = 146) and 63.7% (n = 256) were male. The mean age of the cases was detected to be 61.46 ± 14.06. The number of hospitalized ACS patients for NSTMI suspicion and received medical treatment was 202. The number of patients who underwent PCI and accepted as STMI was 200.Mean neutrophils, MPV, NLR, and Troponin values were also significantly higher than those who are not hospitalized (p

90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Burnout on the frontline: the impact of COVID-19 on emergency department staff wellbeing.

BackgroundBurnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. Healthcare professionals are particularly susceptible to this occupational phenomenon. There is limited literature currently published addressing burnout in the context of the Irish frontline workers during the COVID-19 pandemic.ObjectivesOur study aims to determine the rate and degree of burnout present in the emergency department (ED) staff at St. James hospital Dublin (SJH) and at Cork University Hospital (CUH), in the context of the COVID-19 pandemic.DesignA cross-sectional study was performed on a convenience sample of medical staff and healthcare staff in the ED at Cork University Hospital and St. James Hospital Dublin, two major University Hospital EDs. Burnout was measured using the Oldenburg burnout inventory (OLBI) a standardised 16-question instrument. Participants also provided demographic data and answered several questions relating to the pandemic.ParticipantsNinety-nine participants across two departments responded (a response rate of 30%). All ED cohorts were represented.ResultsBurnout was identified in almost three quarters of respondents (74%). The mean burnout scores were 2.42 (OLBI cut-off 2.18). There was mean disengagement level of 2.25 and a mean exhaustion level of 2.59. There was no statistically significant variance between staff, by demographics (i.e. occupation, years working in the ED, age, or gender). There was no significant difference in burnout rates or scores between St. James Hospital, Dublin, and Cork University Hospital, though the former tended to have a higher rate of burnout at 81% vs the 67% burnout observed in CUH.ConclusionsThe COVID-19 pandemic may be contributing to the long-established problem of health care burnout. The trajectory of this disease is still unclear. Consistent, progressive measures to address staff well-being, and support frontline workers, are imperative going forward.

Evaluation of patients with rheumatic diseases admitted at emergency department: 5-year analysis in a single centre.

Chronic inflammatory diseases can lead to emergency admissions with various acute complications. Unfortunately, there is limited data on emergency admissions because of rheumatological diseases. To evaluate the patients with rheumatic diseases presenting to the emergency department (ED). A total of 1788 patients with a diagnosis of inflammatory rheumatic disease admitted to the ED of a tertiary university hospital between March 2016 and March 2021 were included. The patients' socio-demographic and clinical characteristics, diagnosis and treatments in the ED were recorded. Patients' complaints were classified as rheumatological or non-rheumatological. Over 5years, 1788 patients with an inflammatory rheumatic disease presented to the ED. The mean duration of rheumatological disease was 7±3.4years, and the mean number of emergency admissions was 4.4±5. The four most common groups attending the ED were patients with rheumatoid arthritis, ankylosing spondylitis, familial Mediterranean fever and vasculitis. Of the complaints of the 1788 ED visitors, 1106 (61.9%) were rheumatological, 681 (38.1%) were non-rheumatological and other acute or chronic conditions. Twenty-three patients (1.3%) had the rheumatic disease and died after admission to the ED. When the univariable model results are examined, the risk of hospitalisation increases 1.024 times with increasing age. The risk of hospitalisation is 2.318 times higher in those with ankylosing spondylitis and 2.722 times in those with rheumatoid arthritis compared with those with a diagnosis of vasculitis. The risk of hospitalisation in patients with comorbid diseases is 1.807 times higher than those without. When the results of the multivariable model are examined, the risk of hospitalisation is 2.227 times higher in those with ankylosing spondylitis and 2.615 times in those with rheumatoid arthritis compared to those with vasculitis. Other risk factors were not statistically significant (P>.050). Patients with the rheumatic disease most frequently presented to the ED with musculoskeletal complaints and were discharged from the ED. True rheumatological emergencies are rare, but ED physicians should be aware of serious and life-threatening conditions.

Impact of air temperature on occurrence of bath-related cardiac arrest.

The mortality of the bath-related cardiac arrest (BRCA) is extremely high. While air temperature is reported to be associated with the BRCA occurrence, it is unclear whether daily minimum temperatures or the difference between maximum and minimum air temperatures influences BRCA occurrence the most.A retrospective cohort study of adult patients was conducted between January 2015 and February 2020 at Hirosaki University Hospital Emergency Department. The following data were collected: age, sex, day of cardiac arrest event, location of the event, initial cardiac rhythm, presence of return of spontaneous circulation, and overall mortality (status at 1 month after cardiac arrest event). Based on the day of the event and the location in which the event occurred, daily minimum and maximum temperatures were obtained from the Japan Meteorological Agency database.A total of 215 eligible cardiac arrest cases were identified, including 25 cases of BRCA. Comparing BRCA and non-BRCA, initial shockable cardiac rhythm (4.0% vs 44.7%), presence of return of spontaneous circulation (8.0% vs 34.7%), and overall mortality (96.0% vs 71.6%) differed significantly (P < .05 each). Daily minimum and maximum temperatures showed no significant relationships with BRCA or non-BRCA. Daily minimum temperature was a risk factor of BRCA occurrence after adjusting for age and temperature difference (risk ratio, 0.937; 95% confidence interval, 0.882–0.995).Daily minimum temperature represents a potential risk factor for BRCA occurrence.

Lost diagnoses in not otherwise specified headache in Emergency Department

The diagnosis of Not Otherwise Specified (NOS) headaches in the Emergency Department (ED) is frequent despite many specialist visits performed. The aim of the study was to examine specialist visits carried out in the patients discharged from ED with diagnosis of NOS headache to evaluate discrepancies between specialist and ED diagnosis at discharge. We retrospectively (1.6.2018–31.12.2018) analyzed all the patients admitted with non-traumatic headache to the ED of the tertiary-care University Hospital of Trieste. We evaluated the patients discharged from ED with a final diagnosis of NOS headache and who underwent at least one specialist examination. Demographic data, specialist and ED diagnosis were analyzed. One hundred twenty-four patients (93 F, 31 M, mean age 44 ± 15 years) were included. 71.8% of patients were examined only by a neurologist, 12.9% by non-neurologists, 15.3% by both neurologist and non-neurologist. Only 37% of the patients received a precise diagnosis. Neurologist made a diagnosis slightly more frequently than the other consultants (40.5% vs 37.5%). Neurologists diagnosed primary headaches, headaches secondary to neurological diseases, and facial neuralgia, instead non-neurologists diagnosed only headaches secondary to non-neurological diseases. Primary headaches were diagnosed in 25.7% of cases, migraine being the most frequent. Physicians did not report any specialist diagnoses in the ED discharge sheet. Specialist consultants made specific diagnoses in about one-third of patients that were not reported as final in the discharge records by the ED physician. This leads to a loss of diagnoses and to an overestimation of NOS headache.

A Comparison of Clinical Characteristics and Outcomes Between Indigenous and Non-Indigenous Patients Presenting to Townsville Hospital Emergency Department With Chest Pain

Indigenous Australians have a high rate of ischaemic heart disease (IHD). There is a paucity of local data for North Queensland regarding the clinical characteristics of Indigenous people who present to the emergency department (ED) with chest pain. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between Indigenous and non-Indigenous patients who presented with cardiac-related chest pain. This is a retrospective single-centre audit. The data was collected through chart reviews of chest pain presentations to the Townsville University Hospital Emergency Department, Queensland, Australia, from January to December 2017. We categorised the patients into Indigenous and non-Indigenous groups and compared their cardiac risk factors and social characteristics. We further classified the patients into three diagnosis groups and we measured the clinical outcomes in the patients with a diagnosis of cardiac-related chest pain. We used a data linkage to the Registry of Births, Deaths and Marriages for the death outcomes. A multivariable analysis was done to determine the risk of major adverse cardiac event (MACE) for Indigenous vs non-Indigenous patients. Indigenous patients were over-represented making up 19.1% of the total cohort (compared with 11.1% of the North Queensland Indigenous population) and presented at a younger age (median age: 45 vs 52, p<0.005). Traditional cardiovascular risk factors were significantly higher in Indigenous patients. The incidence of discharge against medical advice was also higher (6.5% vs 2.7%, p<0.005). There was an underutilisation of the local chest pain pathway amongst the Indigenous group (35.8% vs 44.7%, p<0.005). In patients with a diagnosis of cardiac-related chest pain, the rate of receiving invasive coronary angiogram procedures was similar in both cohorts (44.5% vs 43.7%, p=0.836). With regards to outcomes, Indigenous patients suffered from acute coronary syndrome (ACS) at a younger median age (51 vs 64, p<0.005) and were more likely to have severe three vessel disease (17% vs 6%, p<0.005) leading to coronary bypass graft surgery (CABG) (19% vs 6%, p<0.005). When adjusted for age, gender, and comorbidities, Indigenous patients were more likely to have MACE within 1 year of their chest pain presentation, compared with non-Indigenous patients with the same diagnosis (adjusted odds ration [AOR]=2.0, 95% CI [1.1, 3.8], p=0.03). In our study, Indigenous patients carried a heavier burden of cardiovascular risk factors, presented at a younger age, with more severe coronary disease and had a higher rate of CABG. We found an underutilisation of the local chest pain protocol amongst the Indigenous cohort, which suggests a need to improve support structures in the ED. In our multivariable analysis, Indigenous patients suffered from a significantly higher MACE compared to non-Indigenous patients which indicates that more collaborative efforts are needed to improve the cardiovascular health of local Aboriginal and Torres Strait Islander people.

Strong and Direct Correlation in Heart Failure Between B-Lines and NT-ProBNP Levels

The aim of the study was to evaluate the compliance of the number of B-lines on focused lung ultrasound with the clinical heart failure classification of the New York Heart Association (NYHA) and NT-proBNP levels in the emergency department. This prospective study was conducted in a tertiary university hospital emergency department. Patients over 18 years of age complaining of shortness of breath or heart failure diagnosis between January 2016 and July 2016. The number of B-lines according to the BLUE point regions was measured. Correlations between the clinical heart failure stage, NT-proBNP level and number of B-lines on ultrasonography were analyzed. Of the 143 patients, 92 (64.3%) were male and 51 (35.7%) were female. The median age was 73.00 (66.00-79.00). There was a very strong correlation between the number of B-lines and NYHA stages for each region (r > 0.85 for all variables; p <0.001 for all). There was also a strong and direct correlation between the number of B-lines and the NT-proBNP levels for each region (r > 0.70; p <0.001). Regarding the shortness of breath numerical score (r > 0.45; p <0.001), there was an inverse relationship with ejection fraction (EF). The relationship between the EF and BLUE points was moderate, but negative and significant (p <0.001). NT-proBNP levels, the NHYA classification, and lung ultrasound can be used as a tool in the emergency department for a faster diagnosis and decision-making in lung congestion.

Evaluation of spontaneous reduction among the invagination cases admitted to the paediatric emergency department; retrospective study.

We aimed to determine the factors that determine the conditions in cases of invagination with spontaneous reduction. Study was conducted retrospectively in the Paediatric Emergency Department (PED) of the tertiary University Hospital in Ankara, Turkey. Invagination cases admitted between January 1, 2019 and December 31, 2019 were included in the study. Patient information (demographic data such as age, gender, physical examination findings, laboratory and imaging methods, treatment and follow-up) were recorded on the data form prepared by the researchers before the study, using patient files and hospital patient information system. Data were analysed with IBM SPSS V23. During the study period, the number of cases who applied to the PED was 33,849 and 74 of these cases were diagnosed with invagination. In the cases diagnosed with invagination, 69 (93%) of them spontaneously reduced during the follow-up. Among all cases, the male sex ratio was 56.5% (39/69). The average age was 44.6months (minimum: 6; maximum: 154). The mean follow-up time in the emergency room was 12hours and in the hospital service was 38hours. Vomiting was observed in 89.9% (58/69) of all cases, abdominal pain in 68.1% (44/69) and rectal bleeding in 1.4% (1/69).The invagination of 21.7% (15/69) of the patients at the first USG was ileo-ileal. 63.8% (44/69) of the patients were discharged after followed up in emergency observation. The number of USGs was lower in the group that was discharged after the follow-up in the emergency room, than the follow-up groups in the service monitoring (P=.012). Invagination is one of the surgical emergencies. With the widespread use of USG, most of these cases are followed up by clinical and USG follow-up in paediatric emergency services. Spontaneous reduction frequently develops in cases of intussusception with small bowel localisation and short bowel segment (less than 3cm).

Clinical alarms and alarm fatigue in a University Hospital Emergency Department-A retrospective data analysis.

Alarm fatigue is hypothesized to be caused by vast amount of patient monitor alarms. Objectives were to study the frequency and types of patient monitor alarms, to evaluate alarm fatigue, and to find unit specific alarm threshold values in a university hospital emergency department. We retrospectively gathered alarm data from 9 September to 6 October 2019, in Jorvi Hospital Emergency department, Finland. The department treats surgical, internal and general medicine patients aged 16 and older. The number of patients is on average 4600 to 5000 per month. Eight out of 46 monitors were used for data gathering and the monitored modalities included electrocardiography, respiratory rate, blood pressure, and pulse oximetry. Total number of alarms in the study monitors was 28176. Number of acknowledged alarms (ie acknowledgement indicator pressed in the monitor) was 695 (2.5%). The most common alarm types were: Respiratory rate high, 9077 (32.2%), pulse oximetry low, 4572 (16.2%) and pulse oximetry probe off, 4036 (14.3%). Number of alarms with duration under 10s was 14936 (53%). Number of individual alarm sounds was 105 000, 469 per monitor per day. Of respiratory rate high alarms, 2846 (31.4%) had initial value below 30 breaths min-1 . Of pulse oximetry low alarms, 2421 (53.0%) had initial value above 88%. Alarm sound load, from individual alarm sounds, was nearly continuous in an emergency department observation room equipped with nine monitors. Intervention by the staff to the alarms was infrequent. More than half of the alarms were momentary.

A Case Report: Probably Concurrent Nasogastric Tube Syndrome and Cerebrovascular Disease in a Postoperative Patient

Nasogastric tube syndrome (NTS) is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. Although NTS is a rare cause of vocal cord paralysis, it has the potential of causing serious morbidities even mortality. We here with present a case of concurrent NTS and cerebrovascular disease patient. 73 year-old male was admitted to our university hospital emergency department with acute respiratory distress and stridor days after his cholecystectomy operation and laryngoscopy showed bilateral vocal cord paralysis. The patient was admitted to the intensive care unit (ICU) and urgent tracheotomy was performed. On the day after his discharge from the hospital, his vocal cord movements fully recovered state. Nasogastric tube syndrome can be considered in patient who complains because of acute upper airway obstruction with nasogastric tube inserted. Thinking NTS early may be reducing the complication rate.