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P614 __________________________________ Neurology could contribute to ischemic damage are believed to represent a
response to the existing injury, the possibility that white cells may
THE RELATIONSHIP BETWEEN THE INITIAL LEVEL OF also play a role in the chain of events leading to the impairment of
GLUCOSE AND WHITE BLOOD CELL WITH THE PROGNOSIS cerebral circulation and then to the induction of the ischemic event
AT THE PATIENTS ADMITTED TO THE EMERGENCY has been suggested. This hypothesis is also supported by the
DEPARTMENT WITH CEREBROVASCULAR DISEASES evidence that an elevated white blood cell count is a predictor of
AB Erdem (1), UY Çavuş (2), A Ceylan (3), U Kaya (4), F cerebral ischemia (6).
Büyükcam (2) In conclusion, the increased level of the white blood cells of
patients diagnosed with CVD were considered to be an important
1. Department of Emergency Medicine, Diskapi Yildirim Beyazit Training&Research role in the severity of the disease.
Hospital, Ankara, Turkey
2. Department of Emergency Medicine, Diskapi Yildirim Beyazit Training&Reseach P615 ___________________________ Obstetric Emergencies
Hospital, Ankara, Turkey
Corresponding author: Mr Büyükcam Fatih ([email protected]) ACUTE ABDOMEN SECONDARY TO SPONTANEOUS
Key-words: cerebrovascular disease ; white blood cell ; mortality RUPTURE OF UTERINE VARICOSE VEIN IN THE SECOND
TRIMESTER OF PREGNANCY . CASE REPORT AND
Introduction: Among adult neurological diseases, cerebrovascular RETROSPECTIVE REVIEW OF PREGNANT WOMEN
diseases (CVD) are common and important. Therefore, to fight PRESENTED WITH ACUTE ABDOMEN TO A MIDDLE SIZE
against the preventable prognostic factors in these patients has an EMERGENCY DEPARTMENT.
important role in reducing the severity of the disease. Zs Erdélyi, Z Kákonyi, F Rupp, I Szabó, L Zag
Material and Method: In our study, during the six-month period, 98
patients hospitalized at the neurology services after the first Emergency Department, County Hospital of Kecskemét, Kecskemét, Hungary
evaluation at the emergency department were examined Corresponding author: Mme Erdélyi Zsuzsanna ([email protected])
retrospectively. Their glucose levels and white blood cell (WBC) Key-words: ruputure of uterine vein ; acute abdomen ; pregnancy
counts are recorded and the relationship of them with mortality
was researched. Background: The diagnosis and management of acute abdomen in
Results: 43 (43.9%) of the patients were male, M:F ratio was 0.78. pregnant women presented to the emergency department (ED) is a
Median of the age was 73 (37-99 range). 87 (88.8%) of the patients difficult task for the physicians. The physiological and anatomical
diagnosed as ischemic CVD and others were hemorrhagic CVD. changes during pregnancy can make the diagnosis of acute
Diabetes mellitus was present at admission at 27 (27.6%) of the abdomen even more difficult. There are several non-obstetric
patients. Brain computed tomography (BCT) was applied 94 of the conditions leading to acute abdomen: appendicitis, acute
patients, other patients were diagnosed with physical examination pancreatitis, ileus, liver or spleen rupture, perforation of peptic
and magnetic resonance imagining (MRI). 60 (63.8%) of the BCT ulcer and obstetric conditions including rupture secondary to extra-
were normal, 23 (24.4%) of them were reported as ischemia and 11 uterine pregnancy, placental abruption and hemorrhage of arteries
(11.7%) were hematoma. MRI was performed for 53 of the or veins of genitourinary organs. Rupture of uterine vein is a rare
patients, ischemia was seen 52 (98.1%) of them and one of the condition but it can be serious complication of pregnancy. Prompt
patient was diagnosed as CVD only with physical examination. In diagnosis is essential for early management and it can reduce
hospital 19 (19.4%) of the patients has died, 65 (66.3%) of them morbidity and mortality rates in mothers and babies as well.
were discharged with sequel and 14 (14.3%) of them without any Objective: The aim was to evaluate the number and the underlying
complication or sequel. Mean value of WBC was 9.30±3.31 causes of acute abdomen among pregnant women presented with
(10^3/µL) in ischemic CVD and 10.05±5.45 (10^3/µL) in abdominal symptoms to our ED. In addition, present a case history
hemorrhagic CVD group, there wasn't any statistical difference of a pregnant woman with acute abdomen secondary to rupture of
(p=0.514). Mean value of glucose was 144.32±56.78 mg/dL in uterine vein in emergency department.
ischemic CVD and 131.27±59.15 mg/dL in hemorrhagic CVD group, Methods: Retrospective review of medical records of pregnant
there wasn't any statistical difference (p=0.272). Glucose levels of women presented with symptoms of acute abdomen to our ED
dead and alive patient group were similar (p=0.327). The WBC between 01.01.2007-30.04.2012. Physical examination, vital sign
values of dead patient group was higher than the alive patient assessment, laboratory tests, abdominal ultrasound and urine test
group (p=0.003). In alive patient group, there wasn't any difference were performed in every case of pregnancy with acute abdomen.
of WBC between patient with and without sequel. There wasn't Results and case report: The number of pregnant women
any relationship between type of CVD (ischemic or hemorrhagic) presented to our ED in the study period was 337. 198 patients had
and prognosis (0.263). abdominal symptoms from which 24 patients had acute abdomen.
Discussion: Some of the hematologic parameters has important The non-obstetric cause of acute abdomen in pregnancy were:
role on cerebral microperfusion and regulation of perfusion (1-2). appendicitis (9 cases), pancreatitis or acute cholecystitis (9 cases)
Leucocytes contribute the onset and continuation of ischemic CVD and complication of peptic ulcer (3 cases). The obstetric cause of
and elevations in leukocytes may be independently associated with acute abdomen in pregnancy were tubarian rupture due to ectopic
markers of subclinical atherosclerosis and increased risk of pregnancy (2 cases) and rupture of uterine vein (1 case).
ischemic stroke (3-4). Güven et al reported that the WBC count at We report the case of a 32 year-old twin pregnant women who
admission of ischemic CVD is associated with initial clinical picture was admitted for sudden onset of abdominal pain. Physical
and ischemia severity. Also the WBC count in the first 12 hours is a examination, vital sign assessment, laboratory tests, abdominal
good prognostic predictor of mortality (5). In our study we also ultrasound, gynecological and surgical examination were
reported the relationship between the initial WBC count and the performed during ED staying. Due to results of the tests surgical
mortality. exploration was performed which identified the ruptured vein of
Although the influx of leukocytes into injured ischemic tissue and the uterus, the bleeding was stopped by suture. After successful
the subsequent hemorheologic and biochemical reactions that

BOOK OF ABSTRACTS 347

operation she was admitted to the intensive care unit later to the risk factors (in the case pre-sented, these included overweight,
gynecologic department. pregnancy at age over 35, thrombophilia, immobility during a
Conclusion: Almost half of pregnant women presented to our ED flight, and initial symptoms in the left leg compatible with DVT).
had abdominal symptoms and the small part of them requires early Laboratory results such as respiratory alkalosis or ele-vated fibrin
surgery. Qualified and experienced emergency physicians are degradation products are also commonly found in healthy
needed for differential diagnosis and appropriate treatment. pregnant women; levels of the latter increase with gestational age
Collaboration between other specialties (including ambulance, and reach a maximum at the time of birth, but such tests should be
surgery, gynecology, radiology) is essential. performed due to their abil-ity to exclude disease and to avoid
unnecessary exposure to ionizing radiation.
P616 ____________________________Obstetric Emergencies A major problem with diagnosis of PTE is clinicians’ reluc-tance to
expose the fetus to ionizing radiation, often due to overestimation
PULMONARY EMBOLISM IN PREGNANCY of the risk of harm. When faced with the clin-ical probability of PTE,
HM Durgun, M Icer, the primary diagnostic modalities are pulmonary ventilation-
E Ozcete, A Ozhasenekler, E Tektas perfusion scintigraphy (VPS) and tho-racic CT. The estimated
radiation dose from CT absorbed by the fetus is 0.003-0.13 mGy,
Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey while from VPS it is 0.2 mGy. There is no evidence that doses of up
Corresponding author: Mr Ozhasenekler Ayhan ([email protected]) to 50 mGy lead to fetal abnormalities, low IQ, growth restriction or
Key-words: pregnancy ; pulmonary embolism ; emergency miscar-riage. Less radiation is absorbed by the mother’s mammary
and pulmonary tissue with VPS than with CT.Although VPS and CT
INTRODUCTION:Pregnancy is a physiologic process in which appear to be safe for the fetus, it should be noted that some
thromboembolic complications increase. Although uncommon, studies suggest that exposure to low radiation doses in utero can
pulmonary embolism is important due to maternal mortality and increase the risk of childhood leukemia (1 in 2000 compared to the
morbidity. baseline risk of 1 in 2800), which does not compare with the risk of
CASE:A 40-year-old and 8-week pregnant female patient presented maternal death from undi-agnosed and untreated PTE (15%).
to emergency department with 5-day dyspnea and chest pain. Her CONCLUSIONS:Pulmonary thromboembolism is common in
general status was moderately stressed; she was conscious, pregnancy and is associated with significant maternal morbidity
cooperated and tachypneic. Her vital signs and systemic and mortality. It should always be considered in the presence of
examination were otherwise normal.Her ECG showed sinus suspicious symptoms and signs and confirmed by appropriate
tachycardia without ST-T changes. Her mediastinum and diagnostic exams, including VPS or CT.
cardiothoracic index on chest x-ray were of normal width,
costophrenic sinuses were patent, and no parenchymal pathology P617 ___________________________ Obstetric Emergencies
was present. Her D-Dimer was 3,24 mg/L (0-0,55). Her arterial
saturation on room air was SO2:84%. Her arterial blood gas ANALYSIS OF PREGNANT CASES ADMITTING TO THE
analysis on oxygen therapy revealed the following: Ph:7,49 EMERGENCY SERVICE
PO2:128,3 mmHg PCO2:28,3 mmHg SO2:98,8 % HCO3:22 mmol/L. A Guler (1), S Karadas (2), N Kurt (2), G Zirhlioglu (3)
Echocardiography demonstrated mild tricuspid insufficiency with
pulmonary hypertension (PAPs: 48 mmHg). Her bilateral lower 1. Obstetrics and Gynecology, Yuzuncu Yil University Medical Faculty, Van, Turkey
extremity Doppler USG was normal. With the initial diagnosis of 2. Emergency Medicine, Yuzuncu Yil University Medical Faculty, Van, Turkey
pulmonary embolism she underwent Thorax angio CT which 3. Measurement and Evaluation, Yuzuncu Yil University Education Faculty, Van, Turkey
revealed pulmonary arterial emboli bilaterally in the lower lobe Corresponding author: Melle Guler Ayse ([email protected])
and segmentary branches in the upper and middle lobe Key-words: emergency service ; pregnancy ; retrospective analysis
segmentary branches. She was admitted to chest diseases
intensive care and begun on thrombolitic therapy. Objective: In this study, investigation of pregnant cases admitted to
DISCUSSION:The most feared manifestation of venous the emergency service in terms of age, gravidity, parity,
thromboembolism (VTE) is PTE, a common entity with a mortality miscarriage, gestational age, complaint at admission, diagnosis,
of 30% if untreated, mainly due to recurrence. Oral anticoagulation treatment results and duration of hospitalisation was aimed.
(OAC) at therapeutic doses within 24 hours reduces mortality to 2- Design: Data between 01.06.2010 and 01.06.2011 was collected by
8%.In-hospital mortality is 5-17% in patients who present evidence screening the hospital registrations and emergency record book
of RV dysfunction at diagnosis and 20-30% in those with retrospectively. SPSS 15.0 package programme was used for
hemodynamic compromise. statistical analyses of the data. Kolmogorow Smirnov test was used
VTE, which includes DVT and PTE, is the leading cause of maternal to check the dispersion of variables to be compared between the
death (20%) in developed countries, accounting for 1.2-4.7 deaths groups. The level of 0.05 was considered as significant. Since the
per 100 000 pregnancies. The precise inci-dence of VTE is unknown registrations were insufficient, 141 cases were excluded from the
but is estimated at 0.5-2 cases per 1000 pregnancies. The risk is study. 1254 pregnant cases were grouped into 3 according to the
greatest in the first three weeks after birth by cesarean section,but age as group 1 (n=218); ≤20 year-old, group 2 (n=767); 21-35 year-
the risk is still high between the third and sixth week after delivery old and group 3 (n=269); ≥36 year-old. According to the gestational
and is the same as during pregnancy. From the sixth week the risk week, the cases were further divided into 4 as group 1 (n=81); ≤12
is the same as for non-pregnant women. weeks, group 2 (n=96); 13-24 weeks, group 3 (n=595); 25-36 weeks
The clinical features of VTE can be frustratingly difficult to evaluate, and group 4 (n=482); >36 weeks.
since most healthy pregnant women have lower limb edema and Results: Ages were between 14-52 years and the mean age was
up to 70% suffer from shortness of breath during found as 29,32±7,5 year-old. According to the age, the most
pregnancy.Diagnosis of VTE, and particu-larly PTE, requires a high frequently seen diagnoses were preterm labor (n=43, 19.8%) in
index of clinical suspicion, based on predisposing conditions and group 1, hypertensive disorders (preeclampsia, eclampsia, chronic
hypertension, gestational hypertension, HELLP) in group 2 (n=185

BOOK OF ABSTRACTS 348

(24.2 %) and group3 (n=102 (38.1%)). On the other hand, the least She had vaginal bleeding, abdominal tenderness and rebound on
frequently encountered diagnoses in group 1 and group 2 were pelvic and abdominal examination. There were mass in the right
systemic diseases (n=0 (0%) and n=5 (0.7 %), respectively) and in cornual region with dimensions of 33x38 mm and massive free
group 3 were truma and intoxications (n=3, 1.1%). fluid in douglas on the transvaginal ultrasonography also the
In terms of gestational week, the most frequently made diagnoses endometrial cavity was empty. The patient was operated by
were; vaginal bleeding (n=25 (31,3%)) in group 1, genitourinary laparoscopic surgery with the diagnosis of cornual ectopic
system infections (n=29 (30.5%)) and neurological disorders (n=12 pregnancy. Right cornual pregnancy was ruptured and active
(12.5%)) in group 2, hypertensive disorders (n=174 (29.3%)) in bleeding was observed during the operation. We wanted to protect
group 3 and term pregnancies with labor (n=190 (39.5%)) in group the right fallopian tube for fertility but taking into consideration
4. the patient's hemodynamic status, superficial cornual resection
Of the cases, 977 (78%) were hospitalised, 199 (15.9%) were and complete salpingectomy were performed and after that the
outpatient, 63 (5%) declined any treatment and 15 (1.1%) were bleeding was controlled.
referred to other centers for various reosons. According to the Discussion
treatment results of hospitalised cases, 321 pregnant were Conservative approach can be applied in the treatment of
delivered by cesarean, 365 were by vaginal delivery and 291 cases unruptured interstitial pregnancy. There are two important factors
were undergone medical treatment. Of the 686 cases who in the surgical treatment of this troubled type of ectopic
delivered, 25 had twin pregnancy. Dead fetuses were delivered in pregnancy. These are, the patient’s desire about fertility and do
37 births. Of these dead-fetuses, 33 were at 24-36 weeks, 4 were not damage to the uterine wall. Laparoscopic cornuostomy,
at 36-42 gestational weeks. Of the neonates, 382 were male and salpingostomy or corneal wedge resection may be tried for
292 were female babies. The mortality was found as 3/1254 (0.2%). unruptured cornual pregnancies’ treatment but cornual resection,
Conclusions: Considering all pregnant cases at emergency service in laparotomy or hysterectomy options should be kept in mind in
our hospital during 1 year, emergency admissions were found to be ruptured cornual ectopic pregnancies with active bleeding. If
the most frequent at 24-36 gestational weeks. The most frequent cornual resection is superficial, suture may not be required.
diagnosis was the normal labor at term followed by gestational However, suture should be used in deep myometrial resections.
hypertensive diseases. In accordance with literature, hypertesive The risk of uterine rupture in vaginal birth must be explained to
disorders were diagnosed mostly at 24-36. gestational weeks. A these patients when discussing the mode of delivery.
pregnant woman applying to the emergency service should always
be evaluated by an obstetrician as well following the first P619 ___________________________ Obstetric Emergencies
examination by the emergency service doctor.

P618 ____________________________Obstetric Emergencies COMPARISON OF ECTOPIC PREGNANCY TREATMENT
MODALITIES IN A TERTIARY CENTER: FIVE-YEAR
LAPAROSCOPIC TREATMENT OPTIONS OF CORNUAL EXPERIENCE
ECTOPIC PREGNANCY M Albayrak (1), I Biyik (1), A Karatas (2), F Keskin (1)
YK Akpak (1), I Gün (2), N Kaya (2), V Atay (2), U Savaşçı (3),
U Kaldırım (4) 1. Obstetrics and Gynecology, Duzce University, Duzce, Turkey
2. Obstetrics and Gynecology, Duzce University Medical Faculty, Duzce, Turkey
1. Department of Obstetrics and Gynecology, Sarıkamış Military Hospital, Kars, Turkey Corresponding author: Mr Saritas Ayhan ([email protected])
2. Department of Obstetrics and Gynecology, GATA Haydarpaşa Training Hospital, Key-words: ectopic pregnancy ; methotrexate therapy ; surgical treatment
Istanbul, Turkey
3. Department of Infectious Diseases and Clinical Microbiology, Sarıkamış Military Background: Ectopic pregnancy (EP) is the leading cause of
Hospital, Kars, Turkey maternal mortality in first trimester. It constitutes 75% and 9% of
4. Department of Emergency Medicine, Gülhane Military Medical School, Ankara, Turkey pregnancy related deaths in first and all three trimesters,
Corresponding author: Mr Akpak Yasam Kemal ([email protected]) respectively.
Key-words: Cornual ectopic pregnancy ; Laparoscopy ; Cornual resection Objectives: The aim of this study was to review and analyze the
outcomes of various treatment modalities and predictors of
Introduction success in women with EP with a special focus on un-ruptured
Ectopic pregnancy is a serious morbidity alone. We should be kept tubal pregnancies treated in our clinic.
the clinical diagnosis in mind in the diagnosis of women presenting Methods: 124 women diagnosed with EP were included into the
to the emergency department with vaginal bleeding. Cornual or study. 7 were excluded because of the incomplete records, and 11
interstitial ectopic is a pregnancy that implants in the intrauterine were excluded because an aborting intrauterine pregnancy could
part of fallopian tube. It makes this disease more rare but the most not be excluded. Remaining 106 were found eligible for inclusion
dangerous type. The incidence of cornual ectopic pregnancies is 1- into analysis. All the cases were subdivided into three groups as
2 % of all ectopic pregnancies. Cornual ectopic pregnancies can management: expectant (group I); medical with methotrexate
cause excessive bleeding with sudden rupture of the cornua, which (group II) and surgical (group III). Demographic characteristics were
is a vascular portion of the fallopian tube. Until recently, cornual analyzed and success rates between groups were compared.
ectopic pregnancies has been treated by laparotomy with Results: Group I, II and III consisted of 21, 46 and 39 women,
hysterectomy. We wanted to emphasize the laparoscopic respectively. Mean age of women was 30.5±5.3 years and mean
treatment options of cornual ectopic pregnancy with this case. gestational age was 42.3±18.8 days. β-hCG levels were significantly
Case Report higher in group III than group I and group II with a level of 2337
The patient was admitted to emergency department with pelvic mIU/mL (range, 287-9803), 713 mIU/mL (range, 67-2449) and 1017
pain and vaginal bleeding over the last one day. She was 29-year- mIU/mL (range, 124 - 9328), respectively (P for group I vs. III
old and her last menstrual period was passed 17 days. The patient <0.001, P for group II vs. III = 0.004). Mean time to resolution of β-
had no previous pregnancy. The patient's general condition was hCG in expectant, medical and surgery groups were 20 (11 - 60),
variable, she had a state of hypotension and her pulse was weak. 27.5 (12 - 49), and 20 (10 - 47) days, respectively with a significance

BOOK OF ABSTRACTS 349

only between medical and surgery groups. Surgery was more failure, icterus and disseminated intravascular coagulopathy (due
successful than expectant and medical managements (97% vs. to commelina madagascariensis herb »). The average hemoglobin
66.7%, and 97% vs. 81.6%). level on admission (HemoCue®) was 7.1±1.5 g/dl, and transfusion
Conclusion: According to this study, the highest success rates was required in 70% of the patients.
observed with surgical treatment. But, based on this study, The invasive mechanical abortive methods were frequently used
expectant and medical treatment may eliminate the need for for the terms ≥ 12 WA (60%, p<0.0001), or when the date of last
surgery for the treatment of EP especially in women who wish to menstrual period was unknown (50%). They were suppliers of
preserve their fertility. infectious complications. For documented cases, the most frequent
microbial agent germ found was staphylococcus aureus (85%),
P620 ____________________________Obstetric Emergencies isolated or in association with anaerobic or gram negative germs.
These invasive acts are responsible for high risk infections:
LIFE-THREATENING COMPLICATIONS OF CLANDESTINE pelviperitonitis (54%), endometritis (45%) and uterus perforation
VOLUNTARY INDUCED ABORTION DEPEND ON ABORTIVE (1%). Empiric antibiotics with broad spectrum were used in 82% of
METHOD infectious cases. The rate of death from all-causes was 3.4%, i.e.
T RASOLONJATOVO (1), P JABRE (2), B VIVIEN (3), B 9.6% of all maternal deaths during the same period.
RAKOTOAMBININA (4) Conclusion:
This study highlights the occult aspect and the life threatening
1. Anesthesiology and Emergency Gynecological Obstetric Unit, Antananarivo Universitary complications due to clandestine voluntary induced abortion. The
Hospital, Madagascar, Madagascar method chosen to terminate pregnancy mainly depend on the
2. SAMU de Paris, Anesthesiology and Intensive Care Department, Necker-Enfants stage of pregnancy. An algorithm for suspected VIA management
Malades Hospital and Paris Descartes University, Paris, France must focus on the epidemio-clinical profile of these women and
3. Necker-Enfants Malades Hospital and Paris Descartes University, SAMU de Paris, the relevant use of broad spectrum antibiotics. Recommendations
Anesthesiology and Intensive Care Department, Paris, France against the dangerousness of both drug-induced and invasive
4. Physiology Research Unit, Collaboration Necker-Enfants Malades, Antananarivo mechanical abortive methods must be diffused. Finally, this study
University Hospital, Paris, France strengthens the need for the contraceptive education towards the
Corresponding author: Mr Vivien Benoît ([email protected]) target public and stakeholders of underground business of VIA.
Key-words: Clandestine voluntary induced abortion ; Life-threatening complications ;
Abortive technique P621 ___________________________ Obstetric Emergencies

Introduction: EVALUATION OF MATERNAL-FETAL MORBIDITY AND
While the liberalization of abortion laws is widespread in MORTALITY IN HYPERTENSIVE PREGNANCIES
developed countries, the voluntary induced abortion (VIA) remains A Karatas (1), Z Karatas (2), T Sener (3), HM Tanir (3)
illegal in most Third World countries such as in Madagascar and
subsequently generates an underground practice. It is an actual 1. Obstetrics and Gynecology, Duzce University Medical Faculty, Duzce, Turkey
societal phenomenon with dramatic medical complications, 2. Pediatrics department, Konya University Meram Medical Faculty, Konya, Turkey
validating unsafe abortion concept (WHO). There are scarce 3. Obstetrics&Gynecology department, Eskisehir Osmangazi University, Eskisehir, Turkey
malagasy data enabling the appraisal of problem magnitude. This Corresponding author: Mr Saritas Ayhan ([email protected])
study aims at establishing both epidemiological and clinical profile Key-words: Preeclampsia ; eclampsia ; maternal-fetal mortality and morbidity
of women admitted in gynecological emergency unit after
clandestine voluntary induced abortion. Background: Hypertension is the most common systemic disease
Methods: during pregnancy. Morbidity and mortality increase in both mother
This is a retrospective study from January 2007 until December and infant when preeclampsia and eclampsia have been
2008 of admitted women for termination of pregnancy in a developed.
referred gynecological and obstetric ICU in a university-affiliated Aims: Evaluation of maternal-fetal morbidity and mortality in
hospital of the capital of Madagascar. We excluded medical hypertensive pregnancies.
interruption of pregnancy, molar abortion and declared Methods: Three hundred and fifty four of 595 patients and babies
spontaneous abortion. The analyzed parameters were: age, parity, of these mothers whose data of clinical records and files were
weeks of amenorrhea (WA), socioeconomic level, abortive available at last ten years in a tertiary center hospital were
methods, microbial agents, and outcome at hospitalization included in the study.
discharge. Results: Among all hypertensive pregnancies 66% were not
Results: followed up regularly during pregnancy. The prevalence of
Among 22994 admissions, 419 cases of admitted termination of hypertension, gestational hypertension, chronic hypertension,
pregnancy were recorded. The average frequency per year was severe preeclampsia, eclampsia and HELLP were 7%, 2.8%, 5%,
18.2±0.2‰. The first emergency signs were: vaginal bleeding, 1.9%, 0.47%, and 0.64%, respectively during pregnancy. Dialysis
common genital infection, sub-occlusion and states of shock. The was required for 4 mothers (1.1%) and seven (2%) were applied
candidates to VIA were young women 20-30 years old, with a ventilatory support at postpartum period. A total of 11 maternal
stable partner (p<0.0001), mostly primiparous (p=0.012), with an deaths (0.31%) were detected. There were 234 preterm and 120
income reaching 100% of the minimum wage salary (p<0.0001). term labor, and a total 124 infant deaths, of them 23 were in the
The rates of hemorrhagic and infectious complications were antenatal period. 197 babies were delivered by caesarean, while
respectively 61% and 39%. 157 babies were vaginally. The mortality rates in caesarean and
The drug-induced abortive methods (including herb decoction) vaginal deliveries were 24.3%(48/197) and 48.4%(76/157),
were frequently used for the terms < 12WA (40%, p<0.0001). They respectively. Newborns with 1. minute APGAR score ≥4 and 5.
led to hemorrhages, which came as 4 clinical profiles: intermittent minute APGAR score ≥8 had significantly higher umbilical artery
vaginal bleeding, excessive genital bleeding, placental retention
hemorrhage with shock, non-specific hemorrhages with renal

BOOK OF ABSTRACTS 350

and vein blood pH than the newborns with lower APGAR score P623 _________________________________ Orthopedics
(p<0.001).
Conclusions: This retrospective study showed that hypertensive WHAT PLACE FOR SEDATION IN THE TREATMENT OF
pregnancies predict an important risk for preterm delivery. Also it SHOULDER DISLOCATION IN EMERGENCY DEPARTMENT?
has an important role in determining perinatal morbidity and V. Wauters (1), A. Higuet (2), C. Mélot (1)
mortality. Currently, the only successful treatment is still early
diagnosis and delivery. 1. Emergency department, Hôpital Erasme, Brussel, Belgium
2. Emergency department, AZ Sint-Maria, Halle, Halle, Belgium
P622 ____________________________Obstetric Emergencies Corresponding author: Mr Higuet Adeline ([email protected])
Key-words: shoulder dislocation ; pain ; emergency
PREDICTORS OF THE NEED OF MASSIVE TRANSFUSION IN
PATIENTS WITH POSTPARTUM HEMORRHAGE PRESENTED Introduction: It should no longer be permitted to suffer pain a long
TO THE EMERGENCY DEPARTMENT time in an emergency department. Dislocated shoulder is one of
HJ Kim, WY Kim, BJ Oh, DW Seo, CH Sohn these painful diseases. What scope is there for sedation-analgesia?
Materials and methods: This represents a bi-centric retrospective
Emergency Department, Asan Medical Center, Seoul, Korea, (South) Republic of observational study. We compared the treatment of dislocated
Corresponding author: Mr Sohn Chang Hwan ([email protected]) shoulders in two university hospitals. The criteria used were: age,
Key-words: postpartum hemorrhage ; massive transfusion ; emergency department sex, traumatic cause, duration of the treatment, administration of
analgesics, administration of sedatives and the speciality of the
Background: doctor involved.
Postpartum hemorrhage (PPH) is a major cause of maternal Results: The number of patients was 28 for hospital A and 77 for
mortality and morbidity worldwide. Early and aggressive use of hospital B. The study population was homogeneous and consisted
massive transfusion (MT) patients with postpartum hemorrhage respectively of 64,3% men for hospital A and 65% men for hospital
may restore effective intravascular volume, correct coagulopathy, B. Women were older and a traumatic cause was associated with
and improves outcomes. them in 100% of the cases. The reduction of shoulder dislocation
However, early identification of patients who require MT has been was very successful: there were minor complications in only 10,7%
difficult and there is no research related to this topic. of the cases. The administration of Propofol occurred in 35% of the
The aim of this study was to determine which variables, available cases treated in hospital A compared to 75% in hospital B. Transit
early after postpartum hemorrhage, especially in the emergency time was 368 minutes in the former hospital against 298 minutes in
department, are associated with the need of MT. the latter hospital.
Methods: Discussion: The study population was the same in both groups. The
This was a retrospective cohort study on patients with postpartum painkillers were administered in all cases without accurate
hemorrhage presented to the ED of a tertiary care university- information about the doses. We noted a wide disparity in the
affiliated hospital in Korea from January 1, 2004 to May 31, 2012. administration of Propofol between the two hospitals.
Patients who required MT (defined as the transfusion of 10 units or Conclusion: Based on a multivariate linear regression analysis of
more of packed red blood cells) were compared with patients who data, it may be concluded that, in addition to decreasing age,
did not. Demographic, clinical, and laboratory variables obtained Propofol reduces the time spent in the emergency room by 70
upon presentation were evaluated. Univariate and multivariate minutes in average.
analyses were performed. Perspectives: This study could translate into the establishment of a
Results: more uniform protocol of care to be agreed upon in agreement
A total of 238 patients were included in this study. Of these with the anaesthesia society.
patients, 101 patients received MT. Patients with required MT Such protocol could allow for the administration of Propofol by the
showed lower systolic pressure (p=0.000), diastolic pressure emergency physician in the acute treatment of shoulder dislocation
(p=0.003), hemoglobin (p=0.003), hematocrit (p=0.004) and higher for a better comfort for the patient.
pulse rate (p=0.000), PT INR (P=0.000), lactate values (p=0.000), as
compared to those who did not require MT. We established a P624 _________________________________ Orthopedics
statistically significant association between PT INR > 1.2 (OR=5.46,
95% CI 2.70-11.0, p=0.000)), platelets < 138,000/mm3 (OR=3.59, A SURVEY INVESTIGATION OF THE FREQUENCY OF EATING
95% CI 1.82-7.06, p=0.000) , pulse rate > 108 bpm (OR=2.73, 95% CI FAST FOOD AND ORTHOPEDIC HEALTH
1.39-5.35, p=0.003) and the requirement of massive transfusion. P Hurd (1), L Myers (2), L Moreno-Walton (3)
Conclusion:
Our study showed that PT INR > 1.2, platelets < 138,000/mm3, 1. medical student, Louisiana State University Health Sciences Center, New Orleans,
pulse rate > 108 bpm were the three parameters that United States
demonstrated the highest association with the requirement of 2. Biostatistics, Tulane University School of Public Health & Tropical Medicine, New
massive transfusion in patients with postpartum hemorrhage Orleans, United States
presented to the emergency department. 3. Emergency Medicine & Research Genetics, Louisiana State University Health Sciences
Center, New Orleans, United States
Corresponding author: Mme Moreno-walton Lisa ([email protected])
Key-words: orthopedics ; injury ; diet

BOOK OF ABSTRACTS 351

BACKGROUND: Campaigns to increase awareness about the health preparatory factors its frequency increases. The mortality rate of
risks of obesity have resulted in Americans becoming more aware the disease is high. (% 6-76).
of healthy eating habits. Despite this, rates of obesity continue to CASE
rise. Presently, obesity is one of the most prevalent diseases in our A 22 years old female patient applied to our emergency center
society, affecting over 30% of the US population. Fast food is with pain and swelling complaint on the left elbow. She said serum
recognized as a major contributory factor in both childhood and was applied to her left arm the day before in the same center. As
adult obesity. Obesity has been documented to have an increased the pain was intense and no pathology could be observed in the x-
correlation with orthopedic injury and saturated fat intake with a ray film, Ultrasound was applied to the patient. Thickening and
higher risk of bone loss and osteoporotic fractures. No literature edema was observed in the subcutaneous soft tissues around the
exists which establishes the relationship between frequency of elbow and fluid increase was observed in the elbow joint. The
eating at fast food restaurants (FFR) and the frequency of patient was laid after the soft tissue infection diagnosis of the
orthopedic injuries. orthopedist and treatment was initiated with sefazolin sodyum
OBJECTIVE: To test the correlation between the frequencies with 1000 mg İ.V 3x1,gentamisin sülfat 160 mg İ.V. Due to increase in
which subjects eat at fast food restaurants (EaFFR) and the number patient pain and lab values becoming worse, emergency surgery
of orthopedic injuries (OI) that they sustain. was applied to her after 24 hours. During surgery, necrosis was
METHODS: This is a self-reported survey study of a convenience present in subcutaneous tissues and fascias and bad smell was felt.
sample of 100 subjects recruited in the Emergency Department After application of wide debridman the wound was left open and
waiting area of an urban teaching hospital during day, night and due to opinion of infectious diseases department, Clindamisin hcl
weekend shifts. Body mass index (BMI) was calculated for each. 3x600 mg Penicillin 3x6000000 units and Amikacin sülfat 1X1gr
The survey included questions about orthopedic injuries over the treatment was applied parenterally. As convalescence was
previous 5 years, stratifying by injury type and surgical v. non- observed clinically and according to lab results, the wound was
surgical intervention, as well as questions about the favorite meal closed with graft at the end of 14.day.
at their favorite FFR, for which the nutritional information was DISCUSSION
calculated. Tabulated values were assessed using chi-square test. The most determining clinical finding for necrotizing fasciitis is
Relationships between variables were analyzed using Spearman intense pain and sensitivity which is not in accordance with the
correlation coefficients. physical appearance of the lesion. Necrotizing fasciitis diagnosis
RESULTS: The average BMI was 29.4 (SD= 6.62). Average number should be made depending on clinical findings and anamnesis.
of orthopedic injuries was 1.06 (SD = 2.11). The rho value of the Tang and friends, emphasized that accurate and correct diagnosis
relationship between the number of times subjects EaFFR and OI will be mad clinically and no method cen be replaced with carefully
was 0.25 (p-value = 0.0138). EaFFR and the number of fractures made physical examination. In lab studies, a significant leucocytosis
sustained was not statistically significant, but there was significant and bending to left, creatinin kynasis, erythrocyte sedimentation
correlation between EaFFR and the number of sprains, strains, speed and C-reactive protein increase is observed. In these
and/or ligamentous injuries sustained (rho = 0.30 and p = 0.0024). subjects, the basis of the cure is early diagnosis, wide spectrum
The relationship between EaFFR and OI was not impacted by age. antibiotic treatment, debridement that can reach to healthy tissues
(Age adjusted correlation= 0.275; p = 0.006). Older subjects were and leave no necrotic tissues behind, maintaining the liquid-
less likely to EaFFR than were younger subjects (p = 0.0006). electrolyte balance, oxygenization of the infected area and
CONCLUSION: There is a positive correlation between EaFFR and sufficient nutritional support and analgesia.
OI independent of the known correlation between obesity and OI.
Younger subjects EaFFR more often than older subjects. These P626 _________________________________ Orthopedics
findings may indicate that today’s young people will have more
orthopedic injuries than their counterparts in earlier generations TAKING OUT THE RING STUCK ON THE FINGER BY A
due to a life time of EaFFR. MOTOR WITH HIGH RPM
MF Ceylan (1), S Güner (1), R Dursun (2), H Taşkınöz (1), G
P625 _________________________________ Orthopedics Görmeli (3)

NECROTISING FASCIITIS AFTER INTRAVENOUS INFUSION: A 1. ortopedy department, Yüzüncü Yıl University, van, Turkey
RARE CASE 2. emergency department, Van Region Training and Research Hospital, van, Turkey
R Dursun (1), CC Turan (2), MF Ceylan (3), S Karadas (4), S 3. ortopedy department, Van Region Training and Research Hospital, Van, Turkey
Güner (3) Corresponding author: Mr Dursun Recep ([email protected])
Key-words: high rpm motor ; ring pressure ; emergency service
1. emergency department, Van Region Training and Research Hospital, van, Turkey
2. ortopedy department, Private Gözde Kışla Hospital, malatya, Turkey PURPOSE
3. ortopedy department, Yüzüncü Yıl University, van, Turkey A subject where a ring which is stuck in the finger and caused
4. emergency department, Yüzüncü Yıl University, van, Turkey edema and infection is removed with unusual method.
Corresponding author: Mr Dursun Recep ([email protected]) METHODS
Key-words: necrotising fasciitis ; intravenous infusion ; emergency surgery A 17 years old lady applied to emergency service with complaint of
swelling and pain in her finger due to a ring which was stuck. When
INTRODUCTİON the patient clinic was evaluated the ring in her 4th finger in her
Necrotizing fasciitis is a life threatening infection which is right hand was extremely stuck. The ring was produced from a hard
characterized by the advancing necrosis of skin, subcutaneous alloy and with a shape of double circle and also it was thicker and
tissues and fascias. The first description of the disease was made wider than the regular rings. Wire cutter, pliers, gigli saw and ring
by Wilson who observed that skin necrosis do not always occur but cutter tool in emergency service was used before but they could
fascias necrosis always occurs. It is found rare in childhood age. It not cut the ring. The finger of the patient was too stretched and
can be observed in healthy individuals too but in case of there was a risk for compartment syndrome development. The ring

BOOK OF ABSTRACTS 352

was removed by cutting in 10 minutes by using high rpm motor reduction as most trials excluded high risk patients from
with no. 40 diamond end that we use in spinal surgery. The pain randomization11. The authors advise administration of LMWH
and swelling got better after the ring was removed. Oral treatment during the entire period of immobilization of the lower extremity.
was applied to the patient with Cefazolin 3*1 gr and after 3 days of According to a meta-analysis by Ettema et al12 the mean VTE rate
follow up the infection in the hand of patient was cured. dropped from 17.1% to 9.6% with the use of LMWH, without a
RESULTS significant increase in bleeding. PE was a rare event. Most DVTs in
High rpm motors can be used for cutting hard rings. the studies were asymptomatic and located in the distal veins. Of
DISCUSSION the non-operated patients, 17 patients developed DVT in the
When hard rings cause edema and infection in the finger, it may LMWH group versus 44 patients in the control group4. The number
not be removed with traditional tools. In such cases high rpm needed to treat is 14; hence 14 patients require prophylaxis to
motors are effective. prevent one event of asymptomatic DVT. The relative risk (RR) of
asymptomatic DVT in below-knee immobilization is 0.66 (95%CI
P627 _________________________________ Orthopedics 0.44-1.02)13.
The American College of Chest Physicians (ACCP) analyzed an
THROMBOPROPHYLAXIS FOR AMBULATORY PATIENTS additional multicenter study by Selby et al14 and performed a
WITH LOWER LEG INJURIES. meta-analysis15. The results of this analysis failed to demonstrate
M Hageman or exclude a beneficial effect of LMWH on symptomatic DVT (RR
0.34; 95%CI 0.09-1.28). In a recently published guideline, the ACCP
Emergency department, Isala Klinieken, Zwolle, Netherlands advise against routine prophylaxis for patients with injuries of a
Corresponding author: Melle Hageman Mariëlle ([email protected]) lower limb.
Key-words: venous thromboembolism ; prophylaxis ; lower leg injury In 2009 Goel et al16 published a RCT which compared the use of
LMWH in patients who had sustained an isolated fracture below
Background the knee which required surgery, with controls. There was no
Lower leg trauma is a frequent pathology in the emergency statistically significant difference in the incidence of DVT between
department of every hospital. Many of these injuries do not those patients treated with LMWH or the placebo (p=0.22). The
require surgery and these patients are treated as outpatients with overall incidence of DVT in this series was 11% and all patients with
a plaster cast. a DVT were asymptomatic and did not require medical
Immobilization of the lower leg is a significant risk factor for the management. However, due to a cessation of funding, recruitment
development of venous thromboembolism (VTE)1. The use of to this trial had to be ended prior to establishing the necessary
pharmacological thromboprophylaxis for patients with lower leg sample size.
immobilization in plaster casts is still controversial. There is Discussion
substantial practice variation amongst physicians regarding the use There was considerable variation in the pathology, management,
of anticoagulation measures1,2. screening method and type of prophylaxis among studies. There is
Objectives an obvious risk that the use of heterogeneous patient populations
The aim of this study was to find an evidence-based answer to our will affect the risk of DVT and therefore also the outcome about
clinical question following the PICO principle. Is the efficacy of thromboprophylaxis. There is still no world-wide
thromboprophylaxis necessary for ambulatory patients with lower consensus in guidelines regarding the use of thromboprophylaxis.
leg injuries immobilized in plaster cast? The clinical and cost effectiveness of pharmacological prophylaxis
Patient Adult outpatients with lower leg injuries immobilized in for reducing the risk of VTE in patients with lower limb plaster casts
plaster casts remains to be shown. A further multicenter trial is recommended
Intervention Thromboprophylaxis to resolve this matter.
Control No thromboprophylaxis or placebo
Outcome VTE P628 _________________________________ Orthopedics
Methods
Pubmed, National guideline clearinghouse, TRIP database and the AN UNUSUAL CAUSE OF FACTITOUS ARTHRITIS
Cochrane library were searched for national and international A Aygun (1), O Gonenc Cekic (1), Y Karaca (2), O Tatlı (3), S
guidelines and trials on prevention of VTE. The following search Turkmen (4)
terms were used: deep vein thrombosis, venous
thromboembolism, antithrombotic therapy, thromboprophylaxis, 1. Emergency department, Karadeniz Technical University, Trabzon, Turkey
prevention, low molecular weight heparin (LMWH), plaster-cast, 2. emergency department, Kanuni State Hospital, Trabzon, Turkey
immobilization, lower limb, lower extremity, lower leg. Within the 3. Emergency department, Kanuni State Hospital, Trabzon, Turkey
identified studies a cross-reference check was performed. 4. Emergency Department, Karadeniz Technical University, Trabzon, Turkey
Results Corresponding author: Mme Gönenç Çekiç Özgen ([email protected])
Meek et al3 retrospectively determined the incidence of Key-words: Clinical toxicology ; Inflammation ; Natural toxins
symptomatic VTE in adult patients who were discharged from the
ED with rigid immobilization for lower limb injury. The estimated Septic arthritis and toxic synovitis are clinical conditions that can
incidence of VTE was 4.3%. Increasing age and a diagnosis of develop in association with various causes and involve symptoms
Achilles tendon rupture (ATR) appeared to increase the risk of VTE. such as pain,swelling, redness, sensitivity and restricted movement
A Cochrane systematic review4 analyzed data from six randomized in the joint. A 42-year-old male presented to the emergency
controlled trials5-10 involving approximately 1500 patients who department with severe joint pain and nausea after injecting a 1 cc
required lower leg immobilization for at least one week and mixture of turpentine oil, eucalyptus oil, mint oil and thyme oil he
compared LMWH with controls and showed a significant reduction purchased from an alternative medicine store into his right knee
in VTE. This is likely to be an underestimate of the real risk with a syringe because of chronic knee pain. Ballottement and
sensitivity were present at physical examination. Knee puncture

BOOK OF ABSTRACTS 353

yielded 60 cc of cloudy fluid. There was no growth in the material increase length of the motion and then contuining with
obtained. Improvement was observed following subsequent movements to increase strength of muscles around shoulder.
arthroscopic washing of the joint space and IV antibiotherapy, and There was no decrease in length of motion and muscular strength
the patient was discharged on day 21 of hospitalization with oral during 1-year follow-up and stability of each shoulder was normal.
antibiotic and analgesic therapy. Intra-articular injection of foreign Additionally, the patient was followed by psychiatry and prescribed
bodies into the knee joint space for therapeutic purposes,is a very benzodiazepins and since then he had no any new attacks.
rare occurrence, but may lead to potentially complicated arthritis. Discussion
The shoulder joint is the most unstable joint in the body and is
P629 _________________________________ Orthopedics easily dislocated. Anterior shoulder dislocation is the most
common major joint dislocation encountered in the emergency
SIMULTANEOUS BILATERAL ANTERIOR SHOULDER department. Its injury mechanism is forced extension, abduction,
DISLOCATION OCCURRED AFTER SLEEPWALKING and external rotation. Anterior dislocation of the shoulder may
F Yılmaz, A Solakoglu,M Ozlem, A Demir, C Kavalci,M occur in a violent contraction of the shoulder muscles or a direct
Sonmez,ED Arslan blow to the posterior aspect of the shoulder. Because of the
position naturally adopted by the upper extremity during a fall,
Emergency department, Numune Training and Research Hospital, Ankara, Turkey unilateral anterior dislocation of the shoulder is common. Bilateral
Corresponding author: Mr Yilmaz Fevzi ([email protected]) glenohumeral dislocations are rare and almost always posterior.
Key-words: Bilateral shoulder dislocation ; bilateral anterior dislocation ; sleepwalking However, simultaneous bilateral anterior shoulder dislocation is
rare: only about 30 cases have been described in the literature. A
Abstract review of the literature revealed about 30 reports of bilateral
Bilateral shoulder dislocation is a rare entity and almost always anterior shoulder dislocations, 15 of which were of fracture-
occur in the posterior direction. Simultaneous bilateral anterior dislocation. Most were due to violent trauma or electrocution; the
shoulder dislocation is seen much less frequently and only a few remaining few were attributed to epileptic or hypoglycemic
cases are stated in the literature. This article reports bilateral seizures. Sports injuries, seizures, electrical shock,
simultaneous anterior shoulder dislocation occurred after electroconvulsive therapy, drug overdose, neuromuscular
sleepwalking. disorders, and psychiatric disturbances have been implicated.
Introduction Conclusion
Although anterior shoulder dislocation is the most common major All orthopedic surgeons and emergency physicians should be aware
joint dislocation encountered in the emergency department, of such unusual possibilities to have an early diagnosis and
bilateral glenohumeral dislocations are rare and almost always treatment. An early reduction and appropriate rehabilitation can
posterior. Such dislocations are usually caused by sports injuries, provide satisfactory functional outcome
seizures, electrical shock, or electroconvulsive therapy. However,
simultaneous bilateral anterior shoulder dislocation is very rare: P630 _________________________________ Orthopedics
only about 30 cases have been described in the literature. This
article reports that bilateral simultaneous anterior shoulder COUGH–SNEEZE INDUCED CLAVICLE FRACTURE IN
dislocation occurred after sleepwalking. To the best of our OSTEOPOROTIC PATIENT
knowledge, this is the first case report of such condition. H. Hocagil, ÖF. Aydın, Ö. Güneysel
Case report
A 17-years-old male presented to our emergency department with Emergency Department, Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Türkiye
a complaint of bilateral shoulder pain and motion restriction. His Corresponding author: Mme Hilal Hocagil ([email protected])
past medical history was unremarkable for epilepsy or major Key-words: Cough-sneeze ; Clavicle fractures ; Osteoporosis
trauma. His family members said that he was a sleepwalker since
he was 5 or 6 years old and sometimes he was going to another Introduction: Osteoporosis is a condition characterized by a
place from his bed and when they saw him there were abrasions decrease in the density of bone, decreasing its strength and
especially on his face and extremities. It was learned that he left resulting in fragile bones. This disorder of the skeleton weakens the
the drugs given by the doctors for his complaint after using a short bone and results in frequent fractures in the bones. The spine, hips,
time. ribs, and wrists are common areas of bone fractures from
On his physical examination in the emergency department he osteoporosis although osteoporosis-related fractures can occur
appeared to be good, he was concious, cooperative and oriented almost in any skeletal bone. Clavicle fractures are not common
to person, time and place. His vital signs and neurological fracture site, either in osteoporosis or in osteopenia.
examination were normal. His extremity examination revealed that In this case, we present a case of uncommon cough–sneeze
his arms were slightly in abduction and external rotation. There induced clavicle fracture in osteoporotic patient.
was epaulet sign bilateral on his shoulders and his peripheral Case report: A 72 year old woman presented to our emergency
neurological examination was otherwise normal. The radiological department with sudden pain in the left shoulder after coughing-
evaluation revealed bilateral subchorocoidal anterior dislocation sneezing. There was no history of any thoracic or shoulder trauma.
without signs of fracture. After sedation closed reduction with Past medical history revealed osteoporosis but she had not any
Kocher manevuer was performed initially and then evaluated treatment for osteoporosis. Vital signs were as follows; blood
radiologically. After reduction, forward flexion and abduction of pressure 135/85 mmHg, heart rate 98/minute, respiratory rate
each shoulder were over 75 degrees and immobilization with 14/minute, oxygen saturation 95 % at room air. On physical
Valpeau bandage was applied bilaterally for 3 weeks. The bandage evaluation, she had seriously tenderness over her left clavicle other
was removed after immobilization period and the patient was physical examination was completely normal. Because of initial
taken into 6-week exercise programme in control of physical diagnosis of cough- sneeze induced fracture of bone in
therapy unite beginning with pendulum like movements to

BOOK OF ABSTRACTS 354

osteoporotic patient may be misdiagnosed in X ray, chest in structural failure of the shaft over a long area, with extreme
computed tomography imaging was performed. fracture combination. The hip abduction cannot occur; associated
CT demonstrated left clavicle fracture. Medical treatment and acetabular or femoral neck fracture may also be sustained. The
bandage applied; and she was discharged with no complication. impact area is the knee region. CONCLUSION: Prevention of this
Discussion: The most frequent and best documented complications injury requires safety engineering of automobiles and highways.
of cough- sneeze are rib fractures. Rib fractures are caused by Proper construction of the instrument panel and the installation of
opposing muscular forces in the middle of the rib at the axillary line seat belts to allow controlled deceleration on impact are both
from the serratus anterior and external oblique muscles. Other feasible and economical. The wearing of seat belts will specifically
cough - sneeze induced rib fractures are caused by a complex prevent dashboard injury to the femur, knee, and hip.
interplay between inspiratory and exspiratory muscles. But there is
not cough-sneeze induced clavicle fracture in the literature. P632 _________________________________ Orthopedics
Probable reason for cough-sneeze induced clavicle fractures are
sudden pull out the clavicle via sternocleidomastoid muscle due BILATERAL ANTERIOR SHOULDER DISLOCATION DUE TO
to a sudden increase in intratoracic pressure and osteoporosis SEIZURE
facilitated the fracture. Pathological fractures of clavicle may be SEIZURE,BILATERAL,SHOULDER
encountered secondary to malignancy, osteoporosis due to older S GÖKHAN (1), M TAS (1), M GEM (2), C YAYLALI (1)
age, renal failure, pregnancy, chronic steroid use and radiation
therapy. Its worth of interest that isolated clavicle fracture due to 1. Emergency Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
cough-sneeze without rib fractures. 2. Orthopedy and Traumatology, Dicle University, Diyarbakır, Turkey
Cough-sneeze induced clavicle fractures are rare complications Corresponding author: Mr Gökhan Servan ([email protected])
nonetheless pathological clavicle fractures should be kept in mind Key-words: seizure ; bilateral ; shoulder
in patients with osteoporosis.
INTRODUCTION: Unilateral shoulder dislocations are the
P631 _________________________________ Orthopedics commonest dislocations in emergency rooms whereas bilateral
shoulder dislocations are very rare. Bilateral shoulder dislocations
A CASE WITH DASHBOARD FEMORAL FRACTURE are typically posterior while bilateral anterior shoulder dislocations
N ERDEM (1), M ERGIN (2), H GUVEN (3), B have been quite rarely reported. Anterior shoulder dislocations
KARAHASANOGLU (4) most frequenlty develop by falling on the palms with hands open
and elbows unflexed. Forces creating bilateral dislocation should
1. EMERGENCY DEPARTMENT, GUMUSHANE STATE HOSPITAL, GUMUSHANE, Turkey be simultaneously effective in both joints. We report in this paper a
2. EMERGENCY DEPARTMENT, NECMETTIN ERBAKAN UNIVERSITY HOSPITAL, KONYA, case presenting to our emergency clinic with bilateral anterior
Turkey shoulder dislocation following generalized tonic clonic seizure
3. RADIOLOGY, GUMUSHANE STATE HOSPITAL, GUMUSHANE, Turkey Case: A 56-year-old female patient who had been on epilepsy
4. INFECTIOUS DISEASE, GUMUSHANE STATE HOSPITAL, GUMUSHANE, Turkey therapy for 7 years had a history of unilateral anterior shoulder
Corresponding author: Mme Erdem Nalan ([email protected]) dislocation following a seizure. She presented to our emergency
Key-words: femur shaft fracture ; seat belt ; dashboard injury clinic with pain and movement limitation in both shoulders
following generalized tonic clonic seizure. On arrival, she had pain
INTRODUCTION: The dashboard femoral fracture is characteristic with palpation. Both arms were in abduction and internal rotation
and cannot easily be confused with the other types of femoral- position. Shoulders were depressed internally and there was a
shaft fractures. We are presenting a motor vehicle victim with typical depression below acromion. There was no neural, vascular
bilateral open-femoral shaft fracture. CASE: AC, 24, M, was injury or any other pathology. X-Ray revealed bilateral anterior
admitted to ED due to motor vehicle accident. During first shoulder dislocation without any accompanying fracture. Both
evaluation, he had hypotension and tachycardia. Physical exam shoulders were reduced with the method of external rotation
showed that Glasgow Coma Scale with 15; laceration of the left under sedation ( 0,05 mg/kg intravenous midazolam).
eyelid but no loss vision, the fourth and fifth rib fracture on the left DISCUSSION: Shoulder dislocations are associated with direct or
but there weren’t any pneumothorax, hemothorax nor lung indirect traumas to these regions. Shoulder dislocations are
contusion. He had bilateral opened-femur shaft fracture. The classified in 4 main groups as anterior, posterior, superior, and
abdominal computed tomography demonstrated bleeding in the inferior. Anterior dislocations forms 85% of all traumatic shoulder
upper pole of the right kidney, which was limited to the capsule dislocations. Bilateral dislocations are frequently caused by
and did not require any surgical intervention. After femoral convulsions, diving, and falls. Bilateral shoulder dislocations are
traction was performed at ED, he was admitted to orthopedic caused by trauma of both extremities of the same instant,
department. DISCUSSION: The femoral-shaft fracture is peculiar to intensity, and mode of occurence. Thus, anterior shoulder
the driver or front-seat automobile passenger traveling in high dislocations are rare. The mechanism of development is
speeds. In the usual sitting posture, the femoral shaft is parallel to overextension of resting of humerus and tuberculum majus against
the major line of force, with the patella and upper portion of the acromion because of abduction and external rotation. Such
tibia facing the dashboard. During a head-on collision with its dislocations can be reduced at emergency service with the method
resultant rapid deceleration, the front-seat occupants continue of external rotation under sedation, as in our case.
directly forward and the knee region strikes the instrument panel As a conclusion, we aimed to draw attention to the necessity of
or floorboard. A passenger with his knee two inches from the remembering that, although rare, shoulder dislocations may be
impact object, none was wearing a seat belt, decelerating totally bilateral and importance of suspicion from the diagnosis and
from sixty mile per hour, may have a force of fifty tons or more radiologic examination in patients presenting with bilateral
applied to the longitudinal axis of the femoral shaft. Basically, shoulder pain after convulsion.
therefore, this fracture results from instantaneous longitudinal
compression of the femoral shaft by extraordinary force, resulting

BOOK OF ABSTRACTS 355

P633 _________________________________ Orthopedics pseudoarthrosis and elbow arthroplasty. Because of this reason;
such injuries must be kept in the mind as high morbidity.

AN UNUSUAL CAUSE OF POST OPERATIVE PROLONGED P635 _________________________________ Orthopedics
BLEEDING AFTER TOTAL KNEE ARTHROPLASTY: MULTIPLE
MYELOMA; A CASE REPORT POLYMEDICATION RELATIONSHIP AND OTHER FACTORS
S Inal (1), F Taspinar (2), AO Uzumcugil (3) OF OSTEOPOROTIC FRACTURES IN REGIONAL HOSPITAL
LLUÍS ALCANYÍS-XÀTIVA (SPAIN)
1. Orthopaedics and Traumatology Department, Dumlupinar University School of R Alvarez (1), E Ferrer Brandley (2), A Lombardi (3), JC
Medicine, Kutahya, Turkey Montalva Barra (4), A Pinzón Rivadeneira (5), R Sanchez
2. Physiotherapy and Rehabilitation Department, Dumlupinar University Kutahya Artal (6)
Graduate School of Health, Kutahya, Turkey
3. Orthopaedics and Traumatology Department, Dumlupinar University Kutahya Evliya 1. Xativa, Hospital Lluis Alcanys, Xativa, Spain
Celebi Education and Research Hospital, Kutahya, Turkey 2. Xativa, H Lluis Alcanys, Xativa, Spain
Corresponding author: Mr Taspinar Ferruh ([email protected]) 3. Xativa, H Lluis Alcanys, Xativa, Italy
Key-words: blood ; diagnosis ; complications 4. Emergency deparment, Hospital Lluis Alcanyis, Xativa (Valencia), Spain
5. Xativa, H. Lluis Alcanys, Xativa, Spain
Multiple myeloma is a kind of leukemia usually seen in older age 6. xativa, hospital lluis alcanys, xativa, Spain
and grouped under the plasma cells dyscrasias. This malignity can Corresponding author: Mr Montalva Barra Juan Carlos ([email protected])
also cause to abnormal bleeding diathesis by infiltration of bone Key-words: osteoporosis ; interaction drugs ; fractures
marrow. Here, we are presenting a sixty-eight years old male
gonarthrosis patient who had undiagnosed multiple myeloma and The relationship with osteoporosis and polypharmacy compliance
diagnosed after a total knee arthroplasty operation. The prolonged is increasingly studied and related side effects that highlight the
bleeding at the operation area of the knee has thought us that may osteoporotic fracture origin.
be a hematogenic malignity. After transfusion of more than 10 Osteoporosis is the most important metabolic bone disease in the
units of erythrocyte suspension, the patient referred to fracture and increased mortality in both sexes now, not just pot-
hematologist in another hospital. Preoperatively undiagnosed menopausal, increasing secondary to other processes and
multipl myeloma or another hematogenic malignity can be a cause treatments with certain drugs involved in this.
of prolonged bleeding after an orthopaedic surgical procedure to OBJECTIVE: To demonstrate the relationship between age, sex, and
the bone. In fact, this status is an emergency and multiple some factors, with polypharmacy, which determine the type of
myeloma or other hematogeneous malignity must be thought as a fracture and subsequent treatment after surgery is offered by the
rare cause of postoperative prolonged bleeding in any orthopaedic Trauma Service at our hospital.
procedure related to the bone. MATERIALS AND METHODS: Retrospective descriptive study of all
patients with a fracture in the emergency department between
P634 _________________________________ Orthopedics January and August 2011. We included all patients over 50 years of
both sexes and diagnosis of fracture and secondarily osteoporsis.
ARTHROPLASTY APPLICATION OF A PATIENT WHO We analyzed the type of osteoporotic fracture, the treatment
DEVELOPED PSEUDOARTHROSIS AFTER THE FIRST followed by Trauma, treatments before and after surgery. For this
STABILIZATION OF COMMINUTED INTRAARTICULAR was used GAYA system from Health Service of the Valencia
ELBOW FRACTURE; A CASE REPORT electronic prescribing of medication through ABUCASIS. Statistical
S Inal (1), F Taspinar (2), O Ersan (3) analysis was analyzed using SPSS for Windows 15.0, as a measure
of association used the value of the odds ratio with confidence
1. Orthopaedics and Traumatology Department, Dumlupinar University School of interval 95%.
Medicine, Kutahya, Turkey RESULTS: Of a sample of 25 patients with fractures associated with
2. Physiotherapy and Rehabilitation Department, Dumlupinar University Kutahya a previous diagnosis of osteoporosis, 23 of these (92%) were
Graduate School of Health, Kutahya, Turkey women and 2 (8%) men with a mean age of 85.64 years. Alpha
3. Orthopaedics and Traumatology Department, Diskapi Yildirim Beyazit Education and 100% of patients previously diagnosed with a fracture of
Research Hospital, Ankara, Turkey osteoporosis densitometric and FRAX positive. The type of fracture
Corresponding author: Mr Taspinar Ferruh ([email protected]) by 52% gave at the left (13 left hip fractures) and the rest straight.
Key-words: fracture ; intraarticular ; nonunion 84% were operated (21 patients) and 100% used a technique
similar blade plate anchor. As for treatments prior to the fracture
The comminuted fractures are in the difficult group to treat. point: only 44% of patients had been treated with
Generally; these injuries occur as a result of high energy trauma. In bisphosphonates- vitamin D, and subsequent surgery kept
particular; if the fracture pattern is intraarticular, it is more difficult bisphosphonates, 36% of all patients, taking prior to the fracture
to treat. So that; malunion, nonunion or the other morbidity rates calcium in their various preparations for 44% while post-surgery
increases in these cases. Here, we are reporting a fifty-nine years were taking calcium 96% of patients. 16% of the patients
old female patient who developed pseudoarthrosis after the screw consumed oral corticosteroids, anticoagulants in 36%, proton
fixation of a comminuted intraarticular elbow fracture. Finally; her pump inhibitors 64%, anxiolytics or antidepressants in 32% of
definitive surgery has been done with elbow arthroplasty. We cases, and anticolestiramina (simvastatin, atorvastatin) in 40% of
treated the instability of the elbow joint and related symptoms by all patients.
application of elbow arthroplasty and rehabilitation. The patients CONCLUSIONS: Our study demonstrates the direct relationship
who come to emergency services with intraarticular comminuted between osteopororsis, age, sex and fractures studied. Is shown
elbow fractures must be consider as a candidate for under monitoring of treatment of osteoporosis. Surgical treatment
is effective in most patients regardless of age. The results in patient

BOOK OF ABSTRACTS 356

outcomes favoring rehabilitation and improvement of quality of life most cases, directing the needle towards the ipsilateral nipple can
of patients. Polypharmacy is a factor in most of the patients avoid the carotid artery and also puncture the IJV.
studied and emphasizes oral glucocorticoids, inhibitors of proton
pump anticogulantes oral and statins. The proportions of these P637 ________________________________ Other - Part 2
drugs is as follows: 36% of patients are consumers of oral
corticosteroids, 64% inhibitors of proton pump inhibitors ARE WE TOUCHES TO WATER AND SOAP?
(omeprazole, lansoprazole or pantoprazole), 32% anxiolytics or E. Altunbilek, C. Kavalcı, D. Öztürk, O. Hakbilir, C. Akman, Ö.
antidepressants and 40% lipid-lowering drugs (simvastatin or Aslan, M. Sönmez
atorvastatin).
It is important to note that the discharge of its intervention only Emergency Department, Numune Training and Research Hospital, Ankara, Turkey
36% of patients remained on bisphosphonates or calcium Corresponding author: Mr Kavalci Cemil ([email protected])
treatment earlier, with increase to 36% of patients in the calcium, Key-words: emergency ; handwashing ; soap
without revision or indicate the pattern of vitamin D, where most
were efficient and kept below levels in blood and as minimum OBJECTIVE: In this study, we aimed to define effects of the endemic
guidelines. infective processes on the hand-washing habits of the emergency
department staff in contact with the patients.
P636 ________________________________ Other - Part 2 METHODS: The study was prospectively conducted in Emergency
Clinic of Ankara Numune Training and Research Hospital.
VALIDATION OF THE IPSILATERAL NIPPLE AS THE Information recorded in the study forms consisted of the title of
DIRECTIONAL GUIDE DURING RIGHT INTERNAL JUGULAR health care staff, type of the contact with the patients, whether
VEIN CATHETERIZATION the hands were washed before and after the contact with the
IK Jang, JY Jeong, H Lee, HG Ryu patients, duration of the hand-washing, using soap or disinfectant,
hand-drying, proper use of the glove and whether the gloves were
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, destroyed in a proper way. Ki-kare test assay was used in the
Seoul, Korea, (South) Republic of statistical analysis and p<0.05 values were considered significant.
Corresponding author: Melle Lee Hannah ([email protected]) RESULTS: Following all the clean and dirty contacts, hand washing
Key-words: Internal jugular vein catheterization ; ; was made in 237 (28.9 %) of total 819 contacts. Of the total 819
contacts, 538 (65.7 %) were found to be clean and 281 (34.3 %)
The ipsilateral nipple has traditionally been used as a directional dirty contacts. Incidence of the hand-washing was found as 84
guide for needle advance during internal jugular vein (IJV) times (15.6 %) in 538 clean and 153 times (54.4 %) in 281 dirty
catheterization. However, the rationale for its use is very weak. We contacts. Frequency of the hand-washing was found higher in the
attempted to validate the ipsilateral nipple’s utility as a directional dirty than in the clean contacts. Totally, 462 gloves were used
guide during IJV catheterization. during the study. When areas of use for 462 gloves were examined,
One hundred and two patients (M:F=54:48) scheduled to undergo it was observed that 219 gloves (47.4 %) was used in the clean and
elective surgery were enrolled. Patients with anomalies or history 243 gloves (52.6 %) in the dirty contacts. It was found during the
of surgery at the neck or the ipsilateral breast were excluded. observation that, soap was used in 134 (56.5 %), while no soap was
Patients were placed in the 15 degree Trendelenberg position with used in 103 (43.5 %) of 237 hand-washing.
their head rotated 30 degrees to the left. The tip of the triangle CONCLUSION: In the emergency department in which the study
formed by the 2 heads of the SCM muscle and the clavicle was was conducted, incidence of the hand-washing was found to be
identified with palpation and marked by a single investigator. A line more than in the previous studies, but still it was not at a desired
connecting the tip and the ipsilateral nipple was drawn. Using a level.
ultrasound device, the center of IJV at the cricoid cartilage level
and the course of the IJV was drawn. The angle formed by the two P638 ________________________________ Other - Part 2
lines and the distance between the tip of the anatomical triangle
and the IJV center identified via ultrasound were measured. The INVESTIGATION OF THE FREQUENCY OF HEALTH CARE
relationship between the IJV and the carotid artery at the cricoid PERSONNEL SAFETY BELT USAGE IN TURKEY
level was also recorded. B. Uyanık, C. Kavalci, ED. Arslan, F.Yilmaz, Ö. Aslan, S. Dede
The average angle formed between the actual course of the IJV and
the line connecting the tip of the anatomical triangle and the Emergency Department, Numune Training and Research Hospital, Ankara, Turkey
ipsilateral nipple was 16(±7.6) degrees. Regression analysis showed Corresponding author: Mr Kavalci Cemil ([email protected])
that height, weight, gender, and age did not affect the angle as an Key-words: Traffic accidents ; seat belt ; health care providers
independent factor. The tip of the anatomical triangle was on
average 0.5 cm medial to the center of the IJV. The extended In Turkey, as in so many other developing countries, traffic
course of the IJV crossed the line between the two nipples at 4.8 accidents appear as a major public health problem that causes
(±2.4) cm medial to the ipsilateral nipple. The carotid artery was damage to thousands of people every year. Use of seat belt which
either medial or mediolateral to the IJV in 91/102 (90%) patients. is one of the most important life-saving safety measures in car
Our study showed that when the needle is directed towards the accidents has not yet reached the desired level. In this study, the
ipsilateral nipple during IJV catheterization, it crosses the course of sensibilities of hospital health care providers with respect to seat
the IJV. This is because the tip of the anatomical triangle is lateral belt use were investigated. After approved to local ethics
to the actual center of the IJV and the IJV runs more medially committee we conducted this study in Ankara Numune Training
compare to the path that heads toward the ipsilateral nipple.
Considering the fact that the carotid artery is medial to the IJV in

BOOK OF ABSTRACTS 357

and Research Hospital. Health care providers were observed at the P640 ________________________________ Other - Part 2
parking entrance in order to see whether they put on seat belt or
not while driving. The personal data of the subjects were obtained ADULT EMERGENCY SERVICES AT ŞAHINBEY RESEARCH
either from themselves or through the hospital employee records. AND PRACTICE HOSPITAL: A COST ANALYSIS
Their names, gender, age, marital status, work unit, education level C Yildirim, R Guzel, S Zengin, B Al, S Kartal, E Sarcan
seat belt usage status, and professional parameters were recorded.
Fisher’s exact chi-square test was used in statistical analysis. In Emergency Department, Gaziantep University, Gaziantep, Turkey
conclusion, we found that health care providers have significantly 2. Emergency department, Gaziantep University, Gaziantep, Turkey
higher seat belt use rate. In other words, the use of seat belt Corresponding author: Mr Zengin Suat ([email protected])
increases in direct proportion to the education level and socio- Key-words: Emergency department, ; cost analysis ; cost effectivity
economic status.
In this study, we aimed to calculate the costs of emergency service
P639 ________________________________ Other - Part 2 unit examinations by using the administrative, financial, and
medical data of Şahinbey Research and Practice Hospital in 2011.
THE ANALYSIS OF PATIENTS ADMITTED TO EMERGENCY Every billed service and every documented income and expense for
DEPARTMENT DUE TO COMPLICATIONS RELATED TO a year of adult emergency services within the hospital’s Emergency
WARFARIN TREATMENT Department, between January 1 and December 31, 2011 was
S Hüseyin (1), S Oğuz (2), MB Sayhan (3), E Seçgin Sayhan included in the study. The conventional cost analyzing method was
(4), G Yagcı (5), V Yüksel (1) used to calculate the emergency service unit’s examination costs,
based on this data. Microsoft Office Excel was used to carry out the
1. Cardiovascular Surgery, Trakya University Medical School, Edirne, Turkey analysis.
2. General Surgery, Trakya University Medical School, Edirne, Turkey In 2011, the total expense of adult emergency services for the
3. Emergeny Medicine, Trakya University Medical School, Edirne, Turkey Gaziantep University Medical Faculty at Şahinbey Research and
4. Public Health, Trakya University Medical School, Edirne, Turkey Practice Hospital was calculated to be 4,026,436.70 TL, including
5. Emergeny Medicine, Trakya University Medical School, edirne, Turkey gross personnel salaries. The total income was calculated to be
Corresponding author: Mr Sayhan Mustafa Burak ([email protected]) 3,682,551.21 TL. In the same year, a total loss of 343,885.49 TL was
Key-words: Emergency Department ; Warfarin ; oral anticoagulant detected, which was a high percentage (46.15%) of the total cost of
personnel expenses. Emergency service unit examination costs,
Objective including gross personnel salaries, were calculated to be 54.09 TL.
Warfarin is the most commonly used oral anticoagulant around the Since personnel salary is paid from the head office’s budget, in a
world. The most important complication of warfarin is bleeding. calculation not including gross salaries, the profit was determined
This study was conducted to evaluate the patients admitted to our to be 403,655.12 TL. Emergency service unit examination costs,
emergency department due to complications related to warfarin excluding gross personnel salary, were calculated to be 44.05 TL.
treatment. Personnel salary costs per unit patient were found to be 10.04 TL.
Materials and Methods In 2011, the emergency service unit examination price paid by SGK
Eighty-nine patients (32 female,57 male) were enrolled into this (a social security institution) was 15.50 TL.
retrospective study. The patients were evaluated according to their Hospitals should primarily aim to manage health and not to profit.
age,gender, duration of the therapy (year), co-administered drugs, Their primary task is to provide for the health needs of citizens in
bleeding localization, treatments, amount of blood transfusions, the best way possible. However, In order to be able to offer
duration of bleeding, initial and after treatment PT, INR, complete continuing, high-quality services, institutions should look after their
blood count and aPTT. income-expense ratios rather than their profits. In this context,
Results institutions providing health services should also be considered and
Mean duration of anticoagulant use was 3.05±2.87 years. The most evaluated by management. In public hospitals, the most important
common indication of warfarin was atrial fibrilation. The most question in cost analysis is whether to include personnel salaries
frequent bleeding localization was upper gastrointestinal tract. paid from the main budget.
Thirty-four (38.2%) of the patients had major bleeding, and 55
(61.8%) had minor bleeding. Age, co-administered drugs, amount P641 ________________________________ Other - Part 2
of erythrocyte suspension transfusions, the presence of previous
warfarine overdose history, Hb levels at the admission and EVALUATION OF RISK FACTORS AND CLINICAL
duration of follow-up at ED were different among bleeding types (p CHARACTERISTICS OF ELDERLY PATIENTS WITH ACUTE
< 0.05). UPPER GASTROINTESTINAL HEMORRHAGE
Conclusion MB Sayhan (1), S Oğuz (2), H Umit (3), E Seçgin Sayhan (4),
In this study we found that the bleeding complications of warfarin mo eralp (5), g akdur (5), c kavalcı (6), T Sagıroglu (7)
were associated with the aged population, the presence of
previous warfarine overdose history and concomitant drug use. 1. Emergeny Medicine, Trakya University Medical School, Edirne, Turkey
2. General Surgery, Trakya University Medical School, Edirne, Turkey
3. Gastroenterology, Takya Universty, Edirne, Turkey
4. Public Health, Trakya University Medical School, Edirne, Turkey
5. emergency mediccine, trakya universty, edirne, Turkey
6. emergency mediccine, Ankara Numune Hospital, Ankara, Turkey
7. General Surgery, Takya Universty, Edirne, Turkey
Corresponding author: Mr Sayhan Mustafa Burak ([email protected])

BOOK OF ABSTRACTS 358

Key-words: Elderly Patients ; Gastrointestinal Hemorrhage ; Emergency Department flows trend in incoming and outbound, constant in time, has to be
correlated to the method: the Short Intensive Observation isn’t
Introduction: Acute upper gastrointestinal hemorrhage (AUGIH) is operator-dependent.
a life-threatening emergency problem in the elderly population. In Materials and methods
this study we aimed at investigating the risk factors and clinical We have analyzed the data of the flows in incoming and outbound
features of the elderly and very elderly patients presenting to the from the Short Intensive Observation, the times of permanence,
Emergency Department (ED) with AUGIH. the percentage of discharge in the single months and also the
Method and Materials: A historical cohort study was conducted in percentage of the return after 72 hours with the respective result
a university-based hospital. 194 patients were divided into two of the return (discharged, hospitalized, dead) from January 2008 to
groups: Group A (n=128); elderly group (ages 65-79 years) and December 2011. Moreover we have also estimated the progress of
Group B (n=66); very elderly group (aged > 79 years). the hospitalizations for that particular kind of pathology after the
Results: The mean age was 76,34±7,91 years. The most frequent institution of Short Intensive Observation in relation with former
presenting symptom was melana (87,1%). Fourteen patients (7,2%) years, that were taken as sample.
were in shock at the time of bleeding. 133 patients (68,5%) had a Results
history of rebleeding. Underlying comorbid illnesses were detected In the considered period, about 20.000 patients have passed in
in 171 patients (88,1%). There was a significant difference in Short Intensive Observation, with an average permanence of 30
terms of alcohol consumption and coroner artery disease between hours. The 76% of the patients has been discharged or transferred
two groups (respectively p=0,038 and p=0,049). The most in external structures (57% discharged, 19 % transferred), the 21%
frequently observed endoscopic lesions were peptic ulcer and hospitalized. The remaining percentage (3%) include the dead
gastroduodenal erosions in both groups.Most patients in both patients and the patients that have refused the hospitalization. The
groups were submitted to medical treatment. Conservative average number of re-accesses in Emergency Department within
medical treatments were applied in most of the patients in both 72 hours from the discharge has been of 48,5 % patients/year ( <
groups but there were no statistically significant differences 2%).
between them (p=0,892). The overall mortality rate was 11,7% in The pathologies, that are mainly passed in Short Intensive
group A and 19,7% in group B. Observation, were:
Conclusion: In order to successfully diagnose and treat AUGIH in -Thoracic pain (25%)
the elderly and the very elderly presenting in the emergency -Syncope (30%)
department, physicians must be well-versed in geriatric emergency -Abdominal pain (23%)
medicine approaches. -BPCO (20%)
-Renal colic (15%)
P642 ________________________________ Other - Part 2 -Pneumonia (5%)
-Vertigos (5%)
SANDRO PERTINI HOSPITAL OF ROME - MODEL - SHORT -TIA (10%)
INTENSIVE OBSERVATION -Cardiac decompensation (8%)
C Cancrini, D Livoli, FR Pugliese, A Revello, A Simone, V -Head Injury (9%)
Valeriano Conclusion
The existence of itineraries, that offer clinical care post-discharge,
Emergency Departiment, Hospital Sandro Pertini, Rome, Italy and the adhesion to defined guidelines (both on the clinical
Corresponding author: Mr Livoli Donatella ([email protected]) management, both on the handling), has allowed to reduce the
Key-words: Emergency ; Overcrowding ; Hospitalizations hospitalization for the most part of the cases. The Short Intensive
Observation method is based on a continuous revaluation of the
Introduction patient, on the application of procedures and itineraries, on the
From 1st January 2008 has been instituted in the UOC of itineraries verification through focused clinical audit. Moreover the
Emergency Department and Emergency Medicine of the Sandro training on field, the operators’ motivations and the stratification
Pertini Hospital in Rome the “Short Intensive Observation”, of the risk according to scientific criteria guide to the itinerary
according to the indications suggested by SIMEU- region Latium. In more appropriate for the patient.
four years of activity, the Short Intensive Observation has
constituted a valid answer to the overcrowding and to the P643 ________________________________ Other - Part 2
necessity of optimize the hospitalizations, necessity based on the
application of scientific criteria, following the international CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF OVER
guidelines, as EBM. That offers a welfare setting completely 65 YEARS PATIENTS ADMITTED EMERGENCY
alternative in comparison with the traditional hospitalization. The DEPARTMENT.
starting point of the Short Intensive Observation experience was A Ozhasenekler, HM Durgun, C Guloglu, M Orak, I Tunc, M
the modality of the handling related to acute clinical problems, Ustundag
selected according to the rank of graveness. These clinical
problems were also selected in connection with other aspects, as Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey
the necessity of a diagnostic procedure not inferior than 6 hours Corresponding author: Mr Ozhasenekler Ayhan ([email protected])
and not superior than 36 hours, in order to estimate the concrete Key-words: older patient ; emergency departmant ; clinical and demographic
necessities of a hospitalization or safe discharge. characteristics
The purpose of the work
The management experience, began four years ago, has brought to Aim: In Turkey as well as in the world, along with the rising share of
the achievement of the optimal gold standard (70% of discharges older people in the total population, their presentation rates to
and 30% of hospitalizations), thanks to the application of a method Emergency Departments are steadily increasing in this study,
strictly scientific, based on EBM and shared by all the staff. The

BOOK OF ABSTRACTS 359

therefore, our aim is to document clinical and socio-demographic warmth, ecchymosis and hemorrhagic edema. The patient’s vital
characteristics of patients aged 65 and older presenting to our signs were stable. Left upper extremity evaluated in terms of
Emergency Service. compartment syndrome. In the patient’s blood test’s results WBC:
Patients and Method: In the study, the attendance data of 1719 12700, AST: 51 U/L, ALT: 214 U/l, GGT: 160 U/L. The patient was
patients aged 65 and above, treated in the Emergency Service of hospitalized for systemic complications and compartment
Dicle University Hospital, were retrospectively stuided. syndrome. Local wound care was made. And supportive therapy
Findings: 1719 patients of included into the study, 903 (52.5%) was given. After a close follow up the patient was discharged when
were males, and 816 (47.5%) were females. Of those patients, 197 the local findings were regressed.
(11.5%) died, 57.9% (n=114) of whom were males and 42.1% Even the main treatment of the snake bites is fluid therapy and
(n=83) of whom were females. antiserum therapy as in our case patients should be monitored in
When analysed in terms of mean ages according to the gender, the terms of possible systemic complications and compartment
mean age was found to be 75.20± 7.14 (65-107) years in females, syndrome. Initially applied antiserum treatment can be inadequate
while it was 74.18± 6.20 (65-102) years in males, suggesting that in preventing local signs but systemic complications that may occur
the mean age of females was significantly higher with respect to can be prevented with this treatment.
male patients (p=0,002).
As for marital status of our patients, the rate of being widowed in P645 ________________________________ Other - Part 2
females, and that of being married in males were determined to be
significantly higher when compared with their counter-genders (p < DIAMINE OXIDASE IN DIAGNOSIS OF ACUTE MESENTERIC
0.001). ISCHEMIA
When our patients were examined in terms of education, the dr Narci, dr ucar karabulut
education level was found to be significantly higher in males.
In additten , through analysis of the patients presententing Emergency, Baskent University Konya Hospital, konya, Turkey
complaints, the first five causes were as follows: dyspnea (27.9%), Corresponding author: Mme Ucar Karabulut Keziban ([email protected])
other internal complaints (23.6%), abdominal pain (15.3%), chest Key-words: Acute mesenteric ischemia ; Diamine oxidase ; Amylase
pain (13.0%) and conscience alteratien (9.9%). The mortality rate
was observed to be significantly higher in those with conscience Objective
alteratien and exposure to non-vehicle traffic accidents. Acute Mesenteric Ischemia (AMI) is an important clinical
The follow-up and treatment of 41.2% of our patients were
performeal at our emergency service and the mortality rate of our condition with a high mortality rate in abdominal emergencies due
clinic, where the diagnosis and therapies of the majority of our to delay in diagnosis in spite of the new strategies in the
patients are conducted was 7.6%. management. We have studied the role of Diamine oxidase (DAO)
Results: Through the improvement of living conditiens, elder in the early diagnosis of AMI.
population is increasing in our country as well, and thus the
number of elder patients presenting to the emergency service is Method
also rising. Ageing-related problems accompanied by more than In the study, 21 New Zeland rabbits were used. Subjects were
one chronic illness require a more different and careful approach
towards the elderly patients. named as the groups of controls, sham and ischemia. No
intervention was performed in the subjects in the control group. In
P644 ________________________________ Other - Part 2 the subjects from sham and ischemia groups, laparotomy was
performed with middle line incision. However, Superior Mesenteric
EXTENSIVE EDEMA OF THE LEFT ARM FROM A SNAKE BİTE Artery (SMA) was found and tied in those from ischemia group
CASE after the performance of laparotomy. From the animals in 3
S Karaman (1), O Delice (1), H Şahin (1), A Bayramoğlu (2) groups, blood was drawn at the hours of 0, 1, 3 and 6, and DAO
and amylase were studied in these samples.
1. Emergency Department, Erzurum District Training and Research Hospital, Erzurum,
Turkey Results
2. Emergency Department, Atatürk University Medical Faculty,, Erzurum, Turkey The increase in serum amylase levels was found to be
Corresponding author: Mr Karaman Serhat ([email protected])
Key-words: snake bites ; comppartment syndrome ; antiserum therapy statistically significant in the ischemia group compared to the
control and the sham groups (p < 0.05). The decrease in serum
In our country snake bites rarely causes life-threatening DAO levels was found to be statistically significant in the ischemia
complications. Especially the Southern Anatolia and Southeast group compared to the control and the sham groups (p < 0.05).
Anatolia regions of Turkey are often encountered with snake bites. DAO levels were found to decrease, beginning from the 1. hour
Viper snakes of venomous snakes group found in most in our after ischemia had been developed and this rise was found to
country. Snake bites can cause serious morbidity and mortality. continue for 6 hours (p < 0.05).
Local or systemic findings can be monitored based on the contents
in the type of the snake toxin. Conclusion
52-year-old female patient admitted to state hospital after a snake Serum DAO levels were decreased in ischemia. Further
bite between the fourth and fifth fingers of her left hand. Because
of the increase of the left hand and left arm edema and formation clinical and experimental investigations would be valuable to
of eccymosis she referred to our center. 10 ml of antiserum (1 vial) confirm the probable role of DAO in AMI.
IM/IV was applied to the patient. Prophylactic intravenous
antibiotics, tetanus vaccine and fluid therapy was given. On
physical examination in the bite site of the patient there were pain,

BOOK OF ABSTRACTS 360

P646 ________________________________ Other - Part 2 Epidemiology of deaths in emergency departments is not well
known in Tunisia contrary to the epidemiology of deaths in critical
EVALUATION OF THE PATIENTS DIAGNOSED WITH care units.
DIAPHRAGMATIC RUPTURE IN EMERGENCY DEPARTMENT Objective :
F İçme (1), E Balkan (2), S Becel (3), H Şahin Kavaklı (3), Y To study the epidemiologic characteristics of deaths in emergency
Yüzbaşıoğlu (3), A Şener (3) departments.
Material and methods :
1. Emergency department, Ankara Atatürk Training and Research Hospital, Ankara, This retrospective study covered a 3-year period from January 2008
Turkey to December 2010, including all deaths occurring in the emergency
2. Thoracic Surgery Department, Ankara Atatürk Training and Research Hospital, Ankara, department of the military hospital of Tunis.
Turkey Results :
3. Emergency department, Ankara Atatürk Training and Research Hospital, Ankara, Turkey There were 131 deaths representing 0.15% of all cases treated in
Corresponding author: Mr Içme Ferhat ([email protected]) the department. Mean age of patients was 69.5 + 15 years, and
Key-words: Diaphragmatic rupture ; radiologic diagnosis ; treatment their sex-ratio 1.8. Seventy eight percent of patients were more
than 60 years old, and 6.1% of them were less than 40 years old.
Background: The aims of this study are to review the characteristics Past medical facts included essentially high blood pressure in
and management of diaphragmatic injuries which we diagnosed in 46.87% of cases and diabetes in 30.23% of cases. In 26% of deaths
patients who admitted to emergency room because of patients were admitted to the emergency department for chronic
thoracoabdominal trauma and to investigate the effect of the and essentially cardio-vascular diseases. In 95.4% of cases, patients
trauma scoring systems in predicting hospitalization time. were not taken to hospital by any hospital means of transport. In
Methods: In this retrospective study we evaluated 20 patients who 94% of cases death occurred in the department. In 6% of cases,
admitted to Ankara Ataturk Training and Research Hospital patients had a cardiac arrest before reaching the hospital. Mean
Emergency Department between 25/04/2005 and 12/31/2011 length of stay in the emergency department before death was 19.7
because of thoracoabdominal trauma who we diagnosed with + 9 hours. Fifty-three of patients died within 6 hours after
diaphragmatic injury. Demographic characteristics, etiology, admission. Death occurred following a cardio-vascular disease in
diagnostic evaluation, associated injuries, treatment and effects of 38.1% of cases, a neurological disease in 16% of cases and an
trauma scores [Glascow Coma Score (GCS), Revised Trauma Score infectious disease in 13% of cases. Necropsy was warranted in 5.3%
(RTS), Injury Severity Score (ISS), Trauma Injury Severity Score of cases. In 34.4% of cases of cardiocirculatory arrest we decided to
(TRISS)] in hospitalization time were evaluated for all the subjects. refrain from providing further critical care.
Results: Eighteen of the patients were male 90%), and 2 patients Conclusion :
were female (10%). The mean age of patients was 44.4 ± 13.8 (18- According to the present study, death occurred in 0.15% of cases
72). Four of the patients had penetrating injuries, 16 of the following essentially a cardiovascular complication. Multicentre
patients had blunt trauma. In the first examination GCS in the ED prospective studies would be of great importance.
was 13.4 ± 2.78, RTS: 5.8 ± 3.09, ISP: 18.75 ± 7.63 and Predicted
death rate according to TRISS was 6.4 ± 10.4, respectively. There P648 ________________________________ Other - Part 2
was no statistically significant difference in duration of
hospitalization with RTS and GCS whereas in patients with ISS score ANALYSıS OF JUDıCıAL CASES AT EMERGENCY
16 and above hospitalization time was significantly longer. Hospital DEPARTMENT
stay of patients was 20.4 ± 23.1 days and no mortality was N Kozacı
observed.
Conclusion: In cases of thoracoabdominal trauma especially in the acil tıp, adana NEAH, adana, Turkey
upper abdomen and / or lower thoracic region diaphragmatic Corresponding author: Mme Kozaci Nalan ([email protected])
injury should always be considered and the tests should be Key-words: Emergency ; forensic report ; forensic cases
assessed carefully. In addition, we suggest that in predicting
mortality and the duration of hospitalization anatomical scoring Objective: In this study, we aimed to analyse the demographic
systems (ISS) should be preferred rather than physiologic scoring features of judicial cases admitted to emergency department of an
systems (RTS, GCS) in certain anatomical disorders which may be education and research hospital, the content of life-threatening of
life-threatening lonely such as rupture of the diaphragm. forensic reports, the status of simple medical intervention and
outcomes in the emergency department.
P647 ________________________________ Other - Part 2 Material and Methods: Judicial cases, admitted to the emergency
department during December 1, 2009 and December 31, 2010
EPIDEMIOLOGY OF DEATHS IN EMERGENCY were included in the study. Patients were evaluated from the
DEPARTMENTS patient cards retrospectively. Categorical data summarized as
M. Ben Lassoued, S. Ben Nasr, O. Djebbi, M. Haggui, G. Ben number and percentage, numerical measurements summarized as
Jrad, I. Bennouri, K. Lamine mean and standard deviation. the data were statistically analyzed
with using SPSS 16.0 statistical program.
Emergency department, Military Hospital of Tunis, Tunis, Tunisia Results: Of the 5870 judicial cases, 63,78 % were male and 36,22 %
Corresponding author: Mr Ben Lassoued Mehdi ([email protected]) were female. Mean age of patients were 33,75±12,4. Traffic
Key-words: death ; epidemiology ; emergency department accident (27,3 %), intoxication (24,3 %) and to be beaten (17,6 %)
were the first three judicial events. Traffic accidents were seen in
Introduction : males between 26-33 ages mostly and intoxications were seen in
females betmeen 18-25 ages commonly. The most reason of
injüries were limb injuries with 2404 cases. 73,3 % of patients were

BOOK OF ABSTRACTS 361

discharged and 26,3 % of patients were hospitalized. When Corresponding author: Mr Yildiz Mustafa ([email protected])
forensic reports were eveluated, 28,8 % of males and 11,3 % of Key-words: geriatric patient ; emergency department ; comorbidity
females were not resolved with simple medical intervention. 21,1%
of patients whom life-threatening condition were defined had life- Admission to the emergency department by the elderly is
threatening. increasing proportionally with the increase in the elderly
Conclusion: Forensic cases are seen in young adult males most population in Türkiye. The presence of multiple diseases causes a
commonly. Extremities are most frequently injured region. Many complicated clinical situation. Evaluation of elderly patients in the
forensic patients can be treated with simple medical intervention emergency department may be difficult. Approaching the
but In one fifth of the patients have life threatening. emergency problems of the elderly population with specially
educated personnel will result in the prevision of a faster and more
P649 ________________________________ Other - Part 2 qualified health service. From these reasons, knowing the elderly
patient profile presenting to emergency department becomes
PARAOXONASE-1 GENE IN PATIENTS WITH ISCHEMIC important. Our study, we aimed to evaluate the demographics of
STROKE DISEASE INVESTIGATION Q192R AND L55M elderly patients who were admitted to the emergency department.
POLYMORPHISMS Complaints, diagnosis, history of illnesses, medications, length of
I Adsiz (1), M Yildiz (2), M Kara (3), CF Demir (4), M Gurger hospital stay, wards of admission, and mortality rates of patients
(2), N Adsiz (2) older than 65 years, presenting to Fırat University Emergency
Department from June 2011 to November 2011 were recorded
1. Department of Emergency Medicine, Elazığ Training and Research Hospital, Elazığ, prospectively from patient records.
Turkey On average, 13.8% of the total number of patients who applied to
2. Department of Emergency Medicine, Firat University, School of Medicine, Elazığ, the emergency department represented the geriatric population
Turkey over the age of 65. Mean of age was 74.8±7.2. The results indicated
3. Department of Medical Genetic, Firat University, School of Medicine, Elazığ, Turkey that 37.2% hypertension, 21.9% coronary artery disease and 18%
4. Department of Norology, Firat University, School of Medicine, Elazığ, Turkey diabetes mellitus. Top three disease was found as follows: strokes
Corresponding author: Mr Yildiz Mustafa ([email protected]) (%5.3), congestive heart failure (%4.8), vertigo (%4.2). The gender
Key-words: İschemic stroke ; paraoxonase ; polymorphism distribution of the elderly was 49.2% women and 50.8 men. 38.3%
of all admission to the geriatric patients were hospitalized. The
The effect of increased oxidative stress in development of acut most common department of hospitalization was cardiology.
ischemic stroke is well known. One of the antioxidative systems High rates of geriatric patients applying to emergency department
against oxidative stress in human body is paraoxonase (PON) show the necessity for emergency staff to be informed and trained
enzyme that protects low density lipoproteins against oxidation. In about geriatrics. We think that, more research needs to be done on
this study we aimed to search the polymorphisms on PON1, this subject.
Q192R, L55M genes of patients with ischemic stroke.
The DNAs extraction was obtained from blood samples of the 50 P651 ________________________________ Other - Part 2
patients diagnosed with ischemic stroke and 50 patients as control
group who were presented to emergency clinic. Genotypes were EVALUATION OF EMERGENCY DISEASES OF NURSING
obtained with polymerase chain reaction and AIw I and Hsp92II HOME RESIDENTS
restriction enzymes were used for Q192R and L55M A. Karakus (1), C. Zeren (2), S Arıca (3), ES. Erden (4), M.
polymorphisms, respectively. Analysis of data was done with Chi- CELIK (5), H. Kandis (6)
Squire and Fisher’s exact tests.
A statistically significant difference regarding Q192R polymorphism 1. Department of Emergency Medicine, Mustafa Kemal University, Hatay, Turkey
was found between ischemic stroke patients and control group (P = 2. Department of Forensic Medicine, Mustafa Kemal University Faculty of Medicine,
0.05). There was no statistically significant difference about L55M Hatay, Turkey
polymorphisms in patient and control groups (P > 0.05). 3. Family Medicine, Mustafa Kemal University, Faculty of Medicine,, HATAY, Turkey
In our study, we observed PON-1 gen Q192R and L55M 4. Department of Chest Diseases, Mustafa Kemal University Faculty of Medicine, Hatay,
polymorphism in patient with ischemic cerebrovascular disease. Turkey
Consequently, we suggest that PON-1 gen Q192R polymorphism 5. Department of Internal Medicine, Mustafa Kemal University, Faculty of Medicine,
contribute pathogenesis of cerebrovascular disease. We believe Hatay, Turkey
that more studies are needed in this subject. 6. Emergency department, Düzce University, Düzce, Turkey
Corresponding author: Mr Karakus Ali ([email protected])
P650 ________________________________ Other - Part 2 Key-words: Emergency disease ; Nursing Home ; Elderly Patient

DEMOGRAPHICS FEATURES OF PATIENTS OLDER THAN 65 Objective: This study was aimed to evaluate diseases of nursing
YEARS PRESENTING TO EMERGENCY DEPARTMENT home residents requiring emergency intervention.
B Mutlu (1), M Yildiz (1), M Gurger (1), E Gul (2), MN Material and methods: A total of 185 nursing home residents
Bozdemir (3), I Kilicaslan (4) residing in Hatay nursing home, between November 2010 and
January 2012, were included in the study. Governorship approval
1. Department of Emergency Medicine, Firat University, School of Medicine, Elazığ, (11/02/2011-1040- Local Family and Social Policy Directorate) was
Turkey obtained. Nurse observation records and relevant medical files
2. Department of Emergency Medicine, Elazığ Training and Research Hospital, Elazığ, were investigated.
Turkey Results: Of residents 114 (61.6%) were male while 71 (38.4%) were
3. Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey female with a mean age of 78.67 ± 8.38 years. Out of all 89 (48.1%)
4. Department of Emergency Medicine, Gazi University, School of Medicine, Ankara, cases were suffering from a chronic ilness. Hypertension was found
Turkey to be the most common chronic disease (n:27, 33.7%). The most

BOOK OF ABSTRACTS 362

common illness reports were those of diseases related internal P653 ________________________________ Other - Part 2
medicine (n:37, 41.5%) and acetyl salicylic acid was the most
commonly used drug as in 17 patients (22.6%). Of 67 (36.2%) EVALUATION OF DERMATOLOGICAL DISORDERS AMONG
patients treated in Emergency Departments the most common ADMITTANCES TO 112 EMERGENCY SERVICES IN KAYSERI
complaint was impaired general condition with 19 (28.3%) patients - 2011
a complaint was taken 89 times. Patients were mostly diagnosed K. Ozyurt (1), S. Bozkurt (2), P. Ozturk (1), M. Okumuş (2),
with hypertension (n:10, 15.3%). Out of hospitalized patients, H. Baykan (3)
twenty-seven (36.0%) were discharged, while patients were
frequently admitted and followed in internal medicine (n:15, 20%) 1. Dermatology Department, Sutcu Imam University Medical Faculty, Kahramanmaras,,
departments. Out of hospitalized patients 10 (13.3%) were died. Turkey
Conclusion: It was determined that the most common complaints 2. Emergency Medicine Department, Sutcu Imam University Medical Faculty,
were general poor health, fall and respiratory failure and the most Kahramanmaras, Turkey
common diagnosis were hypertension, heart disease and 3. Plastic and Reconstrictive Surgery Department, Sutcu Imam University Medical Faculty
orthopedic emergencies in nursing home residents. Kahramanmaras, Turkey
Corresponding author: Mr Ozyurt Kemal ([email protected])
P652 ________________________________ Other - Part 2 Key-words: emergency ; 112 ; emergency dermatology

ADMITTED TO THE EMERGENCY DEPARTMENT This study aimed to determine the clinical characteristics of the
ASSESSMENT OF THE IMPORTANCE OF THE FINDINGS OF patients admitted to 112 emergency services with dermatological
PHYSICAL EXAMINATION IN PATIENTS WITH ACUTE disorders in Kayseri city in 2011. A total of 52472 cases admitted to
ABDOMEN. 112 emergency services in Kayseri, in 2011. Of the cases 39815
E KAYA (1), G. Kuvandık (2), A. Karakus (3), E UCAR (4), M. (75,8 %) were from urban and 12657 (24,2 %) were from rural
CELIK (5), A AYDOGAN (6) regions of the city. Of the cases, 0,88 % admitted due to
dermatological disorders. The most common dermatological
1. Emergency Medicine, Mustafa Kemal University, Faculty of Medicine, hatay, Turkey reason for calling the 112 emergency services was insect bite (70,8
2. Emergency department, Mustafa Kemal University Faculty of Medicine,, Hatay,, Turkey %) and the most diagnosed dermatological disorder was insect bite
3. Department of Emergency Medicine, Mustafa Kemal University, Hatay, Turkey (70,8 %). It is often a challenge for a primary care provider to
4. Internal Medicine, Mustafa Kemal University, Faculty of Medicine, HATAY, Turkey differentiate common skin disorders from more serious,
5. Department of Internal Medicine, Mustafa Kemal University, Faculty of Medicine, lifethreatening conditions that require immediate intervention. The
Hatay, Turkey purpose of this study is to highlight some dermatologic
6. General Surgery, Mustafa Kemal University, Faculty of Medicine, HATAY, Turkey emergencies
Corresponding author: Mr Karakus Ali ([email protected])
Key-words: Acute abdominal pain ; physical examination ; emergency service P654 ________________________________ Other - Part 2

Acute abdominal pain is common among patients admitted to the RETROSPECTIVE ANALYSIS OF SKIN DISEASES ADMITTED
emergency department.The pain less than a week is called acute TO A EMERGENCY DEPARTMENT
pain.The differential diagnosis of the patients with acute S Güneş Bilgili (1), S Karadas (2), R Dursun (3), AS Karadag
abdominal pain is always difficult for emergency (1), O Calka (1)
physicians.Nowadays in many countries, more effective, less
expensive and easily accessed health care services is 1. Dermatology department, Yüzüncü Yıl University, van, Turkey
targeted.Physical examination still has greater importance than 2. emergency department, Yüzüncü Yıl University, van, Turkey
laboratory tests and imaging in diagnosis of abdominal. 3. emergency department, Van Region Training and Research Hospital, van, Turkey
The study is a coss-sectional descriptive study carried out in Corresponding author: Mr Dursun Recep ([email protected])
emergency department of Mustafa Kemal University.The study was Key-words: skin diseases ; emergency department ; urticaria-angioedema
performed prospectively in the emergency department.150
patients were included in the study(76 male(51,3%)-74 Aim
female(48,7%).150 patients presenting to the emergency In this study we aimed to investigate regarding the reasons for
department with an abdominal pain in the last seven days application, clinical characteristics, diagnoses, treatments, and
comprised the study sample. hospitalization rates of patients applying to the emergency service
Patients classified according to their treatment such as medical, who underwent dermatology consultation.
surgical and medical in surgery department in respect to the results Materials and Method
of the attending time.Nonspesific abdominal pain was the most We retrospectively analyzed 902 patients admitted to emergency
frequent type.Physical findings of patients undergoing surgical department between January 2006 and December 2010. The data
operation were correlated with their abdoinal x-rays. were analyzed according to age, sex, diagnosis and time of
After all the work of general literature, and as we have shown in admittance.
our study:34-53% of the patients with abdominal pain final Results
diagnosis of nonspecificabdominal pain is the nude.This patients Of the 182,456 patients who attended to emergency department,
diagnosis with physical examination findings along with laboratory 902 (0.5%) were diagnosed with skin conditions. The age of the
and imaging methods are needed for the differential diagnosis. patients ranged from 16 years to 87 years, with a mean age of
40±16 years. There was a predominance of women, who
accounted for 60% of the group. According to seasonal distribution,
31.7% patients admitted to the emergency department in summer,

BOOK OF ABSTRACTS 363

26.8% patients were in spring, 21.6% were in autumn, and 19.8%) RESULTS II 14.72%
were in winter. The five most frequently encountered diseases in • ROMANIA: 12.84%
patients were urticaria-angiodema (27.4%), bacterial infections • MOROCCO : 9.66 %
(18.8%), drug reactions (16.4%), eczematous dermatitis (12.6%), •BOLIVIA: 8.48%
viral infections (6.44%). 61.5% of the patients were treated in •ECUADOR: 6.24 %
outpatient clinic while 22.5% of them were needed inpatient •COLOMBIA : 5.89%
treatment. 4.5% of the patients were refused inpatient treatment. •PERU: 4.12 %
6% of the patients were interned in the other departments and •PARAGUAY:
5.4% of them were interned in the emergency department.
Conclusion RESULTS III 39.34 %
Skin diseases are less frequent in emergency department •INTERNAL MEDICINE: 27.44%
comparing with the other diseases that depend to the other •TRAUMA-SURGERY: 14.84%
depatments. The major part of the skin diseaes that seen in •GYNECOLOGY 6.71%
emergency department are; urticaria-angioedema, bacterial skin •PEDIATRICS: 5.89%
infections, drug reactions and eczema. Surprisingly the skin •OFTALMOLOGY: 2.83%
diseases are frequent in summer while most of the acute diseases •OTOLARYNGOLOGY: 2.24 %
in emergency departments are seen in winter. Most of the patients •ESCAPE. 0.71 %
with skin diseases are followed in outpatient clinic and that costs •PSYCHIATRY:
lower prices to the healt care units
RESULTS IV
P655 ________________________________ Other - Part 2 •INTERNAL MEDICINE 7,07%
–Abdominal Pain 4,36%
INMIGRATION AT THE E.R. •OBGYN 4,12%
–Labor
C Jiménez Hidalgo, A Ferrer Baena, JL Gálvez San Román, •TRAUMATOLOGY
MC Navarro Bustos, ME Oncala Sibajas, E Salamanca Rivera –Contusions

Emergency department, Universitary Hospital Virgen Macarena, Seville, Spain RESULTS V
COMPLEMENTARY TESTS
Corresponding author: Mr Jiménez Hidalgo Cristina ([email protected]) •RX: 36.63%
•LABORATORY TESTS. 27.44%
Key-words: INMIGRATION ; EMERGENCY ; DEPARTMENT •EKG: 7.66%
•VAGINAL ECO: 6.60 %
INTRODUCTION •ABDOMINAL ECO: 4.36%
In the last 30 years, Spain has turned from an emigrant country to a •CRANIAL CAT: 1.18%
huge receptor of migratory flows. According to the I.N.E., in •ABDOMINAL CAT : 0.35%
January 2011 almost 6.7 million foreigners were living in our •ECO DOPPLER: 0.12 %
country. At present, net immigration rate only reaches 0,99%, •ECOCARDIOGRAPHY: 0.12 %

occupying the 15th position of the European Union. RESULTS VI
In Spain, most foreigners are Latin American. In Andalusia, the DISCHARGE DERIVATION
majority are Moroccans. •DISCHARGE:
AIMS •ADMISION 87.99%
To determine the frequency of attendance and the type of •NOT STATED: 7.18 %
pathology due to which foreigners attend the E.R., as well as the 4.83%

prescriptions done with electronical prescriptions. CONCLUSIONS
MATERIAL AND METHODS Foreigner patients that attend our E.R. are mostly young women.
This is a descriptive, retrospective study of the foreigner One third of these are originary from Latin America, mostly
population living in Spain in a legal situation, that attends the E.R. presenting banal pathologies with abdominal pain accounting for
during the month of November, 2011. most of the cases and discharge from the hospital as the most
We analyzed 849 records. The information was obtained from the frequent outcome.
medical records registered in the computerized system Digitalized
Citizen’s Health Records of the Andalusian Health System
«DIRAYA». We collected data such as affiliation, hours of
attendance, priority during triage, specialty, cause of consultation, P656 ________________________________ Other - Part 2
complementary tests, clinical opinion on discharge and
prescriptions as well as the number of cases attended during the INGESTION OF A TEA SPOON AS A FOREIGN BODY
year, exporting them to a calculation sheet for a further analysis. HM Durgun, M Icer, E Ozcete, A Ozhasenekler, Y Zengin
RESULTS I
•ATTENDANCES 5,28% ( 849/16081) Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey
•WOMEN:MEN 59,36% : 39,81% Corresponding author: Mr Ozhasenekler Ayhan ([email protected])
•MEAN AGE 31,84 años Key-words: foreign body ; tea spoon ; emergency
•ATTENDANCES/YEAR/PAC 2,47
•DIGITAL PRESCRIPTIONS 677 Introduction: Inadvertent foreign body ingestion is generally seen
•BANAL PATHOLOGY 50,4% in infants and young children. Infants tend to bring every object to
•IMMEDIATE ATTENTION 5,54% their mouth. These objects may be anything they can swallow.

BOOK OF ABSTRACTS 364

Older children, on the other hand, may inadvertently swallow Tetanus prophylaxis and wide-spectrum antibiotics were begun.
foreign objects they play with. We report in this paper a case of The patient was referred to a tertiary center for penile
foreign body swallowing of a 12-year-old boy swallowing a tea reconstruction.
spoon after he had bent it while playing. Our aim was to draw Case 2: A sixty-seven-year-old male patient was bitten by his own
attention to foreign body swallowing incidents in infancy and horse from his genital region. He was brought to our clinic two
childhood. hours later with total penile amputation and amputated part
Case: A 12-year-old male patient was referred by another center brought with. Amputated part was necrotic. He told that he had
with foreign body swallowing. He inadvertently swallowed a tea been using warfarin for 10 days against deep vein thrombosis. His
spoon he had bent while playing with it, one hour ago. He was general condition was good, he was conscious, blood pressure was
brought to a different clinic with chest pain and difficulty in 130/85 mmHg, pulse rate was 95 bpm. On physical examination,
swallowing. His past history was unremarkable. His general distal part of the penis was amputated and the bleeding had been
condition was good, he was conscious, GKS was 15. On physical stopped with pressure dressing. His INR was 5.7, and prothrombin
examination, he was nervous and had an increased salivation. time was 73.5, other laboratory tests were in normal limits. He was
Other systems were normal. Posteroanterior chest X-Ray showed given tetanus prophylaxis and wide-spectrum antibiotics. Warfarin
an opacity consistent with a tea spoon folded in two at the distal was stopped, fraxiparine was begun and fresh frozen plasma was
1/3 part of the esophagus. The patient was consulted with given. A cystostomy was performed. Foley catheter was placed.
pediatric surgery. After entering esophagus with flexible Operation for amputated part was contemplated but since it is
endoscope, the foreign body was removed with the help of a necrotic, only stump revision was made. He was discharged on day
forceps. No complication developed and the patient was 4 with foley catheter in place.
discharged after an appropriate monitorization period. Discussion: Animal bites are rare in traumatic penile amputations,
Discussion: Foreign body ingestion is most commonly seen dog bites are more common. Horse bites leading to penile
between 6 months and 3 years of age. The most common ingested amputations are mostly seen in rural regions. Prevention of
foreign bodies are coins, toys, toy parts, magnets, watch batteries, infections is paramount in animal bites. Typically Pasteurella
staples, pins, bone pieces, and big morsels. It is uncommon to Multicoda infection develops. The primary treatment in such
ingest materials used daily such as spoons or tooth brushes. patients is reimplantation of the amputated organ.
Foreign bodies generally caught by physiologic narrowings of As a conclusion, the length of post-amputation duration, transport
esophagus which are, in descending order, upper esophageal of amputated part under adequate conditions, and degree of
sphincter, level of arcus aorta, and lower esophageal sphincter. damage of amputated part are the main factors influencing the
Most of these bodies are removed spontaneously; however, 10- success of reimplantation.
20% may require endoscopic or rarely surgical intervention.
As a conclusion, it should be remembered that foreign body P658 ________________________________ Other - Part 2
ingestion may be encountered in every age group although it is
more common under the age of 3; the families should be warn SIDE EFFECTS OF INTRAVENOUS ADRENALINE
about this danger since it is common in infants.

P657 ________________________________ Other - Part 2 E Acar, CS Tanrıkulu, S Karaman, H Şahin

TRAUMATIC PENILE AMPUTATIONS DUE TO HORSE BITE: Emergency department, Erzurum district education and research hospital, Erzurum,
REPORT OF TWO CASES Turkey
HM Durgun, C Guloglu, M Orak, A Ozhasenekler, M Corresponding author: Mr Acar Ethem ([email protected])
Ustundag Key-words: Adrenaline ; side effects ; emergency department

Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey Introduction
Corresponding author: Mr Ozhasenekler Ayhan ([email protected]) Adrenaline has many functions in the body, regulating heart rate,
Key-words: penil amputation ; horse bite ; emergency blood vessel and air passage diameters, and metabolic shifts;
Adrenaline release is a crucial component of the fight-or-flight
Introduction: Genitourinary trauma is more common in men than response of the sympathetic nervous system. Adrenaline is used to
women, which is due to both anatomical differences and more treat a number of conditions including: cardiac arrest, anaphylaxis,
active state of men in society. Genital traumas in men may be seen and superficial bleeding. Due to its vasoconstrictive effects,
in all age groups due to fall on blunt, sharp objects and animal adrenaline is the drug of choice for treating anaphylaxis.
bites, particularly by dogs. The most common animal bites are by Anaphylaxis is treated with 0.3-0.5 mg subcutaneous (SC).The
cats and dogs, although rarely bites of other animals may be implementation of adrenaline accidentally leads to serious side
encountered. Two cases of total penile amputations due to horse effects out of these indications. In this study, a case is presented
bite were reported in this paper. that it was considered anaphylaxis and should have been done SC
Case 1: An eleven-year-old male patient was bitten by an unowned for adrenaline, but intravenous (IV) was applied accidentally.
horse while he was trying to get on it. He was brought to our clinic Case
with total penile amputation 1 hour after the incident. His general This case was observed because adrenaline-IV applied by mistake
condition was good, he was conscious, blood pressure was 120/70 instead of SC for 16-year-old female patient. She applied to
mmHg, and pulse rate was 105 bpm. On physical examination, Emergency Department with breath shortness complaint.
distal ½ penis was amputated with active bleeding from the stump. According to patient story, she used bronchodilator for asthma;
The amputated distal part was not brought with the patient. His had lung widespread bronchi on physical examination, and also
other systems were normal on examination, so were the laboratory applied B-mimetic treatment. It was learned that anaphylactic
tests. Wound hemostasis was achieved and wound care was made. reactions were thought due to increasing breath shortness and
being cyanosis by following treatment. Thus, adrenaline application
was planned, but 1 mg IV was applied accidentally. Patients were
monitored. Blood pressure was 140/80 mmHg, and rhythm sinus

BOOK OF ABSTRACTS 365

heart rate was 135 beats per minute. On physical examination, P660 ________________________________ Other - Part 2
conscious was open; there was no uvula edema; the patient's lungs
was natural, but she severe headache. After approximately 10 ARE ACCIDENT AND EMERGENCY PATIENTS GETTING
minutes, her orientation was deteriorated and agitations were OLDER AND SICKER?
begun. Brain CT was normal. Analgesic was done for headache and S Hill (1), R Jarman (2), S. Parker (1)
fluid replacement, but agitation continued approximately 1 hour,
and headache continued approximately 2 hours. Then they were 1. Newcastle Medical School, Newcastle University, Newcastle, United Kingdom
recovered. The patient was followed for fluid replacement with 2. Accident and Emergency department, Queen Elizabeth Hospital, Gateshead, United
monitor, and her vitality was evaluated at frequent intervals, and Kingdom
there was no additional complaint. Corresponding author: Melle Hill Susanna ([email protected])
Result Key-words: Accident and emergency ; Ageing population ; Triage
Anxiety, irritability, headache, chills, dizziness, nervousness,
insomnia, agitation, nausea, vomiting, color fading, tachycardia, Background: The population of the UK is changing. As people are
palpitations, ECG T flattening, hypertension, hypotension, and living longer they are more likely to be living with a long term
arrhythmias may occur as a side effect of adrenaline. It is health condition requiring the services of the NHS(1). In accident
important monitored following and hydration with plenty of fluid and emergency (A&E) departments, previous studies have
for such patients demonstrated that the time taken to manage patients and the
number of investigations performed increased with the age of the
P659 ________________________________ Other - Part 2 patient(2).
The Manchester Triage System(3) is used at Queen Elizabeth
SPONTANEOUS EPIDURAL HEMATOMA IN SICKLE CELL Hospital (QEH), Gateshead, UK, to classify patients into an
ANEMIA PATIENT appropriate priority category [P1 to P5] to determine the urgency
A. Karakus, K Calıskan, G. Kuvandık, M. Duru, V Tasın, I in which they require treatment. Changes in the acuteness of
Gencay patients’ conditions may also impact on the time required to treat
them as well as on the staffing levels, space and resources needed
Department of Emergency Medicine, Mustafa Kemal University,Faculty of Medicine, to run an efficient A&E department.
Hatay, Turkey Aims: To identify whether there have been demographic changes
Corresponding author: Mr Karakus Ali ([email protected]) in patients attending A&E at Queen Elizabeth Hospital, Gateshead,
Key-words: Spontaneous epidural hematoma ; sickle cell anemia ; emergency department UK from 2003-2012.
To identify whether there has been a change in the pattern of
Intracranial bleeding is uncommon and serious complication of patients presenting most acutely unwell (as P1 or P2) to A&E at
sickle cell disease (SCD). A few cases of spontaneous epidural Queen Elizabeth Hospital from 2006-2012.
hemorrhage have been reported. The real cause of epidural Methods: Numbers of attendances to A&E each year and
hemorrhage is not well known in this patient, but it is probably due demographic data (age, triage category) were collected from the
to vaso-occlusive episodes and tearing of small vessels. Neurologic “Symphony” database from 2003-2012 (544,727 attendances).
complications of SCD include stroke, both ischemic and Further demographic data, including presenting complaint, were
hemorrhagic, as well as epidural hemorrhage. In some cases, vague obtained from Symphony for 862 attendances. Data were collected
symptoms consistent with a transient ischemic attack may be for all patients presenting as a P1 or P2 on the first day of every
present as potential warnings of impending stroke. The cause of month for the years 2006, 2007, 2008, 2010 and 2012.
stroke in most patients is cerebral infarction because of occlusion Results: From 2003 to 2012, patients requiring the most urgent
or narrowing of cerebral vessels. We report a case have epidural treatment have increased (category P1: +63% P2: +184% and P3:
hematoma in the absence of trauma, thrombocytopenia or any +71%) and less urgent patients have decreased (category P4: -25%
detectable haemostatic defect. Emergency physicians thought that and P5: -43%).
it should not forget. There has been a 9% increase in total patients attending A&E from
18 year old female patient two days ago hospitalized because of 2003 to 2012, and a disproportionate 53% increase in patients over
progressive back and neck pain. In first day no complaints other the age of 75 attending A&E.
than pain. She felt pain in the back of the neck especially. Because The percentage of adult attendances that were admitted also
of the change in consciousness, patient referred to our hospital. increased by 8.5% from 2003 to 2012.
Physical examination: temperature:36,7 °C, pulse: 95/min, blood The average age of a category P1 patient (56) is greater than that
pressure: 100/80 mm/hg, sPO2: %98,Glasgow coma scale: of P2 (52) and both are greater than the average age of all A&E
10(v:2,e:3,m:5), No trace of the head and neck trauma, natural patients combined (39).
pupils, bilateral light reflex and other reflexes are normal, norma- The average age of all A&E attendees, P1’s and P2’s have increased
active deep tendon reflexes. Other system examinations were from 2006 to 2012
normal. Laboratory values; Hb:7,46 g/dl, Hct:%21,8, Plt:122000 , Chest pain, shortness of breath, abdominal pain, limb problems
Wbc: 5000, Ure:15 mg/dl, Cre:0,61 mg/dl, Glu:123 mg/dl, AST/ALT: and ‘unwell’ were the most common complaints presenting to A&E
57,4/10 U/L, Na:141 mmol/L, K:4,06 mmol/L, Cl:107,9 mmol/L, from 2006 to 2012. Numbers of patients presenting as ‘unwell’ or
T.bil/D.bil: 2,04/0,4 mg/dl. Other laboratory values were normal. with chest pain increased from 2006 to 2012.
For our patient principally ischemic origin was thought by Conclusions: There are many reasons why the number of acutely
hematologist. But we determined epidural hematoma in the unwell patients presenting to Queen Elizabeth Hospital A&E has
absence of skull fracture with non-contrasts brain CT (Resim 1.) increased. These results demonstrate that an ageing population is a
Key Words: Spontaneous epidural hematoma, sickle cell anemia, likely contributing factor. Increased public awareness of common
emergency department acute conditions (Myocardial infarction, stroke) and the publics
demand for more immediate, convenient treatment may also play
a part.

BOOK OF ABSTRACTS 366

As the population continues to shift towards an increase in older P662 ________________________________ Other - Part 2
people, numbers of patients presenting as acutely unwell in A&E
patients are likely to increase. These results are of particular TRENDS OF CT USE IN THE PEDIATRIC EMERGENCY
relevance when considering both the staffing and resources DEPARTMENT IN A TERTIARY ACADEMIC HOSPITAL OF
required by the A&E department. More acutely unwell patients KOREA DURING 2001 - 2010
require more time and input from senior staff and greater J Cho (1), EY Kim (2), HJ Yang (1)
resources to assess and treat them. An increase in the number of
staff, particularly at a senior level, may be necessary to reflect the 1. Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea,
increase in both the number and the severity of acutely unwell (South) Republic of
patients seen in A&E at the Queen Elizabeth Hospital. 2. Department of Radiology, Gil Hospital, Incheon, Korea, (South) Republic of
References Corresponding author: Mme Kim Eun Young ([email protected])
1.Department of Health. Working together for a stronger NHS. Key-words: Computed Tomography ; Pediatric ; Emergency Department
London. 2011.
2.George, G. Jell, C. Todd, B. Effect of population ageing in Objective: We wanted to assess the trends of computed
emergency department speed and efficiency: a historical tomography (CT) examinations in a pediatric emergency
perspective from a general hospital in the UK. Emergency Medicine department (ED).
Journal. 2006, 23; 379-383 Materials and Methods: We searched the medical database to
3.Mackway-Jones, K. (ed.) Emergency Triage: Manchester Triage identify pediatric patients who had visited the ED and the number
Group. London; BMJ Publishing Group. 1997. of CTs from January 2001 to December 2010. We analyzed the
types of CTs according to anatomic region and the patients who
P661 ________________________________ Other - Part 2 underwent CT examinations for multiple regions. Data were
stratified according to the patient age (<13 years and 13 ≤ ages <
TRENDS OF CT USE IN THE ADULT EMERGENCY 18 years).
DEPARTMENT IN A TERTIARY ACADEMIC HOSPITAL OF Results: The number of CTs per 1000 patients increased by 92%
KOREA DURING 2001 - 2010 during the 10-year period (per 1,000 patients, increased from 50.1
J Cho (1), EY Kim (2), HJ Yang (1) CTs in 2001 to 156.5 CTs in 2006, and then decreased to 96.0 CTs in
2010). Although head CTs were performed most often (74.6% of
1. Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, Korea, all CTs), facial bone CTs showed the largest rate of increase
(South) Republic of (3188%) per 1000 patients, followed by cervical CTs (642%),
2. Department of Radiology, Gil Hospital, Incheon, Korea, (South) Republic of abdominal CTs (474%), miscellaneous CTs (236%), chest CTs (89%)
Corresponding author: Mme Kim Eun Young ([email protected]) and head CTs (39%). Patients who had CT examinations for multiple
Key-words: Computed Tomography ; Adult ; Emergency Department regions in the same day showed a similar pattern of increase with
that of overall CT examinations. Increase of CT utilization was more
Objective: We wanted to assess the trends of computed pronounced in adolescents than in pediatric patients younger than
tomography (CT) examinations that were conducted in an adult 13 years (189% vs. 59%).
emergency department (ED). Conclusion: Utilization of CTs increased from 2001 to 2006 and has
Materials and Methods: We searched the medical database to declined since 2006. Increase of CTs was more pronounced in
identify adult patients (≥18 years) who’d visited the ED and the adolescents and facial bone CTs showed the greatest increase,
number of CT examinations of the patients during the period from followed by cervical CTs, abdominal CTs, miscellaneous CTs, chest
January 2001 to December 2010. We also analyzed the types of CT CTs, and head CTs.
scans performed by body part as follows; head CTs, facial bone CTs,
cervical CTs, chest CTs, abdominal CTs, and miscellaneous CTs. And P663 ________________________________ Other - Part 2
miscellaneous CTs were subdivided as CT angiographies and et
cetera. SELF REPORTED USE OF GUIDELINES AMONG EMERGENCY
Results: A total of 113,656 CT scans were examined for 409,439 MEDICAL COMMUNICATION CENTER OPERATORS – A
adult ED patients during the 10-year period, and the number of CT QUESTIONNAIRE BASED SURVEY
scans increased by 255% (from 4,743 CTs in 2001 to 16,856 CTs in EN Ellensen (1), T Wisborg (2), S Hunskår (3), E Zakariassen
2010), while the adult ED patient volume increased by 34% during (1)
the period. Although the head CTs occupied proportionally the
most, the facial bone CTs revealed the largest rate of increase 1. Research department, Norwegian Air Ambulance Foundation, Drøbak, Norway
(3118%), followed by cervical CTs (1173%) and chest CTs (455%), 2. Anasthesia and Critical Care Research Group, Faculty of Health Sciences, University of
miscellaneous CTs (388%; 862% and 84% for CT angiographies and Tromsø, Tromsø, Norway
et cetera, respectively), abdominal CTs (315%) and head CTs (95%) 3. National Centre for Emergency Primary Health Care, Uni Health, Bergen, Norway
per 1000 patients for a decade. Corresponding author: Mme Ellensen Eirin ([email protected])
Conclusion: Utilization of CT scans has increased at a rate that far Key-words: Dispatch ; Guidelines ; Compliance
exceeds the growth of the ED patient volume, with facial bone CTs
and cervical CTs increasing the most, followed by chest CTs, Objective
miscellaneous CTs, abdominal CTs and head CTs. The Norwegian Index for Medical Emergency Assistance (Index) is
the criteria-based dispatch guidelines used by the Emergency
Medical Communication Centers (EMCCs) in Norway. The
electronic version is under development, but for now the EMCCs

BOOK OF ABSTRACTS 367

still use the paper version, an A3 flip over desk protocol. After 18 Methods: we compared the characteristics of acute upper
years the Index’ validity is still unknown. Furthermore, there are no gastrointestinal bleeding in the old patients, (defined as the
data on the operators’ compliance with the dispatch guidelines patients >70 years) with patients under 70 years issued from a
when answering an emergency medical phone call. As a step prospective multicentre study (6 emergency departments).
towards the validation process, we invited all EMCC operators in Analysed parameters concerned characteristics of patients,
Norway to answer a questionnaire regarding their use of Index. The endoscopic data and outcome.
objective was to determine their self-reported compliance with the Results: During the study, 253 presented at emergency department
dispatch guidelines. with haematemesis or melaena and were analysed. Eighty-four
Methods patients (33%) were diagnosed with cirrhosis. 82 were >70 y old
The EMCCs were asked to distribute the questionnaire to all their (Group old: GO) and 171 <70 y old (Group young: GY). There were
employees with primary task to answer emergency medical phone 45 males in GO (55%) vs. 136 in GY (80%) (p<0.0001). There was no
calls. All 19 EMCCs in Norway participated, distributing a total of difference in terms of initial shock, initial hemoglobinemia, oxygen
443 questionnaires. A prepaid return envelope was attached to therapy, admission in ICU, quality of gastrointestinal tract
each questionnaire to secure no management involvement in the visualisation, rebleeding and death at one month. There were less
answering process, thus securing anonymity. We analyzed total use cirrhosis in GO than in GJ (7% vs. 45), uremia was higher in GO than
of flip over paper version, specific use of start page, and reasons in GY (17 moles/l vs. 11). Patients of GO were more frequently
for not using either one. transfused than of GY (83% vs. 66, P<0.005). There were more
Results undetermined lesions in GO than in GJ (31% vs. 14, P<0.006)
251 questionnaires were returned, all EMCCs were represented, Discussion: In elderly people with gastrointestinal bleeding,
giving a response rate of 56.7 %. 32.3 % of the responders claimed morbidity and mortality is determined by both the nature of the
to use the flip over Index always during an emergency medical bleeding lesion and the presence of comorbid conditions. In such
phone call, while 75.7 % used it often or always (> 75 % of the patients, immediate attention should focus on hemodynamic
calls). The start page, which includes important questions like stabilization and diagnostic evaluation. Although the initial
location and the patient’s state of consciousness and breathing, hemodynamic status of elderly people did not differ from the
was always used by 21.5 %, whereas 47.0 % used it often or always young group, the old people were more transfused than the young
(> 75 % of the calls). people. As previously described, the prevalence of cirrhosis is weak
The main reason for not using the flip over Index, in general or the in elderly people and peptic ulcer disease is the most frequent
start page in particular, was reported to be the perception of source of acute upper gastrointestinal bleeding. Endoscopy can be
knowing the content very well. performed safely but the efficiency to determine the cause of the
Conclusion bleeding seems to be lower than in younger patients. Prognosis of
There is a mismatch between the criteria based system’s required elderly did not differ in our study, but this could be explained by
active use of the guidelines and the actual self reported use by the the high prevalence of cirrhosis in the young group and the loss of
operators. The main reason for not using the flip over Index was statistic power.
reported to be the operators’ belief that they know it by heart. Conclusion: Acute upper gastrointestinal bleeding in elderly is
Whether that is true, is yet to find out. characterised by a high prevalence of peptic ulcer disease and a
weak prevalence of cirrhosis. Elderly people are more transfused
P664 ________________________________ Other - Part 2 than the others due to co morbid conditions. The diagnostic
endoscopic performance is lower than usually described.

UPPER GASTROINTESTINAL BLEEDING IN THE ELDERLY AT P666 ________________________________ Other - Part 2
EMERGENCY DEPARTMENT
F Adnet (1), E Debuc (2), O Gardy (3), C Hermand (2), D THROMBOEMBOLIC DISEASE AND THROMBOPHILIA IN AN
Pateron (4), P Ray (4), E Vicaut (5) EMERGENCY DEPARTMENT
I. Blasco-Esquivias, R. Vera-Cruz, P. Salamanca-Bautista, M.
1. Emergency Medicine, Hopital Avicenne, APHP, Université Paris 13, Bobigny, France Vaquero-De Sedas, J.L. Pérez-Alonso, C. Navarro-Bustos.
2. Emergency department, Hopital Saint-Antoine, Paris, France
3. Emergency Department, Hopital Saint-Antoine, Paris, France Emergency department, Hospital Virgen Macarena, Sevilla, Spain
4. Emergency Medicine, Hopital Saint-Antoine, APHP, Université Paris 6, Paris, France Corresponding author: Melle Salamanca Prado ([email protected])
5. Unité de recherche clinique, Hopital Fernand Widal, APHP, Université Paris 7, Paris, Key-words: Thromboembolic disease ; Emergency department ; Thrombophilia
France
Corresponding author: Mr Pateron Dominique ([email protected]) INTRODUCTION: Venous thromboembolic disease (VTD) is a
Key-words: gastrointestinal bleeding ; elderly ; endoscopy pathology that encompasses deep venous thrombosis (DVT) and
pulmonary embolism (PE) and conditioned by the interaction of
Acute upper gastrointestinal bleeding is a common medical genetic, acquired and environmental factors that determine the
emergency with a high morbidity and mortality rate. Global appearance of a thrombotic episode.
incidence of acute upper gastrointestinal bleeding has decreased Annual incidence of VTD is 1 case per 1.000 inhabitants among
these last ten years, but this decrease was not observed in old general population, being more prevalent in the elderly as its
patients. In the elderly, the nature, severity and outcome of increases with age until reaching 1% incidence in people older than
bleeding are influenced by the presence of comorbidities and the 75 years old.
use of drugs. Age is known to be by itself a prognostic factor. Few Genetic risk factors are present throughout life in 55-60% of the
studies concerning the elderly people with acute gastrointestinal patients with VTD and cannot be modified.
bleeding at emergency department (ED) have been yet performed. 5% of the VTD cases are deadly, especially due to PE.
This study analysed the characteristics of acute upper
gastrointestinal bleeding in the old patients (>70 years) compared
with patients under 70 years, admitted in emergency department.

BOOK OF ABSTRACTS 368

Thrombophilia is a group of heterogeneous alteration that P667 ________________________________ Other - Part 2
conditions an increased trend of suffering thrombosis. Two types
are described: acquired and congenital. ABDOMINAL PAIN IN PATIENTS ADMITTED IN THE
AIMS: The aim of our study is to conduct a retrospective EMERGENCY DEPARTMENT OBSERVATION AREA IN A
descriptive analysis of a cohort of patients with VTD and PRIVATE HOSPITAL
thrombophilia, analyzing their distribution by gender, age and OJ Simón (1), J Robles (3), R Gambero (2), S Soler (1), R
mode of presentation, most frequent thrombophilia, incidence Sabes (1), C Morales (1), F Moya (1)
according to gender and correlation between the mode of
presentation of VTD and thrombophilia, as well as associated 1. Emergency Department,Hospital Xanit Internacional, Benalmadena, Málaga, Spain
acquired risks. 2. Laboratory and Clinical Analysis, Hospital Xanit Internacional, Benalmadena, Málaga.
METHODOLOGY: A retrospective descriptive study of a cohort Spain
including 606 patients with a diagnosis of VTD from the E.R. Unit in 3. Intensive Care Unit, Hospital Xanit Internacional, Benalmadena, Málaga, Spain
the latest 5 years. It was revised by a VTD monographic Corresponding author: Mr Simón Padilla Oscar Jerónimo ([email protected])
consultation area from the E.R. Key-words: abdominal pain ; emergeny ; obsevation area
RESULTS: Of the 606 analyzed patients 16,83% presented
thrombophilia. Gender distribution was 53% men and 47% women. OBJECTIVE: To determine the prevalence of abdominal pain in
In both of them, increased factor VIII was the most frequent patients admitted to ED observation area of a private hospital, and
thrombophilia. Mean age was 60,12 years. Mode of presentation: the characteristics of patients with this presentation and the final
94 patients shoed DVT, 63,83% of them were proximal and 36,17% diagnosis of the process.
were distal. In 3 patients 2,94% PE was confirmed and 3,92% has MATERIAL AND METHODS: A descriptive study without therapeutic
SVT. Thrombosis distribution: In 3 patients 3,22% it was located in intervention for 12 months, among patients admitted for
the upper limb, 2,15% in the right arm and 1,08% in the left arm. In abdominal pain in the observation area of a private hospital (N =
40 patients 43,01% DVT in the right leg was observed and in 512), obtaining data on age, sex, length of stay entered,
53,76% in the left one. The most frequent thrombophilia: increased destination on discharge and final diagnosis after the study of
factor VIII 41,18%; hyperhomocysteinemia 23,53%; prothrombin these patients. We obtained data from our internal Medyction
20210A 16,67%. In SVT the most frequent thrombophilia was FVL program, and processed using Microsoft Excel 2011.
50%, in DVT increased factor VIII 46% and in PE RESULTS: Of the patients admitted for abdominal pain, the average
hyperhomocysteinemia 41%. The most frequently associated age of the patients was 47,3 years old, 60,9% were women,
acquired risk factor was obesity followed by immobilization. average time spent 155,6 minutes, the main destinations were
DISCUSSION: Almost half of the patients with VTD have an home (52,68%) and admission by the Department of Internal
identifiable congenital cause for their hypercoagulability. Data Medicine (22,7%). The most common diagnosis was acute
from our study cannot prove this fact, as only 16,83% of our gastroenteritis (41,07%), followed by non specific epigastric pain
patients present thrombophilia. (7,08%) and appedicitis (4,3%).
According to published data, there isn’t a clear predominance of CONCLUSIONS: This study showed that the prevalence of
any gender when presenting the first episode of VTD. In out cohort, abdominal pain as main complaint in our hospital is 26,76%, being
distribution was similar 53% men and 47% women. the most frequent diagnosis of acute gastroenteritis. Most patients
Mean age was 60,12 years old. are discharged home after being evaluated in the emergency
The most frequent mode of presentation was DVT, especially department of our hospital. The average age of patients with this
proximal in the left leg. picture is 47,3 years old, being more frequent in women
In different series, factor VIII appears in 25% of the patients with
VTD and, when increased, the risks of suffering VTD is multiplied by P668 ________________________________ Other - Part 2
1,5. Hyperhomocysteinemia shows a prevalence of 10-20%. In our
patients, factor VIII was the most frequent alteration (41,18%) THE SATISFACTION DEGREE OF PATIENT'S RELATIVES IN
while homocysteinemia appears in 23,53% of the analysed EMERGENCY DEPARTMENT OF AN UNIVERSITY HOSPITAL
patients. The most common genetic alteration for VTD, except for IN TURKEY
factor V Leiden, is the mutation of the gene encoding prothrombin O Akdur (1), O Aydın (2), E Guzeldere (3)
G20210A. In our patients, prothrombin 20210a appears in 16,675
of the cases and FVL in 15,67%. 1. Emergency Medicine, Canakkale Onsekiz Mart University Medical Faculty Emergency
In several cases, a combination of two or more factors was Medicine, CANAKKALE, Turkey
observed. 2. Emergency, Canakkale Onsekiz Mart University Research and Application Hospital,
CONCLUSIONS: Emergency, Turkey
1.Thrombophilia is an important casue of VTD. 3. Emergency, Canakkale Onsekiz Mart University Research and Application Hospital,
2.Gender distribution was similar in our patients. Mean age of Emergency Medicine, Turkey
60,12 years old and the most frequent thrombophilia, in relation to Corresponding author: Mr Okhan Akdur ([email protected])
gender distribution, is increased factor VIII. Key-words: Medicine, Emergency ; Satisfaction, Patient ; University Hospitals
3.The most common mode of presentation is DVT, proximal in the
left leg. The pleasure range of patients and their relatives is one of the
4.The most common congenital thrombophilia in our patients are important criterias for evaluation the qualification of exhibited
factor VIII, hyperhomocysteinemia and prothrombin 20210A. health service. Emergency Services are departments in where
5.FVL, the most frequent congenital thrombophilia, is in fourth employment is given consistently to patients and their relatives
place in our study and it is the most frequent mode of presentation and also these places are the ones at where the hospitals
in SVT. In DVT this is factor VIII and in EP it is
hyperhomocysteinemia.
6.The most frequent acquired factor is obesity, followed by
immobilization.

BOOK OF ABSTRACTS 369

communicate with population in whole world. But the factors recognized as potentially dangerous for humans. Scorpion
impressed the pleasure levels of patients and especially their envenomation is common in and around Malatya.
relatives could not be exerted totally. The aim of this study is to Objective: The aim of this study is to describe the circumstances
evaluate the pleasure levels of patient's relatives in Emergency and clinical effects of stings scorpions in Beydagı, Malatya, Turkey.
Departments and make contribution for the development of health Methods: Fifty four patients with scorpion sting were collected
service given in Emergency Services. prospectively from presentations to emergency departments of
This anterograd complementary study was carried out with Malatya State Hospital from June 2010 to November 2010. The
patient's relatives who are over 18 years and can dial with us and following information were prospectively recorded:
appealed to the emergency department in daytime between demographics(age, gender), circumstances of the sting(location,
01.03.2012 and 31.05.2011.In this study, we wanted from patient's time, date, activity at the time), sting site, local and systemic
relatives to declare their closeness degree and arrival form, their effects, vital signs(heart rate, respiratory rate, systolic and diastolic
demographic informations, the problems they had in emergency blood pressure), past medical history. Blood samples were
room, difficulties and their pleasure levels. Informations taken collected for evaluation of biochemical and cardiac panel studies.
from study was evaluated with “SPSS for Windows, Version 10.0”. ECG recordings were gathered. The patients were monitored after
The study included 108 patients. The mean age of patient's their history and physical examination. Patients were examined at
relatives was 38.2±13.2 years and 51 of these were men (%47.2). least every 6 h for the first 24 h and daily thereafter. Biochemical
Closeness degree in % 69.4 (75 persons) was 1. degree; %12 (13 investigations were repeated 24 h later. The patients who had
persons) was 2. degree and %18.6 (20 persons) was just friends. hypertension were treated with sublingual captopril. Diklofenak
%89 of patient's relatives said that they had not a difficulty about Sodyum (Dikloran® 75 mg ım. ampoule, Deva, Turkey) was
finding emergency room entrance but 6 persons (%5.5) told they performed to the patients who had mild and severe pain.
had difficulty with registration. 88 persons said they were satisfied Results: A total of 54 subjects were recruited during the 6 month
with waiting room and there must be mostly newspaper, book, period. Of victims, 59.3%(n=32) were females, and 40.7% (n=22)
journal, suitable chair, cafe, and a system on where they follow were males with a mean age of 34.2 (range 11-80 years old). The
their patients in there. Relatives of 19 patient's (%17.6) said they majority of (85.2%) stings occurred in the warmest months (July
had parking problem and 18 (%16.7) said they were not satisfied and August) throughout Beydagı, Malatya. Of stings, 14.8%
with the cleaning of emergency room. 35 persons (%32.4) were occurred between 24:00 -06:00, 27.8% between 06:00 -12:00,
satisfied for interest too much, 31 persons (%28.7) indicated the 27.8% between 12:00-18:00, and 29.6% occurred between 18:00-
interest as normal. 44 patient's relatives (% 40.7) were too much 24:00 o’clock. Stings occurred to all parts of the body, with 48.1%
pleased of interest of nurses worked in emergency department and upper extremities (hand and arm), 40.7% on the lower extremities
24 (%22.7) said that the interest was normal. The interest of (leg, foot wrist and finger), 7.4% on the trunk, and 3.7% on the
doctors was too fine for 52 persons (%48.1) but normal for 22 head/neck. In this study, signs of envenoming were 94.5% pain,
relatives (%20.3). While the comfort of emergency department 47.6% numbness and 1.8% edema. Systemic effects that occurred
evaluated as too fine by 27 patient's relatives (%25), 29 persons in victims were including nausea-vomiting (13.3%), chest pain
(%26.8) evaluated it as normal. While the general satisfaction from (7.5%) and headache(6.7%). The most common
the service given in emergency department was too fine for 36 electrocardiography sign was tachycardia (7,4%). There was an
persons (%33.3), 47 of those (%43.5) evaluated as fine, 22 (%20.4) increase of CK and CKMB on 27.7% of patients but no increase of
as normal, 2 (% 1.9) as bad and 1(%0.9) as too bad. troponin . There were no cases of hypersensitivity reactions,
As the consequence; emergency departments are for answering cardiogenic shock and pulmonary edema.
the needs of patients and their relatives. The satisfaction of Conclusion: Medically significant scorpion stings are almost
patient's relatives must be kept in view during the duty. Education universally characterized by intense local pain, usually without local
of personnel is essential to realize this. Experience of emergency tissue injury. Systemic effects occur in a smaller proportion of
service personnel and education of them about behavior, scorpion stings, depending on scorpion species involved and are
communication and notification are effective positively on the caused by a variety of excitatory neurotoxins.
quality of duty given. Generally, scorpion stings appear to cause mild effects in Turkey.
Severe or life-threatening effects were detected in 0,9% patients.
P669 ________________________________ Other - Part 2 Scorpion stings occurred in and around Malatya region do not
appear to cause severe or life-threatening effects.

THE EPIDEMIOLOGICAL AND CLINICAL PROPERTIES OF P670 ________________________________ Other - Part 2
SCORPION ENVENOMATION IN BEYDAGI, MALATYA,
TURKEY THE AWARENESS AND PERFORMANCE OF THE FORENSIC
M İÇER, Y ZENGİN, HM DURGUN, MN GÜLLÜ, E GÜNDÜZ, A NURSING ROLE IN EMERGENCY DEPARTMENTS
ÖZHASENEKLER MH Han (1), HS Hong (2)

Emergency department, Dicle University, Diyarbakir, Turkey 1. Emergency department, Seoul National University Hospital, Seoul, Korea, (South)
Corresponding author: Mr Zengin Yilmaz ([email protected]) Republic of
Key-words: epidemiology ; Malatya ; Scorpion sting 2. College of Nursing, Kyungpook National University, Deagu, Korea, (South) Republic of
Corresponding author: Melle Han Mi Hyun ([email protected])
Introduction: The scorpionism and its consequences are an actual Key-words: Awareness ; Forensic nursing role ; Performance
public health problem in several parts of the world. Scorpion
envenomation is common in certain areas of the world including Study Objectives: This study attempted to measure the awareness
the Middle East, Latin America, Africa and India. Approximately and performance of the forensic nursing role among the
1500 species of scorpions are described. About thirty of them are emergency department (ED) nurses to emphasize the presence of

BOOK OF ABSTRACTS 370

forensic nurses in ED and suggest encouraging essential forensic decision making while female had her duty on taking care of family
nursing education. members and complied with her husband’s requirements. Violence
Methods: From June 7 to June 15, 2012, a quantitative descriptive was divided into 3 groups by those abused wives as; 1)
survey using a questionnaire was carried out to the nurses, who psychological violence – their husbands had close relationship with
had a minimum of 6 months experience in the ED. This study other women, 2) physical violence and 3) sexual violence. When
conducted at 7 hospitals in Republic of Korea. The study was they were faced with violent problems they would mainly assess on
approved by the institutional review boards at all sites. more physical and psychological violence. If those circumstances
Results: A total of 124 nurses were enrolled. As to the question on did not harm themselves and family members, they would be still.
‘Awareness of the role of forensic nurses’, 44.4% answered ‘Not at If there was more violence, they would adjust their emotions, be
all’. 54.0% responded ‘A little’, no one answered ‘Most of it’ and patient and comply with their husband’s requirements. Finally, if
1.6% selected ‘Know exactly’. As to the Awareness of the forensic such violent circumstance was still occurred, they would sue in
nursing role, all the core data obtained an average of 3.39 points accordance with their legal rights, divorce or separate.
out of 4 points, and the documentation category was the highest
score of 3.57. The lowest score was contact category, which P672 ________________________________ Other - Part 2
acquired 3.10. For the performance of the forensic nursing role, all
the core data obtained an average of 2.50 points out of 4 points, UTILITY OF INFORMATION AND COMMUNICATION
and a documentation category acquired the highest score of 2.91. TECHNOLOGY IN DISASTER MANAGEMENT
However, a contact category was 2.13, which is the lowest score. A A Taotho, W Amornsongchai, N Buayen
degree of the awareness and performance of the forensic nursing
role according to a subject’s general characteristic had no Department of Trauma and Emergency Medicine, Phramongkutklao Hospital, Bangkok,
significant distinction. There is a significant correlation of (r=.452, Thailand
p=.000) the awareness and performance of the forensic nursing Corresponding author: Melle Taotho Artittaya ([email protected])
role. Key-words: information ; technology ; disaster management
Conclusion: Currently, the awareness regarding to forensic nursing
role is below par. Therefore, the performance of forensic nursing Purpose
role is also became low level. To conclude, Forensic nursing Information technology entails the collection, storage,
education is the essential part of ED nurses to preserve evidence dissemination, and management of information. Lack of disaster
accurately. information can cause catastrophes. Information and
communication technology (ICT) can greatly benefit disaster
P671 ________________________________ Other - Part 2 management.
Method
DOMESTIC VIOLENCE: A CASE STUDY OF ABUSED WIVES IN In 2011, Thailand Great Flood affected over 560 healthcare
NAKHON RATCHASIMA PROVINCE facilities; the worst-hit was the abruptly shut down Ayutthaya
J Deankhuntod hospital. Phramongkutklao Hospital (PMK), the largest military
hospital in Thailand, accomplished the medical evacuation of 122
Accident and Emergency, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, patients (14 intubated) from the Ayutthaya hospital, without
Thailand fatality. A retrospective study of the mission was carried out to
Corresponding author: Melle Rojtinnakorn Nitaya ([email protected]) demonstrate roles of ICT in disaster management.
Key-words: violence ; famyly violence ; domestic violence Result
Although hydrological data (rainfall, dam status, river and sea
This research aimed to study way of life, causal factors and level) and satellite images display can be used for early warning, it
methods for coping with domestic violence of abused wives. The was difficult to predict accurately flood depth and travel time
study was a qualitative research. Key informants were 5 abused because of water diversion, barriers, and urban drainage system or
wives who used services in Children and Women's Rights lack thereof. In addition to traditional telecommunication, two-way
Protection Center, Maharat Nakhon Ratchasima Hospital. Data was radios and mobile phones, various ICT applications had been
collected from February – December 2010 by in-dept interview, implemented by PMK team to facilitated the multi-modal (river,
observation and home visit . Content analysis was used for data air, land) evacuation and transportation to the remote receiving
analyzing. The research results revealed that: those abused wives hospitals such as Google Maps for naval rout planning, Google
aged between 29-58 years, duration of cohabitation between 3-37 Earth for terrain viewing, GPS positioning for en-route navigation,
years, 4 of them had registered their marriages, lived in warm GPS tracking for knowing real-time location of ambulances, Geo-
family among their childhood. All of them were thought to be informatics and space technology websites for aviation safety,
patient and good housewives, adhered to Thai good old traditions Multimedia Messaging Service for sending visual information of
and customs as well as honored family leaders. Expectations on patients, Biosignals telemonitoring of patients, personal mobile
their married life were to have their life’s partners for sharing both WiFi (MiFi) for providing wireless network connection at the
of happiness and suffering, to have their family leaders and did not incident command post, and electronic mailing referral letters or
want to fail of their married lives. For factors that caused violence, reports.
it was found that their husbands were aggressive, hot-tempered, Conclusion
flirt, drug addicts and alcoholics. Most of their families were in Effective disaster management relies on accurate information and
moderate level of economy without debts but wives had to earn data. ICT is of vital importance in minimizing the impact of
extra incomes and they were single family that had no one to warn disasters.
or assist while violence was appeared. Their social culture was
mixed by urban and rural culture and considered that nobody
should not concern with those abused wives. For recognition of
male and female’s role, it was found that male had his power on

BOOK OF ABSTRACTS 371

P673 ________________________________ Other - Part 2 Corresponding author: Mr Huh Jin ([email protected])
Key-words: external jugular vein ; subclavian vein ; central venous catheterization
PATIENTS PRESENTING WITH ALTERED MENTAL STATUS
DUE TO SUICIDE IN THE EMERGENCY DEPARTMENT Central venous catheterization via external jugular vein (EJV) can
M. Saritemur, S.T. Akgol Gur, A. Bayramoglu, A. Akoz, M. be unsuccessful in approximately 30% of patients due to the
Emet obstruction of the guide-wire by the fascia, clavicle, venous valve
or the acute angle of the junction with the subclavian vein (SCV).
Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey The aim of this study was to test the hypothesis that the angle
Corresponding author: Mr Saritemur Murat ([email protected]) between SCV and EJV is the major determinant in successful
Key-words: Suicide ; Altered Mental Status ; Emergency Department placement of catheter.
In eighty surgical patients, catheterization of the central venous
Introduction: In our country, the patients with altered mental system via an EJV was attempted using the Seldinger technique. If
status (AMS) due to a suicidal attempt are generally followed by the wire could not be placed in the Trendelenberg position, the
internal medicine clinic or anesthesia and were treated in intensive shoulder on the puncture side was elevated in the second attempt.
care units before the emergency services had started to work as a If catheterization was not successful after this manipulation, an
department. Some problems have been experienced in the additional lateral flexion of the head toward the puncture side was
treatment and follow-up of these patients. We aimed to study done in the third attempt.
whether there is a change of treatment or follow-up of these In the first attempt, catheterization was successful 47 times with
patients after emergency departments (ED) had been established. success rate of 58.6% (47/80). In 22 of 33 (66.7%) patients the wire
Method: The patients admitted to our ED with suicidal attempt and could not be placed successfully in the first attempt, manipulating
had AMS between 2008 and 2012 were reviewed retrospectively. the shoulder and neck enabled the wire to be placed successfully
Patients higher than 16 years old were included. Patients with (95% confidence interval: 0.501 - 0.838). The angle between the
Glasgow coma score (GCS) ≤ 14 were considered having altered EJV and the clavicle in the overall success was significantly more
mental status and GCS ≤8 were considered in a comatose state. than that in the failure group (77.9 vs 61).
Results: A total of 84 patients with AMS (GCS <15) admitted to our Shoulder manipulation and neck tilting to augment the angle
ED in the study period. Along with 220 control patients [attempted between SCV and EJV increased the success rate of the central
suicide without AMS (GCS = 15)], a total of 304 patients were venous catheterization via EJV.
studied. Of the patients with AMS, 54 (64.3%) were female and
mean age was 26.1 ± 10.1. GCS was ≤8 in 27 (32.1%) of these P675 ________________________________ Other - Part 2
patients. Of the patients considered comatose, 13 (48.1%) were
female and mean age was 26.5 ± 10.4. Of the patients without AMS HEREDITARY ANGIOEDEMA: A CASE REPORT
(GCS=15), 150 (68.2%) were female and mean age was 25.7 ± 8.7. md cemil kavalci (1), Md Miray Ozlem (2), md özgür arslan
According to the drugs used for suicidal attempt, the majority of (3)
patients with AMS used antidepressants. The rate of using more
than one drug in each group was similar and high. According to the 1. emergency, numune research and training hospital, ankara, Turkey
admission rates, of the patients with AMS, %4.8 (n=4) were 2. Emergency Department, Numune Training and Research Hospital, Ankara, Turkey
discharged from the ED, %2.4 (n=2) were left after initial treatment 3. emergency, numune training and research hospital, ankara, Turkey
without medical advice, and %92.9 (n=78) were hospitalized. Of the Corresponding author: Mr Kavalci Cemil ([email protected])
patients without AMS, %16.8 (n=37) were discharged from the ED, Key-words: emergency ; hereditary angioedema ; airway
%13.6 (n=30) were left without medical advice, and %69.5 (n=153)
were hospitalized (P<0.0001). A total of 58.3% (n=177) patients Hereditary angioedema (HAE) is a extremely rare disease with
were treated in the ED. Although, the majority (51.9%, n=14) of the autosomal dominant inheritance, which is resulted from deficiency
comatose patients admitted to intensive care units (ICUs), patients or dysfunction of C1-esterase inhibitor (C1-inh) produced by liver
with GCS 9-14 were followed and treated in the ED with a and involved in regulation of kinin-kallikrein, complement and
percentage of 68.4% (n=39). fibrinolytic system.
Conclusion: Emergency services and ICUs have an important role in A 28-years old woman presented to emergency department with
the treatment of patients presenting with attempted suicide. edema at face, eyes and around mouth and tongue. The patient
Therefore, psychiatric support of these patients should be initiated with good general status and stable vital signs was considered as
in the ED in addition to the emergent management, and classical angioedema and was given methylprednisolone (80 mg IV)
emergency physicians should improve their knowledge about this and chlorphenoxamine.However, we further evaluated the patient,
problem. as edema on face and eyes was escalated. In the physical
examination, vital signs were as follows: blood pressure, 110/60
P674 ________________________________ Other - Part 2 mmHg; heart rate, 119 beat/min, body temperature, 36.2,
respiratory rate, 24/min. Diffuse edema developed at face, eyes, lip
METHOD OF INCREASING SUCCESS RATE OF CENTRAL and tongue mucosa.
VENOUS CATHETERIZATION VIA EXTERNAL JUGULAR VEIN It has been reported that angioedema attack might be triggered by
J Huh (1), JY Hwang (2), DK Kim (3) factors including disorders causing tissue injury, infection, tooth
extraction, surgical interventions such as tonsillectomy, trauma,
1. Department of anesthesia and pain medicine, SNU-SMG boramae hospital, Seoul, menstruation, stress, oral contraceptive use, anxiety and fatigue.].
Korea, (South) Republic of In HAE, follow-up is sufficient in mild cutaneous and abdominal
2. Anesthesia and pain medicine, SMG-SNU boramae hospital, Seoul, Korea, (South) symptoms, as they may spontaneously resolve. If there is a larynx
Republic of edema or severe abdominal attack, it should be treated. The
3. Anesthesia and pain medicine, Samsung hospital, Seoul, Korea, (South) Republic of optimal and most rapid approach is to use intravenous C1-inh

BOOK OF ABSTRACTS 372

concentrates. Symptoms relieves 30-60 minutes after injection. Swellings in the neck are frequently encountered. These are one of
However, it is difficult to provide this preparation in the first attack. the causes for referring to the emergency department because of
Thus, the optimal alternative is fresh frozen plasma in patients malignancy suspicion. Although the most common reasons are
presented with first attack. It is used at a dose of 10 ml/kg infectious causes, also neoplastic causes, trauma, congenital and
developmental neck masses can cause swelling in the neck region.
P676 ________________________________ Other - Part 2 We report a case of branchial cyst aggravated after upper
respiratory tract infection.
ACUTE GASTROINTESTINAL BLEEDING IN PATIENTS ON Case:
ORAL ANTICOAGULATION THERAPY; IN EMERGENCY 41-year-old female patient. She referred to emergency room with
DEPARTMENT complaints of palpable painful swelling on the left side of the neck.
N. Nouira, K. Majed, S. Othamani, Y. Yahya, N. Chouikh, M. She started to use flu drug for runny nose and sore throat three
Modhaffer, A. Meganem, C. Hamouda, N. Borsali-Falfoul days ago . On physical examination, hyperemic oropharynx,
normal-sized tonsils, both outer ear and eardrum were seen as
Emergency department, la Rabta Academic Medical Center, Tunisia intact. With palpation, painful, elastic viscous fluctuating mass
Corresponding author: Mme Nouira Mzahma Nour ([email protected]) which is 4-5 cm away from the thyroid cartilage, was found on the
Key-words: gastrointestinal tracts ; bleeding ; overdose acenocoumarol left side of the neck. By ultrasound study of the superficial tissues
, thick-walled 20x20 mm lesion with thin septations, and the rich
AIM: acute gastrointestinal bleeding is a severe complication in wall blood supplied cyst image were taken adjacent to the lateral
patients receiving long-term oral anticoagulant therapy. They were wall of the jugular vein. Patient was diagnosed as Type 2 infected
the subject of numerous scientific publications, but few studies branchial cyst, localized in the left neck and operation was planned
have focused on the AVK overdose in emergency departments. The as a result of otorhinolaryngology consultation.
purpose of this study was to describe the causes, clinical CONCLUSION:
management and outcome of these patients and to develop Type 2 branchial cyst generates 95% of branchial anomalies. The
practical recommendations. mouth of the cyst, or fistula formation located along the anterior
METHODS: a retrospective review was conducted in patients border of the sternocleidomastoid muscle in the carotid triangle.
treated with acenocoumarol who consulted the emergency Malignant degeneration is rare. Usually diagnosed at the age of 20-
department of la Rabta hospital in Tunis for various symptoms 3 0. 25% of these are appears as a growing up fluid-filled mass
during five years since January 2006 until December 2010. with upper respiratory tract infection. When lateral-neck localized
RESULTS: we collected 54 cases of gastrointestinal bleeding during fluid-filled masses aggravates especially with upper respiratory
5 years. The average age was 57.6 ± 15.5 years and the sex ratio tract infection, branchial cyst should be kept in mind. In such cases,
was 0.47. The indications for anticoagulation were an ACFA (40%), instead of antibiotic therapy with ultrasound guided diagnosis
valvular disease (27%) and VTE (31%). The median time to onset of patient should be directed to the surgery .
first hemorrhagic stroke was 17.2 weeks. 42.% Of gastrointestinal
bleeding were classified as Grade II on the Constans classification P678 ________________________________ Other - Part 2
and 55% with grade IV and V of the CCMU. 22% of these patients
were kept in emergency department. Only five patients received INFLAMMATORY BOWEL DISEASE ARRIVING BY ATTACKS
the PPSB, the mortality rate was 7.4%. OF ILEUS: A CASE REPORT
CONCLUSION: gastrointestinal bleeding is unique by their YE EYİ (1), AO YILDIRIM (2), SK TUNCER (3), U KALDIRIM (3),
recurrence and severity. Half of bleeding event are classified as B KARSLIOĞLU (4), I ARZIMAN (3), M EROĞLU (2), C KAYA
very serious. The management of these patients to the emergency (3)
requires the development of practical recommendations to
prescribers and consumers of oral anticoagulants. 1. Emergency department, Hakkari Miltary Hospital, Hakkari, Turkey
2. Emergency Department, GATA Haydarpaşa Training Hospital, İstanbul, Turkey
P677 ________________________________ Other - Part 2 3. Emergency Department, GATA, Ankara, Turkey
4. Orthopeadics and Traumatology Department, Hakkari Miltary Hospital, Hakkari, Turkey
GROWING CONGENITAL NECK MASS IN OLD AGE: Corresponding author: Mr Eyi Yusuf Emrah ([email protected])
BRANCHIAL CYST Key-words: ILEUS ; INFLAMMATORY BOWEL DISEASE ; EMERGENCY DEPARTMENT
YE EYİ (1), SK TUNCER (2), AO YILDIRIM (3), U KALDIRIM (2),
M EROĞLU (3), B KARSLIOĞLU (4), I ARZIMAN (2), M INTRODUCTION
DURUSU (2), O TEZEL (2) Inflammatory bowel disease (IBD), occurs because of intestinal
epithelial barrier dysfunction and associated with an abnormal
1. Emergency department, Hakkari Miltary Hospital, Hakkari, Turkey response of the mucosal immune system due to immunologic
2. Emergency Department, GATA, Ankara, Turkey defects . IBD causes excessive defecation, abdominal pain,
3. Emergency Department, GATA Haydarpaşa Training Hospital, İstanbul, Turkey symptoms such as weight loss.Although rarely bowel obstruction
4. Orthopeadics and Traumatology Department, Hakkari Miltary Hospital, Hakkari, Turkey and related symptoms can also occur.
Corresponding author: Mr Eyi Yusuf Emrah ([email protected]) CASE
Key-words: CONGENITAL ; BRANCHIAL CYST ; NECK MASS 21-year-old male patient . He admitted to the emergency room
complaining about , constipation and abdominal pain for 15 days.
INTRODUCTION He had history of being operated for ileus at 11-year-old and
hospitalization by most centers because of ileus.His vital signs were
stable. Physical examination: there was abdominal tenderness and
generalized rebound. Rectal examination showed off empty
ampulla. WBC was 21 000 e3/mikroL and at patient's standing
abdominal X-ray showed the air-fluid levels . Ultrasound exposed

BOOK OF ABSTRACTS 373

ileum wall thickening and reduced bowel movements. IV-oral embolization for bleeding control and in-hospital mortality was
contrast-enhanced abdominal computed tomography planned. At 27.3%.
computerized tomography expansion of the colon and rectum Conclusion
walls and thickening, and slight irregularities in the wall of the Emergency physicians should be familiar with spontaneous rupture
distal ileum were observed. These findings are considered with the as a first presentation of not previously diagnosed hepatocellular
inflammatory bowel disease. The patient underwent colonoscopy carcinoma and should consider this rare disease entity in the
and biopsy after Gastroenterology consultation and was diagnosed differential diagnosis in male patients between 50 and 60 years old
as Crohn's disease. who present to the emergency department with abdominal pain,
CONCLUSION: abdominal distension, shock and have a history of chronic viral
Postoperative adhesions, electrolyte abnormalities, masses, and hepatitis B or C, habitual alcohol consumption.
many other reasons, such as gall stones can cause ileus,. Although
rare inflammatory bowel disease can also cause ileus. When there P680 ________________________________ Other - Part 2
is recurrent episodes of ileus, especially at a young age, keep in
mind inflammatory bowel disease, to facilitate diagnosis and MANAGEMENT OF PATIENTS WITH CONGENITAL
reduce unnecessary surgeries. HAEMORRHAGIC DISEASE IN EMERGENCY DEPARTMENT
A.C. Giuffrida (1), A. Bonora (2), N. Guerra (1), A.
P679 ________________________________ Other - Part 2 Maccagnani (2), G. Gandini (1), G. Zerman (2), G. Aprili (1),
C. Pistorelli (2)
SPONTANEOUS RUPTURE AS A FIRST PRESENTATION OF
NOT PREVIOUSLY DIAGNOSED HEPATOCELLULAR 1. Medical Transfusion Department, University Hospital, VERONA, Italy
CARCINOMA: A SINGLE CENTER EXPERIENCE IN KOREA 2. Emergency Department, University Hospital, VERONA, Italy
WY Kim, BJ Oh, DW Seo, CH Sohn Corresponding author: Mr Bonora Antonio ([email protected])
Key-words: Congenital haemorrhagic disease ; Emergency Department ; Haemorrhagic
Emergency Department, Asan Medical Center, Seoul, Korea, (South) Republic of complications
Corresponding author: Mr Sohn Chang Hwan ([email protected])
Key-words: hepatocellular carcinoma ; spontaneous rupture ; emergency department Patients suffering from congenital haemorrhagic disease (CHD) can
refer to Emergency Departments (ED) in high risk of complications
Introduction and even life-threatening clinical conditions, like traumatic and
Spontaneous rupture of hepatocellular carcinoma (HCC) is a life- haemorrhagic events. An adequate management of these patients,
threatening condition and most of these patients have been seen that is the right identification of CHD and the timely administration
in emergency department (ED). Diagnosis of spontaneous rupture of the lacking factor, has a basic role both in preventing or treating
of HCC may be extremely difficult, especially in patients with not haemorrhagic events and in avoiding complications during invasive
previously diagnosed HCC. procedures.
The aim of this study was to describe the clinical characteristics and We retrospectively evaluated all the CHD patients followed-up in
outcomes of patients with spontaneous rupture as a first the Medical Transfusion Department (MTD) of the University of
presentation of not previously diagnosed HCC. Verona, observed in ED in a 10-years period. All clinical MTD
Methods documents and ED reports were checked up in order to point out
This was a retrospective case series on all consecutive patients with critical steps and assess the most effective intra-hospital
diagnosis of spontaneous rupture as a first presentation of not management of acute event.
previously diagnosed HCC presented to the ED of a tertiary care From July 2002 to June 2012, out of 148 patients followed-up in
university-affiliated hospital from January 1, 2005 to December 31, MTD for CHD, 59 (36 males, 23 females; mean age 44 years, range
2011. 17-79) resulted to have been observed once or more times (overall
Demographic and clinical data including sex, age, history of chronic accesses 189, median 3) in the Emergency Department of the
hepatitis B or C, habitual alcohol consumption, chief complaint, University of Verona.
sudden or non-sudden onset, presence of shock, definitive These 59 patients appeared to suffer from: Haemophilia A (19 pts,
treatments and outcomes were reviewed. 32.2%); Haemophilia B (3 pts, 5.1%); Von Willebrand Disease (28
Results pts, 47.4%), other disorders (9 pts, 15.3%).
A total of 11 patients were included in this study. Most of these Out of the overall number, in 130 cases (68.8%) patients were
patients were male (90.9%) and between 50 and 60 years old admitted for high risk events, like trauma or haemorrhage. In 55 of
(81.8%). All patients had risk factors for HCC; chronic viral hepatitis these cases (42.3%) CHD was not properly identified neither on the
B (63.6%), habitual alcohol consumption (27.3%) and chronic viral arrival of the patient nor on the medical examination, while in 26
hepatitis C (9.1%). The chief complaint was abdominal pain (72.7%) cases (20%), although the adequate identification of the disease,
and abdominal distension (27.3%). Non-sudden onset the need for MTD evaluation was not considered. In the remaining
presentations were more common than sudden onset 49 cases (37.7%) the patients were submitted to MTD evaluation
presentations (63.6% vs. 36.4%). On ED arrival, only two patients and in 40 cases (30.8%) antihaemorrhagic treatment was timely
were in a shock state. However, four patients developed into a administrated. Notably, in 17 (13%) of the latter accesses the
shock state during ED evaluation. In 4 patients, CT was performed patients were referred to ED by means of MTD.
to investigate right upper quadrant tenderness and abnormal liver At last, in a cool 19.3% of the cases (25) patients with potentially
function test. In 3 patients, ultrasonography and paracentesis were dangerous and even life-threatening events, such as head trauma,
performed to investigate abdominal distension and CT was or submitted to invasive procedures did not receive nor a properly
performed after identification of bloody ascites. In 4 patients, CT identification of CHD or a necessary MTD evaluation.
was performed for differential diagnosis of shock that occurred An instrumental diagnostic assessment was performed in 81 cases
during ED evaluation. Five patients undergone emergent (62.3%) by means of conventional X rays (66), ultrasonography

BOOK OF ABSTRACTS 374

(11), CT-scan (9). In 69 cases (53.1%) patients underwent a further Key-words: Code Blue ; Nurse ; Gulhane Military Medical Academy Haydarpasa Training
consultant evaluation (mostly orthopaedical). Hospital
Finally, in most of the cases (87.7%) patients were discharged,
while 16 (12.3%) were hospitalized because of severe traumatic or Code Blue provides a CPR team to arrive to scene as soon as they
haemorrhagic events. can by warning all hospital staff in interventions that requiring
The revision of our series pointed out a general perception of emergency. This study was planned to evaluate the perception of
haemorrhagic risk in CHD patients less than, for example, those in the nurses about Code Blue who works in Gulhane Military Medical
anticoagulation treatment. This often lead to not timely identify Academy Haydarpasa Training Hospital. In April in 2012, this
the disease and to inadequately manage the risk of complications. descriptive study was achieved with the participation of 189 nurses
An improvement in the management of these patients is likely in Gulhane Military Medical Academy Haydarpasa Training
expected after a creation of an identification card for patients Hospital. Questionnaire form which was prepared by the
suffering from CHD and the adoption of intrahospital protocols, researches includes 13 questions and results were saved by SPSS
aimed to a more accurate reception in ED and a larger demand for and some special test were used. It was determined that 55.56 %
MTD evaluation. . of the included nurses are between ages of 30-39, 29.63% of them
had worked for 16 or more years. It was seen that 66.14% of nurses
P681 ________________________________ Other - Part 2 has an idea about Code Blue and 80.95% of them thinks Code Blue
is necessary and useful. 91.01% of nurses can describe Code Blue;
HEMATURIA, CLINICAL MANIFESTATIONS OF OVERDOSE IN more than 50% of them know situations that categorized Code
ORAL ANTICOAGULANTS UNDERESTIMATED Blue. More than 1/3 of nurses said that in Code Blue Team there
A. Chargui, N Nouira, K. Majed, K. Zaouche, S. Othmani, A. must be doctor, nurse, anesthetist, caregiver and 82.54% of them
Ben Hamida, M. Modhaffer, C. Hamouda, N. Borsali-Falfoul think that a Code Blue Team must established in our hospital. The
questions about perception of the nurses about Code Blue were
Emergency Department, La Rabta Academic Medical Center, Tunisia compared with some parameters like age, work time, education,
Corresponding author: Mme Nouira Mzahma Nour ([email protected]) unit of work, work program and founded significant results. It was
Key-words: HEMATURIA ; ORAL ANTICOAGULANT ; EMERGENCY DEPARTMENT determined that the nurses have a high awareness about Code
Blue and think the application of Code Blue is necessary in our
AIM: Treatment with oral anticoagulants exposes to a real risk of hospital.
bleeding. Hemorrhagic episodes are frequent in emergency KAYNAKÇA
department, some of which may involve life-threatening. 1. Qureshi SA , Ahern T , O'Shea R , Hatch L , Henderson SO. A
The objective of this study was to assess the incidence of standardized Code Blue Team eliminates variable survival from in-
hematuria in overdose in AVK, with special reference to its hospital cardiac arrest. J Emerg Med. 2012; 42(1):74-8.
frequency and severity, and to evaluate its management in 2. Canural R, Gokalp N, Yıldırım K, Şahin HM, Korkmaz A, Şahin N,
emergencies. Cınar F(2009). Sağlık hizmetlerinde hasta güvenliği: Mavi kod
METHODS: a retrospective review was conducted in patients uygulaması. Uluslar arası Sağlıkta Performans ve Kalite Kongresi
treated with acenocoumarol who consulted the emergency Kitabı, Ed: Kırılmaz H, Cilt:2, s:105-110, Antalya.
department of la Rabta hospital in Tunis for hematuria during five 3. Hoerth MT, Drazkowski JF, Noe KH, Sirven JI. Code blue: seizures.
years since January 2005 until December 2009. Epilepsy Behav. 2011 Jun; 21(2):189-90. Epub 2011 May 04.
RESULTS: 40 patients were collected with a mean age of 56.2 years 4. Kımaz S, Soysal S, Çımrın HA, Günay T.(2006). Assessment of
and sex ratio at 0.79, 24 patients had other associated hemorrhagic physicians employed in emergency medical services about their
manifestations. 3 patients required a filling with colloids, 3 by level of knowledge on basic life support, advenced cardiac life
transfusion of packed red blood cells, two by the PFC, six have support and medicolegal responsibilities. Turkish Journal of Trauma
received vitamin K, and no patient received PPSB.11 of patients and Emergency Surgery, 12(1):59-67
required exploration of this hematuria in a specialized department 5. Kuczkowski KM. Code blue in the air: implications of rendering
(urology). care during in-flight medical emergencies. Can J Anaesth.
CONCLUSION: Hematuria by overdose in oral anticoagulants is a 2007;54(5):401-2.
rare cause of consultation, its initial management in emergency
department is symptomatic. It is rarely life threatening. An P684 ________________ Pain Management/ Analgesia / Anesthesia
etiologic research is needed for early diagnosis of urinary tract
lesions. ANAESTHETISTS AND EMERGENCY MEDICINE PHYSICIANS:
A SURVEY OF CURRENT PRACTICE IN PROCEDURAL
SEDATION AND FASTING IN THE WEST OF SCOTLAND
REGION.

P682 ________________________________ Other - Part 2 EL Hartley, C McKiernan

EVALUATION OF THE PERCEPTION LEVEL OF THE NURSES Emergency Department, Southern General Hospital, Glasgow, United Kingdom
ABOUT CODE BLUE IN A TRAINING HOSPITAL Corresponding author: Melle Hartley Emma ([email protected])
C. EKER (1), E. KARATAŞ (1), Y. KEÇİCİOĞLU (1), A. SÖNMEZ Key-words: fasting ; procedural sedation ; emergency medicine
(2)
Objective: In view of the lack of guidelines and limited evidence for
1. x, Gulhane Military Medical Academy Haydarpasa Training Hospital, Gulhane, Turkey fasting in procedural sedation a survey of current practice was
2. x, Gulhane Military Medical Academy Haydarpasa Training Hos, Gulhane, Turkey performed in emergency physicians and compared to anaesthetists
Corresponding author: Mr Kecicioglu Yasemin ([email protected]) to assess any difference in practice and opinion.
Methods: A questionnaire of fasting status and its application to
procedural sedation was sent to both Emergency Medicine (EM)

BOOK OF ABSTRACTS 375

and Anaesthesia departments in the West of Scotland allowing moderate to severe pain at discharge. The pain score at admission
individual practice to be surveyed. according to Manchester Triage System (MTS) was lower, namely
Results: A total of 56 responded from Emergency Medicine and 91 3.5 (SD=1.4). After 6 weeks, 69% of the patients still reported pain.
from Anaesthesia. Fifty five (98%) of EM physicians routinely ask The main score was reduced to 1.7 (SD=1.9).
about fasting status prior to administering procedural sedation, Pain management was applied in 58% of the patients before
compared to 88 (97%) of anaesthetists. Fasting status in relation to attending the ED; 40% cooled their injury, 25% used self-
the high risk patient, non-emergent procedure, depth and length of medication and 14% received medication from a professional.
sedation and use of drugs were also surveyed. Several patients used a combination. Overall, only 10% of the
Conclusion: Anaesthetists have a more cautious approach to patients received pharmacological pain medication at the ED, 8%
procedural sedation preferring patients to be fasted. EM physicians received pain medication and a prescription and 9% only received a
put fasting status into context but still ensure adequate safety. In prescription for pain medication. Nevertheless, more than sixty
view of no current UK guidelines a risk benefit assessment prior to percent of the patients were immobilized during ED-visit.
sedation in each patient needs to be adopted. Symptoms of anxiety (12%) and depression (7%) were present in
patients before injury. Both vital status and health perceptions of
P685 ________________ Pain Management/ Analgesia / Anesthesia the patients before trauma were comparable with the general
Dutch population. After 6 weeks kinesiophobia (TSK-DV score>40)
BIOMEDICAL AND PSYCHOSOCIAL FACTORS OF PATIENTS was found in 27 % of patients and 4 % showed a clinically relevant
WITH ACUTE MUSCULOSKELETAL PAIN level of pain catastrophizing.
-TOWARDS PREVENTING CHRONIC PAIN- DISCUSSION: The present study provides insight in characteristics,
JG Pierik (1), MI Gaakeer (2), MJ IJzerman (1), AB Van Vugt pain and pain management of patients with acute musculoskeletal
(3), CJ Doggen (1) trauma. Multiple factors within this acute pain phase may be
responsible for transition from acute to chronic pain after trauma.
1. Health Technology & Services Research, MIRA Institute for Biomedical Technology and Those prognostic factors will give us the ability to target high-risk
Technical Medicine, University of Twente, Enschede, Netherlands patients already in the acute care setting and provide them with
2. Emergency Department, University Medical Center Utrecht, Utrecht, Netherlands appropriate treatment to avoid the development and subsequently
3. Emergency Department and Department of Surgery, Medisch Spectrum Twente, the consequences of chronic musculoskeletal pain.
Enschede, Netherlands
Corresponding author: Melle Pierik Jorien ([email protected]) P686 ________________ Pain Management/ Analgesia / Anesthesia
Key-words: acute musculoskeletal trauma ; biomedical and psychosocial factors ; pain
management PROCEDURAL SEDATION VERSUS HAEMATOMA BLOCK IN
THE DISTAL RADIUS FRACTURES IN EMERGENCY
BACKGROUND: Acute pain following traumatic injury is one of the DEPARTMENT: A PROSPECTIVE STUDY
most frequent reasons why patients are seeking medical care. V Gavrila, AN Carstea, G Filip, CL Bartha, A Petrica
Most trauma patients who attend the Emergency Department (ED)
have acute musculoskeletal pain. This pain is complex and Emergency Department, Emergency County Hospital, Timisoara, Romania
multifactorial. A combination of biomedical and psychosocial Corresponding author: Mr Gavrila Vasile ([email protected])
factors may be involved in pain perception and in the transition Key-words: distal radius fractures ; haematoma block ; procedural sedation
from acute to chronic pain. Most of these factors can be
determined in the emergency setting. Only a few studies assessed Introduction
these characteristics of patients with musculoskeletal trauma in The fractures of the distal radius are extremely common in the
the ED. Emergency Department (ED). Between January 2012 and April
OBJECTIVE: The aim of our study is to describe characteristics of 2012, 0,7% of the patients who presented to the ED of County
patients with acute musculoskeletal trauma to the extremities. Hospital from Timisoara had fractures of the distal radius. This
METHODS: This study is part of an one year prospective follow-up study compares the efficiency of the haematoma block with
study in about 2000 adult patients with injury (fracture, soft tissue) procedural sedation and analgesia in adults with distal radius
due to blunt trauma to the extremities of the musculoskeletal fractures requiring manipulation and reduction in the ED.
system who attend the ED of Medisch Spectrum Twente, the Material and methods
Netherlands. Characteristics of the patient, including psychosocial-, This study was prospective, randomised clinical trial with
biomedical and health related factors, perception of pain and pain consecutive recruitment of adult patients who presented to the ED
management are collected from hospital registration and of County Hospital from Timisoara between January 2012 and April
questionnaires at ED-visit and 6 weeks follow-up. 2012 with distal radius fractures who required reduction and
RESULTS: manipulation. Inclusion criteria: 1) informed consent; 2) no
From September 2011 till March 2012, 314 patients (50% women; contraindication to any method of analgesia. Exclusion criteria: 1)
mean age=40.1; SD =15.1) filled out a questionnaire. Sixty-one under 18 years old; 2) open fractures; 3) pregnancy; 4) refused or
percent of the patients had an injury to the lower extremities, were unable to give informed consent; 5) known allergy to involved
mostly fractures (36%) and distortions (43%). Fractures were seen drugs; 6) association with other serious injuries; 7) association with
most (64%) as injury to the upper extremities. other severe disease. Discharge criteria:1) normal level of
Pain was in 74% of the patients the main reason to attend the ED consciousness 2) normal standing position 3) normal range of
after musculoskeletal trauma. Almost half of the patients (47%) blood pressure. Patients were randomized into 2 equal groups. The
attended the ED within 2 hours after onset of pain. Patients A group received intravenous sedation, and the B group received
reported a high frequency of pain, both on admission (99%) and 10 ml of 2% Lidocaine hydrochloride into the fracture haematoma.
discharge (97%). Their mean pain score measured on a numerical Parameters measured: pain perception using the visual analogue
rating scale changed from 6.3 (SD =2.3) on admission to 5.6 scale (VAS), time procedure (the time in the ED, for manipulation
(SD=2.5) at discharge. Moreover, 67% of the patients had

BOOK OF ABSTRACTS 376

and up to hospital discharge were measured), complications rate All 91 abstract were read: 85 Could be excluded (previous
and failed manipulation. Cochrane reviews, case reports, studies concerning other type of
Results blocks; sacral plexus, psoasblock, spinal, 3-1block, postoperative
64 patients with displaced fractures of the distal radius with a pain, 2 were written in Swedish and Danish).
mean age of 54.3 (19-84) years old, M/F rate 1/2.93, left/right The pubmed search produced 6 hits including the Cochrane review.
hand 1.5/1, between 01 January 2012 and 30 April 2012. The VAS With the related citations the 7th study was found (Monzon 2010).
was 0.27 ± 0.2 in group A during reduction and 2.81 ± 0.6 in group The final selection of 7 included 2 systematic reviews, 3 double
B and VAS one hour after reduction was 1.52 ± 0.4 in group A and blind RCT’s, 1 not blinded RCT and 1 cohort study.
1.85 ± 0.5 in group B. The time for reduction was 2.63 ± 0.96 hours Conclusions
in A and 0.90 ± 0.47 hours in B. There are no RCT’s that compare a FICB with a femoral block or 3-1
Discussion block. The FICB in theory has less complications and can be done
The characteristic features of ideal analgesia during reduction are without ultrasound or nerve stimulator
determined by safety, simplicity, affectivity and costs. The waiting The FICB:
and manipulation times and resources cost were greater in those - Provides in the 2 biggest RCT’s (Mozoupoulos and Monzon) an
receiving a general anesthesia. Instead, procedural sedation is less equal pain relief compared with systemic analgesics
painful both during and after reduction. - Gives less chance for a delirium
Conclusion - Is easy to learn
Haematoma block with local anesthetic is a safe and an effective - Has very few complications
alternative to intravenous general analgesia in the reduction of the But: More research has to be done especially for feasibility for the
distal radius fractures in the ED. very old
Clinical Bottom Line:
P687 ________________ Pain Management/ Analgesia / Anesthesia The FICB can be a safe and effective alternative for pain treatment
of hip fractures. It is not proven better than systemic analgesics but
CAN A FASCIA ILIACA COMPARTMENT BLOCK BE AN there are probably less side effects in the elderly. But more
EFFECTIVE ANALGESIC FOR THE ELDERLY WITH A HIP research has to be done before a firm conclusion can be drawn.
FRACTURE? Level of recommendation
F Beije B
References:
Emergency department, Isala Klinieken, Zwolle, Netherlands 1.Traumaregistration Isala klinieken 2010, Netwerk Acute Zorg.
Corresponding author: Mme Beije Femke ([email protected]) 2.Clinical anaesthesiology. 4th edidtion. G. Edward Morgan
Key-words: Fascia Iliaca Compartment Block ; Hip fracture ; Elderly 3.Winnie et al. The inguinal paravascular technic of lumbar plexus
anesthesia: the 3-in-1 block. Anesth Analg. 1973 Nov-
Background: Dec;52(6):989-96.
In our emergency department about one patient with a hip 4.Abou-Setta et al. Comparative Effectiveness of Pain Management
fracture is diagnosed daily(1). The typical patient with a hip Interventions for Hip Fracture: A Systematic Review. Ann Intern
fracture is >70 years of age with co-morbidity and polyfarmacy use. Med. 2011 Aug 16;155(4):234-45.
Effective analgesia is necessary and prevents stress reactions, 5.Cochrane review: Nerve blocks (subcostal, lateral cutaneous,
prolonged hospital stay and delirium. Providing effective analgesia femoral, triple, psoas) for hip fractures. Martyn J. Parker et al. Issue
is challenging in this patient group. NSAID’s and opioids can have 2. 2009
various side effects especially in elderly. A loco regional nerve block 6.Foss et al. Fascia iliaca compartment blockade for acute pain
might be a good alternative. control in hip fracture patients: a randomize placebo-controlled
Two methods are described to perform this procedure(2) . The first trial. Anesthesiology. 2007 Apr;106(4):773-8.
is a femoral nerve block or the more advanced 3-1 nerve block as 7.Mouzopoulos et al. Fascia iliaca block prohylaxis for hip fracture
described by Winnie3. These procedures are mostly done nerve patients at risk for delirium: a randomized placebo-controlled
stimulator or ultrasound guided. The second method, the Fascia study. J Orthop Traumatol. 2009 Sep;10(3):127-33
Iliaca Compartment Block (FICB), is described below. The puncture 8.Monzón et al. Pain treatment in posttraumatic hip fracture in the
side is more laterally and the risk of bleeding or nerve damage is elderly: regional block vs. systemic non-steroidal analgesics. Int J
minimal. The clinical question was if a FICB can be an effective Emerg Med. 2010 Nov 6;3(4):321-5.
analgesic for the elderly with a hip fracture. 9.Haddad et al. Femoral nerve block in extracapsular femoral neck
Search strategy and outcome: fractures. J Bone Joint Surg Br. 1995 Nov;77(6):922-3
•Patient: Patient with a hip fracture pre-operative 10.Elkhodair et al. Single fascia iliaca compartment block for pain
•Intervention: FICB or femoral block relief in patients with fractured neck of femur in the emergency
•Comparison: Systemic analgesia department: a pilot study. Eur J Emerg Med. 2011 Dec;18(6):340-3.
•Outcome: Pain level, side effects
No relevant guidelines were found in the national guideline P688 ________________ Pain Management/ Analgesia / Anesthesia
clearinghouse. No relevant reviews were found in the DARE-
database. POST-INTUBATION HYPOTENSION WAS ASSOCIATED WITH
In the Cochrane Library One relevant review was found. LIDOCAINE AS ONE OF THE RAPID SEQUENCE INTUBATION
Pubmed search: PREMEDICATIONS – A COMPARISON BETWEEN
(femoral nerve block OR nerve block MeSH) AND (femoral neck TRADITIONAL REGRESSION METHODS AND PROPENSITY
fracture OR hip fractures MeSH (neck/intertrochanter): 91 hits SCORE BASED MATCHING METHOD
MT Chiu

Emergency department, Chang Gung Memorial Hospital, Taoyuan county, Taiwan

BOOK OF ABSTRACTS 377

Corresponding author: Mr Chiu Ming Ta ([email protected]) and scalds increase documentation of pain score & administration
Key-words: lidocaine ; rapid sequence intubation ; propensity of analgesia.
Methods
Background: Lidocaine was used as a premedication in rapid The case notes of all children who attended the PED with burns &
sequence intubation (RSI) to blunt the sympathetic stimulation scalds over a 3 month period were reviewed, after introduction of
broadly in emergency departments, although the beneficial effects a paediatric burns protocol. This process assessed the usage of
were inconsistent and controversial. Traditional regression protocol, scoring of severity of pain, administration & usage of
methods are commonly used for causal inference in observational analgesia and documentation.
studies, despite one of the limitation, multi-dimension, usually Results
limits the statistical power. Propensity score based matching 89 case notes were reviewed. The protocol was used in half of the
method, which is broadly utilized in public health and clinical patients. In 38% of children where the protocol was used, there
research, has yet been widely applied in emergency medicine was a documented pain score. This was only 7%, when the protocol
research. was not used. In the protocol used group, 74% had analgesia, of
Objective: To re-examine the association between post-intubation which 31% had intranasal Diamorphine with or without
hypotension (PIH) and lidocaine injection by different data mining Paracetamol & Ibuprofen. When the protocol was not used,
methods. analgesia was administered only to 43% of children, of whom only
Methods: A secondary analysis of a retrospective cohort study with 11% had Diamorphine.
patients consecutive admitted to the ED of a tertiary hospital with Conclusion
RSI. Detailed clinical information was recorded using standardized Documentation of severity of pain & administration of analgesia for
form. PIH was defined as systolic blood pressure (SBP) < 90 mmHg children with burns and scalds in a busy PED can be improved by
after intubation. Different matching and subclassification methods using a compulsory burns protocol.
based on propensity score of having lidocaine injection generated
by pre-intubation vitals, underlying illness and ongoing diseases P690 ________________ Pain Management/ Analgesia / Anesthesia
were utilized, in order to generate a comparable control group to
mimic the “quasi-randomized” study population. Outcome models ANALGESIA IN THE EMERGENCY DEPARTMENT: MYTH OR
based on logistic regression were compared using original dataset REALITY?
with matched dataset. S Pauwels (1), T Schmitz (2), G van Berlaer (2), I Roggen (2),
Results: among 149 patients with RSI agents, 28 (19%) developed I Hubloue (2)
PIH. Among 120 patients received lidocaine injection, 27 (23%)
developed PIH, compared to one (3%) of 29 patients who did not 1. Emergency department, Universitair ziekenhuis Brussel, Jette, Belgium
(p-value: 0.02). In the traditional regression model adjusting pre- 2. Emergency department, Universitair Ziekenhuis Brussel, Jette, Belgium
intubation SBP < 140 mmHg, underlying COPD history, ongoing Corresponding author: Melle Pauwels Sofie ([email protected])
septic status, and body weight as confounders, lidocaine was found Key-words: pain intensity ; analgesia ; emergency department
to be not significantly associated with PIH (aOR: 1.13, 95%CI: 0.97-
1.31, p-value: 0.1). After 1:5 nearest matching with replacement Background: Oligoanalgesia is a well-known problem in Emergency
based on propensity score, all measurable potential confounders Departments (EDs) around the world. Prevalence of pain as well as
were comparable in lidocaine treated and control groups, except its intensity tends to be high, but patients are often left under- or
ongoing heart disease (e.g. atrial fibrillation, coronary artery even untreated for their pain.
disease, p=0.03). In the subsequent logistic regression model Aim: The aim of the current study was to investigate the pain policy
adjusting ongoing heart disease in the matched dataset, lidocaine in the ED of a university teaching hospital.
was found to be significantly associated with PIH (aOR: 8.47, Methods: 180 female and 124 male patients were asked to self-
95%CI: 0.98-72.92, p-value: 0.047). evaluate their pain intensity by means of a Visual Analogue Scale
Conclusion: Lidocaine injection might be associated with PIH, which (VAS). Pain medication details were extracted from individual
merits further investigation. Researcher should consider more than patients’ charts and attending physicians were asked if the patient
traditional statistical methods while making causal inference. was given a prescription. At discharge the patients scored their
satisfaction on a 5-point Likert Scale.
P689 ________________ Pain Management/ Analgesia / Anesthesia Results: More than 80% of patients (256 out of 304) reported some
level of pain at arrival at the ED, of which 77 received an analgesic.
CAN WE IMPROVE PAIN MANAGEMENT IN CHILDREN Of the 256 patients with pain, 167 experienced moderate to severe
WITH BURNS & SCALDS BY INTRODUCING A COMPULSORY pain and in this particular subcategory, only 35% were treated for
BURNS PROTOCOL IN PAEDIATRIC EMERGENCY their pain. Since many patients were left untreated, it was
DEPARTMENTS? interesting to explore whether these patients were given a
C MAPATUNA, F PASHA prescription for pain medication at discharge of the ED. In total,
54% of all patients were given a prescription for analgesics at
EMERGENCY MEDICINE, LEEDS TEACHING HOSPITALS NHS TRUST UNITED KINGDOM, discharge. Of all the patients that declared suffering from severe
LEEDS, United Kingdom pain, nearly 75% were given such a prescription. This shows that
Corresponding author: Mr Pasha Farooq ([email protected]) physicians seem to acknowledge the patients’ pain, but rather
Key-words: BURNS ; PAEDIATRICS ; ANALGESIA prefer to translate that recognition into a prescription than to
provide pain treatment on the spot at the ED. Of all patients with
Objectives moderate to severe pain who did not receive analgesia, yet 80%
To assess whether use of a burns protocol in all children attending still revealed to be neutral to very satisfied with their treatment.
a dedicated paediatric emergency department (PED) with burns Conclusions: Although patients do not appear to be dissatisfied
with their treatment at the ED of a university teaching hospital,
many are undertreated for their pain. This could be avoided by the

BOOK OF ABSTRACTS 378

implementation of a well-elaborated protocol and training sessions MK. Erkuran (1), S Karaman (2), O. Odabaş (3)
in pain management for young residents.
1. Emergency Department, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
P691 ________________ Pain Management/ Analgesia / Anesthesia 2. Emergency Department, Erzurum District Training and Research Hospital, Erzurum,
Turkey
BARRIERS AND FACILITATORS IN PAIN MANAGEMENT IN 3. Emergency Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital,
TRAUMA PATIENTS IN THE CHAIN OF (PRE)HOSPITAL Ankara, Turkey
BASED EMERGENCY CARE Corresponding author: Mr Karaman Serhat ([email protected])
SA Berben (1), CJ Doggen (2), PP Rood (3), AC Scholten (1), L Key-words: headache ; metoclopramide ; visual analogue scale of patient satisfaction
Schoonhoven (4), AH Westmaas (1)
Headache is among the most common painful conditions that
1. Regional Emergency Healthcare Network, Radboud University Nijmegen Medical affect the people and the most common health problem. The aim
Centre, Nijmegen, Netherlands of this study is to investigate the efficacy of metoclopramide for
2. School for Management and Governance, Health Technology and Services Research, the treatment of headache at the emergency departmen.
University of Twente, Enschede, Netherlands 16-56 years old patients complaining of headache at the Dışkapı
3. Emergency Department, Erasmus Medical Centre, Rotterdam, Netherlands Yıldırım Beyazıt Training and Research Hospital Emergency
4. Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Department included to the study. Emergency department patients
Centre, Nijmegen, Netherlands presenting with headache because of head injury, haemostatic
Corresponding author: Mme Berben Sivera ([email protected]) disorders, high fever, ischemic stroke, transient ischemic stroke,
Key-words: Pain management ; Implementation ; Wounds and injuries non-traumatic bleeding, seizures, arterial hypertension, intracranial
neoplasm were excluded from the study. Of the 306 patients were
Introduction randomized into three groups. Treatment of paracetamol 1000 mg
To improve pain management in trauma patients, professionals in iv as the first group (Group P), the second group received 10 mg
the chain of emergency care recently developed an evidence based metoclopramide iv (Group M), the third group received 100 cc of
guideline. The guideline addresses pain management in trauma normal saline iv (Group SF). Patient satisfaction was scored with
patients by general practitioners (GPs), ambulance emergency visual analogue scale at 15-30-45th minutes. In mild headache
medical services (EMS), helicopter emergency medical services group, at 15-30-45th minutes, paracetamol is superior to
(HEMS) and the emergency department (ED). Implementation of metochlopramide; only at 15th minutes metochlopromide is
this guideline is pivotal, as the prevalence of pain is high, and the superior to placebo, paracetamol is superior to placebo at 15th and
consequences of mistreatment are serious (chronic pain and 45th minutes. In severe and moderate headache groups, there
disability). Although the guideline is acknowledged by national wasn't any significance between metochlopramide and
societies in the Netherlands, implementation seems problematic as paracetamol at 15-30 and 45th minutes.
it requires a change of behavior of physicians and nurses. Theories In conclusion, the patients admitted to the emergency department
on implementation of innovations stress how a tailored complaining of headache could be treated by metochlopramide.
implementation strategy should be based on thorough analysis of
the setting and target group. P693 ________________ Pain Management/ Analgesia / Anesthesia
Aim
The aim of the study is to develop a tailored implementation COMPARISON OF ICE AND LIDOCAINE- PRILOCAINE
strategy for effective change behavior interventions in order to MIXTURE CREAM FOR REDUCTION OF THE PAIN DURING
improve guideline adherence on pain management in trauma PERIPHERAL INTRAVENOUS CANNULATION IN
patients in the chain of (pre)hospital based emergency care. EMERGENCY DEPARTMENT PATIENTS.
Method H. Aygun, E. Armagan, F. Ozdemir, O. Koksal, S.A. Aydın, K.
The multicentre study is performed in three regions in the Selimoglu
Netherlands in the chain of emergency care. We use a multi
method approach. We will assess current practice and deviation of Emergency Department, Uludag University Faculty of Medicine, Bursa, Turkey
the guideline through analyses of patient files (n=700). Barriers and Corresponding author: Melle Ozdemir Fatma ([email protected])
facilitators will be explored through qualitative focus group Key-words: ice ; intravenous cannulation ; emergency department
interviews in each region with GPs, EMS, HEMS and the ED
(n=3x4=12), multi-professional simulation meetings (n=3), and Objective: We aimed to to compare the efficacies of ice, lidocaine-
patient interviews (n=20). Furthermore, we quantify the identified prilocaine mixture cream and classical method in the reduction of
barriers and facilitators with questionnaires among emergency the pain observed during intravenous cannulation, which is the
care professionals (n=510). most performing procedure in emergency departments, and to
Finally, we will develop implementation strategies by the use of define the most effective method.
intervention mapping (Bartholomew). Methods: One hundred-twenty patients applied to emergency
Results department of Uludag University Faculty of Medicine were
The presentation will be focused on the methodology and included in this presented study. Cannulations were performed
preliminary results of this ongoing study. after one minute application of ice package at ice group. Patients
applied to emergency only for blood transfusion were choosen for
P692 ________________ Pain Management/ Analgesia / Anesthesia lidocaine- prilocaine group and their cannulations were
performed at the 60. minute of mixture cream application. Finally
INVESTIGATION OF EFFECTIVENESS OF METOCLOPRAMIDE none of any applications before cannulation were used as
IN PATIENTS WITH HEADACHE INCOMING EMERGENCY classically for control group . All cannulations were performed from
ROOM.

BOOK OF ABSTRACTS 379

antecubital region and 18 G cannula were used. Visual analog scale that MVAS is especially useful for persons who have low threshold
(VAS) and patient satisfaction was scored . for pain.
Results: VAS scores for ice, lidocaine- prilocaine and control groups This ‘early result’ of our study including 37 patients was presented
are 2,8 ± 1.7, 4,1 ± 1.8, 4,4 ± 1.9, respectively. VAS score at ice at 7th National Emergency Congress Of EPAT.
group was significantly low than both lidocaine- prilocaine and
control groups(p< 0,05). In addition to that there was no P695 ________________ Pain Management/ Analgesia / Anesthesia
statistically significant difference between lidocaine- prilocaine and
control group (p= 0,40). Eighty percent of patients in ice group COMPARISON OF THE EFFECTS BETWEEN MEPERIDINE
and 75% of patients in lidocaine- prilocaine mixture cream group AND DEKSKETOPROFEN IN RENAL COLIC
notified that they would prefer the same application before A Acikalin (1), MO Ay (1), N Kozaci (1), S Satar (1), A Sebe (2)
subsequent cannulations.
Conclusion: Ice application method before intravenous 1. Emergency department, Adana Numune Education and Research Hospital, Adana,
cannulation, in addition to its advantages like inexpensiveness, Turkey
easily obtainment and application, is more effective than 2. Emergency department, Cukurova University, Adana, Turkey
lidocaine- prilocaine cream. Corresponding author: Mr Ay Mehmet Oguzhan ([email protected])
Key-words: Analgesic ; Deksketoprofen ; Renal colic
P694 ________________ Pain Management/ Analgesia / Anesthesia
Selection of appropriate and effective analgesic for the patients
IS IT POSSIBLE TO MAKE ‘VISUAL PAIN SCALE’ OBJECTIVE? admitted to emergency services with renal colicky pain is very
AS Girisgin (1), G Calik (1), I Ertas (1), M Ergin (2), B Cander important. In this study we aimed to compare the analgesic
(1), S Kocak (1), S Kebapcioğlu (3) efficacy and the effects on hemodynamic variables between
meperidin and deksketoprofen in patients admitted to Cukurova
1. Emergency Medicine, NEU Meram Medical School, KONYA, Turkey University Medical Faculty Emergency Service. A prospective,
2. Emergency department, NEU Meram Medical School, KONYA, Turkey randomized, double-blind clinical study was planned and initiated
3. Emergency Medicine, Mevlana University, KONYA, Turkey after obtaining the approval of the Ethics Committee of the Board.
Corresponding author: Mr Girisgin A. Sadik ([email protected])
Key-words: Visual Analogue Scale ; Emergency Medicine ; pain The patients between the ages of 18 to 70 with both
sexes who admitted to our emergency service and take a diagnosis
Background: There are many pain scoring systems developed of renal colic were included in our study. The patients who has
because people have had difficulty in defining and determining NSAİ drug allergy, received analgesic drugs in last 24 hours, with a
severity of pain. The subjectivity of all scoring systems causes diagnosis of peptic ulser, receiving anticoagulant therapy, has a
deficiency in evaluation. In this study, a standardization of Visual solitary kidney, with moderate or severe hydronephrosis, serum
Analogue Scale (VAS) was achieved by the help of pain resulting creatinine level determined over 2 mg/dl, pregnant, breast-feeding
from a standard procedure and then renal colic pain was evaluated were exluded from study. Total 52 patients were enrolled. Before
with ‘modified VAS’ to find out whether it was more objective scale drug injection, we randomly chosen deksketoprofen trometamol
than VAS or not. Material – Method: This study included 63 patient and meperidine hydrochloride placed in closed envelopes ,
admitted to Necmettin Erbakan University Meram Medicine faculty patients were given a single dose of intravenous infusion of 20 per
Emergency Medicine Department with renal colic pain. The study minute.
had a control group including 33 patients admitted due to
complaining other than pain. The demographic characteristics were Vital signs, labaratory tests and ultrasound findings were
same for both group. All patients with renal colic had physical exam compared between meperidine and deksketoprofen drug
and their pain were questioned with VAS. Then, an intravenous line administration groups. There was no significant statistical
at antecubital region was performed to treat their pain. Their differences between the systolic and diastolic blood pressures,
expression of pain during IV line process were asked in terms of pulse rates, respiration rates, BUN, creatinin, WBC, hematuria,
VAS and this was accepted as ‘standard pain’. After a standard leucocyturia values, the detection rate of nefrolithiazis and mild
analgesic treatment, the pain scoring was performed at 0, 15 and hydronephrosis.
30 min in terms of VAS and modified VAS which was equal to ‘’VAS
minus Standart Pain Score’’. We performed a comparison between When we look at changes in vital signs before and 30
VAS and modified VAS. Results: Patients had VAS for their minutes after application of analgesic drugs, we see that both two
presenting pain between 40-100 while standard pain scores were analgesic groups made statistically significant decreases in pulse
between 0-70. After analgesic treatment, VAS scores at 0, 15, 30 rate, breathing rate, systolic and diastolic blood pressure. Although
min were 0-100. Modified VAS (MVAS) scores were equal to ‘VAS the reduction of these parameters in the meperidine group is a
score – Standart Pain Scores’. There was a statistical difference little bit more than deksketoprofen, there was no significant
between VAS scores of all time points (p< 0.05). There was also statistically differences.
statistical difference in relieving pain between men and women.
When MVAS was used to evaluate in relieving pain, there was no According to our study, an opiate drug meperidine and
statistical difference between gender at 0 and 30 min but the NSAI drug deksketoprofen which is used to treat renal colic has
statistical difference at 15 min. Also no statistical difference similar analgesic efficacy. Meperidin and deksketoprofen has a
between variances of presenting renal colic pain and standard pain similar pattern of decline in Visual Analog Scale and Renal Colic
was found. Conclusion: Our results were hopeful about diminishing Symptom Score.
subjectivity of VAS. When renal colic pain at 0, 15 and 30 min were
evaluated by standard VAS, there was a meaningful difference in In conclusion; the NSAI drug deksketoprofen can be
terms of feeling pain between genders. However, our results considered as one of the primary treatment options because of it
showed that there wasn’t any difference using MVAS. We thought showed similar analgesic efficacy in renal colic pain, lack of serious
side effects, well tolerated by patients.

BOOK OF ABSTRACTS 380

P696 ________________ Pain Management/ Analgesia / Anesthesia 30mg of iv-morphine during the first 24h after surgery. No patient
had respiratory depression or other major complications. During
INTRATHECAL MORPHINE IS FEASIBLE FOR ACUTE the whole period 66 ampoules of morphine were needed
POSTOPERATIVE PAIN MANAGEMENT IN A RESOURCE- [(48)+(18)][(1 flacon per day x 48 working day when administered
CONSTRAINED ENVIRONMENT. intrathecally)+(3 flacon per patient when administered iv.)] and 32
L Ragazzoni, A Ripoll, E Giovagnoni, PL Ingrassia, M Foletti, S of fentanyl for a total cost of 40.700CFA
Giachello, LB Some, F Della Corte [(350CFAx66)+(550CFAx32)]. If compared with the anesthetic
regime (about 2-3 vials of fentanyl per day) in force before the
Research Center in Emergency and Disaster Medicine, CRIMEDIM, Novara, Italy introduction of morphine, the consumption of fentanyl would have
Corresponding author: Mr Ragazzoni Luca ([email protected]) been on average 120 vials for an amount of 66.000CFA.
Key-words: intrathecal morphine ; cost reduction ; low-income countries Conclusion
The teaching of the pathophysiology of pain and the principles of
Background analgesic pharmacology has raised the awareness of the hospital
The lack of knowledge of pathophysiological mechanisms of pain medical staff in Nanoro towards the importance of pain
and of the pharmacologic action of analgesic drugs, combined with management. The training on the use of morphine administered
the scarcity of supplies led to a chronic inadequate control of acute intrathecally has dramatically changed the clinical approach to
postoperative pain at the Centre Medicale Advancè de Nanoro in acute postoperative pain and this choice has permitted the
Burkina Faso where we recently started a voluntary humanitarian utilization of the few vials available. This technique could be
action. The use of morphine was unfamiliar to nurses and the imposed as a solution for the treatment of postoperative pain in
stocks very short for a proper intravenous postoperative analgesia. low-income countries due to its benefit on lowering costs and not
Several studies have underlined the effectiveness of low-dose less to its simplicity of utilization and its relative safety. During the
morphine administered intrathecally in decreasing postoperative next mission to verify also the effectiveness of the control of
pain intensity and in delaying the request for supplemental postoperative pain, basic concepts of pain assessment will be
analgesia after minor and major surgery under general or spinal introduced. Through two letters African staff expressed its
anesthesia. Moreover its relative safety and its benefit in reducing satisfaction and gratitude for what they have been taught.
costs were demonstrated. This abstract aims to describe the results
of the training on the specific use of intrathecal morphine as a P697 ________________ Pain Management/ Analgesia / Anesthesia
treatment option able to make the postoperative pain
management feasible through the reduction of costs in such a low- FICB ON PROXIMAL FEMORAL FRACTURES: OPIOID
income setting. SPARING AND EFFECTIVE ANALGESIC EFFECT?
Methods M Kreeft, N Mullaart-Jansen
During the humanitarian mission (October 1st-31th,2011)
developed as a part of the residency program of Anesthesia and Emergency Department, Westfriesgasthuis, Hoorn, Netherlands
Intensive Care at the University of Eastern Piedmont, a team Corresponding author: Mr Kreeft Mathijs ([email protected])
composed of two residents and one consultant in anesthesia Key-words: fascia iliaca compartment block ; proximal femoral fractures ; pain
organized a training course on the basic principles of acute management
postoperative pain management addressed to the operating room
staff. A 10hrs teaching was designed in order to cover the following BACKGROUND:
topics: pathophysiology of pain; pharmacokinetics and Patients with a femoral fracture are in severe pain on arrival in the
pharmacodynamics of opioid and non-opioid analgesic drugs; Emergency Department and providing sufficient pain relief is a
dosage, side effects of morphine and its routes of administration; major challenge. Traditionally pain treatment is based on systemic
the specific use of low-dose morphine administered intrathecally opioids, which have large potential for side effects. Undertreated
and its minor and major risks. After this, a 2-weeks coaching pain is a predictor for delirium on itself. Recent studies have
mentoring in the operating room was provided. After our leave, all indicated Fascia Iliaca Compartment Block (FICB) is an effective
major and minor surgeries in adult and elderly patients have been analgesic for patients with hip-fractures. It also has the potential of
registered by local staff from November 1st 2011 to January reducing the incidence of delirium by better analgesic effect and
31th,2012 and medical records were retrospectively analyzed. opioid sparing.
Frequencies and proportions of anesthetic techniques, the number MATERIALS AND METHODS:
of opioids ampoules used were reported and the cost were From April 2011 until January 2012 all patients in our Emergency
expressed in Communaute Financiere Africaine franc (CFA). No Department were possible candidates for an ultrasound guided
rescue therapy was taken into consideration given the high FICB performed by an Emergency Physician. The effectiveness of
unreliability of this data depending on the economic availability of the FICB was monitored with the Visual Analogue Scale (VAS),
patients. which was recorded before the FICB, after 30 minutes, on
Results admission and every 3 hours after admission. Another primary
Data from 259 patients, 173 (66,8%) male and 86 (33,2%) female, outcome was the use of rescue medication after the FICB, mostly
212 (81,9%) aged between 18 and 65 and 47 (18,1%) over 65), who dipidolor subcutaneously. We also looked at the total use of
underwent major and minor surgery were collected. 241/259 opioids comparing our study group with a non-FICB control group.
patients (93,1%) were operated under spinal anesthesia with a Complications were listed in the medical records.
dose of 0,2mg of it-morphine added to local anesthetic. The RESULTS:
procedures included general surgery (36,1%), urologic surgery 37 FICB’s were done in the study period. VAS-scores showed a clear
(23,2%), orthopedic surgery (20,3%), gynecologic surgery (13,7%) decline in pain after the FICB, based on VAS-scores of 18 patients
and caesarean section (6,6%). 12/18 major surgery performed that were correctly monitored. 35% of the patients with a FICB had
under general anesthesia were driven with the adjunct of 0,2mg of to use rescue medication within 10 hours after the FICB comparing
it-morphine before the induction of anesthesia and 6/18 with to 65% in the control group. The total use of opioids was lower in

BOOK OF ABSTRACTS 381

the FICB group compared to the non-FICB control group. No Title: Pain assessment by the first aid workers: which scale?
complications were registered. Introduction: First aids of the Fire Department of Paris carry 350
CONCLUSION: 000 victims of trauma or medical pathologies per year. Pain must
Results show that FICB is an effective analgesic for patients with a be assessed as soon as possible to be correctly relieved. Three pain
femoral fracture in the Emergency Department. It also reduces the scales can be used in prehospital emergency practice: numeric
total use of opioids in this fragile group of patients and no rating scale (NRS), visual analogue scale (VAS) and verbal rating
complications were noted in our pilot study. scale (VRS). First aids of Paris Fire Department usually use VRS.
Furthermore, effectiveness of NRS in prehospital settings has been
P698 ________________ Pain Management/ Analgesia / Anesthesia established in several data sets but there have been no studies of
NRS or VAS validity in first aids practice. The main objective of this
WHICH IS MORE EFFECTIVE FOR RENAL COLIC PAIN? study was to identify the most effective pain scale for the first aid
AS Girisgin (1), I Ertas (1), G Calik (1), M Ergin (2), S Kocak workers practice.
(1), M Okumus (3), C Yaylalı (4), B Cander (1) Materials and methods: This multicenter prospective study records
information from four questionnaires which were filled out by
1. Emergency Medicine, NEU Meram Medical School, KONYA, Turkey patients, first aids from nine Fire Brigade centers and nurses from
2. Emergency department, NEU Meram Medical School, KONYA, Turkey four emergency departments. Trauma patient aged 18 or older
3. Emergency Medicine, Sutcu Imam University, Kahramanmaras, Turkey with limb trauma were recruited by first aids during 4 months. The
4. Emergency Medicine, Diyarbakır State Hospital, Diyarbakir, Turkey first aids were given educational program about pain assessment
Corresponding author: Mr Girisgin A. Sadik ([email protected]) using verbal rating scale, numeric rating scale and visual analog
Key-words: Renal colic ; Analgesia ; Visual Analogue Scale scale. They assessed patient's pain at their arrival and after initial
cares, just before transport. Nurses of the emergency department
BACKGROUND: Renal colic pain is one of the cause of most severe destination were questioned about their use of the first aids
pain. Visual Analogue Scale (VAS) used for other pain reasons can assessment. First aids workers adhesion was evaluated by asking
bu used to determine severity of renal colic pain. After diagnosis, it them which scale they prefer. Correlations between these three
is appropriate to use analgesics to decrese pain. During last two scales were evaluated by Spearman test.
decade, nonsteroidal antiinflammatuar agents have been used as Results: Ninety-two patients (average aged 45[22,7-65,3]) were
well as spasmolitic agents, both of which are effective in pain included. Among them, 51,1% were female. They had fractures
reliefing. However there are lots of choices in NSAIDs. METHODS: (21%), sprains or dislocations (28,1%) and superficial injuries or
The study was double blinded – prospective trial. It was conducted contusions (25%). The average value of pain intensity assessed by
to make comparison between tenoxicam and dexketoprofen in NRS at the first time was 5,5/10. Pain was assessed with VRS for
treatment of renal colic pain. Tenoxicam and dextketoprofen group 96,6% of the patients, with NRS for 96,6% and with VAS for 90,9%
inclueded 31 and 32 patients, respectively. The patients who at the arrival of the first aid workers. After initial cares, NRS was
admitted to ED with complain of renal colic pain was randomly used in 87,5% and VAS in 71,6% of cases. Strong correlation
selected in terms of drug choice. After diagnosis of renal colic, their between NRS and VAS was found (r=0,79 ; p<0,005). NRS and VAS
analgesic treatment was begun. The severity of thier pain were was less correlated (r=0,66 : p<0,005).
asked by VAS at 0, 15 and 30 min. There was no statistical In our study, 72,5% of the first aids thought that NRS was usable in
difference between groups at the beginning but it was found that their practice, 75% thought VAS was usable and only 52,4% though
there was statistically important decrement in pain relief for VRS was usable. Thirty four (43,6%) of the 78 first aids who
dexketoprofen group. CONCLUSION: The NSAIDs are useful in pain answered preferred EN, 31 (39,7%) preferred VAS. Their arguments
relief for renal colic patients. We found that dexketoprofen were simplicity of comprehension and quality and precision of
reduced pain more than tenoxicam in a limited number of patients these scales. They talked about practical aspects when they
with renal colic. There is a need for further studies with large answered that they prefer NRS. Finally, 59,6% of the 48 nurses
number patients. questioned said that they didn't use the first aid pain assessment.
They argued that they missed information and that there was
P699 ________________ Pain Management/ Analgesia / Anesthesia problem with first aid scale.
Discussion: The French society of Anesthesiology and Resuscitation
PAIN ASSESSMENT BY THE FIRST AID WORKERS : WHICH advises to use the NRS for the prehospital settings for physicians
SCALE? and nurses but first aids are not mentioned. It specifies that a pain
M Boursier (1), F Briche (2), MP Petit (3), B Auguste (4), D scale has to be chosen according to validity, feasibility and
Jost (2), V Lanoë (2), JP Tourtier (5), C Verret (6), L agreement of users. The validity of NRS and VAS is well known.
Domanski (7) However, this study offered the possibility to apply those elements
to first aids practice. Indeed, the strong correlation between NRS
1. médecine générale, Hôpital d'Instruction des Armées PERCY, Paris, France and VAS and their good feasibility in our study suggest their
2. service médical, Brigade de Sapeurs-pompiers de Paris, Paris, France effectiveness in this setting. Correlation between NRS and VAS and
3. Etat Major, Brigade de Sapeurs-pompiers de Paris, Paris, France their feasibility were already proven in several studies. Otherwise,
4. CMA Paris, Service de Santé des Armées, Paris, France first aids who were questioned clearly answered that they prefer
5. Anesthésie Réanimation, Hôpital d'Instruction des Armées du Val de Grâce, Paris, NRS because of its ease of use and its accuracy. The last but not
France least argument for the use of NRS by the first aids is the continuity
6. CESPA Bégin, Service de Santé des Armées, Paris, France of care. Indeed, all French emergency departments who
7. Etat major, Brigade de Sapeurs-pompiers de Paris, Paris, France participated in our study use NRS for pain assessment. If first aids
Corresponding author: Mme Boursier Marion ([email protected]) and nurses use the same pain scale, it will guarantee better
Key-words: pain assessment ; first aid workers ; pain scale communication between partners, better monitoring of pain
evolution and so better pain support.

BOOK OF ABSTRACTS 382

P700 ________________ Pain Management/ Analgesia / Anesthesia improvement of pre-procedural analgesia and particularly anxiety.
Additional patients have to be included to confirm and strengthen
PAIN AND ANXIETY DURING LUMBAR PUNCTURE these findings.
A. HUTIN, A. SANTIN, B. RENAUD
P701 ________________________________ Other - Part 1
Emergency Department, University Hospital, CRETEIL, France
Corresponding author: Mme Santin Aline ([email protected]) IMPACT OF A WORKING GROUP ON GASTROINTESTINAL
Key-words: lumbar puncture ; pain ; anxiety DECONTAMINATION OF PEDIATRIC EMERGENCIES IN
SPAIN.
Introduction: Lumbar puncture (LP) is a routinely performed
procedure in the emergency department setting. Systemic YY. ACEDO (1), L. DEL ARCO (1), S. MINTEGI (1), M.
analgesia is recommended to prevent pain due to this procedure in PALACIOS (2), N. SALMON (1), R. VELASCO (3), W.
oncology patients who are exposed to iterative lumbar punctures. WORKING GROUP OF POISONINGS OF THE SPANISH
Up to now, few reports have been published regarding the SOCIETY OF PEDIATRIC EMERGENCIES (4)
maximal level of pain and anxiety resulting from lumbar puncture.
Objective: To determine the higher pain and anxiety levels caused 1. PEDIATRICS, HOSPITAL DE CRUCES, BILBAO, Spain
by LP in the emergency care setting. 2. PEDIATRICS, COMPLEJO HOSPITALARIO DE NAVARRA, PAMPLONA, Spain
Material and methods: We conducted a prospective observational 3. PEDIATRICS, HOSPITAL RIO HORTEGA, VALLADOLID, Spain
study in an adult emergency department of a university hospital. 4. PEDIATRICS, SEUP, SPAIN, Spain
All patients requiring a diagnostic lumbar puncture were eligible for
inclusion in this study. We excluded patients who denied Corresponding author: Mr Roberto Velasco ([email protected])
participation, and patients with previous history of dementia or
severe cognitive impairment and those unable to give full informed Key-words: ; ;
consent due to encephalopathy or alteration of conscientiousness
for instance. Data collected were: age, sex, body mass index (BMI), INTRODUCTION. In a study conduced in 2001-02
as well as procedure duration, performance of pre-procedural including 17 pediatric emergency departments (PED) in Spain high
analgesia and its nature (systemic or topical). Pain and anxiety variability was detected in management of acute pediatric
levels were obtained by auto-evaluation using analogical visual intoxications and more specifically in gastrointestinal
scale (AVS). We collected the maximum intensity of pain and decontamination. Since that time, the Working Group of Posioning
anxiety before and during LP. We compared patients according to (WGP) of the Spanish Pediatric Emergencies Society (SEUP)
the maximal intensity of pain during LP, below or above 4 (<4 and designed and spread in different ways recommendations based on
≥4 designated group B and A, respectively). Quantitative international guidelines on scientific evidence about the
characteristics were described using mean and standard deviation management of these patients. The objective of this study is
while for categorical characteristics we reported the number of analyze the impact of the measures designed by the WGP in the
cases and corresponding proportion. We compared patient management of acute poisonings in PED.
characteristics between the 2 study groups using Student t test or PATIENTS AND METHODS. Comparative cohort study. We
Fisher exact test and Pearson’s chi 2 test when appropriate. analyze management and, specifically, gastrointestinal
Results: 19 patients were included (9 in B and 10 in A). Main decontamination in three time periods in PED included in the WGP
population characteristics were sex ratio 0.72, age 43 (± 15) years, Group A: 2001-02, 17 PED, 2157 episodes. Group B: 2008-09, 37
BMI 24 (3.5) kg/m2. Procedural duration was 17.5 minutes (±7.3). 6 PED, 612 episodes. Group C: 2009-11, 42 PED, 400 episodes).
(32%) patients had more than one attempt of LP. Mean level of RESULTS. Of the 3169 episodes recorded, 1031
pain and anxiety before procedure were 3.7 (±3.3) and 2.9 (±4.0). (32,5%) underwent for a gastrointestinal decontamination
11 (58%) patients had pre-procedural systemic analgesia procedure (Group A: 34,1%; Group B: 27,8%; Group C: 31,5%).
(Tramadol or Paracetamol) among whom 4 were also administered Prior to the creation of the Working Group, activated charcoal was
local analgesia (Lidocain patch). Anxiety level during LP was 4.0 administered to 94,8% of patients in whom gastrointestinal
(1.0) Patients characteristics between the 2 study groups, B and A deconamination was performed, 29,1% underwente for gastric
respectively, did not differ with the exception of the following: BMI lavage, and 22,8% were administered ipecac syrup. Patients in
26 (3) versus 23 (3) kg/m2 (p=0.05), anxiety before LP 1.1 (3.3) whom ipecac syrup was used decreased drastically in group B
versus 4.7 (3.9)(p=0.05), and anxiety after LP 1.6 (3.4) versus 6.4 (1,7%), and were none in group C. The number of patients who
(3.1) (p<0.01). underwent gastric lavage remained constant until last year, when it
Discussion: The levels of pain and anxiety associated with LP were showed a sharp decline (14,7%), although not statistically
high for most patients. In spite of these levels of procedural pain significant (p=0,08). Use of activated charcoal remained almost the
and anxiety many patients did not receive analgesic medication same in Gropus B (p8%) and C (96%). CONCLUSIONS.
and no one was administered anxiolytic treatment. LP related pain Recommendations developed and spread by a Working Group have
and anxiety seemed to depend on one another and particularly, approached the management of acute pediatric poisonings in Spain
procedural pain was associated with patient anxiety before LP. to international guidelines based on scientific evidence.
Interestingly, per procedural level of pain was not associated with
pre-procedural intensity of pain. P702 __________________________________ Pediatrics
during). Our findings suggest that our management of pain and
anxiety related with LP should be improved particularly in patients PHYSOSTIGMINE TREATMENT IN AN ADOLESCENT WITH
that required more than one attempt. Improving anxiolytic AKINETON OVERDOSE
treatment seemed to be worth of interest. SS Sahin Sabiha (1), OZ Zorbozan Onur (2)
Conclusion: In the ED setting, our preliminary findings suggest that
LP is associated with high levels of pain and anxiety that require 1. Pediatrics Emergency, Eskisehir Osmangazi University, Eskisehir, Turkey
2. Emergency department, Eskisehir Osmangazi University, Eskisehir, Turkey

BOOK OF ABSTRACTS 383

Corresponding author: Mme Sahin Sabiha ([email protected]) removal of a coin in the upper oesophagus under general
Key-words: ; ; anaesthetic. The rest of the coins had passed.
38 patients were admitted to ENT with17 asymptomatic and 21
Case:Fourteen-year-old boy who was taken to Paediatric symptomatic. 17 coins were confirmed in the upper oesophagus,
Emergency Department due to hallucinate and agitation has a story 12 in the middle oesophagus and 9 in the lower oesophagus.
of received 12 tablets of akineton which belong to his aunt about 9 Symptoms included vomiting (52%) drooling (38%) and coughing
hours ago. Before he was referred to our hospital, he applied to a (10%). Of the admitted patients 9 were observed and re-x-rayed up
healthcare centre after 2 hours and he treated with gastric lavage to 8 hours later, they were all discharged as the coin had passed.
and activated charcoal. During the initial evaluation in our 29 had a general anaesthetic to remove the oesophageal coin.
Emergency Department, blood pressure (BP) was 110/60, pulse Conclusion
was 84/min, respiratory rate (RR) was 20/min and temperature Patients that are asymptomatic on presentation of a confirmed
was 36.8, and euphoric state and visual hallucinations were oesophageal coin could be conservatively managed and re-x-rayed
observed. Poison Information Centre was called considering the within 24 hours.
biperiden intoxication due to existing symptoms. They said that
there is no any toxic dose in biperidon toxicity, the half-life of drug P704 __________________________________ Pediatrics
is 8-48 hours, absorption is low and haemodialysis and peritoneal
dialysis is ineffective. They noted that toxic effects include CAN INTRANASAL KETAMINE PROVIDE SAFE AND
somnolence, hallucination, delirium mydriasis, hypertension, EFFECTIVE SEDATION AND ANALGESIA IN PEDIATRIC
urinary retention, slowing in intestinal mobility and respiratory PATIENTS?
depression. The patient was taken to Paediatric Intensive Care Unit MC van Schepen
to give physostigmine for delirium if needed and to close follow-up.
Diazepam was given due to ongoing agitation. During the intensive Emergency department, Isala Klinieken, Zwolle, Netherlands
care follow-up, physostigmine was introduced two times and his Corresponding author: Mme Van Schepen Marian Christine ([email protected])
hallucinations and agitations decreased markedly. On the third day Key-words: intranasal ketamine ; sedation/analgesia ; pediatric patients
of follow-up, his general situation improved and Glasgow Coma
Scale (GCS) score was 15. Patient’s biochemical parameters and Background
EGC become normal. He was evaluated by paediatric and Children who need a painful procedure in the ED are often a
adolescent psychiatry and he was discharged advising polyclinic challenge to the emergency medicine resident. The use of
control after 15 days. intravenous or intramuscular medication is painful, causes needle
phobias and may leave the child with unpleasant memories. We
P703 __________________________________ Pediatrics looked for an alternative, not painful route of administration of
sedative and analgesic medications. Ketamine has been used
MANAGEMENT OF OESOPHAGEAL COINS IN CHILDREN widely and in addition to the usual routes of administration, a
J Acheson (1), O Nafousi (1), R Pertwee (2), D Roland (1) variety of alternative applications to the buccal and nasal
membranes are being tried. The question arose whether intranasal
1. Paediatric Emergency Department, Leicester Royal Infirmary, Leicester, UK ketamine could provide safe and effective sedation and analgesia
2. Children's Hospital, Leicester Royal Infirmary, Leicester, UK in pediatric patients.
Corresponding author: Mr Pertwee Richard ([email protected]) Search Strategy and outcome
Key-words: Paediatric ; Oesophageal ; Coin An extended literature search was done and four relevant articles
were found (descriped in the abstracts document)
Purpose Conclusion
Evidence suggests that asymptomatic children, with no previous During the time this search was done, only one study was
oesophageal pathology, presenting within 24 hours of ingestion published about the intranasal use of ketamine 3 mg/kg as a
with an oesophageal coin, can be managed conservatively for up to sedative drug followed by a painful procedure. The other three
24 hours rather than early active removal. Our aims were to studies were done as premedication studies to provide smooth
determine the number of children this could be applied to and to separation from the parents and induction of anesthesia. From this
determine what percentage of asymptomatic coins presenting in search some conclusions can be drawn:
the oesophagus will pass spontaneously with no intervention. 1. The data presented above suggests that intranasal ketamine 3
Methods mg/kg may be an ideal agent for sedation administered via the
A retrospective analysis was conducted for children presenting intranasal route in the pediatric population for brief procedures
with an ingested oesophageal coin to the Paediatric Emergency 2. Recovery time was of short duration
Department from 2004-2011. Patients were identified by searching 3. Important adverse effects on saturation, haemodynamics,
for “foreign body in alimentary canal”, “ingestion of foreign body” emergence reactions and salivation were not found in these
and “oesophageal obstruction” on the Emergency Department studies
Information System (EDIS). Patients < 16 yrs with a confirmed Clinical Bottom Line
oesophageal coin foreign body were included. According to the publications outlined above intranasal ketamine
Results 3mg/kg can be used as an save and effective agent for sedation in
63 patients (26 female and 37 male) presented with a confirmed the pediatric population.
oesophageal coin and the median age was 4yrs (8months – 13yrs).
25 asymptomatic patients were not admitted. 10 were followed up
in the Paediatric ED review clinic the next day and 15 were
reviewed in the ENT clinic the same day. All were re-x-rayed within
18hrs, 1 patient was admitted from the ENT clinic for

BOOK OF ABSTRACTS 384

P705 __________________________________ Pediatrics P706 __________________________________ Pediatrics

CASE REPORT: A WORM IN THE WORM-LIKE APPENDAGE? PEDIATRIC CPR LITERACY AND BARRIERS TO TRAINING IN
F Beije AN URBAN POPULATION
L Moreno-Walton (1), CI Leach (2), CM Zeretzke 3), L Myers
Emergency department, Isala Klinieken, Zwolle, Netherlands (4)
Corresponding author: Mme Beije Femke ([email protected])
Key-words: ascaris lumbrocoides ; appendicitis ; Child 1. Emergency Medicine & Research Genetics, Louisiana State University Health Sciences
Center, New Orleans, United States
Case: 2. medical student, Louisiana State University Health Sciences Center, New Orleans,
A 13 year old man presented at out emergency department with a United States
2 days persisting fever and abdominal pain. One week previously 3. Pediatric Emergency Department, Our Lady of the Lake Medical Center, Baton Rouge,
he was treated with mebendazol because of a 33 cm long worm in United States
his stool, later identified as an Ascaris Lumbrocoides. One day after 4. Biostatistics, Tulane University School of Public Health & Tropical Medicine, New
finishing his treatment he developed a fever and abdominal Orleans, United States
cramps. Corresponding author: Mme Moreno-walton Lisa ([email protected])
We saw a sick young man; with a tachypnea, tachycardia and a Key-words: Pediatric ; Resusciation ; Knowledge
temperature of 39,4oC. Upon abdominal palpation, rebound
tenderness at McBurney’s point was present. Further laboratory Background: Administering CPR in early stage cardiac arrest has
tests showed a leucocytosis of 14,1x109/l and a C-reactive protein been shown to decrease mortality and morbidity of infants and
of 41 mg/l. Additionally an ultrasound was made which showed children. Most children who have an out-of-hospital cardiac arrest
characteristics of an appendicitis. Shortly thereafter the patient do not receive bystander CPR.
underwent an appendectomy during which a necrotizing and Objectives: To determine the percentage of parents who know
perforated appendix was removed. Postoperative an ileus how to effectively perform CPR on infants or children and if, after
complicated the patient’s recovery, after two weeks he could receiving pediatric CPR training, they would do so.
return home. Pathologic analysis of the appendix showed Methods: A convenience sample of 300 parents of Pediatric ED
inflammation, perforation an serositis, in particular no worms or patients at an urban teaching hospital were enrolled during all
worm eggs were found. shifts. They completed an anonymous survey on pediatric CPR (p-
Background: CPR). Data was analyzed using Pearson’s Chi Square Test and
The Ascaris Lumbrocoides can be found in up to 25% of the world simple proportions.
population, especially children1). Fertilized eggs which can be Results: 31.3% of parents had a child < 1 year old, 76% had a child
found in soil, enter the body through the digestive system. In de 2-12 years, and 23% 13-18 years. 21.3% had a premature infant.
small intestine the larvae enter the blood or lymph system through 82% could define CPR. 49.3% had trained in p-CPR and 53.3% in
the intestinal wall. Penetration into the lung parenchyma can cause adult. Parents of premature infants were more likely to have
an Ascaris pneumonia. After coughing up and swallowing the trained. 5% had performed CPR on an infant, 5% on a child 2-12,
larvae, they re-enter the digestive system. The worms mature and and 2.7% on a child 13-18. If trained in CPR, 85% would be willing
produce a few months later eggs, which leave the body with the to perform it on their own child and 76.7% would be willing to
stool. Now the cycle can be repeated. perform p-CPR on someone else’s child. 52.8% did not know
Large amounts of worms can cause intestinal obstruction, invasion where to go to train or re-train. 30.2% did not know that parents
of the appendix can cause an appendicitis2). Considering the high could be trained.
prevalence of colonization, the risk of appendicitis seems to be Conclusions: The study is limited by being a single site convenience
very low. Of all appendix inflammations which needed an sample, but demonstrates the need for public education. Not
appendectomy only 0.5 to 7.46% were due to a parasitic knowing where to train was the greatest barrier to learning p-CPR.
infection2,4). One survey observed children with Ascariasis during Most parents, if trained, would be willing to perform bystander p-
surgery because of different intestinal complications; 11 patients CPR.
had a worm present in the appendix but only 3 of them had
appendicitis3). P707 __________________________________ Pediatrics
Conclusion:
Our patient developed an appendicitis acuta one week after CAN INTRODUCTION OF A BURNS PROTOCOL IN
Ascariasis. We will never know for sure if there was a relation PAEDIATRIC EMERGENCY DEPARTMENTS INCREASE
between the two or if it was just a coincidence…... Nevertheless; if APPLICATION OF DELAYED ACTIVE FIRST AID COOLING FOR
a child presents with an appendicitis it is worth considering worm THERMAL BURNS?
infections, even in the Netherlands. C MAPATUNA, F PASHA
References:
1. Khuroo et al. “Ascariasis”. Gastroenterol Clin North Am. 1996 EMERGENCY MEDICINE, LEEDS TEACHING HOSPITALS NHS TRUST UNITED KINGDOM,
Sep;25(3):553-77. LEEDS, United Kingdom
2. Dorfman et al. “The role of parasites in acute appendicitis of Corresponding author: Mr Pasha Farooq ([email protected])
pediatric patients”. Invest Clin. Dec 2003 Dec;44(4):337-40. Key-words: BURNS ; PAEDIATRICS ; PROTOCOL
3. Wani et al. “Appendiceal ascariasis in children”. Ann Saudi Med.
2010 Jan-Feb;30(1):63-6.
4. Karatepe et al. “Parasitic infestation as cause of acute
appendicitis”. G.Chir. 2009 Oct 30(10)”:426-8

BOOK OF ABSTRACTS 385

Background Results
There is evidence to demonstrate delayed tap water cooling for 20 89 case notes were reviewed. The protocol was used in half of the
minutes is effective up to 3hours from a thermal burn, where initial patients. In 86% of children, where the protocol was used, there
first aid cooling hasn’t taken place. was documented presence or absence of cause for concern for NAI.
Objective This was only 46%, when the protocol was not used. In the protocol
To assess whether introduction of mandatory delayed cooling as an used group, 53% had confirmed “no cause for concern” in writing
integral part of the burns protocol increases detection of thermal after reviewing a list of indicators for possible NAI. When the
burns which would benefit from delayed tap water cooling and protocol was not used, this confirmation was reached only in 18%
application of this first aid measure in PED. and 54% had no documentation of presence or absence of cause
Methods for concern. 33% had positively identified indicators for possible
The case notes of all children who attended the PED with burns NAI when the protocol was used and 82 % of these children were
over a 3 month period were reviewed, after introduction of the referred for further investigation. Similarly a substantial
delayed cooling flowchart in to the paediatric burns protocol. This improvement was seen in the quality of note keeping, checks with
process assessed the usage of protocol, identification of patients EDT/ previous attendances, pain scoring and usage of analgesia.
who would benefit from delayed cooling (presenting within 3hours Conclusion
since burn) and application of this first aid measure. Identification & documentation of burns in children with possibility
Results of NAI in a busy PED can be improved by using a compulsory burns
101 case notes were reviewed. In half of the patients with burns, protocol along with an increase in emergency medicine seniors’
the protocol was used and identified the time since burn in 69% of contribution and an improvement in referrals to child protection
cases. 85% cases presented within 3hours since burn & were team for further assessment.
suitable for delayed cooling. Every third of these suitable patients
had documented active tap water cooling for 20minutes in PED. On P709 __________________________________ Pediatrics
the other hand, in the remaining half of the patients, where the
protocol was not used, the time since burn was identified only in EMERGENCY DEPARTMENT UTILIZATION BY CHILDREN IN
29% of cases. Furthermore, none had received documented active KOREA
cooling in PED, even though majority were deemed suitable for J Choi, SY Park, JH Lee, DK Kim, YH Kwak
delayed cooling.
Conclusions Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea, (South)
Delayed active cooling with tap water for 20minutes in PED would Republic of
be useful for a significant number patients presenting to our Corresponding author: Mr Suh Dongbum ([email protected])
department with burns. Usage of the protocol with the flowchart Key-words: Child ; Emergencies ; Epidemiology
increased the identification of suitable patients for this simple first
aid measure & application of it. Furthermore, this would give a This study was conducted to know nation-wide utilization pattern
good first aid learning experience for the parents to take back to of emergency department (ED) by children in Korea. Most EDs from
the community. referral hospitals provide their essential ED information to National
Emergency Medical Center (NEMC) through the National
P708 __________________________________ Pediatrics Emergency Department Information System (NEDIS). We obtained
and analyzed the NEDIS data on pediatric visits (< 19 years old)
CAN WE IMPROVE DETECTION OF POSSIBLE NAI IN during three years, from 1 June 2008 to 31 May 2010. A total of
CHILDREN WITH BURNS & SCALDS BY INTRODUCING A 2,072,664 children visited the 124 EDs during study period, which
COMPULSORY BURNS PROTOCOL IN PAEDIATRIC comprise 31.2% of total ED visits. Male patients were 59.1%, and
EMERGENCY DEPARTMENTS? the mean age was 5.44 (SD; ± 5.40) years. Among age groups, 1∼4
C MAPATUNA, F PASHA year group was the largest (42.3%). Most patients visited EDs in the
evening (from 18:00 to 24:00, 42.1%) and on weekend (Saturday
EMERGENCY MEDICINE, LEEDS TEACHING HOSPITALS NHS TRUST UNITED KINGDOM, and Sunday, 44.1%). The most common mode of arrival was non-
LEEDS, United Kingdom emergency medical service (EMS)/walk-in (90.7%) and only 4.2% of
Corresponding author: Mr Pasha Farooq ([email protected]) patients used EMS transport. The most common chief complaints
Key-words: NON ACCIDENTAL INJURY ; PAEDIATRICS ; BURNS of infants (< 1 year) were fever (37.4%), followed by vomiting
(8.0%), however, older children (15∼18 years) were brought to EDs
Abstract: mainly due to abdominal pain (15.4%) or headache (4.8%). The
Objectives ratio of diseases versus injuries as the cause of ED visits was about
To assess whether use of a burns protocol in all children attending 2.5:1 (1,480,432 vs. 592,232). Most patients could be discharged
a dedicated paediatric emergency department (PED) with burns (81.2%) and 15.3% of the children were admitted. We report
and scalds increases detection of cause for concern for non- nation-wide epidemiological data on pediatric visits to major EDs in
accidental injury (NAI), improve case note documentation and Korea, which will be useful to improve emergency medical service
management of cases. system.
Methods
The case notes of all children who attended the PED with burns &
scalds over a 3 month period were reviewed, after introduction of
a paediatric burns protocol. This process assessed the usage of
protocol, identification & documentation of cause for concern for
NAI, paediatric medical referral for further investigation and pain
management.

BOOK OF ABSTRACTS 386

P710 __________________________________ Pediatrics support team records. Day, time and month of attendance plus
presenting triage complaint and outcome were noted.
THE STORY OF A SUMMER HOLIDAY IN TERMS OF Results
PEDIATRIC TRAUMA There were 362 attendances of 131 HETF patients with a mean (SD)
M Ergin (1), MR Ozer (1), A Harmankaya (1), Y Durduran (2), annual period prevalence of HETF patients attending the PED on an
I Kayitmazbatir (1), H Nak (1), S Kocak (1), AS Girisgin (1), M unscheduled basis of 18(2)%. Mean (SD) attendance rates were
Gul (1), B Cander (1) 120 (24) per year representing 60 (5) patients. Presenting
complaints included gastrostomy tube removal (29%), nasogastric
1. Emergency Department, Necmettin Erbakan University Meram Medicine Faculty, tube removal (27%), jejunal tube removal (5%) hardware fault
Konya, Turkey (6%), tube blockage (12%), infection (9%), leakage (4%),
2. Public Health Department, Necmettin Erbakan University Meram Medicine Faculty, malposition (5%) or other (3%). Only 37 (10.2%) of patients
Konya, Turkey required hospital admission, mostly for surgical reinsertion. 54% of
Corresponding author: Mr Ergin Mehmet ([email protected]) all attendances were outwith CCN service hours. More patients
Key-words: Pediatric Trauma ; Trauma Room ; Emergency Service attended on Sundays than any other day (p=0.003).
Conclusions
BACKGROUND: As in the adult age group, trauma is the most Up to 20% of HETF patients attend PED annually with feeding tube-
common reason of death for 1 year and older children. MATERIAL - related problems; 54% attend outwith CCN service hours.
METHOD: This prospective study included ≤16 year old children Significantly higher attendance rates on the day without CCN
admitted to Trauma Room of Emergency Service of Necmettin service cover highlights a flaw in this service design, given that
Erbakan University Meram Medicine Faculty Hospital between 15 most HETF problems do not need PED expertise and resources.
June – 15 September 2011. RESULTS: There were 317 patients
included. 64% of patients were men and their median age was 5 P712 __________________________________ Pediatrics
(min-max; 0-16) years old. 31% of patients had inter-hospital
transfer after their first evaluation in another hospital. Most of the DISASTERS AND PERINATAL HEALTH, CORTISOL
injuries were at home and due to blunt injuries. Falling from height INDEPENDENT TRANSFER OF MATERNAL STRESS EFFECTS
and bicycle accidents were the most common reasons. There was TO THE FETUS
only one patient for whom child abuse was diagnosed. Isolated R Schiffner
head trauma was the most common type of injury. During follow
up duration at emergency service, there was no mortality (Table 2). Accident and Emergency Dept., Univ. Hospital of Friedrich Schiller Univ., Jena, Germany
It was found that there was no statistical difference in terms of 2. Institute for Animal Sciences and Welfare, Univ. Hospital of Friedrich Schiller Univ.,
result of emergency visiting according to genders, types of injury Jena, Germany
and injuried part of body, separately (P>0.05). CONCLUSION: There 3. Neurology, Univ. Hospital of Friedrich Schiller Univ., Jena, Germany
was a serious deficiency in terms of protective measures which Corresponding author: Mr Schiffner Rene ([email protected])
should be taken to prevent pediatric trauma in Turkey. Key-words: Perinatal Health, ; Disasters, ; Maternal Stress

P711 __________________________________ Pediatrics Introduction:
Maternal stress during pregnancy induces fetal growth retardation
HOME ENTERAL TUBE FEEDING: A CASE BURDEN FOR THE and programs neuropsychiatric diseases in later life (Van den
PAEDIATRIC EMERGENCY DEPARTMENT? Bergh, 2005 / Beydoun, 2008). A single event e.g. disasters is
JK Smith (1), CE Paxton (2), P Leonard (1), DC Wilson (3) enough to cause this effects (Dencause, 2012). It is assumed that
these effects are mediated by maternal cortisol which crosses the
1. Paediatric Emergency Department, Royal Hospital for Sick Children Edinburgh, placenta and programs hyperactivity of the fetal hypothalamo
Edinburgh, United Kingdom pituitary adrenal axis (HPAA). However, early stress has the most
2. Gastroenterology, Hepatology & Nutrition, Royal Hospital for Sick Children Edinburgh, pronounced effects (Rakers, 2012) when glucocorticoid receptors
Edinburgh, United Kingdom are not expressed yet (Yang, 1990) and the fetal HPAA is still
3. Child Life & Health, University of Edinburgh, Edinburgh, United Kingdom inactive. We hypothesized that maternal catecholamines, although
Corresponding author: Melle Smith Jennifer ([email protected]) they virtually do not cross the placenta directly, have major effects
Key-words: attendances ; enteral ; unscheduled on the fetus by decreasing uterine blood flow (UBF).
Materials and Methods:
Objectives Five pregnant ewes were chronically instrumented at 125 dGA
The contribution of home enteral tube feeding (HETF) issues to (days gestational age, term 150 dGA) with maternal and fetal
Paediatric Emergency Department (PED) workload is poorly catheters inserted into the carotid artery and the jugular vein and
understood. We aimed to describe the PED burden of children an uterine ultrasound flow probe. At 130dGA, animals were
receiving HETF (attendance rates, presenting complaints, stressed by isolation for 2h before and after an infusion of
outcomes) and assess trends between timing of attendances and labetalol, a mixed alpha and beta adrenergic antagonist.
hours of service provided by our Children’s Community Nursing Results and Discussion: Ewes responded to the isolation stress with
(CCN) team. an increase in maternal blood pressure (MBP) from 83±2.7 to
Design 89±3.9 mmHg (mean±SEM) for 9 min (p< 0.05), an increase in
We searched all 114,606 attendances to PED over three years maternal heart rate (MHR) from 98±4.7 to 126.9±6.2 beats per
(April 2008 – March 2011) and reviewed all those involving cases minute (bpm) for 30 min (p< 0.05) and a transient hyperventilation
on HETF, correlating them with our regional paediatric nutrition mediated hypocapnia (p< 0.05) for 15 min. UBF decreased by
11.8±2.7 % for 75 min (p< 0.05) with a maximum of 19±3 %
reflecting uterine vasoconstriction. The fetus responded with a
delayed and prolonged decrease of pH from 7.39±0.01 to

BOOK OF ABSTRACTS 387

7.36±0.01, increase of lactate from 1.5±0.2 to 1.8±0.2 mmol/L and discontinuation of chronic stress and is a risk factor for pre-and
decrease of oxygen saturation from 75±2.5 to 67±3.6 % starting at postnatal emergency and intensive care.
60 min of isolation (p< 0.05).
Labetalol infusion led to a decrease of MBP from 72±1.8 to 64±2.9 P714 __________________________________ Pediatrics
mmHg, MHR from 104±8.9 to 91±6.2 bpm and UBF by 23±7.6 % (p<
0.05). Isolation stress increased MBP and MHR in tendency and THE FIRST SIGN AND THE SECOND LOOK: WHAT’S HIDDEN
UBF by 11±3.4 % (p< 0.05) over the entire period of isolation. The BEHIND YELLOW SKIN? THREE DIFFERENT UNUSUAL CASES
latter is a consequence of increased cardiac output in the presence OF CHILDHOOD JAUNDICE IN ED
of absent vasoconstriction. D Moldovan, A Balas, A Kovari
Conclusion: Maternal stress in pregnant sheep induces a
catecholamine mediated UBF decrease which is followed by a Emergency Department, Division of Pediatrics, The Emergency Clinical County Hospital
prolonged fetal lactate increase and decrease in oxygen saturation Tirgu Mures, Tirgu Mures, Romania
that may contribute to fetal growth retardation and programming Corresponding author: Melle Moldovan Diana ([email protected])
of diseases in later life. Key-words: children ; jaundice ; hyperbilirubinemia

P713 __________________________________ Pediatrics We report the cases of three children with jaundice, each of them
brought to ED for an unusual clinical sign for their disease, which
CHRONIC STRESS DURING PREGNANCY, A RISK FACTOR could mislead us in reaching the correct diagnosis.
FOR PRE-AND POSTNATAL EMERGENCY AND INTENSIVE A 5-year old boy was brought by ambulance in ED for seizures. First
CARE fever, than hypoglicaemia seemd to be the cause, yet he also had a
S. Bischoff (1), R. Schiffner (2), F. Rakers (3), S. Rupprecht mild jaundice. Lab tests showed slightly elevated bilirubinemia, on
(3), H. its direct fraction account and its underline condition turned up to
Schubert (1), M. Schwab (3) be finally a fulminant hepatic failure (FHF). FHF is a rare, but poor
prognosis syndrome in children, death occuring in more than a half
1. Institute for Animal Sciences and Welfare, Univ. Hospital of Friedrich Schiller Univ., of these patients.
Jena, Germany An 11-year old girl came in ED with her parents for an allegedly
2. Accident and Emergency Dept., Univ. Hospital of Friedrich Schiller Univ., Jena, Germany sudden onset of a jaw tumor. It was a fairly common dental
3. Neurology, Univ. Hospital of Friedrich Schiller Univ., Jena, Germany abscess, although requiring surgical treatment. Physical exam
Corresponding author: Mr Schiffner Rene ([email protected]) revealed mild to moderate jaundice and slightly elevated indirect
Key-words: Pregnancy, ; Prenatal Health, ; Maternal stress bilirubinemia. Further lab tests led to Gilbert syndrome diagnosis.
This is a benign and quite common condition, usually diagnosed in
Introduction: puberty.
Acute stress in pregnant sheep leads to a catecholamine mediated A 15-year old girl was brought in ED by her parents for insidious
decrease in uterine blood flow (UBF) and induces prolonged fetal abdominal pain, drowsiness and fatigue. She also had an intense
lactate increase and decrease in oxygen saturation. In agreement yellow-green jaundice, thought to be due to hemolysis, as she had
with, chronic exposure to maternal stress induces fetal growth a medical background of microcytic hemolytic anemia. Lab tests
retardation in sheep (Frauendorf, Reprod Sci, 2011) and humans showed markedly increased hyperbilirubinemia (38mg/dl), mostly
(Rondo, Eur J Clin Nutr, 2003). We hypothesized, chronic maternal due to increased direct bilirubin. Abdominal ultrasound revealed
stress attenuates the UBF decrease and fetal lactacidosis due to many small gallstones, which led finally to the diagnosis of
adaptation to the stressor. obstructive jaundice. Cholelithiasis is uncommon in children, but
Methods: however, one of its most important etiology is hemolytic.
Ten pregnant sheep underwent repeated isolation stress between
0.2 and 0.66 gestation (30 and 100 days gestation age, dGA, term P715 __________________________________ Pediatrics
150 days) resulting in a reproducible cortisol increases with only
slight habituation. Ten pregnant ewes functioned as controls. Five A NATION-WIDE SURVEY ON KNOWLEDGE AND PRACTICE
stressed and five control animals were chronically instrumented OF EMERGENCY AND PEDIATRIC RESIDENTS FOR THE
with maternal and fetal catheters into the carotid artery and the MANAGEMENT OF FEBRILE CHILDREN
jugular vein and an uterine ultrasound flow probe five days before J Choi, SY Park, JH Lee, DK Kim, YH Kwak
acute isolation stress at 0.75 or 0.87 gestation (110 or 130 dGA).
Results: Acute maternal stress at 0.75 and 0.87 gestation Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea, (South)
transiently increased maternal blood pressure (MBP) and maternal Republic of
heart rate (MHR) and decreased UBF (p< 0.05). UBF decrease was Corresponding author: Mr Suh Dongbum ([email protected])
prolonged in chronically stressed ewes at both gestational ages (p< Key-words: fever ; children ; physicians
.05). Fetuses in all groups responded with an increase in lactate (p<
0.05). There was no drop in fetal pH and oxygen saturation at 0.75 Objectives: Although fever is one of the most common complaints
gestation. At 0.87 gestation, fetal pH and oxygen saturation among children visiting emergency department (ED), there are
decreased. Preceding stress prevented the drop in pH (p< 0.05) considerable variations of the management of febrile children
probably because of hyperventilation-mediated maternal among health care providers. We conducted a nation-wide survey
hypocapnia. to know knowledge and practice of emergency (EM) and pediatric
Conclusions: Maternal stress induces a decrease in UBF during the (PD) on the management of febrile children, and to understand the
third trimester that is more prolonged with gestational age. The
UBF decrease is potentiated by preceding chronic stress during the
first and second trimester and persists for 4 weeks after

BOOK OF ABSTRACTS 388

impact of unrealistic fear about fever (fever phobia) on the A total of 1,000 guardians (mean age: 37.0 ± 9.9 years) all over the
management. country were enrolled. The male to female ratio was 1:1 and the
Methods: We surveyed EM and PD residents on knowledge and majority of the respondents were parents of the child (54.5%).
practice for fever management using standard questionnaires, Among child patients, 531 (53.1%) were younger than 8 years old.
from April to May, 2009. The 16 questions were administered to To the question on overall satisfaction of ED visits, 40.2% of
the residents, including general demographic characteristics of the guardians answered as ‘satisfied’. The proportion of the guardians
subjects, scientific knowledge about measurement and cut-off who would re-visit the ED or recommend the ED to others was
value of fever, and management and disposition of febrile children. 34.4%. On multivariate logistic regression analysis of the factors
Results: A total of 217 (EM 108, PD 109) residents from 23 that are associated with more satisfaction, fast administrative
hospitals in Korea responded to the survey. When comparing with process (OR 1.56, 95% CI: 1.34-1.82), attitude (OR 1.44, 95% CI:
EM residents, PD residents were more to be female (PD vs. EM, 1.23-1.70) and professional skill (OR 1.30, 95% CI: 1.11-1.52) of
56.9% vs. 23.2%; p<0.001), and had more experience on the doctors, and length of stay (OR 1.35, 95% CI: 1.16-1.57) showed
management of febrile children (78.9% vs. 36.1%; p<0.001). statistically significant relationship.
Concern on the complications of fever and preference on the Conclusion:
measuring method of body temperature were similar between two The overall satisfaction of the guardians who visited ED with child
groups. For the management of febrile children, comparable patients was relatively low, and can be influenced by
proportion of the both groups believed that the tepid massage administrative process, doctor factors, and length of stay.
alone is effective (36.7% vs. 37.0%; p=0.30). Although more PD
residents had their own standards of body temperature to start P717 __________________________________ Pediatrics
antipyretics than EM residents (97.3% vs. 89.8%; p=0.026), the
temperature were lower than usually recommended. The PD PAEDIATRIC COMMUNITY – ACQUIRED SEPTIC SHOCK:
residents preferred alternative use of antipyretics more than EM RESULTS FROM THE REPEM NETWORK STUDY.
residents (89.9% vs. 51.9%; p<0.001), and were tended to permit J Benito Fernandez (1), D Biarent (2), N Boelsma (3), L Da
discharge only after the patients’ body temperature was Dalt (4), J De Dooy (5), T Detaille (6), A Dupont (2), B
normalized (p=0.003). Emerson (7), B Gomez Cortez (1), S Hachimi Idrissi (3), I
Conclusion: We found that the practice of PD and EM residents on Iglowstein (8), E Kerkhof (9), I Maconochie (10), H Moll (9),
febrile children was substantially variable, and influenced by M Mor (11), N Mulle
unrealistic fever-phobic idea. A standardized guideline for the
management of febrile children in ED is warranted to standardize 1. Pediatric Emergency Dep., University Hospital Cruces, Bilbao, Spain
and improve the management among health care providers. 2. Pediatric Intensive Care, University Hospital Queen Fabiola HUDERF, Brussels, Belgium
3. Pediatric Intensive Care, University Hospital Brussels, Brussels, Belgium
P716 __________________________________ Pediatrics 4. Pediatric Department, Cà Foncello Hospital, Treviso, Italy
5. Pediatric Intensive Care, Antwerp University Hospital, Antwerp, Belgium
A NATIONAL SURVEY ON GUARDIANS’ SATISFACTION TO 6. Pediatric Intensive Care, university hospital Louvain UCL, Brussels, Belgium
PEDIATRIC EMERGENCY DEPARTMENTS IN KOREA 7. Pediatric Emergency Dep., Yale Univeristy Hospital, New Haven, United States
YH Kwak (2), HY Jang (1), DK Kim (2), SY Park (2), DB Suh (2) 8. Pediatric Emergency Dep., Ostschweizer Children’s hospital, St Gallen, Switzerland
9. Pediatric Emergency Dep., Sophia Children’s Hospital, Rotterdam, Rotterdam,
1. Emergency Department, Seoul National University Hospital, Seoul, Korea, (South) Netherlands
Republic of 10. Pediatric Emergency Dep., St Mary’s Hospital, london, United Kingdom
2. Emergency Department, Soonchunhyang University Seoul Hospital, Seoul, Korea, 11. Pediatric Emergency Dep., Schneider Children’s Medical Center of Israel,, Tel Aviv,
(South) Republic of Israel
Corresponding author: Melle Park So Young ([email protected]) 12. Pediatric Emergency Dep. / SMUR, University Hospital Pellegrin, Bordeaux, France
Key-words: pediatrics ; emergency departments ; guardians’ satisfaction 13. Pediatric Intensive Care, Children’s hospital CHUC, coimbra, Portugal
14. Pediatric Emergency Dep., King Faisal Specialist Hospital and Research Center, Riyadh,
Study Objectives: Saudi Arabia
This nation-wide survey was conducted to know the overall 15. emergency dep, University Hospital Leuven, Leuven, Belgium
satisfaction and relevant factor(s) affecting patient satisfaction 16. Pediatric Emergency Dep., UH Ghent, Ghent, Belgium
among guardians who brought a child to emergency departments 17. Pediatric Emergency Dep., Children's hospital Yale, New Haven, United States
(ED) in Korea. 18. Pediatric Intensive Care, Çukurova University Hospital, Adana, Turkey
Methods: Corresponding author: Mr Van De Voorde Patrick ([email protected])
This cross-sectional study was performed through web-based, E- Key-words: Sepsis ; Pediatrics ; shock
mail response system on September, 2011. A standard
questionnaire was administered to guardians who have brought a Aim: To describe the true epidemiology of severe paediatric
child patient (younger than 19 years old) to EDs of Korea in past ‘community-acquired’ sepsis and establish the feasibility of a future
three years. The questionnaire included the questions on prospective trial on early goal directed therapy [EGDT] in children.
demographic data of respondents, overall satisfaction on ED Methods: Retrospective study in 18 emergency departments [ED]
utilization, and relative preference on each factor which may be from ‘upper-middle to high income’ countries. Children were
closely related with the overall satisfaction, such as attitude, included if they presented with severe sepsis and signs of
professional skill, and explanation of ED personnel, quality of decreased perfusion. Consecutive periods were screened until at
facility, fast administrative process, waiting time, and total length least 20 cases were included or until before 01/02/2008 or any
of stay. Seven point Likert scale was used to describe relative date before which data quality was insufficient.
preference. The point 1 to 3, point 4, and point 5 to 7 were Results: 240 cases were included.The estimated prevalence was
regarded as ‘disappointed’, ‘neutral’ and, ‘satisfied’, respectively. thus 1/2400 pediatric ED consultations. Significant comorbidity was
Results: present in 35% of these. Intensive care admission was deemed
necessary in 68%, mechanical ventilation in 27.1% and vasoactive
medications in 38.1%. The mean amount of fluid given in the first
six hours was 41.8ml/kg. The overall mortality in this sample was
5.8% and 7.1% if associated severe comorbidity. Only 1.8% of the

BOOK OF ABSTRACTS 389

survivors showed a substantial decrease in Paediatric Overall are out-performing those who do not. This is probably due to an
Performance Category [POPC]. ‘Severe’ outcome [death or a increased familiarity with local paediatric policy. We recommend
decrease ≥2 in POPC] was significantly related (p< 0.01) to among increased exposure to local paediatric policy for all practitioners
other ‘any desaturation below 90%’, cardiovascular failure, the who may be involved in treating children – perhaps in the form of a
length of mechanical ventilation or vasoactive support, the use of regular departmental education programme.
packed red cells, a lower Glasgow Coma Scale, a higher lactate and
lower base excess, and suboptimal antibiotic therapy. P719 __________________________________ Pediatrics
Conclusion: The outcome in our sample was very good, despite a
lack of compliance with EGDT as such. Many children received EVALUATION OF SCORPION STING CASES ADMINISTRATED
treatment early in their disease course, so avoiding subsequent TO PEDIATRIC EMERGENCY DEPARTMENT FOR SEVEN
intensive care. Future studies might prove difficult to organise in YEARS
view of our data. S KAYA (1), C KARAKURT (2), O ELKIRAN (3), O AYCAN KAYA
(4), A. Karakus (5), G KOCAK (6)
P718 __________________________________ Pediatrics
1. Children's Service, Antakya State Hospital, HATAY, Turkey
MANAGEMENT OF DISTAL RADIUS FRACTURES IN 2. Pediatric Cardiology, Inonu University,, MALATYA, Turkey
CHILDREN IN THE PAEDIATRIC EMERGENCY DEPARTMENT 3. Pediatric Cardiology, Inonu University, -, MALATYA, Turkey
RL Parish, A Tabner 4. Parasitology, Mustafa Kemal University, Faculty of Medicine,, HATAY, Turkey
5. Department of Emergency Medicine, Mustafa Kemal University, Hatay, Turkey
Paediatric Emergency Department, Queens Medical Centre, Nottingham, United Kingdom 6. Pediatric Cardiology,, Maltepe University Faculty of Medicine,, Istanbul, Turkey
Corresponding author: Melle Parish Rachel ([email protected]) Corresponding author: Mr Karakus Ali ([email protected])
Key-words: Paediatric ; Wrist fracture ; Management Key-words: Scorpion sting ; pediatry ; emergency department

INTRODUCTION: Distal radius fracture is one of the commonest Aim: In this study, 32 cases of scorpion sting that is admitted to
injury presentations to a Paediatric Emergency Department. Whilst Inonu University School of Medicine Children's Emergency
some fractures of the distal radius have a high complication rate Department between 2001-2007 were evaluated retrospectively.
and require careful follow-up, others do not. Buckle or torus Material and Method: The cases were evaluated for the clinical
fractures affecting the dorsal cortex of the distal radius can be findings, laboratory results, treatment and prognosis.
safely managed in a Futura splint or similar. All other fractures Results: The patients mean age were 8.1±2.2 years, seventeen
require plaster of Paris immobilisation. This management strategy (53.1%) were female and 15 (46.8%) were male respectively. Most
is supported by both the available literature and our local of the cases were in June (25.1%) and most of the bites were at
guidelines. Outcomes for dorsal buckle fractures treated as above upper extremities (53.1%). The most common findings were rash
in terms of fracture healing and functional status have been shown (eight patients-25.1%), and tachycardia (9.5%). The prothrombin
to be equivalent. Splinting achieves better patient and parent time (PT) was higher in four patients (12.9%). The fluid therapy was
satisfaction and may involve some cost savings. Inappropriate use initiated the patients that is required the intravenous therapy.
of a Futura for other fractures may result in poor healing, potential Scorpion serum and tetanus vaccine were not applied to 28
displacement and increased pain. patients (87.5%) who in the center is referred that scorpion serum
METHOD: Notes and imaging from patients presenting to the QMC and tetanus vaccine are administered. 19 patients (59.3%) were
Paediatric Emergency Department between 01/02/12 and followed up for a day. 31 cases (96.8%) were discharged without
31/03/12 with a discharge diagnosis of “Closed Fracture – Wrist complications and one case (3.1%) were died due to respiratory
(excl. Scaphoid)”, “Closed Fracture – Radius” and “Closed Fracture and circulatory collapse
– Ulna” were reviewed. Only patients with a fracture site < 2in Conclusions: Our study, scorpion poisoning in childhood was
from the articular surface of the wrist were included in this audit. evaluated under the light of literature with regard to
Diagnosis, management plan and job role/grade of treating epidemiolgical, clinical, laboratory and prognostic factors.
practitioner were recorded; compliance with local guidelines was
determined by two Emergency Medicine trainees (CT3) reviewing P720 __________________________________ Pediatrics
independently
RESULTS: Seventy-six patient records were deemed appropriate for SAFETY NETTING IN CHILDREN AT RISK FOR SERIOUS
inclusion. Of these, 86% were managed in accordance with local ILLNESS IN PAEDIATRIC EMERGENCY CARE.
guidelines. The majority of the patients were seen by either Senior D Geurts (1), E Kerkhof (1), H Moll (2), R Oostenbrink (1), N
House Officers (SHO -47%) or Nurse Practitioners (ENP - 42%), with Seiger (2)
the remainder seen by registrars or consultants. One patient was
seen by a locum of unknown grade. ENPs consistently complied 1. General Pediatrics, Sophia Children's Hospital-Erasmus MC, Rotterdam, Netherlands
with local protocol (91%), with SHOs performing similarly (86%). 2. General Pediatrics, Sophia Children's Hospital- Erasmus MC, Rotterdam, Netherlands
75% of patients treated by a consultant and 67% of those treated Corresponding author: Mme Geurts Dorien ([email protected])
by a registrar were managed in accordance with local policy. Key-words: Safety netting ; children ; serious illness
CONCLUSION: Compliance with the local policy for management of
distal radius fractures is variable. Compliance alters with grade/job Background:
role of treating practitioner, with ENPs consistently performing Fever, dyspnoea and vomiting/ diarrhoea are the most common
above average. The SHOs were based in the Paediatric Emergency problems presenting at a paediatric emergency department (ED).
Department on a full time basis, whilst all other practitioners In five- ten percent of children with fever without source who
worked with both adult and paediatric patients. Those
practitioners that regularly work within a paediatric environment

BOOK OF ABSTRACTS 390

present at the ED a serious bacterial infection (SBI) with a Question
complicated clinical course is described. Children with dyspnoea or In children with gastroenteritis (P) does ondansetron (I) work
vomiting/ diarrhoea can also have a complicated clinical course. As better against vomiting (O) than metoclopramide (C)?
a complicated clinical course can never be surely predicted after ED Background
discharge, clinicians use scheduled follow-up. Evidence on which The use of antiemetics in children with nausea and vomiting after
children are at risk for a complicated clinical course and how to chemotherapy or post-operative is well known. In paediatric
perform follow-up after discharge from the ED is lacking. patients with gastroenteritis doctors are often reluctant to use
Aim: antiemetics because of the possible development of neurological
To describe characteristics of Emergency Department (ED) revisits side-effects. Acute gastroenteritis is a common cause of morbidity
for children with fever, dyspnoea or vomiting/ diarrhoea at risk for and mortality in paediatric patients. The use of the right
a complicated clinical course after discharge. antiemetics could reduce vomiting. Moreover the use of
Methods: antiemetics is cost-effective due to the reduce of the use of
Children with fever, dyspnoea or vomiting/diarrhoea (1 month-16 expensive intravenous fluids and hospitalisation.
years) who attended the ED of Erasmus MC-Sophia, Rotterdam Search strategy
(March-December 2010), Netherlands were included. Standardised MeSH terms were used and the following search was conducted in
questionnaires on disease course were applied by phone to parents Pubmed:
three days after ED-discharge. Sequential ED-visits were defined as Gastroenteritis (Major topic) AND child AND ondansetron AND
'necessary' if requiring diagnostics, therapeutics and/or metoclopramide.
hospitalisation. We compared frequencies of necessary, Using this method, 2 articles were found.
scheduled/unscheduled ED-revisits between the three patients 1. From Alhashimi et al, A Cochrane intervention review,
groups using Chi-square and multivariate logistic regression. published in 2009
Preliminary results: 2. From Cubbeddu et al, a randomized, double-blind,
Follow-up data were available for 1178/1519 children (77.6%), placebo-controlled, parallel-group study, 1997, which was already
median age 22 months (IQR11-47), 56.8% boys. included in the Cochrane review.
Seven-hundred- thirty- seven children (62.6%) had fever, 247 Conclusion
children (21.0%) had vomiting/diarrhoea and 194 children (16.5%) The small number of included trials provided some limited
dyspnoea. evidence favouring the use of ondansetron and metoclopramide
Total number of revisits was 407 (34.6 %), consisting of 255 over placebo to reduce the number of episodes of vomiting due to
children with fever (62.7 %), 89 children with vomiting/ diarrhoea gastroenteritis in children. Ondansetron was statistically superior
(21.9 %) en 60 children with dyspnoea (14.7%). to placebo in preventing emesis associated with acute
Of the 407 revisits, 268 (65.8 %) were unscheduled and 217 (53.3%) gastroenteritis in paediatric patients, however, metoclopramide
revisits were defined as necessary. has been shown only moderately effective against vomiting
An unscheduled revisit took place in 180/ 253 (71,1%) children with associated with acute gastroenteritis in children and was not
fever, in 46/ 59 (78.0%) children with dyspnoea and in 37/ 85 significant.
(43.5%) children with vomiting/ diarrhoea. Younger children were Comments
more likely to have an unscheduled revisit (p =0.02). Gender, These results were obtained from 1 Cochrane review which
complaint and parental concern did not significantly influence the included 4 RCT’s. Two studies were excluded because one of them
odds of unscheduled revisit. was a non randomised controlled trial and the other did not
Revisit was necessary in 140/ 253 (55.3%) of children with fever, include any of the primary or secondary outcomes. There are two
39/ 59 (66.1 %) with dyspnoea and 32/ 85 (37.6%) with vomiting/ studies awaiting assessment because of incomplete data. After
diarrhoea (p 0.02). This was not influenced by age, gender or response from the trialists in either of the studies, the Cochrane
parental concern. review will be able to add to the data available and build on the
The proportion of necessary revisits was higher in the strength of evidence for the planned outcomes specified in the
unscheduled- revisit- group (40.3%) compared with the scheduled- protocol of this review.
revisit-group (13.0%) (p< 0.05). The primary outcome specified in the protocol for this review was
Conclusion: the time taken from the administration of the treatment measure
Revisits are common at the ED. Unscheduled revisits are mostly until cessation of vomiting. None of the included trials provided
seen in children with fever and dyspnoea and were significantly any data addressing this outcome but some of the secondary
more necessary than scheduled revisits. Surprisingly, having a outcomes were reported.
revisit was not influenced by parental concern. Hopefully, in the Clinical Bottom line
future we will be able to develop evidence- based follow-up This review showed us that the use of ondansetron favours that of
programs, which can be used at discharge from the ED, guided by a placebo, therefore ondansetron can be used against vomiting in
complaint, age and other predictors for complicated clinical course. the paediatric patient with gastroenteritis. The use of
metoclopramide was found not significant in the use with
P721 __________________________________ Pediatrics paediatric patients with gastroenteritis so therefore should not be
used for that purpose. However, the limited numbers of included
ONDANSETRON VERSUS METOCLOPRAMIDE IN CHILDREN trials gives implications for more research. Future research should
WITH VOMITING DUE TO GASTROENTERITIS. also focus on outcomes that are of relevance to patients and thus
O. America the time to cessation of vomiting rather than a reduction in the
number of episodes of vomiting as outcomes would appear to be
Emergency department, Radboud University Nijmegen Medical Centre, Nijmegen, more appropriate.
Netherlands References
Corresponding author: Melle America O. ([email protected]) Alhashimi D, Al-Hashimi H, Fedorowicz Z. Antiemetics for reducing
Key-words: Vomiting in children with gastroenteritis ; Ondansetron ; Metoclopramide vomiting related to acute gastroenteritis in children and
adolescents: An intervention review. Cochrane Database of
Systematic Reviews 2009, Issue 2.

BOOK OF ABSTRACTS 391

P722 __________________________________ Pediatrics ac antonio casal sanchez, ai antonio iglesias vazquez, ls luis
sanchez santos
ASSESSMENT OF THE INTERVENTION OF PRIMARY CARE
PEDIATRICIANS IN A SIMULATED CLINICAL SCENARIO OF emergency department, public foundation of emergency health services of galicia 061,
ANAPHYLAXIS. STRENGTHS AND WEAKNESSESS. santiago, Spain
ls luis sanchez santos, ai antonio iglesias vazquez, ac Corresponding author: Mr Sanchez Luis ([email protected])
antonio casal sanchez Key-words: asthma ; dyspnea ; assessment

emergency department, public foundation of emergency health services of galicia 061, OBJECTIVE
santiago, Spain To assess the performance of various groups of primary care
Corresponding author: Mr Sanchez Luis ([email protected]) pediatricians in a simulated case of asthma crisis, with the
Key-words: anaphilaxis ; epinephrine ; fluids objective to recognize the potential areas for improvement of the
professional practice in a relatively common clinical situation.
Introduction: Anaphylaxis is a common risk for the babies, primary MATERIALS AND METHODS
care pediatricians should be able to recognize and and treat it A systematic review of the 19 debriefings of the asthma crisis
effectively. recorded along the first year of the courses of advanced medical
Objective: To assess the attitudes and procedures performed by simulation integrated in the training program of Pediatrics Primary
primary care pediatricians in a simulated clinical scenario of Care Society of Spain.
anaphylactic shock, and to design a proccess to improve their In each case, a group of 4 pediatricians should undertake the
performance in the critical key points established by international practical management of a case simulating a bronchospasm, for up
scientific recomendations. to 20 minutes.
Methods: An anaphylactic shock scenario based on a real case was RESULTS
designed. The data were obtained from an infant of 10 months Patient management was variable but generally can be considered
treated by one of the authors. The data were implemented in a acceptable, recognized common mistakes such as not raising the
pediatric advanced simulation system. The scenario was developed head to aerosolize the patient (7 of 19 groups), do not request a
systematically into the standard course of advanced medical transfer to a referral center (8 of 19) and keep the focus on the
simulation in pre-hospital pediatrics of the Spanish Society of patient over time (5 of 19). The results allowed the design of an
Extrahospitalary Pediatrics (SEPEAP), and analyzed the objective rating scale for assessing performance in similar cases.
performance of 42 groups of 4 primary care pediatricians in those CONCLUSIONS
courses. The assessment was established by means of: Using advanced simulation, primary care pediatricians can benefit
identification, adequation of the initial treatment provided, routes from training for the acquisition and maintenance of emergency
of administration of drugs and fluids, sequential treatment and management skills and simple means of relatively frequent cases
time to transfer to the referral center. such as bronchospasm.The systematic assessment of the
Results: All groups recognized immediately the clinical problem performance of simulated cases allows professionals to know their
and the severity of the case. However, most of the groups didn´t capabilities and areas for improvement, which should focus on
apply completely the recommended treatment protocols. Oxygen continuing education programs.
was provided in 90% of the scenarios (with different methods) and
the pulse-oxymeter was placed on the first two minutes, while only P724 __________________________________ Pediatrics
50% proceeded to the manual opening of the airway. In 97% of
cases the treatment used initially (time range between 1 and 10 THE EPIDEMIOLOGY OF ENTEROVIRUS MENINGITIS IN A
minutes) was epinephrine, but the route of administration was PEDIATRIC EMERGENCY DEPARTMENT IN BELGIUM
subcutaneous in 93%. Along the 20 minute-long clinical scenario, I Roggen, D Bulckaert, G van Berlaer, I Hubloue
90% administered two doses of epinephrine, 60% three and 30%
four. In 80% of cases intravenous access was peripheral and 20% Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit
intraosseous. Liquid replacement (saline bolus at doses of 20 cc/kg) Brussel, Jette, Belgium
was provided to the 97% of patients, and corticosteroids were Corresponding author: Mme Roggen Inge ([email protected])
administered to the 80% of the patients. Key-words: enterovirus meningitis ; epidemiology ; Belgium
Conclusions: Advanced medical simulation provides a systematic
assessment of the clinical performance, and maybe useful to detect Background
the strengths and weaknesses of primary care professionals in a Enteroviruses are the most common cause of meningitis,
situation of severe anaphylaxis. The main strength shown is the responsible for 85 to 95% of all cases of meningitis. It is most
ability to make a correct an immediate clinical identification and frequent in infants, but occurs in all age categories. Males-to-
triage. Areas detected that need an improvement include the female ratio is 3:1. The incidence in Europe and Northern America
management of the airway and the administration of adrenaline by is the highest in summer and fall.
the appropriate route (intramuscular). Objective
We wanted to chart the incidence and characteristics of
P723 __________________________________ Pediatrics enterovirus meningitis in our pediatric emergency department
(PED).
ADVANCED SIMULATION AS A TRAINING TOOL TO Methods
IMPROVE CLINICAL PERFORMANCE OF PRIMARY CARE Using a retrospective cohort study design, we analyzed all medical
PEDIATRICIANS: THE CASE OF ASTHMA CRISIS. records of children below the age of 16 who were admitted to our
ED between 1/1/2002 and 31/12/2011 and had a positive

BOOK OF ABSTRACTS 392

polymerase chain reaction (PCR) or viral culture for enterovirus on Choi HS(1), Jung JH, Choo JH, Gwak YH(1), Jang YS(1), Jang
cerebrospinal fluid (CSF). YS(1), Kim DG(1), Kim JW(1), Lee SY(1), Oh SK(1), Park
Results SY(1), Seo DB(1)
During this 10-year-period 131 children (96 males - 35 females) out
of 142,387 PED visits (0.09%), were diagnosed with enterovirus pediatric emergemcy department, Seoul national university of hospital, Seoul, Korea,
meningitis. Incidence peaks at the age of 0-6 months (13.7%) and (South) Republic of
from 3 to 6 years old (50.4%). Most cases are reported from mid- 2. p, Seoul national university of hospital, Seoul, Korea, (South) Republic of
May to mid-July (51.9%), with a smaller peak from mid-September Corresponding author: Mme Kim Juwon ([email protected])
to mid-November (19.1%). At least one sign of meningeal irritation Key-words: Length of stay ; Prescription ; Discharge
was present in 128/131 children: in infants (0-1 year old; n=18)
22.2% had a bulging fontanel and 61.1% were irritable, while in Background
older children (1-15 year old; n=113) 86.7% presented with nuchal The purpose of this study was to evaluate a factor of delaying
rigidity, 90.3% with headache and 29.2% with photophobia. discharge in the pediatric emergency department (PED) and to
Median (range) C-reactive protein (CRP) was 7.4 mg/L (0.2 - 67.8), survey satisfaction of emergency care and length of stay (LOS) in
90.8% had a CRP below 30 mg/L; median leukocyte count of the PED after intervention of shortening discharge activities to
11,300/mm³ (4,200 - 22,200) and median neutrophil count of 78.6 develop an effective discharge management strategy.
% (6.0 - 93.0). Leukocyte count was similar in infants and older Method
children, CRP and neutrophil count were significantly lower in the This study was conducted in two phases. The first phase was to find
infants: median (IQR) were respectively 2.5 mg/L (1.4 - 10.9) vs. 8.0 factors delaying of discharge process in the PED from a survey of
mg/L (3.9 - 16.1); p=0.01 and 39% (29 - 45) vs. 80% (73 - 81); guardians and medical staffs (pre-intervention group). Base on the
p<0.0001. These differences are not linked to the moment of survey results, we designed a LOS shortening program and we
presentation: median (IQR) duration of symptoms is 1 day (1 - 1) applied it in our PED. The second phase was to evaluate the LOS
for both groups. shortening in the PED after applying program and to estimate the
CSF PCR returned positive in 129/131 samples, viral culture in change of satisfaction of the caregivers and medical teams through
49/131 samples. Sixteen CSF samples were traumatic and were not a survey (post-intervention group).
included in the following results. CSF results show a median Before the intervention, patients received discharge medications
glucose of 58.0 mg/dL (43.0 - 84.0); median protein of 32.0 mg/dL only in the hospital pharmacy at discharge and the decision to
(10.0 - 151.0); median RBC count of 4/mm³ (0 - 142), 91.3% had a select discharge agents was made on a case-by-case basis at the
RBC count below 50/mm³; median WBC count of 96/mm³ (1 - discretion of the provider. The program’s contents are made up
1600), only 2 children had a WBC count above 1000/mm³. In that discharge medications is able to be received in hospital or out
infants glucose levels in CSV was significantly lower: median (IQR) of hospital pharmacy by caregiver's preference, the selection of
was 48.1 mg/dL (45.6 - 50.0) vs. 60 mg/dL (53.9 - 65.3); p<0.0001 discharge medications is recommended according to set orders,
and protein levels were significantly higher: median (IQR) was 52.3 and the guardians watch the video of discharge precautions during
mg/dL (33.0 - 92.0) vs. 30.1 mg/dL (23.0 - 39.0); p=0.0005. None of discharge waiting.
laboratory findings correlated with the duration of symptoms. Survey was conducted using a telephone to caregivers and a
All but one children were admitted to the hospital; 28 children questionnaire to medical staffs. Length of stays were defined time
received IV antibiotics, which was higher in infants (77.8% vs. from patient registered in the PED to patient discharged, and were
12.4%; p<0.0001). Median (range) length-of-stay (LOS) was 2 days checked to review the electronic medical record system.
(0 - 15). LOS was significantly longer when children received IV Results
antibiotics, regardless the age of the child: median (IQR) 2 days (1 - In pre-intervention group, 100 caregivers and 85 medical staffs
2) vs. 4 days (3 - 6); p<0.0001. Eleven (8.4%) children returned to were enrolled and 143 caregivers and 69 medical staffs were
the ED within 5 days after discharge, of which 6 were readmitted. enrolled in post-intervention group. In caregivers, female were
The reason for returning was persisting headache in all 11 cases. 83(83.0%) in pre-intervention group and 122(85.3%) in post-
Eventually all 131 children left the hospital without any sequelae. intervention group, and mean age were 37.5(±6.04) and
Conclusions 34.62(±4.78). Prescription was issued to 35(24.5%) in pre-
The occurrence pattern of enterovirus meningitis in our PED intervention group, whereas prescription was issued to 96(67.1%)
matches the occurrence in similar regions: a very low incidence; a in post-intervention group.
3-fold higher incidence in males and peaks during summer and fall, LOS was 7.70(±27.72) and 6.75(±26.8) hours, and from discharge
yet a small decrease during summer holidays. Inflammatory order to discharge time was 2.25(±28.87) and 1.05(±6.16). The
parameters tend to be low in all children, with an outspoken statistical results decreased 1.2 hours, but There were no
difference in leukocyte formula between infants and older significant differences (p=0.235). At discharge, using the procedure,
children. Though almost all children were admitted, LOS was low in hospital drug prescription and discharge process for ease of survey
children that did not receive AB, yet with almost 10% of children data, satisfaction mean scores were 7.41(±1.97) in pre-intervention
returning to the ED for persisting headache, we do have to stay group and 7.35(±1.74) in post-intervention group, but there were
alert for adequate pain management and patient information on no significant differences (p=0.801). Medical staff’s survey,
the natural course of the disease. satisfaction increased from 11.8 to 17.4%, dissatisfaction reduced
from 31.8 to 24.6%, but there were no significant differences
P725 __________________________________ Pediatrics (p=0.464).
Conclusion
SHORTENING LENGTH OF STAY USING ALTERATION OF Prescription is thought of the main factor of delaying discharge in
DISCHARGE ACTIVITIES IN THE PEDIATRIC EMERGENCY the PED. After intervention, LOS in the PED and from discharge
DEPARTMENT order to discharge time was shortened, but statistically no
significant difference.

BOOK OF ABSTRACTS 393

P726 __________________________________ Pediatrics BACKGROUND: Propionic acidemia is a metabolic disease which
causes the accumulation of propionic acid due to deficiency of
THE CHARACTERISTICS AND TREATMENT PATTERNS OF propionyl CoA carboxylase. Mild forms may occur due to mutations
EMERGENCY DEPARTMENT(ED) BY CHILDREN RETURNING in PCCA and PCCB genes, and the actual incidence is estimated to
VISIT IN KOREA. be 1/18000. It usually occurs in the neonatal period or early
JH Choo, HS Choi, JH Choi, YH Gwak (2), YS Jang, JH Jung, infancy. Mild forms may have delayed appearance. Patients may
DG Kim apply with vomiting, seizures, lethargy, hypotonia, and
JW Kim, SY Lee, encephalopathy complains. Early and late-onset (6 weeks before
SY Park, DB Seo and after) the types are available. Early-onset causes mental
retardation and early death. In late-onset group, excessive
Pediatric Emergemcy Department, Seoul National University of Hospital, Seoul, Korea, movement disorders and dystonia develop. The initial symptoms
(South) Republic of can be movement disorders in patients with propionic acidemia.
Corresponding author: Mme Kim Juwon ([email protected]) We are presenting case diagnosed with propionic acidemia during
Key-words: Pediatric emergency room ; returning visit ; characteristics and treatment the follow-up after post-traumatic seizures. CASE: 7 month old
patterns male patient came to the emergency with neck immobility as a
result of falling from seat. His physical exam revealed no strength
Most EDs from referral hospitals provide their essential ED loss of extremites. Cervical X-ray and comptuted tomography were
information to National Emergency Medical Center (NEMC) also normal. Choreiform movements with the arms and legs were
through the National Emergency Department Information System developed in the patient for about 2 months after the trauma. The
(NEDIS). We obtained and analyzed the NEDIS data for children 15 patient was given biperiden because of lack of improvement in
years old and younger and revisited ED from 1 January to 31 movements; phenytoin was loaded to the patient. There was no
December, 2011. Revisiting criteria is the patients back to the ED significant improvement. Patient had normal EEG findings. Nörodol
within 48 hours of initial visit, and exclude visits with was applied to the patient. Due to the persistence of the
administrative procedures, computer network problems, and complaints his family admitted to our pediatric clinic. He was
cancellation received of first visit. hypotonic. There was no history of sibling deaths. Cranial MRI was
A total of 16,751 eligible children visited the EDs during study normal. The baby had a history of consanguinity. On tandem mass
period, and 570 (3.4%) children returned to EDs. Male patients spectrometric study, C3-propionyl carnitin level was increased,
were 57.4% and the mean age 4.5years. C3/C2 ratio with 2.69 (NR: <0.2), C2 with 21.49 (NR:<6.92). Urinary
Among age groups, 3 months to younger than 3 years group was organic acid analysis revealed increased 3-OH propionic acid, 3-OH
the largest(38.1%). Most patients visited EDs on Sunday (21.8%) butyric acid and propionyl-glycine levels. He was diagnosed as
(p<0.001). The most common revisit reason was worsening or propionic acidemia and recommended protein-restricted diet with
relapse of initial symptoms (60.9%), followed by emergence of new oral L-carnitine and biotin supplementations. CONCLUSION: Rate of
disease (17.4%). The most diagnosis of initial visit was patients with consanguineous marriages is high in our country. So that taken into
gastrointestinal problem (21.4%), however, in return visit, consideration of the transition of this autosomal recessive disease,
infectious disease was most common (20.2%). When initial visit, congenital metabolic disease propionic acidemia should be
the Emergency Severity Index (ESI) level 2 was 7%, and level 3 was remembered in case of healthy inborn but with late movement
78.6%, whereas when return visit, ESI level 2 was 8.8%, level 3 was disorders.
82.1% (p<0.001). In return visit the ED length of stay was
significantly longer than in initial visit (671.7 minute vs. 322.9 P728 __________________________________ Pediatrics
minute, p<.00). Hospitalization is more than in return visit (1.6% vs.
26.0%, p=0.029). The patients younger than 3 years old was easily THE PNEUMONIA INTERFERING WİTH ACUTE
discharged, however 3 years old and older preferred APPENDICITIS:CASE PRESENTATION
hospitalization (p=.002) T Acar (1), H Seker (2), M Keser (2), C Dikmetaş (1), K Yavuz
We compared characteristics of the initial visit with of the return (1), B Cander (1)
visit. Day of the week, the ESI level, diagnosis, and disposition is
significantly different between two groups. 1. Emergency department, University of Necmettin Erbakan, Meram Medical Faculty,
Konya, Turkey
P727 __________________________________ Pediatrics 2. Pediatri department, University of Necmettin Erbakan, Meram Medical Faculty, Konya,
Turkey
PROPIONIC ACIDEMIA PATIENT THE FOLLOW-UP DUE TO Corresponding author: Mr Acar Tarik ([email protected])
POSTTRAUMATIC EPILEPSY:CASE PRESENTATION Key-words: PNEUMONIA ; INTERFERING ; ACUTE APPENDICITIS
T Acar (1), B Cander (1), S Kocak (1), M Ergin (1), H Caksen
(2), H Seker (2) INTRODUCTION: Abdominal pain is a common symptom during the
course of various diseases in children. No matter how old the
1. Emergency department, Necmettin Erbakan University Meram Medicine Faculty, patients are, it is not always possible to understand the cause of
Konya, Turkey the abdominal pain. Since there is no exact borders between
2. Pediatri department, Necmettin Erbakan University Meram Medicine Faculty, Konya, quadrants of abdomen, it is difficult to determine localization of
Turkey pathology.
Corresponding author: Mr Acar Tarik ([email protected]) Children can be brought to the doctor because of abdominal pain
Key-words: PROPIONIC ACIDEMIA ; POSTTRAUMATIC EPILEPSY ; METABOLIC DISEASE in right lower lobe pneumonia. Tachypnea, intercostal and
subcostal retractions are observed during physical examination.
Crepitation and rhonchi are usually heard during listening in case of
bronchopneumonia. In case of lobar pneumonia, breath sounds
decreased on that area and tubersufl is determined in lung fields

BOOK OF ABSTRACTS 394

adjacent to that area. Irritation of the lower intercostal nerves and emergency and requirement of acute seizure treatment were
diaphragm tenderness due to pneumonic infiltrates in the right significantly associated with abnormal neuroimaging findings. In
inferior lobe causes spasm of the anterior abdominal wall muscles afebrile group, there was association between younger age and
and severe abdominal pain. Left lower lobe pneumonia can mimic abnormal neuroimaging findings. The incidence of acute surgical
acute appendicitis. Pain increase with a deep inspiration is typical treatment or intervention was 6.1%.
in these patients.In this study, a case who had suspicion of acute As a conclusion, when assessing a child with first seizure, carefully
appendicitis but was diagnosed as right lower lobe pneumonia was examine the child after taking detailed history and than the
presented here. physcian consider the necessity of emergent neuroimaging in the
CASE: 3-year-old male patient, previously without any complaint, pediatric emergency. The pediatric emergency clinician’s main
began to have fever four days ago before admission to ED. He priority is to rule out a life-threatening intracranial condition such
vomited two times in last four days and had abdominal pain. as hemorrhage or neurosurgical intervention, deferring nonurgent
Analgesic and antipyretic regimens were started at another evaluation to a later time.
medical center. His complaints didn’t regress. Leukocytosis and
edema of the wall of intestine on ultrasonography were P730 __________________________________ Pediatrics
determined. The patient was referred to our hospital with
suspicion of appendicitis. His physical exam revealed diminished COMPARING SEVERITY OF ILLNESS BETWEEN REFERRED
lung sounds in the right lower lobe and normal abdominal findings. AND SELF-REFERRED CHILDREN IN EMERGENCY CARE
X-ray of chest and abdomen showed infiltartion of right lobe. The D. Bosman, A. Eikendal, S. Heisterkamp, C. de Kruiff, F. de
contrast enhanced chest computed tomography was reported Lorijn
pneumonic consolidation of the right lung upper lobe and middle
lobe, parapneumonic pleural effusion. Abdominal ultrasonography General Pediatrics, Emma’s Childrens Hospital / AMC, Amsterdam, The Netherlands
was in normal range. Corresponding author: Mr De Kruiff Chris ([email protected])
CONCLUSION: Only 5% of children presenting with abdominal pain Key-words: referral ; emergency ; triage
require surgery, Auscultation of the lungs and chest X-ray provide
clarification of the incident. Overlooking of this situation in the Objective
lungs can cause a surgical intervention which can result in Children who are referred and children who are self-referred
unnecessary anesthesia and surgical operation. follow different pathways of care when they present themselves at
the Emergency Department (ED) of the Academic Medical Centre
P729 __________________________________ Pediatrics (AMC), a tertiary referral centre. Referred children are primarily
consulted by a paediatrician whereas self-referred children are,
ASSESSMENT OF PATIENTS PRESENTING WITH FOCAL after triage, seen by an emergency physician. The emergency
SEIZURE TO DIVISION OF PEDIATRIC EMERGENCY physician decides whether a paediatrician needs to be consulted.
MEDICINE This results in a considerable amount of paediatric patients leaving
T Serdar (1), O TEKŞAM (1), G TURANLI (2) the ED without being consulted by a paediatrician implicating that
the type of medical specialist that will primarily consult the patient
1. Division of Pediatric Emergency Medicine, Hacettepe University Faculty of Medicine depends on referral status. Only little evidence is present
Department of Pediatrics, Ankara, Turkey concerning whether referral status solitarily is an adequate
2. Division of Pediatric Neurology, Hacettepe University Faculty of Medicine Department predictor to categorize severity of illness in children.
of Pediatrics, Ankara, Turkey The first aim of this study is to assess whether referral of children
Corresponding author: Mme Teksam Özlem ([email protected]) to the ED is associated with greater severity of illness when
Key-words: Focal seizure, ; febrile seizure, ; brain imaging compared self-referred children.
A second aim of this study is to evaluate whether self-referred
The aim of this study was to determine incidence of abnormal children that are only seen by an emergency physician are more
neuroimaging findings and to investigate the clinical indicators of severely ill than self-referred children that are seen by an
these abnormal findings in patients presenting with first focal emergency physician and a paediatrician.
seizure. With these aims we will assess whether it is justified to base the
The study consisted of 65 patients who are at the age of 30 days-18 specialism that will primarily consult the patient solitarily on
years and presented to Hacettepe University İhsan Doğramacı referral status. Hence we can evaluate whether the current
Childrens’ Hospital Division of Pediatric Emergency Medicine pathways of care deliver adequate quality of care and to make
between January 2001-February 2012, with febrile or afebrile first bottlenecks in Paediatric Emergency Healthcare at the AMC
focal seizure, without any history of previous seizure other than intelligible and perceive issues of improvement.
simple febrile seizure, and had brain computer tomography (CT) Methods
and/or magnetic resonans imaging (MRI). Clinical informations A retrospective, cross-sectional study of data was performed for all
about the patients obtained from patient’s charts and hospital children between 37 weeks of gestational age and 18 years at the
information system retrospectively and recorded on a standardized moment of inclusion, who were presented at the ED of the AMC
data collection form. during a five month period. We included children with the most
Complex focal febrile seizure observed in 33% of patients and prevalent paediatric, non-surgical complaints. These complaints
afebrile focal convulsion in 67% of patients, 95% of all patients had concern the respiratory-, gastro-intestinal- or urogenital tract, the
brain CT and the incidence of abnormal CT scan was 32%, whereas central nervous system or the ear-, nose- and throat region. Data
the incidence of focal abnormality was 24%. If three patients who concerning patient demographics, referral status, work diagnosis
had only MRI were also considered as a first neuroimaging, than and treating physician were collected from the electronic medical
the incidence of abnormality was 35%, focal abnormality was 26%. records and analyzed. Markers for severity of illness that were
Absence of fever, history of trauma, consistence of neurological or obtained and analyzed were urgency classification according to the
systemic disease, number of seizures, recurrence of seizure in the

BOOK OF ABSTRACTS 395

Manchester Triage System, abnormal vital signs at presentation, dispatching center when the ambulance left its base and arrived on
admittance, duration of admittance and whether additional scene, which are recorded into a FileMarker Pro database, beside
diagnostics were performed. Referred children were compared to the location, the condition, and other characteristics of the
self-referred children. We corrected for potential confounders like intervention. Main criterion was the median response time for
false referral route, age and gender. each municipality. Results are expressed as median [IQR] and
Results percentage and compared by non-parametric tests for quantitative
First aim: of 941 eligible children, 353 (37.5%) were referred and data and chi-square test for qualitative data. Median intervention
588 (62.5%) were self-referred. With adjustment for age and times have been also classified as < 5, < 10, < 15 and < 20 minutes.
gender, referred patients were significantly more likely to be Results: During the study period, 2620 interventions were
classified as high urgency (P<0.001); to have one or more abnormal performed. Median intervention times for the different
vital signs at presentation at the ED (P=0.003); to be admitted municipalities of the first-line service zone are presented in the Fig.
(P<0.001); to have additional diagnostics performed (P=0.001) and Noteworthy, some municipalities that are adjacent to the first-line
to have a longer duration of admittance (P=0.009) when compared area have relatively low intervention times: 6 [5-8] for St-Ouen, 7
to self-referred patients. [6-8] for the 17th district of Paris and 7 [6-10] for the 18th district
Second aim: of 287 eligible self-referred children, 104 (36.2%) were of Paris. Median intervention times did not show any difference
consulted by an emergency physician and a paediatrician and 183 between day and night or working days and weekends, as show in
(63.8%) were only seen by an emergency physician and sent home. Table 2. There was also no difference if the motive of intervention
With adjustment for age and gender, patients that were consulted was cardiac arrest (8 [5-10] min) vs any other motive (7 [5-10] min,
by an emergency physician and a paediatrician were significantly p = 0.18).
more likely to be classified as high urgency (P<0.001); to have one Conclusion: Our study shows acceptable response times on the
or more abnormal vital signs at presentation at the ED (P<0.001) area when our teams are the first-line and second-line responders.
and to have additional diagnostics performed (P=0.001) when Interestingly, because of the particular location next to other
compared to self-referred patients that are only seen by an districts, response times are in the same range for some
emergency physician. However, of all the self-referrals that were municipalities that are adjacent to the first-line service zone. In a
only seen by an emergency physician and sent home, 41.2% had an new system in which catching areas would not only based on
urgent triage category and 19.3% had one or more abnormal vital administrative criteria anymore but also on performance
signs. evaluation, response times for EMS might be optimized.
Conclusion
Referral of children to an ED is associated with a greater severity of P732 ____________________ Pre-hospital / EMS / Out of Hospital
illness. However, referral status alone is an average predictor to
assess severity of illness. OUTCOMES OF DISPATCHER-ASSISTED CPR ON SURVIVAL
The aim of future research is to develop more indicators to AFTER NON-TRAUMATIC OUT-OF-HOSPITAL CARDIAC
improve the identification of children at risk, in order to guarantee ARREST.
optimal pathways of paediatric emergency healthcare. M Plodr (1,2), A.Truhlar (2), D. Tucek (3), J. Masek (2)

P731 ____________________ Pre-hospital / EMS / Out of Hospital 1. 7th Field Hospital, Hospital Base Hradec Kralove, Czech Armed Forces, Czech Republic
2. Emergency Medical Service of the East Bohemian Region. Hradec Kralove, Czech
RESPONSE TIME EVALUATION FOR EMERGENCY MEDICAL Republic
SERVICE AS A PART OF ITS PERFORMANCE 3. Emergency Department, University Hospital Hradec Kralove, Czech Republic
J. Josseaume (1), D. Garnier-Connois (2), A. Ricard-Hibon Corresponding author: Mr Plodr Michal ([email protected])
(1), J. Mantz (2), E. Casalino (3), F. Duchateau (2) Key-words: dispatcher-assisted CPR ; OHCA ; emergency medicine

1. Emergency Department, Hopital Beaujon, Paris, France Introduction:
2. Intensive Care Unit, Hopital Beaujon, Paris, France Dispatcher- assisted cardiopulmonary resuscitation (D-A CPR) has
3. Emergency Department, Hopital Bichat, France an important role in the management of out-of-hospital cardiac
Corresponding author: Mr Josseaume Julien ([email protected]) arrest (OHCA). This procedure was systematically implemented in
Key-words: Prehospital medecine ; Response time ; Performance to the Emergency Medical Service of the East Bohemian Region
from 2006. The aim of this analysis is present results of CPR after
Introduction: Response time is one of the components of OHCA with initiation of dispatcher-assisted CPR.
emergency medical service (EMS) performance. Current locations Methods:
of physician-staffed French EMS units are mainly based on Retrospective data analysis, from 1st January to 31st December
historical and common sense factors and not on the results of 2011 from Emergency Medical Service of the East Bohemian
previous intervention time evaluation. The study aimed to evaluate Region. Only non-traumatic etiology of cardiac arrest has been
the response time of our EMS unit in both first-line and second-line involved. Two groups of patients were compared (Group A: D-A
service zones as part of its performance and how best to integrate CPR with bystanders and Group B: non-bystanders: CPR by EMS
it into its geographical specificity. crew). Final data evaluation was made on the basis of medical
Methods: The study is a retrospective, descriptive record that was report and recordings analysis.
conducted over a 1-year period (October 2009-September 2010) in Results:
a large urban physician-staffed EMS unit (4 squads) of a teaching During the 12-month period, a total of 452 patients with non-
hospital covering an area of 6 municipalities as first-line responders traumatic OHCA were analyzed. Dispatcher-assisted CPR by
and another area of 4 municipalities as systematic second-line bystanders was initiated within 277 (61 %) of patients (Group A),
responders, but frequently led to intervene in the neighbouring 178 patients (39 %) were EMS-crew resuscitated (Group B).
areas as well in case their first-line unit is not available. Response Primary survival rate (admission to hospital with ROSC) for Group A
times were calculated based on times given on radio by the was 35 % (96 patients), for Group B 40 % (72 patients). Incidence of

BOOK OF ABSTRACTS 396