- Email: [email protected]
Lipothymia: Etiology and outcome in a prehospital setting
S42
Abstracts / Resuscitation 81S (2010) S1–S114
AP031 Lipothymia: Etiology and outcome in a prehospital setting Zwisler S.T., Mikkelsen S. Mobile Emergency Care Unit, Department of Anaetshesiology and Intensive Care, Odense University Hospital, Odense, Denmark Purpose: Lipothymia, or syncope, is merely a description of a symptom and is a condition including loss of postural tone and loss of consciousness. The etiology of lipothymia is not always obvious. The aim of the study was to investigate the patients attended to by the Mobile Emergency Care Unit (MECU) in Odense, Denmark, who were given the initial diagnosis lipothymia in order to establish the etiology. Methods: During a four-year period (May 1st 2006 to April 30th 2010), all records at the MECU concerning patients with lipothymia were sought. We investigated the outcome of the patient after the involvement of the MECU. If admitted to Odense University Hospital, we compared the primary discharge diagnosis recorded in the hospital discharge letter with the diagnosis found in the MECU database. Results: During the 4-year period 17980 MECU runs were registered and within these 678 were assigned the diagnosis lipothymia (3.8%). 578 patients were admitted to hospital. Of these, 278 patients were discharged from the emergency room and 265 were admitted to the hospital. 23 were admitted to other hospitals and lost to follow-up. 112 patients did not want treatment, died, or were left at the scene following treatment. 299 patients were discharged with the diagnosis lipothymia and 237 patients were discharged with specific diagnoses. Conclusion: Following a syncopal attack, 85% required admission to hospital. Of the patients admitted to hospital, 48% were discharged from the emergency room and 46% were admitted to hospital. In 44% of the patients presenting with lipothymia, that particular diagnosis was considered the sole diagnosis at the hospital and no etiology was found. doi:10.1016/j.resuscitation.2010.09.176 AP032 Medical emergencies in dental practices Timerman L. 1 , Conrado V.C.L.S. 1 , Andrade A.C.P. 1 , Angelis G.A.M.C. 1 , Neves I.L.I. 2 , Timerman S. 3,4 1 Dental
department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil Dental department, Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil 3 Cardiology Division, Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil 4 School of Health Science and Medicine, Anhembi Morumbi University, Sao Paulo, Brazil 2
Medical emergencies occur in the dental practice. Dental practitioners and their staff must be adequately prepared and equipped to deal with these common life threatening conditions. In Sao Paulo, Brazil, two cardiology hospitals conducted retrospective study 2005–2009 by the Dental department. The results from this study showed that from 22% to 51% of dentists had a patient with a medical emergency in any one year. Most of these complications (89%), were mild, 11% were considered to be serious. It was found that 43% of the patients were known to have some underlying disease. Cardiovascular disease was found in 73% of those patients. Medical emergencies were most likely to occur during and after local anesthesia, primarily during tooth extraction and endodontics. Over 50% of the emergencies were syncope, the next most common event, mild allergy, represented 12% of all emergencies. In addition to syncope, other emergencies reported to have occurred include allergic reactions, angina pectoris/myocardial infarction, cardiac arrest, postural hypotension, seizures, bronchospasm and diabetic emergencies. In summary, medical emergencies do occur in dental offices. Dentists must be prepared to manage these patients until they recover or help arrives. doi:10.1016/j.resuscitation.2010.09.177 AP033 Prehospital hypoglycemia Hatting N.P. 1 , Mikkelsen S. 2 1 Department
of Anaesthesiology, Lillebaelt Hospital, Vejle, DK-7100 Vejle Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark 2
Purpose: The purpose was to evaluate the appropriateness of the current treatment principles regarding hypoglycemia treated by the Mobile Emergency Care Unit (MECU), judged by the amount of hospital contacts and repeated MECU-contacts within the following 30 days. Materials and methods: We searched the MECU-database for all hypoglycemia related encounters registered from May 1st 2006 until April 30th 2010. 108 patients with a number of MECU-contacts ranging from 1 to 4 were entered into the study. Repeated contacts (further MECU-contacts, admissions to hospital, enquiries at the emergency department, out-patients’ clinics) were registered for a period of 30 days following the initial MECU treatment.
Results: We found that 50% of the patients presenting with the diagnosis hypoglycemia were admitted to hospital in spite of blood glucose level being normalized. A total of 10 patients left at the scene (14.5%) meet the criteria of a repeated contact within 30 days. 4 of these (5.8%) were admitted within 24 h because of secondary hypoglycemia – either by their general practitioner or the MECU. 3 patients contacted the department of endocrinology, 1 patient contacted the emergency department and 2 patients required the services of the MECU within the 30-day period. Conclusion: One in 13 patients left at the scene by the MECU following a hypoglycemic episode required renewed treatment within 24 h following the first treatment. In spite of our institution admitting a large proportion of hypoglycemic patients to hospital following treatment in relation to other institutions with a similar setup, the total number of patients suffering from recurrent hypoglycemia is just as high as numbers reported from other institutions with a similar setup (5.8% vs. 5%).1 Poor compliance with diabetic treatment instructions is a possible explanation involved in these cases. doi:10.1016/j.resuscitation.2010.09.178
Prevention of cardiac arrest AP034 The IPI identifies the window of opportunity for treatment before cardio-respiratory arrest Einav S. 1 , Helvitz Y. 1 , Ronen M. 2 , Hersch M. 1 1 Intensive 2
Care Unit, Shaare Zedek Hebrew University Medical Center, Jerusalem, Israel Algorithm Engineering, Department of Research and Development, Oridion Medical
Purpose: Human working memory has an integrating capacity limited to three variables1 and is impaired by stress.2 This may cause treatment delays with resultant cardiopulmonary arrests despite patient monitoring. The Integrated Pulmonary Index (IPI) (Oridion medical Ltd.), integrates four non-invasively measured physiological parameters [end-tidal CO2 (EtCO2), respiratory rate (RR), heart rate and blood oxygenation] into a patient condition score (scale of 1–10) by using a mathematical method which mimics human logical thinking (fuzzy logic3,4 ). The current study examined the value of the IPI in-hospital as a predictor of endotracheal intubation in critically ill patients. Methods: A random sample of spontaneously-breathing adult patients without chronic lung disease who underwent ICU admission due a high risk of respiratory failure was included. Patients were connected to a CapnostreamTM 20 portable bedside monitor within 48 h of admission for a 6–8 h recording period in parallel to standard ICU monitoring. EtCO2 and RR values were obtained through a sidestream Smart CapnoLine® sampling system. The Capnostream screen was covered throughout the recording period and disconnected immediately afterwards; treatment therefore remained independent of IPI values and wholly dependent on expert clinical evaluation. Recorded data were downloaded through dedicated software to MATLAB® for analysis. Patients were followed until ICU discharge. Results: The study group included 8 patients; four were eventually intubated pending arrest and four eventually improved without intubation. The cumulative IPI of patients who never required intubation was 8.22 ± 1.57 (median 8). That of patients who eventually required intubation was 4.02 ± 2.08 (median 4). t-Test comparison between the two groups demonstrated a p-value of Conclusions: Cumulative IPI data may be able to differentiate between patients who will eventually require intubation for critical deterioration and those who will improve without intubation. Further substantiation of this find is required in a larger cohort. References 1. Baddeley A. Working memory. Science 1992;255:556–9. 2. Luethi M, Meier B, Sandi C. Stress effects on working memory, explicit memory, and implicit memory for neutral and emotional stimuli in healthy men. Front Behav Neurosci 2008;2:5. 3. Gadaras I, Mikhailov L. An interpretable fuzzy rule-based classification methodology for medical diagnosis. Artif Intell Med 2009;47:25–41. 4. Spring B. Health decision making: lynchpin of evidence-based practice. Med Decis Making 2008;28:866–74. doi:10.1016/j.resuscitation.2010.09.179
Abstracts / Resuscitation 81S (2010) S1–S114
AP031 Lipothymia: Etiology and outcome in a prehospital setting Zwisler S.T., Mikkelsen S. Mobile Emergency Care Unit, Department of Anaetshesiology and Intensive Care, Odense University Hospital, Odense, Denmark Purpose: Lipothymia, or syncope, is merely a description of a symptom and is a condition including loss of postural tone and loss of consciousness. The etiology of lipothymia is not always obvious. The aim of the study was to investigate the patients attended to by the Mobile Emergency Care Unit (MECU) in Odense, Denmark, who were given the initial diagnosis lipothymia in order to establish the etiology. Methods: During a four-year period (May 1st 2006 to April 30th 2010), all records at the MECU concerning patients with lipothymia were sought. We investigated the outcome of the patient after the involvement of the MECU. If admitted to Odense University Hospital, we compared the primary discharge diagnosis recorded in the hospital discharge letter with the diagnosis found in the MECU database. Results: During the 4-year period 17980 MECU runs were registered and within these 678 were assigned the diagnosis lipothymia (3.8%). 578 patients were admitted to hospital. Of these, 278 patients were discharged from the emergency room and 265 were admitted to the hospital. 23 were admitted to other hospitals and lost to follow-up. 112 patients did not want treatment, died, or were left at the scene following treatment. 299 patients were discharged with the diagnosis lipothymia and 237 patients were discharged with specific diagnoses. Conclusion: Following a syncopal attack, 85% required admission to hospital. Of the patients admitted to hospital, 48% were discharged from the emergency room and 46% were admitted to hospital. In 44% of the patients presenting with lipothymia, that particular diagnosis was considered the sole diagnosis at the hospital and no etiology was found. doi:10.1016/j.resuscitation.2010.09.176 AP032 Medical emergencies in dental practices Timerman L. 1 , Conrado V.C.L.S. 1 , Andrade A.C.P. 1 , Angelis G.A.M.C. 1 , Neves I.L.I. 2 , Timerman S. 3,4 1 Dental
department, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil Dental department, Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil 3 Cardiology Division, Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil 4 School of Health Science and Medicine, Anhembi Morumbi University, Sao Paulo, Brazil 2
Medical emergencies occur in the dental practice. Dental practitioners and their staff must be adequately prepared and equipped to deal with these common life threatening conditions. In Sao Paulo, Brazil, two cardiology hospitals conducted retrospective study 2005–2009 by the Dental department. The results from this study showed that from 22% to 51% of dentists had a patient with a medical emergency in any one year. Most of these complications (89%), were mild, 11% were considered to be serious. It was found that 43% of the patients were known to have some underlying disease. Cardiovascular disease was found in 73% of those patients. Medical emergencies were most likely to occur during and after local anesthesia, primarily during tooth extraction and endodontics. Over 50% of the emergencies were syncope, the next most common event, mild allergy, represented 12% of all emergencies. In addition to syncope, other emergencies reported to have occurred include allergic reactions, angina pectoris/myocardial infarction, cardiac arrest, postural hypotension, seizures, bronchospasm and diabetic emergencies. In summary, medical emergencies do occur in dental offices. Dentists must be prepared to manage these patients until they recover or help arrives. doi:10.1016/j.resuscitation.2010.09.177 AP033 Prehospital hypoglycemia Hatting N.P. 1 , Mikkelsen S. 2 1 Department
of Anaesthesiology, Lillebaelt Hospital, Vejle, DK-7100 Vejle Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark 2
Purpose: The purpose was to evaluate the appropriateness of the current treatment principles regarding hypoglycemia treated by the Mobile Emergency Care Unit (MECU), judged by the amount of hospital contacts and repeated MECU-contacts within the following 30 days. Materials and methods: We searched the MECU-database for all hypoglycemia related encounters registered from May 1st 2006 until April 30th 2010. 108 patients with a number of MECU-contacts ranging from 1 to 4 were entered into the study. Repeated contacts (further MECU-contacts, admissions to hospital, enquiries at the emergency department, out-patients’ clinics) were registered for a period of 30 days following the initial MECU treatment.
Results: We found that 50% of the patients presenting with the diagnosis hypoglycemia were admitted to hospital in spite of blood glucose level being normalized. A total of 10 patients left at the scene (14.5%) meet the criteria of a repeated contact within 30 days. 4 of these (5.8%) were admitted within 24 h because of secondary hypoglycemia – either by their general practitioner or the MECU. 3 patients contacted the department of endocrinology, 1 patient contacted the emergency department and 2 patients required the services of the MECU within the 30-day period. Conclusion: One in 13 patients left at the scene by the MECU following a hypoglycemic episode required renewed treatment within 24 h following the first treatment. In spite of our institution admitting a large proportion of hypoglycemic patients to hospital following treatment in relation to other institutions with a similar setup, the total number of patients suffering from recurrent hypoglycemia is just as high as numbers reported from other institutions with a similar setup (5.8% vs. 5%).1 Poor compliance with diabetic treatment instructions is a possible explanation involved in these cases. doi:10.1016/j.resuscitation.2010.09.178
Prevention of cardiac arrest AP034 The IPI identifies the window of opportunity for treatment before cardio-respiratory arrest Einav S. 1 , Helvitz Y. 1 , Ronen M. 2 , Hersch M. 1 1 Intensive 2
Care Unit, Shaare Zedek Hebrew University Medical Center, Jerusalem, Israel Algorithm Engineering, Department of Research and Development, Oridion Medical
Purpose: Human working memory has an integrating capacity limited to three variables1 and is impaired by stress.2 This may cause treatment delays with resultant cardiopulmonary arrests despite patient monitoring. The Integrated Pulmonary Index (IPI) (Oridion medical Ltd.), integrates four non-invasively measured physiological parameters [end-tidal CO2 (EtCO2), respiratory rate (RR), heart rate and blood oxygenation] into a patient condition score (scale of 1–10) by using a mathematical method which mimics human logical thinking (fuzzy logic3,4 ). The current study examined the value of the IPI in-hospital as a predictor of endotracheal intubation in critically ill patients. Methods: A random sample of spontaneously-breathing adult patients without chronic lung disease who underwent ICU admission due a high risk of respiratory failure was included. Patients were connected to a CapnostreamTM 20 portable bedside monitor within 48 h of admission for a 6–8 h recording period in parallel to standard ICU monitoring. EtCO2 and RR values were obtained through a sidestream Smart CapnoLine® sampling system. The Capnostream screen was covered throughout the recording period and disconnected immediately afterwards; treatment therefore remained independent of IPI values and wholly dependent on expert clinical evaluation. Recorded data were downloaded through dedicated software to MATLAB® for analysis. Patients were followed until ICU discharge. Results: The study group included 8 patients; four were eventually intubated pending arrest and four eventually improved without intubation. The cumulative IPI of patients who never required intubation was 8.22 ± 1.57 (median 8). That of patients who eventually required intubation was 4.02 ± 2.08 (median 4). t-Test comparison between the two groups demonstrated a p-value of Conclusions: Cumulative IPI data may be able to differentiate between patients who will eventually require intubation for critical deterioration and those who will improve without intubation. Further substantiation of this find is required in a larger cohort. References 1. Baddeley A. Working memory. Science 1992;255:556–9. 2. Luethi M, Meier B, Sandi C. Stress effects on working memory, explicit memory, and implicit memory for neutral and emotional stimuli in healthy men. Front Behav Neurosci 2008;2:5. 3. Gadaras I, Mikhailov L. An interpretable fuzzy rule-based classification methodology for medical diagnosis. Artif Intell Med 2009;47:25–41. 4. Spring B. Health decision making: lynchpin of evidence-based practice. Med Decis Making 2008;28:866–74. doi:10.1016/j.resuscitation.2010.09.179