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Transthoracic echocardiography in non-arrhythmogenic cardiac arrest due to massive pulmonary embolism
Abstracts / Resuscitation 81S (2010) S1–S114 AP178
AP180
A 5-year retrospective study of toxic coma presented in a pediatric emergency department
Asthma and COPD as cause of cardiac arrest: Presentation and Outcome
S79
Wallmüller C., Kürkcijan I., Sterz F. Nitescu G., Ulmeanu C.E., Stemate C.C. Department of Emergency Medicine, Medical University, Vienna Emergency Department, Emergency Hospital For Children, Argentina Objective: To study the prevalence of coma due to acute poisoning in children admitted in a Pediatric Emergency Department. Methods: We performed a retrospective study of all the children admitted in the Emergency Department between November 1st, 2004 and October 31st, 2009, taking into consideration: consciousness status assessed by Reed Coma Scale (RCS), type of poisoning and modality of producing (accidental or intentional). Results: Toxic coma was diagnosed in 220 cases, representing 64% out of the comatose patients registered. According to the Reed Coma Scale we noted: 113 cases (51.36%) RCS 0, 63 cases RCS 1 (28.64%), 15 cases (6.82%) RCS 2, 18 cases (8.18%) RCS 3, 11 cases RCS (5%). The main causes of toxic coma were: ethanol - 73 patients (33%) and multiple drugs poisoning – 46 cases (21%); benzodiazepines – 15 patients (7%), antidepressants – 11 cases (5%), Dentocalmin – 11 cases (5%), barbiturates – 9 cases (4%), pesticides – 5 patients (2%), hydrocarbons – 3 cases (1.5%), carbon monoxide – 2 cases (1%), heroin – 1 patient (0.5%), 44 patients 20 (1%). In 155 cases we registered intentional poisoning and in 65 cases accidental poisoning. Conclusion: Even if their prevalence in the total of emergencies is not very high, toxic coma remains one of the most severe life-threatening situations in pediatric pathology. Toxic etiology represents the main cause of coma in children. Consequently, facing a child with sudden coma we must always think about poisoning.
Background: Asthma and the chronic obstructive pulmonary diseases (COPD) are possible noncardiac causes of cardiac arrest. Aim of the study: We analyzed clinical presentation, diagnosis, therapy and outcome of patients with cardiac arrest after a fatal asthma attack or an acute exacerbation of the COPD admitted to the emergency department of an urban tertiary care hospital. Methods: We retrospectively searched a registry of cardiac arrest patients admitted after primarily successful resuscitation to an emergency department and analyzed the records of asthma and COPD patients. Results: Over 14.5 years, asthma and COPD was identified as the immediate cause of cardiac arrest in 40 (1.6%) of 2558 sudden cardiac arrest patients, primarily affecting asthma in 17 and COPD in 23 cases. The characteristics of the 40 patients were as follows: male gender (58%), mean age 56 years (IQR 45–62), the initial rhythm diagnosis was asystole (48%) and pulseless electrical activity (45%) and previously known asthma/COPD in all cases. Pronounced respiratory acidosis (median pH, 7.09 and pCO2 level, 62 mmHg) was found in most patients. Return of spontaneous circulation occurred in 34 (85%) of 40 patients, 18 (45%) patients survived and 15 (83%) could be discharged in good neurological condition. Conclusion: Cardiac arrest caused by asthma/COPD is rare and overall survival is good. Diagnostic investigation is very unspecific, so common features such as previously known asthma/COPD, cardinal symptom dyspnoea or respiratory acidosis should increase suspicion.
doi:10.1016/j.resuscitation.2010.09.323 doi:10.1016/j.resuscitation.2010.09.325 AP179 AP181 Prevalence of emergency events in dental practice and emergency management of dentists
Transthoracic echocardiography in non-arrhythmogenic cardiac arrest due to massive pulmonary embolism
Oliveira R., Veiga D., Mourão J. Bertone M.V., Parramon F., Arias S., García R., Pardina B., Villalonga A. Department of Anaesthetics, Hospital de São João, EPE, Porto, Portugal Servicio de Anestesiología, Hospital Universitario Dr Trueta, Girona, Espa˜ na Purpose of the study: Medical emergencies in dental practice are generally perceived as being rare but when an emergency does occur it can be life-threatening. The ability of the dentist to initiate management is the key to minimizing morbidity and mortality. Few studies exist about the occurrence of emergencies in dental practice and the training experience of dental practice teams in life support. The aim of this study was to evaluate the prevalence of emergencies in dental practices and their training experience. Material and methods: An anonymous questionnaire survey was submitted by phone call to the 240 clinics and hospitals from Oporto city listed in the Health Control Institution during 6 months. This questionnaire was performed by three Anesthesiologists from our institution. Results: We had a response rate of 25%. 66% of the responders were male and 34% female. 42% work in a dental office, 52% in a clinical and 6% in a hospital. 67% reported an emergency during their practice and only 33% did not have any emergency situation. The most frequently reported emergency was syncope (59%), followed by hypoglycemia (53%), asthma (34%), hypertensive crisis (34%), epileptic fit (30%) and anaphylaxis (21%). 58% of dentists felt competent to treat syncope and 46% to treat a hypoglycemia. However 90% felt unable to manage a cardiac arrest, 95% a hypertensive crisis and 96% asthma. 97% underwent training in medical emergencies. 77% of the dentists considered important to have more emergency training. Conclusion: Medical emergencies are not rare in dental practice, although most of them are not life-threatening. Future postgraduate training in emergency care for dentists needs to be more accurately targeted to the known prevalence of emergencies and deficiencies in dentist’s emergency skills. doi:10.1016/j.resuscitation.2010.09.324
Introduction: Recent studies and case-reports have implied the importance of using emergent ultrasound-guided techniques for the diagnosis of many different causes of cardiac arrest. Echocardiography is a non-invasive and safe method to identify some of the most common and reversible causes of non-arrhythmic cardiac arrest such as: hypovolemia, tension pneumothorax, pericardial tamponade and pulmonary embolism (PE). We report a case of a patient undergoing cardiac arrest due to massive PE following bariatric surgery. We emphasize about the benefits of performing ultrasound during advanced life support (ALS). Case-report: A 48-year-old woman with a BMI of 40 kg/m2 underwent cardiac arrest while walking in the critical care unit ten hours after bariatric surgery. ALS was immediately performed and pulseless electrical activity (PEA) was noted. Chest compression was briefly interrupted to perform transthoracic echocardiography that showed a dilated hypokinetic right ventricle and a collapsed left ventricle. She was then placed under anticoagulation therapy. Cardiac output was re-established 15 min after ALS but she then started undergoing intermittent episodes of PEA along with hemodynamic instability during the following ten hours. She was finally stabilized and discharged from the hospital fully recovered ten days later. Discussion: Patients undergoing bariatric surgery are at high risk of PE (0.3–2%). The overall mortality rate is 30%. Some protocols propose the use of ultrasound during cardiac arrest to determine its etiology and to decrease the time between the arrest and the appropriate therapy. Ultrasound appears to be a good bedside test during cardiac arrest to guide management in real time without interrupting chest compression. It has a high specificity for detecting large pulmonary emboli responsible for cardiovascular collapse. This case demonstrates that ultrasound diagnosis can make physicians feel more confident on employing more aggressive life-saving therapies not currently used due to the fear of catastrophic outcomes. doi:10.1016/j.resuscitation.2010.09.326
AP180
A 5-year retrospective study of toxic coma presented in a pediatric emergency department
Asthma and COPD as cause of cardiac arrest: Presentation and Outcome
S79
Wallmüller C., Kürkcijan I., Sterz F. Nitescu G., Ulmeanu C.E., Stemate C.C. Department of Emergency Medicine, Medical University, Vienna Emergency Department, Emergency Hospital For Children, Argentina Objective: To study the prevalence of coma due to acute poisoning in children admitted in a Pediatric Emergency Department. Methods: We performed a retrospective study of all the children admitted in the Emergency Department between November 1st, 2004 and October 31st, 2009, taking into consideration: consciousness status assessed by Reed Coma Scale (RCS), type of poisoning and modality of producing (accidental or intentional). Results: Toxic coma was diagnosed in 220 cases, representing 64% out of the comatose patients registered. According to the Reed Coma Scale we noted: 113 cases (51.36%) RCS 0, 63 cases RCS 1 (28.64%), 15 cases (6.82%) RCS 2, 18 cases (8.18%) RCS 3, 11 cases RCS (5%). The main causes of toxic coma were: ethanol - 73 patients (33%) and multiple drugs poisoning – 46 cases (21%); benzodiazepines – 15 patients (7%), antidepressants – 11 cases (5%), Dentocalmin – 11 cases (5%), barbiturates – 9 cases (4%), pesticides – 5 patients (2%), hydrocarbons – 3 cases (1.5%), carbon monoxide – 2 cases (1%), heroin – 1 patient (0.5%), 44 patients 20 (1%). In 155 cases we registered intentional poisoning and in 65 cases accidental poisoning. Conclusion: Even if their prevalence in the total of emergencies is not very high, toxic coma remains one of the most severe life-threatening situations in pediatric pathology. Toxic etiology represents the main cause of coma in children. Consequently, facing a child with sudden coma we must always think about poisoning.
Background: Asthma and the chronic obstructive pulmonary diseases (COPD) are possible noncardiac causes of cardiac arrest. Aim of the study: We analyzed clinical presentation, diagnosis, therapy and outcome of patients with cardiac arrest after a fatal asthma attack or an acute exacerbation of the COPD admitted to the emergency department of an urban tertiary care hospital. Methods: We retrospectively searched a registry of cardiac arrest patients admitted after primarily successful resuscitation to an emergency department and analyzed the records of asthma and COPD patients. Results: Over 14.5 years, asthma and COPD was identified as the immediate cause of cardiac arrest in 40 (1.6%) of 2558 sudden cardiac arrest patients, primarily affecting asthma in 17 and COPD in 23 cases. The characteristics of the 40 patients were as follows: male gender (58%), mean age 56 years (IQR 45–62), the initial rhythm diagnosis was asystole (48%) and pulseless electrical activity (45%) and previously known asthma/COPD in all cases. Pronounced respiratory acidosis (median pH, 7.09 and pCO2 level, 62 mmHg) was found in most patients. Return of spontaneous circulation occurred in 34 (85%) of 40 patients, 18 (45%) patients survived and 15 (83%) could be discharged in good neurological condition. Conclusion: Cardiac arrest caused by asthma/COPD is rare and overall survival is good. Diagnostic investigation is very unspecific, so common features such as previously known asthma/COPD, cardinal symptom dyspnoea or respiratory acidosis should increase suspicion.
doi:10.1016/j.resuscitation.2010.09.323 doi:10.1016/j.resuscitation.2010.09.325 AP179 AP181 Prevalence of emergency events in dental practice and emergency management of dentists
Transthoracic echocardiography in non-arrhythmogenic cardiac arrest due to massive pulmonary embolism
Oliveira R., Veiga D., Mourão J. Bertone M.V., Parramon F., Arias S., García R., Pardina B., Villalonga A. Department of Anaesthetics, Hospital de São João, EPE, Porto, Portugal Servicio de Anestesiología, Hospital Universitario Dr Trueta, Girona, Espa˜ na Purpose of the study: Medical emergencies in dental practice are generally perceived as being rare but when an emergency does occur it can be life-threatening. The ability of the dentist to initiate management is the key to minimizing morbidity and mortality. Few studies exist about the occurrence of emergencies in dental practice and the training experience of dental practice teams in life support. The aim of this study was to evaluate the prevalence of emergencies in dental practices and their training experience. Material and methods: An anonymous questionnaire survey was submitted by phone call to the 240 clinics and hospitals from Oporto city listed in the Health Control Institution during 6 months. This questionnaire was performed by three Anesthesiologists from our institution. Results: We had a response rate of 25%. 66% of the responders were male and 34% female. 42% work in a dental office, 52% in a clinical and 6% in a hospital. 67% reported an emergency during their practice and only 33% did not have any emergency situation. The most frequently reported emergency was syncope (59%), followed by hypoglycemia (53%), asthma (34%), hypertensive crisis (34%), epileptic fit (30%) and anaphylaxis (21%). 58% of dentists felt competent to treat syncope and 46% to treat a hypoglycemia. However 90% felt unable to manage a cardiac arrest, 95% a hypertensive crisis and 96% asthma. 97% underwent training in medical emergencies. 77% of the dentists considered important to have more emergency training. Conclusion: Medical emergencies are not rare in dental practice, although most of them are not life-threatening. Future postgraduate training in emergency care for dentists needs to be more accurately targeted to the known prevalence of emergencies and deficiencies in dentist’s emergency skills. doi:10.1016/j.resuscitation.2010.09.324
Introduction: Recent studies and case-reports have implied the importance of using emergent ultrasound-guided techniques for the diagnosis of many different causes of cardiac arrest. Echocardiography is a non-invasive and safe method to identify some of the most common and reversible causes of non-arrhythmic cardiac arrest such as: hypovolemia, tension pneumothorax, pericardial tamponade and pulmonary embolism (PE). We report a case of a patient undergoing cardiac arrest due to massive PE following bariatric surgery. We emphasize about the benefits of performing ultrasound during advanced life support (ALS). Case-report: A 48-year-old woman with a BMI of 40 kg/m2 underwent cardiac arrest while walking in the critical care unit ten hours after bariatric surgery. ALS was immediately performed and pulseless electrical activity (PEA) was noted. Chest compression was briefly interrupted to perform transthoracic echocardiography that showed a dilated hypokinetic right ventricle and a collapsed left ventricle. She was then placed under anticoagulation therapy. Cardiac output was re-established 15 min after ALS but she then started undergoing intermittent episodes of PEA along with hemodynamic instability during the following ten hours. She was finally stabilized and discharged from the hospital fully recovered ten days later. Discussion: Patients undergoing bariatric surgery are at high risk of PE (0.3–2%). The overall mortality rate is 30%. Some protocols propose the use of ultrasound during cardiac arrest to determine its etiology and to decrease the time between the arrest and the appropriate therapy. Ultrasound appears to be a good bedside test during cardiac arrest to guide management in real time without interrupting chest compression. It has a high specificity for detecting large pulmonary emboli responsible for cardiovascular collapse. This case demonstrates that ultrasound diagnosis can make physicians feel more confident on employing more aggressive life-saving therapies not currently used due to the fear of catastrophic outcomes. doi:10.1016/j.resuscitation.2010.09.326