International Conference on Emergency & Acute Care Medicine August 22-23, 2018 Tokyo, Japan

Biography:

Segundo Mesa Castillo. As Specialist in Neurology, he worked for 10 years in the Institute of Neurology of Havana, Cuba.  He has worked in Electron Microscopic Studies on Schizophrenia for 32 years. He was awarded with the International Price of the Stanley Foundation Award Program and for the Professional Committee to work as a fellowship position in the Laboratory of the Central Nervous System Studies, National Institute of Neurological Diseases and Stroke under Dr. Joseph Gibbs for a period of 6 months, National Institute of Health, Bethesda, Maryland, Washington D.C. USA, June 5, 1990. At present he is member of the Scientific Board of the Psychiatric Hospital of Havana and give lectures to residents in psychiatry.

Abstract:

There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed  to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.

Biography:

Mehrdad Soltani Delgosha is a Specialist of Emergency Medicine in Karaj Emam Ali hospital.

Abstract:

Background; Electrocardiograph (ECG) changes along with brain trauma injuries have been reported in many studies. The brain injuries accompanied with ECG abnormalities had more mortality rate. The aim of study is assessing the relationship between electrocardiograph (ECG) changes and GCS among patients with traumatic brain injury.

Methods; This cross-sectional study was performed on the brain trauma patients admitted to the Emergency Department (ED) of Imam Hossein Hospital, Tehran, Iran during January 2015 to February 2016. After stabilization of the patients, according to the inclusion criteria, GCS was determined and ECG was taken. This process was repeated three times with the interval of two hours, and the relation between GCS and ECG changes was determined and reported. After one year the Glasgow outcome score (GOS) was measured by telephone the patients and getting the history.

Results; After consideration of the inclusion criteria, 200 patients were assessed (168 males and 32 females). During the first ECG assessment, 42% of the patients had ST alteration, while in the second and third ECG assessments, 46% of the patients had ST changes, which was in relation to lower GCS and severity of the brain injury. According to the analysis, there was also a direct association between QT correction (QTc), QT dispersion (QTd (and GCS, GOS.

Conclusion; The ECG changes would be in association with the GCS and GOS, therefore, the evaluation of ECG parameters can be useful in determining the early outcome of patients.

Biography:

Byoungseok Yoon has completed his bachelor’s degree at the age of 22 from Yonsei Unieversity, Bio-engineering department, Seoul, Korea and MD at the age of 26 years from Gachon University, School of Medicine. He is working in residency at Yonsei University, School of Medicine, Emergency Department, Severance hospital, Seoul, Korea.     
 

Abstract:

Many studies have reported the effectiveness of ‘time target’ on reducing emergency department (ED) overcrowding and improving clinical quality. We investigated the effect of introducing ‘time target’ on ED overcrowding and clinical quality using meta-analysis.

We searched electronic databases including PubMed, Cochrane Library and Embase until June 2017. Search keywords were including time target, national emergency access target, four hour rule, and shorter stays in ED. Two investigators selected and reviewed articles according to predefined inclusion and exclusion criteria. The quality of articles were evaluated by RoBANS checklist. Data were abstracted by a predetermined criteria and performed meta-analysis using RevMan software.

Out of 721 articles, 16 studies were included in the final analysis. A meta-analysis of four studies on ED length of stay (LOS) showed that the mean EDLOS was reduced by 0.64 hours (95% CI, 0.34~0.94) since the introduction of the “time target”. Other studies also showed that EDLOS was reduced. There was no definite trend for hospital admission rate. A meta-analysis of nine studies on the clinical quality. Showed that the total odds ratio was 1.02 (95% CI, 0.74~1.32). Time taken until the visitation of a doctor and the ainitiation of treatment were both reduced. The rate of “left without being seen” was decreased.

EDLOS was reduced and no significant association was seen between mortality and the application of ‘time target’ since the introduction of ‘time target’. “Rate of revisiting”, “time to clinician”, “time to treatment” and “rate of left without being seen” was reduced.

Biography:

Following my graduation from Christian Medical College, Vellore, India, I took up the challenge of working in a rural hospital with limited facilities.  That experience inspired me to pursue a career in Emergency Medicine which was in its infancy in India at that time.  After completing my Fellowship in Accident and Emergency Medicine from CMC Vellore, I was sponsored to train in the NHS by the Royal College of Emergency Medicine, UK.  After completing my Fellowship, I returned to India and took over as Head of Department of Emergency Medicine at Kauvery Hospital, Trichy, India.

Abstract:

Statement of the Problem:

Ratol paste is an easily available cheap rodenticide which is contains 3% yellow phosphorus.  It’s easy availability over the counter has led to its use for deliberate self-harm.  Accidental poisoning in children have also been reported.  It is a general protoplasmic poison with high mortality rate.  No specific antidote is available and treatment is mainly supportive.  There is paucity of published literature on its management and treatment varies from centre to centre.

Methodology:

A retrospective audit of patients presenting to a tertiary hospital with history of Ratol paste poisoning was done.  The laboratory investigations and treatment given were analysed to derive treatment recommendations.

Findings:

The leading cause of death is due to fulminant hepatic failure.  Multi-system involvement is common.  Presentation to hospital is often delayed due to early asymptomatic phase.  Early initiation of supportive treatment helps in preventing hepatic encephalopathy and reduces mortality and duration of hospitalisation.

Conclusions:

In the absence of a specific antidote, early initiation of supportive management and close clinical monitoring is the way forward in its treatment.

Biography:

Dr. Hemanshu K Warrier is an MBBS Graduate from P.R China. He has also completed the Membership of Royal College of Emergency Medicine, RCEM, UK & Masters in Emergency Medicine from The George Washington University, USA.He has rich experience of over 7 years to his credit with reputed Institutes such as Moolchand Hospital, Lok nayak Hospital in New Delhi and is currently heading the department of emergency at Max Hospital, Gurgaon,

Abstract:

Statement of the Problem: Community-acquired pneumonia is a common and serious illness worldwide. It is the main cause of mortality, which particularly targets young patients, elderly patients and those with co morbid conditions. Most patients with pneumonia are managed in the outpatient setting but patient admitted in the hospital due to pneumonia have a high mortality. Chest ultrasound (CUS) is being increasingly utilized in emergency and critical settings. Aim of this study was to compare the sensitivity and specificity of chest ultrasound and chest x-ray. Methodology & Theoretical Orientation: This was a prospective clinical study. We aimed for a sample size of 96 patients. Patients were enrolled every alternate day to randomise the study. Informed written consent was taken from all enrolled patients or their immediate relatives. The result of chest computerized tomography scan was taken as gold standard. The duration of study was 6 months(from September’16 to February’16). 100 patients were included in the study. Findings: Chest Ultrasound was found to have a higher sensitivity of 0.96 (95% CI 0.85 – 0.99) compared to x-ray which had a sensitivity of 0.57 (95% CI 0.42 – 0.70). Also a higher specificity was found in Chest Ultrasound compared to chest x-ray, 0.95 (95% CI 0.84-0.99) vs 0.85 (95% CI 0.71-0.93). Chest ultrasound was found to have a perfect agreement with the final diagnosis i.e k=0.91 compared to a moderate agreement between chest x-ray and the final diagnosis i.e k=0.42 . The two tailed p value was 0.02 and by conventional criteria, this difference was found to be statistically significant. Conclusion & Significance: We concluded that chest ultrasound is more sensitive and specific the chest x-ray in diagnosing patients with pneumonia. Chest ultrasound is easily available, less expensive, faster and gives off no radiation when compared to chest x-ray. We recommend that with adequate training chest ultrasound should be preferred over chest x-ray for patients in a critical care setting.

Biography:

Byoungseok Yoon has completed his bachelor’s degree at the age of 22 from Yonsei Unieversity, Bio-engineering department, Seoul, Korea and MD at the age of 26 years from Gachon University, School of Medicine. He is working in residency at Yonsei University, School of Medicine, Emergency Department, Severance hospital, Seoul, Korea.     
 

Abstract:

Many studies have reported the effectiveness of ‘time target’ on reducing emergency department (ED) overcrowding and improving clinical quality. We investigated the effect of introducing ‘time target’ on ED overcrowding and clinical quality using meta-analysis.

We searched electronic databases including PubMed, Cochrane Library and Embase until June 2017. Search keywords were including time target, national emergency access target, four hour rule, and shorter stays in ED. Two investigators selected and reviewed articles according to predefined inclusion and exclusion criteria. The quality of articles were evaluated by RoBANS checklist. Data were abstracted by a predetermined criteria and performed meta-analysis using RevMan software.

Out of 721 articles, 16 studies were included in the final analysis. A meta-analysis of four studies on ED length of stay (LOS) showed that the mean EDLOS was reduced by 0.64 hours (95% CI, 0.34~0.94) since the introduction of the “time target”. Other studies also showed that EDLOS was reduced. There was no definite trend for hospital admission rate. A meta-analysis of nine studies on the clinical quality. Showed that the total odds ratio was 1.02 (95% CI, 0.74~1.32). Time taken until the visitation of a doctor and the ainitiation of treatment were both reduced. The rate of “left without being seen” was decreased.

EDLOS was reduced and no significant association was seen between mortality and the application of ‘time target’ since the introduction of ‘time target’. “Rate of revisiting”, “time to clinician”, “time to treatment” and “rate of left without being seen” was reduced.

Biography:

The Ebola epidemic in Western Africa (Liberia, Sierra Leone, Guinea, and Nigeria) infected tens of thousands of individuals with an approximately 60% fatality rate.  This outbreak challenged the local, regional, and national medical community to prevent a global pandemic.  The global response involving logistical, epidemiological, public health, and medical interventions slowed and eventually contained the spread.  The experiences and lessons learned awakened the global medical community to the fragility of the global health response system and provides a template from which to address future pandemics.

Abstract:

Description of the experience; This Ebola discussion will include lessons learned from the initial phases of engagement and global monitoring to first-hand experience as a Medical Coordinator of an Ebola Treatment Unit (ETU) in Monrovia, Liberia during the height of the outbreak to the eventual decline, and containment of the virus.  These experiences include the role of a disaster planner during the initial spread, student going through the education and training process, acting Medical Coordinator and provider in the ETU, member of the laboratory Cluster in Monrovia, and eventual trainer for local providers and other health care and public health officials.

Lessons Learned; The development and spread of the Ebola virus provides lessons learned including sending an effective public health message, how to coordinate an effective local and global response, how to manage an Ebola patient, how to run an effective and safe Ebola Treatment Unit (ETU), the complexities of coordinating a global community, and the current development and training of Rapid Response Teams.  This presentation is based on experiences that included initial protocol development, training, policy creation, and two months as Medical a Coordinator of an ETU in Monrovia, Liberia during the height and decline of the outbreak.

Learning Objectives

1. How to send an effective public health message
2. Coordination of local and global response resources
3. How to manage suspected and confirmed highly infectious cases
4. Review some of the challenges and problems identified that impacted response and care but never received public attention – i.e. the inside story.

Biography:

Tegwen commenced as Manager, Research Support Network (RSN), Emergency Medicine Foundation (EMF), in July 2014 and is responsible for a team whose role is to expand and enhance the scope of emergency medicine research. She has over twenty-five years health research experience in Australia and Canada. She has worked across the health spectrum, including public health, health economics, health policy, health technology assessment and clinical research. She also has experience in disaster management and recovery in Australia, Canada and New Zealand, including the short and long term mental health impact of natural disasters. She is passionate about building collaborative relationships that foster interest in applicable emergency medicine research as well as helping people to develop the skills needed to address such research questions. Through such an approach, Tegwen aims to develop strong, robust and multi-disciplinary relations that can inform improve the care of patients irrespective of their geographical location.

Abstract:

Statement of the Problem: Conducting research in the emergency care setting is challenging. Potential issues such as acuity of potential participants, inability to obtain consent in the traditional manner, and the very nature of delivering emergency care, impact the execution of research. Research Support Networks (RSNs) offer a potential solution to overcoming barriers to emergency care-based research. Various models have been adopted across Canada, United Kingdom and the USA. Methodology & Theoretical Orientation: The Emergency Medicine Foundation (EMF) was established in 2007 to support emergency medicine research across Queensland. In 2014, EMF established the RSN in a response to a lack of capacity and research support in emergency departments.  It was devised to provide leadership, support and collaborative opportunities for emergency care research professionals. EMFs RSN model is different to networks in other countries as it operates as a hub and spoke model that facilitates multi-disciplinary collaboration and translation of knowledge to strengthen all emergency medicine care. Research Development Managers (RDMs) work across multiple Hospital and Health Services (HHSs) to expand and enhance emergency care research. All RDMs are required to capture key performance data to enable the RSN Manager to monitor increases and changes in research activities. After two full years of operation, the RSN was evaluated using an observational study of research activity metrics.  Conclusion & Significance: Through the RSN there has been an increase in emergency medicine research activity across Queensland, and not limited to those HHSs directly covered by a RDM. In total 12/16 HHS are now involved in research, either directly as the lead HHS or as a collaborating HHS. With support from the RSN, rural and remote sites that have limited exposure to research activities have become involved with projects lead by senior clinician’s at large tertiary hospitals.

Biography:

I am Dr Thahseena having 2 years’ experience as a physician mainly in gynecology and infertility treatments.

Abstract:

Biography:

Mehrdad Soltani Delgosha is a Specialist of Emergency Medicine in Karaj Emam Ali hospital.

Abstract:

Background; Electrocardiograph (ECG) changes along with brain trauma injuries have been reported in many studies. The brain injuries accompanied with ECG abnormalities had more mortality rate. The aim of study is assessing the relationship between electrocardiograph (ECG) changes and GCS among patients with traumatic brain injury.

Methods; This cross-sectional study was performed on the brain trauma patients admitted to the Emergency Department (ED) of Imam Hossein Hospital, Tehran, Iran during January 2015 to February 2016. After stabilization of the patients, according to the inclusion criteria, GCS was determined and ECG was taken. This process was repeated three times with the interval of two hours, and the relation between GCS and ECG changes was determined and reported. After one year the Glasgow outcome score (GOS) was measured by telephone the patients and getting the history.

Results; After consideration of the inclusion criteria, 200 patients were assessed (168 males and 32 females). During the first ECG assessment, 42% of the patients had ST alteration, while in the second and third ECG assessments, 46% of the patients had ST changes, which was in relation to lower GCS and severity of the brain injury. According to the analysis, there was also a direct association between QT correction (QTc), QT dispersion (QTd (and GCS, GOS.

Conclusion; The ECG changes would be in association with the GCS and GOS, therefore, the evaluation of ECG parameters can be useful in determining the early outcome of patients.

Biography:

Following my graduation from Christian Medical College, Vellore, India, I took up the challenge of working in a rural hospital with limited facilities.  That experience inspired me to pursue a career in Emergency Medicine which was in its infancy in India at that time.  After completing my Fellowship in Accident and Emergency Medicine from CMC Vellore, I was sponsored to train in the NHS by the Royal College of Emergency Medicine, UK.  After completing my Fellowship, I returned to India and took over as Head of Department of Emergency Medicine at Kauvery Hospital, Trichy, India.

Abstract:

Statement of the Problem: Ratol paste is an easily available cheap rodenticide which is contains 3% yellow phosphorus.  It’s easy availability over the counter has led to its use for deliberate self-harm.  Accidental poisoning in children have also been reported.  It is a general protoplasmic poison with high mortality rate.  No specific antidote is available and treatment is mainly supportive.  There is paucity of published literature on its management and treatment varies from centre to centre.

Methodology: A retrospective audit of patients presenting to a tertiary hospital with history of Ratol paste poisoning was done.  The laboratory investigations and treatment given were analysed to derive treatment recommendations.

Findings: The leading cause of death is due to fulminant hepatic failure.  Multi-system involvement is common.  Presentation to hospital is often delayed due to early asymptomatic phase.  Early initiation of supportive treatment helps in preventing hepatic encephalopathy and reduces mortality and duration of hospitalisation.

Conclusions: In the absence of a specific antidote, early initiation of supportive management and close clinical monitoring is the way forward in its treatment.

Biography:

Dr. Hemanshu K Warrier is an MBBS Graduate from P.R China. He has also completed the Membership of Royal College of Emergency Medicine, RCEM, UK & Masters in Emergency Medicine from The George Washington University, USA.He has rich experience of over 7 years to his credit with reputed Institutes such as Moolchand Hospital, Lok nayak Hospital in New Delhi and is currently heading the department of emergency at Max Hospital, Gurgaon.

Abstract:

Statement of the Problem: Community-acquired pneumonia is a common and serious illness worldwide. It is the main cause of mortality, which particularly targets young patients, elderly patients and those with co morbid conditions. Most patients with pneumonia are managed in the outpatient setting but patient admitted in the hospital due to pneumonia have a high mortality. Chest ultrasound (CUS) is being increasingly utilized in emergency and critical settings. Aim of this study was to compare the sensitivity and specificity of chest ultrasound and chest x-ray. Methodology & Theoretical Orientation: This was a prospective clinical study. We aimed for a sample size of 96 patients. Patients were enrolled every alternate day to randomise the study. Informed written consent was taken from all enrolled patients or their immediate relatives. The result of chest computerized tomography scan was taken as gold standard. The duration of study was 6 months(from September’16 to February’16). 100 patients were included in the study. Findings: Chest Ultrasound was found to have a higher sensitivity of 0.96 (95% CI 0.85 – 0.99) compared to x-ray which had a sensitivity of 0.57 (95% CI 0.42 – 0.70). Also a higher specificity was found in Chest Ultrasound compared to chest x-ray, 0.95 (95% CI 0.84-0.99) vs 0.85 (95% CI 0.71-0.93). Chest ultrasound was found to have a perfect agreement with the final diagnosis i.e k=0.91 compared to a moderate agreement between chest x-ray and the final diagnosis i.e k=0.42 . The two tailed p value was 0.02 and by conventional criteria, this difference was found to be statistically significant. Conclusion & Significance: We concluded that chest ultrasound is more sensitive and specific the chest x-ray in diagnosing patients with pneumonia. Chest ultrasound is easily available, less expensive, faster and gives off no radiation when compared to chest x-ray. We recommend that with adequate training chest ultrasound should be preferred over chest x-ray for patients in a critical care setting.

Biography:

I am Dr Thahseena having 2 years’ experience as a physician mainly in gynecology and infertility treatments.

Abstract: