Læknablaðið : fylgirit - 15.06.2002, Side 10

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
(OMA) were more likely to survive to hospital admission com-
pared to those without OMA, 27% vs. 3% (p<0.001). The SOAP-3
pilot revealed a 47% reduction in ED-length of stay, 45% fewer OB
consults, and 33% fewer ancillary tests in PLUS vs. NON-PLUS
patients. The SOAP-4 modeled study revealed a 20% reduction in
ED-length of stay in PLUS vs. NON-PLUS patients (p<0.001).
Conclusions: Limited ultrasonography performed at the point-of-
care may reduce ED length of stay, use of other tests and consul-
tants, in-hospital length of stay, and mortality. Cost savings may
prove to be substantial. The first 4 SOAP trials, when completed,
should elucidate the effectiveness of PLUS in trauma patients,
pulseless patients, early pregnant patients, and patients with non-
traumatic abdominal pain. Future SOAP trials are in development
to assess the use of PLUS in invasive procedures, deep venous
thrombosis with or without suspected pulmonary emboli, acute
testicular pain, ocular trauma, and musculoskeletal injuries.
O 04 - Ultrasound Ultrasound in the ED
Loco-regional thrombolytic treatment of acute peripheral
arterial ischemia
Ruggiano G
S. Maria Annunziata Hospital, Florencc, Italy
Introductiun: Acute peripheral arterial obstruction (APAO) of the
limbs represents a vascular emergency which has a high mortality
and morbidity with respect to the risk of limb amputation. During
the 90's four trials studied the effects of loco-regional thrombolytic
therapy as a good alternative therapy instead of surgery.
Objectives: To verify the feasibility and the success rate of this
therapeutic procedure in our ED, using a protocol that would use
the loco-regional thrombolytic therapy as the main therapeutic tool
for APAO.
Methods: We studied 25 consecutive patients in 24 months (17
males and 8 females), of which 19 patients had thrombotic arterial
occlusion and 6 patients had embolic arterial occlusion. On arrival
at the ED the patients underwent an ultrasound vascular exami-
nation to establish the obstruction site, type and grade. The patients
were then divided into four groups of disease gravity depending on
the clinical and ultrasound examination, following the Rutheford
Classification. All the patients were started on intravenous Heparin
at an anticoagulant dose; those with the indications for thrombo-
lytic therapy (I and IIA) were rapidly assigned to an angiographic
study after the positioning of an angiography catheter (5 F) close to
or inside the thrombus. The thrombolytic agent we used was rt-PA,
we used a continuous intra-arterial (i.a.) infusion of 0,05 mg/kg/h,
after an intra-thrombus bolus of 5 mg; low dose Sodium Heparin
(500 U/h) was always used in conjunction.
Rcsults: At hospital discharge arterial patency was present in 20
patients (80%); this result was achieved both with thrombolytic
therapy alone and in association with other procedures (PTA with
or without stenling, angio-jet); those adjunctive procedures were
used in 31% of patients with thrombotic occlusion but only one
patient with embolic occlusion. The success rate of thrombolytic
therapy in embolic arterial occlusion was 100%, while in thrombo-
tic arterial occlusion it was 73%. Of the 5 patjents in which throm-
bolytic therapy failed, 2 were treated with a conservative medical
approach, 2 underwent amputation of the limb, and 1 died of a
severe haemorrhage.
Conclusions: The results we have so far are encouraging. To opti-
mise the utilization of this technique, we need to have always well
trained staff, intensive care units and easy access to the angiography
room, and we are working to obtain those objectives.
O 05 - Pediatric Emergency Medicine
Initial base deficit predicts mortality in children with shock
Browne G
Childrens Hospital at Westmead, Sydney, Australia
Objective: We investigated the association between initial base
deficit and mortality, Paediatric Intensive Care (PICU) admission
and length of stay in hospital in children who present to the
emergency department with shock from any cause.
Methods: We studied prospectively gathered data from the last 5
year for children retrieved to a tertiary paediatric hospital who
presented with shock from any cause. The main study factors were
initial base deficit, cause of shock, gender, age and time before
initial base deficit. Association with the main outcome measures-
mortality, PICU admission and length of stay in hospital were
determined via multiple logistic regression.
Results: Children whose initial base deficit was -11 or lower had a
significantly higher mortality and shorter length of stay in hospital
compared with children whose initial base deficit was 0 to -10 (both
p < 0.05). No association was found with PICU admission. Multiple
logistic regression suggested that this association was independent
of the other main study factors, in particular the cause of shock
(odds ratio 4.78,95% confidence interval 1.34 -17.1).
Conclusion: Initial base deficit predicts mortality and length of
hospital stay in children who present to the emergency department
with shock independent of cause.
O 06 - Pediatric Emergency Medicine '
The usefulness of a modified adult protocol for the clearance of
paediatric cervical spine injury in the Emergency Department
Browne G
Childrens Hospital at Westmead, Sydney, Australia
Aim: To determine if the use of a modified adult protocol that uses
cervical spine imaging on presentation for the assessment of cervi-
cal spine injury in children improves clinical outcome.
Methods: This is a case series study on all consecutive trauma
patients presenting between April through July 2000 to the emer-
gency department (ED) of a major paediatric trauma hospital.
Children presenting to the ED with potential cervical spine injuries
were identified using standard selection criteria. Patient demo-
graphics, mechanism of injury, method and time of presentation,
associated injuries, radiological investigation and clinical outcome
were recorded. The major outcome measures for this study was
time to clearance of the cervical spine, length of stay in the ED and
admission to an in-hospital bed. Data was analysed for compliance
to the protocol, this the standard assessment pathway of cervical
spine clearance used by our trauma service
Rcsults: The trauma registry identified 1721 trauma presentations
10 Læknablaðið/Fylgirit 45 2002/88