Læknablaðið : fylgirit - 15.06.2002, Qupperneq 11

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
during the 4-month study period; 208 presentations representing
200 children with potential cervical spine injury were entered into
the study. Males represented 72.5% of the study population, having
a mean age of 8.32 years, although 29% were less than 5 years of
age. The majority of presentations (69%) occurred outside of
normal working hours. In 17.8% of cases children were clear based
on clinical assessment alone, half less than 5 years of age. Com-
pliance to the protocol occurred for the study population in 78% of
presentations. However when examined by age group, children 5
years of age or above were 1.5 times more likely to comply with the
protocol as compared with younger children. Adequate plain
imaging was not obtained in 18% of presentations, this group
almost exclusively less than 5 years of age. There were no missed
injuries and no short or long-term neurological sequelae reported
during this study. There were no differences in time to clearance,
length of stay and admission rate between compliant and non-
compliant groups
Conclusions: We have not shown that the use of a modified adult
cervical spine protocol that include cervical spine imaging improve
clinical outcome for children, although they do offer guidance
during their assessment. We have shown that the use of these
protocols is not always practical in young children, in these children
there is a need for greater reliance on clinical assessment.
O 07 - Injury Prevention
lcelandic Accident Registration
Mogensen B,J, Sigbjörnsdóttir HB3, Guömundsson S23
'Landspitali University Hospital of Iceland, Dircctorate General of Health in
Iceland, 'Icelandic Accident Prevention Council. Reykjavík, Iceland
Introduction: It can be expected that 55 thousand people will be
injured in accidents in Iceland every year (population 280.00 inha-
bitants). More working years are lost due to accidents than to
cardiovascular disease or cancer. The annual cost to society is at
least USD 300 million. Many different institutions register acci-
dents and it is difficult to obtain information because registration
systems are not comparable. The role of Icelandic Accident
Prevention Council (IAPC) is prevention at the public health level.
Thus, the council has created a coordinated, computerized central
accident registry.
Material and niethods: IAPC in consultation and cooperation with
the health care system (all hospitals and health care centers), police,
insurance companies, the State Social Security Institute, Icelandic
Traffic Council and Administration of Occupational Safety and
Health decided to standardize their accident registration and
created the Icelandic Accident Registration which will be fully
operating by the year 2003 after thorough testing during the year
2002. Hospitals and health care centers register causes of accidents
either according to the NOMESCO Classification of External
Causes of Injuries or ICD 10 external causes of morbidity and
mortality, injury diagnostics by ICD 10 and severity by AIS and ISS.
An online data bank will be established for those who register
accidents. Each accident will be assigned a unique number and all
personal information such as ID numbers will be encrypted in a
one- to-one mode. The encryption will take place before starting
any information processing. No communications will occur
between registration centers and they will not be able to get
information from each other. The Icelandic Accident Registration
will register information about each accident such as day, time, and
type of accident, age, gender and damage. AU statistical work will
take place within the Icelandic Accident Registration. Causes of
accidents and analyses thereof will be extracted specifically for the
health care system. Statistical information and recommendations
based on that information would be published regularly and put on
the Internel.
Conclusions: Accurate and comprehensive regislration of the
causes of injury should create a tool that provides dynamic
information on the etiology of accidents which is a prerequisite for
targeted preventive measures and continuous evaluation of their
efficacy.
O 08 - Cardiovascular Emergencies
Amiodarone and bretylium in the treatment of hypothermic
ventricular fibrillation in a canine model
Stoner J, Martin G, O'mara K, Ehler J
Henry Ford Hospital, Dept. of Emergency Medicine, United States
Background: Refractory ventricular fibrillation (VF) is a compli-
cation of severe hypothermia. Despite mixed experimental data,
some authors view bretylium as the drug of choice in hypothermic
VF. Bretylium was removed from ACLS guidelines, and to date,
efficacy of amiodarone in hypothermia is unknown.
Objectives: To determine the utility of amiodarone and bretylium
in the treatment of hypothermic VF.
Methods: This was a randomized, blinded, and placebo controlled
laboratory experiment. 30 anesthetized dogs were mechanically
ventilated and instrumented to monitor coronary perfusion pres-
sure (CPP), rectal temperature, and electrocardiogram (ECG).
Animals were cooled to 22°C or, to the onset of spontaneous VF.
VF was induced as needed with a transthoracic AC current. CPR
was initiated and animals were randomized (N=10 each group) to
receive amiodarone lOmg/kg (A), bretylium 5mg/kg (B), or
placebo (P) intravenously. CPR was continued while monitoring
for chemical defibrillation. Re-warming was limited to removal
from the cold environment. After 10 minutes, up to 3 escalating
defibrillatory shocks were administered. Hemodynamic monitoring
continued after resuscitation. Return of spontaneous circulation
(ROSC) was defined as a sustainable ECG rhythm generating a
corresponding arterial pressure tracing and lasting a minimum 10
minutes. Sample size permitted 80% power to detect a 59%
difference in conversion rate between groups.
Results: CPR was adequate based on CPP > 15mmHg in all
animals. Mean CPP was 35.3 ± 18.8mmHg with no significant
differences between groups (p=0.06). No instance of chemical
defibrillation was noted. There was no significant difference in
ROSC rates between groups. Resuscitation rates were: A=l/10,
B=4/10, and P=3/10 (p=0.45).
Conclusions: In this model of severe hypothermic VF, neither
amiodarone nor bretylium was significantly better than placebo in
improving resuscitation rate.
Læknablaðið/Fylgirit 45 2002/88 11