Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 15

ABSTRACTS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
for intubation according to our guidelines. According to the
protocol, the residents were required to perform early rapid-
sequence intubation, except for cardio-pulmonary arrest, in
which inlubation was performed without drugs.
II)Once the patient was intubated and transported, either by
ambulance or by air, successful endotracheal tube placement
was confirmed on the chest x-ray by the resuscitation team
leader on arrival at hospital.
Results: I) There were 1,252 patients who had indication for
intubation according to the protocol. Among these, 36 were not
intubated (13 cardio-pulmonary arrests, 1 burn patient, 12 head
trauma patients with GCS < 8, 1 multiply injured patient with
shock, 9 respiratory failures). Violation of the protocol was
explained by age and/or previous medical condition of the patients
(7) or severity of the lesions (2). The significant protocol failure rate
was thus 27 / 1252 (2.2 %). 492 were not transporled because of
cardio-pulmonary resuscitation failure.
II) Among the 724 patients who had ETI attempted and who were
transported, 693 had successful ETI. 11 had intubation failures, 1
had esophageal intubation and 2 had iv catheter failures. The
overall intubation failure rate was thus 14 / 724 (1,9 %). By the way,
17 had mainstem bronchus intubations not considered to be intuba-
tion failures. Lastly, 36 patients were intubated without indication
(8 traumas, 15 cerebral hemorrhages, 5 cardio-pulmonary prob-
lems, 4 epileptic status, 2 intoxications and 2 hypothermias).
Conclusion: The success rate of airway management by residents in
our emergency prehospital setting is 95.9 %. Failure of airway
management is explained either by protocol violation (2.2 %) or
intubation failure (1.9 %). These results emphasize the efficacy of a
prehospital emergency rescue system reinforced by medical resi-
dents.
017- Airway/Respiratory Emergencies
Prehospital prediction of pneumonia in patients with shortness
of breath
Beauboeuf A, Shih RD, Fask A
Morristown Memorial Hospital & Fairleigh Dickinson University. Morristown, NJ,
United States
Background: Prehospital patients with shortness of breath (SOB)
are often difficult to assess diagnostically. Treatment for these
patients is dependent on the specific diagnosis. This study attempts
to assess patient characteristics that would be useful in predicting
pneumonia in patients who present prehospitally with SOB.
Methods: This study utilized a retrospective design and was
approved by the IRB. The inclusion criteria were patients brought
in by paramedics with the chief complaint of SOB over a 1 year
period. Data collected included vital signs, skin exam, mucous
membrane exam, capillary refill, neck vein distension, peripheral
edema, lung exam, cardiac rhythm, and past medical history. All
hospital records were located and the final clinical diagnosis was
determined. Logistic stepwise regression was performed to identify
independent predictors for patients with CHF.
Results: 236 patients were identified with the prehospital chief
coniplaint of SOB. The final diagnosis was not determined in 36 of
the cases. Of the remaining 200, 46 (23%) were diagnosed with
pneumonia. These patients had the following characteristics: mean
age, 78.3 yo; female, 45%; mean HR, 102/min; mean SBP, 135
mmHg; mean DBP 67 mmHg; diaphoresis, 20%; moist mucous
membranes, 86%; good capillary refill, 83%; neck vein distension,
17%; peripheral edema, 21%; rales, 30%; and sinus rhythm, 78%. 3
variables were found to correlate with the diagnosis of pneumonia:
neck distension (p<.037; OR=2.7, 95% CI, 1.06-6.99), an abnormal
cardiac rhythm (p<.031; OR=0.40,95% CI, 0.17-0.92) and a normal
systolic blood pressure (p<.015; OR=0.99, 95% CI, 0.098-1.00)
when compared to patients not diagnosed with pneumonia. A pro-
bability equation for the diagnosis of pneumonia was developed.
Conclusion: Several prehospital variables were identified that
correlate with the diagnosis of pneumonia in patients with SOB. A
probability equation was developed for predicting the likelihood of
pneumonia. These results need to be validated in future
prospective prehospital studies of patients with SOB.
0 18 - Airway/Respiratory Emergencies
Seasonal changes in the percent of patients with pneumonia
admitted to the hospital: an analysís of 3,340,598 Emergency
Department visits
Allegra JR
Morristown Memorial Hospital, United States
Introduction: More patients present to the Emergency Department
(ED) with pneumonia in cold months. We hypothesized that the
severity of illness would also increase in cold months and thus
hospital admission rates for pneumonia would increase in cold
months.
Objective: To determine if there are seasonal changes in hospital
admission rates for pneumonia. Methods: Design: 10-year retro-
spective analysis of a computerized database of ED visits.
Setting: Multiple New Jersey, USA EDs.
Participants: Consecutive patients seen by ED physicians diag-
nosed with pneumonia (1992 - 2001). The chi-square statistic was
used with a p value <0.05 taken as significant.
Results: The database had 3,340,598 patient visits with 52,512
(1.6%) having a pneumonia diagnosis. The number of ED patients
that had pneumonia was lowest in July (3192 patients, 1.1% of total
July patients) and highest in January (6853 patients, 2.4% of total
January patients) (p< 0.001). The pneumonia hospital admission
rates from the ED varied from a high of 67% for the warm months
of June and July, to a low of 59% for the colder month of November
(p< 0.001). This tendency for lower admission rates in the colder
months and greater in the warmer months was consistent for other
months throughout the year.
Conclusion: We conclude that although a greater number of
patients have pneumonia in the colder months the severity of illness
may be less in the colder months as the pneumonia admission rates
decreased in the colder months.
019- Pediatric Emergency Medicine
Single-dose intravenous salbutamol bolus for managing
children with acute severe asthma in the Emergency
Department: re-analysis of data
Browne G
Childrens Hospilal at Westmead, Sydney, Australia
Objective: The aim of this study is to reanalyse data from two
Læknablaðið/Fylgirit 45 2002/88 15