Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 24

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
P 22 - Cardiovascular Emergencies
Nuclear perfusion imaging in the ED evaluation of acute
coronary syndromes
Falk JL
Orlando Regional Heallhcare, United States
Objective: Nuclear perfusion imaging studies (NPIS) have been
demonstrated to facilitate correct disposition of intermediate risk
pts with suspected acute coronary syndromes (ACS). While these
data are impressive in the setting of a tightly controlled research
protocol, the utility of NPIS in community clinical practice has not
been reported. This study evaluates the impact of NPIS on pt
disposition and outcome in a non-protocolized ED.
Methods: This is a retrospective review of consecutive pts over 11
months that presented to the ED with suspected ACS who under-
went NPIS as part of their initial evaluation. A standard sestamibi
isotope (MIBI) protocol developed by the nuclear medicine dept
was employed. Pts underwent MIBI at the discretion of the EP. Nuc
Med specialists interpreted all scans. Pt disposition from the ED,
additional testing, and outcomes were abstracted from the records.
Results: 91 pts were studied (41% male). Mean age was 41 ± 10 yrs
(range 22-79). Each pt's ECG was normal or non-diagnostic of
ACS. None of the pts had positive Troponin-I at baseline. 82(90%)
pts had ongoing pain at the time of MIBI injection. 6(7%) pts with
ongoing pain had received SL NTG prior to injection. Pts had 1.8 ±
1.2 CAD risk factors. 52/91(57%) MIBIs were read as “indetermi-
nate” (42% breast attenuation, 42% possible perfusion defect, 16%
scaling artifact). Results are presented in the table.
MIBI RESULTS
Pos Neg Indeterminate
n Adm Adm D/C Adm D/C
Men 37 6 i 12 14 4
Women 54 3 2 15 20 14
Total 91 9(100%) 3(10%) 27 (90%) 34 (65%) 18 (35%)
None of the admitted indeterminate pts had positive follow-up studies.
Condusions: An unacceptably high proportion of MIBIs was read as
indeterminate in this setting. Indeterminate studies may have caused
unnecessary admission, reducing the overall utility of the test.
P 23 - Cardiovascular Emergencies
How do Belgian mobile intensive care units deal with cardiac
emergencies?
Calle PA, Heyse AM, Buylaert WA
Ghent University Hospital, Bclgium
Objective: In 2000, many scientific cardiological societies released
new guidelines on diagnosis, risk stratification and treatment of
acute coronary syndromes. Similarly, the American Heart Associa-
tion (in collaboration with the International Liaison Committee on
Resuscitation) published the Guidelines 2000 for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. The aim of this
study was to assess the availability in the Belgian physician-staffed
and hospital-based mobile intensive care units (MICUs) of diag-
nostic tools, therapeutic equipment and drugs for the prehospital
treatment of acute coronary syndromes, cardiopulmonary arrest
and other cardiac emergencies.
Methods: In April 2001, a questionnaire was sent to all Belgian
MlCU-centers. A reminder letter was sent in August 2001.
Results: The response rate was 90% (79/88). Availability was asses-
sed for:
• therapeutic equipment/diagnostic tools: defibrillator 100%
(monophasic 75%, biphasic 25%), pacemakers 90% (intra-
cardiac 6%, transcutaneous 90%), 12-lead ECG recorder 46%,
ECG-transmission facilities 5%, troponin-test 5%.
• anti-thrombotics: aspirin 90% (orally 33%, intravenously 87%),
heparin 53% (unfractioned 52%, low molecular weight heparin
1%), thrombolytics 20%.
• anti-ischemic drugs : nitrates 100% (orally/sublingually 99%,
intravenously 72%), B-blockers 75% (orally 6%, intravenously
75%).
• anti-arrhythmics: lidocaine 100%, amiodarone 87%, magnesium
66%, bretylium 65%, procainamide 24%, adenosine 58%,
verapamil 90%, digoxin 83%, flecainide 1%, disopyramide 5%,
sotalol 11%.
• vasopressors/catecholamines: epinephrine 100%, norepinep-
hrine 42%, dopamine 86%, isoproterenol 92%, dobutamine
14%, ephedrine 6%, vasopressin 0%.
• anti-hypertensive drugs: oral calcium-entry blocker 61 %, ACE-
inhibitor 3%, diazoxide 1%, urapidil 13%, dihidralazine 1%,
clonidine 18%.
• additional drugs: atropine 100%, diuretic 100%, bicarbonate
99%.
We also asked how frequently an available diagnostic tool or drug
was actually used when it's use was indicated. For simplicity
reasons, one could only mark “frequently used” or “rarely used”.
The results are given as “frequently used” versus “rarely used”; the
number of MlCU-centers involved is given between brackets.
• Diagnostic tools: 12-lead ECG recorder 75% vs. 25% (n=36),
ECG-transmission facilities 0% vs. 100% (n=4), troponin-test
50% vs. 50% (n=4).
• Drugs: aspirin (orally + intravenously) 79% vs. 21% (n=71),
thrombolytics 37% vs. 63% (n=16), intravenous B-blocker 17%
vs. 83% (n=59), nitrates (orally + intravenously) 89% vs. 11%
(n=79).
Conclusion: In Belgian MICUs there is a considerable variation in
the availability and use of cardiac drugs and technical equipment.
We propose that in each MlCU-center cardiologists and emergency
physicians - in close co-operation - should evaluate the local
situation (training level of prehospital care providers, transport
times, cathlab facilities,...) in order to implement in the prehospital
phase - as good as possible - the current guidelines for the treat-
ment of cardiac emergencies.
P 24 - Cardiovascular Emergencies
Premedication with propofol vs. ketalar and midazolam for
electrical cardioversion of atrial fibrillation in the emergency
department
Darawshe A, Frid V, Malatskey L, Seligmann L, Feldman A, Chiporen L,
KazY
HaEmek Medical Center, Afula, Israel
Electrical cardioversion to sinus rhythm is frequently necessary in
both chronic and acute atrial fibrillation. Selection of the anesthetic
agent is important because a short duration of action and hemo-
24 Læknablaðið/Fylgirit 45 2002/88