Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 26

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
P 28 - Cardiovascular Emergencies
Acute haematogenous osteomyelitis in children in Aleppo City
Kaadan AN
Aleppo University, Aleppo-Syria
Background: Acule haematogenous osteomyelitis in children still
represents a real challenge in our developing country, because the
majority of these cases have a tragic outcome. The aim of this study
is to recognize and analyze the causes of such sequelae.
Methods: 122 children with acute haematogenous osteomyelitis,
aged 2 months -15 years, admitted to the largest three hospitals in
Aleppo between April 1994 and April 2001, were studied and
followed.
Results: From the whole series, only 16.4% were diagnosed and
received the appropriate treatment during the first 48 hours. 53.3%
of the cases were diagnosed and treated during the first week of the
disease. The rest of the patients (46.7%) were admitted to the
hospital and received treatment after the first week of the disease.
55.7% of our patients consulted family physicians or a general
practitioner during the first few days of the disease, but they were
given drugs and sent back home. Among them 85.3% were living in
the rural areas. The majority of them were wrongly diagnosed and
treated as rheumatic fever or cellulitis. Complications happened in
44.3% of all cases, of them 85.2% developed chronic osteomyelitis.
Condusions: We have to concentrate in our country on the
necessity of reviewing the continuous educational programs of our
practitioners, and to stress recognizing acute osteomyelitis in
children, as an emergency case, which needs early diagnosis and
prompt treatment to avoid the high incidence of complications.
P 29 - Cardiovascular Emergencies
Pharmacological cardioversion to sinus rhythm of recent onset
paroxysmal atrial fibrillation in the emergency roomAmatucci G,
De Luca A, Mancini I, Signorini H, Tobien MS
Verzuri Department of Internal Medicine, University of Siena, Siena, Italy
Objective: The present study evaluates the treatment of paroxys-
mal atrial fibrillation of recent onset in the Emergency Department
with flecainide.
Methods: One hundred and forty adult subjects (76 male, 64
female, age between 19 and 95 years; mean age 75 years) admitted
to Emergency Room for paroxysmal atrial fibrillation of recent
onset (< 24 hours)in the period from March 2000 until March 2002
were enrolled in this observational study. All patients without
documented severe cardiac dysfunction were included in the study
group, presenting with palpitations as the only symptom. Exclusion
criteria included the following conditions: patients with unstable
angina, acute myocarditis, acute pericarditis, a recent myocardial
infarction, heart surgery within the previous 6 months, severe
uncontrolled heart failure (ejection fraction < 30 %), sick sinus
syndrome, a history of second- or third-degree atrioventricular
block, those who had taken any antiarrhythmic drug other than
digoxin within a period of 5 half lives of the drug prior to study,
cardiogenic shock, significant COPD, pulmonary embolism,
pneumonia, liver or kidney failure, thyroid disease, electrolyte
disturbances, pregnancy and lactation.
Results: Thirty-fíve patients according to the absence of comorbidi-
ties were treated with the flecainide, the other patients were treated
with propafenone, digoxin and verapamil. Our findings indicate a
positive effect of class Ic antiarrhythmic drugs in all patients with-
out documented severe cardiac dysfunction. Particularly, flecainide
induced a significant rate of cardioversion in a relatively short
period (less than one hour).
Conclusion: Our data could indicate the effectiveness of flecainide
in patients admitted to the Emergency Room with paroxysmal
atrial fibrillation of recent onset without severe cardiac dysfunction
for the following reasons:
1. The primary outcome was cardioversion to sinus rhythm of all
palients in less than one hour
2. Under these circumstances, anticoagulant therapy was not
necessary
3. Patients left the Emergency Room after some hours reducing
hospitalization and correlated costs
4. Treatment with flecainide increased the length of the interval
between the paroxysms.
P 30 - Cardiovascular Emergencies
Psychological interventions in the observation unit for patients
with non-cardiac chest pain: needed and acceptable
Esler J, Becker B, Bock B, Partridge RA
Department ot Emergency Medicine, Rhode Island Hospital/Brown Medical
School, United States
Objectives: Patients with non-cardiac chest pain admitted to ED
Observation Units (OU’s) may have anxiety, depression, and other
psychiatric disorders that are not usually addressed. We assessed
psychological symptoms among patients in a chest pain OU and
their willingness to receive an intervention.
Methods: A convenience sample of 106 aduit patients who presen-
ted with chest pain to a large, urban ED and were admitted to the
OU. Patients were excluded if they had a previous cardiac history
or had a positive cardiac work-up while in the OU. Descriptive data
were analyzed with SPSS 10.0.
Results: Participants’ anxiety levels as measured by the Anxiety
Sensitivity Index were comparable to published scores of patients
diagnosed with anxiety disorders (22.5 vs.24.9). Participants were
interested in many types of psychological interventions including
anxiety reduction (85.8%) and stress management (83.6%). Most
subjects were prepared to spend at least 30 minutes with an inter-
ventionist. Almost half (43%) of patients were ready to receive an
intervention immediately.
Conclusions: OU patients with non-cardiac chest pain exhibited
significant anxiety and psychological distress, and were interested in
receiving intervention. The OU may be an opportune setting in which
to address the psychological sequelae of non-cardiac chest pain.
P 31 - Airway/Respiratory Emergencies
Comparative evaluatíon of prehospital analgesia between
fentanyl and morphine in trauma adult patients: a retrospective
study
Albrecht E, Tucci M, Hugli O, Spahn DR, Yersin B, Fishman D
Emergency Department and Anesthesiology Department, University Hospital
(CHUV), Lausanne, Switzerland
Objective: In this retrospective study we compared the efficacy of
26 Læknablaðið/Fylgirit 45 2002/88