Emergency Medicine Conference - Highlights for November 25

Highlights for THURSDAY November 25

8.00-9.30 session

Climate change and environmental degradation, whether they are due to extreme weather events or outbreaks of infectious disease, have their severest impact on the most vulnerable.

The conference will hear about the practicalities of coordinating the response to such events in conflict-affected and resource-poor settings.

Dr Robyn Lucas, ACT-based epidemiologist and public health physician, will discuss ultraviolet radiation, vitamin D and multiple sclerosis.

There is increasing interest in whether low sun exposure and/or vitamin D status are important in multiple sclerosis (MS) onset.

“Ecological studies have suggested that sun exposure of the mother during pregnancy may be important in reducing MS risk, while prevalence case-controls studies have suggested that higher sun exposure in early life – age 6-15 years is associated with reduced MS risk in later life.”

Studies in the US have shown that higher vitamin D intake is associated with a decreased risk of MS, Dr Lucas said.

She will discuss results from the Ausimmune Study, a major multi-centre incident case-control study in Australia, which supports the independent role of sun exposure and vitamin D – the first human study to show this effect.

Also in this conference session, Dr Keith Dear, from the National Centre for Epidemiology and Population Health at ANU, will offer his view of future health implications of climate change.

“Climate change is happening, faster than expected and with no sign of slowing.

“International efforts to reduce greenhouse gas emissions have so far come to nothing: emissions are still tracking above the highest scenario envisaged by the Geneva-based Intergovernmental Panel on Climate Change.

“At the current rate of warming, in about 2060 we will reach the 2ºC ‘guardrail’, beyond which it is recognized that the situation will become critical.

“As the world fails to take the necessary steps to mitigate climate change, it becomes prudent to consider the full range of potential consequences; that is, while still pursuing what we hope to happen in coming decades, we should now begin to face squarely the question of what realistically may happen.

“The health implications are wide-ranging and severe.”

10.00-11.30 session

Sudden cardiac death in young athletes – call to think out of the box, for early CPR, and for defibrillator availability

One to three of every hundred thousand adolescent may have an episode which could result in their sudden death during sporting activity. Many of these young athletes have underlying cardiac disease.

“Sudden cardiac death in teenage athletes is commonly reported during vigorous activities, and even prior clinical screening cannot guarantee early diagnosis,” according to Dr Gary Browne, paediatrician and emergency physician at the Children’s Hospital Westmead.

Dr Browne will tell the conference that the diagnosis of many of cardiac conditions remains a challenge as presentation can be subtle, and routine investigation such as the ECG difficult to interpret in children.

“If the clinician is aware of these perils and pitfalls by maintaining a high index of suspicion then recognition before fatal cardiac arrest may be possible.

“For the emergency physician a thorough assessment of the symptomatic young athlete should focus on the appropriate work-up of syncope the most frequently reported symptom.”

He says prevention strategies are many and include primary measures such as avoiding triggers, such as vigorous exercise, and secondary measures such as insertion of an implantable defibrillator.

“We must ensure that there is an emergency plan to deal with the young athlete who collapses or ‘goes to ground’.

“The mechanisms for sudden cardiac death in children now direct attention toward recognition and management of ventricular fibrillation/tachycardia, which has a better outcome.

“In the emergency department the rapid identification of exercise-induced symptoms, and/or a positive family history of sudden death, should prompt further investigation.

“In the case of aborted cardiac arrest, diagnosis must be prompt as early insertion of an implantable defibrillator can be life saving.”

He advises emergency physicians to “think out of the box” and modify the standard approach to resuscitation as epinephrine may result in unresponsiveness in some of the genetically caused conditions.

“We must maintain a high index of suspicion when assessing the symptomatic young athlete.

“For the young athlete with witnessed ‘collapse’ effective CPR and the timely availability of defibrillators can save lives.

“It is through a better understanding of the causes of sudden cardiac death that more appropriate management strategies are now available for conditions that were once thought to be unsalvageable.”

Canberra Walk in Centre increased emergency department workload (rather than reduced)

Introduction of a hospital-based nurse-led "Walk in centre" in the Canberra Hospital in May 2010 did not result in a reduction in workload in the hospital's emergency department, a study has found.

Associate Professor Drew Richardson, chair of road trauma and emergency at Australian National University Medical School, will release the first results of a workload study carried out when the centre opened.

Professor Richardson said that there had actually been an increase in presentations to the emerency department immediately upon the Walk-in-Centre opening.

"In 28 days after the WIC opened there were 4650 presentations to the ED, 303 more than in the preceding 28 days and the largest number ever recorded at this time of year.

“The increase of 6.97% between the two 28-day periods was much greater than the average increase of 1.32% observed at that time of year over the previous decade.

"The largest component of the increase was an average of 7.8 patients per day sent from the Walk in Centre to ED, most of whom did not require hospital admission."

Professor Richardson will release new figures at the conference showing that even after the initial settling in period, there are still more presentations to ED than in the past.

ENDS

© Scoop Media