Day 1 :
Akershus University Hospital, Norway
Time : 10:30-11:10
Willy Aasebo is a Specialist in Internal Medicine and Nephrology and Leader of section of Nephrology (Medical Department), Akershus University Hospital, Norway. He has published a few scientific articles about alcohol intoxication, deaths in police cells and some nephrological topics including transplantation.
Alcohol (ethanol) is probably the most commonly used intoxication agent worldwide. During the latest decades the possible beneficial effects of moderate use of alcohol have been focused on. Alcohol abuse may cause death by a variety of causes, including accidents, violence and the many diseases that alcoholics may obtain. However, binge drinking may also cause unexpected sudden deaths, but the exact mechanism behind these deaths is not known. Many of the reports on alcohol related deaths have been casuistic, but sudden unexpected deaths have been reported more often in person drinking alcohol regularly than others. Alcoholics may have autonomic neuropathy (caused by functional changes in nervous vagus) increasing their risk of arrhythmias. In alcoholics cardiac arrhythmias, as the holiday heart syndrome, has been described in relation to binge, and atrial fibrillation may be caused by, or is at least associated with, alcoholism. Arrhythmias have also been reported when non- alcoholics drink. Thus, ventricular tachyarrhythmias degenerating into fibrillation is a possible cause of deaths by alcohol intoxication. In general, no single variable in the ECG can predict cardiac arrhythmias, though some features have been associated with later development of arrhythmia. Prolongation of the QTc interval has, during the last decade, been identified as such a risk factor. In an effort to create hypothesis on how alcohol in high blood concentrations affect the ECG, we collected ECGs from all patients that were admitted to our hospital for alcohol intoxication during a one year period and from before they were discharged. Mean alcohol blood concentration was 2.9‰. We measured durations of P-waves, PR intervals, QRS complexes and QTc intervals. We also measured voltage, thinking that if voltage differed from intoxicated to sober in the same patient; this might indicate a mechanism of action from alcohol. Finally, we measured QT dispersion (QTd), even though the significance of QTd has been disputed. We described prolongations in several ECG intervals, but also interesting differences in voltage and QTd in persons with high blood concentrations. Most important is, probably the QTc interval prolongation which has been described by other investigators also. The prolongation of QTc interval has also been found to persist during the abstinence phase in alcoholics. The studies on this topic are few and have methodological difficulties. However it is important to find out more about how alcohol (Ethanol), being as popular as it is worldwide, affects the risk of arrhythmias.
University of Pretoria, South Africa
Keynote: An audit of the management of tricyclic antidepressant overdose in the Emergency Unit of Steve Biko Academic Hospital, Pretoria, South-Africa from 2009 to 2012.
Time : 11:30-12:10
Andreas Engelbrecht is the Head of Emergency Medicine at the University of Pretoria/Steve Biko Academic Hospital. He completed his MBChB degree from the University of Pretoria. His other qualifications include FCEM, MMed (Fam Med), Dip PEC, DA, DTM&H and MMed in Pharmacology. He is the Director of Emergency Medicine at the University of Pretoria. He has published more than 13 papers in reputed journals and chapters in emergency medicine textbooks. He developed the VAPP course (venomous animals poisonous plants) and the Pearls and Pitfalls in Emergency Medicine.
Background: Tricyclic antidepressants (TCA) are frequently used in South-Africa due to their availability and low costs. These drugs are highly toxic in overdose. Aim: The aim of the study was to audit the key aspects in the management of patients with TCA overdose against an international benchmark.rnMethods: A cross sectional descriptive audit of clinical records was done. The findings were measured against the Guidelines for medical therapy of the emergency network (GEM net). rnResults: Thirty-two clinical records were recruited and audited. The following findings were made: The vital signs of 30 (93.7%) patients were recorded, 21 (70%) were abnormal. One case with hypotension was not managed appropriately. Eighteen (56%) patients had their blood pH analysed and 6 were abnormal. None of these were managed appropriately. Thirty (93.7%) EKG assessments were done. Only 17 (56.6%) were recorded. Five (29%) printouts could be found within the files. Of these 4 (80%) had an abnormal tracing but had not been treated. Of those EKGs only documented, 3 (25%) were described as abnormal but were managed inappropriately. Treatment with bicarbonate was either omitted or done inappropriately and without monitoring. The level of consciousness of 31 (96%) patients was recorded. Three who required intubation were not intubated.rnrnConclusion: The management of TCA overdose did not meet the standards prescribed by GEM net in our sample. This audit had a number of limitations but was used to improve the management of this condition in our unit and may be useful to others.
Hamad Medical Corporation, Qatar
Time : 12:10-12:50
Aisha Larem is an ORL-HNS Consultant at Qatari nationality. She graduated from Gulf University Otology subspecialty. She is an Associate Program Director and worked as a Fellowship Program Director and is a Clinical Instructor at Weill corneal at Qatar.
We present a unique and challenging case of a remnant foreign body that presented to us in a child, disguised as a strongly suspected congenital branchial cleft anomaly. This case, featuring a 2 years old male child, entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case.