1 10 45 https://repository.horizon.ac.id/files/original/8397a7848e5fd5a5e31ffda345bf411b.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Variation of recognising atypical ECG patterns of occlusion myocardial infarction among emergency physicians in Egypt (E-Poster Presentations) Subject The topic of the resource atypical ECG patterns of occlusion myocardial infarction, emergency physicians in Egypt Description An account of the resource Coronary artery disease is the foremost single cause of mortality and loss of Disability Adjusted Life Years globally. It is the third leading cause of mortality worldwide and is associated with 17.8 million deaths annually. This study aims to identify the degree of familiarity of Egyptian emergency physicians with different levels of training and experience with atypical ECG patterns associated with occlusive myocardial infarction not meeting classic ST elevation myocardial infarction criteria. A cross-sectional survey screening study was conducted from June 2022 to June 2023. This study was carried out on a sample of 301 physicians dealing with patients presenting by chest pain in particular Emergency physicians, also other specialities as Cardiologists, Internal medicine / Acute medicine, General Practice or Family medicine, Anaesthesia and Intensive care physicians. All candidates were Of both genders, With varying levels of experience and post-graduate clinical training We generated our survey questionnaire which included 10 ECG patterns, classified into 4 main groups of occlusive and non occlusive myocardial infarction ECGs and normal ECG as control After generation of the questionnaire, validation was activated through 2 steps, initially, the questionnaire was reviewed by 2 experts cardiologists supervising this thesis to guarantee its consistency and validity. Final form was disseminated among groups of target population digitally and responses were collected automatically and anonymously. Responses were collected, and multiple responses were not allowed. A total of 301 physicians in Egypt were enrolled in our study. Regarding gender distribution, 170 (56.5%) males, and 131(43.5%) females. The male to female ratio was 1.3:1. The most recognized ECG strip in the first 4 ECGs was ECG 1 (inferiorSTEMI), and the least recognized ECG strip in the control group was ECG 9 (acute pericarditis). The average score of true recognition of the first 6 ECG patterns, which means PCI activation, was 3.82± 1.33 (range 1 to 6). A cardiologist scored 0.91 higher than an emergency medicine physician (P &lt; 0.01). A physician with a medical doctorate scored higher than bachelor’s degree (P &lt; 0.01). We can conclude that cardiologists with long years of experience and/or candidates who had medical doctorate degree were the most who truly recognized the ECG patterns with occlusive myocardial infarction. Finally, we can state that the good points in our research were that it was national research, with different medical experiences with different specialties, a large scale of participants and variability of presentations Creator An entity primarily responsible for making the resource Omneya Raafat, Mohamed Nasreddin, mohamed Elheniedy, raghda Elsheikh, Mona Elsaidy Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/db7c8d395e2c6ca3d34d333d384798c9.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A rare case of leukocytoclastic vasculitis (E-Poster Presentations) Subject The topic of the resource leukocytoclastic vasculitis Description An account of the resource Introduction Leukocytoclastic vasculitis is a rare small vessel vasculitis characterized by immune-complex mediated vasculitis of dermal capillaries and venules. Its annual incidence is around 45 per million individuals. We present a rare case of leukocytoclastic vasculitis after a viral upper respiratory infection that responded to steroids. Case presentation A 40-year-old female presented to the hospital with rash on her lower extremities, sporadically affecting the buttocks and abdomen for one week after having upper respiratory symptoms for 1 week. She denied photosensitivity and had no prior history of similar rashes. Physical examination revealed generalized joint tenderness and a painful purpural rash symmetrically on both legs. A provisional diagnosis of cutaneous small-vessel-vasculitis secondary to viral aetiology was made. Steroid treatment was commenced, but her skin condition worsened upon tapering the dose. Investigations ruled out connective tissue or rheumatological disease but indicated mild IgA elevation. Initial punch biopsy suggested neutrophilic urticarial reactions and early Sweet's syndrome. The patient developed gastrointestinal symptoms, including diarrhoea and abdominal pain, concomitant with worsening painful cutaneous manifestations impeding ambulation. Chest and abdominal CT imaging didn’t show evidence of systemic vasculitis and endoscopy did not reveal any neutrophilic infiltration. A multidisciplinary discussion pointed to leukocytoclastic vasculitis, recommending a more gradual steroid tapering regimen. Some skin lesions at this time had ulcerated and topical tacrolimus was advised. Discussion The patient's prodromal viral symptoms, the evolution of her classically looking rash, elevated IgA and the response to steroids corroborated the clinical course consistent with leukocytoclastic vasculitis. Conclusion Clinicians should be aware that leukocytoclastic vasculitis could happen in adults although it is rare. Vasculitis should be always suspected in any patient with bilateral symmetric rash. Creator An entity primarily responsible for making the resource Mahrukh Asad Chandna, Kubranur Durmaz, Mohamed Mortagy, Ahmed Elsandouby Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/7935c84c520137a422156a38bcb216c4.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pathway for Inpatient and Outpatient Cellulitis Management (E-Poster Presentations) Subject The topic of the resource Pathway for Inpatient and Outpatient Cellulitis Management Description An account of the resource Background Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue. The infected area is characterized by pain, warmth, swelling, and erythema. Blisters and bullae may form. Fever, malaise, nausea, and rigors may accompany or precede the skin changes. Risk factors for cellulitis include previous cellulitis, trauma to the skin, lymphoedema, leg oedema, venous insufficiency, and obesity. Most cases of cellulitis resolve with treatment, but the correct treatment in the appropriate setting is important to avoid commonly occurring acute and chronic complications. NICE have published guidelines on how to classify severity of cellulitis, and how to manage based on severity and co-morbidities. Class I No signs of systemic toxicity and no uncontrolled comorbidities Class II Systemically unwell or systemically well but with a comorbidity Class III Significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities, or a limb-threatening infection due to vascular compromise Class IVSepsis or severe life-threatening infection, such as necrotizing fasciitis NICE have recommended treating for a minimum of seven days of antibiotics. They recommend treating as an inpatient when: • Class III or IV cellulitis • Class II cellulitis and unable to deliver IV Abx in the community • Class I cellulitis and risk factors including: immunocompromised, frail, lymphoedema, suspicion of osteomyelitis or septic arthritis NICE advise patients treated as an outpatient should have a review at 2-3 days depending on clinical judgement or if symptoms are deteriorating. If there is no substantial improvement at the end of a 7-day course, then antibiotics should be continued for a further 7 days. Results Our practice: We took a random sample of 19 patients seen on the RHCH medical take with a diagnosis of lower limb cellulitis between May to Nov 2023. Mean age was 73 years (SD=9.6 years), and 63% were male. Severity of cellulitis or classification of cellulitis was not mentioned in any clerking documents or clinical noting at the time of the patient’s admission. By retrospectively examining clinical noting, observations, and blood results, we classified these patients as presenting with Class I cellulitis (n=9), Class II cellulitis (n=7), Class III cellulitis (n=1), Class IV cellulitis (n=2). Of patients classified Class II-IV, all received a length of IV Abx, apart from one Class II patient with no risk factors who received 14 days of oral antibiotics as an outpatient. He was reviewed three times in SDEC during his treatment. Of the 3, Class I cellulitis patients with risk factors, 2 had IV Abx but one received only oral Antibiotics. Of the 6, Class I cellulitis patients without risk factors, half had IV antibiotics and half had orals. This demonstrates a lack of adherence to recommended NICE guidelines in a large proportion of Class I patients. Of patients classified Class II-IV, 90% (9/10) appropriately had IV Abx. The one patient who had orals only had regular follow up throughout their antibiotic course. 5 of the 19 patients had follow up arranged. Creator An entity primarily responsible for making the resource Abdul Basit Malik, Zara Ali, Mohamed Kafala, Ana-Maria Bologan Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/f2b3f8cea28bf24580da567e932a6495.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Rare association of Helicobacter Pylori induced Gastritis and Reactive Hypoglycaemia (E-Poster Presentations) Subject The topic of the resource Helicobacter Pylori, Gastritis and Reactive Hypoglycaemia Description An account of the resource Introduction Reactive hypoglycaemia happens after eating within four hours. It can occur in people with and without diabetes. It could also happen after gastric or intestinal. I could also occur in gastritis due to Helicobacter pylori infection. We present a rare case of H. Pylori induced gastritis leading to reactive hypoglycaemia. Case Presentation A 78 year old non-diabetic female with past medical history of antiphospholipid syndrome presented to the emergency department after she was found to have symptomatic hypoglycaemia especially after her morning meals. CT scans of the chest, Abdomen and Pelvis were unremarkable. Chest X-ray, blood and urine cultures were unremarkable. All reports concluded normal. Stool sample for H. Pylori Antigen came back positive. The recurrent low blood sugar readings were recorded for 4 days while the Triple therapy targeted for H. Pylori eradication started from the 5th day. A 72 hour Fasting Protocol were initiated but unable to induce any Hypoglycaemia events. On Follow up, A repeat H. pylori stool antigen was negative suggesting successful eradication while no further episodes of symptoms related to hypoglycaemia, or none recorded on glucometer. Discussion The presentation of patient to hospital following recently diagnosed H. Pylori and symptoms of reactive hypoglycaemia and otherwise negative investigations suggest a very rare but apparent relation between the two. The patient’s significant improvement in blood sugar levels and absence of symptoms post H. Pylori eradication would also support the unusual association. Cases like this have been reported in small numbers in the literature. The likely underlying mechanism could be that H. Pylori infection causes increased levels of gastrin intensifying the production of insulin. Conclusion Clinicians should be aware of this unusual relation of H. Pylori gastritis and Reactive hypoglycaemia. This case prompts clinician to keep H. Pylori as list of their differentials while assessing any patient with reactive hypoglycaemia of unclear cause. Creator An entity primarily responsible for making the resource Ashish Sahi, Chirag Subedi, Mohamed Mortagy Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/a749792c23c58ab8983c496504aaa77e.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Pneumonia Mimicking Meningitis: An Atypical Presentation of Mycoplasma Pneumoniae (E-Poster Presentations) Subject The topic of the resource Pneumonia Mimicking Meningitis, Mycoplasma Pneumoniae Description An account of the resource Introduction Mycoplasma Pneumoniae is a common cause of community acquired pneumonia. It usually presents with respiratory symptoms and sometimes with central nervous system symptoms. We present a case of mycoplasma pneumoniae presenting with meningitis-like symptoms. Case presentation A 32-year-old man presented to the hospital with a 3-day history of progressively worsening headache, vomiting, and fever. There was no cough or shortness of breath. There was no significant past medical history. He had recently travelled to Lanzarote 2 weeks prior. Upon examination, there was mild neck stiffness and a fever of 38.3°C. His chest was clear. Blood tests showed elevated CRP & WBCs. The chest X-ray (CXR) was unremarkable, as well as the CT scan of the head. There was no significant family history. The patient was started on empiric treatment for bacterial meningitis with IV ceftriaxone & Dexamethasone. A lumbar puncture was performed, and cerebrospinal fluid (CSF) samples were sent for analysis. The CSF was clear in appearance, with a white cell count of only 3, and no organisms were found. The patient was reviewed the following day and reported that since admission, his headache had improved, but he had started developing a productive cough with purulent sputum. Upon examination, there were now coarse crackles at the left lung base. A repeat chest X-ray was also clear. The case was discussed with a microbiology consultant who advised to stop treatment for meningitis and start amoxicillin & doxycycline to cover for pneumonia. It was advised to send further microbiology investigations including a PCR for Mycoplasma pneumoniae, as it can sometimes present with neurological symptoms. The PCR came back positive for Mycoplasma. The patient was then switched to only Doxycycline and discharged home. Discussion Mycoplasma Pneumoniae is a common cause of community-acquired pneumonia, especially in healthy adults. It is frequently associated with CNS symptoms, though respiratory symptoms normally precede them or happen concurrently. While CXR findings tend to be worse than the clinical picture in many Mycoplasma infections, the opposite can also occur with a clinical infection and a clear CXR. Conclusion This case highlights the importance of keeping Mycoplasma as a differential with patients presenting with pneumonia and CNS symptoms, as well as patients with clinical evidence of pneumonia and a clear CXR. Creator An entity primarily responsible for making the resource Moustafa Hendawy, Mohamed Mortagy Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/6e30e1fe8bac30441334a83a83c5b69a.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Shock Indices as Predictors of Outcomes in Emergency Severity Index level 3 Emergency Department Patients (E-Poster Presentations) Subject The topic of the resource Shock Indices as Predictors of Outcomes in Emergency Severity Index, evel 3 Emergency Department Patients Description An account of the resource Introduction This study evaluated the usefulness of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) in predicting outcomes among Emergency Severity Index (ESI) level 3 emergency department (ED) patients. Methods We prospectively analysed 250 ESI level 3 ED patients aged 20-60 years. Associations between SI, MSI, ASI and mortality, intensive care unit (ICU) admission, length of hospital stay (LOS), and readmission were assessed using regression analyses. Predictive performance was evaluated using receiver operating characteristic (ROC) curves. Results The univariate analyses revealed significant associations of MSI (≥1.0) and ASI (≥36.8) with increased odds of mortality (MSI≥1.0, OR:2.46, 95% CI:1.21-18.9, p=0.042; ASI≥36.8, OR:8.19, 95% CI:1.03-58.9, p=0.049), ICU admission (MSI≥1.0, OR:5.6, 95% CI:1.09-28.79; ASI≥36.8, OR:6.56, 95% CI:1.17-36.76) and longer LOS (MSI≥1.0, OR:2.59, 95% CI:1.27-5.3; ASI≥36.8, OR:3.51, 95% CI:1.87-6.6). In multivariate analyses, all three shock indices remained independently associated with mortality (SI ≥1.2, OR:11.1, 95% CI:2.38-63.4, p=0.026; MSI ≥1.0, OR:8.82, 95% CI:1.48-46.8, p=0.018; ASI≥36.8, OR:12.14, 95% CI:3.24-19.4, p=0.013), while only ASI≥36.8 (OR:3.23, 95% CI:1.68-6.23, p<0.001) maintained an independent association with longer LOS. ROC analyses demonstrated good predictive ability for mortality (AUC 0.81 for SI, 0.82 for ASI) and ICU admission (AUC 0.81 for SI, 0.79 for ASI). Discussion This study evaluated the predictive performance of the SI, MSI and Age SI, for key outcomes in ED patients triaged as ESI level 3. All three indices exhibited independent associations with mortality after adjusting for confounders. The ASI emerged as the strongest predictor of mortality, outperforming SI and MSI, likely due to incorporating age which enhances prognostic value in older adults. The ASI also independently predicted longer hospital stay. However, no index showed robust associations with ICU admission or readmissions, underscoring that other factors influence these outcomes. Optimal cut-off values for mortality and ICU admission prediction were identified. Conclusions Among ESI level 3 ED patients, ASI ≥36.8 and SI ≥1.2 exhibited moderate predictive value for mortality, while the ASI was associated with longer hospital stay. These shock indices, particularly the SI & ASI, may serve as useful adjuncts to clinical assessment for predicting mortality risk in this patient population. Creator An entity primarily responsible for making the resource Sara Usman, Kamlesh Bhojwani, Ahmed Raheem, Mehmood Alam Khan, Nadeem Ullah Khan Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/bfffdadd2fe737cbc0e1ec805c2e8671.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Quality Improvement Project Analysis: Point of Care Ultrasound in the Emergency Medicine Department. (E-Poster Presentations) Subject The topic of the resource Quality Improvement Project Analysis, Point of Care Ultrasound, Emergency Medicine Department. Description An account of the resource Introduction In the Emergency Medicine Department, a significant gap was identified in the use and training of Point of Care Ultrasound (POCUS), which negatively impacted patient safety and diagnostic efficiency. The absence of an organized teaching pattern, dedicated faculty for POCUS, and consistent adherence to training protocols highlighted the urgent need for improvement. This Quality Improvement (QI) project aimed to establish a structured POCUS training program to enhance the competency, confidence, and frequency of POCUS usage among all staff members, including both trainees and non-trainees, senior and junior doctors. Methods The project employed the Plan-Do-Check-Act (PDSA) cycle to systematically address the identified issues. The steps included: Plan: Identifying the problem, setting objectives, and developing an intervention plan. Do: Implementing the training program and organizing POCUS sessions. Study: Collecting and analysing data through surveys and feedback. Act: Refining and adjusting the training program based on collected data. Interventions included establishing a dedicated POCUS faculty, creating a POCUS club and WhatsApp group for continuous learning, conducting monthly training sessions, and running comprehensive Level 1 ultrasound courses. Engagement tools such as surveys and feedback forms were used to assess baseline data and improvements. Results The effectiveness of the project was evaluated through several measures: Frequency of POCUS usage: There was a marked increase in daily, weekly, and monthly usage. Confidence levels: Staff reported significantly higher confidence in performing POCUS. Satisfaction with training: Overall satisfaction with the POCUS training program improved. Familiarity with the RCEM POCUS curriculum: Staff showed better understanding and adherence to the curriculum. Feedback on practice sessions and courses: Qualitative feedback indicated that the sessions were effective and valuable. Engagement in the POCUS WhatsApp group: High levels of participation and utility were reported. These results demonstrated substantial improvements in all targeted areas, validating the effectiveness of the interventions. Discussion The project successfully addressed the initial gaps in POCUS training and usage within the Emergency Medicine Department. Key factors in the success included the collaborative effort of a team consisting of consultants, middle-grade doctors, and junior doctors, and the engagement of key stakeholders such as hospital management, the training department, and patients. Continuous feedback and iterative improvements, guided by the PDCA cycle, were crucial in achieving the desired outcomes. The project also emphasized the importance of a supportive team environment and effective communication in overcoming challenges and fostering improvements. Conclusion This Quality Improvement project significantly enhanced the use and training of POCUS in the Emergency Medicine Department. The structured training program led to increased frequency of POCUS usage, higher confidence levels among staff, and better adherence to the RCEM POCUS curriculum. Future plans involve expanding the training program to include advanced modules and continuous assessments to ensure sustained competency and further enhance patient care. The success of this project underscores the value of continuous learning, stakeholder engagement, and systematic improvement methodologies in healthcare settings. Creator An entity primarily responsible for making the resource QAZI ZIA ULLAH, Amr Elhalaly Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available . From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/1a5a4516047d341ca14507040bf0ff85.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A Chef with fever and jaundice (E-Poster Presentations) Subject The topic of the resource Chef, fever, jaundice Description An account of the resource Introduction Leptospirosis is one of the most widespread zoonosis. It is an under-reported infection, and there are no reliable global incidence figures. A systematic review and modeling exercise estimated that more than one million human cases occur worldwide annually, including almost 60,000 deaths. It is most prevalent in tropical regions but also occurs in temperate regions [1,2]. Regions with the highest incidence of infections include South and Southeast Asia, Oceania, the Caribbean, parts of sub-Saharan Africa, and parts of Latin America [3]. In the United States, the incidence of leptospirosis is relatively low (approximately 100 to 150 cases are reported annually) [4]. Puerto Rico and Hawaii consistently report the most cases. The most common animals that play an important role in the transmission of human leptospirosis are rodents, in particular rats [5]. The infection is acquired by direct contact with infected urine and by indirect exposure or contact with contaminated water or soil. Infection by rat urine is the more frequent form of infection [6]. Case Report 54 male chef by profession, known to have Pemphigus vulgaris and foliaceous on azathioprine presented with 5 days history of fever which was accompanied with rigors and chills. The fever was not documented. He was taking paracetamol and limsip 4 hourly and 2 hourly respectively. On day 5 he went to GP who noticed yellow discoloration of skin and eyes therefore referred him to hospital. He did not report any sore throat or flu like symptoms. He did not report any cough, or phlegm, no shortness of breath, no cerebrovascular, no bowel or bladder concerns. He was on azathioprine, omeprazole and used to take steriods only when his pemphigus vulgaris worsens. He did not report any allergies. He had no significant family history. He lives with his wife and kids. He had never drink alcohol and quit smoking 3 years ago. On examination he was tachycardiac with low blood pressure and his temperature was 38.7C. On general physical examination he was jaundiced, had petechia on shins. However, there was no conjunctival pallor no, cyanosis no lymphadenopathy and no pedal oedema. His liver was 1.5cm below the costal margin and rest of the systemic examination was unremarkable. Following this he had blood investigations and it revealed low platelets of 43, elevated bilirubin of 77, raised urea (8.7), creatinine 169 and GFR 39. His PT was prolong. His CRP was 236 and PCT of 32.5. Along with this his paracetamol was 22. His dipstick urine was +++ protein and +blood. His CXR and ECG were unremarkable. He was started on IV NAC along with intravenous fluids, and intravenous antibiotics which include gentamicin, metronidazole, and amoxicillin. Further blood tests were requested including viral hepatitis screen, autoimmune and leptospirosis. In view of low platelets and for the possibility of TTP/HUS the case was discussed with haematologist consultant but as LDH was normal and he did not fulfil the criteria of TTP/HUS therefore this differential was ruled out. His hepatitis A results were in keeping with previous hepatitis A exposure. His CMV IgG was positive, hepatitis B, C, E and HIV were negative. Autoimmune liver screen was negative as well. However, his leptospirosis IgM and PCR was positive. He was started on ceftriaxone and doxycycline and responded to the treatment and was safely discharged. Discussion Leptospirosis is a zoonosis with protean with clinical manifestation caused by pathogenic spirochetes of the genus Leptospira. Leptospira are spiral-shaped, highly motile aerobic spirochetes with 18 or more coils per cell. The clinical course of leptospirosis is variable. Most cases are mild and self-limited or asymptomatic, whereas some are severe and potentially fatal. Syndromes caused by leptospirosis are divided into two categories anicteric leptospirosis and icteric leptospirosis. Most of the symptomatic patients with leptospirosis have the anicteric form of disease. Anicteric leptospirosis has been described as a biphasic illness, with an acute phase and an "immune" phase. Most patients never proceed to the immune phase of illness. In some cases, the two phases may overlap clinically. The acute phase of anicteric leptospirosis typically lasts two to nine days [4]. It usually begins 5 to 14 days after exposure, although the incubation period can range from 2 to 30 days. The acute phase is characterized by acute febrile bacteraemia. 75 to 100 of patients have following clinical features which include abrupt onset of fever, rigors, myalgias (especially in the calves and lower back), and headache [7]. Approximately half of the patients experience nausea, vomiting, and diarrhoea, and nonproductive Abstract and Poster Presentations Book – EPIC24 77 cough. Rarely, rapidly progressive pulmonary haemorrhage can happen during the acute phase, although this is more commonly seen with icteric leptospirosis. Symptoms include shortness of breath and haemoptysis. This presentation is associated a high mortality rate. Following the acute phase, a minority of patients with anicteric leptospirosis experience an "immune" phase characterized by specific immune-mediated complications. Rarely, patients can present with the manifestations of the immune phase without experiencing a preceding symptomatic acute phase. During the immune phase, leptospires are absent from the blood, and antibodies to the organism are present. The organism may be detectable in the urine during this phase. Icteric leptospirosis (Weils’s disease) occurs in approximately 5 to 10 percent of symptomatic leptospirosis cases and is a rapidly progressive multisystem illness associated with mortality rates of 5 to 15 percent [9]. The symptoms associated with icteric leptospirosis include fever, jaundice and renal failure. Pulmonary haemorrhage with ARDS, myocarditis with ECG changes and rhabdomyolysis may also occur as part of this syndrome [10]. Conjunctival injection is also common. The diagnosis is confirmed by a positive PCR of blood or urine or by positive serologic testing; rarely, a diagnosis is made by a positive culture of blood or urine. Serologic tests measure specific immunoglobulin (Ig)M and IgG antibodies against Leptospira organisms. Leptospirosis is treated with antibiotics which in our case were ceftriaxone and doxycycline. Conclusion When a patient presents with fever and jaundice it is important to take the social history as well The profession in my case was the clue that it could be leptospirosis. Creator An entity primarily responsible for making the resource Maria Syed Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/8247e17e9cf16c7c6264cad9439a73db.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A late diagnosis of a congenital absence of the left pulmonary artery (E-Poster Presentations) Subject The topic of the resource congenital absence of the left pulmonary artery Description An account of the resource Introduction Congenital absence of left pulmonary artery is very rare, but this case is of particular interest due to the patients age and the diagnosis being missed in previous imaging. Case presentation A 79-year-old female presented to the emergency department with fluid overload and a 2-day history of shortness of breath. She denies chest pain, palpitations, fever, cough, and weight loss. Her past medical history is significant of unexplained JAK-2 negative polycythaemia, hypertension, an old left occipital infarct, and a new left parietal infarct. Examination was remarkable for reduced saturations (74%), raised JVP, tachycardia, and pedal oedema to knees. Bloods were unremarkable except for Hb of 177g/L (normal 120-160g/L) and NT-Pro BNP of 8258ng/L (normal < 400ng/L). COVID and flu swabs were negative. A CTPA was performed which ruled out pulmonary embolism, but noted the absence of a left pulmonary artery and a hypoplastic left lung, and severe anatomical distortion with the heart displaced to the left and the right lung extending into much of the left thoracic cavity. TTE showed a high probability of pulmonary hypertension with disproportionate RV dysfunction and only mildly reduced LV function. A right-to-left shunt is also suspected, which helps explain the two strokes. The patient denied any previous thoracic surgery. She was treated with Furosemide for fluid overload and discharged with home oxygen. Discussion Congenital absence of the left pulmonary artery is a rare condition with a wide range of presentations. It is believed to result from an embryological defect in the sixth aortic arch, with an estimated incidence of 1 in 200,000. The working diagnosis is chronic hypoxaemia secondary to the above anatomical variation (which explains the long-standing polycythaemia), with consequential pulmonary hypotension leading to decompensated right ventricular failure. This patient, therefore, has likely been hypoxemic for some time, highlighting the body’s remarkable ability to adapt to chronic conditions. Given the significant sequelae of this condition (notably RV failure and two strokes), the patient’s age, and a history of previous CT CAPs, we must give further thought to the reasons for a lack of earlier diagnosis. Conclusion Although very rare, a unilateral absence of pulmonary artery has many significant clinical sequalae, so an early diagnosis is important to avoid complications. Whilst unusual, the condition may remain minimally symptomatic or asymptomatic until late adulthood, increasing the difficulty of diagnosis. Creator An entity primarily responsible for making the resource Glen Reynolds Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text https://repository.horizon.ac.id/files/original/c3d6478f25a1f3cac1fb18b006ccfec3.pdf 115560defac3c2c1413139042e32a551 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Prosiding 3rd Emergency Physician's International Conference Contributor An entity responsible for making contributions to the resource Sri Wahyuni Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Using clinical photographs to improve dermatological care in the acute setting (E-Poster Presentations) Subject The topic of the resource clinical photographs, dermatological care, acute setting Description An account of the resource Introduction/ Objective The Dermatology team at our NHS DGH Trust requests that every inpatient e-referral to Dermatology, is accompanied by a clinical photo. Our Quality Improvement Project focuses on improving the referral system, by ensuring it is user-friendly and effective with the aim of reducing the time taken for specialist advice, ultimately improving patient care. Methods Using a Plan-Study-Do-Act (PDSA) methodology, we undertook a baseline audit of the electronic referrals sent to the Dermatology department over a 2-month period. We applied an exclusion and inclusion criteria. We used Microsoft excel to undertake our data analysis. We then created a survey and collected the responses from both junior doctors and the Dermatology team, so we could ensure our interventions were tailored to the needs of both the users and the team receiving the electronic referrals. As a result of our baseline audit, we worked with both IT and Dermatology to introduce a system called MedXnote, this a software within the Microsoft Teams app. It enables photographs to be taken safely within the app on a personal device, without saving to the device. These photos then upload directly to EDMS, a system which is already used in this hospital for Echocardiogram reports, which all members of the MDT can access via the online documentation system. We undertook a teaching session, created a user guide which was circulated by posters on the wards, e-mail and published on the Trust Intranet. Initial Results of Baseline Audit Our junior doctor survey identified issues with data governance and confidentiality within the current process of uploading clinical photos to e-referrals. Further to this, we found 67% of junior responses stated there could be a delay in completing dermatology referrals due to difficulties in attaching photos. Within the baseline audit undertaken over a 2 month period, only 45% of referrals were accompanied by a clinical photo. Having a photo attached was shown to significantly reduced the time taken for specialist advice to be given. Conclusions We will be undertaking our 2nd cycle of data collection post-intervention, to review the effectiveness of our initial interventions. The ability to attach clinical photos to a patient’s electronic referrals, has the scope to improve patient care, by acting as an efficient triage tool for referrals, providing virtual advice where possible and highlighting the need for an urgent face-to face review when required. Medxnote has potential to be utilised in the Acute setting to expedite advice, including discharge where appropriate and providing continuity between the MDT. Creator An entity primarily responsible for making the resource Dr Emily Taylor, Dr Nikita Cliff-Patel Source A related resource from which the described resource is derived Ibrahim, H. A. K. (Ed.). (2024). Abstract and Poster Presentations Book: 3rd Emergency Physician’s International Conference (EPIC24), 10 July 2024. From Zero to Hero Medical Education LTD Publisher An entity responsible for making the resource available From Zero to Hero Medical Education LTD Date A point or period of time associated with an event in the lifecycle of the resource 10 July 2024. Contributor An entity responsible for making contributions to the resource Sri Wahyuni Format The file format, physical medium, or dimensions of the resource PDF Language A language of the resource English Type The nature or genre of the resource Text