2 10 45 https://repository.horizon.ac.id/files/original/5006461e11481eafa07b6c030f7bb514.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 Spontaneous Coronary Artery Dissection in a patient with a Single Coronary Artery (E-Poster Presentations) Subject The topic of the resource Spontaneous Coronary Artery Dissection, Single Coronary Artery Description An account of the resource Spontaneous coronary artery dissection (SCAD) is an uncommon non-atherosclerotic aetiology of acute coronary syndromes (ACS) characterised by the formation of a false lumen inside the arterial wall, resulting in sudden occlusion of blood flow without any trauma or intervention. The pathogenesis of SCAD is not completely understood, and the association between coronary artery anomalies and SCAD is unclear. This case study reports a unique occurrence of Non-ST-Elevation Myocardial Infarction (NSTEMI) in a 43-year-old female patient. The NSTEMI was caused by Spontaneous Coronary Artery Dissection (SCAD) affecting the Posterior Descending Artery (PDA),in the setting of a single coronary artery. This is a very rare subtype of coronary artery anomalies in which the right coronary artery (RCA) gives rise to the left anterior descending artery (LAD) and left circumflex artery (LCx). The patient was managed conservatively, taking into consideration the extent of myocardial involvement and the resolution of symptoms. This congenital anomaly may have been the primary predisposing factor for her develop SCAD. Additional research is required to determine the correlation between coronary artery anomalies and SCAD Creator An entity primarily responsible for making the resource Ali Al-Shammari, Steven Danial Amy Habib, Fredy Gad 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/1c2c49b214e4f6cdda3731a071b1137c.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 Eye-drop induced Bradycardia (E-Poster Presentations) Subject The topic of the resource Eye-drop induced Bradycardia Description An account of the resource One of the most effective medications to treat glaucoma is Timolol Maleate. Timolol is a non-selective beta-adrenoceptor antagonist, available in both oral and topical preparations. Timolol eye-drops can reduce aqueous humour formation, thus decreasing intraocular pressure. This slows the development of glaucoma, and subsequent vision loss. However, unlike other glaucoma medications, the non-selective mechanism of action means the medication can have widespread effects if absorbed systemically. The most significant cardiovascular side effects include bradycardia and hypotension, but there may also be pulmonary and central nervous system effects. An 81-year-old man presented to the Emergency Department with acute urinary retention, reporting increased supra-pubic discomfort and reduced urine output in his catheter bag for the last 24 hours. The catheter was changed after a bladder scan showed the patient was retaining 500mls urine. A physical examination, blood results and observations were unremarkable, but he was admitted overnight for monitoring. The following day, the patient reported dizziness, was bradycardic with pulse 36 beats per minute and hypotensive with a blood pressure of 86/50mmHg. This persisted despite adequate oral intake and following a fluid bolus. The electrocardiogram showed slow atrial fibrillation and right bundle branch block. On admission, the patient’s observations were within normal range, and the pain response had likely masked the bradycardia and hypotension. It was only once the patient was more settled that these signs were noted. A medication review showed the patient had been prescribed Timolol eye-drops for primary open-angle glaucoma for the past four years. After excluding other causes for these symptoms, a clinical diagnosis of Timolol-induced Bradycardia was made. The Timolol eye-drops were discontinued and Azopt (brinzolamide) drops prescribed on advice of the Ophthalmology team. The patient’s pulse and blood pressure later normalised and he was safely discharged. In this case, an elderly patient experienced significant cardiovascular effects caused by the topical application of Timolol. The potential for systemic absorption of Timolol eye-drops cannot be disregarded and highlights the need for close monitoring of patients using this medication. Creator An entity primarily responsible for making the resource Zara Marchant 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/ed35e4eb2576f65da2f2144ffdb93777.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 Maternal Collapse and Cardiac Arrest- A simulation case scenario in a resource-poor setting in Sri Lanka (E-Poster Presentations) Subject The topic of the resource Maternal Collapse and Cardiac Arrest, Sri Lanka Description An account of the resource INTRODUCTION Maternal collapse, a critical event during pregnancy or postpartum, necessitates prompt intervention to prevent cardiac arrest, with each minute delay reducing survival chances by 10%. Challenges, including provider unfamiliarity and coordination, are worsened by sparse training and infrequent occurrences. Simulation-based training shows promise in improving emergency response. This study aims to enhance junior doctors' skills in managing maternal cardiac arrest to improve outcomes and guide future training in Sri Lanka. METHOD Doctors from an obstetric ward participated in a simulation-based study during resident education sessions, utilizing low-fidelity equipment. The simulation, triggered by a critical condition, employed a checklist to guide actions, followed by debriefing sessions for feedback and improvement. Analysis of videotapes and participant input identified areas for program enhancement. RESULTS Ten doctors from the obstetric ward participated, comprising three house officers, five registrars, and one senior registrar. Eight were males, and two were females, with a mean age of 32.3 years. Two had over 5 years of obstetrics experience, three had 1 to 5 years, and the majority, 5 out of 10, had less than one year of experience. Five participants had prior experience with a simulation�based maternal case scenario. Four had encountered maternal cardiac arrest in real life, while nine out of ten had not performed a perimortem c-section. The training enhanced competence, confidence, and crisis management, with swift identification and treatment initiation for critically ill patients. Adherence to the maternal cardiac arrest resuscitation algorithm led to successful resuscitation, followed by post-resuscitation care. However, the maternal early warning chart and initial foetal monitoring were overlooked, and some procedural shortcomings were noted, including delayed defibrillator connection and inconsistent chest compressor changes. The unavailability of essential equipment like non-rebreather masks and perimortem caesarean section kits was highlighted. During debriefing, participants expressed anxiety and excitement, particularly among intern medical officers, but valued the learning experience and suggested regular repetition. Nine out of ten found the simulation realistic and applicable, with increased confidence in managing maternal cardiac arrest. They appreciated feedback for improvement and advocated for regular simulation-based sessions, preferably with high-fidelity equipment. DISCUSSION AND CONCLUSION The simulation-based session underscored the importance of regular training to enhance maternal emergency management in Sri Lanka, addressing the lack of experience and aiming to reduce morbidity and mortality. Despite resource constraints, successful simulation-based training can be achieved. However, investing in a high-fidelity birthing manikin and simulator control software is recommended for enhanced training effectiveness. Creator An entity primarily responsible for making the resource W V R WICKREMASINGHE, HESHAN AMARATUNGA, A K P RANAWEERA 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/a8c5bd328adaebd5e5c3d35ee3e1d240.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 Can Multidisciplinary In-Situ Simulation be a useful tool in low-resource settings to identify and correct latent errors in the management of adult emergencies? (E-Poster Presentations) Subject The topic of the resource Multidisciplinary In-Situ Simulation, adult emergencies Description An account of the resource Introduction Emergency medicine is an emerging field in many areas of sub-Saharan Africa. The majority of emergency care is provided by nurses and intern doctors with little formal training in emergency medicine. In-situ simulation takes place in the clinical area with the on-duty healthcare team. It provides an opportunity to address key learning points and expose hidden system and environmental flaws, termed latent errors. The purpose of our study was to implement a programme of regular in-situ simulation and demonstrate its effectiveness as a practical method for the proactive detection and correction of latent errors. Methods In a semi-urban Emergency Department in Northern Uganda, healthcare professionals responded to 8 unanticipated simulated adult emergencies. Each simulation lasted approximately 20 minutes followed by debriefing. A standardised debriefing template was completed, documenting clear action points to address identified errors. The primary outcome measure was the number and type of latent errors identified, which were later scored on a predefined risk matrix. Proposed solutions and implemented changes were tracked. Results Throughout 8 simulations we identified 61 latent errors, an average of 7.6 per simulation. These latent errors were categorised, with the majority (63%) being related to education and training, followed by equipment (13%) and communication (13%) issues. When scoring these on a risk matrix 18 were classified as ‘high risk’ and 43 as ‘catastrophic risk’. Discussion Since emergency care is a relatively new speciality in Uganda, it is to be expected that most latent errors were related to education/training. Owing to the lack of up-to-date local guidelines, decisions around best-practice in this setting was often at the discretion of the facilitator. A good understanding of local resources and flexibility in selecting latent errors was necessary. Judging performance against expected high-resourced standards risked identifying errors that cannot be influenced by staff resulting in de-motivation. Time constraints limited discussion of all errors, hence only those that had the potential to be influenced and required urgent intervention were highlighted, explaining why all latent errors identified fell into ‘high’ and ‘catastrophic’ risk categories. Conclusion Regular in-situ simulations can provide a method to identify and correct latent errors. This can be particularly beneficial when emergency care centres are still in their infancy to prompt continual development. Whilst providing training remained a core element of the scenarios, subsequent actions led to the improvement of protocols, resources and fostered a culture of team�learning, accountability and quality improvement, ultimately improving patient care. Creator An entity primarily responsible for making the resource Emma Ridings 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/3ac06e12b21793689dcb94c55670a936.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 Extreme metabolic acidosis (E-Poster Presentations) Subject The topic of the resource Extreme metabolic acidosis Description An account of the resource Introduction Metformin-associated lactic acidosis is a rare but critical condition with a high mortality rate, making prompt recognition and intervention crucial for patient survival. In this case report, we explore an extraordinary survival from extreme metabolic acidosis, challenging the traditionally accepted “unsurvivable” acid-base balances. Case presentation A 49-year-old patient on metformin and canagliflozin therapy for type 2 diabetes was found unconscious, in shock, and experiencing respiratory distress after one week of vomiting and diarrhoea. Blood gas analysis revealed extreme metabolic acidosis (pH 6.50, HCO3 1.9, BE -34, lactate 23.88), hypoglycaemia (glucose <1.1), and ketosis (blood ketones 5.9). Immediate balanced fluid resuscitation was initiated, hypoglycaemia was corrected using 20% glucose, and initial acidosis treatment involved 8.4% bicarbonate. Peripheral adrenaline was administered for shock refractory to fluid therapy, and rapid sequence induction was performed to facilitate cross-sectional imaging, which excluded mesenteric ischemia or acute intracranial pathology. Blood cultures, viral swabs, toxin biochemistry, and autoimmune investigations revealed no abnormalities. Despite these interventions, acid-base balance remained severely deranged (pH 6.56, HCO3 2.1, BE -35, Lac 21). The patient was admitted to the intensive care unit for continuous renal replacement therapy (CRRT) alongside mechanical ventilation and supportive vasopressors. After 14 hours of CVVHDF, the acid-base balance began normalizing (pH 7.35, HCO3 16.6, Lac 13.7). After 2 days, the patient was successfully extubated, RRT was discontinued, and after 5 days, the patient was discharged to the ward with no neurological deficit. Discussion Regulation of pH is essential for normal cellular function. This case demonstrates a rare but critical complication of metformin therapy, resulting in extreme physiological conditions. To the authors' knowledge, this is the most severe metabolic acidosis without contributing cardiac arrest ever reported. Remarkably, the patient made a full recovery without neurological deficit, despite presenting with concomitant hypoglycaemia. Conclusion This case underscores the importance of prompt recognition and intervention in extreme acid-base disturbances, suggesting that with reversible causes, even traditionally deemed "incompatible with life" pH levels may be survivable. It raises the question: in the presence of reversible causes, are the numbers just numbers after all? Creator An entity primarily responsible for making the resource Laurence Baker, Anna Todd, Rosie Kalsi 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/59ca1fdb62eda3ef5722b46e5ca3085f.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 CTPA Outcomes at Single UK Centre (E-Poster Presentations) Subject The topic of the resource CTPA Outcomes at Single UK Centre Description An account of the resource Aim To estimate the positive rate for PE in CTPA requests in accordance to RCR guidelines and trust adherence to NICE guidelines in the diagnosis of PE (requesting a CTPA). Estimate the proportion of those patients who had an alternative explanation on chest x ray for symptoms. To identify areas of improvement in requesting CTPA. Methods Hospital numbers and wells scores of 317 patients for all patients over age 18 who had CTPA’s performed during the month of September- October 2023 were obtained. CTPA reports were evaluated, along with the prior work-up of investigations for each patient, including chest x-ray. Data were recorded and analysed anonymously onto a spreadsheet. Results Royal College of Radiologists recommend a minimum yield of 15.4% as the acceptable positive rate of CTPA for PE. The audit shows that the positive rate of CTPA for PE in the trust is around 12%. 10.4% of the patients had evidence of consolidation on chest X ray out of which 9.7% were negative for PE. 1.5% of the patients had evidence of heart failure on chest X ray out of which all of them were negative for PE. Conclusion All patients who had evidence of heart failure on chest X ray were negative for PE. The trust currently uses D-dimer>500 as a threshold for CTPAs, when considering age-appropriate D-dimer in patients over 50, all 14 patients were negative for CTPA. Creator An entity primarily responsible for making the resource Usama Hussain, Alex Chandy, Aaron Deane 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/176fcd17c98f1bad949c120e27abf40d.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 Role of CPET in influencing patient selection for elective AAA repair (E-Poster Presentations) Subject The topic of the resource Role of CPET in influencing patient selection for elective AAA repair Description An account of the resource Introduction Cardiopulmonary exercise testing (CPET) provides an objective assessment of a patient’s functional capacity and is increasingly being used in pre-operative medicine to risk stratify patients. One of the important uses of CPET is in patient selection for elective AAA repair. The 2020 NICE guidelines on AAA recommend: consider cardiopulmonary exercise testing when assessing people for elective repair. However, it does not provide any further details on which patients should undergo CPET or how to interpret CPET results. As a result, there is significant variation in patient selection. In this research, we evaluate the role of CPET in influencing vascular surgeons’ decision making. Methods Data was collected from 58 vascular patients at DCHFT who had CPET performed from January 2020 to December 2022. Patients who scored an anaerobic threshold (AT) of 10.2ml/kg/min and peak oxygen consumption (peak VO2) of 15ml/kg/min or above were considered fit for intervention according to the available literature. The number of patients who had an intervention (open repair/EVAR/FEVAR) was calculated and assumed to have had a good outcome if no data was found to say otherwise on their records. Excel was used to collate data and convey it in bar graphs and pie charts. Results There appears to be no relation between CPET variables and a decision to electively repair. A total of 28 patients had an AT <10.2ml/kg/min; of these only 17 patients were deemed not fit and 11 patients had an intervention. A total of 24 patients had a peak VO2 <15ml/kg/min; of these only 15 patients were deemed not fit and 9 patients had an intervention. 19 patients had 2 subthreshold CPET values (AT and peak VO2); of these, 7 patients had an intervention anyway. Conclusions Patient selection for surgical intervention mainly depends on a surgeon’s clinical assessment. It is fundamental that we should not be using CPET to confirm an already made clinical decision. The lack of detailed NICE guidelines makes it quite difficult to decide which patients should undergo CPET. Further research and updated guidelines would undoubtedly help to avoid unnecessary CPET requests Creator An entity primarily responsible for making the resource Mariam Allam 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/5df055364596366eea3f452286d44afc.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 The Compassionate Shift: Enriching Emergency Department Clinical Handovers to Improve Clinical Performance and Safety (E-Poster Presentations) Subject The topic of the resource The Compassionate Shift: Enriching Emergency Department Clinical Handovers to Improve Clinical Performance and Safety Description An account of the resource AIMS AND OBJECTIVES 1) To introduce wellbeing into Airedale General Hospital (AGH)’s Emergency Department (ED) clinician handover. 2) To increase awareness of wellbeing, and its potential impact on clinical performance. METHOD AND DESIGN May 2023: baseline wellbeing survey distributed to AGH ED clinicians. June: STEP Handover launched. Self (Emergency Practitioner In Charge (EPIC)’s wellbeing:-2 to +2 scale), Team (challenging shift patterns highlighted, clinicians rate their wellbeing numerically with sharing opportunity). Environment (departmental issues), Patient Handover. Estimated 15 seconds/clinician. July: Survey repeated. September: Project re-launch. Wellbeing and Learning Goals Handover Huddle (WLGHH): challenging shift patterns highlighted, clinicians rate their wellbeing using traffic-light colour scale or thumbs-up scale, with sharing opportunity. October: Survey repeated. February 2024: Confidential online Wellbeing SitRep (via QR code) launched. RESULTS AND CONCLUSIONS 57% baseline/83% STEP/57% WLGHH of clinicians value sharing their wellbeing during handover. 94%/92%/78% value learning team members’ wellbeing. 44%/58%/56% of clinicians sometimes find themselves in situations they feel uncomfortable, or are not best-suited for, because their personal situation is unknown. EPICs sometimes consider clinicians' wellbeing, and how this may affect them clinically, when allocating 70%/100%/86% of cases and tasks. “Great initiative.” “Encouraging this conversation is important.” “Hesitant handover is the right environment - very ‘public’.” “Limited time in handover.” STEP implemented in 50% or fewer handovers, and WLGHH in 20% or fewer handovers due to busy department pressures (“process needs streamlining”) and sense that “there’s little we can do with [wellbeing] information…it adds a cloud to the shift”. EPICs aware of vulnerability within their team have been shown to lead compassionately. Our initiative demonstrates ED clinicians value sharing their wellbeing status. However, there are individual, cultural and departmental barriers to achieving project engagement. Through ongoing process modification we aim to create a psychologically safe working environment, improved clinician wellbeing, and an enhanced safety culture in AGH ED. EPICs aware of vulnerability within their team have been shown to lead compassionately. Our initiative demonstrates ED clinicians value sharing their wellbeing status. However, there are individual, cultural and departmental barriers to achieving engagement with this work. Through ongoing process modification we aim to create a psychologically safe working environment with better awareness of team vulnerabilities, and an enhanced safety culture in AGH ED Creator An entity primarily responsible for making the resource Alice Faulkner, Alexandra Danecki 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/799c21c2b5f49d379a2423e131a9ddcb.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 Successfully managed suicidal cut-throat injury: A case report (E-Poster Presentations) Subject The topic of the resource Successfully managed suicidal cut-throat injury Description An account of the resource Introduction Cut-throat injuries are one of the medical emergencies within the purview of Otorhinolaryngology (ENT) specialists. If not promptly treated, it carries a high rate of mortality. Emergency physicians play a key role in prevention and mitigation of fatal complications by urgently securing the airway using tracheostomy or intubation, promptly controlling hemorrhage and transfusing blood. Case history A 26-year-old man diagnosed with a psychiatric illness presented to the emergency department with a deep cut injury over the anterior neck exposing the thyroid cartilage with gush of air. It was a witnessed suicidal attempt according to the family which is consistent with the patient’s previous history of similar behavior. He was in respiratory distress with a respiratory rate of 36 bpm and SpO2 80% on room air. Blood pressure was 110/86 mmHg and pulse rate was 112 bpm. His GCS level was 14/15 and was not under the influence of alcohol. The patient was managed in the resuscitation area and was immediately prepared for intubation while setting the plan according to the Difficult Airway Society (DAS) guidelines. Both anesthesia and ENT teams were notified, and the patient was successfully intubated using modified rapid sequence induction (RSI) with bougie-guided conventional laryngoscopy. Intravenous antibiotics, Tranexamic acid and intramuscular Tetanus toxoid were given. One unit of cross matched blood was transfused. The cut injury was explored and repaired by ENT team followed by insertion of a tracheostomy tube after reconstruction. He received positive pressure ventilation through the tracheostomy, and the tube was removed on the seventh day of hospitalization. Psychiatric referral and follow up were also arranged. Discussion Cut-throat injuries can damage major blood vessels, nerves, the upper airway, thyroid, and rarely esophagus. In this case the injury occurred through the thyro-hyoid membrane severing both thyro-hyoid muscle and thyroid cartilage. Securing the air way is pivotal to prevent hypoxia and aspiration. Though the preferred technique is awake intubation with fibro-optic laryngoscopy it requires time and cooperation from the injured. Considering the acute nature and reduced GCS, we had to proceed with conventional laryngoscopy. Successful first fast intubation can be achieved by adhering to DAS guidelines and promptly preparing for the specific airway management plan. Conclusion Cut-throat injuries pose significant challenges to emergency physicians, demanding swift and decisive action alongside effective teamwork with regards to rapid intubation to secure the airway. Successful first past intubation is crucial and dramatically enhances the survival rate of such patients. Creator An entity primarily responsible for making the resource Prabhani Ganegoda, Madurangi Ariyasinghe 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/860f5036abd0d8e742b34ce1f032d1fa.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 THE FARMER’S POISON: The dilemma of chelation and dialysis (E-Poster Presentations) Subject The topic of the resource THE FARMER’S POISON Description An account of the resource INTRODUCTION Monosodium Methanearsonate (MSMA) is an organic arsenical herbicide commonly used in the rural areas of Sabah with agriculture as its main economic activity.[1] CASE DESCRIPTION We present a case series of symptomatic MSMA poisoning from ingestion of ANSAR 550 and Monex HC containing 35.5% and 38.5% MSMA respectively. All three patients progressed to have haemodynamic instability, anuric acute renal injury (AKI) and were given IM dimercaprol chelation. All cases resulted in death but the patient who underwent haemodialysis survived longer. DISCUSSION Early symptoms of acute arsenic poisoning include gastrointestinal tract irritability, followed by numbness, tingling sensation of extremities, muscle cramps and in extreme cases, death.[2] The mainstay treatment for MSMA poisoning is chelation therapy and haemodialysis.[3] Dimercaprol and its modern derivatives, DMSA (meso2,3-dimercaptosuccinic acid) and DMPS (23-dimercapto-1- propanesulfonate) are chelating agents that bind the arsenic heavy metal to form complexes and are eliminated by urinary excretion.[4] Early administration was shown to improve patient outcomes.[5] Anuric AKI patients benefit most from haemodialysis as their role to eliminate the chelator-metal-complexes is imperative to avoid redistribution to the central nervous system.[6] There were also reports on the benefits of haemodialysis without chelation, similar to our case.[7] The major limitation in our centre is the unavailability of Dimercaprol which accounted for the administration delay, and the difficulty to obtain an urgent dialysis on site. As a result, both our earlier patients became too unstable to start haemodialysis. There was also no available Continuous Veno-Venous Hemofiltration (CVVH) in our setting. CONCLUSION Future strategies at our centre will focus on early chelation and haemodialysis treatment before the onset of haemodynamic instability. Early dialysis can also be considered in centres where antidotes are not readily available. Creator An entity primarily responsible for making the resource Joanne Chin, Johnathan Chong Yee Onn, Syahrizal Azizi Shaharudin, Helena Sharmini A Rajoe, Dzulhelmy Sulaiman 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