3 10 45 https://repository.horizon.ac.id/files/original/956b3bd59a5a048cfae201d6846a0841.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 New Case ofDe Quervain's Thyroiditis in Emergency Departement (E-Poster Presentations) Subject The topic of the resource De Quervain's Thyroiditis Description An account of the resource Introduction Thyroid toxicosis can be developed after minor infection, has to be taken seriously and start treatment urgently despite the clinical picture. It should be kept under a close observation until it has been seen by an endocrine specialist. Case presentation 31 year old lady female, NHS member . Exposed to possible nuclear radiation so she was taking iodine supplement in her childhood. No known allergies. Came to the hospital with: Sore throat, HR up to 130 , Mild sore Tenderness left side of neck + no swollen ,discomfort on swallowing, no stridor / SOB, Noted fine tremor , No rash Discussion In ED she had IV hydrocortisone and BB (tachycardic 130 bpm, HR improved to 97) then referred to medicine for discussion. ED SpR suggested discharging the patient with SDEC endocrine review. The discussion was the clinical picture stabilised, Is it safe to discharge the patient for next day SDEC review with endocrine team. Patient was given co-amoxiclav in ED. 10 minutes after that, she developed lips numbness, more tachycardia ( 180) and hypotension ( 70/40) . (given adrenalin). Moved to resus and discussed with ICU team by ED. There was doubt, is this rapid drop in observation was a reaction to co-amoxiclav or a thyrotoxicosis storm. Patient confirmed that she had co-amoxiclav many times before without any allergic reaction. On examination : on thyroid examination : no enlargement , but tender on left side of the thyroid. No eyes signs for hyperthyroidism (no protrusion , no lid leg ,no lid retraction ) Blood tests: TSH: 0.008 , T4 : 44 CRP 45, WBC 13 , neutrophils normal , lymphocytes low Burch-Warsofsky point scale 50 ( keeping with thyroid storm) Investigation and management plan: Impression was Viral infection induced thyroiditis leading to thyrotoxic state -thyroid storm Patient was admitted given IV hydrocortisone , IV BB and PTU and then discharged on oral prednisolone with endocrine follow up with US thyroid. Seen in Endocrine clinic and diagnosed with settled De Quervain's Thyroiditis. Conclusion Mild infection could result in a serious thyroid storm which should be taken seriously during out of hour shifts even though patient may look clinically well but the storm could strike at any moment. Creator An entity primarily responsible for making the resource Anwar Alkour 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/b4adb1754e050d334e508f9a78970051.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 Enhancing Mortality Benefit: A Quality Improvement Initiative for Optimizing Sepsis Care in the Emergency Department through Revised Pathway Implementation (E-Poster Presentations) Subject The topic of the resource Mortality Benefit, Quality Improvement Initiative for Optimizing Sepsis Care in the Emergency Department through Revised Pathway Implementation. Description An account of the resource Introduction Sepsis, a life-threatening condition resulting from the body's extreme response to infection, remains a critical global health concern. Understanding its burden, incidence, and impact is vital for effective prevention and treatment. In lower middle-income countries like Pakistan, sepsis management faces unique challenges due to limited resources and disparities in healthcare delivery. Formulating and updating evidence-based sepsis pathways are essential for delivering high-quality care and optimizing patient outcomes. Methods Detailed discussions among critical care and emergency medicine experts were conducted to formulate a revised sepsis pathway based on the latest Surviving Sepsis Campaign guidelines. The pathway underwent institutional review to ensure adherence to policies and procedures. Healthcare providers received training on pathway implementation. An audit was scheduled after 6 months to evaluate implementation impact, focusing on parameters such as time of recognition, antibiotic administration, mortality benefit, length of stay, mortality rates, and early disposition. Results Data on audit parameters were collected from electronic health records. Statistical analysis compared pre- and post�implementation data. Significant improvements were observed post-implementation in time of recognition, antibiotic administration, mortality benefit, length of hospital and ICU stay, mortality rates, and early disposition of patients. Discussion The findings highlight the effectiveness of the revised pathway in optimizing sepsis care in the ED. Timely recognition and treatment adherence contribute to improved patient outcomes. Continuous quality improvement efforts are crucial for sustaining these improvements and addressing evolving challenges in sepsis management. Conclusion The revised sepsis pathway, aligned with evidence-based practices, enhances mortality benefit, and improves patient care outcomes in the ED. Multidisciplinary collaboration and continuous quality improvement efforts are essential for sustaining these improvements and ensuring excellence in sepsis management. Creator An entity primarily responsible for making the resource Sundas Sajid, Madiha Ismail, Hassan Jafri, Erum Shakeel 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/8c9138efd73202c35b864b99c78ebd44.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 Exploring Urinary Catheter-Related Complications and Contributing Factors in the Emergency Department of a Tertiary Care Hospital (E-Poster Presentations) Subject The topic of the resource Urinary Catheter-Related Complications and Contributing Factors, Emergency Department of a Tertiary Care Hospital Description An account of the resource INTRODUCTION The Emergency Department (ED) plays a crucial role in admitting many hospitalized patients, often needing to decide on urinary catheter placement. While catheters help monitor urine output and alleviate urinary issues, they also pose safety risks. Ineffective or unnecessary use can lead to discomfort, activity limitations, and significant healthcare burdens. Catheter-associated urinary tract infections (CAUTIs) significantly contribute to hospital-acquired infections linked to indwelling urinary catheters (UCs). Additionally, iatrogenic urethral injuries during UC insertion, with potential complications like acute gross hematuria and urethral strictures, highlight the need for quality control measures during catheter insertion in the emergency department to mitigate risks. METHOD The research conducted at the Emergency Medicine department of Aga Khan University Hospital in Karachi spanned six months from April 1st, 2022, to September 30th, 2022, following approval from the Ethical Review Committee. Utilizing a non-probability consecutive sampling method, 202 patients were enrolled, with exhaustive medical histories collected, encompassing demographics, admission diagnoses, laboratory analyses (including Urine Analysis), and complications associated with urinary catheterization, along with potential contributing factors documented using a standardized proforma. RESULTS The study population displayed demographic diversity, with an average age of 60.79 years and a gender distribution of 47% male and 54% female participants. Catheter-related issues were identified in 75% of cases, predominantly hematuria (59%) and catheter-associated urinary tract infections (CAUTI) (53%). Urethral injury occurred in 1% of cases, with no instances of urethral stricture. Additionally, four systematic factors within the ED were assessed, including prolonged hospitalization (6% of patients), immobilization (13% of patients), urinary retention (4% of patients), and palliative care (7% of patients). DISCUSSION This study highlights healthcare providers' inadequate understanding of catheterization indications and the absence of a monitoring protocol for unnecessary catheters. Preventing catheter-associated urinary tract infections (CAUTIs), significant contributors to hospital-acquired infections, necessitates adherence to appropriate catheter use guidelines. Risk factors for CAUTI include prolonged use (with up to 43.9–54% of catheter insertions deemed inappropriate), female gender, and the absence of systemic antibiotics. Guidelines emphasize employing catheters only when medically indicated and promptly removing them when unnecessary. Various researchers have reported similar and additional factors contributing to catheter-associated complications. By identifying and addressing these factors, our study aims to facilitate the development of targeted interventions to reduce complications and enhance patient outcomes in the emergency department. CONCLUSION This study emphasizes the high prevalence of catheter-related complications in the Emergency Department, urging targeted interventions for improved patient outcomes. Creator An entity primarily responsible for making the resource Naheed Habibullah, Noor Baig 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/0c18e7d7250f716c8e998499ef9d6193.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 ABDOMINAL COCOON: A RARE PRESENTATION OF ABDOMINAL DISTENTION IN A YOUNG ADULT MALE - A CASE REPORT (E-Poster Presentations) Subject The topic of the resource ABDOMINAL COCOON, ABDOMINAL DISTENTION Description An account of the resource INTRODUCTION Abdominal Cocoon Syndrome (ACS), a rare condition characterized by small bowel encapsulation, poses significant diagnostic challenges. First described by Foo et al. in 1978, this condition presents with a range of symptoms, including abdominal colic, intermittent pain, nausea, vomiting, bloating, and a non-tender soft abdominal mass on palpation, potentially leading to small bowel obstruction or peritonitis. The exact pathogenesis of ACS remains elusive, but it is frequently associated with peritoneal dialysis, abdominal surgery, or chronic inflammatory conditions. Prompt and accurate diagnosis is crucial for timely intervention and management. Management is controversial, with conservative approaches being common, while surgical intervention may be necessary. Postoperative care involves nutritional support, pain management, and close monitoring. CASE PRESENTATION A 35-year-old man presented with sudden onset of generalized abdominal pain and distension. He reported passing stool but not flatus and had previously been treated for subacute intestinal obstruction. Examination showed a soft, distended abdomen, mild tenderness, and a firm palpable mass in the supraumbilical region, along with hyperactive bowel sounds and an empty rectum on digital rectal examination (DRE). Imaging revealed clustered small bowel loops encapsulated by a thin peritoneal layer, indicating abdominal cocoon. Initially managed conservatively, he was later readmitted with recurrent intestinal obstruction. Subsequently, he underwent exploratory laparotomy, adhesiolysis, and appendectomy. Postoperatively, he recovered well, with no recurrence of symptoms during follow-up. DISCUSSION ACS, also known as sclerosing encapsulating peritonitis, is rare, with only 50 reported cases. It often leads to intestinal obstruction, presenting diagnostic challenges due to its rarity and vague symptoms. ACS primarily affects young to middle-aged individuals, with a slight male predominance, manifesting as acute, subacute, or chronic abdominal pain. In a retrospective study of 24 patients, only 16% received a preoperative diagnosis. Surgeons must integrate clinical history, physical examination, and imaging to avoid misdiagnosis. Surgical intervention, particularly exploratory laparotomy with membrane excision and adhesiolysis, often yields satisfactory results. Individualized treatment decisions are essential based on symptom severity. Conservative management may be suitable for hemodynamically stable patients with minimal symptoms. CONCLUSION Abdominal cocoon, a rare cause of intestinal obstruction, requires timely recognition and appropriate management, including conservative measures or surgery. This case highlights the importance of considering it in patients with subacute intestinal obstruction, especially those with relevant medical history. Further research is needed for better understanding and management. Creator An entity primarily responsible for making the resource Naheed Habibullah, Syed Hassan, Najmus Sahar, Badar Afzal 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/31b726a299ce6019a793a66ee2f9d68f.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 Unveiling Left-Sided Appendicitis and the Role of Clinical Intuition - A Unique Case Report Subject The topic of the resource Unveiling Left-Sided Appendicitis and the Role of Clinical Intuition Description An account of the resource INTRODUCTION Acute appendicitis, a frequently encountered surgical emergency, accounts for 4% to 8% of all emergency visits, and typically presents with right lower quadrant pain, fever, and localized tenderness, often diagnosed using the Alvarado score. However, anatomical variations or malposition of the appendix can complicate diagnosis, resulting in delayed treatment and heightened risks of complications like abscess formation or perforation. By examining a specific case featuring left lumbar pain—an atypical manifestation documented in approximately 30% of cases—this report underscores the significance of clinical intuition in identifying left-sided acute appendicitis (LSAA) and guiding appropriate management decisions. CASE PRESENTATION A 30-year-old man presented with sudden left lumbar pain and tenderness lasting one day. He denied fever, and his Alvarado score of 3 initially ruled out appendicitis. Examination showed stable vitals and left lumbar tenderness without visceromegaly. Despite a leukocyte count of 16.2 × 10^9 cells/L (neutrophil count: 82.8%), all other tests were negative. The general surgery team initially chose not to intervene, but clinical intuition led the emergency consultant to order a CT scan, confirming acute appendicitis. The patient had a successful laparoscopic appendectomy, revealing an inflamed, malrotated appendix, and recovered swiftly, with no complaints at follow-up. DISCUSSION The case of left-sided acute appendicitis (LSAA) amidst anatomical anomalies prompts a detailed discussion on diagnostic intricacies, clinical intuition, and emergency surgical management. LSAA, often linked to congenital anomalies, may present with symptoms such as bowel disturbance and bilious vomiting, occurring at an incidence varying from 0.03% to 0.5% among live births. LSAA commonly presents between the ages of 8 and 82, with a prevalence 1.5 times higher in males compared to females. Diagnosis hinges upon a multifaceted approach encompassing clinical manifestations, physical examinations, radiological assessments, and the surgical expertise. Addressing LSAA necessitates unconventional diagnostic approaches to prevent delays and complications with the decision to pursue a CT scan, despite initial indications against appendicitis, proving crucial in identifying LSAA with malrotation and facilitating timely surgical intervention. This case report educates healthcare professionals on considering rare presentations and recognizing the value of clinical intuition in navigating diagnostic uncertainties. Sharing such cases enriches medical education and equips practitioners to handle unusual clinical scenarios effectively. CONCLUSION LSAA challenges traditional clinical expectations, emphasizing the importance of clinical intuition and a collaborative approach in emergency medicine. Adapting to unconventional presentations is crucial for improving patient care as healthcare evolves, highlighting the complexity of clinical decision-making. Creator An entity primarily responsible for making the resource Naheed Habibullah, Bushra Qaiser, Syed Hassan 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/dc941ee19524bbdd4431a11ecbc4724d.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 Intramuscular Use of Glucagon in Esophageal Food Impaction (E-Poster Presentations) Subject The topic of the resource Intramuscular Use of Glucagon in Esophageal Food Impaction Description An account of the resource The standard management of esophageal foreign body impactions typically involves either observational strategies or endoscopic removal. In scenarios where endoscopy is not accessible, pharmacological interventions offer a viable alternative. Glucagon, when administered intravenously, represents one such pharmacological option; however, its use has been linked to a heightened risk of complications. This case study delineates the management of a patient experiencing dysphagia due to a meat bolus obstructing the lower esophagus, in a setting bereft of conventional therapeutic options. The study highlights the effectiveness of intramuscular glucagon injection as a strategy to reduce risk of complications . The intramuscular route may inspire further research in pharmacological management of food bolus impaction, which is particularly pertinent in hospitals where endoscopic facilities are scarce. The outcomes of this study indicate that the mode of glucagon administration plays a pivotal role in diminishing the complications encountered in emergency situations. Case Report Middle-aged man presented with dysphagia after eating meat, suggestive of lower esophageal obstruction. Vital signs normal, no significant medical history. Despite normal chest X-Ray, clinical signs indicated esophageal foreign body. Due to urgency and no endoscopy available, administered 1mg glucagon intramuscularly. Symptoms resolved within 12 minutes without side effects, avoiding endoscopy. Discussion This case report highlights the successful use of intramuscular glucagon in managing esophageal food impaction (EFI) when endoscopic intervention is unavailable. While intravenous glucagon has been explored in similar scenarios, the intramuscular route offers a novel approach with potential benefits. By utilizing the slower absorption rate of intramuscular delivery, this method minimizes the risk of adverse effects associated with intravenous administration, such as nausea and vomiting. Moreover, the physiological mechanism behind intramuscular glucagon’s efficacy involves gradual activation of adenylate cyclase, leading to reduced lower esophageal sphincter pressure and facilitated passage of the food bolus. This approach not only resolves the immediate issue of EFI but also underscores the importance of innovative treatment strategies in resource�constrained emergency departments. Conclusion In conclusion, intramuscular glucagon administration presents a promising alternative for managing EFI in settings where endoscopic facilities are limited. This case demonstrates its effectiveness in resolving dysphagia without the need for invasive procedures, ensuring timely patient care and potentially improving outcomes. Further research is warranted to validate the safety and efficacy of this approach, particularly in emergency care settings, to expand therapeutic options and enhance patient management strategies for EFI. Creator An entity primarily responsible for making the resource Danusha Sanchez, Raghav Gupta, Su yang Zhao 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/5ed714ac6fcdedd8ca59619f78a904a2.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 Neuroendocrine cancer (E-Poster Presentations) Subject The topic of the resource Neuroendocrine cancer Description An account of the resource Introduction 59 years old lady presented with six month history of unsteadiness feeling generally unwell, poor balance, N&V, loss of appetite along with ongoing headaches Case presentation 59 years old lady presented with six month history of unsteadiness feeling generally unwell, poor balance, N&V, loss of appetite along with ongoing headaches CT head confirms that the left cerebellar lesion is heavily calcified. MRI head: Likely meningioma in the left posterior fossa causing obstructive hydrocephalus MRI Head with Gadolinium: a calcified meningioma neurosurgery suggested OP clinic to discuss resection vs surveillance. CT CAP looking for primary lesion showed diffuse liver metastasis and abdominal para-aortic lymphadenopathy. Prominent appearance of the uterus with irregular enhancement of the endometrium, gynaecological opinion is advised in first instance. US Pelvis showed: Thickened endometrium at 8 mm. direct visualization of uterine cavity via hysteroscopy and a polypectomy, which after histology demonstrated no evidence of uterine malignancy. No further action needed at this time. CTPA: A calcified gallstone is noted. degenerative changes at the L1/2 disc space. No PE. Liver Biopsy: these liver cores are infiltrated by a tumour of showing solid nests and sheets of uniform oval cells with irregular round nuclei. No mitoses are seen CD 56, synaptophysin and MNF 116 are strongly positive in keeping with a neuroendocrine carcinoma ki67 is very low (< 2% ) consistent with a well-differentiated NEC. Random urinary 5-HIAA along with Fasting Chromogranin A were sent Discussion Following discussion in the NET MDT discussion Grade 1 ileal (small bowel) neuroendocrine tumour with mesenteric nodal and liver metastases - well differentiated, grade 1 Carcinoid syndrome For treatment with Lanreotide Conclusion Initial symptoms of of N&V, loss of appetite, abdominal pain flushing and diarrhoea were typical of carcinoid syndrome symptoms and starting treatment with long acting octreotide will relieve symptoms .gradually worsening balance- posterior fossa meningioma for which discuss resection vs surveillance Creator An entity primarily responsible for making the resource Mohamed Haron 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/c0ffca8662406f23f79820b0960b2956.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 Unilateral perioral and thumb numbness - Cheiro-Oral Syndrome secondary to acute left thalamic infarct (E-Poster Presentations) Subject The topic of the resource Cheiro-Oral Syndrome, acute left thalamic infarct Description An account of the resource Introduction Cheiro-Oral Syndrome (COS) is a rare form of lacunar stroke characterized by pure sensory impairment, typically affecting the perioral region and fingers. Case Presentation A 61-year-old male presented to the emergency department with a one-day history of numbness over the upper and lower lips on the right side and the tip of the right thumb. He had no other neurological deficits or systemic symptoms. His medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia, lung cancer, prostate cancer, and brain metastases. A year prior, he had a similar presentation on the left side, associated with cerebral metastasis. During the current presentation, neurological examination revealed reduced sensation in the right perioral area and right thumb. Blood investigations showed a deranged lipid profile. CT head imaging revealed a small hypodensity in the left thalamus, which MRI confirmed as a small acute infarct. He was admitted, started on aspirin, and referred to the stroke team. Discussion COS is a rare and often overlooked pure sensory stroke. It is typically caused by lacunar infarcts in the thalamus, pons, medulla oblongata, or cortex. This case highlights the importance of recognizing the symptoms of COS, performing neuroimaging, and ensuring appropriate management and disposition in emergency settings. Conclusion Awareness of COS among emergency physicians is crucial for prompt diagnosis and management, which can significantly impact patient outcomes Creator An entity primarily responsible for making the resource Mohammed Sameer Ali, Vijaya Banu Mohan, Fred Sackey 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/8566f532952236ac1db33f9a7632175c.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 Coeliac Artery Thrombosis and Gastric Ischemia - An Unusual Presentation in Emergency Department (E-Poster Presentations) Subject The topic of the resource Coeliac Artery Thrombosis and Gastric Ischemia Description An account of the resource Background Acute gastric ischemia is a rare but fatal condition due to the risk of necrosis and perforation. This case report details the presentation, diagnostic process, and management of a 76-year-old male patient with acute gastric ischemia secondary to coeliac artery thrombosis. Case Presentation A 76-year-old male with multiple co-morbidities presented to the emergency department with severe abdominal pain radiating to the back, vomiting, constipation, and shortness of breath. Physical examination revealed tachypnea, tachycardia, hypotension, fever, and a distended abdomen with generalised tenderness, guarding, and absent bowel sounds. Venous gas analysis showed metabolic acidosis with elevated lactate levels. Imaging studies, including chest and abdominal radiographs, revealed dilated large bowel loops. At the same time, a CT scan of the abdomen indicated no contrast opacification of the celiac axis with collateral filling of the hepatic artery distal to a thrombus, suggesting gastric ischemia. Blood tests revealed leukocytosis, elevated C-reactive protein, and amylase levels. The patient was started on morphine, IV fluids, antibiotics, and unfractionated heparin for anticoagulation. Multidisciplinary consultations determined that the patient was not a candidate for surgical or endovascular intervention due to poor physiological status and a high mortality risk. Despite aggressive medical management, the patient died 26 hours after admission. Discussion Acute gastric ischemia, although rare, necessitates a high index of suspicion, particularly in patients with predisposing factors like systemic hypoperfusion or thrombotic conditions. Despite its robust collateral circulation, the coeliac artery can be a site for thrombosis, leading to significant gastric ischemia. Diagnosis primarily relies on radiological imaging, particularly CT angiography, which is critical for visualising vascular obstructions and ischemic changes. Management involves a combination of medical therapy aimed at resuscitation and stabilisation, with interventional radiology or surgery considered based on the patient's stability and underlying cause. Conclusion Timely recognition and diagnosis of coeliac trunk thrombosis are imperative to prevent significant morbidity and mortality. The treatment approach should be individualised, considering the patient's overall health and specific clinical presentation, with a focus on early restoration of blood flow through appropriate medical or surgical interventions. Creator An entity primarily responsible for making the resource Avikal Sharma, Vijaya Banu Mohan 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/2620b04dbc82def355b642bace728949.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 Case Report of Bilateral Seminal Vesicle and Prostatic Abscesses in a Patient with Type 2 Diabetes Mellitus Subject The topic of the resource Bilateral Seminal Vesicle and Prostatic Abscesses, Patient with Type 2 Diabetes Mellitus Description An account of the resource Introduction Patients with Diabetes Mellitus are at increased risk of genitourinary infections due to impaired immune function and urinary stasis. Here, we present a case of an extended genitourinary abscess in a male with type 2 diabetes mellitus (T2DM). The patient's clinical-presentation, diagnostic workup, treatment, and outcome are discussed. Case-Presentation A 54-year-old man known to have T2DM, hypertension, and hyperlipidemia presented with complaints of feeling unwell, suprapubic pain, urine urgency, dysuria, and decreased appetite. The patient has no history of sexually transmitted infections. On�examination, he exhibited suprapubic tenderness with guarding, and scrotal redness. Urine-dipstick confirmed urinary infection, and blood tests revealed elevated glucose and ketones. Imaging studies, including CT-abdomen/pelvis , US-testes and MRI�pelvis, confirmed the presence of bilateral seminal-vesicle abscesses and prostatic abscess. The patient was initially admitted and treated for Diabetic Keto-Acidosis and conservatively with antibiotics for the abscesses. Then he self-discharged on Co�Amoxiclav. Following that, he had two subsequent presentations to the emergency room. The second time the patient presented after completing the course of antibiotics with no improvement. He had raised inflammatory markers and urine culture showed coliform bacillus. Therefore, urology was contacted, and he was discharged on Cefalexin. The third time patient presented with left lower quadrant pain and raised inflammatory markers. CT-abdomen/pelvis ruled out any surgical sinister and confirmed prostatic abscess with extension to the seminal-vesicle as well as to the retroprostatic area and along the left spermatic cord. Eventually, he underwent a bipolar transurethral resection of prostate. Follow-up imaging and discussions with the urology team were recommended to ensure resolution of the abscesses and exclude alternative pathologies. Discussion This case highlights the importance of prompt diagnosis and management of genitourinary infections in patients with T2DM presenting with urinary symptoms. This is crucial to prevent complications and ensure favourable outcomes. Conclusion Bilateral seminal vesicle and prostatic abscesses are rare but can lead to serious complications. Clinicians should maintain a high index of suspicion for these infections in patients presenting with urinary symptoms, especially those with underlying comorbidities. Timely diagnosis and management, including surgical intervention are essential for optimal outcomes Creator An entity primarily responsible for making the resource Rawan Honeini 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