Seizures at the emergency department in Thailand and risk factors for recurrent seizures

Background: Seizure is a common neurological presenting symptom at the emergency department (ED). Recurrent seizure may result in an overcrowded ED and affect morbidity. Factors associated with recurrent seizure in Thailand or other developing countries are limited. Methods: Clinical features of adult patients who presented with seizure at the ED, Ramathibodi Hospital, Mahidol University, Thailand were retrospectively reviewed. Factors associated with recurrent seizure were identified by multivariate logistic regression analysis. Results: During the study period, there were 65,586 patients who visited the ED. Of those, there were 156 seizure patients who were identified for analysis. The mean (S.D.) age of all patients was 47.44 (19.80) and males accounted for 41.67%. There were 40 patients who had recurrent seizures (25.64%). There were 10 significant factors associated with recurrent seizure at the ED. Of those, seven factors had a positive association with recurrent seizure; the top three factors were seizure attacks >4 times prior to ED visit, age >70 years and cerebral infarction, while the other three factors were negatively associated (history of antiepileptic drugs, brain surgery and alcohol consumption). Conclusions: Recurrent seizure at the ED may be related to seizure history prior to the ED visit, age, cause of seizure, and co-morbid conditions.

Out of hospital cardiac arrest outcomes report - using Utstein template

Emergency Medicine service and training system in Thailand are in its developing stage. Cardiac arrest and result of cardiopulmonary resuscitation is one of the most important indicator in ED. Improvement of those need standardized and reliable database. Aim of this study is to initiate using Utstein template for collecting out of hospital cardiac arrest and outcome data in ED Ramathibodi hospital. From April 1, 2006 to April 30, 2007. All medical records of Out-of-Hospital cardiac arrest (OHCA) patients who were sent to Emergency room Ramathibodi Hospital were reviewed. Core element data (according to Utstein definition) were recorded. Ninety-Six Out-of-Hospital cardiac arrest patients were sent to ED. 30 files were lost. 51 OHCA patients were suspected cardiac cause of cardiac arrest and completed CPR. The majority of OHCA occurred at home. Only 4 patients got pre-hospital resuscitation. Six patients showed shockable rhythm as the first mornitoried rhythm. Twenty patients had returned of spontaneous circulation (ROSC) but nobody survived to discharge. Sex and kind of the first monitored rhythm do not affect to result of outcome.

Non-invasive positive pressure ventilation (NIPPV) as a first line treatment for acute respiratory failure in the emergency room : the new experience in Ramathibodi Emergency Department

Background: The Ramathibodi Hospital is a big University hospital that has many problems in the bed management especial ICU beds. The patients presenting with severe respiratory symptoms have waited for in-patient admissions so long time at the Ramathibodi Emergency room and sometimes they have changed their status into acute or impending respiratory failure. Most of these acute or impending respiratory failure patients have needed to be intubated and admitted at a limited amount of ICU beds. This study is to use NIPPV early in the acute or impending respiratory failure patients for reducing the rate of intubation and improving the patients’ conditions so they would have more opportunities to be admitted at in-patient beds instead of a limited amount of ICU beds only.Objective: To compare the effects between using by NIPPV plus standard treatment and only standard treatment on the rate of intubation, length of hospitalization and mortality rate in the patients with acute respiratory failure in Emergency Department.Methods: This research was a prospective cohort study with historical control, and was designed to compare the efficiency of NIPPV method plus standard treatment and only standard treatment in the patients with acute respiratory failure at Emergency Department (ED). The medical records of 88 patients with acute respiratory failure who visited ED at Ramathibodi hospital were enrolled in the study from July 2006 to December 2007. Based on the inclusion criteria, All patients were applied by either NIPPV method plus standard treatment (44 patients) or only standard treatment (44 patients). The researcher collected data in the only standard treatment group by reviewing medical records retrospectively. The on duty Emergency physicians who applied NIPPV to the patients recorded data in the forms and sent to the researcher for data collection. Patients’ demographic data and all clinical outcome variables (respiratory rate, pulse rate, oxygen saturation, intubation rate, length of hospital stay, mortality rate, subjective score of compliance to therapy) were analysed.Results: Statistically significant differences were found in the NIPPV plus standard treatment group for reducing intubation rate (p-value = 0.001) or length of hospitalization (p-value =0.011). Patients who were applied by NIPPV showed no significant differences of mortality rate (p=0.398), possibly due to the small sample size and missed data.Conclusion: The NIPPV plus standard treatment group has improved the outcomes of acute respiratory failure patients as a comparison with the only standard treatment group. NIPPV as an adjuvant treatment has benefits for acute respiratory failure and impending respiratory failure patients in the ED especially in the situation of overcrowded ED and limited beds for ICU admission.