Disease-based registries can form the basis of comparative research to improve and inform policy for optimizing outcomes, for example, in out-of-hospital cardiac arrest (OHCA). Such registries are often lacking in resource-limited countries and settings. Anecdotally, survival rates for OHCA in Asia are low compared to those in North America or Europe, and a regional registry is needed. The Pan-Asian Resuscitation Outcomes Study (PAROS) network of hospitals was established in 2009 as an international, multicenter, prospective registry of OHCA across the Asia-Pacific region, to date representing a population base of 89 million in nine countries. The network's goal is to provide benchmarking against established registries and to generate best practice protocols for Asian emergency medical services (EMS) systems, to impact community awareness of prehospital emergency care, and ultimately to improve OHCA survival. Data are collected from emergency dispatch, ambulance providers, emergency departments, and in-hospital collaborators using standard protocols. To date (March 2011), there are a total of 9,302 patients in the database. The authors expect to achieve a sample size of 13,500 cases over the next 2 years of data collection. The PAROS network is an example of a low-cost, self-funded model of an Asia-Pacific collaborative research network with potential for international comparisons to inform OHCA policies and practices. The model can be applied across similar resource-limited settings.

Between 1993 and 2004, patients with antidepressant poisoning admitted to an emergency department (ED) were analysed retrospectively with regard to demographics, clinical findings and treatment attempts. Age, gender, suicide attempts, classification of antidepressants, Glasgow Coma Scale (GCS) score, ECG findings, need for endotracheal intubation, follow-up period and Antidepressant Overdose Risk Assessment (ADORA) criteria were analysed by SPSS software. A total of 356 antidepressant poisoning cases were evaluated. Tricyclic antidepressants (TCA), especially opipramol and amitriptyline, were the most common agents (58.4%). The most frequent ECG finding was sinus tachycardia (40.7%, n=145). Endotracheal intubation was required in 9.6% of cases. Patients with TCA ingestion had a longer observation time in the ED, abnormal ECG findings, abnormal physical examination findings and more ADORA criteria, than patients who ingested selective serotonin re-uptake inhibitors (SSRI) (P=0.008, P=0.008, P<0.001, P<0.001). It was found that the patients who ingested TCA (P=0.001), poisoned with amitriptyline (P=0.001), patients with GCS scores of 8 and less (P=0.001), patients with two or more ADORA criteria (P=0.001), with seizures (P=0.001), with abnormal ECG (P=0.012), and patients with a history of two or more suicide attempts were intubated more frequently. Suicide attempts, classification of the antidepressant, ECG findings, seizure, GCS score and number of detected ADORA criteria affect the need for intubation in patients with antidepressant poisoning.

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We report a case presenting with massive overdose of hydroxychloroquine who survived without any sequelae. A 17-year-old girl presented to the Emergency Department 45 min after the ingestion of 22 g of hydroxychloroquine in a suicide attempt. We believe this is highest dose yet reported in the medical literature. The patient developed hypotension, life-threatening ventricular arrhythmias and mild hypokalemia. She was managed with saline infusion and dopamine for hypotension, gastric lavage and activated charcoal for decontamination, lidocain, magnesium sulfate and defibrillation for pulseless ventricular tachycardia. Potassium replacement and bicarbonate administration were performed. Quick treatment of hypotension, gastric decontamination, continuous long-term cardiac monitoring, and treatment of arrhythmias are the cornerstones of hydroxychloroquine overdose management.

ObjectivesRecent developments in computer and video technology, multimedia resources enter quickest way possible into medical education and have started to gain popularity. The aim of this study is to evaluate the impact of video-supported lectures on leaning, with comparison to traditional lectures.MethodsAccording to lecture techniques, two separate groups; one is the traditional lectures group (TLG) and the other is video-supported lectures group (VSLG), are formed. While the TLG is offered a traditional lecture the VSLG is offered a video-supported lecture with imbedded videos which are related to the topics in the traditional lecture. Both study groups take pretest and posttest with MCQs (multiple choice questions) and OSCEs (objective structured clinical examination).ResultsThe study includes 30 volunteer residents in Dokuz Eylul University School of Medicine Department of Emergency Medicine. No difference is observed between TGL and VSLG in pretest and posttest scores (p = 0.949, p = 0.580). And additionally, comparing the scores of both groups, we cannot observe any difference between the pretest OSCE scores of each group (p = 0.300), however posttest OSCE scores shows a dramatic odd in-between (p = 0.010). When pretest MCQs and posttest MCQs mean scores are compared, both tests (TLG, VSLG) has not any significant difference (p=0.949, p = 0.580). Nevertheless, after comparing OSCEs pretest and posttest mean scores, we can see significant difference in mean scores of both (TLG, VSLG), (p = 0.011, p = 0.001).ConclusionsTaken into consideration, the findings of this study shows possibility of improving educational techniques to acquire clinical skills by using local resources and low-cost technology.

We found variation in the EMS systems across the eight Asia-Pacific countries/regions studied. The findings will inform the construction of a multinational Asia-Pacific research network for future comparative studies and could serve as a model for international research networks.

Extreme heat wave increases the number of emergency department (ED) admissions and mortality rates. The purpose of our study is to investigate the effects of the heat wave experienced in Izmir province of Turkey on mortality.During a 9-day period between 17th and 25th June 2016 (study period), air temperature values were higher than the seasonal norms in Izmir, Turkey. In this cross-sectional study, nontraumatic admissions and in-hospital mortality rates were compared this historical interval of the extreme heat wave with the same period of the previous year and the other 21 days of June 2016.The average air temperature between 17th and 25th June 2016, was higher than the average air temperature of the previous year's same period and the average air temperature from the other 21 days of June 2016 (27.8 ± 3.6 °C, (24.5 ± 1.9°C, 24.1 ± 2.1°C, respectively) (P <.01)During the study period, the mean number of ED visits and mortality rates were significantly higher than the previous year's same period (320 ± 30/day vs 269 ± 27/day, [P <.01], and 1.6% vs 0.7%, [P <.01]).Although the admission rate was similar between the study period and the other 21 days of June 2016 (320 ± 30/day vs 310 ± 32/ day, [P = .445]); in-hospital mortality rate was significantly higher during study period (1.6% vs 0.7%, [P <.01]).During the extreme heat waves, ED admissions and in-hospital mortality rates are increased. Precautions should be addressed for adaptation of people to extreme hot weather.

Tricyclic antidepressant overdose is known to cause cardiopulmonary and central nervous system complications. As with other cardiovascular complications, amitriptyline toxicity may cause acute myocardial infarction. This paper reports the case of a young female with acute myocardial infarction as a novel consequence of tricyclic antidepressant overdose.Tricyclic antidepressant overdose is the one of the most common in self-poisoning. Tricyclic antidepressants account for the third largest number of deaths reported to American poison control centres. Amitriptyline is the most common single agent (Watson et al. 2005). The high rate of mortality in tricyclic antidepressant overdosing is due to central nervous system and cardiovascular system toxicity. Evidence of cardiovascular toxicity is present in the majority of tricyclic antidepressant overdoses. Cardiotoxicity is hypotension, QRS widening and ventricular arrhythmias (Smilkstein 1990). Transient electrocardiographic changes and cardiac arrhythmias are well-documented complications of tricyclic antidepressant overdose, however acute myocardial infarction has only been rarely reported. Here we report a case of tricyclic antidepressant overdose, followed by acute myocardial infarction. Materials and MethodsCase report. A 33 year old female was referred to Emergency Department after ingestion of 30 tablets (300 mg) of amitriptyline for suicidal purpose. She was admitted to state hospital 4 hr after ingestion, and because of decreased level of consciousness (Glasgow coma score 3) she had been intubated with nasogastric tube administered, 50 g of activated charcoal and the finally referred to the Emergency Departments.Her past medical history was major depression, and she had been heated with amitriptyline for five years. She had no coronary artery risk factors such as a diabetes, hypertension, hyperlipidaemia, smoking and no family history of heart disease. Her blood pressure was 110/70 mmHg, heart rate was 120 beats/min., and pulse oxymetre with artificial ventilation was 100% on admission. Her oral mucous membrane was dry, and bowel sounds werediminished. Her pupils reacted to light and no neurological signs were found. The rest of physical examination was also normal. Her initial ECG revealed sinus tachycardia, QRS widening (120 msec.) and QTc interval prolongation (521 msec.) ( fig. 1). Initial complete blood count and serum electrolytes were normal. Arterial blood gas examination Author for corresponcence: Selahattin Kiyan, Ege University Hospital, Department of Emergency Medicine, 35100, Bornova, Izmir, Turkey (fax π90 232 388 38 05, e-mail selahattin.kiyan/ege.edu.tr). revealed respiratory alkalosis (pH: 7.55, PaCO2: 24.9 mmHg, PaO2: 99.3 mmHg, BE: 1.7 mmol/l). D Dimer 0.4 mg/ml (0-0.5 mg/ml) was normal. Toxicological screen cocaine, amphetamine, opiates and heroin was negative. In our institution, amitriptyline level could not be measured. The patient was extubated 26 hr after ingestion. She denied any drug ingestion other than amitriptyline after...