Resuscitative transoesophageal echocardiography performed by emergency physicians in the emergency department: insights from a 1-year period.

AIMS: Transoesophageal echocardiography (TOE) has increasingly been described as a possible complementary and point-of-care approach for patients with cardiac arrest (CA). It provides information about potentially reversible causes and prognosis and allows monitoring of resuscitation efforts without affecting ongoing chest compressions. The aim of this study was to assess the feasibility of TOE performed by emergency physicians (EPs) during CA in an emergency department (ED). METHODS AND RESULTS: This prospective study was performed at the Department of Emergency Medicine at the Medical University of Vienna from February 2020 to February 2021. All patients of ≥18 years old presenting with ongoing resuscitation efforts were screened. After exclusion of potential contraindications, a TOE examination was performed and documented by EPs according to a standardized four-view imaging protocol. The primary endpoint represents feasibility defined as successful probe insertion and acquisition of interpretable images. Of 99 patients with ongoing non-traumatic CA treated in the ED, a total of 62 patients were considered to be examined by TOE. The examination was feasible in 57 patients (92%) [females, 14 (25%), mean age 53 ± 13, and witnessed collapse 48 (84%)]. Within these, the examiners observed 51 major findings in 32 different patients (66%). In 21 patients (37%), these findings led to a direct change of therapy. In 18 patients (32%), the examiner found ventricular contractions without detectable pulse. No TOE-related complications were found. CONCLUSION: Our findings suggest that EPs may be able to acquire and interpret TOE images in the majority of patients during CA using a standardized four-view imaging protocol.

Education in Academic Emergency Medicine During the COVID-19 Pandemic - Our Experience From an Ongoing Crisis.

Background: The COVID-19 pandemic has resulted in the suspension of the entire teaching program at the Medical University of Vienna till the end of the summer semester. As the department that is responsible for emergency medicine teaching, we adapted the program to continue the courses and maintain the learning progress. Our objective is to evaluate the number of courses conducted and report the methods used. Methods: Teaching was measured as credit hours per week (CHW) in accordance with the university's prospectus. One CHW represents 15 academic hours (45 min) in one semester. Webinars were conducted using the CISCO Webex Events®, Webex Training, and ZOOM®. The Moodle® was utilized for resuscitation courses. Results: Courses and clerkships equivalent to 80.2 out of 101.4 CHW (79.1%) could be held during the ongoing crisis in the summer semester. Courses in the winter semester were all completed. In the human medicine curriculum, 73.7 out of 94.9 CHW (77.7%) could be conducted. In the case of emergency lectures for the dentistry curriculum, all courses were conducted through webinars (6.5 CHW, 100%). After calculating the exact number of students in each class, it has been determined that courses and clerkships equivalent to 78.7% could be conducted. Conclusion: Despite the challenge of preparing for the treatment of numerous patients during the ongoing pandemic, we could shoulder a majority of our teaching responsibilities. Although sufficient skill training could not be imparted under these circumstances, we could provide sufficient theoretical knowledge to allow students to continue studies.

Severe Hypernatraemic Dehydration and Unconsciousness in a Care-Dependent Inpatient Treated with Empagliflozin.

A 66-year-old Caucasian male became unconscious 2 weeks after initiation of add-on therapy with empagliflozin for poorly controlled type 2 diabetes mellitus. The inpatient had recently suffered focal pontine stroke, rendering him bedridden and requiring increased nursing care, including assistance with drinking. The patient had received empagliflozin 10 mg once daily for glycaemic control. Investigations revealed hypernatraemia (164 mmol/l), a urine glucose level of 3935 mg/dl, and a creatinine level of 2.1 mg/dl. The patient was diagnosed with severe hypernatraemic dehydration due to iatrogenic glucosuria and prerenal kidney failure. Empagliflozin was discontinued and the patient received hypotonic fluids (including 5% dextrose and free water). Over the following 4 days, glucosuria subsided, blood sodium levels and kidney function normalized and the patient regained full consciousness. He was discharged for rehabilitation 40 days after admission. A Naranjo assessment score of 6 was obtained, indicating a probable relationship between the patient's hypernatraemic dehydration and administration of empagliflozin. In this care-dependent inpatient, who lost the ability to replace water loss autonomously because of a stroke, continuous administration of empagliflozin caused persistent glucosuria and contributed to progressive volume depletion. Excessive dehydration resulted from ignorance of both the populations that are susceptible to dehydration under sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy and the drug's mechanism of action. In patients who depend on support from others in daily tasks, including fluid intake, patients with an impaired sense of thirst and those who have lost the ability to communicate thirst, SGLT2 inhibitor therapy should not be initiated or might be (temporarily) discontinued.