#SIMEU14: Barbara Hogan, presidente EuSEM, al congresso nazionale Simeu di Torino, 6-8 novembre 2014

Il passaggio di consegne per il prossimo congresso Eusem che Simeu organizzerà a Torino, 10-14 ottobre 2015




Barbara Hogan, presidente EuSEM

La tavola rotonda inaugurale del congresso di Torino 2014, che si terrà giovedì 6 novembre, alle ore 17.30 nell’Auditorium del Centro Congressi del Lingotto, avrà come ospite d’eccezione Barbara Hogan, presidente dell’Eusem, European society of emergency medicine, il cui congresso annuale si è recentemente tenuto ad Amsterdam, dal 28 settembre al 1° ottobre scorsi. Barbara Hogan è direttore del Dipartimento di emergenza della Asklepios Klinik Altona, di Amburgo, uno dei principali ospedali tedeschi.

Tema della tavola rotonda sarà Il pronto soccorso, riferimento più sociale che sanitario. Parteciperanno fra gli altri, il presidente nazionale Simeu, Gian Alfonso Cibinel; il segretario nazionale Fimmg, Federazione italiana dei medici di medicina generale, Giacomo Milillo; l’assessore alla Sanità della Regione Piemonte, Antonio Saitta e il vicesindaco e assessore alle Politiche sociali della Città di Torino, Elide Tisi. Moderatrice della tavola rotonda sarà la giornalista Luisella Costamagna.

Il congresso di Amsterdam, che ha visto la partecipazione di oltre 2.300 professionisti dell’emergenza, provenienti da tutti i Paesi europei, Stati Uniti e paesi non-europei, ha avuto un momento di particolare rilevanza per la delegazione italiana in occasione della premiazione dei migliori abstract inviati al congresso da giovani medici: su dieci lavori selezionati, otto erano italiani, tutti premiati, a testimonianza della qualità professionale dei ricercatori italiani.

Il congresso della Società scientifica europea si è concluso con la cerimonia di passaggio di consegne da Amsterdam a Torino, prossima sede del congresso Eusem, Centro congressi Lingotto, 10 – 14 ottobre 2015. Erano presenti Barbara Hogan, Riccardo Pini, responsabile scientifico del Congresso Eusem 2015 per Simeu, e il presidente della Società scientifica olandese di medicina d’emergenza-urgenza che ha ospitato il congresso di quest’anno.

Per Torino2014, Barbara Hogan parteciperà anche sabato 8 novembre, alla tavola rotonda Cambiamento organizzativo: cambiare tutto per non cambiare nulla? Alle ore 8.30 in Sala 500.

La presenza del presidente Eusem in carica, oltre rimarcare il legame fra Amsterdam2014 e Torino2015, radica il congresso nazionale della Società italiana della medicina di emergenza-urgenza nel contesto europeo, particolarmente importante per una disciplina relativamente nuova in Italia, che, in questi anni così difficili per tutti i Paesi europei, sta definendo i confini della propria identità professionale.


Il programma aggiornato è disponibile sul sito del Congresso Simeu di Torino 2014.

Diagnose on Sight: 6 year old with elbow pain

elbowCase: A previously healthy 6 year old male presents with left elbow pain after wrestling with a friend. What is the diagnosis? Click on image for a larger view.





Answer (Click for explanation)

Type II Supracondylar fracture of the elbow



More than half of all pediatric elbow fractures are supracondylar, because this is the weakest part of the elbow joint. They are most commonly caused by a fall on outstretched hand [1].

In this case, the anterior humeral line (red) does not intersect the middle third of the capitellum, suggesting a fracture. The arrow points to a disruption of the anterior cortex.

elbow with arrows

Choice of treatment is guided by the Gartland classification. Most orthopedists recommend conservative management for non or minimally displaced fractures, while displaced fractures are treated with operative fixation [2].

Gartland classification [2]


Special attention must be paid to a careful neurovascular exam to evaluate for compartment syndrome. A delay in diagnosis can lead to the devastating complication of Volkmann’s ischemic contracture, which results in severe muscle fibrosis and neuropathy [3].


Master Clinician Bedside Pearls

ChrisDoty-298x298Christopher I. Doty, MD
Program Director & Vice Chair for Education
Associate Professor of Emergency Medicine
University of Kentucky-Chandler Medical Center




  1. Chasm RM, Swencki SA. Pediatric orthopedic emergencies. Emerg Med Clin North Am. 2010 Nov;28(4):907-26. PMID: 20971397.
  2. Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr. 2014 Feb;26(1):64-9. PMID: 24378825.
  3. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am. 2008 May;90(5):1121-32. PMID: 18451407.

Author information

Jeff Riddell, MD

Jeff Riddell, MD

Chief Resident

UCSF-Fresno Emergency Medicine Residency

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Ebola– how prepared is your PED?

With all of the news about Ebola our ED staff was fearful and concerned that our ED was not ready.  After hearing about nurses in Texas acquiring the disease the staff started to discuss if they would care for a patient with Ebola or call out sick.  Our senior staff remembered the days of similar fear related to caring for patient with HIV. What would we do if we had a parent or patient screen positive at triage?  Where we prepared?  Are we safe?  Do we have PPE?  Can we don? Can we doff?  Do we have each others backs?? We conducted an in-situ simulations to walk through our EDs plan and this raised more questions and identified many important questions about what we would do if we had a case in New Haven. Click here to access an Ebola sim case in word format In-situ simulation (ISS) can be used to “crash test” the emergency department for a high stakes case such as this.  In situ simulation is conducted in patient care areas, using actual equipment and resources and involving actual members of the healthcare team. ISS can be used to evaluate system safety and identify latent safety conditions in the system. Latent safety threats are defined as systems-based threats to safety that can materialize at any time and have a negative impact on patient care. They are previously not recognized and include errors in design, organization, training (Reason 2000). This involves exploring interactions with front-line providers with patients, other providers and tools/technology as well as the higher level organizational work processes, policies and cultural factors. (Pronovost, et al 2009) With in situ simulation all of the components of the complex health care system can be evaluated, discussed and improved.  In-situ simulation can be used to understand the existing processes of care and measure our department “on-demand” in a way that would not be safe, feasible, ethical or timely through traditional research (Carayon, et al. 2006).  This ISS provided a prospective approach to safety and new processes of care similar to what is used in other high reliabilty industries and served as a stepping off point for dialogue. The next day a student presented who had recently been to Liberia and presented to our hospital with vomiting.  This case required our institution to activate a disaster response and was a true test of our preparedness.  Fortunately the patient ended up ruling out for the virus.   Subsequent to this case we have continued to focus on how to safely care for an Ebola patient.  The changing guidelines have required our team to have an ongoing dialogue about staff safety and preparedness.  In situ simulation can be used for ongoing training and assessment of staff as the CDC recommends in its most recent Ebola guideline. What is your ED doing to prepare for Ebola? This guidance contains the following key principles: Prior to working with Ebola patients, all healthcare workers involved in the care of Ebola patients must have received repeated training and have demonstrated competency in performing all Ebola-related infection control practices and procedures, and specifically in donning/doffing proper PPE. While working in PPE, healthcare workers caring for Ebola patients should have no skin exposed. The overall safe care of Ebola patients in a facility must be overseen by an onsite manager at all times, and each step of every PPE donning/doffing procedure must be supervised by a trained observer to ensure proper completion of established PPE protocols.      

A Rational Approach to Emergency Ebola Preparedness

In this special 15 minute EM Cases podcast on Ebola preparedness we bring you an interview with Professor Howard Ovens, the director of emergency medicine at Mount Sinai Hospital in Toronto. As an EM physician who took care of many SARS patients and the chief of the ED during the SARS outbreak, Dr. Ovens has a very rational approach to how to prepare our emergency departments for patients who present with fever who have been traveling in an Ebola outbreak region, including triaging and personal protective equipment (PPE).

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Sepsis and Ppm Failure

85 yo M with PMHx of CHF, paroxysmal atrial fibrillation and dual chamber PPM placed for sick sinus syndrome, who presents with lightheadedness, confusion and progressive lethargy x 1 day. At arrival to the ED patient hypotensive 70/30, bradycardic 46 x min, febrile 102 F.

EKG is obtained






Initial labs are remarkable for pH 7,10 HCO3 10 and Lactate of 5, with normal electrolytes

Patient’s pacemaker is set at a rate of 60 and recent interrogation showed no abnormalities.

What is the diagnosis and most likely explanation for this problem? 

Dx: Failure to capture 

EKG shows low voltage pacing spikes (circles) which are not associated with ventricular activity.

Following initial standard resuscitation measures (fluids, abx, etc.) in the setting of suspected severe sepsis, pacemaker dysfunction was addressed.

CXR showed no evidence of lead displacement or fractures and further pacemaker interrogation showed no problems with output failure or pacemaker sensing.

Problem was thought to be pacemaker’s failure to capture in the setting of metabolic acidemia due to sepsis from urinary source. Patient was temporarily supported with noreepineprhine and IV fluids and pacemaker function normalized once metabolic disturbances were corrected.


Main causes to consider for a malfunctioning pacemaker can be classified as:

1. Problems with sensing

- Undersensing: pacemaker fails to sense native cardiac activity

- Oversensing: artifact signals such as skeletal muscle contractions or lead contact problems are inappropriately recognized as native cardiac activity and pacing is inhibited

2. Problems with pacing:

- Output failure: paced stimulus is not generated (common causes include wire fracture and lead displacement)

- Failure to capture: when pacemaker stimulus does not result in myocardial depolarisation


In a patient who presents with pacemaker malfunction in the setting of sepsis, metabolic acidemia should be considered as a potential underlying factor causing failure of the device to capture. Additional attempts of pacing such as placement of a intravenous pacing wire will likely not be effective until correction this problem.