938 Abstracts

tolerating less severe pain during ED stay than the other group.All the differences mentioned above between procedures withand without ultrasound guidance were statisticallysignificant. Conclusions: This study indicated that the ultra-sound-guided technique for axillary nerve block is a simple,useful, and safe technique that could be done by EmergencyPhysicians more effectively than surface anatomic landmark-guided technique. However, it is recommended that a moreextensive survey be done on this topic with a larger study pop-ulation and possibly more centers involved, and comparison bedone between these local interventions and systemic ones suchas analgesic medications.

, BREAK THE FASTWITH FEAST (eFAST)? H. Kataria,Emergency Department, University Hospital Aintree,Liverpool, UK; J. Mcvicar, Emergency Department, RoyalLiverpool University Hospital, Liverpool, UK.

Objective: In patients with major trauma, FAST (focused as-sessment with sonography in trauma) often is the initial imagingexamination. This systematic review of literature aims to estab-lish whether thoracic ultrasound should be used to detect pneu-mothorax in traumatic patients presenting to an EmergencyDepartment (ED) as an extension of FAST (eFast). Methods:A comprehensive literature search was conducted to identifyrelevant literature. The Medline and Embase Healthcare data-bases were individually searched, with terms mapped to The-saurus and then with keywords related to Ultrasound,Pneumothorax, and Chest trauma. The following criteria wereused to include a study for review: Participants: Studies that en-rolled adult emergency trauma patients. Intervention: Thoracicultrasound was performed in the ED for the detection of pneu-mothorax. Comparator: Chest computed tomography (CT)scan was used as the gold standard. Outcome: Studies thatused the primary outcome measure to identify the diagnostic ac-curacy of ultrasound to detect pneumothorax. Results: Ninestudies were found to meet the search strategy criteria. All stud-ies were individually appraised including the Quality Assess-ment of Studies of Diagnostic Accuracy included inSystematic Reviews tool. When comparing with the gold stan-dard of CT scan, thoracic ultrasound has been found to have sen-sitivity from 46.5% to 100% and specificity of 94% to 100%.This would be level 1b in terms of hierarchy of evidence. Thisdegree of specificity can be acceptable to use ultrasound asa ‘‘rule in’’ test. The major weakness of the evidence is thateach study has a small number of patients, and power calcula-tion was not done in any study. Conclusions: Ultrasound is a re-liable tool to detect pneumothorax in trauma patients. It isportable, rapid, and has high specificity similar to the gold stan-dard of CT scan. Therefore, we recommend that FAST in traumashould be extended to include thoracic ultrasound (eFAST), butthe introduction of this modality will require training and main-tenance of skills.

, SENGSTAKEN-BLAKEMORE TUBE APPLICATIONTO INTRACTABLE TRAUMATIC EPISTAXIS FOR HE-MOSTASIS. G.-W. Kim B. Kang, Emergency Medicine, AjouUniversity Medical Center, Suwon, KOREA; W. Jeon,Emergency Medicine, Inje University Ilsan Hospital, Goyang,

KOREA; Younggi Min, Emergency Medicine, AjouUniversity Medical Center, Suwon, KOREA.

Objective: Airway establishment and hemorrhage controlmay be difficult to achieve in patients with massive oronasalbleeding from maxillofacial injuries, although it is rare. Thisstudy was formulated to investigate hemostatic effectivenessfor managing these challenging injuries. Methods: Trauma reg-istries from the author’s emergencymedical center were queriedover a 3-year period for injuries with abbreviated injury scaleface$ 3 and transfusion of$ 3 units of blood within 24 h. Pa-tients with severe epistaxis and inserted Sengstake-Blakemore(SB) tube were included, and patients with extra-head andface injury, for example, hemothorax or hemoperitoneum,were excluded. Patient demographics, hemodynamic status, he-mostatic procedures, and outcome were analyzed. Results:Twelve patients were identified. Initial airway managementwas by endotracheal intubation in all patients. Emergent crico-thyrotomy and tracheostomy were necessary in 9 and 3 patients,respectively. Anterior packing alone didn’t control bleeding inall patients. Transarterial embolization was used in 5 patients.SB tube was successful for definitive control of hemorrhage in11 patients and kept in for 3 days in ICU. Systolic blood pres-sure was increased a mean 25.3 mm Hg after SB tube applica-tion. Overall mortality was 4 deaths directly attributable tomaxillofacial injuries and severe head injuries, and no compli-cation in nasal cavity from the SB tube. Conclusions: SB tubeapplication was easy to apply and highly successful in control-ling hemorrhage in the ED.

, THE APPROPRIATENESS OF TRAUMA TEAM AC-TIVATION BY EMERGENCY PHYSICIAN IN THEEMERGENCY DEPARTMENT. K. M. Cha, S. P. Choi,J. H. Wee, J. H. Park, Emergency Department, The CatholicUniversity of Korea, Seoul, KOREA.

Objective: Rapid multidisciplinary trauma care by thetrauma team is essential for severely injured patients. Thereare different protocols for the trauma team’s activation ineach hospital. Correct trauma triage is needed to appropri-ately use medical resources. The aim of this study was toevaluate the performance of the activation protocol of ourtrauma team. Methods: This was an observational, retrospec-tive cohort study. Injured patients with trauma team activation(TTA) and severely injured patients admitted to a surgical inten-sive care unit with a trauma diagnosis (Injury Severity Score[ISS] > 15) were investigated from March 1, 2010 to May 31,2012. The TTA protocol was analyzed with respect to sensitiv-ity, positive predictive value (PPV), and overtriage (1� PPV).Undertriage was defined as the probability of no TTA condi-tional on severe injury. Results: Two hundred twenty-nine pa-tients were included. There were 201 patients with TTA and28 patients without TTA. Of the 201 patients with TTA, 103were identified as severely injured (ISS > 15), yielding a sensi-tivity of 79%, PPVof 51%, and overtriage of 49%. Undertriagewas 21% (n = 28) when considering all severely injured patients(n = 132). Among 12 criteria of our TTA, ‘‘injury in two or morebody regions’’ accounted for 86% of the overtriage. Of the pa-tients with undertriage, 75% represented isolated head injuryand 29% inter-hospital transfers. Conclusions: The overtriage