Outlines of My Talks in ICEM 2010

Below are the outlines of the two invited talks I will be giving in International Conference in Emergency Medicine (ICEM) 2010 in Suntec Singapore International Convention & Exhibition Centre from 9 - 12 June 2010.

Talk no 1:
Handling Cardiovascular Emergencies In A Malaysian Hospital.

Using acute coronary syndrome as a model for discussion, this talk will explore some of the pertinent issues and challenges of managing cardiovascular emergencies within the Malaysian socio-cultural framework. Reflecting from the lens of an emergency physician, I will first paint a panoramic view of the healthcare status in Malaysia as well as the current doctor : population ratio in Malaysia before delving into the main part of the talk. I will divide my talk into three domains, namely:

From symptom recognition to activation of the emergency medical services (EMS)

Issues and challenges within this domain:
1. Factors significantly associated with a diagnosis of acute myocardial infarction in a Malaysian population
2. The problem of prank calls: the abuse and misuse of 999 in Malaysia
3. The role of bystander cardiopulmonary resuscitation (CPR)
4. The dire need for more public accessed automated external defibrillator (AED)
5. The willingness of Malaysian public members to perform bystander CPR in the event of cardiac arrest

From activation of the EMS to arrival in emergency department

Issues and challenges within this domain
1. Response time of the EMS: how good are we?
2. The illusion of a "one size fit all" EMS set-up in Malaysia due to its geographical and logistic difficulties

From initial management in emergency department to decision making of a definitive coronary care plan

Issues and challenges within this domain:
1. What's the number? Fibrinolytics versus Percutaneous Coronary Intervention (PCI)
2. Door-to-needle time in a Malaysian population
3. The issue of streptokinase failure

Nevertheless, I will not delve on the detailed aspects of care conventionally under the jurisdiction of the cardiologists including the technicalities of PCI.

Talk 2:
Mushroom Poisoning

Conventionally, when we think of mushroom poisoning, we often think of Amanita sp. poisoning, where its phallotoxin causes irreversible polymerization of G-actin to F-actin and results in disruption of cell membrane and cell death, particularly in the liver.

In this talk, however, I will share on a real series of five cases of mushroom poisoning that presented with muscarinic manifestations typical of organophosphate poisoning. Using this case series that I have personally managed, I will highlight on the difficulties I faced with the exact species and toxin identification and the importance and usefulness of a syndromic classification of mushroom poisoning first described by Diaz JH. The common symptoms in the case series that the I will share are blurred vision, diarrhea, vomiting and abdominal cramp.