income (p � 0.012). Conclusion: We concluded that there is a lowlevel of knowledge among caregivers of children � 13 years oldin reference to child car seat safety laws and guidelines in PR.Future efforts should be directed towards improving populationknowledge about the correct use of child car safety seats.

e HYPOGLYCEMIA, AN UNCOMMON BUT REALCOMPLICATION OF STANDARD HYPERKALMIATREATMENT. Y.C. Huang, Department of Emergency Med-icine, Chiayi Christian Hospital, Chiayi City, TAIWAN.

Introduction: Hyperkalemia is life-threatening and requires im-mediate treatment. A combination of 25 g glucose and 10 unitsregular insulin given intravenously over 15–30 min is suggested aspart of the standard treatment for hyperkalemia in AdvancedCardiac Life Support (ACLS); however, no precaution has beenmentioned for potential side effects. Some patients became hypo-glycemic after treatment. We thus investigated our hyperkalemicpatients and their response to treatment with insulin and glucose.Methods: This is a tertiary transfer hospital serving over 90,000emergency visits annually. We treat hyperkalemic patients basedon ACLS recommendations. A cross-sectional, cohort, observa-tion study was undertaken from May 2004 to April 2009. Wecollected data on hyperkalemic patients treated to review theirdemographics and co-morbidities that may predispose to hypogly-cemia. We used multivariable analysis to check potential risks thatmay predispose to hypoglycemia. Results: There were 160 pa-tients treated for hyperkalemia. Seven cases were excluded and153 patients were enrolled. There were 76 men and 77 women,with ages ranging from 41 to 96 years (median: 74, interquartilerange 65�82). About their hyperkalemia: 56 (36.6%) were mild,63 (41.2%) were moderate, and 34 (22.2%) were severe. Most hadmultiple systemic illnesses, and renal diseases were the leadingco-morbidity: 21(13.7%) received replacemental dialysis, another86 (56.2%) had documented chronic kidney diseases. Emergencydepartment studies revealed elevated serum creatinine in 133(86.9%) patients, including 4 (2.6%) with acute renal failure.Seven (4.6%) patients were hypoglycemic 49–240 (median 79)min after insulin treatment, and 5/7 were symptomatic. No riskfactor could be identified that predisposed to the hypoglycemiaafter insulin and glucose treatment. Conclusion: The risk of hy-poglycemia is real after standard ACLS treatment of hyperkalemiawith insulin and glucose. Most instances happened 1–2 h afterinsulin treatment and were symptomatic. We should pay attentionto potential hypoglycemia in hyperkalemic patients who receivesinsulin treatment, especially when their sensorium is impaired.

e A RANDOMIZED, BLINDED, CONTROLLED CLIN-ICAL TRIAL OF 1000 CC VERSUS 500 CC ORAL CON-TRAST IN ADULTS UNDERGOING ABDOMINAL CTSCANS. L. Moreno-Walton, Department of Emergency Medi-cine, Louisiana State University Health Sciences Center, NewOrleans, LA; F. Azubiuke, Mt. Sinai Medical Center, Miami, FL;M.S. Radeos, New York Hospital, Queens, NY; A. Baquero, M.T.Ryan, Lincoln Medical and Mental Health Center, Bronx, NY.

Objective: To determine if reducing oral contrast volume to500 cc results in more rapid oral contrast administration with-

out increasing the percentage of technically inadequate com-puted tomography (CT) scans of the abdomen. Methods: Pro-spective randomized blinded study at an urban Level I traumacenter. We enrolled subjects � 18 years of age presenting to theemergency department (ED) who had an abdominal CT scanordered. Subjects were excluded if they were pregnant orunstable. They were randomized into two groups using num-bered envelopes. We diluted 30 cc of oral contrast (diatrizoatemeglumine and diatrizoate sodium) in 500 cc (study group) or1000 cc water (control group). Data were collected by physi-cian questionnaire. Radiologists were blinded to study alloca-tion. Analysis was by chi-squared for categorical and Kruskal-Wallis for non-parametric data. Results: There were 139patients randomized to each group; 160 (58%) were males.There was no statistical significance between the control andstudy groups in the median patient age (45 vs. 41 years, p �0.12), number of CT scans that answered the clinical question(94% vs. 91%, p � 0.41), number read as acceptable byradiology (87% vs. 85%, p � 0.55), number who requiredsubsequent studies (14% vs. 16%, p � 0.74), total time frombeginning contrast to completing CT scan (146 vs. 140 min,p � 0.70), number of patients who vomited (9.5% vs. 5.7%,p � 0.26), and number who underwent surgery (8.7% vs.10.4%, p � 0.64). The time to consume the 500 cc wassignificantly less (20 min) than time to consume the 1000 cc(30 min), p � 0.0001. Patients were more likely to complete the500-cc volume than the 1000-cc volume (91.2% vs. 73.6%),p � 0.001; odds ratio 1.41 (95% confidence interval 1.2–1.7)even after adjusting for gender and age. Conclusions: Patientsconsume the 500-cc solution faster and the resulting CT scanshave similar technical acceptability compared with the 1000-ccsolution. Future studies should focus on even smaller amountsof oral contrast volume for abdominal CT scans.

e SENSITIVITY OF A NEW DIAGNOSTIC SCALEFOR PULMONARY THROMBOEMBOLISM IN TWOUNIVERSITY-AFFILIATED HOSPITALS. O. Pallas, M.T.Martınez, Department of Emergency Medicine, Hospital delMar, Barcelona, Catalunya, SPAIN; M. Marinosa, M. Payes,Hospital Parc Taulı, Sabadell, SPAIN; F. Del Bano, A. Super-via, E. Skaf, Department of Emergency Medicine, Hospital delMar, Barcelona, Catalunya, SPAIN; M.L. Iglesias, HospitalParc Taulı, Sabadell, SPAIN; J.L. Echarte, Department ofEmergency Medicine, Hospital del Mar, Barcelona, Catalunya,SPAIN.

Introduction: Validated scales for grading the clinical suspicionof pulmonary thromboembolism (PT) are used in the emergencydepartment setting. The Wells (WS) and the Ginebra (GS) scaleshave been prospectively validated but have limitations in ourenvironment. Objectives: To compare the sensitivity of a newscale of clinical prediction of PT (Catalan scale) with WS and GSin two hospitals. Methods: There were 194 patients diagnosedwith PT between 2004 and 2006. Diagnosis was confirmed bycomputed chest angiotomography or high-probability ventilation-perfusion (V/P) lung scanning. Hospital discharge records andimaging studies were reviewed. The WS, GS, and the Catalanscale (CS), were applied. Data were analyzed with SPSS 13.0

234 The Journal of Emergency Medicine