scholarly journals Does our emergency department comply with the royal college of emergency medicine guidelines recommending a consultant review of patients over the age of seventy presenting with abdominal pain?

2018 ◽  
Vol 55 ◽  
pp. S38
Author(s):  
H. Burns ◽  
K. Thomson
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Abdominal Pain ◽  
Royal College

Parenteral opioids in emergency medicine – A systematic review of efficacy and safety

2011 ◽  
Vol 2 (4) ◽  
pp. 187-194 ◽  
Author(s):  
Leila Niemi-Murola ◽  
Jani Unkuri ◽  
Katri Hamunen
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Abdominal Pain ◽  
Chest Pain ◽  
Adverse Effects ◽  
Acute Pain ◽  
Acute Abdominal Pain ◽  
Prehospital Setting ◽  
Efficacy And Safety

AbstractIntroduction and aimPain is a frequent symptom in emergency patients and opioids are commonly used to treat it at emergency departments and at pre-hospital settings. The aim of this systematic review is to examine the efficacy and safety of parenteral opioids used for acute pain in emergency medicine.MethodQualitative review of randomized controlled trials (RCTs) on parenteral opioids for acute pain in adult emergency patients. Main outcome measures were: type and dose of the opioid, analgesic efficacy as compared to either placebo or another opioid and adverse effects.ResultsTwenty double-blind RCTs with results on 2322 patients were included. Seven studies were placebo controlled. Majority of studies were performed in the emergency department. Only five studies were in prehospital setting.Prehospital studiesFour studies were on mainly trauma-related pain, one ischemic chest pain. One study compared two different doses of morphine in mainly trauma pain showing faster analgesia with the larger dose but no difference at 30 min postdrug. Three other studies on the same pain model showed equal analgesic effects with morphine and other opioids. Alfentanil was more effective than morphine in ischemic chest pain.Emergency department studiesPain models used were acute abdominal pain seven, renal colic four, mixed (mainly abdominal pain) three and trauma pain one study. Five studies compared morphine to placebo in acute abdominal pain and in all studies morphine was more effective than placebo. In four out of five studies on acute abdominal pain morphine did not change diagnostic accuracy, clinical or radiological findings. Most commonly used morphine dose in the emergency department was 0.1 mg/kg (five studies). Other opioids showed analgesic effect comparable to morphine.Adverse effectsRecording and reporting of adverse effects was very variable. Vital signs were recorded in 15 of the 20 studies (including all prehospital studies). Incidence of adverse effects in the opioid groups was 5–38% of the patients in the prehospital setting and 4–46% of the patients in the emergency department. Nausea or vomiting was reported in 11–25% of the patients given opioids. Study drug was discontinued because of adverse effects five patients (one placebo, two sufentanil, two morphine). Eight studies commented on administration of naloxone for reversal of opioid effects. One patient out of 1266 was given naloxone for drowsiness. Ventilatory depression defined by variable criteria occurred in occurred in 7 out of 756 emergency department patients.ConclusionEvidence for selection of optimal opioid and dose is scarce. Opioids, especially morphine, are effective in relieving acute pain also in emergency medicine patients. Studies so far are small and reporting of adverse effects is very variable. Therefore the safety of different opioids and doses remains to be studied. Also the optimal titration regimens need to be evaluated in future studies. The prevention and treatment of opioid-induced nausea and vomiting is an important clinical consideration that requires further clinical and scientific attention in this patient group.

scholarly journals Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Monica D. Chow ◽  
Richard D. Shih
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Abdominal Pain ◽  
Splenic Rupture ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Abdominal Computed Tomography

Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.

EP.FRI.943 Time to surgical review in NELA patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Laura Kenny ◽  
Ahmed Waqas ◽  
Elizabeth Hall
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Royal College ◽  
Small Sample Size ◽  
Surgical Care ◽  
Small Sample ◽  
Surgical Patients ◽  
Emergency Laparotomy ◽  
Pain Pathway ◽  
National Emergency

Abstract Introduction The Royal College of Surgeons standards on unscheduled surgical care state that an ST3 or above should review emergency cases within 60 minutes of referral from the Emergency Department (ED). Method Data was gathered from all admissions (n = 50), from 01/9/19 to 31/10/19, registered on the National Emergency Laparotomy Audit (NELA).  After exclusions, there were 20 patients who were admitted to surgery from ED.  14 of these had both time of referral and time of review documented. Results On average, patients were reviewed 2 hours and 23 minutes after referral.  9 of these patients (64%) were referred overnight (20:00-08:00) and their average time to review was longer; 2 hours and 49 minutes. 7 of all 50 NELA patients (14%) were never referred to surgery from ED. Conclusion Limitations include that ED doctors did not document what time patients were referred to surgery, and a small sample size; partially due to poor documentation. The recommended 60 minutes time to registrar review is not being achieved but data is limited. To improve this, surgical registrars will be asked to document time of referral. Data on time to review will continue to be gathered. An abdominal pain pathway will be introduced to improve ED’s recognition of surgical patients. A re-audit which will encompass patients admitted via ED and ambulatory care, as well as including data on time to decision to operate is currently underway.

scholarly journals 285 Improving the Identification of Symptomatic or Ruptured AAA in The Emergency Department

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Al-Khazaali
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Back Pain ◽  
Clinical Practice ◽  
Royal College ◽  
Screening Program ◽  
Standard Technique ◽  
Cycle Phase ◽  
Number Of Patients ◽  
Life Threatening

Abstract Background rAAA is a life-threatening emergency. Without early treatment, it can be fatal. Patient > 50 presented with abdominal/back pain &hypotension or collapse a diagnosis of rAAA should be considered. Aortic ultrasound is recommended as it is the standard technique used in clinical practice and the screening program. Objective The project aimed to determine the number of patients who were screened for rAAA according to Royal College of Emergency Medicine (RCEM) guidelines and increase the adherence in clinical practice in the emergency department. Method Retrospective baseline data were obtained for 40 patients >50 with abdominal/back pain, hypotension and collapse between 1st of November to 31st of December 2019. Re-auditing was conducted after the first intervention (phase one), which included informing colleagues about RCEM guidance via emails and paper forms to record the scans’ results. In August 2020, a final cycle (phase two) was performed after educational posters were put up in the department. Results Baseline showed that out of the 40 patients only 10% of them received the U/S scan. After phase one, the audit demonstrated an increase in screening to 42%, and in the final cycle, the percentage improved to 53%. Conclusions Routine screening of rAAA were minimal in the emergency department. As a result of the project, more patients received the U/S screening and adherence to RCEM guidelines improved.

scholarly journals Az ágy melletti ultrahangvizsgálat diagnosztikus lehetőségeinek vizsgálata a sürgősségi betegellátásban

2016 ◽  
Vol 157 (15) ◽  
pp. 569-574
Author(s):  
András Mesterházi ◽  
Miklós Barta ◽  
László Zubek
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Retrospective Study ◽  
Respiratory Failure ◽  
Critically Ill Patients ◽  
Circulatory Failure ◽  
Unknown Etiology ◽  
Bedside Ultrasonography

Introduction: Rapid differential diagnosis of circulatory failure (shock) with unknown etiology is a daily challenge in the field of emergency medicine. The Rapid Ultrasound in Shock (RUSH) protocol is well known since 2010. With the use of targeted steps, the 4 forms of shock (cardiogen, distributive, obstructive, hypovolemic) can be separated in a few minutes. Aim: The aim of the authors was to evaluate the usefulness of the Rapid Ultrasound in Shock protocol for the diagnosis of different forms of shock. Method: The retrospective study included 123 critically ill patients admitted to the Emergency Department of Markusovszky Hospital, Szombathely, Hungary. Detailed records were obtained from all patients. Results: From the 123 crirically ill patients, 64 patients suffered from circulatory failure, while the remaining patients had acute severe chest or abdominal pain, or respiratory failure. Conclusions: Based on the results of the first evaluation of the Rapid Ultrasound in Shock protocol in Hungarian patients, the authors conclude that, the bedside ultrasonography has a great value in emergency medicine, and this the protocol is suitable for its integration into patient care and education of emergency medicine. Orv. Hetil., 2016, 157(15), 569–574.

Bedside ultrasound in the emergency department and abdominal pain

2016 ◽  
Vol 37 (S 01) ◽  
Author(s):  
M Algaba Montes ◽  
AÁ Oviedo García ◽  
M Patricio Bordomás
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Bedside Ultrasound

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

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