PP19 Opioid Poisoning Deaths: A National Picture

2018 ◽  
Vol 34 (S1) ◽  
pp. 73-73
Author(s):  
Matthew Jones ◽  
Helen Snooks ◽  
Bridie Evans ◽  
Alan Watkins ◽  
Gordon Fuller
Keyword(s):  
Emergency Department ◽  
Service Utilization ◽  
Linked Data ◽  
Emergency Service ◽  
Clinical Presentation ◽  
Published Data ◽  
Autopsy Study ◽  
Female Age ◽  
Diagnostic Codes ◽  
Poisoning Deaths

Introduction:The factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents (a term used for people who are deceased) of opioid poisoning in Wales in 2015. Using anonymized linked data, we describe demographic characteristics, patterns of emergency service utilization, and clinical presentation prior to death.Methods:Decedents of opioid poisoning in Wales in 2015 were identified from the Office of National Statistics (ONS) mortality dataset. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymized Information Linkage (SAIL) databank. The data were accessed and analyzed in the SAIL gateway.Results:Age at death ranged from eighteen to seventy-eight years, with a mean age of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-three percent of decedents were men (n = 228/312). Eight-seven percent of decedents (n = 281/312) attended the emergency department in the three years prior to death. In total 2081 attendances were made, forty-one percent of which involved conveyance by ambulance. Attendances per individual ranged from one to 114, with over half of decedents attending more than three times. Diagnostic codes were mostly missing or non-specific, with only seven and a half percent of attendances representing eighty-two decedents, coded as drug related. Treatment codes were also mostly missing or non-specific, with sixteen percent of attendances representing 148 attendees attributed a treatment code. Thirty-nine percent of attendances (n = 822) ended in treatment and discharge, whilst twenty-seven percent (n = 562) led to hospital admission.Conclusions:Matching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilization. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.

PP19 Opioid poisoning deaths: a national picture

2019 ◽  
Vol 36 (1) ◽  
pp. e8.1-e8
Author(s):  
Matthew Jones ◽  
Helen Snooks ◽  
Bridie Angela Evans ◽  
Alan Watkins ◽  
Gordon Fuller
Keyword(s):  
Emergency Department ◽  
Linked Data ◽  
Emergency Service ◽  
Mortality Data ◽  
Published Data ◽  
Service Utilisation ◽  
Autopsy Study ◽  
Female Age ◽  
Diagnostic Codes ◽  
Poisoning Deaths

BackgroundThe factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents of opioid poisoning in Wales in 2015. Using anonymised linked data, we describe demographic characteristics, patterns of emergency service utilisation, and clinical presentation prior to death.MethodsDecedents of opioid poisoning in Wales in 2015 were identified from Office of National Statistics (ONS) mortality data. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymised Information Linkage (SAIL) databank. Data were accessed and analysed in the SAIL gateway.ResultsAge at death ranged from eighteen to seventy-eight years, with a mean of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-six percent of decedents were men (n=98/112).Eight-seven percent of decedents (n=112/129) attended the emergency department in the three years prior to death; eighty-nine in the previous year, ninety-nine in the previous two years and 112 in the previous three years. Eighty-four percent of male and ninety-three percent of female decedents attended the ED in the three years prior to death.In total 665 attendances were made, half of which involved conveyance by ambulance. Attendances per individual ranged from one to sixty, with over half of decedents attending more than three times.Diagnostic codes were mostly missing or non-specific, with only six and a half percent of attendances representing twenty seven decedents, coded as drug related.ConclusionsMatching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilisation. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women.

scholarly journals An Unusual Cause of Pulmonary Nodules in the Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Ryan Yu ◽  
Melanie Ferri
Keyword(s):  
Emergency Department ◽  
Smooth Muscle ◽  
Clinical Presentation ◽  
Pulmonary Nodules ◽  
Pleuritic Chest Pain ◽  
Benign Metastasizing Leiomyoma ◽  
Spindle Cells ◽  
Smooth Muscle Tumors ◽  
Metastasizing Leiomyoma ◽  
Tomography Scan

We report a 51-year-old woman who presented to the emergency department with left-sided pleuritic chest pain 2 weeks after subtotal hysterectomy and bilateral salpingo-oophorectomy for a leiomyomatous uterus. Computed tomography scan of the chest revealed bilateral pulmonary nodules. Biopsy showed cytologically bland spindle cells without overt malignant features. Immunohistochemistry confirmed smooth muscle phenotype, in keeping with a clinicopathologic diagnosis of benign metastasizing leiomyoma (BML). BML does not frequently come to the attention of the emergency physician because it is rare and usually asymptomatic. When symptomatic, its clinical presentation depends on the site(s) of metastasis, number, and size of the smooth muscle tumors. Emergent presentations of BML are reviewed.

scholarly journals Rectosigmoid prolapse - a case report

2015 ◽  
Vol 72 (12) ◽  
pp. 1118-1121
Author(s):  
Vasilije Jeremic ◽  
Srdjan Mijatovic ◽  
Slobodan Krstic ◽  
Sanja Dragasevic ◽  
Tamara Alempijevic
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Sigmoid Colon ◽  
Severe Pain ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Preoperative Management ◽  
Perianal Region ◽  
Rectosigmoid Colon ◽  
Possible Cause

Introduction. Many factors have been indentified as a possible cause of rectal prolaps. Despite the fact that it is not a lifethreating condition, its clinical presentation varies, and sometimes it can present as an emergency. We presented a patient with prolapse of an unusually large segment of the rectosigmoid colon caused by chronic constipation, as an incarcerated segment repaired surgically. Case report. A 62-year-old female patient was referred to the Emergency Department in bad condition with severe pain in the perianal region. On examination a complete rectal prolaps as well as a part of sigmoid colon were found. Macroscopically, the prolapsed segment appeared edematous, livid, with ulcerations. An attempt to manually reduce prolapse failed, therefore resection of 50 cm of sigmoid colon with rectopexy had to be performed. No complications occurred and the patient was without symptoms six months later. Colonoscopy did not reveal any abnormality. Conclusion. Although the preoperative management and preparation of the patient was limited, emergancy surgical intervention for such a case was the strategy of choice due to magnitude of the prolapsing segment. It provided a successful and permenant solution.

scholarly journals A Sample of The Relationship Between The Non-Integrated Healthcare System And National Epidemic of Emergency Department Overcrowding In Turkey

2021 ◽  
Author(s):  
Cihad Dundar ◽  
Seydanur Dal Yaylaoglu
Keyword(s):  
Emergency Department ◽  
Female Gender ◽  
Tertiary Hospital ◽  
Emergency Department Visits ◽  
Work Hours ◽  
Diagnostic Code ◽  
Diagnostic Codes ◽  
Logistic Analysis ◽  
Ed Visits ◽  
Negative Impacts

Abstract Background: The use of EDs has significantly increased, and a majority of this increase is attributed to non-urgent visits, which has negative impacts. We aim to explore the frequency of non-urgent emergency department (ED) visits and to identify risk factors for non-urgent ED visits. Methods: This retrospective, the record-based study was conducted at a tertiary hospital in Samsun province of Turkey. The records of all adult patients who visited to the ED between January 1 and December 31, 2017, were included in this study. All emergency department visits were evaluated according to age, gender, time of visit, means of arrival, ICD diagnostic codes, and the number of repeated non-urgent ED visits. The number of ED visits was 87,528 for the year 2017. Results: The non-urgent emergency visit rate was 9.9%. According to binary logistic analysis, non-urgent visits were associated with young age (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). The prevalence of non-emergent visits was very similar between weekends and weekdays but was significantly higher in work hours on weekdays than non-work hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeated visits was 14.8% of non-urgent ED visits. Conclusions: Harmonization of various databases at the primary level in terms of design and connectivity and integration with hospital information systems will contribute to the identification of problems and the generation of solutions. The next step is establishing an integrated health care system that can benefit emergency care organizations in Turkey.

scholarly journals Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

2021 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

Survival after emergency department thoracotomy in the pediatric trauma population: a review of published data

2018 ◽  
Vol 34 (8) ◽  
pp. 857-860 ◽  
Author(s):  
Eliza E. Moskowitz ◽  
Clay Cothren Burlew ◽  
Ann M. Kulungowski ◽  
Denis D. Bensard
Keyword(s):  
Emergency Department ◽  
Pediatric Trauma ◽  
Published Data ◽  
Emergency Department Thoracotomy ◽  
Trauma Population

Trends and outcomes of ruptured ovarian cysts

2021 ◽  
pp. postgradmedj-2020-138833
Author(s):  
Wei How Lim ◽  
Nikki Woods ◽  
Vincent P Lamaro
Keyword(s):  
Emergency Department ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Ovarian Cysts ◽  
Free Fluid ◽  
Vaginal Intercourse ◽  
Imaging Diagnosis ◽  
Retrospective Audit ◽  
Common Clinical Presentation ◽  
Health Institutions

BackgroundRuptured ovarian cysts are common gynaecological presentation to health institutions with abdominal pain. While this phenomenon is generally self-limiting, surgery may be necessary in cases of haemodynamic compromise or association with torsion. The aim of this audit is to identify the trend of hospital presentations, as well as the review the management of modern gynaecology practice.MethodsA retrospective audit of all women who presented to the emergency department with an imaging diagnosis of ruptured ovarian cysts was conducted over a 5-year period at St Vincent’s Hospital, Sydney.ResultsDuring the study period, 408 women were identified. There was a trend towards conservative management, as observed in 84.7% of women, while the remaining 15.4% underwent surgery. Haemorrhagic or ruptured corpus luteum was the most common diagnoses. As expected, women who had surgical intervention were more likely to have larger cysts (20 vs 50%; p<0.05), and larger free fluid findings on imaging (1.4 vs 23.8%; p<0.05) compared with those managed conservatively. There were no statistically significant differences in location of ovarian cysts (right or left) or antecedent to hospital presentation (vaginal intercourse or trauma).ConclusionRuptured ovarian cysts of both functional and non-functional types remained a common clinical presentation of acute pain for women to the emergency department. Majority of women were managed conservatively in our cohort, and indications for surgery were large ovarian cysts and large free fluid seen on imaging findings. Surgery was largely feasible with minimal complications.

Basic Clinical Syndromes and Definitions

2018 ◽  
pp. 1-21
Author(s):  
Aparna Pendurthi ◽  
Maxim Mokin
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Transient Ischemic Attacks ◽  
Stroke Patients ◽  
Duration Of Symptoms ◽  
Surgical Interventions ◽  
Clinical Syndromes

The goal for neurological evaluation in the Emergency Department is to appropriately route potential acute stroke patients toward medical or surgical interventions in the most expedient manner possible. This chapter focuses on familiarizing the reader with main stroke subtypes and clinical manifestations associated with specific syndromes. Acute neurologic episodes being evaluated in the emergent setting for stroke workup can be divided into broad categories based on duration of symptoms, clinical presentation, and findings from basic imaging. This chapter explores the most common of these stroke syndromes and discusses the classification and clinical characteristics of transient ischemic attacks and ischemic and hemorrhagic strokes.

scholarly journals Late recurrence of a giant left ventricular pseudoaneurysm: the importance of multimodality imaging approach

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Antonio Landi ◽  
Anto Luigi Andres ◽  
Massimo Napodano
Keyword(s):  
Emergency Department ◽  
Ventricular Tachycardia ◽  
Clinical Presentation ◽  
Multimodality Imaging ◽  
Cardiac Computed Tomography ◽  
Late Recurrence ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Left Ventricular Pseudoaneurysm ◽  
Imaging Approach

Left ventricular pseudoaneurysms (LVP) are rare but may arise after myocardial infarction, trauma or cardiac surgery, tending to expand and rupture over the time. We show the case of a 75-year-old patient with a recurrent giant ventricular pseudoaneurysm, who presented to the emergency department with sustained ventricular tachycardia. Pseudoaneurysmatic lesion was investigated through echocardiography, angiography and Cardiac Computed Tomography, in order to evaluate the size and spatial orientation of the pseudoaneurysm and to set a tailored treatment. At emergency department, sustained ventricular tachycardia may be the first and unique clinical presentation of ventricular pseudoaneurysm late recurrence, whose management requires a multimodality imaging approach to guide surgical correction.

Female Patient with Simultaneous Occurrence of Subacute Thyroiditis and Focal Autonomy

2019 ◽  
Vol 58 (05) ◽  
pp. 401-402
Author(s):  
Christina Loberg ◽  
Dirk Mallek ◽  
Felix M. Mottaghy ◽  
Mohsen Beheshti ◽  
Alexander Heinzel
Keyword(s):  
Emergency Department ◽  
Sore Throat ◽  
Female Patient ◽  
Clinical Presentation ◽  
Subacute Thyroiditis ◽  
Simultaneous Occurrence ◽  
Severe Diarrhea ◽  
Loss Of Appetite

Clinical presentationA 57-year-old female patient presented at the emergency department with fatigue, increased sweating, flushing symptoms, loss of appetite, drowsiness and severe diarrhea. Besides she also mentioned painful left-sided sore throat radiating to the temples, beginning two weeks after a flu and subfebrile temperatures.

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