219 Documentation of Scrotal Examination in Male Children with Abdominal Pain

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Da Costa ◽  
S Watson ◽  
H Perks ◽  
C Battersby
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Junior Doctor ◽  
Testicular Torsion ◽  
Age Groups ◽  
Common Presentation ◽  
Financial Consequences ◽  
Legal Professional

Abstract Background Abdominal pain is a common presentation in all age groups with 7-10% of emergency department admissions. Method This registered audit looks at male children (aged <16), admitted with abdominal pain during this period. Approximately 2,877 children under the age of sixteen were admitted, 1,582 males. This equates to 55% of children admitted within 3 months. Manual note analysis from ED records identified 53 males <16 years of age with abdominal pain for inspection of documentation. Results 45% of inspected notes had documented genital and scrotal examination, none of which had a documented consent. In addition, 21% had a documented chaperone for the intimate examination. None of the cases had BOTH consent and presence of chaperone documented. Conclusions A common presentation in children lacks significant elements of documentation. This is noted in multiple specialties. Potentially overlooked aspects of examination can lead to missed or delayed identification of time sensitive diagnosis namely testicular torsion, with possible substantial legal, professional, and financial consequences. To improve the quality of documentation, education at junior doctor level has been carried out, with further analysis to take place and with the view to incorporate the three elements of an intimate examination: consent, chaperone, and findings.

scholarly journals Use of Analgesia in an Emergency Department

2013 ◽  
Vol 52 (189) ◽  
pp. 224-228 ◽  
Author(s):  
Rabin Bhandari ◽  
Gyanendra Malla ◽  
Indrajit Prasad Mahato ◽  
Pramendra Gupta
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Descriptive Statistics ◽  
Emergency Ward ◽  
Record Keeping ◽  
Case File ◽  
Common Presentation ◽  
Pain Descriptor ◽  
Set Up

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment. Methods: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70). Conclusions: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain. Keywords: analgesia; emergency; Nepal.  

Unscheduled Revisits after Diagnosis of Abdominal Pain at Emergency Department, Mukdahan Hospital

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S40-S43
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Patient Care ◽  
Acute Abdominal Pain ◽  
Signs And Symptoms ◽  
Discharge System ◽  
Effective Discharge ◽  
Time Period ◽  
Pain Patients

Background: Abdominal pain is a common complaint for patients revisiting the Emergency Department (ED). Evaluating the cause of the revisit can improve the quality of ED patient care. Objective: We aimed to analyzed unscheduled revisits after diagnosis of abdominal pain at emergency department. Materials and Methods: In order to determine the characteristics of their abdominal pain and the causes for the revisits, the charts of 90 patients were reviewed. These patients had experienced acute abdominal pain and had returned to the Emergency Department within 48 hours after their initial treatment during the period between January 2019 and December 2019. Results: During that time period, 44,000 patients visited the ED. Of these, 90 patients (0.2%) with acute abdominal pain or related symptoms had revisited the ED within the following 48 hours. Most of these patients had been 20 to 60 years of age and had had no co-morbid diseases. Almost half of patient revisits had occurred during the evening shift (45.6%). There were 74% of these patients, who had been admitted to hospital for observation or for procedures. No in-hospital mortality was reported for this study. The signs and symptoms of abdominal pain in these patients had not been specific. The factors, which most often contributed to the ED revisits, had been inappropriate consultations and inappropriate discharges or advises. Conclusion: The majority of the acute abdominal pain patients, who revisited the ED within 48 hours, had been admitted. The most common cause of revisits had been inappropriate consultations and inappropriate discharges. Improving ED patient care can be managed by contributing to effective consultations and to establishing an effective discharge system for the ED. Keywords: Revisits, Emergency medicine department, Acute abdominal pain

scholarly journals Practice of analgesia in an emergency department of eastern Nepal

2003 ◽  
Vol 42 (150) ◽  
Author(s):  
Rabin Bhandari
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Descriptive Statistics ◽  
Emergency Ward ◽  
Record Keeping ◽  
Case File ◽  
Common Presentation ◽  
Pain Descriptor ◽  
Set Up

Introduction: Pain is a common presentation to the emergency department but often overlooked with little research done on the topic in Nepal. We did an observational retrospective study on 301 patients in the emergency ward of BP Koirala Institute of Health Sciences with the objective of finding the practice of analgesia. The specific focus was on the time to analgesia, drugs for analgesia and method of pain assessment.Method: Case file analysis of patients discharged home after presenting with pain was performed. Time to analgesia and other factors were analyzed with descriptive statistics. Results: Diclofenac injection intramuscular (80%) was the commonest analgesic used. Assessment methods and record keeping were poor. Pain in the abdomen was the commonest. The median time to analgesia from triage was 45 minutes (IQR 30 to 80) and the median time to analgesia from doctor evaluation was 40 minutes (IQR 20 to 70).  Conclusion: Time to analgesia from triage and doctors assessment in our set up is comparable to others. The quality of documentation is poor. Problems with pain identification and assessment may lead to inadequate analgesia so reinforcing the use of pain descriptor at triage itself with pain score would be helpful in adopting a protocol based management of pain.Key Words: Analgesia, Emergency, Nepal

scholarly journals Ingested Foreign Body Migration to the Liver: An Unusual Cause of Persistent Abdominal Pain in a 54-Year-Old Female

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Alan Lucerna ◽  
James Espinosa ◽  
Kelly Schuitema ◽  
Risha Hertz
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Foreign Body ◽  
Bone Fragment ◽  
Common Presentation ◽  
Persistent Abdominal Pain ◽  
Ingested Foreign Body ◽  
History Of ◽  
Small Bone

Abdominal pain is a common presentation in emergency medicine. We describe the case of a 54-year-old female who presented to the emergency department due to worsening abdominal pain. She had a history of right upper quadrant (RUQ) abdominal pain that had been ongoing for several months. The pain had been thought by the primary care team to be related to gastritis and she had been prescribed a proton pump inhibitor (PPI). Her abdominal pain increased in the three days prior to her presentation to the emergency department (ED). The computed tomography (CT) scan of the abdomen showed a foreign body (FB) in the liver which was successfully removed surgically. Pathology results showed that the FB was consistent with a small bone fragment. Ingestions of FB are common but seldom result in complications. When complications do arise, perforation of a hollow viscous is typically seen. Rarely, transmigration of the FB can occur.

A Stone Left Unturned

2020 ◽  
pp. 253-258
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Young Woman ◽  
Crohn Disease ◽  
Emergency Physician ◽  
Hemorrhagic Cystitis ◽  
Correct Diagnosis ◽  
Technical Quality ◽  
History Of

In this case, a young woman presents to the emergency department with severe abdominal pain. She has a history of Crohn disease and this attack feels similar to previous flare-ups. The emergency physician orders urinalysis, blood work, and an abdominal series. Although the technical quality of his viewing of the images is limited, he is satisfied that there are no signs of obstruction or perforation. The patient settles well with analgesics and antiemetics. The urinalysis shows signs of infection, and the emergency physician prepares to discharge the patient on antibiotics for what he believes is hemorrhagic cystitis. At this point, a radiologist provides an interpretation of the patient’s abdominal series that allows for a correct diagnosis of her abdominal pain.

scholarly journals Comparative evaluation of the role of Sonography in diagnosis of Acute Appendicitis versus Surgeon`s clinical impression

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Ahsen Nazir Ahmad ◽  
Noor Fatima ◽  
Rana Amjad Hussain ◽  
Qadir SNR
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Clinical Evaluation ◽  
Clinical Judgment ◽  
Ultrasound Examination ◽  
Lower Abdominal Pain ◽  
Clinical Impression ◽  
Abdominal Sonography

A randomly selected group of patients presented in Accidents & Emergency department of Jinnah hospital Lahore with complaint of acute lower abdominal pain were subjected to abdominal sonography and those positive for acute appendicitis on ultrasound examination were operated. Another group of randomly selected patients with acute lower abdominal pain in Emergency department were clinically evaluated for acute appendicitis and surgery was done based on clinical impression (history and classical signs for acute appendicitis). Ultrasound examination showed the following parameters. Sensitivity 71.8%, specificity 62.5%, PPV 88.4%, NPV 35.7%. Clinical evaluation showed the sensitivity of 95.2%, specificity 77.7%, PPV 90.9%, NPV 87.5%. It was concluded on the basis of the results that clinical evaluation of the patient is more sensitive in correctly categorizing those who need appendicectomy than the ultrasound examination. Although the latter can be used in suspected cases and to rule out other pathological conditions resulting in acute abdomen. Limitations: Clinical judgment to a large extent rest on the experience and expertise of the surgeon and so is the quality of sonographic results, which depend on experience of sonographer & quality of ultrasound machine.

scholarly journals Investigation of Geriatric Patients with Abdominal Pain Admitted to Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Pınar Henden Çam ◽  
Ahmet Baydin ◽  
Savaş Yürüker ◽  
Ali Kemal Erenler ◽  
Erdinç Şengüldür
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Emergency Service ◽  
Geriatric Patients ◽  
Age Groups ◽  
Clinical Findings ◽  
Age Related ◽  
Frequent Finding ◽  
Surgical Treatments ◽  
Length Of Hospitalization

Introduction. The aim of this study is to detect the possible reasons of abdominal pain in the patients aged 65 and older admitted to emergency department (ED) with complaint of abdominal pain which is not related to trauma, to determine the length of hospitalization of old (65–75 age) and elderly (aged 75 and older) patients, and to define the hospitalization and mortality rates.Material and Methods.In the study, 336 patients were included. Groups were compared in respect to gender, internal or surgical prediagnoses, complaints accompanying abdominal pain, vital findings, comorbidities, requested consultations, hospitalizing service, waiting time in the ED and in the hospital, and treatment methods.Results. Of the patients, 48.2% were male, and 51.8% were female. While 52.4% of the patients were in 65–74 age group, 47.6% of them were aged 75 years and above. An internal disease was detected in 76.8% of the patients as an origin of abdominal pain. Most common prediagnoses were biliary diseases and diseases related to biliary tract followed by nonspecific abdominal pain, abdominal pain secondary to malignity, ileus, and acute gastroenteritis, respectively. The most frequent finding accompanying abdominal pain was vomiting. The most frequent chronic disease accompanying abdominal pain was hypertension in both age groups. We observed that 75.9% of the patients required consultation. We detected that 48.8% of the patients with abdominal pain were hospitalized and they were hospitalized mostly by gastroenterology ward (24.8%). Surgical treatments were applied to the 17.6% of the patients with abdominal pain.Conclusion. Clinical findings become indistinct by age, and differential diagnosis of abdominal pain gets more difficult in geriatric patients. Therefore, physicians should consider age related physiological changes in order to distinguish geriatric patients admitted to emergency service with abdominal pain from pathological cases requiring immediate surgical operation.

scholarly journals Acute lead poisoning: a diagnostic challenge in the emergency department

2021 ◽  
Vol 14 (1) ◽  
pp. e239740
Author(s):  
Bharath Gopinath ◽  
Vignan Kappagantu ◽  
Roshan Mathew ◽  
Nayer Jamshed
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Chelation Therapy ◽  
Acute Abdominal Pain ◽  
Lead Level ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Diagnostic Challenge ◽  
Common Presentation ◽  
Life Threatening

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient’s abdominal pain resolved within 4 days.

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