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 Acute Torsion of Appendicular Mucocele

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Farshid Ejtehadi ◽  
James Brooks ◽  
Hebah Hassan Ali ◽  
Vardhini Vijay
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Acute Abdominal Pain ◽  
Emergency Laparotomy ◽  
Fat Stranding

We present the case of an 81-year-old man with a known appendicular mucocele who presented to the emergency department with acute abdominal pain. A CT scan showed a change in orientation of the previously seen ovoid mass with surrounding fat stranding suggesting torsion. An emergency laparotomy with appendicectomy and resection of the caecal pole was performed. We discuss the findings and histopathology.

Effectiveness of the Weighted Blanket With Psychiatric Patients in the Emergency Department: A Pilot Study

2021 ◽  
pp. 107839032110267
Author(s):  
Debra A. Dickson ◽  
Laura Gantt ◽  
Melvin Swanson
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Small Sample Size ◽  
Psychiatric Patients ◽  
Small Sample ◽  
Control Group ◽  
Significant Finding ◽  
Control Group Design ◽  
Research With Children ◽  
Quasi Experimental

BACKGROUND Restraint and seclusion continue to be used with patients demonstrating aggressive and violent behaviors while in the emergency department and as inpatients in behavioral health (BH) units. The use of sensory interventions such as the weighted blanket (WB) is garnering interest as alternatives to aid in managing anxiety, anger, and aggressive behaviors. Reports of the effectiveness of the WB have primarily been anecdotal, and results of research with children have been mixed. Only one study has been conducted with the WB with adults on an inpatient psychiatric unit. OBJECTIVES The aim of this pilot study was to assess the effectiveness of the WB by determining whether it decreases anxiety and/or anger in adult emergency department patients with preexisting psychiatric diagnoses. METHODS The study used a quasi-experimental, nonequivalent control group design with pre- and posttests for anxiety and anger. The intervention was a 15-pound WB. Participants ( N = 15) were in one of three groups, which included no weighted blanket (NWB), WB for 15 minutes, or WB for 30 minutes. RESULTS All three groups showed a decrease in anxiety and anger scores. However, participants in the WB groups had a greater decrease in anxiety and anger posttest scores. CONCLUSIONS The small sample size in this study did not allow for the determination of any differences between groups on anxiety or anger scores that could be viewed as a significant finding.

scholarly journals Uterus Didelphys: Report of a Puerperal Torsion and a Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Lucio M. A. Cipullo ◽  
Slobodan Milosavljevic ◽  
Elisabeth D. van Oudgaarden
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Caesarean Section ◽  
Lower Abdominal Pain ◽  
Emergency Laparotomy ◽  
Review Of The Literature ◽  
Uterus Didelphys

A 29-year-old Para 2 was admitted to the emergency department with increasing lower abdominal pain. The patient had undergone an uncomplicated elective repeat caesarean section 7 days before being admitted to the emergency department. An emergency laparotomy revealed a uterus didelphys with a torsion of one of the uteri.

scholarly journals MP35: Acceptability of older patients’ self-assessment in the emergency department (ACCEPTED) – a randomized cross-over trial

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S55
Author(s):  
V. Boucher ◽  
M. Lamontagne ◽  
J. Lee ◽  
P. Carmichael ◽  
J. Déry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Qualitative Data ◽  
Small Sample Size ◽  
Statistical Tests ◽  
Age Groups ◽  
Small Sample ◽  
Self Assessment ◽  
Use Of Technology ◽  
Patient Self Assessment

Introduction: It is recommended that seniors consulting to the Emergency Department (ED) undergo a comprehensive geriatric screening, which is difficult for most EDs. Patient self-assessment using electronic tablet could be an interesting solution to this issue. However, the acceptability of self-assessment by older ED patients remains unknown. Assessing acceptability is a fundamental step in evaluating new interventions. The main objective of this project is to compare the acceptability of older patient self-assessment in the ED to that of a standard assessment made by a professional, according to seniors and their caregivers. Methods: Design: This randomized crossover design cohort study took place between May and July 2018. Participants: 1) Patients aged ≥65 years consulting to the ED, 2) their caregiver, when present. Measurements: Patients performed self-assessment of their frailty, cognitive and functional status using an electronic tablet. Acceptability was measured using the Treatment Acceptability and Preferences (TAP) questionnaires. Analyses: Descriptive analyses were performed for sociodemographic variables. Scores were adjusted for confounding variables using multivariate linear regression. Thematic content analysis was performed by two independent analysts for qualitative data collected in the TAP's open-ended question. Results: A total of 67 patients were included in this study. Mean age was 75.5 ± 8.0 and 55.2% of participants were women. Adjusted mean TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively. We found no difference between the two types of evaluations (p = 0.0831). When patients are stratified by age groups, patients aged 85 and over (n = 11) showed a difference between the TAPs scores, 2.27 for RA evaluation and 1.72 for patient self-assessment (p = 0.0053). Our qualitative data shows that this might be attributed to the use of technology, rather than to the self-assessment itself. Data from 9 caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. However, this relatively small sample size prevented us to perform statistical tests. Conclusion: Our results show that older patients find self-assessment in the ED using an electronic tablet just as acceptable as a standard evaluation by a professional.

Rocuronium Reversal in the Emergency Department: Retrospective Evaluation of Hemodynamic Instability Following Administration of Sugammadex Versus Neostigmine With Glycopyrrolate

2021 ◽  
pp. 089719002110487
Author(s):  
Garrett B. Hile ◽  
Karl J. Healy ◽  
Lars R. Almassalkhi
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Hemodynamic Instability ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Small Sample ◽  
Rapid Sequence Intubation ◽  
Rapid Sequence ◽  
Pharmacologic Agents

Background Rocuronium is an intermediate-acting non-depolarizing neuromuscular blocking agent frequently used in the emergency department for rapid sequence intubation. The prolonged effects of rocuronium may prevent the ability to conduct a meaningful neurological examination, thereby delaying appropriate diagnosis and treatment. Sugammadex and neostigmine are pharmacologic agents commonly used to reverse rocuronium. The safety of sugammadex versus neostigmine with glycopyrrolate for the reversal of rocuronium in the emergency department has not been well described. Objective Evaluate the occurrence of hemodynamic instability post-administration of sugammadex versus neostigmine with glycopyrrolate in the emergency department for the reversal of rocuronium. Methods A retrospective cohort study conducted among adult patients that received sugammadex or neostigmine with glycopyrrolate in the emergency department for the reversal of rocuronium. The primary outcome was occurrence of hemodynamic instability that required escalation of treatment. Secondary outcomes included occurrence of hypotensive, bradycardic, or cardiac arrest events. Results A total of 37 patients met inclusion criteria (n = 10, sugammadex; n = 27, neostigmine). There was no difference between the two groups in regard to hemodynamic instability that required escalation of treatment within 30 minutes after receiving either sugammadex or neostigmine with glycopyrrolate ( P = .557). Conclusion There was no difference between the two groups in regard to occurrence of hemodynamic instability that required escalation of treatment. Given the small sample size, future studies are warranted to further delineate the safety of sugammadex and neostigmine with glycopyrrolate for the reversal of rocuronium in the emergency department.

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