SP9.1.7 Emergency Laparotomy for Trauma in the United Kingdom and Ireland: a Prospective Multicentre Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Paul Vulliamy ◽  
Max Marsden ◽  
Richard Carden ◽  
Karim Brohi ◽  
Ross Davenport ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Prehospital Care ◽  
Trauma System ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Transfusion Rate ◽  
Young Males ◽  
Prospective Multicentre Study ◽  
The Uk ◽  
Emergency Abdominal Surgery

Abstract Aims Trauma patients requiring abdominal surgery have significant morbidity and mortality, but are not included in existing national audits of emergency laparotomy. The aim of this study was to examine processes of care and outcomes among trauma patients undergoing emergency abdominal surgery in the UK and Ireland. Methods A prospective trainee-led multicentre audit was conducted over six months from January 2019 across the national trauma system. Patients undergoing laparotomy or laparoscopy within 24 hours of injury were included. Subgroup analysis was conducted in those requiring major haemorrhage protocol (MHP) activation. Results The study included 363 patients from 34 hospitals (22 major trauma centres). The majority were young males with no co-morbidities who required surgery for control of bleeding (51%) or exploration of penetrating injuries (46%). Over 85% received consultant-led care in the emergency department (318/363) and operating theatre (321/363). The MHP subgroup made up 45% of the cohort but accounted for 97% of deaths and 79% of ICU days, with a mortality rate of 19% and a massive transfusion rate of 32%. Compared to non-MHP patients they had shorter times to theatre (122 vs 218 minutes, p < 0.001), higher rates of advanced prehospital care (60% vs 33%, p < 0.001) and higher rates of consultant-led care (95% vs 85%, p < 0.001). Conclusion The majority of trauma patients requiring emergency abdominal surgery receive consultant-delivered perioperative care which is appropriately tailored to patient risk profile. Despite this, mortality and resource utilization among high-risk patients remains substantial, justifying ongoing performance improvement initiatives and research into novel therapeutics.

Under-recognised burden of postoperative anaemia in patients undergoing emergency abdominal surgery in the UK

2021 ◽  
Author(s):  
Kate Kanga ◽  
Edward Dickson ◽  
Hans Van Huellen ◽  
Ruth De Las Casas ◽  
Matthew Cadd ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
The Uk ◽  
Emergency Abdominal Surgery

Clinical suspicion regarding needle decompression for patients with chest trauma

2019 ◽  
Vol 11 (8) ◽  
pp. 330-334
Author(s):  
Alastair Beaven ◽  
James Harrison ◽  
Keith Porter ◽  
Richard Steyn
Keyword(s):  
Chest Trauma ◽  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Trauma Team ◽  
Trauma Network ◽  
Trauma Patients ◽  
Care Providers ◽  
Trauma Population ◽  
The Uk ◽  
Needle Decompression

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

scholarly journals Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018–2020)

2021 ◽  
Vol 8 (10) ◽  
pp. 209
Author(s):  
Aida Fages ◽  
Carme Soler ◽  
Nuria Fernández-Salesa ◽  
Giuseppe Conte ◽  
Massimiliano Degani ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Abdominal Surgery ◽  
Clinical Course ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
Intraoperative Hypotension ◽  
Lactate Acidosis ◽  
Emergency Abdominal Surgery

Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterising the outcome of these surgeries as a single group in dogs. The aim of the study was to characterise the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was a gastrointestinal foreign body. Overall, the 15-day mortality rate was 20.7% (17/82). The median (range) length of hospitalisation was 3 (0.5–15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) developed minor complications. Perioperative factors significantly associated with death included tachycardia (p < 0.001), hypothermia (p < 0.001), lactate acidosis (p < 0.001), shock index > 1 (p < 0.001), leukopenia (p < 0.001) and thrombocytopenia (p < 0.001) at admission, as well as intraoperative hypotension (p < 0.001) and perioperative use of blood products (p < 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.

scholarly journals EMERGENCY ABDOMINAL SURGERY;

2019 ◽  
Vol 14 (01) ◽  
pp. 10-16
Author(s):  
JUNAID SULTAN ◽  
HARIS BIN BILAL ◽  
HUMAIRA KIRAN ◽  
Badar Bin Bilal ◽  
Azam Yusuf
Keyword(s):  
Mortality Rate ◽  
Abdominal Surgery ◽  
Abdominal Sepsis ◽  
Cross Sectional Study ◽  
Successful Outcome ◽  
Emergency Laparotomy ◽  
Cross Sectional ◽  
Surgical Unit ◽  
Emergency Abdominal Surgery ◽  
Overall Mortality

Intra-abdominal (I.A) sepsis is widely recognized as the leading cause of death in patients following emergency abdominal surgery. Objective To determine the incidence of intra-abdominal sepsis after emergency abdominal surgery. To study the predisposing factors which lead to post-op. I.A sepsis. To determine the micro flora involved in I.A sepsis Study design: A quantitative cross sectional study.. Place of study: Surgical unit-l General Hospital Rawalpindi. Period: March 1999 to August 2000. Material & methods:565 patients) were followed after emergency abdominal surgery and incidence determined. Results: These 565 patients included 400 patients of acute appendicitis, 140 patients of emergency laparotomy and 25 patients of obstructed/strangulated hernias. The incidence of I.A sepsis after emergency abdominal surgery was found to be 10.6% with incidence of generalized I.A sepsis of 6.6%. Different risk factors predispose to the development of post-op. I.A sepsis. Aerobic microflora of the I.Asepsis consists predominantly of E.coli. Overall mortality rate was 7.6% with 4% cases due to post-op. I.A sepsis. Mortality rate in patients with post-op. I.A sepsis was 38.33% with mortality rate of 78% in patients with post-op, generalized I.A sepsis and of 20% in patients with I.A abscesses. Conclusion: IA sepsis continues to be one of the major challenges in general surgery. A successful outcome depends on early diagnosis, rapid and appropriate surgical intervention, prompt administration of broad spectrum antibiotics and aggressive supportive care in ICU remains the therapeutic strategy for these patients. It is important first to determine the risk status of these patients and then to apply proper and sound surgical technique and do timely decision.

scholarly journals From roadside to hospital: A pilot study to investigate the factors influencing the time taken to deliver trauma patients to a regional hospital

2015 ◽  
Vol 6 (3) ◽  
Author(s):  
Malcolm Boyle ◽  
Peter O’Meara
Keyword(s):  
Emergency Department ◽  
Pilot Study ◽  
Emergency Services ◽  
Prehospital Care ◽  
Trauma System ◽  
Regional Hospital ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Transport Time ◽  
The Right

IntroductionOne of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study.MethodsA retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times > 20 minutes and transport times > 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted.ResultsThere were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were > 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital > 30 minutes.ConclusionThis pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time > 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.

scholarly journals Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020)

2021 ◽  
Author(s):  
Aida Fages ◽  
Carme Soler ◽  
Nuria Fernández-Salesa ◽  
Giuseppe Conte ◽  
Massimiliano Degani ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Abdominal Surgery ◽  
Clinical Course ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Mortality And Morbidity ◽  
Intraoperative Hypotension ◽  
Lactate Acidosis ◽  
Length Of Hospitalization ◽  
Emergency Abdominal Surgery

Emergency abdominal surgery carries high morbidity and mortality rates in human medicine; however, there is less evidence characterizing the outcome of these surgeries as a single group in dogs. The aim of the study was to characterize the clinical course, associated complications and outcome of dogs undergoing emergency abdominal surgery. A retrospective study was conducted. Dogs undergoing emergency laparotomy were included in the study. Logistic regression analysis was performed to identify variables correlated with death and complications. Eighty-two dogs were included in the study. The most common reason for surgery was gastrointestinal foreign body. Overall 15-day mortality rate was 20.7% (17/82). Median (range) length of hospitalization was 3 (0.5 - 15) days. Of the 82 patients, 24 (29.3%) developed major complications and 66 (80.5%) minor complications. Perioperative factors significantly associated with death included tachycardia (P &amp;lt; 0.001), hypothermia (P &amp;lt; 0.001), lactate acidosis (P &amp;lt; 0.001), shock index &amp;gt; 1 (P &amp;lt; 0.001), leukopenia (P &amp;lt; 0.001), thrombocytopenia (P &amp;lt; 0.001) at admission; intraoperative hypotension (P &amp;lt; 0.001) and perioperative use of blood products (P &amp;lt; 0.001). The results of this study suggest that mortality and morbidity rates after emergency abdominal surgery in dogs are high.

scholarly journals A rare case of Pseudomonas aeruginosa bacteremia in a newborn with 58 perforations in the small intestine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Xu ◽  
Danqun Jin ◽  
Huan Ye ◽  
Youfeng Liang
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Small Intestine ◽  
Early Detection ◽  
Abdominal Surgery ◽  
Rare Case ◽  
Venous Blood ◽  
Case Presentation ◽  
Systemic Infections ◽  
Emergency Abdominal Surgery ◽  
Timely Treatment

Abstract Background Community-acquired infections of Pseudomonas aeruginosa (P. aeruginosa) occur very rarely. Case presentation P. aeruginos was detected in cultures of venous blood and peritoneal exudate of a newborn with 58 perforations in the small intestine. Intravenous administration of imipenem cilastratin sodium and emergency abdominal surgery were performed. The patient fully recovered and was discharged 17 days after the operation. Conclusions Mild symptoms of systemic infections in newborns may delay the diagnosis. Early detection and timely treatment are the key to improved prognosis.

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