Impaired Consciousness in the Emergency Department

2018 ◽  
Vol 80 (3-4) ◽  
pp. 179-186 ◽  
Author(s):  
Stefanie Völk ◽  
Uwe Koedel ◽  
Hans-Walter Pfister ◽  
Roland Schwankhart ◽  
Mark op den Winkel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Epileptic Seizures ◽  
Transient Global Amnesia ◽  
Final Diagnosis ◽  
Sudden Onset ◽  
Time Of Arrival ◽  
Clinical Approach ◽  
Care Hospital ◽  
Impaired Consciousness

Background: The approach to unconscious patients in the emergency department (ED) is difficult, often depends on local resources and interests, and workup strategies often lack standardization. One reason for this is that data on causes, management, and outcome of patients who present to the ED with sudden onset unconsciousness of unknown cause is limited. Objectives: This study was performed to analyze the causes of acute impaired consciousness in patients in an interdisciplinary ED. Methods: Here, we analyzed all patients who were admitted to the ED of a tertiary care hospital with the dominating symptom of “sudden onset unconsciousness” within 1 year (September 2014 until August 2015). Patients with a clear diagnosis at arrival that explained the altered state of consciousness or other dominating symptoms at the time of arrival were not included. Results: A total of 212 patients were analyzed. In 88% of the patients, a final diagnosis could be established in the ED. Most common causes for unconsciousness were cerebrovascular diseases (24%), infections (14%), epileptic seizures (12%), psychiatric diseases (8%), metabolic causes (7%), intoxications (7%), transient global amnesia (5%), and cardiovascular causes (4%). The diagnoses were predominantly established by physical examination in combination with computed tomography (23%) and by the results of laboratory testing (25%). In-hospital mortality was 11%, and 59% of all patients were discharged with a Glasgow Outcome Score of 2–4. Conclusions: This analysis demonstrates a large variety of etiologies in patients with unknown unconsciousness of acute onset who are admitted to an ED. As neurological diagnoses are among the most common etiologies, neurological qualification is required in the ED, and availability of diagnostics such as cerebral imaging is indispensable and recommended as an early step in a standardized clinical approach.

scholarly journals Triaging the triage: reducing waiting time to triage in the emergency department at a tertiary care hospital in New Delhi, India

2019 ◽  
Vol 36 (9) ◽  
pp. 558-563
Author(s):  
Akshay Kumar ◽  
Dheeneshbabu Lakshminarayanan ◽  
Nitesh Joshi ◽  
Sonali Vaid ◽  
Sanjeev Bhoi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Time ◽  
Tertiary Care ◽  
Time Of Arrival ◽  
New Delhi ◽  
Care Hospital ◽  
Senior Leadership ◽  
Frontline Staff ◽  
Patient Load ◽  
Hot Weather

BackgroundProlonged wait times prior to triage outside the emergency department (ED) were a major problem at our institution, compromising patient safety. Patients often waited for hours outside the ED in hot weather leading to exhaustion and clinical deterioration. The aim was to decrease the median waiting time to triage from 50 min outside ED for patients to <30 min over a 4-month period.MethodsA quality improvement (QI) team was formed. Data on waiting time to triage were collected between 12 pm and 1 pm. Data were collected by hospital attendants and recorded manually. T1 was noted as a time of arrival outside the ED, and T2 was noted as the time of first medical contact. The QI team used plan–do–study–act cycles to test solutions. Change ideas to address these gaps were tested during May and June 2018. Change ideas were focused on improving the knowledge and skills of staff posted in triage and reducing turnover of triage staff. Data were analysed using run chart rules.ResultsWithin 6 weeks, the waiting time to triage reduced to <30 min (median, 12 min; IQR, 11 min) and this improvement was sustained for the next 8 weeks despite an increase in patient load.ConclusionThe authors demonstrated that people new to QI could use improvement methods to address a specific problem. It was the commitment of the frontline staff, with the active support of senior leadership in the department that helped this effort succeed.

scholarly journals An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Yuwares Sittichanbuncha ◽  
Patchaya Sanpha-asa ◽  
Theerayut Thongkrau ◽  
Chaiyapon Keeratikasikorn ◽  
Noppadol Aekphachaisawat ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Tertiary Care ◽  
Previous History ◽  
Final Diagnosis ◽  
Care Hospital ◽  
Online Tool ◽  
Coronary Syndrome ◽  
Nurse Triage

Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital.Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed.Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively.Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

scholarly journals Troponin Testing in the Emergency Department: Real world experience

2018 ◽  
Vol 17 (4) ◽  
pp. 398
Author(s):  
Mohammed Al-Maskari ◽  
Mahmoud Al-Makhdami ◽  
Hatim Al-Lawati ◽  
Hafidh Al-Hadi ◽  
Sunil K. Nadar
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Final Diagnosis ◽  
University Hospital ◽  
Care Hospital ◽  
Test Results ◽  
Coronary Syndrome ◽  
Cardiac Symptoms ◽  
Cardiac Condition

Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay (LOS). Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction wereexcluded. Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results (81.3%). Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests (mean: three versus one day; P = 0.001). In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome (ACS), atrial fibrillation or other types of arrhythmia. Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected.

scholarly journals Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

2020 ◽  
Vol 41 (S1) ◽  
pp. s203-s204
Author(s):  
Rozina Roshanali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Limited Resource ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Care Hospital ◽  
Middle Income ◽  
Safe Patient Care ◽  
Bed Management ◽  
Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

scholarly journals Epidemiology and outcome of sepsis in a tertiary-care hospital in a developing country

2005 ◽  
Vol 134 (2) ◽  
pp. 315-322 ◽  
Author(s):  
M. D. TANRIOVER ◽  
G. S. GUVEN ◽  
D. SEN ◽  
S. UNAL ◽  
O. UZUN
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Approach ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Underlying Diseases ◽  
Major Pathogens ◽  
Very High

Sepsis continues to have a substantial mortality and morbidity despite advances in the diagnosis and management of this condition. We retrospectively analysed hospital charts of patients diagnosed to have sepsis between January 2002 and June 2003. Demographic characteristics of patients, microbiological findings and predictors of survival were evaluated. Sixty-nine sepsis episodes that occurred in 63 patients were analysed. The most common underlying diseases were hypertension, malignancies and diabetes mellitus. Renal insufficiency, respiratory distress and disseminated intravascular coagulation developed in 52·2, 30·4 and 30·4% of the episodes respectively; 47·7% of the blood cultures yielded an organism. Gram-negative bacteria were the predominant microorganisms (65·9%). Fifty-five patients (87·3%) died. Mechanical ventilation and underlying renal disease were significant determinants of mortality. In conclusion, Gram-negative bacteria remain the major pathogens in sepsis. The mortality remains very high, and a change in the clinical approach to the septic patient should be employed to improve the outcome.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

VALIDATION OF QUICK COVID SEVERITY INDEX IN COVID PATIENTS ADMITTED THROUGH EMERGENCY DEPARTMENT OF A PRIVATE TERTIARY CARE HOSPITAL IN WEST BENGAL, INDIA

2021 ◽  
pp. 53-55
Author(s):  
Harsimran Singh Das
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Tertiary Care Hospital ◽  
Clinical Status ◽  
Tertiary Care ◽  
Severity Index ◽  
Adult Patients ◽  
Care Hospital ◽  
Oxygen Requirement ◽  
Clinical Tool

Introduction:qCSI (Quick COVID severity index) is a clinical tool established recently post pandemic to predict respiratory failure within 24 hours of admission in COVID-19 patients; respiratory failure being explain as increased oxygen requirement greater than 6L/min by low ow device, high ow device, noninvasive or invasive ventilation to maintain spO2 of greater than or equal to 94%, or death. Aim:To verify and validate the application of the qCSI in Emergency Department in Indian demographic for evidence-based guidance to aid physician decision making in safely dispositioning adult patients with COVID-19 with oxygen requirement less than or equal to 6L/min via low ow devices including nasal cannula and oxygen mask Materials and methods:This is an observational, retrospective study from Emergency Department in a private tertiary care hospital of admitted adult patients with COVID-19 disease. Clinical parameters in qCSI and disposition of 210 patients admitted through Emergency Department included in this study selected randomly was sought on admission and clinical status with level of care 24 hours following admission was recorded and compared with prediction based on qCSI from a period of 1 May 2020 to 31 October 2020. Result:We found that19(9.0%) patients Initial qCSI Score was Low, 80(38.1%) patients Initial qCSI Score was Low-intermediate, 84(40.0%) patients Initial qCSI Score was High-intermediate and 27(12.9%)patients Initial qCSI Score was High.qCSI Score after 24 hours 16(11.4%) patients were Low, 43(30.7%) patients were Low-intermediate, 63(45.0%) patients was High-intermediate and 18(12.9%) patients was High.Out of 210(100.0%) patients, 70 (33.3%) patients were critically ill. Conclusion:In conclusion these data show that the quick COVID-19 Severity Index provides easily accessed risk stratication relevant to Emergency Department provider.

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

A CLINICOEPIDEMIOLOGICAL STUDY ON PAEDERUS DERMATITIS IN A TERTIARY CARE CENTRE, CHENNAI

2021 ◽  
pp. 25-27
Author(s):  
P. Mohan ◽  
P. Revathi Guru ◽  
V. Sudha ◽  
L. Balamurugan ◽  
Pavithra Gunasekaran ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sudden Onset ◽  
The Body ◽  
Care Hospital ◽  
Age Group ◽  
Common Condition ◽  
Tertiary Care Centre ◽  
Linear Lesions ◽  
Paederus Dermatitis

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.

Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Tertiary Care ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Care Hospital ◽  
Acute Migraine ◽  
Pain Scores ◽  
Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

Sign in / Sign up

Export Citation Format

Share Document