Abstract 302: First of It's Kind Capillary Refill Monitoring Device to Guide Resuscitation

Background: Capillary refill is an early reflection of decreased end organ perfusion resulting in shunt of blood from the extremities to vital organs. Physicians rate this as the most important factor to guide therapeutic resuscitation efforts. However, literature shows that providers have significant variability in their bedside measurement of capillary refill. Objective: The objective of this study was to develop and evaluate a novel technology to detect capillary refill in a noninvasive and rapid manner through an iterative, problem-based innovation approach. Methods: This was a prospective study at a level 1 tertiary care hospital of patients presenting to an emergency department. The research team used in a new technology that utilizes light transmission and pressure to objectively quantify extremity capillary refill time. This measurement was compared to manual refill time performed by a trained study provider. Results: Through an iterative approach the team developed a platform technology and enrolled 63 subjects in this prospective trial. 9 subjects had inadequate data and so the final cohort consisted of 54 subjects with both manual capillary refill time and the new novel technology measurement. The device measured capillary refill time showed a high degree of correlation to manual estimate of capillary refill time with a Pearson coefficient of 0.7. Conclusions: Novel technology to measure capillary refill time can significantly improve the treatment and care of multiple medical conditions that rely on timely diagnosis and initiation of resuscitation in the emergency department and other care settings. This study shows a modest correlation of technology with automated signal processing algorithms for noninvasive measurement of capillary refill. Integration of this technology into standard hospital monitors has broad applicability to make capillary refill a standard vital sign.

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Combined score based on arterial lactate, aspartate transaminase and prolonged capillary refill time is a useful diagnostic criterion for identifying severe dengue

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa088 ◽

2020 ◽

Vol 114 (11) ◽

pp. 838-846

Author(s):

Sarika Gupta ◽

Pranaya Mall ◽

Areesha Alam

Keyword(s):

Predictive Value ◽

Clinical Laboratory ◽

Tertiary Care ◽

Severe Dengue ◽

Dengue Case ◽

Care Hospital ◽

Aspartate Transaminase ◽

Capillary Refill Time ◽

Capillary Refill ◽

Laboratory Parameters

Abstract Background Taking into consideration, the variable performance of WHO’s dengue case definition and the magnitude of epidemics in India, a score based on clinical and laboratory parameters is required for the early identification of severe dengue. Methods A retrospective observational study of children (aged ≤12 y) presenting with dengue, defined as per the WHO 2009 classification and NS1 antigen/IgM ELISA positivity, was conducted at a tertiary care hospital from 2013 to 2015. Clinical laboratory parameters were compared between severe/non-severe dengue using univariate and multivariate analysis. Areas under receiver operating characteristic curves (AUROCs), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were obtained for independent and composite markers. Results Of 135 dengue patients, 46 (34.1%) had non-severe dengue and 89 (65.9%) had severe dengue. Logistic regression determined prolonged capillary refill time (CRT), lactate ≥2.9 mmol/L and serum aspartate transaminase (AST) ≥135 IU/L as predictive for severe dengue. AUROCs of lactate, AST and combined score incorporating AST, lactate and prolonged CRT for identifying severity were 7.55, 7.23 and 8.5, respectively. The combined score cut-off ≥1 had 87.6% sensitivity, 65.2% specificity, 83% PPV and 73.2% NPV. The combined score cut-off ≥3 had 100% specificity and 100% PPV. However, AST >135 IU/L and lactate >2.9 mmol/L together had 97.8% specificity and 97.1% PPV for identifying severity. Conclusions The presence of either ‘prolonged capillary refill time with one deranged biochemical parameter’ or ‘both deranged biochemical parameters’ is nearly 100% specific for severity of dengue.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.746 ◽

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

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

Circulation ◽

10.1161/circ.142.suppl_3.14721 ◽

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.

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

10.36106/ijsr/7821858 ◽

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.

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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

10.21203/rs.3.rs-820832/v1 ◽

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

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

10.22514/sv.2021.040 ◽

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.

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Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

10.21203/rs.3.rs-22231/v3 ◽

2020 ◽

Author(s):

Julia Brandenberger ◽

Christian Pohl ◽

Florian Vogt ◽

Thorkild Tylleskär ◽

Nicole Ritz

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Hospital Admissions ◽

Tertiary Care ◽

Median Number ◽

Care Hospital ◽

Children With Medical Complexity ◽

Cross Sectional ◽

Number Of Visits

Abstract BackgroundAsylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital.MethodsWe performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups.Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. ConclusionsHospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.

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Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

10.21203/rs.3.rs-84330/v3 ◽

2021 ◽

Author(s):

Maria Khan ◽

Uzair Yaqoob ◽

Zair Hassan ◽

Muhammad Muizz Uddin

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Road Traffic ◽

Tertiary Care ◽

Initial Assessment ◽

Care Hospital ◽

Mild Tbi ◽

Epidemiological Characteristics ◽

The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

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Study of Profile, Pattern and Outcome of Oral Poisoning Cases admitted in Emergency Department of a Tertiary Care Teaching Hospital in North India.

JMS SKIMS ◽

10.33883/jms.v21i1.348 ◽

2018 ◽

Vol 21 (1) ◽

pp. 24-30

Author(s):

Susan Jalali ◽

Shahnawaz Hamid Khan ◽

Farooq A Jan ◽

Illahay Jalali

Keyword(s):

Emergency Department ◽

Rural Areas ◽

Tertiary Care ◽

North India ◽

Care Hospital ◽

Medical Sciences ◽

Medicine Department ◽

Health Practitioners ◽

Public Health Practitioners ◽

And Training

Introduction: Poisoning is a common medico-social problem. It is a significant contributor to morbidity and mortality. Knowledge of the epidemiology of poisoning and its changes is important to both emergency physicians and public health practitioners. Our study was to determine the socio-demographic profile, pattern and outcome of the poisoning cases reported to the Emergency Department of a tertiary care hospital. Methods: The study was a Retrospective observational type of study conducted at Sheri-Kashmir Institute of medical sciences, Srinagar J&K. The patients with acute poisonings presenting to and managed in the Emergency Medicine department between February 2016 to February 2018 were reviewed for inclusion. Data was collected by reviewing records . Using a pre-structured format, case records of poisoning cases were reviewed for gender, age, residence, type of poison, route of poison and outcome of treatment. The collected data was analyzed using descriptive statistical analysis. Results: In the present study the Female: male ratio was 1.9:1 (131 Females and 68 Males).Females outnumbered the males. Highest cases of Poisoning were reported in the age group of 10-20 years. The poisoning in extreme of ages was less observed. Maximum cases of Poisoning belongs to rural areas (60.8%). The most common implicating agents were Pesticides (75.3%). The second common cause of poisoning was drug overdose (20.52%) Maximum cases recovered after treatment (94%). Conclusion: Pattern and magnitude of poisoning are multidimensional and demand multi-sectorial approach for facing this problem. There is a need for stringent pesticide regulation laws and counseling and training programs to reduce the incidence of poisonings. JMS 2018;21(1):24-30

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