Management of epistaxis: a guide for junior doctors

2021 ◽  
pp. 1-8
Author(s):  
Jake Ahmed ◽  
Daniel Leopard ◽  
Alex Teasdale ◽  
Wilson Cheah ◽  
Conor Marnane
Keyword(s):  
Emergency Department ◽  
Upper Airway ◽  
Junior Doctors ◽  
Initial Management ◽  
Acute Presentation ◽  
Life Threatening ◽  
A Minor ◽  
Distressing Condition

Epistaxis is commonly seen as an acute presentation to the emergency department. The level of severity can range from a minor ooze to a life-threatening bleed. The initial management is often the responsibility of junior doctors working in otolaryngology or the emergency department, so they must be familiar with the initial steps in treating this often distressing condition. The COVID-19 pandemic has complicated matters further as much of the management takes place in the upper airway. This article outlines the key considerations in the management of epistaxis, especially during the COVID-19 pandemic.

scholarly journals Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

2002 ◽  
Vol 30 (6) ◽  
pp. 804-806 ◽  
Author(s):  
H. Butterell ◽  
R. H. Riley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Airway Obstruction ◽  
Pulmonary Oedema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Tracheal Compression ◽  
Negative Pressure Pulmonary Oedema ◽  
Life Threatening ◽  
Thyroid Goitre

We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.

scholarly journals An extremely rare phenomenon: Angina bullosa hemorrhagica

2020 ◽  
pp. 102490792096481
Author(s):  
Mehmet Cihat Demir ◽  
İlter Ağaçkıran
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Female Patient ◽  
Soft Palate ◽  
Emergency Physician ◽  
Upper Airway ◽  
Case Presentation ◽  
Life Threatening ◽  
Hemorrhagic Bullae ◽  
Posterior Pharynx

Introduction: Angina bullosa hemorrhagica is a disease without a concomitant hematological or vesiculobullous disorder characterized by painless hemorrhagic bullae in the oral mucosa; it is rarely seen and has a good course. Case presentation: A 45-year-old female patient was admitted to the emergency department with a painless hemorrhagic bulla that suddenly appeared on the soft palate. A blister, 2 cm in diameter and dark red in color, was seen extending from the hard palate’s posterior to the soft palate. Nasolaryngoscopic evaluation was performed, and no additional hemorrhagic bulla was detected. She was discharged with the recommendation of oral mouthwash. Discussion: Solitary hemorrhagic bulla, suddenly occurring on the soft palate, is diagnostic for angina bullosa hemorrhagica. Some authors have reported that blisters in the posterior pharynx may progress to acute upper airway obstruction. Conclusion: Early nasolaryngoscopic evaluation in angina bullosa hemorrhagica is an excellent option to be considered by the emergency physician to prevent life-threatening situations.

Problem-based review: The patient with acute heart failure

2013 ◽  
Vol 12 (1) ◽  
pp. 44-50
Author(s):  
Tim Holzmann ◽  
◽  
Georgina Eltenton ◽  
Simon Anderson ◽  
Stephen J Bonny ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Clinical Scenario ◽  
Cardiogenic Pulmonary Oedema ◽  
Initial Management ◽  
Life Threatening ◽  
Underlying Causes ◽  
The Uk

Acute heart failure is a common and potentially life threatening presentation to hospitals in the UK. Acute Physicians at the front door of the hospital will often be involved with the initial management of these patients. Despite its many underlying causes, certain general treatment principles exist. We present a typical clinical scenario followed by an overview of the pathophysiology and management of acute heart failure and cardiogenic pulmonary oedema. The aim is to cover a broad spectrum of therapies ranging from medical treatment up to invasive devices, thereby discussing the available options from the Emergency Department to the Intensive Care Unit.

scholarly journals Efektifitas Ketepatan Triage Trauma Terhadap Aktivasi Kode Trauma Pada Pasien Trauma Kategori Merah Di Instalasi Gawat Darurat: Literature Review

JKEP ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 29-42
Author(s):  
Fatriani Fatriani ◽  
Masfuri Masfuri ◽  
Agung Waluyo
Keyword(s):  
Emergency Department ◽  
Health Workers ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Initial Management ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Management Priorities

Emergency trauma can occur at any time, occur everywhere and can be experienced by everyone. The speed and accuracy of relief in trauma emergency conditions, will determine the outcome of the assistance provided. Help for trauma patients in the Emergency Department begins when the triage officer receives the patient. The triage process sorts patients according to the patient's emergency condition using parameters of level of consciousness, respiratory status and circulation status of the patient. An efficient trauma triage system aims to assist health workers in identifying life-threatening conditions, making timely assessments and management priorities that are appropriate to the severity of the patient. Trauma Code Activation is implemented as a system for providing emergency relief in cases of trauma in the red category. In some countries the application of Trauma Team Activation in cases of trauma in the red category is the main one to optimize the initial management of trauma emergency department. Trauma Code Activation at Cipto Mangunkusumo Hospital Jakarta Emergency Department from September 2018 to June 2019 totaled 362 cases, consisting of 34.1% head injuries (7.6% bleeding), 19.3% fractures, 13% burns, 6, 7% politrauma, and there are 3.8% died.

A dangerous cause of airway obstruction: deep neck infection

2020 ◽  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Deep Neck Infection ◽  
Jugular Vein Thrombosis ◽  
Neck Infection ◽  
Vein Thrombosis ◽  
Lethal Complications ◽  
Life Threatening ◽  
Fascial Spaces ◽  
Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

2021 ◽  
pp. 105477382199968
Author(s):  
Anas Alsharawneh
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Emergency Setting ◽  
Extended Length ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

Laryngeal Movement Disorders and Their Management

2016 ◽  
Vol 1 (3) ◽  
pp. 75-82 ◽  
Author(s):  
Thomas Murry ◽  
Claudio F. Milstein
Keyword(s):  
Movement Disorders ◽  
Upper Airway ◽  
Management Options ◽  
Current Information ◽  
Voice Changes ◽  
A Minor ◽  
The Voice ◽  
Methods Of Treatment

This review describes the current information related to laryngeal neuropathic disorders and the possible management options available. Voice changes may range from severe hoarseness due to choking and coughing to a mild intermittent dysphonia possibly accompanied by unusual breathing. Neither the sound of the voice nor the lack of hoarseness should suggest that the problem itself is a minor one. Laryngeal neuropathic disorders may be the outcome of inflammation, irritation, infection, or a combination of these that causes a disruption in normal sensation. When sensory mediators no longer function normally, breathing, phonation, and even swallowing changes may be affected. Clinicians must be aware of the numerous sensory related disorders in the upper airway and currently accepted methods of treatment.

A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit

1988 ◽  
Vol 33 (8) ◽  
pp. 711-715 ◽  
Author(s):  
A.J. Cooper
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Clinical Study ◽  
Hospital Stay ◽  
General Hospital ◽  
Alcohol Misuse ◽  
Psychiatric Ward ◽  
Violent Behaviour ◽  
Initial Management ◽  
Retrospective Examination

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

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